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Exhibit 99.1

LOGO

NEWS RELEASE

Contact:

Alliance HealthCare Services

Howard Aihara

Executive Vice President

Chief Financial Officer

(949) 242-5300

ALLIANCE HEALTHCARE SERVICES REPORTS RESULTS

FOR THE FIRST QUARTER ENDED MARCH 31, 2011

AND REAFFIRMS FULL YEAR 2011 GUIDANCE

NEWPORT BEACH, CA—April 28, 2011–Alliance HealthCare Services, Inc. (NYSE:AIQ) (the “Company” or “Alliance”), a leading national provider of outpatient diagnostic imaging and radiation therapy services, announced results for the first quarter ended March 31, 2011.

First Quarter 2011 Financial Results

Revenue for the first quarter of 2011 was $118.4 million compared to $118.7 million in the first quarter of 2010, a decrease of 0.2%. On a sequential quarter basis, revenue increased 0.6% to $118.4 million in the first quarter of 2011 compared to $117.7 million in the fourth quarter of 2010.

Alliance’s Adjusted EBITDA (as defined below) was $36.6 million in the first quarter of 2011 compared to $40.2 million in the first quarter 2010, a decrease of 9.0%. On a sequential quarter basis, Adjusted EBITDA increased 4.6% to $36.6 million in the first quarter of 2011 compared to $35.0 million in the fourth quarter of 2010.

Alliance’s net loss, computed in accordance with generally accepted accounting principles (“GAAP”), totaled ($2.4) million in the first quarter of 2011 and ($2.2) million in the first quarter of 2010.

Net loss per share on a diluted basis, computed in accordance with generally GAAP, was ($0.05) per share in the first quarter of 2011 and ($0.04) per share in the first quarter of 2010. In the first quarter of 2011, net loss per share on a diluted basis was impacted by ($0.02) in the aggregate due to fair value adjustments related to interest rate swaps, severance and related costs, mergers and acquisitions transaction costs and a lower GAAP income tax rate than our historical income tax rate. Alliance’s historical income tax rate has been approximately 42%, rather than the GAAP income tax benefit rate of 35.9% in the first quarter of 2011.

Cash flows provided by operating activities were $19.5 million in the first quarter of 2011 compared to $30.7 million in the first quarter of 2010. Capital expenditures in the first quarter of 2011 were $9.9 million compared to $20.2 million in the first quarter of 2010. Alliance opened five new fixed-site imaging centers in the first quarter of 2011.

 

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Alliance HealthCare Services

Press Release

April 28, 2011

Page 2

 

Alliance’s net debt, defined as total long-term debt (including current maturities) less cash and cash equivalents, decreased $6.9 million to $549.2 million at March 31, 2011 from $556.1 million at December 31, 2010. Cash and cash equivalents were $101.9 million at March 31, 2011 and $97.2 million at December 31, 2010. The Company’s net debt, as defined above, divided by the last twelve months Adjusted EBITDA (pro forma for acquisitions during the last twelve month period ended March 31, 2011), was 3.5x for the twelve month period ended March 31, 2011.

The Company’s total long-term debt (including current maturities) decreased to $651.1 million at March 31, 2011 from $653.3 million at December 31, 2010. The Company’s total long-term debt (including current maturities) divided by last twelve months Adjusted EBITDA (pro forma for acquisitions during the last twelve month period ended March 31, 2011) was 4.2x for the twelve month period ended March 31, 2011.

Paul S. Viviano, Chairman of the Board and Chief Executive Officer, stated, “Alliance continues to perform consistent with our full year 2011 guidance. We are pleased with the progress of first quarter Adjusted EBITDA relative to the fourth quarter of 2010. We are very pleased regarding the two recently announced acquisitions: US Radiosurgery and 24/7 Radiology. These investments reflect our commitment to expanding our presence in the growth oriented clinical service lines of radiation oncology and professional radiology services. The integration of these two organizations continues to progress well and in accordance with our plan. Alliance continues to focus on increasingly becoming the hospital outsource partner of choice through the development of new fixed site imaging centers, adding new customers for MRI, PET/CT and professional radiology services and developing new de novo radiation oncology centers.”

