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    AMS
    Earnings call· Jun 2026(Q2 FY26)

    AMERICAN SHARED HOSPITAL SERVICES Q2 FY26 earnings call AMS

    Aug 13, 2026 Source

    Executive summary

    American Shared Hospital Services Q2 FY26 — Strong Revenue Growth and Cash Generation

    American Shared Hospital Services delivered strong Q2 FY26 results, driven by significant revenue growth in Direct Patient Services and robust cash generation from operations. The company is strategically transforming from equipment leasing to a diversified radiation oncology platform, focusing on utilization and international expansion. While addressing balance sheet challenges and a notable credit loss charge, management remains confident in the underlying business strength and long-term value creation.

    Highlights

    5

    • Total revenue increased 19.2% year-over-year to $8.4 million in Q2 FY26.

    • First half revenue increased 17.7% to over $15.5 million.

    • Direct Patient Services segment revenue increased 40% to $4.9 million in Q2 FY26.

    • Operating activities generated $4.4 million of cash during the first half of FY26.

    • Cash balance increased over 80% since year-end 2025 to $6.8 million.

    Concerns

    5

    • Adjusted EBITDA decreased to $1.3 million in Q2 FY26 from $1.7 million in Q2 FY25.

    • Recorded a $909,000 allowance for credit losses against Rhode Island receivables prior to May 31, 2025.

    • Incurred $285,000 in legal and professional costs related to negotiating the third amendment to the credit agreement.

    • Domestic Gamma Knife leasing activity was impacted by the expiration of one customer agreement in 2025.

    • Ongoing need to strengthen the balance sheet and pursue longer-term capital solutions for the $15.5 million loan due June 30, 2027.

    Guidance & targets

    2
    CategoryTargetConfidence
    Fifth Third Bank Loan Maturity
    June 30, 2027
    high materiality
    High
    Fifth Third Bank Loan Balance
    $13.3 million
    high materiality
    High

    Segment performance

    4
    SegmentRevenueYoYQoQMargin
    Direct Patient Services
    Revenue increased primarily due to higher patient procedure volumes at Rhode Island radiation oncology centers and strong performance from Peru and Pueblo, Mexico facilities. For the first half of 2026, revenue increased 35% to approximately $8.9 million.
    		$4.9 million40%——
    Medical Equipment Leasing
    Overall revenue remained relatively stable compared to the prior year. The expiration of a domestic Gamma Knife customer agreement in 2025 was offset by strength in proton beam radiation therapy.
    		—relatively stable——
    Proton Beam Radiation Therapy (within Medical Equipment Leasing)
    Revenue increased due to higher treatment volumes and improved reimbursement levels. First half revenue was approximately $4.3 million.
    		$2.3 million22%——
    Gamma Knife (within Medical Equipment Leasing)
    Revenue increased modestly as procedure volumes recovered at international treatment centers following the Esprit upgrade in Lima.
    		modestly increased———

    Operational metrics

    10
    Total Revenue
    $8.4 millionup 19.2% YoY
    Q2 FY26

    Total revenue for the second quarter.

    Total Revenue
    $7.1 million
    Q2 FY25

    Total revenue for the prior year period (Q2 FY25), explicitly requested by prompt.

    Total Revenue
    $15.5 millionup 17.7% YoY
    H1 FY26

    Total revenue for the first six months of 2026.

    Total Revenue
    $13.2 million
    H1 FY25

    Total revenue for the first six months of 2025, explicitly requested by prompt.

    Gross Margin
    $1.4 millionmodestly below last year's level, improved sequentially from Q1 FY26
    Q2 FY26

    Gross margin for the quarter, explicitly requested by prompt.

    Legal and professional costs
    $285,000
    Q2 FY26

    Costs associated with negotiating the third amendment to the credit agreement, contributing to increased selling and administrative expenses.

    Allowance for credit losses
    $909,000
    Q2 FY26

    Charge against Rhode Island receivables, primarily from insurance carriers, explicitly requested by prompt.

    Cash, cash equivalents and restricted cash
    $6.8 millionup over 80% since year-end 2025
    Q2 FY26

    Cash balance at the end of the second quarter.

    Cash, cash equivalents and restricted cash
    $3.7 million
    FY25

    Cash balance at year-end 2025.

    Subordinated financing
    $2 million
    post Q2 FY26

    Investment from a newly created company formed by the Executive Chairman, enhancing liquidity.

    Industry KPIs

    2
    MetricValueDetails
    Utilization trendshigher patient volumes
    Adjusted EPS EBITDA leverage guidance$1.3 millionUSD

    Deals & partnerships

    2
    Fifth Third BankThird amendment and forbearance agreement to credit facilityExtended maturity to June 30, 2027

    The agreement provides a defined framework for the company to focus on operating strategy while pursuing longer-term capital solutions.

