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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
___________________________
FORM 10-Q
___________________________
xQUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended June 30, 2023
OR
oTRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from______________to______________
Commission file number: 001-39479
___________________________
AKUMIN INC.
(Exact name of registrant as specified in its charter)
___________________________
Delaware88-4139425
(State or other jurisdiction of
incorporation or organization)
(I.R.S. Employer
Identification No.)
8300 W. Sunrise Boulevard
Plantation, Florida 33322
(844) 730-0050
(Address, Including Zip Code, and Telephone Number, Including Area Code, of Registrant’s Principal Executive Offices)
Not Applicable
(Former Name, Former Address and Former Fiscal Year,
if Changed Since Last Report)
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading SymbolName of each exchange on which registered
Common Stock, $0.01 par value per shareAKUThe Nasdaq Stock Market
Common Stock, $0.01 par value per shareAKUThe Toronto Stock Exchange
___________________________
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes x No o
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes x No o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large accelerated fileroAccelerated filero
Non-accelerated filerxSmaller reporting companyx
Emerging growth companyx
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. o
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act). Yes o No x
As of August 7, 2023, there were 90,998,491 shares of common stock outstanding.



TABLE OF CONTENTS
Page



SPECIAL NOTE REGARDING FORWARD-LOOKING STATEMENTS
This Quarterly Report on Form 10-Q and the information incorporated by reference in this Quarterly Report on Form 10-Q contain or incorporate by reference “forward-looking information” or “forward-looking statements” as defined in the Private Securities Litigation Reform Act of 1995, that involve substantial risks and uncertainties. Forward-looking statements describe Akumin Inc.’s (together with its subsidiaries, the “Company”) future plans, strategies, expectations and objectives, and are generally identifiable by use of the words “may”, “will”, “should”, “continue”, “expect”, “anticipate”, “estimate”, “believe”, “intend”, “plan” or “project” or the negative of these words or other variations on these words or comparable terminology. Forward-looking statements include, but are not limited to, statements about:
expected performance and cash flows;
changes in laws and regulations affecting the Company;
expenses incurred by the Company as a public company;
future growth of the outpatient diagnostic imaging and radiation oncology markets;
changes in reimbursement rates by payors;
remediation and effectiveness of the design and effectiveness of our disclosure controls and procedures and internal control over financial reporting;
the outcome of litigation and payment obligations in respect of prior settlements;
competition;
acquisitions and divestitures of businesses;
potential synergies from acquisitions;
non-wholly owned and other business arrangements;
access to capital and the terms relating thereto;
technological changes in our industry;
successful execution of internal plans;
compliance with our debt covenants;
anticipated costs of capital investments; and
future compensation of our directors and executive officers.
Such statements may not prove to be accurate and actual results and future events could differ materially from those anticipated in such statements. The following are some of the risks and other important factors that could cause actual results or outcomes to differ materially from those discussed in the forward-looking statements:
our ability to successfully grow the market and sell our services;
general market conditions in our industry;
our ability to service existing debt;
our ability to acquire new centers and, upon acquisition, to successfully integrate markets and sell new services that we acquire;
goodwill impairment and related charges, as well as other accounting charges or adjustments could negatively impact our operating results;
our ability to achieve the financing necessary to complete our acquisitions;
our ability to enforce any claims relating to breaches of indemnities or representations and warranties in connection with any acquisition;
market conditions in the capital markets and our industry that make raising capital or consummating acquisitions difficult, expensive or both, or which may disrupt our annual operating budget and forecasts;
inflation, labor shortages, and adverse market conditions in the healthcare industry that may force us to scale back operations, divest existing centers and put any new acquisitions on hold for an indefinite period of time;
1


unanticipated cash requirements to support current operations, to expand our business or for capital expenditures;
delays or setbacks with respect to governmental approvals or manufacturing or commercial activities;
changes in laws and regulations;
the loss of key management, personnel or customers;
the risk the Company is not able to arrange sufficient cost-effective financing to repay maturing debt and to fund expenditures, future operational activities and acquisitions, and other obligations;
the risks related to the additional costs and expenses associated with being a U.S. domestic issuer as opposed to a foreign private issuer;
the risks associated with legislative and regulatory developments that may affect costs, revenues, the speed and degree of competition entering the market, global capital markets activity and general economic conditions in geographic areas where we operate (including the adverse impact of the coronavirus (“COVID-19”) pandemic on the Company);
the risks associated with macroeconomic conditions, including inflation and the threat of recession;
the risks associated with wage inflation and labor shortages among healthcare professionals;
financial market volatility and declines in financial market prices of equity securities, including the risk of delisting from the Nasdaq Capital Market (“Nasdaq”);
the risk that the potential delisting from the Nasdaq and other changes to the Company’s liquidity and capital resources will have a material adverse effect on the Company’s ability to borrow funds and access to private capital sources and public capital markets; and
the impact of global events, including the ongoing Russian-Ukrainian conflict, on our business and the actions we may take in response thereto.
Various assumptions or factors are typically applied in drawing conclusions or making the forecasts or projections set out in forward-looking information. Those assumptions and factors are based on information currently available to us, including information obtained from third-party industry analysts and other third-party sources. In some instances, material assumptions and factors are presented or discussed elsewhere in this Quarterly Report on Form 10-Q in connection with the statements or disclosure containing the forward-looking information. The reader is cautioned that the following list of material factors and assumptions is not exhaustive. The factors and assumptions include, but are not limited to:
no unforeseen changes in the legislative and operating framework for our business;
no unforeseen changes in the prices for our services in markets where prices are regulated;
no unforeseen changes in the regulatory environment for our services;
a stable competitive environment; and
no significant event occurring outside the ordinary course of business such as a foreign conflict, natural disaster, public health epidemic or other calamity.
Although we have attempted to identify important factors that could cause our actual results to differ materially from our plans, strategies, expectations and objectives, there may be other factors that could cause our results to differ from what we currently anticipate, estimate or intend. Forward-looking statements are provided to assist external stakeholders in understanding management’s expectations and plans relating to the future as of the date of the original document and may not be appropriate for other purposes. Readers are cautioned not to place undue reliance on forward-looking statements. Except as required under applicable securities laws, we undertake no obligation to publicly update or revise forward-looking statements, whether as a result of new information, future events or otherwise.
We qualify all the forward-looking statements contained in this Quarterly Report on Form 10-Q and the information incorporated by reference in this Quarterly Report on Form 10-Q by the foregoing cautionary statements.
2


PART I - FINANCIAL INFORMATION
Item 1. Financial Statements
AKUMIN INC.
INDEX TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
3


AKUMIN INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
(Unaudited; in thousands, except share amounts)
June 30,
2023
December 31,
2022
ASSETS
Current assets:
Cash and cash equivalents$37,968 $59,424 
Accounts receivable115,790 114,166 
Prepaid expenses8,477 8,003 
Other current assets10,309 10,352 
Total current assets172,544 191,945 
Property and equipment, net197,559 221,214 
Operating lease right-of-use assets156,778 166,823 
Goodwill715,269 769,110 
Other intangible assets, net370,512 392,095 
Other assets23,080 23,928 
Total assets$1,635,742 $1,765,115 
LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITY
Current liabilities: 
Accounts payable$43,575 $36,618 
Current portion of long-term debt19,282 19,961 
Current portion of obligations under finance leases7,837 7,800 
Current portion of obligations under operating leases15,744 17,223 
Accrued liabilities88,339 86,916 
Total current liabilities174,777 168,518 
Long-term debt, net of current portion1,273,077 1,254,652 
Obligations under finance leases, net of current portion15,991 19,505 
Obligations under operating leases, net of current portion151,957 160,475 
Other liabilities19,384 20,674 
Total liabilities1,635,186 1,623,824 
Redeemable noncontrolling interests26,800 30,337 
Stockholders’ deficit:
Preferred stock, $0.01 par value; 50,000,000 shares authorized; no shares issued and outstanding at June 30, 2023 and December 31, 2022
  
Common stock, $0.01 par value; 300,000,000 shares authorized; 90,998,491 shares issued and outstanding at June 30, 2023; 89,811,513 shares issued and outstanding at December 31, 2022
910 898 
Additional paid-in capital231,842 231,014 
Accumulated other comprehensive income24 73 
Accumulated deficit(411,985)(280,185)
Total stockholders’ deficit(179,209)(48,200)
Noncontrolling interests152,965 159,154 
Total equity (deficit)(26,244)110,954 
Total liabilities, redeemable noncontrolling interests and equity$1,635,742 $1,765,115 
See accompanying notes to the condensed consolidated financial statements.
4


AKUMIN INC.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS
(Unaudited; in thousands, except per share amounts)
Three Months Ended June 30,Six Months Ended June 30,
2023202220232022
Revenues$184,840 $192,128 $372,432 $378,391 
Operating expenses:  
Cost of operations, excluding depreciation and amortization158,495 154,574 314,062 309,735 
Depreciation and amortization35,015 25,200 58,008 49,931 
Impairment charges53,460  53,460  
Restructuring charges944 7,244 6,680 7,324 
Severance and related costs22 5,559 (27)7,797 
Settlements, recoveries and related costs465 814 1,913 677 
Stock-based compensation441 758 840 1,819 
Other operating expense (income), net477 586 (274)579 
Total operating expenses249,319 194,735 434,662 377,862 
Income (loss) from operations(64,479)(2,607)(62,230)529 
Other expense (income):
Interest expense31,164 29,290 61,861 57,971 
Other non-operating expense (income), net2,346 (2,335)2,214 (2,011)
Total other expense, net33,510 26,955 64,075 55,960 
Loss before income taxes(97,989)(29,562)(126,305)(55,431)
Income tax benefit(1,578)(3,483)(704)(2,920)
Net loss(96,411)(26,079)(125,601)(52,511)
Less: Net income attributable to noncontrolling interests241 4,390 6,199 8,769 
Net loss attributable to common stockholders$(96,652)$(30,469)$(131,800)$(61,280)
Comprehensive loss, net of taxes:
Net loss$(96,411)$(26,079)$(125,601)$(52,511)
Other comprehensive income (loss):
Unrealized gain (loss) on hedging transactions, net of taxes(7)7 (21)36 
Reclassification adjustment for gains (losses) included in net loss, net of taxes(14)9 (28)26 
Other comprehensive income (loss)(21)16 (49)62 
Comprehensive loss, net of taxes(96,432)(26,063)(125,650)(52,449)
Less: Comprehensive income attributable to noncontrolling interests241 4,390 6,199 8,769 
Comprehensive loss attributable to common stockholders$(96,673)$(30,453)$(131,849)$(61,218)
Net loss per share attributable to common stockholders:
Basic and diluted$(1.07)$(0.34)$(1.46)$(0.69)
See accompanying notes to the condensed consolidated financial statements.
5