Full Year 2011 Guidance

Alliance reaffirms its full year 2011 guidance ranges:

 

     Guidance
     Ranges
     (dollars in millions)

Revenue

   $500 - $530

Adjusted EBITDA

   $150 - $175

Cash capital expenditures

   $65 - $75

Decrease in long-term debt, net of the change in cash and cash equivalents (before investments in acquisitions)

   $25 - $45

Fixed-site imaging center openings

   20 - 25

Radiation therapy center openings

   3 - 5

First Quarter 2011 Earnings Conference Call

Investors and all others are invited to listen to a conference call discussing first quarter 2011 results. The conference call is scheduled for Friday, April 29, 2011 at 8:30 a.m. Eastern Time. The call will be broadcast live on the Internet and can be accessed by visiting the Company’s website at www.alliancehealthcareservices-us.com. Click on Audio Presentations in the Investors section of the website to access the link.

 

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Alliance HealthCare Services

Press Release

April 28, 2011

Page 3

 

The conference call can be accessed at (888) 694-4676 (United States) or (973) 582-2737 (International). Interested parties should call at least 5 minutes prior to the call to register. A telephone replay will be available until July 29, 2011. The telephone replay can be accessed by calling (800) 642-1687 (United States) or (706) 645-9291 (International). The conference call identification number is 61776694.

Definition of Adjusted EBITDA

Adjusted EBITDA, as defined by the Company’s management, represents net income (loss) before: interest expense, net of interest income; income taxes; depreciation expense; amortization expense; net income (loss) attributable to noncontrolling interests; non-cash share-based compensation; severance and related costs; loss on extinguishment of debt; fees and expenses related to acquisitions, non-cash impairment charges, and other non-cash charges included in other (income) expense, net, which includes non-cash losses on sales of equipment. The components used to reconcile net income (loss) to Adjusted EBITDA are consistent with our historical presentation of Adjusted EBITDA. Adjusted EBITDA is not a measure of financial performance under generally accepted accounting principles in the United States, or “GAAP.” For a more detailed discussion of Adjusted EBITDA and reconciliation to net income (loss), see the section entitled “Adjusted EBITDA” included in the tables following this release.

About Alliance HealthCare Services

Alliance HealthCare Services is a leading national provider of advanced outpatient diagnostic imaging and radiation therapy services based upon annual revenue and number of systems deployed. Alliance focuses on MRI, PET/CT and CT through its Imaging division and radiation therapy through its Oncology division. With more than 2,300 team members committed to providing exceptional patient care and exceeding customer expectations, Alliance provides quality clinical services for over 1,000 hospitals and other healthcare partners in 46 states. Alliance operates 559 diagnostic imaging and radiation therapy systems. The Company is the nation’s largest provider of advanced diagnostic mobile imaging services and one of the leading operators of fixed-site imaging centers, with 136 locations across the country. Alliance also operates 35 radiation therapy centers, providing state-of-the-art treatment and care for cancer patients.

 

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Alliance HealthCare Services

Press Release

April 28, 2011

Page 4

 

