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Washington D.C. 20549

(Mark One)
For the quarterly period ended March 31, 2021
For the transition period from                      to                     
Commission File Number 001-33307
RadNet, Inc.
(Exact name of registrant as specified in charter)
(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
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 6, 2021 was 52,700,039 shares.

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ITEM 6.  Exhibits


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Item 1 – Financial Statements
March 31,
December 31,
   Cash and cash equivalents$31,091 $102,018 
   Accounts receivable146,665 129,585 
   Due from affiliates7,521 5,836 
   Prepaid expenses and other current assets37,720 32,985 
      Total current assets 222,997 270,424 
   Property and equipment, net412,711 399,335 
   Operating lease right-of-use assets529,563 483,661 
      Total property, equipment and right-of-use assets942,274 882,996 
   Goodwill502,566 472,879 
   Other intangible assets52,198 52,393 
   Deferred financing costs1,590 1,767 
   Investment in joint ventures36,813 34,528 
   Deferred tax assets, net of current portion31,554 34,687 
   Deposits and other38,794 36,983 
       Total assets$1,828,786 $1,786,657 
    Accounts payable, accrued expenses and other$231,700 $236,684 
    Due to affiliates18,133 14,010 
    Deferred revenue40,648 39,257 
    Current finance lease liability2,080 2,578 
    Current operating lease liability69,890 65,794 
    Current portion of notes payable40,166 39,791 
        Total current liabilities402,617 398,114 
    Long-term finance lease liability414 743 
    Long-term operating lease liability504,474 463,096 
    Notes payable, net of current portion602,684 612,913 
    Other non-current liabilities37,239 53,488 
        Total liabilities1,547,428 1,528,354 
Common stock - $0.0001 par value, 200,000,000 shares authorized; 52,340,856 and 51,640,537 shares issued and outstanding at March 31, 2021 and December 31, 2020, respectively
5 5 
    Additional paid-in-capital316,032 307,788 
    Accumulated other comprehensive loss(23,138)(24,051)
    Accumulated deficit(108,541)(117,999)
        Total RadNet, Inc.'s stockholders' equity184,358 165,743 
Noncontrolling interests97,000 92,560 
       Total equity281,358 258,303 
       Total liabilities and equity$1,828,786 $1,786,657 

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


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 Three Months Ended
March 31,
     Service fee revenue$279,577 $248,333 
     Revenue under capitation arrangements35,742 33,231 
Total service revenue315,319 281,564 
     Provider relief funding6,248  
     Cost of operations, excluding depreciation and amortization282,280 267,417 
     Depreciation and amortization22,656 21,934 
     (Gain) loss on sale and disposal of equipment and other(1,307)771 
     Severance costs285 218 
Total operating expenses303,914 290,340 
     Interest expense12,826 11,552 
     Equity in earnings of joint ventures(2,285)(1,955)
     Non-cash change in fair value of interest rate hedge(11,245) 
     Other expenses206 6 
Total other (income) expenses(498)9,603 
     (Provision for) benefit from income taxes(4,376)4,381 
NET INCOME (LOSS)13,775 (13,998)
     Net income attributable to noncontrolling interests4,317 2,360 
Basic51,951,506 50,294,329 
Diluted52,828,941 50,294,329 
The accompanying notes are an integral part of these financial statements.

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 Three Months Ended March 31,
NET INCOME (LOSS)$13,775 $(13,998)
     Foreign currency translation adjustments(12)1 
     Change in fair value of cash flow hedge, net of taxes (18,549)
     Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes925  
     Less comprehensive income attributable to noncontrolling interests4,317 2,360 
The accompanying notes are an integral part of these financial statements.