AKUMIN INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY
(Unaudited; in thousands, except share amounts)
Common StockAdditional Paid-In CapitalAccumulated
 Other
 Comprehensive
Income (Loss)
Accumulated
Deficit
Total
 Stockholders’
Equity (Deficit)
Noncontrolling
Interests
Total
Equity
SharesAmount
Balance, March 31, 202289,516,513 $895 $228,761 $64 $(154,235)$75,485 $176,724 $252,209 
Net income (loss), net of the net income attributable to redeemable noncontrolling interests— — — — (30,469)(30,469)3,856 (26,613)
Stock-based compensation— — 758 — — 758 — 758 
Other comprehensive income— — — 16 — 16 — 16 
Distributions paid to noncontrolling interests— — — — — — (5,878)(5,878)
Balance, June 30, 202289,516,513 $895 $229,519 $80 $(184,704)$45,790 $174,702 $220,492 
Common StockAdditional Paid-In CapitalAccumulated
 Other
 Comprehensive
Income (Loss)
Accumulated
Deficit
Total
 Stockholders’
Equity (Deficit)
Noncontrolling
Interests
Total
Equity
SharesAmount
Balance, March 31, 202390,498,491 $905 $231,406 $45 $(315,333)$(82,977)$158,179 $75,202 
Net income (loss), net of the net loss attributable to redeemable noncontrolling interests— — — — (96,652)(96,652)776 (95,876)
Settlement of restricted share units500,000 5 (5)— — — —  
Stock-based compensation— — 441 — — 441 — 441 
Other comprehensive loss— — — (21)— (21)— (21)
Distributions paid to noncontrolling interests— — — — — — (5,990)(5,990)
Balance, June 30, 202390,998,491 $910 $231,842 $24 $(411,985)$(179,209)$152,965 $(26,244)
See accompanying notes to the condensed consolidated financial statements.
6


AKUMIN INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY
(Unaudited; in thousands, except share amounts)
Common StockAdditional Paid-In CapitalAccumulated
 Other
 Comprehensive
Income (Loss)
Accumulated
Deficit
Total
 Stockholders’
Equity (Deficit)
Noncontrolling
Interests
Total
Equity
SharesAmount
Balance, December 31, 202189,026,997 $890 $227,705 $18 $(123,424)$105,189 $178,490 $283,679 
Net income (loss), net of the net income attributable to redeemable noncontrolling interests— — — — (61,280)(61,280)7,655 (53,625)
Settlement of restricted share units489,516 5 (5)— — — —  
Stock-based compensation— — 1,819 — — 1,819 — 1,819 
Other comprehensive income— — — 62 — 62 — 62 
Distributions paid to noncontrolling interests— — — — — — (11,604)(11,604)
Purchase accounting adjustments— — — — — — 161 161 
Balance, June 30, 202289,516,513 $895 $229,519 $80 $(184,704)$45,790 $174,702 $220,492 
Common StockAdditional Paid-In CapitalAccumulated
 Other
 Comprehensive
Income (Loss)
Accumulated
Deficit
Total
 Stockholders’
Equity (Deficit)
Noncontrolling
Interests
Total
Equity
SharesAmount
Balance, December 31, 202289,811,513 $898 $231,014 $73 $(280,185)$(48,200)$159,154 $110,954 
Net income (loss), net of the net income attributable to redeemable noncontrolling interests— — — — (131,800)(131,800)5,588 (126,212)
Settlement of restricted share units1,186,978 12 (12)— — — —  
Stock-based compensation— — 840 — — 840 — 840 
Other comprehensive loss— — — (49)— (49)— (49)
Distributions paid to noncontrolling interests— — — — — — (11,777)(11,777)
Balance, June 30, 202390,998,491 $910 $231,842 $24 $(411,985)$(179,209)$152,965 $(26,244)
See accompanying notes to the condensed consolidated financial statements.

7


AKUMIN INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited; in thousands)
Six Months Ended June 30,
20232022
Operating activities:
Net loss$(125,601)$(52,511)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization58,008 49,931 
Impairment charges53,460  
Stock-based compensation840 1,819 
Non-cash interest expense27,962 24,604 
Amortization of deferred financing costs and accretion of discount/premium on long-term debt1 54 
Deferred income taxes(914)(3,368)
Distributions from unconsolidated investees305 915 
Earnings from unconsolidated investees(279)(488)
Other non-cash items, net1,380 (498)
Changes in operating assets and liabilities:  
Accounts receivable(2,326)(4,547)
Prepaid expenses and other assets(1,181)(1,919)
Accounts payable and other liabilities6,171 6,502 
Operating lease liabilities and right-of-use assets129 585 
Net cash provided by operating activities17,955 21,079 
Investing activities:  
Purchases of property and equipment(11,460)(15,466)
Other investing activities823 963 
Net cash used in investing activities$(10,637)$(14,503)

See accompanying notes to the condensed consolidated financial statements.
8


AKUMIN INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (CONTINUED)
(Unaudited; in thousands)

Six Months Ended June 30,
20232022
Financing activities:
Proceeds from revolving loan$14,000 $20,000 
Principal payments on revolving loan(14,000)(20,000)
Proceeds from long-term debt1,706 10,292 
Principal payments on long-term debt(10,618)(8,365)
Principal payments on finance leases(3,937)(4,330)
Contributions received from redeemable noncontrolling interests107  
Distributions paid to noncontrolling and redeemable noncontrolling interests(16,032)(14,145)
Net cash used in financing activities(28,774)(16,548)
Net decrease in cash and cash equivalents(21,456)(9,972)
Cash and cash equivalents, beginning of period59,424 48,419 
Cash and cash equivalents, end of period$37,968 $38,447 
Supplemental disclosure of cash flow information:  
Interest paid$33,986 $32,439 
Income taxes paid, net of refunds929 502 
Supplemental disclosure of non-cash investing and financing activities:
Property and equipment purchases in accounts payable and accrued liabilities3,551 4,852 
Derecognition of operating lease right-of-use assets and lease liabilities associated with lease terminations3,656 3,635 
Equipment acquired in exchange for finance lease obligations460 1,433 
Operating lease right-of-use assets obtained in exchange for operating lease liabilities3,500 668 
See accompanying notes to the condensed consolidated financial statements.
9


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
June 30, 2023
(Unaudited)

1. Basis of Presentation
The accompanying unaudited condensed consolidated financial statements have been prepared by Akumin Inc. (the “Company” or “Akumin”) and do not include all of the information and disclosures required by accounting principles generally accepted in the U.S. (“GAAP”). In the opinion of management, all normal recurring accruals and adjustments considered necessary for a fair presentation have been included. The results for the three and six months ended June 30, 2023 are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. The accompanying condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes to the consolidated financial statements for the year ended December 31, 2022.
The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could differ from those estimates.
Certain reclassifications have been made to prior period condensed consolidated financial statements to conform to the current period presentation.
2. New Accounting Standards
Recently Adopted Accounting Standards
ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments
In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the Securities and Exchange Commission (“SEC”), which gave the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company adopted this standard on January 1, 2023 using the modified retrospective approach and it did not have a material impact on the Company's condensed consolidated financial statements, resulting in no adjustments to prior year earnings.
Recently Issued Accounting Standards Not Yet Effective
ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805)
In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers, creating an exception to the recognition and measurement principles in ASC 805, Business Combinations. The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers, rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets, fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For
10


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
all other entities, this ASU is effective for fiscal years beginning after December 15, 2023. The Company is considered an Emerging Growth Company as classified by the SEC, which gives the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company is currently evaluating the impact of the standard on its consolidated financial statements.
3. Variable Interest Entities
In accordance with consolidation guidance, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenues and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. A reporting entity is considered to have a controlling financial interest in a variable interest entity (“VIE”) if (i) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (ii) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE.
As a result of the financial relationship established between the Company and certain entities (the “Revenue Practices”) through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenues and expenses of the Revenue Practices are included in the condensed consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. As of June 30, 2023 and December 31, 2022, the Revenue Practices’ assets included in the Company’s condensed consolidated balance sheets were $39.6 million and $36.0 million, respectively, and liabilities included in the Company’s condensed consolidated balance sheets were $2.9 million and $1.4 million, respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the six months ended June 30, 2023 and 2022, the Revenue Practices’ revenues were $85.7 million and $92.8 million, respectively, and the net cash provided by operating activities was $77.9 million and $93.2 million, respectively.
4. Property and Equipment
Property and equipment consists of the following:
(in thousands)June 30,
2023
December 31,
2022
Medical equipment$254,247 $244,517 
Leasehold improvements44,000 43,382 
Equipment under finance leases45,348 44,845 
Office and computer equipment19,151 17,742 
Transportation and service equipment11,542 11,672 
Furniture and fixtures3,439 3,362 
Construction in progress 3,550 4,636 
381,277 370,156 
Less accumulated depreciation183,718 148,942 
$197,559 $221,214 
Depreciation expense was $18.2 million and $20.2 million for the three months ended June 30, 2023 and 2022, respectively, and $36.4 million and $39.9 million for the six months ended June 30, 2023 and 2022, respectively.
As of June 30, 2023 and December 31, 2022, the equipment under finance leases had a net book value of $25.4 million and $26.3 million, respectively.
11


