0001493152-20-015694.txt : 20200814 0001493152-20-015694.hdr.sgml : 20200814 20200814090038 ACCESSION NUMBER: 0001493152-20-015694 CONFORMED SUBMISSION TYPE: 10-Q PUBLIC DOCUMENT COUNT: 75 CONFORMED PERIOD OF REPORT: 20200630 FILED AS OF DATE: 20200814 DATE AS OF CHANGE: 20200814 FILER: COMPANY DATA: COMPANY CONFORMED NAME: IMAC Holdings, Inc. CENTRAL INDEX KEY: 0001729944 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SPECIALTY OUTPATIENT FACILITIES, NEC [8093] IRS NUMBER: 473579961 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 10-Q SEC ACT: 1934 Act SEC FILE NUMBER: 001-38797 FILM NUMBER: 201101655 BUSINESS ADDRESS: STREET 1: 1605 WESTGATE CIRCLE CITY: BRENTWOOD STATE: TN ZIP: 37027 BUSINESS PHONE: 844-266-4622 MAIL ADDRESS: STREET 1: 1605 WESTGATE CIRCLE CITY: BRENTWOOD STATE: TN ZIP: 37027 FORMER COMPANY: FORMER CONFORMED NAME: IMAC HOLDINGS LLC DATE OF NAME CHANGE: 20180131 10-Q 1 form10-q.htm

 

 

 

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 JUNE 30, 2020
   

 

[  ] 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)

 

Delaware   83-0784691

(State or Other Jurisdiction of

Incorporation or Organization)

 

(I.R.S. Employer

Identification No.)

 

1605 Westgate Circle, Brentwood, Tennessee   37027
(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 class   Trading Symbol(s)   Name of each exchange on which registered
Common Stock, par value $0.001 per share   IMAC   NASDAQ Capital Market
Warrants to Purchase Common Stock   IMACW   NASDAQ 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 August 14, 2020 the registrant had 11,839,973 shares of common stock (par value $0.001 per share) outstanding.

 

 

 

   

 

 

IMAC HOLDINGS, INC.

TABLE OF CONTENTS

 

  Page
IMPORTANT INFORMATION REGARDING FORWARD-LOOKING STATEMENTS 3
   
PART I. FINANCIAL INFORMATION 4
Item 1. Financial Statements (Unaudited) 4
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations 21
Item 3. Quantitative and Qualitative Disclosures about Market Risk 32
Item 4. Controls and Procedures 32
   
PART II. OTHER INFORMATION 33
Item 1. Legal Proceedings 33
Item 1A. Risk Factors 33
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds 33
Item 3. Defaults Upon Senior Securities 34
Item 4. Mine Safety Disclosures 34
Item 5. Other Information 34
Item 6. Exhibits 34

 

 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, 2019 filed with the U.S. Securities and Exchange Commission on March 26, 2020. 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

(Unaudited)

 

    June 30,
2020
    December 31,
2019
 
ASSETS                
Current assets:                
Cash   $ 2,802,769     $ 373,689  
Accounts receivable, net     1,489,872       1,258,325  
Deferred compensation, current portion     263,859       312,258  
Other assets     336,958       633,303  
Total current assets     4,893,458       2,577,575  
                 
Property and equipment, net     3,293,992       3,692,009  
                 
Other assets:                
Goodwill     2,040,696       2,040,696  
Intangible assets, net     7,081,218       7,169,072  
Deferred equity costs     143,655       170,274  
Deferred compensation, net of current portion     356,085       549,563  
Security deposits     451,284       499,488  
Right of use asset     3,600,198       3,719,401  
Total other assets     13,673,136       14,148,494  
                 
Total assets   $ 21,860,586     $ 20,418,078  
                 
LIABILITIES AND STOCKHOLDERS’ EQUITY                
                 
Current liabilities:                
Accounts payable and accrued expenses   $ 2,543,165     $ 2,909,666  
Patient deposits     351,142       189,691  
Notes payable, current portion, net of deferred loan costs     4,471,874       1,422,554  
Finance lease obligation, current portion     17,853       17,473  
Line of credit     79,961       79,961  
Liability to issue common stock, current portion     326,356       421,044  
Operating lease liability, current portion     980,967       1,025,247  
Total current liabilities     8,771,318       6,065,636  
                 
