American Shared Hospital Services reported financial results for the fourth quarter and full year 2025, revealing a net loss of $1.6 million compared to net income of $2.2 million in 2024, while announcing a seven-year extension of its proton therapy lease agreement with Orlando Health through 2033. The company's strategic shift toward direct patient care services, which now represents the majority of revenue, comes with lower margins but creates more stable revenue streams according to company leadership.
Total revenue for 2025 was $28.1 million, a slight decrease from $28.3 million in 2024. The company experienced growth in LINAC revenue, which increased 35.4% year-over-year to $11.5 million, while Gamma Knife revenue declined 5.5% to $9.2 million and Proton Beam Radiation Therapy revenue decreased 26.0% to $7.4 million. The decline in leasing revenue was attributed primarily to the expiration of three Gamma Knife agreements and lower PBRT volumes, which the company described as normal cyclical fluctuations in treatment volumes.
The seven-year lease extension with Orlando Health represents a significant commitment to proton therapy technology, with the partnership now extending over two decades. This agreement underscores the long-term nature of the company's relationships in advancing access to cutting-edge cancer care. Proton beam radiation therapy procedures totaled 4,056 in fiscal year 2025, compared with 5,139 in fiscal year 2024, reflecting what the company believes are normal cyclical fluctuations that the healthcare industry experiences periodically.
Direct patient care services revenue increased 23.7% to $15.5 million for the full year 2025, driven by the first full year of operations from three radiation therapy centers in Rhode Island and the company's radiation therapy center in Puebla, Mexico. LINAC treatment sessions totaled 28,147 in full year 2025, compared with 14,662 in full year 2024, demonstrating significant growth in this treatment modality. The company ended the quarter with eight domestic medical equipment leasing agreements and six direct patient care service centers operating in the United States and Latin America.
Gary Delanois, Chief Executive Officer, stated that 2025 was a year of transition and operational expansion, with successful integration of Rhode Island radiation therapy treatment centers and completion of the first full year of operations in Puebla, Mexico. The company completed upgrades of its Gamma Knife units, including the Esprit platform upgrade in Lima, Peru, which expanded treatment capabilities to support future patient growth. Same-center Gamma Knife procedures increased during the year following technology upgrades that allow treatment of a broader range of diagnoses.
Ray Stachowiak, Executive Chairman, emphasized the strategic shift toward direct patient care services strengthens long-term growth potential and creates more stable revenue streams. The company has Certificate of Need approvals for a radiation therapy treatment center in Bristol, Rhode Island, where permitting activities are underway, and a proton beam radiation therapy treatment center in Johnston, Rhode Island. These efforts position the company to further expand its Rhode Island footprint and growth potential.
Financial results for the three months ended December 31, 2025, showed revenue decreased 14.8% to $7.7 million compared to $9.1 million in the prior year period. Gross margin was $906,000 or 12% in Q4 2025, compared to 35% or $3.2 million in Q4 2024, due to lower treatment volumes and increased operating costs driven by the shift to direct patient care services. The company ended the year with $3.7 million in cash and cash equivalents, including restricted cash, compared with $11.3 million at December 31, 2024, with the decrease driven by $7.5 million in capital expenditures.
American Shared Hospital Services' shareholders' equity was $24.0 million or $3.66 per outstanding share, compared to $25.2 million or $3.92 per outstanding share at December 31, 2024. The company noted that certain financial covenants under its credit facility were not met as of December 31, 2025, and it is engaged in constructive discussions with its lender to secure waivers and/or amendments to align the debt structure with evolving business needs. Additional information is available through the company's website at https://www.ashs.com and the Securities and Exchange Commission filings.