Forward-Looking Statements

This press release contains forward-looking statements relating to future events, including statements related to investment, development and acquisition activity, the implementation of strategic initiatives, the integration of acquired businesses into the Company, the opening of new imaging and radiation oncology centers, and the Company’s full year 2011 guidance. In this context, forward-looking statements often address the Company’s expected future business and financial results and often contain words such as “expects,” “anticipates,” “intends,” “plans,” “believes,” “seeks” or “will.” Forward-looking statements by their nature address matters that are uncertain and subject to risks. Such uncertainties and risks include: changes in the preliminary financial results and estimates due to the restatement or review of the Company’s financial statements; the nature, timing and amount of any restatement or other adjustments; the Company’s ability to make timely filings of its required periodic reports under the Securities Exchange Act of 1934; issues relating to the Company’s ability to maintain effective internal control over financial reporting and disclosure controls and procedures; the Company’s high degree of leverage and its ability to service its debt; factors affecting the Company’s leverage, including interest rates; the risk that the counterparties to the Company’s interest rate swap agreements fail to satisfy their obligations under these agreements; the Company’s ability to obtain financing; the effect of operating and financial restrictions in the Company’s debt instruments; the accuracy of the Company’s estimates regarding its capital requirements; the effect of intense levels of competition in the Company’s industry; changes in the methods of third party reimbursements for diagnostic imaging and radiation oncology services; fluctuations or unpredictability of the Company’s revenues, including as a result of seasonality; changes in the healthcare regulatory environment; the Company’s ability to keep pace with technological developments within its industry; the growth in the market for MRI and other services; the disruptive effect of hurricanes and other natural disasters; adverse changes in general domestic and worldwide economic conditions and instability and disruption of credit markets; difficulties the Company may face in connection with recent, pending or future acquisitions, including unexpected costs or liabilities resulting from the acquisitions, diversion of management’s attention from the operation of the Company’s business, and risks associated with integration of the acquisitions; and other risks and uncertainties identified in the Risk Factors section of the Company’s Form 10-K for the year ended December 31, 2010, filed with the Securities and Exchange Commission (the “SEC”), as may be modified or supplemented by our subsequent filings with the SEC. These uncertainties may cause actual future results or outcomes to differ materially from those expressed in the Company’s forward-looking statements. Readers are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. The Company does not undertake to update its forward-looking statements except as required under the federal securities laws.

 

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ALLIANCE HEALTHCARE SERVICES, INC.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

AND COMPREHENSIVE INCOME (LOSS)

(Unaudited)

(in thousands, except per share amounts)

 

     Quarter Ended
March 31,
 
     2010     2011  

Revenues

   $ 118,661      $ 118,428   

Costs and expenses:

    

Cost of revenues, excluding depreciation and amortization

     65,226        67,366   

Selling, general and administrative expenses

     16,117        17,058   

Transaction costs

     351        372   

Severance and related costs

     462        464   

Depreciation expense

     23,691        22,052   

Amortization expense

     2,806        3,326   

Interest expense and other, net

     13,304        11,735   

Other (income) and expense, net

     (360     (63
                

Total costs and expenses

     121,597        122,310   
                

Loss before income taxes, earnings from unconsolidated investees, and noncontrolling interest

     (2,936     (3,882

Income tax benefit

     (613     (1,343

Earnings from unconsolidated investees

     (907     (989
                

Net loss

     (1,416     (1,550

Less: Net income attributable to noncontrolling interest

     (747     (853
                

Net loss attributable to Alliance HealthCare Services, Inc.

   $ (2,163   $ (2,403
                

Comprehensive loss, net of taxes

    

Net loss attributable to Alliance HealthCare Services, Inc.

   $ (2,163   $ (2,403

Unrealized gain on hedging transactions, net of taxes

     495        47   
                

Comprehensive loss, net of taxes:

   $ (1,668   $ (2,356
                

Loss per common share attributable to Alliance HealthCare Services, Inc.:

    

Basic

   $ (0.04   $ (0.05
                

Diluted

   $ (0.04   $ (0.05
                

Weighted average number of shares of common stock and common stock equivalents:

    

Basic

     52,755        52,997   

Diluted

     52,755        52,997   

 

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ALLIANCE HEALTHCARE SERVICES, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(Unaudited)

(in thousands)

 

     December 31,
2010
    March 31,
2011
 

ASSETS

    

Current assets:

    

