Item 8. Financial Statements and Supplementary Data.
INDEX TO FINANCIAL STATEMENTS
|
|
Audited Consolidated Financial Statements: |
|
Report of Independent Registered Public Accounting Firm (PCAOB ID 238) |
78 |
Consolidated Balance Sheets as of December 31, 2025 and 2024 |
79 |
Consolidated Statements of Operations and Comprehensive Loss for the Years ended December 31, 2025, 2024 and 2023 |
81 |
Consolidated Statements of Stockholders’ Equity for the Years ended December 31, 2025, 2024 and 2023 |
82 |
Consolidated Statements of Cash Flows for the Years ended December 31, 2025, 2024 and 2023 |
83 |
Notes to Consolidated Financial Statements |
84 |
Audited Financial Statements of BTDI JV, LLP and Subsidiaries presented pursuant to Rule 3-09 of Regulation S-X: |
|
Report of Independent Auditors |
125 |
Consolidated Balance Sheets as of December 31, 2025 and 2024 |
127 |
Consolidated Statements of Income for the years ended December 31, 2025, 2024 and 2023 |
128 |
Consolidated Statements of Partner’s Capital for the years ended December 31, 2025, 2024 and 2023 |
129 |
Consolidated Statements of Cash Flows for the years ended December 31, 2025, 2024 and 2023 |
130 |
Notes to Consolidated Financial Statements |
131 |
Report of Independent Registered Public Accounting Firm
To the Board of Directors and Stockholders of Lumexa Imaging Holdings, Inc.
Opinion on the Financial Statements
We have audited the accompanying consolidated balance sheets of Lumexa Imaging Holdings, Inc. and its subsidiaries (the “Company”) as of December 31, 2025 and 2024, and the related consolidated statements of operations and comprehensive loss, stockholders’ equity and cash flows for each of the three years in the period ended December 31, 2025, including the related notes (collectively referred to as the “consolidated financial statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the Company as of December 31, 2025 and 2024, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2025 in conformity with accounting principles generally accepted in the United States of America.
Basis for Opinion
These consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion on the Company’s consolidated financial statements based on our audits. We are a public accounting firm registered with the Public Company Accounting Oversight Board (United States) (PCAOB) and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our audits of these consolidated financial statements in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud.
Our audits included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the consolidated financial statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements. We believe that our audits provide a reasonable basis for our opinion.
/s/ PricewaterhouseCoopers LLP
Raleigh, North Carolina
March 30, 2026
We have served as the Company’s auditor since 2018.
LUMEXA IMAGING holdings, inc.
Consolidated Balance Sheets
December 31, 2025 and 2024
(in thousands, except for common shares)
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
ASSETS |
|
|
|
|
|
|
Cash and cash equivalents |
|
$ |
58,828 |
|
|
$ |
26,131 |
|
Accounts receivable |
|
|
112,942 |
|
|
|
107,046 |
|
Accounts receivable, related party |
|
|
18,893 |
|
|
|
23,308 |
|
Other receivables |
|
|
19,015 |
|
|
|
5,644 |
|
Prepaid expenses |
|
|
17,582 |
|
|
|
10,391 |
|
Total current assets |
|
|
227,260 |
|
|
|
172,520 |
|
Property and equipment, net of accumulated depreciation |
|
|
144,709 |
|
|
|
121,133 |
|
Operating lease right-of-use assets |
|
|
76,555 |
|
|
|
80,792 |
|
Investments in unconsolidated affiliates |
|
|
423,191 |
|
|
|
415,819 |
|
Intangible assets, net of accumulated amortization |
|
|
41,335 |
|
|
|
47,788 |
|
Goodwill |
|
|
807,554 |
|
|
|
807,554 |
|
Other assets |
|
|
43,953 |
|
|
|
24,958 |
|
TOTAL ASSETS(1) |
|
$ |
1,764,557 |
|
|
$ |
1,670,564 |
|
LIABILITIES AND EQUITY |
|
|
|
|
|
|
Accounts payable |
|
$ |
44,857 |
|
|
$ |
29,889 |
|
Accrued expenses and other current liabilities |
|
|
95,561 |
|
|
|
108,454 |
|
Accounts receivable pledging arrangement |
|
|
1,599 |
|
|
|
— |
|
Current portion of long-term debt |
|
|
13,112 |
|
|
|
16,001 |
|
Current portion of finance lease liabilities |
|
|
11,552 |
|
|
|
5,509 |
|
Current portion of operating lease liabilities |
|
|
12,513 |
|
|
|
13,807 |
|
Total current liabilities |
|
|
179,194 |
|
|
|
173,660 |
|
Long-term debt, less current maturities |
|
|
819,029 |
|
|
|
1,185,080 |
|
Long-term finance lease liabilities, less current maturities |
|
|
33,262 |
|
|
|
16,120 |
|
Long-term operating lease liabilities, less current maturities |
|
|
71,437 |
|
|
|
72,746 |
|
Deferred income taxes |
|
|
40,772 |
|
|
|
32,696 |
|
Other liabilities |
|
|
34,740 |
|
|
|
28,608 |
|
Total liabilities(1) |
|
|
1,178,434 |
|
|
|
1,508,910 |
|
COMMITMENTS AND CONTINGENCIES (Note 15) |
|
|
|
|
|
|
EQUITY (2): |
|
|
|
|
|
|
Common stock, $0.001 par value, 1,000,000,000 shares authorized, 96,109,927 shares issued and outstanding at December 31, 2025 and 69,523,830 shares issued and outstanding at December 31, 2024 |
|
|
96 |
|
|
|
70 |
|
Additional paid-in-capital |
|
|
1,217,087 |
|
|
|
745,540 |
|
Accumulated deficit |
|
|
(631,060 |
) |
|
|
(583,956 |
) |
Total equity |
|
|
586,123 |
|
|
|
161,654 |
|
TOTAL LIABILITIES AND EQUITY |
|
$ |
1,764,557 |
|
|
$ |
1,670,564 |
|
(1)The Company’s consolidated balance sheets include assets of consolidated variable interest entities(“VIEs”), that can only be used to settle obligations and liabilities of the VIE and for which creditors do not have recourse to the primary beneficiary (Lumexa Imaging Holdings, Inc.). As of December 31, 2025 and 2024, total assets of consolidated VIEs consisted of accounts receivable of $49,560 and $47,175, respectively; accounts receivable, related party of $5,811 and $5,078, respectively; prepaid expenses of $1,502 and $1,103, respectively; other receivables of $4,463 and $4,621, respectively; property and equipment, net of accumulated depreciation of $17,669 and $10,600, respectively; operating lease right-of-use assets of $9,541 and $8,021, respectively; goodwill of $101,802 and $101,802, respectively; investments in unconsolidated affiliates of $54,087 and $53,350, respectively; and other assets of $21,554 and $17,872, respectively. As of December 31, 2025 and 2024, total liabilities of consolidated VIEs consisted of accounts payable of $373 and $369, respectively; accrued expenses and other current liabilities of $18,150 and $20,895, respectively; current portion of operating leases of $1,647 and $2,917, respectively; other liabilities of $25,724 and $23,162, respectively; and long-term operating lease liabilities, less current maturities of $8,492 and $5,598, respectively. See Note 17 “Variable Interest Entities” for further discussion.
(2)Both the number of shares outstanding and their par value have been retrospectively recast for all prior periods presented to reflect the par value of the outstanding stock of Lumexa Imaging Holdings, Inc. as a result of the Equity Reorganization. See Note 1 -“Nature of Operations and Basis of Presentation” and Note 3 - “Loss per Share.”
The accompanying notes are an integral part of these consolidated financial statements.
LUMEXA IMAGING holdings, inc
Consolidated Statements of Operations and Comprehensive Loss
Years Ended December 31, 2025, 2024 and 2023
(in thousands, except for share and per share data)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
REVENUES: |
|
|
|
|
|
|
|
|
|
Net patient service revenue |
|
$ |
766,696 |
|
|
$ |
715,560 |
|
|
$ |
747,738 |
|
Net patient service revenue, related party |
|
|
36,011 |
|
|
|
31,290 |
|
|
|
19,653 |
|
Management fee and other revenue |
|
|
19,622 |
|
|
|
14,951 |
|
|
|
4,526 |
|
Management fee and other revenue, related party |
|
|
200,752 |
|
|
|
187,068 |
|
|
|
164,008 |
|
Total revenues |
|
|
1,023,081 |
|
|
|
948,869 |
|
|
|
935,925 |
|
OPERATING EXPENSES: |
|
|
|
|
|
|
|
|
|
Cost of operations, excluding depreciation and amortization |
|
|
865,516 |
|
|
|
852,606 |
|
|
|
836,958 |
|
General and administrative expenses |
|
|
90,453 |
|
|
|
70,361 |
|
|
|
55,165 |
|
Depreciation and amortization |
|
|
40,379 |
|
|
|
42,164 |
|
|
|
56,630 |
|
Goodwill impairment charge |
|
|
— |
|
|
|
— |
|
|
|
18,969 |
|
Loss on disposal of property and equipment |
|
|
968 |
|
|
|
— |
|
|
|
1,285 |
|
Total operating expenses |
|
|
997,316 |
|
|
|
965,131 |
|
|
|
969,007 |
|
Equity in earnings of unconsolidated affiliates |
|
|
72,135 |
|
|
|
71,505 |
|
|
|
55,527 |
|
INCOME FROM OPERATIONS |
|
|
97,900 |
|
|
|
55,243 |
|
|
|
22,445 |
|
OTHER INCOME AND EXPENSES: |
|
|
|
|
|
|
|
|
|
Interest expense |
|
|
118,539 |
|
|
|
136,027 |
|
|
|
141,694 |
|
Loss on extinguishment of debt |
|
|
13,453 |
|
|
|
703 |
|
|
|
— |
|
Other income |
|
|
(1,873 |
) |
|
|
— |
|
|
|
— |
|
Gain on imaging center sold, related party |
|
|
— |
|
|
|
(2,294 |
) |
|
|
— |
|
Total other expenses |
|
|
130,119 |
|
|
|
134,436 |
|
|
|
141,694 |
|
LOSS BEFORE INCOME TAXES |
|
|
(32,219 |
) |
|
|
(79,193 |
) |
|
|
(119,249 |
) |
Income tax provision |
|
|
14,885 |
|
|
|
14,906 |
|
|
|
2,978 |
|
NET LOSS AND COMPREHENSIVE LOSS |
|
$ |
(47,104 |
) |
|
$ |
(94,099 |
) |
|
$ |
(122,227 |
) |
NET LOSS PER SHARE: |
|
|
|
|
|
|
|
|
|
Weighted average shares outstanding—Basic and diluted |
|
|
70,978,092 |
|
|
|
69,469,401 |
|
|
|
69,412,457 |
|
Basic and diluted loss per share |
|
$ |
(0.66 |
) |
|
$ |
(1.35 |
) |
|
$ |
(1.76 |
) |
The accompanying notes are an integral part of these consolidated financial statements.
LUMEXA IMAGIng holdings, inc.
Consolidated Statements of Stockholders’ Equity
Years Ended December 31, 2025, 2024 and 2023
(in thousands, except common shares)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common Stock |
|
|
Additional |
|
|
Accumulated |
|
|
Total Stockholders' |
|
|
|
Shares |
|
|
Amount |
|
|
paid-in-capital |
|
|
Deficit |
|
|
Equity |
|
Balance at December 31, 2022 |
|
|
69,377,838 |
|
|
$ |
70 |
|
|
$ |
630,780 |
|
|
$ |
(367,630 |
) |
|
$ |
263,220 |
|
Capital contributions |
|
|
112,360 |
|
|
|
— |
|
|
|
2,255 |
|
|
|
— |
|
|
|
2,255 |
|
Repurchase of incentive units |
|
— |
|
|
|
— |
|
|
|
(118 |
) |
|
|
— |
|
|
|
(118 |
) |
Stock-based compensation |
|
— |
|
|
|
— |
|
|
|
55,296 |
|
|
|
— |
|
|
|
55,296 |
|
Net loss |
|
— |
|
|
|
— |
|
|
|
|
|
|
(122,227 |
) |
|
|
(122,227 |
) |
Balance at December 31, 2023 |
|
|
69,490,198 |
|
|
|
70 |
|
|
|
688,213 |
|
|
|
(489,857 |
) |
|
|
198,426 |
|
Capital contributions |
|
|
33,632 |
|
|
|
— |
|
|
|
673 |
|
|
|
— |
|
|
|
673 |
|
Stock-based compensation |
|
|
— |
|
|
|
— |
|
|
|
56,654 |
|
|
|
— |
|
|
|
56,654 |
|
Net loss |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(94,099 |
) |
|
|
(94,099 |
) |
Balance at December 31, 2024 |
|
|
69,523,830 |
|
|
|
70 |
|
|
|
745,540 |
|
|
|
(583,956 |
) |
|
|
161,654 |
|
Capital contributions |
|
|
41,605 |
|
|
|
— |
|
|
|
835 |
|
|
|
— |
|
|
|
835 |
|
Vesting of restricted stock units |
|
|
13,513 |
|
|
|
— |
|
|
|
250 |
|
|
|
— |
|
|
|
250 |
|
Issuance of restricted stock awards |
|
|
95,061 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Conversion of retention bonus into restricted stock units |
|
|
— |
|
|
|
— |
|
|
|
2,161 |
|
|
|
|
|
|
2,161 |
|
Stock-based compensation |
|
|
— |
|
|
|
— |
|
|
|
38,779 |
|
|
|
— |
|
|
|
38,779 |
|
Common stock converted from historical profits interest units |
|
|
1,435,918 |
|
|
|
1 |
|
|
|
2,574 |
|
|
|
— |
|
|
|
2,575 |
|
Shares issued and issuance of common stock in connection with initial public offering, net of underwriting discounts, commissions and other offering costs |
|
|
25,000,000 |
|
|
|
25 |
|
|
|
426,948 |
|
|
|
— |
|
|
|
426,973 |
|
Net loss |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(47,104 |
) |
|
|
(47,104 |
) |
Balance at December 31, 2025 |
|
|
96,109,927 |
|
|
$ |
96 |
|
|
$ |
1,217,087 |
|
|
$ |
(631,060 |
) |
|
$ |
586,123 |
|
The accompanying notes are an integral part of these consolidated financial statements.
LUMEXA IMAGING holdings, inc.
Consolidated Statements of Cash Flows
Years Ended December 31, 2025, 2024 and 2023
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
CASH FLOWS FROM OPERATING ACTIVITIES: |
|
|
|
|
|
|
|
|
|
Net loss |
|
$ |
(47,104 |
) |
|
$ |
(94,099 |
) |
|
$ |
(122,227 |
) |
Adjustments to reconcile net loss to net cash provided by operating activities |
|
|
|
|
|
|
|
|
|
Depreciation and amortization |
|
|
40,379 |
|
|
|
42,164 |
|
|
|
56,630 |
|
Amortization of operating lease right-of-use assets |
|
|
15,010 |
|
|
|
14,961 |
|
|
|
15,436 |
|
Amortization of debt issuance costs |
|
|
5,739 |
|
|
|
6,185 |
|
|
|
6,312 |
|
Amortization of cloud computing implementation costs |
|
|
439 |
|
|
|
— |
|
|
|
— |
|
Write-off of debt issuance costs due to extinguishment of debt |
|
|
5,435 |
|
|
|
703 |
|
|
|
— |
|
Equity in earnings of unconsolidated affiliates |
|
|
(72,135 |
) |
|
|
(71,505 |
) |
|
|
(55,527 |
) |
Distributions from investments in unconsolidated affiliates |
|
|
64,885 |
|
|
|
79,531 |
|
|
|
59,881 |
|
Loss on disposal of property and equipment |
|
|
968 |
|
|
|
— |
|
|
|
1,285 |
|
Gain on insurance recovery for disposed property and equipment |
|
|
(1,873 |
) |
|
|
— |
|
|
|
— |
|
Gain on imaging center sold, related party |
|
|
— |
|
|
|
(2,294 |
) |
|
|
— |
|
Non-cash change in fair value of interest rate caps |
|
|
— |
|
|
|
1,274 |
|
|
|
4,984 |
|
Deferred income taxes |
|
|
8,076 |
|
|
|
9,753 |
|
|
|
611 |
|
Stock-based compensation |
|
|
41,604 |
|
|
|
56,654 |
|
|
|
55,296 |
|
Goodwill impairment charge |
|
|
— |
|
|
|
— |
|
|
|
18,969 |
|
Changes in operating assets and liabilities: |
|
|
|
|
|
|
|
|
|
Accounts receivable |
|
|
(5,896 |
) |
|
|
2,354 |
|
|
|
(14,848 |
) |
Accounts receivable, related party |
|
|
4,554 |
|
|
|
(8,584 |
) |
|
|
2,266 |
|
Capitalized cloud computing implementation costs |
|
|
(5,940 |
) |
|
|
— |
|
|
|
— |
|
Other receivables |
|
|
(12,669 |
) |
|
|
907 |
|
|
|
(2,715 |
) |
Prepaid expenses |
|
|
(6,277 |
) |
|
|
(911 |
) |
|
|
917 |
|
Other assets |
|
|
(7,361 |
) |
|
|
(5,952 |
) |
|
|
(11,441 |
) |
Accounts payable |
|
|
14,415 |
|
|
|
2,948 |
|
|
|
4,759 |
|
Accrued expenses and other current liabilities |
|
|
(17,932 |
) |
|
|
12,078 |
|
|
|
22,881 |
|
Other liabilities |
|
|
6,133 |
|
|
|
7,109 |
|
|
|
8,471 |
|
Operating lease liabilities |
|
|
(13,376 |
) |
|
|
(12,549 |
) |
|
|
(14,426 |
) |
Net cash provided by operating activities |
|
|
17,074 |
|
|
|
40,727 |
|
|
|
37,514 |
|
CASH FLOWS FROM INVESTING ACTIVITIES: |
|
|
|
|
|
|
|
|
|
Proceeds from sale or disposal of property and equipment |
|
|
2,643 |
|
|
|
361 |
|
|
|
— |
|
Purchases of property and equipment |
|
|
(23,477 |
) |
|
|
(27,773 |
) |
|
|
(24,007 |
) |
Cash paid for acquisition |
|
|
— |
|
|
|
— |
|
|
|
(3,200 |
) |
Proceeds from sale of businesses |
|
|
— |
|
|
|
3,744 |
|
|
|
— |
|
Proceeds from sale of business, related party |
|
|
— |
|
|
|
1,385 |
|
|
|
— |
|
Contributions to investments in unconsolidated affiliates |
|
|
(123 |
) |
|
|
— |
|
|
|
(2,450 |
) |
Net cash used in investing activities |
|
|
(20,957 |
) |
|
|
(22,283 |
) |
|
|
(29,657 |
) |
CASH FLOWS FROM FINANCING ACTIVITIES: |
|
|
|
|
|
|
|
|
|
Proceeds from initial public offering, net of underwriting discounts and commissions |
|
|
434,750 |
|
|
|
— |
|
|
|
— |
|
Transaction costs incurred in connection with initial public offering |
|
|
(7,777 |
) |
|
|
— |
|
|
|
— |
|
Payment of third-party debt issuance costs |
|
|
(9,304 |
) |
|
|
(506 |
) |
|
|
— |
|
Proceeds from long-term debt, net of issuance costs |
|
|
827,848 |
|
|
|
10,608 |
|
|
|
8,934 |
|
Payments of long-term debt |
|
|
(1,204,056 |
) |
|
|
(11,845 |
) |
|
|
(15,111 |
) |
Proceeds from revolving line of credit |
|
|
5,000 |
|
|
|
30,000 |
|
|
|
15,000 |
|
Repayments of revolving line of credit |
|
|
(5,000 |
) |
|
|
(30,000 |
) |
|
|
(15,000 |
) |
Payments of finance lease liabilities |
|
|
(7,315 |
) |
|
|
(11,429 |
) |
|
|
(4,729 |
) |
Capital contributions |
|
|
835 |
|
|
|
673 |
|
|
|
2,255 |
|
Proceeds from accounts receivable pledging arrangement |
|
|
1,599 |
|
|
|
— |
|
|
|
— |
|
Payments for repurchase of incentive units |
|
|
— |
|
|
|
— |
|
|
|
(118 |
) |
Net cash provided by (used in) financing activities |
|
|
36,580 |
|
|
|
(12,499 |
) |
|
|
(8,769 |
) |
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS |
|
|
32,697 |
|
|
|
5,945 |
|
|
|
(912 |
) |
CASH AND CASH EQUIVALENTS, beginning of year |
|
|
26,131 |
|
|
|
20,186 |
|
|
|
21,098 |
|
CASH AND CASH EQUIVALENTS, end of year |
|
$ |
58,828 |
|
|
$ |
26,131 |
|
|
$ |
20,186 |
|
The accompanying notes are an integral part of these consolidated financial statements.
LUMEXA IMAGING holdings, inc
Notes to Consolidated Financial Statements
1. Organization and Nature of Business
Lumexa Imaging Holdings, Inc., a Delaware corporation, (the “Company”) was incorporated on November 14, 2025. On December 10, 2025, Lumexa Imaging Equity Holdco, LLC (formerly US Radiology Specialists Holdings LLC) (“Holdings LLC”) contributed 100% of its equity in its wholly owned consolidated operating entities to the Company in exchange for 68,856,706 shares of the Company’s common stock, par value $0.001 per share (“Common Stock”) at the time of the pricing of the Company’s initial public offering (“IPO”), and the Company agreed to issue certain additional shares of Common Stock in the future in respect of certain Holdings LLC Incentive Units that remained outstanding after the IPO (such contribution, the “Equity Reorganization”). The number of shares received by Holdings LLC in the Equity Reorganization was calculated based on a distribution ratio of 1 share of Common Stock per 9 units of Holdings LLC. The Equity Reorganization was accounted for as a common control transaction as it did not result in a change of control over the Company's operating entities. The consolidated historical financial statements prior to the IPO are those of Holdings LLC and its consolidated subsidiaries after giving effect to the Equity Reorganization.
On December 12, 2025, the Company completed the IPO of 25,000,000 shares of Common Stock at a price to the public of $18.50 per share. The gross proceeds of the IPO were $462.5 million, before underwriting discounts of $27.8 million and offering costs of $7.8 million. $406.4 million of the net proceeds were used to pay down a portion of the Company's outstanding borrowings.
The Company, together with its subsidiaries, is a network of diagnostic outpatient imaging centers in the United States, many of which are operated directly or indirectly through investments in unconsolidated affiliates with hospital partners. The investments in unconsolidated affiliates are accounted for using the equity method of accounting. The Company also has relationships with physician-owned radiology practices, which provide professional services to the Company and third-party hospitals. The Company has operations in 13 states.
The Company operates its business through two wholly owned subsidiaries: Lumexa Imaging, Inc. (formerly US Radiology Specialists, Inc., (“LII”)) and Lumexa Imaging Outpatient, Inc. (formerly US Outpatient Imaging Specialists, Inc., (“LIOI”)). The consolidated financial statements include the accounts of Lumexa Imaging Holdings, Inc., its wholly owned subsidiaries and entities in which the Company has a controlling financial interest, also known as a variable interest entity (“VIE”). Generally accepted accounting principles in the United States of America (“GAAP”) require variable interest entities to be consolidated if an entity’s interest in the VIE is a controlling financial interest. See further discussion of VIEs in Note 2 “Summary of Significant Accounting Policies.”
2. Summary of Significant Accounting Policies
Principles of Consolidation and Basis of Financial Statement Presentation
The consolidated financial statements include the accounts of the Company, its wholly owned subsidiaries and controlled affiliates that are considered to be VIEs for which the Company is the primary beneficiary. See “Variable Interest Entities” below for further discussion of the Company’s VIEs. Investments in companies in which the Company has the ability to exercise significant influence, but not control, are accounted for under the equity method of accounting.
All significant intercompany accounts and transactions with consolidated entities have been eliminated in consolidation. The Company does not have any components of other comprehensive income within its consolidated financial statements, and, therefore, does not separately present a statement of comprehensive income in its consolidated financial statements. The accompanying consolidated financial statements have been prepared in conformity with accounting principles generally accepted in the United States of America (“US GAAP”).
The Company presents equity in earnings from investments in unconsolidated affiliates as a component of operating income since the activities of the investees are closely aligned with the operations of the Company.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
Use of Estimates
The preparation of the consolidated financial statements in conformity with US GAAP requires the use of estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. The most significant assumptions and estimates underlying these consolidated financial statements and accompanying notes involve calculation of the Company’s provision for price concessions reducing revenue, allowances on accounts receivable, the fair value of assets and liabilities acquired in business combinations, the fair value of common units issued in business combinations, useful lives of property and equipment, long-lived asset and goodwill impairment analyses, valuation allowance on deferred tax assets, and the fair value of equity incentive units. These estimates involve judgments with respect to numerous factors that are difficult to predict and are beyond management’s control. Although the Company believes its assumptions are reasonable, actual results could differ from those estimates.
