Equibles

8-K

RadNet, Inc. (RDNT)

8-K 2022-03-02 For: 2022-03-01
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Added on April 09, 2026

UNITED STATES

SECURITIES AND EXCHANGECOMMISSION

Washington, D.C. 20549

FORM

8-K

CURRENT REPORT

Pursuant to Section13 or 15(d) of the Securities Exchange Act of 1934

Date of Report (Date of

earliest event reported March 1, 2022)

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RadNet, Inc.

(Exact name of registrant as specified in its charter)

Delaware 001-33307 13-3326724
(State or other jurisdiction<br><br><br>of incorporation) (Commission File Number) (IRS<br>Employer Identification Number)
1510 Cotner Avenue<br><br> <br>Los Angeles, CA ****<br><br> <br>90025
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(Address of principal executive offices) (Zip Code)

(310) 478-7808

(Registrant’s Telephone Number, Including Area Code)

Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:

¨ Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)
¨ Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)
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¨ Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))
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¨ Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))
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Securities registered pursuant to Section 12(b) of the Act:

Title of Each Class Trading Symbol(s) Name of each exchange on which registered
Common Stock, $.0001 par value RDNT NASDAQ Global Market

Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§240.12b-2 of this chapter).

Emerging growth company   ¨

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

Item 2.02 RESULTS OF OPERATIONS AND FINANCIAL CONDITION

On March 1, 2022 RadNet, Inc. (“RadNet”) issued a press release and held a conference call regarding our 2021 financial results for the fourth quarter and full fiscal year ended December 31, 2021. A copy of the press release is furnished as Exhibit 99.1 and a copy of the transcript of the conference call is furnished as Exhibit 99.2 to this Current Report.

The information in this Current Report, including Exhibit 99.1 and Exhibit 99.2 is being furnished and shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the liabilities of that Section. The information in this Current Report, including Exhibit 99.1 and Exhibit 99.2 shall not be incorporated by reference into any registration statement or other document filed with the Commission.

Item 9.01 FINANCIAL STATEMENTS AND EXHIBITS.

(d) Exhibits

Exhibit Number Description of Exhibit
99.1 Press Release dated March 1, 2022 relating to RadNet, Inc.’s financial results for the quarter and full fiscal year ended December 31, 2021
99.2 Transcript of Conference Call
104 Cover Page Interactive Data File (embedded within the Inline XBRL document) 
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SIGNATURE

Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.

Date:  March 1, 2022 RADNET, INC.
By: /s/ Mark D. Stolper<br><br> <br>Name: Mark D. Stolper<br><br> Title: Chief Financial Officer 
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EXHIBIT INDEX

Exhibit Number Description of Exhibit
99.1 Press Release dated March 1, 2022 relating to RadNet, Inc.’s financial results for the quarter and full fiscal year ended December 31, 2021
99.2 Transcript of Conference Call
104 Cover Page Interactive Data File (embedded within the Inline XBRL document) 
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Exhibit 99.1

FOR IMMEDIATE RELEASE

RadNet Reports Fourth Quarter 2021 Results and Releases 2022 FinancialGuidance

· Revenue increased 8.0% to $333.2 million in the fourth quarter of 2021from $308.5 million in the fourth quarter of 2020
· Adjusted EBITDA^(1)^ increased 7.5% to $54.5 million in the fourthquarter of 2021 from $50.7 million in the fourth quarter of 2020
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· RadNet estimates that its Adjusted EBITDA^(1)^ was negativelyimpacted by the most recent Omicron surge of COVID-19 by approximately $3 million during the fourth quarter of 2021
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· Adjusting for unusual or one-time items impacting Net Income in the quarter,Adjusted Earnings Per Share^(3)^ was $0.13 for the fourth quarter of 2021; This compares with Adjusted Earnings Per Share^(3)^of $0.20 for the fourth quarter of 2020
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· Aggregate procedural volumes increased 11.4%; Same-center procedural volumesincreased 7.3% compared to the fourth quarter of 2020
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· At quarter end, Net Leverage Ratio (Net Debt divided by Trailing 12 MonthAdjusted EBITDA^(1)^) was 2.9x; RadNet ended 2021 with a cash balance of $134.6 million and undrawn on its $195 million revolvingline of credit
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· RadNet announces 2022 guidance ranges, anticipating increases in Revenueand Adjusted EBITDA^(1)^ for 2022 over 2021 (as adjusted for one-time benefits recognized in 2021 from provider relief fundingand employee retention credit under the CARES Act)
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LOS ANGELES, California, March 1, 2022 –RadNet, Inc. (NASDAQ: RDNT), a national leader in providing high-quality, cost-effective, fixed-site outpatient diagnostic imaging services through a network of 347 owned and/or operated outpatient imaging centers, today reported financial results for its fourth quarter and full year ended December 31, 2021.

Financial Results

Fourth Quarter Report:

Dr. Howard Berger, President and Chief Executive Officer of RadNet, commented “Despite being impacted from the Omicron surge of COVID-19 during the quarter, I am pleased that we were able to increase our Revenue by 8.0% and our Adjusted EBITDA^(1)^ by 7.5% from last year’s fourth quarter. This was the result of ongoing strong demand for our services and the continuing migration of patient procedures from hospitals to free-standing ambulatory outpatient imaging centers. The improvement in our operating metrics during the quarter overshadowed the negative impact from the Omicron surge, which reduced our Revenue by over $4 million and our Adjusted EBITDA^(1)^ by approximately $3 million in the fourth quarter. The COVID-19 surge not only disrupted normal patient volumes, particularly in December, but also created staffing issues at our facilities. At the height of the Omicron surge in December, we had 565 employees out on COVID leave, representing 6.3% of our entire work force. I am pleased to report that currently the percentage of our employee base out with COVID-19 has decreased to 1.2% and patient volume is returning to normalized levels.”

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“Throughout the fourth quarter, we continued to successfully manage our liquidity and financial leverage, while we made important investments to differentiate our facilities from those of our competition. At year-end 2021, we had a cash balance of over $134 million and our net debt leverage ratio remained under 3.0 times Adjusted EBITDA^(1)^. Our Days Sales Outstanding (DSOs) at December 31, 2021 was 34.0 days, the lowest in our Company’s history. The improvement in revenue cycle operations and collections has materially contributed to our ability to manage the challenges presented by COVID-19 and to make important investments for our future,” Dr. Berger noted.

“Moving into 2022, the demand for diagnostic imaging remains robust and is growing. Our strong financial position and operating model has presented us with targeted opportunities to expand our business, particularly through the construction of new centers to meet the growing demand and utilization in strategic markets. Currently, we have 15 new sites in various stages of construction and development, with almost half of this expansion occurring within existing health system joint ventures. We believe these sites should be positive contributors to our performance in the second half of 2022 and throughout 2023,” added Dr. Berger.

Dr. Berger concluded, “Subsequent to the end of the fourth quarter of 2021, we completed the acquisitions of Aidence Holding B.V. and Quantib B.V., two Netherlands-based Artificial Intelligence (“AI”) companies focused on creating population health screening tools primarily for lung cancer and prostate cancer, respectively. During 2022, we will continue to develop the technical offerings and commercial expansion of these two businesses, along with that of our DeepHealth’s breast cancer AI screening algorithms. Though we have budgeted losses from these businesses in 2022, we expect that they will be important to the growth and development of our network screening and population health strategies in 2023 and beyond.”

For the fourth quarter of 2021, RadNet reported Revenue of $333.2 million and Adjusted EBITDA^(1)^ of $54.5 million. Revenue increased $24.6 million (or 8.0%) and Adjusted EBITDA^(1)^ increased $3.8 million (or 7.5%) from the fourth quarter of 2020. Adjusted to remove $2.8 million of provider relief funding under the CARES Act, Adjusted EBITDA^(1)^ was $51.7 million during the fourth quarter, an increase of 2.0% from the fourth quarter of 2020.

Adjusted Diluted Net Income Attributable to RadNet, Inc. Common Stockholders (Adjusted Net Income^(3)^) for the fourth quarter of 2021 was $6.9 million, or $0.13 per diluted share (“Adjusted Earnings Per Share”) as compared with $10.2 million, or $0.20 per diluted share for the same period in 2020. The decrease in Adjusted Net Income and Adjusted Earnings Per Share is primarily the result of an increase in depreciation and amortization expense, non-cash stock compensation expense and the fully diluted share count in the fourth quarter of 2021.

Unadjusted for unusual or one-time items in the quarter, Net Income (Loss) Attributable to RadNet, Inc. Common Shareholders (“Net Income” or “Net Loss”) for the fourth quarter of 2021 was $(3.8) million, or $(0.07) per diluted share. This compares to Net Income of $6.0 million, or $0.11 per diluted share, in the fourth quarter of 2020. These per share values are based upon weighted average number of diluted shares outstanding of 54.0 million in the fourth quarter of 2021 and 52.2 million in the fourth quarter of 2020.

In addition to the provider relief funding under the CARES Act, affecting Net Income in the fourth quarter of 2021 were certain non-cash expenses or non-recurring items including: $3.6 million of non-cash employee stock compensation expense; $29,000 of severance paid in connection with headcount reductions related to cost savings initiatives; $1.5 million loss on the disposal of certain capital equipment; $7.5 million of non-cash gain from interest rate swaps; $831,000 legal settlement; $1.2 million transaction costs associated with completing the Aidence Holding B.V. and Quantib B.V. acquisitions; $646,000 of amortization of deferred financing costs and loan discount related to our existing credit facilities; and $19.7 million loss from abandoning certain leases related to facility closures.

