RadNet, Inc. - Quarter Report: 2010 March (Form 10-Q)
UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington
D.C. 20549
FORM
10-Q
(Mark One) | |
x |
QUARTERLY REPORT PURSUANT TO
SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF
1934
|
For the
quarterly period ended March 31, 2010
OR
|
|
o |
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 0-19019
RadNet,
Inc.
(Exact
name of registrant as specified in 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)
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 x No o
Indicate
by check mark whether the registrant has submitted electronically and posted on
its corporate Web site, if any, every Interactive Data File required to be
submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding
12 months (or for such shorter period that the registrant was required to submit
and post such files). Yes x No o
Indicate
by check mark whether the registrant is a large accelerated filer, an
accelerated filer, a non-accelerated filer, or a smaller reporting company. See
the definitions of “large accelerated filer”, “accelerated filer” and “smaller
reporting company” in Rule 12b-2 of the Exchange Act. (Check
one):
Large
accelerated filer ¨
|
Accelerated
filer x
|
Non-accelerated
filer ¨
|
Smaller reporting company ¨
|
(do
not check if a smaller reporting
company)
|
Indicate
by check mark whether the registrant is a shell company (as defined in Rule
12b-2 of the Exchange Act) Yes o No x
The
number of shares of the registrant’s common stock outstanding on May 10, 2010,
was 36,774,279 shares.
Table of
Contents
RADNET,
INC.
INDEX
PART
I – FINANCIAL INFORMATION
|
Page
|
ITEM
1. Condensed
Consolidated Financial Statements
|
|
Condensed
Consolidated Balance Sheets at March 31, 2010 and December 31,
2009
|
3
|
Condensed
Consolidated Statements of Operations for the Three Months ended March 31,
2010 and 2009
|
4
|
Condensed
Consolidated Statement of Equity Deficit for the Three Months ended March
31, 2010
|
5
|
Condensed
Consolidated Statements of Cash Flows for the Three Months Ended March 31,
2010 and 2009
|
6
|
Notes
to Condensed Consolidated Financial Statements
|
8
|
ITEM
2. Management’s Discussion and
Analysis of Financial Condition and Results of Operations
|
19
|
ITEM
3. Quantitative and
Qualitative Disclosures About Market Risk
|
29
|
ITEM
4. Controls
and Procedures
|
30
|
PART
II – OTHER INFORMATION
|
|
ITEM
1. Legal
Proceedings
|
30
|
ITEM
1A. Risk Factors
|
30
|
ITEM
2. Unregistered Sales of
Equity Securities and Use of Proceeds
|
33
|
ITEM
3. Defaults
Upon Senior Securities
|
33
|
ITEM
4. Removed and
Reserved
|
33
|
ITEM
5. Other
Information
|
33
|
ITEM
6. Exhibits
|
33
|
SIGNATURES
|
34
|
INDEX
TO EXHIBITS
|
35
|
2
PART
I - FINANCIAL INFORMATION
RADNET,
INC. AND SUBSIDIARIES
CONDENSED
CONSOLIDATED BALANCE SHEETS
(IN
THOUSANDS EXCEPT SHARE DATA)
March
31,
|
December
31,
|
|||||||
2010
|
2009
|
|||||||
(unaudited)
|
||||||||
ASSETS
|
||||||||
CURRENT
ASSETS
|
||||||||
Cash
and cash equivalents
|
$ | - | $ | 10,094 | ||||
Accounts
receivable, net
|
88,219 | 87,825 | ||||||
Prepaid
expenses and other current assets
|
11,416 | 9,990 | ||||||
Total
current assets
|
99,635 | 107,909 | ||||||
PROPERTY
AND EQUIPMENT, NET
|
178,217 | 182,571 | ||||||
OTHER
ASSETS
|
||||||||
Goodwill
|
110,555 | 106,502 | ||||||
Other
intangible assets
|
53,507 | 54,313 | ||||||
Deferred
financing costs, net
|
7,559 | 8,229 | ||||||
Investment
in joint ventures
|
17,507 | 18,741 | ||||||
Deposits
and other
|
3,693 | 2,406 | ||||||
Total
assets
|
$ | 470,673 | $ | 480,671 | ||||
LIABILITIES
AND EQUITY
|
||||||||
CURRENT
LIABILITIES
|
||||||||
Accounts
payable and accrued expenses
|
$ | 70,268 | $ | 69,641 | ||||
Due
to affiliates
|
5,187 | 7,456 | ||||||
Notes
payable
|
8,658 | 6,927 | ||||||
Current
portion of deferred rent
|
605 | 560 | ||||||
Obligations
under capital leases
|
13,015 | 14,121 | ||||||
Total
current liabilities
|
97,733 | 98,705 | ||||||
LONG-TERM
LIABILITIES
|
||||||||
Deferred
rent, net of current portion
|
9,234 | 8,920 | ||||||
Deferred
taxes
|
277 | 277 | ||||||
Notes
payable, net of current portion
|
413,172 | 416,699 | ||||||
Obligations
under capital leases, net of current portion
|
10,964 | 13,568 | ||||||
Other
non-current liabilities
|
18,612 | 17,263 | ||||||
Total
liabilities
|
549,992 | 555,432 | ||||||
COMMITMENTS
AND CONTINGENCIES
|
||||||||
EQUITY
DEFICIT
|
||||||||
Common
stock - $.0001 par value, 200,000,000 shares authorized;
|
||||||||
36,399,279
and 36,259,279 shares issued and outstanding at
|
||||||||
March
31, 2010 and December 31, 2009, respectively
|
4 | 4 | ||||||
Paid-in-capital
|
157,779 | 156,758 | ||||||
Accumulated
other comprehensive loss
|
(3,060 | ) | (1,588 | ) | ||||
Accumulated
deficit
|
(234,100 | ) | (229,989 | ) | ||||
Total
Radnet, Inc.'s equity deficit
|
(79,377 | ) | (74,815 | ) | ||||
Noncontrolling
interests
|
58 | 54 | ||||||
Total
equity deficit
|
(79,319 | ) | (74,761 | ) | ||||
Total
liabilities and equity deficit
|
$ | 470,673 | $ | 480,671 |
The
accompanying notes are an integral part of these financial
statements.
3
RADNET,
INC. AND SUBSIDIARIES
CONDENSED
CONSOLIDATED STATEMENTS OF OPERATIONS
(IN
THOUSANDS EXCEPT SHARE DATA)
(unaudited)
Three
Months Ended
|
||||||||
March
31,
|
||||||||
2010
|
2009
|
|||||||
NET
REVENUE
|
$ | 124,178 | $ | 128,003 | ||||
OPERATING
EXPENSES
|
||||||||
Operating
expenses
|
98,639 | 97,013 | ||||||
Depreciation
and amortization
|
13,275 | 13,174 | ||||||
Provision
for bad debts
|
7,677 | 7,974 | ||||||
Loss
on sale of equipment
|
104 | 26 | ||||||
Severance
costs
|
132 | 17 | ||||||
Total
operating expenses
|
119,827 | 118,204 | ||||||
INCOME
FROM OPERATIONS
|
4,351 | 9,799 | ||||||
OTHER
EXPENSES
|
||||||||
Interest
expense
|
9,967 | 13,022 | ||||||
Other
expenses
|
- | 197 | ||||||
Total
other expenses
|
9,967 | 13,219 | ||||||
LOSS
BEFORE INCOME TAXES AND EQUITY IN EARNINGS OF JOINT
VENTURES
|
(5,616 | ) | (3,420 | ) | ||||
Provision
for income taxes
|
(334 | ) | (37 | ) | ||||
Equity
in earnings of joint ventures
|
1,861 | 2,635 | ||||||
NET
LOSS
|
(4,089 | ) | (822 | ) | ||||
Net
income attributable to noncontrolling interests
|
22 | 20 | ||||||
NET
LOSS ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
|
$ | (4,111 | ) | $ | (842 | ) | ||
BASIC
AND DILUTED NET LOSS PER SHARE
|
||||||||
ATTRIBUTABLE
TO RADNET, INC. COMMON STOCKHOLDERS
|
$ | (0.11 | ) | $ | (0.02 | ) | ||
WEIGHTED
AVERAGE SHARES OUTSTANDING
|
||||||||
Basic
and diluted
|
36,363,946 | 35,916,169 |
The
accompanying notes are an integral part of these financial
statements.
4
RADNET,
INC. AND SUBSIDIARIES
CONDENSED
CONSOLIDATED STATEMENT OF EQUITY DEFICIT
(IN
THOUSANDS EXCEPT SHARE DATA)
(unaudited)
Accumulated
Other
|
Total
|
|||||||||||||||||||||||||||||||
Common
Stock
|
Paid-in
|
Accumulated
|
Comprehensive
|
Radnet,
Inc.'s
|
Noncontrolling
|
Total
|
||||||||||||||||||||||||||
Shares
|
Amount
|
Capital
|
Deficit
|
Loss
|
Equity
Deficit
|
Interests
|
Equity
Deficit
|
|||||||||||||||||||||||||
BALANCE
- JANUARY 1, 2010
|
36,259,279 | $ | 4 | $ | 156,758 | $ | (229,989 | ) | $ | (1,588 | ) | $ | (74,815 | ) | $ | 54 | $ | (74,761 | ) | |||||||||||||
Issuance
of common stock to shareholders of Union Imaging
|
75,000 | - | 153 | - | - | 153 | - | 153 | ||||||||||||||||||||||||
Issuance
of common stock upon exercise of options/warrants
|
65,000 | - | 49 | - | - | 49 | - | 49 | ||||||||||||||||||||||||
Stock-based
compensation
|
- | - | 819 | - | - | 819 | - | 819 | ||||||||||||||||||||||||
Dividends
paid to noncontrolling interests
|
- | - | - | - | - | - | (18 | ) | (18 | ) | ||||||||||||||||||||||
Change
in fair value of cash flow hedge
|
- | - | - | - | (1,472 | ) | (1,472 | ) | - | (1,472 | ) | |||||||||||||||||||||
Net
loss
|
(4,111 | ) | (4,111 | ) | 22 | (4,089 | ) | |||||||||||||||||||||||||
Comprehensive
income
|
- | - | - | - | - | (5,583 | ) | 22 | (5,561 | ) | ||||||||||||||||||||||
BALANCE
- MARCH 31, 2010
|
36,399,279 | $ | 4 | $ | 157,779 | $ | (234,100 | ) | $ | (3,060 | ) | $ | (79,377 | ) | $ | 58 | $ | (79,319 | ) |
The
accompanying notes are an integral part of these financial statements.
5
RADNET,
INC. AND SUBSIDIARIES
CONDENSED
CONSOLIDATED STATEMENTS OF CASH FLOWS (IN THOUSANDS)
(unaudited)
Three
Months Ended
|
||||||||
March
31,
|
||||||||
2010
|
2009
|
|||||||
CASH
FLOWS FROM OPERATING ACTIVITIES
|
||||||||
Net
loss
|
$ | (4,089 | ) | $ | (822 | ) | ||
Adjustments
to reconcile net loss to net cash provided by operating
activities:
|
||||||||
Depreciation
and amortization
|
13,275 | 13,174 | ||||||
Provision
for bad debts
|
7,677 | 7,974 | ||||||
Equity
in earnings of joint ventures
|
(1,861 | ) | (2,635 | ) | ||||
Distributions
from joint ventures
|
3,095 | 1,770 | ||||||
Deferred
rent amortization
|
359 | (177 | ) | |||||
Deferred
financing cost interest expense
|
670 | 670 | ||||||
Loss
on sale of equipment
|
104 | 26 | ||||||
Stock-based
compensation
|
819 | 709 | ||||||
Changes
in operating assets and liabilities, net of assets acquired and
liabilities assumed in purchase transactions:
|
||||||||
Accounts
receivable
|
(8,071 | ) | (9,047 | ) | ||||
Other
current assets
|
(1,426 | ) | 1,955 | |||||
Other
assets
|
(1,287 | ) | 4 | |||||
Accounts
payable and accrued expenses
|
7,337 | 3,087 | ||||||
Net
cash provided by operating activities
|
16,602 | 16,688 | ||||||
CASH
FLOWS FROM INVESTING ACTIVITIES
|
||||||||
Purchase
of imaging facilities
|
(6,708 | ) | (1,811 | ) | ||||
Purchase
of property and equipment
|
(12,900 | ) | (6,885 | ) | ||||
Purchase
of equity interest in joint ventures
|
- | (210 | ) | |||||
Net
cash used in investing activities
|
(19,608 | ) | (8,906 | ) | ||||
CASH
FLOWS FROM FINANCING ACTIVITIES
|
||||||||
Principal
payments on notes and leases payable
|
(5,538 | ) | (5,519 | ) | ||||
Distributions
paid to noncontrolling interests
|
(18 | ) | (21 | ) | ||||
Payments
on line of credit
|
- | (1,742 | ) | |||||
Distributions
to counterparties of cash flow hedges
|
(1,581 | ) | (500 | ) | ||||
Proceeds
from issuance of common stock
|
49 | - | ||||||
Net
cash used in financing activities
|
(7,088 | ) | (7,782 | ) | ||||
NET
DECREASE IN CASH AND CASH EQUIVALENTS
|
(10,094 | ) | - | |||||
CASH
AND CASH EQUIVALENTS, beginning of period
|
10,094 | - | ||||||
CASH
AND CASH EQUIVALENTS, end of period
|
$ | - | $ | - | ||||
SUPPLEMENTAL
DISCLOSURE OF CASH FLOW INFORMATION
|
||||||||
Cash
paid during the period for interest
|
$ | 9,340 | $ | 11,020 |
The
accompanying notes are an integral part of these financial
statements.