Variable Interest Entities
US GAAP requires an entity to consolidate a VIE if the entity is determined to be the primary beneficiary of the VIE. Under the VIE model, the primary beneficiary is the party that meets both the following criteria: it has (i) the power to direct the activities of the VIE that most significantly impact the VIE’s economic performance and (ii) the obligation to absorb the losses, or the right to receive benefits, from the VIE that could potentially be significant to the VIE. The Company determines whether the Company is the primary beneficiary of a VIE through a qualitative analysis. As the primary beneficiary, the VIE’s assets, liabilities and results of operations are included in the Company’s consolidated financial statements (see Note 17 “Variable Interest Entities”). The creditors of the VIEs do not have recourse to the Company’s general credit, however, the Company may need to provide financial support to cover any operating expenses in excess of operating revenues in the VIEs. The Company performs ongoing reassessments of whether changes in the facts and circumstances regarding the Company’s involvement with a VIE will cause the consolidation conclusion to change. Changes in consolidation status, if any, are applied prospectively.
The consolidated financial statements include VIEs in which the Company is the primary beneficiary. Those VIEs include Charlotte Radiology, P.A. (“CRAD”), Connexia, LLC (“Connexia”), South Jersey Radiology Associates, P.A. (“South Jersey”), Radiology Associates of Burlington County, P.A. (“RABC”), Larchmont Imaging Associates, L.L.C. (“LIA”), Upstate Carolina Radiology, P.A. (“UCR”), and Windsong Radiology Group, P.C. (“Windsong”) (collectively, the “VIE Physician Practices”). Additionally, one of the Company’s wholly owned subsidiaries, American Health Imaging, Inc. (“AHI”), provides management and administrative services to five unaffiliated physician-owned imaging centers which use the AHI name (“Franchise Centers”). The Franchise Centers are also considered VIEs that the Company consolidates. Transactions with VIEs are eliminated in consolidation.
Revenues
Net Patient Service Revenue
The Company’s revenues are generated by providing diagnostic imaging services (i.e. scans) and physician interpretation services (i.e. reads) to patients within outpatient imaging centers. The Company also earns professional services revenue where revenue is earned by providing physician interpretation services to patients at hospitals or other sites of care. The contractual relationships with patients (i.e., the customers), in most cases, also involve a third-party payor. Third-party payors include entities such as Medicare, Medicaid, managed care health plans and commercial insurance companies. The fees for the services provided are dependent upon the terms provided by Medicare and Medicaid, or negotiated with managed care health plans and commercial insurance companies.
The payment arrangements with third-party payors for the services the Company provides to the related patients typically specify payments at amounts less than the Company’s standard charges and generally provide for payments based upon predetermined rates per diagnostic imaging service and physician interpretation service. The payment terms indicate that payment is due upon receipt and there is no significant financing component associated with the services provided. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
renegotiations and renewals. As such, revenue is recognized based on the Company’s estimate of the implicit price concessions (i.e. expected cash collections from patients and third-party payors) for each service offering rendered. The Company determines its estimate of implicit price concessions based on historical collection experience with classes of patients using a portfolio approach as a practical expedient. Performance obligations for net patient services revenue are recognized at the read date. This point in time is considered to be representative of the timing in which the respective performance obligations are satisfied. The Company has no obligation to provide further patient service, and because the Company primarily performs outpatient procedures, performance obligations are generally satisfied same day and revenue is recognized on the date of service.
The Company evaluates amounts collected in relation to billed charges and records estimated price concessions to account for the anticipated differences between billed amounts and amounts ultimately collected. Estimates of price concessions are reported in the period during which the services are provided even though the actual amounts may become known at a later date.
Accordingly, net patient service revenue is presented net of an estimated provision for price concessions. The Company estimates the allowance for price concessions based upon historical collections experience in relation to the amounts billed, changes in contractual rates, past adjustments, current contract and reimbursement terms, changes in payor mix, an aging of accounts receivable, and other relevant information.
The following table disaggregates net patient service revenue by major third-party payor source for the years ended December 31, 2025, 2024 and 2023:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Commercial insurance |
|
|
58 |
% |
|
|
57 |
% |
|
|
58 |
% |
Government—Medicare |
|
|
24 |
|
|
|
24 |
|
|
|
23 |
|
Government—Medicaid |
|
|
5 |
|
|
|
4 |
|
|
|
4 |
|
Attorney liens |
|
|
4 |
|
|
|
4 |
|
|
|
4 |
|
Self-pay |
|
|
3 |
|
|
|
4 |
|
|
|
4 |
|
Other third-party payors |
|
|
6 |
|
|
|
7 |
|
|
|
7 |
|
|
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
Management Fee and Other Revenue, Related Party
The Company has contracts with certain unconsolidated affiliates and other related parties to provide management and administrative services on a monthly basis. These management and administrative services include, but are not limited to, contract negotiation, claims processing, utilization review, operations management, information technology, human resources, risk management, legal, compliance, budgeting and finance, accounting, staffing, and marketing services.
Additionally, the Company provides management and administrative services to its consolidated VIEs, including CRAD, South Jersey, RABC, LIA, UCR, Windsong and Connexia, directly or through various wholly owned management service organization (“MSO”) subsidiaries. The MSOs provide management and administrative services including, but not limited to, contract negotiation, claims processing, utilization review, operations management, information technology, human resources, risk management, legal, compliance, budgeting and finance, accounting, and marketing services. These services are provided through administrative services agreements (“ASAs”), which have term lengths that are between 20 and 30 years long.
Pursuant to the ASAs, the Company receives fees from the VIEs, unconsolidated affiliates, and other related parties for the services performed. The Company has exclusive responsibility for the provision of all nonmedical services required for the day-to-day operation and management of the physician practices and outpatient imaging centers, which are subject to these ASAs. These fees charged to consolidated physician practices and outpatient imaging centers are eliminated in consolidation.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
AHI provides management and administrative services to the Franchise Centers pursuant to the associated franchise agreements. The franchise agreements have a term length of 20 years. The services include, but are not limited to, contract negotiation, claims processing, utilization review, operations management, information technology, human resources, risk management, legal, compliance, budgeting and finance, accounting, and marketing services. The Company, via AHI, receives royalty, billing, and management fees from the Franchise Centers for the use of the AHI name and the services performed. The Company has exclusive responsibility for the provision of all nonmedical services required for the day-to-day operation and management of the Franchise Centers. The fees received from the Franchise Centers are eliminated in consolidation.
These management agreements also provide for the recovery of clinical and management support costs that these entities incur based on their utilization of the Company’s clinical staff in their operations and actual costs incurred by the Company in delivering the management services (collectively referred to as “pass-through costs”).
The Company charges for the management and administrative services rendered based on a defined formula outlined in the contracts based on the net revenues of the related party. The amount recognized for the recovery of pass-through costs is based on the actual costs of leased employees providing the services. Both the charges for management and administrative services and the amounts recognized for the recovery of pass-through costs are considered variable consideration. There is no fixed consideration with respect to these arrangements. This revenue is reported within management fee and other revenue, related party.
The Company recognizes management fee revenue on a monthly basis as the performance obligations are satisfied over time (i.e., monthly revenues are recorded for the month to which the services relate), and any unpaid amounts are reflected in accounts receivable, related party in the consolidated balance sheets. The performance obligation with respect to management fee revenue is treated as a series of distinct services provided over the related contracts’ terms, because each month of services performed is substantially the same and has the same pattern of transfer to the customer. The remaining variable consideration at the end of each reporting period is allocated entirely to that single performance obligation. See Note 19 “Related Party Transactions” for further information regarding the Company’s related party transactions.
Management Fee and Other Revenue
Management fee and other revenue primarily consists of management and administrative services performed for third-party hospitals. This revenue is recognized as the performance obligations are satisfied over time and any unpaid amounts are reflected in accounts receivable in the consolidated balance sheets.
Cash and Cash Equivalents
The Company considers all highly liquid investments with maturities of three months or less when purchased to be cash equivalents. The Company maintains its cash on hand in bank deposit accounts which, at times, may exceed the Federal Deposit Insurance Corporation (“FDIC”) insured limit of $250,000.
Accounts Receivable
Accounts receivable represent charges to patients, third-party insurance payors, government-sponsored payors, and other payors for which payment has not been received. The Company continuously monitors collections from payors based upon specific payor collection issues that it has identified and historical experience. While changes in estimated reimbursement from third-party payors remain a possibility, the Company expects that any such changes would be minimal and, therefore, would not have a material effect on its financial condition or results of operations.
The Company’s collection policies and procedures are based on the type of payor, size of claim, and estimated collection percentage for each modality. The Company analyzes accounts receivable at each of its operating entities to ensure the proper collection and aged category. Collection efforts include direct contact with third-party payors or patients, written correspondence, and the use of legal or collection agency assistance, as required.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
The Company’s percentage of accounts receivable by payor class at December 31, 2025 and 2024, was as follows:
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Commercial insurance |
|
|
42 |
% |
|
|
43 |
% |
Attorney liens |
|
|
36 |
|
|
|
36 |
|
Government—Medicare |
|
|
12 |
|
|
|
11 |
|
Government—Medicaid |
|
|
3 |
|
|
|
3 |
|
Self-pay |
|
|
1 |
|
|
|
1 |
|
Other third-party payors |
|
|
6 |
|
|
|
6 |
|
|
|
|
100 |
% |
|
|
100 |
% |
Attorney liens represent patient accounts receivable related to ongoing litigation between third parties, in which the Company has been contracted to provide imaging services. The Company is not directly involved in the ongoing litigation. Payment is not made until litigation is completed, which can exceed 36 months. Other third-party payors include government plans (excluding Medicare and Medicaid), workers’ compensation, and contract plans.
Accounts Receivable, Related Party
Accounts receivable, related party represent fees from management service arrangements for which payment has not been received. The Company monitors collections from related parties and considers whether there is a need to establish an allowance for credit losses based upon collection issues that it identifies and historical experience.
Accounts Receivable Pledging Arrangement
For the purposes of securing short-term financing, the Company (“the transferor”) treats accounts receivable pledging arrangements with third-party financing entities (“transferees” or “secured parties”) in accordance with Accounting Standards Codification (“ASC”) Topic 860, Transfers and Servicing. A transfer of noncash financial assets that does not meet the conditions for sale accounting is a secured borrowing. As the Company retains all rights to collections on the pledged receivables, the Company will account for its accounts receivable pledging arrangements as secured borrowings, and the Company will recognize the transferred noncash financial assets as a unit of account separate from the liabilities recognized for the secured borrowing (i.e., presented as a current liability within the consolidated balance sheet). The Company has elected the fair value option to account for these secured borrowings. For further information on the Company’s election of the fair value option, refer to the Fair Value Measurements significant accounting policy below and Note 10 “Long-Term Debt” for the financial assets and liabilities that are recorded at fair value on a recurring basis within the consolidated balance sheets.
Property and Equipment
Property and equipment are stated at cost, less accumulated depreciation. When assets are retired or disposed of, the cost and accumulated depreciation are eliminated from the accounts and any gain or loss is reflected in the consolidated statements of operations and comprehensive loss.
Additions and improvements are capitalized, while expenditures for maintenance and repairs are charged to expense as incurred. Depreciation of property and equipment is provided by use of the straight-line method over the following estimated useful lives of the assets:
|
|
|
Leasehold improvements |
|
Lesser of lease term or their estimated useful lives, which range from 3-15 years |
Computers and software |
|
3-5 years |
Medical office equipment |
|
5-8 years |
Furniture and fixtures |
|
3-8 years |
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
Concentration of Credit Risk and Significant Customers
No single customer exceeded 10% of net patient service revenue during the years ended December 31, 2025, 2024 or 2023.
Financial instruments that potentially subject the Company to concentrations of credit risk consist principally of cash, cash equivalents, and accounts receivable. The Company maintains its cash balances principally in major financial institutions. The cash is subject to credit risk to the extent that the balances exceed the FDIC insured limit of $250,000.
Management regularly considers its ability to collect outstanding receivable balances. The Company receives payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers, attorneys, and patients.
The Company recognizes that revenues and receivables from commercial payors and government agencies are significant to its operations but does not believe there are significant credit risks associated with these counterparties.
The Company owns 49% of an investment in an unconsolidated affiliate, BTDI JV, LLP (“BTDI”), which made up 71%, 73% and 69% of management fees and other revenue, related party, during the years ended December 31, 2025, 2024 and 2023, respectively, and 60% and 70% of accounts receivable, related party, as of December 31, 2025 and 2024, respectively. Refer to Note 19 “Related Party Transactions” for further discussion on the related party relationships.
Holdings LLC Common Units
Prior to the IPO, Holdings LLC had historically issued common units of Holdings LLC in exchange for cash. Additionally, affiliates of the Company (the “Holding Companies”), whose only assets were the Holdings LLC common units, had issued their own equity in conjunction with the acquisition of certain physician practices. Shares of the Holding Companies generally vest on a cliff basis after five years of service or upon a sale of Holdings LLC.
Unless subject to documented exceptions for retirees, Holdings LLC equity that is issued to owners who do not perform the requisite five years of service is forfeited, and if owned indirectly via a Holding Company, the forfeited interest is reallocated to the remaining owners of the Holding Company. Given that the Holding Companies’ primary purpose is to own common equity of Holdings LLC, it was concluded that the Holding Company shares are substantially similar to Holdings LLC’s common equity. As a result, the Holding Company equity is accounted for in accordance with ASC 718, Compensation—Stock Compensation (“ASC 718”).
Net Loss Per Share Attributable to Common Stockholders
The Company follows the two-class method when computing net loss per common share when shares are issued that meet the definition of participating securities. The two-class method determines net income (loss) per common share for each class of common share and participating securities according to dividends declared or accumulated and participation rights in undistributed earnings. The two-class method requires income available to common stockholders for the period to be allocated between common shares and participating securities based upon their respective rights to receive dividends as if all income for the period had been distributed. Holdings LLC incentive units are considered participating securities because they contractually entitle the holders of such units to participate in dividends, however, they do not contractually require such holders to participate in Holdings LLC’s losses.
Basic net loss per share is computed by dividing the net loss by the weighted-average number of common shares outstanding during the period, less shares subject to repurchase. The diluted net loss per share is computed by giving effect to all potentially dilutive securities outstanding for the period. For periods in which the Company reports net losses, diluted net loss per common share attributable to common stockholders is the same as basic net loss per common share attributable to common stockholders, because potentially dilutive common shares are not assumed to have been issued if their effect is antidilutive.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
For the purposes of determining the basic and diluted weighted-average number of common shares outstanding during the periods presented that are prior to the IPO, the Company retrospectively reflected the Equity Reorganization that occurred (described in Note 1 in greater detail) in connection with the IPO. As such, the basic and diluted weighted-average number of common shares outstanding for those periods reflect the contribution by the Company of shares of Common Stock to Holdings LLC on a 1 share of Common Stock to 9 units of Holdings LLC ratio, assuming that all such shares of Common Stock were issued and outstanding as of the beginning of the earliest period presented.
Holdings LLC Incentive Unit Plan
Prior to the IPO, Holdings LLC granted incentive units to key employees, directors and physicians achieving partner status under its 2018 Equity Incentive Plan (the “2018 Equity Plan”). Compensation expense is recognized for all incentive unit awards based on estimated fair value on the grant date. Unit-based compensation is expensed over the requisite service period using the straight-line method for awards with time-based vesting criteria, and forfeitures are accounted for as they occur. Upon a qualifying liquidity event of Holdings LLC, which is defined as the date when all or substantially all of the Holdings LLC’s securities have been sold, all time-based incentive units outstanding will vest. Certain incentive unit awards have performance-based vesting criteria based on the achievement of a qualifying liquidity event. Awards with performance criteria will vest, and the related compensation expense will be recognized, when the probability of a qualifying liquidity event is probable. The fair value of awards is computed using the Monte Carlo simulation which is affected by Holdings LLC’s unit price and related volatility, expected dividend yield, term of the award, exercise price and risk-free interest rate. As part of the IPO, outstanding Holdings LLC incentive units either remained outstanding, were converted to shares of the Common Stock or converted to new equity awards in the Company under the Lumexa Imaging Holdings, Inc. 2025 Equity and Incentive Plan (“2025 Equity Plan”). See Note 14 “Stock-Based Compensation” for further discussion.
Stock-based Compensation
The Company has issued stock-based awards to key employees and directors under the 2025 Equity Plan in the form of restricted stock units (“RSUs”), restricted stock awards (“RSAs”) and stock options. The Company accounts for these stock-based awards based on their grant date fair values. Determining the grant date fair values of stock-based awards requires management to make assumptions and judgments. The fair value of awards with market conditions is computed using the Monte Carlo simulation which is affected by the Company’s stock price and related volatility, expected dividend yield, term of the award, exercise price and risk-free interest rate. The fair value of service-based RSUs and RSAs is determined using the Company’s stock price as of the date of grant. These assumptions reflect the Company’s best estimates, but they involve inherent uncertainties based on market conditions. Stock-based compensation expense is recognized on a straight-line basis for awards with service vesting conditions, whereas awards with market conditions are recognized using the accelerated attribution method. Forfeitures are accounted for as they occur. See Note 14 “Stock-based Compensation”, for further discussion.
Goodwill
Goodwill represents the excess of the fair value of the consideration conveyed in an acquisition over the fair value of net assets acquired. The Company uses estimates and judgments to measure the fair value of identifiable assets acquired and liabilities assumed.
Goodwill and indefinite-lived intangible assets are assessed for impairment annually on October 1, or when specific circumstances may be present, between annual tests.
In performing these assessments, the Company may first assess goodwill for impairment qualitatively as determined appropriate at the reporting unit level. If goodwill is more likely than not impaired, the Company is required to perform a quantitative assessment. When performing quantitative goodwill impairment assessments, the Company estimates fair value using either appraisals developed with the assistance of an independent third-party valuation firm, which consider both discounted cash flow estimates for the reporting units and observed market multiples for similar businesses, or recent good-faith offer prices received for the reporting units that would be acceptable to the Company. An impairment charge is recognized when and to the extent a reporting unit’s carrying amount is determined to exceed its fair value.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
As of October 1, 2025 and 2024, the Company performed its annual assessment of goodwill and determined that goodwill was not impaired.
Intangible Assets
Intangible assets with finite lives, such as facility contracts, management services agreements and trade names, along with intangible assets with indefinite lives, such as certificates of need, are recognized apart from goodwill at the time of acquisition based on the contractual-legal and severability criteria established in the accounting guidance for business combinations. Intangible assets with finite lives are amortized over periods ranging from three to ten years utilizing the straight-line method, which represents the estimated useful life.
Indefinite-lived intangible assets, consisting of certificates of need, are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. In evaluating indefinite-lived intangible assets for impairment, the Company first assesses qualitative factors to determine whether it is more likely than not the fair value of an indefinite-lived intangible asset is less than its carrying amount. If the Company concludes it is more likely than not that the fair value of an indefinite-lived intangible asset is less than its carrying amount, the Company conducts a quantitative impairment test, which consists of a comparison of the fair value to its carrying amount. The Company estimates fair value using appraisals developed with the assistance of an independent third-party valuation firm, which consider replacement costs estimates. If the carrying amount exceeds its fair value, an impairment loss is recognized in an amount equal to that excess. If indefinite-lived assets are impaired, the impairment recognized is measured as the excess of the carrying value over the fair value. As of October 1, 2025 and 2024, the Company performed its annual assessment of indefinite-lived intangible assets and determined that these assets were not impaired.
Cloud Computing Software Implementation Costs
The Company capitalizes certain costs related to cloud computing software implementations. These costs are capitalized once certain criteria are met and are primarily comprised of contracted labor, direct labor and related expenses. Costs related to overhead, general and administrative and training costs are expensed as incurred. The eligible costs are capitalized once the project is defined, funding is committed, and it is confirmed the software will be used for its intended use. Capitalization of these costs concludes once the project is substantially complete and ready for its intended purpose. Post-configuration training and maintenance costs are expensed as incurred.
The capitalized cloud computing software implementation costs are reported as a component of prepaid expenses and other assets on the consolidated balance sheets. At December 31, 2025, the Company had $1.3 million (within prepaid expenses) and $4.6 million (within other assets) of such costs on the consolidated balance sheet. At December 31, 2024, the capitalized cloud computing software implementation costs were immaterial.
These costs are amortized using the straight line method over their respective contract service periods, including periods covered by an option to extend, ranging from one to 10 years. Amortization expense for capitalized cloud computing implementation costs for the year ended December 31, 2025 was $0.4 million and is included in cost of operations, excluding depreciation and amortization in the consolidated statements of operations and comprehensive loss. Amortization expense for capitalized cloud computing implementation costs for the years ended December 31, 2024 and 2023 were de minimis.
Long-lived Assets
The Company is required to evaluate long-lived assets, whenever events or changes in circumstances indicate that the carrying value of the assets may not be fully recoverable. The recoverability of such assets is measured by a comparison of the carrying value of the assets to the future undiscounted cash flows generated by the assets. If long-lived assets are impaired, the impairment recognized is measured as the excess of the carrying value over the fair value. The Company does not believe there are any indicators that would require an adjustment to such assets or their estimated periods of recovery at December 31, 2025 and 2024.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
Medical Malpractice Accrual Liability
In the ordinary course of business, professional liability claims have been asserted against the Company by various claimants. These claims are in various stages of processing or, in certain instances, are in litigation. In addition, there are known incidents, and there also may be unknown incidents, which may result in the assertion of additional claims. The Company has accrued its best estimate of both asserted and unasserted claims based on actuarially determined amounts. These estimates are subject to the effects of trends in loss severity and frequency, and ultimate settlement of professional liability claims may vary significantly from estimated amounts. The associated liabilities are recorded on a gross basis within accrued expenses for those that are estimated to be settled in the near term and within other liabilities for those expected to be settled over a longer duration. Management believes that its accrual for claims incurred but not reported obligations is adequate as of December 31, 2025 and 2024.
Medical Malpractice Insurance Recoverable
The Company maintains professional liability insurance policies with third-party insurers primarily on a claims-made basis. The Company maintains coverage for medical providers, as well as entity-level coverage equal to the individual limits. The Company’s internal policies and culture of open reporting by medical providers is an integral component of its risk management protocol, which aids the Company in minimizing claims and potential losses. Management regularly reviews its claims and loss history and secures coverage commensurate with that history and anticipated future economic and legal factors. Management estimates and has recorded amounts receivable from its insurers and the anticipated insurance recovery is presented as other receivables in the consolidated balance sheets for those expected to be received in the near term or other assets for those expected to be received over a longer duration.
Debt Issuance Costs
The Company defers certain expenses incurred to obtain debt financing and amortizes these costs over the scheduled maturity of the respective debt agreements using the effective interest method. The Company presents debt issuance costs related to long-term debt, other than revolving credit arrangements, as a direct deduction from the carrying value of long-term debt. Amortization of debt issuance costs are recognized as interest expense in the Company’s consolidated statements of operations and comprehensive loss.
Derivative Financial Instruments
Derivative financial instruments are initially recorded at fair value on the date on which a derivative contract is entered into and are subsequently remeasured to fair value at period end. Any gains or losses arising from changes in fair value on derivative contracts not designated for hedge accounting are recorded in interest expense in the Company’s consolidated statement of operations.
Fair Value Measurements
The Company measures certain assets and liabilities at fair value, which is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. The criticality of a particular fair value estimate to the Company’s consolidated financial statements depends upon the nature and size of the item being measured, the extent of uncertainties involved, and the nature and magnitude or potential effect of assumptions and judgments required. Certain fair value estimates can involve significant uncertainties and require significant judgment on various matters, some of which could be subject to reasonable disagreement.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
Inputs used to measure fair value are categorized into the following hierarchy:
Level 1 Quoted prices in active markets for identical assets or liabilities.
Level 2 Observable inputs other than Level 1 prices, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
Level 3 Unobservable inputs that are supported by little or no market activity, but which are significant to the fair value of the assets or liabilities as determined by market participants.
The Company holds various financial instruments that are not required to be recorded at fair value. For cash, accounts receivable, accounts payable, and short-term debt the carrying amounts approximate fair value due to the short maturity of these instruments. See Note 10 “Long-Term Debt” for further information on liabilities measured at fair value.
