Table of Contents
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 September 30, 2020March 31, 2021
ORor
     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 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 and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted 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. (Check one)
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
Securities registered pursuant to Section 12(b) of the Act:
Class TitleTrading SymbolRegistered Exchange
Common StockRDNTNASDAQ
The number of shares of the registrant’s common stock outstanding on November 5, 2020May 6, 2021 was 51,636,09952,700,039 shares.


Table of Contents
RADNET, INC.
TABLE OF CONTENTS
Page

ITEM 6.  Exhibits

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Table of Contents
PART I - FINANCIAL INFORMATION
Item 1 – Financial Statements
RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(IN THOUSANDS EXCEPT SHARE AND PER SHARE DATA)
September 30,
2020
December 31,
2019
March 31,
2021
December 31,
2020
(unaudited) (unaudited) 
ASSETSASSETS  ASSETS  
CURRENT ASSETSCURRENT ASSETS  CURRENT ASSETS  
Cash and cash equivalents Cash and cash equivalents$89,739 $40,165  Cash and cash equivalents$31,091 $102,018 
Accounts receivable Accounts receivable137,411 154,763  Accounts receivable146,665 129,585 
Due from affiliates Due from affiliates424 1,242  Due from affiliates7,521 5,836 
Prepaid expenses and other current assets Prepaid expenses and other current assets31,482 45,004  Prepaid expenses and other current assets37,720 32,985 
Total current assets Total current assets259,056 241,174  Total current assets222,997 270,424 
PROPERTY, EQUIPMENT AND RIGHT-OF-USE ASSETSPROPERTY, EQUIPMENT AND RIGHT-OF-USE ASSETSPROPERTY, EQUIPMENT AND RIGHT-OF-USE ASSETS
Property and equipment, net Property and equipment, net361,950 367,795  Property and equipment, net412,711 399,335 
Operating lease right-of-use assets Operating lease right-of-use assets451,613 445,477  Operating lease right-of-use assets529,563 483,661 
Total property, equipment and right-of-use assets Total property, equipment and right-of-use assets813,563 813,272  Total property, equipment and right-of-use assets942,274 882,996 
OTHER ASSETSOTHER ASSETSOTHER ASSETS
Goodwill Goodwill470,685 441,973  Goodwill502,566 472,879 
Other intangible assets Other intangible assets57,152 42,994  Other intangible assets52,198 52,393 
Deferred financing costs Deferred financing costs1,944 1,559  Deferred financing costs1,590 1,767 
Investment in joint ventures Investment in joint ventures35,571 34,470  Investment in joint ventures36,813 34,528 
Deferred tax assets, net of current portion Deferred tax assets, net of current portion42,188 34,548  Deferred tax assets, net of current portion31,554 34,687 
Deposits and other Deposits and other37,707 36,996  Deposits and other38,794 36,983 
Total assets Total assets$1,717,866 $1,646,986  Total assets$1,828,786 $1,786,657 
LIABILITIES AND EQUITYLIABILITIES AND EQUITYLIABILITIES AND EQUITY
CURRENT LIABILITIESCURRENT LIABILITIESCURRENT LIABILITIES
Accounts payable, accrued expenses and other Accounts payable, accrued expenses and other$205,701 $207,585  Accounts payable, accrued expenses and other$231,700 $236,684 
Due to affiliates Due to affiliates12,287 14,347  Due to affiliates18,133 14,010 
Deferred revenue Deferred revenue45,846 1,316  Deferred revenue40,648 39,257 
Current finance lease liability Current finance lease liability3,041 3,283  Current finance lease liability2,080 2,578 
Current operating lease liability Current operating lease liability67,449 61,206  Current operating lease liability69,890 65,794 
Current portion of notes payable Current portion of notes payable39,463 39,691  Current portion of notes payable40,166 39,791 
Total current liabilities Total current liabilities373,787 327,428  Total current liabilities402,617 398,114 
LONG-TERM LIABILITIESLONG-TERM LIABILITIESLONG-TERM LIABILITIES
Long-term finance lease liability Long-term finance lease liability1,108 3,264  Long-term finance lease liability414 743 
Long-term operating lease liability Long-term operating lease liability428,233 420,922  Long-term operating lease liability504,474 463,096 
Notes payable, net of current portion Notes payable, net of current portion627,179 652,704  Notes payable, net of current portion602,684 612,913 
Other non-current liabilities Other non-current liabilities41,438 9,529  Other non-current liabilities37,239 53,488 
Total liabilities Total liabilities1,471,745 1,413,847  Total liabilities1,547,428 1,528,354 
EQUITYEQUITYEQUITY
Common stock - $0.0001 par value, 200,000,000 shares authorized; 51,596,098 and 50,314,328 shares issued and outstanding at September 30, 2020 and December 31, 2019, respectively
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, respectivelyCommon 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
Additional paid-in-capital Additional paid-in-capital306,079 262,865  Additional paid-in-capital316,032 307,788 
Accumulated other comprehensive loss Accumulated other comprehensive loss(24,923)(8,026) Accumulated other comprehensive loss(23,138)(24,051)
Accumulated deficit Accumulated deficit(123,956)(103,159) Accumulated deficit(108,541)(117,999)
Total RadNet, Inc.'s stockholders' equity Total RadNet, Inc.'s stockholders' equity157,205 151,685  Total RadNet, Inc.'s stockholders' equity184,358 165,743 
Noncontrolling interestsNoncontrolling interests88,916 81,454 Noncontrolling interests97,000 92,560 
Total equity Total equity246,121 233,139  Total equity281,358 258,303 
Total liabilities and equity Total liabilities and equity$1,717,866 $1,646,986  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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RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(IN THOUSANDS EXCEPT SHARE AND PER SHARE DATA)
(unaudited)
Three Months Ended
September 30,
Nine Months Ended
September 30,
Three Months Ended
March 31,
202020192020201920212020
REVENUEREVENUE    REVENUE  
Service fee revenue Service fee revenue$256,730 $261,908 $660,760 $762,751  Service fee revenue$279,577 $248,333 
Revenue under capitation arrangements Revenue under capitation arrangements35,046 30,784 103,145 90,587  Revenue under capitation arrangements35,742 33,231 
Total service revenueTotal service revenue291,776 292,692 763,905 853,338 Total service revenue315,319 281,564 
Provider relief funding Provider relief funding221 25,696  Provider relief funding6,248 
OPERATING EXPENSESOPERATING EXPENSESOPERATING EXPENSES
Cost of operations, excluding depreciation and amortization Cost of operations, excluding depreciation and amortization246,462 254,383 708,095 743,997  Cost of operations, excluding depreciation and amortization282,280 267,417 
Depreciation and amortization Depreciation and amortization21,247 20,490 64,536 60,193  Depreciation and amortization22,656 21,934 
Loss on sale and disposal of equipment and other342 917 543 1,990 
(Gain) loss on sale and disposal of equipment and other (Gain) loss on sale and disposal of equipment and other(1,307)771 
Severance costs Severance costs571 52 1,647 1,054  Severance costs285 218 
Total operating expensesTotal operating expenses268,622 275,842 774,821 807,234 Total operating expenses303,914 290,340 
INCOME FROM OPERATIONS23,375 16,850 14,780 46,104 
INCOME (LOSS) FROM OPERATIONSINCOME (LOSS) FROM OPERATIONS17,653 (8,776)
OTHER INCOME AND EXPENSESOTHER INCOME AND EXPENSESOTHER INCOME AND EXPENSES
Interest expense Interest expense11,061 11,895 33,443 36,589  Interest expense12,826 11,552 
Equity in earnings of joint ventures Equity in earnings of joint ventures(2,276)(1,955)(5,176)(6,072) Equity in earnings of joint ventures(2,285)(1,955)
Non-cash change in fair value of interest rate hedge Non-cash change in fair value of interest rate hedge679 4,523  Non-cash change in fair value of interest rate hedge(11,245)
Other (income) expenses(139)(247)1,271 
Total other expenses9,325 9,942 32,543 31,788 
Other expenses Other expenses206 
Total other (income) expensesTotal other (income) expenses(498)9,603 
INCOME (LOSS) BEFORE INCOME TAXESINCOME (LOSS) BEFORE INCOME TAXES14,050 6,908 (17,763)14,316 INCOME (LOSS) BEFORE INCOME TAXES18,151 (18,379)
(Provision for) benefit from income taxes (Provision for) benefit from income taxes(3,825)(1,816)5,029 (3,556) (Provision for) benefit from income taxes(4,376)4,381 
NET INCOME (LOSS)NET INCOME (LOSS)10,225 5,092 (12,734)10,760 NET INCOME (LOSS)13,775 (13,998)
Net income attributable to noncontrolling interests Net income attributable to noncontrolling interests4,069 1,897 8,063 6,400  Net income attributable to noncontrolling interests4,317 2,360 
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERSNET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$6,156 $3,195 $(20,797)$4,360 NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$9,458 $(16,358)
BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERSBASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$0.12 $0.06 $(0.41)$0.09 BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$0.18 $(0.33)
DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERSDILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$0.12 $0.06 $(0.41)$0.09 DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS$0.18 $(0.33)
WEIGHTED AVERAGE SHARES OUTSTANDINGWEIGHTED AVERAGE SHARES OUTSTANDINGWEIGHTED AVERAGE SHARES OUTSTANDING
BasicBasic51,358,603 49,807,460 50,746,380 49,597,138 Basic51,951,506 50,294,329 
DilutedDiluted51,955,815 50,360,360 50,746,380 50,113,306 Diluted52,828,941 50,294,329 
The accompanying notes are an integral part of these financial statements.
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RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
(IN THOUSANDS)
(unaudited)
Three Months Ended September 30,Nine Months Ended September 30, Three Months Ended March 31,
202020192020201920212020
NET INCOME (LOSS)NET INCOME (LOSS)$10,225 $5,092 $(12,734)$10,760 NET INCOME (LOSS)$13,775 $(13,998)
Foreign currency translation adjustments Foreign currency translation adjustments11 (23)(28) Foreign currency translation adjustments(12)
Change in fair value of cash flow hedge, net of taxes Change in fair value of cash flow hedge, net of taxes195 (5,283)(18,764)(14,481) 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 taxes Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes969 1,861  Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes925 
COMPREHENSIVE INCOME (LOSS)COMPREHENSIVE INCOME (LOSS)11,400 (214)(29,631)(3,749)COMPREHENSIVE INCOME (LOSS)14,688 (32,546)
Less comprehensive income attributable to noncontrolling interests Less comprehensive income attributable to noncontrolling interests4,069 1,897 8,063 6,400  Less comprehensive income attributable to noncontrolling interests4,317 2,360 
COMPREHENSIVE INCOME (LOSS) ATTRIBUTABLE TOCOMPREHENSIVE INCOME (LOSS) ATTRIBUTABLE TOCOMPREHENSIVE INCOME (LOSS) ATTRIBUTABLE TO
RADNET, INC. COMMON STOCKHOLDERSRADNET, INC. COMMON STOCKHOLDERS$7,331 $(2,111)$(37,694)$(10,149)RADNET, INC. COMMON STOCKHOLDERS$10,371 $(34,906)
The accompanying notes are an integral part of these financial statements.

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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 September 30, 2020March 31, 2021 and September 30, 2019.March 31, 2020.
Common StockAdditional Paid-In
Capital
Accumulated Other
Comprehensive
Income (Loss)
Accumulated
Deficit
Total
Radnet, Inc.'s
Equity
Noncontrolling
Interests
Total
Equity
Common StockAdditional Paid-In
Capital
Accumulated Other
Comprehensive
Income (Loss)
Accumulated
Deficit
Total
Radnet, Inc.'s
Equity
Noncontrolling
Interests
Total
Equity
SharesAmountSharesAmount
BALANCE - July 1, 202051,554,760 $$304,012 $(26,098)$(130,111)$147,808 $85,448 $233,256 
BALANCE - January 1, 2021BALANCE - January 1, 202151,640,537 $$307,788 $(24,051)$(117,999)$165,743 $92,560 $258,303 
Issuance of common stock under the equity compensation planIssuance of common stock under the equity compensation plan37,000 — — — — — — Issuance of common stock under the equity compensation plan699,825 — — — — — — 
Issuance of common stock under the DeepHealth equity compensation planIssuance of common stock under the DeepHealth equity compensation plan4,338 — — — — — — Issuance of common stock under the DeepHealth equity compensation plan494 — — — — — — 
Stock-based compensation expenseStock-based compensation expense— — 2,067 — — 2,067 — 2,067 Stock-based compensation expense— — 8,248 — — 8,248 — 8,248 
Distributions paid to noncontrolling interests— — — — — — (601)(601)
Purchase of noncontrolling interestsPurchase of noncontrolling interests— — (4)— — (4)— (4)
Contribution from noncontrolling partnerContribution from noncontrolling partner— — — — — — 123 123 
Change in cumulative foreign currency translation adjustmentChange in cumulative foreign currency translation adjustment— — — 11 — 11 — 11 Change in cumulative foreign currency translation adjustment— — — (12)— (12)— (12)
Change in fair value of cash flow hedge, net of taxes— — — 195 — 195 — 195 
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxesChange in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes— — — 969 — 969 — 969 Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes— — — 925 — 925 — 925 
Other— — — — (1)(1)— (1)
Net incomeNet income— — — — 6,156 6,156 4,069 10,225 Net income— — — — 9,458 9,458 4,317 13,775 
BALANCE-SEPTEMBER 30, 202051,596,098 $$306,079 $(24,923)$(123,956)$157,205 $88,916 $246,121 
BALANCE-MARCH 31, 2021BALANCE-MARCH 31, 202152,340,856 $$316,032 $(23,138)$(108,541)$184,358 $97,000 $281,358 
BALANCE - July 1, 201950,127,234 $$257,607 $(6,942)$(116,752)$133,918 $78,512 $212,430 
BALANCE - January 1, 2020BALANCE - January 1, 202050,314,328 $$262,865 $(8,026)$(103,159)$151,685 $81,454 $233,139 
Issuance of common stock under the equity compensation planIssuance of common stock under the equity compensation plan25,000 — — — — — — Issuance of common stock under the equity compensation plan380,047 — — — — — — 
Stock-based compensation expenseStock-based compensation expense— — 1,356 — — 1,356 — 1,356 Stock-based compensation expense— — 6,596 — — 6,596 — 6,596 
Issuance of common stock for purchase of membership interest in HVRA101,902 — 1,500 — — 1,500 — 1,500 
Change in cumulative foreign currency translation adjustmentChange in cumulative foreign currency translation adjustment— — — (23)— (23)— (23)Change in cumulative foreign currency translation adjustment— — — — — 
Change in fair value cash flow hedge, net of taxesChange in fair value cash flow hedge, net of taxes— — — (5,283)— (5,283)— (5,283)Change in fair value cash flow hedge, net of taxes— — — (18,549)— (18,549)— (18,549)
Other— — — (2)— — 
Net income— — — — 3,195 3,195 1,897 5,092 
BALANCE-SEPTEMBER 30, 201950,254,136 $$260,463 $(12,250)$(113,555)$134,663 $80,409 $215,072 
Net (loss) incomeNet (loss) income— — — — (16,358)(16,358)2,360 (13,998)
BALANCE-MARCH 31, 2020BALANCE-MARCH 31, 202050,694,375 $$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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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 nine months ended September 30, 2020 and September 30, 2019.
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Common StockAdditional Paid-In
Capital
Accumulated Other
Comprehensive
Income (Loss)
Accumulated
Deficit
Total
Radnet, Inc.'s
Equity
Noncontrolling
Interests
Total
Equity
SharesAmount
BALANCE - January 1, 202050,314,328 $$262,865 $(8,026)$(103,159)$151,685 $81,454 $233,139 
Issuance of common stock under the equity compensation plan453,817 — — — — — — 
Issuance of common stock under the DeepHealth equity compensation plan4,338 — — — — — — 
Stock-based compensation expense— — 10,203 — — 10,203 — 10,203 
Issuance of common stock for sale of unregistered securities for the DeepHealth acquisition823,615 — 33,011 — — 33,011 — 33,011 
Distributions paid to noncontrolling interests— — — — — — (601)(601)
Change in cumulative foreign currency translation adjustment— — — — — 
Change in fair value cash flow hedge, net of taxes— — — (18,764)— (18,764)— (18,764)
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes— — — 1,861 — 1,861 — 1,861 
Net loss— — — — (20,797)(20,797)8,063 (12,734)
BALANCE-SEPTEMBER 30, 202051,596,098 $$306,079 $(24,923)$(123,956)$157,205 $88,916 $246,121 
BALANCE - January 1, 201948,977,485 $$242,835 $2,259 $(117,915)$127,184 $73,069 $200,253 
Issuance of common stock upon exercise of options10,000 — 50 — — 50 — 50 
Issuance of common stock under the equity compensation plan726,042 — — — — — — 
Stock-based compensation expense— — 6,993 — — 6,993 — 6,993 
Issuance of common stock for purchase of membership interest in HVRA440,207 — 6,000 — — 6,000 — 6,000 
Forfeiture of restricted stock(1,500)— (5)— — (5)— (5)
Sale of noncontrolling interests, net of taxes— — 3,090 — — 3,090 2,008 5,098 
Purchase of noncontrolling interests— — — — — — (1,818)(1,818)
Contribution from noncontrolling partner— — — — — — 750 750 
Issuance of common stock for purchase of Nulogix101,902 — 1,500 — — 1,500 — 1,500 
Change in cumulative foreign currency translation adjustment— — — (28)— (28)— (28)
Change in fair value cash flow hedge, net of taxes— — — (14,481)— (14,481)— (14,481)
Net income— — — — 4,360 4,360 6,400 10,760 
BALANCE-SEPTEMBER 30, 201950,254,136 $$260,463 $(12,250)$(113,555)$134,663 $80,409 $215,072 
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
(IN THOUSANDS)
(unaudited)
Nine Months Ended September 30,
20202019
CASH FLOWS FROM OPERATING ACTIVITIES  
Net (loss) income$(12,734)$10,760 
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Depreciation and amortization64,536 60,193 
Amortization of operating lease right-of-use assets50,769 49,948 
Equity in earnings of joint ventures, net of dividends530 (2,148)
Amortization of deferred financing costs and loan discount3,266 3,103 
Loss on sale and disposal of equipment and other543 1,990 
Amortization of cash flow hedge2,204 
Non-cash change in fair value of interest rate hedge4,523 
Stock-based compensation10,144 6,963 
Other non-cash items included in cost of operations(559)
Change in fair value of contingent consideration(145)(1,749)
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:
Accounts receivable17,380 (3,467)
Other current assets13,522 (1,569)
Other assets(700)(5,770)
Deferred taxes(7,640)(4,230)
Operating lease liability(43,351)(49,721)
Deferred revenue44,530 (490)
Accounts payable, accrued expenses and other22,966 19,349 
Net cash provided by operating activities170,343 82,603 
CASH FLOWS FROM INVESTING ACTIVITIES
Purchase of imaging facilities and other acquisitions(10,125)(27,150)
Equity investments at fair value(143)
Purchase of property and equipment(77,303)(68,269)
Proceeds from sale of equipment779 760 
Proceeds from the sale of equity interests in a joint venture132 
Nulogix return of capital792 
Equity contributions in existing and purchase of interest in joint ventures(1,631)(103)
Net cash used in investing activities(88,280)(93,981)
CASH FLOWS FROM FINANCING ACTIVITIES
Principal payments on notes and leases payable(2,704)(4,778)
Payments on term loan debt(32,472)(29,918)
Additional deferred finance costs on revolving loan amendment(741)
Proceeds from debt issuance, net of issuing costs97,144 
Proceeds from Payment Protection Program4,023 
Distributions paid to noncontrolling interests(601)(1,818)
Proceeds from sale of noncontrolling interest5,275 
Contribution from noncontrolling partner750 
Proceeds from revolving credit facility250,900 251,200 
Payments on revolving credit facility(250,900)(279,200)
Proceeds from issuance of common stock upon exercise of options50 
Net cash (used in) provided by financing activities(32,495)38,705 
EFFECT OF EXCHANGE RATE CHANGES ON CASH(28)
NET INCREASE IN CASH AND CASH EQUIVALENTS49,574 27,299 
CASH AND CASH EQUIVALENTS, beginning of period40,165 10,389 
CASH AND CASH EQUIVALENTS, end of period$89,739 $37,688 
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid during the period for interest$31,210 $36,058 
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Three Months Ended March 31,
20212020
CASH FLOWS FROM OPERATING ACTIVITIES  
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 consideration200 
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 
CASH FLOWS FROM INVESTING ACTIVITIES
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)
CASH FLOWS FROM FINANCING ACTIVITIES
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 
EFFECT OF EXCHANGE RATE CHANGES ON CASH(12)
NET INCREASE IN CASH AND CASH EQUIVALENTS(70,927)54,117 
CASH AND CASH EQUIVALENTS, beginning of period102,018 40,165 
CASH AND CASH EQUIVALENTS, end of period$31,091 $94,282 
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
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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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 $28.1$28.8 million and $14.1$30.8 million during the ninethree months ended September 30,March 31, 2021 and 2020, and 2019, respectively, which were not paid for as of September 30,March 31, 2021 and 2020 and 2019, respectively. The offsetting amounts due were recorded in our condensed consolidated balance sheet under accounts payable, accrued expenses and other.
On JuneJanuary 1, 2020,2021 we completed our stock purchase of DeepHealth, Inc. by issuing 823,615 shares of our common stock to purchase all of DeepHealth's shares and share equivalents. The shares were ascribed a value of $13.9 million.
On August 1, 2019 we issued RadNet common stock inentered into the amount of $1.5 million to acquire 75% controlling interest in our formerly 25% owned joint venture Nulogix. See Note 2, Significant Accounting Policies, for further information.
We transferred approximately $4.3 million in net assets to our new joint venture, Ventura CountySimi Valley Imaging Group, LLC, in March 2019.
On February 27, 2019, we issued 440,207 sharespartnership agreement with Simi Valley Hospital and Health Services ("Simi Adventist"). Of the total combined assets of our common stock to$0.4 million, RadNet transferred $0.3 million and Simi Adventist contributed the sellers of Hudson Valley Radiology Associates, P.L.L.C. ("HVRA") which permitted our variable interest entity, Lenox Hill Radiology and Medical Imaging Associates, P.C., to complete its purchase of the membership interest of HVRA. The shares were ascribed a value of $6.0remaining $0.1 million.



