Form 10-Q - Quarterly report [Sections 13 or 15(d)]

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UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington D.C. 20549

FORM 10-Q

(Mark One)

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2024

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from to

Commission File Number 001-33307

RadNet, Inc.

(Exact name of registrant as specified in its charter)


Delaware		13-3326724
(State or other jurisdiction of incorporation or organization)		(I.R.S. Employer Identification No.)

1510 Cotner Avenue
Los Angeles,	California	90025
(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 Title

Trading Symbol

Registered Exchange

Common Stock

RDNT

NASDAQ

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities and Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). Yes ☒ No ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”, “smaller reporting company”, and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer

☒

Accelerated filer

☐

Non-accelerated filer

☐

Smaller reporting company

☐

Emerging growth company

☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act) Yes ☐ No ☒

The number of shares of the registrant’s common stock outstanding on November 8, 2024 was 74,026,737 shares.

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RADNET, INC.

TABLE OF CONTENTS


			Page

PART I – FINANCIAL INFORMATION			1

ITEM 1. Financial Statements			1

Condensed Consolidated Balance Sheets at September 30, 2024 and December 31, 2023			1

Condensed Consolidated Statements of Operations for the Three and Nine Months Ended September 30, 2024 and 2023			1

Condensed Consolidated Statements of Comprehensive Income for the Three and Nine Months Ended September 30, 2024 and 2023			3

Condensed Consolidated Statement of Stockholders' Equity for the Three and Nine Months Ended September 30, 2024 and 2023			6



Condensed Consolidated Statements of Cash Flows for the Nine Months Ended September 30, 2024 and 2023			8

Notes to Condensed Consolidated Financial Statements			10

ITEM 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations			29

ITEM 3. Quantitative and Qualitative Disclosures About Market Risk			47

ITEM 4. Controls and Procedures			48

PART II – OTHER INFORMATION			49

ITEM 1. Legal Proceedings			49

ITEM 1A. Risk Factors			49

ITEM 2. Unregistered Sales of Equity Securities and Use of Proceeds			49

ITEM 3. Defaults Upon Senior Securities			49

ITEM 4. Mine Safety Disclosures			49

ITEM 5. Other Information			49

ITEM 6. Exhibits			49

SIGNATURES			50

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PART I - FINANCIAL INFORMATION

Item 1 – Financial Statements

RADNET, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED BALANCE SHEETS

(IN THOUSANDS EXCEPT SHARE DATA)


	September 30, 2024		December 31, 2023
	(unaudited)
ASSETS
CURRENT ASSETS
Cash and cash equivalents	$	748,916	$	342,570
Accounts receivable	199,076		163,707
Due from affiliates	30,210		25,342
Prepaid expenses and other current assets	38,051		47,657

Total current assets	1,016,253		579,276
PROPERTY, EQUIPMENT AND RIGHT-OF-USE ASSETS
Property and equipment, net	663,867		604,401
Operating lease right-of-use assets	646,750		596,032
Total property, equipment and right-of-use assets	1,310,617		1,200,433
OTHER ASSETS
Goodwill	711,841		679,463
Other intangible assets	84,441		90,615
Deferred financing costs	2,416		1,643
Investment in joint ventures	104,514		92,710

Deposits and other	45,260		46,333
Total assets	$	3,275,342	$	2,690,473
LIABILITIES AND EQUITY
CURRENT LIABILITIES
Accounts payable, accrued expenses and other	$	338,737	$	342,940
Due to affiliates	44,872		15,910
Deferred revenue	4,392		4,647

Current operating lease liability	58,751		55,981
Current portion of notes payable	23,378		17,974
Total current liabilities	470,130		437,452
LONG-TERM LIABILITIES

Long-term operating lease liability	658,434		605,097
Notes payable, net of current portion	996,272		812,068
Deferred tax liability, net	20,795		15,776
Other non-current liabilities	10,077		6,721
Total liabilities	2,155,708		1,877,114
EQUITY
Common stock - $0.0001 par value, 200,000,000 shares authorized; 73,976,284 and 67,956,318 shares issued and outstanding at September 30, 2024 and December 31, 2023, respectively	7		7
Additional paid-in-capital	979,279		722,750
Accumulated other comprehensive loss	(1,843)		(12,484)
Accumulated deficit	(82,130)		(79,578)
Total RadNet, Inc.'s Stockholders' equity:	895,313		630,695
Noncontrolling interests	224,321		182,664
Total equity	1,119,634		813,359
Total liabilities and equity	$	3,275,342	$	2,690,473

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,
	2024		2023		2024		2023
REVENUE
Service fee revenue	$	427,579	$	361,927	$	1,247,513	$	1,078,265
Revenue under capitation arrangements	33,563		40,041		105,050		117,982
Total service revenue	461,142		401,968		1,352,563		1,196,247
OPERATING EXPENSES
Cost of operations, excluding depreciation and amortization	391,800		341,635		1,169,113		1,038,647

Depreciation and amortization	34,979		32,210		101,822		95,705
Gain on contribution of imaging centers into joint venture	—		(16,808)		—		(16,808)
Loss on sale and disposal of equipment and other	148		527		735		1,183
Severance costs	304		1,153		797		3,157
Total operating expenses	427,231		358,717		1,272,467		1,121,884
INCOME FROM OPERATIONS	33,911		43,251		80,096		74,363

OTHER INCOME AND EXPENSES
Interest expense	19,427		16,115		61,776		47,876
Equity in earnings of joint ventures	(3,595)		(1,084)		(11,308)		(3,935)
Non-cash change in fair value of interest rate hedge	6,755		1,015		7,429		949
Debt restructuring and extinguishment expenses	147		—		8,909		—
Other income	(5,414)		(4,081)		(16,248)		(2,609)
Total other expenses	17,320		11,965		50,558		42,281
INCOME BEFORE INCOME TAXES	16,591		31,286		29,538		32,082
Provision for income taxes	(4,335)		(7,220)		(4,927)		(7,741)
NET INCOME	12,256		24,066		24,611		24,341
Net income attributable to noncontrolling interest	9,047		6,526		27,163		19,437
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$	3,209	$	17,540	$	(2,552)	$	4,904

BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$	0.04	$	0.26	$	(0.04)	$	0.08

DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$	0.04	$	0.25	$	(0.04)	$	0.08

WEIGHTED AVERAGE SHARES OUTSTANDING
Basic	73,494,709		67,793,404		72,587,321		62,113,707
Diluted	75,165,435		68,809,818		72,587,321		63,221,251

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

(IN THOUSANDS)

(unaudited)


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
NET INCOME	$	12,256	$	24,066	$	24,611	$	24,341
Foreign currency translation adjustments	5,228		(4,035)		2,399		(385)

Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes	986		921		8,242		2,765
COMPREHENSIVE INCOME	18,470		20,952		35,252		26,721
Less comprehensive income attributable to noncontrolling interests	9,047		6,526		27,163		19,437

COMPREHENSIVE INCOME ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$	9,423	$	14,426	$	8,089	$	7,284

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, 2024 and September 30, 2023.


	Common Stock			Additional Paid-In Capital		Accumulated Other Comprehensive Loss		Accumulated Deficit		Total RadNet, Inc.'s Equity		Noncontrolling Interests		Total Equity
	Shares	Amount
BALANCE - JUNE 30, 2024	73,968,042	$	7	$	974,355	$	(8,057)	$	(85,339)	$	880,966	$	211,874	$	1,092,840


Issuance of common stock under the equity compensation plan	9,075	—		—		—		—		—		—		—


Stock-based compensation expense	—	—		4,727		—		—		4,727		—		4,727



Forfeiture of restricted stock and share cancellation	(833)	—		(4)		—		—		(4)		—		(4)





Contributions from noncontrolling interests	—	—		201		—		—		201		—		201
Sale of economic interests in majority owned subsidiary, net of taxes	—	—		—		—		—		—		3,400		3,400

Change in cumulative foreign currency translation adjustment	—	—		—		5,228		—		5,228		—		5,228

Change in fair value of cash flow hedge from prior periods reclassified to earnings	—	—		—		986		—		986		—		986









Net income	—	—		—		—		3,209		3,209		9,047		12,256
BALANCE - SEPTEMBER 30, 2024	73,976,284	$	7	$	979,279	$	(1,843)	$	(82,130)	$	895,313	$	224,321	$	1,119,634

BALANCE - JUNE 30, 2023	67,669,564	$	7	$	703,593	$	(15,183)	$	(95,258)	$	593,159	$	167,845	$	761,004

Issuance of common stock upon exercise of options	3,424	—		21		—		—		21		—		21
Issuance of common stock under the equity compensation plan	3,447	—		—		—		—		—		—		—

Issuance of common stock under the DeepHealth equity compensation plan	1,871	—		—		—		—		—		—		—
Stock-based compensation expense	—	—		4,326		—		—		4,326		—		4,326

Issuance of common stock, net of issuance costs	—	—		(370)		—		—		(370)		—		(370)
Issuance of common stock in connection with acquisitions	169,903	—		5,123		—		—		5,123		—		5,123





Contribution from noncontrolling partner	—	—		—		—		—		—		2,885		2,885
Sale of economic interests in majority owned subsidiary, net of taxes	—	—		2,217		—		—		2,217		—		2,217

Change in cumulative foreign currency translation adjustment	—	—		—		(4,035)		—		(4,035)		—		(4,035)

Change in fair value of cash flow hedge from prior periods reclassifed to earnings	—	—		—		921		—		921		—		921
Other	—	—		—		—		(1)		(1)		1		—









Net income	—	—		—		—		17,540		17,540		6,526		24,066
BALANCE - SEPTEMBER 30, 2023	67,848,209	$	7	$	714,910	$	(18,297)	$	(77,719)	$	618,901	$	177,257	$	796,158

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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, 2024 and September 30, 2023.


	Common Stock			Additional Paid-In Capital		Accumulated Other Comprehensive Loss		Accumulated Deficit		Total RadNet, Inc.'s Equity		Noncontrolling Interests		Total Equity
	Shares	Amount
BALANCE - DECEMBER 31, 2023	67,956,318	$	7	$	722,750	$	(12,484)	$	(79,578)	$	630,695	$	182,664	$	813,359

Issuance of common stock upon exercise of options	60,605	—		367		—		—		367		—		367
Issuance of common stock under the equity compensation plan	666,962	—		—		—		—		—		—		—

Issuance of common stock under the DeepHealth equity compensation plan	9,377	—		—		—		—		—		—		—
Stock-based compensation expense	—	—		21,406		—		—		21,406		—		21,406

Issuance of common stock	5,232,500	—		218,385		—		—		218,385		—		218,385

Issuance of common stock in connection with acquisitions	95,019	—		4,607		—		—		4,607		—		4,607
Forfeiture of restricted stock and share cancellation	(44,497)	—		(38)		—		—		(38)		—		(38)


Distributions paid to noncontrolling interests	—	—		—		—		—		—		(2,423)		(2,423)

Contributions from noncontrolling interests	—	—		11,802		—		—		11,802		—		11,802

Sale of economic interests in majority owned subsidiary, net of taxes	—	—		—		—		—		—		16,917		16,917
Change in cumulative foreign currency translation adjustment	—	—		—		2,399		—		2,399		—		2,399

Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes	—	—		—		8,242		—		8,242		—		8,242









Net (loss) income	—	—		—		—		(2,552)		(2,552)		27,163		24,611
BALANCE-BALANCE - SEPTEMBER 30, 2024	73,976,284	$	7	$	979,279	$	(1,843)	$	(82,130)	$	895,313	$	224,321	$	1,119,634


BALANCE - DECEMBER 31, 2022	57,723,125	$	6	$	436,288	$	(20,677)	$	(82,622)	$	332,995	$	158,457	$	491,452

Issuance of common stock upon exercise of options	8,424	—		72		—		—		72		—		72
Issuance of common stock under the equity compensation plan	1,069,324	—		—		—		—		—		—		—

Issuance of common stock under the DeepHealth equity compensation plan	21,956	—		—		—		—		—		—		—
Stock-based compensation expense	—	—		21,381		—		—		21,381		—		21,381

Sale of economic interests in majority owned subsidiary, net of taxes	—	—		2,217		—		—		2,217		—		2,217
Issuance of common stock	8,711,250	1		245,831		—		—		245,832		—		245,832

Issuance of common stock in connection with acquisitions	314,130	—		9,123		—		—		9,123		—		9,123



Distributions paid to noncontrolling interests	—	—		—		—		—		—		(3,523)		(3,523)

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Contributions from noncontrolling interests	—	—		—		—		—		—		2,885		2,885
Change in cumulative foreign currency translation adjustment	—	—		—		(385)		—		(385)		—		(385)

Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes	—	—		—		2,765		—		2,765		—		2,765
Other	—	—		(2)		—		(1)		(3)		1		(2)










Net income	—	—		—		—		4,904		4,904		19,437		24,341
BALANCE-SEPTEMBER 30, 2023	67,848,209	$	7	$	714,910	$	(18,297)	$	(77,719)	$	618,901	$	177,257	$	796,158

The accompanying notes are an in

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tegral 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,
	2024		2023
CASH FLOWS FROM OPERATING ACTIVITIES
Net Income	$	24,611	$	24,341
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	101,822		95,705
Noncash operating lease expense	45,516		47,542
Equity in earnings of joint ventures, net of dividends	(10,308)		5,012

Amortization of deferred financing costs and loan discount	2,336		2,240
Loss on sale and disposal of equipment	735		1,183
Loss on extinguishment of debt	2,080		—

Gain on contribution of imaging centers into joint venture	—		(16,808)

Amortization of cash flow hedge, net of taxes	8,242		2,765
Non-cash change in fair value of interest rate hedge	7,429		949
Stock-based compensation	21,368		21,380
Loss on impairment	1,200		3,949

Change in fair value of contingent consideration	1,974		(4,112)
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:
Accounts receivable	(35,369)		(1,379)
Other current assets	4,738		5,754
Other assets	(7,388)		(16,641)
Deferred taxes	4,834		7,389
Operating leases	(40,497)		(43,390)
Deferred revenue	(255)		1,155
Accounts payable, accrued expenses and other	57,426		(5,091)
Net cash provided by operating activities	190,494		131,943
CASH FLOWS FROM INVESTING ACTIVITIES
Purchase of imaging facilities and other acquisitions	(37,748)		(10,915)

Purchase of property and equipment and other	(145,164)		(136,537)
Proceeds from sale of equipment	151		82




Equity contributions in existing and purchase of interest in joint ventures	(1,496)		(5,453)
Net cash used in investing activities	(184,257)		(152,823)
CASH FLOWS FROM FINANCING ACTIVITIES
Principal payments on notes and leases payable	(4,296)		(1,929)
Payments on Term Loan Debt	(688,375)		(11,062)


Proceeds from debt refinancing, net of issuing costs	863,815		—

Contribution from noncontrolling partners	7,569		—
Payments on contingent consideration	(3,614)		(3,390)
Distributions paid to noncontrolling interests	(2,423)		(3,523)
Proceeds from sale of economic interests in majority owned subsidiary, net of taxes	8,641		5,102



Proceeds from issuance of common stock	218,385		245,831
Proceeds from issuance of common stock upon exercise of options	367		72
Net cash provided by financing activities	400,069		231,101
EFFECT OF EXCHANGE RATE CHANGES ON CASH	40		(171)
NET INCREASE IN CASH AND CASH EQUIVALENTS	406,346		210,050
CASH AND CASH EQUIVALENTS, beginning of period	342,570		127,834
CASH AND CASH EQUIVALENTS, end of period	$	748,916	$	337,884

SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid during the period for interest	$	51,520	$	59,421
Cash paid during the period for income taxes	$	2,202	$	225

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 $43.2 million and $50.2 million during the nine months ended September 30, 2024 and 2023, respectively, which were not paid for as of September 30, 2024 and 2023, respectively. The amounts due were recorded in our condensed consolidated balance sheet under accounts payable, accrued expenses and other.

On April 1, 2024, we issued promissory notes in the amount of $6.3 million to acquire radiology equipment previously leased under operating leases, related to the acquisition of Houston Medical Imaging, LLC.

On March 29, 2024, we received $1.4 million in fixed assets, imaging equipment, and $6.0 million in goodwill from our partner in Tri Valley Imaging Group, LLC. See Note 4, Business Combinations and Related Activity.

On March 27, 2024, we issued 95,019 shares of common stock to settle the stock contingent liabilities as part of our purchase of Heart & Lung Imaging Limited. The shares were ascribed a value of $4.6 million.

On January 15, 2024, we issued promissory notes in the amount of $6.9 million to acquire radiology equipment previously leased under operating leases.

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RADNET, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(unaudited)

NOTE 1 – NATURE OF BUSINESS AND BASIS OF PRESENTATION

We are a national provider of freestanding, fixed-site outpatient diagnostic imaging services in the United States. At September 30, 2024, we operated directly or indirectly through joint ventures with hospitals, 399 centers located in Arizona, California, Delaware, Florida, Maryland, New Jersey, New York and Texas. 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.

In the first quarter of 2024, we revised our reportable segments to combine our eRad business, which was included in the Imaging Center segment, with our AI segment to form a new Digital Health reportable segment. Prior period amounts were adjusted retrospectively to reflect the change in reportable segment. For further financial information about these segments, see Note 5, Segment Reporting.

In March 2024, we closed on a public offering of 5,232,500 shares of our common stock, including 682,500 shares sold pursuant to the exercise of an underwriter's overallotment option, at a price to the public of $44.00 per share. The gross proceeds as a result of this public offering was $230.2 million before underwriting discounts, commissions, and costs totaling $11.8 million.

The consolidated financial statements include the accounts of RadNet, Inc as well as its subsidiaries in which RadNet has a controlling financial interest. The consolidated financial statements also include certain variable interest entities in which we are the primary beneficiary (as described in more detail below). All material intercompany transactions and balances have been eliminated upon consolidation. All of these affiliated entities are referred to collectively as “RadNet,” “we,” “us,” “our” or the “Company” in this report.

Accounting regulations stipulate that generally any entity with a) insufficient equity to finance its activities without additional subordinated financial support provided by any parties, or b) equity holders that, as a group, lack the characteristics which evidence a controlling financial interest, is considered a Variable Interest Entity (“VIE”). We consolidate all VIEs in which we are the primary beneficiary. We determine whether we are the primary beneficiary of a VIE through a qualitative analysis that identifies which variable interest holder has the controlling financial interest in the VIE. The variable interest holder who has both of the following has the controlling financial interest and is the primary beneficiary: (1) the power to direct the activities of the VIE that most significantly impact the VIE’s economic performance and (2) the obligation to absorb losses of, or the right to receive benefits from, the VIE that could potentially be significant to the VIE. In performing our analysis, we consider all relevant facts and circumstances, including: the design and activities of the VIE, the terms of the contracts the VIE has entered into, the nature of the VIE’s variable interests issued and how they were negotiated with or marketed to potential investors, and which parties participated significantly in the design or redesign of the entity.

VIEs that we consolidate as the primary beneficiary include professional corporations which are owned or controlled by individuals within our senior management and provide professional medical services for centers in Arizona, California, Delaware, Maryland, New Jersey and New York. These VIEs are collectively referred to as the “Consolidated Medical Group". RadNet provides non-medical, technical and administrative services to the Consolidated Medical 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 Consolidated Medical Group has insignificant operating assets and liabilities, and de minimis equity. Substantially all cash flows of the Consolidated Medical Group after expenses, including professional salaries, are transferred to us. We consolidate the revenue and expenses, assets and liabilities of the Consolidated Medical Group. The creditors of the Consolidated Medical Group do not have recourse to our general credit and there are no other arrangements that could expose us to losses on behalf of the Consolidated Medical Group. However, RadNet may be required to provide financial support to cover any operating expenses in excess of operating revenues.

The Consolidated Medical Group on a combined basis recognized $55.3 million and $51.3 million of revenue, net of management services fees to RadNet, for the three months ended September 30, 2024 and 2023, respectively and $55.3 million and $51.3 million of operating expenses for the three months ended September 30, 2024 and 2023, respectively. RadNet recognized $207.4 million and $214.7 million of total billed net service fee revenue for the three months ended September 30, 2024, and 2023, respectively, for management services provided to the Consolidated Medical Group relating primarily to the technical portion of billed revenue.

The Consolidated Medical Group on a combined basis recognized $162.5 million and $151.5 million of revenue, net of management services fees to RadNet, for the nine months ended September 30, 2024 and 2023, respectively and $162.5 million

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and $151.5 million of operating expenses for the nine months ended September 30, 2024 and 2023, respectively. RadNet recognized $673.3 million and $638.3 million of total billed net service fee revenue for the nine months ended September 30, 2024, and 2023, respectively, for management services provided to the Consolidated Medical Group relating primarily to the technical portion of billed revenue.

In our condensed consolidated balance sheets at September 30, 2024 and December 31, 2023, we have included approximately $118.0 million and $94.1 million, respectively, of accounts receivable and approximately $21.7 million and $16.7 million of accounts payable and accrued liabilities related to the Consolidated Medical Group, respectively. The cash flows of the Consolidated Medical Group are included in the accompanying condensed consolidated statements of cash flows. All intercompany balances and transactions have been eliminated in consolidation.

At all of our centers not serviced by the Consolidated Medical Group we have entered into long-term contracts with medical groups to provide professional services at those centers, including supervision and interpretation of diagnostic imaging procedures. The medical groups maintain full control over the physicians they employ. Through our management agreements, we make available to the medical groups the imaging centers, including all furniture, fixtures and medical equipment therein. The medical groups are compensated for their services from the professional component of the global net service fee revenue and after deducting management service fees paid to us, we have no economic controlling interest in these medical groups. As such, the financial results of these groups are not consolidated in our financial statements.

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X and, therefore, do not include all information and footnotes necessary for conformity with U.S. generally accepted accounting principles for complete financial statements; however, in the opinion of management, all adjustments consisting of normal recurring adjustments necessary for a fair presentation of the financial position, results of operations and cash flows for the interim periods ended September 30, 2024 and 2023 have been made. The results of operations for any interim period are not necessarily indicative of the results for a full year. These interim condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes thereto contained in our annual report on Form 10-K for the year ended December 31, 2023.

NOTE 2 - SIGNIFICANT ACCOUNTING POLICIES

There have been no material changes to the significant accounting policies we use and have explained in our annual report on Form 10-K for the fiscal year ended December 31, 2023. The information below is intended only to supplement the disclosure in our annual report on Form 10-K for the fiscal year ended December 31, 2023.

REVENUES - Our revenues generally relate to net patient fees received from various payors and patients themselves under contracts in which our performance obligations are to provide diagnostic services to the patients. Revenues are recorded during the period when our obligations to provide diagnostic services are satisfied. Our performance obligations for diagnostic services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payor (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the fees for the services provided are dependent upon the terms provided by Medicare and Medicaid, or negotiated with managed care health plans and commercial insurance companies. The payment arrangements with third-party payors for the services we provide to the related patients typically specify payments at amounts less than our standard charges and generally provide for payments based upon predetermined rates per diagnostic services or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

As it relates to the Consolidated Medical Group, this service fee revenue includes payments for both the professional medical interpretation revenue recognized by the Consolidated Medical Group as well as the payment for all other aspects related to our providing the imaging services, for which we earn management fees. As it relates to others centers, this service fee revenue is earned through providing the use of our diagnostic imaging equipment and the provision of technical services as well as providing administration services such as clerical and administrative personnel, bookkeeping and accounting services, billing and collection, provision of medical and office supplies, secretarial, reception and transcription services, maintenance of medical records, and advertising, marketing and promotional activities.

Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payors. Estimates of contractual allowances under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual

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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, 2024 and 2023 are presented in the table below based on an allocation of the estimated transaction price with the patient between the primary patient classification of insurance coverage (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Commercial insurance	$	255,375	$	218,923	$	752,514	$	652,597
Medicare	102,852		89,981		298,001		262,719
Medicaid	10,894		10,519		32,804		30,279
Workers' compensation/personal injury	10,232		9,745		33,088		34,785
Other patient revenue	10,607		10,443		34,524		30,191
Management fee revenue	6,242		3,922		18,255		12,203
Heart and lung	4,696		2,441		12,553		6,377
Other	10,314		3,768		18,918		14,248
Revenue under capitation arrangements	33,563		40,041		105,050		117,982
Imaging Center Segment Revenue	444,775		389,783		1,305,707		1,161,381
Digital Health Segment Revenue	16,367		12,185		46,856		34,866
Total service revenue	$	461,142	$	401,968	$	1,352,563	$	1,196,247

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

We have entered into factoring agreements with various institutions and sold certain accounts receivable under non-recourse agreements in exchange for notes receivables from the buyers. These transactions are accounted for as a reduction in accounts receivable as the agreements transfer effective control over and risk related to the receivables to the buyers. Proceeds on notes receivables are reflected as operating activities on our statement of cash flows and on our balance sheet as prepaid expenses and other current assets for the current portion and deposits and other for the long term portion. Amounts remaining to be collected on these agreements were $5.9 million and $14.3 million at September 30, 2024 and December 31, 2023, respectively. We do not utilize factoring arrangements as an integral part of our financing for working capital and assess the party's ability to pay upfront at the inception of the notes receivable and subsequently by reviewing their financial statements annually and reassessing any insolvency risk on a periodic basis.

DEFERRED FINANCING COSTS - Costs of financing are deferred and amortized using the effective interest rate method and are related to our revolving credit facilities. Deferred financing costs, net of accumulated amortization, were $2.4 million and $1.6 million, as of September 30, 2024 and December 31, 2023, respectively. See Note 6, Credit Facilities and Notes Payable for more information.

PROPERTY AND EQUIPMENT - Property and equipment are stated at cost, less accumulated depreciation and amortization. Depreciation of property and equipment is performed using the straight-line method over the estimated useful lives of the assets acquired, which range from 3 to 15 years. Leasehold improvements are amortized at the lesser of lease term or their estimated useful lives, which range from 3 to 15 years. Maintenance and repairs are charged to expense as incurred.

BUSINESS COMBINATIONS - 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

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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 - Goodwill at September 30, 2024 totaled $711.8 million. Goodwill is recorded as a result of business combinations. If we determine the carrying value of a reporting unit exceeds its fair value an impairment charge would be recognized and should not exceed the total amount of goodwill allocated to that reporting unit. We tested goodwill and indefinite lived intangibles for impairment on October 1, 2023 noting no impairment, and we have not identified any indicators of impairment through September 30, 2024.