Cash and cash equivalents

   $ 97,162      $ 101,869   

Accounts receivable, net of allowance for doubtful accounts

     62,956        68,633   

Deferred income taxes

     7,344        7,344   

Prepaid expenses

     9,802        8,706   

Other receivables

     3,594        4,432   
                

Total current assets

     180,858        190,984   

Equipment, at cost

     902,829        909,638   

Less accumulated depreciation

     (591,145     (610,376
                

Equipment, net

     311,684        299,262   

Goodwill

     193,126        193,126   

Other intangible assets, net

     94,622        91,296   

Deferred financing costs, net

     14,883        14,341   

Other assets

     21,028        24,106   
                

Total assets

   $ 816,201      $ 813,115   
                

LIABILITIES AND STOCKHOLDERS’ EQUITY

    

Current liabilities:

    

Accounts payable

   $ 15,541      $ 16,012   

Accrued compensation and related expenses

     17,061        16,274   

Accrued interest payable

     5,812        9,036   

Other accrued liabilities

     37,138        35,911   

Current portion of long-term debt

     9,709        9,321   
                

Total current liabilities

     85,261        86,554   

Long-term debt, net of current portion

     455,747        453,888   

Senior notes

     187,809        187,882   

Other liabilities

     1,229        1,032   

Deferred income taxes

     72,496        71,159   
                

Total liabilities

     802,542        800,515   

Stockholders’ equity:

    

Common stock

     525        525   

Treasury stock

     (2,551     (2,551

Additional paid-in capital

     16,062        17,465   

Accumulated comprehensive loss

     (669     (622

Accumulated deficit

     (11,176     (13,579
                

Total stockholders’ equity attributable to Alliance HealthCare Services, Inc.

     2,191        1,238   

Noncontrolling interest

     11,468        11,362   
                

Total stockholders’ equity

     13,659        12,600   
                

Total liabilities and stockholders’ equity

   $ 816,201      $ 813,115   
                

 

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ALLIANCE HEALTHCARE SERVICES, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(Unaudited)

(in thousands)

 

     Quarter Ended
March 31,
 
     2010     2011  

Operating activities:

    

Net loss

   $ (1,416   $ (1,550

Adjustments to reconcile net loss to net cash provided by operating activities:

    

Provision for doubtful accounts

     (141     264   

Share-based payment

     1,520        1,406   

Depreciation and amortization

     26,497        25,378   

Amortization of deferred financing costs

     645        705   

Accretion of discount on long term debt

     378        393   

Adjustment of derivatives to fair value

     (578     24   

Distributions greater than (less than) undistributed earnings from investees

     513        (820

Deferred income taxes

     (772     (1,439

Gain on sale of assets

     (360     (64

Changes in operating assets and liabilities, net of acquisitions:

    

Accounts receivable

     421        (5,941

Prepaid expenses

     351        1,104   

Other receivables

     726        (838

Other assets

     201        (913

Accounts payable

     (4,788     10   

Accrued compensation and related expenses

     727        (787

Accrued interest payable

     5,806        3,224   

Income taxes payable

     50        29   

Other accrued liabilities

     871        (707
                

Net cash provided by operating activities

     30,651        19,478   
                

Investing activities:

    

Equipment purchases

     (20,205     (9,913

Decrease (increase) in deposits on equipment

     553        (1,384

Proceeds from sale of assets

     772        176   
                

Net cash used in investing activities

     (18,880     (11,121
                

 

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ALLIANCE HEALTHCARE SERVICES, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (continued)

(Unaudited)

(in thousands)

 

     Quarter Ended
March 31,
 
     2010     2011  

Financing activities:

    

Principal payments on equipment debt

     (1,856     (1,417

Proceeds from equipment debt

     358        —     

Principal payments on term loan facility

     (1,150     (1,150

Principal payments on senior subordinated notes

     (5,582     —     

Payments of debt issuance costs

     (153     (163

Noncontrolling interest in subsidiaries

     (1,150     (959

Proceeds from shared-based payment arrangements

     75        39   
                

Net cash used in financing activities

     (9,458     (3,650
                

Net increase in cash and cash equivalents

     2,313        4,707   

Cash and cash equivalents, beginning of period

     111,884        97,162   
                

Cash and cash equivalents, end of period

   $ 114,197      $ 101,869   
                

Supplemental disclosure of cash flow information:

    

Interest paid

   $ 5,591      $ 7,449   

Income taxes paid, net of refunds

     67        31   

Supplemental disclosure of non-cash investing and financing activities:

    

Net book value of assets exchanged

   $ 52      $ —     

Comprehensive gain from hedging transactions, net of taxes

     495        47   

Equipment purchases in accounts payable

     1,217        690   

Contingent consideration for acquisitions

     —          3,357   

 

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ALLIANCE HEALTHCARE SERVICES, INC.