    Hospital San JavierPartnership to upgrade Gamma Knife center

    Partnering to upgrade their Gamma Knife center in Guadalajara, Mexico, leveraging an experienced physician and institutional platform.

    Risks & headwinds

    3
    Balance sheet and capital structurenext 10 months

    $15.5 million loan due to Fifth Third Bank by June 30, 2027

    Mitigation: Secured a 12-month extension of loan maturity and $2 million in subordinated financing; pursuing any and all options for refinancing.

    Allowance for credit lossesQ2 FY26 (for prior period receivables)

    $909,000 charge against Rhode Island receivables

    Mitigation: Focused on improving accounts receivable and billing systems to prevent future occurrences.

    Domestic Gamma Knife customer agreement expiration2025 (reflected in current period)

    Impacted domestic leasing volumes

    Mitigation: Offset by continued strength in proton beam radiation therapy business and international Gamma Knife growth.

    What to watch in Q3 FY26

    4

    Fifth Third Bank loan repayment progress

    next quarter
    Current$15.5 million due by June 30, 2027 (expected to be $13.3 million after payments)
    TargetProgress on refinancing or finding a solution

    Why it matters

    Resolving the debt situation is critical for long-term financial stability and strategic execution, as the company is exploring all options.

    We owe Fifth Third about $15.5 million by the end of June of next year. It will be down to about $13.3 million. If you look at our business, we generated $4.4 million of cash in the first 6 months of this year... I think we're going to be able to find a solution over this period of time to refinance our indebtedness with Fifth Third Bank.

    Q&A highlights

    3

    Will the company have the same ability to control and drive procedure volume increases in international facilities as it does in Rhode Island, given the success seen there?

    Executive Chairman Ray Stachowiak confirmed that they are growing volumes at international sites, citing substantial increases in Peru post-Esprit upgrade and in Puebla, Mexico. He also highlighted the upcoming Gamma Knife upgrade in Guadalajara, Mexico, and emphasized that greater control and expanding hospital partnerships are key to their business model.

    “Yes, we will be growing and have been growing our volumes at our international sites. Peru has seen substantial volume increases, especially since we upgraded their technology to the latest and greatest Esprit model, Gamma Knife.”

    asked by Marla Marin · answered by Raymond Stachowiak

    2 min read6 chapters

    Detailed Narrative

    01

    Strategic Transformation and Diversification

    American Shared Hospital Services is undergoing a strategic transformation, shifting from a primary dependence on equipment leasing to a more diversified radiation oncology platform. This new model integrates direct patient care operations, hospital partnerships, international treatment centers, Gamma Knife leadership, and proton beam radiation therapy. This diversification aims to create a broader, more resilient operating platform with multiple avenues for growth.

    02

    Improving Utilization and Operating Leverage

    A key focus for the company is improving utilization across its network, which is seen as the single greatest driver of long-term value creation. The Rhode Island centers, Orlando proton beam therapy partnership, and the Peru Gamma Knife center have all demonstrated higher patient volumes and improved operating performance. Management expects that as procedure volumes increase, the significant operating leverage in their facilities will translate incremental revenue into improved profitability and stronger cash generation.

    03

    International Expansion and Upgrades

    The company is actively pursuing international growth opportunities, particularly in Latin America. The Puebla, Mexico radiation therapy center continues to perform strongly, and the Gamma Knife center in Peru has seen substantial volume increases following an Esprit upgrade completed in 2025. Future plans include a Gamma Knife upgrade in Guadalajara, Mexico, in partnership with Hospital San Javier, leveraging an established market and clinical partner.

    04

    Capital Structure and Liquidity Enhancement

    Subsequent to the quarter end, the company completed a third amendment and forbearance agreement with Fifth Third Bank, extending the maturity of its loans to June 30, 2027. Additionally, a new company formed by Executive Chairman Ray Stachowiak invested $2 million in subordinated financing. These actions are intended to enhance liquidity, provide financial flexibility, and allow management to focus on executing its operating strategy while pursuing longer-term capital solutions.

    05

    Rhode Island Growth Initiatives

    In Rhode Island, the company is advancing development opportunities stemming from previously approved certificates of need. These projects include plans for a new radiation therapy center in Bristol and a proton beam radiation therapy center in Johnston. These initiatives are expected to significantly expand the company's presence in one of its strongest operating markets and are considered an important component of its long-term growth strategy.

    06

    Accounts Receivable Management

    The company recorded a $909,000 allowance for credit losses against Rhode Island receivables that originated prior to May 31, 2025, primarily from insurance carriers. Management acknowledged this charge and stated that they have been focused on improving accounts receivable and billing systems, indicating good progress in that area to better position the company going forward⏳.

    AI-generated summary of the company’s earnings call. Not investment advice.