For the fourth quarter of 2021, as compared with the prior year’s fourth quarter, MRI volume increased 13.8%, CT volume increased 10.7% and PET/CT volume was flat. Overall volume, taking into account routine imaging exams, inclusive of x-ray, ultrasound, mammography and other exams, increased 11.4% over the prior year’s fourth quarter. On a same-center basis, including only those centers which were part of RadNet for both the fourth quarters of 2021 and 2020, MRI volume increased 8.0%, CT volume increased 6.6% and PET/CT volume decreased 0.4%. Overall same-center volume, taking into account routine imaging exams, inclusive of x-ray, ultrasound, mammography and other exams, increased 7.3% from the prior year’s same quarter.

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Annual Report:

For full year 2021, RadNet reported Revenue of $1,315.1 million and Adjusted EBITDA^(1)^ of $218.9 million (inclusive of $9.1 million benefit from provider relief funding and $7.7 million of benefit from the employee retention credit). Revenue increased $243.2 million (or 22.7%) and Adjusted EBITDA^(1)^ increased $79.5 million (or 57.0%) as compared with 2020. Adjusting to exclude the provider relief funding and employee retention credit under the CARES Act, Adjusted EBITDA^(1)^ was $202.1 million, an increase of $62.7 (or 44.9%) as compared with 2020.

Net Income for 2021 was $24.7 million, or $0.46 per diluted share. This compares to Net Loss of $14.8 million, or $(0.29) per diluted share, in 2020. These per share values are based upon weighted average number of diluted shares outstanding of 53.4 million in 2021 and 50.9 million in 2020.

In addition to the provider relief funding and employee retention credit under the CARES Act, affecting Net Income for 2021 were certain non-cash expenses or non-recurring items including: $25.2 million of non-cash employee stock compensation expense; $744,000 of severance paid in connection with headcount reductions related to cost savings initiatives; $1.2 loss on the disposal of certain capital equipment; $6.0 loss on extinguishment of debt and related expenses in conjunction with our debt refinancing transaction in April; $21.7 million of non-cash gain from interest rate swaps; $831,000 legal settlement; $1.2 million transaction costs associated with completing the Aidence Holding B.V. and Quantib B.V. acquisitions; $3.3 million of amortization of deferred financing costs and loan discount related to our existing credit facilities; and $19.7 million loss from abandoning certain leases related to facilities closed.

For the year ended December 31, 2021, as compared to 2020, MRI volume increased 26.2%, CT volume increased 21.9% and PET/CT increased 8.6%. Overall volume, taking into account routine imaging exams, inclusive of x-ray, ultrasound, mammography and other exams, increased 25.2% for the twelve months of 2021 over 2020.

Actual 2021 Results vs. 2021 Guidance:

The following compares the Company’s 2021 performance with previously announced revised guidance levels.

Original<br>Guidance<br><br> Range Revised Guidance <br><br>Range After Q3 <br><br>Results 2021 Actual Results
Total Net Revenue $1,250 - $1,300 million $1,300 - $1,350 million $1,315.1 million
Adjusted EBITDA^(1)^ $180 - $190 million $210 - $220 million $218.9 million
Capital Expenditures^(a)^ $70 - $75 million $85 - $90 million $98.8 million
Cash Paid for Interest $39 - $44 million $35 - $40 million $29.0 million
Free Cash Flow ^(b)(2)^ $60 - $70 million $80 - $90 million $91.1 million
(a) Net of proceeds from the sale of equipment, imaging centers and joint venture interests, and excludes<br>New Jersey Imaging Network capital expenditures of $12.4 million and the opportunistic purchase of $26.0 in the fourth quarter of equipment<br>that were on operating leases from certain OEM lessors.
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(b) Defined by the Company as Adjusted EBITDA^(1)^ less<br>Capital Expenditures and Cash Paid for Interest.
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Dr. Berger commented, “We finished 2021 within our revised Revenue guidance range and close to the high end of our revised Adjusted EBITDA^(1)^ range, ranges we increased from our initial guidance levels throughout 2021. Our Free Cash Flow ^(2)^ results slightly exceeded our revised guidance range as a result of our strong Adjusted EBITDA^(1)^ performance and lower than anticipated cash interest expense, driven by our debt refinancing transaction in April. Our capital expenditures exceeded our revised guidance range primarily as a result of the construction of certain de novo locations that are expected to be operational in 2022.”

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2022 Fiscal Year Guidance

For its 2022 fiscal year, RadNet announces its guidance ranges as follows:

Total Net Revenue $1,350 million - $1,400 million
Adjusted EBITDA^(1)^ Excluding Anticipated Losses<br> <br>from Artificial Intelligence Businesses $205 million - $215 million
Capital Expenditures ^(a)^ $85 million - $90 million
Cash Paid for Interest ^(c)^ $27 million - $32 million
Free Cash Flow Generation ^(b)(2)^ $80 million - $90 million
(a) Net of proceeds from the sale of equipment, imaging centers and joint venture interests, and excludes<br>New Jersey Imaging Network capital expenditures.
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(b) Defined by the Company as Adjusted EBITDA^(1)^ less<br>Capital Expenditures and Cash Paid for Interest.
(c) Excludes payments to counterparties on interest rate swaps.

Dr. Berger noted, “It is important to understand that our 2021 Adjusted EBITDA^(1)^ was positively impacted by $9.1 million of provider relief proceeds and $7.7 million of employee retention credit under the CARES Provider Relief Act. Additionally, we are estimating an impact of $7.4 million of Medicare reimbursement reductions for 2022, based upon Medicare’s final rule released in November. Removing these three items from 2021 Adjusted EBITDA^(1)^, including the Medicare rate cuts as if they had existed at the beginning of 2021, the Adjusted EBITDA^(1)^ to which we compare our 2022 guidance is $194.7 million. The anticipated growth built into our guidance in 2022 from this value to our 2022 Adjusted EBITDA^(1)^ guidance range of $205 million to $215 million is projected to come from same-center growth, reimbursement increases from private and capitated payers, new and expanded health system joint ventures and the contribution from acquisitions completed at various times in 2021.”

Dr. Berger continued, “For conservatism, we have not included any new acquisitions or new health system joint ventures during 2022 into our guidance, and we have included approximately $15 million of additional salaries and wages expense as a result of operating in a tighter labor market, where it has become more expensive to attract and retain talent at all levels. We think our guidance has room for us to outperform, subject to the risks and uncertainties of a continuing COVID-19 environment, and we look forward to providing updates to this guidance as we progress through the year.”

“Also, note that our Adjusted EBITDA^(1)^ guidance for 2022 excludes anticipated losses from our AI division (DeepHealth, Aidence and Quantib) of $12 million to $17 million, a range which is impacted by the timing of certain FDA approvals and the resulting commercialization of various product offerings. We will endeavor to report the losses in these businesses separately each quarter throughout 2022, providing transparency of the performance of our core imaging business and allowing our stakeholders to track our progress in AI throughout the year,” concluded Dr. Berger.

Conference Call for Today

Dr. Howard Berger, President and Chief Executive Officer, and Mark Stolper, Executive Vice President and Chief Financial Officer, will host a conference call today, at 10:30 a.m. Eastern Time. During the call, management will discuss the Company's 2021 fourth quarter and year-end results.

Conference Call Details:

Date: Tuesday, March 1, 2022

Time: 10:30 a.m. ET

Dial In-Number: 888-254-3590

International Dial-In Number: 929-477-0402

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There will also be simultaneous and archived webcasts available at https://viavid.webcasts.com/starthere.jsp?ei=1532554&tp_key=cca2370690 or http://www.radnet.com under the “About RadNet” menu section and “News & Press Releases” sub-menu of the website. An archived replay of the call will also be available and can be accessed by dialing 844-512-2921 from the U.S., or 412-317-6671 for international callers, and using the passcode 8161927.

About RadNet, Inc.

RadNet, Inc. is the leading national provider of freestanding, fixed-site diagnostic imaging services and related information technology solutions (including artificial intelligence) in the United States based on the number of locations and annual imaging revenue. RadNet has a network of 347 owned and/or operated outpatient imaging centers. RadNet's markets include California, Maryland, Delaware, New Jersey, New York, Florida and Arizona. Together with affiliated radiologists, and inclusive of full-time and per diem employees and technicians, RadNet has a total of approximately 9,000 employees. For more information, visit http://www.radnet.com.

Forward Looking Statements

This press release contains “forward-looking statements” within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995. Forward-looking statements are expressions of our current beliefs, expectations and assumptions regarding the future of our business, future plans and strategies, projections, and anticipated future conditions, events and trends. Forward-looking statements can generally be identified by words such as: “anticipate,” “intend,” “plan,” “goal,” “seek,” “believe,” “project,” “estimate,” “expect,” “strategy,” “future,” “likely,” “may,” “should,” “will” and similar references to future periods. Forward-looking statements in this press release include, among others, statements we make regarding response to and the expected future impacts of COVID-19, including statements about our anticipated business results, balance sheet and liquidity and our future liquidity, burn rate and our continuing ability to service or refinance our current indebtedness.