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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 with operations in seven7 U.S. states. At September 30, 2020,March 31, 2021, we operated, directly or indirectly through joint ventures with hospitals, 334346 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 Intelligenceartificial 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 Entityvariable 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 $38.3$46.1 million and $40.6$39.6 million of revenue, net of management services fees to RadNet, for the three months ended September 30,March 31, 2021 and 2020, and 2019, respectively and $38.3$46.1 million and $40.6$39.6 million of operating expenses for the three months ended September 30,March 31, 2021 and 2020, and 2019, respectively. RadNet recognized $169.0$179.0 million and $154.5$147.9 million of total billed net service fee revenue for the three months ended September 30,March 31, 2021, and 2020, and 2019, respectively, for management services provided to the Group relating primarily to the technical portion of billed revenue.

The Group on a combined basis recognized $104.8 million and $116.9 million of revenue, net of management services fees to RadNet, for the nine months ended September 30, 2020 and 2019, respectively and $104.8 million and $116.9 million of operating expenses for the nine months ended September 30, 2020 and 2019, respectively. RadNet recognized $433.3 million
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and $456.1 million of total billed net service fee revenue for the nine months ended September 30, 2020, and 2019, 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 September 30, 2020March 31, 2021 and December 31, 2019,2020, we have included approximately $84.5$89.9 million and $100.3$82.3 million, respectively, of
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accounts receivable and approximately $10.7$20.5 million and $7.0$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, RadNetwe 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 the CompanyRadNet 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 our 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 September 30,March 31, 2021 and 2020 and 2019 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, 2019.2020.
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, 2019.2020. 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, 2019.2020.
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.
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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 and nine months ended September 30,March 31, 2021 and 2020 and 2019 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
September 30,
Nine Months Ended
September 30,
Three Months Ended
March 31,
202020192020201920212020
Commercial insuranceCommercial insurance$160,524 $163,152 $412,415 $475,064 Commercial insurance$182,096 $155,461 
MedicareMedicare62,704 61,599 154,847 175,825 Medicare63,589 57,749 
MedicaidMedicaid7,098 7,128 18,072 21,564 Medicaid8,451 6,628 
Workers' compensation/personal injuryWorkers' compensation/personal injury7,183 10,865 25,705 32,950 Workers' compensation/personal injury10,399 10,274 
Other patient revenueOther patient revenue8,328 6,085 17,211 17,947 Other patient revenue4,775 5,662 
Management fee revenueManagement fee revenue2,675 1,792 8,574 5,662 Management fee revenue5,219 2,567 
Teleradiology and Software revenueTeleradiology and Software revenue2,349 4,412 8,319 12,861 Teleradiology and Software revenue2,426 3,770 
OtherOther5,869 6,875 15,617 20,878 Other2,622 6,222 
Service fee revenueService fee revenue256,730 261,908 660,760 762,751 Service fee revenue279,577 248,333 
Revenue under capitation arrangementsRevenue under capitation arrangements35,046 30,784 103,145 90,587 Revenue under capitation arrangements35,742 33,231 
Total service revenueTotal service revenue$291,776 $292,692 $763,905 $853,338 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. Patient volumesTo aid businesses and stimulate the related revenues for our services were significantly impacted duringnational economy, Congress passed the latter portion of the first quarter through the middle of the third quarter of 2020 as a result of federal, stateThe Coronavirus Aid, Relief, and local government mandated restrictions requiring many peopleEconomic Security ("CARES") Act, which was signed in to remain at home and forced the closure of or limitationslaw on certain businesses, as well as suspended elective procedures by health care facilities. Many of these restrictions have been eased or completely lifted across the states the Company operates in however, we are unable to predict the future impact of the pandemic on our operations.March 27, 2020.

DuringThrough March 31, 2021, we have received since inception of the nine months ended September 30, 2020, we received $39.4various programs established by the CARES Act, $39.5 million of accelerated Medicare payments, $5.0$32.5 million from Blue Cross, $25.7 million from the general distribution and $4.0 million from the Paycheck Protection Program established through the Coronavirus Aid, Relief and Economic Security (“CARES”) Act. 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 under the caption “to Deferred Revenue“Revenue in our condensed consolidated balance sheet and will be repaidapplied 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 funds were accounted for as government grants and recognized as other revenue once reasonable assurance that the applicable terms and conditions required to retain the funds were met, under the caption “Providerdisplayed as Provider relief funding”funding in our condensed Consolidated Statementsconsolidated statements of Operations

Duringoperations, of which $6.2 million of the total $32.5 million was received in the three months ended September 30,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 Departmenteligibility requirements under the government guidelines for forgiveness and the loans were written off to gain on extinguishment of Health and Human Services significantly changed the measurement of Provider Relief Funds that providers are able to retain. We received approximately $0.2 million in
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funding and based on our assessment of the likelihood of meeting the applicable terms and conditions of the general distribution we continue to recognized the funds received as other revenue.debt.

The CARES Act also providersprovides 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 September 30, 2020,March 31, 2021, the Company had deferred $10.8in 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.

We believe the extent of the COVID-19 pandemic’s impact on our operating results and financial condition has been and will continue to be driven by many factors, most of which are beyond our control and ability to forecast. Such factors include, but are not limited to, the scope and duration of stay-at-home practices, business closures and restrictions, suspensions of elective procedures and continued decline in procedure volumes for an indeterminable length of time and incremental expenses required for supplies and personal protective equipment. Because of these uncertainties, we cannot estimate the length or impact of the pandemic on our business. If we incur declines in cash flows and results of operations, such declines could have an impact on the inputs and assumptions used in significant accounting estimates, including implicit prices concessions related to uninsured patient accounts, and potential impairment of goodwill and long-lived assets. During the third quarter of 2020, procedure volumes increased and have had a positive impact on our patient revenue. However, the impact of COVID-19 in future periods may vary and could adversely impact our results of operations.

RECLASSIFICATION –We have reclassified certain amounts previously classified as held for sale related to property and equipment and goodwill to conform to our 2020 presentation.
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. In regards to the credit loss standard, we have concluded that the historical credit loss experienced across our receivable portfolio is materially similar to any current expected credit losses estimated under the Current Expected Credit Loss ("CECL") model.

In 2018 and 2019 weWe 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 September 30, 2020March 31, 2021 we have $20.4$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. To employ the CECL model for the notes receivable, wecapital 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. In the event of a significant past due balance, as the sold receivables were already revalued and recorded at net realizable value, we can mitigate the expected credit loss by offsetting any collections from the underlying factored receivables and not remitting that to the counter party.
DEFERRED REVENUE - As noted above, in April of 2020, we received approximately $39.4 million in advanced Medicare payments from the Centers for Medicare and Medicaid Services ("CMS") as part of the expanded Accelerated and Advance Payment Program under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. As these payments are required to be repaid to CMS beginning 120 days after their receipt through offsets from new Medicare claims over a three month period, we have recorded amounts received to deferred revenue which will be amortized as Medicare reimbursements are earned. In addition, in May of 2020 we received $5.0 million in advance payments from an insurance carrier with similar repayment terms as the CMS.
DEFERRED FINANCING COSTS - Costs of financing are deferred and amortized using the effective interest rate method. Deferred financing costs, net of accumulated amortization, were $1.9$1.6 million and $1.6$1.8 million, as of September 30, 2020March 31, 2021 and December 31, 2019,2020, respectively and related to our Barclays line of credit.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.
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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 September 30, 2020March 31, 2021 totaled $470.7$502.6 million. Indefinite lived intangible assets at September 30, 2020March 31, 2021 were $11.3$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, 2019,2020, 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 the novel strain of coronavirus ("COVID-19")COVID-19 pandemic and did not identify an indication of goodwill impairment being more likely than not through September 30, 2020.March 31, 2021. Activity in goodwill for the ninethree months ended September 30, 2020March 31, 2021 is provided below (in thousands):
Balance as of December 31, 20192020$441,973472,879 
Goodwill acquired through the acquisition of Olney Open MRI, LLCacquisitions60129,609 
Goodwill acquired through the acquisitionattributable to formation of MRI at Woodbridge,Simi Valley Imaging Group LLC1,833105 
Goodwill acquired through the acquisition of DeepHealth, Inc.Other Adjustments23,396 (27)
Goodwill acquired through the acquisition of AZ-Tech Radiology & Open MRI, LLC2,882 
Balance as of September 30, 2020March 31, 2021$470,685502,566 
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 an income tax expense of $3.8$4.4 million, or an effective tax rate of 27.2%24.1%, for the three months ended September 30, 2020March 31, 2021 compared to ana benefit from income tax expensetaxes of $1.8$4.4 million, or an effective tax rate of 26.3%23.8% for the three months ended September 30, 2019. We recorded an income tax benefit of $5.0 million, or an effective tax rate of 28.3%, for the nine months ended September 30, 2020 compared to an income tax expense of $3.6 million , or an effective tax rate of 24.8% for the nine months ended September 30, 2019.TheMarch 31, 2020. The income tax rates for the three and nine months ended September 30, 2020March 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 Coronavirus Aid, Relief, and Economic SecurityCARES Act, ("CARES Act"). 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
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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, 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 in 2020.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 4, Facility Acquisitions and 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 and nine months ended September 30, 2020March 31, 2021 and 2019.2020.
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.
DERIVATIVE INSTRUMENTS
2016 CAPS
In the fourth quarter of 2016, we entered into 2 forward interest rate cap agreements ("2016 Caps"). The 2016 Caps will mature in September and October 2020. The 2016 Caps had notional amounts of $150,000,000 and $350,000,000, respectively. Under these arrangements, the Company purchased a cap on 3 month LIBOR at 2.0%. We incurred a $5.3 million premium to enter into the 2016 Caps which is being accrued over the life of the agreements.
At inception, we designated our 2016 Caps 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 of the hedge (i.e. change in fair value) is reported as a component of comprehensive loss in the consolidated statement of equity since such hedge has been determined to be effective. See Fair Value Measurements section below for the fair value of the 2016 Caps at September 30, 2020.
A tabular presentation of the effect of derivative instruments on our consolidated statement of comprehensive loss of the 2016 Caps is as follows (amounts in thousands):
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For the three months ended September 30, 2020
AccountJuly 1, 2020 BalanceAmount of comprehensive gain recognized on derivative net of taxesSeptember 30, 2020 BalanceLocation
Accumulated Other Comprehensive Loss, net of taxes(1,409)195 (1,214)Liabilities and Equity
For the nine months ended September 30, 2020
AccountJanuary 1, 2020 BalanceAmount of comprehensive gain recognized on derivative net of taxesSeptember 30, 2020 BalanceLocation
Accumulated Other Comprehensive Loss, net of taxes(1,877)663 (1,214)Liabilities and Equity
2019 SWAPS
In the second quarter of 2019, we entered into 4 forward interest rate agreements ("2019 Swaps"). The 2019 Swaps have total notional amounts of $500,000,000, consisting of two2 agreements of $50,000,000 each and two2 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. As a result of the economic impact of the coronavirus pandemic, which precipitated a reduction in interest rates , theThe 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 20252023 at approximately $0.4 million per month.month and continuing at approximately $0.3 million through October 2025.
A tabular presentation of the effect of derivative instruments on our consolidated statement of comprehensive loss of the 2019 swapsSwaps which remain ineffective is as follows (amounts in thousands):
For the three months ended September 30, 2020
For the three months ended March 31, 2021For the three months ended March 31, 2021
AccountAccountJuly 1, 2020 BalanceAmount of comprehensive loss recognized on derivative net of taxesAmount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxesSeptember 30, 2020 BalanceLocationAccountJanuary 1, 2021 BalanceAmount of comprehensive loss recognized on derivative net of taxesAmount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxesMarch 31, 2021 BalanceLocation
Accumulated Other Comprehensive Loss, net of taxesAccumulated Other Comprehensive Loss, net of taxes$(24,406)$$969 $(23,437)Liabilities and EquityAccumulated Other Comprehensive Loss, net of taxes$(22,581)$$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 $(22,581)Equity
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For the nine months ended September 30, 2020
AccountJanuary 1, 2020 BalanceAmount of comprehensive loss recognized on derivative net of taxesAmount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxesSeptember 30, 2020 BalanceLocation
Accumulated Other Comprehensive Loss, net of taxes$(5,870)$(19,428)$1,861 $(23,437)Liabilities and Equity
A tabular presentation of the effect of derivative instruments on our statement of operations of the 2019 Swaps for the Swaps that becamewhich remain ineffective during the third quarter is as follows (amounts in thousands):
For the three months ended September 30, 2020
For the three months ended March 31, 2021For the three months ended March 31, 2021
Ineffective interest rate swapIneffective interest rate swapAmount of loss recognized in income on derivative (current period ineffective portion)Location of loss recognized in Income on derivative (current period ineffective portion)Amount of loss reclassified from accumulated OCI into income (prior period effective portion)Location of gain (Loss) reclassified from accumulated OCI into income (prior period effective portion)Ineffective interest rate swapAmount of gain recognized in income on derivative (current period ineffective portion)Location of gain recognized in Income on derivative (current period ineffective portion)Amount of loss reclassified from accumulated OCI into income (prior period effective portion)Location of loss reclassified from accumulated OCI into income (prior period effective portion)
Interest rate contractsInterest rate contracts$(679)Other income (expense)$(1,312)Equity and Interest ExpenseInterest rate contracts$11,245 Other income (expense)$(925)Interest Expense
For the nine months ended September 30, 2020
Ineffective interest rate swapAmount of loss 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 gain (Loss) reclassified from accumulated OCI into income (prior period effective portion)
Interest rate contracts$(4,523)Other income (expense)$(2,204)Equity and Interest Expense