Activity in goodwill for the nine months ended September 30, 2024 is provided below (in thousands):


	Imaging Center segment		Digital Health segment		Total
Balance as of December 31, 2023	606,557		$	72,906	$	679,463
Goodwill from acquisitions	30,729		—		30,729

Currency translation	1,223		426		1,649

Segment reorganization	(12,300)		12,300		—








Balance as of September 30, 2024	$	626,209	$	85,632	$	711,841

INTANGIBLE ASSETS - Intangible assets are primarily related to our business combinations and software development. They include the estimated fair values of such items as service agreements, customer lists, covenants not to compete, acquired technologies, and trade names. The components of intangible assets, both finite and indefinite lived, along with annual amortization expense that will be recorded over the next five years at September 30, 2024 and December 31, 2023 are as follows (in thousands):

As of September 30, 2024:


	2024*		2025		2026		2027		2028		Thereafter		Total		Weighted average amortization period remaining in years
Management service contracts	$	572	$	2,287	$	2,287	$	2,287	$	2,287	$	6,669	$	16,389	7.2
Covenant not to compete and other contracts	261		897		610		315		225		68		2,376		3.1
Customer lists	318		1,141		1,019		844		803		11,108		15,233		17.4
Patent and trademarks	78		311		311		311		311		197		1,519		5.2
Developed technology	1,913		7,651		7,611		7,077		7,077		6,856		38,185		5.8
Trade names amortized	19		77		77		77		63		27		340		4.5
Trade names indefinite life	—		—		—		—		—		8,500		8,500		—
IPR&D	—		—		—		—		—		1,899		1,899		—
Total annual amortization	$	3,161	$	12,364	$	11,915	$	10,911	$	10,766	$	35,324	$	84,441

*Excluding the nine months ended September 30, 2024

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As of December 31, 2023:


	2024		2025		2026		2027		2028		Thereafter		Total		Weighted average amortization period remaining in years
Management service contracts	$	2,287	$	2,287	$	2,287	$	2,287	$	2,287	$	6,671	$	18,106	7.9
Covenant not to compete and other contracts	946		714		427		132		45		6		2,270		3.4
Customer lists	1,234		1,104		981		797		764		10,564		15,444		17.7
Patent and trademarks	316		316		316		315		300		164		1,727		5.8
Developed technology	7,785		7,785		7,745		7,210		7,046		6,117		43,688		5.7
Trade names amortized	77		77		77		77		63		27		398		5.3
Trade names indefinite life	—		—		—		—		—		7,100		7,100		—
IPR&D	—		—		—		—		—		1,882		1,882		—
Total annual amortization	$	12,645	$	12,283	$	11,833	$	10,818	$	10,505	$	32,531	$	90,615

Total intangible asset amortization expense was $3.1 million and $9.4 million for the three and nine months ended September 30, 2024, respectively. Total amortization expense was $3.0 million and $8.9 million for the three and nine months ended September 30, 2023, respectively. Intangible assets are amortized using the straight-line method over their useful life determined at acquisition. Management service contracts are amortized over 25 years using the straight line method. Developed technology is capitalized and amortized over the useful life of the software when placed into service. In process research and development (" IPR&D") and Trade names are reviewed annually for impairment.

INCOME TAXES - Income tax expense is computed using an asset and liability method and using expected annual effective tax rates. Under this method, deferred income tax assets and liabilities result from temporary differences in the financial reporting bases and the income tax reporting bases of assets and liabilities. The measurement of deferred tax assets is reduced, if necessary, by the amount of any tax benefit that, based on available evidence, is not expected to be realized. When it appears more likely than not that deferred taxes will not be realized, a valuation allowance is recorded to reduce the deferred tax asset to its estimated realizable value. For net deferred tax assets we consider estimates of future taxable income in determining whether our net deferred tax assets are more likely than not to be realized.

In 2021, the Organization for Economic Co-operation and Development ("OECD") announced an inclusive framework on base erosion and profit shifting including Pillar Two Model Rules defining the global minimum tax, which calls for taxation of large multinational corporations at a minimum rate of 15%. Subsequently, multiple sets of administrative guidance have been issued. Many non-US tax jurisdictions have either recently enacted legislation to support certain components of Pillar Two Model Rules beginning 2024 (including the European Union Member States) with the adoption of additional components in later years or announced their plans to enact legislation in future years. The model rules provide a framework for applying the minimum tax, countries may enact Pillar Two Model Rules slightly differently than the model rules and on different timelines and may adjust domestic tax incentives in response to Pillar Two Model Rules. On a long-term basis, we will continue to evaluate the impacts of enacted legislation and pending legislation to enact Pillar Two Model Rules in all countries applicable to us. For 2024, we expect that we will meet one or more transactional safe harbor rules, and as such, we do not believe Pillar Two model will have an impact on our annual effective tax rate for the year ending December 31, 2024.

We recorded an income tax expense of $4.3 million, or an effective tax rate of 26.1%, for the three months ended September 30, 2024 and $7.2 million, or an effective tax rate of 23.1% for the three months ended September 30, 2023. We recorded income tax expense of $4.9 million, or an effective tax rate of 16.7%, for the nine months ended September 30, 2024 and $7.7 million, or an effective tax rate of 24.1% for the nine months ended September 30, 2023. The income tax rates for the three and nine months ended September 30, 2024 diverge from the federal statutory rate due to (i) effects of state income taxes ; (ii) officer's compensation limitations; (iii) partial valuation allowance on losses in foreign jurisdictions, partially offset by (iv) excess tax benefits attributable to share based compensation; and (v) noncontrolling interests from controlled partnerships.

LEASES - We determine if an arrangement is a lease at inception. Operating leases are included in operating lease right-of-use (“ROU”) assets, current operating lease liabilities, and long term operating lease liability in our condensed consolidated balance sheets. 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

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elected to account for the components as a single lease component. ROU assets are tested for impairment if circumstances suggest that the carrying amount may not be recoverable. Our ROU assets consist of facility and equipment assets on operating leases. No events have occurred such as fire, flood, or other acts which have impaired the integrity of our ROU assets as of September 30, 2024. Our facility leases require us to maintain insurance policies which would cover major damage to our facilities. We maintain business interruption insurance to cover loss of business due to a facility becoming non-operational under certain circumstances. Our equipment leases are covered by warranty and service contracts which cover repairs and provide regular maintenance to keep the equipment in functioning order.

EQUITY BASED COMPENSATION – We have one long-term incentive plan that we adopted in 2006 and which we have amended and restated at various points in time: April 20, 2015, March 9, 2017, April 15, 2021 April 27, 2023, and most recently by our stockholders at our annual stockholders meeting on June 7, 2023 (the “Restated Plan”). We have reserved 20,100,000 shares of common stock for issuance under the Restated Plan which can be issued in the form of incentive and/or nonstatutory stock options, restricted and/or unrestricted stock, stock units, and stock appreciation rights. Terms and conditions of awards can be direct grants or based on achieving a performance metric. We also consider probability of achievement of performance conditions when determining expense recognition. For the awards where vesting is probable, equity-based compensation is recognized over the related vesting period. Stock options generally vest over three years to five years and expire five years to ten years from date of grant. We determine the compensation expense for each stock option award using the Black Scholes model. This model requires that our management make certain estimates concerning risk free interest rates and volatility in the trading price of our common stock. The compensation expense recognized for all equity-based awards is recognized over the awards’ service periods. Equity-based compensation is classified in operating expenses within the same line item as the majority of the cash compensation paid to employees. In connection with our acquisition of DeepHealth Inc. on June 1, 2020, we assumed the DeepHealth, Inc. 2017 Equity Incentive Plan, including outstanding options awards that can be exercised for our common stock. No additional awards will be granted under the DeepHealth, Inc. 2017 Equity Incentive Plan. See Note 7, Stock-Based Compensation, for more information.

COMPREHENSIVE INCOME (LOSS) - Accounting guidance establishes rules for reporting and displaying other comprehensive income (loss) and its components. Our foreign currency translation adjustments and the amortization of balances associated with derivatives previously classified as cash flow hedges are included in other comprehensive income (loss). The components of other comprehensive income (loss) for the three and nine months ended September 30, 2024 and September 30, 2023 are included in the consolidated statements of comprehensive income.

INTEREST INCOME - We recognized interest income of approximately $9.6 million and $3.6 million for the three months ended September 30, 2024 and 2023, respectively, and $22.7 million and $6.3 million for the nine months ended September 30, 2024 and 2023, respectively. Interest income is recorded within Other non-operating income in our Condensed Consolidated Statements of Operations.

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. If one or more of these matters were resolved against us for amounts in excess of management's expectations, our results of operations and financial condition, including in a particular reporting period in which any such outcome becomes probable and estimable, could be materially adversely affected.

DERIVATIVE INSTRUMENTS - In the second quarter of 2019, we entered into four forward interest rate agreements ("2019 Swaps"). The 2019 Swaps have total notional amounts of $500.0 million, consisting of two agreements of $50.0 million each and two agreements of $200.0 million each. The 2019 Swaps secure a constant interest rate associated with portions of our variable rate bank debt and have an effective date of October 13, 2020. They matured in October 2023 for the smaller notional and will mature in October 2025 for the larger notional. We arranged the 2019 Swaps with locked in 1 month Term SOFR rates at 1.89% for the $100.0 million notional and at 1.98% for the $400.0 million notional. As of the effective date, we are liable for premium payments if interest rates decline below arranged rates, but will receive interest payments if rates are above the arranged rates.

At inception, we designated our 2019 Swaps as cash flow hedges of floating-rate borrowings. In accordance with accounting guidance, derivatives that have been designated and qualify as cash flow hedging instruments are reported at fair value. The gain or loss on the effective portion of the hedge (i.e. change in fair value) is reported as a component of comprehensive gain or loss in the consolidated statement of equity. The remaining gain or loss, if any, is recognized currently in earnings. The cash flows for both our $400.0 million notional interest rate swap contract locked in at 1.98% due October 2025 and our $100.0 million notional interest rate swap contract locked in at 1.89% did not match the cash flows for our term

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loans under our Barclays Credit Facility, so we determined that they are not effective as cash flow hedges. Accordingly, all changes in their fair value after April 1, 2020 for the $400.0 million notional and after July 1, 2020 for the $100.0 million notional are being recognized in earnings. As of July 1, 2020, the total change in fair value relating to swaps included in other comprehensive income was approximately $24.4 million, net of taxes. This amount was amortized to interest expense through October 2023 at approximately $0.4 million per month and continuing at approximately $0.3 million per month through October 2025. The effect for the release of the taxes from other comprehensive income is based on the current tax rate.

A tabular presentation of the effect of derivative instruments on our consolidated statement of comprehensive income of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):

For the three months ended September 30, 2024

Account

June 30, 2024 Balance

Amount of comprehensive loss recognized on derivative net of taxes

Amount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxes*

September 30, 2024 Balance

Location

Accumulated Other Comprehensive Loss, net of taxes

$(4,369)

$—

$986

$(3,383)

Equity

*Net of taxes of $0.4 million for the three months ended September 30, 2024.

For the nine months ended September 30, 2024

Account

December 31, 2023 Balance

Amount of comprehensive loss recognized on derivative net of taxes

Amount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxes*

September 30, 2024 Balance

Location

Accumulated Other Comprehensive Loss, net of taxes

$(11,625)

$—

$8,242

$(3,383)

Equity

*Net of taxes of $2.8 million for the nine months ended September 30, 2024.

A tabular presentation of the effect of derivative instruments on our statement of operations of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):

For the three months ended September 30, 2024

Ineffective interest rate swap

Amount recognized (current period ineffective portion)

Location recognized in profit and loss (current period ineffective portion)

Amount reclassified from accumulated OCI (prior period effective portion)

Location reclassified from accumulated OCI into profit and loss (prior period effective portion)

Interest rate contracts

6,755

Other income (expense)

986

Interest Expense

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For the nine months ended September 30, 2024

Ineffective interest rate swap

Amount recognized (current period ineffective portion)

Location recognized in profit and loss (current period ineffective portion)

Amount reclassified from accumulated OCI (prior period effective portion)

Location reclassified from accumulated OCI into profit and loss (prior period effective portion)

Interest rate contracts

7,429

Other income (expense)

8,242

Interest Expense

See Fair Value Measurements below for the fair value of the 2019 Swaps at September 30, 2024.

CONTINGENT CONSIDERATION -

The HLH Imaging Group Limited fka Heart and Lung Imaging Limited

On November 1, 2022, we completed our acquisition of 75% of the equity interests of Heart and Lung Imaging Limited. The purchase included up to $10.2 million in contingent milestone consideration and cash holdback of $0.6 million to be issued 24 months after acquisition subject to adjustment for any indemnification claims, which will be adjusted to fair value in subsequent periods. The holdback had a value of approximately $0.6 million as of September 30, 2024. The contingent consideration is determined by the achievement of a specific number of physician reads. On September 20, 2023, we settled a milestone contingent liability by issuing 56,600 shares of our common stock at an ascribed value of $1.6 million and cash of $1.8 million. On December 12, 2023, we settled a milestone contingent liability by issuing 64,569 shares of our common stock at an ascribed value of $2.3 million and cash of $2.1 million. On March 27, 2024, we partially settled a milestone contingent liability by issuing 95,019 shares of our common stock at an ascribed value of $4.6 million. On April 1, 2024, we settled the remaining milestone contingent liability in cash of $3.6 million.

A tabular roll forward of contingent consideration is as follows (amounts in thousands):

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For the three months ended September 30, 2024
Entity	Account	June 30, 2024 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2024 Balance
Heart and Lung	Accrued expenses	632	$	—	$	—	$	—	$	632






For the three months ended September 30, 2023
Entity	Account	June 30, 2023 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2023 Balance
Heart and Lung	Accrued Expenses & Other Long Term Liabilities	14,358	$	(3,402)	$	915	$	(772)	$	11,099






For the nine months ended September 30, 2024
Entity	Account	January 1, 2024 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2024 Balance
Heart and Lung	Accrued expenses	6,879	$	(8,221)	$	1,060	$	914	$	632






For the nine months ended September 30, 2023
Entity	Account	January 1, 2023 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2023 Balance
Heart and Lung	Accrued Expenses & Other Long Term Liabilities	11,656	$	(3,402)	$	2,906	$	(61)	$	11,099

Gain or loss from change in valuation of contingent consideration are recorded within Cost of operations in our Consolidated Statements of Operations.

See Fair Value Measurements below for the fair value of contingent consideration at September 30, 2024.

FAIR VALUE MEASUREMENTS – Assets and liabilities subject to fair value measurements are required to be disclosed within a fair value hierarchy. The fair value hierarchy ranks the quality and reliability of inputs used to determine fair value. Accordingly, assets and liabilities carried at, or permitted to be carried at, fair value are classified within the fair value hierarchy in one of the following categories based on the lowest level input that is significant to a fair value measurement:

Level 1—Fair value is determined by using unadjusted quoted prices that are available in active markets for identical assets and liabilities.

Level 2—Fair value is determined by using inputs other than Level 1 quoted prices that are directly or indirectly observable. Inputs can include quoted prices for similar assets and liabilities in active markets or quoted prices for identical assets and liabilities in inactive markets. Related inputs can also include those used in valuation or other pricing models such as interest rates and yield curves that can be corroborated by observable market data.

Level 3—Fair value is determined by using inputs that are unobservable and not corroborated by market data. Use of these inputs involves significant and subjective judgment.

Derivatives:

The tables below summarize the estimated fair values of certain of our financial assets that are subject to fair value measurements, and the classification of these assets on our condensed consolidated balance sheets, as follows (in thousands):

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	As of September 30, 2024
	Level 1		Level 2		Level 3		Total
Long term assets

2019 Swaps - Interest Rate Contracts	$	—	$	7,689	$	—	$	7,689


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total
Current and long term assets

2019 Swaps - Interest Rate Contracts	$	—	$	15,118	$	—	$	15,118

The estimated fair value of these contracts was determined using Level 2 inputs. More specifically, the fair value was determined by calculating the value of the difference between the fixed interest rate of the interest rate swaps and the counterparty’s forward SOFR curve. The forward SOFR curve is readily available in the public markets or can be derived from information available in the public markets.

Contingent Consideration:

The table below summarizes the estimated fair values of holdback relating to our Heart and Lung Imaging Limited acquisition on November 1, 2022 that are subject to fair value measurements and the classification of these liabilities on our condensed consolidated balance sheets, as follows (in thousands):


	As of September 30, 2024
	Level 1		Level 2		Level 3		Total
Accrued expenses
Heart & Lung Imaging Limited	$	—	$	—	$	632	$	632


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total
Accrued expenses



Heart & Lung Imaging Limited	$	—	$	—	$	6,879	$	6,879

The estimated fair value of these liabilities was determined using Level 3 inputs. For Heart & Lung Imaging Limited the contingent consideration is determined by the achievement of a specific number of physician reads. The fair value is measured based upon the probability adjusted amount expected to be paid. As significant inputs for the contingent consideration of Heart & Lung Imaging Limited are not observable and cannot be corroborated by observable market data they are classified as Level 3.

Long Term Debt:

The table below summarizes the estimated fair value compared to the face value of our long-term debt as follows (in thousands):


	As of September 30, 2024
	Level 1		Level 2		Level 3		Total Fair Value		Total Face Value
Barclays Term Loan and Truist Term Loan	$	—	$	1,010,778	$	—	$	1,010,778	$	1,009,687


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total Fair Value		Total Face Value
Barclays Term Loan and Truist Term Loan	$	—	$	824,759	$	—	$	824,759	$	823,063

The estimated fair value of our long-term debt, which is discussed in Note 6, Credit Facilities and Notes Payable, was determined using Level 2 inputs primarily related to comparable market prices.

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We consider the carrying amounts of cash and cash equivalents, receivables, other current assets, current liabilities and other notes payables to approximate their fair value because of the relatively short period of time between the origination of these instruments and their expected realization or payment.

EARNINGS PER SHARE - Earnings per share is based upon the weighted average number of shares of common stock and common stock equivalents outstanding, net of common stock held in treasury, as follows (in thousands except share and per share data):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$	3,209	$	17,540	$	(2,552)	$	4,904

BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period	73,494,709		67,793,404		72,587,321		62,113,707
Basic net income (loss) per share attributable to RadNet, Inc.'s common stockholders	$	0.04	$	0.26	$	(0.04)	$	0.08

DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period	73,494,709		67,793,404		72,587,321		62,113,707
Add non-vested restricted stock subject only to service vesting	233,235		217,238		—		202,082
Add additional shares issuable upon exercise of stock options and contingently issuable shares	1,437,491		799,176		—		905,462
Weighted average number of common shares used in calculating diluted net income per share	75,165,435		68,809,818		72,587,321		63,221,251


Diluted net income (loss) income per share attributable to RadNet, Inc.'s common stockholders	$	0.04	$	0.25	$	(0.04)	$	0.08




Stock options and non-vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Non-vested restricted stock subject to service vesting	—		—		680,318		—
Shares issuable upon the exercise of stock options	—		88,600		820,932		761,708
Shares issuable subject to satisfaction of certain contingencies	—		—		—		193,207
Weighted average shares for which the exercise price exceeds average market price of common stock	—		—		—		94,346

INVESTMENTS IN EQUITY SECURITIES–Accounting guidance requires entities to measure equity investments at fair value, with any changes in fair value recognized in net income. If there is no readily determinable fair value, the guidance allows entities the ability to measure investments at cost, adjusted for observable price changes and impairments, with changes recognized in net income.

As of September 30, 2024, we have four equity investments with an aggregate carrying value of $8.0 million.

During the three months ended September 30, 2024, we recognized a $1.2 million impairment loss on our investment in Israel-based Medic Vision. This was driven by the escalating geopolitical tensions in Israel, which adversely affected market conditions, along with a bona fide offer we received for a similar investment. The offer, which was below the carrying value of our investment, provided a reliable indication of the current fair value of our Medic Vision investment. As a result, we

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determined that the carrying amount of the investment exceeded its fair value, and the impairment loss has been recorded within "Other income" in our Condensed Consolidated Statements of Operations.

No other observable price changes or impairments in our investments were identified as of September 30, 2024.

INVESTMENT IN JOINT VENTURES – We have 13 unconsolidated joint ventures with ownership interests ranging from 33% 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 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, 2024.

Joint venture investment and financial information

The following table is a summary of our investment in joint ventures during the nine months ended September 30, 2024 (in thousands):


Balance as of December 31, 2023	$	92,710
Equity in earnings in these joint ventures	11,308
Distribution of earnings	(1,000)



Equity contributions in existing joint ventures	1,496
Balance as of September 30, 2024	$	104,514

We charged management service fees from the centers underlying these joint ventures of approximately $5.9 million and $3.9 million for the three months ended September 30, 2024 and 2023 and $17.8 million and $12.2 million for the nine months ended September 30, 2024 and 2023, respectively. We eliminate any unrealized portion of our management service fees with our equity in earnings of joint ventures. As we have the ability to exercise significant influence over our joint venture entities, we consider them related parties. Amounts transacted between ourselves and the entities are in the ordinary course of business and are disclosed on our balance sheet in the due from/to affiliate accounts.

The following table is a summary of key balance sheet data for these joint ventures as of September 30, 2024 and December 31, 2023 and income statement data for the nine months ended September 30, 2024 and 2023 (in thousands):


Balance Sheet Data:	September 30, 2024		December 31, 2023
Current assets	$	64,175	$	39,819
Noncurrent assets	219,478		224,936
Current liabilities	(41,550)		(46,587)
Noncurrent liabilities	(70,607)		(70,834)
Total net assets	$	171,496	$	147,334


Income statement data for the nine months ended September 30,	2024		2023
Net revenue	$	195,905	$	129,020
Net income	$	23,949	$	7,906

NOTE 3 – RECENT ACCOUNTING AND REPORTING STANDARDS

Recently Issued Accounting Pronouncements

In November 2023, the FASB issued Accounting Standards Updates (ASUs) 2023-07 ("ASU 2023-07"), Segment Reporting (Topic 280) Improvements to Reportable Segment Disclosures. The guidance requires entities to provide enhanced disclosures about significant segment expenses. For entities that have adopted the amendments in ASU 2023-07, the updated

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guidance is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, and is applicable to the Company in fiscal 2025. Early adoption is permitted. This ASU will likely result in us including the additional required disclosures when adopted. We are currently evaluating the provisions of this ASU and expect to adopt them for the year ending December 31, 2024.

NOTE 4 – BUSINESS COMBINATIONS AND RELATED ACTIVITY

Imaging Center Segment

Acquisitions

During the nine months ended September 30, 2024, we completed the acquisition of certain assets of the following entities, which either engage directly in the practice of radiology or associated businesses. The primary reason for these acquisitions was to strengthen our presence in the California and Texas market. These acquisitions are reported as part of our Imaging Center segment. As of September 30, 2024, we made a preliminary fair value determination of the acquired assets and assumed liabilities and the following were recorded (in thousands). The valuation of assets acquired and liabilities assumed has not yet been finalized as of September 30, 2024; and the fair value determination is preliminary and may be subject to change:


Entity	Date Acquired	Total Consideration		Property & Equipment	Right of Use Assets	Goodwill	Intangible Assets	Other Assets	Right of Use Liabilities	Notes payable

Stanislaus Surgical Hospital, LLC	9/16/2024	3,000		504	1,468	2,382	100	15	(1,468)	—
Global Imaging LLP	9/1/2024	$	2,900	1,266	—	1,584	50	—	—	—
U.S. Imaging, Inc.	6/1/2024	4,200		4,025	5,597	—	175	—	(5,597)	—
Houston Medical Imaging, LLC	4/1/2024	22,703		15,826	7,929	11,584	1,660	90	(8,089)	(6,297)
Grossman Imaging Center of CMH, LLC	3/31/2024	10,344		1,717	6,304	8,501	280	56	(6,514)	—
Providence Health System - Southern California	3/31/2024	$	7,369	1,378	3,441	5,991	—	—	(3,441)	—
Antelope Valley Outpatient Imaging	2/1/2024	$	3,530	2,794	563	687	50	—	(563)	—

Total		54,046		27,509	25,302	30,729	2,315	160	(25,672)	(6,297)

During the three months ended September 30, 2024, the Company revised the fair value of certain assets acquired and liabilities assumed of Houston Medical Imaging, LLC’s, Grossman Imaging Center of CMH, LLC, and Providence Health System - Southern California, resulting in an increase of $4.4 million in the net fair value of these assets and liabilities and a corresponding decrease in goodwill. These adjustments did not have an impact on the Company’s condensed consolidated statement of operations for the nine months ended September 30, 2024.

Formation of majority owned subsidiary and sale of economic interest

On February 23, 2024, we formed Tri Valley Imaging Group, LLC ("TVIG"), a partnership with Providence Health System - Southern California ("PHS"). The operation offers multi-modality services out of seven locations in Southern

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California. On March 29, 2024, we contributed the operations of four centers to the enterprise and PHS contributed a business comprising three centers including $1.4 million of fixed assets and $6.0 million in goodwill. Simultaneously, PHS purchased from us an additional economic interest in TVIG for cash payment of $9.6 million. As a result of the transaction, we recognized a gain of $7.9 million to additional paid in capital and retained a 52% controlling economic interest in TVIG and PHS retains a $7.8 million or 48% noncontrolling economic interest in TVIG.

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

NOTE 5 – SEGMENT REPORTING

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

Our Imaging Center segment provides physicians with imaging capabilities to facilitate the diagnosis and treatment of diseases and disorders. Services include magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), nuclear medicine, mammography, ultrasound, diagnostic radiology (X-ray), fluoroscopy and other related procedures. The vast majority of our centers offer multi-modality imaging services, a strategy that diversifies revenue streams, reduces exposure to reimbursement changes and provides patients and referring physicians one location to serve the needs of multiple procedures.

Our Digital Health segment develops and deploys clinical applications to enhance interpretation of medical images and improve patient outcomes with an emphasis on brain, breast, prostate, and pulmonary diagnostics. Included in the segment is our eRad subsidiary, which designs the underlying critical scheduling, data storage and retrieval systems necessary for imaging center operation.

Our chief operating decision maker ("CODM"), who is also our CEO, evaluates the financial performance of our segments based upon their respective revenue and segmented internal profit and loss statements prepared on a basis not consistent with GAAP. We do not report balance sheet information by segment since it is not reviewed by our CODM.

In the normal course of business, our Imaging Center and Digital Health segments enter into transactions with each other. While intersegment transactions are treated like third-party transactions to determine segment performance, the revenues recognized by a segment and expenses incurred by the counterparty are eliminated in consolidation and do not affect consolidated results.


	Three Months Ended September 30, 2024
	Imaging Center		Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	452,368	$	8,774	$	—	$	461,142
Intersegment	—		7,593		(7,593)		—
Total revenue	$	452,368	$	16,367	$	(7,593)	$	461,142


	Three months ended September 30, 2023
	Imaging Center		Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	395,613	$	6,355	$	—	$	401,968
Intersegment	—		5,830		(5,830)		—
Total revenue	$	395,613	$	12,185	$	(5,830)	$	401,968

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	Nine Months Ended September 30, 2024
	Imaging Center			Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	1,325,825		$	26,738	$	—	$	1,352,563
Intersegment	—			20,118		(20,118)		—
Total revenue	$	1,325,825	1325825000	$	46,856	$	(20,118)	$	1,352,563


	Nine Months Ended September 30, 2023
	Imaging Center			Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	1,178,873		$	17,374	$	—	$	1,196,247
Intersegment	—			17,492		(17,492)		—
Total revenue	$	1,178,873	1178873	$	34,866	$	(17,492)	$	1,196,247

The table below presents segment information reconciled to our financial results, with segment operating income or loss including revenue less cost of operations, depreciation and amortization, and other operating expenses to the extent specifically identified by segment (in thousands):

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	Three months ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Revenue:
Imaging Center	444,775		389,783		$	1,305,707	$	1,161,381
Digital Health	16,367		12,185		46,856		34,866
Total revenue	$	461,142	401,968		$	1,352,563	$	1,196,247

Cost of Operations
Imaging Center	$	374,789	$	334,580	$	1,120,542	$	1,008,814
Digital Health	17,011		7,055		48,571		29,833
Total cost of operations	$	391,800	$	341,635	$	1,169,113	$	1,038,647

Depreciation and Amortization:
Imaging Center	$	32,032	$	30,221	$	94,095	$	89,743
Digital Health	2,947		1,989		7,727		5,962
Total depreciation and amortization	$	34,979	$	32,210	$	101,822	$	95,705

Gain on contribution of imaging centers into joint venture:
Imaging Center	$	—	$	(16,808)	$	—	$	(16,808)
Digital Health	—		—		—		—
Total (gain) loss on contribution of imaging centers into joint venture	$	—	$	(16,808)	$	—	$	(16,808)

Loss (gain) on Disposal of Equipment:
Imaging Center	$	153	$	524	$	739	$	1,185
Digital Health	(5)		3		(4)		(2)
Total loss on disposal of equipment	$	148	$	527	$	735	$	1,183

Severance
Imaging Center	$	271	$	1,141	$	720	$	1,417
Digital Health	33		12		77		1,740
Total severance	$	304	$	1,153	$	797	$	3,157

Income (Loss) from Operations
Imaging Center	$	37,530	$	40,125	$	89,611	$	77,030
Digital Health	(3,619)		3,126		(9,515)		(2,667)
Total income from operations	$	33,911	$	43,251	$	80,096	$	74,363

NOTE 6 – CREDIT FACILITIES AND NOTES PAYABLE

At September 30, 2024 we had two principal secured credit facilities consisting of our Barclays credit facility and our Truist credit facility. Each facility includes a term loan component and a revolving credit facility. At September 30, 2024, we were in compliance with all covenants under our credit facilities.