Forward-looking statements are neither historical facts nor assurances of future performance. Because forward-looking statements relate to the future, they are inherently subject to uncertainties, risks and changes in circumstances that are difficult to predict and many of which are outside of our control. Our actual results and financial condition may differ materially from those indicated in the forward-looking statements. Therefore, you should not place undue reliance on any of these forward-looking statements. Important factors that could cause our actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following:

· the ongoing impact of the COVID-19 pandemic on<br>our business, suppliers, payors, customers, referral sources, partners, patients and employees, including (i) government’s unprecedented<br>action regarding existing and potential restrictions and/or obligations related to citizen and business activity to contain the virus;<br>(ii) the consequences of an economic downturn resulting from the impacts of COVID-19 and the possibility of a global economic recession;<br>(iii) the impact of the volume of canceled or rescheduled procedures, whether as a result of government action or patient choice; (iv)<br>measures we are taking to respond to the COVID-19 pandemic, including changes to business practices; (v) the impact of government and<br>administrative regulation, guidance and appropriations; (vi) changes in our revenues due to declining patient procedure volumes, changes<br>in payor mix; (vii) potential increased expenses or workforce disruptions related to our employees that could lead to unavailability of<br>key personnel; (viii) workforce disruptions related to our key partners, suppliers, vendors and others we do business with; (ix) the impact<br>of return to work orders in certain states in which we operate; and (x) increased credit and collectability risks;
· the availability and terms of capital to fund<br>our business;
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· our ability to service our indebtedness, make<br>principal and interest payments as those payments become due and remain in compliance with applicable debt covenants, in addition to our<br>ability to refinance such indebtedness on acceptable terms;
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· changes in general economic conditions nationally<br>and regionally in the markets in which we operate;
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· the availability and terms of capital to fund<br>the expansion of our business and improvements to our existing facilities;
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· our ability to maintain our current credit rating<br>and the impact on our funding costs and competitive position if we do not do so;
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· volatility in interest and exchange rates, or<br>credit markets;
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| --- | | · | the adequacy of our cash flow and earnings to<br>fund our current and future operations; | | --- | --- | | · | changes in service mix, revenue mix and procedure<br>volumes; | | --- | --- | | · | delays in receiving payments for services provided; | | --- | --- | | · | increased bankruptcies among our partner physicians<br>or joint venture partners; | | --- | --- | | · | the impact of the political environment and related<br>developments on the current healthcare marketplace and on our business, including with respect to the future of the Affordable Care Act; | | --- | --- | | · | the extent to which the ongoing implementation<br>of healthcare reform, or changes in or new legislation, regulations or guidance, enforcement thereof by federal and state regulators or<br>related litigation result in a reduction in coverage or reimbursement rates for our services, or other material impacts to our business; | | --- | --- | | · | closures or slowdowns and changes in labor costs<br>and labor difficulties, including stoppages affecting either our operations or our suppliers' abilities to deliver supplies needed in<br>our facilities; | | --- | --- | | · | the occurrence of hostilities, political instability<br>or catastrophic events; | | --- | --- | | · | the emergence or reemergence of and effects related<br>to future pandemics, epidemics and infectious diseases; and | | --- | --- | | · | noncompliance by us with any privacy or security<br>laws or any cybersecurity incident or other security breach by us or a third party involving the misappropriation, loss or other unauthorized<br>use or disclosure of confidential information. | | --- | --- |

Any forward-looking statement contained in this current report is based on information currently available to us and speaks only as of the date on which it is made. We undertake no obligation to publicly update any forward-looking statement, whether written or oral, that we may make from time to time, whether as a result of changed circumstances, new information, future developments or otherwise, except as required by applicable law.

Regulation G: GAAP and Non-GAAP FinancialInformation

This release contains certain financial information not reported in accordance with GAAP. The Company uses both GAAP and non-GAAP metrics to measure its financial results. The Company believes that, in addition to GAAP metrics, these non-GAAP metrics assist the Company in measuring its cash-based performance. The Company believes this information is useful to investors and other interested parties because it removes unusual and nonrecurring charges that occur in the affected period and provides a basis for measuring the Company's financial condition against other quarters. Such information should not be considered as a substitute for any measures calculated in accordance with GAAP, and may not be comparable to other similarly titled measures of other companies. Non-GAAP financial measures should not be considered in isolation from, or as a substitute for, financial information prepared in accordance with GAAP. Reconciliation of this information to the most comparable GAAP measures is included in this release in the tables which follow.

CONTACTS:

RadNet, Inc.

Mark Stolper, 310-445-2800

Executive Vice President and Chief FinancialOfficer

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RADNET, INC. AND SUBSIDIARIES

CONSOLIDATED BALANCE SHEETS

(IN THOUSANDS EXCEPT SHARE AND PER SHARE DATA)
2020
ASSETS
CURRENT ASSETS
Cash and cash equivalents 134,606 $ 102,018
Accounts receivable, net 135,062 129,585
Due from affiliates 5,384 5,836
Prepaid expenses and other current assets 49,212 32,985
Total current assets 324,264 270,424
PROPERTY, EQUIPMENT AND RIGHT-OF-USE ASSETS
Property and equipment, net 484,247 399,335
Operating lease right-of-use assets 584,291 483,661
Total property, equipment and right-of-use assets 1,068,538 882,996
OTHER ASSETS
Goodwill 513,820 472,879
Other intangible assets 56,603 52,393
Deferred financing costs 2,135 1,767
Investment in joint ventures 42,229 34,528
Deferred tax assets, net of current portion 14,853 34,687
Deposits and other 36,032 36,983
Total assets 2,058,474 $ 1,786,657
LIABILITIES AND EQUITY
CURRENT LIABILITIES
Accounts payable, accrued expenses and other 263,937 236,684
Due to affiliates 23,530 14,010
Deferred revenue related to software sales 10,701 39,257
Current portion of finance lease – 2,578
Current portion of operating lease 65,452 65,794
Current portion of notes payable and long term debt 11,164 39,791
Total current liabilities 374,784 398,114
LONG-TERM LIABILITIES
Finance lease, net of current portion – 743
Operating lease, net of current portion 577,675 463,096
Notes payable, net of current portion 743,498 612,913
Other non-current liabilities 16,360 53,488
Total liabilities 1,712,317 1,528,354
EQUITY
RadNet, Inc. stockholders' equity:
Common stock - .0001 par value, 200,000,000 shares authorized; 53,548,227 and 51,640,537 shares issued and outstanding at December 31, 2021 and December 31, 2020, respectively 5 5
Additional paid-in-capital 342,592 307,788
Accumulated other comprehensive loss (20,421 ) (24,051 )
Accumulated deficit (93,272 ) (117,999 )
Total RadNet, Inc.'s stockholders' equity 228,904 165,743
Noncontrolling interests 117,253 92,560
Total equity 346,157 258,303
Total liabilities and equity 2,058,474 1,786,657

All values are in US Dollars.

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RADNET, INC. AND SUBSIDIARIES

CONSOLIDATED STATEMENTS OF OPERATIONS

(IN THOUSANDS EXCEPT SHARE AND PER SHARE DATA)

Years Ended December 31,
2021 2020 2019
REVENUE
Service fee revenue $ 1,166,743 $ 931,722 $ 1,028,236
Revenue under capitation arrangements 148,334 140,118 125,943
Total revenue 1,315,077 1,071,840 1,154,179
Provider relief funding 9,110 26,264 –
OPERATING EXPENSES
Cost of operations, excluding depreciation and amortization 1,123,274 965,902 999,692
Lease abandonment charges 19,675 – –
Depreciation and amortization 96,694 86,795 80,607
Loss on sale and disposal of equipment and other 1,246 1,200 2,383
Loss on impairment – 4,170 –
Severance costs 744 4,353 1,619
Total operating expenses 1,241,633 1,062,420 1,084,301
INCOME FROM OPERATIONS 82,554 35,684 69,878
OTHER INCOME AND EXPENSES
Interest expense 48,830 45,882 48,044
Equity in earnings of joint ventures (10,967 ) (7,945 ) (8,350 )
Non-cash change in fair value of interest rate hedge (21,670 ) 2,528 –
Gain on re-measurement of pre-existing interest – – (768 )
Loss (gain) on extinguishment of debt and related expenses 6,044 (4,047 ) –
Other expenses 1,438 120 1,283
Total other expenses 23,675 36,538 40,209
INCOME (LOSS) BEFORE INCOME TAXES 58,879 (854 ) 29,669
Provision for income taxes (14,560 ) (895 ) (6,229 )
NET INCOME (LOSS) 44,319 (1,749 ) 23,440
Net income attributable to noncontrolling interests 19,592 13,091 8,684
`
NET INCOME (LOSS) ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS $ 24,727 $ (14,840 ) $ 14,756
BASIC NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS $ 0.47 $ (0.29 ) $ 0.30
DILUTED NET INCOME (LOSS) PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS $ 0.46 $ (0.29 ) $ 0.29
WEIGHTED AVERAGE SHARES OUTSTANDING
Basic 52,496,679 50,891,791 49,674,858
Diluted 53,421,033 50,891,791 50,244,006 
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RADNET, INC. AND SUBSIDIARIES

CONSOLIDATED STATEMENTS OF CASH FLOWS

(IN THOUSANDS)

