UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

FORM 10-Q

(Mark One)

[X]QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR THE QUARTERLY PERIOD ENDED MARCH 31, 2019JUNE 30, 2022

[  ]TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR THE TRANSITION PERIOD FROM             TO

Commission file number: 001-38797

IMAC Holdings, Inc.

(Exact name of registrant as specified in its charter)

Delaware83-0784691

(State or Other Jurisdiction of

Incorporation or Organization)

(I.R.S. Employer

Identification No.)

1605 Westgate Circle, Brentwood, Tennessee37027
(Address of Principal Executive Offices)(Zip Code)

(844)266-4622

(Registrant’s Telephone Number, Including Area Code)

Securities registered pursuant to Section 12(b) of the Act:

Title of each classTrading Symbol(s)Name of each exchange on which registered
Common Stock, par value $0.001 per shareIMACBACKNASDAQ Capital Market
Warrants to Purchase Common StockIMACWNASDAQ Capital Market

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 [  ]

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 [  ]

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, 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 filer[  ]Accelerated filer[  ]
Non-accelerated filer[X]Smaller reporting company[X]
Emerging growth company[X]

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. [  ]

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes [  ] No [X]

As of May 10, 2019August 15, 2022, the registrant had 8,316,79727,289,911 shares of Common Stock ($0.001 par value)common stock (par value $0.001 per share) outstanding.

 

 

 

IMAC HOLDINGS, INC.

TABLE OF CONTENTS

Page
IMPORTANT INFORMATION REGARDING FORWARD-LOOKING STATEMENTS3
PART I. FINANCIAL INFORMATION4
Item 1. Financial Statements (Unaudited)4
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations2021
Item 3. Quantitative and Qualitative Disclosures about Market Risk2830
Item 4. Controls and Procedures2830
PART II. OTHER INFORMATION2931
Item 1. Legal Proceedings2931
Item 1A. Risk Factors2931
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds2934
Item 3. Defaults Upon Senior Securities2934
Item 4. Mine Safety Disclosures2934
Item 5. Other Information2934
Item 6. Exhibits3034

2

 

Important Information Regarding Forward-Looking Statements

Portions of this Quarterly Report on Form 10-Q (including information incorporated by reference) include “forward-looking statements” based on our current beliefs, expectations, and projections regarding our business strategies, market potential, future financial performance, industry, and other matters. This includes, in particular, “Item 2 — Management’s Discussion and Analysis of Financial Condition and Results of Operations” of this Quarterly Report on Form 10-Q, as well as other portions of this Quarterly Report on Form 10-Q. The words “believe,” “expect,” “anticipate,” “project,” “could,” “would,” and similar expressions, among others, generally identify “forward-looking statements,” which speak only as of the date the statements were made. The matters discussed in these forward-looking statements are subject to risks, uncertainties, and other factors that could cause our actual results to differ materially from those projected, anticipated, or implied in the forward-looking statements. The most significant of these risks, uncertainties, and other factors are described in “Item 1A — Risk Factors” in our Annual Report on Form 10-K for the fiscal year ended December 31, 20182021 filed with the U.S. Securities and Exchange Commission on April 16, 2019.14, 2022. Except to the limited extent required by applicable law, we undertake no obligation to update or revise any forward-looking statements, whether as a result of new information, future events, or otherwise.

3

 

PART I. FINANCIAL INFORMATION

ITEM 1. FINANCIAL STATEMENTS

IMAC HOLDINGS, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

  

June 30,

2022

(Unaudited)

  

December 31,

2021

 
ASSETS        
Current assets:        
Cash $1,614,190  $7,118,980 
Accounts receivable, net  3,055,017   1,209,333 
Deferred compensation, current portion  173,963   191,657 
Other assets  528,769   547,536 
Total current assets  5,371,939   9,067,506 
         
Property and equipment, net  2,050,074   2,323,163 
         
Other assets:        
Goodwill  4,661,796   4,661,796 
Intangible assets, net  5,351,779   5,797,469 
Deferred compensation, net of current portion  -   73,816 
Security deposits  351,819   357,050 
Right of use assets  4,280,675   4,948,393 
Total other assets  14,646,069   15,838,524 
         
Total assets $22,068,082  $27,229,193 
         
LIABILITIES AND STOCKHOLDERS’ EQUITY        
         
Current liabilities:        
Accounts payable and accrued expenses $2,100,709  $2,523,332 
Patient deposits  506,495   320,917 
Notes payable, current portion  78,618   254,487 
Finance lease obligation, current portion  19,469   19,050 
Liability to issue common stock, current portion  387,230   337,935 
Operating lease liability, current portion  1,470,241   1,478,140 
Total current liabilities  4,562,762   4,933,861 
         
Long-term liabilities:        
Notes payable, net of current portion  72,562   104,697 
Finance lease obligation, net of current portion  19,432   29,273 
Liability to issue common stock, net of current portion  -   189,375 
Operating lease liability, net of current portion  3,318,566   4,018,926 
         
Total liabilities  7,973,322   9,276,132 
         
Commitments and Contingencies – Note 14  -   - 
         
Stockholders’ equity:        
Preferred stock - $0.001 par value, 5,000,000 authorized, NaN issued and outstanding at June 30, 2022 and December 31, 2021, respectively.  -   - 
Common stock - $0.001 par value, 30,000,000 authorized; 27,543,409 and 26,876,409 shares issued at June 30, 2022 and December 31, 2021, respectively; and 27,289,911 and 26,218,167 outstanding at June 30, 2022 and December 31, 2021, respectively.  27,290   26,218 
Additional paid-in capital  47,280,628   46,133,777 
Accumulated deficit  (33,213,158)  (28,206,934)
Total stockholders’ equity  14,094,760   17,953,061 
         
Total liabilities and stockholders’ equity $22,068,082  $27,229,193 

(Unaudited)

  March 31, 2019  December 31, 2018 
ASSETS        
Current assets:        
Cash $3,065,553  $194,316 
Accounts receivable, net  665,080   303,630 
Due from related parties  -   - 
Other assets  400,959   170,163 
Total current assets  4,131,592   668,109 
         
Property and equipment, net  3,221,183   3,333,638 
         
Other assets:        
Goodwill  2,042,125   2,042,125 
Intangible assets, net  4,126,748   4,257,434 
Deferred IPO Costs  -   335,318 
Security deposits  441,473   438,163 
Right of use asset  4,027,124   - 
Total other assets  10,637,470   7,073,040 
         
Total assets $17,990,245  $11,074,787 
         
LIABILITIES AND STOCKHOLDERS’ EQUITY (DEFICIT)        
         
Current liabilities:        
Accounts payable and accrued expenses $1,548,220  $1,261,582 
Acquisition liabilities  10,000   7,259,208 
Patient deposits  939,772   454,380 
Due to related parties  -   - 
Notes payable, current portion  3,032,686   4,459,302 
Capital lease obligation, current portion  16,920   16,740 
Line of credit  229,961   379,961 
Operating lease  724,587   - 
Total current liabilities  6,502,146   13,831,173 
         
Long-term liabilities:        
Notes payable, net of current portion  276,854   317,291 
Capital Lease Obligation, net of current portion  79,740   84,038 
Deferred Rent  185,022   197,991 
Lease Incentive Obligation  549,695   576,454 
Operating lease, net of current portion  3,310,403   - 
         
Total liabilities  10,903,860   15,006,947 
         
Stockholders’ equity (deficit):        
Preferred stock - $0.001 par value, 5,000,000 authorized, nil issued and outstanding  -   - 
Common stock; $0.001 par value, 30,000,000 authorized, 7,252,923 and 4,533,623 shares issued and outstanding at March 31, 2019 and December 31, 2018, respectively  7,253   4,534 
Additional paid-in capital  14,280,204   1,233,966 
Accumulated deficit  (5,144,009)  (3,544,820)
Non-controlling interest  (2,057,063)  (1,625,840)
Total stockholders’ equity (deficit)  7,086,385   (3,932,160)
         
Total liabilities and stockholders’ equity (deficit) $17,990,245  $11,074,787 

See accompanying notes to the unaudited condensed consolidated financial statements.

4

 

IMAC HOLDINGS, INC.

CONDENSEDCONSOLIDATED STATEMENTS OF OPERATIONS

(Unaudited)

(Unaudited)

                 
  

Three Months Ended

June 30,

  

Six Months Ended

June 30,

 
  2022  2021  2022  2021 
             
Patient revenues, net $5,033,088  $3,462,814  $8,928,075  $6,487,622 
Other income  -   2,701   -   6,078 
Management fees  -   -   -   36,068 
Total revenue  5,033,088   3,465,515   8,928,075   6,529,768 
                 
Operating expenses:                
Patient expenses  397,235   339,951   857,708   681,363 
Salaries and benefits  3,782,518   2,996,674   7,492,796   5,750,922 
Share-based compensation  80,571   123,169   269,691   233,776 
Advertising and marketing  242,562   315,529   613,050   581,077 
General and administrative  1,857,915   1,661,193   3,673,162   2,880,531 
Depreciation and amortization  438,612   441,804   885,384   864,005 
(Gain) loss on disposal or impairment of assets  34,832   (49)  82,261   3,994 
Total operating expenses  6,834,245   5,878,271   13,874,052   10,995,668 
                 
Operating loss  (1,801,157)  (2,412,756)  (4,945,977)  (4,465,900)
                 
Other income (expense):                
Interest income  1,321   -   1,321   - 
Other expense  (39,530)  243   (52,704)  243 
Interest expense  (4,733)  (126,228)  (8,864)  (302,507)
Total other expenses  (42,942)  (125,985)  (60,247)  (302,264)
                 
Net loss before income taxes  (1,844,099)  (2,538,741)  (5,006,224)  (4,768,164)
                 
Income taxes  -   -   -   - 
                 
Net loss  (1,844,099)  (2,538,741)  (5,006,224)  (4,768,164)
                 
Net loss per share attributable to common stockholders                
Basic and diluted $(0.07) $(0.10) $(0.19) $(0.24)
                 
Weighted average common shares outstanding                
Basic and diluted  26,800,926   25,143,201   26,584,532   19,476,793 

  Three Months Ended March 31, 
  2019  2018 
       
Patient revenues $7,289,022  $532,872 
Contractual adjustments  (4,519,194)  (298,619)
Total patient revenue, net  2,769,828   234,253 
         
Management fees  -   33,600 
Total revenue  2,769,828   267,853 
         
Operating expenses:        
Patient expenses  436,129   37,134 
Salaries and benefits  2,064,623   446,796 
Share-based compensation  3,749   3,749 
Advertising and marketing  347,016   93,178 
General and administrative  977,369   239,692 
Depreciation and amortization  285,567   31,268 
Total operating expenses  4,114,453   851,817 
         
Operating loss  (1,344,626)  (583,964)
         
Other income (expense):        
Interest income  -   3,312 
Other (loss)  (15,955)  - 
Beneficial conversion interest expense  (639,159)  - 
Interest expense  (30,671)  (23,552)
Total other (expenses)  (685,785)  (20,240)
         
Loss before equity in (loss) of non-consolidated affiliate  (2,030,410)  (604,204)
         
Equity in (loss) of non-consolidated affiliate  -   (85,651)
         
Net loss before income taxes  (2,030,410)  (689,855)
         
Income taxes  -   - 
         
Net loss  (2,030,410)  (689,855)
         
Net loss attributable to the non-controlling interest  431,223   285,191 
         
Net loss attributable to IMAC Holdings, Inc. $(1,599,187) $(404,664)
         
Net loss per share attributable to common stockholders        
Basic and diluted $(0.27) $(0.09)
         
Weighted average common shares outstanding        
Basic and diluted  5,919,856   

4,533,623

 

See accompanying notes to the unaudited condensed consolidated financial statements.

5

 

IMAC HOLDINGS, INC.

CONDENSEDCONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (DEFICIT)

(Unaudited)

                     
  Common Stock  Additional       
  

Number of

Shares

  Par  

Paid-In-

Capital

  

Accumulated

Deficit

  Total 
                
Balance, December 31, 2020  12,747,055  $12,747  $25,465,094  $(17,664,687) $7,813,154 
Issuance of common stock  11,259,676   11,260   17,198,664   -   17,209,924 
Issuance of employee stock options  -   -   39,052   -   39,052 
Net loss  -   -   -   (2,229,423)  (2,229,423)
Balance, March 31, 2021  24,006,731   24,007   42,702,810   (19,894,110)  22,832,707 
Issuance of common stock  1,315,625   1,316   2,043,459   -   2,044,775 
Issuance of employee stock options  -   -   39,542   -   39,542 
Net loss  -   -   -   (2,538,741)  (2,538,741)
Balance, June 30, 2021  25,322,356  $25,323  $44,785,811  $(22,432,851) $22,378,283 

  Common Stock  Additional       
  

Number of

Shares

  Par  

Paid-In-

Capital

  

Accumulated

Deficit

  Total 
                
Balance, December 31, 2021  26,218,167  $26,218  $46,133,777  $(28,206,934) $17,953,061 
Issuance of common stock  167,000   167   148,393   -   148,560 
Issuance of employee stock options  -   -   32,587   -   32,587 
Net loss  -   -   -   (3,162,125)  (3,162,125)
Balance, March 31, 2022  26,385,167   26,385   46,314,757   (31,369,059)  14,972,083 
Issuance of common stock  904,744   905   934,757   -   935,662 
Issuance of employee stock options  -   -   31,114   -   31,114 
Net loss  -   -   -   (1,844,099)  (1,844,099)
Balance, June 30, 2022  27,289,911  $27,290  $47,280,628  $(33,213,158) $14,094,760 

  Common Stock  Additional  Non-       
  

Number of

Shares

  Par  

Paid-In-

Capital

  

Controlling

Interest

  

Accumulated

Deficit

  Total 
                   
Balance, December 31, 2018  4,533,623  $4,534  $1,233,966  $(1,625,840) $(3,544,820) $(3,932,160)
                         
Common stock issued for initial public offering proceeds, net of related fees  850,000   850   3,503,314   -   -   3,504,164 
                         
Issuance of common stock in connection with convertible notes  449,217   449   2,245,636   -   -   2,246,085 
                         
Issuance of common stock in connection with acquisitions  1,410,183   1,410   7,247,798   -   -   7,249,208 
                         
Exercise of warrants  9,900   10   49,490   -   -   49,500 
                         
Net loss  -   -   -   (431,223)  (1,599,187)  (2,030,410)
                         
Balance, March 31, 2019  7,252,923  $7,253  $14,280,204  $(2,057,063) $(5,144,007) $7,086,387 

See accompanying notes to unaudited condensed consolidated financial statements.

6

 

IMAC HOLDINGS, INC.

CONDENSEDCONSOLIDATED STATEMENTS OF CASH FLOWS

(Unaudited)

(Unaudited)

         
  

Six Months Ended

June 30,

 
  2022  2021 
Cash flows from operating activities:        
Net loss $(5,006,224) $(4,768,164)
Adjustments to reconcile net loss to net cash used in operating activities:        
Depreciation and amortization  885,384   864,005 
Share based compensation  269,691   233,776 
Loss on disposition of assets  82,261   3,994 
Changes in operating assets:        
Accounts receivable, net  (1,845,684)  173,340 
Other assets  18,767   (630,626)
Security deposits  5,231   (7,349)
Right of use/lease liability  (40,541)  - 
Accounts payable and accrued expenses  (417,271)  (317,776)
Patient deposits  185,578   118,172 
Net cash from operating activities  (5,862,808)  (4,330,628)
         
Cash flows from investing activities:        
Purchase of property and equipment  (256,279)  (240,938)
Brand development  -   (66,495)
Acquisitions  -   (731,909)
Proceeds from sale of property and equipment  2,060   2,650 
Net cash from investing activities  (254,219)  (1,036,692)
         
Cash flows from financing activities:        
Proceeds from issuance of common stock  829,663   19,005,323 
Payments on notes payable  (208,004)  (2,624,102)
Payments on finance lease obligation  (9,422)  (16,243)
Net cash from financing activities  612,237   16,364,978 
         
Net increase in cash  (5,504,790)  10,997,658 
         
Cash, beginning of period  7,118,980   2,623,952 
         
Cash, end of period $1,614,190  $13,621,610 
         
Supplemental cash flow information:        
Interest paid $8,864  $183,849 

  Three Months Ended March 31, 
  2019  2018 
       
Cash flows from operating activities:        
Net loss $(2,030,410) $(689,855)
Adjustments to reconcile net loss to net cash used in operating activities:        
Depreciation and amortization  285,567   31,268 
Beneficial conversion interest expense  

639,159

   

-

 
Deferred rent  (12,969)  2,408 
Equity in loss of non-consolidated affiliate  -   85,651 
(Increase) decrease in operating assets:        
Accounts receivable, net  (361,450)  (503)
Due from related parties  -   - 
Other assets  (230,796)  (118,410)
Security deposits  (3,310)  - 
Increase (decrease) in operating liabilities:        
Accounts payable and accrued expenses  361,428   136,685 
Patient deposits  485,392   (22,249)
Lease incentive obligation  (26,759)  (1,536)
Net cash (used in) operating activities  (894,149)  (576,541)
         
Cash flows from investing activities:        
Purchase of property and equipment  (42,426)  (1,191,620)
Investment in and advances go IMAC St Louis LLC  -   (124,106)
Net cash (used in) investing activities  (42,426)  (1,315,726)
         
Cash flows from financing activities:        
Proceeds from initial public offering  3,839,482   - 
Proceeds from warrants exercised  49,500   - 
Proceeds from notes payable  100,000   2,262,500 
Payments on notes payable  (27,053)  (20,590)
Proceeds from line of credit  -   75,000 
Payments on line of credit  (150,000)  - 
Payments on capital lease obligation  (4,118)  (1,922)
Net cash provided by financing activities  3,807,811   2,314,988 
         
Net increase in cash  2,871,237   422,721 
         
Cash, beginning of period  194,316   127,788 
         
Cash, end of period $3,065,553  $550,509 
         
Supplemental cash flow information:        
Interest paid $30,671  $23,552 

See accompanying notes to the unaudited condensed consolidated financial statements.

7

 

IMAC HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

(Unaudited)

Note 1 – Description of Business

IMAC Holdings, Inc. is a holding company for IMAC Regeneration Centers, The Back Space retail stores and our Investigational New Drug division. IMAC Holdings, Inc. and its affiliates (collectively, the “Company”) provide movement, orthopedic and neurological therapies through its chain of IMAC Regeneration Centers. Through its consolidated and equity owned entities, its outpatient medical clinics provide conservative, non-invasive medical treatments to help patients with back pain, knee pain, joint pain, ligament and tendon damage, and other related soft tissue conditions. The Company had opened two (2) medical clinics located in Tennessee andhas opened or acquired through management service agreements nine (9)twelve (12) medical clinics located in Florida, Illinois, Kentucky, Louisiana and Missouri at March 31, 2019.as of June 30, 2022. The CompanyBack Space operates a healthcare center specializing in chiropractic and spinal care services inside Walmart retail locations. As of June 30, 2022, the Back Space has partnered with several well-known sports stars such as Ozzie Davisopened ten retail clinic locations in Florida, Missouri and David Price in openingTennessee. The Company’s Investigational New Drug division is conducting a clinical trial for its medical clinics, with a focus around treating sports injuries.