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The following table summarizes changes in the Company’s consolidated stockholders' equity, including noncontrolling interest, during the three months ended March 31, 2021 and March 31, 2020.
Common StockAdditional Paid-In
Accumulated Other
Income (Loss)
Radnet, Inc.'s
BALANCE - January 1, 202151,640,537 $5 $307,788 $(24,051)$(117,999)$165,743 $92,560 $258,303 
Issuance of common stock under the equity compensation plan699,825 — — — — — —  
Issuance of common stock under the DeepHealth equity compensation plan494 — — — — — —  
Stock-based compensation expense— — 8,248 — — 8,248 — 8,248 
Purchase of noncontrolling interests— — (4)— — (4)— (4)
Contribution from noncontrolling partner— — — — — — 123 123 
Change in cumulative foreign currency translation adjustment— — — (12)— (12)— (12)
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes— — — 925 — 925 — 925 
Net income— — — — 9,458 9,458 4,317 13,775 
BALANCE-MARCH 31, 202152,340,856 $5 $316,032 $(23,138)$(108,541)$184,358 $97,000 $281,358 
BALANCE - January 1, 202050,314,328 $5 $262,865 $(8,026)$(103,159)$151,685 $81,454 $233,139 
Issuance of common stock under the equity compensation plan380,047 — — — — — —  
Stock-based compensation expense— — 6,596 — — 6,596 — 6,596 
Change in cumulative foreign currency translation adjustment— — — 1 — 1 — 1 
Change in fair value cash flow hedge, net of taxes— — — (18,549)— (18,549)— (18,549)
Net (loss) income— — — — (16,358)(16,358)2,360 (13,998)
BALANCE-MARCH 31, 202050,694,375 $5 $269,461 $(26,574)$(119,517)$123,375 $83,814 $207,189 
The accompanying notes are an integral part of these financial statements.

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Three Months Ended March 31,
Net income (loss)$13,775 $(13,998)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization22,656 21,934 
Amortization of operating lease right-of-use assets17,863 17,259 
Equity in earnings of joint ventures, net of dividends(2,285)(1,955)
Amortization of deferred financing costs and loan discount1,147 1,081 
(Gain) loss on sale and disposal of equipment and other(1,307)771 
Amortization of cash flow hedge925  
Non-cash change in fair value of interest rate hedge(11,245) 
Stock-based compensation8,248 6,622 
Change in fair value of contingent consideration
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:
Accounts receivable(17,493)10,504 
Other current assets(4,308)5,164 
Other assets(3,507)677 
Deferred taxes3,133 (11,413)
Operating lease liability(18,291)(17,345)
Deferred revenue1,416 28 
Accounts payable, accrued expenses and other17,157 21,584 
Net cash provided by operating activities28,084 40,913 
Purchase of imaging facilities and other acquisitions(57,075)(4,300)
Purchase of property and equipment(30,424)(51,538)
Proceeds from sale of equipment151 779 
Net cash used in investing activities(87,348)(55,059)
Principal payments on notes and leases payable(827)(914)
Payments on term loan debt(10,824)(10,824)
Proceeds from revolving credit facility87,100 215,900 
Payments on revolving credit facility(87,100)(135,900)
Net cash (used in) provided by financing activities(11,651)68,262 
CASH AND CASH EQUIVALENTS, beginning of period102,018 40,165 
CASH AND CASH EQUIVALENTS, end of period$31,091 $94,282 
Cash paid during the period for interest$8,267 $9,934 
The accompanying notes are an integral part of these financial statements.

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Supplemental Schedule of Non-Cash Investing and Financing Activities
We acquired equipment and certain leasehold improvements for approximately $28.8 million and $30.8 million during the three months ended March 31, 2021 and 2020, respectively, which were not paid for as of March 31, 2021 and 2020, respectively. The offsetting amounts due were recorded in our condensed consolidated balance sheet under accounts payable, accrued expenses and other.
On January 1, 2021 we entered into the Simi Valley Imaging Group, LLC, partnership agreement with Simi Valley Hospital and Health Services ("Simi Adventist"). Of the total combined assets of $0.4 million, RadNet transferred $0.3 million and Simi Adventist contributed the remaining $0.1 million.