Barclays Credit Facility

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On April 18, 2024, we entered into a Third Amended and Restated First Lien Credit and Guaranty Agreement (the “Barclays Credit Agreement”), with Barclays Bank Plc and the lenders and financial institutions named therein, which provides for $875.0 million of senior secured term loans (the “Barclays Term Loan”) and a $282.0 million senior secured revolving credit facility (the “Barclays Revolving Credit Facility”). Our borrowing under the Barclays Revolving Credit Facility is secured by a lien on all of our assets.

The proceeds from the April 18, 2024 restatement of the Barclays Credit Agreement were used to refinance the $678.7 million of term loans outstanding under the prior credit facility, to pay accrued interest through the date of closing, and to pay fees and expenses associated with the refinancing transaction. Total costs incurred in connection with the restatement amounted to approximately $19.9 million segregated as follows: $11.1 million recognized as discount and deferred finance cost, $2.1 million charged to loss on early extinguishment of debt and $6.7 million to related expenses. Amounts capitalized will be amortized over the remaining terms of the respective credit facilities under the Barclays Credit Agreement.

Barclays Term Loan:

The Barclays Term Loan provides for interest payments based on a base rate, plus an applicable margin. During the periods covered by this report, the base rates, margins and effective interest rates (without giving effect to our 2019 Swaps) were as follows for the periods indicated:


Period	Base Rate plus Margin	Effective Rate
Through March 31, 2023	Eurodollar plus 2.50% Alternative Base Rate plus 2.00%	4.63% 8.00%
April 1, 2023 to April 18, 2024	SOFR plus 3.00% Alternative Base Rate plus 2.00%	8.33% (credit spread adjustment of 0.11%) 10.5%
After April 18, 2024	SOFR plus 2.5% Prime Rate plus 1.5%	7.78% (credit spread adjustment of 0.00% ) 9.5%

With the recent restatement, we are required to make quarterly principal payments of $2.2 million (up from $1.8 million under the prior credit agreement). The Barclays Term Loan will mature on April 18, 2031 unless otherwise accelerated under the terms of the Barclays Credit Agreement.

Barclays Revolving Credit Facility:

The Barclays Revolving Credit Facility is a $282.0 million senior secured revolving credit facility. Associated with the Barclays Revolving Credit Facility is deferred financing costs, net of accumulated amortization, of $2.0 million at September 30, 2024.

Amounts borrowed under the Barclays Revolving Credit Facility bear interest at either SOFR plus 3.00% or the Prime Rate plus 2% (with step-downs based on attainment of certain first lien net leverage ratio benchmarks). As of September 30, 2024, the effective interest rate payable on revolving loans under the Barclays Revolving Credit Facility was 10.50%. In addition, a commitment fee of 0.50% per annum accrues on the unused revolver commitments under the Barclays Revolving Credit Facility.

We had no outstanding balance under our $282.0 million Barclays Revolving Credit Facility at September 30, 2024. After reserves of $8.3 million for certain letters of credit, $273.7 million was available to draw upon as of September 30, 2024.

The Barclays Revolving Credit Facility terminates on April 18, 2029, unless otherwise accelerated under the terms of the Barclays Credit Agreement.

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Truist Credit Facility

On October 7, 2022 our subsidiary New Jersey Imaging Network, Inc.("NJIN") entered into Second Amended and Restated Revolving Credit and Term Loan Agreement (the “Truist Credit Agreement”), with Truist Bank and the lenders and financial institutions named therein, which provides for a $150.0 million term loan (the "Truist Term Loan") and a $50.0 million revolving credit facility (the “Truist Revolving Credit Facility”). The Truist Credit agreement is secured by the assets of NJIN.

Truist Term Loan:

The Truist Term Loan currently bears interest at SOFR or a Base Rate plus an applicable margin and fees which step down based on a leverage ratio. At September 30, 2024 the applicable margin for SOFR was 1.5%.

We are required to make quarterly principal payments of $1.9 million, which increases by $0.9 million at scheduled intervals, with the remaining balance to be paid at maturity. The Truist Term Loan will mature on October 10, 2027 unless otherwise accelerated under the terms of the Truist Credit Agreement.

Truist Revolving Credit Facility:

The Truist Revolving Credit Facility is a $50.0 million secured revolving credit facility. Associated with the Truist Revolving Credit Facility are deferred financing costs, net of accumulated amortization, of $0.4 million at September 30, 2024.

Amounts borrowed under the Truist Revolving Credit Facility bear interest at either SOFR or a Base Rate plus an applicable margin and fees which step down based on a leverage ratio. In addition, a commitment fee of 0.30% per annum accrues on the unused revolver commitments under the Truist Revolving Credit Facility.

We had no balance under our $50.0 million Truist Revolving Credit Facility at September 30, 2024. With no letters of credit reserved against the facility, the full $50.0 million was available to draw upon as of September 30, 2024.

The Truist Revolving Credit Facility terminates on October 7, 2027, unless otherwise accelerated under the terms of the Truist Credit Agreement.

Notes Payable

We have issued certain notes payable in connection with the purchase of equipment previously leased under operating leases. On April 1, 2024, January 15, 2024, and February 1, 2023 we issued promissory notes in the amount of $6.3 million, $6.9 million and $19.8 million, respectively, to purchase previously leased equipment.

Debt Obligations

As of September 30, 2024 and December 31, 2023 our term loan debt and other obligations are as follows (in thousands):



	September 30, 2024		December 31, 2023
Barclays Term Loans collateralized by RadNet's tangible and intangible assets	$	872,812	$	678,687
Discount on Barclays Term Loans	(15,234)		(9,041)
Truist Term Loan Agreement collateralized by NJIN's tangible and intangible assets	136,875		144,375
Discount on Truist Term Loan Agreement	(792)		(990)

Equipment notes payable at 3.6% to 7.2%, due through 2029, collateralized by medical equipment	25,989		17,011
Total debt obligations	1,019,650		830,042
Less: current portion	(23,378)		(17,974)
Long term portion of debt obligations	$	996,272	$	812,068

NOTE 7 – STOCK-BASED COMPENSATION

Stock Incentive Plans

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We have one long-term equity incentive plan, the RadNet, Inc. Equity Incentive Plan, which has been amended and restated on April 20, 2015, March 9, 2017, April 15, 2021, April 27, 2023, and most recently following approved by our stockholders at our annual stockholders meeting on June 7, 2023 (the “Restated Plan”). We have reserved for issuance under the Restated Plan 20,100,000 shares of common stock. We can issue options (incentive and nonstatutory), performance based options, stock awards (restricted or unrestricted), stock units, performance based stock units, and stock appreciation rights under the Restated Plan.

Options

Certain options granted under the Restated Plan to employees are intended to qualify as incentive stock options under existing tax regulations. Stock options generally vest over 3 to 5 years and expire 5 to 10 years from the date of grant.

The following summarizes all of our option transactions for the nine months ended September 30, 2024:


Outstanding Options Under the 2006 Plan	Shares	Weighted Average Exercise price Per Common Share		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Balance, December 31, 2023	911,411	$	16.60
Granted	—	—
Exercised	(60,306)	6.15

Balance, September 30, 2024	851,105	17.34		5.69	$	44,301
Exercisable at September 30, 2024	729,806	16.62		5.31	38,515

Aggregate intrinsic value in the table above represents the total pretax intrinsic value (the difference between our closing stock price on September 30, 2024 and the exercise price, multiplied by the number of in-the-money options as applicable) that would have been received by the holder had all holders exercised their options on September 30, 2024. As of September 30, 2024, total unrecognized stock-based compensation expense related to non-vested employee awards was $0.5 million, which is expected to be recognized over a weighted average period of approximately 0.39 years.

DeepHealth Options

During the second quarter of fiscal 2020, in connection with the completion of the DeepHealth acquisition, we granted options to acquire 412,434 shares at a grant date fair value of $16.93 per share unit to DeepHealth employees in replacement of their stock options that were outstanding as of the closing date. As of September 30, 2024, total unrecognized stock based compensation expense related to non-vested DeepHealth options was insignificant.


Outstanding Options Under the Deep Health Plan	Shares	Weighted Average Exercise price Per Common Share		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Balance, December 31, 2023	79,073	$	—
Exercised	(9,377)	—
Balance, September 30, 2024	69,696	—		5.0	$	4,836
Exercisable at September 30, 2024	69,696	—		5.0	4,836

Options issued in replacement of original DeepHealth options as a result of our acquisition are not included in the share count under the Restated Plan.

Restricted Stock Awards ("RSAs") and Restricted Stock Units ("RSUs")

The Restated Plan permits the award of RSAs and RSUs. The following summarizes all unvested RSA's and RSU's activities during the nine months ended September 30, 2024:

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	RSAs and RSUs	Weighted-Average Remaining Contractual Term (Years)	Weighted-Average Fair Value per Share
RSAs and RSUs unvested at December 31, 2023	762,083		$	22.13
Changes during the period
Granted	797,309		$	37.40
Vested	(875,185)		$	27.78
Forfeited or Canceled	(13,460)		$	27.74
RSAs and RSUs unvested at September 30, 2024	670,747	1.74	$	32.33

We determine the fair value of all RSAs and RSUs based on the closing price of our common stock on the award date.

Performance based stock units ("PSUs")

In January 2023, we granted certain employees PSUs with a target award of 60,685 shares of our common stock. The PSUs will vest in two equal parts, starting three years from the grant date based on continuous service, with the number of shares earned (0% to 200% of the target award) depending upon the extent to which we achieve a performance condition as determined by the board of directors over the period from January 1, 2023 through December 31, 2023. In March of 2024, based on the performance condition being achieved, the board of directors issued 121,370 units with a fair value of $18.64 per unit.

Performance based stock options ("PSOs")

In January 2023, we granted certain employees PSOs with a potential to option a maximum of 235,227 shares of our common stock. The PSOs will vest in three equal parts, starting three years from the grant date based on continuous service, with the number of shares earned (0% to 100% of the target award) depending upon the extent to which we achieve a performance condition as determined the board of directors over the period from January 1, 2023 through December 31, 2023. In March 2024, based on the performance condition being achieved, the board of directors issued 235,227 options with a strike price of $18.64 per share.

Shares available

Of the 20,100,000 shares of common stock reserved for issuance under the Restated Plan, at September 30, 2024, there remain approximately 3,285,500 shares available under the Restated Plan for future issuance.

NOTE 8 – SUBSEQUENT EVENTS

Pink Perception LLC

On October 1, 2024, we entered into an agreement to acquire Pink Perception LLC for a purchase consideration of approximately $4.0 million. Pink Perception LLC consists of two multi-modality imaging centers located in New York. The acquisition closed in the fourth quarter of 2024.

Kheiron Medical Technologies Limited

On October 22, 2024, we acquired Kheiron Medical Technologies Limited for a purchase consideration of approximately $1.0 million. Kheiron Medical Technologies Limited is a UK-based AI cancer diagnostic company focused on developing deep learning solutions to support radiologists improve breast cancer detection.

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 included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2023 filed with the U.S. Securities and Exchange Commission (the "SEC") on February 29, 2024.

Forward-Looking Statements

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This report contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements reflect current views about future events and are based on our currently available financial, economic and competitive data and on current business plans. Actual events or results may differ materially depending on risks and uncertainties that may affect our 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 report include, among others, statements we make regarding:

•expectations concerning domestic and global economic conditions, rates of inflation, or changes in interest rates;

•anticipated trends in our revenues, operating expenses or capital expenditures, and our financial guidance;

•expected timing and potential impact of regulatory changes affecting our business;

•expected future market acceptance for our products or services, and our competitive strengths in the markets we serve;

•our ability to successfully acquire and integrate new businesses, and achieve expected benefits, synergies or operating results from those acquisitions; and

•economics and cost savings anticipated to be derived from our investments in artificial intelligence and machine learning products and solutions.

Forward-looking statements are neither historical facts nor assurances of future performance. Because forward-looking statements relate to the future, they are inherently subject to known and unknown risks, uncertainties and other factors that are difficult to predict and out of our control. Our actual results, level of activity, performance or achievements may be materially different from any future results, levels of activity, performance or achievements expressed or implied by these forward-looking statements. Important factors that could cause our actual results to differ materially from those indicated or implied in our forward-looking statements include the factors included in “Risk Factors,” in our annual report on Form 10-K for the fiscal year ended December 31, 2023 as 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.

Any forward-looking statement in this report is based on information currently available to us and speaks only as of the date of this report. We do not undertake any responsibility to release publicly any revisions to these forward-looking statements to take into account events or circumstances that occur after the date of this report or any unanticipated events which may cause actual results to differ from those expressed or implied by the forward-looking statements contained in this report, except as required by law.

Overview

We are a national provider of diagnostic imaging services in the United States. At September 30, 2024, we operated directly or indirectly through joint ventures with hospitals, 399 centers located in Arizona, California, Delaware, Florida, Maryland, New Jersey, New York and Texas. 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. Internationally, our subsidiary The HLH Imaging Group Limited fka Heart and Lung Imaging Limited, provides teleradiology services for remote interpretation of images on behalf of providers within the framework of the United Kingdom's National Health Service.

In addition to our imaging business, we have established a Digital Health business segment for our 2024 fiscal year, which combines our former Artificial Intelligence (“AI”) business segment with our eRad, Inc. business. Our digital health segment develops and delivers AI-powered health informatics solutions to drive quality, efficiency, and outcomes in imaging and radiology. The portfolio of software solutions are anchored by eRad, Inc.'s RIS/PACS, informatics designed specifically for outpatient radiology and DeepHealth OS, a cloud-native operating system that helps operate all aspects of the radiology service line from scheduling and patient preparation to technologist workflow to interpretation and referral management.

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In addition we are using AI to develop solutions that employ machine learning to assist radiologists and other clinicians in interpreting images and improving radiologist efficiency and patient care, initially in the fields of screening for breast, prostate, lung and colon cancers. Our DeepHealth, Inc. subsidiary has received FDA clearance for use of its SaigeQ ”triage”/workflow product, SaigeDX advanced diagnostic product and Saige-Density breast density assessment software for screening breast mammography, which we have begun to roll out in certain markets as an Enhanced Breast Cancer Detection solution. Our Aidence Holding B.V. subsidiary is developing solutions for interpretation of chest and lung CT scans for lung cancer screening. It has received the CE mark for its solution and has existing customers in seven European countries, with its largest concentration in the United Kingdom, and plans to submit an application for FDA clearance to sell in the United States. Our Quantib B.V. subsidiary is primarily focused on interpretation of prostate MRI for widespread prostate cancer screening. Quantib’s prostate MRI post-processing software has both FDA clearances and European CE marking. Our digital health segment provides these solutions to RadNet and to over 400 customers in the United States, Europe, and Israel.

Our operations comprise two segments for financial reporting purposes for this reporting period, Imaging Centers and Digital Health. For further financial information about these segments, see Note 5, Segment Reporting, in the notes accompanying our financial statements included in this report. Prior period amounts in the financial statements included in this report have been adjusted retrospectively to reflect the change in reportable segment.

Recent Developments

The following table shows our imaging centers in operation and revenues for the nine months ended September 30, 2024 and 2023:


	Nine Months Ended September 30,
	2024		2023
Centers in operation	399		363
Net revenues (millions)	$	1,353	$	1,196

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Our imaging services include magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), nuclear medicine, mammography, ultrasound, diagnostic radiology (X-ray), fluoroscopy and other related procedures. The vast majority of our centers offer multi-modality imaging services, a key point of differentiation from our competitors. The multi-modality offering provides a “one-stop” solution for our customers and referral sources. It also diversifies our revenue base, and reduces our exposure to changes in reimbursement rates for certain imaging modalities. The following charts summarize our procedure volumes for various imaging modalities for the three months ended September 30, 2024 and 2023:

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Our revenue is derived from a diverse mix of payors, including private, managed care capitated and government payors. We believe our payor diversity mitigates our exposure to possible unfavorable reimbursement trends within any one payor class. Our total service fee revenue, net of contractual allowances and discounts, and implicit price concessions for the three and nine months ended September 30, 2024 and 2023 received from our various payors is summarized in the following table (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
Payor	2024		2023		2024		2023
Commercial insurance	$	255,375	$	218,923	$	752,514	$	652,597
Medicare	102,852		89,981		298,001		262,719
Medicaid	10,894		10,519		32,804		30,279
Workers' compensation/personal injury	10,232		9,745		33,088		34,785
Other patient revenue	10,607		10,443		34,524		30,191
Management fee revenue	6,242		3,922		18,255		12,203
Heart and lung	4,696		2,441		12,553		6,377
Other	10,314		3,768		18,918		14,248
Revenue under capitation arrangements	33,563		40,041		105,050		117,982
Imaging Center Segment Revenue	444,775		389,783		1,305,707		1,161,381
Digital Health Segment Revenue	16,367		12,185		46,856		34,866
Total service revenue	461,142		$	401,968	$	1,352,563	$	1,196,247

Acquisitions

During the nine months ended September 30, 2024, we completed the acquisition of certain assets of entities which engage directly in the practice of radiology or in associated businesses for an aggregate consideration of $54.0 million. These acquisitions include:

Antelope Valley Outpatient Imaging: 1 imaging center in California;

Providence Health System Southern California: 3 imaging centers in California;

Grossman Imaging Center of CMH, LLC: 4 imaging centers in California;

Houston Medical Imaging, LLC: 9 imaging centers in Houston, Texas;

U.S. Imaging, Inc.: 6 imaging centers in Houston, Texas;

Stanislaus Surgical Hospital: 1 imaging center in Modesto, California; and

Global Imaging LLP: 1 imaging center in Sugar Land, Texas.

The purpose of these acquisitions was to expand our imaging business into Houston, Texas a new market, and to strengthen our presence in the California market. With a population of approximately 7.3 million people, Houston is the fourth largest city in the United States. See Note 4, Business Combinations and Related Activity to the financial statements in this report for additional information, including the fair value determination of the acquired assets and assumed liabilities, associated with these acquisitions.

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Joint Venture Activity

At September 30, 2024, 38% of our imaging centers were operating as joint ventures with large health care providers. We have joint venture arrangements with 24 hospital and health system partners (inclusive of consolidated and unconsolidated joint ventures), including MemorialCare (24 centers), RWJ Barnabas (35 centers), Cedars Sinai (18 centers), Dignity Health (28 centers), and MedStar Health System (5 centers). We manage the day to day operations for these joint ventures and perform most management services in exchange for a management fee. We charged management service fees from the centers underlying these joint ventures of approximately $5.9 million and $3.9 million for the three months ended September 30, 2024 and 2023, respectively. For information on our investment in unconsolidated joint ventures, key balance sheet data and income

statement data for the unconsolidated joint ventures, see Note 2, Significant Accounting Policies – Investment in Joint Ventures

to the financial statements included in this report.

Critical Accounting Policies

The Securities and Exchange Commission defines critical accounting estimates as those that (a) are most important to the portrayal of a company’s financial condition and results of operations and (b) 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 financial statements included in this report and in our annual report on Form 10-K for the year ended December 31, 2023, 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.

Use of Estimates

The financial statements included in this report 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 our obligations to provide diagnostic services are satisfied, which is generally 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 re-negotiations and renewals.

As it relates to the Consolidated Medical 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 office supplies, secretarial, reception and transcription services, maintenance of medical records, and advertising, marketing and promotional activities.

Our revenues are based upon our 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

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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.

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. Our estimates and assumptions for allowances on our account receivable did not change materially during the quarter ended September 30, 2024.

Business Combination

We evaluate all acquisitions under the framework Clarifying the Definition of a Business in the accounting guidance. Once a purchase has been determined to be the acquisition of a business, we are required to recognize the assets acquired and the liabilities assumed at their acquisition date fair values. Any portion of the purchase consideration transferred in excess of 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, 2024 totaled $711.8 million. Indefinite Lived Intangible Assets at September 30, 2024 were $20.2 million and are associated with the value of certain trade name intangibles and in process research and development ("IPR&D"). Goodwill, trade name intangibles and IPR&D are recorded as a result of business combinations. When we determine the carrying value of goodwill for a reporting unit exceeds its fair value, an impairment charge would be recognized which should not exceed the total amount of goodwill allocated to that reporting unit. We determined fair values for each of the reporting units using the market approach, when available and appropriate, or the income approach, or a combination of both. We assess the valuation methodology based upon the relevance and availability of the data at the time we perform the valuation. If multiple valuation methodologies are used, the results are weighted appropriately. Our annual impairment test of goodwill and trade name noted no impairment as of October 1, 2023, and we have not identified any other indicators of impairment through September 30, 2024.

Recent Accounting Standards

See Note 3, Recent Accounting and Reporting Standards to the financial statements included in this report for further information.

Results of Operations

Three Months Ended September 30, 2024 Compared to the Three Months Ended September 30, 2023

Imaging Center Segment

We have developed our medical imaging centers segment through a combination of organic growth, acquisitions and joint venture formations. In the discussion below same center metrics are based on imaging centers that were in operation throughout the period of July 1, 2023 through September 30, 2024. Excluded amounts relate to imaging centers that were acquired or divested between July 1, 2023 through September 30, 2024.

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Total Revenue


In Thousands	Three Months Ended September 30,
Revenue	2024	2023	$ Increase	% Change
Total	$444,775	$389,783	$54,992	14.1%
Same Center	$422,881	$381,620	$41,261	10.8%
Excluded	$21,894	$8,163	—	—

Our 10.8% increase in same center revenue over the same period last year was driven by increases in fees charged per imaging procedure and an increase in procedures volumes. Same center total procedure volume grew at an overall rate of 4.0% which was comprised of a 2.55% increase in routine imaging and an 8.6% increase in advanced modality imaging procedures. The increase in revenue was largely attributable to product mix, as advanced imaging was a greater portion of overall procedures. A significant contributor to the change in product mix was the increase in PETHC procedures related to prostate cancer and suspect Alzheimer’s studies, which are included in advanced modality imaging procedures.

Operating Expenses

Total operating expenses for the three months ended September 30, 2024 increased approximately $57.6 million, or 16.5%, to $407.2 million for the three months ended September 30, 2024 from $349.7 million for the three months ended September 30, 2023. The following table breaks down our cost of operations and total operating expenses for the three months ended September 30, 2024 and 2023 (in thousands):


	Three Months Ended September 30,
	2024		2023
Salaries and professional reading fees, excluding stock-based compensation	$	243,066	$	210,314
Stock-based compensation	4,195		3,937
Building and equipment rental	31,104		29,720
Medical supplies	26,668		21,285
Other operating expenses *	69,756		69,324
Cost of operations	374,789		334,580

Depreciation and amortization	32,032		30,221
Gain on contribution of imaging centers into joint venture	—		(16,811)
Loss on sale and disposal of equipment	153		524
Severance costs	271		1,141
Total operating expenses	$	407,245	$	349,655

*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 September 30, 2024 and 2023 (in thousands):

Salaries and professional reading fees, excluding stock-based compensation and severance


In Thousands	Three Months Ended September 30,
Salaries and Professional Fees	2024	2023	$ Increase/(Decrease)	% Change
Total	$243,066	$210,314	$32,752	15.6%
Same Center	$231,039	$206,401	$24,638	11.9%
Excluded	$12,027	$3,913	—	—

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Consistent with the higher procedure volumes noted above, our staffing levels were adjusted to support the influx of patients seeking radiology procedures. We are continuing to face inflation in employee wage rates as we compete for talent in a tight labor market.

Stock-based compensation

Stock-based compensation for the three months ended September 30, 2024 increased approximately $0.3 million, or 6.6%, to $4.2 million from $3.9 million for the three months ended September 30, 2023. The increase is primarily due to higher fair value of stock awards granted in the first quarter of 2024.

Building and equipment rental


In Thousands	Three Months Ended September 30,
Building & Equipment Rental	2024	2023	$ Increase/(Decrease)	% Change
Total	$31,104	$29,720	$1,384	4.7%
Same Center	$27,763	$27,512	$251	0.9%
Excluded	$3,341	$2,208	—	—

Building and equipment rental expense on a same center basis was relatively unchanged from the prior period.

Medical supplies


In Thousands	Three Months Ended September 30,
Medical Supplies Expense	2024	2023	$ Increase/(Decrease)	% Change
Total	$26,668	$21,285	$5,383	25.3%
Same Center	$25,213	$20,614	$4,599	22.3%
Excluded	$1,455	$671	—	—

The increase in medical supplies expense was driven by our higher patient volume and product shift towards more advanced imaging modalities. The increase in PETHC procedures related to prostate cancer and suspected Alzheimer studies also raised medical supplies expense due to the requirement for high-cost isotope tracers.

Other operating expenses


In Thousands	Three Months Ended September 30,
Other Operating Expenses	2024	2023	$ Increase/(Decrease)	% Change
Total	$69,756	$69,324	$432	0.6%
Same Center	$66,254	$67,584	$(1,330)	(2.0)%
Excluded	$3,502	$1,740	—	—

Other operating expenses was relatively unchanged compared to the same period in the prior year and lower as a percentage of overall revenues.

Additional segment operating and non-operating expenses


In Thousands	Three Months Ended September 30,
	2024	2023	$ Increase/(Decrease)	% Change
Depreciation and amortization	$32,032	$30,221	$1,811	6.0%

Loss on disposal of equipment and other	$153	$524	$(371)	(70.8)%
Non-cash change in fair value of interest rate hedge	$6,754	$1,014	5,740	566.1%
Other income	($8,233)	($4,673)	(3,560)	76.2%
Severance	$271	$1,141	(870)	(76.2)%

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The increase in depreciation expense was the result of our higher depreciable asset base.

The fair value of the 2019 Swaps at September 30, 2024 was a net asset of $7.7 million compared to a net asset of $14.4 million June 30, 2024, resulting in a loss of $6.8 million during the three months ended September 30, 2024. This change in fair value was driven by market expectations of continued declines in interest rates over the remaining term of the 2019 Swaps.