Effective June 1, 2018,investigational compound utilizing umbilical cord-derived allogenic mesenchymal stem cells for the Company converted from IMAC Holdings, LLC a Kentucky limited liability companytreatment of bradykinesia due to IMAC Holdings, Inc. a Delaware corporation, followed by a reverse stock split in February 2019. These accounting changes have been given retrospective treatment in the condensed consolidated financial statements.Parkinson’s disease.

During February 2019, the Company completed an initial public offering (“IPO”) of securities. See Note 13.

Note 2 – Summary of Significant Accounting Policies

Principles of Consolidation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with Generally Accepted Accounting Principles (“GAAP”) in the United States of America (“U.S.”) as promulgated by the Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) and with the rules and regulations of the U.SU.S. Securities and Exchange Commission (“SEC”). In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (which are of a normal recurring nature) necessary for a fair presentation. Interim results are not necessarily indicative of results for a full year. Therefore, the interim unaudited condensed consolidated financial statements should be read in conjunction with the consolidated financial statements contained in the Company’s Annual Report on Form 10-K.

The accompanying condensed consolidated financial statements include the accounts of IMAC Holdings, Inc. (“IMAC Holdings”) and the following entities which are consolidated due to direct ownership of a controlling voting interest or other rights granted to us as the sole general partner or managing member of the entity: IMAC Regeneration Center of St. Louis, LLC (“IMAC St. Louis”), IMAC Management Services, LLC (“IMAC Management”), IMAC Regeneration Management, LLC (“IMAC Texas”) and IMAC Regeneration Management of Nashville, LLC (“IMAC Nashville”) IMAC Management of Illinois, LLC (“IMAC Illinois”), Advantage Hand Therapy and Orthopedic Rehabilitation, LLC (“Advantage Therapy”), IMAC Management of Florida, LLC (“IMAC Florida”), Louisiana Orthopaedic & Sports Rehab (“IMAC Louisiana”) and The Back Space, LLC (“BackSpace”); the following entity which is consolidated with IMAC Regeneration Management of Nashville, LLC due to control by contract: IMAC Regeneration Center of Nashville, PC (“IMAC Nashville PC”); the following entities which are consolidated with IMAC Management of Illinois, LLC due to control by contract: Progressive Health and Rehabilitation, Ltd., Illinois Spine and Disc Institute, Ltd. and Ricardo Knight, P.C.; the following entities which are consolidated with IMAC Management Services, LLC due to control by contract: Integrated Medicine and Chiropractic Regeneration Center PSC (“Kentucky PC”) and IMAC Medical of Kentucky, PSC; the following entities which are consolidated with IMAC Florida due to control by contract: Willmitch Chiropractic, P.A. and IMAC Medical of Florida, P.A.; the following entity which prioris consolidated with Louisiana Orthopaedic & Sports Rehab due to June 1, 2018 was held ascontrol by contract: IMAC Medical of Louisiana, a minority interest, IMAC Regeneration CenterMedical Corporation; and the following entities which are consolidated with BackSpace due to control by contract: ChiroMart LLC, ChiroMart Florida LLC, and ChiroMart Missouri LLC.

8

In February 2021, the Company completed the asset purchase of St. Louis, LLC (“IMAC St. Louis”).and signed a Management Services Agreement with Willmitch Chiropractic, P.A. in Tampa, Florida.

In March 2021, the Company completed the asset purchase of NHC Chiropractic, PLLC dba Synergy Healthcare in Orlando, Florida.

In June 2018,2021, the Company completed the asset purchase of Fort Pierce Chiropractic in Fort Pierce, Florida and Active Medical Center in Naperville, Illinois.

In October 2021, the Company consummated certain transactions resulting in the acquisition of the outstanding equity interestsinterest in IMAC St. Louis and Clinic Management Associates of KY, LLC (“CMA of KY”),Louisiana Orthopaedic & Sports Rehab Institute, Inc, an entity which is consolidated with Integratedpresents the results of Louisiana Medical and Chiropractic Regeneration Center, PSC (“IMAC Kentucky”) due to control by contract.

These entitiesacquisitions are included in the condensed consolidated financial statements from the date of acquisition.

In August 2018, the Company acquired 100% of Advantage Hand Therapy and Orthopedic Rehabilitation, LLC (“Advantage Therapy”) and 70% of BioFirma LLC (“BioFirma”). Both companies are consolidated due to direct ownership of a controlling voting interest or other rights granted to us as the sole general partner or managing member of the entity.

All significant intercompany balances and transactions have been eliminated in consolidation.

Use of Estimates

The preparation of condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses at the date and for the periods that the condensed consolidated financial statements are prepared. On an ongoing basis, the Company evaluates its estimates, including those related to insurance adjustments and provisions for doubtful accounts. The Company bases its estimates on historical experience and on various other assumptions that are believed to be reasonable under the circumstances. Actual results could materially differ from those estimates.

COVID-19 Pandemic

The full impact of the COVID-19 outbreak continues to evolve as of the date of these condensed consolidated financial statements. As such, it is uncertain as to the full magnitude that the pandemic will have on the Company’s combined financial condition, liquidity and future results of operations. Management is actively monitoring the impact of the global situation on its consolidated financial condition, liquidity, operations, suppliers, industry and workforce. Given the daily evolution of the COVID-19 outbreak and the global responses to curb its spread, the Company is not able to estimate the effects of the COVID-19 outbreak on its results of operations, financial condition, or liquidity beyond the results presented in these condensed consolidated financial statements.

Due to the impacts of COVID-19 we have experienced an increase in recruiting and labor costs as well as staffing disruptions and fulfilment delays in supplies and equipment.

Revenue Recognition

The Company’s patient service revenue is derived from non-surgical procedures performed at our outpatient medical clinics and patient visits to physicians.clinics. The fees for such services are billed either to the patient or a third- partythird-party payer, including Medicare. We recognize patient

The Company recognizes service revenue, netrevenues based upon the estimated amounts the Company expects to be entitled to receive from patients and third-party payers. Estimates of contractual allowances, which we estimateadjustments are based upon the payment terms specified in the related contractual agreements. The Company also records estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the historical trendestimated amounts expected to be collected.

Starting in January 2020, the Company implemented wellness maintenance programs on a subscription basis. There are currently four membership plans offered with different levels of our cash collectionsservice for each plan. The Company recognizes membership revenue on a monthly basis. Enrollment in the wellness maintenance program can occur at any time during the month and contractual write-offs.can be dis-enrolled at any time.

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Other management service fees are derived from management services where the Company provides billings and collections support to the clinics and where management services are provided based on state specific regulations known as the corporate practice of medicine (“CPM”). Under the CPM, a business corporation is precluded from practicing medicine or employing a physician to provide professional medical services. In these circumstances, the Company provides all administrative support to the physician-owned PC through ana LLC. The PC is consolidated due to control by contract (an “MSA” – Management Services Agreement). The fees we derive from these management arrangements are either based on a predetermined percentage of the revenue of each clinic or a percentage mark up on the costs of the LLC. We recognizeThe Company recognizes other management service revenue in the period in which services are rendered. These revenues are earned by IMAC Nashville, and IMAC Management, IMAC Illinois, IMAC Florida, IMAC Louisiana and the Back Space and are eliminated in consolidation to the extent owned.

Starting in June 2021, the Company introduced BackSpace and began offering outpatient chiropractic and spinal care services as well as memberships services in Walmart retail locations. The fees for such services are paid and recognized as incurred.

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Patient Deposits

Patient deposits are derived from patient payments in advance of services delivered. Our service lines include traditional and regenerative medicine. Regenerative medicine procedures are notrarely paid by insurance carriers; therefore, the Company typically requires up-front payment from the patient for regenerative services and any co-pays and deductibles as required by the patient specific insurance carrier. For some patients, credit is provided through an outside vendor. In this case, the Company is paid from the credit card company and the risk is transferred to the credit card company for collection from the patient. These funds are accounted for as patient deposits until the procedures are performed at which point the patient deposit is recognized as patient service revenue.

Fair Value of Financial Instruments

The carrying amount of accounts receivable and accounts payable and acquisition liabilities approximate their respective fair values due to the short- termshort-term nature. The carrying amount of the line of credit and note payable approximates fair values due to their market interest rates. Financial instruments that potentially subject the Company to concentrations of credit risk consist principally of cash and cash equivalents and accounts receivable.

Variable Interest Entities

Certain states prohibit the “corporate practice of medicine,” which restricts business corporations from practicing medical care by exercising control over clinical decisions by doctors. In states which prohibit the corporate practice of medicine, the Company enters into long-term management agreements with professional corporations (“PCs”) that are owned by licensed doctors, which, in turn employ or contract with doctors who provide professional care in its clinics. Under these management agreements with PCs, the Company provides, on an exclusive basis, all non-clinical services of the practice.

The condensed consolidated financial statements include the accounts of variable interest entities (“VIE”) in which the Company is the primary beneficiary under the provisions of the FASB Accounting Standards Codification 810, “Consolidation”. The Company has the power to direct the activities that most significantly impact a VIE’s economic performance. Additionally, the Company would absorb substantially all of the expected losses from any of these entities should such expected losses occur. As of June 30, 2022, the Company’s consolidated VIE’s include 12 PCs.

The total assets (excluding goodwill and intangible assets, net) of the consolidated VIEs included in the accompanying condensed consolidated balance sheets as of June 30, 2022 and December 31, 2021, were approximately $2.1 million and $2.2 million respectively, and the total liabilities of the consolidated VIEs were approximately $897,000 and $661,000, respectively.

Cash and Cash Equivalents

The Company considers all short-term investments with an original maturity of three months or less to be cash equivalents. The Company had no0 cash equivalents.equivalents at June 30, 2022 and December 31, 2021.

Accounts Receivable

Accounts receivable primarily consists of amounts due from third-party payers (non-governmental), governmental payers and private pay patients and is recorded net of allowances for doubtful accounts and contractual discounts. The Company’s ability to collect outstanding receivables is critical to its results of operations and cash flows. Accordingly, accounts receivable reported in the Company’s condensed consolidated financial statements areis recorded at the net amount expected to be received. The Company’s primary collection risks are (i) the risk of overestimation of net revenues at the time of billing that may result in the Company receiving less than the recorded receivable, (ii) the risk of non-payment as a result of commercial insurance companies’ denial of claims, (iii) the risk that patients will fail to remit insurance payments to the Company when the commercial insurance company pays out-of-network claims directly to the patient, (iv) resource and capacity constraints that may prevent the Company from handling the volume of billing and collection issues in a timely manner, (v) the risk that patients do not pay the Company for their self-pay balances (including co-pays, deductibles and any portion of the claim not covered by insurance) and (vi) the risk of non-payment from uninsured patients.

The Company’s accounts receivable from third-party payers are recorded net of estimated contractual adjustments and allowances from third-party payers, which are estimated based on the historical trend of the Company’s facilities’ cash collections and contractual write- offs,write-offs, accounts receivable aging, established fee schedules, relationships with payers and procedure statistics. While changes in estimated reimbursement from third-party payers remain a possibility, the Company expects that any such changes would be minimal and, therefore, would not have a material effect on the Company’s financial condition or results of operations. The Company’s collection policies and procedures are based on the type of payer,payor, size of claim and estimated collection percentage for each patient account. The operating systems used to manage the Company’s patient accounts provide for an aging schedule in 30-day increments, by payer, physician and patient. The Company analyzes accounts receivable at each of the facilities to ensure the proper collection and aged category. The operating systems generate reports that assist in the collection efforts by prioritizing patient accounts. Collection efforts include direct contact with insurance carriers or patients and written correspondence.

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Allowance for Doubtful Accounts, Contractual and Other Discounts

Management estimates the allowance for contractual and other discounts based on its historical collection experience and contracted relationship with the payers. The services authorized and provided and related reimbursement are often subject to interpretation and negotiation that could result in payments that differ from the Company’s estimates. The Company’s allowance for doubtful accounts is based on historical experience, but management also takes into consideration the age of accounts, creditworthiness and current economic trends when evaluating the adequacy of the allowance for doubtful accounts. An account may be written-off only after the Company has pursued collection efforts or otherwise determines an account to be uncollectible. Uncollectible balances are written-off against the allowance. Recoveries of previously written-off balances are credited to incomeapplied against operating expenses when the recoveries are made.

Property and Equipment

Property and equipment are stated at cost, less accumulated depreciation. Additions and improvements to property and equipment are capitalized at cost. Depreciation of owned assets are computed using the straight-line method over the estimated useful lives and amortization of leasehold improvements are computed using the straight-line method over the shorter of the estimated useful lives of the related assets or the lease term. The cost of assets sold or retired, and the related accumulated depreciation are removed from the accounts and any resulting gains or losses are reflected in other income (expense)operating expenses for the year. Expenditures for maintenance and repairs are charged to expense as incurred.

Intangible Assets

The Company capitalizes the fair value of intangible assets acquired in business combinations. Intangible assets are amortized on a straight-line basis over their estimated economic useful lives, generally the contract term. The Company performs valuations of assets acquired and liabilities assumed on each acquisition accounted for as a business combination and allocates the purchase price of each acquired business to its respective net tangible and intangible assets. AcquiredThe Company records an impairment loss when the carrying amount of the asset is not recoverable and exceeds its fair value. In March 2022 the Company decided to close a clinic in Florida with a total intangible carrying amount of approximately $30,000, which was written off as impaired. As a result, the Company recorded a noncash impairment loss for this amount during the three months ended March 31, 2022. NaN impairments of intangible assets include trade names, non-compete agreements, customer relationships and contractual agreements.were recorded for the three months ended June 30, 2022 or the six months ended June 30, 2021.

Goodwill

The Company tests goodwill for impairment on an annual basis, or when events or circumstances indicate the fair value of a reporting unit is below its carrying value.

Our goodwill represents the excess of the purchase price over the fair value of the net identifiable assets acquired and liabilities assumed in business combinations. The goodwill generated from the business combinations is primarily related to the value placed on the employee workforce and expected synergies. Judgment is involved in determining if an indicator or change in circumstances relating to impairment has occurred. Such changes may include, among others, a significant decline in expected future cash flows, a significant adverse change in the business climate, and unforeseen competition.

The goodwill test is performed at least annually, or more frequently if events or changes in circumstances indicate that the asset might be impaired. The annual impairment test includes an option to perform a qualitative assessment of whether it is more likely than not that a reporting unit’s fair value is less than its carrying value; the qualitative test may be performed prior to, or as an alternative to, performing a quantitative goodwill impairment test. If, after assessing the totality of events or circumstances, the Company determines that it is more likely than not that the fair value of a reporting unit is less than its carrying value, then the Company is required to perform the quantitative goodwill impairment test. Otherwise, no further analysis is required.

The Company operates under one reporting unit. The quantitative impairment test involves the comparison of the fair value of the reporting unit to its carrying value. The Company calculates the fair value of each reporting unit using either (i) a discounted cash flows analysis that converts future cash flow amounts into a single discounted present value amount or (ii) a market approach. The Company assesses the valuation methodology based upon the relevance and availability of the data at the time that the valuation is performed. The Company compares the estimate of fair value for the reporting unit to the carrying value of the reporting unit. If the carrying value is greater than the estimate of fair value, an impairment loss will be recognized in the amount of the excess.

The Company performs its annual impairment test during the fourth quarter of the fiscal year. For the year ended December 31, 2021, the Company performed a qualitative impairment test and, based on the totality of information available for the reporting unit, the Company concluded that it was more-likely-than-not that the estimated fair value of the reporting unit was greater than the carrying value of the reporting unit and, as such, no further analysis was required. There was no0 goodwill impairment for the yearsmonths presented.

Long-Lived Assets

Long-lived assets such as property and equipment and intangible assets are evaluated for impairment whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. There were no impairments of long livedlong-lived assets for the years presented.

Advertising and Marketing

The Company uses advertising and marketing to promote its services. Advertising and marketing costs are expensed as incurred. Advertising and marketing expense was $347,016approximately $243,000 and $93,178$316,000 for the three months ended March 31, 2019June 30, 2022 and 2018,2021, respectively (unaudited).and was approximately $613,000 and $581,000 for the six months ended June 30, 2022 and 2021, respectively.

Net Loss Per Share

Basic net loss per common share is computed by dividing net loss applicable to common stockholders by the weighted-average number of common shares outstanding during the period.year. Diluted net loss per common share is determined using the weighted-average of common shares outstanding during the period,year, adjusted for the dilutive effect of common stock equivalents, consisting of the conversion option embedded in convertible debt. The weighted-average number of common shares outstanding excludes common stock equivalents because their inclusion would have an anti-dilutive effect.

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Income Taxes

IMAC Management, IMAC Texas,Income taxes are accounted for under the asset and IMAC Nashville are limited liability companiesmethod. Deferred tax assets and are taxed as partnerships. IMAC Holdings was taxed as a partnership through May 31, 2018. As a result, income tax liabilities are passed throughrecognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carry forwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date.

Deferred tax assets are required to be reduced by a valuation allowance to the individual members. Accordingly, no provision for income taxes were reflected inextent that, based on the condensed consolidated financial statements for periods prior to May 31, 2018 at which time IMAC Holdings converted from a limited liability company to a Delaware corporation.

The Company records a liability for uncertain tax positions whenweight of available evidence, it is probable that a loss has been incurred and the amount can be reasonably estimated. Interest and penalties related to income tax matters, if any, would be recognized as a component of income tax expense. For the three months ended March 31, 2019 and 2018, the Company had no liabilities for uncertain tax positions. The Company continually evaluates expiring statutes of limitations, audits, proposed settlements, changes in tax law and new authoritative rulings. Currently, the tax years subsequent to 2016 are open and subject to examination by the taxing authorities.

Recently Issued Accounting Pronouncements

In January 2017, the Financial Accounting Standards Board (“FASB”) issued ASU 2017-04 “Intangibles - Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment”. This update simplifies the subsequent measurement of goodwill by eliminating Step 2 from the goodwill impairment test. Under this updated standard, an entity should recognize an impairment charge for the amount by which the carrying amount exceeds the reporting unit’s fair value, but the loss recognized shouldmore likely than not exceed the total amount of goodwill allocated to that reporting unit. An entity also should consider income tax effects from any tax-deductible goodwill on the carrying amount of the reporting unit when measuring the goodwill impairment loss, if any. This guidance is effective prospectively and is effective for interim and annual periods beginning after December 15, 2019 with early adoption permitted. The Company does not expect the adoption of this guidance to have a material impact on our condensed consolidated financial statements.

In February 2016, the FASB issued ASU 2016-02, “Leases” which, for operating leases, requires a lessee to recognize a right-of-use asset and a lease liability, initially measured at the present value of the lease payments, in its balance sheet. The standard also requires a lessee to recognize a single lease cost, calculated so that the cost of the lease is allocated over the lease term, on a generally straight-line basis. The ASU was effective for fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. We recognized a right of use asset and related obligation on our condensed consolidated financial statements.deferred tax assets will not be realized.