Long-term liabilities:                
Notes payable, net of current portion     1,232,677       2,109,065  
Finance lease obligation, net of current portion     57,542       66,565  
Liability to issue common stock, net of current portion     362,979       578,866  
Operating lease liability, net of current portion     3,482,242       3,660,654  
Other non-current liabilities     30,000       -  
                 
Total liabilities     13,936,758       12,480,786  
                 
Stockholders’ equity:                
Preferred stock - $0.001 par value, 5,000,000 authorized, nil issued and outstanding at June 30, 2020 and December 31, 2019     -       -  
Common stock - $0.001 par value, 30,000,000 authorized, 11,839,973 and 8,913,258 shares issued and outstanding at June 30, 2020 and December 31, 2019, respectively     11,834       8,907  
Additional paid-in capital     24,079,504       20,050,634  
Accumulated deficit     (13,806,283 )     (10,042,050 )
Non-controlling interest     (2,361,227 )     (2,080,199 )
Total stockholders’ equity     7,923,828       7,937,292  
                 
Total liabilities and stockholders’ equity   $ 21,860,586     $ 20,418,078  

 

See accompanying notes to the unaudited condensed consolidated financial statements.

 

 4 

 

 

IMAC HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

(Unaudited)

 

    Three Months Ended June 30,     Six Months Ended June 30,  
    2020     2019     2020     2019  
                         
Patient revenues, net   $ 2,572,580     $ 3,756,755     $ 5,881,649     $ 6,526,583  
Management fees     -       -       12,487       -  
Total revenue     2,572,580       3,756,755       5,894,136       6,526,583  
                                 
Operating expenses:                                
Patient expenses     405,367       927,778       785,184       1,363,907  
Salaries and benefits     2,334,249       2,593,209       5,260,399       4,657,832  
Share-based compensation     121,945       171,590       203,029       175,339  
Advertising and marketing     174,350       349,328       416,167       696,344  
Grant funds     (415,978 )     -       (415,978 )     -  
General and administrative     1,208,457       1,429,822       2,444,595       2,407,191  
Depreciation and amortization     453,651       396,989       904,146       682,556  
Total operating expenses     4,282,041       5,868,716       9,597,542       9,983,169  
                                 
Operating loss     (1,709,461 )     (2,111,961 )     (3,703,406 )     (3,456,586 )
                                 
Other income (expense):                                
Interest income     39       5       39       5  
Other income (expenses)     -       665       -       (15,290 )
Beneficial conversion interest expense     -       -       -       (639,159 )
Loss on extinguishment of debt     (109,544 )     -       (109,544 )     -  
Loss on disposal of assets     (21,225 )     -       (21,225 )     -  
Interest expense     (134,921 )     (85,210 )     (211,125 )     (115,881 )
Total other (expenses)     (265,651 )     (84,540 )     (341,855 )     (770,325 )
                                 
Net loss before income taxes     (1,975,112 )     (2,196,501 )     (4,045,261 )     (4,226,911 )
                                 
Income taxes     -       -       -       -  
                                 
Net loss     (1,975,112 )     (2,196,501 )     (4,045,261 )     (4,226,911 )
                                 
Net loss (income) attributable to the non-controlling interest     (55,576 )     295,733       281,028       726,956  
                                 
Net loss attributable to IMAC Holdings, Inc.   $ (2,030,688 )   $ (1,900,768 )   $ (3,764,233 )   $ (3,499,955 )
                                 
Net loss per share attributable to common stockholders                                
Basic and diluted   $ (0.20 )   $ (0.23 )   $ (0.38 )   $ (0.50 )
                                 
Weighted average common shares outstanding                                
Basic and diluted     10,184,294       8,106,177       9,897,773       7,018,559  

 

See accompanying notes to the unaudited condensed consolidated financial statements.