Investments in Unconsolidated Affiliates
Investments in unconsolidated affiliates in which the Company has the ability to exert significant influence but less than a controlling interest are accounted for using the equity method of accounting. Investments in unconsolidated affiliates are initially recorded at cost, unless there is a deconsolidation where the investments are a result of the Company no longer having control of a previously controlled entity but still retaining a non-controlling interest. Under the equity method of accounting, the Company’s proportionate share of an investee’s net assets is reflected on the Company’s consolidated balance sheets and the Company’s proportionate share of earnings and losses are reflected on the Company’s consolidated statements of operations and comprehensive loss. The Company assesses the carrying value of its investments in unconsolidated affiliates annually or more frequently if events arise that may indicate that the value of the investment is not recoverable. The Company examines potential impairments by considering factors such as current economic and market conditions and the operating performance of the investees. Should such examination indicate that an impairment is more than short-term in nature, a charge to earnings and the carrying value of the investment would be recorded. As of December 31, 2025 and 2024, the Company performed its annual assessment of investments in unconsolidated affiliates and determined that these investments were not impaired.
The Company’s investments in unconsolidated affiliates distribute cash and allocate income to the Company in accordance with the terms of their respective agreements. The Company has made an accounting policy election to classify distributions received from such unconsolidated affiliates using the “nature of distribution” approach which classifies distributions received from unconsolidated affiliates as either cash inflows from operating activities or cash inflows from investing activities in the statement of cash flows based on the nature of the activities of the unconsolidated affiliate that generated the distribution.
Income Taxes
Prior to the Equity Reorganization, the Company was organized as a partnership for federal income tax purposes and thus paid no federal income tax at the Company level. Since the Company wholly owns two separate tax consolidated groups (LII and LIOI), it reports its provision for income taxes as computed based upon the reported amount of income before income taxes for each of the taxable corporations. As the two corporate tax groups are not consolidated under one tax filing, the tax accounts included in the consolidated financial statements are a combination of those two corporate tax groups, the sum of which may not equal the same amount as if those entities were to file a consolidated return. After the Equity Reorganization, the Company is organized as a corporation for federal income tax purposes and files one federal consolidated return.
The Company uses the asset and liability method to account for income taxes. Under this method, deferred income tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
A valuation allowance will be established for deferred tax assets when the recoverability is deemed to be uncertain. The carrying value of the net deferred tax assets is based upon estimates and assumptions related to our ability to generate sufficient future taxable income in certain tax jurisdictions. If these estimates and related assumptions change in the future, the Company will be required to adjust our deferred tax valuation allowances.
The Company recognizes a tax position in its financial statements when that tax position is more likely than not to be sustained upon examination by the relevant taxing authority. Recognized tax positions are measured at the largest amount that is greater than 50 percent likely of being realized upon ultimate settlement with the relevant tax authority. The Company recognizes interest and penalties related to uncertain tax positions in its income tax provision.
Leases
The Company determines if an arrangement is a lease at inception by assessing whether an identified asset exists and if the Company has the right to control the use of the identified asset. The Company categorizes leases with contractual terms longer than 12 months as either operating or finance leases. Finance leases are generally those leases that allow the Company to substantially utilize or pay for the entire asset over its estimated life. All other leases are categorized as operating leases. For short-term leases with a term of less than 12 months, the Company does not recognize lease right-of-use assets or lease liabilities and instead recognizes short-term lease costs as rent expense directly as incurred.
Financing and operating lease liabilities are measured at the net present value of lease payments over the lease term as of the commencement date. Since most of the Company’s leases do not provide an implicit rate of return, the Company uses its incremental borrowing rate based on information available at the lease commencement date or remeasurement date in determining the present value of lease payments. In calculating the incremental borrowing rate, consideration is given to the Company’s credit risk, the term of the lease, the total lease payments, and adjustments for the impacts of collateral, as necessary.
The Company has elected the practical expedient to not separate lease components from non-lease components for its financing and operating leases. Variable components of lease payments fluctuating with a future index or rate are estimated at lease commencement based on the index or rate at lease commencement. If the payments change as the result of a change in an index or rate subsequent to lease commencement, the difference is recognized in the consolidated statements of operations and comprehensive loss in the period in which the change occurs. Variable payments for maintenance, such as common area maintenance costs and taxes, are not included in determining lease payments and are expensed as incurred.
Most leases include one or more options to extend the lease. However, for purposes of calculating lease liabilities, options have only been included if it was reasonably certain the Company would exercise the option on the lease commencement date. The Company’s lease agreements do not contain any material residual value guarantees or material restrictive covenants. Lease expense for lease payments is recognized on a straight-line basis over the lease term.
Right-to-use assets under operating leases are recorded on the consolidated balance sheets as operating lease right-of-use assets and liabilities for operating lease obligations are recorded as operating lease liabilities. Both amortization of operating lease right-of-use assets and interest accretion on operating lease liabilities are recorded to rent expense over the lease term. Finance leases are reported on the Company’s consolidated balance sheets with the right-of-use assets included in property and equipment, net, and the liabilities included in current portion of finance lease liabilities and long-term finance lease liabilities, net. Finance lease assets are amortized to depreciation expense on a straight-line basis over the shorter of their estimated useful lives or the expected lease term. Accretion of interest on finance lease liabilities is included in interest expense within the Company’s consolidated statements of operations and comprehensive loss.
The Company evaluates its lease right-of-use assets for impairment in a similar manner to long-lived assets, as described above under “Long-lived Assets.” The Company’s facility leases require it to maintain insurance policies which would cover major damage to the facilities. The Company maintains business interruption insurance to cover loss of business due to a facility becoming nonoperational under certain circumstances. The Company’s equipment
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
leases are covered by warranty and service contracts which cover repairs and provide regular maintenance to keep the equipment in functioning order.
Business Combinations
The Company records acquisitions resulting in the consolidation of a business using the acquisition method of accounting, and the results of operations are included in the consolidated statement of operations from the respective dates of acquisition. The purchase price of a transaction is allocated to the assets acquired and liabilities assumed based upon their respective fair values at the date of acquisition and can be subject to change up to 12 months subsequent to the acquisition date due to measurement period adjustments, such as settling amounts related to purchased working capital and final determination of fair value estimates.
Segment Reporting
The Company prepares its segment reporting in accordance with ASC 280, Segment Reporting, which establishes standards for entities reporting information about the operating segments and geographic areas in which they operate. The Company’s products and operations are managed and reported in two operating segments: Outpatient Imaging Centers (“Outpatient”) and Professional Services (“Professional”). The Company’s Chief Executive Officer, who is its Chief Operating Decision Maker (“CODM”), reviews the segments’ performance for the purpose of making operating decisions, assessing financial performance, and deciding how to allocate resources.
As of December 31, 2025 and 2024, all of the Company’s long-lived assets were located in the United States, and for the years ended December 31, 2025, 2024 and 2023 all revenue was earned in the United States.
Recent Accounting Pronouncements
In September 2025, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2025-06, Accounting for and Disclosure of Software Costs. The new standard modernizes the guidance to reflect the software development approaches currently being used by removing all references to “development stages” from ASC 350-40, Intangibles--Good and Other - Internal Use Software. Under ASU 2025-06, only the following criteria in ASC 350-40-25-12(b) and (c) must be met for entities to begin capitalizing software costs: (i) management, with the relevant authority, implicitly or explicitly authorizes and commits to funding a computer software project and (ii) it is probable that the project will be completed and the software will be used to perform the function intended (referred to as the “probable-to-complete recognition threshold”). ASU 2025-06 is effective for all entities for annual reporting periods beginning after December 15, 2027, and interim reporting periods within those annual reporting periods, with early adoption permitted. Entities may apply the guidance prospectively, retrospectively, or via a modified prospective transition method. The Company is evaluating this new standard, but does not expect it to have a significant impact on its consolidated financial statement presentation or results.
In July 2025, the FASB issued ASU 2025-05, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses for Accounts Receivable and Contract Assets, which provides a practical expedient permitting an entity to assume that conditions at the balance sheet date remain unchanged over the life of the asset when estimating expected credit losses for current accounts receivable and current contract assets. ASU 2025-05 is effective for annual reporting periods beginning after December 15, 2025, and for interim periods within those annual reporting periods, with early adoption permitted. The amendments in ASU 2025-05 should be applied prospectively. The Company is currently evaluating the impact of adopting this new standard.
In November 2024, the FASB issued ASU 2024-03, Income Statement—Reporting Comprehensive Income—Expense Disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses, which requires the disclosure of information about certain costs and expenses that are included in relevant expense captions on the face of the income statement. The amendments require disclosure of specific expense categories in the notes to the financial statements for both interim and annual reporting periods. The amendment also requires disaggregated information about certain prescribed expense categories underlying any relevant income statement expense caption. ASU No. 2024-03 is effective for annual periods beginning after December 15, 2026 and interim periods beginning
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
after December 15, 2027. Early adoption is permitted. The Company is currently evaluating the impact the adoption of this guidance will have on its consolidated financial statement disclosures.
In December 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which expands income tax disclosure requirements to include additional information related to the rate reconciliation of effective tax to statutory rates, as well as additional disaggregation of taxes paid in both U.S. and foreign jurisdictions. The amendments in the ASU also remove disclosures related to certain unrecognized tax benefits and deferred taxes. The Company has elected to take advantage of the extended transition period pursuant to Section 107 of the Jump Start Our Business Startups Act (“JOBS Act”). Section 107 of the JOBS Act provides that an emerging growth company can use the extended transition period provided in Section 7(a)(2)(B) of the Securities Act of 1933, as amended for complying with new or revised accounting standards. This permits an emerging growth company, like the Company, to delay the adoption of certain accounting standards until those standards would otherwise apply to private companies. As a result, ASU No. 2023-09 will be effective for fiscal years beginning after December 15, 2025. The Company is currently evaluating the impact the adoption of this guidance will have on its consolidated financial statement disclosures.
3. Net Loss Per Common Share
The following table sets forth the computation of basic and diluted net loss per common share for the years indicated (in thousands, except for common share and per common share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Numerator: |
|
|
|
|
|
|
|
|
|
Net loss |
|
$ |
(47,104 |
) |
|
$ |
(94,099 |
) |
|
$ |
(122,227 |
) |
Denominator: |
|
|
|
|
|
|
|
|
|
Weighted-average common shares outstanding, basic and diluted |
|
|
70,978,092 |
|
|
|
69,469,401 |
|
|
|
69,412,457 |
|
Net loss per share attributable to common stockholders: |
|
|
|
|
|
|
|
|
|
Basic and diluted |
|
$ |
(0.66 |
) |
|
$ |
(1.35 |
) |
|
$ |
(1.76 |
) |
As of December 31, 2024 and 2023, Common Stock associated with potentially dilutive securities associated with 12,296,602 and 12,246,688 Incentive Units, respectively, were excluded from the computation of diluted net loss per common share because including them would have had an anti-dilutive effect.
In 2025, the outstanding Incentive Units, stock options, RSAs and RSUs disclosed in Note 14 “Stock-Compensation Expense” were excluded from the computation of diluted net loss per common share because including them would have had an anti-dilutive effect.
For the purposes of determining the basic and diluted weighted-average number of common shares outstanding during 2024 and 2023, the Company retrospectively reflected the Equity Reorganization that occurred (See Note 1) in connection with the IPO. As such, the basic and diluted weighted average number of common shares outstanding for those periods reflect the contribution by the Company of shares of Common Stock to Holdings LLC on a 1 share of Common Stock to 9 units of Holdings LLC ratio, assuming that all such shares of Common Stock were issued and outstanding as of the beginning of the earliest period presented.
4. Dispositions
The Company did not dispose of or sell any centers during 2025. In November 2023, the Company entered into a letter of intent to sell six imaging centers in Houston, Texas and designated the assets as held for sale. Upon classification as held for sale, the carrying value of the assets held for sale approximated fair value and as such, there was no corresponding loss recorded. The fair value of the assets held for sale was $4.0 million at December 31, 2023. The centers held for sale were comprised of $4.0 million and $2.9 million of property and equipment and operating lease right-of-use assets, respectively, as of December 31, 2023. The liabilities related to imaging centers held for sale
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
were comprised of $3.1 million of operating lease liabilities as of December 31, 2023. In May 2024, the Company sold the assets for $4.2 million.
5. Supplemental Cash Flow Information
|
|
|
|
|
|
|
|
|
|
|
|
|
(in thousands) |
|
2025 |
|
|
2024 |
|
|
2023 |
|
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION |
|
|
|
|
|
|
|
|
|
Cash paid for interest |
|
$ |
112,800 |
|
|
$ |
128,567 |
|
|
$ |
130,009 |
|
Cash paid for income taxes, net |
|
$ |
14,966 |
|
|
$ |
604 |
|
|
$ |
4,749 |
|
SUPPLEMENTAL DISCLOSURE OF NONCASH INVESTING AND FINANCING ACTIVITIES: |
|
|
|
|
|
|
|
|
|
Equipment acquired under finance leases |
|
$ |
30,500 |
|
|
$ |
11,228 |
|
|
$ |
6,223 |
|
Purchase of property and equipment in accounts payable and accrued expenses |
|
$ |
8,149 |
|
|
$ |
2,528 |
|
|
$ |
2,000 |
|
Non-cash contributions to investments in unconsolidated affiliates |
|
$ |
— |
|
|
$ |
1,385 |
|
|
$ |
— |
|
Issuance of common stock in respect of historical profits interest units |
|
$ |
2,575 |
|
|
$ |
— |
|
|
$ |
— |
|
6. Other Receivables
Other receivables consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Insurance receivable—medical malpractice |
|
$ |
5,333 |
|
|
$ |
4,984 |
|
Income tax receivable |
|
|
3,500 |
|
|
|
— |
|
Other |
|
|
10,182 |
|
|
|
660 |
|
Total |
|
$ |
19,015 |
|
|
$ |
5,644 |
|
7. Property and Equipment, Net
Property and equipment, net, consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Leasehold improvements |
|
$ |
93,878 |
|
|
$ |
60,745 |
|
Medical equipment |
|
|
268,155 |
|
|
|
134,741 |
|
Furniture and fixtures |
|
|
6,199 |
|
|
|
4,198 |
|
IT equipment and software |
|
|
40,410 |
|
|
|
26,182 |
|
Buildings |
|
|
898 |
|
|
|
1,445 |
|
Projects in progress |
|
|
14,723 |
|
|
|
6,891 |
|
Less accumulated depreciation |
|
|
(279,554 |
) |
|
|
(113,069 |
) |
Property and equipment, net |
|
$ |
144,709 |
|
|
$ |
121,133 |
|
Depreciation expense for the years ended December 31, 2025, 2024, and 2023 was $33.9 million, $31.6 million and $29.3 million, respectively.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
8. Goodwill and Intangible Assets
Goodwill is recorded as a result of business combinations. Changes in the carrying amount of goodwill by reportable segment for the years ended December 31, 2025 and 2024, were as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
OUTPATIENT |
|
|
PROFESSIONAL |
|
|
TOTAL NET CARRYING VALUE |
|
Balance as of December 31, 2023 |
|
|
|
|
|
|
|
|
|
Goodwill |
|
$ |
669,701 |
|
|
$ |
189,222 |
|
|
$ |
858,923 |
|
Accumulated impairment losses |
|
|
(32,400 |
) |
|
|
(18,969 |
) |
|
|
(51,369 |
) |
|
|
|
637,301 |
|
|
|
170,253 |
|
|
|
807,554 |
|
Sale of Houston centers |
|
|
(32,400 |
) |
|
|
— |
|
|
|
(32,400 |
) |
UCR dissolution |
|
|
— |
|
|
|
(18,969 |
) |
|
|
(18,969 |
) |
Balance as of December 31, 2024 |
|
|
|
|
|
|
|
|
|
Goodwill |
|
|
637,301 |
|
|
|
170,253 |
|
|
|
807,554 |
|
Accumulated impairment losses |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
637,301 |
|
|
|
170,253 |
|
|
|
807,554 |
|
Balance as of December 31, 2025 |
|
|
|
|
|
|
|
|
|
Goodwill |
|
|
637,301 |
|
|
|
170,253 |
|
|
|
807,554 |
|
Accumulated impairment losses |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
$ |
637,301 |
|
|
$ |
170,253 |
|
|
$ |
807,554 |
|
During the year ended December 31, 2024, the Company sold six imaging centers in Houston, Texas. (See Note 4 “Dispositions”). The goodwill related to these imaging centers was fully impaired prior to December 31, 2022. Upon the sale in 2024, the goodwill and offsetting accumulated goodwill impairment for the Houston imaging centers were written off.
In 2023, the Company wound down the UCR physician practice. As a result, the Company determined that the full UCR goodwill amount of $19.0 million was impaired and should be written down as of December 31, 2023. The impairment charge was determined based on the present value of future cash flows, which were nominal given the decision to wind down the business.
There was no accumulated impairment as of December 31, 2025 or 2024 as reporting units with previous impairments had been disposed of or dissolved.
Intangible assets consisted of the following as of December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
|
ESTIMATED USEFUL LIFE (IN YEARS) |
|
GROSS CARRYING VALUE |
|
|
ACCUMULATED AMORTIZATION |
|
|
NET CARRYING VALUE |
|
Finite-lived intangible assets: |
|
|
|
|
|
|
|
|
|
|
|
Facility contracts |
|
8 |
|
$ |
58,400 |
|
|
$ |
(45,200 |
) |
|
$ |
13,200 |
|
Trade names |
|
5 |
|
|
41,030 |
|
|
|
(38,870 |
) |
|
|
2,160 |
|
Management services agreements |
|
5 |
|
|
34,800 |
|
|
|
(34,800 |
) |
|
|
— |
|
Total finite-lived intangible assets |
|
|
|
|
134,230 |
|
|
|
(118,870 |
) |
|
|
15,360 |
|
Indefinite-lived intangible assets certificate of need |
|
Indefinite |
|
|
25,975 |
|
|
|
— |
|
|
|
25,975 |
|
Total indefinite-lived intangible assets |
|
|
|
|
25,975 |
|
|
|
— |
|
|
|
25,975 |
|
Total intangible assets |
|
|
|
$ |
160,205 |
|
|
$ |
(118,870 |
) |
|
$ |
41,335 |
|
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2024 |
|
|
|
ESTIMATED USEFUL LIFE (IN YEARS) |
|
GROSS CARRYING VALUE |
|
|
ACCUMULATED AMORTIZATION |
|
|
NET CARRYING VALUE |
|
Finite-lived intangible assets: |
|
|
|
|
|
|
|
|
|
|
|
Facility contracts |
|
8 |
|
$ |
58,400 |
|
|
$ |
(42,117 |
) |
|
$ |
16,283 |
|
Trade names |
|
5 |
|
|
41,030 |
|
|
|
(35,500 |
) |
|
|
5,530 |
|
Management services agreements |
|
5 |
|
|
34,800 |
|
|
|
(34,800 |
) |
|
|
— |
|
Total finite-lived intangible assets |
|
|
|
|
134,230 |
|
|
|
(112,417 |
) |
|
|
21,813 |
|
Indefinite-lived intangible assets certificate of need |
|
Indefinite |
|
|
25,975 |
|
|
|
— |
|
|
|
25,975 |
|
Total indefinite-lived intangible assets |
|
|
|
|
25,975 |
|
|
|
— |
|
|
|
25,975 |
|
Total intangible assets |
|
|
|
$ |
160,205 |
|
|
$ |
(112,417 |
) |
|
$ |
47,788 |
|
Amortization expense for intangible assets was $6.5 million, $10.6 million and $27.4 million for the years ended December 31, 2025, 2024 and 2023, respectively. Expected future amortization expense for intangible assets as of December 31, 2025, is as follows (in thousands):
|
|
|
|
|
Years Ending December 31, |
|
|
|
2026 |
|
$ |
4,360 |
|
2027 |
|
|
2,200 |
|
2028 |
|
|
2,200 |
|
2029 |
|
|
2,200 |
|
2030 |
|
|
2,200 |
|
Thereafter |
|
|
2,200 |
|
Total |
|
$ |
15,360 |
|
9. Accrued Expenses and Other Current Liabilities
Accrued expenses and other current liabilities consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Accrued compensation and benefits |
|
$ |
39,625 |
|
|
$ |
56,763 |
|
Contract labor |
|
|
7,753 |
|
|
|
6,320 |
|
Medical claims payable |
|
|
3,912 |
|
|
|
2,084 |
|
Profit sharing plan |
|
|
14,870 |
|
|
|
14,567 |
|
Medical malpractice accrual |
|
|
6,395 |
|
|
|
5,033 |
|
Taxes payable |
|
|
421 |
|
|
|
4,036 |
|
Accrued professional fees |
|
|
8,671 |
|
|
|
2,400 |
|
Accrued severance |
|
|
1,978 |
|
|
|
1,769 |
|
Other accrued expenses |
|
|
11,936 |
|
|
|
15,482 |
|
Total |
|
$ |
95,561 |
|
|
$ |
108,454 |
|
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
10. Long-Term Debt
The following is a summary of the Company’s long-term debt as of December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Senior secured term loan |
|
$ |
825,000 |
|
|
$ |
1,200,215 |
|
Promissory notes |
|
|
17,441 |
|
|
|
16,372 |
|
Accounts receivable pledging arrangement |
|
|
1,599 |
|
|
|
— |
|
Total debt obligations |
|
|
844,040 |
|
|
|
1,216,587 |
|
Less debt issuance costs and discount |
|
|
(10,300 |
) |
|
|
(15,506 |
) |
Long-term debt, net of debt issuance costs |
|
|
833,740 |
|
|
|
1,201,081 |
|
Less accounts receivable pledging arrangement |
|
|
(1,599 |
) |
|
|
— |
|
Less current maturities of long-term debt |
|
|
(13,112 |
) |
|
|
(16,001 |
) |
Long-term debt, less current maturities |
|
$ |
819,029 |
|
|
$ |
1,185,080 |
|
Scheduled maturities of long-term debt as of December 31, 2025, excluding the Accounts Receivable Pledging Arrangement, were as follows (in thousands):
|
|
|
|
|
Years Ending December 31, |
|
|
|
2026 |
|
$ |
13,112 |
|
2027 |
|
|
13,532 |
|
2028 |
|
|
12,551 |
|
2029 |
|
|
10,267 |
|
2030 |
|
|
9,226 |
|
Thereafter |
|
|
783,753 |
|
Total |
|
$ |
842,441 |
|
Senior Secured Credit Facility
On December 15, 2020, the Company entered into a senior secured credit agreement (“Original Credit Agreement”) consisting of a secured term loan facility of $790 million (“Original Term Loan”) and a secured revolving credit facility of $165 million (“Original Revolving Credit Facility”). The Original Term Loan was scheduled to mature in December 2027, and the Original Revolving Credit Facility was scheduled to mature on September 15, 2027. On December 31, 2021, the Company entered into Incremental Amendment No. 1 (“First Amendment”) to its Original Credit Agreement. The First Amendment consisted of an additional $450 million incremental term loan. All other terms of the Original Credit Agreement remained unchanged. On March 21, 2023, the Company entered into Amendment No. 2 (“Second Amendment”) to its Original Credit Agreement. The Second Amendment transitioned the term loan benchmark interest rate from Eurodollar to Secured Overnight Financing Rate (“SOFR”) interest pricing. The Original Term Loan (as amended) provided for quarterly payments of principal in the amount of $3.1 million. On July 16, 2024, the Company entered into Amendment No. 3 (“Third Amendment”) to its Original Credit Agreement. The Third Amendment reduced the Original Term Loan's interest rate to SOFR, plus 4.75% per annum (where the applicable SOFR rate had a 0.5% floor). On November 22, 2024, the Company entered into Amendment No. 4 (“Fourth Amendment”) to its Original Credit Agreement. The Fourth Amendment extended the maturity to the Original Revolving Credit Facility to September 2027.
On December 17, 2025, the Company entered into Amendment No. 5 to the Original Credit Agreement (Original Credit Agreement, as so amended, the “Amended Credit Agreement”). The Amended Credit Agreement provides for (i) a secured term loan facility of $825.0 million (“Refinancing Term Loan”) and (ii) a secured revolving line of credit of $250.0 million (“Amended Revolving Credit Facility”). The Refinancing Term Loan bears interest at SOFR plus 3.0%, or the Prime Rate plus 2.0%, and matures in December 2032. The Amended Revolving Credit Facility bears interest at SOFR plus 3.0%, or the Prime Rate plus 2.0%, and matures in December 2030. Proceeds from the Refinancing Term Loan of $825.0 million, along with $406.4 million of the Company’s IPO proceeds, were utilized to repay the term loans in full that were outstanding under the Original Credit Agreement.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
The Amended Credit Agreement was evaluated under ASC 470-50, Debt-Modifications and Extinguishments. The borrowings under the Original Credit Agreement and the Amended Credit Agreement represented a loan syndication. As such, the accounting for the Amended Credit Agreement was evaluated on a lender by lender basis and resulted in new borrowings, extinguishments and modifications depending on each lender’s participation or lack thereof in the Amended Credit Agreement and the Original Credit Agreement. The Company incurred a total of $19.3 million in third party and lender costs as part of the Amended Credit Agreement. The Company capitalized $5.4 million and $5.9 million of costs associated with the Refinancing Term Loan and Amended Revolving Credit Facility, respectively. Such amounts are reported in Long-term debt, less current maturities and Other assets, respectively, on the consolidated balance sheet as of December 31, 2025. The remaining $8.0 million of costs were expensed within Loss on extinguishment of debt in the consolidated statement of operations for the year ended December 31, 2025. Additionally, as part of the Amended Credit Agreement, $5.4 million of previously capitalized debt issuance costs were expensed within Loss on extinguishment of debt in the consolidated statement of operations for the year ended December 31, 2025.
