American Shared Hospital Services (AMS): Business Model Canvas [Dec-2025 Updated]

You're trying to map out the financial engine behind specialized healthcare tech deployment, and honestly, the model for American Shared Hospital Services (AMS) is a masterclass in asset-light/asset-heavy balance. Here's the quick math: through the first nine months of 2025, they pulled in $20.4 million in total revenue, cleverly split between direct patient care services ($10.7 million) and equipment leasing ($9.7 million). This dual approach funds their heavy investment, like the $7.5 million in CapEx they spent in that same nine-month window. It's a model built on deep health system partnerships and high-precision equipment-the kind of structure that demands a closer look. See the full nine-block breakdown below to understand the mechanics of their joint ventures and international push.

American Shared Hospital Services (AMS) - Canvas Business Model: Key Partnerships

You're looking at the core relationships American Shared Hospital Services (AMS) relies on to deliver its specialized cancer treatment services. These aren't just vendor agreements; they are deep, often equity-based, operational alliances. Here's the breakdown of the key partners as of late 2025, grounded in the latest figures.

Health systems for joint venture operations and profit sharing

AMS structures its health system relationships so that both parties share the burden and the reward. For centers operating under these health system partnerships, the Company and the health system partner share in the capital investment cost and profitability of the operations based on their respective ownership interests. This model is central to their growth in direct patient care.

• The Company announced a 10-year Extension and an Upgrade to their Gamma Knife System with an existing health system partner in Q3 2025.
• Direct patient services revenue, which heavily involves these partnerships, was $4.0 million for Q3 2025, a 9.4% increase period over period.
• For the first nine months of 2025, direct patient care revenue reached $10.7 million, marking a 36.5% year-over-year increase.
• In Q3 2025, the direct patient care services segment represented 56% of total sales.

Equipment manufacturers like Elekta (Gamma Knife) for technology supply

The relationship with Original Equipment Manufacturers (OEMs) is critical for supplying the advanced technology that forms the basis of their service lines. The most defined partnership here is with Elekta for the Gamma Knife system.

American Shared Hospital Services also works closely with other major global OEMs to provide financing support for systems including MR Guided Radiation Therapy Linacs and Advanced Digital Linear Accelerators.

Financial institutions for funding the $7.5 million in 9M 2025 CapEx

Financing the expansion and technology refresh is a constant need. You know the scale of the investment from the nine-month results.

Here's the quick math on the capital deployment as of September 30, 2025: The Company utilized $7.5 million for capital expenditures during the first nine months of 2025. This spending contributed to the cash position ending at $5.3 million at that date, down from $11.3 million at the end of 2024. What this estimate hides is the specific mix of debt versus internal cash flow used for that $7.5 million spend. The Company reports a strong balance sheet to support growth, but specific external financial institution names tied to this CapEx aren't detailed in the Q3 2025 release.

Clinical physician groups for staffing direct patient care centers

The shift toward direct patient care requires securing the clinical talent to run the centers. The CEO noted that revenue increases in the direct patient care segment were primarily driven by new physicians in Rhode Island ramp up and volumes increase. This segment's performance directly reflects the success of these staffing arrangements.

• Q3 2025 Direct patient services revenue increased 9.4% to $4.0 million.
• The segment accounted for 56% of total sales in Q3 2025.
• Growth was also cited from the new facility in Puebla, Mexico, where revenue grew by 263% period over period in Q3 2025, indicating successful local staffing and volume ramp.

Finance: draft 13-week cash view by Friday.

American Shared Hospital Services (AMS) - Canvas Business Model: Key Activities

Operating direct patient care radiation therapy centers (e.g., Rhode Island, Puebla).

The direct patient care services segment is a growing focus for American Shared Hospital Services. For the three months ended September 30, 2025, revenue from this segment rose 9.4% period over period to $4.0M. This segment accounted for 56% of total sales in Q3 2025, up from 53% the prior year. Year-to-date for the first nine months of 2025, direct patient care revenue increased 36.5% to $10.7M compared to $7.8M for the same period in 2024. The growth is primarily attributed to the Rhode Island centers, acquired in May 2024 (60% interest), and the new facility in Puebla, Mexico, which began treating patients in July 2024. The Puebla facility has seen significant revenue growth. Separately, the Gamma Knife Radiosurgery center in Lima, Peru, has treated over 600 patients with brain tumors and/or functional disorders non-invasively since opening.

Managing and maintaining high-tech medical equipment (Gamma Knife, PBRT).