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
5. Goodwill
Changes in the carrying amount of goodwill are as follows:
(in thousands)RadiologyOncologyTotal
Balance, December 31, 2022$682,725 $86,385 $769,110 
Impairment(53,460) (53,460)
Goodwill written off in connection with site closure (381)(381)
Balance, June 30, 2023$629,265 $86,004 $715,269 
The Company tests its goodwill and indefinite-lived intangible assets annually or more frequently depending on certain impairment indicators. Such indicators include a significant decline in expected future cash flows due to changes in company-specific factors or the broader business climate. During the second quarter of 2023, the Company determined that potential indicators of impairment existed and thus performed a quantitative test for impairment at the reporting unit level as of May 31, 2023. In estimating fair values, the Company gave equal weight to an income approach (the DCF method) and a market approach (the GPC method).
Specifically, the Company utilized the following Level 3 estimates and assumptions in its analysis:
Discount rate
9.5% to 10.0%
Perpetual growth rate3.0%
Tax rate26.0%
Risk-free interest rate3.5%
Revenue multiple
1.8 to 2.2
EBITDA multiple
7.5 to 9.5
The impairment test yielded a fair value for the Oncology reporting unit that exceeded its carrying value; therefore, this reporting unit was not considered at risk of impairment. In connection with the impairment test for the Radiology reporting unit, the Company concluded that the carrying value exceeded its estimated fair value based on management's assessment of the outlook and long-term business plans for this division. Consequently, the Company recorded an impairment charge of $53.5 million related to goodwill for the Radiology reporting unit, which was recorded in the condensed consolidated statements of operations and comprehensive loss for the three and six months ended June 30, 2023.
Changes in these estimates or assumptions could materially affect the determination of fair value and the conclusions of the Company's impairment test.

12


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
6. Other Intangible Assets
Other intangible assets consist of the following:
(dollars in thousands)Weighted
Average
Useful
Life
(in years)
June 30, 2023December 31, 2022
Gross
Carrying
Amount
Accumulated
Amortization
Other
Intangible
Assets, Net
Gross
Carrying
Amount
Accumulated
Amortization
Other
Intangible
Assets, Net
Finite-lived intangible assets:
Customer contracts20$250,733 $(23,057)$227,676 $263,388 $(17,588)$245,800 
Trade names1876,391 (13,324)63,067 77,135 (11,063)66,072 
Management agreements1710,200 (1,100)9,100 10,200 (800)9,400 
Other55,739 (4,628)1,111 5,719 (4,454)1,265 
Total $343,063 $(42,109)300,954 $356,442 $(33,905)322,537 
Certificates of Need69,558 69,558 
Total other intangible assets$370,512 $392,095 
The Company performs an impairment test when indicators of impairment are present. As of June 30, 2023, there were no indications of impairment of the Company's other intangible assets balances.
The aggregate amortization expense for the Company’s finite-lived intangible assets was $16.8 million and $5.0 million for the three months ended June 30, 2023 and 2022, respectively, and $21.6 million and $10.0 million for the six months ended June 30, 2023 and 2022, respectively. Amortization expense for the three and six months ended June 30, 2023 includes $12.1 million of accelerated amortization related to the closure of one site and winding down operations of a second site in the Oncology segment.
7. Long-Term Debt
Long-term debt consists of the following:
(in thousands)June 30,
2023
December 31,
2022
2028 Senior Notes$375,000 $375,000 
2025 Senior Notes475,000 475,000 
Subordinated Notes451,265 423,303 
Equipment Debt63,842 72,754 
1,365,107 1,346,057 
Debt discount/premium and deferred issuance costs(72,748)(71,444)
1,292,359 1,274,613 
Less current portion19,282 19,961 
Long-term debt, net of current portion$1,273,077 $1,254,652 
During the six months ended June 30, 2023, the Company elected to pay interest in-kind on the Subordinated Notes pursuant to the original agreement and, accordingly, $28.0 million of accrued interest was added to the principal balance of the Subordinated Notes.
13


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
Certain of the debt obligations are subject to covenants with which the Company must comply on a quarterly or annual basis. The Company was in compliance with, or had received waivers for, all such covenants as of June 30, 2023.
8. Accrued Liabilities
Accrued liabilities consist of the following:
(in thousands)June 30,
2023
December 31,
2022
Accrued compensation and related expenses$21,743 $25,655 
Accrued interest expense18,267 18,183 
Other48,329 43,078 
$88,339 $86,916 
9. Redeemable Noncontrolling Interests
The Company has noncontrolling interests with redemption features. These redemption features could require the Company to make an offer to purchase the noncontrolling interests in the case of certain events, including (i) the expiration or termination of certain operating agreements of the joint venture, or (ii) the noncontrolling interests’ tax-exempt status is jeopardized by the joint venture.
As of June 30, 2023, the Company holds redeemable noncontrolling interests of $26.8 million, which are not currently redeemable or probable of becoming redeemable. The redemption of these noncontrolling interests is not solely within the Company’s control, therefore, they are presented in the temporary equity section of the Company’s condensed consolidated balance sheets. The Company does not believe it is probable the redemption features related to these noncontrolling interest will be triggered as the triggering events are generally not probable until they occur. As such, these noncontrolling interests have not been remeasured to redemption value.
The following is a rollforward of the activity in the redeemable noncontrolling interests for the six months ended June 30, 2023:
(in thousands)
Balance, December 31, 2022$30,337 
Net income attributable to redeemable noncontrolling interests611 
Contributions received from redeemable noncontrolling interests107 
Distributions paid to redeemable noncontrolling interests(4,255)
Balance, June 30, 2023$26,800 
14


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
10. Financial Instruments
Assets and Liabilities that are Measured at Fair Value on a Recurring Basis
The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis:
Fair Value as of June 30, 2023Fair Value as of December 31, 2022
(in thousands)Level 1Level 2Level 3TotalLevel 1Level 2Level 3Total
Current and long-term assets:
Interest rate and fuel option contracts$ $64 $ $64 $ $52 $ $52 
Long-term liabilities:
Derivative in subordinated notes$ $ $5,831 $5,831 $ $ $6,132 $6,132 
The derivative in subordinated notes relates to the Change of Control Redemption Election included in the Subordinated Notes (see Note 7). The fair value of the Change of Control Redemption Election liability was determined using a probability weighted scenario analysis regarding a potential change of control during the seven years from initiation date. The estimated fair values of the Change of Control Redemption Election as of June 30, 2023 and December 31, 2022 use unobservable inputs for probability weighted time until an exit event of 3.2 years and 3.5 years, respectively, and an exit event probability weighting of 21.7% and 22.9%, respectively.
The following is a reconciliation of the opening and closing balances for the derivative in subordinated notes liability measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the six months ended June 30, 2023:
(in thousands)
Balance, December 31, 2022$6,132 
Change in fair value(301)
Balance, June 30, 2023$5,831 
The decrease in the fair value of the derivative in subordinated notes liability was recorded as a gain and included in other non-operating expense (income), net in the Company's condensed consolidated statements of operations and comprehensive loss for the six months ended June 30, 2023.
The Company’s interest rate contracts are primarily pay-fixed, receive-variable interest rate swaps related to certain of the Company’s equipment debt. The amount that the Company expects to reclassify from accumulated other comprehensive income to interest expense over the next twelve months is immaterial. During the second quarter of 2023, the Company entered into a fuel call option contract to hedge against fluctuations in fuel prices through April 2024.
15


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
Assets and Liabilities for which Fair Value is only Disclosed
The estimated fair values of other current and non-current liabilities are as follows:
(in thousands)June 30,
2023
December 31,
2022
2028 Senior Notes$247,705 $228,894 
2025 Senior Notes390,814 339,385 
Subordinated Notes294,380 254,951 
Equipment Debt53,272 58,698 
$986,171 $881,928 
As of June 30, 2023 and December 31, 2022, the estimated fair values of the 2028 Senior Notes and 2025 Senior Notes were determined using Level 2 inputs and the estimated fair values of the Subordinated Notes and Equipment Debt were determined using Level 3 inputs.
The carrying value of cash and cash equivalents, accounts receivable, accounts payable, accrued liabilities, and the current portion of lease liabilities approximates their fair value given their short-term nature. The carrying value of the non-current portion of lease liabilities approximates their fair value given the difference between the discount rates used to recognize the liabilities in the condensed consolidated balance sheets and the normalized expected market rates of interest is insignificant.
Financial instruments are classified into one of the following categories: amortized cost, fair value through earnings and fair value through other comprehensive income. The following table summarizes information regarding the carrying value of the Company’s financial instruments:
(in thousands)June 30,
2023
December 31,
2022
Financial assets measured at amortized cost:
Cash and cash equivalents$37,968 $59,424 
Accounts receivable115,790 114,166 
$153,758 $173,590 
Financial liabilities measured at amortized cost:  
Accounts payable$43,575 $36,618 
Current portion of long-term debt19,282 19,961 
Current portion of leases23,581 25,023 
Non-current portion of long-term debt1,273,077 1,254,652 
Non-current portion of leases167,948 179,980 
Accrued liabilities88,339 86,916 
$1,615,802 $1,603,150 
Financial assets measured at fair value through earnings:
Fuel option contract$36 $ 
Financial liabilities measured at fair value through earnings:  
Derivative in subordinated notes$5,831 $6,132 
Financial assets measured at fair value through other comprehensive income:  
Interest rate contracts$28 $52 
16