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We are a national provider of freestanding, fixed-site outpatient diagnostic imaging services with operations in seven U.S. states. At March 31, 2021, we operated, directly or indirectly through joint ventures with hospitals, 346 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 the convenience of a single location to serve the needs of multiple procedures. In addition to our imaging services, we design and develop software applications, artificial intelligence tools and other computerized systems for the diagnostic imaging industry. Our operations comprise a single segment for financial reporting purposes.

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 consist of professional corporations which are owned or controlled by individuals within our senior management, namely Howard G. Berger, M.D., our President and Chief Executive Officer, and John V. Crues, III, M.D., RadNet's Medical Director, both of whom are members of our Board of Directors. Dr. Berger owns, indirectly, 99% of the equity interests in Beverly Radiology Medical Group III (BRMG) and a controlling interest in two professional corporations in New York City. BRMG is responsible for the professional medical services at nearly all of our facilities located in California. Dr. Crues owns six professional corporations which provide medical services in Delaware, Maryland, New Jersey and New York. Additionally, Dr. Crues is a 1% owner of BRMG. 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. Through management agreements with us, 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 Group on a combined basis recognized $46.1 million and $39.6 million of revenue, net of management services fees to RadNet, for the three months ended March 31, 2021 and 2020, respectively and $46.1 million and $39.6 million of operating expenses for the three months ended March 31, 2021 and 2020, respectively. RadNet recognized $179.0 million and $147.9 million of total billed net service fee revenue for the three months ended March 31, 2021, and 2020, 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, 2021 and December 31, 2020, we have included approximately $89.9 million and $82.3 million, respectively, of

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accounts receivable and approximately $20.5 million and $15.2 million of accounts payable and accrued liabilities related to the Group, respectively.

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 their behalf. However, we may be required to provide financial support to cover any operating expenses in excess of operating revenues.

We also own a 49% economic interest in ScriptSender, LLC, which provides secure data transmission services of medical information. Through a management agreement, RadNet provides management and accounting services and receives an agreed upon fee. ScriptSender, LLC is dependent on RadNet to finance its own activities, and as such we determined that it is a VIE but we are not a primary beneficiary since we do not have the power to direct the activities of the entity that most significantly impact the entity’s economic performance.

At all of our centers not serviced by the Group we have entered into long-term contracts (typically up to 40 years) with independent radiology groups to provide physician services at those centers. These radiology practices provide professional services, including supervision and interpretation of diagnostic imaging procedures, in our diagnostic imaging centers. The radiology practices maintain full control over the provision of professional services. Under these arrangements, in addition to obtaining technical fees for the use of our diagnostic imaging equipment and the provision of technical services, we provide management services and receive a fee based on the value of the services we provide. We own the diagnostic imaging equipment and, therefore, receive 100% of the technical reimbursements associated with imaging procedures. The radiology practice groups retain the professional reimbursements associated with imaging procedures after deducting management service fees paid to us and we have no economic controlling interest in these radiology practices as such, the financial results of these practices 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, 2021 and 2020 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, 2020.
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, 2020. 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, 2020.
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 transaction prices 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 third-party payors. 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 them 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

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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.
Our total service revenues during the three months ended March 31, 2021 and 2020 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,
Commercial insurance$182,096 $155,461 
Medicare63,589 57,749 
Medicaid8,451 6,628 
Workers' compensation/personal injury10,399 10,274 
Other patient revenue4,775 5,662 
Management fee revenue5,219 2,567 
Teleradiology and Software revenue2,426 3,770 
Other2,622 6,222 
Service fee revenue279,577 248,333 
Revenue under capitation arrangements35,742 33,231 
Total service revenue$315,319 $281,564 

COVID-19 PANDEMIC AND CARES ACT FUNDING - On March 11, 2020 the World Health Organization (WHO) designated COVID-19 as a global pandemic. To aid businesses and stimulate the national economy, Congress passed the The Coronavirus Aid, Relief, and Economic Security ("CARES") Act, which was signed in to law on March 27, 2020.