Note 3 – Capital Requirements, Liquidity and Going Concern Considerations

The Company’s condensed consolidated financial statements are prepared in accordance with GAAP includingand includes the assumption of a going concern basis, which contemplates the realization of assets and liquidation of liabilities in the normal course of business. However, as shown in the accompanying condensed consolidated financial statements, the Company has sustained substantial losses from operations since inception and haswhich raises substantial doubt regarding the Company’s ability to continue as a deficiency ingoing concern. The Company had working capital of approximately $13.1 million$809,000 at June 30, 2022 and $2.4$4.1 million at December 31, 2018 and March 31, 2019, respectively.2021. The Company had a net loss of approximately $2.0$5.0 million and $0.7 million at March 31, 2019 and 2018, respectively,for the six months ended June 30, 2022, and used cash in operations of $0.8approximately $5.9 million and $0.6 million at March 31, 2019 and 2018, respectively, in its operations.for the six months ended June 30, 2022. The Company expects to continue to incur significant expenditures to develop and expand its owned and managed outpatient medical clinics.

Management recognizes that the Company must obtain additional resources to successfully integrate its acquired and managed clinics and implement its business plans. Through December 31, 2018, the Company had received funding in the form of indebtedness. Subsequent to December 31, 2018, the Company completed an initial public offering of 850,000 units, in which the Company received aggregate gross proceeds of approximately $4.3 million and extinguished liabilities of approximately $7.2 million. Management plans to continue to raise funds and/or refinance the Company’s indebtedness to support itsour operations in 20192022 and beyond. However, no assurances can be given that the Companywe will be successful. If management is not able to timely and successfully raise additional capital, and/or refinance indebtedness, the implementation of the Company’s business plan, financial condition and results of operations will be materially affected. These condensed consolidated financial statements do not include any adjustments relating to the recoverability and classification of recorded asset amounts and classification of liabilities that might be necessary should the Company be unable to continue as a going concern.

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Note 4 – Concentration of Credit Risks

Cash

The Company maintains its cash in accounts at financial institutions, which may, at times, exceed federally-insured limits of $250,000. $250,000.

Revenue and Accounts Receivable

As of March 31, 2019June 30, 2022 and December 31, 2018,2021, the Company had $2,536,458 and $0, respectively, of cash in excess of federally insured limits. The Company has not experienced any losses on such accounts and does not feel it is exposed to any significant risk with respect to cash.

Revenue and Accounts Receivable

The Company had the following revenue and accounts receivable concentrations:

Schedule of Concentration Risk

  March 31, 
  2019  2018 
  % of Revenue  % of Accounts Receivable  % of Revenue  % of Accounts Receivable 
     (unaudited)    
Patient payment  54%  54%  64%  64%
Medicare payment  22%  22%  13%  13%
Insurance payment  24%  24%  23%  23%
Total  100%  100%  100%  100%
  

June 30,

2022

  

December 31,

2021

 
  

% of

Revenue

  

% of

Accounts

Receivable

  

% of

Revenue

  

% of

Accounts

Receivable

 
  (Unaudited)       
Medicare  27%  23%  37%  16%

Note 5 – Accounts Receivable

AccountsAs of June 30, 2022 and December 31, 2021, the Company’s accounts receivable consisted of the following at March 31, 2019 and December 31, 2018:following:

Schedule of Accounts Receivable

  

June 30,

2022

  

December 31,

2021

 
  (Unaudited)    
Gross accounts receivable $3,135,996  $1,290,312 
Less: allowance for doubtful accounts  (80,979)  (80,979)
Accounts receivable, net $3,055,017  $1,209,333 

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  March 31, 2019  December 31, 2018 
  (unaudited) 
Gross accounts receivable $727,976  $314,185 
Less: allowance for doubtful accounts        
and contractual adjustments  (62,896)  (10,555)
Accounts receivable, net $665,080  $303,630 

Note 6 – Business Acquisitions

IMAC Florida

During June 2018,In February 2021, the Company completed the acquisition of and signed Management Services Agreement with Willmitch Chiropractic, P.A. in Tampa, Florida. The transaction was completed for $421,000. Willmitch Chiropractic’s founder, Martin Willmitch, will remain with the Company and serve as Vice President of Managed Care of IMAC Holdings. A total of $7,400 was allocated to property and equipment with the remaining $413,600, being allocated to goodwill.

In March 2021, the Company completed the asset purchase of NHC Chiropractic, PLLC dba Synergy Healthcare in Orlando, Florida. The transaction was completed as an asset purchase for $142,500. A total of $149,720 was allocated to property and equipment and $7,220 being allocated to acquired CMApayables.

In June 2021, the Company completed an asset purchase of KentuckyFort Pierce Chiropractic in Fort Pierce, Florida. The transaction was completed as an asset purchase for $50,000. A total of $45,000 was allocated to property and equipment with the remaining $5,000 being allocated to customer lists.

IMAC St. LouisChicago

In June 2021, the Company also completed an asset purchase of Active Medical Center in Naperville, Illinois. The transaction was completed as an asset purchase for aggregate consideration$205,000. A total of approximately $6.1 million$200,000 was allocated to be paid in equity. The operating results of these two companies have been includedproperty and equipment with the remaining $5,000 being allocated to deposits.

IMAC Louisiana

In October 2021, the Company consummated certain transactions resulting in the Company’s consolidated financial statements from their dates of acquisition. The Company accounted for the transactions as business combinations, and has allocated the purchase consideration to the net assets acquired based on estimated fair values.

In addition, during June 2018, the Company acquired the non-controlling interest held in its majority-owned subsidiary IMAC Nashville for $300,000 to be paid in equity.

During August 2018, the Company acquired Advantage Therapy and BioFirma for aggregate consideration of approximately $900,000 to be paid in cash and equity. The operating results of these two companies have been included in the Company’s consolidated financial statements from their dates of acquisition. The Company accounted for the transactions as business combinations, and has allocated the purchase consideration to the net assets acquired based on estimated fair values.

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IMAC Kentucky

On June 29, 2018, IMAC Management completed a merger of CMA of KY into IMAC Management. Pursuant to this merger, IMAC Management has a long-term MSA to provide exclusive comprehensive management and related administrative services to IMAC Kentucky, an entity engaged in the practice of medicine through physicians and nurse practitioners. Under the IMAC Kentucky MSA, the Company receives service fees based on the cost of the services provided, plus a specified markup percentage, and a discretionary annual bonus.

The Company has included the consolidated financial results of IMAC Kentucky in its consolidated financial statements from the date of acquisition.

IMAC St. Louis

On June 1, 2018, the Company acquired the remaining 64% membership interest in IMAC St. Louis not already owned by it pursuant to a Unit Purchase Agreement, increasing the Company’s ownership to 100%. IMAC St. Louis operates two (2) Ozzie Smith Centers in Missouri. Pursuant to the terms of the Unit Purchase Agreement, the Company agreed to pay the current owners, upon the closing of the Company’s initial public offering, an amount equal to 1.05 times the total collections from payments at the IMAC St. Louis centers on account of regeneration-related services and associated products from the period from June 1, 2017 to May 31, 2018, or $1,490,632. The purchase consideration will be payable in the form of shares of our common stock based on the price per share of the Company’s common stock in the Company’s initial public offering. See Note 13.

The Company has included the financial results of IMAC St. Louis in its consolidated financial statements from June 1, 2018, the date of acquisition.

IMAC Nashville

Also on June 1, 2018, the Company acquired the remaining 25%acquisition of the outstanding units of the limited liability company membership interests not already owned by theequity interest in Louisiana Orthopaedic & Sports Rehab Institute, Inc, (the “Louisiana Acquisition”). The transaction was completed for $1,200,000 and $1,200,000 stock.

The Company in IMAC Nashville for $300,000 which was paid in shares of our common stock based on the price per share of the Company’s common stockis in the Company’s initial public offering. See Note 13.

Advantage Therapy

On August 1, 2018, the Company entered into an agreementprocess of completing its formal valuation analysis to purchase all outstanding membership units of Advantage Therapy. The purchase price for the interests was equal to the dollar amount represented by 0.7 times the total collections from payments for service in Advantage Therapy’s account from June 1, 2017 to May 31, 2018, or approximately $892,000, of which $870,000identify and $22,000 and were payable in equity and cash, respectively. See Note 13.

The Company has included the financial results of Advantage Therapy in its consolidated financial statements from August 1, 2018, the date of acquisition.

BioFirma

On August 1, 2018, the Company entered into an agreement to purchase 70% of all outstanding membership units of BioFirma LLC. The purchase price for the interests was $1,000 paid in cash. BioFirma owns a trademark on NeoCyte, an umbilical cord-derived mononuclear cell product following FDA cGMP regulations. The Company has committed to further research and development of NeoCyte and other regenerative medicine products.

The Company has included the financial results of BioFirma in its consolidated financial statements from August 1, 2018, the date of acquisition.

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The following table summarizesdetermine the fair value of consideration paid andidentifiable tangible assets acquired related to this acquisition. Thus, the final allocation of the purchase price may differ from this preliminary allocation, based on completion of the valuation of the identifiable intangible assets. A total of $192,500 has been allocated to property and equipment with the fair value of net assets acquired forremaining $2,207,500 allocated to goodwill. Changes in the business acquisitions:estimated valuation will likely result in adjustments to goodwill. The Company does not expect the adjustments to be material.

  IMAC Kentucky  IMAC St. Louis  Advantage
Therapy
  BioFirma 
Property & equipment $607,257  $-  $18,647  $- 
Intangible Assets  4,224,113   264,000   37,000   1,429 
Goodwill  -   1,327,507   713,189   - 
Other assets  5,521   -   255,018   - 
Current liabilities  (119,902)  -   (50,948)  - 
Noncurrent liabilities  (118,413)  -   (79,975)  - 
Non-controlling interest  -   -   -   (429)
  $4,598,576  $1,591,507  $892,931  $1,000 

Note 7 – Property and Equipment

The Company’s property and equipment consisted of the following:following at June 30, 2022 and December 31, 2021:

Schedule of Property and Equipment

 Estimated March 31, December 31,  

Estimated

Useful Life in Years

 

June 30,

2022

 

December 31,

2021

 
 Useful Life in Years 2019 2018        
     
Land and Building 40 $1,175,000  $1,175,000 
Leasehold improvements Shorter of asset or lease term  1,614,778   1,427,828  Shorter of asset or lease term $2,302,421  $2,127,762 
Equipment 1.5 - 7  1,557,646   1,180,093  1.5 - 7  2,968,621   2,810,028 
Total property and equipment  4,347,424   3,782,921     5,271,042   4,937,790 
          
Less: accumulated depreciation  (1,126,241)  (449,283)    (3,238,905)  (2,990,902)
Property and equipment    2,032,137   1,946,888 
Construction in progress    17,937   376,275 
Total property and equipment, net $3,221,183  $3,333,638    $2,050,074  $2,323,163 

In March 2018, the Company purchased real estate in Lexington, Kentucky for the development of an IMAC facility forDepreciation expense was approximately $1.2 million. The Company funded the purchase with a note payable. See Note 11.

Depreciation was $154,881$238,000 and $31,268$171,000 for the three months ended March 31, 2019June 30, 2022 and 2018,2021, respectively and approximately $473,000 and $335,000 for the six months ended June 30, 2022 and 2021, respectively.

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Note 8 – Intangibles Assets and Goodwill

The Company’s intangible assets that were acquired in connection withand goodwill consisted of the business acquisition transactions (Note 6) during 2018 were as follows:following at June 30, 2022 and December 31, 2021:

Schedule of Intangible Assets and Goodwill

    June 30, 2022 
  Estimated    Accumulated    
  Useful Life Cost  Amortization  Net 
            
Intangible assets:              
Management service agreements 10 years $7,940,398  $(2,897,438) $5,042,960 
Non-compete agreements 3 years  306,000   (303,708)  2,292 
Brand development 10 years  69,071   (6,291)  62,777 
Total definite lived assets    8,315,469   (3,207,440)  5,108,029 
Research and development    243,750   -   243,750 
Goodwill    4,661,796   -   4,661,796 
Total intangible assets and goodwill   $13,221,015  $(3,207,440) $10,013,575 

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    December 31, 2018 
  Estimated    Accumulated    
  Useful Life Cost  Amortization  Net 
            
Intangible assets:              
Management service agreement 10 years $4,224,113  $(211,206) $4,012,907 
Non-compete agreements    301,000   (56,473)  244,527 
Definite lived assets 3 years  4,525,113   (267,679)  4,257,434 
Goodwill    2,042,125   -   2,042,125 
Total intangible assets and goodwill   $6,567,238  $(267,679) $6,299,559 

    March 31, 2019 
            
  Estimated      Accumulated     
  Useful Life  Cost   Amortization   Net 
               
Intangible assets:              
Management service agreement 10 years $4,224,113  $(316,808) $3,907,305 
Non-compete agreements    301,000   (81,557)  219,443 
Definite lived assets 3 years  4,525,113   (398,365)  4,126,748 
Goodwill    2,042,125   -   2,042,125 
Total intangible assets and goodwill   $6,567,238  $(398,365) $6,168,873 

    December 31, 2021 
  Estimated    Accumulated    
  Useful Life Cost  Amortization  Net 
            
Intangible assets:              
Management service agreements 10 years $7,940,398  $(2,500,418) $5,439,980 
Non-compete agreements 3 years  306,000   (302,458)  3,542 
Customer lists 3 years  134,882   (89,921)  44,961 
Brand development 15 years  69,071   (3,835)  65,236 
Total definite lived assets    8,450,351   (2,896,632)  5,553,719 
Research and development    243,750   -   243,750 
Goodwill    4,661,796   -   4,661,796 
Total intangible assets and goodwill   $13,355,897  $(2,896,632) $10,459,265 

Amortization was approximately $200,000 and $270,000 for the three months ended June 30, 2022 and 2021, respectively and approximately $412,000 and $529,000 for the six months ended June 30, 2022 and 2021, respectively. The Company’s estimated future amortization of intangible assets was as follows:

Schedule of Future Amortization of Intangible Assets

Years Ending December 31,   
    
2019 (nine months) $392,058 
2020  522,744 
2021  466,273 
2022  422,411 
2023  422,411 
Thereafter  1,900,851 
  $4,126,748 
Years Ending December 31,    
     
2022 (six months)  $400,572 
2023   799,686 
2024   798,645 
2025   798,645 
2026   798,645 
Thereafter   1,511,836 
Total  $5,108,029 

Note 9 – Operating Leases

Adoption of ASC Topic 842, Leases

On January 1, 2019, the Company adopted TopicASC 842 using the modified retrospective method applied to leases that were in place as ofat January 1, 2019. Results for reportingoperating periods beginning after January 1, 2019 are presented under TopicASC 842, while prior period amounts are not adjusted and continue to be reported in accordance with our historic accounting under TopicASC 840. The Company’s leases consistsconsist of operating leases that mostly relate to real estate rental agreements. AllMost of the value of the Company’s lease portfolio relates to a real estate lease agreements that were entered into starting March 2017.

Practical Expedients and Elections

The Company elected the package of practical expedients permitted under the transition guidance, which allowed us to carryforward our historical lease classification, our assessment on whether a contract is or contains a lease, and our initial direct costs for any leases that exist prior to adoption of the new standard. We also elected the short-term lease recognition exemption for all leases that qualify.

Discount Rate Applied to Property Operating LeaseLeases

To determine the present value of minimum future lease payments for operating leases at January 1, 2019, the Company was required to estimate a rate of interest that we would have to pay to borrow on a collateralized basis over a similar term an amount equal to the lease payments in a similar economic environment (the “incremental borrowing rate” or “IBR”).

The Company determined the appropriate IBR by identifying a reference rate and making adjustments that take into consideration financing options and certain lease-specific circumstances. For the reference rate of leases added as of June 30, 2022 and December 31, 2021, the Company used the ten year mortgagea weighted average interest rate.

15

 

Right of Use Assets

Right of use assets are included in the unaudited condensed consolidated Balance Sheet as follows:Total operating lease cost

Non-current assets   
Right of use assets, net of amortization $4,027,124 
     
Total operating lease cost    

Individual components of the total lease cost incurred by the Company iswere as follows:

Schedule of Operating Lease Cost

  

Three Months Ended

March 31, 2019

 
    
Operating lease expense $208,912 
     
Minimum rental payments under operating leases are recognized on a straight light basis over the term of the lease.    
  

Six Months

Ended

June 30, 2022

  

Six Months

Ended

June 30, 2021

 
         
Operating lease expense $830,373  $595,936 

Maturity of operating leases

Minimum rental payments under operating leases are recognized on a straight light basis over the term of the lease.

Maturity of operating leases

The Company’s amount of future minimum lease payments under operating leases are as follows:

  Operating Lease 
     
Undiscounted future minimum lease payments:    
2019 (remainder of year) $637,733 
2020  794,101 
2021  643,082 
2022  641,947 
2023  611,158 
Thereafter  1,100,783 
Total  4,428,803 
Amount representing imputed interest  (393,813)
Total operating lease liability  4,034,990 
Current portion of operating lease liability  (724,587)
Operating lease liability, non-current $3,310,403 

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Note 10 – LinesSchedule of CreditFuture Minimum Lease Payments

  

Operating

Leases

 
    
Undiscounted future minimum lease payments:    
2022 (six months) $842,325 
2023  1,612,648 
2024  1,223,487 
2025  869,279 
2026  576,741 
Thereafter  167,306 
Total  5,291,786 
Amount representing imputed interest  (502,979)
Total operating lease liability  4,788,807 
Current portion of operating lease liability  (1,470,241)
Operating lease liability, non-current $3,318,566 

IMAC Nashville had a $150,000 line of credit with a financial institution that matured on October 15, 2018. The line bore interest at 6.50% per annum. The line is secured by substantially all of the Company’s assets and personally guaranteed by the members. The LOC had a $150,000 balance at December 31, 2018. The line of credit was repaid in February 2019.

IMAC Kentucky has a $150,000 line of credit with a financial institution that matured on August 1, 2018. The line bears interest at 4.25% per annum. The line was secured by substantially all of the IMAC Kentucky’s assets and personally guaranteed by the members. The LOC had a $150,000 balance at December 31, 2018 and $150,000 (unaudited) at March 31, 2019.

Advantage Therapy has a $100,000 line of credit with a financial institution that matures on November 20, 2020. The line bears interest at a variable rate which is currently 6.0% per annum. The line is secured by substantially all of IMAC Holding’s assets. The LOC had a $79,975 balance at December 31, 2018 and $79,961 at March 31, 2019.