Years Ended December 31,
2021 2020 2019
CASH FLOWS FROM OPERATING ACTIVITIES
Net income (loss) $ 44,319 (1,749 ) $ 23,440
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization 96,694 86,795 80,607
Amortization of operating right-of-use assets 73,967 67,915 66,842
Lease abandonment charges 19,675 – –
Equity in earnings of joint ventures (10,967 ) (7,945 ) (8,350 )
Distributions from joint ventures 4,707 9,522 8,598
Amortization and write off of deferred financing costs and loan discount 3,254 4,413 4,184
Loss on sale and disposal of equipment 1,246 1,200 2,383
Loss (gain) on extinguishment of debt 1,496 (4,047 ) –
Gain on re-measurement of pre-existing interest – – (768 )
Loss on impairment – 4,170 –
Amortization of cash flow hedge 3,695 3,448 –
Non-cash change in fair value of interest rate hedge (21,670 ) 2,528 –
Stock-based compensation 25,203 12,405 8,730
Other non cash item in other expenses – 242 (371 )
Change in value of contingent consideration – – (3,123 )
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:
Accounts receivable (5,890 ) 25,206 (17,482 )
Other current assets (15,777 ) 6,588 (3,557 )
Other assets 662 (5,425 ) (2,326 )
Deferred taxes 19,834 (611 ) (3,888 )
Operating lease liability (72,553 ) (53,906 ) (66,831 )
Deferred revenue (28,319 ) 37,941 (1,082 )
Accounts payable, accrued expenses and other 9,915 45,069 17,316
Net cash provided by operating activities 149,491 233,759 104,322
CASH FLOWS FROM INVESTING ACTIVITIES
Purchase of imaging facilities (77,691 ) (31,265 ) (27,150 )
Investment at cost – – (143 )
Purchase of property and equipment (137,874 ) (94,172 ) (74,153 )
Purchase of intangible assets (5,130 ) – –
Proceeds from sale of equipment 625 828 1,160
Proceeds from sale of equity interest in a joint venture – – 132
Nulogix return of capital – – 792
Equity contributions in existing and purchase of interest in joint ventures (1,441 ) (1,635 ) (103 )
Net cash used in investing activities (221,511 ) (126,244 ) (99,465 )
CASH FLOWS FROM FINANCING ACTIVITIES
Principal payments on notes and leases payable (3,302 ) (3,562 ) (6,494 )
Payments on senior notes (619,529 ) (43,296 ) (40,742 )
Additional deferred finance costs on revolving loan amendment (938 ) (741 ) –
Proceeds from debt issuance, net of issuance costs 717,307 – 97,144
Proceeds from Payment Protection Program – 4,023 –
Distributions paid to noncontrolling interests (2,426 ) (1,985 ) (3,057 )
Proceeds from sale of noncontrolling interest 13,073 – 5,275
Contributions from noncontrolling partners – – 750
Proceeds from revolving credit facility 128,300 250,900 261,200
Payments on revolving credit facility (128,300 ) (250,900 ) (289,200 )
Proceeds from issuance of common stock upon exercise of options 488 – 75
Net cash provided by (used in)  financing activities 104,673 (45,561 ) 24,951
EFFECT OF EXCHANGE RATE CHANGES ON CASH (65 ) (101 ) (32 )
NET INCREASE IN CASH AND CASH EQUIVALENTS 32,588 61,853 29,776
CASH AND CASH EQUIVALENTS, beginning of period 102,018 40,165 10,389
CASH AND CASH EQUIVALENTS, end of period $ 134,606 $ 102,018 $ 40,165
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid during the period for interest $ 29,042 $ 39,521 $ 46,254
Cash paid during the period for income taxes $ 1,950 $ 5,069 $ 5,884 
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RADNET, INC. AND SUBSIDIARIES

CONSOLIDATED STATEMENTS OF OPERATIONS

(IN THOUSANDS EXCEPT SHARE AND PER SHARE DATA)

Three Months Ended
December 31,
2021 2020
REVENUE
Service fee revenue $ 296,264 $ 271,530
Revenue under capitation arrangements 36,885 36,973
Total revenue 333,150 308,503
Provider relief funding 2,819 –
OPERATING EXPENSES
Cost of operations, excluding depreciation and amortization 284,667 257,808
Lease abandonment charges 19,675-
Depreciation and amortization 25,421 22,259
Loss on sale and disposal of equipment 1,524 657
Loss on impairment – 4,170
Severance costs 29 2,706
Total operating expenses 331,316 287,599
INCOME FROM OPERATIONS 4,652 20,903
OTHER INCOME AND EXPENSES
Interest expense 11,801 12,439
Equity in earnings of joint ventures (2,707 ) (2,769 )
Non-cash change in swap valuation (7,520 ) (1,995 )
Gain on extinguishment of debt and related expenses – (4,047 )
Other expenses (261 ) 367
Total other (income) expense 1,312 3,996
INCOME BEFORE INCOME TAXES 3,340 16,908
(Provision for) benefit from income taxes (2,027 ) (5,925 )
NET INCOME 1,313 10,983
Net income attributable to noncontrolling interests 5,137 5,028
NET (LOSS) INCOME ATTRIBUTABLE TO RADNET, INC. COMMON STOCK HOLDERS $ (3,823 ) $ 5,955
BASIC NET (LOSS) INCOME PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON<br> STOCKHOLDERS $ (0.07 ) $ 0.12
DILUTED NET (LOSS) INCOME PER SHARE ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS $ (0.07 ) $ 0.11
WEIGHTED AVERAGE SHARES OUTSTANDING
Basic 53,046,347 51,384,586
Diluted 53,964,751 52,224,090 
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RADNET, INC.

RECONCILIATION OF GAAP NET INCOME ATTRIBUTABLE TO RADNET, INC. COMMON SHAREHOLDERS TO ADJUSTED EBITDA^(1)^

(IN THOUSANDS)

Three Months Ended <br> December 31,
2021 2020
Net Income Attributable to RadNet, Inc. Common Stockholders $ (3,823 ) $ 5,955
Plus Provision for Income Taxes 2,027 5,925
Plus Interest Expense 11,801 12,439
Plus Severance Costs 29 2,706
Plus Depreciation and Amortization 25,421 22,259
Plus Non Cash Employee Stock Based Compensation 3,637 2,260
Plus Loss on Sale and Disposal of Equipment 1,524 657
Plus Other Expenses (261 ) 367
Plus Non Cash (Gain) in Fair Value of Interest Rate Hedge (7,520 ) (1,995 )
Plus Loss on Impairment – 4,170
Plus (Gain) on Extinguishment of Debt – (4,047 )
Plus Legal Settlement and Relate Expenses 831 –
Plus Lease Abandonment Charges 19,675 –
Plus Transaction Costs - Aidence Holdings B.V. and Quantib B.V. 1,171 –
Adjusted EBITDA (1) $ 54,512 $ 50,696
Fiscal Year Ended <br> December 31,
--- --- --- --- --- --- ---
2021 2020
Net Income (Loss) Attributable to RadNet, Inc. Common Stockholders $ 24,727 $ (14,840 )
Plus Provision for Income Taxes 14,560 895
Plus Interest Expense 48,830 45,882
Plus Severance Costs 744 4,353
Plus Depreciation and Amortization 96,694 86,795
Plus Non Cash Employee Stock Based Compensation 25,203 12,405
Plus Loss on Sale and Disposal of Equipment 1,246 1,200
Plus Other Expenses 1,438 120
Plus Non Cash Loss in Fair Value of Interest Rate Hedge (21,670 ) 2,528
Plus Loss on Impairment – 4,170
Plus Legal Settlement and Relate Expenses 831 –
Plus (Gain) on Extinguishment of Debt 6,044 (4,047 )
Plus Lease Abandonment Charges 19,675 –
Plus Transaction Costs - Aidence Holdings B.V. and Quantib B.V. 1,171 –
Less Other Adjustment to Joint Venture Investments (565 ) –
Adjusted EBITDA (1) $ 218,928 $ 139,461 
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RADNET, INC. AND SUBSIDIARIES

SCHEDULE OF ADJUSTED EARNINGS AND EARNINGS PER SHARE ^(3)^

(IN THOUSANDS EXCEPT SHARE DATA)

(unaudited)

Three Months Ended
December 31,
2021 2020
NET (LOSS) INCOME ATTRIBUTABLE TO RADNET, INC.
COMMON STOCKHOLDERS $ (3,823 ) $ 5,955
Add severance costs 29 2,706
Add loss on lease abondonment/impairment 19,675 4,170
Add legal settlement and related expenses 831 –
Add transaction costs Aidence Holdings B.V. & Quantib B.V. 1,171 –
Subtract non-cash gain on swap valuation (7,520 ) (1,995 )
Subtract gain on extinguishment of debt – (4,047 )
Total adjustments - loss (gain) 14,186 834
Subtract tax impact of Adjustments (i) 3,508 217
Tax effected impact of adjustments 10,678 617
Add non-recurring tax adjustment related to joint venture – 3,639
TOTAL ADJUSTMENT TO NET INCOME ATTRIBUTABLE
TO RADNET, INC. COMMON SHAREHOLDERS 10,678 4,256
ADJUSTED NET INCOME ATTRIBUTABLE TO RADNET, INC. 6,855 10,211
COMMON STOCKHOLDERS
WEIGHTED AVERAGE SHARES OUTSTANDING
Diluted 53,964,751 52,224,090
ADJUSTED DILUTED NET INCOME PER SHARE
ATTRIBUTABLE TO RADNET, INC. COMMON STOCKHOLDERS $ 0.13 $ 0.20

(i) Tax effected using 26.00% and 24.73% blended federal and state effective tax rate for 2020 and 2021, respectively.