As of December 31, 2025 and 2024, the interest rate on the Refinancing Term Loan and the Original Term Loan was 6.70% and 9.35%, respectively. No amounts were outstanding under the Amended Revolving Credit Facility or Original Revolving Credit Facility as of December 31, 2025 or 2024. Additionally, a commitment fee accrues per annum on the unused revolver commitments. The fee varies based on the Company’s leverage ratio. As of December 31, 2025 and 2024, the unused commitment fee was 0.50%. The fair value of the Amended Term Loan and the Original Term Loan, which is classified within Long Term Debt on its consolidated balance sheets, was $829.0 million and $1.2 billion as of December 31, 2025 and 2024, respectively. The fair value estimates for the Company's Senior Secured Term Loan are based on bid quotes for comparable liabilities in inactive markets, a Level 2 input.
Covenants
The Amended Credit Agreement contains various restrictive covenants, including financial covenants that limit the Company’s ability and the ability of its subsidiaries to incur additional debt, pay dividends and other distributions, and engage in certain other transactions as specified therein. Failure to comply with these covenants could constitute an event of default notwithstanding the Company’s ability to meet its debt service obligations. The Company’s financial covenant is triggered if outstanding revolving credit exposure exceeds 40% of the aggregate principal amount of the Amended Revolving Credit Facility on the last day of the reporting period (quarterly). If the covenant is triggered, the Company’s consolidated net leverage ratio on the last day of the test period shall not exceed 7.5 to 1. At December 31, 2025, the Company’s outstanding revolving credit exposure did not exceed 40% of the aggregate principal amount of the Amended Revolving Credit Facility and, therefore, did not trigger the covenant. The Amended Credit Agreement includes various customary remedies for the lenders following an event of default. The Company was in compliance with all applicable covenants in the Amended Credit Agreement and the Original Credit Agreement as of December 31, 2025 and 2024, respectively.
The Company’s borrowings under the Amended Credit Agreement are guaranteed by LII and LIOI and each other wholly owned subsidiary of the Company, subject to certain exceptions. Substantially all of the assets of the Company are pledged as collateral in connection with the Amended Credit Agreement.
Promissory Notes
The Company has financed the acquisition of certain medical equipment and leasehold improvements under promissory notes. The promissory notes bear interest at rates ranging from 8.75% to 12.35% per annum and mature at various times through 2030. The promissory notes are collateralized by property and equipment of the Company and given the nature of the promissory notes, it was determined that the fair value approximates carrying value.
Accounts Receivable Pledging Arrangement
In August 2025, the Company entered into an accounts receivable pledging arrangement (the “AR Pledging Arrangement”) with a third-party financing company (the “Financer”). The final payment of the pledged accounts receivable will be settled through the judicial system (i.e., litigation between third parties), rather than by the associated
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
patient or insurance company (the “Legal AR”). Under the AR Pledging Arrangement, the Company pledges certain of its Legal AR to the Financer in exchange for an advance cash payment in an amount equal to a predefined percentage multiplied by the amount due under such Legal AR. The AR Pledging Arrangement does not qualify for sale accounting, and the amounts received are reported as collateralized borrowings. Accordingly, the related assets remain on the Company’s consolidated balance sheet and continue to be accounted for as if the transfer had not occurred. During the year ended December 31, 2025, $1.6 million has been borrowed by the Company from the Financer under the AR Pledging Arrangement, which is secured by $3.3 million of accounts receivable. The amount borrowed is reported as a current liability on the consolidated balance sheet.
The Financer also acts as a servicer of the Legal AR over its remaining life and, upon settlement and collection on the Legal AR, the Company owes the Financer a servicing fee that is equal to a predefined percentage multiplied by the amount of cash collected. Until settlement and collection, the Legal AR under this arrangement is recognized by the Company and used to secure the borrowing from Financer. The Company has elected to account for the secured borrowing by utilizing the fair value option. There have been no material changes in the fair value of the secured borrowing as of the year ended December 31, 2025. Therefore, no mark to market adjustment has been recognized for the year ended December 31, 2025.
11. Leases
Operating Leases
The Company primarily leases medical office space, medical equipment, and corporate office space under noncancellable operating leases which expire at various dates through 2036. Rent expense is recorded in cost of operations and general and administrative expenses in the consolidated statements of operations and comprehensive loss.
The table below presents the operating lease-related right-of-use assets and related liabilities recorded on the Company’s consolidated balance sheets and the weighted-average remaining lease term and discount rate as of December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Assets: |
|
|
|
|
|
|
Operating lease right-of-use assets |
|
$ |
76,555 |
|
|
$ |
80,792 |
|
Liabilities: |
|
|
|
|
|
|
Current portion of operating lease liabilities |
|
|
12,513 |
|
|
|
13,807 |
|
Long-term operating lease liabilities |
|
|
71,437 |
|
|
|
72,746 |
|
Other Information: |
|
|
|
|
|
|
Weighted-average remaining lease term in years |
|
5.8 |
|
|
|
6.0 |
|
Weighted-average discount rate |
|
|
7.8 |
% |
|
|
7.7 |
% |
The table below presents certain information related to the lease costs for operating leases during the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Operating lease costs |
|
$ |
21,630 |
|
|
$ |
21,565 |
|
|
$ |
22,466 |
|
Variable lease costs |
|
|
3,328 |
|
|
|
3,112 |
|
|
|
3,288 |
|
Short-term equipment lease costs |
|
|
1,175 |
|
|
|
1,078 |
|
|
|
1,795 |
|
Total operating lease costs |
|
$ |
26,133 |
|
|
$ |
25,755 |
|
|
$ |
27,549 |
|
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
The table below presents supplemental cash flow information related to operating leases during the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Cash paid for amounts included in the measurement of lease liabilities: |
|
|
|
|
|
|
|
|
|
Operating cash flows for operating leases |
|
$ |
20,021 |
|
|
$ |
20,374 |
|
|
$ |
21,352 |
|
Right-of-use assets obtained in exchange for new or modified operating lease liabilities |
|
|
5,770 |
|
|
|
14,376 |
|
|
|
15,173 |
|
The table below reconciles the undiscounted cash flows for each of the first five years, and total of the remaining years, to the operating leases recorded on the consolidated balance sheets as of December 31, 2025 (in thousands):
|
|
|
|
|
2026 |
|
$ |
18,720 |
|
2027 |
|
|
19,580 |
|
2028 |
|
|
17,051 |
|
2029 |
|
|
15,852 |
|
2030 |
|
|
11,278 |
|
Thereafter |
|
|
25,026 |
|
Total minimum lease payments |
|
|
107,507 |
|
Less amount of payments representing interest |
|
|
(23,557 |
) |
Present value of future minimum lease payments |
|
|
83,950 |
|
Less current obligations |
|
|
(12,513 |
) |
Long-term portion of operating leases |
|
$ |
71,437 |
|
Finance Leases
The Company has financed certain medical equipment under finance leases or other financing arrangements. Obligations under these arrangements are at interest rates ranging from 3.0% to 10.8% due through 2031 and are collateralized by medical equipment. The weighted-average remaining lease term for finance leases is 4.1 years and 3.9 years and the weighted-average discount rate is 7.9% and 8.2% as of December 31, 2025 and 2024, respectively.
Assets under finance leases, included in property and equipment, net, are as follows as of December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Medical office equipment under finance leases |
|
$ |
61,992 |
|
|
$ |
30,736 |
|
Accumulated depreciation |
|
|
(12,465 |
) |
|
|
(8,227 |
) |
|
|
$ |
49,527 |
|
|
$ |
22,509 |
|
The table below presents supplemental cash flow information related to finance leases during the years ended December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Cash paid for amounts included in the measurement of lease liabilities: |
|
|
|
|
|
|
|
|
|
Operating cash outflows from finance leases |
|
$ |
2,561 |
|
|
$ |
1,515 |
|
|
$ |
1,299 |
|
Financing cash flows from financing leases |
|
|
7,652 |
|
|
|
11,429 |
|
|
|
4,729 |
|
Right-of-use assets obtained in exchange for new or modified finance lease liabilities |
|
$ |
30,500 |
|
|
$ |
11,224 |
|
|
$ |
6,223 |
|
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
The table below presents certain information related to the lease costs for finance leases during the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Depreciation on assets under finance leases |
|
$ |
5,976 |
|
|
$ |
4,160 |
|
|
$ |
3,498 |
|
Interest on finance leases |
|
|
2,561 |
|
|
|
1,515 |
|
|
|
1,299 |
|
Total finance lease costs |
|
$ |
8,537 |
|
|
$ |
5,675 |
|
|
$ |
4,797 |
|
Future minimum lease payments under finance leases for the years subsequent to December 31, 2025, are as follows (in thousands):
|
|
|
|
|
2026 |
|
$ |
15,262 |
|
2027 |
|
|
13,658 |
|
2028 |
|
|
10,582 |
|
2029 |
|
|
9,371 |
|
2030 |
|
|
5,216 |
|
Thereafter |
|
|
22 |
|
Total minimum lease payments |
|
|
54,111 |
|
Less amount of payments representing interest |
|
|
(9,297 |
) |
Present value of future minimum lease payments |
|
|
44,814 |
|
Less current obligations |
|
|
(11,552 |
) |
Long-term portion of finance leases |
|
$ |
33,262 |
|
12. Income Taxes
The Company files income tax returns in federal and various state and local jurisdictions in which the Company operates.
Income tax expense consists of the following for the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Current income tax |
|
|
|
|
|
|
|
|
|
Federal |
|
$ |
4,720 |
|
|
$ |
3,232 |
|
|
$ |
1,364 |
|
State and local |
|
|
2,089 |
|
|
|
1,921 |
|
|
|
1,003 |
|
|
|
|
6,809 |
|
|
|
5,153 |
|
|
|
2,367 |
|
Deferred income tax |
|
|
|
|
|
|
|
|
|
Federal |
|
|
8,100 |
|
|
|
8,088 |
|
|
|
1,143 |
|
State and local |
|
|
(24 |
) |
|
|
1,665 |
|
|
|
(532 |
) |
|
|
|
8,076 |
|
|
|
9,753 |
|
|
|
611 |
|
Total income tax expense |
|
$ |
14,885 |
|
|
$ |
14,906 |
|
|
$ |
2,978 |
|
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
A reconciliation of the provision for income taxes as reported in the consolidated statements of operations and comprehensive loss and the amount of income tax expense computed by multiplying consolidated income (loss) in each year by the U.S. federal statutory rate of 21% is as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Federal tax |
|
$ |
(6,766 |
) |
|
$ |
(16,631 |
) |
|
$ |
(25,042 |
) |
State tax, net of federal benefit |
|
|
374 |
|
|
|
132 |
|
|
|
(2,761 |
) |
Stock-based compensation |
|
|
7,673 |
|
|
|
11,897 |
|
|
|
11,612 |
|
Changes in valuation allowance |
|
|
11,343 |
|
|
|
19,921 |
|
|
|
18,663 |
|
Return to provision |
|
|
2,153 |
|
|
|
(601 |
) |
|
|
333 |
|
Other |
|
|
108 |
|
|
|
188 |
|
|
|
173 |
|
Total income tax expense |
|
$ |
14,885 |
|
|
$ |
14,906 |
|
|
$ |
2,978 |
|
The tax effects of temporary differences that give rise to significant portions of deferred tax assets and liabilities of the Company as of December 31, 2025 and 2024, were as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Deferred tax assets |
|
|
|
|
|
|
Accruals and reserves |
|
$ |
5,445 |
|
|
$ |
7,265 |
|
Interest limitation carryforward |
|
|
93,277 |
|
|
|
75,177 |
|
Operating lease liabilities |
|
|
20,945 |
|
|
|
21,595 |
|
Debt issuance costs |
|
|
533 |
|
|
|
— |
|
Stock-based compensation |
|
|
1,769 |
|
|
|
— |
|
Net operating loss carryforward |
|
|
1,350 |
|
|
|
1,596 |
|
Valuation allowance |
|
|
(75,225 |
) |
|
|
(63,882 |
) |
Total deferred tax assets |
|
|
48,094 |
|
|
|
41,751 |
|
Deferred tax liabilities |
|
|
|
|
|
|
Property and equipment |
|
|
(14,106 |
) |
|
|
(12,619 |
) |
Intangible assets |
|
|
(22,694 |
) |
|
|
(12,572 |
) |
Investment in unconsolidated affiliate basis difference |
|
|
(32,966 |
) |
|
|
(29,085 |
) |
Operating lease right-of-use assets |
|
|
(19,100 |
) |
|
|
(20,158 |
) |
Stock-based compensation |
|
|
— |
|
|
|
(13 |
) |
Total deferred tax liabilities |
|
|
(88,866 |
) |
|
|
(74,447 |
) |
Net deferred tax liability |
|
$ |
(40,772 |
) |
|
$ |
(32,696 |
) |
The Company has $5.6 million of federal net operating losses as of December 31, 2025 and none as of December 31, 2024. On December 22, 2017, the U.S. government enacted comprehensive tax legislation known as the Tax Cuts and Jobs Act (TCJA). The TCJA limits a taxpayer’s ability to utilize its net operating loss (“NOL”) deduction for losses arising in tax years beginning after 2017 to 80% of taxable income. The Company has state net operating losses of $4.2 million and $40.4 million as of December 31, 2025 and 2024, respectively. These net operating losses have carryforward periods ranging from 15 years to indefinite carryforward use. The state net operating losses begin to expire in 2034.
At December 31, 2025 and 2024, the Company had no uncertain tax positions requiring accrual.
Management assesses the available positive and negative evidence to estimate whether sufficient future taxable income will be generated to permit use of the existing deferred tax assets.
A significant piece of objective negative evidence evaluated was the cumulative loss incurred over the three-year period ended December 31, 2025. On the basis of this evaluation, as of December 31, 2025 and 2024, a valuation allowance of $75.2 million and $63.9 million, respectively, has been recorded to recognize only the portion of the deferred tax asset that is more likely than not to be realized.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
The changes in the valuation allowance are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Balance at the beginning of the year |
|
$ |
(63,882 |
) |
|
$ |
(43,961 |
) |
|
$ |
(25,298 |
) |
Amounts charged to income tax expense |
|
|
(11,343 |
) |
|
|
(19,921 |
) |
|
|
(18,663 |
) |
Balance at end of year |
|
$ |
(75,225 |
) |
|
$ |
(63,882 |
) |
|
$ |
(43,961 |
) |
The Company has concluded on all U.S. federal income tax matters for years through 2021, but there has been no conclusion on state and local income tax matters for years since the Company’s inception.
The utilization of certain tax attributes may be limited under Section 382 of the Internal Revenue Code (and similar state provisions) if the Company undergoes an “ownership change,” as defined by Section 382. In addition, the Company’s ability to use certain tax attribute maybe limited by separate return year limitation (“SRLY”) rules and other consolidated return regulations. To the extent it is ultimately determined that the Company’s tax attributes are subject to limitations under Section 382, SRLY rules or other provisions, the Company’s deferred tax assets may be reduced, including through an increase to the valuation allowance, and the Company could recognize additional tax expense in the period such determination is made.
On July 4, 2025, the “One Big Beautiful Bill” (H.R. 1) was enacted into law. This legislation included broad changes to individuals, businesses and international income tax provisions. Key components most applicable to the Company include the restoration of favorable tax treatment for depreciation and amortization and interest expense. The Company evaluated the legislation and it did not result in a material impact to its income tax expense or deferred income tax positions as of and for the year ended December 31, 2025. However, it has allowed the Company to realize a tax benefit for more current year interest expense during the year ended December 31, 2025.
13. Equity
Upon completion of the Equity Reorganization and IPO, the Company’s amended and restated certificate of incorporation authorized 1,000,000,000 shares of the Company’s Common Stock, $0.001 par value per share, and 1,000,000 shares of undesignated preferred stock, $0.001 par value per share, the rights, preferences and privileges of which may be designated from time to time by the Company’s Board of Directors.
The Company had 96,109,927 and 69,523,831 shares of Common Stock issued and outstanding at December 31, 2025 and 2024, respectively. The share count as of December 31, 2024, has been recast to reflect the Equity Reorganization.
As of both December 31, 2025 and 2024, 31,869 shares of Common Stock were held in escrow for future indemnities in connection with historical acquisitions. These shares of Common Stock are reflected as outstanding in the statement of changes in equity. The share count as of December 31, 2024 has been recast to reflect the Equity Reorganization.
The number of shares of Common Stock that is outstanding excludes 6,100,839 shares of Common Stock that are available for future issuance under the 2025 Equity Plan and 2,033,613 shares of Common Stock that are available for future issuance under the Lumexa Imaging Holdings, Inc. 2025 Employee Stock Purchase Plan (“ESPP”). No shares were issued under the ESPP during the year ended December 31, 2025. There are currently no outstanding shares of preferred stock.
In addition, excluded from the number of shares of Common Stock outstanding are the additional shares that will become available under the 2025 Plan and the ESPP pursuant to annual evergreen provisions. Under the 2025 Equity Plan, the number of shares of Common Stock available under the 2025 Equity Plan will be increased on the first day of each fiscal year, beginning with the year ending December 31, 2026, and continuing until, and including the year ending December 31, 2035, in amount equal to the lesser of (i) 5% of the number of shares issued on December 31 of the immediately preceding fiscal year and (ii) an amount determined by the Company’s Board of Directors. The number of shares of Common Stock available under the ESPP will automatically increase on the first trading day in January of each calendar year, commencing in 2026 and continuing until (and including) 2035, by an amount equal to
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
the lesser of (i) 1% of the shares issued and outstanding on December 31 of the immediately preceding calendar year, (ii) 2,033,613 shares and (iii) an amount determined by the Company’s Board of Directors.
The Company's Common Stock has the following terms and conditions:
Dividend Rights
Subject to preferences that may apply to shares of preferred stock outstanding at the time, the holders of outstanding shares of the Common Stock are entitled to receive dividends out of funds legally available if the Company’s Board of Directors, in its discretion, determines to issue dividends and only then at the times and in the amounts that the Company’s Board of Directors may determine.
Voting Rights
The holders of the Common Stock are entitled to one vote per share. Stockholders do not have the ability to cumulative votes for the election of directors. The Company’s amended and restated certificate of incorporation and amended and restated bylaws provide for a classified Board of Directors consisting of three classes of approximately equal size, each serving staggered three-year terms. Only one class of directors will be elected at each annual meeting of the Company’s stockholders, with the other classes continuing for the remainder of their respective three-year terms. The Company’s Board of Directors currently consists of nine directors.
Liquidation
Upon the Company’s liquidation, dissolution of winding up, the assets legally available for distribution to the Company’s stockholders would be distributable ratably among the holders of the Common Stock and participating preferred stock outstanding at that time, subject to prior satisfaction of all outstanding debt and liabilities and the preferential rights of and the payment of liquidation preferences, if any, on any outstanding share of preferred stock.
14. Stock-Based Compensation
Holdings LLC Common Units
Prior to the Equity Reorganization, Holdings LLC issued Holdings LLC Common Units to consolidated Holding Companies, for the purpose of granting equity to Holdings LLC's service providers. Contemporaneously with these grants, the Holding Companies issued their own equity, representing Holdings LLC Common Units.
In conjunction with the Equity Reorganization and the IPO, the Company issued Common Stock to Holdings LLC, and Holdings LLC contributed 100% of its equity in its operating entities to the Company. As a result, the Company consolidated the operating entities, and the Holdings LLC Common Units became indexed to the 18,810,689 shares of the Company’s Common Stock, of which 14,251,410 shares were vested upon the Reorganization Transaction. Following the Equity Reorganization, the unvested Holdings LLC Common Units will continue to be accounted for as stock compensation by the Company. The terms and the fair value of the Holdings LLC Common Units were not changed by the Equity Reorganization. Accordingly, the Company continues to recognize the original grant date fair value of these Holdings LLC Common Units over the remaining service period, which is approximately one year as of December 31, 2025.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
During the year ended December 31, 2025, the total fair market value of Holdings LLC Common Units that were granted and vested was $1.7 million and $81.4 million, respectively. Common Unit award transactions for the year ended December 31, 2025 were as follows:
|
|
|
|
|
|
|
|
|
|
|
NUMBER OF UNITS |
|
|
WEIGHTED- AVERAGE GRANT DATE FAIR VALUE |
|
Nonvested as of December 31, 2024 |
|
|
10,549,528 |
|
|
$ |
18.72 |
|
Granted |
|
|
86,986 |
|
|
|
20.07 |
|
Vested |
|
|
(5,990,249 |
) |
|
|
13.60 |
|
Forfeited or cancelled |
|
|
(86,986 |
) |
|
|
26.10 |
|
Nonvested as of December 31, 2025 |
|
|
4,559,279 |
|
|
$ |
25.37 |
|
The Company recognizes compensation expense for the Holdings LLC Common Units subject to vesting over the required vesting period of typically five years upon grant. The Company recognized $28.3 million, $49.3 million and $50.6 million of stock-based compensation expense related to Holdings LLC Common Units subject to vesting for the years ended December 31, 2025, 2024 and 2023, respectively. The fair value of Holdings LLC Common Units subject to vesting is equal to the stated value of Holdings LLC Common Units at the time of issuance.
As of December 31, 2025, there was $24.7 million of unrecognized compensation expense related to Holdings LLC Common Units recognizable over a remaining weighted-average period of one year.
Holdings LLC Incentive Unit Plan
On January 1, 2018, Holdings LLC's Board of Managers approved the 2018 Equity Plan, which provided for the issuance of Incentive Units of Holdings LLC (“Incentive Units”). Upon a qualifying disposition event or distribution from Holdings LLC, Incentive Units entitle holders to receive a portion of the accumulated profits interest in Holdings LLC (above a stated distribution threshold). Incentive Units do not entitle any holders to the contributed capital interest in Holdings LLC. Holdings LLC does not expect to issue additional incentive units, nor does it expect to issue additional units under the 2018 Equity Plan.
The distribution threshold represents the amount of cumulative investment in Holdings LLC at the grant date and distributions from a qualifying disposition event that are in excess of the distribution threshold are applied towards the settlement of vested Incentive Units.
In connection with the Equity Reorganization, certain Incentive Units in Holdings LLC issued under the 2018 Equity Plan held by active members of management were converted into shares of the Company’s Common Stock, stock options and RSAs of the Company under the 2025 Equity Plan. The remaining Incentive Units that were not subject to conversion were not modified and remain outstanding as of December 31, 2025. The Company continues to recognize the original grant date fair value of the Incentive Units that were not subject to conversion over the remaining service period as they were not modified by the Equity Reorganization or IPO. The Incentive Unit share counts have been recast to reflect the Equity Reorganization.
There were 3,851,937 and 8,389,437 time-based Incentive Units authorized and outstanding as of December 31, 2025 and 2024, respectively. The Company recognizes compensation expense for time-based Incentive Unit awards ratably over the corresponding vesting period which is five years. In the case of a change in control, outstanding time-based incentive units will automatically vest.
In addition, there were 3,202,998 and 3,907,165 Incentive Units with performance and market conditions authorized and outstanding as of December 31, 2025 and 2024, respectively. The vesting conditions represent a qualifying disposition event that requires Holdings LLC Incentive Unit holders to receive a minimum return on their initial investment in Holdings LLC (i.e. a minimum unit price). The compensation expense related to these Incentive Units is recognized when it is deemed probable that the performance criteria will be achieved. As of December 31,
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
2025 and 2024, achievement of the performance-based criteria was not determined to be probable. As such, no compensation expense has been recorded from the grant date for these Incentive Units through December 31, 2025, 2024 or 2023, except for awards accelerated through a modification.
