* A reconciliation of each non-GAAP measure to the most comparable measure under GAAP has been provided in this press release in the accompanying tables. An explanation of these Non-GAAP measures is also included below under the heading “Non-GAAP Financial Measures.”
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Fourth Quarter 2021
Revenue increased 45% to $554.2 million, from $383.3 million in the fourth quarter of 2020. Access fees revenue grew 51% to $469.9 million and visit fee revenue grew 21% to $68.9 million. U.S. Revenues grew 45% to $482.9 million and International revenues grew 40% to $71.3 million.
Net loss totaled $11.0 million, or $(0.07) per share, compared to $394.0 million, or $(3.07) per share, in the fourth quarter of 2020. Results for the fourth quarter of 2021 included stock-based compensation expense of $61.6 million, or $(0.39) per share, amortization of acquired intangibles of $45.1 million, or $(0.28) per share, and non-cash income tax benefit of $49.7 million, or $0.31 per share.
Results for the fourth quarter of 2020 included stock-based compensation expense of $414.4 million, or $(3.23) per share, amortization of acquired intangibles of $33.0 million, or $(0.26) per share, and non-cash income tax benefit of $85.5 million, or $0.67 per share.
Adjusted EBITDA* increased 53% to $77.1 million, compared to $50.4 million in the fourth quarter of 2020.
GAAP Gross margin, which includes depreciation and amortization, was 67.5 percent for the fourth quarter of 2021 compared to 67.2 percent for the fourth quarter of 2020.
Adjusted Gross margin* was 68.4 percent for the fourth quarter of 2021 compared to 67.9 percent for the fourth quarter of 2020.
Average revenue per U.S. paid member increased to $2.49 in the fourth quarter of 2021, from $1.63 in the fourth quarter of 2020 and $2.40 in the third quarter of 2021.
Full Year Ended December 31, 2021
Revenue increased 86% to $2,032.7 million, from $1,094.0 million for the year ended December 31, 2020. Access fees revenue grew 104% to $1,732.0 million and visit fee revenue grew 15% to $254.2 million. U.S. Revenues grew 94% to $1,774.0 million and International revenues grew 44% to $258.7 million.
Net loss totaled $428.8 million, or $(2.73) per share, compared to $485.1 million, or $(5.36) per share, for the year ended December 31, 2021. Results for the year ended December 31, 2021 included stock-based compensation expense of $302.6 million, or $(1.93) per share, amortization of acquired intangibles of $178.9 million, or $(1.14) per share, loss on extinguishment of debt of $43.7 million, or $(0.28) per share, and non-cash income tax expense of $44.1 million, or $(0.28) per share.
Results for the year ended December 31, 2020 included stock-based compensation expense $475.5 million, or $(5.25) per share, amortization of acquired intangibles $57.5 million, or $(0.64)