 

 5 

 

 

IMAC HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY

(Unaudited)

 

   Common Stock   Additional   Non-         
   Number of
Shares
   Par   Paid-In-
Capital
   Controlling
Interest
   Accumulated Deficit   Total 
                         
Balance, December 31, 2018   4,553,623   $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 
Issuance of common stock in connection with acquisitions   1,002,306    1,002    4,072,436    -    -    4,073,438 
Exercise of warrants   61,569    62    307,783    -    -    307,845 
Issuance of employee stock options   -    -    16,216    -    -    16,216 
Net loss   -    -    -    (295,733)   (1,900,768)   (2,351,875)
Balance, June 30, 2019   8,316,798   $8,317   $18,676,639   $(2,352,796)  $(7,044,775)  $9,287,385 

 

   Common Stock   Additional   Non-         
   Number of
Shares
   Par   Paid-In-
Capital
   Controlling
Interest
   Accumulated Deficit   Total 
                         
Balance, December 31, 2019   8,913,258   $8,907   $20,050,634   $(2,080,199)  $(10,042,050)  $7,937,292 
Issuance of common stock   1,095,840    1,096    1,376,122    -    -    1,377,218 
Issuance of employee stock options   -    -    38,359    -    -    38,359 
Net loss   -    -    -    (336,604)   (1,733,545)   (2,070,149)
Balance, March 31, 2020   10,009,098    10,003    21,465,115    (2,416,803)   (11,775,595)   7,282,720 
Issuance of common stock   1,830,875    1,831    2,576,820    -    -    2,578,651 
Issuance of employee stock options   -    -    37,569    -    -    37,569 
Net income (loss)   -    -    -    55,576    (2,030,688)   (1,975,112)
Balance, June 30, 2020   11,839,973   $11,834   $24,079,504   $(2,361,227)  $(13,806,283)  $7,923,828 

 

See accompanying notes to unaudited condensed consolidated financial statements.

 

 6 

 

 

IMAC HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(Unaudited)

 

   

Six Months Ended

June 30,

 
    2020     2019  
Cash flows from operating activities:                
Net loss   $ (4,045,261 )   $ (4,226,911 )
Adjustments to reconcile net loss to net cash used in operating activities:                
Depreciation and amortization     904,146       682,556  
Beneficial conversion interest expense     -       639,159  
Share based compensation     203,030       175,339  
Loss on disposition of assets     (16,577 )     -  
(Increase) decrease in operating assets:                
Accounts receivable, net     (210,707 )     (259,712 )
Other assets     299,721       (98,685 )
Security deposits     48,204       (70,773 )
Increase (decrease) in operating liabilities:                
Accounts payable and accrued expenses     (329,056 )     675,820  
Patient deposits     161,451       861,409  
Lease incentive obligation     -       (57,262 )
Net cash used in operating activities     (2,985,049 )     (1,679,060 )
                 
Cash flows from investing activities:                
Purchase of property and equipment     (10,511 )     (389,469 )
Purchase of license fee     (243,750 )     -  
Acquisition of IMAC Florida (Note 6)     (200,000 )     -  
Net cash used in investing activities     (454,261 )     (389,469 )
                 
Cash flows from financing activities:                
Proceeds from initial public offering, net of related fees     -       3,839,482  
Proceeds from warrants exercised     -       357,345  
Proceeds from issuance of common stock     3,774,617       -  
Proceeds from notes payable     2,891,520       100,000  
Payments on notes payable     (719,104 )     (54,377 )
Payments of debt issuance costs     (70,000 )     -  
Proceeds from line of credit     -       20,000  
Payments on line of credit     -       (150,000 )
Payments on finance lease obligation     (8,643 )     (6,835 )
Net cash provided by financing activities     5,868,390       4,105,615  
                 
Net increase in cash     2,429,080       2,037,086  
                 
Cash, beginning of period     373,689       194,316  
                 
Cash, end of period   $ 2,802,769     $ 2,231,402  
                 
Supplemental cash flow information:                
Interest paid   $ 56,058     $ 30,671  
Non cash financing and investing:                
Debt discount notes payable   $ 115,000     $ -  
Business acquisition via stock issuance   $ -     $ 3,771,978  

 

See accompanying notes to the unaudited condensed consolidated financial statements.