See Fair Value Measurements section below for the fair value of the 2016 caps and 2019 swapsSwaps at September 30, 2020.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.
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):
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 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 September 30, 2020
Level 1Level 2Level 3Total
Current and long term liabilities    
2016 caps - Interest Rate Contracts$$182 $$182 
2019 swaps - Interest Rate Contracts$$39,983 $$39,983 
As of December 31, 2019 As of December 31, 2020
Level 1Level 2Level 3TotalLevel 1Level 2Level 3Total
Current and long term liabilitiesCurrent and long term liabilities    Current and long term liabilities    
2016 caps - Interest Rate Contracts$$1,081 $$1,081 
2019 swaps - Interest Rate Contracts$$9,477 $$9,477 
2019 Swaps - Interest Rate Contracts2019 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 September 30, 2020 As of March 31, 2021
Level 1Level 2Level 3Total Fair ValueTotal Face ValueLevel 1Level 2Level 3Total Fair ValueTotal Face Value
First Lien Term Loans and SunTrust Term LoanFirst Lien Term Loans and SunTrust Term Loan$$663,140 $$663,140 $673,227 First Lien Term Loans and SunTrust Term Loan$$652,331 $$652,331 $651,580 
 As of December 31, 2019
Level 1Level 2Level 3TotalTotal Face Value
First Lien Term Loans and SunTrust Term Loan$$708,948 $$708,948 $705,699 
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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 September 30, 2020March 31, 2021 and at December 31, 20192020 our Barclays revolving credit facility had 0 balance outstanding. Our SunTrust revolving credit facility relating to our consolidated subsidiary NJIN,The New Jersey Imaging Network ("NJIN"), had 0 principal amount outstanding at September 30, 2020March 31, 2021 and at December 31, 2019.2020.
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,
20212020
Net income (loss) attributable to RadNet, Inc.'s common stockholders$9,458 $(16,358)
BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC.'S COMMON STOCKHOLDERS
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)
DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC.'S COMMON STOCKHOLDERS
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 vesting314,962 
Shares issuable upon the exercise of stock options:82,595 527,899 

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 Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Net income (loss) attributable to RadNet, Inc.'s common stockholders$6,156 $3,195 $(20,797)$4,360 
BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC.'S COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period51,358,603 49,807,460 50,746,380 49,597,138 
Basic net income (loss) per share attributable to RadNet, Inc.'s common stockholders$0.12 $0.06 $(0.41)$0.09 
DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC.'S COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period51,358,603 49,807,460 50,746,380 49,597,138 
Add nonvested restricted stock subject only to service vesting120,605 200,567 191,375 
Add additional shares issuable upon exercise of stock options and warrants476,607 352,333 324,793 
Weighted average number of common shares used in calculating diluted net income per share51,955,815 50,360,360 50,746,380 50,113,306 
Diluted net income (loss) per share attributable to RadNet, Inc.'s common stockholders$0.12 $0.06 $(0.41)$0.09 
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 vesting331,659 
Shares issuable upon the exercise of stock options:48,948 933,370 

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 September 30, 2020,March 31, 2021, we have three3 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. On March 24, 2017, we acquired an initial 12.5%Our investment of $1.2 million represents a 14.21% equity interest in Medic Vision for $1.0 million. We also received an option to exercise warrants to acquire up to an additional 12.5% equity interest for $1.4 million within one year from the initial share purchase date, if exercised in full. On March 1, 2018 we exercised our warrant in part and acquired an additional 1.96% for $0.2 million. Our initial equity interest has been diluted to 12.25% and our total equity investment stands at 14.21%. In accordance with accounting guidance, as we exercise no significant influence over Medic Vision’s operations, the investment is recorded at its cost of $1.2 million, given that the fair value is not readily determinable.company. No observable price changes or impairment in our investment was identified as of September 30, 2020.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 September 30, 2020.
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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 the principalin support of which is due November 2022. To leverage their artificial intelligence expertise, we entered into a software subscription service contract to assist our radiology work flow and advanced them $4.0 million for future software subscription fees that is recorded as a prepaid expense in Prepaid and Other Current assets in our consolidated balance sheets.its operations. No observable price changes, or impairment in our investment or impairment of the loan receivable was identified as of September 30, 2020.March 31, 2021.
INVESTMENT IN JOINT VENTURES – We have 1213 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 September 30, 2020.March 31, 2021.
Joint venture investment contribution
In the month of August 2020, we made additional cash contributions to our Santa Monica Imaging Group, LLC partnership in the amount of $1.6 million in support of its expanded operations. We maintain our 35% economic interest in the partnership.

Joint venture investment and financial information
The following table is a summary of our investment in joint ventures during the ninethree months ended September 30, 2020March 31, 2021 (in thousands):
Balance as of December 31, 20192020$34,47034,528 
Equity in earnings in these joint ventures5,176 
Distribution of earnings(5,706)2,285 
Equity contributions in existing joint ventures1,631 
Balance as of September 30, 2020March 31, 2021$35,57136,813 
We charged management service fees from the centers underlying these joint ventures of approximately $2.7$5.2 million and $1.8$2.6 million for the three months ended September 30,March 31, 2021 and 2020, and 2019, respectively, and $8.6 million and $7.8 million for the nine months ended September 30, 2020 and 2019, respectively. We eliminate any unrealized portion
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Table of our management service fees with our equity in earnings of joint ventures.Contents
The following table is a summary of key balance sheet data for these joint ventures as of September 30, 2020March 31, 2021 and December 31, 20192020 and income statement data for the ninethree months ended September 30,March 31, 2021 and 2020 and 2019 (in thousands):
Balance Sheet Data:Balance Sheet Data:September 30, 2020December 31, 2019Balance Sheet Data:March 31, 2021December 31, 2020
Current assetsCurrent assets$26,618 $27,427 Current assets$33,265 $27,085 
Noncurrent assetsNoncurrent assets70,576 61,037 Noncurrent assets68,493 68,686 
Current liabilitiesCurrent liabilities(10,487)(9,217)Current liabilities(13,929)(12,545)
Noncurrent liabilitiesNoncurrent liabilities(22,751)(18,872)Noncurrent liabilities(21,371)(21,582)
Total net assetsTotal net assets$63,956 $60,375 Total net assets$66,458 $61,644 
Book value of RadNet joint venture interestsBook value of RadNet joint venture interests$29,121 $28,001 Book value of RadNet joint venture interests$30,351 $28,079 
Cost in excess of book value of acquired joint venture interests and otherCost in excess of book value of acquired joint venture interests and other6,450 6,469 Cost in excess of book value of acquired joint venture interests and other6,462 6,449 
Total value of Radnet joint venture interests$35,571 $34,470 
Total value of RadNet joint venture interestsTotal value of RadNet joint venture interests$36,813 $34,528 
Total book value of other joint venture partner interests$34,835 $32,374 
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Income statement data for the nine months ended September 30,20202019
Income statement data for the three months ended March 31,Income statement data for the three months ended March 31,20212020
Net revenueNet revenue$78,988 $80,115 Net revenue$31,718 $26,341 
Net incomeNet income$13,651 $13,718 Net income$4,803 $4,245 
 
NOTE 3 – RECENT ACCOUNTING AND REPORTING STANDARDSSTANDARD

Accounting standards adopted

In June 2016,January 2021, the FASB issued ASU No. 2016-132021-01 ("ASU 2016-13), Financial Instruments - Credit Losses. ASU 2016-13 replaces the incurred loss methodology previously utilized for valuing financial instruments with an expected loss methodology that is referred to as the current expected credit loss (CECL) methodology. We prospectively adopted the standard on January 1, 2020 and the adoption did not have a material impact to the condensed consolidated financial statements, resulting in no adjustments to our prior year earnings. See the Accounts Receivable section to Note 2 for further information on our allowances for credit losses.

In August 2018, the FASB issued ASU No. 2018-15 (“ASU 2018-15”2021-01"), Intangibles-GoodwillReference 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 Other-Internal-Use Software. ASU 2018-15 aligns the requirements for deferring implementation costs incurredexceptions in a cloud computing arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software. This ASUTopic 848. The guidance is effective in the first quarter of 2020 with early adoption permittedupon issuance and generally can be applied either retrospectively or prospectively to all implementation costs incurred after the date of adoption. The adoption of this standard did not have a material impact on our condensed consolidated balance sheet.

In March 2020, the FASB issued ASU 2020-03 ("ASU 2020-03"), Codification Improvements to Financial Instruments. The amendments in this update represent changes to clarify or improve the codification and correct unintended application. ASU 2020-03 was effective immediately upon issuance and its adoption did not have a material impact on our financial statements.

In August 2018, the FASB issued ASU No. 2018-13 ("ASU 2018-13"), Disclosure Framework – Changes to the Disclosure Requirements for Fair Value Measurements. This standard removes, modifies and adds certain disclosures related to recurring and nonrecurring fair value measurements. We adopted ASC 2018-13 effective January 1, 2020 and it had no effect on our disclosures.

Accounting standards not yet adopted
Inthrough 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 will be effective beginning in the first quarter of 2021. Early adoption is permitted. Certain amendments in this update must be applied on a prospective basis, certain amendments must be applied on a retrospective basis, and certain amendments must be applied on a modified retrospective basis through a cumulative-effect adjustment to retained earnings/(deficit) in the period of adoption.31, 2022. We are currently evaluating the potential impact thisof ASU will have on our financial statements and related disclosures as well as the timing of adoption.

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. We do not expect the adoption of this guidance will have a material impact2021-01 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.
NOTE 4 – FACILITY ACQUISITIONS

Acquisitions

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NOTE 4 – FACILITY ACQUISITIONS AND DISPOSITIONS
Acquisitions:

On August 31, 2020During the first quarter of 2021, we completed ourthe acquisition of certain assets of AZ-Tech Radiology & Open MRI, LLC, consisting of 8 multi-modality imaging centersthe following entities, all located in the Phoenix, Arizona area for purchase consideration of $5.5 million.New York city area. We made a preliminary fair value determination of the acquired assets and assumed liabilities and approximately $2.5 million in property and equipment, $7.6 million in right-of-use assets, $0.1 million in other assets, $7.6 million in operating lease liabilities, and $2.9 million in goodwillthe following were recorded.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 LLC9,3864,30410,1155,032500(10,115)
SLZM Realty LLC13,6713,8627,7159,759500(7,715)
2012 Sunrise Merrick LLC11,4282,3635,9199,015500(5,919)
ZP Bayside LLC3,5453,3859,393405070(9,393)
ZP Laurelton LLC2,6582,5305,157325046(5,157)
ZP Smith LLC3,9783,58110,558347500(10,558)
Total$57,075 $26,757 $55,312 $29,609 $500 $209 $(55,312)
Formation of majority owned subsidiary
On JuneJanuary 1, 2020,2021 we completed our acquisition of allentered into the equity interests of DeepHealth Inc.,Simi Valley Imaging Group, LLC, a partnership with Simi Valley Hospital and Health Services ("DeepHealth"Simi Adventist") an artificial intelligence and machine learning company in an all stock purchase. As initial purchase consideration, we issued 915,132 shares at $16.93 per share (823,615 issued at execution, with up to 91,517 shares to be issued 18 months after acquisition subject to adjustment for any indemnification claims). The transaction was accounted for as an acquisition of a business and total purchase consideration determined to be approximately $34.6 million including i) 823,615 shares issued on the date of closing with fair value of $13.9 million, ii) a liability of 91,517 shares with a fair value of $1.5 million to be issued 18 months after acquisition subject to adjustment for any indemnification claims andoperation will be marked to market in subsequent periods, iii) replacement awards attributable to pre-combination service issued to DeepHealth option holders with allocated fair value of $2.0 million, iv) acquisition date fair value of contingent consideration of $17.0 million and v) $0.1 million in closing costs reimbursed to the seller. The fair values of replacement awards attributable to pre-combination service and contingent consideration are recorded in additional paid in capital upon closing of the transaction. For the contingent consideration, there are three arrangements that will be settled in a fixed number of shares upon achievement of three individual specific milestones which are mutually exclusive of each other, with 390,789, 586,184, and 195,393 shares, respectively, issuable for each milestone arrangement. The fair value of the contingent consideration was estimated at the date of acquisition based on our share price and estimated probability of the achievement of the respective milestones. We preliminarily recorded $0.1 million in current assets, $3.5 million in deferred tax liabilities, $14.8 million in intangible assets, primarily in-process research and development ("IPR&D'), and $23.4 million in goodwill. The goodwill is primarily attributable to expected post-acquisition synergies from integrating DeepHealth’s assembled workforce and IPR&D technologies. The fair values of the identifiable intangible assets related to IPR&D were determined by the income method and the assets will not be amortized until completion.

On March 2, 2020 our consolidated subsidiary New Jersey Imaging Networks ("NJIN") completed the acquisition of certain assets of MRI at Woodbridge, LLC consisting of a singleoffer multi-modality imaging center locatedservices out of two locations in Avenel, New Jersey for cash consideration of $2.6Ventura County, California. Total investment in the venture is $0.4 million. NJIN made a fair value determination of the acquired assets and assumed liabilities and approximately $0.5 million in property and equipment, $1.1 million in right-of-use assets,RadNet contributed $0.3 million in intangible assets $1.1 million in operating lease liabilities,for a 60% economic interest and Simi Adventist contributed assets totaling $0.1 million in finance lease liabilities, and $1.8 million in goodwill were recorded.

    On January 2, 2020 we completed our acquisition of certain assets of Olney Open MRI, LLC, consisting offor a single multi-modality imaging center located in Columbia, Maryland for cash consideration of $1.8 million. We have made a fair value determination of the acquired assets and assumed liabilities and approximately $0.8 million in property and equipment, $1.3 million in right-of-use assets, $0.3 million in intangible assets, $1.3 million in operating lease liabilities and $0.6 million in goodwill were recorded.
Dispositions:
On June 1, 2020 we completed our sale of certain assets of our Imaging On Call subsidiary to RadVantage P.C. (an unrelated corporation) for approximately $1.0 thousand. With this transaction, we have exited the teleradiology business.

