10-Q 1 rdnt-20240331.htm 10-Q rdnt-20240331
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington D.C. 20549

FORM 10-Q
(Mark One)
     QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended March 31, 2024
or
     TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from                      to                     
Commission File Number 001-33307
RadNet, Inc.
(Exact name of registrant as specified in its charter)
Delaware13-3326724
(State or other jurisdiction of
incorporation or organization)
(I.R.S. Employer
Identification No.)
1510 Cotner Avenue 
Los Angeles,California90025
(Address of principal executive offices)(Zip Code)
(310) 478-7808
(Registrant’s telephone number, including area code)

Not Applicable
(Former name, former address and former fiscal year, if changed since last report)
Securities registered pursuant to Section 12(b) of the Act:
Class TitleTrading SymbolRegistered Exchange
Common StockRDNTNASDAQ
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities and Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes  No
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). Yes   No
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”, “smaller reporting company”, and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large accelerated filerAccelerated filer
Non-accelerated filerSmaller reporting company
Emerging growth company
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  ☐
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act) Yes No
The number of shares of the registrant’s common stock outstanding on May 8, 2024 was 73,880,145 shares.


RADNET, INC.
TABLE OF CONTENTS
Page

ITEM 6.  Exhibits

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PART I - FINANCIAL INFORMATION
Item 1 – Financial Statements
RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(IN THOUSANDS EXCEPT SHARE AND PER SHARE DATA)
March 31,
2024
December 31,
2023
(unaudited) 
ASSETS  
CURRENT ASSETS  
   Cash and cash equivalents$526,980 $342,570 
   Accounts receivable189,572 163,707 
   Due from affiliates34,269 25,342 
   Prepaid expenses and other current assets45,007 47,657 
      Total current assets 795,828 579,276 
PROPERTY, EQUIPMENT AND RIGHT-OF-USE ASSETS
   Property and equipment, net618,926 604,401 
   Operating lease right-of-use assets621,612 596,032 
      Total property, equipment and right-of-use assets1,240,538 1,200,433 
OTHER ASSETS
   Goodwill694,292 679,463 
   Other intangible assets86,883 90,615 
   Deferred financing costs1,483 1,643 
   Investment in joint ventures97,034 92,710 
   Deposits and other53,497 46,333 
       Total assets$2,969,555 $2,690,473 
LIABILITIES AND EQUITY
CURRENT LIABILITIES
    Accounts payable, accrued expenses and other$324,578 $342,940 
    Due to affiliates20,494 15,910 
    Deferred revenue4,475 4,647 
    Current operating lease liability58,138 55,981 
    Current portion of notes payable20,202 17,974 
        Total current liabilities427,887 437,452 
LONG-TERM LIABILITIES
    Long-term operating lease liability630,348 605,097 
    Notes payable, net of current portion814,442 812,068 
    Deferred tax liability, net14,479 15,776 
    Other non-current liabilities5,074 6,721 
        Total liabilities1,892,230 1,877,114 
EQUITY
Common stock - $0.0001 par value, 200,000,000 shares authorized; 73,901,654 and 67,956,318 shares issued and outstanding at March 31, 2024 and December 31, 2023, respectively
7 7 
    Additional paid-in-capital969,248 722,750 
    Accumulated other comprehensive loss(13,943)(12,484)
    Accumulated deficit(82,357)(79,578)
        Total RadNet, Inc.'s stockholders' equity872,955 630,695 
Noncontrolling interests204,370 182,664 
       Total equity1,077,325 813,359 
       Total liabilities and equity$2,969,555 $2,690,473 

The accompanying notes are an integral part of these financial statements.



1

RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(IN THOUSANDS EXCEPT SHARE AND PER SHARE DATA)
(unaudited)
 Three Months Ended
March 31,
20242023
REVENUE  
     Service fee revenue$397,189 $352,420 
     Revenue under capitation arrangements34,518 38,144 
Total service revenue431,707 390,564 
OPERATING EXPENSES
     Cost of operations, excluding depreciation and amortization387,589 351,865 
     Depreciation and amortization32,368 31,315 
     Loss (gain) on sale and disposal of equipment and other186 579 
     Severance costs225 134 
Total operating expenses420,368 383,893 
INCOME FROM OPERATIONS11,339 6,671 
OTHER INCOME AND EXPENSES
     Interest expense16,267 15,722 
     Equity in earnings of joint ventures(4,324)(1,428)
     Non-cash change in fair value of interest rate hedge(1,216)4,093 
Other (income) expense(2,934)1,432 
Total other expense7,793 19,819 
INCOME (LOSS) BEFORE INCOME TAXES3,546 (13,148)
 Benefit from (provision for) income taxes1,864 (1,135)
NET INCOME (LOSS) 5,410 (14,283)
Net income attributable to noncontrolling interests8,189 6,722 
NET LOSS ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$(2,779)$(21,005)
BASIC AND DILUTED NET LOSS PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$(0.04)$(0.36)
WEIGHTED AVERAGE SHARES OUTSTANDING
Basic and Diluted69,307,078 57,701,439 
The accompanying notes are an integral part of these financial statements.
2

RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
(IN THOUSANDS)
(unaudited)
 Three Months Ended March 31,
20242023
NET INCOME (LOSS) $5,410 $(14,283)
     Foreign currency translation adjustments(2,198)2,777 
     Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes739 922 
COMPREHENSIVE INCOME (LOSS) 3,951 (10,584)
Less comprehensive income attributable to noncontrolling interests8,189 6,722 
COMPREHENSIVE LOSS ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$(4,238)$(17,306)
The accompanying notes are an integral part of these financial statements.

3

RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY
(IN THOUSANDS EXCEPT SHARE DATA)
(unaudited)
The following table summarizes changes in the Company’s consolidated stockholders' equity, including noncontrolling interest, during the three months ended March 31, 2024 and March 31, 2023.
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Common StockAdditional Paid-In
Capital
Accumulated Other
Comprehensive
 Loss
Accumulated
Deficit
Total
Radnet, Inc.'s
Equity
Noncontrolling
Interests
Total
Equity
SharesAmount
BALANCE - DECEMBER 31, 202367,956,318 $7 $722,750 $(12,484)$(79,578)$630,695 $182,664 $813,359 
Issuance of common stock upon exercise of options1,299 — 8 — — 8 — 8 
Issuance of common stock under the equity compensation plan616,767 — — — — — — — 
Issuance of common stock under the DeepHealth equity compensation plan4,393 — — — — — — — 
Stock-based compensation expense— — 11,906 — — 11,906 — 11,906 
Issuance of common stock, net of issuance costs5,232,500 — 218,385 — — 218,385 — 218,385 
Issuance of common stock in connection with acquisitions95,019 — 4,607 — — 4,607 — 4,607 
Forfeiture of restricted stock(4,642)— (9)— — (9)— (9)
Sale of economic interests in majority owned subsidiary, net of taxes— — 11,601 — — 11,601 9,590 21,191 
Contribution from noncontrolling partner— — — — —  3,927 3,927 
Change in cumulative foreign currency translation adjustment— — — (2,198)— (2,198)— (2,198)
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes— — — 739 — 739 — 739 
Net income (loss)— — — — (2,779)(2,779)8,189 5,410 
BALANCE-MARCH 31, 202473,901,654 $7 $969,248 $(13,943)$(82,357)$872,955 $204,370 $1,077,325 
BALANCE - DECEMBER 31, 202257,723,125 $6 $436,288 $(20,677)$(82,622)$332,995 $158,457 $491,452 
Issuance of common stock upon exercise of options5,000 — 51 — — 51 — 51 
Issuance of common stock under the equity compensation plan527,692 — — — — — — — 
Issuance of common stock under the DeepHealth equity compensation plan14,473 — — — — — — — 
Stock-based compensation expense— — 12,185 — — 12,185 — 12,185 
Change in cumulative foreign currency translation adjustment— — — 2,777 — 2,777 — 2,777 
Change in fair value cash flow hedge, net of taxes— — — — — — —  
Change in fair value of cash flow hedge from prior periods reclassified to earnings— — — 922 — 922 — 922 
Other— — (2)— (1)(3)— (3)
Net income (loss)— — — — (21,005)(21,005)6,722 (14,283)
BALANCE-MARCH 31, 202358,270,290 $6 $448,522 $(16,978)$(103,628)$327,922 $165,179 $493,101 
The accompanying notes are an integral part of these financial statements.