Other income for the three months ended September 30, 2024 included money market interest income of $9.6 million, partially offset by a impairment of non-marketable securities of $1.2 million. Interest income for the three months ended September 30, 2024 increased approximately $6.0 million, or 164.9%, to $9.6 million from $3.6 million for the three months ended September 30, 2023. The increase is primarily due to higher average cash balance in our money market account for the three months ended September 30, 2023


In Thousands	Nine Months Ended September 30,
	2024	2023	$ Increase/(Decrease)	% Change
Interest income	(9,580)	(3,616)	$(5,964)	164.9%
Debt restructuring and extinguishment expenses	147	0	$147	nm
Other non-operating losses (income)	1,200	(1,057)	$2,257	(213.5)%
Total other income	$(8,233)	$(4,673)	$(3,560)	76.2%


In Thousands	Three Months Ended September 30,
	2024	2023	$ Increase/(Decrease)	% Change


Total other income	($8,233)	($4,673)	(3,560)	76.2%

Interest expense


In Thousands	Three Months Ended September 30,
Interest Expense	2024		2023		$ Increase/(Decrease)	% Change
Total Interest Expense	$	19,427	$	16,115	$3,312	20.6	%
Interest expense related to derivatives*	(2,068)		(2,913)
Interest expense related to amortization**	795		746
Adjusted Interest Expense***	20,700		18,282		2,418	13.2	%

*Includes payments from 2019 Swaps

**Includes noncash amortization of deferred loan costs and discount on issuance of debt

***Includes interest related to our term loans, revolving credit line, notes, and other

The increase in interest expense was the result in of refinancing of our Barclays credit facility, which added approximately $196.3 million in additional term loan debt to the facility. The effect of the additional term loan was partially offset by lower interest rates compared to the same period in the prior year.

During the three months ended September 30, 2024, interest rates were above the arranged rates in our 2019 Swaps for most of the year and we received payment of $3.4 million in cash payments from our 2019 swap counterparties, which was reported as a component of interest expense. Also, the 2019 Swaps for $100 million of notional value matured in October 2023, so they were in effect for the third quarter of 2023, but not 2024. See the Derivative Instruments section of Note 2, Significant Accounting Policies, in the notes accompanying in our annual report on Form 10-K for the fiscal year ended December 31, 2023 and Part 1, Item 3 — "Quantitative and Qualitative Disclosure About Market Risk" below 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, 2024 and 2023 we recognized equity in earnings from unconsolidated joint ventures in the amount of $3.6 million and $1.1 million, respectively, an increase of $2.5 million or 231.6%. The increase was mainly due to the additional contribution made to Santa Monica Imaging Group, LLC in September 2023. Santa Monica Imaging Group operated at a net income for the three months ended September 30, 2024, which positively impacted our equity in earnings from unconsolidated joint ventures during the period. Additionally, we experienced improved earnings from our interest in the Arizona Diagnostic Radiology Group joint venture, which was established in the fourth quarter of 2020.

Net income attributable to noncontrolling interests

At September 30, 2024, our consolidated subsidiaries operated 345 imaging centers of which 98 were not wholly-owned and thus a portion of their operating results were attributable to noncontrolling interests. At September 30, 2023, our consolidated subsidiaries included 320 centers of which 83 were not wholly-owned.

For the three months ended September 30, 2024, we recognized net income attributable to noncontrolling interests of $9.0 million versus $6.5 million for the three months ended September 30, 2023, an increase of $2.6 million. The increase in net income attributable to noncontrolling interests was primarily due to the formation of a new majority owned subsidiary, Los Angeles Imaging Group, LLC in September 2023 and Tri Valley Imaging Group, LLC in March 2024. We contributed the operations of three centers to Los Angeles Group, LLC and Cedars-Sinai Medical Center contributed cash. Additionally, patient volumes for advanced modalities improved in 2024 and we closed two underperforming centers in a majority owned subsidiary, Beach Imaging Group, LLC in December 2023.

As noncontrolling interests only represent a portion of our imaging center business, and excludes our Digital Health Segment which generated losses of $3.6 million for the three months ended September 30, 2024, we do not expect changes in net income attributable to noncontrolling interests to correlate with changes in consolidated operating income or pretax income.

Nine Months Ended September 30, 2024 Compared to the Nine Months Ended September 30, 2023

In the discussion below, same center metrics are based on imaging centers that were in operation throughout the period of January 1, 2023 through September 30, 2024. Excluded amounts relate to imaging centers that were acquired or divested between January 1, 2023 through September 30, 2024.

Total Revenue


In Thousands	Nine Months Ended September 30,
Revenue	2024	2023	$ Increase	% Change
Total	$1,305,707	$1,161,381	$144,326	12.4%
Same Center	$1,224,946	$1,107,208	$117,738	10.6%
Excluded	$80,761	$54,173	—	—

Our 10.6% increase in same center revenue over the same period last year was driven by increases in fees charged per imaging procedure and same center total procedure volume growth of 3.3% inclusive of rises in routine and advanced modality imaging procedures of 1.82% and 7.76%, respectively. The increase in revenue was largely attributable to product mix product mix, as advanced imaging was a greater portion of overall procedures. A significant contributor to the change in product mix was the increase in PETHC procedures related to prostate cancer and suspected Alzheimer studies, which are included in advanced modality imaging procedures.

Operating Expenses

Total operating expenses for the nine months ended September 30, 2024 increased approximately $131.7 million, or 12.1%, to $1,216.1 million for the nine months ended September 30, 2024 from $1,084.4 million for the nine months ended September 30, 2023. The following table breaks down our cost of operations and total operating expenses for the nine months ended September 30, 2024 and 2023 (in thousands):

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	Nine Months Ended September 30,
	2024		2023
Salaries and professional reading fees, excluding stock-based compensation	$	731,134	$	635,016
Stock-based compensation	19,614		19,484
Building and equipment rental	89,827		88,592
Medical supplies	75,146		63,829
Other operating expenses *	204,821		201,893
Cost of operations	1,120,542		1,008,814

Depreciation and amortization	94,095		89,743
Gain on contribution of imaging centers into joint venture	—		(16,808)
Loss on sale and disposal of equipment	739		1,185
Severance costs	720		1,417
Total operating expenses	$	1,216,096	$	1,084,351

*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


In Thousands	Nine Months Ended September 30,
Salaries and Professional Fees	2024	2023	$ Increase/(Decrease)	% Change
Total	$731,134	$635,016	$96,118	15.1%
Same Center	$693,291	$611,204	$82,087	13.4%
Excluded	$37,843	$23,812	—	—

Staffing levels have been adjusted to support higher patient volumes with the corresponding rise in salaries and professional fee expense. We are continuing to face inflation in employee wage rates as we compete for talent in a tight labor market.

Stock-based compensation

Stock-based compensation was relatively unchanged at $19.6 million for the nine months ended September 30, 2024 compared to $19.5 million for nine months ended September 30, 2023.

Building and equipment rental


In Thousands	Nine Months Ended September 30,
Building & Equipment Rental	2024	2023	$ Increase/(Decrease)	% Change
Total	$89,827	$88,592	$1,235	1.4%
Same Center	$79,558	$80,442	$(884)	(1.1)%
Excluded	$10,269	$8,150	—	—

The decrease in building and equipment rental expense relates to reduced equipment rental relating to operating lease contracts which ended or were bought out during 2023.

Medical supplies

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In Thousands	Nine Months Ended September 30,
Medical Supplies Expense	2024	2023	$ Increase/(Decrease)	% Change
Total	$75,146	$63,829	$11,317	17.7%
Same Center	$70,494	$60,931	$9,563	15.7%
Excluded	$4,652	$2,898	—	—

The increase in medical supplies expense was consistent with our higher patient volume and product shift towards more advanced imaging modalities. The increase in PETHC procedures related to prostate cancer and suspected Alzheimer studies also raised medical supplies expense due to the requirement for high-cost isotope tracers.

Other operating expenses


In Thousands	Nine Months Ended September 30,
Other Operating Expenses	2024	2023	$ Increase/(Decrease)	% Change
Total	$204,821	$201,893	$2,928	1.5%
Same Center	$191,345	$193,385	$(2,040)	(1.1)%
Excluded Sites	$13,476	$8,508	—	—

Other operating expenses was relatively unchanged compared to the same period in the prior year and lower as a percentage of overall revenues.

Additional segment operating and non operating expenses:


In Thousands	Nine Months Ended September 30,
	2024	2023	$ Increase/(Decrease)	% Change
Depreciation and amortization	$94,095	$89,743	$4,352	4.8%
Gain on contribution of imaging centers into joint venture	$0	$(16,808)	$16,808	nm
Loss on disposal of equipment and other	$739	$1,185	$(446)	(37.6)%
Non-cash change in fair value of interest rate hedge	$7,429	$949	$6,480	682.8%
Other income	$(12,753)	$(6,323)	$(6,430)	101.7%
Severance	$720	$1,417	$(697)	(49.2)%

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The increase in depreciation expense was the result of our higher depreciable asset base.

The fair value of the 2019 Swaps at September 30, 2024 was a net asset of $7.7 million compared to a net asset of $15.1 million December 31, 2023, resulting in a loss of $7.4 million during the nine months ended September 30, 2024. This change in fair value was driven by market expectations of continued declines in interest rates over the remaining term of the 2019 Swaps.

Other income for the nine months ended September 30, 2024 included money market interest income of $22.7 million, partially offset by an impairment of non-marketable securities of $1.2 million and a debt extinguishment and restructuring charges of $8.9 million, which related to refinancing of our Barclays credit facility. See Note 6 Credit Facilities and Notes Payable included in the notes to our condensed consolidated financial statements. Interest income for the nine months ended September 30, 2024 increased approximately $16.4 million, or 260.2%, to $22.7 million from $6.3 million for the nine months ended September 30, 2024. The increase is primarily due to higher average cash balance in our money market account for the nine months ended September 30, 2024


In Thousands	Nine Months Ended September 30,
	2024	2023	$ Increase/(Decrease)	% Change
Interest income	(22,681)	(6,297)	$(16,384)	260.2%
Debt restructuring and extinguishment expenses	8,909	0	$8,909	nm
Other non-operating losses (income)	1,019	(26)	$1,045	(4019.2)%
Total other income	$(12,753)	$(6,323)	$(6,430)	101.7%

nm= not meaningful

Interest expense


In Thousands	Nine Months Ended September 30,
Interest Expense	2024		2023		$ Increase/(Decrease)	% Change
Total Interest Expense	$	61,776	$	47,876	$13,900	29.0	%
Interest expense related to derivatives*	776		(7,138)
Interest expense related to amortization**	2,336		2,240
Adjusted Interest Expense***	58,664		52,774		5,890	11.2	%

*Includes payments from 2019 Swaps

**Includes noncash amortization of deferred loan costs and discount on issuance of debt

***Includes interest related to our term loans, revolving credit line, notes, and other

The increase in interest expense was the result in the general increase in term loan debt as a result of refinancing of our Barclays credit facility, partially offset by lower interest rates compared to the same period in the prior year.

During the nine months ended September 30, 2024, interest rates were above the arranged rates in our 2019 Swaps for most of the year and we received payment of $10.2 million in cash payments from our 2019 swap counterparties, which was reported as a component of interest expense. Also, the 2019 Swaps for $100 million of notional value matured in October 2023, so they were in effect for the third quarter of 2023, but not 2024. See the Derivative Instruments section of Note 2, Significant Accounting Policies, in the notes accompanying in our annual report on Form 10-K for the fiscal year ended December 31, 2023 and Part 1, Item 3 — "Quantitative and Qualitative Disclosure About Market Risk" below for more details on our derivative transactions.

Equity in earnings from unconsolidated joint ventures

For the nine months ended September 30, 2024 we recognized equity in earnings from unconsolidated joint ventures in the amount of $11.3 million compared to $3.9 million for the prior period, an increase of $7.4 million or 187.4%. The increase was mainly due to the additional contribution made to SMIG in September 2023. SMIG operated at a net income for the nine months ended September 30, 2024, which positively impacted our equity in earnings from unconsolidated joint ventures during

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the period. Additionally, the increase was supported by improved earnings from our interest in the Arizona Diagnostic Radiology Group joint venture, which was established in the fourth quarter of 2020.

Income tax expense

We recorded income tax expense of $4.9 million, or an effective tax rate of 16.7%, for the nine months ended September 30, 2024 and $7.7 million, or an effective tax rate of 24.1% for the nine months ended September 30, 2023. The income tax rates for the nine months ended September 30, 2024 diverge from the federal statutory rate due to (i) effects of state income taxes ; (ii) officer's compensation limitations; (iii) partial valuation allowance on losses in foreign jurisdictions, partially offset by (iv) excess tax benefits attributable to share based compensation; and (v) noncontrolling interests from controlled partnerships.

Net income attributable to noncontrolling interests

For the nine months ended September 30, 2024, we recognized net income attributable to noncontrolling interests of $27.2 million versus $19.4 million for the nine months ended September 30, 2024, an increase of $7.8 million. The increase in net income attributable to noncontrolling interests was primarily due to the formation of a new majority owned subsidiary, Los Angeles Imaging Group, LLC in September 2023 and Tri Valley Imaging Group, LLC in March 2024. We contributed the operations of three centers to Los Angeles Imaging Group, LLC and Cedars-Sinai Medical Center contributed cash. Net income attributable to noncontrolling interests was also impacted by an increase in patient volumes for advanced modalities in 2024 and the closure of two underperforming centers in a majority owned subsidiary, Beach Imaging Group, LLC in December 2023.

As noncontrolling interests only represent a portion of our imaging center business, and excludes our Digital Health Segment which generated losses of $9.5 million for the nine months ended September 30, 2024, we do not expect changes in net income attributable to noncontrolling interests to correlate with changes in consolidated operating income or pretax income.

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Digital Health Segment

The breakdown of revenue and expenses of the segment for the three and nine months ended September 30, 2024 and 2023 are as follows:


In Thousands	Three Months Ended September 30,								Nine Months Ended September 30,
	2024		2023		$ Change		% Change		2024		2023		$ Change		% Change
Statement of Operations
Revenue	$	16,367	$	12,185	$	4,182	34.3	%	$	46,856	$	34,866	$	11,990	34.4	%
Salaries and Wages	7,119		6,022		1,097		18.2	%	18,631		18,710		(79)		(0.4)	%
Stock Compensation	528		388		140		36.1	%	1,755		1,897		(142)		(7.5)	%
Other operating	6,020		645		5,375		833.3	%	18,208		9,226		8,982		97.4	%


Non-Capitalized R&D - DeepHealth Cloud OS & Generative AI	3,344		—		3,344		—		9,977		—		9,977		—
Depreciation & Amort.	2,947		1,989		958		48.2	%	7,727		5,962		1,765		29.6	%
(Gain) loss on sale and disposal of equipment and other	(5)		3		(8)		(266.7)	%	(4)		(2)		(2)		100.0	%
Severance	33		12		21		175.0	%	77		1,740		(1,663)		(95.6)	%
Total operating expenses	$	19,986	$	9,059	$	10,927	120.6	%	$	56,371	$	37,533	$	18,838	50.2	%
Loss from Operations	$	(3,619)	$	3,126	$	(6,745)	(215.8)	%	$	(9,515)	$	(2,667)	$	(6,848)	256.8	%
Other expense	2,966		590		2,376		402.7	%	5,413		3,715		1,698		45.7	%
Loss before taxes	(6,585)		2,536		(9,121)		(359.7)	%	(14,928)		(6,382)		(8,546)		133.9	%
Income taxes	$	(37)	$	(4,472)	$	4,435	(99.2)	%	$	(346)	$	(5,829)	$	5,483	(94.1)	%
Segment net loss	(6,548)		7,008		(13,556)		(193.4)	%	(14,582)		(553)		(14,029)		2536.9	%

Revenues for the Digital Health segment increased as a result of core growth in our eRad PICS business, the rollout in 2023 of our Deephealth OS, and continued rollout of our Enhanced Breast Cancer Detection solutions across additional facilities. The increase in operating expenses was primarily related to salary expense as we increased headcount in connection with the commercialization of our initial AI products and higher non-capitalized research and development expenses with respect to our new DeepHealth cloud OS and generative AI. In the three months ended September 30, 2023, we recognized a non-recurring gain of $7.2 million from change in fair value of contingent consideration, offsetting against other operating expense. Aside from the effect of that one-time gain and increased non-capitalized research and development expenses, our net loss for the segment was consistent with the prior year. We expect that our Digital Health segment will continue to generate net losses over the next several years.

Non-GAAP Financial Measures

We use both GAAP and non-GAAP metrics to measure our financial results. We believe that, in addition to GAAP metrics, non-GAAP metrics such as Adjusted EBITDA assist us in measuring our core operations from period to period.

Adjusted EBITDA

Our Adjusted EBITDA metric removes non-cash and non-recurring charges that occur in the affected period and provides a basis for measuring the Company’s core financial performance against other periods.

We define Adjusted EBITDA as earnings before interest, taxes, depreciation and amortization, as adjusted to exclude losses or gains on the disposal of equipment, other income or loss, loss on debt extinguishment, bargain purchase gains, loss on de-consolidation of joint ventures, gain on contribution of imaging centers into joint ventures, and non-cash equity compensation. Adjusted EBITDA includes equity earnings in unconsolidated operations and subtracts allocations of earnings to non-controlling interests in subsidiaries, and is adjusted for non-cash or one-time events that take place during the period.

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Adjusted EBITDA is a non-GAAP financial measure used as an analytical indicator by us and the healthcare industry to assess business performance. Adjusted EBITDA should not be considered a measure of financial performance under GAAP, and Adjusted EBITDA should not be considered in isolation or as alternatives to net income, or other financial statement data presented in the consolidated financial statements as an indicator of financial performance. Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation and this metric, as presented, may not be comparable to other similarly titled measures of other companies.

The following is a reconciliation of the nearest comparable GAAP financial measure, net income, to Adjusted EBITDA for the three and nine months ended September 30, 2024 and 2023, respectively.


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Net income attributable to RadNet, Inc. common stockholders	$	3,209	$	17,540	$	(2,552)	$	4,904
Income taxes	4,335		7,220		4,927		7,741
Interest expense	19,427		16,115		61,776		47,876
Severance costs	304		1,153		797		3,157
Depreciation and amortization	34,979		32,210		101,822		95,705
Non-cash employee stock-based compensation	4,723		4,325		21,369		21,381
Loss (gain) on sale and disposal of equipment and other	148		527		735		1,183
Non-cash change in fair value of interest rate hedge	6,755		1,015		7,429		949
Other expenses	(5,414)		(4,081)		(16,248)		(2,609)
Non-Capitalized R&D - DeepHealth Cloud OS & Generative AI	3,345		—		9,977		—

Loss (gain) on contribution of imaging centers into joint venture	—		(16,808)		—		(16,808)
Loss (gain) on extinguishment of debt and related expenses	147		—		8,909		—


Non-cash change to contingent consideration	—		(6,276)		1,974		(3,646)
Acquisition related non-cash intangible adjustment	—		3,950		—		3,950
Non-operational rent expenses	1,287		1,030		3,119		2,748
Acquisition transaction costs	417		—		417		—

Adjusted EBITDA - Total Company	$	73,662	$	57,920	$	204,451	$	166,531

Adjusted EBITDA - Digital Health Segment	3,229		2,279		10,018		3,689

Adjusted EBITDA - Imaging Center	$	70,433	$	55,641	$	194,433	$	162,842

The following table is a reconciliation of GAAP net income for our Digital Health Segment to Adjusted EBITDA for the three months ended September 30, 2024 and 2023, respectively.

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	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Segment net loss	$	(6,550)	$	7,008	$	(14,582)	$	(552)
Stock Compensation	528		388		1,755		1,897
Depreciation & Amortization	2,947		1,989		7,727		5,962
Other operating loss	(5)		3		(4)		(2)
Other (income) expense	2,966		592		5,414		3,714
Severance	34		12		77		1,740

Income taxes	(36)		(4,472)		(346)		(5,829)
Non-Capitalized R&D - DeepHealth Cloud OS & Generative AI	3,345		—		9,977		—
Non-cash change to contingent consideration	—		(7,191)		—		(7,191)
Acquisition related to non-cash intangible adjustment	—		3,950		—		3,950
Adjusted EBITDA - Digital Health Segment	$	3,229	$	2,279	$	10,018	$	3,689

Liquidity and Capital Resources

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.

Our principal capital requirements are for the development of new diagnostic imaging centers, the acquisition of existing diagnostic imaging centers and the acquisition of new diagnostic imaging equipment. On a continuing basis, we evaluate various transactions to increase shareholder value and enhance our business results, including acquisitions, divestitures and joint ventures. We expect to fund any future acquisitions primarily with cash flow from operations and borrowings, including borrowing available under our 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.

The following table summarizes key balance sheet data related to our liquidity as of September 30, 2024 and December 31, 2023 and income statement data for the nine months ended September 30, 2024 and 2023 (in thousands):


Balance Sheet Data:	September 30, 2024		December 31, 2023
Cash and cash equivalents	$	748,916	$	342,570
Accounts receivable	199,076		163,707
Working capital (exclusive of current operating lease liabilities)	604,874		197,805
Stockholders' equity	1,119,634		813,359


Income statement data for the nine months ended September 30,	2024		2023
Total net revenue	$	1,352,563	$	1,196,247
Net (loss) income attributable to RadNet common stockholders	(2,552)		4,904

Sources and Uses of Cash

The following table summarizes key components of our sources and uses of cash for the nine months ended September 30, 2024 and 2023 (in thousands):

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Cash Flow Data	September 30, 2024		September 30, 2023
Cash provided by (used in) operating activities	$	190,494	$	131,943
Cash provided by (used in) investing activities	(184,257)		(152,823)
Cash provided by (used in) financing activities	400,069		231,101

Cash provided by operating activities for the nine months ended September 30, 2024 increased by $58.6 million compared to September 30, 2023 primarily driven by a $35.7 million change in assets and liabilities, primarily due to the timing of payments for accounts payable and accrued expenses.

Cash used in investing activities for the nine months ended September 30, 2024 increased from September 30, 2023 by $31.4 million. Purchases of imaging centers during the period was $37.7 million, a $26.8 million increase from the prior period. Capital expenditures for property and equipment during the period was $145.2 million, a $8.6 million increase from the prior period.

Cash provided by financing activities for the nine months ended September 30, 2024 resulted from a secondary public offering of our common stock and a refinancing of our Barclays credit facility. In March 2024, we completed a public offering of 5,232,500 shares of our common stock, which included 682,500 shares sold pursuant to an underwriters overallotment option, at a price to the public of $44.00 per share, resulting in net proceeds after underwriting discounts, commissions, and expenses of $218.3 million. In April 2024, we refinanced our Barclays credit facility replacing the prior facility with an $875 million term loan. After paying off the balance on the prior facility, payment of accrued interest through the closing of the refinance transaction, and payment of transaction fees and expenses, we added approximately $167.9 million in cash to the balance sheet.

Secured Credit Facilities

We maintain secured credit facilities with Barclays Bank PLC and with Truist Bank.

On April 18, 2024, we refinanced our Barclays credit facility, replacing the prior facility with an $875.0 million term loan and a $282.0 million revolving credit facility. The refinance transaction reduced our interest rates on the Barclays term loan and revolving credit facility and extended the maturity date for the term loan to April 18, 2031 and for the revolving credit facility to April 18, 2029. The new term loan calls for quarterly principal payments of $2.2 million, compared to $1.8 million under the prior credit facility.

Our condensed consolidated balance sheets at September 30, 2024 include $1,009.7 million of total term loan debt (exclusive of unamortized discounts of $15.8 million) in thousands:


	Face Value		Discount		Total Carrying Value
Barclays Term Loan	$	872,812	$	(15,234)	$	857,578
Truist Term Loan	136,875		(792)		136,083
Total Term Loans	$	1,009,687	$	(16,026)	$	993,661

At September 30, 2024, we had no borrowings under our Barclays or Truist revolving credit facilities. After reserves for outstanding letters of credit of $8.3 million, we had $273.7 million available for borrowing under our Barclays Revolving Credit Facility and $50.0 million available under our Truist Revolving Credit Facility.

Please see Note 6, Credit Facilities and Notes Payable in the notes to financial statements included in this report for more information on our secured credit facilities.

ITEM 3. Quantitative and Qualitative Disclosures about Market Risk

Foreign Currency Exchange Risk:

We are exposed to foreign exchange risk with respect to revenues and expenses denominated in the Pound Sterling, Euro, Canadian Dollar and Hungarian Forint. We provide radiological services in the United Kingdom, conduct Artificial Intelligence operations in the Netherlands, and maintain research and development centers in Canada, Hungary and India. We

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do not have any foreign currency exchange contracts to mitigate this risk. At September 30, 2024, a hypothetical 1% decline in the currency exchange rates between the U.S. dollar against these currencies, would have resulted in an annual increase of approximately $0.3 million in operating expenses.

Interest Rate Sensitivity:

Our debt instruments, including borrowings under our Barclays credit facility and our Truist credit facility, bear interest at variable rates. Accordingly, our interest expense and our earnings are affected by changes in short term interest rates.

To mitigate our future floating rate interest expense exposure we entered into the 2019 Swaps with locked in interest rates for one-month Term SOFR of 1.89% for $100 million of notional value and 1.98% for $400 million of notional value. We are liable for premium payments to the 2019 swap counterparties if interests rates are below the arranged rates, and receive payments from the 2019 swap counterparties if interest rates exceed the arranged rates. If interest rates were to theoretically reduce to 0%, our maximum premium payment would be the difference between the two swapped rates and 0% then multiplied by the notional value of the swaps, or $1.89 million per year for the $100 million swap and $8.0 million per year for the $400 million swap. Payments under the 2019 Swaps are settled in cash on a monthly basis. The 2019 Swaps for the $100 million of notional value matured in October 2023, so they were in effect for the third quarter of 2023, but not 2024. The 2019 Swaps for the $400 million notional amount will expire in October 2025.

We can elect SOFR or Alternative Base Rate interest options on amounts outstanding under the Barclays Term Loan. At September 30, 2024, we had $872.8 million outstanding subject to an SOFR election on the Barclays Term Loan. At September 30, 2024, our effective SOFR interest rate plus applicable margin was 7.78%. The 2019 Swaps secure a $1.98% SOFR rate for a $400 million notional amount. After giving effect to our 2019 Swaps, we had $472.8 million outstanding under the Barclays Term Loan that is unprotected by the 2019 Swaps at September 30, 2024. Consequently, a hypothetical 1% increase in the SOFR rates under the Barclay's credit facility would result in an increase of $4.7 million in annual interest expense and a corresponding decrease in income before taxes. The 2019 Swaps will mature in October 2025.

We can elect SOFR or Base Rate interest rate options on amounts outstanding under the Truist credit facility. At September 30, 2024, we had $136.9 million outstanding subject to an adjusted SOFR election on the Truist Term Loan. At September 30, 2024, our effective SOFR rate plus applicable margin was 6.20%. A hypothetical 1% increase in the adjusted Eurodollar rates under the Truist credit facility would result in an increase of approximately $1.4 million in annual interest expense and a corresponding decrease in income before taxes.

ITEM 4. Controls and Procedures

Evaluation of Disclosure Controls and Procedures

Under the supervision of our management, including our Chief Executive Officer and Chief Financial Officer, we conducted an evaluation of the effectiveness of the design and operation of our disclosure controls and procedures under Rules 13a-15(e) and 15d-15(e) of the Securities Exchange Act of 1934, as amended, as of September 30, 2024. Based on this evaluation, our Principal Executive Officer and Principal Financial Officer concluded that our disclosure controls and procedures were effective as of September 30, 2024 to provide reasonable assurance that information required to be disclosed by the Company in reports that it files or submits under the Exchange Act is (i) recorded, processed, summarized and reported within the time periods specified in the SEC rules and forms and (ii) accumulated and communicated to our management, including our principal executive officer and principal financial officer, as appropriate to allow timely decisions regarding required disclosure.

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, 2024 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

From time to time we are engaged legal proceedings that arise in the ordinary course of our business. We do not believe that the outcome of any of our current legal proceedings will have a material adverse impact on our business, financial condition and results of operations.

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, 2023. The risks described in our annual report on Form 10-K 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

Rule 10b5-1 Trading Plan.