Note 11-Notes Payable

  

March 31,

2019

  December 31,
2018
 
       
Note payable to The Edward S. Bredniak Trust in the amount of up to $2,000,000. An existing note payable with this entity in the amount of $379,676 has been combined into the new note payable. The note carries an interest rate of 10% per annum and all outstanding balances are due and payable December 31, 2019. $1,684,426  $1,584,426 
         
Note payable to a financial institution in the amount of $200,000 dated November 15, 2017. The note requires 66 consecutive monthly installments of $2,652 including principal and interest at 5%, with a balloon payment of $60,000 which was paid on June 15, 2018. The note matures on May 15, 2023, and is secured by the personal guarantees of the Company’s management.  119,259   125,670 
         
Convertible notes issued to various investors, which accrued interest at 4%, and converted to common stock in connection with the closing of the Company’s initial public offering. See Note 13. The notes were convertible to equity at or prior to maturity at a 20% discount to the per share price of a sale of equity securities. At the time of issuance of the convertible notes, the Company was unable to calculate the amount of a beneficial conversion (“BCF”) and related discount to be recorded until the occurrence of a qualified financing by the Company. Upon the closing of the Company’s initial public offering, the Company recognized the BCF and related interest charge associated with the discount, and the BCF has been classified as a liability to the extent it met the conditions for derivative treatment at the time of recognition.  -   1,540,000 
         
$1.2 million mortgage loan with a financial institution. The loan agreement is for 6-months and carries an interest rate 3.35%. The loan matured in 2018 and was extended to 2019. It is currently interest only and is now on a month to month basis.  1,232,500   1,232,500 
         
Note payable to a financial institution in the amount of $131,400 dated August 1, 2016. The note requires 120 monthly installments of $1,394 including principal and interest at 5%. The note matures on July 1, 2026 and is secured by a letter of credit.  102,498   105,374 
         
Note payable to a financial institution in the amount of $200,000 dated May 4, 2016. The note requires 60 monthly installments of $3,881 including principal and interest at 4.25%. The note matures on May 4, 2021 and is secured by the equipment and personal guarantees of the Company’s management.  96,232   106,778 
         
Note payable to an employee in the amount of $101,906 dated March 8, 2017. The note requires 5 annual installments of $23,350 including principal and interest at 5%. The note matures on December 31, 2021 and is unsecured.  60,000   60,000 
         
Note payable to a financial institution in the amount of $133,555 dated September 17, 2014. The note requires 60 monthly installments of $2,475 including principal and interest at 4.25%. The note matures on September 17, 2019.  14,625   21,845 
   3,309,540   4,776,593 
Less: current portion:  (3,032,686)  (4,459,302)
  $276,854  $317,291 

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Note 10 – Notes Payable

Set forth below is a summary of the Company’s outstanding debt as of June 30, 2022 and December 31, 2021:

Schedule of Notes Payable

  June 30,  December 31, 
  2022  2021 
       
       
 $28,443  $43,413 
Note payable to a financial institution in the amount of $200,000 dated November 15, 2017. The note requires 66 consecutive monthly installments of $2,652 including principal and interest at 5%, with a balloon payment of $60,000 which was paid on June 15, 2018. The note matures on May 15, 2023, and is secured by the personal guarantees of certain Company executives. $28,443  $43,413 
         
Note payable to a financial institution in the amount of $131,400 dated August 1, 2016. The note requires 120 monthly installments of $1,394 including principal and interest at 5%. The note matures on July 1, 2026, and is secured by a letter of credit.  61,655   68,378 
         
$112,800 payable to a landlord of Advantage Therapy, LLC pursuant to a lease dated March 1, 2019. The debt is payable in 60 monthly installments of $2,129, including principal and interest at 5%. The debt matures on June 1, 2024.  48,521   59,913 
         
Note payable to a financial institution in the amount of $140,000, dated September 25, 2019. The note requires 36 consecutive monthly installments of $4,225 including principal and interest at 5.39%. The note matures on September 19, 2022 and is secured by a personal guarantee of the Vice President of Business Development of the Company.  12,561   37,179 
         
Note payable in the amount of $2,690,000, dated October 29, 2020. The note was repaid January 2022. The interest on the note accrued at a rate of 7% per annum.  -   150,301 
         
Notes payable  151,180   359,184 
Less: current portion:  (78,618)  (254,487)
Notes payable, net of current portion $72,562  $104,697 

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Principal maturities of the Company’s notes payable are as follows:

Schedule of Principal Maturities of Notes Payable

Years Ending December 31, Amount  Amount 
      
2019 (nine months) $3,012,357 
2020  104,435 
2021  80,968 
2022  43,935 
2022 (six months)  $46,484 
2023  27,404    51,657 
2024   27,631 
2025   15,813 
2026   9,595 
Thereafter  40,441    - 
Total $3,309,540   $151,180 

Note 1211Related Party TransactionsStockholders’ Equity

From time to time,On October 5, 2020, the Company advances fundslaunched an at-the-market offering of up to and receives funds from, entities with common ownership. At December 31, 2018 and March 31, 2019, the amount owed to related parties was $0.

The Company contracted with SpeakLife to provide staff training and patient advocacy services for $99,000 per year. SpeakLife is owned by the Company’s Executive Vice President$5,000,000 worth of Clinical Operations. This contract was terminated on June 30, 2018.

The Company contracted with UCI to provide marketing services to chiropractic practitioners and sources opportunities to expand chiropractic practices into regenerative medicine for $144,000 per year. UCI is owned by the spouseshares of the Company’s Chief Operations Officer. This contract was terminated oncommon stock pursuant to an At-The-Market Issuance Sales Agreement, dated October 5, 2020, by and between the Company and Ascendiant Capital Markets, LLC. Since the launch and as of June 30, 2018.

Note 13 – Shareholders’ Equity

Prior2022, pursuant to the Company’s conversion to a corporation,Agreement, the Company had 400 member units authorized with 365 units issued and outstanding.

On June 1, 2018, the Company converted its 365 outstanding member units into 6,582,737sold 2,346,502 shares of common stock with a $0.001 par value pursuantthrough Ascendiant Capital Markets for aggregate proceeds to the Company’s conversion from a limited liability company to a corporation.Company of $3.7 million. The conversion has been given retrospective treatment.Company sold 804,744 shares during the six months ended June 30, 2022 for an aggregate amount of approximately $830,000 and 634,676 shares during the six months ended June 30, 2021.

On February 12, 2019, the Company reverse split its 6,582,737 shares of common stock outstanding to 4,533,623 shares of common stock outstanding pursuant to an amendment of the Company’s certificate of incorporation. The reverse split has been given retrospective treatment.

During February 2019,March 2021, the Company completed an initiala public offering of securities and issued 850,000 shares of its common stock, along with 1,700,000 warrants to purchase common stock and an option to purchase 34,000by issuing 10,625,000 shares of common stock for gross proceeds of $4,356,815.$17.0 million and incurring $1.2 million in expenses related to public offering. The Company also issued 449,217used approximately $1.8 million for the repayment of certain indebtedness and is using the remaining proceeds for the repayment of certain other indebtedness, to finance the costs of developing and acquiring additional outpatient medical clinics and healthcare centers as part of the Company’s growth and expansion strategy and for working capital.

On April 7, 2021 the Company closed on the sale of an additional 1,193,750 shares of common stock forat the conversionpublic offering price of its 4% convertible notes and 1,410,183 shares$1.60 per share, pursuant to satisfy deferred acquisition consideration payablethe 15% over-allotment option exercised in full by the underwriters in connection with its public offering that closed March 2021. The Company received gross proceeds of $1.91 million and incurred approximately $115,000 in additional expenses.

On October 1, 2021, the Company completed a stock purchase agreement and issued 810,811 shares of its common stock as consideration. This transaction was part of the $1,200,000 in stock consideration for the Louisiana Acquisition.

2018 business acquisitions.Incentive Compensation Plan

The Company’s board of directors and holders of a majority of outstanding shares approved and adopted the Company’s 2018 Incentive Compensation Plan (“2018 Plan”) in May 2018, reserving the issuance of up to 1,000,000 shares of common stock (subject to certain adjustments) upon exercise of stock options and grants of other equity awards. The 2018 Plan provides for the grant of incentive stock options (“ISOs”), nonstatutory stock options, stock appreciation rights, restricted stock awards, restricted stock unit awards, performance-based stock awards, other forms of equity compensation and performance cash awards. ISOs may be granted only to employees. All other awards may be granted to employees, including officers, and to the Company’s non-employee directors and consultants, and affiliates.

1718

 

Stock Options

As of June 30, 2022, the Company had issued and outstanding stock options to purchase 343,707 shares of its common stock as non-qualified stock options to various employees of the Company. Most options vest over a period of four years, with 25% vesting after one year and the remaining 75% vesting in equal monthly installments over the following 36 months and are exercisable for a period of ten years. One award granted in 2021 vests over a period of one year and is exercisable for a period of ten years. Stock based compensation for stock options is estimated at the grant date based on the fair value calculated using the Black-Scholes method. The per-share fair values of these options is calculated based on the Black-Scholes-Merton pricing model.

Restricted Stock Units

On May 21, 2019, the Company granted an aggregate of 277,500 Restricted Stock Units (“RSUs”) to certain employees, executives and directors of the Company, the terms of which vest over various periods between the date of grant and May 21, 2023. On August 13, 2019, 30,000 shares of common stock were issued pursuant to previously granted RSUs which had vested as of such date.

On October 20, 2020, the Company granted an aggregate of 300,000 RSUs to Board members with these RSUs vesting in eight equal quarterly installments commencing on February 1, 2021, provided the Board members remain directors of the Company. Effective October 2021, the vesting schedule was amended to a one-year vesting period. As of March 31, 2022, all these granted RSUs were vested and issued to the Board members.

On January 30, 2021, the Company granted an aggregate of 17,000 RSUs to non-executive staff and contractors with these RSUs vesting after one year. As of March 31, 2022, all these granted RSUs were vested and issued.

On October 27, 2021, the Company granted 10,000 RSUs to a consultant that vested immediately.

On February 21, 2022, the Company granted 100,000 RSUs to an executive that vested immediately.

Note 1412Retirement Plan

The Company offers a 401(k) plan that covers eligible employees. The plan provides for voluntary salary deferrals for eligible employees. Additionally, the Company is required to make matching contributions of 100% up to 3% and 50% of up to 6 %the next 2% of total compensation for those employees making salary deferrals. The Company made contributions of $7,407 approximately $36,000 and $0 $35,000 during the three months ended MarchJune 30, 2022 and 2021, respectively, and approximately $71,000 and $69,000 during the six months ended June 30, 2022 and 2021, respectively.

Note 13 – Income Taxes

ASC 740 requires a valuation allowance to reduce the deferred tax assets reported if, based on the weight of all available positive and negative evidence, it is more likely than not that some portion or all of the deferred tax assets will not be realized. Management assessed all available evidence to estimate if sufficient future taxable income will be generated in the appropriate period and of the appropriate character to realize deferred tax assets. For the three and six months ended June 30, 2022 and June 30, 2021, no income tax expense or benefit was recorded related to income taxes due to the Company’s overall operating results and the full valuation allowance.

The Company performed a comprehensive review of its uncertain tax positions and determined that no adjustments were necessary relating to unrecognized tax benefits as December 31, 20192021. As of June 30, 2022, the Company had no unrecognized tax benefits recorded. The Company is subject to taxation by federal, state, and 2018, respectively.

Note 15 – Income Taxes

local taxing authorities. The Company’s provision for income taxes differs from the amount computed by applying the statutory federal, state, and local income tax ratereturns are subject to income before provisionexamination by taxing authorities for income taxes. The sourcesthree years after the returns are filed, and tax effects of the differences are as follows:

Deferred tax benefit at the federal statutory rate21%
Valuation allowance-21%
0%

At March 31, 2019, the Company has a net operating loss carryforward of approximately $3.7 million forCompany’s federal, state, and state purposes. This loss will be available to offset future taxable income. If not used, this carryforward will begin to expire in 2029. The deferred tax asset relating to the operating loss carryforward has been fully reserved at March 31, 2019. The principal differences between the operating loss forlocal income tax purposes and reporting purposes are shares issuedreturns for services and share-based compensation and a temporary difference in depreciation expense.2018 through 2020 remain open to examination.

19

Note 1614Commitments and Contingencies

The Company is subject to extensive regulation,accrues a liability and charges operations for the estimated costs of contingent liabilities, including health insurance regulations directed at ascertaining the appropriatenessadjudication or settlement of reimbursement, preventing fraudvarious asserted and abuse and otherwise regulating reimbursement. To ensure compliance, various insurance providers often conduct audits and request patient records and other documents to supportunasserted claims submitted by the Company for payment of services rendered to customers. In the event that an audit results in discrepancies in the records provided, insurance providers may be entitled to extrapolate the resultsexisting as of the audit to make overpayment demands based on a wider population of claims than those examined in the audit.

The Company is subject to threatened and asserted various legal proceedings in the ordinary course of business. The outcome of any legal proceeding is not within the Company’s complete control, it is often difficult to predict and is resolved over very long periods of time. Estimating probable losses associated with any legal proceedings or other loss contingencies are very complex and require the analysis of many factors including assumptions about potential actions by third parties. Loss contingencies are disclosed whenbalance sheet date, where there is at least a reasonable possibility that a loss has been incurred and are recorded as liabilitiesthe loss (or range of probable loss) is estimable.

From time to time the Company may become subject to threatened and/or asserted claims arising in the condensed consolidated financial statements when it is both (1) probable or known that a liability has been incurred and (2)ordinary course of our business. Other than the amount of the loss is reasonably estimable. If the reasonable estimate of the loss is a range and no amount within the range is a better estimate, the minimum amount of the range is recorded as a liability. If a loss contingencymatter described below, management is not probableaware of any matters, either individually or cannot be reasonably estimated, a liability is not recorded in the financial statements.

In February 2019, the Company was made aware of a lawsuit involving a contract dispute with BioFirma. Management believes the ultimate resolution of this matter will notaggregate, that are reasonably likely to have a material impact on the Company’s financial condition, or results of operations.operations or liquidity.

18

Third Party Audit

From time to time, in the ordinary course of business, we are subject to audits under various governmental programs in which third party firms engaged by the Center for Medicare & Medicaid Services (“CMS”) conduct extensive reviews of claims data to identify potential improper payments. We cannot predict the ultimate outcome of any regulatory reviews or other governmental audits and investigations.

On June 3, 2021, the Company received a request for payment from CMS in the amount of $2,918,472. The Company initiated the appropriate appeals and then the Company received a notification dated September 30, 2021, from CMS that they “found the request to be favorable by reversing the extrapolation to actual”. The Company received a separate notification stating “the extrapolated overpayment was reduced to the actual overpayment amount for the sampled denied claims $5,327.73,” which was paid in 2021.

This amount represented a statistical extrapolation of $11,530 of charges from a sample of 40 claims for the periods February 2017 to November 2020. The Company began its own internal audit process and disagrees with the interpretation of the medical records and the extrapolation techniques used to derive the balance. The Company continued the appeals process to the second level appeal related to the error rate and are anticipating a third appeal on the remaining $5,327.73 amount. As of June 30, 2022 this had been settled for approximately $5,000.

On October 21, 2021, the Company received notification from Covent Bridge Group, a Center for Medicare & Medicaid Services (“CMS”) contractor, that they are recommending to CMS that the Company was overpaid in the amount of $2,716,056.33. This amount represents a statistical extrapolation of $6,791.33 of charges from a sample of 38 claims for the periods July 2017 to November 2020 for Progressive Health & Rehabilitation, Ltd (“Progressive Health”). The Company entered into a management agreement with Progressive Health in April 2019 and therefore liable for only a portion of the sampled claims. There were a total of 38 claims reviewed, 25 of these claims were from the period prior to the management agreement with the Company and the remaining 13 claims were related to the period that Progressive Health was managed by the Company. In December 2021, the Company received a request for payment from CMS in the amount of $2,709,265. The Company has begun its own internal audit process and has initiated the appropriate appeals.

On May 17, 2022, the Company received notification from Covent Bridge Group, a Center for Medicare & Medicaid Services (“CMS”) contractor, that they are recommending to CMS that the Company was overpaid in the amount of $492,086.22 related to Advantage Therapy. This amount represents a statistical extrapolation of charges from a sample. On May 27, 2022 the Company received a request for payment from CMS in the amount of $481,666.00. The Company has begun its own internal audit process and has initiated the appropriate appeals.

Prior to this May 2022 notification, CMS had implemented a pre-payment audit for Advantage Therapy. As of June 30, 2022, this audit had resulted in a balance of approximately $350,000 of Medicare accounts receivable.

At this stage of the appeals process, based on the information currently available to the Company, the Company is unable to predict the timing and ultimate outcomes of these matters and therefore is unable to estimate the range of possible loss. Any potential loss may be classified as errors and omissions for which insurance coverage was in place during a majority of the years being evaluated.

As of June 30, 2022, the Company has not recorded a provision for either of these claims, as management does not believe that an estimate of a possible loss or range of loss can reasonably be made at this time.

Note 17 – 15 - Subsequent Events

On April 1, 2019,July 6, 2022, the Company entered into an Agreement and PlanCompany’s shareholders approved the Board of Merger (the “Merger Agreement”) forDirectors’ proposal to increase the acquisitionnumber of a practice management group that manages three clinics in the Chicago, Illinois area. On April 19, 2019, the Company entered into an Amendment to the Merger Agreement (the “Amendment”), effective as of April 19, 2019 at 12:05 a.m., with IMAC Management of Illinois, LLC, an Illinois limited liability company (“Merger Sub”), ISDI Holdings, Inc., an Illinois corporation (“ISDI Holdings I”), ISDI Holdings II, Inc., an Illinois corporation (“ISDI Holdings II”), PHR Holdings, Inc., an Illinois corporation (“PHR Holdings”), and Jason Hui, sole shareholder of each of ISDI Holdings II and PHR Holdings (the “Shareholder”), in order to amend the Agreement, executed on April 1, 2019 by and among the Company, Merger Sub, ISDI Holdings I and the Shareholder, to remove ISDI Holdings I as a party to the Agreement and, in its place, add ISDI Holdings II and PHR Holdings as parties to the Agreement and provide for the merger of each of ISDI Holdings II and PHR Holdings with and into Merger Sub (the “Merger”) on the terms and conditions set forth in the Agreement.

The Merger was completed on April 19, 2019, with Merger Sub remaining as the surviving entity. Pursuant to the Agreement, as amended by the Amendment, at the effective time of the Merger (the “Effective Time”), each of ISDI Holdings II and PHR Holdings’ issued and outstanding shares of common stock were cancelled and were converted automatically into the right of the Shareholder to receive 1,002,306 restrictedauthorized shares of the Company’s common stock (the “Merger Consideration”)to 60,000,000 shares from 30,000,000 shares.

On July 26, 2022, the Company announced that its board of directors has initiated an exploration of strategic alternatives. As part of this process, the board will consider a wide range of options for the company including, among other things, a potential merger, spinoff sale, or other strategic transaction for one or more of its key business units or assets.

On August 3, 2022, the Company announced that effective August 8, 2022 the Company’s ticker symbol on the NASDAQ Stock Exchange changed from “IMAC” to “BACK”. The Merger Consideration was issuedCompany’s common stock remains listed on NASDAQ and its CUSIP number remained unchanged.