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
Assets and Liabilities that are Measured at Fair Value on a Nonrecurring Basis
The Company measures certain non-financial assets at fair value on a nonrecurring basis, primarily intangible assets, goodwill and long-lived assets in connection with acquisitions and periodic evaluations for potential impairment. The Company estimates the fair value of these assets using primarily unobservable inputs; therefore, these are considered Level 3 fair value measurements. See disclosure of Level 3 measurements related to the goodwill impairment analysis in Note 5.
Interest Rate Risk
Interest rate risk is the risk the fair value or future cash flows of a financial instrument will fluctuate because of changes in market interest rates. Changes in lending rates can cause fluctuations in interest payments and cash flows. Certain of the Company’s equipment debt arrangements have interest rate swap agreements to hedge the future variable cash interest payments in order to avoid volatility in operating results due to fluctuations in interest rates. As of June 30, 2023 and December 31, 2022, the Company had $0.3 million and $0.4 million, respectively, of variable interest rate equipment debt that is not hedged. In addition, the Company is exposed to variable interest rates related to the 2020 Revolving Facility, which had no outstanding balance as of June 30, 2023 or December 31, 2022. The Company’s exposure to interest rate risk from a 1% increase or decrease in the variable interest rates is not material.
11. Stockholders' Equity
In connection with the Company's change of jurisdiction of incorporation from the province of Ontario, Canada, to the State of Delaware (the "Domestication") in 2022, the Company amended its Certificate of Incorporation to provide for the issuance of up to 300,000,000 shares of common stock, par value $0.01 per share, and 50,000,000 shares of undesignated preferred stock, par value $0.01 per share. The effect of the change in the common stock from no par value to $0.01 par value per share has been reflected in the condensed consolidated financial statements on a retroactive basis for all periods presented.
Stock-Based Awards
The Company may grant stock-based awards to employees, directors and consultants under the Amended and Restated Restricted Share Unit Plan, adopted as of April 18, 2023 (the “RSU Plan”) and the Amended and Restated Stock Option Plan, adopted as of April 18, 2023 (the “Stock Option Plan” and together with the RSU Plan, the “2023 Stock Plans”). Under the 2023 Stock Plans, the collective maximum number of shares reserved for issuance is equal to 10% of the number of capital shares of the Company that are outstanding from time to time. As of June 30, 2023 and December 31, 2022, shares of common stock reserved for issuance under the 2023 Stock Plans were 9,099,849 and 8,981,151, respectively. The 2023 Stock Plans are administered by the Board of Directors, which has authority to select eligible persons to receive awards and to determine the terms and conditions of the awards.
Restricted Share Units
Restricted share units (“RSUs”) represent a right to receive a share of common stock at a future vesting date with no cash payment from the holder. RSUs granted vest over two years from the date of grant. A summary of RSU activity is as
17


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
follows:
Number of
RSUs
Weighted-
Average
Grant Date
Fair Value
Aggregate
Fair Value
(in thousands)
Outstanding and unvested at December 31, 20222,143,601$1.77 
Granted2,217,2130.67 $1,479 
Vested(1,186,978)2.06 $2,450 
Cancelled(57,078)1.10 $(63)
Outstanding and unvested at June 30, 20233,116,758$0.89 $2,761 
Stock Options
Stock options are awarded as consideration in exchange for services rendered to the Company. Stock options granted generally have terms of 7 years, but in no event more than 10 years after the date of grant, and vest over 3 years. A summary of the stock option activity is as follows:
Number of
Options
Weighted-
Average
Exercise price
Weighted-
 Average
Remaining
Contractual
Term (Years)
Aggregate
Intrinsic
Value
(in thousands)
Outstanding at December 31, 20225,348,120$2.56 3.3$378 
Outstanding at June 30, 20235,348,120$2.56 2.8$ 
Exercisable at June 30, 20235,325,020$2.55 2.8$ 
Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on June 30, 2023 and the exercise price multiplied by the number of in-the-money options.
No stock options were granted during the six months ended June 30, 2023.
12. Commitments and Contingencies
Purchase Commitments
The Company has certain binding purchase commitments primarily for the purchase of equipment from various suppliers. As of June 30, 2023, the obligations for these future purchase commitments totaled $38.4 million, of which $32.5 million is expected to be paid during the remaining six months of 2023 and $6.0 million is expected to be paid thereafter.
Guarantees and Indemnities
In the normal course of business, the Company has made certain guarantees and indemnities, under which it may be required to make payments to a guaranteed or indemnified party, in relation to certain transactions. The Company indemnifies other parties, including customers, lessors, and parties to other transactions with the Company, with respect to certain matters. The Company has agreed to hold the other party harmless against losses arising from certain events as defined within the particular contract, which may include, for example, litigation or claims arising from a breach of representations or covenants. In addition, the Company has entered into indemnification agreements with its executive officers and directors and the Company’s bylaws contain similar indemnification obligations. Under these arrangements, the Company is obligated to indemnify, to the fullest extent permitted under applicable law, its current or former officers and directors for various amounts incurred with respect to actions, suits or proceedings in which they were made, or threatened to be made, a party as a result of acting as an officer or director.
18


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
It is not possible to determine the maximum potential amount under these indemnification agreements due to the limited history of prior indemnification claims and the unique facts and circumstances involved in each particular agreement. Historically, payments made related to these indemnifications have been immaterial. As of June 30, 2023, the Company has determined that no liability is necessary related to these guarantees and indemnities.
Legal Matters
On December 20, 2021, an alleged shareholder of the Company filed a putative class action claim with the Ontario Superior Court of Justice against the Company and certain of its directors and officers alleging violations of Securities Act (Ontario), negligent misrepresentation and other related claims relating to the restatement of the Company’s financial statements that were filed in 2021. On February 17, 2023, the plaintiff delivered a motion record for certification and for leave to commence action under Part XXIII.1 of the Securities Act (Ontario). The Company plans to defend the claim and the motion.
Other Matters
The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. With respect to these matters, management evaluates the developments on a regular basis and accrues a liability when it believes a loss is probable and the amount can be reasonably estimated. Management believes that the amount or any estimable range of reasonably possible or probable loss will not, either individually or in the aggregate, have a material adverse effect on the Company’s business and condensed consolidated financial statements. However, the outcome of these matters is inherently uncertain. Therefore, if one or more of these matters were resolved against the Company for amounts in excess of management’s expectations, the Company’s results of operations and financial condition could be materially and adversely affected.
13. Supplemental Revenue Information
Revenues consist primarily of net patient fees received from various payors and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. Revenues are also derived directly from hospitals and healthcare providers.
Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third-party payors, management fees, government grants and fees for other services provided to third parties.
The following table summarizes the components of the Company’s revenues by payor category:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Patient fee payors:
Commercial$65,066 $71,609 $130,588 $140,710 
Medicare20,082 21,002 41,502 42,174 
Medicaid3,256 3,347 6,661 6,449 
Other patient revenue2,729 3,213 5,324 6,487 
91,133 99,171 184,075 195,820 
Hospitals and healthcare providers91,513 90,651 183,975 178,110 
Other revenue2,194 2,306 4,382 4,461 
$184,840 $192,128 $372,432 $378,391 
19


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
14. Cost of Operations, excluding Depreciation and Amortization
The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Employee compensation$68,302 $72,021 $139,829 $147,148 
Third-party services and professional fees32,091 29,919 62,920 59,096 
Rent and utilities12,780 12,742 25,121 25,219 
Reading fees11,953 11,788 23,552 23,286 
Administrative12,944 11,467 23,365 23,091 
Medical supplies and other20,425 16,637 39,275 31,895 
$158,495 $154,574 $314,062 $309,735 
15. Supplemental Statement of Operations Information
Restructuring Charges
Restructuring charges consist of the following:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Transformation costs$939 $4,025 $6,659 $4,025 
Lease termination costs7 1,840 7 1,840 
Domestication and related costs 1,063  1,063 
Other(2)316 14 396 
$944 $7,244 $6,680 $7,324 
Transformation costs consist of third-party consulting fees associated with a significant project to identify, plan, and implement various business improvement initiatives designed to enhance growth opportunities and improve operations. The project is expected to continue into 2024. The consulting agreement provides for fixed fees totaling $12.5 million, milestone fees totaling up to $7.0 million that are earned upon the achievement of certain milestones, and performance fees totaling up to $15.0 million that are earned based on the achievement of certain performance results during the period of the contract. The Company recognizes the fixed fees over the contract period as the services are rendered. Milestone and performance fees that are probable of ultimately being paid are recognized based on a percentage of achievement of the related milestone or performance result. As of June 30, 2023, the accounts payable and accrued liability balance for unpaid transformation consulting costs was $3.4 million and $4.5 million, respectively.
Severance and Related Costs
Severance and related costs represent costs associated with employees whose employment with the Company has been terminated and are generally paid in the year recorded. In connection with certain terminated employees, severance benefits are being paid over periods of 12 to 18 months. As of June 30, 2023, the unpaid balance of severance and related costs totaled $1.5 million, which will be paid during the next twelve months.
Other Operating and Non-Operating Expense (Income)
Other operating expense (income), net consists of the following:
20


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Loss on sale of accounts receivable$922 $ $1,046 $ 
Gain from insurance proceeds  (776) 
Loss (gain) on disposal of property and equipment, net(348)170 (417)372 
Other, net(97)416 (127)207 
$477 $586 $(274)$579 
Other non-operating expense (income), net consists of the following:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Capital structure initiatives$1,912 $ $1,912 $ 
Acquisition-related costs155 86 298 468 
Fair value adjustment on derivative in subordinated notes(258)(1,009)(301)(839)
Earnings from unconsolidated investees(128)(248)(279)(488)
Other, net665 (1,164)584 (1,152)
$2,346 $(2,335)$2,214 $(2,011)
Capital structure initiatives represent costs associated with the Company’s initiative to restructure its long-term debt.
Impairment Charges
Impairment charges relate to the following assets:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Goodwill (Note 5)$53,460 $ $53,460 $ 
$53,460 $ $53,460 $ 
16. Investments in Unconsolidated Investees
Effective March 1, 2021, the Company completed a common equity investment in an artificial intelligence business (“AI business”) as part of a private placement offering for $4.6 million. The AI business develops artificial intelligence aided software programs for use in medical businesses, including outpatient imaging services provided by the Company. As a result of the investment, a previous investment in a convertible note instrument issued by the AI business to the Company in May 2020 converted to common equity. The Company’s total common equity investment has a carrying value
of $7.9 million as of June 30, 2023 and represents a 34.5% interest in the AI business on a non-diluted basis. In addition, the Company holds share purchase warrants which, subject to the occurrence of certain events and certain assumptions, and the payment of $0.4 million, would entitle the Company to acquire an additional 2.4% ownership interest in the AI business common equity.
The Company has a 15% direct ownership in an unconsolidated investee and provides management services under a management agreement with the investee. The Company provides services as part of its ongoing operations for and on behalf of the unconsolidated investee, which reimburses the Company for the actual amount of the expenses incurred. The Company records the expenses in cost of operations and the reimbursement as revenue in the condensed consolidated statements of operations and comprehensive loss.
21