6
RADNET, INC. AND SUBSIDIARIES
CONSOLIDATED
STATEMENTS OF CASH FLOWS (CONTINUED)
(unaudited)
Supplemental
Schedule of Non-Cash Investing and Financing Activities
We
entered into capital leases and equipment notes for approximately $32,000 and
$10.5 million, excluding capital leases assumed in acquisitions, during the
three months ended March 31, 2010 and 2009, respectively. We also
acquired equipment for approximately $3.8 million and $1.3 million during the
three months ended March 31, 2010 and 2009, respectively, that we had not paid
for as of March 31, 2010 and 2009, respectively. The offsetting
amount due was recorded in our consolidated balance sheet under accounts payable
and accrued expenses.
As
discussed in Note 5, we entered into interest rate swap modifications in the
first quarter of 2009. These modifications include a significant
financing element and, as such, all cash inflows and outflows subsequent to the
date of modification are presented as financing activities.
We record
the change in fair value of the effective portion of our interest rate swaps
that are designated as cash flow hedges to accumulated other comprehensive
loss. As such, we recorded unrealized losses as a component of other
comprehensive loss of $1.5 million and $3.1 million for the three months ended
March 31, 2010 and 2009, respectively.
Detail of
investing activity related to acquisitions can be found in Note 3.
7
RADNET,
INC. AND SUBSIDIARIES
NOTES
TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(unaudited)
NOTE
1 – NATURE OF BUSINESS AND BASIS OF PRESENTATION
At March
31, 2010, we operated a group of regional networks comprised of 183 diagnostic
imaging facilities located in seven states with operations primarily in
California, Maryland, Florida, Kansas, Delaware, New Jersey and New
York. We provide diagnostic imaging services including magnetic
resonance imaging (MRI), computed tomography (CT), positron emission tomography
(PET), nuclear medicine, mammography, ultrasound, diagnostic radiology, or
X-ray, fluoroscopy and other related procedures. The Company’s operations
comprise a single segment for financial reporting purposes.
The
condensed consolidated financial statements include the accounts of Radnet
Management, Inc. (or “Radnet Management”) and Beverly Radiology Medical Group
III, a professional partnership (“BRMG”). The consolidated financial
statements also include Radnet Management I, Inc., Radnet Management II,
Inc., Radiologix, Inc., Radnet Management Imaging Services, Inc.,
Delaware Imaging Partners, Inc., New Jersey Imaging Partners, Inc. and
Diagnostic Imaging Services, Inc. ( “ DIS ” ), all wholly owned subsidiaries of
Radnet Management. All of these affiliated entities are referred to
collectively in this report as “RadNet”, “we”, “us”, “our” or the “Company” in
this report.
Howard G.
Berger, M.D. is our President and Chief Executive Officer, a member of our Board
of Directors and owns approximately 15% of our outstanding common stock. Dr.
Berger also owns, indirectly, 99% of the equity interests in BRMG. BRMG provides
all of the professional medical services at the majority of our facilities
located in California under a management agreement with us, and contracts with
various other independent physicians and physician groups to provide the
professional medical services at most of our other California facilities. We
generally obtain professional medical services from BRMG in California, rather
than provide such services directly or through subsidiaries, in order to comply
with California’s prohibition against the corporate practice of medicine.
However, as a result of our close relationship with Dr. Berger and BRMG, we
believe that we are able to better ensure that medical service is provided at
our California facilities in a manner consistent with our needs and expectations
and those of our referring physicians, patients and payors than if we obtained
these services from unaffiliated physician groups. BRMG is a partnership of
ProNet Imaging Medical Group, Inc. (99%), Breastlink Medical Group, Inc. (100%)
and Beverly Radiology Medical Group, Inc. (99%), each of which are 99% or 100%
owned by Dr. Berger. RadNet provides non-medical, technical and
administrative services to BRMG for which it receives a management fee, per the
management agreement. Through the management agreement and our relationship with
Dr. Berger, we have exclusive authority over all non-medical decision making
related to the ongoing business operations of BRMG. Based on the provisions of
the agreement, we have determined that BRMG is a variable interest entity, and
that we are the primary beneficiary, and consequently, we consolidate the
revenue and expenses of BRMG. All intercompany balances and transactions have
been eliminated in consolidation.
At the
remaining centers in California and at all of the centers which are located
outside of California, we have entered into long-term contracts with independent
radiology groups in the area to provide physician services at those
facilities. These third party radiology practices provide
professional services, including supervision and interpretation of diagnostic
imaging procedures, in our diagnostic imaging centers. The radiology
practices maintain full control over the provision of professional services. The
contracted radiology practices generally have outstanding physician and practice
credentials and reputations; strong competitive market positions; a broad
sub-specialty mix of physicians; a history of growth and potential for continued
growth. In these facilities we enter into long-term agreements with
radiology practice groups (typically 40 years). Under these arrangements, in
addition to obtaining technical fees for the use of our diagnostic imaging
equipment and the provision of technical services, we provide management
services and receive a fee based on the practice group’s professional revenue,
including revenue derived outside of our diagnostic imaging
centers. We own the diagnostic imaging equipment and, therefore,
receive 100% of the technical reimbursements associated with imaging
procedures. The radiology practice groups retain the professional
reimbursements associated with imaging procedures after deducting management
service fees. We have no financial controlling interest in the
independent (non-BRMG) radiology practices; accordingly, we do not consolidate
the financial statements of those practices in our condensed consolidated
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 a fair presentation of financial position, results of operations
and cash flows in conformity with U.S. generally accepted accounting principles
complete financial statements; however, in the opinion of our management, all
adjustments consisting of normal recurring adjustments necessary for a fair
presentation of the financial position, results of operations and cash flows for
the interim periods ended March 31, 2010 and 2009 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, 2009.
8
Liquidity and Capital Resources
We had a
working capital balance of $1.9 million and $9.2 million at March 31, 2010 and
December 31, 2009, respectively. We had a net loss attributable
to RadNet, Inc.’s common stockholders of $4.1 million and $842,000 for the three
months ended March 31, 2010 and 2009, respectively. We also had an
equity deficit of $79.4 million and $74.8 million at March 31, 2010 and
December 31, 2009, respectively.
We
operate in a capital intensive, high fixed-cost industry that requires
significant amounts of capital to fund operations. In addition to
operations, we require a significant amount of capital for the initial start-up
and development expense of new diagnostic imaging facilities, the acquisition of
additional facilities and new diagnostic imaging equipment, and to service our
existing debt and contractual obligations. Because our cash flows
from operations have been insufficient to fund all of these capital
requirements, we have depended on the availability of financing under credit
arrangements with third parties.
Our
business strategy with regard to operations focuses on the
following:
● |
maximizing
performance at our existing facilities;
|
||
● |
focusing
on profitable contracting;
|
||
● |
expanding
MRI, CT and PET applications;
|
||
● |
optimizing
operating efficiencies; and
|
||
● |
expanding
our networks.
|
At March
31, 2010, our outstanding indebtedness included a $242.0 million senior secured
term loan B, a $170.0 million second lien term loan and a $55.0 million
revolving credit facility of which we qualified to borrow, as of March 31, 2010,
up to an additional $30.4 million, with GE Commercial Finance Healthcare
Financial Services originally entered into on November 15, 2006 (the “GE Credit
Facility”).
In
connection with the GE Credit Facility, on November 15, 2006, we entered into an
interest rate swap, designated as a cash flow hedge, on $107.0 million fixing
the LIBOR rate of interest at 5.02% for a period of three years, and on
November 28, 2006, we entered into an interest rate swap, also designated
as a cash flow hedge, on $90.0 million fixing the LIBOR rate of interest at
5.03% for a period of three years. Previously, the interest rate on the $270.0
million first lien term and revolving credit facilities was based upon a spread
over LIBOR which floats with market conditions.
During
the first quarter of 2009 we modified the two interest rate swaps designated as
cash flow hedges described above. The modifications, commonly
referred to as “blend and extends,” extended the maturity of, and re-priced
these two interest rate swaps for an additional 36 months, resulting in an
estimated annualized cash interest expense savings of $2.9 million.
With
respect to the $107 million interest rate swap, on January 28, 2009, we replaced
the existing fixed LIBOR rate of 5.02% with a new rate of 3.47% maturing on
November 15, 2012. With respect to the $90 million interest rate
swap, on February 5, 2009, we replaced the existing fixed LIBOR rate of 5.03%
with a new rate of 3.62% also maturing on November 15, 2012. Both modified
interest swaps have been designated as cash flow hedges.
As part
of these modifications, the negative fair values of the original interest rate
swaps, as well as a certain amount of accrued interest, associated with the
original cash flow hedges were incorporated into the fair values of the new
modified cash flow hedges. The related Accumulated Other
Comprehensive Loss (AOCL) associated with the negative fair values of the
original cash flow hedges on their dates of modification, which totaled $6.1
million, was on a straight-line basis to interest expense through
November 15, 2009, the maturity date of the original cash flow
hedges.
9
On April
6, 2010 we completed our debt refinancing plan for an aggregate of $585
million. The debt refinancing plan included the issuance of a $285
million senior secured term loan due April 6, 2016, a $100 million senior
secured revolving credit facility due April 6, 2015 and $200 million in
aggregate principal amount of senior unsecured notes due April 1, 2018 (the
“Notes”). We used $413.7 million of the proceeds from the debt
restructuring to pay off our prior credit facility. As a result of this
refinancing, we recorded in April 2010 a loss on extinguishment of debt of
approximately $9.8 million.
New Credit
Agreement
Radnet
Management, Inc., a wholly-owned subsidiary of RadNet, Inc., entered into a new
Credit and Guaranty Agreement (the “New Credit
Agreement”) pursuant to which the Company obtained $385 million in senior
secured bank financing, consisting of a $285 million, six-year term loan
facility and a $100 million, five-year revolving credit facility (the New Credit
Facilities). In connection with the New Credit Facilities, our
wholly-owned subsidiary, Radnet Management, Inc., terminated the GE Credit
Facility.
Interest. The New Credit
Facilities will bear interest through maturity at a rate determined by adding
the applicable margin to either (a) the Base Rate, which is the highest of the
(i) Prime Rate, (ii) the rate which is 0.5% in excess of the Federal Funds
Effective Rate, (iii) 3.00% and (iv) 1.00% in excess of the one-month Adjusted
Eurodollar Rate at such time, or (b) the Adjusted Eurodollar Rate, which is the
higher of (i) the London interbank offered rate, adjusted for statutory reserve
requirements, for the respective interest period, as determined by the
administrative agent and (ii) 2.00%. Applicable margin means (i)
(a) with respect to Tranche B Term Loans that are Eurodollar Rate Loans, 3.75%
per annum and (b) with respect to Tranche B Term Loans that are Base Rate Loans,
2.75% per annum; and (ii) (a) with respect to Revolving Loans that are
Eurodollar Rate Loans, 3.75% per annum and (b) with respect to Revolving Loans
and Swing Line Loans that are Base Rate Loans, 2.75% per annum.
Payments. Commencing on June
30, 2010, we will be required to make quarterly amortization payments on the
term loan facility, each in the amount of $712,500, with the remaining principal
balance paid off at maturity. Under the New Credit Agreement, we will
also be required to make mandatory prepayments, subject to specified exceptions,
from Consolidated Excess Cash Flow, and upon certain events, including, but not
limited to, (i) the receipt of net cash proceeds from the sale or other
disposition of any property or assets by us or any of our subsidiaries, (ii) the
receipt of net cash proceeds from insurance or condemnation proceeds paid on
account of any loss of any property or assets of us or any of our subsidiaries,
(iii) the receipt of net cash proceeds from the incurrence of indebtedness by us
or any of our subsidiaries (other than certain indebtedness otherwise permitted
under the loan documents relating to the New Credit Facilities) and (iv) the
receipt of net cash proceeds by us or any of our subsidiaries from Extraordinary
Receipts, as defined in the New Credit Agreement.
Guarantees and Collateral.
The obligations under the New Credit Facilities are guaranteed by us, all
of our current and future wholly-owned domestic restricted subsidiaries and
certain of our affiliates. The obligations under the New Credit
Facilities and the guarantees are secured by a perfected first priority security
interest in all of Radnet Management’s and the guarantors’ tangible and
intangible assets, including, but not limited to, pledges of equity interests of
Radnet Management and all of our current and future domestic
subsidiaries.
Restrictive Covenants. In
addition to certain customary covenants, the New Credit Agreement places limits
on our ability to declare dividends or redeem or repurchase capital stock,
prepay, redeem or purchase debt, incur liens and engage in sale-leaseback
transactions, make loans and investments, incur additional indebtedness, amend
or otherwise alter debt and other material agreements, engage in mergers,
acquisitions and asset sales, enter into transactions with affiliates and alter
the business we and our subsidiaries currently conduct.