On August 12, 2022, the Company entered into a securities purchase agreement (the “Securities Purchase Agreement”) with institutional accredited investors (the “Purchasers”) pursuant to which the Company offered for sale to the Shareholder andPurchasers an aggregate of 5,164,474 shares (the “Shares”) of its common stock at a trust designated by the Shareholder on April 22, 2019. Representations were made to the Company regarding such share recipients’ knowledge and experience, ability to bear economic risk and investment purpose with respect to the restricted shares they received. The Merger Consideration was issuedpurchase price of $0.76, in reliance on an exemption from the registration requirements of the Securities Act of 1933, as amendeda registered direct offering (the “Securities Act”“Registered Direct Offering”), provided by Section 4(a)(2) of the Securities Act as. In a concurrent private offering. Such issuance did not involve a public offering, and was made without general solicitation or advertising.

In connection with the completion of the Merger,placement, the Company also entered intoagreed to issue to the investors Series 1 warrants to purchase 5,164,474 shares of common stock that will become exercisable on the date that is six months following the date of issuance of the shares of common stock in the Registered Direct Offering (the “Exercise Date”) and expire on the five year anniversary of the Exercise Date, at an employment agreementexercise price of $0.95 per share, and Series 2 warrants to purchase 5,164,474 shares of common stock that will become exercisable on the Exercise Date and expire on the one year anniversary of the Exercise Date, at an exercise price of $0.95 per share. The Shares were offered by the Company pursuant to its shelf registration statement on Form S-3 (File No. 333-237455) originally filed with Dr. Jason Hui,the SEC on March 27, 2020 (as amended, the “Registration Statement”), which was declared effective ason April 3, 2020. The transactions are expected to close on or about August 16, 2022. The Company anticipates gross proceeds of April 19, 2019both transactions to be approximately $3.9 million. The Company intends to use the net proceeds from this offering for working capital and extends for a term expiring on March 31, 2022. Pursuant to his employment agreement, Dr. Hui has agreed to devote substantially allother general corporate purposes, including financing the costs of his business time, attention and ability, toimplementing the Company as our Executive Vice President of Development. The employment agreement provides that Dr. Hui will receive a base salary at a rate of $350,000 per year through March 31, 2020, a base salary at a rate of $355,000 per year from April 1, 2020 through March 31, 2021 and a base salary at a rate of $360,000 per year for the period of April 1, 2021 through March 31, 2022.Company’s strategic alternative activities.

1920

 

ITEM 2.MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

This management’sThe following discussion and analysis of financial condition and results of operations (“MD&A”), contains forward-looking statements that involve risks and uncertainties. Please see “Important Information Regarding Forward-Looking Statements” for a discussion of the uncertainties, risks, and assumptions that may cause ourOur actual results tocould differ materially from those discussedanticipated in these forward-looking statements as a result of various factors, including those set forth previously under the forward-looking statements.caption “Risk Factors.” This discussionManagement’s Discussion and Analysis of Financial Condition and Results of Operations should be read in conjunction with our unaudited condensed consolidated financial statements and related notes thereto and the other disclosures contained elsewhere in this Quarterly Report on Form 10-Q, and the audited consolidated financial statements and related notes thereto for the fiscal year ended December 31, 2018, which were included elsewhere in our Form 10-K, filed with the SEC on April 16, 2019.this report.

The results of operations for the periods reflected herein are not necessarily indicative of results that may be expected for future periods.

References in this MD&A to “we,” “us,” “our,” “our company,” “our business” and “IMAC Holdings” are to IMAC Holdings, Inc., a Delaware corporation and prior to the Corporate Conversion (defined below), IMAC Holdings, LLC, a Kentucky limited liability company, and in each case, theirthe following entities which are consolidated subsidiaries.due to direct ownership of a controlling voting interest or other rights granted to us as the sole general partner or managing member of the entity: IMAC Regeneration Center of St. Louis, LLC (“IMAC St. Louis”), IMAC Management Services, LLC (“IMAC Management”), IMAC Regeneration Management, LLC (“IMAC Texas”) IMAC Regeneration Management of Nashville, LLC (“IMAC Nashville”) IMAC Management of Illinois, LLC (“IMAC Illinois”), Advantage Hand Therapy and Orthopedic Rehabilitation, LLC (“Advantage Therapy”), IMAC Management of Florida, LLC (“IMAC Florida”), Louisiana Orthopaedic & Sports Rehab (“IMAC Louisiana”) and The Back Space, LLC (“BackSpace”); the following entity which is consolidated with IMAC Regeneration Management of Nashville, LLC due to control by contract: IMAC Regeneration Center of Nashville, PC (“IMAC Nashville PC”); the following entities which are consolidated with IMAC Management of Illinois, LLC due to control by contract: Progressive Health and Rehabilitation, Ltd., Illinois Spine and Disc Institute, Ltd. and Ricardo Knight, P.C.; the following entities which are consolidated with IMAC Management Services, LLC due to control by contract: Integrated Medicine and Chiropractic Regeneration Center PSC (“Kentucky PC”) and IMAC Medical of Kentucky, PSC; the following entities which are consolidated with IMAC Florida due to control by contract: Willmitch Chiropractic, P.A. and IMAC Medical of Florida, P.A.; the following entity which is consolidated with Louisiana Orthopaedic & Sports Rehab due to control by contract: IMAC Medical of Louisiana, a Medical Corporation; and the following entities which are consolidated with BackSpace due to control by contract: ChiroMart LLC, ChiroMart Florida LLC, and ChiroMart Missouri LLC.

 

Overview

We are a provider of movement and orthopedic therapies and minimally invasive procedures performed through our regenerative and rehabilitative medical treatments to improve the physical health of our patients at our fast-growing chain of IMAC Regeneration Centers and BackSpace clinics which we own or manage. Our outpatient medical clinics provide conservative, minimally invasive medical treatments to help patients with back pain, knee pain, joint pain, ligament and tendon damage, and other related soft tissue conditions. Our licensed healthcare professionals evaluate each patient and provide a custom treatment plan that integrates traditional medical procedures and innovative regenerative medicine procedures in combination with physical medicine. We do not use or offer opioid-based prescriptions as part of our treatment options in order to help our patients avoid the dangers of opioid abuse and addiction. The original IMAC Regeneration Center opened in Kentucky in August 2000 and remains the flagship location of our current business, which was formally organized in March 2015. To date, we have opened seven and acquired sevenfifteen outpatient medical clinics in Florida, Illinois, Kentucky, Missouri, TennesseeLouisiana and Illinois,Missouri, and plan to further expand the reach of our facilities to other strategic locations throughout the United States. We have partnered with several activeten BackSpace locations opened in Florida, Missouri and former professional athletes, including Ozzie Smith, David Price, Tony Delk and Mike Ditka, in the branding of our IMAC Regeneration Centers.Tennessee. Our outpatient medical clinics emphasize our focus around treating sports and orthopedic injuries as an alternative to traditional surgeries for repair or joint replacement.

Revenues

Our revenue mix is diversified betweenWe own our medical treatmentsclinics directly or have entered into long-term management services agreements to operate and physiological treatments. Our medical treatments are further segmented into traditional medical and regenerative medicine practices. For the last full fiscal year and the first quarter of 2019, traditional medical treatments comprised approximately 33%control certain of our total net patient revenues, while regenerativemedical clinics by contract. Our preference is to own the clinics; however, some state laws restrict the corporate practice of medicine accounted for approximately 31% ofand require a licensed medical practitioner to own the clinic. Accordingly, our total net patient revenues. Physiological treatments generated the remainder of our total net patient revenues as physical therapy amounted to 33% and chiropractic care at 3% of such revenues. We are an in-network provider for traditional physical medical treatments, such as physical therapy, chiropractic services and medical evaluations, with most private health insurance carriers. Regenerative medical treatments are typically not covered by insurance, but paid by the patient. For more information on our revenue recognition policies, see “Critical Accounting Policies and Estimates - Revenue Recognition.”

See the tables below for more information regarding our revenue breakdown by service type and payor.

  Three Months Ended March 31, 
  2019  2018 
       
Outpatient facilities revenues  100%  87.46%
Other services revenue(1)  -%  12.54%
         
Total  100.00%  100.00%

(1) Other is comprised of administrative and management fees prior to IMAC’s ownership.

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Outpatient Facility Revenue

  Three Months Ended March 31, 
  2019  2018 
Private insurance payors  24%  23%
Government payors  22%  13%
Patient payor  54%  64%
Other  -%  -%
Total  100.00%  100.00%

We recorded consolidated patient billings of $7,289,022 and $532,872 and realized total net patient revenues, less allowances for contractual adjustments with third-party payers, of $2,769,828 and $234,253 for the three months ended March 31, 2019 and 2018, respectively. Our net loss for the three months ended March 31, 2019 and 2018 was $1,599,187 and $404,664, respectively.

Procedures performed and visits to ourmanaged clinics are an indication of business activity. Procedures showed an increase of 1,383.5% for the quarter ended March 31, 2019 compared to the quarter ended March 31, 2018. Procedures increased from 5,011 in the quarter ended March 31, 2018 to 74,340 in the quarter ended March 31, 2019. Visits to our clinics showed an increase of 1,715.3% for the quarter ended March 31, 2019 compared to the quarter ended March 31, 2018. Visits increased from 1,698 in the quarter ended March 31, 2018 to 30,824 in the quarter ended March 31, 2019.

Corporate Conversion

Prior to June 1, 2018, we wereowned exclusively by a Kentucky limited liability company named IMAC Holdings, LLC. Effective June 1, 2018, we converted intomedical professional within a Delawareprofessional service corporation pursuant to a statutory merger (the “Corporate Conversion”) and changed our name to IMAC Holdings, Inc. All of our outstanding membership interests were exchanged on a proportional basis into shares of common stock of IMAC Holdings, Inc.

Following the Corporate Conversion, IMAC Holdings, Inc. continues to hold all of the property and assets of IMAC Holdings, LLC and all of the debts and obligations of IMAC Holdings, LLC continue(formed as the debts and obligations of IMAC Holdings, Inc. The purpose of the Corporate Conversion was to reorganize our corporate structure so that the top tier entity in our corporate structure is a corporation rather than a limited liability company or corporation) and so that our existing owners own sharesare under common control with us in order to comply with state laws regulating the ownership of our common stock rather than membership interests in a limited liability company. Except as otherwise noted herein,medical practices. We are compensated under management services agreements through service fees based on the condensed consolidated financial statements (unaudited) included herein are those of IMAC Holdings, Inc. and its consolidated subsidiaries.

Initial Public Offering

On February 15, 2019, we completed our initial public offering of 850,000 units, with each unit consisting one share of our common stock and two warrants each to purchase one share of our common stock, at a combined initial public offering price of $5.125 per unit. The exercise pricecost of the warrants is $5.00 per warrant. The units immediatelyservices provided, plus a specified markup percentage, and automatically separated upon issuance, and the common stock and warrants trade on The NASDAQ Capital Market under the ticker symbols “IMAC” and “IMACW,” respectively.

We received aggregate gross proceeds of $4,356,250 from our initial public offering, before deducting underwriting discounts, commissions and other related expenses. Proceeds from the offering will be used for financing the costs of leasing, developing and acquiring new clinic locations, funding research and new product development activities, and for working capital and general corporate purposes.

In addition, upon the closing of our initial public offering, we issued unit purchase options to Dawson James Securities, Inc., as representative of the several underwriters, and its affiliates entitling them to purchase a number of our securities equal to 4% of the securities solddiscretionary annual bonus determined in the initial public offering. The unit purchase options have an exercise price equal to 120%sole discretion of the public offering price of the units (or $6.15 per share and two warrants) and may be exercised on a cashless basis. The unit purchase options are not redeemable by us.each professional service corporation.

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Significant financial metrics

Significant financial metrics of the Company for the second quarter of 2022 are set forth in the bullets below.

Net patient revenue increased to $5.0 million for the second quarter of 2022 from $3.5 million for the second quarter of 2021.
Working capital is $809,000 as of June 30, 2022 compared to working capital of $4.1 million as of December 31, 2021.
Adjusted EBITDA1 of ($1.3 million) in the second quarter of 2022 compared to ($1.8 million) in the second quarter of 2021.
The Company had one-time expenses of $96,000, consisting of: $66,000 in post earn-out expense and $30,000 in one-time consulting fees.
(1)Adjusted EBITDA is a non-GAAP financial measure most closely comparable to the GAAP measure of net loss. See “Reconciliation of Non-GAAP Financial Matters” below for a full reconciliation of the GAAP and non-GAAP measures.

Impacts of and Response to COVID-19 Outbreak

The Company has been impacted by recent events such as inflation, the ongoing COVID-19 pandemic and supply chain delays. Our response plan has multiple facets and continues to evolve as events unfold. As a precautionary measure, we have taken steps to enhance our operational and financial flexibility to react to the risks the COVID-19 outbreak presents to our business.

The COVID-19 outbreak appears likely to cause significant economic harm across the United States, and the negative economic conditions that may result in reduced patient demand in our industry. We may experience a material loss of patients, revenue and market share as a result of the suspension of any operations. Initiatives to implement telehealth engagement with patients may not be adopted by existing and new patients. Patient habits may also be altered in the medium to long term. Negative economic conditions, a decrease in our revenue and consequent longer term trends harmful to our business may all exert pressure on our company during the pendency of emergency restrictions on our operations and beyond.

We cannot predict with certainty when public health and economic conditions will return to normal. A decline in patient visits in response to the COVID-19 outbreak, and the consequent loss of revenue and cash flow during this period may make it difficult for us to obtain capital necessary to fund our operations. Due to the impacts of economic events and COVID-19 we have seen an increase in recruiting and labor costs as well as delays in supply chain.

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Matters that May or Are Currently Affecting Our Business

We believe that the growth of our business and our future success depend on various opportunities, challenges, trends and other factors, including the following:

Our ability to identify, contract with, install equipment and operate a large number of outpatient medical clinics and attract new patients to them;
Our need to hire additional healthcare professionals in order to operate the large number of clinics we intend to open;
Our ability to enhance revenue at each facility on an ongoing basis through additional patient volume and new services;
Our ability to obtain additional financing for the projected costs associated with the acquisition, management and development of new clinics, and the personnel involved, if and when needed;
Our ability to attract competent, skilled medical and sales personnel for our operations at acceptable prices to manage our overhead; and
Our ability to control our operating expenses as we expand our organization into neighboring states.

Critical Accounting Policies and Estimates

The preparation of condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses at the date and for the periods that the condensed consolidated financial statements are prepared. On an ongoing basis, we evaluate our estimates, including those related to insurance adjustments and provisions for doubtful accounts. We base our estimates on historical experience and on various other assumptions that are believed to be reasonable under the circumstances. Actual results could materially differ from those estimates.

We believe that, of the significant accounting policies discussed in our Notes to the Condensed Consolidated Financial Statements (Unaudited), the following accounting policies require our most difficult, subjective or complex judgments in the preparation of our financial statements.

Revenue Recognition

Our patient service revenue is derived from minimally invasive procedures performed at our outpatient medical clinics and patient visits to physicians. The fees for such services are billed either to the patient or a third-party payer, including Medicare. We recognize patient service revenue, net of contractual allowances, which we estimate based on the historical trend of our cash collections and contractual write-offs in the period in which services are performed.

Other management service fees are derived from management services where we provide billings and collections support to the clinics and where management services are provided based on state specific regulations known as the corporate practice of medicine (“CPM”). Under the CPM, a business corporation is precluded from practicing medicine or employing a physician to provide professional medical services. In these circumstances, we provide all administrative support to the physician-owned professional corporation (“PC”) through a limited liability company. The PC is consolidated due to control by contract (an “SMA” or Service Management Agreement). The fees we derive from these management arrangements are based on a percentage mark-up on the costs of the LLC. We recognize other management service revenue in the period in which services are rendered. These revenues are eliminated in consolidation.

Patient Deposits

Patient deposits are derived from patient payments in advance of services delivered. Our service lines include traditional and regenerative medicine. Regenerative medicine procedures are not paid by insurance carriers; therefore, we typically require up-front payment from the patient for regenerative services and any co-pays and deductibles as required by the patient specific insurance carrier. For some patients, credit is provided through an outside vendor. In this case, we are paid from the outsourced credit vendor and the risk is transferred to the credit vendor for collection from the patient. These funds are accounted for as patient deposits until the procedures are performed at which point the patient deposit is recognized as patient service revenue.

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Accounts Receivable

Accounts receivable primarily consists of amounts due from third-party payers (non-governmental), governmental payers and private pay patients and is recorded net of allowances for doubtful accounts and contractual discounts. Our ability to collect outstanding receivables is critical to our results of operations and cash flows. Accordingly, accounts receivable reported in our condensed consolidated financial statements are recorded at the net amount expected to be received. Our primary collection risks are (i) the risk of overestimation of net revenues at the time of billing that may result in our receiving less than the recorded receivable, (ii) the risk of non-payment as a result of commercial insurance companies’ denial of claims, (iii) the risk that patients will fail to remit insurance payments to us when the commercial insurance company pays out-of-network claims directly to the patient, (iv) resource and capacity constraints that may prevent us from handling the volume of billing and collection issues in a timely manner, (v) the risk that patients do not pay us for their self-pay balances (including co-pays, deductibles and any portion of the claim not covered by insurance), and (vi) the risk of non-payment from uninsured patients.

Our accounts receivables from third-party payers are recorded net of estimated contractual adjustments and allowances from third-party payers, which are estimated based on the historical trend of our facilities’ cash collections and contractual write-offs, accounts receivable aging, established fee schedules, relationships with payers and procedure statistics. While changes in estimated reimbursement from third-party payers remain a possibility, we expect that any such changes would be minimal and, therefore, would not have a material effect on our financial condition or results of operations. Our collection policies and procedures are based on the type of payer, size of claim and estimated collection percentage for each patient account. The operating systems used to manage our patient accounts provide for an aging schedule in 30-day increments, by payer, physician and patient. We analyze accounts receivable at each of the facilities to ensure the proper collection and aged category. The operating systems generate reports that assist in the collection efforts by prioritizing patient accounts. Collection efforts include direct contact with insurance carriers or patients and written correspondence.

Income Taxes

Prior to June 1, 2018, IMAC Holdings, IMAC Management Services, IMAC Texas, IMAC of St. Louis and IMAC Nashville were limited liability companies and taxed as partnerships. As a result, income tax liabilities were passed through to the individual members. Any future tax benefit arising from post conversion corporate losses have been offset by a valuation allowance. Accordingly, no provision for income taxes is reflected in our condensed consolidated financial statements. For more information, see “Corporate Conversion.”