During the fiscal quarter ended September 30, 2024, none of our directors or executive officers adopted or terminated any contract, instruction or written plan for the purchase or sale of Company securities that was intended to satisfy the affirmative defense conditions of Rule 10b5-1(c) or any "non-Rule 10b5-1 trading arrangement."

ITEM 6. Exhibits


Exhibit Number						Description


10.1						Employment Agreement, dated September 11, 2024, between Aidence B.V. and Cornelis Wesdorp (incorporated by reference to Exhibit 10.1 filed with Form 8-K on September 12, 2024).

31.1						Certification of Howard G. Berger, M.D. pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

31.2						Certification of Mark D. Stolper pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

32.1						Certification of Howard G. Berger, M.D. pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. *

32.2						Certification of Mark D. Stolper pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. *

101						The following financial information from RadNet, Inc.'s Quarterly Report on Form 10-Q for the quarter ended September 30, 2024 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 Income (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.

104						Cover 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.

SIGNATURES

Pursuant to the requirements 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 12, 2024	By:	/s/ Howard G. Berger, M.D.
		Howard G. Berger, M.D., President and Chief Executive Officer (Principal Executive Officer)


Date: November 12, 2024	By:	/s/ Mark D. Stolper
		Mark D. Stolper, Chief Financial Officer (Principal Financial and Accounting Officer)

EXHIBIT 31.1

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350

AS ADOPTED PURSUANT TO

SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Howard G. Berger, M.D., certify that:

1. I have reviewed this report on Form 10-Q of RadNet, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:


a.						designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;


b.						designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;


c.						evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and


d.						disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):


a.						all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and


b.						any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Dated: November 12, 2024


			/s/ Howard G. Berger, M.D.
			Howard G. Berger, M.D.
			President, Chief Executive Officer and Chairman of the Board of Directors

EXHIBIT 31.2

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350

AS ADOPTED PURSUANT TO

SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Mark D. Stolper, certify that:

1.I have reviewed this report on Form 10-Q of RadNet, Inc.;

have:


a.						designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;


b.						designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;


c.						evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and


d.						disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and


a.						all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and


b.						any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Dated: November 12, 2024


			/s/ Mark D. Stolper
			Mark D. Stolper
			Executive Vice President
			and Chief Financial Officer

EXHIBIT 32.2

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of RadNet, Inc. (the “Company”) on Form 10-Q for the quarterly period ended September 30, 2024, as filed with the Securities and Exchange Commission on ### (the “Report”), I, Mark D. Stolper, Chief Financial Officer of the Company, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:

1. The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and

2. The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company as of, and for the periods presented in the Report.


			/s/ Mark D. Stolper
			Mark D. Stolper
			Chief Financial Officer
			(Principal Financial Officer)
			November 12, 2024

A signed original of this written statement required by Section 906 has been provided to the Company and will be furnished to the Securities and Exchange Commission or its staff upon request.

EXHIBIT 32.1

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of RadNet, Inc. (the “Company”) on Form 10-Q for the quarterly period ended September 30, 2024, as filed with the Securities and Exchange Commission on ### (the “Report”), I, Howard G. Berger, M.D., Chairman of the Board of Directors and Chief Executive Officer of the Company, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:

1. The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and


			/s/ Howard G. Berger, M.D.
			Howard G. Berger, M.D.
			Chairman, President and Chief Executive Officer
			(Principal Executive Officer)
			November 12, 2024

A signed original of this written statement required by Section 906 has been provided to the Company and will be furnished to the Securities and Exchange Commission or its staff upon request.

Cover Page - shares	9 Months Ended
Cover Page - shares	Sep. 30, 2024	Nov. 08, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	001-33307
Entity Registrant Name	RadNet, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	13-3326724
Entity Address, Address Line One	1510 Cotner Avenue
Entity Address, City or Town	Los Angeles,
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	90025
City Area Code	310
Local Phone Number	478-7808
Title of 12(b) Security	Common Stock
Trading Symbol	RDNT
Security Exchange Name	NASDAQ
Entity Current Reporting Current	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		74,026,737
Entity Central Index Key	0000790526
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2024

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
CURRENT ASSETS
Cash and cash equivalents	$ 748,916	$ 342,570
Accounts receivable	199,076	163,707
Prepaid expenses and other current assets	38,051	47,657
Total current assets	1,016,253	579,276
PROPERTY, EQUIPMENT AND RIGHT-OF-USE ASSETS
Property and equipment, net	663,867	604,401
Operating lease right-of-use assets	646,750	596,032
Total property, equipment and right-of-use assets	1,310,617	1,200,433
OTHER ASSETS
Goodwill	711,841	679,463
Other intangible assets	84,441	90,615
Deferred financing costs	2,416	1,643
Investment in joint ventures	104,514	92,710
Deposits and other	45,260	46,333
Total assets	3,275,342	2,690,473
CURRENT LIABILITIES
Accounts payable, accrued expenses and other	338,737	342,940
Deferred revenue	4,392	4,647
Current operating lease liability	58,751	55,981
Current portion of notes payable	23,378	17,974
Total current liabilities	470,130	437,452
LONG-TERM LIABILITIES
Long-term operating lease liability	658,434	605,097
Notes payable, net of current portion	996,272	812,068
Deferred tax liability, net	20,795	15,776
Other non-current liabilities	10,077	6,721
Total liabilities	2,155,708	1,877,114
EQUITY
Common stock - $0.0001 par value, 200,000,000 shares authorized; 73,976,284 and 67,956,318 shares issued and outstanding at September 30, 2024 and December 31, 2023, respectively	7	7
Additional paid-in-capital	979,279	722,750
Accumulated other comprehensive loss	(1,843)	(12,484)
Accumulated deficit	(82,130)	(79,578)
Total RadNet, Inc.'s Stockholders' equity:	895,313	630,695
Noncontrolling interests	224,321	182,664
Total equity	1,119,634	813,359
Total liabilities and equity	3,275,342	2,690,473
Affiliates
CURRENT ASSETS
Due from affiliates	30,210	25,342
CURRENT LIABILITIES
Due to affiliates	$ 44,872	$ 15,910

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Common stock - par value (in dollars per share)	$ 0.0001	$ 0.0001
Common stock - shares authorized (in shares)	200,000,000	200,000,000
Common stock - shares issued (in shares)	73,976,284	67,956,318
Common stock - shares outstanding (in shares)	73,976,284	67,956,318

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
REVENUE
Total service revenue	$ 461,142	$ 401,968	$ 1,352,563	$ 1,196,247
OPERATING EXPENSES
Cost of operations, excluding depreciation and amortization	391,800	341,635	1,169,113	1,038,647
Depreciation and amortization	34,979	32,210	101,822	95,705
Gain on contribution of imaging centers into joint venture	0	(16,808)	0	(16,808)
Loss on sale and disposal of equipment and other	148	527	735	1,183
Severance costs	304	1,153	797	3,157
Total operating expenses	427,231	358,717	1,272,467	1,121,884
INCOME FROM OPERATIONS	33,911	43,251	80,096	74,363
OTHER INCOME AND EXPENSES
Interest expense	19,427	16,115	61,776	47,876
Equity in earnings of joint ventures	(3,595)	(1,084)	(11,308)	(3,935)
Non-cash change in fair value of interest rate hedge	6,755	1,015	7,429	949
Debt restructuring and extinguishment expenses	147	0	8,909	0
Other income	(5,414)	(4,081)	(16,248)	(2,609)
Total other expenses	17,320	11,965	50,558	42,281
INCOME BEFORE INCOME TAXES	16,591	31,286	29,538	32,082
Provision for income taxes	(4,335)	(7,220)	(4,927)	(7,741)
NET INCOME	12,256	24,066	24,611	24,341
Net income attributable to noncontrolling interest	9,047	6,526	27,163	19,437
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$ 3,209	$ 17,540	$ (2,552)	$ 4,904
BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS, Basic (in dollars per share)	$ 0.04	$ 0.26	$ (0.04)	$ 0.08
DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS, Diluted (in dollars per share)	$ 0.04	$ 0.25	$ (0.04)	$ 0.08
WEIGHTED AVERAGE SHARES OUTSTANDING
Basic (in shares)	73,494,709	67,793,404	72,587,321	62,113,707
Diluted (in shares)	75,165,435	68,809,818	72,587,321	63,221,251
Service fee revenue
REVENUE
Total service revenue	$ 427,579	$ 361,927	$ 1,247,513	$ 1,078,265
Revenue under capitation arrangements
REVENUE
Total service revenue	$ 33,563	$ 40,041	$ 105,050	$ 117,982

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Statement of Comprehensive Income [Abstract]
NET INCOME	$ 12,256	$ 24,066	$ 24,611	$ 24,341
Foreign currency translation adjustments	5,228	(4,035)	2,399	(385)
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes	986	921	8,242	2,765
COMPREHENSIVE INCOME	18,470	20,952	35,252	26,721
Less comprehensive income attributable to noncontrolling interests	9,047	6,526	27,163	19,437
COMPREHENSIVE INCOME ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$ 9,423	$ 14,426	$ 8,089	$ 7,284

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	DeepHealth, Inc.	Total RadNet, Inc.'s Equity	Common Stock	Common Stock DeepHealth, Inc.	Additional Paid-In Capital	Accumulated Other Comprehensive Loss	Accumulated Deficit	Noncontrolling Interests
Beginning balance (in shares) at Dec. 31, 2022				57,723,125
Beginning balance at Dec. 31, 2022	$ 491,452		$ 332,995	$ 6		$ 436,288	$ (20,677)	$ (82,622)	$ 158,457
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock upon exercise of options (in shares)				8,424
Issuance of common stock upon exercise of options	72		72			72
Issuance of common stock under the equity compensation plan (in shares)				1,069,324	21,956
Stock-based compensation expense	21,381		21,381			21,381
Issuance of common stock (in shares)				8,711,250
Issuance of common stock	245,832		245,832	$ 1		245,831
Issuance of common stock in connection with acquisitions (in shares)				314,130
Issuance of common stock in connection with acquisitions			9,123			9,123
Distributions paid to noncontrolling interests	(3,523)								(3,523)
Contributions from noncontrolling interests	2,885								2,885
Sale of economic interests in majority owned subsidiary, net of taxes	2,217		2,217			2,217
Change in cumulative foreign currency translation adjustment	(385)		(385)				(385)
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes	2,765		2,765				2,765
Other	(2)		(3)			(2)		(1)	1
Net (loss) income	24,341		4,904					4,904	19,437
Ending balance (in shares) at Sep. 30, 2023				67,848,209
Ending balance at Sep. 30, 2023	796,158		618,901	$ 7		714,910	(18,297)	(77,719)	177,257
Beginning balance (in shares) at Jun. 30, 2023				67,669,564
Beginning balance at Jun. 30, 2023	761,004		593,159	$ 7		703,593	(15,183)	(95,258)	167,845
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock upon exercise of options (in shares)				3,424
Issuance of common stock upon exercise of options	21		21			21
Issuance of common stock under the equity compensation plan (in shares)				3,447	1,871
Stock-based compensation expense	4,326		4,326			4,326
Issuance of common stock (in shares)				0
Issuance of common stock	(370)		(370)	$ 0		(370)
Issuance of common stock in connection with acquisitions (in shares)				169,903
Issuance of common stock in connection with acquisitions	5,123		5,123			5,123
Contributions from noncontrolling interests	2,885								2,885
Sale of economic interests in majority owned subsidiary, net of taxes	2,217		2,217			2,217
Change in cumulative foreign currency translation adjustment	(4,035)		(4,035)				(4,035)
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes	921		921				921
Other	0		(1)					(1)	1
Net (loss) income	24,066		17,540					17,540	6,526
Ending balance (in shares) at Sep. 30, 2023				67,848,209
Ending balance at Sep. 30, 2023	$ 796,158		618,901	$ 7		714,910	(18,297)	(77,719)	177,257
Beginning balance (in shares) at Dec. 31, 2023	67,956,318			67,956,318
Beginning balance at Dec. 31, 2023	$ 813,359		630,695	$ 7		722,750	(12,484)	(79,578)	182,664
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock upon exercise of options (in shares)	60,306	9,377		60,605
Issuance of common stock upon exercise of options	$ 367		367			367
Issuance of common stock under the equity compensation plan (in shares)				666,962	9,377
Stock-based compensation expense	21,406		21,406			21,406
Issuance of common stock (in shares)				5,232,500
Issuance of common stock	218,385		218,385			218,385
Issuance of common stock in connection with acquisitions (in shares)				95,019
Issuance of common stock in connection with acquisitions	4,607		4,607			4,607
Forfeiture of restricted stock and share cancellation (in shares)				(44,497)
Forfeiture of restricted stock and share cancellation	(38)		(38)			(38)
Distributions paid to noncontrolling interests	(2,423)		0						(2,423)
Contributions from noncontrolling interests	11,802		11,802			11,802
Sale of economic interests in majority owned subsidiary, net of taxes	16,917								16,917
Change in cumulative foreign currency translation adjustment	2,399		2,399				2,399
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes	8,242		8,242				8,242
Net (loss) income	$ 24,611		(2,552)					(2,552)	27,163
Ending balance (in shares) at Sep. 30, 2024	73,976,284			73,976,284
Ending balance at Sep. 30, 2024	$ 1,119,634		895,313	$ 7		979,279	(1,843)	(82,130)	224,321
Beginning balance (in shares) at Jun. 30, 2024				73,968,042
Beginning balance at Jun. 30, 2024	1,092,840		880,966	$ 7		974,355	(8,057)	(85,339)	211,874
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock under the equity compensation plan (in shares)				9,075
Stock-based compensation expense	4,727		4,727			4,727
Forfeiture of restricted stock and share cancellation (in shares)				(833)
Forfeiture of restricted stock and share cancellation	(4)		(4)			(4)
Contributions from noncontrolling interests	201		201			201
Sale of economic interests in majority owned subsidiary, net of taxes	3,400								3,400
Change in cumulative foreign currency translation adjustment	5,228		5,228				5,228
Change in fair value of cash flow hedge from prior periods reclassified to earnings, net of taxes	986		986				986
Net (loss) income	$ 12,256		3,209					3,209	9,047
Ending balance (in shares) at Sep. 30, 2024	73,976,284			73,976,284
Ending balance at Sep. 30, 2024	$ 1,119,634		$ 895,313	$ 7		$ 979,279	$ (1,843)	$ (82,130)	$ 224,321

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
CASH FLOWS FROM OPERATING ACTIVITIES
Net Income	$ 24,611	$ 24,341
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	101,822	95,705
Noncash operating lease expense	45,516	47,542
Equity in earnings of joint ventures, net of dividends	(10,308)	5,012
Amortization of deferred financing costs and loan discount	2,336	2,240
Loss on sale and disposal of equipment	735	1,183
Loss on extinguishment of debt	2,080	0
Gain on contribution of imaging centers into joint venture	0	(16,808)
Amortization of cash flow hedge, net of taxes	8,242	2,765
Non-cash change in fair value of interest rate hedge	7,429	949
Stock-based compensation	21,368	21,380
Loss on impairment	1,200	3,949
Change in fair value of contingent consideration	1,974	(4,112)
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:
Accounts receivable	(35,369)	(1,379)
Other current assets	4,738	5,754
Other assets	(7,388)	(16,641)
Deferred taxes	4,834	7,389
Operating leases	(40,497)	(43,390)
Deferred revenue	(255)	1,155
Accounts payable, accrued expenses and other	57,426	(5,091)
Net cash provided by operating activities	190,494	131,943
CASH FLOWS FROM INVESTING ACTIVITIES
Purchase of imaging facilities and other acquisitions	(37,748)	(10,915)
Purchase of property and equipment and other	(145,164)	(136,537)
Proceeds from sale of equipment	151	82
Equity contributions in existing and purchase of interest in joint ventures	(1,496)	(5,453)
Net cash used in investing activities	(184,257)	(152,823)
CASH FLOWS FROM FINANCING ACTIVITIES
Principal payments on notes and leases payable	(4,296)	(1,929)
Payments on Term Loan Debt	(688,375)	(11,062)
Proceeds from debt refinancing, net of issuing costs	863,815	0
Contribution from noncontrolling partners	7,569	0
Payments on contingent consideration	(3,614)	(3,390)
Distributions paid to noncontrolling interests	(2,423)	(3,523)
Proceeds from sale of economic interests in majority owned subsidiary, net of taxes	8,641	5,102
Proceeds from issuance of common stock	218,385	245,831
Proceeds from issuance of common stock upon exercise of options	367	72
Net cash provided by financing activities	400,069	231,101
EFFECT OF EXCHANGE RATE CHANGES ON CASH	40	(171)
NET INCREASE IN CASH AND CASH EQUIVALENTS	406,346	210,050
CASH AND CASH EQUIVALENTS, beginning of period	342,570	127,834
CASH AND CASH EQUIVALENTS, end of period	748,916	337,884
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid during the period for interest	51,520	59,421
Cash paid during the period for income taxes	$ 2,202	$ 225

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Parenthetical) - USD ($) $ in Thousands		9 Months Ended
	Mar. 27, 2024	Sep. 30, 2024	Sep. 30, 2023
Equipment acquired and leasehold improvements		$ 43,200	$ 50,200
Property and equipment, net		663,867
Goodwill		$ 711,841
Heart & Lung Imaging Limited \| Stock Holdback
Shares issued (in shares)	95,019
Equity interest issued, value assigned	$ 4,600

NATURE OF BUSINESS AND BASIS OF PRESENTATION	9 Months Ended
NATURE OF BUSINESS AND BASIS OF PRESENTATION	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
NATURE OF BUSINESS AND BASIS OF PRESENTATION	NATURE OF BUSINESS AND BASIS OF PRESENTATION We are a national provider of freestanding, fixed-site outpatient diagnostic imaging services in the United States. At September 30, 2024, we operated directly or indirectly through joint ventures with hospitals, 399 centers located in Arizona, California, Delaware, Florida, Maryland, New Jersey, New York and Texas. 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. In the first quarter of 2024, we revised our reportable segments to combine our eRad business, which was included in the Imaging Center segment, with our AI segment to form a new Digital Health reportable segment. Prior period amounts were adjusted retrospectively to reflect the change in reportable segment. For further financial information about these segments, see Note 5, Segment Reporting. In March 2024, we closed on a public offering of 5,232,500 shares of our common stock, including 682,500 shares sold pursuant to the exercise of an underwriter's overallotment option, at a price to the public of $44.00 per share. The gross proceeds as a result of this public offering was $230.2 million before underwriting discounts, commissions, and costs totaling $11.8 million. The consolidated financial statements include the accounts of RadNet, Inc as well as its subsidiaries in which RadNet has a controlling financial interest. The consolidated financial statements also include certain variable interest entities in which we are the primary beneficiary (as described in more detail below). All material intercompany transactions and balances have been eliminated upon consolidation. All of these affiliated entities are referred to collectively as “RadNet,” “we,” “us,” “our” or the “Company” in this report. Accounting regulations stipulate that generally any entity with a) insufficient equity to finance its activities without additional subordinated financial support provided by any parties, or b) equity holders that, as a group, lack the characteristics which evidence a controlling financial interest, is considered a Variable Interest Entity (“VIE”). We consolidate all VIEs in which we are the primary beneficiary. We determine whether we are the primary beneficiary of a VIE through a qualitative analysis that identifies which variable interest holder has the controlling financial interest in the VIE. The variable interest holder who has both of the following has the controlling financial interest and is the primary beneficiary: (1) the power to direct the activities of the VIE that most significantly impact the VIE’s economic performance and (2) the obligation to absorb losses of, or the right to receive benefits from, the VIE that could potentially be significant to the VIE. In performing our analysis, we consider all relevant facts and circumstances, including: the design and activities of the VIE, the terms of the contracts the VIE has entered into, the nature of the VIE’s variable interests issued and how they were negotiated with or marketed to potential investors, and which parties participated significantly in the design or redesign of the entity. VIEs that we consolidate as the primary beneficiary include professional corporations which are owned or controlled by individuals within our senior management and provide professional medical services for centers in Arizona, California, Delaware, Maryland, New Jersey and New York. These VIEs are collectively referred to as the “Consolidated Medical Group". RadNet provides non-medical, technical and administrative services to the Consolidated Medical 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 Consolidated Medical Group has insignificant operating assets and liabilities, and de minimis equity. Substantially all cash flows of the Consolidated Medical Group after expenses, including professional salaries, are transferred to us. We consolidate the revenue and expenses, assets and liabilities of the Consolidated Medical Group. The creditors of the Consolidated Medical Group do not have recourse to our general credit and there are no other arrangements that could expose us to losses on behalf of the Consolidated Medical Group. However, RadNet may be required to provide financial support to cover any operating expenses in excess of operating revenues. The Consolidated Medical Group on a combined basis recognized $55.3 million and $51.3 million of revenue, net of management services fees to RadNet, for the three months ended September 30, 2024 and 2023, respectively and $55.3 million and $51.3 million of operating expenses for the three months ended September 30, 2024 and 2023, respectively. RadNet recognized $207.4 million and $214.7 million of total billed net service fee revenue for the three months ended September 30, 2024, and 2023, respectively, for management services provided to the Consolidated Medical Group relating primarily to the technical portion of billed revenue. The Consolidated Medical Group on a combined basis recognized $162.5 million and $151.5 million of revenue, net of management services fees to RadNet, for the nine months ended September 30, 2024 and 2023, respectively and $162.5 million and $151.5 million of operating expenses for the nine months ended September 30, 2024 and 2023, respectively. RadNet recognized $673.3 million and $638.3 million of total billed net service fee revenue for the nine months ended September 30, 2024, and 2023, respectively, for management services provided to the Consolidated Medical Group relating primarily to the technical portion of billed revenue. In our condensed consolidated balance sheets at September 30, 2024 and December 31, 2023, we have included approximately $118.0 million and $94.1 million, respectively, of accounts receivable and approximately $21.7 million and $16.7 million of accounts payable and accrued liabilities related to the Consolidated Medical Group, respectively. The cash flows of the Consolidated Medical Group are included in the accompanying condensed consolidated statements of cash flows. All intercompany balances and transactions have been eliminated in consolidation. At all of our centers not serviced by the Consolidated Medical Group we have entered into long-term contracts with medical groups to provide professional services at those centers, including supervision and interpretation of diagnostic imaging procedures. The medical groups maintain full control over the physicians they employ. Through our management agreements, we make available to the medical groups the imaging centers, including all furniture, fixtures and medical equipment therein. The medical groups are compensated for their services from the professional component of the global net service fee revenue and after deducting management service fees paid to us, we have no economic controlling interest in these medical groups. As such, the financial results of these groups are not consolidated in our financial statements. The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X and, therefore, do not include all information and footnotes necessary for conformity with U.S. generally accepted accounting principles for complete financial statements; however, in the opinion of management, all adjustments consisting of normal recurring adjustments necessary for a fair presentation of the financial position, results of operations and cash flows for the interim periods ended September 30, 2024 and 2023 have been made. The results of operations for any interim period are not necessarily indicative of the results for a full year. These interim condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes thereto contained in our annual report on Form 10-K for the year ended December 31, 2023.

SIGNIFICANT ACCOUNTING POLICIES

9 Months Ended

Sep. 30, 2024

Accounting Policies [Abstract]

SIGNIFICANT ACCOUNTING POLICIES


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Commercial insurance	$	255,375	$	218,923	$	752,514	$	652,597
Medicare	102,852		89,981		298,001		262,719
Medicaid	10,894		10,519		32,804		30,279
Workers' compensation/personal injury	10,232		9,745		33,088		34,785
Other patient revenue	10,607		10,443		34,524		30,191
Management fee revenue	6,242		3,922		18,255		12,203
Heart and lung	4,696		2,441		12,553		6,377
Other	10,314		3,768		18,918		14,248
Revenue under capitation arrangements	33,563		40,041		105,050		117,982
Imaging Center Segment Revenue	444,775		389,783		1,305,707		1,161,381
Digital Health Segment Revenue	16,367		12,185		46,856		34,866
Total service revenue	$	461,142	$	401,968	$	1,352,563	$	1,196,247

Activity in goodwill for the nine months ended September 30, 2024 is provided below (in thousands):


	Imaging Center segment		Digital Health segment		Total
Balance as of December 31, 2023	606,557		$	72,906	$	679,463
Goodwill from acquisitions	30,729		—		30,729

Currency translation	1,223		426		1,649

Segment reorganization	(12,300)		12,300		—








Balance as of September 30, 2024	$	626,209	$	85,632	$	711,841

As of September 30, 2024:


	2024*		2025		2026		2027		2028		Thereafter		Total		Weighted average amortization period remaining in years
Management service contracts	$	572	$	2,287	$	2,287	$	2,287	$	2,287	$	6,669	$	16,389	7.2
Covenant not to compete and other contracts	261		897		610		315		225		68		2,376		3.1
Customer lists	318		1,141		1,019		844		803		11,108		15,233		17.4
Patent and trademarks	78		311		311		311		311		197		1,519		5.2
Developed technology	1,913		7,651		7,611		7,077		7,077		6,856		38,185		5.8
Trade names amortized	19		77		77		77		63		27		340		4.5
Trade names indefinite life	—		—		—		—		—		8,500		8,500		—
IPR&D	—		—		—		—		—		1,899		1,899		—
Total annual amortization	$	3,161	$	12,364	$	11,915	$	10,911	$	10,766	$	35,324	$	84,441

*Excluding the nine months ended September 30, 2024

As of December 31, 2023:


	2024		2025		2026		2027		2028		Thereafter		Total		Weighted average amortization period remaining in years
Management service contracts	$	2,287	$	2,287	$	2,287	$	2,287	$	2,287	$	6,671	$	18,106	7.9
Covenant not to compete and other contracts	946		714		427		132		45		6		2,270		3.4
Customer lists	1,234		1,104		981		797		764		10,564		15,444		17.7
Patent and trademarks	316		316		316		315		300		164		1,727		5.8
Developed technology	7,785		7,785		7,745		7,210		7,046		6,117		43,688		5.7
Trade names amortized	77		77		77		77		63		27		398		5.3
Trade names indefinite life	—		—		—		—		—		7,100		7,100		—
IPR&D	—		—		—		—		—		1,882		1,882		—
Total annual amortization	$	12,645	$	12,283	$	11,833	$	10,818	$	10,505	$	32,531	$	90,615

A tabular presentation of the effect of derivative instruments on our consolidated statement of comprehensive income of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):

For the three months ended September 30, 2024

Account

June 30, 2024 Balance

Amount of comprehensive loss recognized on derivative net of taxes

Amount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxes*

September 30, 2024 Balance

Location

Accumulated Other Comprehensive Loss, net of taxes

$(4,369)

$—

$986

$(3,383)

Equity

*Net of taxes of $0.4 million for the three months ended September 30, 2024.

For the nine months ended September 30, 2024

Account

December 31, 2023 Balance

Amount of comprehensive loss recognized on derivative net of taxes

Amount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxes*

September 30, 2024 Balance

Location

Accumulated Other Comprehensive Loss, net of taxes

$(11,625)

$—

$8,242

$(3,383)

Equity

*Net of taxes of $2.8 million for the nine months ended September 30, 2024.