 

 7 

 

 

 

IMAC HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

 

Note 1 – Description of Business

 

IMAC Holdings, Inc. and its affiliates (collectively, the “Company”) provide orthopedic 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 open two (2) medical clinics located in Tennessee and opened or acquired through management service agreements thirteen (13) medical clinics located in Kentucky, Missouri, Illinois and Florida at June 30, 2020. The Company has partnered with several well-known sports stars such as Ozzie Smith, David Price, Tony Delk and Mike Ditka in opening its medical clinics, with a focus around treating sports injuries.

 

Effective June 1, 2018, the Company converted from IMAC Holdings, LLC a Kentucky limited liability company 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.

 

During February 2019, the Company completed an initial public offering (“IPO”) of securities. See Note 12 – Stockholder’s Equity.

 

Note 2 – Summary of Significant Accounting Policies

 

Principles of Consolidation

 

The accompanying 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.S. Securities and Exchange Commission (“SEC” or the “Commission”). The information contained in these condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements and notes thereto for the fiscal year ended December 31, 2019 included in the Company’s Annual Report on Form 10-K filed with the SEC on March 26, 2020.

 

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 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”) and IMAC Management of Florida, LLC (“IMAC Florida”); 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”); and the following which prior to June 1, 2018 was held as a minority interest, IMAC Regeneration Center of St. Louis, LLC (“IMAC St. Louis”).

 

In June 2018, the Company consummated certain transactions resulting in the acquisition of the outstanding equity interests in IMAC St. Louis and Clinic Management Associates of KY, LLC (“CMA of KY”), an entity which consolidates Integrated Medical and Chiropractic Regeneration Center, PSC (“IMAC Kentucky”) due to control by contract. These entities 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. On October 1, 2019, the Company acquired the 30% of BioFirma’s membership interests which were not previously held by the Company, resulting in the Company owning 100% of the membership interests of BioFirma. Substantially all the assets of BioFirma were sold effective December 31, 2019; however as of June 30, 2020, the acquirer of the assets had not paid the purchase price and the Company had established a bad debt reserve of 100% of the purchase price.

 

 8 

 

 

In April 2019, the Company consummated certain transactions resulting in the acquisition of the outstanding equity interest in ISDI Holdings II, Inc., an Illinois corporation (“ISDI Holdings II”), and PHR Holdings, Inc., an Illinois corporation (“PHR Holdings”), entities which consolidate the results of Progressive Health and Rehabilitation, Ltd (“Progressive”) and Illinois Spine and Disc Institute, Ltd (“ISDI”) due to control by contract. These entities are included in the condensed consolidated financial statements from the date of acquisition.

 

In November 2019, IMAC Illinois entered into a management agreement for an occupational and physical therapy practice in Rockford, Illinois. This entity is included in the condensed consolidated financial statements due to control by contract from the date of entry into the management agreement.

 

In January 2020, the Company consummated an agreement for the acquisition of Chiropractic Health of Southwest Florida, Inc. (“CHSF”) in Bonita Springs, Florida. This entity is included in the condensed consolidated financial statements from the date of acquisition.

 

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

 

On January 30, 2020, the World Health Organization (WHO) announced a global health emergency because of a new strain of coronavirus originating in Wuhan, China (the “COVID-19 outbreak”) and the risks to the international community as the virus spread globally beyond the point of origin. On March 20, 2020 the WHO classified the COVID-19 outbreak as a pandemic, based on the rapid increase in exposure globally.

 

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 for fiscal year 2020 beyond the results presented in these condensed consolidated financial statements and this quarterly report.