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
The financial position and results of operations of these unconsolidated investees are not material to the Company’s condensed consolidated financial statements.
17. Income Taxes
The Company is subject to U.S. federal income tax as well as income tax of multiple state jurisdictions. The Company is no longer subject to Canadian tax after the Domestication on September 30, 2022.
The effective tax rate for the three and six months ended June 30, 2023 differs from the U.S. federal statutory rate of 21.0% primarily due to the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit is recognized.
18. Basic and Diluted Loss per Share
The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period.
Three Months Ended June 30,Six Months Ended June 30,
(in thousands, except share and per share amounts)2023202220232022
Net loss attributable to common stockholders$(96,652)$(30,469)$(131,800)$(61,280)
Weighted average common shares outstanding:
Basic and diluted90,503,986 89,516,513 90,163,458 89,296,619 
Net loss per share attributable to common stockholders:
Basic and diluted$(1.07)$(0.34)$(1.46)$(0.69)
Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive1,478,978 2,042,461 2,006,143 2,207,983 
19. Segment Information
Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. The Company operates in two reportable segments: Radiology and Oncology. All intercompany revenues, expenses, receivables and payables are eliminated in consolidation and are not reviewed when evaluating segment performance. Each segment’s performance is evaluated based on revenue and adjusted earnings before interest, taxes, depreciation and amortization ("Adjusted EBITDA").
The following table summarizes the Company’s revenues by segment:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Radiology$156,291 $160,867 $313,692 $316,207 
Oncology28,549 31,261 58,740 62,184 
$184,840 $192,128 $372,432 $378,391 
Adjusted EBITDA is defined as net loss before interest expense, income tax benefit, depreciation and amortization, impairment charges, restructuring charges, severance and related costs, settlements and related costs, stock-based compensation, loss on sale of accounts receivable, capital structure initiatives, fair value adjustment on derivative, deferred rent expense, and items that we do not consider to be indicative of our core/ongoing operations. Adjusted EBITDA should
22


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
not be considered a measure of financial performance under GAAP, and it should not be considered in isolation or as an alternative to net income, cash flows generated by operating, investing or financing activities, or other financial statement data presented in the condensed consolidated financial statements as indicators of financial performance or liquidity. Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation and may not be comparable to other similarly titled measures of other companies. Adjusted EBITDA is the most frequently used measure of each segment’s performance and is commonly used in setting performance goals.
The following table summarizes the Company’s Adjusted EBITDA by segment:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Adjusted EBITDA:
Radiology$25,449 $35,692 $55,775 $64,281 
Oncology8,072 10,302 17,920 20,335 
Corporate(6,994)(7,810)(14,027)(14,414)
$26,527 $38,184 $59,668 $70,202 
A reconciliation of the net loss to total Adjusted EBITDA is shown below:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Net loss$(96,411)$(26,079)$(125,601)$(52,511)
Interest expense31,164 29,290 61,861 57,971 
Income tax benefit(1,578)(3,483)(704)(2,920)
Depreciation and amortization35,015 25,200 58,008 49,931 
Impairment charges53,460  53,460  
Restructuring charges944 7,244 6,680 7,324 
Severance and related costs22 5,559 (27)7,797 
Settlements, recoveries and related costs465 814 1,913 677 
Stock-based compensation441 758 840 1,819 
Loss on sale of accounts receivable922  1,046  
Loss (gain) on disposal of property and equipment, net(348)170 (417)372 
Capital structure initiatives1,912  1,912  
Acquisition-related costs155 86 298 468 
Fair value adjustment on derivative(258)(1,009)(301)(839)
Deferred rent expense(43)247 142 579 
Other, net665 (613)558 (466)
Adjusted EBITDA$26,527 $38,184 $59,668 $70,202 
23


AKUMIN INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)
June 30, 2023
(Unaudited)
The following table summarizes the Company’s total assets by segment:
(in thousands)June 30,
2023
December 31,
2022
Identifiable assets:
Radiology$1,304,358 $1,400,938 
Oncology312,992 346,337 
Corporate18,392 17,840 
$1,635,742 $1,765,115 
The following table summarizes the Company’s capital expenditures by segment:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Capital expenditures:
Radiology$7,093 $4,648 $9,069 $13,460 
Oncology500 858 1,000 1,834 
Corporate1,359 82 1,391 172 
$8,952 $5,588 $11,460 $15,466 
24


Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
The following discussion and analysis of our financial condition and results of operations should be read in conjunction with our unaudited condensed consolidated financial statements and related notes that appear in Item 1 of this Quarterly Report on Form 10-Q and our audited consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2022. In addition to historical information, the following discussion contains forward-looking statements that are subject to risks and uncertainties. Actual results may differ substantially and adversely from those referred to herein due to a number of factors, including, but not limited to, those described below and in Item 1A “Risk Factors” and elsewhere in our Annual Report on Form 10-K for the year ended December 31, 2022.
Overview
We provide fixed-site outpatient diagnostic imaging services through a network of approximately 180 owned and/or operated imaging locations; and outpatient radiology and oncology services and solutions to approximately 1,000 hospitals and health systems across 48 states. Our imaging procedures include magnetic resonance imaging (“MRI”), computed tomography (“CT”), positron emission tomography (“PET” and “PET/CT”), ultrasound, diagnostic radiology (X-ray), mammography and other related procedures. Our cancer care services include a full suite of radiation therapy and related offerings.
We are significantly diversified across business lines, geographies, modality offerings and reimbursement sources. The diversity of our business provides a number of advantages, including having no material revenue concentration with any health system or hospital customer and no material concentration with any commercial payor.
We currently operate in two reportable business segments: radiology and oncology. The following table summarizes our revenues by segment as a percentage of total revenue:
Three Months Ended June 30,Six Months Ended June 30,
2023202220232022
Radiology85 %84 %84 %84 %
Oncology15 %16 %16 %16 %
100 %100 %100 %100 %
Revenues consist primarily of net patient fees received from various payors and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. Revenues are also derived directly from hospitals and healthcare providers.
The following table summarizes the components of our revenues by payor category:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Patient fee payors:
Commercial$65,066 $71,609 $130,588 $140,710 
Medicare20,082 21,002 41,502 42,174 
Medicaid3,256 3,347 6,661 6,449 
Other patient revenue2,729 3,213 5,324 6,487 
91,133 99,171 184,075 195,820 
Hospitals and healthcare providers91,513 90,651 183,975 178,110 
Other revenue2,194 2,306 4,382 4,461 
$184,840 $192,128 $372,432 $378,391 

25


Summary of Factors Affecting Our Performance
Pricing
Continued expansion of health maintenance organizations, preferred provider organizations and other managed care organizations have influence over the pricing of our services because these organizations can exert great control over patients’ access to our services and reimbursement rates for accessing those services.
Competition
The market for outpatient diagnostic imaging and oncology services is highly competitive. We compete principally on the basis of our reputation, our ability to provide multiple modalities at many of our centers, the location of our centers and the quality of our outpatient diagnostic imaging and oncology services. We compete locally with groups of individual healthcare providers, established hospitals, clinics and other independent organizations that own and operate imaging and radiation therapy equipment.
We also face competition from other outpatient diagnostic imaging companies and oncology service providers in acquiring outpatient diagnostic imaging and oncology centers, which makes it more difficult to find attractive products on acceptable terms. Accordingly, we may not be able to acquire rights to additional outpatient diagnostic imaging and oncology centers on acceptable terms.
Our multi-modality imaging offering provides a one-stop-shop for patients and referring physicians and diversifies our revenue sources. Our scalable and integrated operating platform is expected to create value from future acquisitions, cost efficiencies and organic growth.
Seasonality
We experience seasonality in the revenues and margins generated for our services. First and fourth quarter revenues are typically lower than those from the second and third quarters. First quarter revenue is affected primarily by fewer calendar days and inclement weather, typically resulting in fewer patients being scanned or treated during the period. Fourth quarter revenues are affected by holiday and client and patient vacation schedules, resulting in fewer scans or treatments during the period. The variability in margins is higher than the variability in revenues due to the fixed nature of our costs. We also experience fluctuations in our revenues and margins due to acquisition activity and general economic conditions, including recession or economic slowdown.
Industry Trends
Our revenue is impacted by changes to U.S. healthcare laws, our partners’ and contractors’ healthcare costs, and/or reimbursement rates by payors.
Inflation

Inflationary pressures impact us primarily in the area of labor, fuel and medical supplies. The healthcare industry is labor intensive. Wages and other expenses increase during periods of inflation and when labor shortages occur in the marketplace. Suppliers and third-party service providers pass along rising costs to us in the form of higher prices. Managing these costs remains a significant challenge and priority for us.
Labor Shortages

Labor shortages among healthcare providers resulting from the COVID-19 pandemic and new variants, including burnout and attrition, has led to increased difficulty in hiring and retaining staff as well as increased labor costs and wage inflation. The shortage of clinical labor has also impacted our ability to generate same-store revenue growth.