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NOTE 5 – CREDIT FACILITIES AND NOTES PAYABLE
As of September 30, 2020March 31, 2021 and December 31, 20192020 our debt obligations consisted of the following (in thousands):
September 30,
2020
December 31,
2019
March 31,
2021
December 31,
2020
First Lien Term Loans collateralized by RadNet's tangible and intangible assetsFirst Lien Term Loans collateralized by RadNet's tangible and intangible assets$620,727 $649,824 First Lien Term Loans collateralized by RadNet's tangible and intangible assets$601,330 $611,028 
Discounts on First Lien Term LoansDiscounts on First Lien Term Loans(10,669)(13,579)Discounts on First Lien Term Loans(8,730)(9,699)
SunTrust Term Loan Agreement collateralized by NJIN's tangible and intangible assetsSunTrust Term Loan Agreement collateralized by NJIN's tangible and intangible assets52,500 55,875 SunTrust Term Loan Agreement collateralized by NJIN's tangible and intangible assets50,250 51,375 
Paycheck Protection Program loans at 1% due April 20224,037 — 
Equipment note payable at 4.6%, due through 2020, collateralized by medical equipment47 275 
Total debt obligationsTotal debt obligations666,642 692,395 Total debt obligations642,850 652,704 
Less: current portionLess: current portion(39,463)(39,691)Less: current portion(40,166)(39,791)
Long term portion debt obligationsLong term portion debt obligations$627,179 $652,704 Long term portion debt obligations$602,684 $612,913 

Included in our condensed consolidated balance sheets at September 30, 2020March 31, 2021 are $620.7$601.3 million of First Lien Term Loans and $52.5$50.3 million of SunTrust Term Loan debt for a combined total of $673.2$651.6 million of total term loan debt (exclusive of unamortized discounts of $10.7$8.7 million) in thousands:
 Face ValueDiscountTotal Carrying
Value
First Lien Term Loans$620,727 $(10,669)$610,058 
SunTrust Term Loan52,500 52,500 
Total Term Loans$673,227 $(10,669)$662,558 
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 Face ValueDiscountTotal Carrying
Value
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 0 outstanding balance under our $195.0 million Barclays Revolving Credit Facility at September 30, 2020March 31, 2021 and have reserved $6.3$7.9 million for certain letters of credit. The remaining $188.7$187.1 million of our Barclays Revolving Credit Facility was available to draw upon as of September 30, 2020.March 31, 2021. We had 0 outstanding balance under our $30.0 million SunTrust Revolving Credit Facility related toat March 31, 2021. As of March 31, 2021, we were in compliance with all covenants under our consolidated subsidiary NJIN at September 30, 2020.credit facilities.
Senior Secured Credit Facilities
Barclays Credit Facilities:
At September 30, 2020, (a)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 (b) our SunTrust credit facilities, which relate to our consolidated subsidiary NJIN, were comprised of one term loan (the "SunTrust Term Loan")Restated First Lien Credit and a revolving credit facility of $30.0 million (the "SunTrust RevolvingGuaranty Agreement dated July 1, 2016, among RadNet, Barclays Bank plc, as administrative agent, and the lenders identified therein (as amended, the "First Lien Credit Facility"Agreement").
As of September 30, 2020, we were in compliance with all covenants under our credit facilities. Deferred financing costs at September 30, 2020,March 31, 2021, net of accumulated amortization, was $1.9$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
> 5.50x4.50%3.50%
> 4.00x but ≤ 5.50x3.75%2.75%
>3.50x but ≤ 4.00x3.50%2.50%
≤ 3.50x3.25%2.25%

At September 30, 2020March 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 3.75%3.50% and 2.75%2.50%, respectively.
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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 21,1, 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 Eurodollar RateLIBOR 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
IGreater than or equal to 3.00:1.00
2.75%
per annum
1.75%
per annum
2.75%
per annum
0.45%
per annum
IILess than 3.00:1.00 but greater than or equal to 2.50:1.00
2.25%
per annum
1.25%
per annum
2.25%
per annum
0.40%
per annum
III
Less than 2.50:1.00 but greater than or equal to
2.00:1.00
2.00%
per annum
1.00%
per annum
2.00%
per annum
0.35%
per annum
IVLess than 2.00:1.00 but greater than or equal to 1.50:1.00
1.75%
per annum
0.75%
per annum
1.75%
per annum
0.30%
per annum
VLess than 1.50:1.00
1.50%
per annum
0.50%
per annum
1.50%
per annum
0.30%
per annum

The loans and other obligations outstanding under the SunTrust Restated Credit Agreement currently bear interest at a three month LIBOR election at 0.25% plus an applicable margin and fees based on Pricing Level III described above. The loans outstanding under the SunTrust Restated Credit Agreement currently bear interest based on a three month Eurodollar election of 2.00%, plus the applicable margin.

The scheduled amortization of the SunTrust Term Loan began December 31, 2018 with quarterly payments of $0.8 million, representing annual amortization equal to 5.00%5.0% of the original principal amount of the SunTrust Term Loan. At scheduled intervals, the quarterly amortization increases by $0.4 million, with the remaining balance to be paid at maturity. The SunTrust Term Loan will mature on August 1,31, 2023 unless otherwise accelerated under the terms of the SunTrust credit facility.

Credit Facility.

Revolving Credit Facilities
Barclays Revolving Credit Facility

Revolving loans borrowed under the Barclays Revolving Credit Facility bear interest at either an Adjusted Eurodollar Rate or a Base Rate (in each case, as more fully defined in the First Lien Credit Agreement) plus an applicable margin. Rates of theThe applicable margin for borrowing under the Barclays Revolving Credit Facility also change dependingvaries based on our leverage ratio and arein accordance with the same rates as noted in the schedule set forth above for First Lien Term Loans. As of September 30, 2020,March 31, 2021, the effective interest rate payable on revolving loans under the Barclays Revolving Credit Facility was 6.00%5.75%.
LettersFor letters of credit issued under the Barclays Revolving Credit Facility, letter of credit fees accrue at the applicable margin offor Adjusted Eurodollar Rate, currently 3.75%3.50% , and fronting fees accrue at 0.25% per annum, in each case on the average aggregate daily maximum amount available to be drawn under all letters of credit issued under the First Lien 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 Revolving Credit Facility will terminate on the earliest to occurearlier of July 1, 2023 or its earlier termination due to specific events of default pursuant to the First Lien Credit Agreement.

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Our Barclays Revolving Credit Facility was amended in August 2020 to add $57.5 million of revolving commitments, and extendwhich additional commitments increased the maximum borrowing capacity to $195.0 million. Total issue costs added in relation to the eighth amendment amounted to approximately $0.7 million and was capitalized as deferred financing costs and will be amortized over the remaining term of the agreement.First Lien Credit Agreement.

SunTrust Revolving Credit Facility

OurThe SunTrust Revolving Credit Facility isAgreement established a $30.0 million revolving credit facility available to NJIN for funding requirements, with an available borrowing limit of $30.0 million. Revolving loan borrowed under the SunTrust Revolving Credit Facility bear interest at either an Adjusted Eurodollar Rate or a Base Rate plus an applicable margin. Rates of the applicable margin for borrowing under the Revolving Credit Facility also change depending on our leverage ration and are the same rates noted in the schedule above for the SunTrust Term Loan.requirements. The SunTrust Revolving Credit Facility terminates on the earliest of (i) August 31, 2023, unless(ii) the voluntary termination thereof by NJIN pursuant to Section 2.8 of the SunTrust Credit Agreement, or (iii) the date on which all amounts outstanding otherwiseunder the SunTrust Credit Agreement have been declared or have automatically become due and payable (whether
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by acceleration or otherwise). As of March 31, 2021, NJIN has not borrowed againsthad no borrowings under the revolving credit line.SunTrust Revolving Credit Facility.
 
Recent Amendments to credit facilities:
Barclays Credit Facilities:
On April 23, 2021, after the period covered by this report, we entered into the Second Amended and Restated First Lien Credit and Guaranty Agreement which provides for $725.0 million of senior secured first lien term loans and a $195.0 million senior secured revolving credit facility. See Note 7, Subsequent Events, for more information.

On August 28, 2020, RadNet Management, Inc. and RadNet, Inc. entered into Amendment No. 8, Consent and Incremental Joinder Agreement to Credit and Guaranty Agreement "the Eighth(the "Eighth Amendment"). The Eighth Amendment amends the First Lien Credit Agreement to add $57.5 million of revolving commitments to the Barclays Revolving Credit Facility extendingincreasing the maximum borrowing capacity under the revolving credit facility to $195.0 million while leaving the maturity date of July 1, 2023 unchanged. Total issue costs added in relation to the Eighth Amendment amounted to approximately $0.7 million and was capitalized as deferred financing costs and will be amortized over the remaining term of the agreement.First Lien Credit Agreement.

On April 18, 2019 we entered into the following two amendments to the First Lien Credit Agreement: (i) Amendment No. 6, Consent and Incremental Joinder Agreement to Credit and Guaranty Agreement (the “Sixth Amendment”); and (ii) Amendment No. 7 to Credit and Guaranty Agreement (the “Seventh Amendment”). Among other things, The Sixth Amendment amended the First Lien Credit Agreement to issue $100.0 million in incremental First Lien Term Loans and to add an additional $20.0 million of revolving commitments to the Barclay'sBarclays Revolving Credit Facility. The Seventh Amendment amended the First Lien Credit Agreement to extend the maturity date of the Barclays Revolving Credit Facility by an additional two years to July 1, 2023, unless sooner terminated in accordance with the terms of the First Lien Credit Agreement. Total issue costs added in relation to the Sixth and Seventh amendmentsAmendments in 2019 amounted to approximately $4.4 million. Of this amount, $2.1 million was identified and capitalized as discount on debt, $0.7 million was capitalized as deferred financing costs, and $1.6 million was expensed. Amounts capitalized will be amortized over the remaining term of the agreement.

Paycheck Protection Program
The Paycheck Protection Program (PPP) includes funds available for loans to small business and Medicare providers to support operations during the COVID-19 pandemic. The funds are administered by the Small Business Administration (SBA), through approved lenders and do not require collateral or personal guarantees. We received our loans based on being a Medicare provider. The terms and conditions for participation require entities to certify that economic uncertainty related to the COVID-19 pandemic makes the loan necessary to support their current operations, and that they will use the funds to retain workers (e.g., by paying salaries, providing paid sick/medical leave and health insurance benefits) and pay certain debts (mortgage obligations) and expenses (e.g. rent, utilities, telephone). The loans have a 1.0% fixed interest rate and are due in 2 years. Initial repayments have been deferred for six months. The loans are eligible for forgiveness subject to salary limitations and employee retention levels. Certain of our consolidated subsidiaries received 4 loans totaling $4.0 million. We have accounted for the funds received as debt and recorded a liability for the full amount of proceeds received. Interest will be accrued over the term of the loans. If we meet the eligibility requirements for forgiveness the amounts forgiven will be recognized in the income statement as a gain on loan extinguishment in accordance with accounting guidance.First Lien Credit Agreement.

NOTE 6 – STOCK-BASED COMPENSATION
Stock Incentive Plans
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We have one long-term equity incentive plan which we refer to as the 2006 Equity Incentive Plan, 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 for issuance under the Restated Plan 14,000,000 shares of common stock. We can issue options (incentive and non-qualified), stock awards, stock appreciation rights, stock units and cash awards 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.
As of September 30, 2020,March 31, 2021, we had outstanding options to acquire 527,899 shares of our common stock, of which options to acquire 298,863433,202 shares were exercisable. The following summarizes all of our option transactions for the ninethree months ended September 30, 2020:March 31, 2021:
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, 2019478,951 $8.21 
Granted48,948 20.43 
Balance, September 30, 2020527,899 9.34 6.59$3,419,956 
Exercisable at September 30, 2020298,863 7.48 5.852,353,438 
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, 2020527,899 $9.34 
Granted
Balance, March 31, 2021527,899 9.34 6.09$6,549,853 
Exercisable at March 31, 2021433,202 8.35 5.725,806,804 
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Aggregate intrinsic value in the table above represents the total pretax intrinsic value (the difference between our closing stock price on September 30, 2020March 31, 2021 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 September 30, 2020.March 31, 2021. NaN options were exercised during the ninethree months ended September 30, 2020.March 31, 2021. As of September 30, 2020,March 31, 2021, total unrecognized stock-based compensation expense related to non-vested employee awards was $0.7$0.5 million which is expected to be recognized over a weighted average period of approximately 1.681.30 years.
DeepHealth Options
During the second quarter of fiscal 2020, in connection with the completion of the DeepHealth acquisition, we granted 412,434 options 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 September 30, 2020,March 31, 2021, total unrecognized stock based compensation expense related to non-vested DeepHealth options was approximately $4.3$3.4 million which is expected to be recognized over a weighted average period of approximately 2.532.07 years.
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, 2019
Granted, June 1, 2020412,434 $— 
Exercised(6,963)— 
Balance, September 30, 2020405,471 — 8.65$6,223,980 
Exercisable at September 30, 202024,211 — 8.65371,639 
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, 2020400,539 $— 
Exercised— 
Balance, March 31, 2021400,539 — 8.16$8,711,723 
Exercisable at March 31, 202133,647 — 8.16731,822 
Restricted Stock Awards
The Restated Plan permits the award of restricted stock awards (“RSA’s”). As of September 30, 2020,March 31, 2021, we have issued a total of 6,551,8727,152,934 RSA’s of which 331,659410,352 were unvested at September 30, 2020.March 31, 2021. The following summarizes all unvested RSA’s activities during the ninethree months ended September 30, 2020:March 31, 2021:
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RSA'sWeighted-Average
Remaining
Contractual
Term (Years)
Weighted-Average
Fair Value
RSA'sWeighted-Average
Remaining
Contractual
Term (Years)
Weighted-Average
Fair Value
RSA's unvested at December 31, 2019387,934 $11.61 
RSA's unvested at December 31, 2020RSA's unvested at December 31, 2020329,159 $16.69 
Changes during the periodChanges during the periodChanges during the period
GrantedGranted457,596 $19.66 Granted601,061 $18.77 
VestedVested(513,871)$15.47 Vested(519,868)$17.59 
RSA's unvested at September 30, 2020331,659 1.11$16.67 
RSA's unvested at March 31, 2021RSA's unvested at March 31, 2021410,352 1.20$17.71 
We determine the fair value of all RSA’s based on the closing price of our common stock on the award date.
Other stock bonus awards
The Restated Plan also permits the award of stock bonuses not subject to any future service period. These awards are valued and expensed based on the closing price of our common stock on the date of award. During the ninethree months ended September 30, 2020 awards totaling 26,078March 31, 2021 0 such shares were granted.
Plan summary
In summary, of the 14,000,000 shares of common stock reserved for issuance under the Restated Plan, at September 30, 2020,March 31, 2021, we had issued 15,384,31616,109,252 total shares between options, RSA’s and other stock awards. With options canceled and RSA’s forfeited amounting to 3,281,040 and 61,703 shares, respectively, there remain 1,958,4271,233,491 shares available under the Restated Plan for future issuance.
The DeepHealth options were issued outside of the Restated Plan and are a direct result of our acquisition and not included in the share count of the Restated Plan.
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NOTE 7 – SUBSEQUENT EVENTS
FormationRefinancing of majority owned subsidiaryBarclays Credit Facilities:
The Second Amended and Restated First Lien Credit and Guaranty Agreement (the "Restated Credit Agreement"):

On November 1, 2020April 23, 2021, we formedentered into the Restated Credit Agreement which provides for $725.0 million of senior secured first lien term loans and a $195.0 million senior secured revolving credit facility. The proceeds of the loans are being used to refinance the outstanding $611.0 million term and revolving loans, to pay fees and expenses associated with the refinancing transaction, to pay accrued interest on the previously existing facilities through the date of closing and to fund approximately $102.0 million to our balance sheet. The key terms of the Restated Credit Agreement are:

Interest Rates: Borrowings under the Restated Credit Agreement bear interest at either the Eurodollar Rate or the Alternate Base Rate and the floor for the term loans bearing interest at the Eurodollar Rate was reduced from a minimum of 1.00% to a minimum of 0.75%.

Maturity Dates: The maturity date for the term loans is April 23, 2028, and the maturity date for the revolving credit facility is April 23, 2026, in conjunctioneach case unless accelerated in accordance with Simi Valley Hospitalthe terms of the Restated Credit Agreement.