A tabular presentation of the effect of derivative instruments on our statement of operations of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):

For the three months ended September 30, 2024

Ineffective interest rate swap

Amount recognized (current period ineffective portion)

Location recognized in profit and loss (current period ineffective portion)

Amount reclassified from accumulated OCI (prior period effective portion)

Location reclassified from accumulated OCI into profit and loss (prior period effective portion)

Interest rate contracts

6,755

Other income (expense)

986

Interest Expense

For the nine months ended September 30, 2024

Ineffective interest rate swap

Amount recognized (current period ineffective portion)

Location recognized in profit and loss (current period ineffective portion)

Amount reclassified from accumulated OCI (prior period effective portion)

Location reclassified from accumulated OCI into profit and loss (prior period effective portion)

Interest rate contracts

7,429

Other income (expense)

8,242

Interest Expense

See Fair Value Measurements below for the fair value of the 2019 Swaps at September 30, 2024.

CONTINGENT CONSIDERATION -

The HLH Imaging Group Limited fka Heart and Lung Imaging Limited

A tabular roll forward of contingent consideration is as follows (amounts in thousands):


For the three months ended September 30, 2024
Entity	Account	June 30, 2024 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2024 Balance
Heart and Lung	Accrued expenses	632	$	—	$	—	$	—	$	632






For the three months ended September 30, 2023
Entity	Account	June 30, 2023 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2023 Balance
Heart and Lung	Accrued Expenses & Other Long Term Liabilities	14,358	$	(3,402)	$	915	$	(772)	$	11,099






For the nine months ended September 30, 2024
Entity	Account	January 1, 2024 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2024 Balance
Heart and Lung	Accrued expenses	6,879	$	(8,221)	$	1,060	$	914	$	632






For the nine months ended September 30, 2023
Entity	Account	January 1, 2023 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2023 Balance
Heart and Lung	Accrued Expenses & Other Long Term Liabilities	11,656	$	(3,402)	$	2,906	$	(61)	$	11,099

Gain or loss from change in valuation of contingent consideration are recorded within Cost of operations in our Consolidated Statements of Operations.

See Fair Value Measurements below for the fair value of contingent consideration at September 30, 2024.

Level 1—Fair value is determined by using unadjusted quoted prices that are available in active markets for identical assets and liabilities.

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:


	As of September 30, 2024
	Level 1		Level 2		Level 3		Total
Long term assets

2019 Swaps - Interest Rate Contracts	$	—	$	7,689	$	—	$	7,689


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total
Current and long term assets

2019 Swaps - Interest Rate Contracts	$	—	$	15,118	$	—	$	15,118

Contingent Consideration:


	As of September 30, 2024
	Level 1		Level 2		Level 3		Total
Accrued expenses
Heart & Lung Imaging Limited	$	—	$	—	$	632	$	632


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total
Accrued expenses



Heart & Lung Imaging Limited	$	—	$	—	$	6,879	$	6,879

Long Term Debt:

The table below summarizes the estimated fair value compared to the face value of our long-term debt as follows (in thousands):


	As of September 30, 2024
	Level 1		Level 2		Level 3		Total Fair Value		Total Face Value
Barclays Term Loan and Truist Term Loan	$	—	$	1,010,778	$	—	$	1,010,778	$	1,009,687


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total Fair Value		Total Face Value
Barclays Term Loan and Truist Term Loan	$	—	$	824,759	$	—	$	824,759	$	823,063

The estimated fair value of our long-term debt, which is discussed in Note 6, Credit Facilities and Notes Payable, was determined using Level 2 inputs primarily related to comparable market prices.


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$	3,209	$	17,540	$	(2,552)	$	4,904

BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period	73,494,709		67,793,404		72,587,321		62,113,707
Basic net income (loss) per share attributable to RadNet, Inc.'s common stockholders	$	0.04	$	0.26	$	(0.04)	$	0.08

DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period	73,494,709		67,793,404		72,587,321		62,113,707
Add non-vested restricted stock subject only to service vesting	233,235		217,238		—		202,082
Add additional shares issuable upon exercise of stock options and contingently issuable shares	1,437,491		799,176		—		905,462
Weighted average number of common shares used in calculating diluted net income per share	75,165,435		68,809,818		72,587,321		63,221,251


Diluted net income (loss) income per share attributable to RadNet, Inc.'s common stockholders	$	0.04	$	0.25	$	(0.04)	$	0.08




Stock options and non-vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Non-vested restricted stock subject to service vesting	—		—		680,318		—
Shares issuable upon the exercise of stock options	—		88,600		820,932		761,708
Shares issuable subject to satisfaction of certain contingencies	—		—		—		193,207
Weighted average shares for which the exercise price exceeds average market price of common stock	—		—		—		94,346

As of September 30, 2024, we have four equity investments with an aggregate carrying value of $8.0 million.

determined that the carrying amount of the investment exceeded its fair value, and the impairment loss has been recorded within "Other income" in our Condensed Consolidated Statements of Operations.

No other observable price changes or impairments in our investments were identified as of September 30, 2024.

Joint venture investment and financial information

The following table is a summary of our investment in joint ventures during the nine months ended September 30, 2024 (in thousands):


Balance as of December 31, 2023	$	92,710
Equity in earnings in these joint ventures	11,308
Distribution of earnings	(1,000)



Equity contributions in existing joint ventures	1,496
Balance as of September 30, 2024	$	104,514


Balance Sheet Data:	September 30, 2024		December 31, 2023
Current assets	$	64,175	$	39,819
Noncurrent assets	219,478		224,936
Current liabilities	(41,550)		(46,587)
Noncurrent liabilities	(70,607)		(70,834)
Total net assets	$	171,496	$	147,334


Income statement data for the nine months ended September 30,	2024		2023
Net revenue	$	195,905	$	129,020
Net income	$	23,949	$	7,906

RECENT ACCOUNTING AND REPORTING STANDARDS	9 Months Ended
RECENT ACCOUNTING AND REPORTING STANDARDS	Sep. 30, 2024
Accounting Standards Update and Change in Accounting Principle [Abstract]
RECENT ACCOUNTING AND REPORTING STANDARDS	RECENT ACCOUNTING AND REPORTING STANDARDS Recently Issued Accounting Pronouncements In November 2023, the FASB issued Accounting Standards Updates (ASUs) 2023-07 ("ASU 2023-07"), Segment Reporting (Topic 280) Improvements to Reportable Segment Disclosures. The guidance requires entities to provide enhanced disclosures about significant segment expenses. For entities that have adopted the amendments in ASU 2023-07, the updated guidance is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, and is applicable to the Company in fiscal 2025. Early adoption is permitted. This ASU will likely result in us including the additional required disclosures when adopted. We are currently evaluating the provisions of this ASU and expect to adopt them for the year ending December 31, 2024.

BUSINESS COMBINATIONS AND RELATED ACTIVITY

9 Months Ended

Sep. 30, 2024

Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]

BUSINESS COMBINATIONS AND RELATED ACTIVITY

Imaging Center Segment

Acquisitions


Entity	Date Acquired	Total Consideration		Property & Equipment	Right of Use Assets	Goodwill	Intangible Assets	Other Assets	Right of Use Liabilities	Notes payable

Stanislaus Surgical Hospital, LLC	9/16/2024	3,000		504	1,468	2,382	100	15	(1,468)	—
Global Imaging LLP	9/1/2024	$	2,900	1,266	—	1,584	50	—	—	—
U.S. Imaging, Inc.	6/1/2024	4,200		4,025	5,597	—	175	—	(5,597)	—
Houston Medical Imaging, LLC	4/1/2024	22,703		15,826	7,929	11,584	1,660	90	(8,089)	(6,297)
Grossman Imaging Center of CMH, LLC	3/31/2024	10,344		1,717	6,304	8,501	280	56	(6,514)	—
Providence Health System - Southern California	3/31/2024	$	7,369	1,378	3,441	5,991	—	—	(3,441)	—
Antelope Valley Outpatient Imaging	2/1/2024	$	3,530	2,794	563	687	50	—	(563)	—

Total		54,046		27,509	25,302	30,729	2,315	160	(25,672)	(6,297)

Formation of majority owned subsidiary and sale of economic interest

SEGMENT REPORTING

9 Months Ended

Sep. 30, 2024

Segment Reporting [Abstract]

SEGMENT REPORTING

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


	Three Months Ended September 30, 2024
	Imaging Center		Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	452,368	$	8,774	$	—	$	461,142
Intersegment	—		7,593		(7,593)		—
Total revenue	$	452,368	$	16,367	$	(7,593)	$	461,142


	Three months ended September 30, 2023
	Imaging Center		Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	395,613	$	6,355	$	—	$	401,968
Intersegment	—		5,830		(5,830)		—
Total revenue	$	395,613	$	12,185	$	(5,830)	$	401,968


	Nine Months Ended September 30, 2024
	Imaging Center			Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	1,325,825		$	26,738	$	—	$	1,352,563
Intersegment	—			20,118		(20,118)		—
Total revenue	$	1,325,825	1325825000	$	46,856	$	(20,118)	$	1,352,563


	Nine Months Ended September 30, 2023
	Imaging Center			Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	1,178,873		$	17,374	$	—	$	1,196,247
Intersegment	—			17,492		(17,492)		—
Total revenue	$	1,178,873	1178873	$	34,866	$	(17,492)	$	1,196,247


	Three months ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Revenue:
Imaging Center	444,775		389,783		$	1,305,707	$	1,161,381
Digital Health	16,367		12,185		46,856		34,866
Total revenue	$	461,142	401,968		$	1,352,563	$	1,196,247

Cost of Operations
Imaging Center	$	374,789	$	334,580	$	1,120,542	$	1,008,814
Digital Health	17,011		7,055		48,571		29,833
Total cost of operations	$	391,800	$	341,635	$	1,169,113	$	1,038,647

Depreciation and Amortization:
Imaging Center	$	32,032	$	30,221	$	94,095	$	89,743
Digital Health	2,947		1,989		7,727		5,962
Total depreciation and amortization	$	34,979	$	32,210	$	101,822	$	95,705

Gain on contribution of imaging centers into joint venture:
Imaging Center	$	—	$	(16,808)	$	—	$	(16,808)
Digital Health	—		—		—		—
Total (gain) loss on contribution of imaging centers into joint venture	$	—	$	(16,808)	$	—	$	(16,808)

Loss (gain) on Disposal of Equipment:
Imaging Center	$	153	$	524	$	739	$	1,185
Digital Health	(5)		3		(4)		(2)
Total loss on disposal of equipment	$	148	$	527	$	735	$	1,183

Severance
Imaging Center	$	271	$	1,141	$	720	$	1,417
Digital Health	33		12		77		1,740
Total severance	$	304	$	1,153	$	797	$	3,157

Income (Loss) from Operations
Imaging Center	$	37,530	$	40,125	$	89,611	$	77,030
Digital Health	(3,619)		3,126		(9,515)		(2,667)
Total income from operations	$	33,911	$	43,251	$	80,096	$	74,363

CREDIT FACILITIES AND NOTES PAYABLE

9 Months Ended

Sep. 30, 2024

Debt Disclosure [Abstract]

CREDIT FACILITIES AND NOTES PAYABLE

Barclays Credit Facility

Barclays Term Loan:


Period	Base Rate plus Margin	Effective Rate
Through March 31, 2023	Eurodollar plus 2.50% Alternative Base Rate plus 2.00%	4.63% 8.00%
April 1, 2023 to April 18, 2024	SOFR plus 3.00% Alternative Base Rate plus 2.00%	8.33% (credit spread adjustment of 0.11%) 10.5%
After April 18, 2024	SOFR plus 2.5% Prime Rate plus 1.5%	7.78% (credit spread adjustment of 0.00% ) 9.5%

Barclays Revolving Credit Facility:

The Barclays Revolving Credit Facility terminates on April 18, 2029, unless otherwise accelerated under the terms of the Barclays Credit Agreement.

Truist Credit Facility

Truist Term Loan:

Truist Revolving Credit Facility:

The Truist Revolving Credit Facility terminates on October 7, 2027, unless otherwise accelerated under the terms of the Truist Credit Agreement.

Notes Payable

Debt Obligations

As of September 30, 2024 and December 31, 2023 our term loan debt and other obligations are as follows (in thousands):



	September 30, 2024		December 31, 2023
Barclays Term Loans collateralized by RadNet's tangible and intangible assets	$	872,812	$	678,687
Discount on Barclays Term Loans	(15,234)		(9,041)
Truist Term Loan Agreement collateralized by NJIN's tangible and intangible assets	136,875		144,375
Discount on Truist Term Loan Agreement	(792)		(990)

Equipment notes payable at 3.6% to 7.2%, due through 2029, collateralized by medical equipment	25,989		17,011
Total debt obligations	1,019,650		830,042
Less: current portion	(23,378)		(17,974)
Long term portion of debt obligations	$	996,272	$	812,068

STOCK-BASED COMPENSATION

9 Months Ended

Sep. 30, 2024

Share-Based Payment Arrangement [Abstract]

STOCK-BASED COMPENSATION

Stock Incentive Plans

Options

The following summarizes all of our option transactions for the nine months ended September 30, 2024:


Outstanding Options Under the 2006 Plan	Shares	Weighted Average Exercise price Per Common Share		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Balance, December 31, 2023	911,411	$	16.60
Granted	—	—
Exercised	(60,306)	6.15

Balance, September 30, 2024	851,105	17.34		5.69	$	44,301
Exercisable at September 30, 2024	729,806	16.62		5.31	38,515

DeepHealth Options


Outstanding Options Under the Deep Health Plan	Shares	Weighted Average Exercise price Per Common Share		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Balance, December 31, 2023	79,073	$	—
Exercised	(9,377)	—
Balance, September 30, 2024	69,696	—		5.0	$	4,836
Exercisable at September 30, 2024	69,696	—		5.0	4,836

Options issued in replacement of original DeepHealth options as a result of our acquisition are not included in the share count under the Restated Plan.

Restricted Stock Awards ("RSAs") and Restricted Stock Units ("RSUs")

The Restated Plan permits the award of RSAs and RSUs. The following summarizes all unvested RSA's and RSU's activities during the nine months ended September 30, 2024:


	RSAs and RSUs	Weighted-Average Remaining Contractual Term (Years)	Weighted-Average Fair Value per Share
RSAs and RSUs unvested at December 31, 2023	762,083		$	22.13
Changes during the period
Granted	797,309		$	37.40
Vested	(875,185)		$	27.78
Forfeited or Canceled	(13,460)		$	27.74
RSAs and RSUs unvested at September 30, 2024	670,747	1.74	$	32.33

We determine the fair value of all RSAs and RSUs based on the closing price of our common stock on the award date.

Performance based stock units ("PSUs")

Performance based stock options ("PSOs")

Shares available

SUBSEQUENT EVENTS	9 Months Ended
SUBSEQUENT EVENTS	Sep. 30, 2024
Subsequent Events [Abstract]
SUBSEQUENT EVENTS	SUBSEQUENT EVENTS Pink Perception LLC On October 1, 2024, we entered into an agreement to acquire Pink Perception LLC for a purchase consideration of approximately $4.0 million. Pink Perception LLC consists of two multi-modality imaging centers located in New York. The acquisition closed in the fourth quarter of 2024. Kheiron Medical Technologies Limited On October 22, 2024, we acquired Kheiron Medical Technologies Limited for a purchase consideration of approximately $1.0 million. Kheiron Medical Technologies Limited is a UK-based AI cancer diagnostic company focused on developing deep learning solutions to support radiologists improve breast cancer detection.

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$ 3,209	$ 17,540	$ (2,552)	$ 4,904

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Sep. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

SIGNIFICANT ACCOUNTING POLICIES (Policies)	9 Months Ended
SIGNIFICANT ACCOUNTING POLICIES (Policies)	Sep. 30, 2024
Accounting Policies [Abstract]
REVENUES	REVENUES - Our revenues generally relate to net patient fees received from various payors and patients themselves under contracts in which our performance obligations are to provide diagnostic services to the patients. Revenues are recorded during the period when our obligations to provide diagnostic services are satisfied. Our performance obligations for diagnostic services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payor (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the fees for the services provided are dependent upon the terms provided by Medicare and Medicaid, or negotiated with managed care health plans and commercial insurance companies. The payment arrangements with third-party payors for the services we provide to the related patients typically specify payments at amounts less than our standard charges and generally provide for payments based upon predetermined rates per diagnostic services or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. As it relates to the Consolidated Medical Group, this service fee revenue includes payments for both the professional medical interpretation revenue recognized by the Consolidated Medical Group as well as the payment for all other aspects related to our providing the imaging services, for which we earn management fees. As it relates to others centers, this service fee revenue is earned through providing the use of our diagnostic imaging equipment and the provision of technical services as well as providing administration services such as clerical and administrative personnel, bookkeeping and accounting services, billing and collection, provision of medical and office supplies, secretarial, reception and transcription services, maintenance of medical records, and advertising, marketing and promotional activities. Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payors. Estimates of contractual allowances under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record self-pay revenues at the estimated amounts we expect to collect. Under capitation arrangements with various health plans, we earn a per-enrollee amount each month for making available diagnostic imaging services to all plan enrollees under the capitation arrangement. Revenue under capitation arrangements is recognized in the period in which we are obligated to provide services to plan enrollees under contracts with various health plans.
ACCOUNTS RECEIVABLE	ACCOUNTS RECEIVABLE - Substantially all of our accounts receivable are due under fee-for-service contracts from third party payors, such as insurance companies and government-sponsored healthcare programs, or directly from patients. Services are generally provided pursuant to one-year contracts with healthcare providers. We continuously monitor collections from our payors and maintain an allowance for bad debts based upon specific payor collection issues that we have identified and our historical experience. We have entered into factoring agreements with various institutions and sold certain accounts receivable under non-recourse agreements in exchange for notes receivables from the buyers. These transactions are accounted for as a reduction in accounts receivable as the agreements transfer effective control over and risk related to the receivables to the buyers. Proceeds on notes receivables are reflected as operating activities on our statement of cash flows and on our balance sheet as prepaid expenses and other current assets for the current portion and deposits and other for the long term portion.We do not utilize factoring arrangements as an integral part of our financing for working capital and assess the party's ability to pay upfront at the inception of the notes receivable and subsequently by reviewing their financial statements annually and reassessing any insolvency risk on a periodic basis.
DEFERRED FINANCING COSTS	DEFERRED FINANCING COSTS - Costs of financing are deferred and amortized using the effective interest rate method and are related to our revolving credit facilities.
PROPERTY AND EQUIPMENT	PROPERTY AND EQUIPMENT - Property and equipment are stated at cost, less accumulated depreciation and amortization. Depreciation of property and equipment is performed using the straight-line method over the estimated useful lives of the assets acquired, which range from 3 to 15 years. Leasehold improvements are amortized at the lesser of lease term or their estimated useful lives, which range from 3 to 15 years. Maintenance and repairs are charged to expense as incurred.
BUSINESS COMBINATIONS	BUSINESS COMBINATIONS - 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	GOODWILLGoodwill is recorded as a result of business combinations. If we determine the carrying value of a reporting unit exceeds its fair value an impairment charge would be recognized and should not exceed the total amount of goodwill allocated to that reporting unit. We tested goodwill and indefinite lived intangibles for impairment on October 1, 2023 noting no impairment, and we have not identified any indicators of impairment through September 30, 2024.
INCOME TAXES	INCOME TAXES - Income tax expense is computed using an asset and liability method and using expected annual effective tax rates. Under this method, deferred income tax assets and liabilities result from temporary differences in the financial reporting bases and the income tax reporting bases of assets and liabilities. The measurement of deferred tax assets is reduced, if necessary, by the amount of any tax benefit that, based on available evidence, is not expected to be realized. When it appears more likely than not that deferred taxes will not be realized, a valuation allowance is recorded to reduce the deferred tax asset to its estimated realizable value. For net deferred tax assets we consider estimates of future taxable income in determining whether our net deferred tax assets are more likely than not to be realized.
LEASES	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 condensed consolidated balance sheets. 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. ROU assets are tested for impairment if circumstances suggest that the carrying amount may not be recoverable. Our ROU assets consist of facility and equipment assets on operating leases. No events have occurred such as fire, flood, or other acts which have impaired the integrity of our ROU assets as of September 30, 2024. Our facility leases require us to maintain insurance policies which would cover major damage to our facilities. We maintain business interruption insurance to cover loss of business due to a facility becoming non-operational under certain circumstances. Our equipment leases are covered by warranty and service contracts which cover repairs and provide regular maintenance to keep the equipment in functioning order.
EQUITY BASED COMPENSATION	EQUITY BASED COMPENSATION – We have one long-term incentive plan that we adopted in 2006 and which we have amended and restated at various points in time: April 20, 2015, March 9, 2017, April 15, 2021 April 27, 2023, and most recently by our stockholders at our annual stockholders meeting on June 7, 2023 (the “Restated Plan”). We have reserved 20,100,000 shares of common stock for issuance under the Restated Plan which can be issued in the form of incentive and/or nonstatutory stock options, restricted and/or unrestricted stock, stock units, and stock appreciation rights. Terms and conditions of awards can be direct grants or based on achieving a performance metric. We also consider probability of achievement of performance conditions when determining expense recognition. For the awards where vesting is probable, equity-based compensation is recognized over the related vesting period. Stock options generally vest over three years to five years and expire five years to ten years from date of grant. We determine the compensation expense for each stock option award using the Black Scholes model. This model requires that our management make certain estimates concerning risk free interest rates and volatility in the trading price of our common stock. The compensation expense recognized for all equity-based awards is recognized over the awards’ service periods. Equity-based compensation is classified in operating expenses within the same line item as the majority of the cash compensation paid to employees. In connection with our acquisition of DeepHealth Inc. on June 1, 2020, we assumed the DeepHealth, Inc. 2017 Equity Incentive Plan, including outstanding options awards that can be exercised for our common stock. No additional awards will be granted under the DeepHealth, Inc. 2017 Equity Incentive Plan. See Note 7, Stock-Based Compensation, for more information.
COMPREHENSIVE INCOME (LOSS)	COMPREHENSIVE INCOME (LOSS) - Accounting guidance establishes rules for reporting and displaying other comprehensive income (loss) and its components. Our foreign currency translation adjustments and the amortization of balances associated with derivatives previously classified as cash flow hedges are included in other comprehensive income (loss). The components of other comprehensive income (loss) for the three and nine months ended September 30, 2024 and September 30, 2023 are included in the consolidated statements of comprehensive income.
INTEREST INCOME	INTEREST INCOME - We recognized interest income of approximately $9.6 million and $3.6 million for the three months ended September 30, 2024 and 2023, respectively, and $22.7 million and $6.3 million for the nine months ended September 30, 2024 and 2023, respectively. Interest income is recorded within Other non-operating income in our Condensed Consolidated Statements of Operations.
COMMITMENTS AND CONTINGENCIES	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. If one or more of these matters were resolved against us for amounts in excess of management's expectations, our results of operations and financial condition, including in a particular reporting period in which any such outcome becomes probable and estimable, could be materially adversely affected.
DERIVATIVE INSTRUMENTS	DERIVATIVE INSTRUMENTSThe 2019 Swaps secure a constant interest rate associated with portions of our variable rate bank debt and have an effective date of October 13, 2020. They matured in October 2023 for the smaller notional and will mature in October 2025 for the larger notional.As of the effective date, we are liable for premium payments if interest rates decline below arranged rates, but will receive interest payments if rates are above the arranged rates.At inception, we designated our 2019 Swaps as cash flow hedges of floating-rate borrowings. In accordance with accounting guidance, derivatives that have been designated and qualify as cash flow hedging instruments are reported at fair value. The gain or loss on the effective portion of the hedge (i.e. change in fair value) is reported as a component of comprehensive gain or loss in the consolidated statement of equity.
FAIR VALUE MEASUREMENTS	FAIR VALUE MEASUREMENTS – Assets and liabilities subject to fair value measurements are required to be disclosed within a fair value hierarchy. The fair value hierarchy ranks the quality and reliability of inputs used to determine fair value. Accordingly, assets and liabilities carried at, or permitted to be carried at, fair value are classified within the fair value hierarchy in one of the following categories based on the lowest level input that is significant to a fair value measurement: Level 1—Fair value is determined by using unadjusted quoted prices that are available in active markets for identical assets and liabilities. Level 2—Fair value is determined by using inputs other than Level 1 quoted prices that are directly or indirectly observable. Inputs can include quoted prices for similar assets and liabilities in active markets or quoted prices for identical assets and liabilities in inactive markets. Related inputs can also include those used in valuation or other pricing models such as interest rates and yield curves that can be corroborated by observable market data. Level 3—Fair value is determined by using inputs that are unobservable and not corroborated by market data. Use of these inputs involves significant and subjective judgment. The estimated fair value of these contracts was determined using Level 2 inputs. More specifically, the fair value was determined by calculating the value of the difference between the fixed interest rate of the interest rate swaps and the counterparty’s forward SOFR curve. The forward SOFR curve is readily available in the public markets or can be derived from information available in the public markets. The estimated fair value of our long-term debt, which is discussed in Note 6, Credit Facilities and Notes Payable, was determined using Level 2 inputs primarily related to comparable market prices. We consider the carrying amounts of cash and cash equivalents, receivables, other current assets, current liabilities and other notes payables to approximate their fair value because of the relatively short period of time between the origination of these instruments and their expected realization or payment.
EARNINGS PER SHARE	EARNINGS PER SHARE - 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):
INVESTMENTS IN EQUITY SECURITIES	INVESTMENTS IN EQUITY SECURITIES–Accounting guidance requires entities to measure equity investments at fair value, with any changes in fair value recognized in net income. If there is no readily determinable fair value, the guidance allows entities the ability to measure investments at cost, adjusted for observable price changes and impairments, with changes recognized in net income.
INVESTMENTS IN JOINT VENTURES	INVESTMENT IN JOINT VENTURES – We have 13 unconsolidated joint ventures with ownership interests ranging from 33% 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 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, 2024.
RECENTLY ISSUED ACCOUNTING PRONOUNCEMENTS	Recently Issued Accounting Pronouncements In November 2023, the FASB issued Accounting Standards Updates (ASUs) 2023-07 ("ASU 2023-07"), Segment Reporting (Topic 280) Improvements to Reportable Segment Disclosures. The guidance requires entities to provide enhanced disclosures about significant segment expenses. For entities that have adopted the amendments in ASU 2023-07, the updated guidance is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, and is applicable to the Company in fiscal 2025. Early adoption is permitted. This ASU will likely result in us including the additional required disclosures when adopted. We are currently evaluating the provisions of this ASU and expect to adopt them for the year ending December 31, 2024.