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PAYOR CLASS BREAKDOWN

Fourth Quarter
2021
Commercial Insurance 57.8%
Medicare 21.9%
Capitation 11.1%
Medicaid 2.6%
Workers Compensation/Personal Injury 3.5%
Other 3.1%
Total 100.0%

RADNET PAYMENTS BY MODALITY

Fourth Quarter Full Year Full Year Full Year
2021 2021 2020 2019
MRI 35.9% 36.0% 35.4% 35.8%
CT 16.9% 17.2% 17.6% 16.9%
PET/CT 5.3% 5.5% 6.0% 5.6%
X-ray 6.6% 3.9% 7.3% 8.1%
Ultrasound 12.6% 12.7% 12.3% 12.4%
Mammography 17.0% 16.1% 15.7% 15.2%
Nuclear Medicine 1.0% 1.0% 1.0% 1.0%
Other 4.6% 4.6% 4.7% 4.9%
100.0% 100.0% 100.0% 100.0% 
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Footnotes

^^

^(1)^ The Company defines Adjusted EBITDA as earnings before interest, taxes, depreciation and amortization, each from continuing operations and excludes losses or gains on the disposal of equipment, other income or loss, loss on debt extinguishments, bargain purchase gains and non-cash equity compensation. Adjusted EBITDA includes equity earnings in unconsolidated operations and subtracts allocations of earnings to non-controlling interests in subsidiaries, and is adjusted for non-cash and extraordinary events which took place during the period.

Adjusted EBITDA is reconciled to its nearest comparable GAAP financial measure. Adjusted EBITDA is a non-GAAP financial measure used as analytical indicator by RadNet management and the healthcare industry to assess business performance, and is a measure of leverage capacity and ability to service debt. Adjusted EBITDA should not be considered a measure of financial performance under GAAP, and the items excluded from Adjusted EBITDA should not be considered in isolation or as alternatives to net income, cash flows generated by operating, investing or financing activities or other financial statement data presented in the consolidated financial statements as an indicator of financial performance or liquidity. As Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation, this metric, as presented, may not be comparable to other similarly titled measures of other companies.

^(2)^ As noted above, the Company defines Free Cash Flow as Adjusted EBITDA less total Capital Expenditures (whether completed with cash or financed) and Cash Interest paid. Free Cash Flow is a non-GAAP financial measure. The Company uses Free Cash Flow because the Company believes it provides useful information for investors and management because it measures our capacity to generate cash from our operating activities. Free Cash Flow does not represent total cash flow since it does not include the cash flows generated by or used in financing activities. In addition, our definition of Free Cash Flow may differ from definitions used by other companies.

Free Cash Flow should not be considered a measure of financial performance under GAAP, and the items excluded from Adjusted EBITDA should not be considered in isolation or as alternatives to net income, cash flows generated by operating, investing or financing activities or other financial statement data presented in the consolidated financial statements as an indicator of financial performance or liquidity. As Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation, this metric, as presented, may not be comparable to other similarly titled measures of other companies.

^(3)^ The Company defines Adjusted Earnings Per Share as net income or loss attributable to RadNet, Inc. common stockholders and excludes losses or gains on the disposal of equipment, loss on debt extinguishments, bargain purchase gains, severance costs, loss on impairment, loss or gain on swap valuation, gain on extinguishment of debt, unusual or non-recurring entries that impact the Company’s tax provision and any other non-recurring or unusual transactions recorded during the period.

Adjusted Earnings Per Share is reconciled to its nearest comparable GAAP financial measure. Adjusted Earnings Per Share is a non-GAAP financial measure used as analytical indicator by RadNet management and the healthcare industry to assess business performance. Adjusted Earnings Per Share should not be considered a measure of financial performance under GAAP, and the items excluded from Adjusted Earnings Per Share should not be considered in isolation or as alternatives to net income, cash flows generated by operating, investing or financing activities or other financial statement data presented in the consolidated financial statements as an indicator of financial performance or liquidity. As Adjusted Earnings Per Share is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation, this metric, as presented, may not be comparable to other similarly titled measures of other companies.

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Exhibit 99.2

RadNet, Inc. Fourth Quarter and Full-Year 2021 Financial Results Call 8161927 2022/03/01

Operator

Good day, ladies and gentlemen, and welcome to the RadNet, Inc. Fourth Quarter and Full-Year 2021 Financial Results Call.

Today's conference is being recorded.

At this time, I'd like to turn the conference over to Mr. Mark Stolper, Executive Vice President and Chief Financial Officer of RadNet, Inc. Please go ahead.

Mark Stolper

Thank you. Good morning, ladies and gentlemen, and thank you for joining Dr. Howard Berger and me today to discuss RadNet's Fourth Quarter and Full-Year 2021 Financial Results.

Before we begin today, we'd like to remind everyone of the Safe Harbor statement under the Private Securities Litigation Reform Act of 1995. This presentation contains forward-looking statements within the meaning of the U.S. Private Securities Litigation Reform Act of 1995. Specifically, statements concerning anticipated future financial and operating performance, RadNet's ability to continue to grow the business by generating patient referrals and contracts with radiology practices, recruiting and retaining technologists, receiving third-part reimbursement for diagnostic imaging services, successfully integrating acquired operations, generating revenue and Adjusted EBITDA for the acquired operations as estimated, among others, are forward-looking statements within the meaning of the Safe Harbor.

Forward-looking statements are based on Management's current preliminary expectations and are subject to risks and uncertainties which may cause RadNet's actual results to differ materially from the statements contained herein. These risks and uncertainties include those risks set forth in RadNet's reports filed with the SEC from time to time, including RadNet's Annual Report on Form 10-K for the year ended December 31, 2021 to be filed shortly. Undue reliance should not be placed on forward-looking statements, especially guidance on future financial performance which speaks only as of the date it is made. RadNet undertakes no obligation to update publicly any forward-looking statements to reflect new information, events, or circumstances after the date they were made, or to reflect the occurrence of unanticipated events.

With that, I'd like to turn the call back over to Dr. Berger.

Dr. Howard Berger

Thank you, Mark. Good morning, everyone, and thank you for joining us today.

On today's call, Mark and I plan to provide you with highlights from our fourth quarter and full-year 2021 results, give you more insight into the factors which affected this performance and discuss our future strategy. After our prepared remarks, we will open the call to your questions. I'd like to thank all of you for your interest in our Company and for dedicating a portion of your day to participate in our conference call this morning.

Before we start, I would like to say on behalf of myself and the entire team at RadNet, we hope all of you and your loved ones are healthy and staying safe. We are extremely grateful for all of our stakeholders including our employees, business partners, lenders and shareholders and wish you all well during these challenging times.

Let's begin. Despite being impacted by the recent Omicron surge of COVID-19, particularly late in the fourth quarter, I am very pleased with our performance in the fourth quarter. We were able to increase our revenue by 8% and our Adjusted EBITDA by 7.5% from last year's fourth quarter. The improvement with the result of ongoing strong demand for our services and the continuing migration of patient procedures from hospitals to freestanding ambulatory outpatient imaging centers. The strong demand for our services was enough to overcome the negative impact from the surge, which reduced our fourth quarter revenue by over $4 million and our Adjusted EBITDA by approximately $3 million.

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The COVID-19 surge not only disrupted normal patient volumes but also created staffing issues at our facilities. At the height of the Omicron surge, in December, we had 565 employees out on COVID leave representing 6.3% of our entire workforce. I am pleased to report that after peaking in the first week of January where we had 8.2% of our staff out on COVID leave, or 743 employees, currently the percentage of our employee base out with COVID-19 has decreased to 1.2%.

Additionally, the slowdown in COVID cases has patient volume returning to more normalized levels. This gave us the optimism that is embedded in our 2022 guidance levels which Mark will review in detail in his prepared remarks.

Consistent with our efforts throughout the pandemic, during the fourth quarter, we continued to focus on strengthening our balance sheet by managing our liquidity and financial leverage. We accomplished this while still making important investments in our facilities, equipment and technology. At the year-end 2021, we had a cash balance of over $134 million and a net leverage ratio of 2.9 times Adjusted EBITDA. Our days sales outstanding, or DSOs, at December 31, 2021 was 34.0 days, the lowest in our Company's history.

The improvement in revenue cycle operations and collections has materially contributed to our ability to manage the challenges presented by COVID-19 and to make important investments for our future. We are particularly pleased with our liquidity position given that we repaid over $50 million of COVID-19 related deferrals throughout 2021, which included Medicare and Blue Shield of California advanced payments, payroll taxes under federal assistance programs and cash flow concessions we received from landlords of our facilities. Currently, we only have $8 million of deferrals left to repay during 2022.

We are extremely appreciative of the cash flow assistance we received from these government organizations and business partners during the global pandemic and we are gratified that we've been able to repay these deferrals so quickly. We believe that our strong balance sheet position allows us to be aggressive in 2022 with respect to growth initiatives which will include tuck-in acquisitions, de novo centers and continued capital spending to drive same-center performance.

I'd like reflect on some of our achievements throughout 2021, which further our long-term operating plan. Here are some of the highlights.

First, throughout 2021, we focused on improving clinical operations to drive same-center growth and to efficiently manage our capacity to service the recovering demand for diagnostic imaging as the country began to move past COVID-19. We consolidated centers, centralized certain support functions and improved clinical protocols to drive efficiencies and capacity utilization. We drove reimbursement increases from private and capitated payors.

We also made important investments in equipment and improved our throughout and accuracy. We completed our system-wide adoption of 3D mammography and piloted technologies to make MRI scans shorter for our patients and to allow technologists to remotely control equipment in multiple locations.

We also completed a number of tuck-in acquisitions throughout many of our core markets and were successful in expanding several of our health system joint ventures.

