American Shared Hospital Services (NYSEAMERICAN:AMS) reported second-quarter revenue growth of 19.2% as higher patient procedures at its direct patient services locations, stronger proton beam radiation therapy performance and improving international operations lifted results.
The company generated approximately $8.4 million in second-quarter revenue, compared with $7.1 million a year earlier. Revenue for the first six months of 2026 rose 17.7% to about $15.5 million, from $13.2 million in the prior-year period.
Direct Patient Services Drives Growth
Direct Patient Services revenue increased about 40% during the second quarter to $4.9 million, while first-half segment revenue rose 35% to approximately $8.9 million. Interim Chief Financial Officer Alexis Wallace attributed the increase mainly to higher procedure volumes at the company’s Rhode Island radiation oncology centers and contributions from facilities in Peru and Puebla, Mexico.
Interim CEO and President Craig Tagawa said the Rhode Island centers continued to improve through increased procedures and operational execution. The company has focused on strengthening physician relationships and expanding patient access at those locations following their acquisition.
In Puebla, patient activity remained healthy and reimbursement trends were favorable, Tagawa said. Meanwhile, the company’s Gamma Knife center in Peru saw increased treatment volume following an Esprit technology upgrade completed in 2025. Management said the upgrade has shortened treatment times, improved patient throughput and increased utilization.
Stachowiak said the company is also working with Hospital San Javier in Guadalajara, Mexico, to upgrade its Gamma Knife center. Hospital San Javier has provided Gamma Knife treatments since 1994, he said.
Proton Therapy Revenue Rises
The company’s Orlando proton beam radiation therapy leasing arrangement generated revenue growth of 22% year over year during the quarter, reaching approximately $2.3 million. First-half proton beam radiation therapy revenue totaled about $4.3 million.
Wallace said the increase was supported by both higher treatment volumes and improved reimbursement levels. Medical equipment leasing revenue overall was relatively stable, as strength in proton therapy substantially offset lower domestic Gamma Knife leasing activity following the expiration of a customer agreement in 2025.
Management repeatedly cited utilization and patient throughput as important drivers of future profitability. Tagawa said many of the company’s facilities have significant operating leverage, meaning that increased procedure volumes could translate into improved profitability and cash generation.
Profitability, Cash Flow and Receivables Charge
Gross margin was approximately $1.4 million in the second quarter, modestly below the prior-year level but higher than in the first quarter of 2026. Adjusted EBITDA was approximately $1.3 million, compared with $1.7 million a year earlier, while year-to-date adjusted EBITDA totaled approximately $2.5 million.
Reported earnings were affected by legal and professional expenses of $285,000 related to negotiations for the company’s amended credit agreement, as well as a $909,000 allowance for credit losses related to Rhode Island receivables predating May 31, 2025.
During the question-and-answer session, a shareholder asked about the nature of the receivables charge. Stachowiak said the receivables involved several payers and that the company expected a reduction in their viability. Tagawa said the charge largely related to insurance carriers with which the company has relationships. Management did not provide further details on the causes of the payment issues.
Operating activities generated $4.4 million of cash during the first half, and cash equivalents plus restricted cash totaled approximately $6.8 million at quarter-end, compared with $3.7 million at the end of 2025. Wallace said operating cash flow allowed the company to make scheduled debt repayments and distributions to minority partners while increasing its cash position.
Financing Agreement Extends Maturity
After quarter-end, American Shared Hospital Services completed a third amendment and forbearance agreement with Fifth Third Bank. Stachowiak said the agreement extended the maturity of the company’s loans to June 30, 2027 and gives management time to pursue financing alternatives.
He said the company owed Fifth Third about $15.5 million and projected that amount would decline to about $13.3 million by the end of June 2027. A newly created company formed by Stachowiak also provided $2 million of subordinated financing after the quarter ended.
When asked about language in the credit agreement requiring pursuit of a sale of all or part of the company’s assets, Stachowiak said the company was considering “any and all options” and remained confident it would find a solution to refinance its Fifth Third indebtedness.
The company also announced that longtime Chief Accounting Officer Alexis Wallace has been promoted to interim CFO. Former CFO Scott Frech left the company to pursue other opportunities.
About American Shared Hospital Services (NYSEAMERICAN:AMS)
American Shared Hospital Services operates as a specialized healthcare services company focused on delivering diagnostic imaging solutions to community and rural hospitals across the United States. Through strategic joint ventures and management agreements, the company collaborates with hospital partners to develop and operate outpatient imaging centers that provide advanced modalities while sharing the capital and operating costs. By partnering directly with hospitals, American Shared Hospital Services enables facility owners to offer in-house diagnostic capabilities without the burden of full operational oversight and significant equipment investment.
The company’s service portfolio encompasses a wide range of imaging technologies, including magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography/computed tomography (PET/CT), mammography, ultrasound, bone densitometry (DEXA) and nuclear medicine.