American Shared Hospital Services operates by leasing equipment and providing support services, though the mix is shifting toward direct care. The company leases nine Gamma Knife systems and one PBRT system. The leasing segment saw revenue decline for the first nine months of 2025 to $9.7M from $11.5M in the first nine months of 2024, driven by lower Gamma Knife volumes (due to three expired customer contracts since Q4 2024) and lower PBRT volumes. Historically, when a medical facility wants a Gamma Knife, American Shared Hospital Services pays for the equipment and ongoing maintenance costs. For Q3 2025, Gamma Knife revenue increased 25% sequentially but decreased 5% compared to Q3 2024. The company recently signed a 10-year extension and an Esprit upgrade with an existing health system.

Here's a look at the equipment-related revenue performance for Q3 2025:

• LINAC Revenue increased 7% sequentially.
• LINAC Revenue increased 34% compared to Q3 2024.
• Proton Beam Radiation Therapy (PBRT) Revenue increased 17% sequentially.
• PBRT Revenue decreased 21% compared to Q3 2024.

Securing Certificate of Need (CON) approvals for new US centers.

Securing regulatory approval is a key activity supporting U.S. expansion. American Shared Hospital Services announced recent Certificate of Need approvals for two new facilities in Rhode Island. These approvals cover the first radiation therapy treatment center in Bristol, Rhode Island, and a proton beam radiation therapy treatment center in Johnston, Rhode Island. The company also incurred $7.5M in capital expenditures during the first nine months of 2025, which included investments for the Bristol, Rhode Island location.

Executing international expansion, like the Guadalajara center planned for 2026.

International expansion is a stated growth driver, with the company having existing centers in Peru and Ecuador. The next planned international center is in Guadalajara, Mexico, established via a Joint Venture where American Shared Hospital Services holds a 70% ownership interest. This center will upgrade an existing Gamma Knife system to an Esprit. The expected startup for the Guadalajara center is the second quarter of 2026. This planned CapEx is part of the $7.5M spent on capital expenditures for the nine-month period ending September 30, 2025.

American Shared Hospital Services (AMS) - Canvas Business Model: Key Resources

You're looking at the core assets American Shared Hospital Services (AMS) relies on to run its business, which is heavily weighted toward specialized medical technology and the expertise to run it.

The foundation here is the physical and financial muscle. As of September 30, 2025, the balance sheet held $5.3 million in cash, cash equivalents, and restricted cash. This liquidity supports ongoing operations and capital deployment for technology upgrades.

The equipment itself is a massive resource, representing significant capital investment over the years. AMS is a worldwide leader in Leksell Gamma Knife® unit ownership, primarily through its 81% owned subsidiary, GK Financing, LLC (GKF). This resource base includes the latest systems, such as the Esprit model, which is part of recent strategic moves.

The company's ability to secure and maintain these high-value assets is tied directly to its contractual relationships. A recent win here was the signing of a 10-Year Extension with an existing health system, which also included an upgrade to their Gamma Knife system. This demonstrates the stickiness of their service model and the ongoing value of their installed base.

Here's a quick look at the financial snapshot supporting these resources as of the end of the third quarter of 2025:

The clinical and technical expertise is embedded in the operational segment mix. For the three months ended September 30, 2025, revenue from the direct patient care services segment represented 56% of total sales, up from 53% in the prior year period. This segment growth, up 9.4% period over period in Q3 2025, reflects the successful deployment and utilization of that specialized knowledge base, particularly at new centers like the one in Puebla, Mexico.

The physical assets portfolio includes the specialized, capital-intensive equipment necessary for advanced treatments:

• - Leksell Gamma Knife Esprit systems, with a new center expected to start up in Q2 2026.
• - Proton Beam Radiation Therapy (PBRT) systems, though leasing revenue from this area saw lower volumes in Q3 2025.
• - Other advanced devices like Linear Accelerators (LINACs), which saw Q2 2025 revenue increase 34% compared to Q2 2024.

American Shared Hospital Services (AMS) - Canvas Business Model: Value Propositions

You're looking at how American Shared Hospital Services (AMS) delivers distinct value to its partners and patients as of late 2025. The core proposition centers on de-risking and enabling access to capital-intensive cancer treatment modalities.

Access to Advanced Technology Without Upfront Capital Strain

American Shared Hospital Services (AMS) provides hospitals and health systems access to high-cost cancer technology, like their Gamma Knife systems, without requiring them to shoulder the massive initial capital outlay. This model is evident in the revenue mix. For the first nine months of 2025, revenue from the equipment leasing segment was $9.7 million, contrasting with the $10.7 million generated by the direct patient care services segment over the same period. This shows the dual approach in action, where leasing alleviates capital burdens for partners, while direct care captures higher margin service revenue.