With respect to our DeepHealth AI division, we received FDA clearance of the DeepHealth Sage-Q mammography workflow triage (inaudible) in April of last year. We integrated this powerful AI tool within many of our contracted radiology groups throughout the remainder of the year. In 2021, DeepHealth also prepared and filed an FDA submission for its more advanced AI tool, Sage-Dx, which was submitted to the FDA in early January of this year. We expect to receive clearance sometime during the second quarter for this algorithm, which we believe will be integral in our population health and cancer screening strategy.

Also in 2021, we began to execute on our vision to create a suite of AI enhanced diagnostic imaging screening tools for the most prevalent cancers. We believe large scale cancer screening will be an important part of future population health management. We formulated our interest in moving beyond DeepHealth's current focus of breast cancer towards securing screening algorithms for lung, prostate and colon cancer.

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During 2021, we identified two companies to acquire to address opportunities in lung and prostate cancer screening - Aidence Holding B.V. and Quantib B.V. acquisitions were completed in January of this year. Aidence's artificial intelligence for chest and lung CT scanning is currently used by customers in seven European countries and its leading product is pending FDA approval for use in the United States. With customers in 20 countries worldwide, Quantib solutions prostate and brain MRI already have FDA 510(k) clearance in the United States and CE Mark in Europe. Aidence and Quantib have joined DeepHealth in our AI division led by Dr. Gregory Sorenson, who has assumed responsibility for all of RadNet's AI initiatives.

Finally, in April of 2021, we completed the refinancing of our term loan and revolving line of credit. Based upon current leverage ratios, we are saving approximately $6 million annually in our interest expense as compared with our prior debt facilities. Additionally, we no longer are subject to restrictive maintenance covenants with respect to our term loan and have substantially more operating and financial flexibility under the new credit agreement. This includes lowering our annual required amortization payments by over $30 million, providing us with more cash flow to invest in further growth and development.

At this time, I'd like to turn the call back over to Mark to discuss some of the highlights of our fourth quarter and full-year 2021 performance, as well as discuss in detail our guidance levels for 2022. When he is finished, I will make some closing remarks.

Mark Stolper

Thank you, Howard.

I'm now going to briefly review our fourth quarter and full-year 2021 performance and attempt to highlight what I believe to be some material items. I will also give some further explanation of certain items in our financial statements as well as provide some insights into some of the metrics that drove our fourth quarter and full-year 2021 performance. I will also provide 2022 financial guidance levels, which were released in this morning's financial results press release.

In my discussion, I will use the term Adjusted EBITDA which is a non-GAAP financial measure. The Company defines Adjusted EBITDA as earnings before interest, taxes, depreciation and amortization and excludes losses or gains on the disposal of equipment, other income or loss, loss on debt extinguishments and non-equity compensation -- non-cash equity compensation. Adjusted EBITDA includes earnings in unconsolidated operations and then subtracts allocations of earnings to non-controlling interest in subsidiaries and is adjusted for non-cash or extraordinary and one-time events taking place during the period. A full quantitative reconciliation of Adjusted EBITDA to net income or loss attributable to RadNet, Inc. common shares is included in our earnings release.

With that siad, I'd now like to review our fourth quarter and full-year 2021 results.

For the fourth quarter of 2021, RadNet reported revenue of $333.2 million and Adjusted EBITDA of $54.5 million. Revenue increased $24.6 million or 8% and Adjusted EBITDA increased $3.8 million or 7.5% from the fourth quarter of 2020. Adjusted to remove $2.8 million of provider relief funding under the CARES Act, Adjusted EBITDA was $51.7 million during the fourth quarter, an increase of 2% from the fourth quarter of 2020.

As Dr. Berger mentioned in his opening remarks, the strong demand for our services was enough to overcome the negative impact from the Omicron surge, which reduced our revenue by over $4 million and our Adjusted EBITDA by approximately $3 million in the fourth quarter. The COVID-19 surge not only disrupted normal patient volumes but also created staffing issues at our facilities.

For the fourth quarter of 2021, as compared with the prior year's fourth quarter, MRI volume increased 13.8%, CT volume increased 10.7% and PET/CT volume was flat. Overall volume, taking into account routine imaging exams inclusive of x-ray, ultrasound, mammography and all other exams, increased 11.4% over the prior year's fourth quarter.

In the fourth quarter of 2021, we performed 2,201,920 total procedures. The procedures were consistent with our multimodality approach whereby 76.5% of all the work we did by volume was from routine imaging. Our procedures in the fourth quarter of 2021 were as follows: 314,682 MRIs as compared with 276,482 MRIs in the fourth quarter of 2020; 191,180 CTs as compared with 172,728 CTs in the fourth quarter of 2020; 11,066 PET/CTs as compared with 11,063 PET/CTs in the fourth quarter of 2020; and 1,684,992 routine imaging exams as compared with 1,516,813 routine imaging exams in the fourth quarter of 2020.

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On a same-center basis, including only those centers which were part of RadNet for both the fourth quarters of 2021 and 2020, MRI volume increased 8%; CT volume increased 6.6%; and PET/CT volume decreased 0.4%. Overall same-center volume, taking into account routine imaging exams, increased 7.3% from the prior year's same quarter.

Adjusted net income, which is net income adjusted for unusual or one-time items, was $6.9 million or $0.13 per diluted share as compared with $10.2 million or $0.20 per diluted share for the same period in 2020. The decrease in adjusted net income and adjusted earnings per share is primarily the result of an increase in depreciation and amortization expense, non-cash stock compensation expense and the fully diluted share count in the fourth quarter of 2021.

In addition to the $2.8 million of provider relief funding under the CARES Act, affecting net income in the fourth quarter of 2021 were certain non-cash expenses or non-recurring items including the following: $3.6 million of non-cash employee stock compensation expense; $29,000 of severance paid in connection with headcount reductions related to cost savings initiatives; $1.5 million loss on the disposal of certain capital equipment; $7.5 million of non-cash gain from interest rate swaps; $831,000 legal settlement; $1.2 million transaction cost associated with completing the Aidence Holding B.V. and the Quantib B.V. acquisitions; $646,000 of amortization of deferred financing cost and loan discounts related to our existing credit facilities; and $19.7 million loss from abandoning certain leases related to facility closures.

With regards to some specific income statement accounts, overall GAAP interest expense for the fourth quarter of 2021 was $11.8 million. This compares with GAAP interest expense in the fourth quarter of 2020 of $12.4 million.

Cash paid for interest during the period, which excludes non-cash deferred financing expense, accrued interest and payments to swap counterparties, was $7.6 million as compared with $8.3 million in the fourth quarter last year.

For full-year 2021, RadNet reported $1,315,100,000 of revenue and Adjusted EBITDA of $218.9 million. This Adjusted EBITDA includes the benefits of $9.1 million of provider relief funding and $7.7 million of employee retention credit under the CARES Provider Relief Act.

Revenue increased $243.2 million or 22.7% and Adjusted EBITDA increased $79.5 million or 57% as compared with 2020. Adjusting to exclude the provider relief funding and the employee retention credit, Adjusted EBITDA was $202.1 million, an increase of $62.7 million or 44.9% as compared with 2020.

For the year-ended December 31, 2020 as compared to 2020, MRI volume increased 26.2%, CT volume increased 21.9%, and PET/CT volume increased 8.6%. Overall volume, taking into account all routine imaging exams, increased 25.2% for the 12 months of 2021 over 2020.

In 2021, we performed 8,598,593 total procedures. The procedures were consistent with our multimodality approach whereby 76.3% of all the work we did by volume was for routine imaging. Our procedures in 2021 are as follows: 1,232,427 MRIs as compared with 976,633 MRIs in 2020; 756,509 CTs as compared with 620,547 CTs in 2020; 45,124 PET/CTs as compared with 41,567 PET/CTs in 2020; and 6,564,533 routine imaging exams as compared with 5,228,274 of all these exams in 2020.

Net income for 2021 was $24.7 million or $0.46 per diluted share. This compares to a net loss of $14.8 million or negative $0.29 per diluted share in 2020. These per share values are based upon weighted average number of diluted shares outstanding of 53.4 million in 2021 and 50.9 million in 2020.

In addition to the provider relief funding and employee retention credit under the CARES Act, affecting net income for 2021 were certain non-cash expenses or non-recurring items including the following: $25.2 million of non-cash employee stock compensation expense; $744,000 of severance paid in connection with headcount reductions related to cost savings initiatives; $1.2 million loss on the disposal of certain capital equipment; $6 million loss on the extinguishment of debt and related expenses in conjunction with our debt refinancing transaction in April; $21.7 million of non-cash gain from interest rate swaps; $831,000 of legal settlements; $1.2 million transaction cost associated with completing the Aidence Holding B.V. and the Quantib B.V. acquisitions; $3.3 million of amortization of deferred financing cost and loan discount related to our existing credit facilities; and $19.7 million loss from abandoning certain leases related to facilities closed.

With regards to some specific income statement accounts, overall GAAP interest expense in 2021 was $48.8 million. Adjusted for the impacts from items such as amortization of financing fees, accrued interest and payments to swap counterparties, cash interest expense was $29 million in 2021. This compares with GAAP interest expense in 2020 of $45.9 million in cash paid for interest of $39.5 million in 2020.

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With regards to our balance sheet, as of December 31, 2021, unadjusted for bond and term loan discounts, we had $633.3 million of net debt, which is our total debt at par value less our cash balance. Note that this debt balance includes the New Jersey Imaging Network's debt of approximately $46.5 million for which RadNet is neither a borrower nor guarantor. This compares with $563.7 million of net debt at December 31, 2020.