Financial Covenants. The New
Credit Agreement contains financial covenants including a minimum interest
coverage ratio, a maximum total leverage ratio and a limit on annual capital
expenditures. Failure to comply with these covenants could permit the lenders
under the New Credit Facilities to declare all amounts borrowed, together with
accrued interest and fees, to be immediately due and payable.
Events of Default. In
addition to certain customary events of default, events of default under the New
Credit Facilities include failure to pay principal or interest when due, a
material breach of any representation or warranty contained in the loan
documents, covenant defaults, events of bankruptcy and a change of
control.
10
The
Notes
The $200
million in aggregate amount of senior unsecured Notes have a coupon of 10.375%
and were issued at a price of 98.680%. The Notes were issued by Radnet
Management, Inc. and guaranteed jointly and severally on a senior unsecured
basis by us and all of our current and future wholly-owned domestic restricted
subsidiaries. The Notes were offered and sold in a private placement
exempt from registration under the Securities Act to qualified institutional
buyers pursuant to Rule 144A and Regulation S under the Securities Act. The
Notes will mature on April 1, 2018, and bear interest at the rate of 10.375% per
year. We will pay interest on the Notes on April 1 and
October 1, commencing October 1, 2010. The Notes are governed under an indenture
agreement with U.S. Bank National Association as trustee.
Ranking. The Notes and the
guarantees:
● |
rank
equally in right of payment with any existing and
future unsecured senior
indebtedness of the guarantors;
|
||
● |
rank
senior in right of payment to all existing and future subordinated
indebtedness of the Guarantors;
|
||
● |
be
effectively subordinated in right of payment to any secured indebtedness
of the guarantors (including indebtedness under the New Credit Facilities)
to the extent of the value of the assets securing such indebtedness;
and
|
||
● |
be
structurally subordinated in right of payment to all existing and future
indebtedness and other liabilities of any of the Company’s subsidiaries
that is not a guarantor of the
Notes.
|
Optional Redemption. Radnet
Management may redeem the Notes, in whole or in part, at any time on or after
April 1, 2014, at the redemption prices specified under the
Indenture. Prior to April 1, 2013, we may redeem up to 35% of
aggregate principal amount of the Notes issued under the Indenture from the net
proceeds of one or more equity offerings at a redemption price equal to 110.375%
of the Notes redeemed, plus accrued and unpaid interest, if
any. Radnet Management is also permitted to redeem the Notes prior
to April
1, 2014, in whole or in part, at a redemption price equal to 100% of the
principal amount redeemed, plus a make-whole premium and accrued and unpaid
interest, if any.
Change of Control and Asset Sales.
If a change in control of Radnet Management occurs, Radnet Management
must give holders of the Notes the opportunity to sell their Notes at 101% of
their face amount, plus accrued interest. If we or one of our
restricted subsidiaries sells assets under certain circumstances, Radnet
Management will be required to make an offer to purchase the Notes at their face
amount, plus accrued and unpaid interest to the purchase date.
Restrictive Covenants. The
Indenture contains covenants that limit, among other things, the ability of us
and our restricted subsidiaries, to:
● |
pay
dividends or make certain other restricted payments or
investments;
|
||
● |
incur
additional indebtedness and issue preferred
stock;
|
||
● |
create
liens (other than permitted liens) securing indebtedness or trade payables
unless the notes are secured on an equal and ratable basis with the
obligations so secured, and, if such liens secure subordinated
indebtedness, the notes are secured by a lien senior to such
liens;
|
||
● |
sell
certain assets or merge with or into other companies or otherwise dispose
of all or substantially all of our assets;
|
||
● |
enter
into certain transactions with affiliates;
|
||
● |
create
restrictions on dividends or other payments by our restricted
subsidiaries; and
|
||
● |
create
guarantees of indebtedness by restricted
subsidiaries.
|
However,
these limitations are subject to a number of important qualifications and
exceptions, as described in the Indenture.
11
Equipment service
contract
On
February 28, 2010, we amended and extended for approximately five additional
years our arrangement with GE Medical Systems under which GE Medical Systems has
agreed to be responsible for the maintenance and repair of a majority of our
equipment through 2017.
Our
ability to generate sufficient cash flow from operations to make payments on our
debt and other contractual obligations will depend on our future financial
performance. A range of economic, competitive, regulatory,
legislative and business factors, many of which are outside of our control, will
affect our financial performance. Although no assurance can be given,
taking these factors into account, including our historical experience, we
believe that through implementing our strategic plans, we will obtain sufficient
cash to satisfy our obligations as they become due in the next twelve
months.
NOTE
2 – RECENT ACCOUNTING STANDARDS
In
December 2007, the Financial Accounting Standards Board (FASB) issued
Statement of Financial Accounting Standards (SFAS) No. 141(R), Business Combinations,
codified in FASB Accounting Standards Codification (ASC) Topic 805, Business Combinations, which
replaces SFAS No. 141. ASC Topic 805 introduced significant changes in the
accounting for and reporting of business acquisitions. Pursuant to
ASC Topic 805, an acquiring entity is required to recognize all of the assets
acquired and liabilities assumed in a transaction at the acquisition-date fair
value, with limited exceptions, and all transaction related costs are expensed.
Subsequent changes, if any, to the acquisition-date fair value that are the
result of facts and circumstances that did not exist as of the acquisition date
will be recognized as part of on-going operations. In addition, ASC Topic 805
impacts the goodwill impairment test associated with acquisitions. The
provisions of ASC Topic 805 were effective for business combinations for which
the acquisition date was on or after January 1, 2009. The Company applied
the provisions of ASC Topic805 to the facility acquisitions subsequent to
January 1, 2009 as discussed in Note 3.
SFAS No.
160, Noncontrolling Interests
in Consolidated Financial Statements, an amendment of ARB No. 51,
codified in ASC Topic 810, is designed to improve the relevance,
comparability, and transparency of financial information provided to investors
by requiring all entities to report minority interests in subsidiaries in the
same way as equity in the consolidated financial statements. Moreover, ASC Topic
810 eliminates the diversity that accounting for transactions between an entity
and minority interests by requiring they be treated as equity
transactions. The Company adopted the provisions of ASC Topic 810 on
January 1, 2009. Such provisions are applied prospectively
except for the presentation and disclosure requirements which have been applied
retrospectively for all periods presented. Accordingly, we have
reclassified minority interests as a component of equity deficit and renamed
this item “Non-controlling interests” on our consolidated balance sheets at
March 31, 2010 and December 31, 2009. Additionally, our net loss for the
three months ended March 31, 2010 and 2009 have been allocated between RadNet,
Inc.’s common stockholders and noncontrolling interests.
In
December 2009, the FASB issued ASU 2009-17, Consolidations (Topic 810) –
Improvements to Financial Reporting by Enterprises Involved with Variable
Interest Entities. ASU 2009-17 changes how a reporting entity determines
when an entity that is insufficiently capitalized or is not controlled through
voting (or similar rights) should be consolidated. ASU 2009-17 also requires a
reporting entity to provide additional disclosures about its involvement with
variable interest entities and any significant changes in risk exposure due to
that involvement. ASU 2009-17 is effective at the start of a reporting entity’s
first fiscal year beginning after November 15, 2009, or January 1,
2010, for a calendar year entity. Early adoption is not permitted. Our adoption
of ASU 2009-17 did not have a material impact on our consolidated financial
position, results of operations or cash flows.
In
January 2010, the FASB issued authoritative guidance intended to improve
disclosures about fair value measurements. The guidance requires entities to
disclose significant transfers in and out of fair value hierarchy levels and the
reasons for the transfers. Additionally, the guidance clarifies that a reporting
entity should provide fair value measurements for each class of assets and
liabilities and disclose the inputs and valuation techniques used for fair value
measurements using significant other observable inputs (Level 2) and significant
unobservable inputs (Level 3). Currently, the Company does not have any assets
or liabilities that are subject to this guidance. As such, this guidance did not
have an impact on the Company’s results of operation or financial position. This
guidance is effective for interim and annual periods beginning after
December 15, 2009.
In
February 2010, the FASB issued authoritative guidance on subsequent events.
The guidance requires an SEC filer to evaluate subsequent events through the
date the financial statements are issued but no longer requires an SEC filer to
disclose the date through which the subsequent event evaluation occurred. The
guidance became effective for the Company upon issuance and had no impact on the
Company’s results of operations or financial position.
12
NOTE
3 – FACILITY ACQUISITIONS
On
January 1, 2010, we completed the acquisition of Union Imaging Center in Union,
New Jersey from Modern Medical Modalities Corporation for approximately $5.4
million in cash and the issuance of 75,000 shares of RadNet, Inc. common stock
valued at approximately $153,000 on the date of acquisition. The
center operates imaging modalities including MRI, CT, PET/CT, mammography,
ultrasound, nuclear medicine and X-ray. We have made a preliminary purchase
price allocation of the acquired assets and liabilities, and approximately $1.9
million of fixed assets and $3.7 million of goodwill was recorded with respect
to this transaction.
On March
1, 2010, we completed the acquisition of Anaheim Open MRI in Anaheim, CA for
cash consideration of $910,000. The facility operates MRI, CT,
ultrasound and X-ray, and has been rebranded as Anaheim Advanced Imaging. We
have made a preliminary purchase price allocation of the acquired assets and
liabilities, and approximately $605,000 of fixed assets and $305,000 of goodwill
was recorded with respect to this transaction.
On March
15, 2010, we acquired the imaging practice of Theodore Feit, M.D., Inc. in
Burbank, CA for cash consideration of $350,000. We have made a purchase price
allocation of the acquired assets and liabilities, and approximately $350,000 of
fixed assets and no goodwill was recorded with respect to this
transaction.
NOTE
4 – EARNINGS PER SHARE
Earnings
per share is based upon the weighted average number of shares of common stock
and common stock equivalents outstanding, net of common stock held in
treasury, as follows (in thousands except share and per share
data):
Three
Months Ended
|
||||||||
March
31,
|
||||||||
2010
|
2009
|
|||||||
Net
loss attributable to Radnet, Inc.'s common stockholders
|
$ | (4,111 | ) | $ | (842 | ) | ||
Weighted
average number of common shares outstanding during the
year
|
36,363,946 | 35,916,169 | ||||||
Basic
and diluted loss per share attributable to Radnet, Inc.'s common
stockholders
|
||||||||
|
$ | (0.11 | ) | $ | (0.02 | ) |
For the
three months ended March 31, 2010 and 2009, we excluded all options and warrants
in the calculation of diluted loss per share because their effect is
antidilutive.
NOTE
5 – DERIVITIVE INSTRUMENTS
We are
exposed to certain risks relating to our ongoing business
operations. The primary risk managed by using derivative instruments
is interest rate risk. We have entered into interest rate swap
agreements to manage interest rate risk exposure. The interest rate
swap agreements utilized by us effectively modifies our exposure to interest
rate risk by converting our floating-rate debt to a fixed rate basis during the
period of the interest rate swap, thus reducing the impact of interest-rate
changes on future interest expense.
We
designate our interest rate swaps as cash flow hedges of floating-rate
borrowings. For interest rate swaps that are designated and qualify
as a cash flow hedge (i.e., hedging the exposure to variability in expected
future cash flows that is attributable to a particular risk), the effective
portion of the gain or loss on the derivative instrument is initially reported
as a component of other comprehensive income, then reclassified into earnings in
the same line item associated with the forecasted transaction and in the same
period or periods during which the hedged transaction affects earnings (e.g., in
“interest expense” when the hedged transactions are interest cash flows
associated with floating-rate debt). The remaining gain or loss on
the derivative instrument in excess of the cumulative change in the present
value of future cash flows of the hedged item, if any (i.e., the ineffectiveness
portion), or hedge components excluded from the assessment of effectiveness, are
recognized in the statement of operations during the current
period.
13
As
part of
our senior secured credit facility financing, we swapped 50% of the aggregate
principal amount of the facilities to a floating rate within 90 days of the
closing. On April 11, 2006, effective April 28, 2006, we entered into
an interest rate swap on $73.0 million fixing the LIBOR rate of interest at
5.47% for a period of three years. This swap was made in conjunction
with the $161.0 million credit facility that closed on March 9, 2006. In
addition, on November 15, 2006, we entered into an interest rate swap,
designated as a cash flow hedge, on $107.0 million fixing the LIBOR rate of
interest at 5.02% for a period of three years, and on November 28, 2006, we
entered into an interest rate swap, also designated as a cash flow hedge, on
$90.0 million fixing the LIBOR rate of interest at 5.03% for a period of three
years. Previously, the interest rate on the above $270.0 million
portion of the credit facility was based upon a spread over LIBOR which floats
with market conditions.
During
the first quarter of 2009 we modified the two interest rate swaps designated as
cash flow hedges mentioned above. The modifications, commonly
referred to as “blend and extends”, extended the maturity of and re-priced these
two interest rate swaps originally executed in 2006 for an additional 36 months,
resulting in an estimated annualized cash interest expense savings of $2.9
million.