ADJUSTED EBITDA

(in thousands)

Adjusted EBITDA, as defined by the Company’s management, represents net income (loss) before: interest expense, net of interest income; income taxes; depreciation expense; amortization expense; net income (loss) attributable to noncontrolling interests; non-cash share-based compensation; severance and related costs; loss on extinguishment of debt; fees and expenses related to acquisitions, non-cash impairment charges, and other non-cash charges included in other (income) expense, net, which includes non-cash losses on sales of equipment. The components used to reconcile net income (loss) to Adjusted EBITDA are consistent with our historical presentation of Adjusted EBITDA. Adjusted EBITDA is not a measure of financial performance under generally accepted accounting principles in the United States, or “GAAP.”

Management uses Adjusted EBITDA, and believes it is a useful measure for investors, for a variety of reasons. Management regularly communicates its Adjusted EBITDA results and management’s interpretation of such results to its board of directors. Management also compares the Company’s Adjusted EBITDA performance against internal targets as a key factor in determining cash incentive compensation for executives and other employees, largely because management feels that this measure is indicative of how our diagnostic imaging and radiation oncology business is performing and is being managed. Management believes that Adjusted EBITDA is a particularly useful comparative measure within the Company’s industry. The diagnostic imaging and radiation oncology industry continues to experience significant consolidation. These activities have led to significant charges to earnings, such as those resulting from acquisition costs, and to significant variations among companies with respect to capital structures and cost of capital (which affect interest expense) and differences in taxation and book depreciation of facilities and equipment (which affect relative depreciation expense), including significant differences in the depreciable lives of similar assets among various companies. In addition, management believes that because of the variety of equity awards used by companies, the varying methodologies for determining non-cash share-based compensation expense among companies and from period to period, and the subjective assumptions involved in that determination, excluding non-cash share-based compensation from Adjusted EBITDA enhances company-to-company comparisons over multiple fiscal periods and enhances the Company’s ability to analyze the performance of its diagnostic imaging and radiation oncology business.

Adjusted EBITDA may not be directly comparable to similarly titled measures reported by other companies. In addition, Adjusted EBITDA has other limitations as an analytical financial measure. These limitations include the fact that Adjusted EBITDA is calculated before recurring cash charges including interest expense, income taxes and severance costs, and is not adjusted for capital expenditures, the replacement cost of assets or other recurring cash requirements of the Company’s business. Adjusted EBITDA also does not reflect any cost for equity awards to employees. In the future, the Company expects that it may incur expenses similar to the excluded items discussed above. Accordingly, the exclusion of these and other similar items in the Company’s non-GAAP presentation should not be interpreted as implying that these items are non-recurring, infrequent or unusual. Management compensates for the limitations of using Adjusted EBITDA as an analytical measure by relying on the Company’s GAAP results to evaluate its operating performance and by considering independently the economic effects of the items that are or are not reflected in Adjusted EBITDA. Management also compensates for these limitations by providing GAAP-based disclosures concerning the excluded items in the Company’s financial disclosures. As a result of these limitations, however, Adjusted EBITDA should not be considered as an alternative to net income (loss), as calculated in accordance with GAAP, or as an alternative to any other GAAP measure of operating performance.

 

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The calculation of Adjusted EBITDA is shown below:

 

     First Quarter Ended March 31,  
     2010     2011  

Net loss attributable to Alliance HealthCare Services, Inc.