The value proposition is also about enabling the adoption of specific, high-precision tools. For instance, while Gamma Knife revenue for the first nine months of 2025 was $6.8 million, the company continues to invest in and deploy these systems, such as planning for a new Esprit installation in Guadalajara, Mexico, expected to start up in the second quarter of 2026.

Flexible Business Model: Leasing Versus Direct Care

The flexibility of the business model is a key differentiator, allowing American Shared Hospital Services (AMS) to serve different partner needs. You see this flexibility reflected in the shift of revenue contribution between the segments.

The direct patient services segment is clearly gaining traction, increasing its share from 53% last year to 56% in Q3 2025. This segment saw revenue jump 36.5% year-over-year for the first nine months of 2025, reaching $10.7 million from $7.8 million in the prior year.

Operational Expertise Maximizing Utilization

Operational expertise translates directly into better financial performance when volumes increase. The focus on maximizing utilization is supported by the improved gross margin, which reached 22.1% in Q3 2025, marking a 15.8% increase period over period. This margin improvement was explicitly driven by higher treatment volumes. Furthermore, the operational leverage is clear in the EBITDA growth; Q3 2025 EBITDA was $1.94 million, a 42.3% increase over Q3 2024's $1.37 million. The new radiation therapy center in Puebla, Mexico, exemplifies this, showing revenue growth of 263% in Q3 2025 off a small base, proving the model's ability to ramp up new centers effectively.

High-Precision Modalities

American Shared Hospital Services (AMS) delivers value through specialized, high-precision modalities like stereotactic radiosurgery and advanced radiation therapy. The company's Q3 2025 results highlighted increased revenue from direct patient care services, which includes these advanced treatments. The growth in the direct patient services segment, up 9.4% in Q3 2025, is tied to increased procedures at new U.S. centers in Rhode Island and the new facility in Puebla, Mexico. For context on the scale of technology deployment, in the full year 2024, their proton therapy segment recorded 5,139 treatments.

• Q3 2025 Net Loss decreased by 91.8% to a loss of $17,000 from a loss of $207,000 in Q3 2024.
• For the nine months ended September 30, 2025, total revenue was $20.4 million.
• The company is expanding its U.S. footprint, with permitting underway for a fourth radiation therapy center in Bristol, Rhode Island.

American Shared Hospital Services (AMS) - Canvas Business Model: Customer Relationships

American Shared Hospital Services (AMS) maintains long-term, high-touch relationships with health system partners, a critical component given the nature of advanced radiation therapy services.

The emphasis on human interaction is supported by broader healthcare trends; for instance, in late 2025 surveys, 89% of people indicated they prefer to speak to a real person over an AI when contacting a healthcare practice. This underscores the value of the personal connection AMS provides in its direct patient care model.

The relationship structure often involves joint venture structures for shared risk and reward. Specific health system partners mentioned include Care New England and Prospect CharterCare. A concrete example of this shared commitment is the recent signing of a 10-year extension with an existing health system, which also included an upgrade to their Gamma Knife system.

The shift in focus is evident in the revenue mix, demonstrating a move toward deeper integration through direct patient interaction and care management at owned centers.

This growth in direct care is fueled by operations like the new centers in Puebla, Mexico, and the ramp-up in Rhode Island.

The focus is definitely on securing contract extensions and upgrades to ensure revenue visibility and continued partnership. While a 10-year extension was recently secured, the equipment leasing segment revenue was negatively impacted by the expiration of three customer contracts since the fourth quarter of 2024.

Key relationship activities and outcomes include:

• Securing a 10-year extension with an existing health system partner.
• Executing an upgrade to their Gamma Knife system as part of a partnership agreement.
• Managing the impact of three expired customer contracts in the leasing segment since Q4 2024.
• Growing direct patient care revenue by 36.5% for the first nine months of 2025 to $10.7 million.

Finance: draft 13-week cash view by Friday.

American Shared Hospital Services (AMS) - Canvas Business Model: Channels

You're looking at how American Shared Hospital Services (AMS) gets its services and equipment to the market as of late 2025. The Channels block shows a clear pivot, moving from a primary leasing model to one where direct patient care is the main revenue driver. This shift is executed through physical centers and direct sales efforts targeting executive decision-makers in health systems.

The core of the channel strategy is twofold: owning and operating treatment centers, and maintaining a legacy, though shrinking, equipment leasing business. The direct patient care segment is definitely where the near-term momentum is, evidenced by the financial results from the third quarter ended September 30, 2025. Honestly, the numbers tell you where the focus is right now.