Payments: We will be required to make quarterly payments of principal on the terms loans in the amount of approximately $1.8 million compared to approximately $9.7 million under the prior credit agreement.
Acquisitions:
In the months of April and Health Services ("Simi Adventist") the Simi Valley Imaging Group, LLC (“SVIG”), consistingMay, 2021 we acquired certain business assets for purchase consideration of 3 multi-modality imaging centers located in Simi Valley, CA. RadNet will hold a 60% economic interest in SVIG and Simi Adventist will have the remaining 40% interest.approximately $5.0 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, 20192020 included in our Annual Report on Form 10-K for the fiscal year ended December 31, 20192020 filed with the U.S. Securities and Exchange Commission (SEC) on March 11, 2020.15, 2021.
Forward-Looking Statements
This quarterly report on Form 10-Q 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 operations, markets, services, prices and other factors.
In some cases, you can identify forward-looking statements by terminology such as “may,” “will,” “should,” “expect,” “intend,” “plan,” “anticipate,” “believe,” “estimate,” “predict,” “potential,” “continue,” “assumption” or the negative of these terms or other comparable terminology. Forward-looking statements in this current report include, among others, statements we make regarding
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our ability to successfully integrate new operations, to our business and the anticipated benefits to be derived from our investments, acquisitions, and joint ventures;
anticipated trends in our revenues, operating expenses and liquidity and cash flows, including our financial guidance and anticipated effects of cost-savings efforts;

the ongoing impact of the COVID-19 pandemic on our business, suppliers, payors, customers, referral sources, partners, patients and employees, including (i) government’s unprecedented action regarding existing
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and potential restrictions and/or obligations related to citizen and business activity to contain the virus; (ii) the consequences of an economic downturn resulting from the impacts of COVID-19 and the possibility of a global economic recession; (iii) the impact of the volume of canceled or rescheduled procedures, whether as a result of government action or patient choice; (iv) measures we are taking to respond to the COVID-19 pandemic, including changes to business practices; (v) the impact of government and administrative regulation, guidance and appropriations; (vi) changes in our revenues due to declining patient procedure volumes, changes in payor mix; (vii) potential increased expenses or workforce disruptions related to our employees that could lead to unavailability of key personnel; (viii) workforce disruptions related to our key partners, suppliers, vendors and others we do business with; (ix) the impact of return to work orders in certain states in which we operate; and (x) increased credit and collectability risks; and

our future liquidity and our continuing ability to service and remain in compliance with applicable debt covenants or refinance our current indebtedness.
Forward-looking statements are not guarantees of future performance and our actual results may differ significantly from the results discussed in the forward-looking statements. Factors that might cause such differences include, but are not limited to, the factors included in “Risk Factors,” in our annual report on Form 10-K for the fiscal year ended December 31, 2019 and quarterly report on form 10Q for the quarters ended March 31, and June 30, 2020 or supplemented by the information in Part II– Item 1A below. You should consider the inherent limitations on, and risks associated with, forward-looking statements and not unduly rely on the accuracy of predictions contained in such forward-looking statements.
These forward-looking statements speak only as of the date when they are made. We assume no obligation to revise or update any forward-looking statements for any reason, except as required by law.

Overview

We are a leading national provider of freestanding, fixed-site outpatient diagnostic imaging services in the United States based on number of locations and annual imaging revenue. At September 30, 2020,March 31, 2021, we operated, directly or indirectly through joint ventures with hospitals, 334346 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 and may reduce unnecessary invasive procedures, often reducing the cost and amount of care for patients. 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. In addition to our imaging services, we own and operate a number of technology businesses that are complementary to our imaging business. Our subsidiary eRAD, Inc., develops and sells computerized systems for the diagnostic imaging industry, which provide the technology to distribute, display, store and retrieve digital images. Over 2019 and 2020 weWe have made a number of investments in Artificial Intelligence (AI) with our purchases of Nulogix and DeepHealth, combined with our investment in Whiterabbit.ai and our collaborative arrangement with Hologic. Our current AI focus is to develop solutions in machine learning to assist radiologists and other clinicians in interpreting images and improving patient care, initially in the field of mammography.

We derive substantially all of our revenue, directly or indirectly, from fees charged for the diagnostic imaging services performed at our facilities. The following table shows our facilities in operation and revenues for the ninethree months ended September 30, 2020March 31, 2021 and September 30, 2019:March 31, 2020:
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Nine Months Ended September 30, Three Months Ended March 31,
20202019 20212020
Facilities in operationFacilities in operation334340 Facilities in operation346335 
Net revenues (millions)Net revenues (millions)$763.9 $853.3 Net revenues (millions)$315 $282 
Our revenue is derived from a diverse mix of payors, including private, payors, managed care capitated payors and government payors. We believe our payor diversity mitigates our exposure to possible unfavorable reimbursement trends within any one payor class. In addition, our experience with capitation arrangements over the last several years has provided us with the expertise to manage utilization and pricing effectively, resulting in a predictable stream of revenue.
The Company’s
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Our total service revenue during the three and nine months ended September 30,March 31, 2021 and 2020 and 2019 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 September 30,Nine Months Ended September 30,Three Months Ended March 31,
2020201920202019 20212020
Commercial insuranceCommercial insurance$160,524 $163,152 $412,415 $475,064 Commercial insurance$182,096 $155,461 
MedicareMedicare62,704 61,599 154,847 175,825 Medicare63,589 57,749 
MedicaidMedicaid7,098 7,128 18,072 21,564 Medicaid8,451 6,628 
Workers' compensation/personal injuryWorkers' compensation/personal injury7,183 10,865 25,705 32,950 Workers' compensation/personal injury10,399 10,274 
Other patient revenueOther patient revenue8,328 6,085 17,211 17,947 Other patient revenue4,775 5,662 
Management fee revenueManagement fee revenue2,675 1,792 8,574 5,662 Management fee revenue5,219 2,567 
Teleradiology and Software revenueTeleradiology and Software revenue2,349 4,412 8,319 12,861 Teleradiology and Software revenue2,426 3,770 
OtherOther5,869 6,875 15,617 20,878 Other2,622 6,222 
Service fee revenueService fee revenue256,730 261,908 660,760 762,751 Service fee revenue279,577 248,333 
Revenue under capitation arrangementsRevenue under capitation arrangements35,046 30,784 103,145 90,587 Revenue under capitation arrangements35,742 33,231 
Total service revenueTotal service revenue$291,776 $292,692 $763,905 $853,338 Total service revenue$315,319 $281,564 

We typically experience some seasonality to our revenue stream. DuringAlthough we had a resurgence in procedure volumes for the first quarter of each yearended March 31, 2021, it is in this time period that we generally experience the lowest volumes of procedures and the lowest level of revenue for any quarter during the year. It is common for inclement weather to result in patient appointment cancellations and, in some cases, imaging center closures. Second,Also, in recent years, we have observed greater participation in high deductible health plans by patients.  As these high deductibles reset in January for most of these patients, we have observed that patients utilize medical services less during the first quarter, when securing medical care will result in significant out-of-pocket expenditures.

Recent Developments

The discussion below of our results below centers on our performance in the thirdfirst quarter ending September 30, 2020. As discussed in our Form 8-K filed on April 3,March 31, 2021. During 2020, with the overall impactonset of the novel strain of the coronavirus pandemic on RadNet’s business has had("COVID-19") and could continue to have a material impact on our operating results, cash flows and financial position. The magnitude of the impact will ultimately depend on the duration and extent of the COVID-19 pandemic and the impact of governmental actions and patient behavior in response to the pandemic, which remains ongoing.

As as result of the pandemicrelated responses, we began experiencing reduced procedure volumes in mid-Marchat the end of the first quarter which intensified through the early part of the second quarter of 2020. As economic activity has begun to ramp-up, our proceduremid year. Procedure volumes have returned to our90% of pre-COVID-19 pace from a low of 28% pre-COVID-19 volumes experienced in April 2020. Our experience has shownthe third quarter and remained consistent at that lost imaging slots in one quarter are not made up within that period or in subsequent quarters. We continue to adapt our operationslevel through the fourth quarter. During 2020, in response to the pandemic, where needed and implemented several cost-saving measures such aswe adjusted our business operations, inclusive of concentrating patient traffic to larger imaging centers, negotiating payment terms with vendors and landlords, adjusting staff levelsinitiating employee furloughs, compensation reductions, and telecommuting.

As we enter 2021, the arrival of the mRNA vaccine to protect against the virus is a welcome development. As inoculations ramp up across the country and other mitigation procedures continue, we can begin to look forward to a return of normal business operations. We expect that the cost saving measures implemented in 2020 will be beneficial to our financial position in 2021, provided that procedure volumes continue to ramp back up to historic levels. Despite the impact of COVID-19, we continued to invest and position for future growth. We acquired 10 new centers in the New York City area during the quarter ended March 31, 2021.
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Equity Investments, Acquisitions and Dispositions, and Joint Venture Activity
We have developed our medical imaging business through a combination of organic growth, equity investments, acquisitions and joint venture formations. The information below updates our activity of such matters contained in our annual report on Form 10-K for the year ended December 31, 2019.2020.
Equity Investments
As of September 30, 2020,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 followsfollows:
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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. On March 24, 2017, we acquired an initial 12.5%Our investment of $1.2 million represents a 14.21% equity interest in Medic Vision for $1.0 million. We also received an option to exercise warrants to acquire up to an additional 12.5% equity interest for $1.4 million within one year from the initial share purchase date, if exercised in full. On March 1, 2018 we exercised our warrant in part and acquired an additional 1.96% for $0.2 million. Our initial equity interest has been diluted to 12.25% and our total equity investment stands at 14.21%. In accordance with accounting guidance, as we exercise no significant influence over Medic Vision’s operations, the investment is recorded at its cost of $1.2 million, given that the fair value is not readily determinable.company. No observable price changes or impairment in our investment was identified as of September 30, 2020.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 September 30, 2020.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 the principalin support of which is due November 2022. To leverage their artificial intelligence expertise, we entered into a software subscription service contract to assist our radiology work flow and advanced them $4.0 million for future software subscription fees that is recorded as a prepaid expense in Prepaid and Other Current assets in our consolidated balance sheets.it operations. No observable price changes, or impairment in our investment or impairment of the loan receivable was identified as of September 30, 2020.March 31, 2021.
Facility acquisitions

Facility acquisitions
On August 31, 2020During the first quarter of 2021, we completed ourthe acquisition of certain assets of AZ-Tech Radiology & Open MRI, LLC, consisting of eight multi-modality imaging centersthe following entities, all located in the Phoenix, Arizona area for purchase consideration of $5.5 million.New York city area. We made a preliminary fair value determination of the acquired assets and assumed liabilities and approximately $2.5the 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 propertyassets for a 60% economic interest and equipment, $7.6 million in right-of-useSimi Adventist contributed assets totaling $0.1 million in other assets, $7.6 million in operating lease liabilities, and $2.9 million in goodwill were recorded.for a 40% economic interest.
On June 1, 2020, we completed our acquisition of all the equity interests of DeepHealth Inc., ("DeepHealth") an artificial intelligence and machine learning company in an all stock purchase. As initial purchase consideration, we issued 915,132 shares at $16.93 per share (823,615 issued at execution, with up to 91,517 shares to be issued 18 months after acquisition subject to adjustment for any indemnification claims). The transaction was accounted for as an acquisition of a business and total purchase consideration determined to be approximately $34.6 million including i) 823,615 shares issued on the date of closing with fair value of $13.9 million, ii) a liability of 91,517 shares with a fair value of $1.5 million to be issued 18 months after acquisition subject to adjustment for any indemnification claims and will be marked to market in subsequent periods, iii) replacement awards attributable to pre-combination service issued to DeepHealth option holders with allocated fair value of $2.0 million, iv) acquisition date fair value of contingent consideration of $17.0 million and v) $0.1 million in closing costs reimbursed to the seller. The fair values of replacement awards attributable to pre-combination service and contingent consideration are recorded in additional paid in capital upon closing of the transaction. For the contingent consideration, there are three arrangements that will be settled in a fixed number of shares upon achievement of three individual specific milestones which are mutually exclusive of each other, with 390,789, 586,184, and 195,393 shares, respectively, issuable for each milestone arrangement. The fair value of the contingent consideration was estimated at the date of acquisition based on our share price and estimated probability of the achievement of the respective milestones. We preliminarily recorded $0.1 million in current assets, $3.5 million in deferred tax liabilities, $14.8 million in intangible assets, primarily in-process research andJoint Venture Activity
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development ("IPR&D'), and $23.4 million in goodwill. The goodwill is primarily attributable to expected post-acquisition synergies from integrating DeepHealth’s assembled workforce and IPR&D technologies. The fair values of the identifiable intangible assets related to IPR&D were determined by the income method and the assets will not be amortized until completion.
On March 2, 2020 our consolidated subsidiary New Jersey Imaging Networks ("NJIN") completed the acquisition of certain assets of MRI at Woodbridge, LLC consisting of a single multi-modality imaging center located in Avenel, New Jersey for consideration of $2.6 million. NJIN made a fair value determination of the acquired assets and assumed liabilities and approximately $0.5 million in property and equipment, $1.1 million in right-of-use assets, $0.3 million in intangible assets, $1.1 million in operating lease liabilities, $0.1 million in finance lease liabilities, and $1.8 million in goodwill were recorded.

    On January 2, 2020 we completed our acquisition of certain assets of Olney Open MRI, LLC, consisting of a single multi-modality imaging center located in Columbia, Maryland for consideration of $1.8 million. We have made a fair value determination of the acquired assets and assumed liabilities and approximately $0.8 million in property and equipment, $1.3 million in right-of-use assets, $0.3 million in intangible assets, $1.3 million in operating lease liabilities and $0.6 million in goodwill were recorded.
Dispositions:
On June 1, 2020 we completed our sale of certain assets of our Imaging On Call subsidiary to RadVantage P.C. (an unrelated corporation) for approximately $1.0 thousand. With this transaction, we have exited the teleradiology business.
Joint venture investment contribution
During the month of August 2020, we made additional cash contributions to our Santa Monica Imaging Group, LLC partnership in the amount of $1.6 million in support of its expanded operations. We maintain our 35% economic interest in the partnership.
Joint Venture Activity
The following table is a summary of our investment in joint ventures during the ninethree months ended September 30, 2020March 31, 2021 (in thousands):
Balance as of December 31, 20192020$34,47034,528 
Equity in earnings in these joint ventures5,1762,285 
Balance as of September 30, 2020March 31, 2021$35,57136,813 
We charged management service fees from the centers underlying these joint ventures of approximately $2.7$5.2 million and $1.8$2.6 million for the three months ended September 30,March 31, 2021 and 2020, and 2019, respectively. and $8.6 million and $7.8 million for the nine months ended September 30, 2020 and 2019, respectively. We eliminate any unrealized portion of our management service fees with our equity in earnings of joint ventures.
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The following table is a summary of key balance sheet data for these joint ventures as of September 30, 2020March 31, 2021 and December 31, 20192020 and income statement data for the ninethree months ended September 30,March 31, 2021 and 2020 and 2019 (in thousands):
Balance Sheet Data:Balance Sheet Data:September 30,
2020
December 31,
2019
Balance Sheet Data:March 31,
2021
December 31,
2020
Current assetsCurrent assets$26,618 $27,427 Current assets$33,265 $27,085 
Noncurrent assetsNoncurrent assets70,576 61,037 Noncurrent assets68,493 68,686 
Current liabilitiesCurrent liabilities(10,487)(9,217)Current liabilities(13,929)(12,545)
Noncurrent liabilitiesNoncurrent liabilities(22,751)(18,872)Noncurrent liabilities(21,371)(21,582)
Total net assetsTotal net assets$63,956 $60,375 Total net assets$66,458 $61,644 
Book value of RadNet joint venture interestsBook value of RadNet joint venture interests$29,121 $28,001 Book value of RadNet joint venture interests$30,351 $28,079 
Cost in excess of book value of acquired joint venture interestsCost in excess of book value of acquired joint venture interests6,450 6,469 Cost in excess of book value of acquired joint venture interests6,462 6,449 
Total value of Radnet joint venture interests$35,571 $34,470 
Total value of RadNet joint venture interestsTotal value of RadNet joint venture interests$36,813 $34,528 
Total book value of other joint venture partner interests$34,835 $32,374 
Income statement data for the nine months ended September 30,20202019
Income statement data for the three months ended March 31, 2021Income statement data for the three months ended March 31, 202120212020
Net revenueNet revenue$78,988 $80,115 Net revenue$31,718 $26,341 
Net incomeNet income$13,651 $13,718 Net income$4,803 $4,245 
Critical Accounting Policies
The Securities and Exchange Commission defines critical accounting estimates as those that are both most important to the portrayal of a company’s financial condition and results of operations and require management’s most difficult, subjective or complex judgment, often as a result of the need to make estimates about the effect of matters that are inherently uncertain and may change in subsequent periods. In Note 2 to our consolidated financial statements in this quarterly report and in our annual report on Form 10-K for the year ended December 31, 2019,2020, we discuss our significant accounting policies, including those that do not require management to make difficult, subjective or complex judgments or estimates. The most significant areas involving management’s judgments and estimates are described below.
RevenuesUse of Estimates

The financial statements were prepared in accordance with U.S. generally accepted accounting principles (GAAP), which requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. These estimates and assumptions affect various matters, including our reported amounts of assets and liabilities in our consolidated balance sheets at the dates of the financial statements; our disclosure of contingent assets and liabilities at the dates of the financial statements; and our reported amounts of revenues and expenses in our consolidated statements of operations during the reporting periods. These estimates involve judgments with respect to numerous factors that are difficult to predict and are beyond management’s control. As a result, actual amounts could materially differ from these estimates.
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
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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, changes in business and economic conditions, and the frequent changes in managed care contractual terms resulting from contract renegotiationsre-negotiations 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 otherothers 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.

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Our revenues are based upon the estimatedour management's estimate of amounts we expect to be entitled to receive from patients and third-party payors. Estimates of contractual allowances under Medicare, Medicaid, managed care and commercial insurance plans are based upon historical collection experience of the payments received from such payors in accordance with the underlying contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have price concessions applied. 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 estimates and assumptions related to revenue recognition did not change materially for the quarter ended March 31, 2021.