 

CARES Act

 

The Company is continuing to closely monitor legislative actions at the federal, state and local levels including the Coronavirus Aid, Relief, and Economic Security Act (the "CARES Act") and other governmental assistance that might be available in response to the COVID-19 pandemic. As part of the CARES Act, the United States government initially announced that it would offer $100 billion of relief to eligible health care providers. On April 7, 2020, Centers for Medicare and Medicaid Services ("CMS") officials indicated they would distribute $30 billion of direct grants to hospitals, ASCs and other health care providers based on how much they bill Medicare. Payments received from these grants are not required to be repaid provided the recipients attest to and comply with certain terms and conditions, including limitations on balance billing and not using funds received from the grants to reimburse expenses or losses that other sources are obligated to reimburse.

 

The Company received approximately $416,000 of the grant funds distributed under the CARES Act Provider Relief Fund program during the six months ended June 30, 2020. Based on an analysis of the compliance and reporting requirements and the impact of the COVID-19 pandemic on our operating results through the end of the second quarter, these funds were recognized as a reduction in operating expenses under the caption Grant funds in the condensed consolidated statements of operations for the three- and six- months ended June 30, 2020. The recognition of amounts received is conditioned upon certification that payment will be used to prevent, prepare for and respond to the COVID-19 pandemic and shall reimburse the recipient only for healthcare related expenses or lost revenues that are attributable to the COVID-19 pandemic. Amounts are recognized as a reduction to operating costs and expenses only to the extent the Company is reasonably assured that underlying conditions are met.

 

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. The fees for such services are billed either to the patient or a third-party payer, including Medicare. Starting in January 2020, the Company implemented wellness maintenance programs on a subscription basis. There are three membership plans offered with different levels of service for each plan. The Company recognizes service revenues based upon the estimated amounts the Company expects to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments 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 estimated amounts expected to be collected.

 

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 an 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. The company recognize other management service revenue in the period in which services are rendered. These revenues are earned by IMAC Nashville, IMAC Management and IMAC Illinois and are eliminated in consolidation to the extent owned.

 

The Company’s patient revenue consisted of the following for the three and six months ended June 30, 2020 and June 30, 2019:

 

   Three Months Ended   Six Months Ended 
   June 30, 2020   June 30, 2019   June 30, 2020   June 30, 2019 
                 
Patient revenues  $5,595,279   $8,887,819   $12,747,221   $16,176,841 
Contractual adjustments   (3,022,699)   (5,131,064)   (6,865,572)   (9,650,258)
Patient revenue, net  $2,572,580   $3,756,755   $5,881,649   $6,526,583 

 

 9 

 

 

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 rarely 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 approximate their respective fair values due to the short- 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.

 

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 no cash equivalents at June 30, 2020 and December 31, 2019.

 

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 is 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, 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 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.

 

 10 

 

 

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 income 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 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) 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. Acquired intangible assets include trade names, non-compete agreements, customer relationships and contractual agreements.

 

Goodwill

 

Our goodwill represents the excess of the purchase price over the fair value of the net identifiable assets acquired 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. There was no goodwill impairment for the years presented.

 

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

 

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-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 $174,350 and $349,328 for the three months ended June 30, 2020 and 2019, respectively and was $416,167 and $696,344 for the six months ended June 30, 2020 and 2019, 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. Diluted net loss per common share is determined using the weighted-average of common shares outstanding during the period, 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.

 

 11 

 

 

Income Taxes

 

Following the Company’s conversion to a Delaware corporation in 2018, IMAC Nashville, IMAC Texas, IMAC St. Louis continued as single-member limited liability companies (wholly owned by the Company) that are disregarded entities for tax purposes and do not file separate returns. Their activity is included as part of IMAC Holdings Inc. Advantage Therapy, IMAC Illinois and IMAC Florida are also disregarded entities for tax purposes. BioFirma was a limited liability company taxed as a partnership. Effective October 1, 2019, BioFirma became wholly owned by IMAC Holdings and is a disregarded entity for tax purposes. IMAC Management is a C-corporation and is included in the consolidated return of IMAC Holdings as a subsidiary.