Here's a quick look at how the two main revenue-generating channels performed for the first nine months of 2025 compared to the same period in 2024:

The direct-owned and operated radiation therapy treatment centers are clearly the growth engine. You see this in the revenue figures, but also in the geographic expansion. The new center in Puebla, Mexico, is off to a fantastic start, with revenues growing by 263% off a small base in the period leading up to Q3 2025. Also, the Rhode Island operations, including the new physicians ramping up, are contributing heavily to this segment's success. The company is actively building out this channel, with Certificate of Need approvals secured for a radiation therapy center in Bristol, Rhode Island, and a proton beam center in Johnston, Rhode Island, further expanding the domestic footprint.

The equipment leasing agreements directly with hospitals and clinics still form a significant part of the business, though it's contracting. Revenue from this segment was $3.1 million for Q3 2025, a decrease of 5.3% compared to the prior year period. This dip is attributed to lower Proton Beam Radiation Therapy (PBRT) volumes and the expiration of three customer contracts since the fourth quarter of 2024. Still, the business development team is working to secure the future of this channel; they recently signed an Existing Health System to a 10 Year Extension for an Esprit-the latest model Gamma Knife System.

The business development and sales team targeting health system executives is the mechanism that drives both the leasing extensions and the development of new direct-care centers. Their success is measured by securing long-term contracts and new market entries. For instance, the team is executing on the pipeline that includes a new Gamma Knife center in Guadalajara, Mexico, which is expected to start up in the second quarter of 2026. This team is key to translating strategic approvals into operational revenue streams.

The channel strategy is supported by specific operational metrics:

• - Gamma Knife procedures in Q3 2025 were 231, up from 218 in Q3 2024.
• - Linear accelerator (Linac) systems revenue was $2.9 million for Q3 2025, up 51.2% compared to Q3 2024, driven by the Puebla, Mexico launch and staffing in Rhode Island.
• - Capital expenditures of $7.5 million were spent through September 30, 2025, for projects including Peru, Bristol, Rhode Island, and Northwestchester, which directly fund the physical channel expansion.

Finance: draft 13-week cash view by Friday.

American Shared Hospital Services (AMS) - Canvas Business Model: Customer Segments

You're looking at the customer base for American Shared Hospital Services (AMS) as of late 2025. The focus is clearly shifting, with direct patient care now driving a larger piece of the revenue pie.

The customer segments American Shared Hospital Services serves can be broken down by their relationship with the company's two main operating segments: equipment leasing and direct patient care services.

• US and international health systems seeking advanced cancer technology.
• Cancer treatment centers requiring Gamma Knife or PBRT equipment.
• Direct cancer patients in regions with AMS-operated clinics.
• Physicians and oncologists referring patients to AMS centers.

The health systems segment, which involves equipment leasing, saw its revenue dip in the third quarter of 2025. Revenue from this segment was $3.1 million for Q3 2025, reflecting a 5.3% decrease compared to the prior year period, largely due to lower Proton Beam Radiation Therapy (PBRT) volumes. For the first nine months of 2025, leasing revenue was $9.7 million, down from $11.5 million for the same period in 2024. Still, a key relationship was solidified with the signing of a 10-year extension for a Gamma Knife System upgrade with an existing health system.

For centers specifically needing advanced equipment, the Gamma Knife revenue component for the first nine months of 2025 was $6.8 million, a 4.2% decline from the $7.1 million reported in the first nine months of 2024. This highlights the variability in equipment utilization across the customer base.

The direct cancer patients segment, served through American Shared Hospital Services-operated clinics, is showing strong momentum. Revenue from direct patient services in Q3 2025 was $4.0 million, marking a 9.4% increase period over period. This segment accounted for 56% of total sales in Q3 2025, up from 53% in the prior year period. The nine-month revenue for this segment reached $10.7 million, a 36.5% increase over the $7.8 million from the first nine months of 2024. This growth is heavily influenced by the new radiation therapy center in Puebla, Mexico, which is off to a fantastic start, and ramping volumes from new physicians in Rhode Island.

Physicians and oncologists act as key referrers, directly impacting the direct patient services revenue. The growth in this area suggests strong referral patterns, especially given the expansion into new US markets like Bristol and Johnston, Rhode Island, where Certificate of Need approvals were secured. Furthermore, American Shared Hospital Services is planning for future patient volume with the expected startup of a new Esprit Gamma Knife center in Guadalajara, Mexico, in the second quarter of 2026.