Provider Relief Fund (COVID-19 Stimulus Funding)
The Provider Relief Fund offers government assistance to eligible providers throughout the healthcare system in support of certain expenses or lost revenue attributable to the coronavirus pandemic. InWe have recorded provider relief funding in our condensed Consolidated Statements of Operations in the third quarteramount of 2020, we received approximately $0.2$6.2 million in funding and for ninethree months ended September 30, 2020 we have received funding of $25.7 million.March 31, 2021. Generally, the department of Health and Human Services ("HHS") does not intend to recoup funds as long as a provider's lost revenue and increased expenses exceed the amount of provider relief funding one has received. HHS reserves the right to audit Relief Fund recipients in the future to ensure that this requirement is met and collect any Relief Fund amounts that were made in error or exceed lost revenue or increased expenses due to the pandemic. Failure to comply with the terms and conditions may be grounds for recoupment. In recognizing revenue associated with provider relief funding our management is required to assess whether our operations have meet the applicable requirements for the funding received. During the quarter ended September 30, 2020,March 31, 2021, we continued to evaluate our operating results in light of the most recent government guidance and gave consideration to the updated reporting guidelines issued in September by the U.S. Department of Health and Human Services that significantly changed the measurement of Provider Relief Fund distributions providers are able to retain. Basedbased on our assessment, recognitionthe amount of the revenue previously recognized remainedis appropriate.
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. Receivables generally are collected within industry norms for third-party payors. 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. In regards toOur estimates and assumptions for allowances on our account receivable did not change materially during the credit loss standard, our expectation is that the historical credit loss experienced across our receivable portfolio is materially similar to any current expected credit losses that would be estimated under the CECL model.quarter ended March 31, 2021.
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, including tax planning strategies, in determining whether our net deferred tax assets are more likely than not to be realized.
Deferred Revenue
In April of 2020, we received approximately $39.4 million in advanced Medicare payments from the Centers for Medicare and Medicaid Services ("CMS") as part of the expanded Accelerated and Advance Payment Program under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. As these payments are required to be repaid to CMS beginning 120 days after their receipt through offsets from new Medicare claims over a three month period, we have recorded amounts received to deferred revenue which will be amortized as Medicare reimbursements are earned. In addition, in May of 2020 we received $5.0 million in advance payments from an insurance carrier with similar repayment terms as the CMS.
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 rangeBusiness Combination
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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
We evaluate all purchasesacquisitions under the framework in ASU No. 2017-01 (“ASU 2017-01”), Clarifying the Definition of a Business.Business in the accounting guidance.. Once thea purchase has been determined to be the acquisition of a business, we are required to recognize separately from goodwill the assets acquired and the liabilities assumed at their acquisition date fair values. Goodwill asAny portion of the acquisition date is measured as thepurchase consideration transferred in excess of consideration transferred over the net of the acquisition date fair values of the assets acquired and the liabilities assumed, is allocated to goodwill. The allocation requires our management to make estimates of the value of various assets acquired and 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 September 30, 2020March 31, 2021 totaled $470.7$502.6 million. Indefinite Lived Intangible Assets at September 30, 2020March 31, 2021 were $11.3$7.1 million and are associated with the value of certain trade name intangibles. Goodwill and trade name intangibles are recorded asOur management reviews the fair value of our reporting units on an annual basis to determine if an event has occurred which suggest that the fair value of a result of business combinations.reporting unit may be impaired. When 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. The review of fair value requires our management to make assessments of the business and financial prospects for a particular reporting unit. We tested goodwill for impairment on October 1, 2019. In addition2020. We also continue at regular intervals to the annual impairment test, we regularly assess if an event has occurred which would require interim impairment testing. We consideredconsider the current and expected future economic and market conditions surrounding the novel strain of coronavirus ("COVID-19")COVID-19 pandemic and didto date have not identifyhad an indication of goodwill impairment being more likely than not through September 30, 2020.
Long-Lived Assets
We evaluate our long-lived assets (property and equipment) and intangibles, other than goodwill, for impairment whenever indicators of impairment exist. To evaluate the long-lived assets our management estimates the undiscounted future cash flows expected to be derived from the asset. The accounting standards require that if the sum of the undiscounted expected future cash flows from a long-lived asset or definite-lived intangible is less than the carrying value of that asset, an asset impairment charge must be recognized. The amount of the impairment charge is calculated as the excess of the asset’s carrying value over its fair value, which generally represents the discounted future cash flows from that asset or in the case of assets we expect to sell, at fair value less costs to sell. No indicators of impairment were identified with respect to our long-lived assets as of September 30, 2020.
Depreciation and Amortization of Long-Lived Assets
We depreciate our long-lived assets over their estimated economic useful lives with the exception of leasehold improvements where we use the shorter of the assets useful lives or the lease term of the facility for which these assets are associated. We estimate the economic useful lives of assets, other than leasehold improvements, to be between 3 and 15 years depending on the type of asset.
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
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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 in 2020. 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, 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 4, Facility Acquisitions and Note 6, Stock-Based Compensation, for more information.
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.

31, 2021.
Recent Accounting Standards
See Note 3, Recent Accounting and Reporting Standards to the financial statements included in this report orfor further information.
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Results of Operations
The following table sets forth, for the three and nine months ended September 30,March 31, 2021 and 2020, and 2019, the percentage that certain items in the statements of operations bears to total service revenue, inclusive of revenue under capitation contracts.
RADNET, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(IN THOUSANDS EXCEPT SHARE DATA)
(unaudited)
Three Months Ended
September 30,
Nine Months Ended
September 30,
Three Months Ended
March 31,
2020201920202019 20212020
REVENUEREVENUE    REVENUE  
Service fee revenue Service fee revenue88.0 %89.5 %86.5 %89.4 % Service fee revenue88.7 %88.2 %
Revenue under capitation arrangements Revenue under capitation arrangements12.0 %10.5 %13.5 %10.6 % Revenue under capitation arrangements11.3 %11.8 %
Total service revenueTotal service revenue100.0 %100.0 %100.0 %100.0 %Total service revenue100.0 %100.0 %
Provider relief funding Provider relief funding0.1 %— %3.4 %— % Provider relief funding2.0 %— %
OPERATING EXPENSESOPERATING EXPENSES  OPERATING EXPENSES
Cost of operations, excluding depreciation and amortization Cost of operations, excluding depreciation and amortization84.5 %86.9 %92.7 %87.2 % Cost of operations, excluding depreciation and amortization89.5 %95.0 %
Depreciation and amortization Depreciation and amortization7.3 %7.0 %8.4 %7.1 % Depreciation and amortization7.2 %7.8 %
Loss on sale and disposal of equipment and other0.1 %0.3 %0.1 %0.2 %
(Gain) loss on sale and disposal of equipment and other (Gain) loss on sale and disposal of equipment and other(0.4)%0.3 %
Severance costs Severance costs0.2 %— %0.2 %0.1 % Severance costs0.1 %0.1 %
Total operating expensesTotal operating expenses92.1 %94.2 %101.4 %94.6 %Total operating expenses96.4 %103.1 %
INCOME FROM OPERATIONS8.0 %5.8 %1.9 %5.4 %
INCOME (LOSS) FROM OPERATIONSINCOME (LOSS) FROM OPERATIONS5.6 %(3.1)%
OTHER INCOME AND EXPENSESOTHER INCOME AND EXPENSES    OTHER INCOME AND EXPENSES  
Interest expense Interest expense3.8 %4.1 %4.4 %4.3 % Interest expense4.1 %4.1 %
Equity in earnings of joint ventures Equity in earnings of joint ventures(0.8)%(0.7)%(0.7)%(0.7)% Equity in earnings of joint ventures(0.7)%(0.7)%
Non-cash change in fair value of interest rate hedge Non-cash change in fair value of interest rate hedge0.2 %— %0.6 %— % Non-cash change in fair value of interest rate hedge(3.6)%— %
Other (income) expenses— %— %— %0.1 %
Total other expenses3.2 %3.4 %4.3 %3.7 %
Other expenses Other expenses0.1 %— %
Total other (income) expensesTotal other (income) expenses(0.2)%3.4 %
INCOME (LOSS) BEFORE INCOME TAXESINCOME (LOSS) BEFORE INCOME TAXES4.8 %2.4 %(2.3)%1.7 %INCOME (LOSS) BEFORE INCOME TAXES5.8 %(6.5)%
(Provision for) benefit from income taxes (Provision for) benefit from income taxes(1.3)%(0.6)%0.7 %(0.4)% (Provision for) benefit from income taxes(1.4)%1.6 %
NET INCOME (LOSS)NET INCOME (LOSS)3.5 %1.7 %-1.7 %1.3 %NET INCOME (LOSS)4.4 %(5.0)%
Net income attributable to noncontrolling interests Net income attributable to noncontrolling interests1.4 %0.6 %1.1 %0.7 % Net income attributable to noncontrolling interests1.4 %0.8 %
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERSNET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS2.1 %1.1 %(2.6)%0.5 %NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS3.0 %(5.8)%

We have developed our medical imaging business through a combination of organic growth, equity investments, acquisitions and joint venture formations. We have segregated some of our information to demonstrate which is attributable to centers that were in operation through the entirety of the comparison period, and which is attributable to those that were acquired or disposed of during the period. The discussion below shows a breakdown and analysis of revenue and expenses for the three and nine months ended September 30,March 31, 2021 and 2020 and 2019 for our operations at a total company and same center level.
Three Months Ended September 30, 2020March 31, 2021 Compared to the Three Months Ended September 30, 2019March 31, 2020
Total Revenue inclusive of Provider Relief funding where applicable for 2021 and 2020
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In ThousandsIn ThousandsThree Months Ended September 30,In ThousandsThree Months Ended March 31,
RevenueRevenue20202019$ Increase/(Decrease)% ChangeRevenue20212020$ Increase/(Decrease)% Change
Total RevenueTotal Revenue$291,997$292,692$(695)(0.2)%Total Revenue$321,567$281,564$40,00314.2%
Same Center RevenueSame Center Revenue$288,919$288,700$2190.1%Same Center Revenue$304,696$277,990$26,7069.6%
Our nationwide operations were affectedIncreased revenue was spurred by the COVID-19 pandemic starting mid March 2020 and has resulted in an approximate 5% decrease inoverall same center procedural5.1% growth in procedure volumes compared toover the same period lastin the prior year. Same Center Revenue however remained flat dueOn a same center basis, Mammography procedures rose 15.1%, followed by advanced radiology procedures of PET and CT, which expanded at a combined 8.7%. The growth in Mammography procedures was precipitated by our investment in the use of artificial intelligence, which is employed to keep track of patient data, catalog findings, and drive patient notification so a 14% riseregular exam schedule is maintained. Assisting in the revenue under capitation arrangements stemming from a combination ofincrease was $6.2 million received in Provider Relief funding and annual contractual rate increases plan membership growthin capitation and higher copays.fee for service plans. This same center comparison excludes revenue contributions from centers that were acquired or divested subsequent to JulyJanuary 1, 2019.2020. For the three months ended September 30,March 31, 2021, net service fee revenue from centers that were acquired or divested subsequent to January 1, 2020 and excluded from the above comparison was $16.9 million. For the three months ended March 31, 2020, net service fee revenue from centers that were acquired or divested subsequent to JulyJanuary 1, 20192020 and excluded from the above comparison was $3.1 million. For the three months ended September 30, 2019, net service fee revenue from centers that were acquired or divested subsequent to July 1, 2019 and excluded from the above comparison was $4.0$3.6 million.

Operating Expenses

Total operating expenses for the three months ended September 30, 2020 decreasedMarch 31, 2021 increased approximately $7.2$13.6 million, or 2.6%4.7%, from $275.8$290.3 million for the three months ended September 30, 2019March 31, 2020 to $268.6$303.9 million for the three months ended September 30, 2020.March 31, 2021. The following table sets forth a breakdown of our cost of operations and total operating expenses for the three months ended September 30,March 31, 2021 and 2020 and 2019 (in thousands): 
Three Months Ended
September 30,
Three Months Ended
March 31,
20202019 20212020
Salaries and professional reading fees, excluding stock-based compensationSalaries and professional reading fees, excluding stock-based compensation$149,970 $160,757 Salaries and professional reading fees, excluding stock-based compensation$177,861 $167,528 
Stock-based compensationStock-based compensation2,067 1,381 Stock-based compensation8,248 6,622 
Building and equipment rentalBuilding and equipment rental26,703 26,850 Building and equipment rental28,711 26,896 
Medical suppliesMedical supplies12,498 12,313 Medical supplies13,970 12,748 
Other operating expenses *
Other operating expenses *
55,225 53,082 
Other operating expenses *
53,491 53,623 
Cost of operationsCost of operations246,463 254,383 Cost of operations282,281 267,417 
Depreciation and amortizationDepreciation and amortization21,247 20,490 Depreciation and amortization22,656 21,934 
(Gain) loss on sale and disposal of equipment(Gain) loss on sale and disposal of equipment342 917 (Gain) loss on sale and disposal of equipment(1,307)771 
Severance costsSeverance costs571 52 Severance costs285 218 
Total operating expensesTotal operating expenses$268,623 $275,842 Total operating expenses$303,915 $290,340 
    *Includes billing fees, office supplies, repairs and maintenance, insurance, business tax and license, outside services, telecom, utilities, marketing, travel and other expenses.
The discussion below provides additional information and analysis on changes in our various operating expenses for the three months ended March 31, 2021 and 2020 (in thousands):
Salaries and professional reading fees, excluding stock-based compensation and severance
In ThousandsIn ThousandsThree Months Ended September 30,In ThousandsThree Months Ended March 31,
Salaries and Professional FeesSalaries and Professional Fees20202019$ Increase/(Decrease)% ChangeSalaries and Professional Fees20212020$ Increase/(Decrease)% Change
Total SalariesTotal Salaries$149,970$160,757$(10,787)(6.7)%Total Salaries$177,861$167,528$10,3346.2%
Same Center SalariesSame Center Salaries$146,698$158,270$(11,572)(7.3)%Same Center Salaries$168,803$164,287$4,5162.8%

The decreasemoderate rise in same center salaries expense was a result of staff furloughs and salary reductions initiated in responsecorresponded to the COVID-19 pandemic. During this time, we have reengineered our workflow to improve efficiency and make workforce adjustments as necessary resulting in reductions to payroll overall.added professional staff requisite for radiology study interpretation that stemmed from higher procedure volumes. This same center comparison excludes expenses from
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centers that were acquired or divested subsequent to January 1, 2020. For the three months ended March 31, 2021, salaries and professional reading fees from centers that were acquired or divested subsequent to JulyJanuary 1, 2019.2020 and excluded from the above comparison was $9.1 million. For the three months ended September 30,March 31, 2020, salaries and professional reading fees from centers that were acquired or divested subsequent to JulyJanuary 1, 2019 and excluded from the above comparison was $3.3 million. For the three months ended September 30, 2019, salaries and professional reading fees from centers that were acquired or divested subsequent to July 1, 20192020 and excluded from the above comparison was approximately $2.5$3.2 million.
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Stock-based compensation

Stock-based compensation increased $0.7$1.6 million, or 49.7%24.6% to approximately $2.1$8.2 million for the three months ended September 30, 2020March 31, 2021 compared to $1.4$6.6 million for three months ended September 30, 2019.March 31, 2020. This increase was driven by the higher fair value of RSA’s awarded and vested in the thirdfirst quarter of 20202021 as compared to RSA’s awarded and vested in the prior year’s thirdfirst quarter.
Building and equipment rental
In ThousandsIn ThousandsThree Months Ended September 30,In ThousandsThree Months Ended March 31,
Building & Equipment RentalBuilding & Equipment Rental20202019$ Increase/(Decrease)% ChangeBuilding & Equipment Rental20212020$ Increase/(Decrease)% Change
TotalTotal$26,703$26,850$(147)(0.6)%Total$28,711$26,896$1,8156.8%
Same CenterSame Center$25,839$25,968$(129)(0.5)%Same Center$25,685$25,671$140.1%

This same center comparison excludes expenses from centers that were acquired or divested subsequent to JulyJanuary 1, 2019.2020. For the three months ended September 30,March 31, 2021, building and equipment rental expenses from centers that were acquired or divested subsequent to January 1, 2020 and excluded from the above comparison was $3.0 million. For the three months ended March 31, 2020, building and equipment rental expenses from centers that were acquired or divested subsequent to JulyJanuary 1, 2019 and excluded from the above comparison was $0.9 million. For the three months ended September 30, 2019, building and equipment rental expenses from centers that were acquired or divested subsequent to July 1, 20192020 and excluded from the above comparison was approximately $0.9$1.2 million.
Medical supplies
In ThousandsIn ThousandsThree Months Ended September 30,In ThousandsThree Months Ended March 31,
Medical Supplies ExpenseMedical Supplies Expense20202019$ Increase/(Decrease)% ChangeMedical Supplies Expense20212020$ Increase/(Decrease)% Change
TotalTotal$12,498$12,313$1851.5%Total$13,970$12,748$1,2229.6%
Same CenterSame Center$12,374$12,143$2311.9%Same Center$13,370$12,596$7746.2%