26


Acquisitions and New/Closed Facilities
The timing of acquisitions, the opening of new fixed-site facilities, and the closure of existing facilities impact our revenue and the comparability of our results from period to period. The following table shows the number of our radiology diagnostic imaging sites and oncology radiation therapy sites:
June 30,
2023
December 31,
2022
Radiology sites178181
Oncology sites2930
207211



27


Results of Operations
The following table presents our condensed consolidated statements of operations:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands, except per share amounts)2023202220232022
Revenues$184,840 $192,128 $372,432 $378,391 
Operating expenses:  
Cost of operations, excluding depreciation and amortization158,495 154,574 314,062 309,735 
Depreciation and amortization35,015 25,200 58,008 49,931 
Impairment charges53,460 — 53,460 — 
Restructuring charges944 7,244 6,680 7,324 
Severance and related costs22 5,559 (27)7,797 
Settlements, recoveries and related costs465 814 1,913 677 
Stock-based compensation441 758 840 1,819 
Other operating expense (income), net477 586 (274)579 
Total operating expenses249,319 194,735 434,662 377,862 
Income (loss) from operations(64,479)(2,607)(62,230)529 
Other expense (income):
Interest expense31,164 29,290 61,861 57,971 
Other non-operating expense (income), net2,346 (2,335)2,214 (2,011)
Total other expense, net33,510 26,955 64,075 55,960 
Loss before income taxes(97,989)(29,562)(126,305)(55,431)
Income tax benefit(1,578)(3,483)(704)(2,920)
Net loss(96,411)(26,079)(125,601)(52,511)
Less: Net income attributable to noncontrolling interests241 4,390 6,199 8,769 
Net loss attributable to common stockholders$(96,652)$(30,469)$(131,800)$(61,280)
Net loss per share attributable to common stockholders:
Basic and diluted$(1.07)$(0.34)$(1.46)$(0.69)
The following table summarizes statistical information regarding our radiology scan volumes and oncology patient starts:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)20232022Change% Change20232022Change% Change
MRI scans221 225 (4)(2)%438 439 (1)— %
PET/CT scans37 33 12 %72 65 11 %
Oncology patient starts2.523 2.588 (0.065)(3)%5.133 5.132 0.001 — %
The following table summarizes our revenues by segment:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Radiology$156,291 $160,867 $313,692 $316,207 
Oncology28,549 31,261 58,740 62,184 
$184,840 $192,128 $372,432 $378,391 
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The following table summarizes the components of our cost of operations, excluding depreciation and amortization:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Employee compensation$68,302 $72,021 $139,829 $147,148 
Third-party services and professional fees32,091 29,919 62,920 59,096 
Rent and utilities12,780 12,742 25,121 25,219 
Reading fees11,953 11,788 23,552 23,286 
Administrative12,944 11,467 23,365 23,091 
Medical supplies and other20,425 16,637 39,275 31,895 
$158,495 $154,574 $314,062 $309,735 
Three Months Ended June 30, 2023 Compared to Three Months Ended June 30, 2022
Revenues
Revenues for the three months ended June 30, 2023 were $184.8 million and decreased by $7.3 million, or 4%, from the three months ended June 30, 2022. The decrease was attributable to a $4.6 million decrease in radiology revenue and a $2.7 million decrease in oncology revenue. The decrease in radiology revenue was due primarily to changes in business mix and certain site closures over the last twelve months, partially offset by higher same store volume. Oncology revenue decreased primarily due to non-renewal of certain joint venture partnership contracts and site closures over the last twelve months.
Cost of Operations, excluding Depreciation and Amortization
Cost of operations, excluding depreciation and amortization, for the three months ended June 30, 2023 was $158.5 million and increased by $3.9 million, or 2.5%, from the three months ended June 30, 2022. This increase was a result of higher medical supplies and other costs, third-party services and professional fees, and administrative expenses, partly offset by lower employee compensation.
Employee Compensation
Employee compensation for the three months ended June 30, 2023 was $68.3 million and decreased by $3.7 million, or 5%, from the three months ended June 30, 2022. This decrease was primarily driven by workforce reductions implemented during the second quarter of 2022, partly offset by wage inflation and higher compensation to attract and retain clinic staff due to labor shortages in certain markets and merit increases.
Third-Party Services and Professional Fees
Third-party services and professional fees for the three months ended June 30, 2023 were $32.1 million and increased by $2.2 million, or 7%, from the three months ended June 30, 2022. This increase was primarily due to higher information technology related services and other outsourced services.
Rent and Utilities
Rent and utilities for the three months ended June 30, 2023 were $12.8 million compared to $12.7 million for the three months ended June 30, 2022. Rent and utilities are largely a fixed cost.
Reading Fees
Reading fees for the three months ended June 30, 2023 were $12.0 million and increased by $0.2 million, or 1%, from the three months ended June 30, 2022. Our reading fees are primarily based on the volume of procedures performed.
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Administrative Expenses
Administrative expenses for the three months ended June 30, 2023 were $12.9 million and increased by $1.5 million, or 13%, from the three months ended June 30, 2022. The increase was primarily due to higher insurance
costs and increase in bad debt expense, partly offset by cost containment measures put in place after the first quarter of 2022 affecting marketing and advertising, travel and related costs, and other administrative expenses.
Medical Supplies and Other Expenses
Medical supplies and other expenses for the three months ended June 30, 2023 were $20.4 million and increased by $3.8 million, or 23%, from the three months ended June 30, 2022. The increase was primarily due to cost inflation and increased spend on specialty tracers used in PET/CT scans.
Depreciation and Amortization
Depreciation and amortization for the three months ended June 30, 2023 was $35.0 million and increased by $9.8 million, or 39%, from the three months ended June 30, 2022. The increase was primarily due to $12.1 million of accelerated amortization of intangible assets related to the closure of one site and winding down operations of a second site in the Oncology segment, partially offset by lower depreciation for office and computer equipment resulting from fully depreciated assets.
Impairment Charges
Impairment charges of $53.5 million for the three months ended June 30, 2023 consist of a $53.5 million goodwill impairment in our Radiology reporting unit. See further discussion in Note 5 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
Restructuring Charges
Restructuring charges for the three months ended June 30, 2023 were $0.9 million compared to $7.2 million for the three months ended June 30, 2022. Restructuring charges for the 2023 period are composed primarily of transformation costs of $0.9 million. Restructuring charges for the 2022 period are composed primarily of transformation costs of $4.0 million, lease termination costs of $1.8 million and Domestication and related costs of $1.1 million. See further discussion in Note 15 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
Severance and Related Costs
Severance and related costs for the three months ended June 30, 2023 were $0.0 million compared to $5.6 million for the three months ended June 30, 2022. These costs include severance and benefits costs paid to terminated employees. See further discussion in Note 15 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
Other Expense (Income)
Other operating expense, net for the three months ended June 30, 2023 was $0.5 million compared to $0.6 million for the three months ended June 30, 2022. The other operating expense, net in 2023 includes a $0.9 million loss on sale of accounts receivable.
Interest expense for the three months ended June 30, 2023 was $31.2 million and increased by $1.9 million, or 6%, from the three months ended June 30, 2022. This increase was primarily due to higher interest expense on the Subordinated Notes resulting from interest paid in-kind that is added to the principal.
Other non-operating expense, net for the three months ended June 30, 2023 was $2.3 million compared to other non-operating income, net of $2.3 million for the three months ended June 30, 2022. The increase in non-operating expense, net was due primarily to $1.9 million of capital structure initiatives costs incurred during the three months ended June 30, 2023, and a more favorable fair value adjustment of the derivative associated with the Subordinated Notes in the three months ended June 30, 2022. See further discussion in Note 15 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
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Income Tax Benefit
The Company is subject to U.S. federal income tax as well as income tax of multiple state jurisdictions. The Company is no longer subject to Canadian tax after the Domestication on September 30, 2022.
Income tax benefit for the three months ended June 30, 2023 and 2022 was $1.6 million and $3.5 million, respectively. The effective tax rate for the three months ended June 30, 2023 differs from the U.S. statutory rate of 21% primarily due to the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit is recognized. The effective tax rate for the three months ended June 30, 2022 differs from the Canadian statutory rate of 26.5% primarily due to earnings in foreign jurisdictions that are subject to tax rates which differ from the Canadian statutory tax rate, as well as the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit or expense is recognized.
Net Income Attributable to Noncontrolling Interests
Net income attributable to noncontrolling interests for the three months ended June 30, 2023 was $0.2 million and decreased by $4.1 million from the three months ended June 30, 2022. The decrease was due to the impact of the accelerated amortization of intangible assets related to the closure of one site and winding down operations of a second site in the Oncology segment.
Six Months Ended June 30, 2023 Compared to Six Months Ended June 30, 2022
Revenues
Revenues for the six months ended June 30, 2023 were $372.4 million and decreased by $6.0 million, or 2%, from the six months ended June 30, 2022. The decrease was attributable to a $2.5 million decrease in radiology revenue and a $3.4 million decrease in oncology revenue. The decrease in radiology revenue was primarily due to changes in business mix and certain site closures over the last twelve months. Oncology revenue decreased primarily due to non-renewal of certain joint venture partnership contracts and site closures over the last twelve months.
Cost of Operations, excluding Depreciation and Amortization
Cost of operations, excluding depreciation and amortization, for the six months ended June 30, 2023 was $314.1 million and increased by $4.3 million, or 1%, from the six months ended June 30, 2022. This increase was a result of higher medical supplies and other costs and third-party services and professional fees, partly offset by lower employee compensation.
Employee Compensation
Employee compensation for the six months ended June 30, 2023 was $139.8 million and decreased by $7.3 million, or 5%, from the six months ended June 30, 2022. This decrease was primarily driven by workforce reductions implemented during the second quarter of 2022, partly offset by wage inflation and higher compensation to attract and retain clinic staff due to labor shortages in certain markets and merit increases.
Third-Party Services and Professional Fees
Third-party services and professional fees for the six months ended June 30, 2023 were $62.9 million and increased by $3.8 million, or 6%, from the six months ended June 30, 2022. This increase was primarily due to higher information technology related services and other outsourced services.
Rent and Utilities
Rent and utilities for the six months ended June 30, 2023 were $25.1 million compared to $25.2 million for the six months ended June 30, 2022. Rent and utilities are largely a fixed cost.
Reading Fees
Reading fees for the six months ended June 30, 2023 were $23.6 million and increased by $0.3 million, or 1%, from the six months ended June 30, 2022. Our reading fees are primarily based on the volume of procedures performed.
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Administrative Expenses
Administrative expenses for the six months ended June 30, 2023 were $23.4 million and increased by $0.3 million, or 1%, from the six months ended June 30, 2022. The increase was due primarily to an increase in bad debt expense and higher insurance costs, partly offset by cost containment measures put in place after the first quarter of 2022 affecting marketing and advertising, travel and related costs, and other administrative expenses.
Medical Supplies and Other Expenses
Medical supplies and other expenses for the six months ended June 30, 2023 were $39.3 million and increased by $7.4 million, or 23%, from the six months ended June 30, 2022. The increase was primarily due to cost inflation and increased spend on specialty tracers used in PET/CT scans.
Depreciation and Amortization
Depreciation and amortization for the six months ended June 30, 2023 was $58.0 million and increased by $8.1 million, or 16%, from the six months ended June 30, 2022. The increase was primarily due to $12.1 million of accelerated amortization of intangible assets related to the closure of one site and winding down operations of a second site in the Oncology segment, partially offset by lower depreciation for office and computer equipment resulting from fully depreciated assets.
Impairment Charges
Impairment charges of $53.5 million for the six months ended June 30, 2023 consist primarily of a $53.5 million goodwill impairment in our Radiology reporting unit. See further discussion in Note 5 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
Restructuring Charges
Restructuring charges for the six months ended June 30, 2023 were $6.7 million compared to $7.3 million for the six months ended June 30, 2022. Restructuring charges for the 2023 period are composed primarily of transformation costs of $6.7 million. Restructuring charges for the 2022 period are composed primarily of transformation costs of $4.0 million, lease termination costs of $1.8 million and Domestication and related costs of $1.1 million. See further discussion in Note 15 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
Severance and Related Costs
Severance and related costs for the six months ended June 30, 2023 were $0.0 million compared to $7.8 million for the six months ended June 30, 2022. These costs include severance and benefits costs paid to terminated employees. See further discussion in Note 15 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
Other Expense (Income)
Other operating income, net for the six months ended June 30, 2023 was $0.3 million compared to other operating expense, net of $0.6 million for the six months ended June 30, 2022. The other operating expense, net in 2023 includes a $1.0 million loss on sale of accounts receivable and a $0.8 million gain from insurance proceeds. See further discussion in Note 15 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
Interest expense for the six months ended June 30, 2023 was $61.9 million and increased by $3.9 million, or 7%, from the six months ended June 30, 2022. This increase was primarily due to higher interest expense on the Subordinated Notes resulting from interest paid in-kind that is added to the principal.
Other non-operating expense, net for the six months ended June 30, 2023 was $2.2 million compared to other non-operating income, net of $2.0 million for the six months ended June 30, 2022. The increase in non-operating expense, net was due primarily to $1.9 million of capital structure initiatives costs incurred during the six months ended June 30, 2023, and a more favorable fair value adjustment of the derivative associated with the Subordinated Notes in the six months
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ended June 30, 2022. See further discussion in Note 15 to the condensed consolidated financial statements that appear in Item 1 of this Quarterly Report on Form 10-Q.
Income Tax Benefit
The Company is subject to U.S. federal income tax as well as income tax of multiple state jurisdictions. The Company is no longer subject to Canadian tax after the Domestication on September 30, 2022.
Income tax benefit for the six months ended June 30, 2023 and 2022 was $0.7 million and $2.9 million, respectively. The effective tax rate for the six months ended June 30, 2023 differs from the U.S. statutory rate of 21% primarily due to the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit is recognized. The effective tax rate for the six months ended June 30, 2022 differs from the Canadian statutory rate of 26.5% primarily due to earnings in foreign jurisdictions that are subject to tax rates which differ from the Canadian statutory tax rate, as well as the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit or expense is recognized.
Net Income Attributable to Noncontrolling Interests
Net income attributable to noncontrolling interests for the six months ended June 30, 2023 was $6.2 million and decreased by $2.6 million from the six months ended June 30, 2022. The decrease was due to the impact of the accelerated amortization of intangible assets related to the closure of one site and winding down operations of a second site in the Oncology segment.