On the
LIBOR hedge modification for a notional amount of $107 million of LIBOR
exposure, the Company on January 29, 2009 replaced the existing fixed LIBOR
rate of 5.02% with a new rate of 3.47% maturing on November 15,
2012. On the second LIBOR hedge modification for a notional amount of
$90 million of LIBOR exposure, the Company, on February 5, 2009, replaced the
existing fixed LIBOR rate of 5.03% with a new rate of 3.62% also maturing on
November 15, 2012. Both modified interest swaps have been designated as
cash flow hedges.
As part
of these modifications, the negative fair values of the original interest rate
swaps, as well as a certain amount of accrued interest, associated with the
original cash flow hedges were incorporated into the fair values of the new
modified cash flow hedges. The related Accumulated Other
Comprehensive Loss (AOCL) associated with the negative fair values of the
original cash flow hedges on their dates of modification, which totaled $6.1
million, was amortized on a straight-line basis to interest expense through
November 15, 2009, the maturity date of the original cash flow
hedges.
We
document our risk management strategy and hedge effectiveness at the inception
of the hedge, and, unless the instrument qualifies for the short-cut method of
hedge accounting, over the term of each hedging relationship. Our use of
derivative financial instruments is limited to interest rate swaps, the purpose
of which is to hedge the cash flows of variable-rate indebtedness. We do not
hold or issue derivative financial instruments for speculative purposes. In
accordance with ASC Topic 815, 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 initially
reported as a component of accumulated other comprehensive loss in the Company’s
consolidated statement of equity deficit. The remaining gain or loss, if any, is
recognized currently in earnings.
A tabular
presentation of the fair value of derivative instruments as of March 31, 2010 is
as follows (amounts in thousands):
Balance
Sheet Location
|
Fair
Value – Asset (Liability) Derivatives
|
|
Derivatives
designated as hedging
instruments
under ASC Topic 815
|
||
Interest
rate contracts
|
Other
non-current liabilities
|
$(10,373)
|
A tabular
presentation of the effect of derivative instruments on our statement of
operations is as follows (amounts in thousands):
For the Three Months Ended
March 31, 2010
Derivatives
in ASC Topic 815 –
Cash
Flow Hedging Relationships
|
Amount
of Gain (Loss) Recognized in OCI
on
Derivative
(Effective
Portion)
|
Location
of Gain (Loss) Reclassified from
Accumulated
OCI into Income (Effective Portion)
|
Amount
of Gain (Loss)
Recognized
in OCI
During
the Term of the
Hedge
Relationship
Reclassified
into Income
(Effective
Portion)
|
Location
of Gain (Loss)
Recognized
in OCI
During
the Term of the
Hedge
Relationship
Reclassified
into Income
(Effective
Portion)
|
Interest
rate contracts
|
($
1,472)
|
Interest
income/ (expense)
|
None
|
Interest
income/(expense)
|
14
For the three Months Ended
March 31, 2009
Derivatives
in ASC Topic 815 –
Cash
Flow Hedging Relationships
|
Amount
of Gain (Loss) Recognized in OCI
on
Derivative
(Effective
Portion)
|
Location
of Loss
Reclassified
from
Accumulated
OCI into Income (Effective Portion)
|
Amount
of Gain (Loss)
Recognized
in OCI
During
the Term of the
Hedge
Relationship
Reclassified
into Income
(Effective
Portion)
|
Location
of Gain (Loss)
Recognized
in OCI
During
the Term of the
Hedge
Relationship
Reclassified
into Income
(Effective
Portion)
|
Interest
rate contracts
|
($
4,292)
|
Interest
income/ (expense)
|
* ($1,724)
|
Interest
income/(expense)
|
* Amortization
of OCI associated with the original cash flow hedges prior to modification (see
discussion above).
NOTE
6 – INVESTMENT IN JOINT VENTURES
We have
eight unconsolidated joint ventures with ownership interests ranging from 22% to
50%. 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. Investment in joint ventures decreased
$1.2 million to $17.5 million at March 31, 2010 compared to $18.7 million at
December 31, 2009. This decrease is primarily related to our
receipt of distributions of $3.1 million offset by our recording of equity
earnings of $1.9 million.
We
received management service fees from the centers underlying these joint
ventures of approximately $1.6 million and $1.9 million for the three months
ended March 31, 2010 and 2009, respectively.
The
following table is a summary of key financial data for these joint ventures as
of March 31, 2010 and for the three months ended March 31, 2010 and 2009 (in
thousands):
Balance
Sheet Data:
|
March
31, 2010
|
|||||||
Current
assets
|
$ | 18,922 | ||||||
Noncurrent
assets
|
27,192 | |||||||
Current
liabilities
|
(6,692 | ) | ||||||
Noncurrent
liabilities
|
(8,027 | ) | ||||||
Total
net assets
|
$ | 31,395 | ||||||
Book
value of Radnet joint venture interests
|
$ | 13,634 | ||||||
Cost
in excess of book value of acquired joint venture
interests
|
3,383 | |||||||
Elimination
of intercompany profit remaining on Radnet's consolidated balance
sheet
|
490 | |||||||
Total
value of Radnet joint venture interests
|
$ | 17,507 | ||||||
Total
book value of other joint venture partner interests
|
$ | 17,761 | ||||||
Income
Statement Data for the three months ended March 31,
|
2010 | 2009 | ||||||
Net
revenue
|
$ | 17,822 | $ | 18,923 | ||||
Net
income
|
$ | 2,775 | $ | 3,689 |
15
NOTE
7 – STOCK BASED COMPENSATION
We have
two long-term incentive plans that currently have outstanding stock options
which we refer to as the 2000 Plan and the 2006 Plan. The 2000 Plan was
terminated as to future grants when the 2006 Plan was approved by the
stockholders in 2006. We have reserved for issuance under the 2006 Plan
6,500,000 shares of common stock. Certain of the options granted under the 2006
Plan to employees are intended to qualify as incentive stock options under
existing tax regulations. In addition, we issue non-qualified stock options and
warrants under the 2006 Plan from time to time to non-employees, in connection
with acquisitions and for other purposes and we may also issue stock under the
Plan. Stock options and warrants generally vest over two to five years and
expire five to ten years from date of grant.
As of
March 31, 2010, 2,324,417, or approximately 53.6%, of all the outstanding stock
options and warrants under our option plans are fully vested. During
the three months ended March 31, 2010, we granted options and warrants to
acquire 375,000 shares of common stock.
We have
issued warrants outside the Plan under various types of arrangements to
employees, in conjunction with debt financing and in exchange for outside
services. All warrants issued after our February 2007 listing on the
NASDAQ Global Market have been characterized as awards under the 2006
Plan. All warrants outside the Plan have been issued with an exercise
price equal to the fair market value of the underlying common stock on the date
of grant. The warrants expire from five to seven years from the date of
grant. Vesting terms are determined by the board of directors or the
compensation committee of the board of directors at the date of
grant.
As of
March 31, 2010, 2,719,566, or approximately 90.9%, of all the outstanding
warrants outside the 2006 Plan are fully vested. During the
three months ended March 31, 2010, we did not grant any warrants outside the
2006 Plan.
The
following tables illustrate the impact of stock-based compensation on reported
amounts (in thousands except per share data):
For
the Three Months Ended March 31,
|
||||||||||||||||
2010
|
2009
|
|||||||||||||||
Impact
of Stock-Based Compensation
|
||||||||||||||||
As
Reported
|
Comp.
|
As
Reported
|
Comp.
|
|||||||||||||
Income
from operations
|
$ | 4,351 | $ | (819 | ) | $ | 9,799 | $ | (709 | ) | ||||||
Loss
attributable to Radnet, Inc.'s common stockholders before income
tax
|
$ | (3,777 | ) | $ | (819 | ) | $ | (805 | ) | $ | (709 | ) | ||||
Net
loss attributable to Radnet, Inc.'s common stockholders
|
$ | (4,111 | ) | $ | (819 | ) | $ | (842 | ) | $ | (709 | ) | ||||
Net
basic and diluted earning per share attributable to Radnet, Inc.'s common
stockholders
|
$ | (0.11 | ) | $ | (0.02 | ) | $ | (0.02 | ) | $ | (0.02 | ) |
16
The
following summarizes all of our option and warrant activity for the three months
ended March 31, 2010:
Weighted
Average
|
|||||||||||
Weighted
Average
|
Remaining
|
Aggregate
|
|||||||||
Outstanding
Options and Warrants
|
Exercise
price
|
Contractual
Life
|
Intrinsic
|
||||||||
Under
the 2006 Plan and 2000 Plan
|
Shares
|
Per
Common Share
|
(in
years)
|
Value
|
|||||||
Balance,
December 31, 2009
|
3,959,750 | $ | 4.15 | ||||||||
Granted
|
375,000 | 2.07 | |||||||||
Exercised
|
- | - | |||||||||
Canceled
or expired
|
- | - | |||||||||
Balance,
March 31, 2010
|
4,334,750 | 3.97 |
3.96
|
$ 1,650,735
|
|||||||
Exercisable
at March 31, 2010
|
2,324,417 | 3.98 |
3.79
|
941,585
|
Weighted
Average
|
|||||||||||
Weighted
Average
|
Remaining
|
Aggregate
|
|||||||||
Non-Plan
|
Exercise
price
|
Contractual
Life
|
Intrinsic
|
||||||||
Outstanding
Warrants
|
Shares
|
Per
Common Share
|
(in
years)
|
Value
|
|||||||
Balance,
December 31, 2009
|
3,057,898 | $ | 2.24 | ||||||||
Granted
|
- | - | |||||||||
Exercised
|
(65,000 | ) | 0.75 | ||||||||
Canceled
or expired
|
- | - | |||||||||
Balance,
March 31, 2010
|
2,992,898 | 2.28 |
2.11
|
$ 3,911,970
|
|||||||
Exercisable
at March 31, 2010
|
2,719,566 | 2.08 |
2.12
|
3,864,370
|
The
aggregate intrinsic value in the table above represents the difference between
our closing stock price on March 31, 2010 and the exercise price, multiplied by
the number of in-the-money options and warrants on March 31, 2010. Total
intrinsic value of options and warrants exercised during the three months ended
March 31, 2010 was approximately $93,900. As of March 31, 2010, total
unrecognized stock-based compensation expense related to non-vested employee
awards was approximately $4.2 million, which is expected to be recognized over a
weighted-average period of approximately 1.8 years.
The fair
value of each option/warrant granted is estimated on the grant date using the
Black-Scholes option pricing model which takes into account as of the grant date
the exercise price and expected life of the option/warrant, the current price of
the underlying stock and its expected volatility, expected dividends on the
stock and the risk-free interest rate for the term of the
option/warrant.
The
following is the weighted average data used to calculate the fair
value:
Risk-free
|
Expected
|
Expected
|
Expected
|
|||||
Interest Rate
|
Life
|
Volatility
|
Dividends
|
|||||
March
31, 2010
|
2.62%
|
3.2
years
|
89.10%
|
-
|
||||
March
31, 2009
|
1.73%
|
2.5
years
|
74.27%
|
-
|
We have
determined the expected term assumption under the "Simplified Method" as defined
in ASC Topic 718. The expected stock price volatility is based on the
historical volatility of our stock. The risk-free interest rate is based on the
U.S. Treasury yield in effect at the time of grant with an equivalent remaining
term. We have not paid dividends in the past and do not currently plan to pay
any dividends in the near future.
The
weighted-average grant date fair value of stock options and warrants granted
during the three months ended March 31, 2010 and 2009 was $1.22 and $1.61,
respectively.
17
NOTE
8 – FAIR VALUE MEASUREMENTS
We
utilize a three-tier fair value hierarchy, which prioritizes the inputs used in
measuring fair value. These tiers are: Level 1, defined as observable inputs
such as quoted prices in active markets; Level 2, defined as inputs other than
quoted prices in active markets that are either directly or indirectly
observable; and Level 3, defined as unobservable inputs in which little or no
market data exists, therefore requiring an entity to develop its own
assumptions.
Our
consolidated balance sheets include the following financial instruments: cash
and cash equivalents, receivables, trade accounts payable, capital leases,
long-term debt and other liabilities. We consider the carrying
amounts of cash and cash equivalents, receivables, other current assets and
current liabilities to approximate their fair value because of the relatively
short period of time between the origination of these instruments and their
expected realization or payment. Additionally, we consider the
carrying amount of our capital lease obligations to approximate their fair value
because the weighted average interest rate used to formulate the carrying
amounts approximates current market rates.
At
March 31, 2010, based on Level 2 inputs, we determined the fair values of
our first and second lien term loans issued on November 15, 2006 and
extended on August 23, 2007 to be $242.0 million and $171.7 million,
respectively. The carrying amount of the first and second lien term
loans at March 31, 2010 was $242.0 million and $170.0 million,
respectively.
The
Company maintains interest rate swaps which are required to be recorded at fair
value on a recurring basis. At March 31, 2010 the fair value of these swaps of a
liability of $10.4 million was determined using Level 2 inputs. More
specifically, the fair value was determined by calculating the value of the
difference between the fixed interest rate of the interest rate swaps and the
counterparty’s forward LIBOR curve, which would be the input used in the
valuations. The forward LIBOR curve is readily available in the
public markets or can be derived from information available in the public
markets.