Through March 31, 2021, we have received since inception of the various programs established by the CARES Act, $39.5 million of accelerated Medicare payments, $32.5 million from general distribution and $4.0 million from the Paycheck Protection Program. In addition, we have received $5.0 million in advance payments from insurer Blue Shield.

The accelerated Medicare and Blue Shield payments are recorded to Deferred Revenue in our condensed consolidated balance sheet and will be applied to revenue as services are performed beginning in 2021. For the three months ended March 31, 2021, $2.5 million of the accelerated Medicare and $2.5 million of the Blue Shield funds have been applied to revenue.

The amounts obtained from general distribution were accounted for as government grants and recognized as other revenue and displayed as Provider relief funding in our condensed consolidated statements of operations, of which $6.2 million of the total $32.5 million was received in the three months ended March 31, 2021.

The $4.0 million secured from the Paycheck Protection Program was accounted for as debt and in December 2020 we met the eligibility requirements under the government guidelines for forgiveness and the loans were written off to gain on extinguishment of debt.

The CARES Act also provides for a payment deferral of the employer portion of Social Security tax incurred during the pandemic, allowing half of such payroll taxes to be deferred until December 2021 and the remaining half until December 2022. At March 31, 2021, the Company had in total $16.3 million of deferred Social Security taxes. These payment deferrals

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are recorded as payroll tax liability under the caption “Accounts payable, accrued expenses and other” in our condensed consolidated balance sheet.
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. At March 31, 2021 we have $20.5 million remaining to be collected on these agreements. 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. Deferred financing costs, net of accumulated amortization, were $1.6 million and $1.8 million, as of March 31, 2021 and December 31, 2020, respectively and related to our Barclays Revolving Credit Facility. See Note 5, 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.
GOODWILL AND INDEFINITE LIVED INTANGIBLES - Goodwill at March 31, 2021 totaled $502.6 million. Indefinite lived intangible assets at March 31, 2021 were $7.1 million. Goodwill and Indefinite Lived Intangibles are recorded as a result of business combinations. When we determine the carrying value of 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, 2020, noting no impairment. In addition to the annual impairment test, we regularly assess if an event has occurred which would require interim impairment testing. We considered the current and expected future economic and market conditions surrounding COVID-19 pandemic and did not identify an indication of goodwill impairment being more likely than not through March 31, 2021. Activity in goodwill for the three months ended March 31, 2021 is provided below (in thousands):
Balance as of December 31, 2020$472,879 
Goodwill acquired through acquisitions29,609 
Goodwill attributable to formation of Simi Valley Imaging Group LLC105 
Other Adjustments(27)
Balance as of March 31, 2021$502,566 
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

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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.
We recorded income tax expense of $4.4 million, or an effective tax rate of 24.1%, for the three months ended March 31, 2021 compared to a benefit from income taxes of $4.4 million, or an effective tax rate of 23.8% for the three months ended March 31, 2020. The income tax rates for the three months ended March 31, 2021 diverge from the federal statutory rate due to (i) noncontrolling interests due to the controlled partnerships; (ii) effects of state income taxes; and (iii) excess tax benefits attributable to share-based compensation.
We believe no significant changes in the unrecognized tax benefits will occur within the next 12 months.
On March 27, 2020, the President of the United States signed into law the CARES Act, which among other things, includes certain income tax provisions for individuals and corporations; however, these benefits do not impact the Company’s current tax provision.
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 payments for both lease and non-lease components, we have elected to account for the components as a single lease component, as permitted. 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, 2021. 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 first amended and restated as of April 20, 2015, and again on March 9, 2017 (the “Restated Plan”). The Restated Plan was approved by our stockholders at our annual stockholders meeting on June 8, 2017. We have reserved 14,000,000 shares of common stock for issuance under the Restated Plan which can be issued in the form of options, stock awards, stock appreciation rights, stock units, and cash awards. Stock options generally vest over three to five years and expire five 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 Stock 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 6, Stock-Based Compensation, for more information.
COMPREHENSIVE INCOME (LOSS) - ASC 220 establishes rules for reporting and displaying comprehensive income or loss and its components. Our unrealized gains or losses on foreign currency translation adjustments, interest rate cap and swap agreements are included in comprehensive loss and are included in the consolidated statements of comprehensive income (loss) for the three months ended March 31, 2021 and 2020.
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

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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.