The Company recognizes forfeitures of Incentive Units based on the actual number of forfeitures. The Company recognized $2.6 million, $7.4 million and $4.7 million of compensation expense related to Incentive Units for the years ended December 31, 2025, 2024 and 2023 respectively. As of December 31, 2025, there was $2.5 million of unrecognized compensation expense related to Incentive Units with service conditions recognizable over a remaining weighted-average period of five years, and $0.4 million of unrecognized compensation expense related to Incentive Units with an improbable performance condition.
The Company used the Monte Carlo simulation model to estimate the fair value of each Incentive Unit award on the date of grant. The following assumptions were used in estimating these values and determining the related fair value of Incentive Units attributable to the current period:
Expected term of the awards: The expected term of awards granted represented the period of time that they were expected to remain outstanding from the date of grant. The Company determined the expected term of its equity awards based on its historical experience with similar awards, considering the Company’s historical exercise, using the expiration periods and post-vesting termination patterns.
Expected volatility: Expected volatility represented the volatility anticipated over the expected term of the award. The Company determined the expected volatility based on the benchmark historical range of stock prices of comparable companies.
Expected dividend yield: The Company paid dividends on its common units in the past, but does not currently expect to pay dividends during the term of stock awards granted.
Risk-free interest rate: The Company based the expected risk-free interest rate on the implied yield currently available on stripped interest coupons of U.S. Treasury issues with a remaining term equivalent to the expected term of the award.
The weighted-average grant-date fair values for both time-based and performance-based Incentive Unit awards was $3.96 per unit for the years ended December 31, 2025 and 2024 and $4.32 for the year ended December 31, 2023 which were calculated using the following weighted-average assumptions:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Expected volatility |
|
|
45.0 |
% |
|
|
45.0 |
% |
|
|
50.0 |
% |
Expected term |
|
2.5 years |
|
|
2.5 years |
|
|
2.5 years |
|
Weighted-average risk-free interest rate |
|
|
4.7 |
% |
|
|
4.7 |
% |
|
|
4.6 |
% |
Expected dividend yield |
|
|
— |
% |
|
|
— |
% |
|
|
— |
% |
Incentive Unit transactions for the year ended December 31, 2025 were as follows:
|
|
|
|
|
|
|
|
|
|
|
NUMBER OF UNITS |
|
|
WEIGHTED- AVERAGE GRANT DATE FAIR VALUE |
|
Nonvested as of December 31, 2024 |
|
|
7,543,787 |
|
|
$ |
4.14 |
|
Granted |
|
|
4,057,222 |
|
|
|
3.96 |
|
Vested |
|
|
(907,805 |
) |
|
|
3.32 |
|
Forfeited and converted(1) |
|
|
(9,401,861 |
) |
|
|
4.28 |
|
Nonvested as of December 31, 2025(2) |
|
|
1,291,343 |
|
|
$ |
4.03 |
|
(1)The forfeited and cancelled units include 3,795,861 forfeited units as well as 5,606,000 units that converted into shares of Common Stock, stock options and RSAs in conjunction with the Equity Reorganization.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
(2)The unvested units, which were not converted into shares of Common Stock, stock options or RSAs in conjunction with the Equity Reorganization, include 937,789 Incentive Units with a service condition as well as 353,553 Incentive Units with a performance condition.
As part of the Equity Reorganization, the Company has agreed to issue its Common Stock at a future date to be distributed to Incentive Unit holders, if a distribution is declared by Holdings LLC to its equity holders or if Holdings LLC is dissolved. Upon declaration of a distribution by Holdings LLC (or the dissolution of Holdings LLC), if any amount is owed to the Incentive Unit holders, after considering the distribution threshold, the Company will issue shares of Common Stock to Holdings LLC for distribution to the Incentive Unit holders as replacement awards under the 2025 Equity Plan.
2025 Equity Plan
On December 1, 2025, the Company’s Board of Directors approved the 2025 Equity Plan, which provides for the issuance of RSUs, RSAs, options, stock option appreciation rights, and the ESPP.
In connection with the Equity Reorganization and the IPO, the Incentive Units in Holdings LLC issued under the 2018 Equity Plan held by certain active employees were converted into shares of Common Stock, stock options and RSAs of the Company under the 2025 Equity Plan. The replacement awards for the time vesting Incentive Units were issued with substantially identical vesting schedules. The time vesting unit conversion was accounted for as a Type I (probable-to-probable) modification in accordance with ASC 718, in which no material incremental fair value was determined to have been given to the Incentive Unit holders. The Company issued 779,724 shares of Common Stock to Incentive Unit holders with such vested units. The Company estimated the incremental fair value of the service vesting options and RSAs as of the modification date based on a determination of the total fair value of the Company’s equity as of the valuation date which was then run through a hypothetical liquidation model.
Moreover, upon the completion of the Equity Reorganization and the IPO, the Incentive Units that contained both performance and market conditions converted into shares of Common Stock, stock options and RSAs under the 2025 Equity Plan. The Company accounted for the conversion of these units as a Type III (improbable-to-probable) modification under ASC 718 and remeasured the awards at the modification date fair value. The Company issued 656,194 shares of Common Stock to Incentive Unit Holders such vested units. The modification resulted in $33.7 million of incremental fair value, of which a portion is recognized in the year ended December 31, 2025 and the remaining amount will be recognized over the derived service period for the unvested awards. Expense totaling $9.2 million was immediately recognized for awards that vested upon the completion of the Equity Reorganization and the IPO.
Options
During the year ended December 31, 2025, the Company issued 5,572,698 stock options in exchange for Incentive Units in conjunction with the Equity Reorganization and the IPO, of which 3,069,681 stock options are service-based vesting and 2,503,017 stock options are market-based vesting. The market-based vesting provisions are based on established thresholds of the Company’s stock price over a defined trading period. As a result of the terms of the conversion of Incentive Units, 680,648 service-based vesting options, with a grant date fair value of $0.4 million, and 347,347 market-based vesting options, with a grant date fair value of $3.7 million, were vested upon issuance. The remaining service-based vesting options will vest over a remaining service period of up to five years, based on the vesting schedule of the original Incentive Units. Stock options generally expire 10 years after the grant date of the option. No options were exercised during the year ended December 31, 2025. The intrinsic value of options exercised during 2025 and the intrinsic value of options outstanding at December 31, 2025 were immaterial.
The weighted average fair value of the service-based vesting options granted as a part of the Equity Reorganization and the IPO is $4.47 per share and is based on the grant date fair value of the original Incentive Units as the incremental fair value resulting from the conversion into stock options was immaterial. The weighted average fair value of the market vesting options granted as a part of the Equity Reorganization is $10.70 per unit, and was estimated based on a Monte Carlo model and utilized the following assumptions at the time of grant:
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
|
|
|
|
|
|
|
2025 |
|
Expected volatility(1) |
|
|
62.0 |
% |
Expected term(2) |
|
3.0 years |
|
Weighted-average risk-free interest rate(3) |
|
|
4.0 |
% |
Expected dividend yield(4) |
|
|
— |
% |
(1)Expected volatility was based on a historical range of stock prices of comparable companies.
(2)The expected term of the stock options was derived by simulating time to achievement of vesting triggers.
(3)The risk-free rate is based on the U.S. Treasury implied yield curve in effect at the time of grant.
(4)Expected dividend yield is based on the Company's dividend yield at the time of grant.
The following table is a summary of the Company’s stock option activity for options with a service condition for the year ended December 31, 2025:
|
|
|
|
|
|
|
|
|
|
|
|
NUMBER OF OPTIONS |
|
|
WEIGHTED AVERAGE EXERCISE PRICE |
|
WEIGHTED AVERAGE REMAINING CONTRACTUAL TERM |
Outstanding as of December 31, 2024 |
|
|
— |
|
|
$ |
— |
|
|
Granted |
|
|
3,069,681 |
|
|
|
18.50 |
|
|
Exercised |
|
|
— |
|
|
|
— |
|
|
Forfeited |
|
|
— |
|
|
|
— |
|
|
Outstanding as of December 31, 2025 |
|
|
3,069,681 |
|
|
$ |
18.50 |
|
|
Exercisable as of December 31, 2025 |
|
|
681,759 |
|
|
$ |
18.50 |
|
10 years |
Expected to vest |
|
|
2,387,922 |
|
|
$ |
18.50 |
|
10 years |
The following table is a summary of the Company’s stock option activity for options with a market condition for the year ended December 31, 2025:
|
|
|
|
|
|
|
|
|
|
|
|
NUMBER OF OPTIONS |
|
|
WEIGHTED AVERAGE EXERCISE PRICE |
|
WEIGHTED AVERAGE REMAINING CONTRACTUAL TERM |
Outstanding as of December 31, 2024 |
|
|
— |
|
|
$ |
— |
|
|
Granted |
|
|
2,503,017 |
|
|
|
18.50 |
|
|
Exercised |
|
|
— |
|
|
|
— |
|
|
Forfeited |
|
|
— |
|
|
|
— |
|
|
Outstanding as of December 31, 2025 |
|
|
2,503,017 |
|
|
$ |
18.50 |
|
|
Exercisable as of December 31, 2025 |
|
|
347,347 |
|
|
$ |
18.50 |
|
10 years |
Expected to vest |
|
|
2,155,670 |
|
|
$ |
18.50 |
|
10 years |
Restricted Stock Awards and Restricted Stock Units
During the year ended December 31, 2025, the Company issued 95,061 RSAs in exchange for Incentive Units, in conjunction with the Equity Reorganization and the IPO, of which 136 RSAs are service vesting and 94,925 RSAs are market vesting. The market-based vesting provisions are based on established thresholds of the Company’s stock price over a defined trading period. No RSAs vested during 2025. The remaining service vesting RSAs will vest over a remaining service period of up to five years, based on the vesting schedule of the original incentive units.
The weighted average fair value of the service vesting RSAs granted as a part of the Equity Reorganization and the IPO is $3.86 per unit and is based on the grant date fair value of the original Incentive Units as the incremental fair value resulting from the conversion into RSAs was immaterial. The fair value of the market vesting RSAs granted
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
as a part of the Equity Reorganization is $17.12 per unit, and is estimated based on a Monte Carlo model and utilized the following assumptions at the time of grant:
|
|
|
|
|
|
|
2025 |
|
Expected volatility(1) |
|
|
62.0 |
% |
Expected term(2) |
|
1.2 years |
|
Weighted-average risk-free interest rate(3) |
|
|
3.9 |
% |
Expected dividend yield(4) |
|
|
— |
% |
(1)Expected volatility was based on a historical range of stock prices of comparable companies.
(2)The expected term of the RSAs granted was estimated using the historical behavior of employees.
(3)The risk-free rate is based on the U.S. Treasury implied yield curve in effect at the time of grant.
(4)Expected dividend yield is based on the Company's dividend yield at the time of grant.
Additionally, at the time of the Equity Reorganization and the IPO, the Company issued 431,033 new RSUs with a three-year service requirement. The Company also issued 13,514 RSUs that vested immediately upon IPO with a fair value of $0.3 million. Lastly, the Company issued 271,663 RSUs with a market condition during the year, which will be recognized over a three-year service period and over a four-year derived service period. That is, to the extent thresholds with respect to the price of the Company’s Common Stock are not achieved following the three-year service period, the service period shall be extended one-year past the date of the three-year service period to permit achievement of the share price thresholds. The fair value of the market vesting RSUs granted as part of the Equity Reorganization and the IPO is $14.35 per share, and is estimated based on a Monte Carlo model and utilized the following assumptions at the time of grant:
|
|
|
|
|
|
|
2025 |
|
Expected volatility(1) |
|
|
67.0 |
% |
Expected term(2) |
|
4.0 years |
|
Weighted-average risk-free interest rate(3) |
|
|
3.6 |
% |
Expected dividend yield(4) |
|
|
— |
% |
(1)Expected volatility was based on a historical range of stock prices of comparable companies.
(2)The expected term of the RSUs granted was derived by simulating time to achievement of vesting triggers.
(3)The risk-free rate is based on the U.S. Treasury implied yield curve in effect at the time of grant.
(4)Expected dividend yield is based on the Company’s dividend yield at the time of grant.
See Note 15 “Commitments and Contingencies” for additional detail on certain bonus and retention agreements that were converted into 423,009 RSUs upon the IPO.
The following table is a summary of the Company’s RSA and RSU activity with a service condition for the year ended December 31, 2025:
|
|
|
|
|
|
|
|
|
|
|
NUMBER OF SHARES |
|
|
WEIGHTED AVERAGE GRANT DATE FAIR VALUE |
|
Nonvested as of December 31, 2024 |
|
|
— |
|
|
$ |
— |
|
Granted(1) |
|
|
867,691 |
|
|
|
18.50 |
|
Vested |
|
|
(13,514 |
) |
|
|
18.50 |
|
Forfeited or cancelled |
|
|
— |
|
|
|
— |
|
Nonvested as of December 31, 2025 |
|
|
854,177 |
|
|
$ |
18.50 |
|
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
The following table is a summary of the Company’s RSA and RSU activity with a market condition for the year ended December 31, 2025:
|
|
|
|
|
|
|
|
|
|
|
NUMBER OF SHARES |
|
|
WEIGHTED AVERAGE GRANT DATE FAIR VALUE |
|
Nonvested as of December 31, 2024 |
|
|
— |
|
|
$ |
— |
|
Granted(1) |
|
|
366,588 |
|
|
|
15.07 |
|
Vested |
|
|
— |
|
|
|
— |
|
Forfeited or cancelled |
|
|
— |
|
|
|
— |
|
Nonvested as of December 31, 2025 |
|
|
366,588 |
|
|
$ |
15.07 |
|
Stock-based Compensation Expense
The following table presents the components of stock-based compensation expense for the years ended December 31, 2025, 2024 and 2023 (in thousands). Stock-based compensation expense associated with the Holdings LLC Common Units is recorded within Cost of operations, excluding depreciation and amortization and stock-based compensation expense related to the remaining equity awards is presented within General and administrative expense in the Company’s consolidated statements of operations and comprehensive loss.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Holdings LLC Common Units |
|
$ |
28,303 |
|
|
$ |
49,278 |
|
|
$ |
50,600 |
|
Incentive Units |
|
|
2,575 |
|
|
|
7,376 |
|
|
|
4,696 |
|
Common Stock |
|
|
5,320 |
|
|
|
— |
|
|
|
— |
|
Stock Options |
|
|
4,560 |
|
|
|
— |
|
|
|
— |
|
RSAs and RSUs |
|
|
846 |
|
|
|
— |
|
|
|
— |
|
Total |
|
$ |
41,604 |
|
|
$ |
56,654 |
|
|
$ |
55,296 |
|
As of December 31, 2025, there was $76.2 million of total unrecognized compensation cost related to non-vested stock-based compensation with respect to Holdings LLC common units and Incentive Units and the Company's stock options, RSAs and RSUs that are expected to vest. This cost is expected to be recognized over a weighted-average period of approximately two years as of December 31, 2025. Additionally, there is $0.4 million of unrecognized compensation expense related to Incentive Units outstanding as of December 31, 2025, with an improbable performance condition.
15. Commitments and Contingencies
Bonus and Retention Agreements
During 2024, the Company entered into bonus and retention agreements with certain employees (“Bonus Agreements”). One half of an employee’s bonus amount was service-based and vested as of June 30, 2025. The other half of the bonus amount was performance-based and vested upon the occurrence of a sale of the Company. In June 2025, the portion of the bonus agreement that aligned to a potential future sale was amended. The sale portion of the bonus vests with an employee’s continued service to the Company through June 30, 2027, even if no sale occurs. Consistent with the original Bonus Agreements, vesting accelerates if a sale occurs prior to June 30, 2027, and the employee is still employed through the close date of the sale. The bonus was to be paid in cash if vesting occurred due to a sale or the employee’s continued service through June 30, 2027. The performance-based vesting provisions were also amended to add another vesting provision if the Company completed an IPO prior to June 30, 2027. If the employee remained employed through the closing date of the IPO, the bonus was replaced with an equivalent value of RSUs of the public entity. Such RSUs vest a year following the IPO date, but are forfeited if the employee does not remain employed through this period.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
The Company completed its IPO in December 2025, and therefore, under the amended terms of the Bonus Agreements, the total performance-based portion of the bonus was converted to 423,009 RSUs based on the $18.50 value of common stock at the IPO date. Additionally, the amount accrued related to the Bonus Agreements as of the IPO date of $2.2 million was reclassified to additional paid-in-capital upon conversion of the cash bonuses to RSUs. There is $5.5 million of remaining expense related to the performance-based portion of the bonus and such expense will be recorded as stock-based compensation expense over the 12 month explicit service period in the RSU awards. The RSUs will vest on the one year anniversary of the IPO date provided the employee remains employed through December 11, 2026. See Note 14 “Stock-Based Compensation.”
The Company recognized compensation expense over the required service periods under the Bonus Agreements' terms totaling $6.6 million and $11.2 million for the years ended December 31, 2025 and 2024, respectively. The amount related to the Bonus Agreements included in Accrued expenses and other current liabilities as of December 31, 2024 was $11.2 million. The Company paid $15.0 million to employees related to the original service based portion of the Bonus Agreements in July 2025, subsequent to vesting on June 30, 2025.
Regulatory Oversight
The Company expects that audits, inquiries, and investigations from government authorities and agencies will occur in the ordinary course of business.
Such audits, inquiries, and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on the Company’s business, financial conditions, results of the operations, and cash flows. The Company has not recorded a reserve for these matters as of December 31, 2025 and 2024, as the variables affecting any potential eventual liability depends on the current unknown facts and circumstances that arise out of, and are specific to, any particular future audit, inquiry, and investigation and cannot be reasonably estimated at this time. Management believes that the resolution of all current regulatory matters will not result in a material impact to the Company’s financial condition, results of operation, or cash flows.
Legal Proceedings
The Company is subject to various legal proceedings, medical malpractice claims and regulatory tax inquiries and investigations that arise in the ordinary course of its business. With respect to these matters, the Company evaluates the developments on a regular basis and accrues a liability when we believe a loss is probable and the amount can be reasonably estimated. Based on current information, the Company does not believe that reasonably possible or probable losses associated with pending legal proceedings would, either individually or in the aggregate, have a material adverse effect on business and consolidated financial statements. However, the outcome of these matters is inherently uncertain.
16. Defined Contribution Plan
The Company sponsors a profit-sharing plan whereby certain employees who have completed at least one month of service, including at least one hour of service during that period of time, are eligible to participate. Company contributions are in accordance with the plan document. The plan includes a 401(k) feature whereby employees may contribute varying percentages, or flat dollar amounts of their annual compensation, up to the maximum allowable amounts by the Internal Revenue Service on a tax-deferred basis. Total expense for the plan was $23.2 million, $22.9 million and $22.0 million for the years ended December 31, 2025, 2024 and 2023 respectively.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
17. Variable Interest Entities
The Company’s VIEs consist of both VIE Physician Practices and Franchise Centers.
VIE Physician Practices
The VIE Physician Practices are wholly owned, from an equity ownership perspective and for certain regulatory reasons, by certain physicians (the “Physician Owners”) who are employed by the Company or a VIE Physician Practice. The VIE Physician Practices were established to operate as medical radiology practices and provide their patients with professional interpretation services. At various points between 2018 and 2023, via the establishment or acquisition of the MSOs and execution of the ASAs and other contractual agreements, the Company acquired a controlling financial interest in the VIE Physician Practices (described below in detail). Through the ASAs, the MSOs have exclusive responsibility for the provision of non-medical services required for the day-to-day operation and management of each of the VIE Physician Practices, including establishing annual capital and operating budgets, and making recommendations to the VIE Physician Practices in establishing the guidelines for the employment and compensation for the physicians and other employees of the VIE Physician Practices. Via other contractual agreements, the Company has the right to designate an appropriate licensed person(s) to purchase the equity interest of the VIE Physician Practices for nominal amount in the event of a transfer event at the Company’s discretion.
In assessing whether the Company should consolidate the VIE Physician Practices, the Company evaluated whether it has a variable interest in the VIE Physician Practices, whether the VIE Physician Practices are VIEs, and whether the Company has a controlling financial interest in the VIE Physician Practices. The Company concluded that it has variable interests in the VIE Physician Practices on the basis that the Company has the right to receive income as an ongoing management fee under the ASAs, which effectively absorbs all of the residual interests of the VIE Physician Practices. The Company also has the implicit obligation to absorb losses of the VIE Physician Practices and to additionally provide, in certain circumstances, cash advances to the VIE Physician Practices if the VIE Physician Practices have insufficient funds. The Company did not provide any such cash advances to the VIE Physician Practices during the year ended December 31, 2025 or 2024. The Company determined the VIE Physician Practices are VIEs due to insufficient equity at risk and/or the holders of the equity at risk in the VIE Physician Practices (i.e., the Physician Owners) lacking the power, through voting rights or similar rights, to direct the activities that most significantly impact the VIE Physician Practices’ economic performance.
The contractual arrangements described above allow the Company to direct the activities that most significantly impact the economic performance of the VIE Physician Practices. Accordingly, the Company is the primary beneficiary of the VIE Physician Practices and consolidates the VIE Physician Practices under the VIE model.
The tables below illustrate the assets and liabilities of the VIE Physician Practices (in thousands):
|
|
|
|
|
|
|
|
|
|
|
AS OF DECEMBER 31, |
|
|
|
2025 |
|
|
2024 |
|
|
|
VIE PHYSICIAN PRACTICES |
|
|
VIE PHYSICIAN PRACTICES |
|
Assets |
|
|
|
|
|
|
Current assets |
|
$ |
56,239 |
|
|
$ |
53,112 |
|
Non-current assets |
|
|
202,549 |
|
|
|
190,406 |
|
Total assets of consolidated VIEs |
|
|
258,788 |
|
|
|
243,518 |
|
Liabilities |
|
|
|
|
|
|
Current liabilities |
|
|
17,038 |
|
|
|
20,558 |
|
Non-current liabilities |
|
|
32,334 |
|
|
|
28,253 |
|
Total liabilities of consolidated VIEs |
|
|
49,372 |
|
|
|
48,811 |
|
Total net assets of consolidated VIEs |
|
$ |
209,416 |
|
|
$ |
194,707 |
|
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
Franchise Centers
The Franchise Centers operate as franchisees of AHI and are wholly owned, from an equity ownership perspective and for certain regulatory reasons, by certain radiologists (the “Franchisees”) who have contracts with and provide clinical services to the patients of the Franchise Centers. The Franchise Centers were established to operate as medical radiology practices and imaging centers offering patients MRI, CT, and ultrasound imaging services. Through the franchise agreements and management service agreements (“MSAs”), AHI has exclusive responsibility for the provision of non-medical services required for the day-to-day operation and management of each of the Franchise Centers, including establishing annual capital and operating budgets and makes recommendations to the Franchise Centers in establishing the guidelines for the physicians and other employees of the Franchise Centers. The franchise agreements also restrict the Franchisees’ ability to transfer the ownership interest without AHI’s approval.
In assessing whether AHI should consolidate the Franchise Centers, the Company evaluated whether AHI holds a variable interest in the Franchise Centers, if the Franchise Centers are VIEs, and whether AHI has a controlling financial interest in the Franchise Centers. The Company concluded that AHI has the right to receive income as an ongoing management fee under the MSAs, which effectively absorbs all of the residual interest of the Franchise Centers. AHI also has the implicit obligation to absorb losses of the Franchise Centers and to additionally provide, in certain circumstances, cash advances to the Franchise Centers, if the Franchise Centers have insufficient funds. AHI did not provide any such cash advances to the Franchise Centers during the year ended December 31, 2025 or 2024. The Company determined that the Franchise Centers are considered VIEs because their equity at risk is insufficient to finance their activities without additional support.
The contractual arrangements above allow AHI to direct the activities that most significantly impact the Franchise Centers’ economic performance. Thus, AHI is the primary beneficiary and consolidates the Franchise Centers.
Total assets and liabilities included in the Company’s consolidated balance sheets associated with the Franchise Centers were $7.2 million and $5.9 million and $5.0 million and $4.1 million, respectively, at December 31, 2025 and 2024.
As a direct result of the nominal initial equity contributions by the Physician Owners and the Franchisees and the provisions of the contractual arrangements described above, the interests held by the noncontrolling interest holders of the Company’s VIEs (inclusive of the VIE Physician Practices and the Franchise Centers) lack economic substance and do not provide them with any right to participate in residual profits or losses generated by the Company’s VIEs. These rights are instead implicit in the corporate governance laws governing the relevant VIE’s constitutive documents by virtue of the fact that such noncontrolling interest holders are the sole owners of the equity of the relevant VIE. However, after paying relevant expenses, including clinical staff salaries as well as administrative service fees to the Company, the VIEs do not have residual profits remaining. Additionally, because the Company absorbs all expected losses of its VIEs through its deferral of administrative service fees and the Company expects that its VIEs will continue to have a shortfall on their payment of such administrative service fees, noncontrolling interest holders in the VIEs are not expected to be allocated any residual profits, losses, dividends or liquidation proceeds. Therefore, the noncontrolling interests in the VIEs have no material value and the income and expenses recognized by the VIEs are attributable in totality to the Company.