On
January 1, 2009, the Company adopted, without material impact on its
consolidated financial statements, the provisions of FASB ASC Topic 820 related
to nonfinancial assets and nonfinancial liabilities that are not required or
permitted to be measured at fair value on a recurring basis, which include those
measured at fair value including goodwill impairment testing, indefinite-lived
intangible assets measured at fair value for impairment assessment, nonfinancial
long-lived assets measured at fair value for impairment assessment, asset
retirement obligations initially measured at fair value, and those initially
measured at fair value in a business combination.
NOTE
9 – RELATED PARTY TRANSACTIONS
On June
1, 2009 we entered into a 10 year operating lease for a building at one of our
imaging centers located in Wilmington, Delaware in which our Senior Vice
President of Materials Management is a 50% owner. The monthly rent
under this operating lease is approximately $25,000. We believe
that the monthly lease amount is in line with similar 10 year lease contracts
available for comparable buildings in the area.
NOTE
10 – SUBSEQUENT EVENTS
On March
15, 2010, we announced that we had entered into letters of intent to acquire the
business of Truxtun Medical Group in Bakersfield, California and the New Jersey
operating subsidiary of Health Diagnostics. Subsequent to the end of
our first fiscal quarter, on April 16, 2010, we completed the purchase of
Truxtun Medical Group. Truxtun operates four multi-modality
facilities in Bakersfield, a Metropolitan Statistical Area with a population
exceeding 800,000 residents in Kern County, California. Truxtun
provides a broad range of services including MRI, CT, PET/CT, mammography,
nuclear medicine, fluoroscopy, ultrasound, x-ray and related
procedures.
On April
6, 2010 we completed our debt refinancing plan for an aggregate of $585
million. The debt refinancing plan included the issuance of a $285
million senior secured term loan due April 6, 2016, a $100 million senior
secured revolving credit facility due April 6, 2015 and $200 million in
aggregate principal amount of senior unsecured notes due April 1,
2018. See Note 1 for further details regarding this debt
refinancing.
On April
30, 2010, we acquired three multi-modality facilities from Sonix Medical
Resources, Inc. through a bankruptcy proceeding in New York for approximately
$2.3 million in cash. The facilities located in Brooklyn, New York,
Chatham, New Jersey and Haddon Heights, New Jersey operate a combination of MRI,
CT, mammography, ultrasound, fluoroscopy, x-ray and related
modalities.
18
ITEM 2. Management’s
Discussion and Analysis of Financial Condition and Results of
Operations
Forward-Looking
Statements
This
Quarterly Report on Form 10-Q contains “forward-looking statements” within the
meaning of Section 27A of the Securities Act of 1933 and Section 21E of the
Securities Exchange Act of 1934. These forward-looking statements
reflect, among other things, management’s current expectations and anticipated
results of operations, all of which are subject to known and unknown risks,
uncertainties and other factors that may cause our actual results, performance
or achievements, or industry results, to differ materially from those expressed
or implied by such forward-looking statements. Therefore, any
statements contained herein that are not statements of historical fact may be
forward-looking statements and should be evaluated as such. Without
limiting the foregoing, the words “believes,” “anticipates,” “plans,” “intends,”
“will,” “expects,” “should” and similar words and expressions are intended to
identify forward-looking statements. Except as required under the
federal securities laws or by the rules and regulations of the SEC, we assume no
obligation to update any such forward-looking information to reflect actual
results or changes in the factors affecting such forward-looking
information. The factors included in “Risks Relating to Our
Business,” in our Annual Report on Form 10-K for the fiscal year ended December
31, 2009, as amended or supplemented by the information if any, in Part II –
Item 1A below, among others, could cause our actual results to differ materially
from those expressed in, or implied by, the forward-looking
statements.
The
Company intends that all forward-looking statements made will be subject to the
safe harbor protection of the federal securities laws pursuant to Section 27A of
the Securities Act and Section 21E of the Exchange
Act. Forward-looking statements are based upon, among other things,
the Company’s assumptions with respect to:
● | future revenues; | ||
● | expected performance and cash flows; | ||
● | changes in regulations affecting the Company; | ||
● | changes in third-party reimbursement rates; | ||
● | the outcome of litigation; | ||
● | the availability of radiologists at BRMG and our other contracted radiology practices; | ||
● | competition; | ||
● | acquisitions and divestitures of businesses; | ||
● | joint ventures and other business arrangements; | ||
● | access to capital and the terms relating thereto; | ||
● | technological changes in our industry; | ||
● | successful execution of internal plans; | ||
● | compliance with our debt covenants; and | ||
● | anticipated costs of capital investments. |
You
should consider the limitations on, and risks associated with, forward-looking
statements and not unduly rely on the accuracy of predictions contained in such
forward-looking statements. As noted above, these forward-looking
statements speak only as of the date when they are made. The Company
does not undertake any obligation to update forward-looking statements to
reflect events, circumstances, changes in expectations, or the occurrence of
unanticipated events after the date of those statements. Moreover, in
the future, the Company, through senior management, may make forward-looking
statements that involve the risk factors and other matters described in this
Form 10-Q as well as other risk factors subsequently identified, including,
among others, those identified in the Company’s filings with the SEC on Form
10-K, Form 10-Q and Form 8-K.
19
Overview
The
following discussion should be read along with the unaudited condensed
consolidated financial statements included in this Form 10-Q, as well as the
Company’s 2009 Annual Report on Form 10-K filed with the Securities and Exchange
Commission, which provides a more thorough discussion of the Company’s services,
industry outlook, and business trends.
With 183
centers, as of March 31, 2010, located in California, Delaware, Maryland, New
Jersey, Florida, Kansas and New York, we are the leading national provider of
freestanding, fixed-site outpatient diagnostic imaging services in the United
States based on number of locations. Our centers provide
physicians with imaging capabilities to facilitate the diagnosis and treatment
of diseases and disorders and may reduce unnecessary invasive procedures, often
minimizing the cost and amount of care for patients. Our services
include magnetic resonance imaging (MRI), computed tomography (CT), positron
emission tomography (PET), nuclear medicine, mammography, ultrasound, diagnostic
radiology (X-ray), fluoroscopy and other related procedures. The vast
majority of our centers offer multi-modality imaging services, a key point of
differentiation from our competitors. Our multi-modality strategy
diversifies revenue streams, reduces exposure to reimbursement changes and
provides patients and referring physicians one location to serve the needs of
multiple procedures.
We seek
to develop leading positions in regional markets in order to leverage
operational efficiencies. Our scale and density within our selected
geographies provides close, long-term relationships with key payors, radiology
groups and referring physicians. Each of our facility managers is
responsible for meeting our standards of patient service, managing relationships
with local physicians and payors and maintaining profitability. We
provide corporate training programs, standardized policies and procedures and
sharing of best practices among the physicians in our regional
networks.
Our
business strategy with regard to operations focuses on the
following:
● |
maximizing
performance at our existing facilities;
|
||
● |
focusing
on profitable contracting;
|
||
● |
expanding
MRI, CT and PET applications;
|
||
● |
optimizing
operating efficiencies; and
|
||
● |
expanding
our networks.
|
Our
revenue is derived from a diverse mix of payors, including private payors,
managed care capitated payors and government payors. We believe our
payor diversity mitigates our exposure to possible unfavorable reimbursement
trends within any one-payor class. In addition, our experience with
capitation arrangements over the last several years has provided us with the
expertise to manage utilization and pricing effectively, resulting in a
predictable stream of revenue.
The
condensed consolidated financial statements include the accounts of Radnet
Management, Inc. (or “Radnet Management”) and Beverly Radiology Medical Group
III, a professional partnership (“BRMG”). The condensed consolidated
financial statements also include Radnet Management I, Inc., Radnet Management
II, Inc., Radiologix, Inc., Radnet Management Imaging Services, Inc.,
Delaware Imaging Partners, Inc., New Jersey Imaging Partners, Inc. and
Diagnostic Imaging Services, Inc. (“DIS”), all wholly owned subsidiaries of
Radnet Management. All of these affiliated entities are referred to
collectively in this report as “RadNet”, “we”, “us”, “our” or the “Company” in
this report.
Howard G.
Berger, M.D. is our President and Chief Executive Officer, a member of our Board
of Directors and owns approximately 15% of our outstanding common stock. Dr.
Berger also owns, indirectly, 99% of the equity interests in BRMG. BRMG provides
all of the professional medical services at the majority of our facilities
located in California under a management agreement with us, and contracts with
various other independent physicians and physician groups to provide the
professional medical services at most of our other California facilities. We
generally obtain professional medical services from BRMG in California, rather
than provide such services directly or through subsidiaries, in order to comply
with California’s prohibition against the corporate practice of medicine.
However, as a result of our close relationship with Dr. Berger and BRMG, we
believe that we are able to better ensure that medical service is provided at
our California facilities in a manner consistent with our needs and expectations
and those of our referring physicians, patients and payors than if we obtained
these services from unaffiliated physician groups. RadNet provides
non-medical, technical and administrative services to BRMG for which it receives
a management fee, in accordance with the management agreement between RadNet and
BRMG. Through the management agreement and our relationship with Dr. Berger, we
have exclusive authority over all non-medical decision making related to the
ongoing business operations of BRMG. Based on the provisions of the agreement,
we have determined that BRMG is a variable interest entity, and that we are the
primary beneficiary, and consequently, we consolidate the revenue and expenses
of BRMG. All intercompany balances and transactions have been eliminated in
consolidation.
20
Recent Developments
On
February 28, 2010, we amended and extended for approximately five years our
arrangement with GE Medical Systems under which it has agreed to be responsible
for maintenance and repair of a majority of our equipment through
2017. Under this amended contract, we have obtained lower pricing for
the maintenance and repair of the majority of our advanced imaging equipment and
we will be eligible to earn rebates from purchasing other General Electric
products and services, such as medical equipment and information
technology. We believe this revised contract will provide us
significant cost savings through the term of the agreement.
On April
6, 2010, subsequent to the period covered by this report, we completed a debt
refinancing plan for an aggregate of $585 million. The debt
refinancing plan included the issuance of a $285 million senior secured term
loan due April 6, 2016, a $100 million senior secured revolving credit facility
due April 6, 2015 and $200 million in aggregate principal amount of senior
unsecured notes due April 1, 2018. See “Liquidity and Capital Resources”
below. We used $413.7 million of the proceeds from the debt
restructuring to pay off our prior credit facility.
On April
16, 2010, subsequent to the period covered by this report, we completed the
purchase of Truxtun Medical Group. Truxtun operates four
multi-modality facilities in Bakersfield, a Metropolitan Statistical Area with a
population exceeding 800,000 residents in Kern County,
California. Truxtun provides a broad range of services including MRI,
CT, PET/CT, mammography, nuclear medicine, fluoroscopy, ultrasound, x-ray and
related procedures.
On April
30, 2010, we acquired three multi-modality facilities from Sonix Medical
Resources, Inc. through a bankruptcy proceeding in New York for approximately
$2.3 million in cash. The facilities located in Brooklyn, New York,
Chatham, New Jersey and Haddon Heights, New Jersey operate a combination of MRI,
CT, mammography, ultrasound, fluoroscopy, x-ray and related
modalities.
Healthcare
Reform Legislation
Healthcare
reform legislation enacted in the first quarter of 2010 by the Patient
Protection and Affordable Care Act (the “Act”) specifically requires the U.S.
Department of Health and Human Services, in computing physician practice expense
relative value units, to increase the equipment utilization factor for advanced
diagnostic imaging services (such as MRI, CT and PET) from a presumed
utilization rate of 50% to 65% for 2010 through 2012, 70% in 2013, and 75%
thereafter. Excluded from the adjustment are low-technology imaging
modalities such as ultrasound, X-ray and fluoroscopy. The Act also
includes a provision which, for dates of service in 2010 only, replaces the
21.2% reduction in the Medicare Physician Fee Schedule payment update otherwise
scheduled under the statutory formula with an update providing for an increased
payment rate of 0.5%. We cannot predict at this time whether Congress
will enact additional legislation to revise the formula which determines the
annual update to the conversion factor and payment rates, or if it will continue
to pass incremental legislation to delay or decrease the payment reductions
otherwise required under the statutory formula. It is also possible
that no action will be taken and that reductions in payments under the statutory
formula will be implemented.
The Act
also contains certain changes that may result in decreased revenue for the scans
we perform for Medicare beneficiaries. The Health Care and Education
Reconciliation Act of 2010 (H.R. 4872), which was passed by the Senate and
approved by the President on March 30, 2010, amends the provision for higher
presumed utilization of advanced diagnostic imaging services to a presumed rate
of seventy-five percent (75%). The higher utilization rate should be
fully implemented beginning in 2011, in place of the phase-in approach set forth
in the legislation signed by the President into law. Other changes in
reimbursement for services rendered by Medicare Advantage plans may also reduce
the revenues we receive for services rendered to Medicare Advantage
enrollees.
21
Critical
Accounting Policies
Use
of Estimates
Our
discussion and analysis of financial condition and results of operations are
based on our consolidated financial statements that were prepared in accordance
with U.S. generally accepted accounting principles, or
GAAP. Management makes estimates and assumptions when preparing
financial statements. 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 net revenue 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.