2019 SWAPS
In the second quarter of 2019, we entered into four forward interest rate agreements ("2019 Swaps"). The 2019 Swaps have total notional amounts of $500,000,000, consisting of two agreements of $50,000,000 each and two agreements of $200,000,000 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 will mature in October 2023 for the smaller notional and October 2025 for the larger notional. Under these arrangements, we arranged the 2019 Swaps with locked in 1 month LIBOR rates at 1.96% for the $100,000,000 notional and at 2.05% for the $400,000,000 notional. As of the effective date, we will be liable for premium payments if interest rates decline below arranged rates, but will receive interest payments if rates remain 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 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 $400,000,000 notional interest rate swap contract locked in at 2.05% due October 2025 and our $100,000,000 notional interest rate swap contract locked in at 1.96% do not match the cash flows for our First Lien Term Loans 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 $400,000,000 notional and after July 1, 2020 for the $100,000,000 notional will be 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 will be amortized to interest expense through October 2023 at approximately $0.4 million per month and continuing at approximately $0.3 million through October 2025.
A tabular presentation of the effect of derivative instruments on our consolidated statement of comprehensive loss of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):
For the three months ended March 31, 2021
AccountJanuary 1, 2021 BalanceAmount of comprehensive loss recognized on derivative net of taxesAmount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxesMarch 31, 2021 BalanceLocation
Accumulated Other Comprehensive Loss, net of taxes$(22,581)$ $925 $(21,656)Equity

For the twelve months ended December 31, 2020
AccountJanuary 1, 2020 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 taxesDecember 31, 2020Location
Accumulated Other Comprehensive Loss, net of taxes$(5,870)$(19,352)$2,641 $(22,581)Equity

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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, 2021
Ineffective interest rate swapAmount of gain recognized in income on derivative (current period ineffective portion)Location of gain 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$11,245 Other income (expense)$(925)Interest Expense

See Fair Value Measurements section below for the fair value of the 2019 Swaps at March 31, 2021.
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.
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, 2021
Level 1Level 2Level 3Total
Current and long term liabilities    
2019 Swaps - Interest Rate Contracts$ $26,744 $ $26,744 
 As of December 31, 2020
Level 1Level 2Level 3Total
Current and long term liabilities    
2019 Swaps - Interest Rate Contracts$ $37,989 $ $37,989 
The estimated fair value of these contracts was determined using Level 2 inputs. More specifically, the fair value was determined by calculating the value of the difference between the fixed interest rate of the interest rate swaps and the counterparty’s forward LIBOR curve. The forward LIBOR curve is readily available in the public markets or can be derived from information available in the public markets.
Long Term Debt:
The table below summarizes the estimated fair value compared to our face value of our long-term debt as follows (in thousands):
 As of March 31, 2021
Level 1Level 2Level 3Total Fair ValueTotal Face Value
First Lien Term Loans and SunTrust Term Loan$ $652,331 $ $652,331 $651,580 