 

Any future benefit arising from losses have been offset by a valuation allowance. Accordingly, no provision for income taxes is reflected in the condensed consolidated financial statements. The Company records a liability for uncertain tax positions when 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. At June 30, 2020 and December 31, 2019, 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 2017 are open and subject to examination by the taxing authorities.

 

Note 3 – Capital Requirements, Liquidity and Going Concern Considerations

 

The Company’s condensed consolidated financial statements are prepared in accordance with GAAP including 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 had a deficiency in working capital of approximately $3.9 million and $3.5 million at June 30, 2020 and December 31, 2019. The Company had a net loss of approximately $3.8 million and $3.5 million at June 30, 2020 and 2019, respectively, and used cash in operations of approximately $3.0 million and $1.7 million at June 30, 2020 and 2019, respectively. 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 June 30, 2020, the Company has received funding in the form of indebtedness and the issuance of common stock. Management plans to continue to raise funds and/or refinance our indebtedness to support our operations in 2020 and beyond. However, no assurances can be given that we 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.

 

 12 

 

 

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. The Company had approximately $1,724,713 of cash in excess of federally insured limits.

 

Revenue and Accounts Receivable

 

As of June 30, 2020 and December 31, 2019, the Company had the following revenue and accounts receivable concentrations:

 

   June 30, 2020   December 31, 2019 
   % of Revenue   % of Accounts Receivable   % of Revenue   % of Accounts Receivable 
   (Unaudited)         
Patient payment   33%   29%   47%   40%
Medicare payment   41%   28%   27%   26%
Insurance payment   26%   43%   26%   34%

 

Note 5 – Accounts Receivable

 

As of June 30, 2020 and December 31, 2019, the Company’s accounts receivable consisted of the following:

 

   June 30,
2020
   December 31,
2019
 
   (Unaudited) 
Gross accounts receivable  $1,518,854   $1,285,228 
Less: allowance for doubtful accounts   (28,982)   (26,903)
Accounts receivable, net  $1,489,872   $1,258,325 

 

Note 6 – Business Acquisitions

 

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.

 

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

 

On October 1, 2019, the holder of the 30% of the membership interests of BioFirma and the Company entered into an Assignment and Assumption of Interests of BioFirma LLC, pursuant to which the Company acquired the 30% of BioFirma’s membership interests which were not previously held by the Company, resulting in the Company owning 100% of the membership interests of BioFirma.

 

On December 31, 2019, the Company and BioFirma consummated the sale of substantially all of BioFirma’s assets pursuant to an asset purchase agreement with Self Care Regeneration LLC for a purchase price of $320,800, plus the assumption of certain of BioFirma’s liabilities, all of which were due to be paid to us no later than March 30, 2020. On March 31, 2020, the due date for the payment of the asset sale purchase price was extended to June 30, 2020. As of June 30, 2020, the acquirer of the assets had not paid the purchase price and the Company had established a bad debt reserve of 100% of the purchase price.

 

 13 

 

 

IMAC Illinois

 

On April 1, 2019, the Company and its wholly owned subsidiary IMAC Illinois entered into an Agreement and Plan of Merger (the “Merger Agreement”) for the acquisition of a practice management group that manages three clinics in the Chicago, Illinois area. The acquisition was completed on April 19, 2019. Pursuant to the Merger Agreement, the Company issued 1,002,306 restricted shares of the Company’s common stock (the “Merger Consideration”) valued at approximately $4.1 million. The Company has included the financial results of IMAC Illinois, which controls the three Chicago-area clinics, from April 19, 2019, the date of acquisition.

 

IMAC Florida

 

On January 13, 2020, the Company and its wholly owned subsidiary IMAC Florida consummated the acquisition of CHSF, a chiropractic practice in Bonita Springs, Florida. The transaction was completed as a purchase of the practice for $200,000. The Company has included the financial results of IMAC Florida, which controls CHSF, from January 13, 2020, the date of acquisition.