The Company has not identified any VIEs during the year ended December 31, 2025 or 2024, for which the Company determined that it is not the primary beneficiary and thus did not consolidate. No VIEs were deconsolidated during the year ended December 31, 2025 or 2024.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
18. Investments in Unconsolidated Affiliates
BTDI
Touchstone Imaging of Mesquite, LLC (“TMI”), a wholly owned subsidiary of LIOI, and Baylor University Medical Center (BUMC) own a 49% and 51% interest, respectively, in BTDI. The Company accounts for TMI’s noncontrolling interest in the investment in the unconsolidated affiliate under the equity method of accounting.
On May 25, 2021, LIOI made an investment in an unconsolidated affiliate along with BUMC called Gateway Diagnostic JV, LLC (“Gateway”) for the purpose of owning, operating, and managing independent diagnostic testing facilities to provide imaging services to patients in Texas. Prior to the reorganization (described in the succeeding sentence), Gateway was a common controlled affiliate of BTDI and was owned 49% by the Company and 51% by BUMC. During 2023, through a series of transactions, Gateway was reorganized and became a wholly owned subsidiary of BTDI. The reorganization was treated as a common control transaction.
All Others
The Company’s other investments in unconsolidated affiliates include Carolinas Imaging Services, LLC (“CIS”), Virtua Adult Imaging JV (“Virtua JV”), SCLTDI JV, LLC (“SCLTDI”), IH-USRS Imaging, LLC (“IH-USRS”), RLC, LLC, (“RLC”), and Tucson Medical Imaging Partners, LLC (“TMIP”). The Company has ownership interests in these entities ranging from 30% to 50%. The Company accounts for these investments in unconsolidated affiliates under the equity method of accounting.
The following is a summary of balance sheets as of December 31, 2025 and 2024, and statements of income for the investments in unconsolidated affiliates on an aggregated basis for the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
AS OF AND FOR YEARS ENDED DECEMBER 31, |
|
|
|
2025 |
|
|
2024 |
|
|
|
BTDI |
|
|
ALL OTHERS |
|
|
TOTAL |
|
|
BTDI |
|
|
ALL OTHERS |
|
|
TOTAL |
|
Assets: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets |
|
$ |
451,913 |
|
|
$ |
139,105 |
|
|
$ |
591,018 |
|
|
$ |
437,692 |
|
|
$ |
134,281 |
|
|
$ |
571,973 |
|
Liabilities and equity: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities |
|
$ |
147,957 |
|
|
$ |
42,474 |
|
|
$ |
190,431 |
|
|
$ |
151,294 |
|
|
$ |
38,988 |
|
|
$ |
190,282 |
|
Equity |
|
|
303,956 |
|
|
|
96,631 |
|
|
|
400,587 |
|
|
|
286,398 |
|
|
|
95,293 |
|
|
|
381,691 |
|
Total liabilities and equity |
|
$ |
451,913 |
|
|
$ |
139,105 |
|
|
$ |
591,018 |
|
|
$ |
437,692 |
|
|
$ |
134,281 |
|
|
$ |
571,973 |
|
Company’s investment |
|
$ |
343,678 |
|
|
$ |
79,513 |
|
|
$ |
423,191 |
|
|
$ |
337,249 |
|
|
$ |
78,570 |
|
|
$ |
415,819 |
|
Income statement: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenues |
|
$ |
418,393 |
|
|
$ |
162,770 |
|
|
$ |
581,163 |
|
|
$ |
382,321 |
|
|
$ |
151,268 |
|
|
$ |
533,589 |
|
Expenses |
|
|
295,633 |
|
|
|
130,239 |
|
|
|
425,872 |
|
|
|
262,358 |
|
|
|
117,591 |
|
|
|
379,949 |
|
Net income |
|
$ |
122,760 |
|
|
$ |
32,531 |
|
|
$ |
155,291 |
|
|
$ |
119,963 |
|
|
$ |
33,677 |
|
|
$ |
153,640 |
|
Company’s share of net income |
|
$ |
58,597 |
|
|
$ |
15,538 |
|
|
$ |
74,135 |
|
|
$ |
57,661 |
|
|
$ |
15,844 |
|
|
$ |
73,505 |
|
Amortization of basis difference |
|
|
(2,000 |
) |
|
|
— |
|
|
|
(2,000 |
) |
|
|
(2,000 |
) |
|
|
— |
|
|
|
(2,000 |
) |
Equity in earnings of unconsolidated affiliates |
|
$ |
56,597 |
|
|
$ |
15,538 |
|
|
$ |
72,135 |
|
|
$ |
55,661 |
|
|
$ |
15,844 |
|
|
$ |
71,505 |
|
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
FOR YEAR ENDED DECEMBER 31, |
|
|
|
2023 |
|
|
|
BTDI |
|
|
ALL OTHERS |
|
|
TOTAL |
|
Income statement: |
|
|
|
|
|
|
|
|
|
Revenues |
|
$ |
345,791 |
|
|
$ |
125,730 |
|
|
$ |
471,521 |
|
Expenses |
|
|
243,572 |
|
|
|
108,052 |
|
|
|
351,624 |
|
Net income |
|
$ |
102,219 |
|
|
$ |
17,678 |
|
|
$ |
119,897 |
|
Company’s share of net income |
|
$ |
48,981 |
|
|
$ |
8,546 |
|
|
$ |
57,527 |
|
Amortization of basis difference |
|
|
(2,000 |
) |
|
|
— |
|
|
|
(2,000 |
) |
Equity in earnings of unconsolidated affiliates |
|
$ |
46,981 |
|
|
$ |
8,546 |
|
|
$ |
55,527 |
|
19. Related Party Transactions
Net Patient Service Revenue, Related Party
The Company provides diagnostic imaging services and radiology services to its unconsolidated affiliates, which include CIS, BTDI, SCLTDI and IH-USRS based on service agreements. The Company recorded patient revenue of $36.0 million, $31.3 million and $19.7 million related to these services during the year ended December 31, 2025, 2024 and 2023, respectively, which is included in Net patient service revenue, related party on the consolidated statements of operations and comprehensive loss. The Company has a receivable from these investments in unconsolidated affiliates in the amount of $2.8 million and $2.4 million as of December 31, 2025 and 2024, respectively, which is included in Accounts receivable, related party on the consolidated balance sheets.
Management fee revenue and other, Related Party
The Company provides management and administrative services based on management service agreements including staff and administrative support to their investments in unconsolidated affiliates. A large portion of this revenue relates to BTDI, where the Company recorded revenue of $143.3 million, $136.3 million and $113.4 million related to these services during the years ended December 31, 2025, 2024 and 2023, respectively, which is included in Management fee and other revenue, related party on the consolidated statements of operations and comprehensive loss. The Company has a receivable from BTDI in the amount of $9.1 million and $14.7 million as of December 31, 2025 and 2024, respectively, which is included in Accounts receivable, related party on the consolidated balance sheets.
For all other investments in unconsolidated affiliates, the Company recorded management fees of $55.3 million, $47.9 million and $48.4 million, which is included in Management fee and other revenue, related party on the consolidated statements of operations and comprehensive loss during the years ended December 31, 2025, 2024 and 2023, respectively. The Company has a receivable from these investments in unconsolidated affiliates in the amount of $6.4 million and $5.6 million as of December 31, 2025 and 2024, respectively, which is included in Accounts receivable, related party on the consolidated balance sheets.
The Company also provides management services and administrative services based on management service agreements to Atrium Health and its subsidiaries, which is an investor in Lumexa Imaging and has the right to appoint one LII board seat, thus resulting in a related party relationship. Atrium Health also is an investor, along with LII in CIS. The revenue for such services earned from Atrium Health was $2.2 million, $2.9 million and $2.2 million during the years ended December 31, 2025, 2024 and 2023, respectively, and is included in Management fee and other revenue, related party on the consolidated statements of operations and comprehensive loss. Atrium owed the Company $0.6 million at both December 31, 2025 and 2024, for such services, which are included in Accounts receivable, related party on the consolidated balance sheets.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
Unsecured Debt
The Company’s borrowings under the Amended Credit Agreement are guaranteed by LII and LIOI and each other wholly owned subsidiary of the Company, subject to certain exceptions. In addition, the Amended Credit Agreement allows the Company to guarantee, post collateral (e.g., security deposits) or issue letters of credit to creditors of the VIEs. Refer to Note 10 “Long-Term Debt” for further information.
20. Segment Reporting
In January 2025, the Company experienced a strategic shift in connection with changes to its executive leadership, including the hiring of a new Chief Executive Officer (“CEO”). As a result, at the beginning of 2025, the Company began providing its operating results to the CEO, who is the Company’s Chief Operating Decision Maker (“CODM”) on the basis of a single segment. As the CODM progressed in her role, however, she started reviewing disaggregated financial information based upon two segments (the “June Segment Update”). In response, the Company revised its view of reportable segments based on the CODM’s methods for managing the organization and allocating resources. The June Segment Update has been retroactively presented in the Company’s consolidated financial statements for the years ended December 31, 2024 and 2023.
The CODM reviews revenues and Adjusted Earnings Before Interest, Taxes, Depreciation, and Amortization (“EBITDA”) of each segment for the purpose of making operating decisions, assessing financial performance, and deciding how to allocate resources (including employees, property, and financial or capital resources) for each segment predominantly in the annual budget and forecasting process. The CODM considers budget-to-actual variances monthly when making decisions about allocating resources to the segments.
Adjusted EBITDA is defined by the Company as net loss determined in accordance with GAAP, before interest expense, provision for income taxes, depreciation and amortization, unit-based compensation expense and the impact, which may be recurring in nature, of transaction costs, one-time litigation and settlement expenses associated with claims made against the Company, costs associated with strategic initiatives and implementation, goodwill impairment charges, severance and executive recruiting costs, gains or losses on dispositions and other similar or infrequent items (although the Company may not have had such charges in the periods presented). Adjusted EBITDA includes adjustments to reflect the Company’s share of Adjusted EBITDA from unconsolidated affiliates.
The Company’s reportable segments are strategic business units that offer different services or structures for delivering outpatient imaging services. They are managed separately because each business requires a different operational strategy for managing performance and allocating resources. The Outpatient segment consists of imaging centers that are owned or operated by the Company (either wholly owned or via unconsolidated affiliate), where the Company performs the imaging scan and provides the radiologist’s interpretation service (i.e., read). Revenues are also earned through the provision of management services to operate the centers for certain of the Company’s unconsolidated affiliate partners. The Professional segment consists of professional interpretation services, where the imaging scan itself is performed at the hospital or point of care and not by the Company or its unconsolidated affiliates. The Company eliminates any intersegment transactions in consolidation.
Historically, corporate overhead expenses were allocated to each segment on the basis of net patient service revenue for each segment. During the third quarter of 2025, the Company changed its approach to allocating certain segment expenses. Physician compensation expense is now allocated based on the effort associated with services performed for each segment. Corporate overhead expenses are allocated to each segment based on estimated relative usage of these overhead costs. The impact of these revised allocation approaches was not material to the previously reported segment results for the years ended December 31, 2024 and 2023.
The Company does not report balance sheet information by segment since it is not reviewed by its CODM. The CODM uses consolidated expense information to manage operations, and the CODM is not regularly provided disaggregated expenses by segment.
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
The following tables present revenues and Adjusted EBITDA for each reportable segment for the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
YEAR ENDED DECEMBER 31, 2025 |
|
|
|
OUTPATIENT |
|
|
PROFESSIONAL |
|
|
INTERSEGMENT ELIMINATIONS |
|
|
TOTAL OF REPORTABLE SEGMENTS |
|
Revenue |
|
|
|
|
|
|
|
|
|
|
|
|
Net patient service revenue |
|
$ |
560,665 |
|
|
$ |
251,839 |
|
|
$ |
(9,797 |
) |
|
$ |
802,707 |
|
Management fee and other revenue |
|
|
200,822 |
|
|
|
19,552 |
|
|
|
— |
|
|
|
220,374 |
|
Total revenues |
|
|
761,487 |
|
|
|
271,391 |
|
|
|
(9,797 |
) |
|
|
1,023,081 |
|
Other segment items(1) |
|
|
570,081 |
|
|
|
232,643 |
|
|
|
(9,797 |
) |
|
|
792,927 |
|
Adjusted EBITDA |
|
$ |
191,406 |
|
|
$ |
38,748 |
|
|
$ |
— |
|
|
$ |
230,154 |
|
Less: |
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization |
|
|
|
|
|
|
|
|
|
|
|
(40,379 |
) |
Income tax provision |
|
|
|
|
|
|
|
|
|
|
|
(14,885 |
) |
Amortization of basis difference |
|
|
|
|
|
|
|
|
|
|
|
(2,000 |
) |
Interest expense |
|
|
|
|
|
|
|
|
|
|
|
(118,539 |
) |
Loss on extinguishment of debt |
|
|
|
|
|
|
|
|
|
|
|
(13,453 |
) |
Loss on disposal of property and equipment |
|
|
|
|
|
|
|
|
|
|
|
(968 |
) |
Other income(2) |
|
|
|
|
|
|
|
|
|
|
|
1,873 |
|
Stock-based compensation |
|
|
|
|
|
|
|
|
|
|
|
(41,604 |
) |
Severance and executive recruiting(3) |
|
|
|
|
|
|
|
|
|
|
|
(3,523 |
) |
Strategic initiatives and implementation(4) |
|
|
|
|
|
|
|
|
|
|
|
(3,459 |
) |
Transaction costs(5) |
|
|
|
|
|
|
|
|
|
|
|
(21,325 |
) |
Litigation and settlements(6) |
|
|
|
|
|
|
|
|
|
|
|
113 |
|
Other(7) |
|
|
|
|
|
|
|
|
|
|
|
(942 |
) |
Adjustments for equity in earnings of unconsolidated affiliates(8) |
|
|
|
|
|
|
|
|
|
|
|
(18,167 |
) |
Net loss |
|
|
|
|
|
|
|
|
|
|
$ |
(47,104 |
) |
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
YEAR ENDED DECEMBER 31, 2024 |
|
|
|
OUTPATIENT |
|
|
PROFESSIONAL |
|
|
INTERSEGMENT ELIMINATIONS |
|
|
TOTAL OF REPORTABLE SEGMENTS |
|
Revenue |
|
|
|
|
|
|
|
|
|
|
|
|
Net patient service revenue |
|
$ |
521,286 |
|
|
$ |
232,551 |
|
|
$ |
(6,987 |
) |
|
$ |
746,850 |
|
Management fee and other revenue |
|
|
186,169 |
|
|
|
15,850 |
|
|
|
— |
|
|
|
202,019 |
|
Total revenues |
|
|
707,455 |
|
|
|
248,401 |
|
|
|
(6,987 |
) |
|
|
948,869 |
|
Other segment items(1) |
|
|
534,913 |
|
|
|
220,104 |
|
|
|
(6,987 |
) |
|
|
748,030 |
|
Adjusted EBITDA |
|
$ |
172,542 |
|
|
$ |
28,297 |
|
|
$ |
— |
|
|
|
200,839 |
|
Less: |
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization |
|
|
|
|
|
|
|
|
|
|
|
(42,164 |
) |
Income tax provision |
|
|
|
|
|
|
|
|
|
|
|
(14,906 |
) |
Amortization of basis difference |
|
|
|
|
|
|
|
|
|
|
|
(2,000 |
) |
Interest expense |
|
|
|
|
|
|
|
|
|
|
|
(136,027 |
) |
Stock-based compensation |
|
|
|
|
|
|
|
|
|
|
|
(56,654 |
) |
Gain on imaging center sold, related party |
|
|
|
|
|
|
|
|
|
|
|
2,294 |
|
Loss on extinguishment of debt |
|
|
|
|
|
|
|
|
|
|
|
(703 |
) |
Severance and executive recruiting(3) |
|
|
|
|
|
|
|
|
|
|
|
(3,436 |
) |
Strategic initiatives and implementation(4) |
|
|
|
|
|
|
|
|
|
|
|
(5,362 |
) |
Transaction costs(5) |
|
|
|
|
|
|
|
|
|
|
|
(18,167 |
) |
Litigation and settlements(6) |
|
|
|
|
|
|
|
|
|
|
|
(588 |
) |
Other(7) |
|
|
|
|
|
|
|
|
|
|
|
(1,904 |
) |
Adjustments for equity in earnings of unconsolidated affiliates(8) |
|
|
|
|
|
|
|
|
|
|
|
(15,321 |
) |
Net loss |
|
|
|
|
|
|
|
|
|
|
$ |
(94,099 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
YEAR ENDED DECEMBER 31, 2023 |
|
|
|
OUTPATIENT |
|
|
PROFESSIONAL |
|
|
INTERSEGMENT ELIMINATIONS |
|
|
TOTAL OF REPORTABLE SEGMENTS |
|
Revenue |
|
|
|
|
|
|
|
|
|
|
|
|
Net patient service revenue |
|
$ |
535,012 |
|
|
$ |
237,816 |
|
|
$ |
(5,437 |
) |
|
$ |
767,391 |
|
Management fee and other revenue |
|
|
162,070 |
|
|
|
6,464 |
|
|
|
— |
|
|
|
168,534 |
|
Total revenues |
|
|
697,082 |
|
|
|
244,280 |
|
|
|
(5,437 |
) |
|
|
935,925 |
|
Other segment items(1) |
|
|
539,464 |
|
|
|
204,726 |
|
|
|
(5,437 |
) |
|
|
738,753 |
|
Adjusted EBITDA |
|
$ |
157,618 |
|
|
$ |
39,554 |
|
|
$ |
— |
|
|
|
197,172 |
|
Less: |
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization |
|
|
|
|
|
|
|
|
|
|
|
(56,630 |
) |
Goodwill impairment |
|
|
|
|
|
|
|
|
|
|
|
(18,969 |
) |
Income tax provision |
|
|
|
|
|
|
|
|
|
|
|
(2,978 |
) |
Amortization of basis difference |
|
|
|
|
|
|
|
|
|
|
|
(2,000 |
) |
Interest expense |
|
|
|
|
|
|
|
|
|
|
|
(141,694 |
) |
Stock-based compensation |
|
|
|
|
|
|
|
|
|
|
|
(55,296 |
) |
Loss on disposal of property and equipment |
|
|
|
|
|
|
|
|
|
|
|
(1,285 |
) |
Severance and executive recruiting(3) |
|
|
|
|
|
|
|
|
|
|
|
(2,931 |
) |
Strategic initiatives and implementation(4) |
|
|
|
|
|
|
|
|
|
|
|
(14,187 |
) |
Transaction costs(5) |
|
|
|
|
|
|
|
|
|
|
|
(4,013 |
) |
Litigation and settlements(6) |
|
|
|
|
|
|
|
|
|
|
|
(3,835 |
) |
Other(7) |
|
|
|
|
|
|
|
|
|
|
|
(1,582 |
) |
Adjustments for equity in earnings of unconsolidated affiliates(8) |
|
|
|
|
|
|
|
|
|
|
|
(13,999 |
) |
Net loss |
|
|
|
|
|
|
|
|
|
|
$ |
(122,227 |
) |
LUMEXA IMAGING holdings, inc.
Notes to Consolidated Financial Statements—(Continued)
(1)Other segment items for both segments include certain operating expenses that are not regularly provided to the CODM on a segment basis and that are identifiable with that segment, including general and administrative expenses.
(2)Represents the receipt of casualty insurance proceeds related to a flood at one of the Company’s centers.
(3)Includes severance and recruiting expenses for executive leadership departures as part of strategic organizational changes.
(4)Includes third-party consulting, implementation and integration expenses incurred as part of the Company’s strategic transformation and optimization initiatives, specifically related to the deployment of a new technology system and labor model, as well as the development, customization and integration of a new enterprise resource planning (ERP) system.
(5)Includes costs for third-party non-recurring IPO costs, buy-side and sell-side due diligence activities to evaluate and execute potential mergers and acquisitions, integrate acquired businesses and one-time employee retention bonuses related to potential mergers and acquisitions.
(6)Consists of litigation and settlement costs for matters not related to core operations.
(7)Consists of other costs related to debt financing, certain de novo start-up costs related to outpatient imaging centers and certain exit costs related to closed outpatient imaging centers.
(8)Adjusts for the Company’s proportional share of depreciation and amortization, interest expense and losses/gains on asset disposals related to unconsolidated affiliates, which are included in equity in earnings from unconsolidated affiliates on the accompanying consolidated statements of operations and comprehensive loss.
21. Subsequent Events
In February 2026, the Company granted 578,193 RSUs to employees under the 2025 Equity Plan with a total fair market value of $8.5 million. The RSUs vest ratably over a three year service period.
BTDI JV, LLP and Subsidiaries
(A Partnership)
Consolidated Financial Statements
As of December 31, 2025 and 2024,
and for the three years ended December 31, 2025
BTDI JV, LLP and Subsidiaries
(A Partnership)
Index
December 31, 2025, 2024 and 2023
Report of Independent Auditors
To the Board of Trustees of Baylor Scott & White Health
Opinion
We have audited the accompanying consolidated financial statements of BTDI JV, LLP and its subsidiaries (the “Company”), which comprise the consolidated balance sheets as of December 31, 2025 and 2024, and the related consolidated statements of income, of partners' capital and of cash flows for each of the three years in the period ended December 31, 2025, including the related notes (collectively referred to as the “consolidated financial statements“).
In our opinion, the accompanying consolidated financial statements present fairly, in all material respects, the financial position of the Company as of December 31, 2025 and 2024, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2025 in accordance with accounting principles generally accepted in the United States of America.
Basis for Opinion
We conducted our audit in accordance with auditing standards generally accepted in the United States of America (US GAAS). Our responsibilities under those standards are further described in the Auditors' Responsibilities for the Audit of the Consolidated Financial Statements section of our report. We are required to be independent of the Company and to meet our other ethical responsibilities, in accordance with the relevant ethical requirements relating to our audit. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.
Responsibilities of Management for the Consolidated Financial Statements
Management is responsible for the preparation and fair presentation of the consolidated financial statements in accordance with accounting principles generally accepted in the United States of America, and for the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free from material misstatement, whether due to fraud or error.
In preparing the consolidated financial statements, management is required to evaluate whether there are conditions or events, considered in the aggregate, that raise substantial doubt about the Company's ability to continue as a going concern for one year after the date the consolidated financial statements are available to be issued.
Auditors’ Responsibilities for the Audit of the Consolidated Financial Statements
Our objectives are to obtain reasonable assurance about whether the consolidated financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditors' report that includes our opinion. Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with US GAAS will always detect a material misstatement when it exists. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. Misstatements are considered material if there is a substantial likelihood that, individually or in the aggregate, they would influence the judgment made by a reasonable user based on the consolidated financial statements.
In performing an audit in accordance with US GAAS, we:
•Exercise professional judgment and maintain professional skepticism throughout the audit.
•Identify and assess the risks of material misstatement of the consolidated financial statements, whether due to fraud or error, and design and perform audit procedures responsive to those risks. Such procedures include examining, on a test basis, evidence regarding the amounts and disclosures in the consolidated financial statements.
•Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Company's internal control. Accordingly, no such opinion is expressed.
•Evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluate the overall presentation of the consolidated financial statements.
•Conclude whether, in our judgment, there are conditions or events, considered in the aggregate, that raise substantial doubt about the Company's ability to continue as a going concern for a reasonable period of time.
We are required to communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit, significant audit findings, and certain internal control-related matters that we identified during the audit.