Results of Operations for the Three and Six Months Ended March 31, 2019June 30, 2022 Compared to the Three and Six Months Ended March 31, 2018June 30, 2021

We own our medical clinics directly or have entered into long-term management services agreements to operate and control these medical clinics by contract. Our preference is to own the clinics; however, some state laws restrict the corporate practice of medicine and require a licensed medical practitioner to own the clinic. Accordingly, our managed clinics are owned exclusively by a medical professional within a professional service corporation (formed as a corporation or a limited liability company or corporation)company) under common control with us or eligible members of our company in order to comply with state laws regulating the ownership of medical practices. We are compensated under management services agreements through service fees based on the cost of the services provided, plus a specified markup percentage, and a discretionary annual bonus determined in the sole discretion of each professional service corporation.

The following table sets forth a summary of IMAC Holdings, Inc.’s statements of operations for the three months ended March 31, 2019 and 2018:

  Three Months Ended March 31, 
  2019  2018 
       
Patient revenues $7,289,022  $532,872 
Contractual adjustments  (4,519,194)  (298,619)
Total patient revenues, net $2,769,828  $234,253 
Other revenue:        
Internal management fee revenue  -   33,600 
Total revenue  2,769,828   267,853 
Operating expenses:        
Patient expenses  436,129   37,134 
Salaries and benefits  2,064,623   446,796 
Share-based compensation  3,749   3,749 
Advertising and marketing  347,016   93,178 
General and administrative  977,369   239,692 
Depreciation and amortization  285,567   31,268 
Total operating expenses  4,114,454   851,817 
Operating loss $(1,344,626) $(583,964)
Other income (expenses):        
Interest income  -   3,312 
Other (loss)  (15,955)  - 
Beneficial conversion interest expense  (639,159)  - 
Interest expense  (30,671)  (23,552)
Total other (expenses)  (685,785)  (20,240)
Loss before equity in (loss) of non-consolidated affiliate $(2,030,410) $(604,204)
Equity in (loss) of non-consolidated affiliate  -   (85,651)
Net loss before income taxes $(2,030,410) $(689,855)
Income taxes  -   - 
Net loss $(2,030,410) $(689,855)
Net loss attributable to the non-controlling interest  431,223   285,191 
Net loss attributable to the IMAC Holdings, Inc. $(1,599,187) $(404,664)

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During the three months ended March 31, 2019, our revenues increased 934.1% to $2.77 million from $0.27 million for the same period in 2018. We incurred net loss attributable to IMAC Holdings Inc. for the three months ended March 31, 2019 of $1.60 million, compared to net loss of $0.40 million for the three months ended March 31, 2018. The primary reasons for the increase were the costs associated with preparing for, completing and on-going costs relating to our initial public offering, as well as costs associated with our 2018 acquisitions.

Revenues

Our revenue mix is diversified between medical treatments and physiological treatments. Our medical treatments are further segmented into traditional medical and regenerative medicine practices. We are an in-network provider for traditional physical medical treatments, such as physical therapy, chiropractic services and medical evaluations, with most private health insurance carriers. Regenerative medical treatments are typically not covered by insurance, but paid by the patient. For more information on our revenue recognition policies, see “Notes to the Consolidated Financial Statements” that were included in the Form 10-K.

Revenues for the three months ended March 31, 2019June 30, 2022 and 20182021 were as follows:

  

Three Months Ended

June 30,

 
  2022  2021 
  (in thousands, unaudited) 
Revenues:        
Outpatient facility services $4,744  $3,260 
Memberships  289   203 
Total revenues $5,033  $3,463 

Revenues for the six months ended June 30, 2022 and 2021 were as follows:

  

Six Months Ended

June 30,

 
  2022  2021 
  (in thousands, unaudited) 
Revenues:        
Outpatient facility services $8,405  $6,137 
Memberships  523   351 
Total revenues $8,928  $6,488 

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See the table below for more information regarding our revenue breakdown by service type.

 

  Three Months Ended March 31, 
  2019  2018 
  (in thousands) 
Revenues:        
Outpatient facility services $2,770  $234 
All other  -   34 
Total revenues $2,770  $268 
  

Three Months Ended

June 30,

 
  2022  2021 
       
Revenues:        
Medical treatments  66%  64%
Physical therapy  26%  31%
Chiropractic care  2%  3%
Memberships  6%  2%
   100%  100%

 

  

Six Months Ended

June 30,

 
  2022  2021 
       
Revenues:        
Medical treatments  66%  65%
Physical therapy  26%  30%
Chiropractic care  2%  3%
Memberships  6%  2%
   100%  100%

Patient service

Consolidated Results

For the three months ended June 30, 2022, total revenues increased 1,082.4%approximately $1.6 million due to $2.77 millionacquisitions, same-store growth, opening of retail clinics and improved collections. Visits to our clinics are an indication of business activity. Total visits decreased 5% for the three months ended March 31, 2019June 30, 2022 compared to $0.23the three months ended June 30, 2021. Visits decreased from 44,778 in the second quarter of 2021 to 42,516 in the second quarter of 2022. The company has introduced new services into the service mix that have higher charges and improved collection rates.

For the six months ended June 30, 2022, total revenues increased approximately $2.4 million also attributed to acquisitions, same-store growth, opening of retail clinics and improved collections. Total visits slightly decreased by 1% for the six months ended June 30, 2022 compared to the six months ended June 30, 2021. Visits decreased from 83,159 in the second quarter of 2021 to 82,325 in the second quarter of 2022. Similarly to the second quarter, this change is reflected from the changes in service mix with higher collection rates.

IMAC Clinics

Of the total revenue increase, approximately $1.4 million is attributed to the increase of revenues for IMAC Clinics. Same-store revenues increased $503,000 overall for the three months ended March 31, 2018, primarily dueJune 30, 2022 compared to the 2018 acquisitionsthree months ended June 30, 2021. This increase was driven by the closure of seven IMAC clinics resulting in a decrease of Kentucky,$519,000; however, the remaining same stores increased $1 million. New clinics attributed to approximately $914,000 of the overall increase. This increase was driven by services provided with higher charge rates and higher collections.

Of the total revenue increase, approximately $2.2 million is attributed to the increase of revenues for the IMAC Clinics for the six months ended June 30, 2022. Same-store revenues increased $747,000 while new clinics attributed to $1.5 million.

A wellness membership program was implemented at IMAC Clinics in January 2020 and this wellness program has different plan levels that include services for chiropractic care and medical treatments on a monthly subscription basis. Therefore, memberships could have multiple visits in one month, however only one payment is received for these visits. IMAC Clinics had 866 and 1,195 active members for the months ended in June 30, 2022 and 2021, respectively. The membership decrease is attributable to closed clinics and a 10% price increase to the most popular membership plan.

BackSpace Clinics

The Company began opening retail clinics in Walmart in June 2021 and as of June 30, 2022 IMAC had ten clinics opened in Florida, Missouri and Advantage Health.Tennessee. The decrease in other service revenues is dueretail clinics provides outpatient chiropractic and spinal care services. BackSpace offers a single visit and membership plan for chiropractic care on a monthly subscription basis. As of June 30, 2022, 79% of the BackSpace revenue was related to a decrease in management and administrative service fees derived from non-consolidated outpatient clinics.memberships.

Operating Expenses

Operating expenses consist of patient expenses, salaries and benefits, share based compensation, advertising and marketing, general and administrative expenses and depreciation expenses.

Patient expenses consist of medical supplies for services rendered.

Patient Expenses 2022  2021  

Change

from Prior

Year

  

Percent Change

from Prior

Year

 
             
Three Months Ended June 30 $397,000  $340,000  $57,000   17%
Six Months Ended June 30  858,000   681,000   177,000   26%

Cost of revenues (patient expense) was $0.44 millionincreased for the three months ended March 31, 2019June 30, 2022 by $57,000 as compared to $0.04 millionJune 30, 2021. These expenses also increased $177,000 for the threesix months ended March 31, 2018, withJune 30, 2022 compared to the increase in costs primarily attributable to our 2018 acquisitions. As a percentage of revenues, patient expenses were 15.75 % for the threesix months ended March 31, 2019 compared to 15.85% forJune 30, 2021. Patient expenses as a percent of revenue has remained relatively consistent with slight improvement of percent of revenue from the three months ended March 31, 2018.centralized billing improvements.

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Salaries and benefits consist of payroll, benefits and related party contracts.contracts.

Salaries and Benefits 2022  2021  

Change

from Prior

Year

  

Percent Change

from Prior

Year

 
             
Three Months Ended June30 $3,783,000  $2,997,000  $786,000   26%
Six Months Ended June 30  7,493,000   5,751,000   1,742,000   30%

Salaries and benefits expenses were $2.06 million and $0.45 million for the three months ended March 31, 2019 and 2018, respectively. The increase of $1.62 million was attributableJune 30, 2022, as compared to our 2018 acquisitions and the costs related to the preparation and on-going accounting, legal and operational costs of our initial public offering. Salaries and benefit expense related to our 2018 business acquisitions was $1.36 million for the three months ended March 31, 2019 with no acquisition related salaries and benefit expenseJune 30, 2021, increased due to the hiring of new providers for the three10 Backspace clinics opened and the 5 clinics acquired in 2021. The increase for the six months ended March 31, 2018. New employee salaries and benefits expense increased by $0.26 million for the three months ended March 31, 2019June 30, 2022 as compared to the same period for 2018. The increase wassix months ended June 30, 2021 is also attributable to IMAC Holdings adding staff related to the preparation of, and on-going accounting, legal and operational costs of, our initial public offering.these clinic openings.

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Share-based compensation consists of the value of company stock for sponsor efforts outside of an endorsement agreement. Atequity incentive grants issued to employees, directors and board members which have vested during the time of theperiod.

Share-based Compensation 2022  2021  

Change

from Prior

Year

  

Percent Change

from Prior

Year

 
             
Three Months Ended June 30 $81,000  $123,000  $(42,000)  (34)%
Six Months Ended June 30  270,000   234,000   36,000   15%

Share-based compensation our company was still a limited liability company; therefore, compensation was in the form of limited liability company units instead of stock. The units converted to stock effective upon the Company’s conversion from a limited liability company to a corporation.

Share based compensation was $0.004 and $0.004 milliondecreased 34% for the three months ended March 31, 2019 and 2018, respectively. As a percentage of revenues, share based compensation was 0.14% and 1.40% forJune 30, 2022, as compared to the three months ended March 31, 2019June 30, 2021. This decrease was due to the board RSU’s (Restricted Stock Units) expensed in the three months of 2021 and 2018, respectively.no board RSU’s expensed during the three months of 2022.

Share-based compensation increased 15% for the six months ended June 30, 2022, as compared to the six months ended June 30, 2021. This increase was attributable to the decrease in board RSU’s and an increase in executive RSUs from the first quarter of 2022.

Advertising and marketing consistsconsist of marketing, business promotion and brand recognition.

Advertising and Marketing 2022  2021  

Change

from Prior

Year

  

Percent Change

from Prior

Year

 
             
Three Months Ended June 30 $243,000  $316,000  $(73,000)  (23)%
Six Months Ended June 30  613,000   581,000   32,000   6%

Advertising and marketing was $0.35 million and $0.09 millionexpenses decreased $73,000 for the three months ended March 31, 2019 and 2018, respectively. Advertising for acquired clinics was $0.18 million and $0 forJune 30, 2022, as compared to the three months ended March 31, 2019June 30, 2021. $41,000 of the total decrease is in endorser fees as marketing efforts shifted away from endorser fees in 2022.

Advertising and 2018, respectively. Advertising for new clinics opened by us was $0.09 million and $0.05 millionmarketing expenses increased $32,000 for the threesix months ended March 31, 2019 and 2018. As a percentage of revenues, advertising and marketing was 12.53% and 34.79% forJune 30, 2022, as compared to the threesix months ended March 31, 2019June 30, 2021. $101,000 of the total increase was attributed to online and 2018, respectively.website advertising. Similar to the second quarter, endorser fees decreased $54,000 from the six months ended June 30, 2021 to the six months ended June 30, 2022.

General and administrative expense (G&A) consists(“G&A”) consist of all other costs other than advertising and marketing, salaries and wages,benefits, patient expenses and depreciation.

General and Administrative 2022  2021  

Change

from Prior

Year

  

Percent Change

from Prior

Year

 
             
Three Months Ended June 30 $1,858,000  $1,661,000  $197,000   12%
Six Months Ended June 30  3,673,000   2,881,000   792,000   27%

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G&A was $0.98 millionincreased 12% in the three months ended June 30, 2022 as compared to the three months ended June 30, 2021. Rent and $0.24 millionutilities expenses increased $142,000 due to the addition of 12 locations that were added subsequent to the first quarter of 2021. Insurance increased $57,000 also due to the increase in new providers. Travel increased $25,000 as employees trained new clinic locations. Legal expenses increased $28,000 and consultants increased $23,000 as the Company explores business opportunities. The FDA clinical trial is included in G&A with $100,000 in the three months ending June 30, 2022 compared to $195,000 in the three months ending June 30, 2021. See FDA Clinical Trial described below.

G&A increased 27% in the six months ended June 30, 2022 as compared to the six months ended June 30, 2021. Most of the increases are attributable to the 2021 acquisitions and clinic openings. Rent and utilities increased by approximately $290,000, insurance increased approximately $102,000, travel increased $71,000, and subscriptions increased $116,000. Credit card service fees are up $70,000 as we process memberships at IMAC Clinics and Backspace through monthly credit card charges. FDA charges have decreased by $64,000 for the six months ended June 30, 2022 as compared to the six months ended June 30, 2021.

FDA Clinical Trial

In August 2020, the United States Food and Drug Administration (the “FDA”) approved the Company’s investigational new drug application. The Company has begun the third cohort of Phase 1 of the clinical trial, which will be completed during the summer of 2022. The Company incurred $100,000 in G&A expenses related to consultants, supplies, software and travel for the clinic trial during the three months ended June 30, 2022 compared to $195,000 in the three months ended June 30, 2021. The Company incurred $204,000 during the six months ended June 30, 2022 compared to $268,000 expenses in the six months ended June 30, 2021. Salaries related to the trial were $17,000 for the three months ended March 31, 2019 and 2018, respectively. Our 2018 acquisitions accounted for $0.42 million of the increase. New clinics opened by us accounted for $0.006 million of the increase. Overhead costs such as accounting, legal, audit, and other costs associated with our initial public offering accounted for $0.3 million of the increase in expenseJune 30, 2022 compared to $39,000 for the three months ended March 31, 2019 asJune 30, 2021. Salaries related to the trial were $39,000 for the six months ended June 30, 2022 compared to the same period in 2018. As a percentage of revenues, general and administrative expense was 35.29% and 89.49%$69,000 for the threesix months ended March 31, 2019June 30, 2021.

Depreciation is related to our property and 2018, respectively.

We purchase fixed assets, such as equipment or medical equipment,purchases to use in the course of our business activities. We capitalize the full cost of the asset onAmortization is related to our balance sheet and depreciate the cost over the asset’s estimated useful life.business acquisitions.

Depreciation and Amortization 2022  2021  

Change

from Prior

Year

  

Percent Change

from Prior

Year

 
             
Three Months Ended June 30 $439,000  $442,000  $(3,000)  (1)%
Six Months Ended June 30  885,000   864,000   21,000   2%

We incurred $0.29 million and $0.03 million of depreciationDepreciation and amortization costswas consistent for the three months ended March 31, 2019 and 2018, respectively. The increase was due to depreciation and amortization costs associated with the acquisitions of IMAC of Kentucky, IMAC of Missouri, and Advantage Therapy. As a percentage of revenues, depreciation and amortization expense was 10.3% and 11.7% for the three months ended March 31, 2019 and 2018, respectively.

Other income (loss)

Other income (loss) consists of interest expense, interest income, gain on acquisition and loss on disposal of an asset.

We incurred $0.69 million and $0.02 million in other losses for the three months ended March 31, 2019 and 2018, respectively. Beneficial conversion interest expense relating to the conversion of our 4% convertible notes to shares of our common stock accounted for $0.64 million of the increase. Acquisitions in 2018 accounted for $0.014 million of the increase in other losses and additional interest at the corporate level accounted for $0.012 million of the increase.

Loss before equity in (loss) of non-consolidated affiliate

Loss before equity in (loss) of non-consolidated affiliates was $2.03 million and $0.60 million for the three months ended March 31, 2019 and 2018, respectively. Acquisitions accounted for $0.11 million of the increase in loss while the loss for new facilities decreased by $0.25 million in the three months ended March 31, 2019 as compared to the same period in 2018. Overhead loss increased by $0.76 million in the three months ended March 31, 2019 as compared to the same period in 2018.

Equity in (loss) of non-consolidated affiliate

Equity in (loss) of non-consolidated affiliate is the proportional share (based on ownership) of the net earnings or losses of an unconsolidated affiliate.

Equity in (loss) of non-consolidated affiliate is the proportional share (based on ownership) of the net earnings or losses of an unconsolidated affiliate. Total loss of a non-consolidated affiliate decreased by $0.086 million for the three months ended March 31, 2019 as compared to the same period in 2018. The decrease was related to IMAC Holdings’ 36% ownership of the outstanding limited liability company membership units of IMAC of St. Louis.

25

Net loss attributable to the non-controlling interest

Net loss attributable to the non-controlling interest is the amount of net income (loss) for the period allocated to non-controlling partners of IMAC Holdings, Inc. that is included in the entity’s consolidated financial statements.

Net loss attributable to the non-controlling interest increased by approximately $0.15 million for the three months ended March 31, 2019 asJune 30, 2022 compared to the three months ended March 31, 2018. Acquisitions accountedJune 30, 2021 as there was not much activity of acquisitions during these periods of time.

Depreciation and amortization increased for $0.21 millionthe six months ended June 30, 2022 compared to the six months ended June 30, 2021. This increase is attributable to the assets added from acquisitions made during the first six months of 2021 and the increase in lossopening of 9 Backspace locations after June 30, 2021.

27

Loss on disposal and IMACimpairment is related to either gains or losses related to the disposal of Tennessee PC accounted for $0.50 millionour property and equipment purchases or impairment on the write off of the reduction in lossintangible assets.

Loss on disposal and impairment 2022  2021  

Change

from Prior

Year

  

Percent Change

from Prior

Year

 
             
Three Months Ended June 30 $35,000  $-  $35,000   100%
Six Months Ended June 30  82,000   4,000   78,000   1,950%

Loss on disposal increased $35,000 for the three months ended March 31, 2019 asJune 30, 2022 compared to the same period in 2018.

Net loss

Net loss for the three months ended March 31, 2019June 30, 2021. This loss was $1.60 millionattributed to the disposal of assets at 2 closed clinics during the second quarter of 2022.

Loss on disposal increased $78,000 during the six months ended June 30, 2022 compared to a net loss of $0.40 million for the threesix months ended March 31 2018. TheJune 30, 2022. Along with the loss from the closure of clinics in the second quarter of 2022, $33,000 of this increase in net loss of $1.20 million was the result of additional costs to IMAC Holdings, Inc. for the preparation for our initial public offering, on-going costs associated with becoming a public company and restructuring of facility level resourcesis due to the corporate level to prepare for expected growth.