SIGNIFICANT ACCOUNTING POLICIES (Tables)

9 Months Ended

Sep. 30, 2024

Accounting Policies [Abstract]

Schedule of Service Fee Revenue


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Commercial insurance	$	255,375	$	218,923	$	752,514	$	652,597
Medicare	102,852		89,981		298,001		262,719
Medicaid	10,894		10,519		32,804		30,279
Workers' compensation/personal injury	10,232		9,745		33,088		34,785
Other patient revenue	10,607		10,443		34,524		30,191
Management fee revenue	6,242		3,922		18,255		12,203
Heart and lung	4,696		2,441		12,553		6,377
Other	10,314		3,768		18,918		14,248
Revenue under capitation arrangements	33,563		40,041		105,050		117,982
Imaging Center Segment Revenue	444,775		389,783		1,305,707		1,161,381
Digital Health Segment Revenue	16,367		12,185		46,856		34,866
Total service revenue	$	461,142	$	401,968	$	1,352,563	$	1,196,247

Schedule of Goodwill

Activity in goodwill for the nine months ended September 30, 2024 is provided below (in thousands):


	Imaging Center segment		Digital Health segment		Total
Balance as of December 31, 2023	606,557		$	72,906	$	679,463
Goodwill from acquisitions	30,729		—		30,729

Currency translation	1,223		426		1,649

Segment reorganization	(12,300)		12,300		—








Balance as of September 30, 2024	$	626,209	$	85,632	$	711,841

Schedule of Annual Amortization Expense

The components of intangible assets, both finite and indefinite lived, along with annual amortization expense that will be recorded over the next five years at September 30, 2024 and December 31, 2023 are as follows (in thousands):

As of September 30, 2024:


	2024*		2025		2026		2027		2028		Thereafter		Total		Weighted average amortization period remaining in years
Management service contracts	$	572	$	2,287	$	2,287	$	2,287	$	2,287	$	6,669	$	16,389	7.2
Covenant not to compete and other contracts	261		897		610		315		225		68		2,376		3.1
Customer lists	318		1,141		1,019		844		803		11,108		15,233		17.4
Patent and trademarks	78		311		311		311		311		197		1,519		5.2
Developed technology	1,913		7,651		7,611		7,077		7,077		6,856		38,185		5.8
Trade names amortized	19		77		77		77		63		27		340		4.5
Trade names indefinite life	—		—		—		—		—		8,500		8,500		—
IPR&D	—		—		—		—		—		1,899		1,899		—
Total annual amortization	$	3,161	$	12,364	$	11,915	$	10,911	$	10,766	$	35,324	$	84,441

*Excluding the nine months ended September 30, 2024

As of December 31, 2023:


	2024		2025		2026		2027		2028		Thereafter		Total		Weighted average amortization period remaining in years
Management service contracts	$	2,287	$	2,287	$	2,287	$	2,287	$	2,287	$	6,671	$	18,106	7.9
Covenant not to compete and other contracts	946		714		427		132		45		6		2,270		3.4
Customer lists	1,234		1,104		981		797		764		10,564		15,444		17.7
Patent and trademarks	316		316		316		315		300		164		1,727		5.8
Developed technology	7,785		7,785		7,745		7,210		7,046		6,117		43,688		5.7
Trade names amortized	77		77		77		77		63		27		398		5.3
Trade names indefinite life	—		—		—		—		—		7,100		7,100		—
IPR&D	—		—		—		—		—		1,882		1,882		—
Total annual amortization	$	12,645	$	12,283	$	11,833	$	10,818	$	10,505	$	32,531	$	90,615

Schedule of Effect of Derivative Instruments on Comprehensive Income( Loss)

A tabular presentation of the effect of derivative instruments on our consolidated statement of comprehensive income of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):

For the three months ended September 30, 2024

Account

June 30, 2024 Balance

Amount of comprehensive loss recognized on derivative net of taxes

Amount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxes*

September 30, 2024 Balance

Location

Accumulated Other Comprehensive Loss, net of taxes

$(4,369)

$—

$986

$(3,383)

Equity

*Net of taxes of $0.4 million for the three months ended September 30, 2024.

For the nine months ended September 30, 2024

Account

December 31, 2023 Balance

Amount of comprehensive loss recognized on derivative net of taxes

Amount of loss reclassified out of accumulated OCI into income (prior period effective portion), net of taxes*

September 30, 2024 Balance

Location

Accumulated Other Comprehensive Loss, net of taxes

$(11,625)

$—

$8,242

$(3,383)

Equity

*Net of taxes of $2.8 million for the nine months ended September 30, 2024.

A tabular presentation of the effect of derivative instruments on our statement of operations of the 2019 Swaps which remain ineffective is as follows (amounts in thousands):

For the three months ended September 30, 2024

Ineffective interest rate swap

Amount recognized (current period ineffective portion)

Location recognized in profit and loss (current period ineffective portion)

Amount reclassified from accumulated OCI (prior period effective portion)

Location reclassified from accumulated OCI into profit and loss (prior period effective portion)

Interest rate contracts

6,755

Other income (expense)

986

Interest Expense

For the nine months ended September 30, 2024

Ineffective interest rate swap

Amount recognized (current period ineffective portion)

Location recognized in profit and loss (current period ineffective portion)

Amount reclassified from accumulated OCI (prior period effective portion)

Location reclassified from accumulated OCI into profit and loss (prior period effective portion)

Interest rate contracts

7,429

Other income (expense)

8,242

Interest Expense

Schedule of Business Acquisitions by Acquisition, Contingent Consideration

A tabular roll forward of contingent consideration is as follows (amounts in thousands):


For the three months ended September 30, 2024
Entity	Account	June 30, 2024 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2024 Balance
Heart and Lung	Accrued expenses	632	$	—	$	—	$	—	$	632






For the three months ended September 30, 2023
Entity	Account	June 30, 2023 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2023 Balance
Heart and Lung	Accrued Expenses & Other Long Term Liabilities	14,358	$	(3,402)	$	915	$	(772)	$	11,099






For the nine months ended September 30, 2024
Entity	Account	January 1, 2024 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2024 Balance
Heart and Lung	Accrued expenses	6,879	$	(8,221)	$	1,060	$	914	$	632






For the nine months ended September 30, 2023
Entity	Account	January 1, 2023 Balance	Settlement of contingent consideration		Change in valuation of contingent consideration		Currency translation		September 30, 2023 Balance
Heart and Lung	Accrued Expenses & Other Long Term Liabilities	11,656	$	(3,402)	$	2,906	$	(61)	$	11,099

Schedule of Fair Value of Assets and Liabilities


	As of September 30, 2024
	Level 1		Level 2		Level 3		Total
Long term assets

2019 Swaps - Interest Rate Contracts	$	—	$	7,689	$	—	$	7,689


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total
Current and long term assets

2019 Swaps - Interest Rate Contracts	$	—	$	15,118	$	—	$	15,118


	As of September 30, 2024
	Level 1		Level 2		Level 3		Total
Accrued expenses
Heart & Lung Imaging Limited	$	—	$	—	$	632	$	632


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total
Accrued expenses



Heart & Lung Imaging Limited	$	—	$	—	$	6,879	$	6,879

The table below summarizes the estimated fair value compared to the face value of our long-term debt as follows (in thousands):


	As of September 30, 2024
	Level 1		Level 2		Level 3		Total Fair Value		Total Face Value
Barclays Term Loan and Truist Term Loan	$	—	$	1,010,778	$	—	$	1,010,778	$	1,009,687


	As of December 31, 2023
	Level 1		Level 2		Level 3		Total Fair Value		Total Face Value
Barclays Term Loan and Truist Term Loan	$	—	$	824,759	$	—	$	824,759	$	823,063

Schedule of 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 September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$	3,209	$	17,540	$	(2,552)	$	4,904

BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period	73,494,709		67,793,404		72,587,321		62,113,707
Basic net income (loss) per share attributable to RadNet, Inc.'s common stockholders	$	0.04	$	0.26	$	(0.04)	$	0.08

DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period	73,494,709		67,793,404		72,587,321		62,113,707
Add non-vested restricted stock subject only to service vesting	233,235		217,238		—		202,082
Add additional shares issuable upon exercise of stock options and contingently issuable shares	1,437,491		799,176		—		905,462
Weighted average number of common shares used in calculating diluted net income per share	75,165,435		68,809,818		72,587,321		63,221,251


Diluted net income (loss) income per share attributable to RadNet, Inc.'s common stockholders	$	0.04	$	0.25	$	(0.04)	$	0.08




Stock options and non-vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Non-vested restricted stock subject to service vesting	—		—		680,318		—
Shares issuable upon the exercise of stock options	—		88,600		820,932		761,708
Shares issuable subject to satisfaction of certain contingencies	—		—		—		193,207
Weighted average shares for which the exercise price exceeds average market price of common stock	—		—		—		94,346

Schedule of Investment in Joint Ventures

The following table is a summary of our investment in joint ventures during the nine months ended September 30, 2024 (in thousands):


Balance as of December 31, 2023	$	92,710
Equity in earnings in these joint ventures	11,308
Distribution of earnings	(1,000)



Equity contributions in existing joint ventures	1,496
Balance as of September 30, 2024	$	104,514

Schedule of Joint Venture Investment and Financial Information


Balance Sheet Data:	September 30, 2024		December 31, 2023
Current assets	$	64,175	$	39,819
Noncurrent assets	219,478		224,936
Current liabilities	(41,550)		(46,587)
Noncurrent liabilities	(70,607)		(70,834)
Total net assets	$	171,496	$	147,334


Income statement data for the nine months ended September 30,	2024		2023
Net revenue	$	195,905	$	129,020
Net income	$	23,949	$	7,906

BUSINESS COMBINATIONS AND RELATED ACTIVITY (Tables)

9 Months Ended

Sep. 30, 2024

Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]

Schedule of Business Acquisitions

As of September 30, 2024, we made a preliminary fair value determination of the acquired assets and assumed liabilities and the following were recorded (in thousands). The valuation of assets acquired and liabilities assumed has not yet been finalized as of September 30, 2024; and the fair value determination is preliminary and may be subject to change:


Entity	Date Acquired	Total Consideration		Property & Equipment	Right of Use Assets	Goodwill	Intangible Assets	Other Assets	Right of Use Liabilities	Notes payable

Stanislaus Surgical Hospital, LLC	9/16/2024	3,000		504	1,468	2,382	100	15	(1,468)	—
Global Imaging LLP	9/1/2024	$	2,900	1,266	—	1,584	50	—	—	—
U.S. Imaging, Inc.	6/1/2024	4,200		4,025	5,597	—	175	—	(5,597)	—
Houston Medical Imaging, LLC	4/1/2024	22,703		15,826	7,929	11,584	1,660	90	(8,089)	(6,297)
Grossman Imaging Center of CMH, LLC	3/31/2024	10,344		1,717	6,304	8,501	280	56	(6,514)	—
Providence Health System - Southern California	3/31/2024	$	7,369	1,378	3,441	5,991	—	—	(3,441)	—
Antelope Valley Outpatient Imaging	2/1/2024	$	3,530	2,794	563	687	50	—	(563)	—

Total		54,046		27,509	25,302	30,729	2,315	160	(25,672)	(6,297)

SEGMENT REPORTING (Tables)

9 Months Ended

Sep. 30, 2024

Segment Reporting [Abstract]

Schedule of Segment Reporting Information, by Segment


	Three Months Ended September 30, 2024
	Imaging Center		Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	452,368	$	8,774	$	—	$	461,142
Intersegment	—		7,593		(7,593)		—
Total revenue	$	452,368	$	16,367	$	(7,593)	$	461,142


	Three months ended September 30, 2023
	Imaging Center		Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	395,613	$	6,355	$	—	$	401,968
Intersegment	—		5,830		(5,830)		—
Total revenue	$	395,613	$	12,185	$	(5,830)	$	401,968


	Nine Months Ended September 30, 2024
	Imaging Center			Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	1,325,825		$	26,738	$	—	$	1,352,563
Intersegment	—			20,118		(20,118)		—
Total revenue	$	1,325,825	1325825000	$	46,856	$	(20,118)	$	1,352,563


	Nine Months Ended September 30, 2023
	Imaging Center			Digital Health		Intersegment Elimination		Consolidated Total
Revenue:
Third Party	$	1,178,873		$	17,374	$	—	$	1,196,247
Intersegment	—			17,492		(17,492)		—
Total revenue	$	1,178,873	1178873	$	34,866	$	(17,492)	$	1,196,247


	Three months ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Revenue:
Imaging Center	444,775		389,783		$	1,305,707	$	1,161,381
Digital Health	16,367		12,185		46,856		34,866
Total revenue	$	461,142	401,968		$	1,352,563	$	1,196,247

Cost of Operations
Imaging Center	$	374,789	$	334,580	$	1,120,542	$	1,008,814
Digital Health	17,011		7,055		48,571		29,833
Total cost of operations	$	391,800	$	341,635	$	1,169,113	$	1,038,647

Depreciation and Amortization:
Imaging Center	$	32,032	$	30,221	$	94,095	$	89,743
Digital Health	2,947		1,989		7,727		5,962
Total depreciation and amortization	$	34,979	$	32,210	$	101,822	$	95,705

Gain on contribution of imaging centers into joint venture:
Imaging Center	$	—	$	(16,808)	$	—	$	(16,808)
Digital Health	—		—		—		—
Total (gain) loss on contribution of imaging centers into joint venture	$	—	$	(16,808)	$	—	$	(16,808)

Loss (gain) on Disposal of Equipment:
Imaging Center	$	153	$	524	$	739	$	1,185
Digital Health	(5)		3		(4)		(2)
Total loss on disposal of equipment	$	148	$	527	$	735	$	1,183

Severance
Imaging Center	$	271	$	1,141	$	720	$	1,417
Digital Health	33		12		77		1,740
Total severance	$	304	$	1,153	$	797	$	3,157

Income (Loss) from Operations
Imaging Center	$	37,530	$	40,125	$	89,611	$	77,030
Digital Health	(3,619)		3,126		(9,515)		(2,667)
Total income from operations	$	33,911	$	43,251	$	80,096	$	74,363

CREDIT FACILITIES AND NOTES PAYABLE (Tables)

9 Months Ended

Sep. 30, 2024

Debt Disclosure [Abstract]

Schedule of First Lien Credit Agreement

During the periods covered by this report, the base rates, margins and effective interest rates (without giving effect to our 2019 Swaps) were as follows for the periods indicated:


Period	Base Rate plus Margin	Effective Rate
Through March 31, 2023	Eurodollar plus 2.50% Alternative Base Rate plus 2.00%	4.63% 8.00%
April 1, 2023 to April 18, 2024	SOFR plus 3.00% Alternative Base Rate plus 2.00%	8.33% (credit spread adjustment of 0.11%) 10.5%
After April 18, 2024	SOFR plus 2.5% Prime Rate plus 1.5%	7.78% (credit spread adjustment of 0.00% ) 9.5%

As of September 30, 2024 and December 31, 2023 our term loan debt and other obligations are as follows (in thousands):



	September 30, 2024		December 31, 2023
Barclays Term Loans collateralized by RadNet's tangible and intangible assets	$	872,812	$	678,687
Discount on Barclays Term Loans	(15,234)		(9,041)
Truist Term Loan Agreement collateralized by NJIN's tangible and intangible assets	136,875		144,375
Discount on Truist Term Loan Agreement	(792)		(990)

Equipment notes payable at 3.6% to 7.2%, due through 2029, collateralized by medical equipment	25,989		17,011
Total debt obligations	1,019,650		830,042
Less: current portion	(23,378)		(17,974)
Long term portion of debt obligations	$	996,272	$	812,068

STOCK-BASED COMPENSATION (Tables)

9 Months Ended

Sep. 30, 2024

Share-Based Payment Arrangement [Abstract]

Schedule of Options Activity

The following summarizes all of our option transactions for the nine months ended September 30, 2024:


Outstanding Options Under the 2006 Plan	Shares	Weighted Average Exercise price Per Common Share		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Balance, December 31, 2023	911,411	$	16.60
Granted	—	—
Exercised	(60,306)	6.15

Balance, September 30, 2024	851,105	17.34		5.69	$	44,301
Exercisable at September 30, 2024	729,806	16.62		5.31	38,515


Outstanding Options Under the Deep Health Plan	Shares	Weighted Average Exercise price Per Common Share		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Balance, December 31, 2023	79,073	$	—
Exercised	(9,377)	—
Balance, September 30, 2024	69,696	—		5.0	$	4,836
Exercisable at September 30, 2024	69,696	—		5.0	4,836

Schedule of RSAs and RSUS Activity

The Restated Plan permits the award of RSAs and RSUs. The following summarizes all unvested RSA's and RSU's activities during the nine months ended September 30, 2024:


	RSAs and RSUs	Weighted-Average Remaining Contractual Term (Years)	Weighted-Average Fair Value per Share
RSAs and RSUs unvested at December 31, 2023	762,083		$	22.13
Changes during the period
Granted	797,309		$	37.40
Vested	(875,185)		$	27.78
Forfeited or Canceled	(13,460)		$	27.74
RSAs and RSUs unvested at September 30, 2024	670,747	1.74	$	32.33

NATURE OF BUSINESS AND BASIS OF PRESENTATION (Details) $ / shares in Units, $ in Thousands	1 Months Ended	3 Months Ended		9 Months Ended
	Mar. 31, 2024 USD ($) $ / shares shares	Sep. 30, 2024 USD ($) center	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) center	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)
Business Acquisition [Line Items]
Number of centers \| center		399		399
BRMG and NY Groups revenues		$ 55,300	$ 51,300	$ 162,500	$ 151,500
BRMG and NY Groups operating expenses		55,300	51,300	162,500	151,500
Management services provided to BRMG and NY Groups		207,400	$ 214,700	673,300	$ 638,300
BRMG and NY Groups accounts receivable		3,275,342		3,275,342		$ 2,690,473
BRMG and NY Groups accounts payable		2,155,708		2,155,708		1,877,114
Variable Interest Entity, Primary Beneficiary
Business Acquisition [Line Items]
BRMG and NY Groups accounts receivable		118,000		118,000		94,100
BRMG and NY Groups accounts payable		$ 21,700		$ 21,700		$ 16,700
Common Stock \| Public Offering
Business Acquisition [Line Items]
Number of shares issued in transaction (in shares) \| shares	5,232,500
Stock price (in dollars per share) \| $ / shares	$ 44.00
Gross proceeds	$ 230,200
Public offering expenses	$ 11,800
Common Stock \| Public Offering \| Sold Pursuant to Exercise
Business Acquisition [Line Items]
Number of shares issued in transaction (in shares) \| shares	682,500

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Service Fee Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenue from External Customer [Line Items]
Revenue	$ 461,142	$ 401,968	$ 1,352,563	$ 1,196,247
Imaging Center Segment Revenue
Revenue from External Customer [Line Items]
Revenue	444,775	389,783	1,305,707	1,161,381
Commercial insurance
Revenue from External Customer [Line Items]
Revenue	255,375	218,923	752,514	652,597
Medicare
Revenue from External Customer [Line Items]
Revenue	102,852	89,981	298,001	262,719
Medicaid
Revenue from External Customer [Line Items]
Revenue	10,894	10,519	32,804	30,279
Workers' compensation/personal injury
Revenue from External Customer [Line Items]
Revenue	10,232	9,745	33,088	34,785
Other patient revenue
Revenue from External Customer [Line Items]
Revenue	10,607	10,443	34,524	30,191
Management fee revenue
Revenue from External Customer [Line Items]
Revenue	6,242	3,922	18,255	12,203
Heart and lung
Revenue from External Customer [Line Items]
Revenue	4,696	2,441	12,553	6,377
Other
Revenue from External Customer [Line Items]
Revenue	10,314	3,768	18,918	14,248
Revenue under capitation arrangements
Revenue from External Customer [Line Items]
Revenue	33,563	40,041	105,050	117,982
Digital Health
Revenue from External Customer [Line Items]
Revenue	16,367	12,185	46,856	34,866
Service Revenue
Revenue from External Customer [Line Items]
Revenue	$ 461,142	$ 401,968	$ 1,352,563	$ 1,196,247

SIGNIFICANT ACCOUNTING POLICIES - Narrative 1 (Details) - USD ($)		3 Months Ended		9 Months Ended
	Oct. 01, 2023	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Summary of Significant Accounting Policies [Line Items]
Contracts receivable, factoring receivable		$ 5,900,000		$ 5,900,000		$ 14,300,000
Deferred financing costs, net of accumulated amortization		2,400,000		2,400,000		1,600,000
Goodwill		711,841,000		711,841,000		$ 679,463,000
Loss on impairment	$ 0
Intangible asset amortization expense		3,100,000	$ 3,000,000.0	9,400,000	$ 8,900,000
Income tax expense (benefit)		$ 4,335,000	$ 7,220,000	$ 4,927,000	$ 7,741,000
Effective tax rate		26.10%	23.10%	16.70%	24.10%
Management service contracts
Summary of Significant Accounting Policies [Line Items]
Useful life		25 years		25 years
Minimum \| Amounts Returned to Property and Equipment
Summary of Significant Accounting Policies [Line Items]
PPE estimated useful lives		3 years		3 years
Minimum \| Leasehold Improvements
Summary of Significant Accounting Policies [Line Items]
PPE estimated useful lives		3 years		3 years
Maximum \| Amounts Returned to Property and Equipment
Summary of Significant Accounting Policies [Line Items]
PPE estimated useful lives		15 years		15 years
Maximum \| Leasehold Improvements
Summary of Significant Accounting Policies [Line Items]
PPE estimated useful lives		15 years		15 years

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Goodwill [Roll Forward]
Beginning balance	$ 679,463
Goodwill from acquisitions	30,729
Currency translation	1,649
Segment reorganization	0
Ending balance	711,841
Imaging Center segment
Goodwill [Roll Forward]
Beginning balance	606,557
Goodwill from acquisitions	30,729
Currency translation	1,223
Segment reorganization	(12,300)
Ending balance	626,209
Digital Health segment
Goodwill [Roll Forward]
Beginning balance	72,906
Goodwill from acquisitions	0
Currency translation	426
Segment reorganization	12,300
Ending balance	$ 85,632

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Annual Amortization Expense (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets [Line Items]
Remainder of fiscal year	$ 3,161
Expected amortization, year one	12,364	$ 12,645
Expected amortization, year two	11,915	12,283
Expected amortization, year three	10,911	11,833
Expected amortization, year four	10,766	10,818
Expected amortization, year five		10,505
Thereafter	35,324
Thereafter		32,531
Indefinite-Lived Intangible Assets [Line Items]
Other intangible assets	84,441	90,615
Trade names indefinite life
Indefinite-Lived Intangible Assets [Line Items]
Indefinite-lived intangible assets	8,500	7,100
IPR&D
Indefinite-Lived Intangible Assets [Line Items]
Indefinite-lived intangible assets	1,899	1,882
Management service contracts
Finite-Lived Intangible Assets [Line Items]
Remainder of fiscal year	572
Expected amortization, year one	2,287	2,287
Expected amortization, year two	2,287	2,287
Expected amortization, year three	2,287	2,287
Expected amortization, year four	2,287	2,287
Expected amortization, year five		2,287
Thereafter	6,669
Thereafter		6,671
Amortization total	$ 16,389	$ 18,106
Weighted average amortization period remaining in years	7 years 2 months 12 days	7 years 10 months 24 days
Covenant not to compete and other contracts
Finite-Lived Intangible Assets [Line Items]
Remainder of fiscal year	$ 261
Expected amortization, year one	897	$ 946
Expected amortization, year two	610	714
Expected amortization, year three	315	427
Expected amortization, year four	225	132
Expected amortization, year five		45
Thereafter	68
Thereafter		6
Amortization total	$ 2,376	$ 2,270
Weighted average amortization period remaining in years	3 years 1 month 6 days	3 years 4 months 24 days
Customer lists
Finite-Lived Intangible Assets [Line Items]
Remainder of fiscal year	$ 318
Expected amortization, year one	1,141	$ 1,234
Expected amortization, year two	1,019	1,104
Expected amortization, year three	844	981
Expected amortization, year four	803	797
Expected amortization, year five		764
Thereafter	11,108
Thereafter		10,564
Amortization total	$ 15,233	$ 15,444
Weighted average amortization period remaining in years	17 years 4 months 24 days	17 years 8 months 12 days
Patent and trademarks
Finite-Lived Intangible Assets [Line Items]
Remainder of fiscal year	$ 78
Expected amortization, year one	311	$ 316
Expected amortization, year two	311	316
Expected amortization, year three	311	316
Expected amortization, year four	311	315
Expected amortization, year five		300
Thereafter	197
Thereafter		164
Amortization total	$ 1,519	$ 1,727
Weighted average amortization period remaining in years	5 years 2 months 12 days	5 years 9 months 18 days
Developed technology
Finite-Lived Intangible Assets [Line Items]
Remainder of fiscal year	$ 1,913
Expected amortization, year one	7,651	$ 7,785
Expected amortization, year two	7,611	7,785
Expected amortization, year three	7,077	7,745
Expected amortization, year four	7,077	7,210
Expected amortization, year five		7,046
Thereafter	6,856
Thereafter		6,117
Amortization total	$ 38,185	$ 43,688
Weighted average amortization period remaining in years	5 years 9 months 18 days	5 years 8 months 12 days
Trade names indefinite life
Finite-Lived Intangible Assets [Line Items]
Remainder of fiscal year	$ 19
Expected amortization, year one	77	$ 77
Expected amortization, year two	77	77
Expected amortization, year three	77	77
Expected amortization, year four	63	77
Expected amortization, year five		63
Thereafter	27
Thereafter		27
Amortization total	$ 340	$ 398
Weighted average amortization period remaining in years	4 years 6 months	5 years 3 months 18 days

SIGNIFICANT ACCOUNTING POLICIES - Narrative 2 (Details)	3 Months Ended		9 Months Ended		24 Months Ended	40 Months Ended
SIGNIFICANT ACCOUNTING POLICIES - Narrative 2 (Details)	Sep. 30, 2024 USD ($) incentivePlan	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) incentivePlan	Sep. 30, 2023 USD ($)	Oct. 31, 2025 USD ($)	Oct. 31, 2023 USD ($)	Dec. 31, 2023 USD ($)	Jun. 07, 2023 shares	Jul. 01, 2020 USD ($)	Jun. 30, 2019 USD ($) agreement
Summary of Significant Accounting Policies [Line Items]
Number of plans \| incentivePlan	1		1
Number of shares authorized (in shares) \| shares								20,100,000
Interest income	$ 9,600,000	$ 3,600,000	$ 22,700,000	$ 6,300,000
Amount of loss recognized in income on derivative (current period ineffective portion)	$ 895,313,000		$ 895,313,000				$ 630,695,000
Monthly amortization of deferred hedge gains						$ 400,000
Forecast
Summary of Significant Accounting Policies [Line Items]
Monthly amortization of deferred hedge gains					$ 300,000
Accumulated Other Comprehensive Loss, net of taxes
Summary of Significant Accounting Policies [Line Items]
Amount of loss recognized in income on derivative (current period ineffective portion)									$ 24,400,000
2019 SWAPS
Summary of Significant Accounting Policies [Line Items]
Number of forward interest rate cap agreements \| agreement										4
Notional amounts										$ 500,000,000.0
2019 SWAPS \| 2019 Swaps - Interest Rate Contracts
Summary of Significant Accounting Policies [Line Items]
Notional amounts										$ 100,000,000.0
Basis spread on variable rate										1.89%
2019 SWAPS \| October 2023
Summary of Significant Accounting Policies [Line Items]
Number of forward interest rate cap agreements \| agreement										2
Notional amounts										$ 50,000,000.0
2019 SWAPS \| October 2025
Summary of Significant Accounting Policies [Line Items]
Number of forward interest rate cap agreements \| agreement										2
Notional amounts										$ 200,000,000.0
2019 SWAPS-1 \| 2019 Swaps - Interest Rate Contracts
Summary of Significant Accounting Policies [Line Items]
Notional amounts										$ 400,000,000.0
Basis spread on variable rate										1.98%
Minimum
Summary of Significant Accounting Policies [Line Items]
Share-based payment award, award vesting period			3 years
Share-based payment award, expiration period			5 years
Maximum
Summary of Significant Accounting Policies [Line Items]
Share-based payment award, award vesting period			5 years
Share-based payment award, expiration period			10 years
Restated Plan
Summary of Significant Accounting Policies [Line Items]
Number of shares authorized (in shares) \| shares								20,100,000