   $ (2,163   $ (2,403

Income tax benefit

     (613     (1,343

Interest expense and other, net

     13,304        11,735   

Amortization expense

     2,806        3,326   

Depreciation expense

     23,691        22,052   

Share-based payment (included in selling, general and administrative expenses)

     1,506        1,389   

Noncontrolling interest in subsidiaries

     747        853   

Severance and related costs

     462        464   

Transaction costs

     351        372   

Other non-cash charges (included in other (income) and expenses, net)

     79        110   
                

Adjusted EBITDA

   $ 40,170      $ 36,555   
                

The reconciliation from net loss to Adjusted EBITDA for the 2011 guidance range is shown below (in millions):

 

     2011 Full Year
Guidance Range
 
  

Net loss

   ($ 18   ($ 4

Income tax benefit

     (10     (2

Depreciation expense; amortization expense; interest expense and other, net; noncontrolling interest in subsidiaries; share-based payment and other expenses

     178        181   
                

Adjusted EBITDA

   $ 150      $ 175   
                

 

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ALLIANCE HEALTHCARE SERVICES, INC.

SELECTED STATISTICAL INFORMATION

 

     First Quarter Ended
March 31,
 
     2010      2011  

MRI

     

Average number of total systems

     274.3         289.3   

Average number of scan-based systems

     233.1         244.4   

Scans per system per day (scan-based systems)

     8.20         8.05   

Total number of scan-based MRI scans

     122,580         125,753   

Price per scan

   $ 390.32       $ 374.20   

Scan-based MRI revenue (in millions)

   $ 47.9       $ 47.1   

Non-scan based MRI revenue (in millions)

     5.1         5.4   
                 

Total MRI revenue (in millions)

   $ 53.0       $ 52.5   
                 

PET and PET/CT

     

Average number of systems

     119.1         120.3   

Scans per system per day

     5.80         5.47   

Total number of PET and PET/CT scans

     44,231         41,653   

Price per scan

   $ 1,075       $ 1,033   

Total PET and PET/CT revenue (in millions)

   $ 48.3       $ 43.5   
                 

Revenue breakdown (in millions)

     

Total MRI revenue

   $ 53.0       $ 52.5   

PET and PET/CT revenue

     48.3         43.5   

Radiation oncology revenue

     10.8         13.0   

Other modalities and other revenue

     6.6         9.4   
                 

Total revenues

   $ 118.7       $ 118.4   
                 

Total fixed-site revenue (in millions)

     2010         2011   
                 

First quarter ended March 31

   $ 27.5       $ 30.7   

 

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ALLIANCE HEALTHCARE SERVICES, INC.

SELECTED STATISTICAL INFORMATION

IMAGING DIVISION REVENUE GAP

(in millions)

The Company utilizes the imaging division revenue gap as a statistical measure of its client losses and new client contracts. The imaging division revenue gap is calculated by measuring the difference between (a) the quarterly imaging division revenue run rate lost as a result of clients choosing to terminate contracts with the Company, excluding clients for which Alliance provides professional radiology services, interim service and clients that the Company elects to terminate, and (b) projected quarterly new imaging division revenue from new client contracts, excluding professional radiology services, commencing service in the quarter.

The imaging division revenue gap for the last eight calendar quarters and the last twelve month period ended March 31, 2011 is as follows:

 

     (a)     (b)         
     Revenue     New      Imaging Division  
     Lost     Revenue      Revenue Gap  

2009

       

Second Quarter

   ($ 15.0   $ 15.4       $ 0.4   

Third Quarter

     (13.2     10.0         (3.2

Fourth Quarter

     (19.1     9.0         (10.1

2010

       

First Quarter

     (11.5     11.2         (0.3

Second Quarter

     (11.4     9.1         (2.3

Third Quarter

     (10.8     11.5         0.7   

Fourth Quarter

     (8.4     7.0         (1.4

2011

       

First Quarter

     (5.1     12.9         7.8   

Last Twelve Months Ended March 31, 2011

   ($ 35.7   $ 40.5       $ 4.8   

 

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