Liquidity and Capital Resources

Asimpairment of March 31, 2019, we had $3,065,553 in cash and working capital of $(2,370,554). As of December 31, 2018, we had cash of $194,316 and working capital of $(13,163,064). The increase in working capital was primarily due to our initial public offering completed in February 2019.

In February 2019, we completed an initial public offering of units of our common stock and warrants to purchase our common stock for net proceeds to us of approximately $3,797,916, after deducting underwriting discount and commissions and estimated offering expenses payable by us. We believe the net proceeds of our recent public offering, together with the cash at March 31, 2019 will be sufficient to meet our cash, operational and liquidity requirements for at least 12 months.

As of March 31, 2019, we had approximately $6.5 million in current liabilities. In connection with the closing of our initial public offering in February 2019, we subsequently satisfied approximately $7.2 million in acquisition-related liabilities through the issuance of common stock and converted approximately $1.7 million in promissory notes issued in our 2018 private placement into shares of our common stock. Of the remaining current liabilities, approximately $1.2 million representsintangible asset from a mortgage on our Lexington, Kentucky property, approximately $1.6 million represents an existing note payable to the Edward S. Bredniak Revocable Trust, which is due and payableclosed clinic in the fourthfirst quarter of 2019, and approximately $0.94 million represents patient deposits prior to services being performed, which will be recognized as revenue in the near term. Lastly, we have approximately $1.5 million in current liabilities outstanding to our vendors and in operating lines2022.

Analysis of credit, which we have historically paid down in the normal course of our business.Cash Flows

As of March 31, 2019, we had an accumulated deficit of ($5,144,007). Prior to our initial public offering, we funded our operations primarily through the sale and issuance of convertible notes, bridge loans, and the use of funds from operations. Accordingly, we anticipate that we will need to raise additional capital to fund future operations. However, we may be unable to raise additional funds or enter into such arrangements when needed or favorable terms, or at all, which would have a negative impact on our financial condition and could force us to delay, limit, reduce or terminate our development or acquisition activity. Failure to receive additional funding could also cause us to cease operations, in part or in full. Furthermore, even if we believe we have sufficient funds for our current of future operating plans, we may seek additional capital due to favorable market conditions or strategic considerations.

Our independent registered public accounting firm has indicated that our financial condition raises substantial doubt as to our ability to continue as a going concern.

Operating Activities

The primary source of our operating cash flow is the collection of accounts receivable from patients, private insurance companies, government programs, public offering, self-insured employers and other payers.

26

The following table sets forth our primary sources and uses ofDuring the six months ended June 30, 2022, net cash used in operations increased to $5.9 million compared to $4.3 million for the threesix months ended March 31, 2019 and 2018.

  Three Months Ended March 31, 
  2019  2018 
Statements of Cash Flow Data:        
Net cash used in operating activities $(894,149) $(576,541)
Net cash used in investing activities  (42,426)  (1,315,726)
Net cash provided by financing activities  3,807,811   2,314,988 
Net increase in cash  2,871,236   422,721
Cash, beginning of period  194,316   127,788 
Cash, end of period $3,065,552  $550,509 

During the three months ended March 31, 2019, our operating cash flow from operations decreased to $(894,149) compared to $(576,541) for the three months ended March 31, 2018.June 30, 2021. This decreasedifference was primarily attributable to our net loss and increasethe change in accounts receivable and other assets.during the six months ended June 30, 2022.

Investing Activities

Net cash used in investing activities during the threesix months ended March 31, 2019June 30, 2022 and 2018 were $(42,426)2021 was $254,000 and $(1,315,726),$1 million, respectively. This included $(42,426) and $(1,191,620) fordecrease was primarily driven by the threeacquisitions made during the first six months ended March 31, 2019 and 2018, respectively, related to purchases of property and equipment and leasehold improvements.2021, totalling $732,000.

Financing Activities

Net cash provided by financing activities during the threesix months ended March 31, 2019June 30, 2022 and 2021 was $3,807,811, including$612,000 and $16 million, respectively. This difference was attributable to the $19.0 million from the gross proceeds from issuance of common stock offset by $3.5 million paid towards notes payable during the six months ended June 30, 2021.

Reconciliation of Non-GAAP Financial Measures

This report contains certain non-GAAP financial measures, including non-GAAP net income and adjusted EBITDA, which are used by management in analyzing our financial results and ongoing operational performance.

In order to better assess the Company’s financial results, management believes that net income before interest, income taxes, stock based compensation, and depreciation and amortization (“adjusted EBITDA”) is a useful measure for evaluating the operating performance of the Company because adjusted EBITDA reflects net income adjusted for certain non-cash and/or non-operating items. We also believe that adjusted EBITDA is useful to many investors to assess the Company’s ongoing results from current operations. Adjusted EBITDA is a non-GAAP financial measure and should not be considered a measure of financial performance under GAAP. Because adjusted EBITDA is not a measurement determined in accordance with GAAP, such non-GAAP financial measures are susceptible to varying calculations. Accordingly, adjusted EBITDA, as presented, may not be comparable to other similarly titled measures of other companies.

This non-GAAP financial measure should not be considered as a substitute for, or superior to, measures of financial performance which are prepared in accordance with US GAAP and may be different from non-GAAP financial measures used by other companies and have limitations as analytical tools.

A reconciliation of adjusted EBITDA to the most directly comparable GAAP measure is set forth below.

  Three Months Ended  Six Months Ended 
  

June

30, 2022

  

June

30, 2021

  

June

30, 2022

  

June

30, 2021

 
GAAP loss attributable to IMAC Holdings, Inc. $(1,844,000) $(2,539,000) $(5,006,000) $(4,768,000)
Interest income  (1,000)  -   (1,000)  - 
Interest expense  5,000   126,000   9,000   302,000 
Other expense  40,000   -   53,000   - 
Share-based compensation expense  81,000   123,000   270,000   234,000 
Depreciation and amortization  439,000   442,000   885,000   864,000 
Loss on disposition and impairment of assets  35,000   -   82,000   4,000 
Adjusted EBITDA $(1,245,000) $(1,848,000) $(3,708,000) $(3,364,000)

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Liquidity and Capital Resources

As of June 30, 2022, we had $1.6 million in cash and working capital of $809,000. As of December 31, 2021, we had cash of $7.1 million and working capital of $4.1 million. The decrease in working capital was primarily due to the use of cash for operating expenses during the six months ended June 30, 2022, partially offset by the proceeds from the Company’s at-the-market offering.

As of June 30, 2022, we had approximately $4.6 million in current liabilities. Operating leases represent $1.5 million of our current liabilities. Of our remaining current liabilities as of June 30, 2022, approximately $714,000 is current liabilities to our vendors, which we have historically paid down in the normal course of our business and accrued expenses represents approximately $526,000 of the balance. Lastly, accrued wages, taxes, 401 contributions and paid time off represent approximately $859,000 of the remaining liabilities.

On October 29, 2020, the Company entered into the October Purchase Agreement with Iliad Research & Trading, L.P., pursuant to which the Company agreed to issue and sell to the Holder a secured promissory note in an initial principal amount of $2,690,000, which is payable on or before April 29, 2022. The October Principal Amount includes an original discount of $175,000 and $15,000 that the Company agreed to pay to the Holder to cover the Holder’s legal fees, accounting costs, due diligence and other transaction costs. In exchange for the October Note, the Holder paid a purchase price of $2,500,000. The October Purchase Agreement also provides for indemnification of the Holder and its affiliates in the event that they incur loss or damage related to, amount other things, breach by the Company of any of its representations, warranties or covenants under the October Purchase Agreement. In connection with the October Purchase Agreement and the October Note, the Company entered into a Security Agreement with the Holder, pursuant to which the obligations of the Company is secured by all of the assets of the Company, excluding the Company’s accounts receivable and intellectual property. Upon an event of default under the October Note, the October Security Agreement entitles the Holder to take possession of such collateral; provided that the Holder’s security interest and remedies with respect to the collateral are junior in priority to the security interest previously granted by the Company to the Holder in connection with a separate financing entered into by them on March 25, 2020, for which the Holder holds a senior, first-priority security interest in the same collateral.

On March 26, 2021, the Company completed a public offering netby issuing 10,625,000 shares of related fees, which totaled $3,504,164. Net cash provided by financing activities duringcommon stock for gross proceeds of $17 million. The Company used approximately $1.8 million for the three months ended March 31, 2018 was $2,314,988, includingrepayment of certain indebtedness and is using the remaining proceeds from notes payable, which totaled $2,262,500.for the repayment of certain other indebtedness, to finance the costs of developing and acquiring additional outpatient medical clinics and healthcare centers as part of the Company’s growth and expansion strategy and for working capital.

These events served to mitigate the conditions that historically raised substantial doubt about the Company’s ability to continue as a going concern.

Contractual Obligations

The following table summarizes our contractual obligations by period as of March 31, 2019:June 30, 2022:

  Payments Due by Period    
  Total  Less Than 1 Year  1-3 Years  4-5 Years  

More

Than 5 Years

 
Short-term obligations $49,722  $49,722  $-  $-  $- 
Long-term obligations, including interest  111,498   -   101,748   9,750   - 
Finance lease obligations, including interest  42,712   10,903   31,809   -   - 
Operating lease obligations  5,291,786   842,325   3,705,414   662,356   81,691 
  $5,495,718  $902,950  $3,838,971  $672,106  $81,691 

  Payments Due by Period 
  Total  Less Than 1
Year
  1-3 Years  4-5 years  More Than 5
Years
 
                
Short-term debt obligations $3,146,888  $3,146,888  $-  $-  $- 
Long-term debt obligations, including interest  438,380   109,539   255,658   46,708   26,475 
Capital lease obligations, including interest  113,579   16,354   65,417   31,809   - 
Operating lease obligations  4,368,072   637,733   2,079,129   1,062,963   588,247 
Total $8,066,920  $3,910,514  $2,400,204  $1,141,479  $614,722 

  Three Months Ended March 31, 2019 
  Current Portion  Long Term  Total 
Short-term debt obligations $3,146,888  $-  $3,146,888 
Long-term debt obligations, including interest  198,539   328,841   438,380 
Capital lease obligations, including interest  16,354   97,225   113,579 
Operating lease obligations  637,733   3,730,339   4,368,072 
Total contractual obligations $3,910,514  $4,156,406  $8,066,920 

Off-Balance Sheet Arrangements

As of March 31, 2019, weJune 30, 2022, the Company did not have any off-balance sheet arrangements.

Impact of Inflation

We believe that inflation has not had a material impact on our results of operations for the three months ended March 31, 2019 and 2018. We cannot assure you that future inflation will not have an adverse impact on our operating results and financial condition.

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ITEM 3.QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

Not applicable.

ITEM 4.CONTROLS AND PROCEDURES

Disclosure Controls and Procedures

We maintain disclosure controls and procedures that are designed to ensure that information required to be disclosed in our Securities Exchange Act of 1934 (the “Exchange Act”) reports is recorded, processed, summarized, and reported within the time periods specified in the SEC’s rules and forms and that such information is accumulated and communicated to our management, including our chief executive officer and interim chief financial officer, as appropriate, to allow for timely decisions regarding required disclosure. In designing and evaluating the disclosure controls and procedures, we recognize that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives, and management is required to apply its judgment in evaluating the cost-benefit relationship of possible controls and procedures.

As further discussed below, we carried out an evaluation, under the supervision and with the participation of our management, including our chief executive officer and interim chief financial officer, of the effectiveness of the design and operation of our disclosure controls and procedures, as defined in Rules 13a-15(e) and 15d-15(e) of the Exchange Act. Based on that evaluation, our chief executive officer and chief financial officer concluded that, because of certain material weaknesses in our internal control over financial reporting our disclosure controls and procedures as defined in Rule 13a-15(e) and 15d-15(e) under the Exchange Act were not effective as of March 31, 2019.June 30, 2021. The material weaknesses relate to the absence of in-house accounting personnel with the ability to properly account for complex transactions and a lack of separation of duties between accounting and other functions.

We hired a consulting firm to advise on technical issues related to U.S. GAAP as related to the maintenance of our accounting books and records and the preparation of our consolidated financial statements. Although we are aware of the risks associated with not having dedicated accounting personnel, we are also at an early stage in the development of our business. We anticipate expanding our accounting functions with dedicated staff and improving our internal accounting procedures and separation of duties when we can absorb the costs of such expansion and improvement with additional capital resources. In the meantime, management will continue to observe and assess our internal accounting function and make necessary improvements whenever they may be required. If our remedial measures are insufficient to address the material weakness, or if additional material weaknesses or significant deficiencies in our internal control over financial reporting are discovered or occur in the future, our consolidated financial statements may contain material misstatements, and we could be required to restate our financial results. In addition, if we are unable to successfully remediate this material weakness and if we are unable to produce accurate and timely financial statements, our stock price may be adversely affected and we may be unable to maintain compliance with applicable stock exchange listing requirements.

Our management is responsible for establishing and maintaining adequate internal control over financial reporting, as such term is defined in Rules 13a-15(f) and 15d-15(f) of the Exchange Act. Under the supervision and with the participation of our management, including our chief executive officer and interim chief financial officer, we conducted an evaluation of the effectiveness of our internal control over financial reporting based on the framework inInternal Control—Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission (“COSO”). Because of its inherent limitations, internal control over financial reporting may not prevent or detect all misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate. Therefore, even those systems determined to be effective can provide only reasonable assurance with respect to financial statement preparation and presentation. Based on our evaluation under the framework inInternal Control—Integrated Framework (2013), our management concluded that, because of certain material weaknesses in our internal control over financial reporting our disclosure controls and procedures as defined in Rule 13a-15(e) and 15d-15(e) under the Exchange Act were not effective as of March 31, 2019.June 30, 2021.

Changes in Internal Control over Financial Reporting

There has been no change in our internal control over financial reporting identified in connection with the evaluation required by paragraph (d) of Rules 13a-15 or 15d-15 under the Exchange Act that occurred during our most recent fiscal quarter that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

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PART II. OTHER INFORMATION

ITEM 1.LEGAL PROCEEDINGS

From time to time, we may become involved in various lawsuits and legal proceedings that arise in the ordinary course of our business, as described below. Litigation is, however, subject to inherent uncertainties, and an adverse result in these or other matters may arise from time to time that may harm our business. We are currently not aware of any legal proceedings or claims that we believe would or could have, individually or in the aggregate, a material adverse effect on us. Regardless of final outcomes, however, any such proceedings or claims may nonetheless impose a significant burden on management and employees and may come with costly defense costs or unfavorable preliminary interim rulings.

In February 2019, we received notice of a lawsuit involving BioFirma, LLC. We own 70% of the membership interests of BioFirma. As of the date of this filing, the lawsuit is pending; however, we do not believe this will have a material adverse effect on us. The total amount being contested by BioFirma with the opposing party is $30,000.

ITEM 1A.RISK FACTORS

Investors should carefully review and consider the information regarding certain factors which could materially affect our business, operating results, cash flows, and financial condition set forth under Item 1A, Risk Factors, in our fiscal 20182021 Annual Report on Form 10-K filed with the SEC on April 16, 2019.

We do not believe that there14, 2022. There have been any otherno material additions or changes to the risk factors previously disclosed in our fiscal 2018 Annual Report on Form 10-K, although we may disclose changes to such risk factors, or disclose additionalexcept as set forth below. The risk factors from timeset forth below supplement, and should be read together with, that section for disclosures regarding what we believe are the more significant risks and uncertainties related to time in our future filings with the SEC.businesses. Additional risks and uncertainties not presently known to us or that we currently deem immaterial also may impair our business operations.

We are subject to the possible repayment of a claimed CMS overpayment, but we cannot predict the outcome.

On April 15, 2021, the Company received notification from Covent Bridge Group, a Center for Medicare & Medicaid Services (“CMS”) contractor, that they are recommending to CMS that the Company was overpaid in the amount of $2,921,868. This amount represents a statistical extrapolation of $11,530 of charges from a sample of 40 claims for the periods February 2017 to November 2020.

On June 3, 2021, the Company received a request for payment from CMS in the amount of $2,918,472. The Company initiated the appropriate appeals and then the Company received a notification dated September 30, 2021, from CMS that they “found the request to be favorable by reversing the extrapolation to actual”. The Company received a separate notification stating “the extrapolated overpayment was reduced to the actual overpayment amount for the sampled denied claims $5,327.73,” which was paid in 2021.

This amount represented a statistical extrapolation of $11,530 of charges from a sample of 40 claims for the periods February 2017 to November 2020. The Company began its own internal audit process and disagrees with the interpretation of the medical records and the extrapolation techniques used to derive the balance. The Company continued the appeals process to the second level appeal related to the error rate and are anticipating a third appeal on the remaining $5,327.73 amount. As of June 30, 2022, this was settled for approximately $5,000.

On October 21, 2021, the Company received notification from Covent Bridge Group, a Center for Medicare & Medicaid Services (“CMS”) contractor, that they are recommending to CMS that the Company was overpaid in the amount of $2,716,056.33. This amount represents a statistical extrapolation of $6,791.33 of charges from a sample of 38 claims for the periods July 2017 to November 2020 for Progressive Health & Rehabilitation, Ltd (“Progressive Health”). The Company entered into a management agreement with Progressive Health in April 2019 and therefore liable for only a portion of the sampled claims. There were a total of 38 claims reviewed, 25 of these claims were from the period prior to the management agreement with the Company and the remaining 13 claims were related to the period that Progressive Health was managed by the Company. In December 2021, the Company received a request for payment from CMS in the amount of $2,709,265. The Company has begun its own internal audit process and has initiated the appropriate appeals.

On May 17, 2022, the Company received notification from Covent Bridge Group, a Center for Medicare & Medicaid Services (“CMS”) contractor, that they are recommending to CMS that the Company was overpaid in the amount of $492,086.22 related to Advantage Therapy. This amount represents a statistical extrapolation of charges from a sample.  On May 27, 2022 the Company received a request for payment from CMS in the amount of $481,666.00. The Company has begun its own internal audit process and has initiated the appropriate appeals.

The Company is unable to predict the timing and ultimate outcome of these matters. Any potential loss may be classified as errors and omissions for which insurance coverage was in place during a majority of the years being evaluated. As of June 30, 2022, the Company has recorded no liability for these claims as we do not believe that an estimate of a reasonably possible loss or range of loss can be made at this time.

We recorded a net loss for the six months ended June 30, 2022 and June 30, 2021 and there can be no assurance that our future operations will result in net income.

For the six months ended June 30, 2022 and the six months ended June 30, 2021, we had net revenue of approximately $8.9 million and $6.5 million, respectively, and we had net loss of approximately $5.0 million and $4.8 million, respectively. There can be no assurance that our future operations will result in net income. Our failure to increase our revenues or improve our gross margins will harm our business. We may not be able to sustain or increase profitability on a quarterly or annual basis in the future. If our revenues grow more slowly than we anticipate, our gross margins fail to improve or our operating expenses exceed our expectations, our operating results will suffer. The fee we charge for our management services may decrease, which would reduce our revenues and harm our business. If we are unable to sell our services at acceptable prices relative to our costs, or if we fail to develop and introduce new services on a timely basis and services from which we can derive additional revenues, our financial results will suffer.