5

RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(IN THOUSANDS)
(unaudited)
Three Months Ended March 31,
20242023
CASH FLOWS FROM OPERATING ACTIVITIES  
Net income (loss) $5,410 $(14,283)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization32,368 31,315 
Amortization of operating lease right-of-use assets14,711 15,699 
Equity in earnings of joint ventures, net of dividends(4,324)(1,835)
Amortization of deferred financing costs and loan discount748 746 
Loss on sale and disposal of equipment and other186 579 
Amortization of cash flow hedge, net of taxes739 922 
Non-cash change in fair value of interest rate hedge(1,216)4,093 
Stock-based compensation11,897 12,185 
Change in fair value of contingent consideration1,974 2,335 
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:
Accounts receivable(25,865)(9,997)
Other current assets(6,277)(1,691)
Other assets(5,892)(2,726)
Deferred taxes(1,158)942 
Operating lease liability(12,883)(15,080)
Deferred revenue(172)335 
Accounts payable, accrued expenses and other6,839 9,077 
Net cash provided by operating activities17,085 32,616 
CASH FLOWS FROM INVESTING ACTIVITIES
Purchase of imaging centers and other acquisitions(3,530)(9,644)
Purchase of property and equipment(57,409)(55,915)
Proceeds from sale of equipment2 3 
Net cash used in investing activities(60,937)(65,556)
CASH FLOWS FROM FINANCING ACTIVITIES
Principal payments on notes payable(1,102)(184)
Payments on term loan debt(1,875)(3,688)
Contributions from noncontrolling interests4,169  
Proceeds from sale of economic interest of majority owned subsidiary8,713  
Proceeds from issuance of common stock, net of issuance costs218,385  
Proceeds from issuance of common stock upon exercise of options8 51 
Net cash provided by (used in) financing activities228,298 (3,821)
EFFECT OF EXCHANGE RATE CHANGES ON CASH(36)(229)
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS184,410 (36,990)
CASH AND CASH EQUIVALENTS, beginning of period342,570 127,834 
CASH AND CASH EQUIVALENTS, end of period$526,980 $90,844 
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid during the period for interest$18,285 $21,471 
Cash paid during the period for income taxes$1 $40 
The accompanying notes are an integral part of these financial statements.
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RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (CONTINUED)
(unaudited)
Supplemental Schedule of Non-Cash Investing and Financing Activities
We acquired equipment and certain leasehold improvements for approximately $44.1 million and $40.8 million during the three months ended March 31, 2024 and 2023, respectively, which were not paid for as of March 31, 2024 and 2023, respectively. The amounts due were recorded in our condensed consolidated balance sheet under accounts payable, accrued expenses and other.
We acquired Grossman Imaging Center of CMH, LLC for approximately $10.5 million during the three months ended March 31, 2024 which was not paid for as of March 31, 2024. The amounts due were recorded in our condensed consolidated balance sheet under accounts payable, accrued expenses and other.
On March 31, 2024, we issued an additional 12.5% in noncontrolling interest in our Ventura County Imaging Group, LLC joint venture in exchange for $5.1 million which was not paid for as of March 31, 2024. The amounts due were recorded in our condensed consolidated balance sheet under accounts payable, accrued expenses and other.
On March 29, 2024, we received $0.6 million in fixed assets, imaging equipment, and $6.5 million in goodwill from our partner in Tri Valley Imaging Group, LLC. See Note 4, Business combinations and related activity contained herein.
On March 27, 2024, we issued 95,019 shares of common stock to settle the stock contingent liabilities as part of our purchase of Heart & Lung Imaging Limited. The shares were ascribed a value of $4.6 million.
On January 15, 2024, we issued promissory notes in the amount of $6.9 million to acquire radiology equipment previously leased under operating leases.

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RADNET, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(unaudited)
NOTE 1 – NATURE OF BUSINESS AND BASIS OF PRESENTATION

We are a national provider of freestanding, fixed-site outpatient diagnostic imaging services in the United States. At March 31, 2024, we operated directly or indirectly through joint ventures with hospitals, 375 centers located in Arizona, California, Delaware, Florida, Maryland, New Jersey, and New York. Our centers provide physicians with imaging capabilities to facilitate the diagnosis and treatment of diseases and disorders. Our services include magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), nuclear medicine, mammography, ultrasound, diagnostic radiology (X-ray), fluoroscopy and other related procedures. The vast majority of our centers offer multi-modality imaging services. Our multi-modality strategy diversifies revenue streams, reduces exposure to reimbursement changes and provides patients and referring physicians one location to serve the needs of multiple procedures. In the first quarter of 2024, we revised our reportable segments to combine our eRad business, which was included in the Imaging Center segment, with our AI segment to form a new Digital Health reportable segment. Prior period amounts were adjusted retrospectively to reflect the change in reportable segment. For further financial information about these segments, see Note 5, Segment Reporting. In March 2024, we closed on a public offering of 5,232,500 shares of our common stock, including 682,500 shares sold pursuant to the exercise of an underwriter's overallotment option, at a price to the public of $44.00 per share. The gross proceeds as a result of this public offering was $230.2 million before underwriting discounts, commissions, and expenses totaling $11.8 million.
 
The consolidated financial statements include the accounts of RadNet, Inc as well as its subsidiaries in which RadNet has a controlling financial interest. The consolidated financial statements also include certain variable interest entities in which we are the primary beneficiary (as described in more detail below). All material intercompany transactions and balances have been eliminated upon consolidation. All of these affiliated entities are referred to collectively as “RadNet”, “we”, “us”, “our” or the “Company” in this report.
Accounting regulations stipulate that generally any entity with a) insufficient equity to finance its activities without additional subordinated financial support provided by any parties, or b) equity holders that, as a group, lack the characteristics which evidence a controlling financial interest, is considered a Variable Interest Entity (“VIE”). We consolidate all VIEs in which we are the primary beneficiary. We determine whether we are the primary beneficiary of a VIE through a qualitative analysis that identifies which variable interest holder has the controlling financial interest in the VIE. The variable interest holder who has both of the following has the controlling financial interest and is the primary beneficiary: (1) the power to direct the activities of the VIE that most significantly impact the VIE’s economic performance and (2) the obligation to absorb losses of, or the right to receive benefits from, the VIE that could potentially be significant to the VIE. In performing our analysis, we consider all relevant facts and circumstances, including: the design and activities of the VIE, the terms of the contracts the VIE has entered into, the nature of the VIE’s variable interests issued and how they were negotiated with or marketed to potential investors, and which parties participated significantly in the design or redesign of the entity.

VIEs that we consolidate as the primary beneficiary include professional corporations which are owned or controlled by individuals within our senior management and provide professional medical services for centers in Arizona, California, Delaware, Maryland, New Jersey and New York. These VIEs are collectively referred to as the consolidated medical group ("the Group"). RadNet provides non-medical, technical and administrative services to the Group for which it receives a management fee, pursuant to the related management agreements. Through the management agreements we have exclusive authority over all non-medical decision making related to the ongoing business operations and we determine the annual budget. The Group has insignificant operating assets and liabilities, and de minimis equity. Substantially all cash flows of the Group after expenses, including professional salaries, are transferred to us. We consolidate the revenue and expenses, assets and liabilities of the Group. The creditors of the Group do not have recourse to our general credit and there are no other arrangements that could expose us to losses on behalf of the Group. However, RadNet may be required to provide financial support to cover any operating expenses in excess of operating revenues.