The SEC
defines critical accounting estimates as those that are both most important to
the portrayal of a company’s financial condition and results of operations and
require management’s most difficult, subjective or complex judgment, often as a
result of the need to make estimates about the effect of matters that are
inherently uncertain and may change in subsequent periods. In note 2
to our consolidated financial statements in our annual report on Form 10-K for
fiscal year ended December 31, 2009, as amended, 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.
During
the period covered in this report, there were no material changes to the
critical accounting estimates we use, and have described, in our annual report
on Form 10-K for the fiscal year ended December 31, 2009, as
amended.
Revenue
Recognition
Our
consolidated net revenue consists of net patient fee for service revenue and
revenue from capitation arrangements, or capitation revenue. Net
patient service revenue is recognized at the time services are provided net of
contractual adjustments based on our evaluation of expected collections
resulting from the analysis of current and past due accounts, past collection
experience in relation to amounts billed and other relevant
information. The amount of expected collection is continually
adjusted as more information is received and such adjustments are recorded in
current operations. Contractual adjustments result from the
differences between the rates charged for services performed and reimbursements
by government-sponsored healthcare programs and insurance companies for such
services. Capitation revenue is recognized as revenue during the
period in which we were obligated to provide services to plan enrollees under
contracts with various health plans. Under these contracts, we
receive a per-enrollee amount each month covering all contracted services needed
by the plan enrollees.
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.
Depreciation
and Amortization of Long-Lived Assets
We
depreciate our long-lived assets over their estimated economic useful lives with
the exception of leasehold improvements where we use the shorter of the assets
useful lives or the lease term of the facility for which these assets are
associated.
Deferred
Tax Assets
We
evaluate the realizability of the net deferred tax assets and assess the
valuation allowance periodically. If future taxable income or other
factors are not consistent with our expectations, an adjustment to our allowance
for net deferred tax assets may be required. For net deferred tax
assets we consider estimates of future taxable income, including tax planning
strategies in determining whether our net deferred tax assets are more likely
than not to be realized.
22
Valuation
of Goodwill and Long-Lived Assets
Goodwill
at December 31, 2009 totaled $106.5 million. Goodwill is recorded as
a result of business combinations. Management evaluates goodwill, at
a minimum, on an annual basis and whenever events and changes in circumstances
suggest that the carrying amount may not be recoverable in accordance with
Statement of Financial Accounting Standards, or SFAS, No. 142, "Goodwill and Other Intangible
Assets," codified in FASB ASC Topic 350. Impairment of
goodwill is tested at the reporting unit level by comparing the reporting unit's
carrying amount, including goodwill, to the fair value of the reporting
unit. The fair value of a reporting unit is estimated using a
combination of the income or discounted cash flows approach and the market
approach, which uses comparable market data. If the carrying amount
of the reporting unit exceeds its fair value, goodwill is considered impaired
and a second step is performed to measure the amount of impairment loss, if
any. We tested goodwill for impairment on October 1,
2009. Based on our review, we noted no impairment related to goodwill
as of October 1, 2009. However, if estimates or the related
assumptions change in the future, we may be required to record impairment
charges to reduce the carrying amount of goodwill.
We
evaluate our long-lived assets (property and equipment) and definite-lived
intangibles for impairment whenever indicators of impairment
exist. The accounting standards require that if the sum of the
undiscounted expected future cash flows from a long-lived asset or
definite-lived intangible is less than the carrying value of that asset, an
asset impairment charge must be recognized. The amount of the
impairment charge is calculated as the excess of the asset's carrying value over
its fair value, which generally represents the discounted future cash flows from
that asset or in the case of assets we expect to sell, at fair value less costs
to sell. No indicators of impairment were identified with respect to
our long-lived assets as of December 31, 2009.
Derivative
Financial Instruments
The
Company holds derivative financial instruments for the purpose of hedging the
risks of certain identifiable and anticipated transactions. In
general, the types of risks hedged are those relating to the variability of cash
flows caused by movements in interest rates. The Company documents
its risk management strategy and hedge effectiveness at the inception of the
hedge, and, unless the instrument qualifies for the short-cut method of hedge
accounting, over the term of each hedging relationship. The Company's
use of derivative financial instruments is limited to interest rate swaps, the
purpose of which is to hedge the cash flows of variable-rate
indebtedness. The Company does not hold or issue derivative financial
instruments for speculative purposes.
In
accordance with ASC Topic 815, we designate our interest rate swaps as cash flow
hedges of floating-rate borrowings. For interest rate swaps that are
designated and qualify as a cash flow hedge (i.e., hedging the exposure to
variability in expected future cash flows that is attributable to a particular
risk), the effective portion of the gain or loss on the derivative instrument is
initially reported as a component of other comprehensive income, then
reclassified into earnings in the same line item associated with the forecasted
transaction and in the same period or periods during which the hedged
transaction affects earnings (e.g., in "interest expense" when the hedged
transactions are interest cash flows associated with floating-rate
debt). The remaining gain or loss on the derivative instrument in
excess of the cumulative change in the present value of future cash flows of the
hedged item, if any (i.e., the ineffectiveness portion), or hedge components
excluded from the assessment of effectiveness, are recognized in the statement
of operations during the current period.
23
Results
of Operations
The
following table sets forth, for the periods indicated, the percentage that
certain items in the statement of operations bears to net revenue.
RADNET,
INC. AND SUBSIDIARIES
CONDENSED
CONSOLIDATED STATEMENTS OF OPERATIONS
Three
Months Ended
|
||||||||
March
31,
|
||||||||
2010
|
2009
|
|||||||
NET
REVENUE
|
100.0 | % | 100.0 | % | ||||
OPERATING
EXPENSES
|
||||||||
Operating
expenses
|
79.4 | % | 75.8 | % | ||||
Depreciation
and amortization
|
10.7 | % | 10.3 | % | ||||
Provision
for bad debts
|
6.2 | % | 6.2 | % | ||||
Loss
on sale of equipment
|
0.1 | % | 0.0 | % | ||||
Severance
costs
|
0.1 | % | 0.0 | % | ||||
Total
operating expenses
|
96.5 | % | 92.3 | % | ||||
INCOME
FROM OPERATIONS
|
3.5 | % | 7.7 | % | ||||
OTHER
EXPENSES
|
||||||||
Interest
expense
|
8.0 | % | 10.2 | % | ||||
Other
expenses
|
0.0 | % | 0.2 | % | ||||
Total
other expenses
|
8.0 | % | 10.3 | % | ||||
LOSS
BEFORE INCOME TAXES AND EQUITY
|
||||||||
IN
EARNINGS OF JOINT VENTURES
|
-4.5 | % | -2.7 | % | ||||
Provision
for income taxes
|
-0.3 | % | 0.0 | % | ||||
Equity
in earnings of joint ventures
|
1.5 | % | 2.1 | % | ||||
NET
LOSS
|
-3.3 | % | -0.6 | % | ||||
Net
income attributable to noncontrolling interests
|
0.0 | % | 0.0 | % | ||||
NET
LOSS ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS
|
-3.3 | % | -0.7 | % |
Three
Months Ended March 31, 2010 Compared to the Three Months Ended March 31,
2009
Net
Revenue
Net
revenue for the three months ended March 31, 2010 was $124.2 million compared to
$128.0 million for the three months ended March 31, 2009, a decrease of $3.8
million, or 3.0%.
Net
revenue, including only those centers which were in operation throughout the
first quarters of both 2010 and 2009, decreased $9.2 million, or
7.2%. This 7.2% decrease is primarily the result of procedure
cancellations driven by snow storms experienced on the east coast during January
and February of 2010. This comparison excludes revenue contributions
from centers that were acquired or divested subsequent to January 1,
2009. For the three months ended March 31, 2010, net revenue from
centers that were acquired subsequent to January 1, 2009 and excluded from the
above comparison was $5.4 million
24
Operating Expenses
Operating
expenses for the three months ended March 31, 2010 increased approximately $1.6
million, or 1.7%, from $97.0 million for the three months ended March 31,
2009 to $98.6 million for the three months ended March 31,
2010. The following table sets forth our operating expenses for the
three months ended March 31, 2010 and 2009 (in thousands):
Three
Months Ended March 31,
|
||||||||
2010
|
2009
|
|||||||
Salaries
and professional reading fees, excluding stock-based
compensation
|
$ | 54,665 | $ | 52,900 | ||||
Stock-based
compensation
|
819 | 709 | ||||||
Building
and equipment rental
|
11,252 | 10,538 | ||||||
Medical
supplies
|
6,762 | 7,897 | ||||||
Other
operating expenses *
|
25,141 | 24,969 | ||||||
Operating
expenses
|
98,639 | 97,013 | ||||||
Depreciation
and amortization
|
13,275 | 13,174 | ||||||
Provision
for bad debts
|
7,677 | 7,974 | ||||||
Loss
on sale of equipment, net
|
104 | 26 | ||||||
Severance
costs
|
132 | 17 | ||||||
Total
operating expenses
|
$ | 119,827 | $ | 118,204 |
* Includes billing fees, office supplies, repairs and maintenance, insurance, business tax and license, outside services, utilities, marketing, travel and other expenses.
Salaries
and professional reading fees, excluding stock-based compensation and
severance
Salaries
and professional reading fees increased $1.8 million, or 3.3%, to $54.7 million
for the three months ended March 31, 2010 compared to $52.9 million for the
three months ended March 31, 2009.
Salaries
and professional reading fees, including only those centers which were in
operation throughout the first quarters of both 2010 and 2009, decreased
$168,000, or 0.3%. This
comparison excludes contributions from centers that were acquired or divested
subsequent to January 1, 2009. For the three months ended March 31,
2010, salaries and professional reading fees from centers that were acquired
subsequent to January 1, 2009 and excluded from the above comparison was $1.9
million.
Stock-based
compensation
Stock-based
compensation increased $110,000, or 15.5%, to $819,000 for the three months
ended March 31, 2010 compared to $709,000 for the three months ended March 31,
2009. The increase is primarily due to additional options granted
during the second half of 2009.
Building
and equipment rental
Building
and equipment rental expenses increased $714,000, or 6.8%, to $11.2 million for
the three months ended March 31, 2010 compared to $10.5 million for the three
months ended March 31, 2009.
Building
and equipment rental expenses, including only those centers which were in
operation throughout the first quarters of both 2010 and 2009, decreased
$33,000, or 0.3%. This comparison excludes contributions from centers
that were acquired or divested subsequent to January 1, 2009. For the
three months ended March 31, 2010, building and equipment rental expenses from
centers that were acquired subsequent to January 1, 2009 and excluded from the
above comparison was $747,000.
Medical
supplies
Medical
supplies expense decreased $1.1 million, or 14.4%, to $6.8 million for the three
months ended March 31, 2010 compared to $7.9 million for the three months ended
March 31, 2009.
Medical
supplies expenses, including only those centers which were in operation
throughout the first quarters of both 2010 and 2009, decreased $1.3 million, or
17.0%. This 17.0% decrease is primarily due to a change in vendors
supplying certain drugs used in operating our Breastlink centers as well as
obtaining certain rebates during the first quarter of 2010. This comparison
excludes contributions from centers that were acquired or divested subsequent to
January 1, 2009. For the three months ended March 31, 2010, medical
supplies expense from centers that were acquired subsequent to January 1, 2009
and excluded from the above comparison was $204,000.
25
Depreciation and amortization
Depreciation
and amortization increased $101,000, or 0.8%, to $13.3 million for the three
months ended March 31, 2010 compared to the same period last year. The increase
is primarily due to property and equipment additions for existing centers as
well as newly acquired centers.
Provision
for bad debts
Provision
for bad debts decreased $297,000, or 3.7%, to $7.7 million, or 6.2% of net
revenue, for the three months ended March 31, 2010 compared to $8.0 million, or
6.2% of net revenue, for the three months ended March 31, 2009.
Interest
expense
Interest
expense for the three months ended March 31, 2010 decreased approximately $3.1
million, or 23.5%, from the same period in 2009. This decrease is
primarily due to the fact that interest expense for the three months ended March
31, 2009 includes amortization of Other Comprehensive Income associated with the
modification of two interest rate swaps designated as cash flow hedges (see Note
5) as well as a reduction in LIBOR rates over the last 12 months resulting in a
$1.7 million savings during the three months ended March 31, 2010 as compared to
the first quarter of 2009.
Income
tax expense
For the
three months ended March 31, 2010 and 2009, we recorded $334,000 and $37,000,
respectively, for income tax expense primarily related to taxable income
generated in the states of Maryland and Delaware.
Equity
in earnings from unconsolidated joint ventures
For the
three months ended March 31, 2010, we recognized equity in earnings from
unconsolidated joint ventures of $1.9 million compared to $2.6 million for the
three months ended March 31, 2009. This decrease is primarily the
result of procedure cancellations driven by the snow storms experienced on the
east coast during January and February of 2010.
Liquidity
and Capital Resources
We had a
working capital balance of $1.9 million and $9.2 million at March 31, 2010 and
December 31, 2009, respectively. We had a net loss attributable
to RadNet, Inc.’s common stockholders of $4.1 million and $842,000 for the three
months ended March 31, 2010 and 2009, respectively. We also had an
equity deficit of $79.4 million and $74.8 million at March 31, 2010 and
December 31, 2009, respectively.