If our stock price falls below $1.00 per share, our common stock may be subject to delisting from The Nasdaq Capital Market.

If the bid price of our common stock were to close below the required minimum $1.00 per share for 30 consecutive business days, we may receive a deficiency notice from Nasdaq regarding our failure to comply with Nasdaq Marketplace Rule 5550(a)(2). If we receive such a notice, pursuant to Marketplace Rule 5810(c)(3)(A), we may become subject to a period of 180 calendar days to regain compliance with Rule 5550(a)(2). If at any time the bid price of our common stock closes at $1.00 per share or more for a minimum of 10 consecutive business days, we will regain compliance with Rule 5550(a)(2). In the event we do not regain compliance with Rule 5550(a)(2) prior to the expiration of any Nasdaq compliance period, Nasdaq may notify us that our common stock is subject to delisting. We may appeal such a delisting determination to a Nasdaq hearing panel and the delisting may be stayed pending the panel’s determination. At such hearing, we would present a plan to regain compliance and Nasdaq would then subsequently render a decision. We are currently evaluating our alternatives to resolve any listing deficiency. To the extent that we are unable to resolve a listing deficiency, there is a risk that our common stock may be delisted from Nasdaq, which would adversely impact liquidity of our common stock and potentially result in even lower bid prices for our common stock.

31

 

Our ability to utilize our net operating loss carryforwards and certain other tax attributes may be limited.

We may experience ownership changes in the future as a result of subsequent shifts in our stock ownership. Thus, our ability to utilize carryforwards of our net operating losses and other tax attributes to reduce future tax liabilities may be substantially restricted. Further, U.S. tax laws limit the time during which these carryforwards may be applied against future taxes. Therefore, we may not be able to take full advantage of these carryforwards for federal or state tax purposes. As of December 31, 2021, we had federal and state net operating loss carryforwards of approximately $28.8 million and $30.1 million, respectively.

We depend on enrollment of patients in our clinical trials for our product candidates. If we experience delays or difficulties enrolling in our clinical trials, our research and development efforts and business, financial condition, and results of operations could be materially adversely affected.

Successful and timely completion of the clinical trial will require that we enroll a sufficient number of patient candidates. This trial and other trials we may conduct may be subject to delays for a variety of reasons, including as a result of patient enrollment taking longer than anticipated, patient withdrawal or adverse events. These types of developments could cause us to delay the trial or halt further development.

Our clinical trial will compete with other clinical trials that are in the same therapeutic areas as our product candidates, and this competition reduces the number and types of patients available to us, as some patients who might have opted to enroll in our trials may instead opt to enroll in a trial being conducted by one of our competitors. In addition, there may be limited patient pools from which to draw for clinical studies. In addition to the rarity of some diseases, the eligibility criteria of our clinical studies will further limit the pool of available study participants as we will require that patients have specific characteristics that we can measure or to assure their disease is either severe enough or not too advanced to include them in a study. Patient enrollment depends on many factors, including:

the size and nature of the patient population;
the severity of the disease under investigation;
eligibility criteria for the trial;
the proximity of patients to clinical sites;
the design of the clinical protocol;
the ability to obtain and maintain patient consents;
the ability to recruit clinical trial investigators with the appropriate competencies and experience;
the risk that patients enrolled in clinical trials will drop out of the trials before the administration of our product candidates or trial completion;
the availability of competing clinical trials;
the availability of new drugs approved for the indication the clinical trial is investigating; and
clinicians’ and patients’ perceptions as to the potential advantages of the drug being studied in relation to other available therapies.

These factors may make it difficult for us to enroll enough patients to complete our clinical trial in a timely and cost-effective manner. In addition, our clinical trial has experienced, and continues to experience, some delays in patient enrollment as a result of the COVID-19 pandemic, as some clinical sites in high impact areas have delayed new patient enrollment as dictated by local conditions. Such delays have impacted and could further adversely affect the expected timelines for our product development and approval process and may adversely affect our business, financial condition and results of operations. Delays in the completion of any clinical trial increases our costs.

We rely on Contract Research Organizations (“CROs”) to conduct our preclinical studies and clinical trials. If these third parties do not successfully carry out their contractual duties or meet expected deadlines, we may be delayed in completing this phase of the clinical trial.

We have relied and will continue to rely on CROs for the execution of our preclinical and clinical studies and monitor and manage data for our clinical programs. We control only certain aspects of our CROs’ activities, but we are responsible for ensuring that each of our studies is conducted in accordance with the applicable protocol and legal, regulatory and scientific standards. Our reliance on the CROs does not relieve us of these regulatory responsibilities. We and our CROs are required to comply with the FDA’s regulations, which are regulations and guidelines enforced by the FDA and comparable regulatory authorities meant to protect the rights and health of clinical trial subjects. The FDA and comparable regulatory authorities enforce their regulations through periodic inspections of trial sponsors, principal investigators and clinical trial sites. If we or our CROs fail to comply with applicable good clinical practices (“GCPs”), the clinical data generated in our clinical trials may be deemed unreliable, and the FDA (or similar foreign authorities) may require us to perform additional clinical trials before approving our product candidates. We cannot assure you that, upon inspection, the FDA (or similar foreign authorities) will determine that any of our clinical trials comply with GCPs.

In addition, our CROs are not our employees and we cannot control whether or not they devote sufficient time and resources to our non-clinical, preclinical or clinical programs. Our CROs may also have relationships with other commercial entities, including our competitors, for whom they may also be conducting clinical studies or other drug development activities, which could impede their ability to devote appropriate time to our clinical programs. If our CROs do not successfully carry out their contractual duties or obligations or meet expected deadlines, if they need to be replaced, or if the quality or accuracy of the clinical data they obtain is compromised due to the failure to adhere to our clinical protocols or regulatory requirements, or for other reasons, our clinical trials may be extended, delayed or terminated. As a result, our financial results and the commercial prospects for the clinical trial would be harmed, our costs could increase and our ability to generate revenues could be delayed or ended.

If any of our relationships with these CROs change or terminate, we may not be able to enter into arrangements with alternative CROs or clinical study management organizations, or be able to do so on commercially reasonable terms. Switching or adding additional CROs or other clinical study management organizations involves additional cost and requires management time and focus. In addition, there is a natural transition period when a new CRO or clinical study management organization commences work. As a result, delays could occur, which could compromise our ability to meet our desired development timelines.

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We have no experience as a company in bringing a drug to regulatory approval.

As a company, we have never obtained regulatory approval for, or commercialized, a drug or biologic. It is possible that the FDA may refuse to accept any or all of our planned BLAs for substantive review or may conclude after review of our data that our application is insufficient to obtain regulatory approval of any product candidate. If the FDA does not accept or approve any or all of our planned BLAs, it may require that we conduct additional preclinical, clinical or manufacturing validation studies, which may be costly, and submit that data before it will reconsider our applications. Depending on the extent of these or any other FDA required studies, approval of any BLA or application that we submit may be significantly delayed, possibly for several years, or may require us to expend more resources than we have available.

We may be subject, directly or indirectly, to foreign, federal and state healthcare laws, including applicable anti-kickback, fraud and abuse and other healthcare laws and regulations, which could expose us to criminal sanctions, civil penalties, contractual damages, reputational harm and diminished profits and future earnings.

Healthcare providers, physicians and third-party payors play a primary role in the recommendation and prescription of any product candidates for which we obtain marketing approval. Our business operations and current and future arrangements with third-party payors, healthcare providers and customers may expose us to broadly applicable fraud and abuse and other healthcare laws and regulations that may constrain the business or financial arrangements and relationships through which we research, develop, market, sell and distribute our products for which we obtain marketing approval. Restrictions under applicable federal and state healthcare laws and regulations include the following:

the federal healthcare Anti-Kickback Statute prohibits, among other things, persons from knowingly and willfully soliciting, offering, receiving or providing remuneration, directly or indirectly, in cash or in kind, to induce or reward either the referral of an individual for, or the purchase, order or recommendation of, any good or service, for which payment may be made under federal and state healthcare programs such as Medicare and Medicaid. A person or entity does not need to have actual knowledge of the federal Anti-Kickback Statute or specific intent to violate it to have committed a violation;
the federal False Claims Act imposes criminal and civil penalties, including through civil whistleblower or qui tam actions, against individuals or entities for knowingly presenting, or causing to be presented, to the federal government, claims for payment that are false or fraudulent or making a false statement to avoid, decrease or conceal an obligation to pay money to the federal government. In addition, the government may assert that a claim including items or services resulting from a violation of the federal Anti-Kickback Statute constitutes a false or fraudulent claim for purposes of the False Claims Act;
HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act, imposes criminal and civil liability for executing a scheme to defraud any healthcare benefit program;
the federal false statements statute prohibits knowingly and willfully falsifying, concealing or covering up a material fact or making any materially false statement in connection with the delivery of or payment for healthcare benefits, items or services. Similar to the federal Anti-Kickback Statute, a person or entity does not need to have actual knowledge of the statute or specific intent to violate it to have committed a violation;
the federal transparency requirements under the ACA requires certain manufacturers of drugs, devices, biologics and medical supplies for which payment is available under Medicare, Medicaid or the Children’s Health Insurance Program (with certain exceptions) to report to the Department of Health and Human Services information related to physician payments and other transfers of value and ownership and investment interests held by physicians (defined to include doctors, dentists, optometrists, podiatrists and chiropractors), certain non-physician practitioners (physician assistants, nurse practitioners, clinical nurse specialists, certified nurse anesthetists, anesthesiologist assistants and certified nurse midwives), and their immediate family members and payments or other transfers of value made to such physician owners;
analogous state laws and regulations, such as state anti-kickback and false claims laws, and transparency laws, may apply to sales or marketing arrangements and claims involving healthcare items or services reimbursed by non-governmental third-party payors, including private insurers, and some state laws require pharmaceutical companies to comply with the pharmaceutical industry’s voluntary compliance guidelines and the relevant compliance guidance promulgated by the federal government in addition to requiring drug manufacturers to report information related to payments to physicians and other health care providers or marketing expenditures and pricing information; and

Efforts to ensure that our business arrangements with third parties will comply with applicable healthcare laws and regulations will involve substantial costs. It is possible that governmental authorities will conclude that our business practices may not comply with current or future statutes, regulations or case law involving applicable fraud and abuse or other healthcare laws and regulations. If our operations are found to be in violation of any of these laws or any other governmental regulations that may apply to us, we may be subject to significant civil, criminal and administrative penalties, damages, fines, exclusion from government funded healthcare programs, such as Medicare and Medicaid, additional reporting obligations and oversight if we become subject to a corporate integrity agreement or other agreement to resolve allegations of non-compliance with these laws, imprisonment and the curtailment or restructuring of our operations. Further, defending against any such actions, even if successful, can be costly, time-consuming and may require significant personnel resources. If any of the physicians or other providers or entities with whom we expect to do business are found to be not in compliance with applicable laws, they may be subject to criminal, civil or administrative sanctions, including exclusions from government funded healthcare programs.

We may issue additional shares of common stock, warrants or other securities to finance our growth.

We may finance the business development or generate additional working capital through additional equity financing. Therefore, subject to the rules of the Nasdaq, we may issue additional shares of our common stock, warrants and other equity securities of equal or senior rank, with or without stockholder approval, in a number of circumstances from time to time. The issuance by us of shares of our common stock, warrants or other equity securities of equal or senior rank will have the following effects:

the proportionate ownership interest in us held by our existing stockholders will decrease;
the relative voting strength of each previously outstanding share of common stock may be diminished; and
the market price of our common stock may decline.

In addition, if we issue shares of our common stock and/or warrants in a future offering (or, in the case of our common stock, the exercise of outstanding warrants to purchase our common stock), it could be dilutive to our security holders.

There can be no assurance that we will ever provide liquidity to our investors through a sale of our company.

While acquisitions of healthcare companies like ours are not uncommon, potential investors are cautioned that no assurances can be given that any form of merger, combination, or sale of our company will take place, or that any merger, combination, or sale, even if consummated, would provide liquidity or a profit for our investors. You should not invest in our company with the expectation that we will be able to sell the business in order to provide liquidity or a profit for our investors.

We have broad discretion in the use of the net proceeds from our public offerings and private placement and may not use them effectively.

Our management has broad discretion in the application of the net proceeds from our public offerings and private placement and could spend the proceeds in ways that do not enhance the value of our common stock. Because of the number and variability of factors that will determine our use of the net proceeds from our completed offerings, their ultimate use may vary substantially from their currently intended use. The failure by our management to apply these funds effectively could have a material adverse effect on our business. Pending their use, we may invest the net proceeds from the offerings in a manner that does not produce income or that loses value. If we do not apply or invest the net proceeds from the offerings in ways that enhance stockholder value, we may fail to achieve expected financial results, which could cause the price of our securities to decline.

Any of these factors could cause or contribute to the risks and uncertainties identified in our Annual Report on Form 10-K for the year ended December 31, 2021 and could materially adversely affect our business, financial condition and results of operations.

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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

On April 29, 2019, we confirmed that D. Anthony Bond will no longer serve as our Chief Financial Officer or any other position he held with the Company. Mr. Bond’s separation from employment was not in connection with any disagreement relating to our operations, policies or practices.None.

On April 30, 2019, our Board appointed Sheri Gardzina, age 50, to serve as our interim Chief Financial Officer and Corporate Secretary (and to be our principal financial officer and principal accounting officer). Ms. Gardzina is a licensed certified public accountant in Tennessee with more than 20 years of diverse public accounting, financial and business consulting experience with a variety of companies in the healthcare industry. Ms. Gardzina joined the Company in November 2017 as the Controller and was most recently the Executive Vice President of Finance of the Company. She was a key participant in the preparation of the financial statements for our February 2019 initial public offering.

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ITEM 6.EXHIBITS

Exhibit

Number

Description
2.13.1Agreement and Plan of Merger, dates as of April 1, 2019, by and among IMAC Holdings Inc., IMAC Management of Illinois, LLC, ISDI Holdings Inc. and Jason Hui (filed as Exhibit 2.1 to the Company’s Current Report on Form 8-K filed with the SEC on April 3, 2019 and incorporated herein by reference).
2.2Amendment to Agreement and Plan of Merger, dated April 19, 2019, by and among IMAC Holdings Inc., IMAC Management of Illinois, LLC, ISDI Holdings, Inc., ISDI Holdings II, Inc., PHR Holdings, Inc., and Jason Hui (filed as Exhibit 2.2 to the Company’s Current Report on Form 8-K filed with the SEC on April 25, 2019 and incorporated herein by reference).
3.1

Certificate of Incorporation of IMAC Holdings, Inc. (filed as Exhibit 3.1 to the Company’s Registration Statement on Form S-1 filed with the SEC on September 17, 2018 and incorporated herein by reference).

3.2

Certificate of Amendment to the Certificate of Incorporation of IMAC Holdings, Inc. (filed as Exhibit 3.2 to the Company’s Registration Statement on Form S-1/A filed with the SEC on December 10, 2018 and incorporated herein by reference).

3.3

Certificate of Correction of the Certificate of Incorporation of IMAC Holdings, Inc. filed with the Delaware Secretary of State on August 8, 2019 (filed as Exhibit 3.4 to the Company’s Current Report on Form 8-K filed with the SEC on August 9, 2019 and incorporated herein by reference).

3.4

Bylaws of IMAC Holdings, Inc. (filed as Exhibit 3.2 to the Company’s Registration Statement on Form S-1 filed with the SEC on September 17, 2018 and incorporated herein by reference).

4.1

Specimen Common Stock Certificate (filed as Exhibit 4.1 to the Company’s Registration Statement on Form S-1 filed with the SEC on September 17, 2018 and incorporated herein by reference).

4.2

Form of Common Stock Warrant certificate (filed as Exhibit 4.2 to the Company’s Registration Statement on Form S-1/A filed with the SEC on December 3, 2018 and incorporated herein by reference).

4.3

Form of Warrant Agency Agreement between IMAC Holdings, Inc. and Equity Stock Transfer, LLC (filed as Exhibit 4.3 to the Company’s Registration Statement on Form S-1/A filed with the SEC on December 3, 2018 and incorporated herein by reference).

4.4

Form of Underwriters’ Unit Purchase Option (filed as Exhibit 4.4 to the Company’s Registration Statement on Form S-1/A filed with the SEC on February 8, 2019 and incorporated herein by reference).

10.1†

10.1

Employment Agreement, dated as of March 1, 2019,February 4, 2022 and commencing February 21, 2022, between IMAC Holdings, Inc. and Jeffrey S. Ervin (filed as Exhibit 10.13 to the Company’s Annual Report on Form 10-K filed with the SEC on April 16, 2019 and incorporated herein by reference).

10.2†Employment Agreement, dated as of March 1, 2019, between IMAC Holdings, Inc. and Matthew C. Wallis (filed as Exhibit 10.14 to the Company’s Annual Report on Form 10-K filed with the SEC on April 16, 2019 and incorporated herein by reference).
10.3†

Employment Agreement, dated as of April 19, 2019, between IMAC Holdings, Inc. and Jason HuiDr. Ben Lerner. (filed as Exhibit 10.1 to the Company’s Current Report on Form 8-K filed with the SEC on April 25, 2019February 24, 2022 and incorporated herein by reference).

31.1*Certification of the Principal Executive Officer pursuant to Rules 13a-14(a) and 15d-14(a) promulgated pursuant to the Securities Exchange Act of 1934, as amended.
31.2*Certification of the Principal Financial Officer pursuant to Rules 13a-14(a) and 15d-14(a) promulgated pursuant to the Securities Exchange Act of 1934, as amended.

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32.1**Certification of the Principal Executive Officer pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
32.2**Certification of the Principal Financial Officer pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS*Inline XBRL Instance Document
101.SCH*Inline XBRL Taxonomy Extension Schema
101.CAL*Inline XBRL Taxonomy Extension Calculation Linkbase
101.LAB*Inline XBRL Taxonomy Extension Labels Linkbase
101.PRE*Inline XBRL Taxonomy Extension Presentation Linkbase
101.DEF*Inline XBRL Taxonomy Extension Definition Linkbase
104Cover Page Interactive Data File (embedded within the Inline XBRL document)

 

*Compensatory plan or agreement.Filed herewith.
**Filed herewith.
**This certification is being furnished solely to accompany this quarterly report pursuant to 18 U.S.C. § 1350, and is not being filed for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, and is not to be incorporated by reference into any filing of IMAC Holdings, Inc., whether made before or after the date hereof, regardless of any general incorporation language in such filing.

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SIGNATURES

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

IMAC HOLDINGS, INC.
Date: MayAugust 15, 20192022By:/s/ Jeffrey S. Ervin

Jeffrey S. Ervin

Chief Executive Officer

(Principal Executive Officer)

Date: August 15, 2022By:/s/ Sheri Gardzina
Sheri Gardzina

Chief Financial Officer Duly Authorized

(Principal Financial and Accounting Officer)

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