• Direct Patient Services Revenue Growth (Q3 2025 vs. Q3 2024): 9.4%
• Direct Patient Services Revenue Growth (Nine Months 2025 vs. Nine Months 2024): 36.5%
• New US Locations with Approved Centers: 2 (Bristol and Johnston, Rhode Island)
• International Center Driving Growth: Puebla, Mexico

Finance: draft 13-week cash view by Friday.

American Shared Hospital Services (AMS) - Canvas Business Model: Cost Structure

You're looking at the cost drivers for American Shared Hospital Services (AMS) as of late 2025, and honestly, it's a capital-intensive business, which means big upfront and ongoing costs for the high-tech gear they use.

The structure is clearly weighted toward fixed and semi-fixed expenses tied to their advanced radiation therapy equipment, like Gamma Knife systems. While I don't have the exact depreciation schedule, the cash flow impact from new asset acquisition is clear.

• - High fixed costs for equipment depreciation and maintenance.
• - Significant capital expenditures, totaling $7.5 million in 9M 2025.
• - Personnel costs for specialized clinical and technical staff.
• - Operating costs for direct patient care centers (e.g., utilities, supplies).

The capital deployment is a major cost component you need to track. For the first nine months of 2025, American Shared Hospital Services spent $7.5 million on capital expenditures, covering locations like Peru, Bristol, Rhode Island, and Northwestchester. This spending directly feeds into future depreciation expenses, which are a core fixed cost.

The shift in business mix also impacts the cost profile. As direct patient care services grow-accounting for 56% of total sales in Q3 2025-the nature of operating costs changes. The equipment leasing segment, which historically carried higher margins, is seeing revenue decline due to contract expirations. This shift to direct care, while driving revenue growth, comes with lower margins compared to leasing.

Here's a look at the key financial metrics that reflect these costs for the first nine months of 2025:

Personnel costs, covering specialized clinical and technical staff necessary to operate Gamma Knife and other advanced systems, represent a significant, likely high, variable cost within the direct patient care segment. You see the pressure on margins because of this shift; for the nine months ended September 30, 2025, the gross margin was 20.4%, down from $6.0 million in the prior year period. This decline is explicitly attributed to lower treatment volumes in leasing and increased operating costs driven by the direct patient care segment.

To be fair, the company is managing its operating expenses well enough to see Adjusted EBITDA grow to $4.6 million for the nine months ended September 30, 2025, up from $5.1 million in the first nine months of 2024. Still, the net loss for the nine months was $0.9 million. Finance: draft 13-week cash view by Friday.

American Shared Hospital Services (AMS) - Canvas Business Model: Revenue Streams

You're analyzing the revenue streams for American Shared Hospital Services (AMS) as of late 2025, and the numbers clearly show a business in transition, moving away from pure equipment leasing toward direct service delivery. This shift is the defining characteristic of their current revenue profile.

The total top-line performance for the first nine months of 2025 demonstrates growth, driven by the expansion of their patient care footprint. For the first nine months of 2025, American Shared Hospital Services reported a total revenue of $20.4 million.

This total revenue is sourced from two primary, distinct segments, reflecting the dual nature of their business model:

• - Direct patient care services revenue, which grew to $10.7 million in 9M 2025.
• - Equipment leasing revenue, which was $9.7 million in 9M 2025.
• - Service and maintenance fees from leased equipment contracts.
• - Total revenue for the first nine months of 2025 was $20.4 million.

Here's the quick math on how those two main components combine to form the nine-month total: $10.7 million plus $9.7 million equals $20.4 million. This shows that the direct patient care segment is now the larger contributor to revenue, accounting for approximately 52.45% of the total for the nine-month period ($10.7M / $20.4M).

To give you a clearer picture of the segment performance for the nine months ended September 30, 2025, compared to the prior year period, look at this breakdown:

The trend within these streams is telling. Direct patient care revenue saw a substantial year-over-year increase of 36.5% ($10.7M vs $7.8M), clearly indicating successful execution of their strategy, likely driven by new centers in Rhode Island and Puebla, Mexico. Conversely, the equipment leasing revenue declined to $9.7 million from $11.5 million in the first nine months of 2024, a drop of about 15.65%, which management attributes to lower Gamma Knife volumes and expired customer contracts. This decline in the legacy stream is being offset by the growth in the newer patient-centric model.

The composition of the revenue streams is also reflected in the quarterly performance, showing the acceleration of the shift:

• Q3 2025 Direct Patient Services Revenue: $4.0 million.
• Q3 2025 Total Revenue: $7.2 million.
• Percentage of Total Sales from Direct Patient Care (Q3 2025): 56%.

Finance: draft 13-week cash view by Friday.