MedicalHigher same center medical supplies expense remained essentially flat compared to the same period in the prior year, with the nominal increase related to securingadditional consumption of contrast agents in our advanced imaging modalities driven by volume increases of CT and PET procedures and cost of personal protective equipment forin support of staff and patient safety. This same center staff. This comparison excludes expenses from centers that were acquired or divested subsequent to JulyJanuary 1, 2019.2020. For the three months ended September 30, 2020,March 31, 2021, medical supplies expenses from centers that were acquired or divested subsequent to JulyJanuary 1, 20192020 and excluded from the above comparison was $0.1$0.6 million. For the three months ended September 30, 2019,March 31, 2020, medical supplies expense from centers that were acquired or divested subsequent to JulyJanuary 1, 20192020 and excluded from the above comparison was $0.2 million.
Other operating expenses
In ThousandsIn ThousandsThree Months Ended September 30,In ThousandsThree Months Ended March 31,
Other Operating ExpensesOther Operating Expenses20202019$ Increase/(Decrease)% ChangeOther Operating Expenses20212020$ Increase/(Decrease)% Change
TotalTotal$55,225$53,082$2,1424.0%Total$53,491$53,623$(133)(0.3)%
Same CenterSame Center$54,053$52,165$1,8883.6%Same Center$49,900$52,594$(2,694)(5.1)%

The riseSavings in same center other operating expenses resultedreflects the cumulative effect of successful contract re-negotiations aimed to reduce charges across a range of vendors from seasonal utilities usagerepair and outside services, offset by reductions in insurance charges and other expenses.maintenance to professional services. This same center comparison excludes expenses from centers that were acquired or divested subsequent to JulyJanuary 1, 2019.2020. For the three months ended September 30,March 31, 2021, other operating expense from centers that were acquired or divested subsequent January 1, 2020 and excluded from the above comparison was $3.6 million. For the three months ended March 31, 2020, other operating expense from centers that were acquired or divested subsequent Julyto January 1, 2019 and excluded from the above comparison2020 was $1.2 million. For the three months ended September 30, 2019, other operating expense from centers that were acquired or divested subsequent to July 1, 2019 was $0.9$1.0 million.
Depreciation and amortization
In ThousandsThree Months Ended September 30,
Depreciation & Amortization20202019$ Increase/(Decrease)% Change
Total$21,247$20,490$7583.7%
Same Center$20,505$19,912$5933.0%
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In ThousandsThree Months Ended March 31,
Depreciation & Amortization20212020$ Increase/(Decrease)% Change
Total$22,656$21,934$7233.3%
Same Center$20,952$21,470$(518)(2.4)%

The increase inThis same center depreciation and amortization is primarily due to additional equipment and leasehold improvements placed in service in the third quarter in 2020 over the third quarter in 2019. This comparison excludes expenses from centers that were acquired or divested subsequent to JulyJanuary 1, 2019.2020. For the three months ended September 30, 2020,March 31, 2021, depreciation expense from centers that were acquired or divested subsequent to JulyJanuary 1, 20192020 and excluded from the above comparison was $0.7$1.7 million. For the three months ended September 30, 2019,March 31, 2020, depreciation and amortization from centers that were acquired or divested subsequent to JulyJanuary 1, 20192020 and excluded from the above comparison was $0.6$0.5 million.
LossGain on sale and disposal of equipment and other

We recorded lossesgains on the disposal of equipment and other items of approximately $0.3$1.3 million for the three months ended September 30, 2020March 31, 2021 and a loss on sale and disposal of equipment of approximately $0.9$0.8 million for the three months ended September 30, 2019.March 31, 2020.
Non-cash change in fair value of interest rate hedge

We recorded expensea gain of $0.7$11.2 million for the ineffective portion of our 2019 Swaps for the three months ended September 30, 2020.March 31, 2021.
Other (income) expenses

We recorded other incomeexpenses of approximately $0.1$0.2 million for the three months ended September 30, 2020 and other expenses of approximately $0.0 millionMarch 31, 2021. Amounts for the three months ended September 30, 2019 related to refinancing of our term loan debt and legal contingency charges.corresponding period ending March 31, 2020 were immaterial.
Severance Costs

We incurred severance expenses of $0.6$0.3 million for the three months ended September 30, 2020March 31, 2021 and $0.1$0.2 million for the three months ended September 30, 2019.March 31, 2020.
Interest expense
In ThousandsIn ThousandsThree Months Ended September 30,In ThousandsThree Months Ended March 31,
Interest ExpenseInterest Expense20202019$ Increase/(Decrease)% ChangeInterest Expense20212020$ Increase/(Decrease)% Change
Total Interest ExpenseTotal Interest Expense$11,061$11,895Total Interest Expense$12,826$11,552$1,27411.0 %
Interest related to derivatives*Interest related to derivatives*$1,603$(288)Interest related to derivatives*$3,650$362
Interest payable on debt obligations**$9,458$12,183$(2,725)(22.4)%
Interest related to amortization***$1,103$1,081
Adjusted Interest Expense$8,355$11,102$(2,747)(24.7)%
Interest related to amortization**Interest related to amortization**$1,147$1,081
Adjusted Interest Expense***Adjusted Interest Expense***$8,029$10,109$(2,080)(20.6)%
* Includes interest on 2016 capscurrent and 2019 swapsprior derivative instruments not related to debt obligations.
** Includes interest related to on our term loans, revolving credit line, notes, finance leases, and other
***Includes combined noncash amortization of deferred loan costs and discount on issuance of debt.
***Includes interest related to our term loans, revolving credit line,notes, finance leases and other.

Excluding the effect of interest expense forrelated to derivatives and amortization for the three months ended September 30, 2020March 31, 2021 compared to the three months ended September 30, 2019,March 31, 2020, interest expense decreased $2.7$2.1 million, or 24.7%20.6%. The reduction in interest expense corresponds to lowered variable LIBOR and Prime interest rates paid on our term loan and revolving debt in reaction tobased on market conditions surrounding COVID-19.conditions. See “Liquidity and Capital Resources” below for more details on our credit facilities.

To mitigate our future interest expense exposure we have entered into certain interest rate swap agreements. See the Derivative Instruments section of Note 2, Significant Accounting Policies, to the condensed consolidated financial statements included in this report for more details on our derivative transactions.
Equity in earnings from unconsolidated joint ventures
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For the three months ended September 30, 2020March 31, 2021 we recognized equity in earnings from unconsolidated joint ventures in the amount of $2.3 million and for three months ended September 30, 2019March 31, 2020 we recognized equity in earnings from unconsolidated joint ventures of $2.0 million, an increase of $0.3 million or 16.4% and16.9%. The increase was mainly related to improved procedure volumes specifically atthe equity in earnings received from our interest in the Arizona Diagnostic Radiology Group joint venture, sites located within hospital campuses.which was formed in the fourth quarter of 2020.
Income tax provision
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We recorded an income tax provisionexpense of $3.8$4.4 million, or an effective tax rate of 27.2%24.1%, for the three months ended September 30, 2020March 31, 2021 compared to ana benefit from income tax provisiontaxes of $1.8$4.4 million, or an effective tax rate of 26.3%23.8% for the three months ended September 30, 2019.March 31, 2020. The income tax rates for the three and nine months ended September 30, 2020 diverge from the federal statutory rate due to (i) noncontrolling interests due to the controlled partnerships; (ii) effects of state income taxes; and (iii) excess tax benefits attributable to share-based compensation.
Nine Months Ended September 30, 2020 Compared to the Nine Months Ended September 30, 2019
Total Revenue inclusive of Provider Relief funding for 2020
In ThousandsNine Months Ended September 30, 2020
Revenue20202019$ Increase/(Decrease)% Change
Total Revenue$789,601$853,338$(63,737)(7.5)%
Same Center Revenue$750,358$817,492$(67,134)(8.2)%
Our procedure volumes were affected by the COVID-19 pandemic, which has precipitated an approximate 17% decrease in same center procedural volumes year over year. Mitigating the income decline is $25.7 million received in Provider Relief funding, which, per the official designation of the program, was used to offset lost revenues. This comparison excludes revenue contributions from centers that were acquired or divested subsequent to January 1, 2019. For the nine months ended September 30, 2020, net service fee revenue from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was $39.2 million. For the nine months ended September 30, 2019, net service fee revenue from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was $35.8 million.

Operating Expenses

Total operating expenses for the nine months ended September 30, 2020 decreased approximately $32.4 million, or 4.0%, from $807.2 million for the nine months ended September 30, 2020 to $774.8 million for the nine months ended September 30, 2019. The following table sets forth a breakdown of our cost of operations and total operating expenses for the nine months ended September 30, 2020 and 2019 (in thousands): 
 Nine Months Ended September 30, 2020
 20202019
Salaries and professional reading fees, excluding stock-based compensation$429,292 $471,792 
Stock-based compensation10,144 6,964 
Building and equipment rental80,148 79,017 
Medical supplies33,812 33,713 
Other operating expenses *
154,700 152,512 
Cost of operations708,096 743,998 
Depreciation and amortization64,536 60,193 
Loss on sale and disposal of equipment543 1,990 
Severance costs1,647 1,054 
Total operating expenses$774,822 $807,235 
    *Includes billing fees, office supplies, repairs and maintenance, insurance, business tax and license, outside services, telecom, utilities, marketing, travel and other expenses.
Salaries and professional reading fees, excluding stock-based compensation and severance
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In ThousandsNine Months Ended September 30, 2020
Salaries and Professional Fees20202019$ Increase/(Decrease)% Change
Total Salaries$429,292$471,792$(42,501)(9.0)%
Same Center Salaries$409,010$451,738$(42,728)(9.5)%

The decrease in salaries expense was a result of staff furloughs and salary reductions initiated in response to the COVID-19 crisis. As noted in our quarterly explanation above, our review of operational workflows has provided greater efficiencies and resulted in payroll reductions. Additionally certain of our subsidiaries have accepted approximately $4.0 million in loans from the Paycheck Protection Program (PPP) and the funds were used to pay program approved payroll expenses to both maintain and rehire furloughed employees. This comparison excludes expenses from centers that were acquired or divested subsequent to January 1, 2019. For the nine months ended September 30, 2020, salaries and professional reading fees from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was $20.3 million. For the nine months ended September 30, 2019, salaries and professional reading fees from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was approximately $20.1 million.
Stock-based compensation

Stock-based compensation increased $3.2 million, or 45.7% to approximately $10.1 million for the nine months ended September 30, 2020 compared to $7.0 million for nine months ended September 30, 2019. This increase was driven by the higher fair value of RSA’s awarded and vested in the nine months of 2020 as compared to RSA’s awarded and vested in the prior year’s same period.
Building and equipment rental
In ThousandsNine Months Ended September 30, 2020
Building & Equipment Rental20202019$ Increase/(Decrease)% Change
Total$80,148$79,017$1,1311.4%
Same Center$74,705$74,485$2190.3%

This comparison excludes expenses from centers that were acquired or divested subsequent to January 1, 2019. For the nine months ended September 30, 2020, building and equipment rental expenses from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was $5.4 million. For the nine months ended September 30, 2019, building and equipment rental expenses from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was approximately $4.5 million.
Medical supplies
In ThousandsNine Months Ended September 30, 2020
Medical Supplies Expense20202019$ Increase/(Decrease)% Change
Total$33,812$33,713$990.3%
Same Center$31,155$30,971$1840.6%

Year over year medical supplies expense remained relatively flat due to varying factors. The first quarter noted a 21% same store increase stemming from securing personal protective equipment and procurement of specialized imaging agents, while in the second quarter, a 25% same store expense reduction was correlated to lower procedural volumes. In the third quarter we consumed medical supplies ordered in prior periods to meet patient demands. The cumulative effect of these factors has resulted in the year over year stability of medical supplies expense. This comparison excludes expenses from centers that were acquired or divested subsequent to January 1, 2019. For the nine months ended September 30, 2020, medical supplies expenses from centers that were acquired or divested subsequent to April 1, 2018 and excluded from the above comparison was $2.7 million. For the nine months ended September 30, 2019, medical supplies expense from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was $2.7 million.
Other operating expenses
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In ThousandsNine Months Ended September 30, 2020
Other Operating Expenses20202019$ Increase/(Decrease)% Change
Total$154,700$152,512$2,1881.4%
Same Center$148,358$146,397$1,9621.3%

This comparison excludes expenses from centers that were acquired or divested subsequent to January 1, 2019. For the nine months ended September 30, 2020, other operating expense from centers that were acquired or divested subsequent January 1, 2019 and excluded from the above comparison was $6.3 million. For the nine months ended September 30, 2019, other operating expense from centers that were acquired or divested subsequent to January 1, 2019 was $6.1 million.
Depreciation and amortization
In ThousandsNine Months Ended September 30, 2020
Depreciation & Amortization20202019$ Increase/(Decrease)% Change
Total$64,536$60,193$4,3437.2%
Same Center$60,923$57,086$3,8376.7%

The increase in same center depreciation and amortization is primarily due to additional equipment and leasehold improvements placed in service in the nine months of 2020 over the same period in 2019. This comparison excludes expenses from centers that were acquired or divested subsequent to January 1, 2019. For the nine months ended September 30, 2020, depreciation expense from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was $3.6 million. For the nine months ended September 30, 2019, depreciation and amortization from centers that were acquired or divested subsequent to January 1, 2019 and excluded from the above comparison was $3.1 million.
Loss on sale and disposal of equipment and other

We recorded losses on the disposal of equipment and other items of approximately $0.5 million for the nine months ended September 30, 2020 and approximately $2.0 million for the nine months ended September 30, 2019.

Non-cash change in fair value of interest rate hedge

We recorded expense of $4.5 million for the ineffective portion of our 2019 Swaps for the nine months ended September 30, 2020.
Other (income) expenses

We recorded other income of approximately $0.2 million for the nine months ended September 30, 2020 and other expenses of approximately $1.3 million for the nine months ended September 30, 2019 related to refinancing of our term loan debt and legal contingency charges.
Severance Costs

We incurred severance expenses of $1.6 million for the nine months ended September 30, 2020 and $1.1 million for the nine months ended September 30, 2019.
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Interest expense
In ThousandsNine Months Ended September 30, 2020
Interest Expense20202019$ Increase/(Decrease)% Change
Total Interest Expense$33,443$36,589
Interest related to derivatives*$3,152$(1,182)
Interest payable on debt obligations**$30,291$37,771$(7,480)(19.8)%
Interest related to amortization***$3,266$3,103
Adjusted Interest Expense$27,025$34,668$(7,643)(22.0)%
* Includes interest on 2016 caps and 2019 swaps not related to debt obligations.
** Includes interest related to our term loans, revolving credit line, notes, finance leases, and other
***Includes combined noncash amortization of deferred loan costs and discount on issuance of debt.