We
operate in a capital intensive, high fixed-cost industry that requires
significant amounts of capital to fund operations. In addition to
operations, we require a significant amount of capital for the initial start-up
and development expense of new diagnostic imaging facilities, the acquisition of
additional facilities and new diagnostic imaging equipment, and to service our
existing debt and contractual obligations. Because our cash flows
from operations have been insufficient to fund all of these capital
requirements, we have depended on the availability of financing under credit
arrangements with third parties.
Our
business strategy with regard to operations focuses on the
following:
● |
maximizing
performance at our existing facilities;
|
||
● |
focusing
on profitable contracting;
|
||
● |
expanding
MRI, CT and PET applications;
|
26
● |
optimizing
operating efficiencies; and
|
||
● |
expanding
our
networks.
|
At March
31, 2010, our outstanding indebtedness included a $242.0 million senior secured
term loan B, a $170.0 million second lien term loan and a $55.0 million
revolving credit facility of which we qualified to borrow, as of March 31, 2010,
up to an additional $30.4 million, with GE Commercial Finance Healthcare
Financial Services originally entered into on November 15, 2006 (the “GE Credit
Facility”).
In
connection with the GE Credit Facility, on November 15, 2006, we entered into an
interest rate swap, designated as a cash flow hedge, on $107.0 million fixing
the LIBOR rate of interest at 5.02% for a period of three years, and on
November 28, 2006, we entered into an interest rate swap, also designated
as a cash flow hedge, on $90.0 million fixing the LIBOR rate of interest at
5.03% for a period of three years. Previously, the interest rate on the $270.0
million first lien term and revolving credit facilities was based upon a spread
over LIBOR which floats with market conditions.
During
the first quarter of 2009 we modified the two interest rate swaps designated as
cash flow hedges described above. The modifications, commonly
referred to as “blend and extends,” extended the maturity of, and re-priced
these two interest rate swaps for an additional 36 months, resulting in an
estimated annualized cash interest expense savings of $2.9 million.
With
respect to the $107 million interest rate swap, on January 28, 2009, we replaced
the existing fixed LIBOR rate of 5.02% with a new rate of 3.47% maturing on
November 15, 2012. With respect to the $90 million interest rate
swap, on February 5, 2009, we replaced the existing fixed LIBOR rate of 5.03%
with a new rate of 3.62% also maturing on November 15, 2012. Both modified
interest swaps have been designated as cash flow hedges.
As part
of these modifications, the negative fair values of the original interest rate
swaps, as well as a certain amount of accrued interest associated with the
original cash flow hedges were incorporated into the fair values of the new
modified cash flow hedges. The related Accumulated Other
Comprehensive Loss (AOCL) associated with the negative fair values of the
original cash flow hedges on their dates of modification, which totaled $6.1
million, was on a straight-line basis to interest expense through
November 15, 2009, the maturity date of the original cash flow
hedges.
On April
6, 2010 we completed our debt refinancing plan for an aggregate of $585
million. The debt refinancing plan included the issuance of a $285
million senior secured term loan due April 6, 2016, a $100 million senior
secured revolving credit facility due April 6, 2015 and $200 million in
aggregate principal amount of senior unsecured notes due April 1, 2018 (the
“Notes”). We used $413.7 million of the proceeds from the debt
restructuring to pay off our prior credit facility. As a result of this
refinancing, we recorded in April 2010 a loss on extinguishment of debt of
approximately $9.8 million.
New Credit
Agreement
Radnet
Management, Inc., a wholly-owned subsidiary of RadNet, Inc., entered into a new
Credit and Guaranty Agreement (the “New Credit
Agreement”) pursuant to which the Company obtained $385 million in senior
secured bank financing, consisting of a $285 million, six-year term loan
facility and a $100 million, five-year revolving credit facility (the “New Credit
Facilities”). In connection with the New Credit Facilities, our
wholly-owned subsidiary, Radnet Management, Inc., terminated the GE Credit
Facility.
Interest. The New Credit
Facilities will bear interest through maturity at a rate determined by adding
the applicable margin to either (a) the Base Rate, which is the highest of the
(i) Prime Rate, (ii) the rate which is 0.5% in excess of the Federal Funds
Effective Rate, (iii) 3.00% and (iv) 1.00% in excess of the one-month Adjusted
Eurodollar Rate at such time, or (b) the Adjusted Eurodollar Rate, which is the
higher of (i) the London interbank offered rate, adjusted for statutory reserve
requirements, for the respective interest period, as determined by the
administrative agent and (ii) 2.00%. Applicable margin means (i)
(a) with respect to Tranche B Term Loans that are Eurodollar Rate Loans, 3.75%
per annum and (b) with respect to Tranche B Term Loans that are Base Rate Loans,
2.75% per annum; and (ii) (a) with respect to Revolving Loans that are
Eurodollar Rate Loans, 3.75% per annum and (b) with respect to Revolving Loans
and Swing Line Loans that are Base Rate Loans, 2.75% per annum.
27
Payments. Commencing on June
30, 2010, we will be required to make quarterly amortization payments on the
term loan facility, each in the amount of $712,500, with the remaining principal
balance paid off at maturity. Under the New Credit Agreement, we will
also be required to make mandatory prepayments, subject to specified exceptions,
from consolidated excess cash flow, and upon certain events, including, but not
limited to, (i) the receipt of net cash proceeds from the sale or other
disposition of any property or assets by us or any of our subsidiaries, (ii) the
receipt of net cash proceeds from insurance or condemnation proceeds paid on
account of any loss of any property or assets of us or any of our subsidiaries,
(iii) the receipt of net cash proceeds from the incurrence of indebtedness by us
or any of our subsidiaries (other than certain indebtedness otherwise permitted
under the loan documents relating to the New Credit Facilities) and (iv) the
receipt of net cash proceeds by us or any of our subsidiaries from Extraordinary
Receipts, as defined in the New Credit Agreement.
Guarantees and Collateral.
The obligations under the New Credit Facilities are guaranteed by us, all
of our current and future wholly-owned domestic restricted subsidiaries and
certain of our affiliates. The obligations under the New Credit
Facilities and the guarantees are secured by a perfected first priority security
interest in all of Radnet Management’s and the guarantors’ tangible and
intangible assets, including, but not limited to, pledges of equity interests of
Radnet Management and all of our current and future domestic
subsidiaries.
Restrictive Covenants. In
addition to certain customary covenants, the New Credit Agreement places limits
on our ability to declare dividends or redeem or repurchase capital stock,
prepay, redeem or purchase debt, incur liens and engage in sale-leaseback
transactions, make loans and investments, incur additional indebtedness, amend
or otherwise alter debt and other material agreements, engage in mergers,
acquisitions and asset sales, enter into transactions with affiliates and alter
the business we and our subsidiaries currently conduct.
Financial Covenants. The New
Credit Agreement contains financial covenants including a minimum interest
coverage ratio, a maximum total leverage ratio and a limit on annual capital
expenditures. Failure to comply with these covenants could permit the lenders
under the New Credit Facilities to declare all amounts borrowed, together with
accrued interest and fees, to be immediately due and payable.
Events of Default. In
addition to certain customary events of default, events of default under the New
Credit Facilities include failure to pay principal or interest when due, a
material breach of any representation or warranty contained in the loan
documents, covenant defaults, events of bankruptcy and a change of
control.
The
Notes
The $200
million in aggregate amount of senior unsecured Notes have a coupon of 10.375%
and were issued at a price of 98.680%. The Notes were issued by Radnet
Management, Inc. and guaranteed jointly and severally on a senior unsecured
basis by us and all of our current and future wholly-owned domestic restricted
subsidiaries. The Notes were offered and sold in a private placement
exempt from registration under the Securities Act to qualified institutional
buyers pursuant to Rule 144A and Regulation S under the Securities Act. The
Notes will mature on April 1, 2018, and bear interest at the rate of 10.375% per
year. We will pay interest on the Notes on April 1 and
October 1, commencing October 1, 2010. The Notes are governed under an indenture
agreement with U.S. Bank National Association as trustee.
Ranking. The Notes and the
guarantees:
● |
rank
equally in right of payment with any existing and
future unsecured senior
indebtedness of the guarantors;
|
||
● |
rank
senior in right of payment to all existing and future subordinated
indebtedness of the Guarantors;
|
||
● |
be
effectively subordinated in right of payment to any secured indebtedness
of the guarantors (including indebtedness under the New Credit Facilities)
to the extent of the value of the assets securing such indebtedness;
and
|
||
● |
be
structurally subordinated in right of payment to all existing and future
indebtedness and other liabilities of any of the Company’s subsidiaries
that is not a guarantor of the
Notes.
|
Optional Redemption. Radnet
Management may redeem the Notes, in whole or in part, at any time on or after
April 1, 2014, at the redemption prices specified under the
Indenture. Prior to April 1, 2013, we may redeem up to 35% of
aggregate principal amount of the Notes issued under the Indenture from the net
proceeds of one or more equity offerings at a redemption price equal to 110.375%
of the Notes redeemed, plus accrued and unpaid interest, if
any. Radnet Management is also permitted to redeem the Notes prior
to April
1, 2014, in whole or in part, at a redemption price equal to 100% of the
principal amount redeemed, plus a make-whole premium and accrued and unpaid
interest, if any.
28
Change of Control and Asset Sales.
If a change in control of Radnet Management occurs, Radnet Management
must give holders of the Notes the opportunity to sell their Notes at 101% of
their face amount, plus accrued interest. If we or one of our
restricted subsidiaries sells assets under certain circumstances, Radnet
Management will be required to make an offer to purchase the Notes at their face
amount, plus accrued and unpaid interest to the purchase date.
Restrictive Covenants. The
Indenture contains covenants that limit, among other things, the ability of us
and our restricted subsidiaries, to:
● |
pay
dividends or make certain other restricted payments or
investments;
|
||
● |
incur
additional indebtedness and issue preferred
stock;
|
||
● |
create
liens (other than permitted liens) securing indebtedness or trade payables
unless the notes are secured on an equal and ratable basis with the
obligations so secured, and, if such liens secure subordinated
indebtedness, the notes are secured by a lien senior to such
liens;
|
||
● |
sell
certain assets or merge with or into other companies or otherwise dispose
of all or substantially all of our assets;
|
||
● |
enter
into certain transactions with affiliates;
|
||
● |
create
restrictions on dividends or other payments by our restricted
subsidiaries; and
|
||
● |
create
guarantees of indebtedness by restricted
subsidiaries.
|
However,
these limitations are subject to a number of important qualifications and
exceptions, as described in the Indenture.
Our
ability to generate sufficient cash flow from operations to make payments on our
debt and other contractual obligations will depend on our future financial
performance. A range of economic, competitive, regulatory,
legislative and business factors, many of which are outside of our control, will
affect our financial performance. Although no assurance can be given,
taking these factors into account, including our historical experience, we
believe that through implementing our strategic plans, we will obtain sufficient
cash to satisfy our obligations as they become due in the next twelve
months.
Sources
and Uses of Cash
Cash
provided by operating activities was $16.6 million for the three months ended
March 31, 2010 and $16.7 million for the three months ended March 31,
2009.
Cash used
in investing activities was $19.6 million and $8.9 million for the three months
ended March 31, 2010 and 2009, respectively. For the three months
ended March 31, 2010, we purchased property and equipment for approximately
$12.9 million and acquired the assets and businesses of additional imaging
facilities for approximately $6.7 million.
Cash used
by financing activities was $7.1 million and $7.8 million for the three months
ended March 31, 2010 and 2009, respectively. The cash used by
financing activities for the three months ended March 31, 2010 was related to
payments we made toward our term loans, capital leases and line of credit
balances, as well as $1.6 million of cash payments, net of cash receipts,
related to our modified cash flow hedges.
ITEM
3. Quantitative and
Qualitative Disclosures about Market Risk
Foreign Currency
Exchange Risk. We sell our services exclusively in the United States and
receive payment for our services exclusively in United States
dollars. As a result, our financial results are unlikely to be
affected by factors such as changes in foreign currency, exchange rates or weak
economic conditions in foreign markets.
Interest Rate
Sensitivity. A large portion of our interest expense is not
sensitive to changes in the general level of interest in the United States
because the majority of our indebtedness has interest rates that were fixed when
we entered into the note payable or capital lease obligation. Our credit
facility however, which is classified as a long-term liability on our financial
statements, is interest expense sensitive to changes in the general level of
interest in the United States because it is based upon an index rate plus a
factor. As noted in "Liquidity and Capital Resources" above, we have
entered into interest rate swaps to fix the interest rate on approximately $270
million of our credit facility. The remaining portion of the credit
facility bears interest at rates that float as market conditions change, and as
such, is subject to market risk.
29
ITEM 4. Controls and Procedures
Disclosure
Controls and Procedures.
We
maintain disclosure controls and procedures that are designed to provide
reasonable assurance that material information is: (1) gathered and
communicated to our management, including our principal executive and financial
officers, on a timely basis; and (2) recorded, processed, summarized,
reported and filed with the SEC as required under the Securities Exchange Act of
1934, as amended.
Our
management, with the participation of our chief executive officer and chief
financial officer, evaluated the effectiveness of our disclosure controls and
procedures as of March 31, 2010. Based on such evaluation, our chief executive
officer and chief financial officer concluded that our disclosure controls and
procedures were effective for their intended purpose described
above.