As of year-end 2021, we were undrawn on our $195 million revolving line of credit and had a cash balance of $134.6 million, which was substantially up from the $102 million cash balance at year-end 2020.

As Dr. Berger mentioned in his opening remarks, our liquidity position is especially gratifying as we repaid during 2021 over $50 million of deferrals we had received from government assistance programs, private payors and landlords.

At December 31, 2020, our accounts receivable balance was $135.1 million, an increase of $5.5 million from year-end 2020. Our DSO was 34 days at December 31, 2021, lower by 2.2 days when compared with the 36.2 days of DSOs one year earlier. The decrease in our DSO is mainly from improved cash collections, including additional efforts and resources dedicated to patient collections at the time of service.

Throughout 2021, we had total capital expenditures net of asset dispositions and the sale of imaging center assets and joint venture interest of $98.8 million. This amount excludes $12. 4 million of capital expenditures of New York Imaging Network and the opportunistic purchase of $26 million in the fourth quarter of equipment that were on operating leases from certain OEM lessors. Approximately all of our capital expenditures were paid for in cash and we recognized $625,000 in proceeds from the sale of equipment. Capital expenditures in 2021 were higher than what we originally budgeted as a result of the construction of certain de novo locations that are expected to be operational in 2022.

At this time, I'd like to review our 2022 financial guidance levels, which we related this morning in our financial results press release.

For total net revenue, our guidance range is $1.350 billion to $1.400 billion. For Adjusted EBITDA, which excludes anticipated losses from artificial intelligence businesses, the guidance range is $205 million to $215 million. For capital expenditures, our guidance range is $85 million to $90 million. For cash paid for interest, our guidance range is $27 million to $32 million. And finally, for free cash flow generation, our guidance level is $80 million to $90 million.

It's important to understand that our 2021 Adjusted EBITDA results were positively impacted by $9.1 million of provider relief proceeds and $7.7 million of employee retention credit under the CARES Provider Relief Act. Additionally, we are estimating an impact of $7.4 million of Medicare reimbursement reductions for 2022 based upon Medicare's final rule released in November. Adjusting 2021 Adjusted EBITDA for these three items, including the Medicare rate cuts as if they had existed at the beginning of 2021, the Adjusted EBITDA to which we compare our 2022 guidance is $194.3 million.

The anticipated growth built into our guidance in 2022 from this value to our Adjusted EBITDA guidance range of $205 million to $215 million is projected to come from same-center growth, reimbursement increases from private and capitated payors, new and expanded health system joint ventures, and the contribution from acquisitions completed at various times during 2021.

For conservatism, we have not included any new acquisitions or new health system joint ventures during 2022 into our guidance and we have included approximately $15 million of additional salaries and wages in 2022 as a result of operating in a tighter labor market where it has become more expensive to attract and retain talent at all levels.

We think our guidance has room for us to outperform, subject, of course, to the risks and uncertainties of the continuing COVID environment, and look forward to providing updates to this guidance as we progress throughout the year.

Also note that our Adjusted EBITDA guidance for 2022 excludes the anticipated losses from our AI division, which includes DeepHealth, Aidence and Quantib, of roughly $12 million to $17 million, a range which is impacted by the timing of certain FDA approvals and the resulting commercialization of various product offerings. We will endeavor to report the losses in these businesses separately each quarter throughout 2022 providing transparency of the performance of our core imaging business and allowing our stakeholders to track our progress in AI throughout the year.

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I'd now like to turn the call back to Dr. Berger who will make some closing remarks.

Dr. Howard Berger

Thank you, Mark.

Moving into 2022, the demand for diagnostic imaging remains robust and is growing. Our strong financial position and operating model has presented us with targetted opportunities to expand our business, particularly through the construction of new centers to meet the growing demand and utilization in strategic markets. Currently, we have 15 new sites in various stages of construction and development with almost half of these expansions occurring within existing health system joint ventures. These new sites are focused in areas where we currently are unable to meet the demand for services due to capacity constraints or because we simply do not have locations overlapping significant patient populations that we or, in certain cases, our hospital partners, have identified. We believe these denovo sites should be major contributors to our performance in the second half of 2022 and throughout 2023.

As we now approach the end of the first quarter of 2022, we are excited for the remainder of the year. Besides the construction and development of the centers I just mentioned, we expect to make progress on a number of other fronts in 2022. We will continue to focus on driving same-center procedural and revenue growth, while managing expenses carefully. We will advance current discussions with existing and new joint venture partners for establishing new JVs and expanding existing ones. In our AI division, we will focus on getting successful clearances for DeepHealth's advanced mammography algorithm and Aidence's lung CT technology. We will also continue to have discussions with large health plans, employer groups and capitated payors about adopting large scale cancer screening programs driven by artificial intelligence.

Our strong cash position at the end of 2021 leading into this year, along with the availability of a $195 million revolving credit facility, will provide us the financial flexibility and capability to pursue accretive strategic acquisitions and execute on all other facets of our operating plan.

Operator, we are now ready for the question-and-answer portion of the call.

Operator

Thank you.

We'll take our first question from Brian Tanquilut with Jefferies. Plg.

Brian Tanquilut

Hey guys. Good morning. I guess, Howard, my first question for you. I've covered you guys for, gosh, 15 years now and this is the first time I think that I'm seeing you focused on denovos. So, what was the impetus for that and anything you can share with us in terms of maybe what has changed in the market and that whole discussion of buy versus build?

Dr. Howard Berger

Good morning, Brian. Thank you for the question. During the year, despite the challenges presented by COVID, we noticed that there was increasing demand for outpatient elective imaging procedures, which we think is finally being substantially enhanced by the greater efforts that most of the major health payors are making to direct business into lower cost outpatient imaging facilities. That alone with initiatives that we've undertaken, particularly in mammography to improve compliance, has led to very impressive increase in volumes in our markets and where we realized that the only way for us to really provide additional capacity is to build new imaging centers.

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So, in our particular business model where we have densely -- where we have many centers in densely populated markets, and where consolidation continues to occur, we are recognizing that we cannot continue to just add pieces of equipment because we are space constrained and that some of the prospects that we have for the future, particularly with artificial intelligence, which we believe will create greater demand for screening tools, not only in breast cancer but in lung, prostate and colorectal cancer, which we will be aggressively pursuing, we need to prepare for the ability to manage this increased demand. As a result, we've identified 15 new locations that we believe due to our backlogs, increasing demand and migration away from hospital-based outpatient business into these imaging centers will create this need.

That is also something that we decided to embark on as a result of the very high multiples that we see acquisitions being done generally inside the imaging center business. For us, and I think it's unique to our business model and strategy, it becomes substantially more opportunistic for us to build it this time rather than buy. As you know, Brian, over the years, and we still try to target acquisitions in the 3 to 6 times multiple of EBITDA, but given the fact that most of the larger acquisitions that we're seeing are for multiples substantially high than that and that there's a decreasing number of centers in our markets that are available for acquisition, the decision to create denovo centers really satisfies both the need for demand as well as a more prudent use of our capital resources.

So, this is, as I think you've noted astutely, Brian, and because you've been following us so long, a change and it's a substantial change in, I believe, the perspective of how, at least within our given markets, we need to be more judicious in our capital expenditures about creating additional capacities and opportunities for growth. The leverage, if you will, for building a new center and having it become operationally in line with our revenue projections will make these acquisitions of -- or not acquisitions, but the construction of these denovo centers for us less than a 5 times multiple of their EBITDA.

So I think we are being careful and responsible in managing our cash flow and capital expenditures in a way that we think long term will be far more beneficial for the Company's strategic purposes.

Brian Tanquilut

Yes, that makes a lot of sense, Howard. I guess my next question, as I think about your AI strategy and your big push into cancer, we've heard of the Cancer Moonshot being revived here. Just want to hear your thoughts about it. I guess, taking it a step further, my understanding of your strategy, right, where you think or you believe that your AI push into cancer will open the door for top line growth as more screening is encouraged by the payors. So I guess, the question there is, how are those conversations going because obviously we've seen some of these efforts in the past, whether it's CTs to replace colonoscopies or Cologuard, for that matter. Just curious how you're thinking the landscape will evolve where the protocol becomes imaging for cancer screening instead of the existing protocols that are out there.

Dr. Howard Berger

Thanks, Brian. Another good question. If we take a look down the road, which I believe now is a little clearer than it might have been a couple of years ago, there's a number of initiatives which the Cancer Moonshot program has really highlighted. That is that technology has been a major driver in making cancer screening a reality. What I mean by that are two things. Number one, as the equipment itself improves in both resolution and shortening scanning times and making it a more cost-effective and better experience for our patients, the ability for us to do screening for breast, lung, prostate and cancer now becomes a much more realistic financial or economic aspiration. What used to take us, for example, an MRI scanning for doing a prostate MRI of half hour or more, and now with modified tools and other artificial intelligence which is embedded in the equipment itself, allow us to reduce that scanning time to perhaps as little as five minutes. Therefore, we can bring down the cost of screening for prostate into something more like what there is today for breast cancer screening using mammography.

Therein lies really the opportunity which artificial intelligence adding that on, will do two things. Number one, will help identify cancers earlier than other tools, both inside and outside imaging, and create greater accuracy. Not to mention that if these screening tools have the kind of adoption that we think is inevitable, we're going to need artificial intelligence to help the demand to read and interpret all of these imaging procedures much more efficiently than currently exists and in an environment where there's already a shortage of radiologist personnel.