Non-GAAP Financial Measures
We use various measures of financial performance based on financial statements prepared in accordance with GAAP. We believe, in addition to GAAP measures, certain non-GAAP measures are useful for investors for a variety of reasons. We use this information in our analysis of the performance of our business, excluding items we do not consider relevant to the performance of our continuing operations. Such non-GAAP measures include adjusted earnings before interest, taxes, depreciation and amortization (“Adjusted EBITDA”). Our management regularly communicates Adjusted EBITDA and their interpretation of such results to our Board of Directors. We also compare actual periodic Adjusted EBITDA against internal targets as a key factor in determining cash incentive compensation for executives and other employees, largely because we view Adjusted EBITDA results as indicative of how our radiology and oncology businesses are performing and being managed.
We define Adjusted EBITDA as net income before interest expense, income tax benefit, depreciation and amortization, impairment charges, restructuring charges, severance and related costs, settlements and related costs, stock-based compensation, loss on sale of accounts receivable, capital structure initiatives, fair value adjustment on derivative, deferred rent expense, and items that we do not consider to be indicative of our core/ongoing operations. Adjusted EBITDA is a non-GAAP financial measure used as an analytical indicator by us and the healthcare industry to assess business performance and is a measure of leverage capacity and ability to service debt. Adjusted EBITDA should not be considered in isolation or as an alternative to net income, cash flows generated by operating, investing or financing activities or other financial statement data presented in the condensed consolidated financial statements as indicators of financial performance or liquidity. Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation and may not be comparable to other similarly titled measures of other companies.
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The following table presents a reconciliation of our net loss, the most directly comparable GAAP financial measure, to total Adjusted EBITDA:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Net loss$(96,411)$(26,079)$(125,601)$(52,511)
Interest expense31,164 29,290 61,861 57,971 
Income tax benefit(1,578)(3,483)(704)(2,920)
Depreciation and amortization35,015 25,200 58,008 49,931 
Impairment charges53,460 — 53,460 — 
Restructuring charges944 7,244 6,680 7,324 
Severance and related costs22 5,559 (27)7,797 
Settlements, recoveries and related costs465 814 1,913 677 
Stock-based compensation441 758 840 1,819 
Loss on sale of accounts receivable922 — 1,046 — 
Loss (gain) on disposal of property and equipment, net(348)170 (417)372 
Capital structure initiatives1,912 — 1,912 — 
Acquisition-related costs155 86 298 468 
Fair value adjustment on derivative(258)(1,009)(301)(839)
Deferred rent expense(43)247 142 579 
Other, net665 (613)558 (466)
Adjusted EBITDA$26,527 $38,184 $59,668 $70,202 
The following table summarizes our Adjusted EBITDA by segment:
Three Months Ended June 30,Six Months Ended June 30,
(in thousands)2023202220232022
Adjusted EBITDA:
Radiology$25,449 $35,692 $55,775 $64,281 
Oncology8,072 10,302 17,920 20,335 
Corporate(6,994)(7,810)(14,027)(14,414)
$26,527 $38,184 $59,668 $70,202 
Liquidity and Capital Resources
To date, we have financed our operations primarily through cash generated from operations, public and private sales of debt and equity securities, and bank borrowings. The following table presents a summary of our consolidated cash flows and the ending balance of our cash and cash equivalents:
Six Months Ended June 30,
(in thousands)20232022
Cash and cash equivalents at beginning of period$59,424 $48,419 
Net cash provided by operating activities17,955 21,079 
Net cash used in investing activities(10,637)(14,503)
Net cash used in financing activities(28,774)(16,548)
Cash and cash equivalents at end of period$37,968 $38,447 
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Cash Flows from Operating Activities
Cash provided by operating activities was $18.0 million for the six months ended June 30, 2023 and consisted of a net loss of $125.6 million adjusted for certain non-cash items and changes in certain operating assets and liabilities. The primary non-cash charges included in the net loss are $58.0 million of depreciation and amortization, $53.5 million of impairment charges and $28.0 million of non-cash interest expense. Changes in operating assets and liabilities provided $2.8 million of operating cash driven primarily by a $6.2 million increase in accounts payable and other liabilities, partially offset by a $2.3 million increase in accounts receivable and $1.2 million increase in prepaid expenses and other assets.
Cash Flows from Investing Activities
During the six months ended June 30, 2023, cash used in investing activities was $10.6 million, a decrease of $3.9 million from the comparable period in 2022. Purchases of property and equipment during the six months ended June 30, 2023 were $11.5 million, a decrease of $4.0 million from the comparable period in 2022.
Cash Flows from Financing Activities
During the six months ended June 30, 2023, cash used in financing activities was $28.8 million compared to cash used in financing activities of $16.5 million during the six months ended June 30, 2022. Financing activities during the six months ended June 30, 2023 included $14.0 million of proceeds from our revolving facility and $1.7 million of proceeds from long-term debt, offset by payments on our revolving facility of $14.0 million, distributions paid to noncontrolling and redeemable noncontrolling interests of $16.0 million, principal payments on long-term debt of $10.6 million, and principal payments on finance leases of $3.9 million. Financing activities during the six months ended June 30, 2022 was composed primarily of $20.0 million of proceeds from our revolving facility and $10.3 million of proceeds from long-term debt, offset by payments on our revolving facility of $20.0 million, distributions paid to noncontrolling and redeemable noncontrolling interests of $14.1 million, principal payments on long-term debt of $8.4 million, and principal payments on finance leases of $4.3 million.
Liquidity Outlook
Cash and cash equivalents were $38.0 million as of June 30, 2023. In addition, we have a revolving credit facility under which we may borrow up to $55.0 million for working capital and other general corporate purposes. As of June 30, 2023, there were no borrowings outstanding under the revolving credit facility. We believe that our existing cash, cash equivalents and expected future cash flow from operations will provide sufficient funds to finance our operations for at least the next twelve months.
The Company is currently in the process of evaluating options relating to the restructuring of its current debt instruments being the 2025 Senior Notes, the 2028 Senior Notes, the Subordinated Notes and the revolving facility, and incurred $1.9 million of capital structure initiatives costs during the three months ended June 30, 2023. In furtherance of its capital structure initiatives, the Company's Board of Directors has formed a Special Committee to explore strategic initiatives related to its capital structure. The Special Committee is diligently evaluating potential solutions. There can be no assurance that the Special Committee's review process will result in any transaction or other alternative and there is no set timetable for the strategic review process.
Considering the Company’s recent underperformance relative to its operating plan, the Company is evaluating options to improve cash flow and provide increased flexibility in order to meet its obligations and execute on its strategy. Cash interest (as opposed to PIK interest) becomes payable on the Subordinated Notes on and after September 1, 2023 with the first cash interest payment due on September 29, 2023. If we do not pay the cash interest payment when due under the Subordinated Notes, a trigger event (not an event of default) results and the cash interest rate under the Subordinated Notes increases by 200 basis points, which is an increase of the cash interest rate from 11% to 13%, until that trigger event is cured by us or waived by the lender. The Company will continue to evaluate its cash position, operating performance, and other considerations as part of its decision as to whether cash interest will be paid when due. If cash interest is not paid when due, such action will result in an increase of the interest rate under the Subordinated Notes until cured or unless waived by the lender. The Company may be required to obtain a waiver or take other actions as it deems necessary in connection with a failure to pay cash interest on the Subordinated Notes when due.
Other available actions to improve liquidity include, but are not limited to, accelerating cost reduction initiatives, reassessing discretionary capital expenditures, renegotiating payment terms with vendors and sale of non-core assets. The Company’s operating plan anticipates that it will generate sufficient cash flow from operations and has other available resources to meet its obligations as they come due over the next twelve months. However, the Company cannot provide
35