/s/ PricewaterhouseCoopers LLP
Dallas, Texas
March 30, 2026
BTDI JV, LLP and Subsidiaries
(A Partnership)
Consolidated Balance Sheets
December 31, 2025 and 2024
|
|
|
|
|
|
|
|
|
(in thousands) |
|
|
2025 |
|
|
|
2024 |
|
Assets |
|
|
|
|
|
|
|
|
Current assets |
|
|
|
|
|
|
|
|
Cash |
|
$ |
14,653 |
|
|
$ |
14,200 |
|
Accounts receivable, net1 |
|
|
36,813 |
|
|
|
31,674 |
|
Prepaid expenses |
|
|
1,867 |
|
|
|
1,675 |
|
Deposits |
|
|
841 |
|
|
|
454 |
|
Other current assets |
|
|
287 |
|
|
|
223 |
|
Inventory |
|
|
260 |
|
|
|
282 |
|
Total current assets |
|
|
54,721 |
|
|
|
48,508 |
|
Property and equipment, net |
|
|
85,081 |
|
|
|
76,674 |
|
Operating lease right-of-use assets, net2 |
|
|
34,102 |
|
|
|
33,279 |
|
Goodwill |
|
|
277,500 |
|
|
|
277,500 |
|
Other identifiable intangible assets, net |
|
|
509 |
|
|
|
1,731 |
|
Total assets |
|
$ |
451,913 |
|
|
$ |
437,692 |
|
Liabilities and Partners' Capital |
|
|
|
|
|
|
|
|
Current liabilities |
|
|
|
|
|
|
|
|
Accounts payable |
|
$ |
13,239 |
|
|
$ |
11,800 |
|
Related party payables |
|
|
23,343 |
|
|
|
41,239 |
|
Current portion of long-term debt |
|
|
10,135 |
|
|
|
8,402 |
|
Current portion of finance lease obligations |
|
|
3,759 |
|
|
|
1,884 |
|
Current portion of operating lease liabilities3 |
|
|
5,810 |
|
|
|
5,694 |
|
Accrued expenses and other current liabilities |
|
|
20,121 |
|
|
|
17,743 |
|
Total current liabilities |
|
|
76,407 |
|
|
|
86,762 |
|
Long-term liabilities |
|
|
|
|
|
|
|
|
Long-term debt, net |
|
|
24,474 |
|
|
|
26,279 |
|
Long-term portion of finance lease obligations, net |
|
|
15,863 |
|
|
|
9,161 |
|
Long-term portion of operating lease liabilities, net4 |
|
|
31,213 |
|
|
|
29,092 |
|
Total long-term liabilities |
|
|
71,550 |
|
|
|
64,532 |
|
|
|
|
|
|
|
|
|
|
Commitments and contingencies (Note 15) |
|
|
|
|
|
|
|
|
Partnership units |
|
$ |
96,931 |
|
|
$ |
96,931 |
|
Retained earnings |
|
|
204,065 |
|
|
|
186,921 |
|
Total BTDI JV, LLP partners' capital |
|
|
300,996 |
|
|
|
283,852 |
|
Non-controlling interests |
|
|
2,960 |
|
|
|
2,546 |
|
Total partners' capital |
|
|
303,956 |
|
|
|
286,398 |
|
Total liabilities and partners' capital |
|
$ |
451,913 |
|
|
$ |
437,692 |
|
1.Accounts receivable, net includes related party amounts of $1,814 and $1,614 for 2025 and 2024, respectively.
2.Operating lease right-of-use assets, net includes related party amounts of $4,501 and $1,112 for 2025 and 2024, respectively.
3.Current portion of operating lease liabilities includes related party amounts of $504 and $675 for 2025 and 2024, respectively.
4.Long-term portion of operating lease liabilities, net includes related party amounts of $4,069 and $609 for 2025 and 2024, respectively.
The accompanying notes are an integral part of these consolidated financial statements.
127
BTDI JV, LLP and Subsidiaries
(A Partnership)
Consolidated Statements of Income
Years Ended December 31, 2025, 2024 and 2023
|
|
|
|
|
|
|
|
|
|
|
|
(in thousands) |
|
2025 |
|
|
|
2024 |
|
|
|
2023 |
|
Revenue |
|
|
|
|
|
|
|
|
|
|
|
Net patient service revenue1 |
$ |
418,393 |
|
|
$ |
382,321 |
|
|
$ |
345,791 |
|
Total revenue |
|
418,393 |
|
|
|
382,321 |
|
|
|
345,791 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Expenses |
|
|
|
|
|
|
|
|
|
|
|
Salaries, wages, and benefits2 |
|
93,117 |
|
|
|
89,875 |
|
|
|
81,046 |
|
Radiology fees3 |
|
57,599 |
|
|
|
53,023 |
|
|
|
46,019 |
|
Depreciation and amortization |
|
23,404 |
|
|
|
22,070 |
|
|
|
20,116 |
|
Management fees4 |
|
35,416 |
|
|
|
32,033 |
|
|
|
28,469 |
|
General, administrative, and other5 |
|
57,962 |
|
|
|
42,699 |
|
|
|
44,802 |
|
Equipment repairs, maintenance, and rent6 |
|
20,957 |
|
|
|
18,361 |
|
|
|
19,291 |
|
Total operating expenses |
|
288,455 |
|
|
|
258,061 |
|
|
|
239,743 |
|
Operating income |
|
129,938 |
|
|
|
124,260 |
|
|
|
106,048 |
|
Losses on disposal of equipment |
|
(1,551 |
) |
|
|
(302 |
) |
|
|
(740 |
) |
Interest expense |
|
(3,388 |
) |
|
|
(2,406 |
) |
|
|
(1,410 |
) |
Income before income tax |
|
124,999 |
|
|
|
121,552 |
|
|
|
103,898 |
|
Income tax |
|
(2,239 |
) |
|
|
(1,588 |
) |
|
|
(1,679 |
) |
Net income |
|
122,760 |
|
|
|
119,964 |
|
|
|
102,219 |
|
Net income attributable to non-controlling interests |
|
(3,179 |
) |
|
|
(2,289 |
) |
|
|
(2,270 |
) |
Net income attributable to BTDI JV |
$ |
119,581 |
|
|
$ |
117,675 |
|
|
$ |
99,949 |
|
1.Net patient service revenue includes related party amounts of $22,915, $16,971 and $13,331 for 2025, 2024 and 2023, respectively.
2.Salaries, wages, and benefits includes related party amounts of $90,344, $87,142 and $78,749 for 2025, 2024 and 2023, respectively.
3.Radiology fees includes related party amounts of $13,814, $12,743 and $3,606 for 2025, 2024 and 2023, respectively.
4.Management fees includes related party amounts of $34,988, $31,409 and $27,880 for 2025, 2024 and 2023, respectively.
5.General, administrative, and other includes related party amounts of $27,956, $12,927 and $15,532 for 2025, 2024 and 2023, respectively.
6.Equipment repairs, maintenance, and rent includes related party amounts of $1,279, $1,131 and $1,185 for 2025, 2024 and 2023, respectively.
The accompanying notes are an integral part of these consolidated financial statements.
128
BTDI JV, LLP and Subsidiaries
(A Partnership)
Consolidated Statements of Partners' Capital
Years Ended December 31, 2025, 2024 and 2023
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Partnership Units |
|
|
|
Retained |
|
|
|
|
|
|
|
Non-controlling |
|
|
|
|
|
(in thousands, except partnership units) |
|
Units |
|
|
|
Amount |
|
|
|
Earnings |
|
|
Partners' Capital |
|
|
Interests |
|
|
Total |
|
Balances at December 31, 2022 |
|
1,000 |
|
|
$ |
96,931 |
|
|
$ |
212,423 |
|
|
$ |
309,354 |
|
|
$ |
3,101 |
|
|
$ |
312,455 |
|
Distributions |
|
|
|
|
|
|
|
|
|
(105,951 |
) |
|
|
(105,951 |
) |
|
|
(1,908 |
) |
|
|
(107,859 |
) |
Contributions |
|
|
|
|
|
|
|
|
|
— |
|
|
|
— |
|
|
|
911 |
|
|
|
911 |
|
Net income |
|
|
|
|
|
|
|
|
|
99,949 |
|
|
|
99,949 |
|
|
|
2,270 |
|
|
|
102,219 |
|
Balances at December 31, 2023 |
|
1,000 |
|
|
|
96,931 |
|
|
|
206,421 |
|
|
|
303,352 |
|
|
|
4,374 |
|
|
|
307,726 |
|
Distributions |
|
|
|
|
|
|
|
|
|
(137,175 |
) |
|
|
(137,175 |
) |
|
|
(4,117 |
) |
|
|
(141,292 |
) |
Net income |
|
|
|
|
|
|
|
|
|
117,675 |
|
|
|
117,675 |
|
|
|
2,289 |
|
|
|
119,964 |
|
Balances at December 31, 2024 |
|
1,000 |
|
|
|
96,931 |
|
|
|
186,921 |
|
|
|
283,852 |
|
|
|
2,546 |
|
|
|
286,398 |
|
Distributions |
|
|
|
|
|
|
|
|
|
(102,437 |
) |
|
|
(102,437 |
) |
|
|
(2,765 |
) |
|
|
(105,202 |
) |
Net income |
|
|
|
|
|
|
|
|
|
119,581 |
|
|
|
119,581 |
|
|
|
3,179 |
|
|
|
122,760 |
|
Balances at December 31, 2025 |
|
1,000 |
|
|
$ |
96,931 |
|
|
$ |
204,065 |
|
|
$ |
300,996 |
|
|
$ |
2,960 |
|
|
$ |
303,956 |
|
The accompanying notes are an integral part of these consolidated financial statements.
129
BTDI JV, LLP and Subsidiaries
(A Partnership)
Consolidated Statements of Cash Flows
Years Ended December 31, 2025, 2024 and 2023
|
|
|
|
|
|
|
|
|
|
|
|
(in thousands) |
|
2025 |
|
|
|
2024 |
|
|
|
2023 |
|
Cash flows from operating activities |
|
|
|
|
|
|
|
|
|
|
|
Net income |
$ |
122,760 |
|
|
$ |
119,964 |
|
|
$ |
102,219 |
|
Adjustments to reconcile net income to net cash |
|
|
|
|
|
|
|
|
|
|
|
provided by operating activities: |
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization |
|
23,404 |
|
|
|
22,070 |
|
|
|
20,116 |
|
Amortization of operating lease right-of-use assets |
|
8,061 |
|
|
|
6,858 |
|
|
|
7,411 |
|
Losses on disposal of equipment |
|
1,551 |
|
|
|
302 |
|
|
|
740 |
|
Gain on related party payable settlement |
|
— |
|
|
|
(14,100 |
) |
|
|
— |
|
Changes in assets and liabilities: |
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable |
|
(5,139 |
) |
|
|
3,498 |
|
|
|
(4,561 |
) |
Deposits |
|
(387) |
|
|
|
(58 |
) |
|
|
8 |
|
Inventory |
|
22 |
|
|
|
(14 |
) |
|
|
(168 |
) |
Prepaid expenses and other assets |
|
(256 |
) |
|
|
(456 |
) |
|
|
(662 |
) |
Accounts payable and accrued expenses |
|
877 |
|
|
|
3,793 |
|
|
|
15,533 |
|
Related party payables |
|
(17,896 |
) |
|
|
15,217 |
|
|
|
(1,997 |
) |
Operating lease assets and liabilities |
|
(6,647 |
) |
|
|
(7,144 |
) |
|
|
(7,276 |
) |
Net cash provided by operating activities |
|
126,350 |
|
|
|
149,930 |
|
|
|
131,363 |
|
Cash flows from investing activities |
|
|
|
|
|
|
|
|
|
|
|
Purchases of property and equipment |
|
(17,917 |
) |
|
|
(21,020 |
) |
|
|
(23,253 |
) |
Proceeds from sale of property and equipment |
|
40 |
|
|
|
— |
|
|
|
510 |
|
Net cash used in investing activities |
|
(17,877 |
) |
|
|
(21,020 |
) |
|
|
(22,743 |
) |
Cash flows from financing activities |
|
|
|
|
|
|
|
|
|
|
|
Principal payments under long-term debt agreements |
|
(8,979 |
) |
|
|
(7,236 |
) |
|
|
(7,042 |
) |
Proceeds from debt issuance |
|
8,907 |
|
|
|
16,768 |
|
|
|
11,444 |
|
Principal payments under finance lease obligations |
|
(2,746 |
) |
|
|
(1,387 |
) |
|
|
(1,120 |
) |
Contributions |
|
— |
|
|
|
— |
|
|
|
911 |
|
Distributions |
|
(105,202 |
) |
|
|
(141,292 |
) |
|
|
(107,859 |
) |
Net cash used in financing activities |
|
(108,020 |
) |
|
|
(133,147 |
) |
|
|
(103,666 |
) |
Net increase (decrease) in cash |
$ |
453 |
|
|
$ |
(4,237 |
) |
|
$ |
4,954 |
|
Cash |
|
|
|
|
|
|
|
|
|
|
|
Beginning of year |
|
14,200 |
|
|
|
18,437 |
|
|
|
13,483 |
|
End of year |
$ |
14,653 |
|
|
$ |
14,200 |
|
|
$ |
18,437 |
|
Supplemental disclosure of cash flow information |
|
|
|
|
|
|
|
|
|
|
|
Cash paid during the year for interest |
$ |
3,388 |
|
|
$ |
2,406 |
|
|
$ |
1,410 |
|
Equipment acquired under finance leases |
$ |
11,323 |
|
|
$ |
3,253 |
|
|
$ |
1,556 |
|
Purchase of property and equipment in accounts payable and accrued expenses |
$ |
5,362 |
|
|
$ |
2,421 |
|
|
$ |
175 |
|
The accompanying notes are an integral part of these consolidated financial statements.
130
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements
December 31, 2025, 2024 and 2023
1. Organization
BTDI JV, LLP (“BTDI JV”, the “Company”, or the “Partnership”) was formed on July 2, 2013 between Baylor University Medical Center (“BUMC”), a Texas non-profit corporation, and Touchstone Medical Imaging, LLC (“Touchstone”), with a 51% and 49% ownership interest, respectively. Touchstone is an affiliate of Lumexa Imaging Holdings, Inc. (“Lumexa Imaging”). BUMC is an affiliate of Baylor Health Care System, an affiliate of Baylor Scott & White Health, formerly known as Baylor Scott & White Holdings (“BSW Health”). BSW Health and its controlled affiliates are collectively referred to as “BSWH”. The purpose of the Company is to provide high quality and cost-effective medical imaging and diagnostic services to patients in Texas, as part of an integrated health care delivery system.
Under the terms of the partnership agreement, BUMC contributed net assets with a fair value of approximately $75,030,000, resulting in a 51% ownership in BTDI JV. Touchstone contributed net assets with a fair value of approximately $70,958,000 and an approximately $1,127,000 rebalancing payment to BUMC, resulting in a 49% ownership. In the consolidated statements of partners’ capital, Touchstone's assets were valued at approximately $70,958,000, while BUMC's assets were recorded at their carryover accounting basis of approximately $25,973,000 because the transaction constituted a common control business combination in accordance with generally accepted accounting principles in the United States (“GAAP”), and Accounting Standards Codification (“ASC”) Topic 805-50, “Transactions Between Entities Under Common Control”, issued by the Financial Accounting Standards Board (FASB) in the form of Accounting Standards Updates (ASU).
Effective June 20, 2016, BTDI JV and Blue Star Imaging, L.P. (“Blue Star”) formed Blue Stone JV, LLP (“Blue Stone”) which consists of three imaging centers and formed Blue Stone Frisco, LLP (“Frisco”) which consists of one imaging center. BTDI JV is the majority partner with a 70% ownership in Blue Stone and a 51% ownership in Frisco.
Gateway Diagnostic JV, LLC (“Gateway JV”) was formed on May 25, 2021 between BUMC and Lumexa Imaging Outpatient, Inc. (“LIOI”), with a 51% and 49% ownership interest, respectively. LIOI is a wholly-owned affiliate of Lumexa Imaging.
Effective November 3, 2023, Gateway JV was reorganized and became a wholly-owned subsidiary of BTDI JV. The Gateway JV reorganization represented a merger of entities under common control. Accordingly, the accompanying consolidated financial statements including the notes thereto, are presented as if the Gateway JV reorganization had occurred at the earliest period presented.
BTDI JV operates 56 imaging centers as of December 31, 2025.
2. Basis of Presentation and Summary of Significant Accounting Policies
Basis of Presentation
The consolidated financial statements include the accounts of the Company, Blue Stone, Frisco, and Gateway. All significant intercompany accounts and transactions have been eliminated in consolidation. The Company does not have any components of other comprehensive income within its consolidated financial statements, and, therefore, does not separately present a statement of comprehensive income in its consolidated financial statements. The accompanying consolidated financial statements have been prepared in conformity with GAAP.
Revision of Previously Issued Financial Statements
The Company identified an immaterial prior period error in the classification of certain non-cash capital expenditures within the consolidated statements of cash flows. Capital expenditures financed through accounts payable and accrued expenses were previously presented as investing cash outflows rather than as non-cash
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
transactions reflected within operating activities through changes in accounts payable and accrued expenses. The Company has revised the consolidated statements of cash flows for the years ended December 31, 2024 and 2023 to correct this error, resulting in a decrease to cash used in investing activities and a corresponding decrease to cash provided by operating activities of approximately $2,421,000 and $175,000 respectively. The revisions had no impact on net income, total net increase (decrease) in cash, or the consolidated balance sheets.
Additionally, the Company revised the consolidated statements of operations and of cash flows for the years ended December 31, 2024 and 2023, and the consolidated balance sheet as of December 31, 2024, to correct an immaterial error related to amounts previously reported as related-party transactions that were ultimately determined to be third-party transactions. See Note 12, Related-Party Transactions, for additional information.
Going Concern
Under the going concern assumption, an entity is ordinarily viewed as continuing in business for the foreseeable future. Accordingly, assets and liabilities are recorded on the basis that the entity will be able to realize its assets and discharge its liabilities in the normal course of business.
Use of Estimates
The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.
Non-controlling Interests
Non-controlling interests are that part of the net results of operations and of net assets of Blue Stone and Frisco attributable to the interests which are not owned directly or indirectly by the Company.
Cash
Cash includes deposits with financial institutions which, at times, may be in excess of federally insured limits.
Patient Accounts Receivable
Net patient accounts receivable represents charges to patients, third-party payors, and other payors, for which payment has not been received at the balance sheet date, reduced by contractual adjustments provided by the Company’s reimbursement contracts and estimation for uncollectible accounts. The Company estimates explicit price concessions for contractual adjustments related to net patient accounts receivable for claims that have not yet been adjudicated. The Company estimates implicit price concessions for amounts not expected to be collected based on historical experience and directly reduces net patient revenue recognized. The Company does not charge interest on outstanding net patient accounts receivable balances.
The net patient accounts receivable payor mix as of December 31, 2025 and 2024 is as follows:
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Commercial/managed care |
|
|
50 |
% |
|
|
53 |
% |
Attorney liens |
|
|
34 |
|
|
|
33 |
|
Medicare |
|
|
10 |
|
|
|
9 |
|
Patients |
|
|
1 |
|
|
|
1 |
|
Medicaid |
|
|
1 |
|
|
|
1 |
|
Other third-party payors |
|
|
4 |
|
|
|
3 |
|
|
|
|
100 |
% |
|
|
100 |
% |
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
Receivables from commercial and other nongovernmental payors represent the highest concentration of the Company’s patient accounts receivable. Management does not believe there are any unusual collectability risks associated with these programs. Commercial and managed care receivables consist of receivables from various payors involved in diverse activities, subject to differing economic conditions, and do not represent any concentrated collectability risks to the Company. Attorney liens represent patient accounts receivable related to ongoing litigation between third parties (not involving the Company) in which the Company has been contracted to provide imaging services. Payment is not made until litigation is completed, which can exceed 18 months.
Inventory
Inventories, which consist primarily of medical supplies, are stated at the lower of cost and net realizable value, with cost determined by the first-in, first-out (FIFO) method.
Property and Equipment
Property and equipment is stated at cost less accumulated depreciation. Depreciation is calculated using the straight-line method over the lesser of estimated useful lives of the assets or the life of the related finance lease, where applicable. When property and equipment are retired or otherwise disposed of, the appropriate accounts are relieved of cost and accumulated depreciation, and any resulting gain or loss is recognized. Expenditures for normal repairs and maintenance are charged to expense as incurred. Leasehold improvements are amortized using the straight-line method over the shorter of the related lease terms or the useful lives. Expenditures which increase capacities or extend the useful lives of assets are capitalized.
The assets’ estimated useful lives used in computing depreciation are as follows:
|
|
|
|
|
Useful Life of Assets |
Leased buildings and leasehold improvements |
|
5 - 15 years |
Medical equipment |
|
3 - 10 years |
Office equipment |
|
3 - 7 years |
Long-Lived Assets
In accordance with ASC 360, “Property, Plant, and Equipment”, long-lived assets, such as property and equipment and definite-lived intangible assets, are reviewed for impairment if events or changes in circumstances indicate that the carrying amount of an asset group may not be recoverable. Some of the events or changes in circumstances that would trigger an impairment review include, but are not limited to, significant negative industry or economic trends or knowledge of transactions involving the sale of similar property at amounts below the Company’s carrying value. Assets are grouped for recognition, and measurement of impairment, at the lowest level for which identifiable cash flows are largely independent of the cash flows of other assets. At the occurrence of a triggering event, an evaluation is performed to assess the recoverability of the carrying amount of long-lived assets, and impairment charges are recorded as identified. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset group to the estimated undiscounted future cash flows expected to be generated by the asset group. If the carrying amount of an asset group exceeds its undiscounted estimated future cash flows, an impairment charge is recognized in the amount by which the carrying amount of the asset group exceeds the fair value. No impairment charges were recorded for the years ended December 31, 2025 and 2024.
Goodwill
Goodwill represents the residual between consideration transferred in a business combination and the net of the acquisition-date amounts of identifiable assets acquired and liabilities assumed measured at fair value. The Company uses estimates and judgments to measure the fair value of identifiable assets acquired and liabilities assumed.
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
Goodwill is tested for impairment on an annual basis and, when specific circumstances may be present, between annual tests. The Company tests for impairment by making a qualitative assessment of whether it is more likely than not that a reporting unit’s fair value is less than its carrying amount. If the Company concludes that it is more likely than not that the fair value of a reporting unit is less than its carrying amount, the Company compares the fair value of the reporting unit to its carrying amount. Any excess of the reporting unit goodwill carrying amount over the respective fair value of goodwill would be recognized as an impairment loss.
As of December 31, 2025 and 2024, the Company performed its qualitative annual assessment of goodwill and determined that goodwill was not impaired.
Intangible Assets
Intangible assets with determinable lives are identified as part of acquisitions completed by the Company. These assets are amortized on a straight-line basis over the estimated period of economic benefit, currently estimated to be five years. Amortizable lives are adjusted whenever there is a change in the estimated period of economic benefit.
Patient Service Revenue
Most of the Company’s revenues are generated by providing diagnostic imaging services to patients. Revenue is recognized when the performance obligations to provide diagnostic imaging services are satisfied. The majority of patient service revenue is derived from third-party insurance payors and government sponsored healthcare programs. Lesser amounts are recovered from patients. Amounts received for services are generally less than billed charges.
The Company evaluates amounts collected in relation to billed charges and records revenue in an amount based on the consideration to which the entity estimates it is entitled to in exchange for its services including estimates for contractual adjustments and uncollectible amounts. Accordingly, net patient service revenue is presented net of estimates for contractual adjustments, other adjustments, and uncollectible amounts, and is recorded in the period during which the services are provided even though the actual amounts may become known at a later date.
The Company estimates contractual adjustments and uncollectible amounts considering changes in contractual rates, past adjustments, historical collection experience in relation to amounts billed, current contract and reimbursement terms, changes in payor mix, aging of accounts receivable, and other relevant information. Contractual adjustments result from the difference between the billed charges for services performed and the contractual reimbursements by government-sponsored healthcare programs and third-party insurance payors for such services. Estimated adjustments for uncollectible amounts result from the difference between net amounts owed by patients and the estimated amounts to be collected directly from such patients.
The following table disaggregates net patient service revenue by major source for the years ended December 31, 2025, 2024 and 2023:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
|
2024 |
|
|
|
2023 |
|
Commercial/managed care |
|
78 |
% |
|
|
80 |
% |
|
|
78 |
% |
Medicare |
|
12 |
|
|
|
12 |
|
|
|
12 |
|
Patients |
|
4 |
|
|
|
4 |
|
|
|
4 |
|
Attorney liens |
|
2 |
|
|
|
1 |
|
|
|
2 |
|
Medicaid |
|
1 |
|
|
|
1 |
|
|
|
2 |
|
Other third-party payors |
|
3 |
|
|
|
2 |
|
|
|
2 |
|
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
Industry
The Company derives a significant portion of its revenue from third-party payor programs. The receipt of future revenues by the Company is subject to, among other factors, federal and state policies affecting the health care industry, economic conditions that may include an inability to control expenses in a period of inflation, increased
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
competition, market pressures on reimbursement rates, regulatory changes in Medicare/Medicaid reimbursement rates, and other conditions that are difficult to predict. Further, as a healthcare provider, the Company must maintain appropriate licensure, certification, and accreditation and must comply with regulatory billing and coding requirements.
Income Taxes
The Company is treated as a partnership for state and federal tax purposes. For U.S. federal tax purposes, no income tax provision or benefit is recorded in the accompanying consolidated statements of income, as the income flows directly to the partners. However, for Texas purposes, partnerships are subject to the Texas franchise tax. Consequently, the Company records an income tax provision for taxes due to the state of Texas as income tax expense in the accompanying consolidated statements of income. The Company is included in a combined Texas franchise tax return along with other controlled affiliates of BSWH.