The Group on a combined basis recognized $52.3 million and $48.8 million of revenue, net of management services fees to RadNet, for the three months ended March 31, 2024 and 2023, respectively and $52.3 million and $48.8 million of operating expenses for the three months ended March 31, 2024 and 2023, respectively. RadNet recognized $234.8 million and $207.4 million of total billed net service fee revenue for the three months ended March 31, 2024, and 2023, respectively, for management services provided to the Group relating primarily to the technical portion of billed revenue.

The cash flows of the Group are included in the accompanying condensed consolidated statements of cash flows. All intercompany balances and transactions have been eliminated in consolidation. In our condensed consolidated balance sheets at March 31, 2024 and December 31, 2023, we have included approximately $108.9 million and $94.1 million, respectively, of
8

accounts receivable and approximately $16.0 million and $16.7 million of accounts payable and accrued liabilities related to the Group, respectively.

At all of our centers not serviced by the Group we have entered into long-term contracts with medical groups to provide professional services at those centers, including supervision and interpretation of diagnostic imaging procedures. The medical groups maintain full control over the physicians they employ. Through our management agreements, we make available to the medical groups the imaging centers, including all furniture, fixtures and medical equipment therein. The medical groups are compensated for their services from the professional component of the global net service fee revenue and after deducting management service fees paid to us, we have no economic controlling interest in these medical groups. As such, the financial results of these groups are not consolidated in our financial statements.
The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X and, therefore, do not include all information and footnotes necessary for conformity with U.S. generally accepted accounting principles for complete financial statements; however, in the opinion of management, all adjustments consisting of normal recurring adjustments necessary for a fair presentation of the financial position, results of operations and cash flows for the interim periods ended March 31, 2024 and 2023 have been made. The results of operations for any interim period are not necessarily indicative of the results for a full year. These interim condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes thereto contained in our annual report on Form 10-K for the year ended December 31, 2023.
NOTE 2 - SIGNIFICANT ACCOUNTING POLICIES
During the period covered in this report, there have been no material changes to the significant accounting policies we use and have explained, in our annual report on Form 10-K for the fiscal year ended December 31, 2023. The information below is intended only to supplement the disclosure in our annual report on Form 10-K for the fiscal year ended December 31, 2023.
REVENUES - Our revenues generally relate to net patient fees received from various payors and patients themselves under contracts in which our performance obligations are to provide diagnostic services to the patients. Revenues are recorded during the period when our obligations to provide diagnostic services are satisfied. Our performance obligations for diagnostic services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payor (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the fees for the services provided are dependent upon the terms provided by Medicare and Medicaid, or negotiated with managed care health plans and commercial insurance companies. The payment arrangements with third-party payors for the services we provide to the related patients typically specify payments at amounts less than our standard charges and generally provide for payments based upon predetermined rates per diagnostic services or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.
As it relates to the Group, this service fee revenue includes payments for both the professional medical interpretation revenue recognized by the Group as well as the payment for all other aspects related to our providing the imaging services, for which we earn management fees. As it relates to others centers, this service fee revenue is earned through providing the use of our diagnostic imaging equipment and the provision of technical services as well as providing administration services such as clerical and administrative personnel, bookkeeping and accounting services, billing and collection, provision of medical and office supplies, secretarial, reception and transcription services, maintenance of medical records, and advertising, marketing and promotional activities.
Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payors. Estimates of contractual allowances under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record self-pay revenues at the estimated amounts we expect to collect.
Under capitation arrangements with various health plans, we earn a per-enrollee amount each month for making available diagnostic imaging services to all plan enrollees under the capitation arrangement. Revenue under capitation arrangements is recognized in the period in which we are obligated to provide services to plan enrollees under contracts with various health plans.
9

Our total service revenues during the three months ended March 31, 2024 and 2023 are presented in the table below based on an allocation of the estimated transaction price with the patient between the primary patient classification of insurance coverage (in thousands):
 Three Months Ended
March 31,
20242023
Commercial insurance$240,628 $213,061 
Medicare93,525 84,970 
Medicaid10,887 9,959 
Workers' compensation/personal injury11,794 12,433 
Other patient revenue11,470 9,559 
Management fee revenue5,908 4,248 
Heart and lung3,921 1,813 
Other4,395 5,300 
Revenue under capitation arrangements34,518 38,144 
Imaging Center Segment Revenue417,046 379,487 
Digital Health Segment Revenue
14,661 11,077 
Total service revenue$431,707 $390,564 

ACCOUNTS RECEIVABLE - Substantially all of our accounts receivable are due under fee-for-service contracts from third party payors, such as insurance companies and government-sponsored healthcare programs, or directly from patients. Services are generally provided pursuant to one-year contracts with healthcare providers. We continuously monitor collections from our payors and maintain an allowance for bad debts based upon specific payor collection issues that we have identified and our historical experience.

We have entered into factoring agreements with various institutions and sold certain accounts receivable under non-recourse agreements in exchange for notes receivables from the buyers. These transactions are accounted for as a reduction in accounts receivable as the agreements transfer effective control over and risk related to the receivables to the buyers. Proceeds on notes receivables are reflected as operating activities on our statement of cash flows and on our balance sheet as prepaid expenses and other current assets for the current portion and deposits and other for the long term portion. Amounts remaining to be collected on these agreements were $12.1 million and $14.3 million at March 31, 2024 and December 31, 2023, respectively. We do not utilize factoring arrangements as an integral part of our financing for working capital and assess the party's ability to pay upfront at the inception of the notes receivable and subsequently by reviewing their financial statements annually and reassessing any insolvency risk on a periodic basis.
DEFERRED FINANCING COSTS - Costs of financing are deferred and amortized using the effective interest rate method and are related to our revolving credit facilities. Deferred financing costs, net of accumulated amortization, were $1.5 million and $1.6 million, as of March 31, 2024 and December 31, 2023, respectively. See Note 6, Credit Facilities and Notes Payable for more information.
PROPERTY AND EQUIPMENT - Property and equipment are stated at cost, less accumulated depreciation and amortization. Depreciation of property and equipment is performed using the straight-line method over the estimated useful lives of the assets acquired, which range from 3 to 15 years. Leasehold improvements are amortized at the lesser of lease term or their estimated useful lives, which range from 3 to 15 years. Maintenance and repairs are charged to expense as incurred.
BUSINESS COMBINATION - When the qualifications for business combination accounting treatment are met, it requires us to recognize separately from goodwill the assets acquired and the liabilities assumed at their acquisition date fair values. Goodwill as of the acquisition date is measured as the excess of consideration transferred over the net of the acquisition date fair values of the assets acquired and the liabilities assumed. While we use our best estimates and assumptions to accurately value assets acquired and liabilities assumed at the acquisition date, our estimates are inherently uncertain and subject to refinement. As a result, during the measurement period, which may be up to one year from the acquisition date, we record adjustments to the assets acquired and liabilities assumed with the corresponding offset to goodwill. Upon the conclusion of the measurement period or final determination of the values of assets acquired or liabilities assumed, whichever comes first, any subsequent adjustments are recorded to our consolidated statements of operations.
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GOODWILL - Goodwill at March 31, 2024 totaled $694.3 million. Goodwill is recorded as a result of business combinations. If we determine the carrying value of a reporting unit exceeds its fair value an impairment charge would be recognized and should not exceed the total amount of goodwill allocated to that reporting unit. We tested goodwill and indefinite lived intangibles for impairment on October 1, 2023, noting no impairment. Activity in goodwill for the three months ended March 31, 2024 is provided below (in thousands):
Imaging Center
Digital Health
Total
Balance as of December 31, 2023606,557 $72,906 $679,463 
Goodwill from acquisitions16,156  16,156 
Currency translation (1,327)(1,327)
Segment reorganization(12,300)12,300  
Balance as of March 31, 2024$610,413 $83,879 $694,292 
INTANGIBLE ASSETS - Intangible assets are primarily related to our business combinations and software development. They include the estimated fair values of such items as service agreements, customer lists, covenants not to compete, acquired technologies, and trade names. The components of intangible assets, both finite and indefinite, along with annual amortization expense that will be recorded over the next five years at March 31, 2024 and December 31, 2023 are as follows (in thousands):
As of March 31, 2024:

20242025202620272028ThereafterTotalWeighted average amortization period remaining in years
Management Service Contracts$1,715 $2,287 $2,287 $2,287 $2,287 $6,673 $17,536 7.7
Covenant not to compete and other contracts683 774 487 192 102 20 2,258 2.3
Customer Relationships918 1,093 971 794 757 10,470 15,003 17.6
Patent and Trademarks228 303 303 303 303 178 1,618 5.7
Developed Technology & Software5,651 7,534 7,494 6,960 6,960 6,551 41,150 6.4
Trade Names amortized58 77 77 77 63 27 379 5.0
Trade Names indefinite life— — — — — 7,100 7,100 — 
IPR&D— — — — — 1,839 1,839 — 
Total Annual Amortization$9,253 $12,068 $11,619 $10,613 $10,472 $32,858 $86,883 
*Excluding the three months ended March 31, 2024



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As of December 31, 2023:
20242025202620272028ThereafterTotalWeighted average amortization period remaining in years
Management Service Contracts$2,287 $2,287 $2,287 $2,287 $2,287 $6,671 $18,106 7.9
Covenant not to compete and other contracts946 714 427 132 45 6 2,270 3.4
Customer Relationships1,234 1,104 981 797 764 10,564 15,444 17.7
Patent and Trademarks316 316 316 315 300 164 1,727 5.8
Developed Technology & Software7,785 7,785 7,745 7,210 7,046 6,117 43,688 5.7
Trade Names amortized77 77 77 77 63 27 398 5.3
Trade Names indefinite life— — — — — 7,100 7,100 — 
IPR&D— — — — — 1,882 1,882 — 
Total Annual Amortization$12,645 $12,283 $11,833 $10,818 $10,505 $32,531 $90,615 
Total intangible asset amortization expense was $3.2 million and $3.0 million for the three months ended March 31, 2024 and March 31, 2023, respectively. Intangible assets are amortized using the straight-line method over their useful life determined at acquisition. Management service agreements are amortized over 25 years using the straight line method. Software development is capitalized and amortized over the useful life of the software when placed into service. Trade names are reviewed annually for impairment.
INCOME TAXES - Income tax expense is computed using an asset and liability method and using expected annual effective tax rates. Under this method, deferred income tax assets and liabilities result from temporary differences in the financial reporting bases and the income tax reporting bases of assets and liabilities. The measurement of deferred tax assets is reduced, if necessary, by the amount of any tax benefit that, based on available evidence, is not expected to be realized. When it appears more likely than not that deferred taxes will not be realized, a valuation allowance is recorded to reduce the deferred tax asset to its estimated realizable value. For net deferred tax assets we consider estimates of future taxable income in determining whether our net deferred tax assets are more likely than not to be realized.
In 2021, the Organization for Economic Co-operation and Development ("OECD") announced an inclusive framework on base erosion and profit shifting including Pillar Two Model Rules defining the global minimum tax, which calls for taxation of large multinational corporations at a minimum rate of 15%. Subsequently, multiple sets of administrative guidance have been issued. Many non-US tax jurisdictions have either recently enacted legislation to support certain components of Pillar Two Model Rules beginning 2024 (including the European Union Member States) with the adoption of additional components in later years or announced their plans to enact legislation in future years. The model rules provide a framework for applying the minimum tax, countries may enact Pillar Two Model Rules slightly differently than the model rules and on different timelines and may adjust domestic tax incentives in response to Pillar Two Model Rules. On a long-term basis, we will continue to evaluate the impacts of enacted legislation and pending legislation to enact Pillar Two Model Rules in all countries applicable to us. For 2024, we expect that we will meet one or more transactional safe harbor rules, and as such, we do not believe Pillar Two model will have an impact on our annual effective tax rate for the year ending December 31, 2024.
We recorded an income tax expense (benefit) of $(1.9) million, or an effective tax rate of (52.6)%, for the three months ended March 31, 2024 and $1.1 million, or an effective tax rate of (8.6)% for the three months ended March 31, 2023. The income tax rates for the three months ended March 31, 2024 diverge from the federal statutory rate due to (i) effects of state income taxes ; (ii) officer's compensation limitations; (iii) partial valuation allowance on losses in foreign jurisdictions, partially offset by (iv) excess tax benefits attributable to share based compensation; and (v) noncontrolling interests from controlled partnerships.
LEASES - We determine if an arrangement is a lease at inception. Operating leases are included in operating lease right-of-use (“ROU”) assets, current operating lease liabilities, and long term operating lease liability in our consolidated balance sheets. Finance leases are included in property and equipment, current finance lease liability, and long-term finance lease liability in our consolidated balance sheets.  ROU assets represent our right to use an underlying asset for the lease term and lease liabilities represent our obligation to make lease payments arising from the lease. Operating lease ROU assets and liabilities are recognized at commencement date based on the present value of lease payments over the lease term. As most of our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. We use the implicit rate when readily determinable. We include options to extend a lease when it is reasonably certain that we will exercise that option. Lease expense for lease payments is recognized on a straight-line basis over the lease term. For a contract in which we are a lessee that contains fixed
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payments for both lease and non-lease components, we have elected to account for the components as a single lease component. For finance leases, interest expense on the lease liability is recognized using the effective interest method and amortization of the ROU asset is recognized on a straight-line basis over the shorter of the estimated useful life of the asset or the lease term. ROU assets are tested for impairment if circumstances suggest that the carrying amount may not be recoverable. Our ROU assets consist of facility and equipment assets on operating leases. No events have occurred such as fire, flood, or other acts which have impaired the integrity of our ROU assets as of March 31, 2024. Our facility leases require us to maintain insurance policies which would cover major damage to our facilities. We maintain business interruption insurance to cover loss of business due to a facility becoming non-operational under certain circumstances. Our equipment leases are covered by warranty and service contracts which cover repairs and provide regular maintenance to keep the equipment in functioning order.
EQUITY BASED COMPENSATION – We have one long-term incentive plan that we adopted in 2006 and which we have amended and restated at various points in time: first on April 20, 2015, second on March 9, 2017, third on April 15, 2021 and currently as of April 27, 2023 (the “Restated Plan”). The Restated Plan was approved by our stockholders at our annual stockholders meeting on June 7, 2023. We have reserved 20,100,000 shares of common stock for issuance under the Restated Plan which can be issued in the form of incentive and/or nonstatutory stock options, restricted and/or unrestricted stock, stock units, and stock appreciation rights. Terms and conditions of awards can be direct grants or based on achieving a performance metric. We evaluate performance-based awards to determine if it is probable that the vesting conditions will be met. We also consider probability of achievement of performance conditions when determining expense recognition. For the awards where vesting is probable, equity-based compensation is recognized over the related vesting period. Stock options generally vest over three years to five years and expire five years to ten years from date of grant. We determine the compensation expense for each stock option award using the Black Scholes, or similar valuation model. Those models require that our management make certain estimates concerning risk free interest rates and volatility in the trading price of our common stock. The compensation expense recognized for all equity-based awards is recognized over the awards’ service periods. Equity-based compensation is classified in operating expenses within the same line item as the majority of the cash compensation paid to employees. In connection with our acquisition of DeepHealth Inc. on June 1, 2020, we assumed the DeepHealth, Inc. 2017 Equity Incentive Plan, including outstanding options awards that can be exercised for our common stock. No additional awards will be granted under the DeepHealth, Inc. 2017 Equity Incentive Plan. See Note 7, Stock-Based Compensation, for more information.
COMPREHENSIVE INCOME (LOSS) - Accounting guidance establishes rules for reporting and displaying other comprehensive income (loss) and its components. Our foreign currency translation adjustments and the amortization of balances associated with derivatives previously classified as cash flow hedges are included in other comprehensive income (loss). The components of other comprehensive income (loss) for the three months ended March 31, 2024 and March 31, 2023 are included in the consolidated statements of comprehensive income (loss).
COMMITMENTS AND CONTINGENCIES - We are party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. With respect to these matters, we evaluate the developments on a regular basis and accrue a liability when we believe a loss is probable and the amount can be reasonably estimated. Based on current information, we do not believe that reasonably possible or probable losses associated with pending legal proceedings would either individually or in the aggregate, have a material adverse effect on our business and consolidated financial statements. However, the outcome of these matters is inherently uncertain. Therefore, if one or more of these matters were resolved against us for amounts in excess of management's expectations, our results of operations and financial condition, including in a particular reporting period in which any such outcome becomes probable and estimable, could be materially adversely affected.
DERIVATIVE INSTRUMENTS - In the second quarter of 2019, we entered into four forward interest rate agreements ("2019 Swaps"). The 2019 Swaps have total notional amounts of $500.0 million, consisting of two agreements of $50.0 million each and two agreements of $200.0 million each. The 2019 Swaps will secure a constant interest rate associated with portions of our variable rate bank debt and have an effective date of October 13, 2020. They matured in October 2023 for the smaller notional and will mature in October 2025 for the larger notional. Under these arrangements, we arranged the 2019 Swaps with locked in 1 month Term SOFR rates at 1.89% for the $100.0 million notional and at 1.98% for the $400.0 million notional. As of the effective date, we are liable for premium payments if interest rates decline below arranged rates, but will receive interest payments if rates are above the arranged rates.
At inception, we designated our 2019 Swaps as cash flow hedges of floating-rate borrowings. In accordance with accounting guidance, derivatives that have been designated and qualify as cash flow hedging instruments are reported at fair value. The gain or loss on the effective portion of the hedge (i.e. change in fair value) is reported as a component of comprehensive gain or loss in the consolidated statement of equity. The remaining gain or loss, if any, is recognized currently in earnings. The cash flows for both our $400.0 million notional interest rate swap contract locked in at 1.98% due October 2025 and our $100.0 million notional interest rate swap contract locked in at 1.89% do not match the cash flows for our Term
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Loans (the “Barclays Term Loans”) under our Second Amended and Restated First Lien Credit and Guaranty Agreement with Barclays (the “Restated Credit Agreement”), and so we have determined that they are not currently effective as cash flow hedges. Accordingly, all changes in their fair value after April 1, 2020 for the $400.0 million notional and after July 1, 2020 for the $100.0 million notional are being recognized in earnings. As of July 1, 2020, the total change in fair value relating to swaps included in other comprehensive income was approximately $24.4 million, net of taxes. This amount was amortized to interest expense through October 2023 at approximately $0.4 million per month and continuing at approximately $0.3 million through October 2025.
A tabular presentation of the effect of derivative instruments on our consolidated statement of comprehensive income (loss) of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):
For the three months ended March 31, 2024
AccountDecember 31, 2023 BalanceAmount of comprehensive loss recognized on derivative net of taxesAmount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxesMarch 31, 2024 BalanceLocation
Accumulated Other Comprehensive Loss, net of taxes$(11,625)$$739$(10,886)Equity
A tabular presentation of the effect of derivative instruments on our statement of operations of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):