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 As of December 31, 2020
Level 1Level 2Level 3Total Fair ValueTotal Face Value
First Lien Term Loans and SunTrust Term Loan$ $661,640 $ $661,640 $662,403 
As of March 31, 2021 and at December 31, 2020 our Barclays revolving credit facility had no balance outstanding. Our SunTrust revolving credit facility relating to our consolidated subsidiary The New Jersey Imaging Network ("NJIN"), had no principal amount outstanding at March 31, 2021 and at December 31, 2020.
The estimated fair value of our long-term debt, which is discussed in Note 5, 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. Additionally, we consider the carrying amount of our finance lease obligations to approximate their fair value because the weighted average interest rate used to formulate the carrying amounts approximates current market rates.
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):
 Three Months Ended March 31,
Net income (loss) attributable to RadNet, Inc.'s common stockholders$9,458 $(16,358)
Weighted average number of common shares outstanding during the period51,951,506 50,294,329 
Basic net income (loss) per share attributable to RadNet, Inc.'s common stockholders$0.18 $(0.33)
Weighted average number of common shares outstanding during the period51,951,506 50,294,329 
Add nonvested restricted stock subject only to service vesting253,265  
Add additional shares issuable upon exercise of stock options and warrants624,170  
Weighted average number of common shares used in calculating diluted net income per share52,828,941 50,294,329 
Diluted net income (loss) per share attributable to RadNet, Inc.'s common stockholders$0.18 $(0.33)
Stock options and non vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Nonvested restricted stock subject to service vesting 314,962 
Shares issuable upon the exercise of stock options:82,595 527,899 


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EQUITY INVESTMENTS AT FAIR VALUE–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, 2021, we have three equity investments for which a fair value is not readily determinable and therefore the total amounts invested are recognized at cost as follows:
Medic Vision Imaging Solutions Ltd., based in Israel, specializes in software packages that provide compliant radiation dose structured reporting and enhanced images from reduced dose CT scans. Our investment of $1.2 million represents a 14.21% equity interest in the company. No observable price changes or impairment in our investment was identified as of March 31, 2021.
Turner Imaging Systems, based in Utah, develops and markets portable X-ray imaging systems that provide a user the ability to acquire X-ray images wherever and whenever they are needed. On February 1, 2018, we purchased 2.1 million preferred shares in Turner Imaging Systems for $2.0 million. On January 1, 2019 we funded a convertible promissory note in the amount of $0.1 million that converted to additional 80,000 shares December 21, 2019. No observable price changes or impairment in our investment was identified as of March 31, 2021.

WhiteRabbit.ai Inc., based in California, is currently developing an artificial intelligence suite which aims to improve the speed and accuracy of cancer detection in radiology and improve patient care. On November 5, 2019 we acquired an equity interest in the company for $1.0 million and also loaned the company $2.5 million in support of its operations. No observable price changes, impairment in our investment or impairment of the loan receivable was identified as of March 31, 2021.
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, 2021.

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, 2021 (in thousands):
Balance as of December 31, 2020$34,528 
Equity in earnings in these joint ventures2,285 
Balance as of March 31, 2021$36,813 
We charged management service fees from the centers underlying these joint ventures of approximately $5.2 million and $2.6 million for the three months ended March 31, 2021 and 2020, respectively.

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The following table is a summary of key balance sheet data for these joint ventures as of March 31, 2021 and December 31, 2020 and income statement data for the three months ended March 31, 2021 and 2020 (in thousands):
Balance Sheet Data:March 31, 2021December 31, 2020
Current assets$33,265 $27,085 
Noncurrent assets68,493 68,686 
Current liabilities(13,929)(12,545)
Noncurrent liabilities(21,371)(21,582)
Total net assets$66,458 $61,644 
Book value of RadNet joint venture interests$30,351 $28,079 
Cost in excess of book value of acquired joint venture interests and other6,462 6,449 
Total value of RadNet joint venture interests$36,813 $34,528 
Income statement data for the three months ended March 31,20212020
Net revenue$31,718 $26,341 
Net income$4,803 $4,245 

Accounting standards adopted

In January 2021, the FASB issued ASU 2021-01 ("ASU 2021-01"), Reference Rate Reform (Topic 848), Scope. ASU 2021-01 provides clarifies the scope of Topic 848 so that derivatives affected by the discounting transition are explicitly eligible for certain option expedients and exceptions in Topic 848. The guidance is effective upon issuance and generally can be applied through December 31, 2022. We are currently evaluating the potential impact of ASU 2021-01 on our financial statements.