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Effect of Derivative Instruments on Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	$ 1,092,840	$ 761,004	$ 813,359	$ 491,452
Amount reclassified from accumulated OCI (prior period effective portion)	986	921	8,242	2,765
Ending balance	$ 1,119,634	$ 796,158	$ 1,119,634	$ 796,158
Derivative, Gain (Loss), Statement of Income or Comprehensive Income [Extensible Enumeration]	Interest expense		Interest expense
Interest rate contracts
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Amount of comprehensive loss recognized on derivative net of taxes	$ 0		$ 0
Amount reclassified from accumulated OCI (prior period effective portion)	986		8,242
Cash flow hedge, tax amount	400		2,800
Amount recognized (current period ineffective portion)	6,755		7,429
Interest rate contracts \| Interest Expense
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Amount reclassified from accumulated OCI (prior period effective portion)	986		8,242
Interest rate contracts \| Accumulated Other Comprehensive Loss, net of taxes
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(4,369)		(11,625)
Ending balance	$ (3,383)		$ (3,383)

SIGNIFICANT ACCOUNTING POLICIES - Narrative 3 (Details) - Heart and Lung - USD ($) $ in Thousands	Nov. 01, 2022	Sep. 30, 2024	Jun. 30, 2024	Apr. 01, 2024	Mar. 27, 2024	Dec. 31, 2023	Dec. 12, 2023	Sep. 30, 2023	Sep. 20, 2023	Jun. 30, 2023	Dec. 31, 2022
Summary of Significant Accounting Policies [Line Items]
Business acquisition, percentage of voting interests acquired	75.00%
Milestone contingent consideration		$ 632	$ 632			$ 6,879		$ 11,099		$ 14,358	$ 11,656
Contingent consideration, liability, period	24 months
Contingent Milestone Consideration
Summary of Significant Accounting Policies [Line Items]
Milestone contingent consideration	$ 10,200	$ 600					$ 2,300		$ 1,600
Additional number of shares issued (in shares)					95,019		64,569		56,600
Contingent consideration settlement				$ 3,600	$ 4,600		$ 2,100		$ 1,800
Cash Holdback
Summary of Significant Accounting Policies [Line Items]
Milestone contingent consideration	$ 600

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Business Acquisitions by Acquisition, Contingent Consideration (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Business Combination, Contingent Consideration, Liability [Roll Forward]
Change in valuation of contingent consideration			$ 1,974	$ (4,112)
Heart and Lung
Business Combination, Contingent Consideration, Liability [Roll Forward]
Accrued expenses at the beginning	$ 632	$ 14,358	6,879	11,656
Settlement of contingent consideration	0	(3,402)	(8,221)	(3,402)
Change in valuation of contingent consideration	0	915	1,060	2,906
Currency translation	0	(772)	914	(61)
Accrued expenses at the end	$ 632	$ 11,099	$ 632	$ 11,099

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Fair Value of Assets and Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Barclays Term Loan and Truist Term Loan	$ 1,009,687	$ 823,063
Estimate of Fair Value Measurement
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Barclays Term Loan and Truist Term Loan	1,010,778	824,759
Estimate of Fair Value Measurement \| Heart & Lung Imaging Limited
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Milestone contingent consideration	632	6,879
Estimate of Fair Value Measurement \| Level 1
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Barclays Term Loan and Truist Term Loan	0	0
Estimate of Fair Value Measurement \| Level 1 \| Heart & Lung Imaging Limited
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Milestone contingent consideration	0	0
Estimate of Fair Value Measurement \| Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Barclays Term Loan and Truist Term Loan	1,010,778	824,759
Estimate of Fair Value Measurement \| Level 2 \| Heart & Lung Imaging Limited
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Milestone contingent consideration	0	0
Estimate of Fair Value Measurement \| Level 3
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Barclays Term Loan and Truist Term Loan	0	0
Estimate of Fair Value Measurement \| Level 3 \| Heart & Lung Imaging Limited
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Milestone contingent consideration	632	6,879
2019 Swaps - Interest Rate Contracts \| Estimate of Fair Value Measurement
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long term assets	7,689
Current and long term assets		15,118
2019 Swaps - Interest Rate Contracts \| Estimate of Fair Value Measurement \| Level 1
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long term assets	0
Current and long term assets		0
2019 Swaps - Interest Rate Contracts \| Estimate of Fair Value Measurement \| Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long term assets	7,689
Current and long term assets		15,118
2019 Swaps - Interest Rate Contracts \| Estimate of Fair Value Measurement \| Level 3
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long term assets	$ 0
Current and long term assets		$ 0

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Accounting Policies [Abstract]
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS	$ 3,209	$ 17,540	$ (2,552)	$ 4,904
BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period basic (in shares)	73,494,709	67,793,404	72,587,321	62,113,707
Basic net income (loss) per share attributable to RadNet, Inc.'s common stockholders (in dollars per share)	$ 0.04	$ 0.26	$ (0.04)	$ 0.08
DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
Weighted average number of common shares outstanding during the period basic (in shares)	73,494,709	67,793,404	72,587,321	62,113,707
Add non-vested restricted stock subject only to service vesting (in shares)	233,235	217,238	0	202,082
Add additional shares issuable upon exercise of stock options and contingently issuable shares (in shares)	1,437,491	799,176	0	905,462
Weighted average number of common shares used in calculating diluted net income per share (in shares)	75,165,435	68,809,818	72,587,321	63,221,251
Diluted net income (loss) income per share attributable to RadNet, Inc.'s common stockholders (in dollars per share)	$ 0.04	$ 0.25	$ (0.04)	$ 0.08
Non-vested restricted stock subject to service vesting
Stock options and non-vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Weighted average shares for which the exercise price exceeds average market price of common stock (in shares)	0	0	680,318	0
Shares issuable upon the exercise of stock options
Stock options and non-vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Weighted average shares for which the exercise price exceeds average market price of common stock (in shares)	0	88,600	820,932	761,708
Shares issuable subject to satisfaction of certain contingencies
Stock options and non-vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Weighted average shares for which the exercise price exceeds average market price of common stock (in shares)	0	0	0	193,207
Weighted average shares for which the exercise price exceeds average market price of common stock
Stock options and non-vested restricted awards excluded from the computation of diluted per share amounts as their effect would be antidilutive:
Weighted average shares for which the exercise price exceeds average market price of common stock (in shares)	0	0	0	94,346

SIGNIFICANT ACCOUNTING POLICIES - Narrative 4 (Details) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($) jointVenture security	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) jointVenture security	Sep. 30, 2023 USD ($)
Summary of Significant Accounting Policies [Line Items]
Number of securities without readily determinable fair value \| security	4		4
Book value of RadNet joint venture interests	$ 8.0		$ 8.0
Impairment loss on investment	$ 1.2
Number of unconsolidated joint ventures \| jointVenture	13		13
Management service fees	$ 5.9	$ 3.9	$ 17.8	$ 12.2
Dignity Health \| Minimum \| Joint Venture \| Glendale Advanced Imaging
Summary of Significant Accounting Policies [Line Items]
Variable interest entity, ownership percentage			33.00%
Dignity Health \| Maximum \| Joint Venture \| Glendale Advanced Imaging
Summary of Significant Accounting Policies [Line Items]
Variable interest entity, ownership percentage			55.00%

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Investment in Joint Ventures (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Investments in and Advance to Affiliates, Subsidiaries, Associates, and Joint Ventures [Roll Forward]
Beginning balance			$ 92,710
Equity in earnings in these joint ventures	$ 3,595	$ 1,084	11,308	$ 3,935
Distribution of earnings			(1,000)
Equity contributions in existing joint ventures			1,496
Ending balance	$ 104,514		$ 104,514

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Joint Venture Investment and Financial Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Schedule of Equity Method Investments [Line Items]
Current assets	$ 1,016,253		$ 1,016,253		$ 579,276
Current liabilities	(470,130)		(470,130)		(437,452)
Net revenue	461,142	$ 401,968	1,352,563	$ 1,196,247
Net Income	12,256	$ 24,066	24,611	24,341
Joint Venture Interest
Schedule of Equity Method Investments [Line Items]
Total net assets	171,496		171,496		147,334
Equity Method Investment, Nonconsolidated Investee or Group of Investees
Schedule of Equity Method Investments [Line Items]
Current assets	64,175		64,175		39,819
Noncurrent assets	219,478		219,478		224,936
Current liabilities	(41,550)		(41,550)		(46,587)
Noncurrent liabilities	$ (70,607)		(70,607)		$ (70,834)
Net revenue			195,905	129,020
Net Income			$ 23,949	$ 7,906

BUSINESS COMBINATIONS AND RELATED ACTIVITY - Valuation of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Sep. 16, 2024	Sep. 01, 2024	Jun. 01, 2024	Apr. 01, 2024	Mar. 31, 2024	Feb. 01, 2024	Dec. 31, 2023
Business Acquisition [Line Items]
Goodwill	$ 711,841							$ 679,463
Business Acquisitions
Business Acquisition [Line Items]
Total Consideration	54,046
Property & Equipment	27,509
Right of Use Assets	25,302
Goodwill	30,729
Intangible Assets	2,315
Other Assets	160
Right of Use Liabilities	(25,672)
Notes payable	$ (6,297)
Stanislaus Surgical Hospital, LLC
Business Acquisition [Line Items]
Total Consideration		$ 3,000
Property & Equipment		504
Right of Use Assets		1,468
Goodwill		2,382
Intangible Assets		100
Other Assets		15
Right of Use Liabilities		(1,468)
Notes payable		$ 0
Global Imaging LLP
Business Acquisition [Line Items]
Total Consideration			$ 2,900
Property & Equipment			1,266
Right of Use Assets			0
Goodwill			1,584
Intangible Assets			50
Other Assets			0
Right of Use Liabilities			0
Notes payable			$ 0
U.S. Imaging, Inc.
Business Acquisition [Line Items]
Total Consideration				$ 4,200
Property & Equipment				4,025
Right of Use Assets				5,597
Goodwill				0
Intangible Assets				175
Other Assets				0
Right of Use Liabilities				(5,597)
Notes payable				$ 0
Houston Medical Imaging, LLC
Business Acquisition [Line Items]
Total Consideration					$ 22,703
Property & Equipment					15,826
Right of Use Assets					7,929
Goodwill					11,584
Intangible Assets					1,660
Other Assets					90
Right of Use Liabilities					(8,089)
Notes payable					$ (6,297)
Grossman Imaging Center of CMH, LLC
Business Acquisition [Line Items]
Total Consideration						$ 10,344
Property & Equipment						1,717
Right of Use Assets						6,304
Goodwill						8,501
Intangible Assets						280
Other Assets						56
Right of Use Liabilities						(6,514)
Notes payable						0
Providence Health System - Southern California
Business Acquisition [Line Items]
Total Consideration						7,369
Property & Equipment						1,378
Right of Use Assets						3,441
Goodwill						5,991
Intangible Assets						0
Other Assets						0
Right of Use Liabilities						(3,441)
Notes payable						$ 0
Antelope Valley Outpatient Imaging
Business Acquisition [Line Items]
Total Consideration							$ 3,530
Property & Equipment							2,794
Right of Use Assets							563
Goodwill							687
Intangible Assets							50
Other Assets							0
Right of Use Liabilities							(563)
Notes payable							$ 0

BUSINESS COMBINATIONS AND RELATED ACTIVITY - Narrative (Details) $ in Thousands		3 Months Ended		9 Months Ended
	Mar. 29, 2024 USD ($) location	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Feb. 23, 2024 location	Dec. 31, 2023 USD ($)
Business Acquisition [Line Items]
Valuation adjustment		$ 4,400
Increase in fair value assets acquired and liabilities assumed		4,400
Property and equipment, net		663,867		$ 663,867			$ 604,401
Goodwill		711,841		711,841			$ 679,463
Gain (loss) on disposition of property plant equipment		(148)	$ (527)	(735)	$ (1,183)
Book value of RadNet joint venture interests		$ 8,000		$ 8,000
Tri Valley Imaging Group, LLC
Business Acquisition [Line Items]
Number of location offering multi-modality services \| location	4
Providence Health System
Business Acquisition [Line Items]
Number of location offering multi-modality services \| location	3
Providence Health System \| Tri Valley Imaging Group, LLC
Business Acquisition [Line Items]
Book value of RadNet joint venture interests	$ 7,800
Tri Valley Imaging Group, LLC
Business Acquisition [Line Items]
Number of location offering multi-modality services \| location						7
Ownership interest	52.00%
Tri Valley Imaging Group, LLC \| Additional Paid-In Capital
Business Acquisition [Line Items]
Gain (loss) on disposition of property plant equipment	$ 7,900
Tri Valley Imaging Group, LLC \| Tri Valley Imaging Group, LLC
Business Acquisition [Line Items]
Goodwill	6,000
Tri Valley Imaging Group, LLC \| Tri Valley Imaging Group, LLC \| Fixed Assets
Business Acquisition [Line Items]
Property and equipment, net	1,400
Tri Valley Imaging Group, LLC \| Providence Health System
Business Acquisition [Line Items]
Goodwill	6,000
Limited partners' contributed capital	$ 9,600
Minority partner ownership percent	48.00%

SEGMENT REPORTING (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
SEGMENT REPORTING (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Segment Reporting Information [Line Items]
Total revenue	$ 461,142	$ 401,968	$ 1,352,563	$ 1,196,247
Cost of Operations	391,800	341,635	1,169,113	1,038,647
Total depreciation and amortization	34,979	32,210	101,822	95,705
Gain on contribution of imaging centers into joint venture:	0	(16,808)	0	(16,808)
Total loss on disposal of equipment	148	527	735	1,183
Severance	304	1,153	797	3,157
Income (Loss) from Operations	33,911	43,251	80,096	74,363
Imaging Center
Segment Reporting Information [Line Items]
Total revenue	444,775	389,783	1,305,707	1,161,381
Cost of Operations	374,789	334,580	1,120,542	1,008,814
Total depreciation and amortization	32,032	30,221	94,095	89,743
Gain on contribution of imaging centers into joint venture:	0	(16,808)	0	(16,808)
Total loss on disposal of equipment	153	524	739	1,185
Severance	271	1,141	720	1,417
Income (Loss) from Operations	37,530	40,125	89,611	77,030
Digital Health
Segment Reporting Information [Line Items]
Total revenue	16,367	12,185	46,856	34,866
Cost of Operations	17,011	7,055	48,571	29,833
Total depreciation and amortization	2,947	1,989	7,727	5,962
Gain on contribution of imaging centers into joint venture:	0	0	0	0
Total loss on disposal of equipment	(5)	3	(4)	(2)
Severance	33	12	77	1,740
Income (Loss) from Operations	(3,619)	3,126	(9,515)	(2,667)
Third Party
Segment Reporting Information [Line Items]
Total revenue	461,142	401,968	1,352,563	1,196,247
Intersegment
Segment Reporting Information [Line Items]
Total revenue	0	0	0	0
Operating Segments \| Imaging Center
Segment Reporting Information [Line Items]
Total revenue	452,368	395,613	1,325,825	1,178,873
Operating Segments \| Digital Health
Segment Reporting Information [Line Items]
Total revenue	16,367	12,185	46,856	34,866
Operating Segments \| Third Party \| Imaging Center
Segment Reporting Information [Line Items]
Total revenue	452,368	395,613	1,325,825	1,178,873
Operating Segments \| Third Party \| Digital Health
Segment Reporting Information [Line Items]
Total revenue	8,774	6,355	26,738	17,374
Operating Segments \| Intersegment \| Imaging Center
Segment Reporting Information [Line Items]
Total revenue	0	0	0	0
Operating Segments \| Intersegment \| Digital Health
Segment Reporting Information [Line Items]
Total revenue	7,593	5,830	20,118	17,492
Intersegment Eliminations
Segment Reporting Information [Line Items]
Total revenue	(7,593)	(5,830)	(20,118)	(17,492)
Intersegment Eliminations \| Third Party
Segment Reporting Information [Line Items]
Total revenue	0	0	0	0
Intersegment Eliminations \| Intersegment
Segment Reporting Information [Line Items]
Total revenue	$ (7,593)	$ (5,830)	$ (20,118)	$ (17,492)

CREDIT FACILITIES AND NOTES PAYABLE - Narrative (Details) - USD ($)		1 Months Ended	2 Months Ended	3 Months Ended			4 Months Ended	5 Months Ended	9 Months Ended
	Apr. 18, 2024	Apr. 18, 2024	Jun. 30, 2024	Sep. 30, 2024	Sep. 30, 2023	Mar. 31, 2023	Apr. 18, 2024	Sep. 30, 2024	Sep. 30, 2024	Sep. 30, 2023	Apr. 01, 2024	Jan. 15, 2024	Dec. 31, 2023	Feb. 01, 2023	Oct. 07, 2022
Debt Instrument [Line Items]
Loss on extinguishment of debt									$ 2,080,000	$ 0
Interest expense				$ 19,427,000	$ 16,115,000				61,776,000	$ 47,876,000
Deferred financing costs, net of accumulated amortization				$ 2,400,000				$ 2,400,000	$ 2,400,000				$ 1,600,000
Promissory Note
Debt Instrument [Line Items]
Debt instrument face value											$ 6,300,000	$ 6,900,000		$ 19,800,000
Barclays Credit Agreement \| Barclays
Debt Instrument [Line Items]
Total credit facilities outstanding	$ 678,700,000	$ 678,700,000					$ 678,700,000
Debt issuance costs	19,900,000	19,900,000					19,900,000
Amortization of debt issuance costs and discounts	11,100,000
Loss on extinguishment of debt	2,100,000
Interest expense	6,700,000
Barclays Credit Agreement \| Term Loan \| Barclays \| Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity	875,000,000	$ 875,000,000					875,000,000
Periodic payment, principal							1,800,000	$ 2,200,000
Barclays Credit Agreement \| Revolving Credit Facility \| Line of Credit \| SOFR
Debt Instrument [Line Items]
Basis spread on variable rate		3.00%	2.50%			2.50%
Barclays Credit Agreement \| Revolving Credit Facility \| Line of Credit \| Prime Rate
Debt Instrument [Line Items]
Basis spread on variable rate								1.50%
Barclays Credit Agreement \| Revolving Credit Facility \| Barclays
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 282,000,000	$ 282,000,000					$ 282,000,000
Effective interest rate				10.50%				10.50%	10.50%
Unused capacity, commitment fee percentage									0.50%
Letters of credit outstanding				$ 8,300,000				$ 8,300,000	$ 8,300,000
Line of credit facility, remaining borrowing capacity				273,700,000				273,700,000	$ 273,700,000
Barclays Credit Agreement \| Revolving Credit Facility \| Barclays \| SOFR
Debt Instrument [Line Items]
Basis spread on variable rate									3.00%
Barclays Credit Agreement \| Revolving Credit Facility \| Barclays \| Prime Rate
Debt Instrument [Line Items]
Basis spread on variable rate									2.00%
Barclays Credit Agreement \| Revolving Credit Facility \| Barclays \| Line of Credit
Debt Instrument [Line Items]
Deferred financing costs, net of accumulated amortization				2,000,000				2,000,000	$ 2,000,000
First Lien Credit Agreement \| Revolving Credit Facility \| Barclays \| Line of Credit
Debt Instrument [Line Items]
Total credit facilities outstanding				0				0	0
First Lien Credit Agreement Eighth Amendment \| Term Loan \| Truist
Debt Instrument [Line Items]
Maximum borrowing capacity															$ 150,000,000
Debt instrument, periodic payment									1,900,000
Periodic payment amortization increase									$ 900,000
First Lien Credit Agreement Eighth Amendment \| Term Loan \| Truist \| SOFR
Debt Instrument [Line Items]
Basis spread on variable rate									1.50%
First Lien Credit Agreement Eighth Amendment \| Revolving Credit Facility \| Truist
Debt Instrument [Line Items]
Maximum borrowing capacity				50,000,000				50,000,000	$ 50,000,000						$ 50,000,000.0
Total credit facilities outstanding				0				0	0
Deferred financing costs, net of accumulated amortization				400,000				400,000	$ 400,000
Unused capacity, commitment fee percentage									30.00%
Line of credit facility, remaining borrowing capacity				$ 50,000,000				$ 50,000,000	$ 50,000,000

CREDIT FACILITIES AND NOTES PAYABLE - Schedule of Margins and Effective Interest Rates (Details) - Revolving Credit Facility	1 Months Ended	2 Months Ended	3 Months Ended	5 Months Ended
	Apr. 18, 2024	Jun. 30, 2024	Mar. 31, 2023	Sep. 30, 2024	Apr. 19, 2024
Barclays Credit Agreement \| Line of Credit \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	2.00%		2.00%
Barclays Credit Agreement \| Line of Credit \| SOFR
Debt Instrument [Line Items]
Basis spread on variable rate	3.00%	2.50%	2.50%
Barclays Credit Agreement \| Line of Credit \| Prime Rate
Debt Instrument [Line Items]
Basis spread on variable rate				1.50%
First Lien Credit Agreement, Sixth Amendment \| Line of Credit \| Eurodollar
Debt Instrument [Line Items]
Effective interest rate			4.63%
First Lien Credit Agreement, Sixth Amendment \| Line of Credit \| Base Rate
Debt Instrument [Line Items]
Effective interest rate			8.00%
First Lien Term Loan
Debt Instrument [Line Items]
Effective interest rate	8.33%				7.78%
Interest rate, stated percentage					9.50%
First Lien Term Loan \| Base Rate
Debt Instrument [Line Items]
Interest rate, stated percentage	10.50%
First Lien Term Loan \| One Month SOFR
Debt Instrument [Line Items]
Interest rate, stated percentage	0.11%				0.00%

CREDIT FACILITIES AND NOTES PAYABLE - Schedule of Term Loan Debt Obligations (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Total debt obligations	$ 1,019,650	$ 830,042
Less: current portion	(23,378)	(17,974)
Long term portion of debt obligations	996,272	812,068
Equipment notes payable at 3.6% to 7.2%, due through 2029, collateralized by medical equipment
Debt Instrument [Line Items]
Total debt obligations	$ 25,989	17,011
Equipment notes payable at 3.6% to 7.2%, due through 2029, collateralized by medical equipment \| Minimum
Debt Instrument [Line Items]
Interest rate, stated percentage	3.60%
Equipment notes payable at 3.6% to 7.2%, due through 2029, collateralized by medical equipment \| Maximum
Debt Instrument [Line Items]
Interest rate, stated percentage	7.20%
Term Loan \| First Lien Term Loan
Debt Instrument [Line Items]
Discount	$ (15,234)	(9,041)
Total debt obligations	872,812	678,687
Term Loan \| NJIN Term Loan Agreement
Debt Instrument [Line Items]
Discount	(792)	(990)
Total debt obligations	$ 136,875	$ 144,375

STOCK-BASED COMPENSATION - Narrative (Details) $ / shares in Units, $ in Millions	1 Months Ended	3 Months Ended	9 Months Ended
	Jan. 31, 2023 tranche shares	Jun. 30, 2020 $ / shares shares	Sep. 30, 2024 USD ($) incentivePlan shares	Mar. 31, 2024 $ / shares shares	Jun. 07, 2023 shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of plans \| incentivePlan			1
Number of shares authorized (in shares)					20,100,000
Issuance of common stock upon exercise of options (in shares)			0
Shares available for future issuance, options, warrants, shares of restricted stock and other bonus awards (in shares)			3,285,500
DeepHealth Inc.
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in dollars per share) \| $ / shares		$ 16.93
Shares issuable upon the exercise of stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized stock-based compensation expense \| $			$ 0.5
Unrecognized expense weighted average period			4 months 20 days
Shares issuable upon the exercise of stock options \| DeepHealth Inc.
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Issuance of common stock upon exercise of options (in shares)		412,434
Performance Based Stock Units ("PSUs")
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment award, award vesting period	3 years
Granted (in shares)	60,685
Number of vesting traches \| tranche	2
Performance Based Stock Units ("PSUs") \| Board of Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued (in shares)				121,370
Shares issued per share (in dollars per share) \| $ / shares				$ 18.64
Performance Based Stock Options ("PSOs")
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment award, award vesting period	3 years
Issuance of common stock upon exercise of options (in shares)	235,227
Number of vesting traches \| tranche	3
Number of shares available in grant (in shares)				235,227
Performance Based Stock Options ("PSOs") \| Board of Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued per share (in dollars per share) \| $ / shares				$ 18.64
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment award, award vesting period			3 years
Share-based payment award, expiration period			5 years
Minimum \| Performance Based Stock Units ("PSUs")
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	0.00%
Minimum \| Performance Based Stock Options ("PSOs")
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	0.00%
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment award, award vesting period			5 years
Share-based payment award, expiration period			10 years
Maximum \| Performance Based Stock Units ("PSUs")
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	200.00%
Maximum \| Performance Based Stock Options ("PSOs")
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	100.00%

STOCK-BASED COMPENSATION - Schedule of Options Activity (Details) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($) $ / shares shares
Shares
Beginning balance (in shares) \| shares	911,411
Granted (in shares) \| shares	0
Exercised (in shares) \| shares	(60,306)
Ending balance (in shares) \| shares	851,105
Exercisable Shares at the end (in shares) \| shares	729,806
Weighted Average Exercise price Per Common Share
Beginning Balance (in dollars per share) \| $ / shares	$ 16.60
Granted (in dollars per share) \| $ / shares	0
Exercised (in dollars per share) \| $ / shares	6.15
Ending Balance (in dollars per share) \| $ / shares	17.34
Weighted Average Exercise Price Per Common Share, Exercisable (in dollars per share) \| $ / shares	$ 16.62
Weighted Average Remaining Contractual Life (in years)
Balance at end of period	5 years 8 months 8 days
Exercisable at the end	5 years 3 months 21 days
Aggregate Intrinsic Value (in thousands)
Aggregate value outstanding \| $	$ 44,301
Aggregate value exercisable \| $	$ 38,515
DeepHealth, Inc.
Shares
Beginning balance (in shares) \| shares	79,073
Exercised (in shares) \| shares	(9,377)
Ending balance (in shares) \| shares	69,696
Exercisable Shares at the end (in shares) \| shares	69,696
Weighted Average Exercise price Per Common Share
Beginning Balance (in dollars per share) \| $ / shares	$ 0
Exercised (in dollars per share) \| $ / shares	0
Ending Balance (in dollars per share) \| $ / shares	0
Weighted Average Exercise Price Per Common Share, Exercisable (in dollars per share) \| $ / shares	$ 0
Weighted Average Remaining Contractual Life (in years)
Balance at end of period	5 years
Exercisable at the end	5 years
Aggregate Intrinsic Value (in thousands)
Aggregate value outstanding \| $	$ 4,836
Aggregate value exercisable \| $	$ 4,836

STOCK-BASED COMPENSATION - Schedule of RSAs and RSUS Activity (Details) - RSAs and RSUs	9 Months Ended
	Sep. 30, 2024 $ / shares shares
RSAs and RSUs
Outstanding, beginning balance (in shares) \| shares	762,083
Granted (in shares) \| shares	797,309
Vested (in shares) \| shares	(875,185)
Forfeited or Canceled (in shares) \| shares	(13,460)
Outstanding, ending balance (in shares) \| shares	670,747
Weighted-Average Remaining Contractual Term (Years)	1 year 8 months 26 days
Weighted-Average Fair Value per Share
Beginning balance (in dollars per share) \| $ / shares	$ 22.13
Granted (in dollars per share) \| $ / shares	37.40
Vested (in dollars per share) \| $ / shares	27.78
Forfeited or Canceled (in dollars per share) \| $ / shares	27.74
Ending balance (in dollars per share) \| $ / shares	$ 32.33

SUBSEQUENT EVENTS (Details) - Subsequent Event $ in Millions	Oct. 22, 2024 USD ($)	Oct. 01, 2024 USD ($) center
Pink Perception LLC
Subsequent Event [Line Items]
Purchase consideration		$ 4.0
Number of multi-modality imaging centers \| center		2
Kheiron Medical Technologies Limited
Subsequent Event [Line Items]
Purchase consideration	$ 1.0

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