For the three months ended March 31, 2024
Ineffective interest rate swapAmount of gain recognized in income on derivative (current period ineffective portion)Location of loss recognized in Income on derivative (current period ineffective portion)Amount of loss reclassified from accumulated OCI into income (prior period effective portion)Location of loss reclassified from accumulated OCI into income (prior period effective portion)
Interest rate contracts$1,216 Other income (expense)$(739)Interest Expense

See Fair Value Measurements section below for the fair value of the 2019 Swaps at March 31, 2024.
CONTINGENT CONSIDERATION -
Heart and Lung Imaging Limited
On November 1, 2022, we completed our acquisition of 75% of the equity interests of Heart and Lung Imaging Limited. The purchase included up to $10.2 million in contingent milestone consideration and cash holdback of $0.6 million to be issued 24 months after acquisition subject to adjustment for any indemnification claims, which will be adjusted to fair value in subsequent periods. The milestone contingency had a value of approximately $4.2 million as of March 31, 2024. The contingent consideration is determined by the achievement of a specific number of physician reads. On September 20, 2023, we settled a milestone contingent liability by issuing 56,600 shares of our common stock at an ascribed value of $1.6 million and cash of $1.8 million. On December 12, 2023, we settled a milestone contingent liability by issuing 64,569 shares of our common stock at an ascribed value of $2.3 million and cash of $2.1 million. On March 27, 2024, we partially settled a milestone contingent liability by issuing 95,019 shares of our common stock at an ascribed value of $4.6 million. Subsequently on April 1, 2024, we settled the remaining milestone contingent liability in cash of $3.6 million.
A tabular rollforward of contingent consideration is as follows (amounts in thousands):
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For the three months ended March 31, 2024
EntityAccountDecember 31, 2023 BalanceSettlement of contingent considerationChange in valuation of Contingent ConsiderationCurrency TranslationMarch 31, 2024 Balance
Heart and Lung LimitedAccrued Expenses6,879 $(4,607)$1,060 $914 $4,246 

See Fair Value Measurements section below for the fair value of contingent consideration at March 31, 2024.
FAIR VALUE MEASUREMENTS – Assets and liabilities subject to fair value measurements are required to be disclosed within a fair value hierarchy. The fair value hierarchy ranks the quality and reliability of inputs used to determine fair value. Accordingly, assets and liabilities carried at, or permitted to be carried at, fair value are classified within the fair value hierarchy in one of the following categories based on the lowest level input that is significant to a fair value measurement:
Level 1—Fair value is determined by using unadjusted quoted prices that are available in active markets for identical assets and liabilities.
Level 2—Fair value is determined by using inputs other than Level 1 quoted prices that are directly or indirectly observable. Inputs can include quoted prices for similar assets and liabilities in active markets or quoted prices for identical assets and liabilities in inactive markets. Related inputs can also include those used in valuation or other pricing models such as interest rates and yield curves that can be corroborated by observable market data.
Level 3—Fair value is determined by using inputs that are unobservable and not corroborated by market data. Use of these inputs involves significant and subjective judgment.
Derivatives:
The tables below summarize the estimated fair values of certain of our financial assets that are subject to fair value measurements, and the classification of these assets on our condensed consolidated balance sheets, as follows (in thousands):
 As of March 31, 2024
Level 1Level 2Level 3Total
Current and long term assets    
2019 Swaps - Interest Rate Contracts$ $16,334 $ $16,334 
 As of December 31, 2023
Level 1Level 2Level 3Total
Current and long term assets    
2019 Swaps - Interest Rate Contracts$ $15,118 $ $15,118 
The estimated fair value of these contracts was determined using Level 2 inputs. More specifically, the fair value was determined by calculating the value of the difference between the fixed interest rate of the interest rate swaps and the counterparty’s forward SOFR curve. The forward SOFR curve is readily available in the public markets or can be derived from information available in the public markets.
Contingent Consideration:
The table below summarizes the estimated fair values of contingencies and holdback relating to our Heart and Lung Imaging Limited acquisition on November 1, 2022 that are subject to fair value measurements and the classification of these liabilities on our consolidated balance sheets, as follows (in thousands):
 As of March 31, 2024
Level 1Level 2Level 3Total
Accrued expenses:liabilities    
Heart and Lung Imaging Limited$ $ $4,246 $4,246 