In March 2020, the FASB issued ASU 2020-04 ("ASU 2020-04"), Reference Rate Reform (Topic 848), Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU 2020-04 provides optional expedients and exceptions for applying generally accepted accounting principles to certain contract modifications and hedging relationships that reference London Inter-bank Offered Rate (LIBOR) or another reference rate expected to be discontinued. The guidance is effective upon issuance and generally can be applied through December 31, 2022. We are currently evaluating the potential impact of ASU 2020-04 on our financial statements.

In January 2020, the FASB issued ASU 2020-01 ("ASU 2020-01"), Investments—Equity Securities (Topic 321), Investments—Equity Method and Joint Ventures (Topic 323), and Derivatives and Hedging (Topic 815), clarifying the interaction between accounting standards related to equity securities, equity method investments, and certain derivatives. ASU 2020-01 is effective for fiscal years beginning after December 15, 2020. The adoption did not have a material impact on our financial statements.

In December 2019, the FASB issued ASU 2019-12 ("ASU 2019-12"), Income Taxes (Topic 740). ASU 2019-12 removes certain exceptions related to the approach for intraperiod tax allocation, the methodology for calculating income taxes in an interim period, and the recognition of deferred tax liabilities for outside basis differences. It also clarifies and simplifies other areas of the standard. ASU 2019-12 is effective beginning in the first quarter of 2021. The adoption did not have a material impact on our financial statements.



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During the first quarter of 2021, we completed the acquisition of certain assets of the following entities, all located in the New York city area. We made a preliminary fair value determination of the acquired assets and assumed liabilities and the following were recorded (in thousands):

Entity AcquiredTotal Purchase ConsiderationProperty & EquipmentRight of Use AssetsGoodwillIntangible AssetsOther AssetsRight of Use Liabilities
Personal Health Imaging PLLC$2,995 $576 $608 $2,355 $50 $14 $(608)
ZP Elmont LLC2,1941,1121,6951,0055027(1,695)
ZP Freeport LLC6,0653,9682,3612,0185029(2,361)
Broadway Medical Imaging LLC1,1551,0761,79165023(1,791)
3235 Hempstead LLC9,3864,30410,1155,03250(10,115)
SLZM Realty LLC13,6713,8627,7159,75950(7,715)
2012 Sunrise Merrick LLC11,4282,3635,9199,01550(5,919)
ZP Bayside LLC3,5453,3859,393405070(9,393)
ZP Laurelton LLC2,6582,5305,157325046(5,157)
ZP Smith LLC3,9783,58110,55834750(10,558)
Total$57,075 $26,757 $55,312 $29,609 $500 $209 $(55,312)
Formation of majority owned subsidiary
On January 1, 2021 we entered into the Simi Valley Imaging Group, LLC, a partnership with Simi Valley Hospital and Health Services ("Simi Adventist"). The operation will offer multi-modality imaging services out of two locations in Ventura County, California. Total investment in the venture is $0.4 million. RadNet contributed $0.3 million in assets for a 60% economic interest and Simi Adventist contributed assets totaling $0.1 million for a 40% economic interest.
As of March 31, 2021 and December 31, 2020 our debt obligations consisted of the following (in thousands):
March 31,
December 31,
First Lien Term Loans collateralized by RadNet's tangible and intangible assets$601,330 $611,028 
Discounts on First Lien Term Loans(8,730)(9,699)
SunTrust Term Loan Agreement collateralized by NJIN's tangible and intangible assets50,250 51,375 
Total debt obligations642,850 652,704 
Less: current portion(40,166)(39,791)
Long term portion debt obligations$602,684 $612,913 