Excluding interest expense for derivatives and amortization for the nine months ended September 30, 2020 compared to the nine months ended September 30, 2019, interest expense decreased $7.6 million, or 22.0%. The reduction in interest expense corresponds to lowered variable LIBOR and Prime interest rates paid on our term loan and revolving debt in reaction to market conditions surrounding COVID-19. See “Liquidity and Capital Resources” below for more details on our credit facilities.
Equity in earnings from unconsolidated joint ventures

For the nine months ended September 30, 2020 we recognized equity in earnings from unconsolidated joint ventures in the amount of $5.2 million and for nine months ended September 30, 2019 we recognized equity in earnings from unconsolidated joint ventures of $6.1 million, an decrease of $0.9 million or 14.8%, related to market conditions stemming from the COVID-19 pandemic.
Income tax benefit
We recorded an income tax benefit of $5.0 million, or an effective tax rate of 28.3%, for the nine months ended September 30, 2020 compared to an income tax provision of $3.6 million , or an effective tax rate of 24.8% for the nine months ended September 30, 2019. The income tax rates for the three and nine months ended September 30, 2020March 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.
Adjusted EBITDA
We use both GAAP and non-GAAP metrics to measure our financial results. We believe that, in addition to GAAP metrics, thesecertain non-GAAP metrics, such as Adjusted EBITDA assist us in measuring our business performance, cash generated from operations, leverage capacity and ability to service our debt obligations. We believe this information is useful to investors and other interested parties because we are highly leveraged and our non-GAAP metrics remove non-cash and certain other charges that occur in the affected period and provide a basis for measuring the Company's financial condition against other quarters.
One non-GAAP measure we believe assists us is Adjusted EBITDA. We define Adjusted EBITDA as earnings before interest, taxes, depreciation and amortization, each from continuing operations and excluding losses or gains on the disposal of equipment, other income or loss, loss on debt extinguishment, bargain purchase gains and non-cash equity compensation. Adjusted EBITDA includes equity earnings in unconsolidated operations and subtracts allocations of earnings to noncontrolling interests in subsidiaries, and is adjusted for non-cash or extraordinary and one-time events taking place during the period. We have not made specific adjustments to our calculation of Adjusted EBITDA in response to COVID 19. Our net income reflected below includes the effect of the $25$6.2 million in other revenue received under the Provider Relief Fund. We have treated the PPP loans as debt, and accordingly will be liable for an interest charge related to those loans which will be included in interest expense, although the loans may ultimately be forgiven.
Adjusted EBITDA is a non-GAAP financial measure used as an analytical indicator by us and the healthcare industry to assess business performance, and is a measure of leverage capacity and ability to service debt. Adjusted EBITDA should not be considered a measure of financial performance under GAAP, and the items excluded from Adjusted EBITDA should not be considered in isolation or as alternatives to net income, cash flows generated by operating, investing or financing activities or
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other financial statement data presented in the consolidated financial statements as an indicator of financial performance or liquidity. As Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation, this metric, as presented, may not be comparable to other similarly titled measures of other companies.
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Adjusted EBITDA is most comparable to the GAAP financial measure, net income (loss) attributable to RadNet, Inc. common stockholders. The following is a reconciliation of GAAP net income (loss) attributable to RadNet, Inc. common stockholders to Adjusted EBITDA for the three and nine months ended September 30,March 31, 2021 and 2020, and 2019, respectively.
Three Months Ended September 30,Nine Months Ended September 30, Three Months Ended March 31,
2020201920202019 20212020
Net income (loss) attributable to RadNet, Inc. common stockholdersNet income (loss) attributable to RadNet, Inc. common stockholders$6,156 $3,195 $(20,797)$4,360 Net income (loss) attributable to RadNet, Inc. common stockholders$9,458 $(16,358)
Provision for (benefit from) income taxesProvision for (benefit from) income taxes3,825 1,816 (5,029)3,557 Provision for (benefit from) income taxes4,376 (4,381)
Interest expenseInterest expense11,061 11,895 33,443 36,589 Interest expense12,826 11,552 
Severance costsSeverance costs571 52 1,647 1,054 Severance costs285 218 
Depreciation and amortizationDepreciation and amortization21,247 20,490 64,536 60,193 Depreciation and amortization22,656 21,934 
Non-cash employee stock-based compensationNon-cash employee stock-based compensation2,067 1,381 10,144 6,964 Non-cash employee stock-based compensation8,248 6,622 
Loss on sale and disposal of equipment and other342 917 543 1,989 
(Gain) loss on sale and disposal of equipment and other(Gain) loss on sale and disposal of equipment and other(1,307)771 
Non-cash change in fair value of interest rate hedgeNon-cash change in fair value of interest rate hedge679 — 4,523 — Non-cash change in fair value of interest rate hedge(11,245)— 
Other expensesOther expenses(139)(247)1,271 Other expenses206 
Legal settlementsLegal settlements— 1,248 — 1,248 Legal settlements— — 
Adjusted EBITDAAdjusted EBITDA$45,809 $40,996 $88,763 $117,225 Adjusted EBITDA$45,503 $20,364 

Liquidity and Capital Resources

The following table is a summarysummarizes of key balance sheet data related to our liquidity as of September 30, 2020March 31, 2021 and December 31, 20192020 and income statement data for the ninethree months ended September 30,March 31, 2021 and 2020 and 2019 (in thousands):
Balance Sheet Data:Balance Sheet Data:September 30, 2020December 31, 2019Balance Sheet Data:March 31, 2021December 31, 2020
Cash and cash equivalentsCash and cash equivalents$89,739 $40,165 Cash and cash equivalents$31,091 $102,018 
Accounts receivableAccounts receivable137,411 154,763 Accounts receivable146,665 129,585 
Working capital (exclusive of current operating lease liabilities)Working capital (exclusive of current operating lease liabilities)(47,282)(25,048)Working capital (exclusive of current operating lease liabilities)(109,730)(61,896)
Stockholders' equityStockholders' equity246,121 233,139 Stockholders' equity281,358 258,303 
Income statement data for the nine months ended September 30,20202019
Total net revenue$763,905 $853,338 
Net (loss) income attributable to RadNet common stockholders(20,797)4,360 
Income statement data for the three months ended March 3120212020
Total net revenue$315,319 $281,564 
Net income (loss) attributable to RadNet common stockholders9,458 (16,358)

We operate in a capital intensive, high fixed-cost industry that requires significant amounts of capital to fund operations. In addition to operations, we require a significant amount of capital for the initial start-up and development of new diagnostic imaging facilities, the acquisition of additional facilities and new diagnostic imaging equipment. Because our cash flows from operations have been insufficient to fund all of these capital requirements, we have depended on the availability of financing under credit arrangements with third parties.
As noted in our forward looking statements, the COVID 19 pandemic has resulted in a reduction of procedure volumes and corresponding operating revenues. Wewe are uncertain of the duration and ultimate severity of its effects.the effects of the COVID 19 pandemic on our business. Although we have received government stimulus funding and are undertaking measures to reduce operating expenses, and have received government stimulus funding, we may continue toagain experience operating losses.losses as a result of the pandemic which can impact both the consumption and cost of our medical imaging services. We have credit available from our current credit facilities and borrowing under those facilities is subject to continued compliance with lending covenants. We currently meet those requirements, and expect that we will continue to do so for the foreseeable future, but substantial and sustained operating losses could impact our ability to borrow under those facilities. If we are not able to meet such requirements, we may
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be required to seek additional financing and there can be no assurance that we will be able to obtain financing from other sources on terms acceptable to us, if at all.
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On a continuing basis, we also consider various transactions to increase shareholder value and enhance our business results, including acquisitions, divestitures and joint ventures. These types of transactions may result in future cash proceeds or payments but the general timing, size or success of any acquisition, divestiture or joint venture effort and the related potential capital commitments cannot be predicted. We expect to fund any future acquisitions primarily with cash flow from operations and borrowings, including borrowing from amounts available under our senior secured credit facilities or through new equity or debt issuances.
We and our subsidiaries or affiliates may from time to time, in our sole discretion, purchase, repay, redeem or retire any of our outstanding debt or equity securities in privately negotiated or open market transactions, by tender offer or otherwise.
Sources and Uses of Cash
The following table summarizes key components of our sources and uses of cash for the ninethree months ended September 30, 2020March 31, 2021 and 2019:2020:
Cash Flow DataCash Flow DataSeptember 30, 2020September 30, 2019Cash Flow DataMarch 31, 2021March 31, 2020
Cash provided by operating activitiesCash provided by operating activities$170,343 $82,603 Cash provided by operating activities$28,084 $40,913 
Cash used in investing activitiesCash used in investing activities(88,280)(93,981)Cash used in investing activities(87,348)(55,059)
Cash (used in) provided by financing activitiesCash (used in) provided by financing activities(32,495)38,705 Cash (used in) provided by financing activities(11,651)68,262 
Cash provided by operating activities for the ninethree months ended September 30, 2020March 31, 2021 was $170.3$28.1 million and $82.6$40.9 million for the ninethree months ended September 30, 2019.March 31, 2020. Our cash provided by operating activities for the period ended March 31, 2020 was benefited by the recieptreceipt of $39.4$39.5 million in CMS advances recorded as deferred revenue.
Cash used in investing activities for the ninethree months ended September 30, 2020,March 31, 2021, included purchases of property and equipment for approximately $77.3$30.4 million and the acquisition of imaging and software business assets for $10.1$57.1 million. As part of our business operations we continually evaluate investment opportunities. As noted in Note 7, Subsequent Events, we have purchase commitments for acquisitions of $5.0 million.
Cash used in financing activities for the ninethree months ended September 30, 2020,March 31, 2021, was due to principal payments on our term loans and equipment debt obligations.

In 2018 and 2019 weWe have entered into factoring agreements with various institutions and sold certain accounts receivable under non-recourse agreements. 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. Payments on the associated notes receivables will be 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 September 30, 2020March 31, 2021 we have $20.4$20.5 million, net of discount, remaining to be collected on these agreements. We do not utilize factoring arrangements as an integral part of our financing for working capital.
Senior Secured Credit Facilities
We maintain secured credit facilities with Barclays Bank PLC and with SunTrust.SunTrust Bank. The Barclays credit facilities are comprised of first lien term loans and a revolving credit facility. On August 28, 2020 we amended the Barclays credit facilities to increasewhich extended and increased the amount available under the revolving line of credit to $195.0 million. The SunTrust credit facilities are comprised of a term loan and a revolving credit facility of $30.0 million. As of September 30, 2020,March 31, 2021, we were in compliance with all covenants under our credit facilities. Deferred financing costs at September 30, 2020,March 31, 2021, net of accumulated amortization, was $1.9$1.6 million and is specifically related to our Barclays revolving credit facility.
Included in our condensed consolidated balance sheets at September 30, 2020March 31, 2021 are $673.2$651.6 million of total term loan debt (exclusive of unamortized discounts of $10.7$8.7 million) in thousands:
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Face ValueDiscountTotal Carrying
Value
Face ValueDiscountTotal Carrying
Value
First Lien Term LoansFirst Lien Term Loans$620,727 $(10,669)$610,058 First Lien Term Loans$601,330 $(8,730)$592,600 
SunTrust Term LoanSunTrust Term Loan52,500 — 52,500 SunTrust Term Loan50,250 — 50,250 
Total Term LoansTotal Term Loans$673,227 $(10,669)$662,558 Total Term Loans$651,580 $(8,730)$642,850 

At September 30, 2020,March 31, 2021, we had no borrowings under our Barclays or SunTrust revolving credit facilities. After reserves for outstanding letters of credit of $6.3$7.9 million on our Barclays Revolving Credit Facility, we have $188.7$187.1 million available for borrowing and $30.0 million available under our SunTrust revolving credit facility.Revolving Credit Facility. For more information on our secured credit facilities see Note 5 to our condensed consolidated financial statements in this quarterly report.

On April 23, 2021, after the period covered by this report, we entered into the Restated Credit Agreement which provides for $725.0 million of senior secured first lien term loans and a $195.0 million senior secured revolving credit facility. The proceeds of the loan were used to refinance the outstanding $611.0 million term and revolving loans, to pay fees and expenses associated with the refinancing transaction, to pay accrued interest on the previously existing facilities through the date of closing and to fund approximately $102.0 million to our balance sheet. In addition, the Restated Credit Agreement lowered our interest rates and reduced our principal payments from $9.7 million to $1.8 million per quarter. We expect our existing capital resources, anticipated cash from operations and our borrowing capacity under our credit facilities will be sufficient to sustain our operations for the next twelve months and the foreseeable future.


ITEM 3.  Quantitative and Qualitative Disclosures about Market Risk
Foreign Currency Exchange Risk: We receive payment for our services exclusively in United States dollars. As a result, our financial results are unlikely to be affected by factors such as changes in foreign currency, exchange rates or weak economic conditions in foreign markets.
We maintain research and development facilities in Prince Edward Island, Canada and Budapest, Hungary for which expenses are paid in the local currency. Accordingly, we do have currency risk resulting from fluctuations between such local currency and the United States Dollar. At the present time, we do not have any foreign currency exchange contracts to mitigate this risk. At September 30, 2020, a hypothetical 1% decline in the currency exchange rates between the U.S. dollar against the Canadian dollar and the Hungarian Forint would have resulted in an annual increase of approximately $27,500 in operating expenses.
Interest Rate Sensitivity: We pay interest on various types of debt instruments to our suppliers and lending institutions. The agreements entail either fixed or variable interest rates.  Instruments which have fixed rates are mainly leases on radiology equipment. Variable rate interest obligations relate primarily to amounts borrowed under our outstanding credit facilities. Accordingly, our interest expense and consequently, our earnings, are affected by changes in short term interest rates. However due to our purchase of caps, described below, the effects of interest rate changes are limited.
At September 30, 2020, we had $620.7 million outstanding subject to an adjusted Eurodollar election on First Lien Term Loans. We can elect Eurodollar or Base Rate (Prime) interest rate options on amounts outstanding under the First Lien Term Loans. To mitigate interest rate risk sensitivity, in the fourth quarter of 2016At March 31, 2021, we entered into two forward interest rate cap agreements (the “2016 Caps”) which were designated at inception as cash flow hedges of future cash interest payments. The 2016 Caps are designedhad $601.3 million outstanding subject to provide a hedge against interest rate increases. Under these arrangements, we purchased a capan adjusted Eurodollar election on 3 month LIBOR at 2.0%. At September 30, 2020,First Lien Term Loans and our effective 6 month LIBOR rate plus applicable was 1.00%4.75%. A hypothetical 1% increase in the adjusted Eurodollar rates under the First Lien Credit Agreement over the current Eurodollar rate would result in an increase of $6.2$6.0 million in annual interest expense and a corresponding decrease in income before taxes. See Note 2, Significant Accounting Policies, for further information.At March 31, 2021, we had $6.0 million outstanding subject to an adjusted prime election on First Lien Term Loans and our effective prime rate was 5.75%. A hypothetical 1% increase in the adjusted Prime rates under the First Lien Credit Agreement over the current Prime rate would result in an increase of $0.1 million in annual interest expense and a corresponding decrease in income before taxes.

At September 30, 2020,March 31, 2021, we had $52.5$50.3 million outstanding subject to an adjusted Eurodollar election on the SunTrust Restated Credit Agreement. We can elect Eurodollar or Base Rate (Prime) interest rate options on amounts outstanding under the SunTrust Restated Credit Agreement. At September 30, 2020,March 31, 2021, our effective LIBOR rate plus applicable margin was 2.31%2.25%. A hypothetical 1% increase in the adjusted Eurodollar rates under the SunTrust Restated Credit Agreement would result in an increase of approximately $0.5 million in annual interest expense and a corresponding decrease in income before taxes.

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.

ITEM 4.  Controls and Procedures
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Evaluation of Disclosure Controls and Procedures
We maintain controls and procedures designed to ensure that we are able to collect the information we are required to disclose in the reports we file with the SEC, and to process, summarize and disclose this information within the time periods specified in the rules of the SEC. Our management, with the participation of our Chief Executive Officer and our Chief Financial Officer, has conducted an evaluation of the design and operation of our “disclosure controls and procedures” as defined in Rule 13a-15(e) and 15d-15(e) under the Exchange Act. Based on this evaluation, our Chief Executive Officer and our Chief Financial Officer have concluded that our disclosure controls and procedures are effective as of the end of the period covered by this report for the purposes set forth above.


Changes in Internal Control over Financial Reporting
 
There has been no change in our internal control over financial reporting during three months ended September 30, 2020March 31, 2021 that has materially affected, or is reasonably likely to materially affect, our internal controls over financial reporting.
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PART II – OTHER INFORMATION

ITEM 1.  Legal Proceedings
We are engaged from time to time in the defense of lawsuits arising out of the ordinary course and conduct of our business. We do not believe that the outcome of any of our current litigation will have a material adverse impact on our business, financial condition and results of operations. However, we could be subsequently named as a defendant in other lawsuits that could adversely affect us.

ITEM 1A.  Risk Factors
For information about the risks and uncertainties related to our business, please see the risk factors described in our annual report on Form 10-K for the year ended December 31, 2019 and our quarterly report on Form 10-Q for the quarters ended March 31 and June 30, 2020. The risks described in our Form 10-K and Form 10-Q are not the only risks facing our Company. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial also may materially adversely affect our business, financial condition and/or operating results.

ITEM 2.  Unregistered Sales of Equity Securities and Use of Proceeds

None.


ITEM 3.  Defaults Upon Senior Securities
None.
ITEM 4.  Mine Safety Disclosures
Not applicable.
ITEM 5.  Other Information
None.
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INDEX TO EXHIBITS
Exhibit
Number
Description
10.17
31.1
31.2
32.1
32.2
101The following financial information from RadNet, Inc.'s Quarterly Report on Form 10-Q for the quarter ended SeptemberMarch 30, 20202021 formatted in Inline XBRL (Extensible Business Reporting Language) includes: (i) the Condensed Consolidated Balance Sheets, (ii) the Condensed Consolidated Statements of Operations, (iii) the Condensed Consolidated Statements of Comprehensive Loss, (iv) the Condensed Consolidated Statements of Changes in Stockholders Equity, (v) the Condensed Consolidated Statements of Cash Flows, and (vi) Notes to the Condensed Consolidated Financial Statements.
104Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)
*    This certification is being furnished solely to accompany this report pursuant to 18 U.S.C. 1350, and is not being filed for purposes of Section 18 of the Exchange Act and is not to be incorporated by reference into any filing of the registrant, whether made before or after the date hereof, regardless of any general incorporation language in such filing.

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SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
RADNET, INC.
(Registrant)
Date: November 9, 2020May 10, 2021By:/s/ Howard G. Berger, M.D.
Howard G. Berger, M.D., President and Chief Executive Officer
(Principal Executive Officer)
  
  
Date: November 9, 2020May 10, 2021By:/s/ Mark D. Stolper
Mark D. Stolper, Chief Financial Officer
(Principal Financial and Accounting Officer)

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