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The estimated fair value of these liabilities was determined using Level 3 inputs. For Heart Lung Imaging Limited the contingent consideration is determined by the achievement of a specific number of physician reads. As significant inputs for the contingent consideration of Heart Lung Imaging Limited are not observable and cannot be corroborated by observable market data they are classified as Level 3.
Long Term Debt:
The table below summarizes the estimated fair value compared to our face value of our long-term debt as follows (in thousands):
 As of March 31, 2024
Level 1Level 2Level 3Total Fair ValueTotal Face Value
Barclays Term Loans and Truist Term Loan$ $822,884 $ $822,884 $821,187 
 As of December 31, 2023
Level 1Level 2Level 3Total Fair ValueTotal Face Value
Barclays Term Loans and Truist Term Loan$ $824,759 $ $824,759 $823,063 


The estimated fair value of our long-term debt, which is discussed in Note 6, Credit Facilities and Notes Payable, was determined using Level 2 inputs primarily related to comparable market prices.
We consider the carrying amounts of cash and cash equivalents, receivables, other current assets, current liabilities and other notes payables to approximate their fair value because of the relatively short period of time between the origination of these instruments and their expected realization or payment.
EARNINGS PER SHARE - Earnings per share is based upon the weighted average number of shares of common stock and common stock equivalents outstanding, net of common stock held in treasury, as follows (in thousands except share and per share data):
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 Three Months Ended March 31,
20242023
Net loss attributable to RadNet, Inc.'s common stockholders
$(2,779)$(21,005)
BASIC AND DILUTED NET LOSS PER SHARE ATTRIBUTABLE TO RADNET, INC.'S COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period69,307,078 57,701,439 
Basic and diluted net loss per share attributable to RadNet, Inc.'s common stockholders$(0.04)$(0.36)
Earnings per share disclosures:
Fair value change for contingently issuable shares excluded from the computation of diluted per share amounts as its effect would be antidilutive$ $769 
Stock options and non-vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Non-vested restricted stock subject to service vesting699,721 594,758 
Shares issuable upon the exercise of stock options863,792 750,075 
Weighted average shares for which the exercise price exceeds average market price of common stock 273,111 

INVESTMENTS IN EQUITY SECURITIES–Accounting guidance requires entities to measure equity investments at fair value, with any changes in fair value recognized in net income. If there is no readily determinable fair value, the guidance allows entities the ability to measure investments at cost, adjusted for observable price changes and impairments, with changes recognized in net income.
As of March 31, 2024, we have four equity investments for an aggregate of $9.2 million. No observable price changes or impairments in our investments were identified as of March 31, 2024.
INVESTMENT IN JOINT VENTURES – We have 13 unconsolidated joint ventures with ownership interests ranging from 35% to 55%. These joint ventures represent partnerships with hospitals, health systems or radiology practices and were formed for the purpose of owning and operating diagnostic imaging centers. Professional services at the joint venture diagnostic imaging centers are performed by contracted radiology practices or a radiology practice that participates in the joint venture. Our investment in these joint ventures is accounted for under the equity method, since RadNet does not have a controlling financial interest in such ventures. We evaluate our investment in joint ventures, including cost in excess of book value (equity method goodwill) for impairment whenever indicators of impairment exist. No indicators of impairment existed as of March 31, 2024.
Joint venture investment and financial information
The following table is a summary of our investment in joint ventures during the three months ended March 31, 2024 (in thousands):
Balance as of December 31, 2023$92,710 
Equity in earnings in these joint ventures4,324 
Distribution of earnings 
Balance as of March 31, 2024$97,034 
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We charged management service fees to the centers underlying these joint ventures of approximately $5.9 million and $4.2 million for the three months ended March 31, 2024 and 2023.
The following table is a summary of key balance sheet data for these joint ventures as of March 31, 2024 and December 31, 2023 and income statement data for the three months ended March 31, 2024 and 2023 (in thousands):
Balance Sheet Data:March 31, 2024December 31, 2023
Current assets$51,292 $39,819 
Noncurrent assets227,812 224,936 
Current liabilities(49,464)(46,587)
Noncurrent liabilities(74,075)(70,834)
Total net assets$155,565 $147,334 
Income statement data for the three months ended March 31,
20242023
Net revenue$61,208 $42,086 
Net income$5,810 $2,909 

 Formation of majority owned subsidiary and sale of economic interest
On February 23, 2024, we formed Tri Valley Imaging Group, LLC ("TVIG"), a partnership with Providence Health System - Southern California ("PHS"). The operation offers multi-modality services out of seven locations in Southern California. On March 29, 2024, we contributed the operations of four centers to the enterprise and PHS contributed a business comprising three centers included $0.5 million fixed assets, $0.1 million in equipment and $6.5 million in goodwill. Simultaneously, PHS purchased from us an additional economic interest in TVIG for cash payment of $9.6 million. As a result of the transaction, we recognized a gain of $7.6 million to additional paid in capital and retained a 52% controlling economic interest in TVIG and PHS retains and $7.8 million or 48% noncontrolling economic interest in TVIG.

Joint venture investment contribution
In determining the fair value of the imaging centers contributed to TVIG, we used an income approach which is considered a level 3 valuation technique. See Fair Value Measurements above for further detail on the valuation hierarchy. Key assumptions used in measuring the fair value are financial forecasts and a discount rate. We also utilized the cash paid for an additional interest in the joint venture to substantiate the fair value of the contributed assets.
NOTE 3 – RECENT ACCOUNTING AND REPORTING STANDARDS
Recently Issued Accounting Pronouncements

We monitor new accounting pronouncements issued by the Financial Accounting Standards Board ("FASB") and do not believe any accounting pronouncements issued through the date of this report will have a material impact on our financial statements.

NOTE 4 – BUSINESS COMBINATIONS AND RELATED ACTIVITY

Acquisitions

Imaging Center Segment
During the three months ended March 31, 2024, we completed the acquisition of certain assets of the following entities, which either engage directly in the practice of radiology or associated businesses. The primary reason for these acquisitions was to strengthen our presence in the California market. These acquisitions are reported as part of our Imaging Center segment. We made a preliminary fair value determination of the acquired assets and assumed liabilities and the following were recorded (in thousands):

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Entity Date AcquiredTotal ConsiderationProperty & EquipmentRight of Use AssetsGoodwillIntangible AssetsOther AssetsRight of Use Liabilities
Grossman Imaging Center of CMH, LLC*3/31/202410,5001,1786,4049,01625056(6,404)
Providence Health System - Southern California*3/31/2024$7,096 643 3,441 6,453   (3,441)
Antelope Valley Outpatient Imaging*2/1/2024$3,530 2,794 563 687 50  (563)
Total21,1264,61410,40816,15630056(10,408)
*The valuation of assets acquired and liabilities assumed has not yet been finalized as of March 31, 2024, fair value determination is preliminary and subject to change.

NOTE 5 – SEGMENT REPORTING

In the first quarter of 2024, we revised our reportable segments to combine our eRad business, which was included in the Imaging Center segment, with our AI segment to form a new Digital Health reportable segment. Prior period amounts were adjusted retrospectively to reflect the change in reportable segment.