The Company follows the provisions of ASC 740, “Income Taxes.” The Company has no gross unrecognized tax benefits in 2025, 2024 nor 2023. The Company files a partnership income tax return in the U.S. federal jurisdiction and a franchise tax return in the state of Texas. The Company does not expect or anticipate a significant change in unrecognized tax benefits over the next twelve months. The Company recognizes accrued interest and penalties as a component of income tax expense.
Leases
The Company determines if an arrangement is a lease at inception by assessing whether an identified asset exists and if the Company has the right to control the use of the identified asset. For leases with terms greater than 12 months, the Company records the related asset and obligation at the present value of the lease payment using a discount rate that reflects the Company’s estimated incremental borrowing rate. The estimated incremental borrowing rate is derived from information available at the lease commencement date. The Company’s leases of medical office space contain non-lease components which are accounted for separately. Certain lease agreements for real estate include additional charges for actual common area maintenance and other operating expenses. These variable lease payments are recognized in equipment repairs, maintenance and rent and are not included in the right-of-use asset or lease liability balances.
Most leases include one or more options to extend the lease, however, for purposes of calculating the lease liabilities, lease terms are deemed not to include options to extend or terminate the lease until it is reasonably certain that the Company will exercise that option. The Company’s lease agreements do not contain any material residual value guarantees or material restrictive covenants. Lease expense for operating lease payments is recognized on a straight-line basis over the lease term and is recorded within equipment repairs, maintenance, and rent expense in the accompanying consolidated statements of income.
Finance leases are reported on the Company’s consolidated balance sheets with the right-of-use assets included in property and equipment, net, and the liabilities included in the current and long-term portions of finance lease obligations.
Right-of-use assets are tested for impairment if circumstances suggest that the carrying amount may not be recoverable. No events have occurred such as fire, flood, or other acts which have impaired the integrity of the Company’s right-of-use assets as of December 31, 2025 or December 31, 2024.
Advertising
The Company expenses advertising costs as incurred. Advertising costs amounted to approximately $3,263,000, $3,710,000 and $3,373,000 for the years ended December 31, 2025, 2024, and 2023, respectively, and are included in general, administrative, and other expenses, as well as salaries, wages, and benefits, in the accompanying consolidated statements of income.
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
3. Recent Accounting Pronouncements
In November 2024, the FASB issued ASU 2024-03, “Income Statement—Reporting Comprehensive Income—Expense Disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses,” requiring additional disclosure of the nature of expenses included in the income statement in response to longstanding requests from investors for more information about an entity’s expenses. The new standard requires disclosures about specific types of expenses included in the expense captions presented on the face of the income statement as well as disclosures about selling expenses. ASU 2024-03 is effective for annual reporting periods beginning after December 15, 2026 and interim reporting periods within annual reporting periods beginning after December 15, 2027. The Company is currently evaluating the impact the adoption of this guidance will have on its consolidated financial statement disclosures.
In July 2025, the FASB issued ASU 2025-05, “Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses for Accounts Receivable and Contract Assets,” which provides a practical expedient permitting an entity to assume that conditions at the balance sheet date remain unchanged over the life of the asset when estimating expected credit losses for current accounts receivable and current contract assets. ASU 2025-05 is effective for annual reporting periods beginning after December 15, 2025, and for interim periods within those annual reporting periods, with early adoption permitted. The amendments in ASU 2025-05 should be applied prospectively. The Company is currently evaluating the impact of adopting ASU 2025-05 and believes that the adoption will not have a material impact on the consolidated financial statement disclosures.
In September 2025, the FASB issued ASU 2025-06, “Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40): Targeted Improvements to the Accounting for Internal-Use Software.” The new standard modernizes the guidance to reflect the software development approaches currently being used by removing all references to “development stages“ from ASC 350-40, “Intangibles - Goodwill and Other - Internal-Use Software.” Under ASU 2025-06, only the following criteria in ASC 350-40-25-12(b) and (c) must be met for entities to begin capitalizing software costs: (i) management, with the relevant authority, implicitly or explicitly authorizes and commits to funding a computer software project and (ii) it is probable that the project will be completed and the software will be used to perform the function intended (referred to as the “probable-to-complete recognition threshold”). ASU 2025-06 is effective for annual reporting periods beginning after December 15, 2027, and interim reporting periods within those annual reporting periods, with early adoption permitted. The guidance may be applied prospectively, retrospectively, or via a modified prospective transition method. The Company is currently evaluating the impact the adoption of this guidance will have on its consolidated financial statement disclosures.
4. Goodwill
Goodwill is recorded as a result of business combinations. Changes in the carrying amount of goodwill for the years ended December 31, 2025 and 2024 were as follows (in thousands):
|
|
|
|
|
Balance as of December 31, 2023 |
|
$ |
277,500 |
|
2024 activity |
|
|
— |
|
Balance as of December 31, 2024 |
|
|
277,500 |
|
2025 activity |
|
|
— |
|
Balance as of December 31, 2025 |
|
$ |
277,500 |
|
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
5. Property and Equipment
Property and equipment consists of the following at December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
|
2024 |
|
Leased buildings and leasehold improvements |
$ |
69,178 |
|
|
$ |
61,891 |
|
Medical equipment |
|
145,928 |
|
|
|
137,778 |
|
Office equipment |
|
3,263 |
|
|
|
7,557 |
|
Construction-in-progress |
|
5,374 |
|
|
|
1,272 |
|
Property and equipment |
|
223,743 |
|
|
|
208,498 |
|
Accumulated depreciation |
|
(138,662 |
) |
|
|
(131,824 |
) |
Property and equipment, net |
$ |
85,081 |
|
|
$ |
76,674 |
|
Depreciation expense was approximately $22,182,000, $20,849,000 and $18,894,000 for the years ended December 31, 2025, 2024, and 2023, respectively.
Assets under finance leases, included in property and equipment, are as follows as of December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
|
2024 |
|
Real estate and medical equipment |
$ |
25,456 |
|
|
$ |
14,775 |
|
Accumulated depreciation |
|
(7,274 |
) |
|
|
(4,924 |
) |
Finance lease assets, net |
$ |
18,182 |
|
|
$ |
9,851 |
|
6. Other Identifiable Intangible Assets
Trade names acquired by Gateway JV at inception are amortized over a five-year period. Intangible assets consist of the following at December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
|
Gross Carrying Value |
|
|
Accumulated Amortization |
|
|
Net Carrying Value |
|
Trade names |
|
$ |
6,109 |
|
|
$ |
(5,600 |
) |
|
$ |
509 |
|
Total |
|
$ |
6,109 |
|
|
$ |
(5,600 |
) |
|
$ |
509 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2024 |
|
|
|
Gross Carrying Value |
|
|
Accumulated Amortization |
|
|
Net Carrying Value |
|
Trade names |
|
$ |
6,109 |
|
|
$ |
(4,378 |
) |
|
$ |
1,731 |
|
Total |
|
$ |
6,109 |
|
|
$ |
(4,378 |
) |
|
$ |
1,731 |
|
Amortization expense was approximately $1,222,000, $1,221,000 and $1,222,000 for the years ended December 31, 2025, 2024 and 2023, respectively.
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
7. Accrued Expenses and Other Current Liabilities
Accrued expenses and other current liabilities consists of the following at December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
|
2024 |
|
Contract labor |
$ |
4,174 |
|
|
$ |
6,011 |
|
Accrued compensation and benefits |
|
3,310 |
|
|
|
5,804 |
|
Franchises taxes payable |
|
2,839 |
|
|
|
2,452 |
|
Other accrued expenses |
|
3,297 |
|
|
|
382 |
|
Capital expenditures |
|
5,065 |
|
|
|
2,233 |
|
Accrued operating expenses |
|
1,436 |
|
|
|
861 |
|
Accrued expenses and other current liabilities |
$ |
20,121 |
|
|
$ |
17,743 |
|
8. Long-Term Debt
The Company’s long-term debt obligations, excluding finance leases, are reported in the accompanying consolidated balance sheets at carrying value. The long-term debt obligations consist of 78 separate notes that are generally collateralized by property and equipment of the Company and are due at various times starting in June 2026 through December 2031. These notes require monthly principal and interest payments. The Company was in compliance with all financial covenants with respect to long-term debt at December 31, 2025 and 2024.
Long-term debt consists of the following at December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
|
2024 |
|
78 notes collateralized by property and equipment with maturities through 2031 and have interest rates ranging from 2.8% to 8.2% with a 6.3% weighted average rate |
$ |
34,609 |
|
|
$ |
34,681 |
|
Total long-term debt |
|
34,609 |
|
|
|
34,681 |
|
Less: Current portion |
|
(10,135 |
) |
|
|
(8,402 |
) |
Long-term debt, net |
$ |
24,474 |
|
|
$ |
26,279 |
|
Future maturities of long-term debt as of December 31, 2025 are as follows (in thousands):
|
|
|
|
|
2026 |
|
$ |
10,135 |
|
2027 |
|
|
7,609 |
|
2028 |
|
|
6,818 |
|
2029 |
|
|
5,837 |
|
2030 |
|
|
3,228 |
|
Thereafter |
|
|
982 |
|
|
|
$ |
34,609 |
|
Interest expense was approximately $2,174,000, $1,797,000 and $803,000 for the years ended December 31, 2025, 2024 and 2023, respectively.
9. Finance Lease Obligations
The Company has financed certain medical equipment and real estate under finance leases. Obligations under these arrangements are at interest rates ranging from 5.1% to 14.8%, due through 2033. As of December 31, 2025 and 2024, the weighted average remaining lease term for finance leases is 5.0 years and 5.8 years, respectively, and the weighted average discount rate is 6.2% and 6.2%, respectively.
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
Finance lease obligations as of December 31, 2025 and 2024 are as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
Minimum lease payments payable |
|
$ |
22,930 |
|
|
$ |
13,239 |
|
Less: Portion representing interest |
|
|
(3,308 |
) |
|
|
(2,194 |
) |
Finance lease obligations |
|
|
19,622 |
|
|
|
11,045 |
|
Less: Current portion of finance lease obligations |
|
|
(3,759 |
) |
|
|
(1,884 |
) |
Long-term portion of finance lease obligations, net |
|
$ |
15,863 |
|
|
$ |
9,161 |
|
The table below reconciles the undiscounted cash flows for each of the first five years, and total of the remaining years, to the finance lease liabilities recorded on the consolidated balance sheet as of December 31, 2025 (in thousands):
|
|
|
|
|
2026 |
|
$ |
4,867 |
|
2027 |
|
|
4,590 |
|
2028 |
|
|
4,598 |
|
2029 |
|
|
4,143 |
|
2030 |
|
|
2,992 |
|
Thereafter |
|
|
1,740 |
|
Total minimum lease payments |
|
|
22,930 |
|
Less: Amount of payments representing interest |
|
|
(3,308 |
) |
Present value of future minimum lease payments |
|
|
19,622 |
|
Less: Current portion of finance lease obligations |
|
|
(3,759 |
) |
Long-term portion of finance lease obligations |
|
$ |
15,863 |
|
The table below presents supplemental cash flow information related to finance leases during the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Operating cash flows for finance leases |
|
$ |
1,009 |
|
|
$ |
609 |
|
|
$ |
607 |
|
Financing cash flows from finance leases |
|
|
2,746 |
|
|
|
1,387 |
|
|
|
1,120 |
|
Lease liabilities arising from obtaining right-of-use-assets, finance leases |
|
|
11,323 |
|
|
|
3,253 |
|
|
|
1,556 |
|
The table below presents certain information related to the lease costs for finance leases during the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Depreciation on assets under finance leases |
|
$ |
2,351 |
|
|
$ |
1,997 |
|
|
$ |
1,120 |
|
Interest on finance leases |
|
|
1,009 |
|
|
|
609 |
|
|
|
607 |
|
Total finance leases costs |
|
$ |
3,360 |
|
|
$ |
2,606 |
|
|
$ |
1,727 |
|
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
10. Operating Leases
The Company primarily leases medical office space under noncancellable operating leases which expire at various dates through 2035. Most leases include one or more options to extend the lease, however, for purposes of calculating the lease liabilities, options have only been included if it was reasonably certain the Company would exercise the option on the lease commencement date. The table below presents the operating lease related right-of-use assets and related liabilities recorded on the Company’s consolidated balance sheets and the weighted average remaining lease term and discount rate at December 31, 2025 and 2024 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
2024 |
|
Assets: |
|
|
|
|
|
|
|
|
Operating lease right-of-use assets |
|
$ |
34,102 |
|
|
$ |
33,279 |
|
Liabilities: |
|
|
|
|
|
|
|
|
Current portion of operating lease liabilities |
|
|
5,810 |
|
|
|
5,694 |
|
Long-term portion of operating lease liabilities, net |
|
|
31,213 |
|
|
|
29,092 |
|
Other Information: |
|
|
|
|
|
|
|
|
Weighted-average remaining lease term |
|
|
5.5 years |
|
|
|
5.4 years |
|
Weighted-average discount rate |
|
|
5.8 |
% |
|
|
6.0 |
% |
The table below presents certain information related to the lease costs for operating leases during the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Operating lease costs |
|
$ |
8,716 |
|
|
$ |
8,583 |
|
|
$ |
8,197 |
|
Variable lease costs |
|
|
4,071 |
|
|
|
2,644 |
|
|
|
2,340 |
|
Other equipment rent |
|
|
574 |
|
|
|
907 |
|
|
|
1,151 |
|
Total operating lease costs |
|
$ |
13,361 |
|
|
$ |
12,134 |
|
|
$ |
11,688 |
|
The table below presents supplemental cash flow information related to operating leases during the years ended December 31, 2025, 2024 and 2023 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2025 |
|
|
2024 |
|
|
2023 |
|
Operating cash flows for operating leases |
|
$ |
9,079 |
|
|
$ |
8,637 |
|
|
$ |
7,276 |
|
Right-of-use assets obtained in exchange for lease obligations |
|
|
9,045 |
|
|
|
9,489 |
|
|
|
8,052 |
|
The table below reconciles the undiscounted cash flows for each of the first five years, and total of the remaining years, to the operating lease liabilities recorded on the consolidated balance sheet as of December 31, 2025 (in thousands):
|
|
|
|
|
2026 |
|
$ |
7,832 |
|
2027 |
|
|
8,163 |
|
2028 |
|
|
8,109 |
|
2029 |
|
|
6,580 |
|
2030 |
|
|
4,768 |
|
Thereafter |
|
|
9,152 |
|
Total minimum lease payments |
|
|
44,604 |
|
Less: Amount of payments representing interest |
|
|
(7,581 |
) |
Present value of future minimum lease payments |
|
|
37,023 |
|
Less: Current portion of operating lease liabilities |
|
|
(5,810 |
) |
Long-term portion of operating lease liabilities, net |
|
$ |
31,213 |
|
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
11. Employee Benefit Plans
The Company maintains a qualified retirement savings plan which allows participants to defer from 0% to 100% of cash compensation up to the maximum amount allowed under Internal Revenue Service (“IRS”) guidelines. The Company makes safe harbor matching contributions of up to 3% of each participant’s eligible compensation and may elect to make profit sharing contributions at its discretion. Participants are always vested in their contributions and safe harbor matching contributions. Profit sharing contributions vest over five years, with 20% becoming vested following each full year of service, provided that profit sharing contributions will be 100% vested upon a participant’s death or disability or upon reaching age 62 while employed. The Company’s 401(k) contributions totaled approximately $1,922,000, $1,183,000 and $1,075,000 for the years ended December 31, 2025, 2024 and 2023, respectively, and are included in salaries, wages, and benefits expense in the accompanying consolidated statements of income.
12. Related-Party Transactions
Touchstone provides certain management, consulting, and financial services charged to the Partnership pursuant to a formula, as defined in a management services agreement. The amounts charged as the management fees expense for these services were approximately $34,988,000, $31,409,000 and $27,880,000 for the years ended December 31, 2025, 2024 and 2023, respectively.
Under the management services agreement, expenses are reimbursed to Touchstone on an actual cost basis. The amounts for the actual costs of these services for salaries, wages, and benefits expense were approximately $90,344,000, $87,142,000 and $78,749,000 for the years ended December 31, 2025, 2024 and 2023, respectively. The amounts for the actual costs of these services included within radiology fees expense were approximately $13,814,000, $12,743,000 and $3,606,000 for the years ended December 31, 2025, 2024 and 2023, respectively. The amounts for the actual costs of these services included within general, administrative, and other expense were approximately $27,956,000, $12,927,000 and $15,532,000 for the years ended December 31, 2025, 2024 and 2023, respectively. The amounts for the actual costs of these services included within equipment repairs, maintenance, and rent were approximately $1,279,000, $1,131,000 and $1,185,000 for the years ended December 31, 2025, 2024 and 2023, respectively.
The Company leases certain facilities under operating lease agreements with BSWH and Touchstone. The operating lease right-of-use assets and related liabilities are approximately $4,501,000 and $4,573,000, respectively, as of December 31, 2025. The operating lease right-of-use asset and related liabilities are approximately $1,112,000 and $1,284,000, respectively, as of December 31, 2024. These amounts are included in operating lease right-of-use assets and related liabilities on the consolidated balance sheets. The rent expense associated with these agreements is not material.
Amounts due to Touchstone as of December 31, 2025 and 2024, were approximately $9,192,000 and $14,776,000, respectively. Amounts due to BSWH, as of December 31, 2025 and 2024, were approximately $11,962,000 and $25,277,000, respectively. Amounts due to Lumexa Imaging as of December 31, 2025 and 2024, were approximately $2,189,000 and $1,186,000, respectively. Payables to Touchstone, BSWH, and Lumexa Imaging are included as components of related party payables in the accompanying consolidated balance sheets.
The Company performed services for patients covered under certain health insurance plans that are affiliates of BSWH amounting to approximately $22,915,000, $16,971,000 and $13,331,000 for the years ended December 31, 2025, 2024 and 2023, respectively, of which approximately $1,814,000 and $1,614,000 is unpaid as of December 31, 2025 and 2024, respectively, and is included within accounts receivable on the consolidated balance sheets.
In December 2024, the Company's partners agreed to settle an outstanding related party payable for approximately $17,100,000 which gave rise to a gain of approximately $14,100,000, which is classified within general, administrative, and other expenses in the accompanying consolidated statements of income, in order to offset the expense to which the gain relates.
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
The tables below show the impact of the related party revision discussed in Note 2, Basis of Presentation and Summary of Significant Accounting Policies. For the consolidated statements of income, the impacts are to the disclosed related party amounts, and there was no impact to the consolidated amounts. The consolidated balance sheet errors detailed below resulted in immaterial corresponding impacts in the respective changes in assets and liabilities line items in the consolidated statements of cash flows; however, there was no impact to net cash provided by operating activities.
|
|
|
|
|
|
|
|
|
|
|
|
(in thousands) Consolidated Statement of Income |
Year Ended December 31, 2024 |
|
|
As Reported |
|
|
Adjustment |
|
|
As Revised |
|
Endnote 2: Salaries, wages, and benefits, related party |
$ |
89,875 |
|
|
$ |
(2,733 |
) |
|
$ |
87,142 |
|
Endnote 3: Radiology fees, related party |
|
15,229 |
|
|
|
(2,486 |
) |
|
|
12,743 |
|
Endnote 4: Management fees, related party |
|
32,033 |
|
|
|
(624 |
) |
|
|
31,409 |
|
Endnote 5: General, administrative, and other, related party |
|
14,666 |
|
|
|
(1,739 |
) |
|
|
12,927 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated Statement of Income |
Year Ended December 31, 2023 |
|
|
As Reported |
|
|
Adjustment |
|
|
As Revised |
|
Endnote 2: Salaries, wages, and benefits, related party |
$ |
81,046 |
|
|
$ |
(2,297 |
) |
|
$ |
78,749 |
|
Endnote 3: Radiology fees, related party |
|
6,003 |
|
|
|
(2,397 |
) |
|
|
3,606 |
|
Endnote 4: Management fees, related party |
|
28,469 |
|
|
|
(589 |
) |
|
|
27,880 |
|
Endnote 5: General, administrative, and other, related party |
|
17,386 |
|
|
|
(1,854 |
) |
|
|
15,532 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated Balance Sheet |
December 31, 2024 |
|
|
As Reported |
|
|
Adjustment |
|
|
As Revised |
|
Accounts payable |
$ |
11,495 |
|
|
$ |
305 |
|
|
$ |
11,800 |
|
Related party payables |
|
42,396 |
|
|
|
(1,157 |
) |
|
|
41,239 |
|
Accrued expenses and other current liabilities |
|
16,891 |
|
|
|
852 |
|
|
|
17,743 |
|
Total current liabilities |
|
86,762 |
|
|
|
— |
|
|
|
86,762 |
|
13. Maintenance Contracts
The Company has entered into long-term maintenance service agreements on medical equipment. These contracts require monthly payments that range from approximately $30,000 to $265,000 and cover routine maintenance and repair of equipment. Expenditures for normal repairs and maintenance are charged to expense as incurred. The agreements expire in 2029. Maintenance expense under long-term service agreements for the years ended December 31, 2025, 2024 and 2023 was approximately $3,935,000, $5,181,000 and $5,968,000, respectively, and is included in equipment repairs, maintenance, and rent expense in the accompanying consolidated statements of income.
Minimum commitments for noncancelable maintenance contracts are as follows (in thousands):
|
|
|
|
|
|
|
Maintenance Contracts |
|
2026 |
|
$ |
8,443 |
|
2027 |
|
|
3,756 |
|
2028 |
|
|
2,153 |
|
2029 |
|
|
207 |
|
|
|
$ |
14,559 |
|
BTDI JV, LLP and Subsidiaries
(A Partnership)
Notes to Consolidated Financial Statements - continued
December 31, 2025, 2024 and 2023
14. Professional Liability Insurance
The Company is insured against professional liability claims on a claims-made basis with continuous prior acts coverage effective as of July 1, 2013. This policy provides coverage for all medical malpractice and general liability claims reported to the insurance carrier during the policy term, which is currently in effect through September 1, 2026 and renews annually. The policy provides coverage of $1,000,000 per incident and $3,000,000 in the aggregate with a $25,000 deductible per incident applicable only to indemnity payments. The limits apply separately to each location and separately to professional liability and general liability. In addition, there is an excess liability policy with limits of $10,000,000 per incident and $10,000,000 annual aggregate, and an umbrella liability policy with limits of $5,000,000 per incident and $5,000,000 annual aggregate applicable to all locations combined. No accrual for incurred but not reported losses was recorded at December 31, 2025 and 2024 as, in management’s opinion, such liabilities, if any, will not have a material effect on the Company’s financial statements.
15. Commitments and Contingencies
The healthcare industry is subject to numerous federal and state laws and regulations. These laws and regulations include, but are not necessarily limited to, matters such as licensure, accreditation, government healthcare program participation requirements, reimbursement for patient services, physician ownership and self-referral, and Medicare and Medicaid fraud and abuse. Violations of these laws and regulations could result in expulsion from government healthcare programs together with the imposition of significant fines and penalties, as well as significant repayments for patient services previously billed. Management believes that the Company is in compliance with all applicable laws and regulations. There are no recorded contingencies at December 31, 2025 and 2024.
The Company is subject to various matters including legal proceedings, claims, and audits and investigations that arise in the ordinary course of its business. With respect to these matters, the Company evaluates the developments on a regular basis and accrues a liability when they believe a loss is probable and the amount can be reasonably estimated. Based on current information, the Company does not believe that reasonably possible or probable losses associated with pending matters would either individually or in the aggregate, have a material adverse effect on business and consolidated financial statements. However, the outcome of these matters is inherently uncertain.
16. Charity Care
The Company provides care to patients who lack financial resources and are deemed medically or financially indigent as defined by the Company’s financial assistance policy. Because the Company does not pursue collection of amounts determined to qualify as charity care, these amounts have been removed from net patient service revenue in the accompanying consolidated statements of income. The estimated direct and indirect cost of providing these services, calculated using the ratio of patient care cost to charges, was approximately $7,780,000, $6,102,000 and $5,624,000 in 2025, 2024 and 2023, respectively. In addition, the Company provides services through government-sponsored indigent health care programs (such as Medicaid) to other indigent patients.
17. Subsequent Events
Management has performed an analysis of the activities and transactions subsequent to December 31, 2025 to determine the need for any adjustments to and/or disclosures within the financial statements for the year ended December 31, 2025. Management has performed their analysis through March 30, 2026, the date at which the financial statements were available to be issued. No subsequent events have occurred that would require recognition or disclosure.