assurance that its operating plan will be achieved. If the Company is unsuccessful in achieving its plan, there is a risk that actual results will differ from anticipated results.
It is possible that we may need to supplement our existing sources of liquidity to finance our activities beyond the next twelve months and there can be no assurance that sources of liquidity will be available to us at that time or if available will be on commercially reasonable terms.
We may also have access to an additional $349.6 million of debt financing through August 2024 to finance growth and acquisitions, provided certain conditions are met and the lender provides their consent.
For additional information regarding our revolving credit facility and the additional borrowing available for future acquisitions, see Note 9 to the consolidated financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2022.
For a description of contractual obligations, such as debt, finance leases and operating leases, see Note 9, Note 10 and Note 11 to the consolidated financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2022.
Critical Accounting Policies and Estimates
There were no significant changes in our critical accounting policies and estimates during the six-month period ended June 30, 2023 compared to those previously disclosed in “Critical Accounting Policies and Estimates” in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in our Annual Report on Form 10-K for the year ended December 31, 2022.
Item 3. Quantitative and Qualitative Disclosures About Market Risk
The Company is a smaller reporting company as defined by Rule 12b-2 of the Exchange Act and is not required to provide the information required under this item.
Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures
Under the supervision of our management, including our Chief Executive Officer and Chief Financial Officer, we conducted an evaluation of the effectiveness of the design and operation of our disclosure controls and procedures under Rules 13a-15(e) and 15d-15(e) of the Exchange Act, as of June 30, 2023. Based on this evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures were effective as of June 30, 2023.
Changes in Internal Control over Financial Reporting
There were no changes in our internal control over financial reporting that occurred during the six-month period ended June 30, 2023 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
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PART II - OTHER INFORMATION
Item 1. Legal Proceedings
On December 20, 2021, an alleged shareholder of the Company filed a putative class action claim with the Ontario Superior Court of Justice against the Company and certain of its directors and officers alleging violations of Securities Act (Ontario), negligent misrepresentation and other related claims relating to the restatement of the Company’s financial statements that were filed in 2021. On February 17, 2023, the plaintiff delivered a motion record for certification and for leave to commence action under Part XXIII.1 of the Securities Act (Ontario). The Company plans to defend the claim and the motion.
The Company has been, and continues to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment, contract disputes, employment and other commercial or regulatory matters. The defense of these lawsuits may result in significant legal costs, regardless of the outcome, and can result in large settlement amounts or damage awards. We believe that the outcome of our current litigation will not have a material adverse impact on our business, financial condition and results of operations. However, we could be subsequently named as a defendant in other lawsuits that could adversely affect us.
Item 1A. Risk Factors

Except as provided below and to the extent additional factual information disclosed elsewhere in this Quarterly Report on Form 10-Q relates to such risk factors (including, without limitation, the matters discussed in Part I, “Item 2—Management’s Discussion and Analysis of Financial Condition and Results of Operations”), there were no material changes to the risk factors discussed in our Annual Report on Form 10-K for the year ended December 31, 2022 dated March 16, 2023 and filed with the Securities and Exchange Commission pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934.

Risks Relating to our Capital Structure

The Company may be delisted from Nasdaq, further increasing the cost of capital and jeopardizing the Company’s ability to refinance existing indebtedness.

On April 19, 2023, the Company received a written notification (the “Notice”) from Nasdaq’s Listing Qualifications Department notifying the Company that the closing bid price for its Common Stock had been below $1.00 for 30 consecutive business days and that the Company therefore is not in compliance with the minimum bid price requirement for continued inclusion on The Nasdaq Capital Market under Nasdaq Listing Rule 5550(a)(2) (the “Bid Price Requirement”). The Notice has no immediate effect on the listing of the Company’s Common Stock on the Nasdaq Capital Market. Under the Nasdaq Listing Rules, the Company must maintain a closing bid price for its Common Stock of at least $1.00 for a minimum of ten consecutive business days prior to the end of the 180 calendar day period starting from the date of the Notice to regain compliance with the Bid Price Requirement. Accordingly, the Company has until October 16, 2023 to regain compliance with the Bid Price Requirement. A delisting of our Common Stock is likely to reduce the liquidity of the Common Stock and may inhibit or preclude the Company’s ability to raise additional financing and may also materially and adversely impact the Company’s credit terms with its vendors.

If the Company is delisted from Nasdaq, the resulting drop in the market price for the Company’s Common Stock and any further debt offering may jeopardize the Company’s ability to fund its operations.

The delisting of our Common Stock from Nasdaq could impair the liquidity and market price of the Common Stock. It could also materially, adversely affect our access to the capital markets, and any limitation on market liquidity or reduction in the price of the Common Stock as a result of such delisting could adversely affect our ability to raise capital on terms acceptable to us, or at all.

The Company may incur additional costs including increasing the cost of capital in connection with its capital structure initiatives or failure to pay cash interest on its Subordinated Notes.

The Company is currently in the process of evaluating options relating to the restructuring of its current debt instruments being the 2025 Senior Notes, the 2028 Senior Notes, the Subordinated Notes and the revolving facility, and incurred $1.9 million of capital structure initiatives costs during the three months ended June 30, 2023. In furtherance of its capital structure initiatives, the Company's Board of Directors has formed a Special Committee to explore strategic initiatives related to its capital structure. The Special Committee is diligently evaluating potential solutions. There can be
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no assurance that the Special Committee's review process will result in any transaction or other alternative and there is no set timetable for the strategic review process.

The Company may incur additional costs including an increase in its cost of capital in connection with its capital structure initiatives. In addition, cash interest (as opposed to PIK interest) becomes payable on the Subordinated Notes on and after September 1, 2023 with the first cash interest payment due on September 29, 2023. If we do not pay the cash interest payment when due under the Subordinated Notes, then it results in a trigger event and the cash interest rate under the Subordinated Notes increases by 200 basis points, which is an increase of the cash interest rate from 11% to 13%, until that trigger event is cured by us or waived by the lender. There can be no assurance whether cash interest will be paid when due under the Subordinated Notes and such failure will result in an increase of the interest rate under the Subordinated Notes until cured or unless waived. The Company may be required to obtain a waiver or take other actions as it deems necessary (including termination of its revolving facility) in connection with any failure to pay cash interest on the Subordinated Notes when due.

Risks Related to Accounting Matters

We have recorded goodwill impairment charges in the past and may be required to record additional impairment
charges if our goodwill becomes further impaired or our intangible assets become impaired.

We are required under generally accepted accounting principles to review our goodwill and definite-lived intangible assets for impairment when events or changes in circumstances indicate the carrying value may not be recoverable. Goodwill must be tested for impairment at least annually. Factors that may be considered a change in circumstances indicating that the carrying value of our reporting units and intangible assets may not be recoverable include a decline in stock price and market capitalization, slower growth rates in our industry or our own operations, and/or other materially adverse events that have implications on the profitability of our business. We have recorded an impairment charge of $53.5 million related to goodwill for the Radiology reporting unit, which was recorded in the condensed consolidated statements of operations and comprehensive loss for the three and six months ended June 30, 2023. We may be required to record additional impairment charges during any period in which a further impairment of our goodwill or other intangible assets is recognized.

Further declines in our market capitalization increase the risk that we may be required to perform another goodwill
impairment analysis, which could result in an impairment of up to the entire balance of our goodwill based on the
quantitative assessment performed and adversely affect our results of operations. Additionally, an impairment charge may
adversely influence our ability to raise capital in the future.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
None.
Item 3. Defaults Upon Senior Securities
None.
Item 4. Mine Safety Disclosures
Not applicable.
Item 5. Other Information
None.
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Item 6. Exhibits
Exhibit
Number
Description of Exhibit
10.1
10.2
10.3
31.1
31.2
32.1
101.INSInline XBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document
101.SCHInline XBRL Taxonomy Extension Schema Document
101.CALInline XBRL Taxonomy Extension Calculation Linkbase Document
101.DEFInline XBRL Taxonomy Extension Definition Linkbase Document
101.LABInline XBRL Taxonomy Extension Label Linkbase Document
101.PREInline XBRL Taxonomy Extension Presentation Linkbase Document
104Cover Page Interactive Data File (formatted in iXBRL and contained in Exhibit 101)
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SIGNATURE
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
AKUMIN INC.
By:/s/ Riadh Zine
Riadh Zine
Chairman, Chief Executive Officer and Director
Date: August 9, 2023
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