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Our need and responsibility, and which we think if you read the White House's press release about reviving Cancer Moonshot, almost looks like it could have been something that we wrote about cancer screening. When you talk about cancer screening, while we can talk about things like Cologuard or even some of these other blood tests, they don't identify if they do see a high risk or potential for cancer, where that cancer is and which part of the body it is. The only way we believe they have effective cancer screening is really through imaging protocols and particularly the four cancers that I mentioned - breast, lung, prostate and colon - represent 70% of all solid tumors. So, we're talking about something which could have a major impact on cancer, both in terms of screening people earlier and changing the curve, if you will, about morbidity and cost for the system.

Our responsibility, as well as that of the government, is really not just to put these tools in place, but to also get our patients and the population to come to these tools. So in regard to I think what you're talking about, we see as part of our strategy here is not only bringing artificial intelligence to RadNet centers, but working with other providers out there, other imaging centers, hospitals to provide cancer screening networks which we believe we can be instrumental in making happen and create networks throughout the country that, along with helping create new tools or even plans within the healthcare payors, to drive more and more people for compliance.

So, as we see, what we call our network strategy in population health initiatives, we believe there will be opportunities to drive revenue into this Company that are capital light, if you will, and at the same time help provide what is really necessary to get Cancer Moonshot off the ground.

So we're looking at this as not only a great opportunity for RadNet, but more importantly a great opportunity for the healthcare industry and population health management.

Operator

We'll take our next question from Sarah James with Barclays. Please go ahead.

Steve Braun

Hi guys. This is Steve Braun on for Sarah. I just had a question...

Mark Stolper

Hi Steve.

Steve Braun

Hey guys. Just had a question going back to the priorities for capital deployment. I think last quarter it seems like you had highlighted fielding more inbound calls from payors to move business away from traditional brick-and-mortar hospitals. I guess can you talk about how that's evolved up through the end of the year and the beginning of the year? Also update us on the view for the JV strategy. As it relates to where you see it going as a percentage of your imaging centers, do you still think that it could be half of imaging centers versus, I guess, it's roughly 25% or 30% in 3Q?

Dr. Howard Berger

Yes. Thank you, Steve. Good morning. The change that has occurred really is discussions that we're having with the payors in our various markets as to programs we can begin implementing that will help direct patients into outpatient centers, and particularly RadNet centers. So this is the first time that we've really seen a more aggressive effort on the part of the payors to do this. I believe that in large part, this may actually be occurring as an outgrowth of COVID because more and more people are less inclined to go into a hospital environment because of the concerns that they have for COVID, which are very likely to persist for a very long time.

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So, I believe that has provided some additional impetus to the payors to talk to us, given that our network strategy and our markets provides us with an enormous amount of access where they can make substantial strides in. So while I can't necessarily quantify to what extent that has happened, we hope to be able to facilitate that for the payors as well as our own centers here as we move into 2022 -- excuse me, past (phon) 2020/22.

So we're really having discussions that we really never had before with virtually almost every major payor out there in terms of not only how we take business (inaudible) starting conversations with them about screening technology and artificial intelligence to help further distinguish the outpatient ambulatory imaging center marketplace versus the hospital. So, we think this is very much a shift in sentiment that we've seen starting in the second half of 2021 and with that we hope to have conversations about how the insurance company can actually change their plans in order to encourage more business being directed into outpatient centers as well as more screening tools.

So, we're very confident that our same store center growth, which generally we assume will be about 2% to 3%, could be significantly higher than that. But I think we have to wait through the remainder of this year to see how much of that we really can realize. I will say that starting off this year, while January still had a significant impact from the Omicron surge that spread from the second half into January, February volumes are very impressive and I think are reflecting a number of the elements of shift of business into our centers, particularly on the East Coast here and virtually every market that we're in.

I'm not sure I answered your second question, Steve. If you want to repeat that for me?

Steve Braun

Yes, I guess, I was just looking to get to see if the joint ventures with the hospital systems, are they roughly flat from 3Q at 25% to 30% or have they improved at all in 4Q?

Dr. Howard Berger

Yes, thank you for reminding me of that, Steve. Yes, there is a slow shift where they were about 25% coming into 2021. They're now probably closer to 30%. We believe a number of initiatives that we're working on and our goal is to be able to drive that number closer to 50% within the next couple of years. That will come from both current centers that we have that we put in with some of our current joint venture partners

Howard Berger

Yes, thank you for reminding me that, Steve. There is a slow shift where they were about 25% coming into 2021. They're now probably closer to 30%. We believe a number of initiatives that we're working on and our goal is still to drive that number closer to 50% within the next couple of years. That will come from both current centers that we have that we put in with some of our current joint venture partners as well as new joint ventures that we're starting to get some inbound calls from about this opportunity.

I think that RadNet's health system initiatives for joint ventures has really started to take root. And a number of the systems that we work with are so large and have other sites and even states that we could potentially move into as long as we can do that with joint venture partners that we're getting a very good inbound calls from people that want us to look at venture even beyond the core markets that we're currently in.

So we're as confident that not only that strategy itself is a good strategy for us, but that the opportunity to grow our imaging centers into almost half of them being in joint ventures is very realistic.

Operator

We'll take our next question from Mitra Ramgopal with Sidoti.

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Mitra Ramgopal

Yes, a couple of questions for me. First, I was just curious as it relates to the tight labor market and the significantly higher costs you're incurring, if there's anything you can do to help maybe mitigate some of the impact?

Howard Berger

Yes, there are and they are initiatives that we started working on last year. Many of the equipment manufacturers have developed new tools, which shorten scan times and allow remote operation of some of our equipment. Both of these, we believe, will have the ability for us to improve our capacity for helping manage the demand that we have, while not necessarily requiring additional labor, particularly technologists, to perform them.

That is a big part of our 2022 and rolling into 2023 initiatives. And we that along with artificial intelligence, which we think can create additional capacity both at the scanner level as well as efficiency by our professional and nonprofessional staff, we think will help address some of the labor shortages. So I think there is a bright light on the horizon about addressing the labor shortage, not with just the -- trying to find more and more technologies.

But how to create additional capacity within our existing centers without necessarily needing to increase -- part of that, so thank you for bringing that up because it is a big initiative that we're working directly with almost all of the OEMs for tools that they have or tools that we're trying to suggest to them in the way of equipment design that will help facilitate throughput capacity.

Mitra Ramgopal

Okay, no, that's great. And then just back on the AI division. I know it's still very early days here, and you're anticipating a loss of $12 million to $17 million this year. Just a big picture in terms of your expectation for when, you might expect this division as a stand-alone to start breaking even and eventually contributing to profits?

Howard Berger

Okay. This is a bold initiative, but it's something that I think has to be done, whether it would be done by RadNet or somebody else. We believe we have right milieu to create these opportunities. Based on some of our preliminary numbers, we think that within 24 months or thereabouts that the AI division will start contributing positively to the company's profitability.

If indeed that's the case. I think whatever the burden from a cash burn standpoint, it takes over the next 2 years will be well worth it, not just for RadNet, but for the industry as a whole. All of this could be facilitated to the extent that the President's plan to revive Cancer Moonshot is taken up very seriously and a number of initiatives that we think they should be doing, such as expediting FDA approval for 510(k) clearance of some of our new algorithms.

Helping to create screening networks and engaging people like RadNet, who clearly understand the outpatient world into the discussion. We have entered the portal and hope to be part of the summit, which I hope will take place somewhere next -- in the next 60 to 90 days so that our voice, not just as RadNet, but as a steward for the potential opportunity to make cancer screening, using imaging a reality is heard, and we are engaging a number of resources inside and outside the company to try to jump-start that.

So the 2-year perspective to make this division more contributing to the company's profitability could be shortened if we are effective in having our voice heard both on local levels with payors and on a national level with the federal government.

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Mitra Ramgopal

Okay for additional color. And then finally, just as it relates to Omicron I'm assuming now as we're sort of exiting the first quarter by 2Q going forward, you should be anticipating back to normal levels in terms of patient volumes, but also internally with your workforce not being as impacted as you saw in 4Q. Is that fair?

Howard Berger

Yes, it is. I think assuming that there's not another surge over the horizon and -- and who knows what impact the current geopolitical issues may have. We're very optimistic that not only do we see our volumes returning to normal, but also a lot of the delayed care that people experienced during the 2 years that we've been in COVID, I believe, are starting to come together.

So the opening up of the cities, the major metropolitan cities that we predominantly have centers in, should have this kind of an impact. I may note that to the extent that people read the press release from the White House about Cancer Moonshot there. The headline in their press release was that they estimated that 9.2 million women did not receive their normal screening mammography during this 2-year period and the potential for a large increase in the number of identified cancers was likely.

That same logic applies to lung cancer, prostate cancer and colorectal cancer, given that those are all elective procedures that people clearly did not undertake as normally as they would. So the prospects for the opportunity to really reengage the public and to heighten that but hopefully, some efforts on the part of the federal government and the payors could have substantial implications not only for RadNet, but all imaging providers.

Operator

We have no further questions in the queue. At this time, I'd like to turn the conference back to Dr. Berger for any additional or closing remarks.

Howard Berger

Again, I would like to take the opportunity to thank all of our shareholders for their continued support and particular employees of RadNet for their dedication and hard work. Management will continue its endeavor to be a market leader that provides great services with an appropriate return on investment for all shareholders. Thank you for your time today, and I look forward to our next call. Take care and stay safe.

Operator

Ladies and gentlemen, this concludes today's conference. We appreciate your participation. You may now disconnect.

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