 

The following table summarizes the fair value of consideration paid and the allocation of purchase price to the fair value of net assets acquired for the acquisition of the IMAC Florida business:

 

   Florida 
Property & equipment  $50,358 
Customer lists   128,802 
Other assets   20,840 
   $200,000 

 

Note 7 – Property and Equipment

 

The Company’s property and equipment consisted of the following at June 30, 2020 and December 31, 2019:

 

   Estimated
Useful Life in Years
  June 30,
2020
   December 31,
2019
 
            
Land and building  40 (Building)  $1,175,000   $1,175,000 
Leasehold improvements  Shorter of asset or lease term   2,249,673    2,262,398 
Equipment  1.5 - 7   1,980,871    1,948,347 
Total property and equipment      5,405,544    5,385,745 
              
Less: accumulated depreciation      (2,114,820)   (1,693,736)
       3,290,724    3,692,009 
Construction in progress      3,268    - 
Total property and equipment, net     $3,293,992   $3,692,009 

 

Depreciation was $218,818 and $173,394 for the three months ended June 30, 2020 and 2019, respectively and $437,661 and $328,276 for the six months ended June 30, 2020 and 2019, respectively.

 

Note 8 – Intangibles Assets and Goodwill

 

The Company’s intangible assets and goodwill consisted of the following at June 30, 2020 and December 31, 2019:

 

        June 30, 2020  
    Estimated         Accumulated        
    Useful Life   Cost     Amortization     Net  
                       
Intangible assets:                            
Management service agreements   10 years   $ 7,940,398     $ (1,309,360 )   $ 6,631,038  
Non-compete agreements   3 years     301,000       (206,972 )     94,028  
Customer lists   3 years     134,882       (22,480 )     112,402  
Definite lived assets         8,376,280       (1,538,812 )     6,837,468  
Research and development         243,750       -       243,750  
Goodwill         2,040,696       -       2,040,696  
Total intangible assets and goodwill       $ 10,660,726     $ (1,538,812 )   $ 9,121,914  

 

 14 

 

 

      December 31, 2019 
   Estimated      Accumulated     
   Useful Life  Cost   Amortization   Net 
                
Intangible assets:                  
Management service agreements  10 years  $8,019,199   $(994,321)  $7,024,878 
Non-compete agreements  3 years   301,000    (156,806)   144,194 
Definite lived assets      8,320,199    (1,151,127)   7,169,072 
Goodwill      2,040,696    -    2,040,696 
Total intangible assets and goodwill     $10,360,895   $(1,151,127)  $9,209,768 

 

Amortization was $234,833 and $223,595 for the three months ended June 30, 2020 and 2019, respectively, and $466,485 and $354,280 for the six months ended June 30, 2020 and 2019, respectively.

 

The Company’s estimated future amortization of intangible assets was as follows:

 

Years Ending December 31,    
     
2020 (six months)  $469,666 
2021   882,861 
2022   839,000 
2023   794,040 
2024   794,040 
Thereafter   3,057,861 
   $6,837,468 

 

Note 9 – Operating Leases

 

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

 

Discount Rate Applied to Operating Leases

 

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, the Company used the ten year mortgage interest rate.

 

Right of Use Assets

 

Right of use assets included in the Company’s condensed consolidated balance sheet were as follows:

 

   June 30,
2020
   December 31,
2019
 
         
Non-current assets          
Right of use assets, net of amortization  $3,600,198   $3,719,401 

 

 15 

 

 

Total operating lease cost

 

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

 

  

Six Months
Ended

June 30, 2020

  

Six Months
Ended

June 30, 2019

 
           
Operating lease expense  $618,508   $456,772 

 

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
Leases
 
     
Undiscounted future minimum lease payments:     
2020 (six months)  $577,124 
2021   1,035,714 
2022   1,030,098 
2023   939,971 
2024   601,468 
Thereafter   588,246 
Total   4,772,621 
Amount representing imputed interest   (309,412)
Total operating lease liability   4,463,209 
Current portion of operating lease liability   (980,967)
Operating lease liability, non-current  $3,482,242 

 

Note 10 – Line of Credit

 

Advantage Therapy has a $100,000 line of credit with a financial institution that matures on November 20, 2020. The line accrues interest at a variable rate which is currently 6.0% per annum. The line is secured by substantially all of IMAC Holding’s assets. This line of credit had a balance of $79,961 at June 30, 2020 and December 31, 2019.