Our reportable segments are described below:
Imaging Center
Our Imaging Center segment provides physicians with imaging capabilities to facilitate the diagnosis and treatment of diseases and disorders. Services include magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), nuclear medicine, mammography, ultrasound, diagnostic radiology (X-ray), fluoroscopy and other related procedures. The vast majority of our centers offer multi-modality imaging services, a strategy that diversifies revenue streams, reduces exposure to reimbursement changes and provides patients and referring physicians one location to serve the needs of multiple procedures.
Digital Health
Our Digital Health segment develops and deploys clinical applications to enhance interpretation of medical images and improve patient outcomes with an emphasis on brain, breast, prostate, and pulmonary diagnostics. Included in the segment is our eRad subsidiary, which designs the underlying critical scheduling, data storage and retrieval systems necessary for imaging center operation.
Our chief operating decision maker ("CODM"), who is also our CEO, evaluates the financial performance of our segments based upon their respective revenue and segmented internal profit and loss statements prepared on a basis not consistent with GAAP. We do not report balance sheet information by segment since it is not reviewed by our CODM.
In the normal course of business, our reportable segments enter into transactions with each other. While intersegment transactions are treated like third-party transactions to determine segment performance, the revenues recognized by a segment and expenses incurred by the counterparty are eliminated in consolidation and do not affect consolidated results.
Three Months Ended March 31, 2024
Imaging Centers
Digital Health
Intersegment EliminationConsolidated Total
Revenue:
Third Party$423,209 $8,498 $ $431,707 
Intersegment 6,163 (6,163) 
Total revenue$423,209 $14,661 $(6,163)$431,707 


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Three months ended March 31, 2023
Imaging CentersDigital HealthIntersegment EliminationConsolidated Total
Revenue:
Third Party$385,251 $5,313 $ $390,564 
Intersegment 5,764 (5,764) 
Total revenue$385,251 $11,077 $(5,764)$390,564 
The table below presents segment information reconciled to our financial results, with segment operating income or loss including revenue less cost of operations, depreciation and amortization, and other operating expenses to the extent specifically identified by segment (in thousands):
Three months ended March 31,
20242023
Revenue:
Imaging Centers$417,046 $379,487 
Digital Health14,661 11,077 
Total revenue$431,707 $390,564 
Cost of Operations
Imaging Centers$372,305 $340,151 
Digital Health15,284 11,714 
Total cost of operations$387,589 $351,865 
Depreciation and Amortization:
Imaging Centers$29,974 $29,448 
Digital Health2,394 1,867 
Total depreciation and amortization$32,368 $31,315 
(Gain) Loss on Disposal of Equipment:
Imaging Centers$188 $577 
Digital Health(2)2 
Total loss on disposal of equipment$186 $579 
Severance
Imaging Centers$225 $122 
Digital Health 12 
Total severance$225 $134 
 Income (Loss) from Operations
Imaging Centers$14,354 $9,189 
Digital Health(3,015)(2,518)
Total income from operations$11,339 $6,671 
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NOTE 6 – CREDIT FACILITIES AND NOTES PAYABLE
As of March 31, 2024 and December 31, 2023 our term loan debt and other obligations are as follows (in thousands):
March 31,
2024
December 31,
2023
Barclays Term Loans collateralized by RadNet's tangible and intangible assets$678,687 $678,687 
Discount on Barclays Term Loans(8,519)(9,041)
Truist Term Loan Agreement collateralized by NJIN's tangible and intangible assets142,500 144,375 
Discount on Truist Term Loan Agreement(924)(990)
Equipment notes payable at 6.0% to 6.7%, due through 2029, collateralized by medical equipment
22,900 17,011 
Total debt obligations834,644 830,042 
Less: current portion(20,202)(17,974)
Long term portion of debt obligations$814,442 $812,068 
We had no outstanding balance under our $195.0 million Barclays Revolving Credit Facility at March 31, 2024 and have reserved $7.6 million for certain letters of credit. The remaining $187.4 million of our Barclays Revolving Credit Facility was available to draw upon as of March 31, 2024. We also had no balance under our $50.0 million Truist Revolving Credit Facility related to our consolidated subsidiary NJIN at March 31, 2024, with no letters of credit reserved against the facility, the full amount was available to draw upon. At March 31, 2024, we were in compliance with all covenants under our credit facilities. On January 15, 2024 and February 1, 2023, we issued promissory notes in the amount of $6.9 million and $19.8 million, respectively, to acquire radiology equipment previously leased under operating leases.
Secured Credit Facilities
Barclays Term Loans:

Through March 31, 2023, the Barclays Term Loans bore interest at either a Eurodollar Rate or an Alternate Base Rate (in each case, as defined in the Restated Credit Agreement), plus an applicable margin. The applicable margin for Eurodollar Rate and Alternate Base Rate First Lien Term Loans under the Restated Credit Agreement was 3.00% and 2.00%, respectively, with an effective Eurodollar Rate and the Alternate Base Rate of 4.63% and 8.00%, respectively.

Effective March 31, 2023, the Barclays credit agreement was amended so that the term loan bears interest either at a SOFR or Alternative Base Rate (in each such case, as defined in the Barclays credit agreement) plus an applicable margin.The applicable margin for the SOFR and Alternate Base Rate is 3.00% and 2.00%, respectively. At March 31, 2024, we have an effective SOFR of 8.33%, with an applicable credit spread adjustment of 0.11448%, and an Alternate Base Rate of 10.5%, respectively.
The Barclays Restated Credit Agreement provides for quarterly payments of principal for the Barclays Term Loans in the amount of approximately $1.8 million. The Barclays Term Loans will mature on April 23, 2028 unless otherwise accelerated under the terms of the Barclays Restated Credit Agreement.

The Barclays credit agreement was amended after the period covered by this report. See Note 8, Subsequent Events, below.
Truist Term Loan:
The Truist Term Loan currently bears interest at a three month SOFR election of 5.33% plus an applicable margin and fees based on based a leverage ratio. At March 31, 2024 the applicable margin was 1.75%.
The scheduled amortization of the Truist Term Loan began March 31, 2023 with quarterly payments of $1.9 million, representing 1.00% of the original principal balance. At scheduled intervals, the quarterly amortization increases by $0.9 million, with the remaining balance to be paid at maturity. The Truist Term Loan will mature on October 10, 2027 unless otherwise accelerated under the terms of the Restated Credit and Term Loan Agreement.

Barclays Revolving Credit Facility
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The Barclays revolving credit facility is a $195.0 million senior secured revolving credit facility. At March 31, 2024, we had no borrowings under the Barclays revolving credit facility. Associated with the Barclays revolving credit facility is deferred financing costs, net of accumulated amortization, of $1.0 million at March 31, 2024.

Amounts borrowed under the Barclays revolving credit facility bear interest at either a SOFR or an Alternate Base Rate (in each case, as defined in the Barclays credit agreement) plus an applicable margin which adjusts depending on our first lien net leverage ratio. As of March 31, 2024, the effective interest rate payable on revolving loans under the Barclays revolving credit facility was 10.50%.

For letters of credit issued under the Barclays revolving credit facility, letter of credit fees accrue at the applicable margin for SOFR revolving loans which is currently 3.00% and fronting fees accrue at 0.125% per annum, in each case on the average aggregate daily maximum amount available to be drawn under all letters of credit issued under the Barclays credit agreement. In addition, a commitment fee of 0.50% per annum accrues on the unused revolver commitments under the Barclays revolving credit facility.

The Barclays credit agreement was amended after the period covered by this report. See Note 8, Subsequent Events, below.