Changes
in Internal Control over Financial Reporting
No
changes were made in our internal control over financial reporting (as defined
in Rules 13a-15(f) and 15d-15(f) of the Exchange Act) during our most recent
fiscal quarter that has materially affected, or is likely to materially affect,
our internal control over financial reporting.
Limitations
on Disclosure Controls and Procedures.
Our
management, including our chief executive officer and chief financial officer,
does not expect that our disclosure controls or internal controls over financial
reporting will prevent all errors or all instances of fraud. A control system,
no matter how well designed and operated, can provide only reasonable, not
absolute, assurance that the control system’s objectives will be met. Further,
the design of a control system must reflect the fact that there are resource
constraints, and the benefits of controls must be considered relative to their
costs. Because of the inherent limitations in all control systems, no evaluation
of controls can provide absolute assurance that all control issues and instances
of fraud, if any, within our company have been detected. These inherent
limitations include the realities that judgments in decision-making can be
faulty, and that breakdowns can occur because of simple error or mistake.
Controls can also be circumvented by the individual acts of some persons, by
collusion of two or more people, or by management override of the controls. The
design of any system of controls is based in part upon certain assumptions about
the likelihood of future events, and any design may not succeed in achieving its
stated goals under all potential future conditions. Over time, controls may
become inadequate because of changes in conditions or deterioration in the
degree of compliance with policies or procedures. Because of the inherent
limitation of a cost-effective control system, misstatements due to error or
fraud may occur and not be detected.
PART
II – OTHER INFORMATION
ITEM
1. Legal
Proceedings
We are
engaged from time to time in the defense of lawsuits arising out of the ordinary
course and conduct of our business. We believe that the outcome of our current
litigation will not have a material adverse impact on our business, financial
condition and results of operations. However, we could be
subsequently named as a defendant in other lawsuits that could adversely affect
us.
ITEM
1A. Risk
Factors
In
addition to the other information set forth in this report, we urge you to
carefully consider the factors discussed in Part I, “Item 1A Risk Factors” in
our Form 10-K for the year ended December 31, 2009, as amended, which could
materially affect our business, financial condition and results of
operations. The risks described below and in our Form 10-K, as amended,
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.
30
We may not be able to finance future needs or adapt our business plan to changes because of restrictions placed on us by our New Credit Facilities, the indenture governing the notes offered hereby and instruments governing our other indebtedness.
The
indenture governing the Notes and our New Credit Facilities contain affirmative
and negative covenants which restrict, among other things, our ability
to:
● |
pay
dividends or make certain other restricted payments or
investments;
|
||
● |
incur
additional indebtedness and issue preferred
stock;
|
||
● |
create
liens (other than permitted liens) securing indebtedness or trade payables
unless the notes are secured on an equal and ratable basis with the
obligations so secured, and, if such liens secure subordinated
indebtedness, the notes are secured by a lien senior to such
liens;
|
||
● |
sell
certain assets or merge with or into other companies or otherwise dispose
of all or substantially all of our assets;
|
||
● |
enter
into certain transactions with affiliates;
|
||
● |
create
restrictions on dividends or other payments by our restricted
subsidiaries; and
|
||
● |
create
guarantees of indebtedness by restricted
subsidiaries.
|
All of
these restrictions could affect our ability to operate our business and may
limit our ability to take advantage of potential business opportunities as they
arise. A failure to comply with these covenants and restrictions
would permit the relevant creditors to declare all amounts borrowed under the
applicable agreement governing such indebtedness, together with accrued interest
and fees, to be immediately due and payable. If the indebtedness
under the New Credit Facilities or the Notes is accelerated, we may not have
sufficient assets to repay amounts due under the New Credit Facilities, the
Notes or on other indebtedness then outstanding.
We
are vulnerable to earthquakes, harsh weather and other natural
disasters.
Our
corporate headquarters and 97 of our facilities are located in California, an
area prone to earthquakes and other natural disasters. Three of our
facilities are located in an area of Florida that has suffered from
hurricanes. Some of our facilities have been affected by snow and
other harsh weather conditions, particularly in February 2010, when winter snow
storms in the mid-Atlantic region, including Maryland, Delaware and New Jersey,
caused us to close many of our facilities for up to 5 business
days. An earthquake, harsh weather conditions or other natural
disaster could decrease scan volume during affected periods and seriously impair
our operations. Damage to our equipment or interruption of our
business would adversely affect our financial condition and results of
operations.
Changes
in the method or rates of third-party reimbursement could have a negative impact
on our results.
From time
to time, changes designed to contain healthcare costs have been implemented,
some of which have resulted in decreased reimbursement rates for diagnostic
imaging services that impact our business. For services for which we
bill Medicare directly, we are paid under the Medicare Physician Fee Schedule,
which is updated on an annual basis. Under the Medicare statutory
formula, payments under the Physician Fee Schedule would have decreased for the
past several years if Congress failed to intervene. For example, for
2008, the fee schedule rates were to be reduced by approximately
10.1%. The Medicare, Medicaid and SCHIP Extension Act of 2007
eliminated the 10.1% reduction for 2008 and increased the annual payment rate
update by 0.5%. This increase to the annual Medicare Physician Fee
Schedule payment update was effective only for Medicare claims with dates of
service between January 1, 2008 and June 30, 2008. Beginning July 1,
2008, under the Medicare Improvement for Patients and Providers Act of 2008
(MIPPA), the 0.5% increase was continued for the rest of 2008. In
addition, MIPPA established a 1.1% increase to the Medicare Physician Fee
Schedule payment update for 2009. For 2010, CMS is projecting a rate
reduction of 21.2%. For 2010, the health care reform legislation
enacted as the Patient Protection and Affordable Care Act, or PPACA, signed into
law on March 23, 2010, includes a provision which, for dates of service in 2010
only, replaces the 21.2% reduction in the Medicare Physician Fee Schedule
payment update otherwise scheduled under the statutory formula with a 0.5%
update. It remains uncertain whether Congress will enact additional
legislation to revise the statutory formula which determines the annual update
to the conversion factor and payments made under the Medicare Physician Fee
Schedule or if, once again, it will pass incremental legislation to delay the
payment reductions. It is also possible that no action will be taken
and that reductions in payments under the statutory formula will be implemented
in the future.
31
MIPPA
also modified the methodology by which the budget neutrality formula was applied
to the 2009 physician fee schedule payment rates, resulting in an overall
reduction in payment rates for services performed by many specialties, including
an estimated 3% reduction for radiation oncology and 1% reduction for nuclear
medicine. The impact of these payment rate reductions could impact
the Company's future revenue depending upon our service mix.
A number
of other legislative changes impact our business. For example, DRA
imposed caps on Medicare payment rates for certain imaging services furnished in
physician's offices and other non-hospital based settings. The caps
impact MRI and PET/CT. Under the cap, payments for specified imaging
services cannot exceed the hospital outpatient payment rates for those
services. This change applies to services furnished on or after
January 1, 2007. The limitation is applicable to the technical
components of the diagnostic imaging services only, which is the payment we
receive for the services for which we bill directly under the Medicare Physician
Fee Schedule.
The DRA
also codified the reduction in reimbursement for multiple images on contiguous
body parts, which was previously announced by CMS. The DRA mandated
payment at 100% of the technical component of the higher priced imaging
procedure and 50% for the technical component of each additional imaging
procedure for multiple images of contiguous body parts within a family of codes
performed in the same session. Beginning in 2006, CMS had only
implemented a 25% reduction for each additional imaging procedure on contiguous
body parts. However, for services furnished on or after July 1, 2010,
the recently approved PPACA requires the 50% percentage reduction to be
implemented, as mandated by the DRA.
Regulatory
updates to payment rates for which we bill the Medicare program directly are
published annually by CMS. For payments under the Physician Fee
Schedule for calendar year 2010, CMS changed the way it calculates components of
the Medicare Physician Fee Schedule. First, CMS reduced payment rates
for certain diagnostic services using equipment costing more than $1 million
through revisions to usage assumptions from the current 50% usage rate to a 90%
usage rate. This change applied to MRI and CT scans. The
Health Care and Education Affordability Reconciliation Act (the "Reconciliation
Act"), signed into law on March 30, 2010, resets the assumed usage rate for
diagnostic imaging equipment costing more than $1 million to a rate of 75%,
effective for payments made under the 2011 Medicare Physician Fee Schedule and
subsequent years. Further with respect to its 2010 changes, CMS also
reduced payment for services primarily involving the technical component rather
than the physician work component, including the services we provide, by
adjusting downward malpractice payments for these services. The
reductions primarily impacted radiology and other diagnostic
tests. All these changes to the Medicare Physician Fee Schedule will
be transitioned over a four year period such that beginning in 2013, CMS will
fully implement the revised payment rates. For the 2010 transitioned
payment, CMS estimates the impact of its changes will result in a 5% reduction
in radiology, 18% reduction in nuclear medicine and 12% reduction for all
suppliers providing the technical component of diagnostic tests
generally.
Newly
enacted and future federal legislation could limit the prices we can charge for
our services, which would reduce our revenue and adversely affect our operating
results.
The PPACA
and the Reconciliation Act introduced certain changes that may result in
decreased revenue for the scans we perform. Among other things, the
new legislation will adjust Medicare payment rates for physician imaging
services in an attempt to better reflect actual usage, by revising upward the
assumed usage rate for diagnostic imaging equipment costing more than $1
million. For certain diagnostic services performed on or after
January 1, 2011, the legislation reduces the assumed usage rate for such
equipment from CMS's current rate of 90% to a rate of 75%, resulting in an
increase in payment rates for such services. The new legislation also
adjusts the technical component discount on single-session imaging studies on
contiguous body parts from 25% to 50% as initially mandated by
DRA. These latter changes will reduce payments for the applicable
services and thus may result in a decrease in the associated revenues we
receive. Other changes in reimbursement for services rendered by
Medicare Advantage plans may reduce the revenues we receive for services
rendered to Medicare Advantage enrollees.
We cannot
predict at this time the full impact of the healthcare reform measures, nor can
we predict the extent to which future reform measures may be initiated and
implemented.
32
ITEM
2. Unregistered
Sales of Equity Securities and Use of Proceeds
On
January 1, 2010, we completed the acquisition of Union Imaging Center in Union,
New Jersey from Modern Medical Modalities Corporation for approximately $5.4
million in cash and the issuance of 75,000 shares of RadNet, Inc. common stock
valued at approximately $153,000 on the date of acquisition. The
shares of common stock were issued in reliance upon an exemption from the
registration requirements of the Securities Act under Section 4(2) of the
Act.
ITEM
3. Defaults Upon
Senior Securities
None
ITEM
4. Removed and
Reserved
ITEM
5. Other
Information
None
ITEM
6. Exhibits
The list
of exhibits filed as part of this report is incorporated by reference to the
Index to Exhibits at the end of this report.
33
SIGNATURES
Pursuant
to the requirements of Section 13 or 15(d) of the Securities Exchange Act of
1934, the Registrant has duly caused this report to be signed on its behalf by
the undersigned, thereunto duly authorized.
RADNET,
INC.
|
|||
(Registrant)
|
|||
Date: May
10, 2010
|
By:
|
/s/ Howard G. Berger, M.D. | |
Howard
G. Berger, M.D., President and
Chief
Executive Officer
|
|||
(Principal Executive Officer) | |||
Date: May 10, 2010 |
By:
|
/s/ Mark D. Stolper | |
Mark
D. Stolper, Chief Financial Officer
(Principal
Financial and Accounting Officer)
|
34
INDEX
TO EXHIBITS
Exhibit
Number
|
Description
|
|
4.1*
|
Pledge
and Security Agreement, dated as of April 6, 2010, among each of the
grantors party thereto and Barclays Bank PLC.
|
|
4.2*
|
Indenture,
dated as of April 6, 2010, among Radnet Management, Inc., RadNet, Inc. and
the other guarantors party thereto and U.S. Bank National Association, as
trustee.
|
|
4.3*
|
Registration
Rights Agreement, dated as of April 6, 2010, among RadNet, Inc., the other
guarantors party thereto, and Deutsche Bank Securities Inc., as
representative of the several initial purchasers of the
Notes.
|
|
10.1*
|
Credit
and Guaranty Agreement, dated as of April 6, 2010, among Radnet
Management, Inc., as borrower, RadNet, Inc., certain subsidiaries and
affiliates of Radnet Management, Inc., as guarantors, Barclays Capital,
Deutsche Bank Securities Inc., GE Capital Markets, Inc. and Royal Bank of
Canada, as joint bookrunners and joint lead arrangers, Deutsche Bank
Securities Inc. and General Electric Capital Corporation, as
co-syndication agents, RBC Capital Markets, as documentation agent, and
Barclays Bank PLC, as administrative agent and collateral
agent.
|
|
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
Pursuant to 18 U.S.C. Section 1350, as Adopted pursuant to Section 906 of
The Sarbanes-Oxley Act of 2002 of Howard G. Berger, M.D.
|
|
32.2
|
Certification
Pursuant to 18 U.S.C. Section 1350, as Adopted pursuant to Section 906 of
The Sarbanes-Oxley Act of 2002 of Mark D. Stolper
|
* Incorporated by reference to the Form
8-K filed on April 6, 2010.
35