Included in our condensed consolidated balance sheets at March 31, 2021 are $601.3 million of First Lien Term Loans and $50.3 million of SunTrust Term Loan debt for a combined total of $651.6 million of total term loan debt (exclusive of unamortized discounts of $8.7 million) in thousands:

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 Face ValueDiscountTotal Carrying
First Lien Term Loans$601,330 $(8,730)$592,600 
SunTrust Term Loan50,250  50,250 
Total Term Loans$651,580 $(8,730)$642,850 
We had no outstanding balance under our $195.0 million Barclays Revolving Credit Facility at March 31, 2021 and have reserved $7.9 million for certain letters of credit. The remaining $187.1 million of our Barclays Revolving Credit Facility was available to draw upon as of March 31, 2021. We had no outstanding balance under our $30.0 million SunTrust Revolving Credit Facility at March 31, 2021. As of March 31, 2021, we were in compliance with all covenants under our credit facilities.
Senior Secured Credit Facilities
Barclays Credit Facilities:
At March 31, 2021, our Barclays credit facilities were comprised of one tranche of term loans (“First Lien Term Loans”) in the principal amount described in the table above and a revolving credit facility of $195.0 million (the “Barclays Revolving Credit Facility”) both of which are provided pursuant to the Amended and Restated First Lien Credit and Guaranty Agreement dated July 1, 2016, among RadNet, Barclays Bank plc, as administrative agent, and the lenders identified therein (as amended, the "First Lien Credit Agreement"). Deferred financing costs at March 31, 2021, net of accumulated amortization, was $1.6 million and is specifically related to our Barclays Revolving Credit Facility.

Our First Lien Term Loans bear interest at either an Adjusted Eurodollar Rate or a Base Rate, plus an applicable margin according to the following schedule:
First Lien Leverage RatioEurodollar Rate SpreadBase Rate Spread
> 5.50x
> 4.00x but ≤ 5.50x
>3.50x but ≤ 4.00x

At March 31, 2021 the effective Adjusted Eurodollar Rate and the Base Rate for the First Lien Term Loans was 1.00% and 3.25%, respectively and the applicable margin for Adjusted Eurodollar Rate and Base Rate borrowings was 3.50% and 2.50%, respectively.

The First Lien Credit Agreement provides for quarterly payments of principal under the First Lien Term Loans in the amount of approximately $9.7 million. The First Lien Term Loans will mature on July 1, 2023 unless otherwise accelerated under the terms of the First Lien Credit Agreement.
SunTrust Credit Facilities:
At March 31, 2021, our SunTrust credit facilities, which relate to our consolidated subsidiary NJIN, were comprised of one term loan in the principal amount described in the table above (the "SunTrust Term Loan") and a revolving credit facility of $30.0 million (the "SunTrust Revolving Credit Facility") both of which are provided pursuant to the Amended and Restated Revolving Credit and Term Loan Agreement dated August 31, 2018, among NJIN, as borrower, with SunTrust Bank, as administrative agent, and the lenders identified therein (as amended, the "SunTrust Credit Agreement"). Our SunTrust Term Loan bears interest at either an Adjusted LIBOR or a Base Rate (each as defined in the SunTrust Credit Agreement), plus an applicable margin according to the following schedule:


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Pricing LevelLeverage RatioApplicable Margin for Eurodollar LoansApplicable Margin for Base Rate LoansApplicable Margin for Letter of Credit FeesApplicable Percentage for Commitment Fee
Greater than or equal to 3.00:1.00
per annum
per annum
per annum
per annum
Less than 3.00:1.00 but greater than or equal to 2.50:1.00
per annum
per annum
per annum
per annum
Less than 2.50:1.00 but greater than or equal to
per annum
per annum
per annum
per annum
Less than 2.00:1.00 but greater than or equal to 1.50:1.00
per annum
per annum
per annum
per annum
Less than 1.50:1.00
per annum
per annum
per annum
per annum

The loans and other obligations outstanding under the SunTrust Credit Agreement currently bear interest at a three month LIBOR election at