Truist Revolving Credit Facility:

Associated with the Truist Revolving Credit Facility of $50.0 million are deferred financing costs, net of accumulated amortization, of $0.5 million at March 31, 2024. As of March 31, 2024, NJIN had no borrowings under the Truist Revolving Credit Facility.

Amounts borrowed under the Truist revolving credit facility bear interest at either a base rate plus an applicable margin which adjusts depending on our leverage ratio. The Truist Revolving Credit Facility bears interest with different margins based on types of borrowings and pricing level.

The Truist revolving credit facility terminates on October 7, 2027, unless otherwise accelerated under the terms of the Truist credit agreement.
NOTE 7 – STOCK-BASED COMPENSATION
Stock Incentive Plans
We have one long-term equity incentive plan, the RadNet, Inc. Equity Incentive Plan, which we first amended and restated April 20, 2015, second on March 9, 2017, third on April 15, 2021, and currently as of April 27, 2023 (the "Restated Plan”). The Restated Plan was most recently approved by our stockholders at our annual stockholders meeting on June 7, 2023. We have reserved for issuance under the Restated Plan 20,100,000 shares of common stock. We can issue options (incentive and nonstatutory), performance based options, stock awards (restricted or unrestricted), stock units, performance based stock units, and stock appreciation rights under the Restated Plan.
Options
Certain options granted under the Restated Plan to employees are intended to qualify as incentive stock options under existing tax regulations. Stock options generally vest over 3 to 5 years and expire 5 to 10 years from the date of grant.
The following summarizes all of our option transactions for the three months ended March 31, 2024:
Outstanding Options
Under the 2006 Plan
SharesWeighted Average
Exercise price
Per Common Share
Weighted Average
Remaining
Contractual Life
(in years)
Aggregate
Intrinsic
Value
Balance, December 31, 2023911,411 $16.60 
Granted  
Exercised(1,000)6.30 
Balance, March 31, 2024910,411 16.61 5.93$29,178,798 
Exercisable at March 31, 2024789,112 15.83 5.5325,907,138 
23

Aggregate intrinsic value in the table above represents the total pretax intrinsic value (the difference between our closing stock price on March 31, 2024 and the exercise price, multiplied by the number of in-the-money options as applicable) that would have been received by the holder had all holders exercised their options on March 31, 2024. As of March 31, 2024, total unrecognized stock-based compensation expense related to non-vested employee awards was $1.1 million, which is expected to be recognized over a weighted average period of approximately 0.88 years.
DeepHealth Options
During the second quarter of fiscal 2020, in connection with the completion of the DeepHealth acquisition, we granted options to acquire 412,434 shares at a grant date fair value of $16.93 per share unit to DeepHealth employees in replacement of their stock options that were outstanding as of the closing date. As of March 31, 2024, total unrecognized stock based compensation expense related to non-vested DeepHealth options was insignificant.
Outstanding Options
Under the Deep Health Plan
SharesWeighted Average
Exercise price
Per Common Share
Weighted Average
Remaining
Contractual Life
(in years)
Aggregate
Intrinsic
Value
Balance December 31, 202379,073 $ 
Exercised(4,393) 
Balance, March 31, 202474,680  5.5$3,633,929 
Exercisable at March 31, 202474,680  5.53,633,929 
Options issued in replacement of original DeepHealth options as a result of our acquisition are not included in the share count under the Restated Plan.
Restricted Stock Awards ("RSAs") and Restricted Stock Units ("RSUs")
The Restated Plan permits the award of RSAs and RSUs. The following summarizes all unvested RSA's and RSU's activities during the three months ended March 31, 2024:
 RSAs and RSUsWeighted-Average
Remaining
Contractual
Term (Years)
Weighted-Average
Fair Value per Share
RSAs and RSUs unvested at December 31, 2023762,083 $22.13 
Changes during the period
Granted762,561 $35.91 
Vested(824,374)$27.85 
Forfeited or Canceled(549)$20.00 
RSAs and RSUs unvested at March 31, 2024699,721 2.09$29.96 
We determine the fair value of all RSAs and RSUs based on the closing price of our common stock on the award date.
Performance based stock units ("PSUs")
In January 2023, we granted certain employees PSUs with a target award of 60,685 shares of our common stock. The PSUs will vest in two equal parts, starting three years from the grant date based on continuous service, with the number of shares earned (0% to 200% of the target award) depending upon the extent to which we achieve a performance condition as determined by the board of directors over the period from January 1, 2023 through December 31, 2023. In March of 2024, based on the performance condition achieved, the board of directors issued 121,370 units with a fair value of $18.64 per unit.
Performance based stock options ("PSOs")
In January 2023, we granted certain employees PSOs with a potential to option a maximum of 235,227 shares of our common stock. The PSOs will vest in three equal parts, starting three years from the grant date based on continuous service, with the number of shares earned (0 shares to 235,227 shares) depending upon the extent to which we achieve a performance condition as determined the board of directors over the period from January 1, 2023 through December 31, 2023. In March
24

2024, based on the performance condition achieved, the board of directors issued 235,227 options with a strike price of $18.64 per share.
Restated Plan summary
In summary, of the 20,100,000 shares of common stock reserved for issuance under the Restated Plan, at March 31, 2024, there remain approximately 3,323,670 shares available under the Restated Plan for future issuance.
NOTE 8 – SUBSEQUENT EVENTS
Houston Medical Imaging, LLC

On February 16, 2024, we entered into an agreement to acquire Houston Medical Imaging, LLC for a purchase consideration of approximately $29.0 million. Houston Medical Imaging consists of seven multi-modality imaging centers located in Houston, Texas. We expect to close the acquisition in the second quarter of 2024.
U.S. Imaging, Inc.
On February 26, 2024 we entered into an agreement to acquire U.S. Imaging, Inc. for a purchase consideration of approximately $4.2 million. U.S. Imaging, Inc consists of eight multi-modality imaging centers located in Texas. We expect to close the acquisition in the second quarter of 2024.
Refinancing of Barclays Credit Facilities:

On April 18, 2024, we entered into a Third Amended and Restated First Lien Credit and Guaranty Agreement (the “Third Restated Credit Agreement”), with Barclays Bank Plc and the lenders and financial institutions named therein, which provides for $875.0 million of senior secured term loans and a $282.0 million senior secured revolving credit facility. The proceeds of the loans are being used to refinance the outstanding $678.7 million of term loans outstanding under the prior credit facility along with accrued interest through the date of closing, to pay fees and expenses associated with the refinancing transaction.

The key terms of the Third Restated Credit Agreement are:

Interest Rates. The interest rate on the term loan is either, at our election, (i) Term SOFR plus 2.5% or (ii) the prime rate plus 1.5%. The interest rate on the revolving credit facility is either (i) Term SOFR plus 3% or (ii) the prime rate plus 2% (with step-downs based on attainment of certain first lien net leverage ratio benchmarks).

Maturity. The maturity date for the term loan is April 18, 2031 and the maturity date is April 18, 2029 for the revolving credit facility.

Payments. Under the Restated Credit Agreement, we are required to make quarterly payments of principal on the term loan in the amount of approximately $2.2 million.
ITEM 2.  Management’s Discussion and Analysis of Financial Condition and Results of Operations
You should read the following discussion and analysis of our financial condition and results of operations in conjunction with our unaudited condensed consolidated financial statements and notes thereto included in Part I, Item 1 of this Quarterly Report on Form 10-Q and with our audited consolidated financial statements and notes thereto for the year ended December 31, 2023 included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2023 filed with the U.S. Securities and Exchange Commission (SEC) on February 29, 2024.
Forward-Looking Statements
This report contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements reflect current views about future events and are based on our currently available financial, economic and competitive data and on current business plans. Actual events or results may differ materially depending on risks and uncertainties that may affect our operat