 

Note 11 – Notes Payable

 

On March 25, 2020, the Company entered into a note purchase agreement with Iliad Research & Trading, L.P. (the “Holder”), pursuant to which the Company agreed to issue and sell to the Holder a secured promissory note (the “Note”) in an aggregate initial principal amount of $1,115,000 (the “Initial Principal Amount”), which is payable on or before the date that is 18 months from the issuance date (the “Maturity Date”). The Initial Principal Amount includes an original issue discount of $100,000 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 Note, the Holder paid an aggregate purchase price of $1,000,000. Interest on the Note accrues at a rate of 10% per annum and is payable on the Maturity Date or otherwise in accordance with the Note. The Note may be prepaid by the Company (with the payment of a premium), may be required by the Holder to be redeemed by the Company for up to $200,000 per month after the six-month anniversary of the issuance of the Note (subject to certain deferral rights), and is subject to customary event of default (with a default interest rate of up to 22%). The Note transaction documents also give the Holder a right of first refusal to future debt issuances and a right to the first $250,000 of every $1 million of proceeds from future sales of equity by the Company. The Note is secured by the assets of the Company, other that the Company’s owned real property, intellectual property and accounts receivable, pursuant to a security agreement.

 

On April 16, 2020, the Company entered into a loan with Pinnacle Bank as the lender (“Lender”) in an aggregate principal amount of $1,691,520 (the “Loan”) pursuant to the Paycheck Protection Program (the “PPP”) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The Loan is evidenced by a promissory note (the “PPP Note”) dated April 16, 2020 and matures on April 16, 2022. The PPP Note bears interest at a rate of 1.000% per annum, with the first six months of payments deferred. Principal and interest are payable monthly commencing on November 16, 2020 and may be prepaid by the Company at any time prior to maturity with no prepayment penalties. In order to be entitled to forgiveness, funds from the Loan may only be used for payroll costs, costs used to continue group health care benefits, mortgage payments, rent utilities, and interest on other debt obligations under the terms and conditions outlined by the PPP. The Company intends to use all or a significant majority of the Loan amount for the qualifying expenses. The Loan will not be deemed restricted issuance pursuant to the terms of the note purchase agreement entered into by the Company and Iliad Research & Trading, L.P. on March 25, 2020.

 

 16 

 

 

Set forth below is a summary of the Company’s outstanding debt as of June 30, 2020 and December 31, 2019:

 

   June 30,   December 31, 
   2020   2019 
         
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 which carries an interest rate of 10% per annum. The Note was amended in June 2019 and all outstanding balances are due January 5, 2021.  $1,750,000   $1,750,000 
           
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.   86,107    99,628 
           
$1.2 million mortgage loan with a financial institution. The loan agreement was originally for 6-months and carries an interest rate 3.35%. The loan matured in 2019. As of June 30, 2020, it was due on demand, with interest being paid monthly. This mortgage was repaid on July 24, 2020 (see Note 16 below).   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.   87,568    93,652 
           
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 certain Company executives.   41,788    63,913 
           
Note payable to an employee in the amount of $101,906 dated March 8, 2017. The note requires payment of five annual installments of $23,350, including principal and interest at 5%. The note matures on December 31, 2021, and is unsecured.   40,000    60,000 
           
$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.   92,433    102,744 
           
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.   107,119    129,182 
           
Note payable to a financial institution in the amount of $1,691,520 dated April 16, 2020. The note requires 18 consecutive monthly installments, commencing on November 16, 2020, of $95,193 including principal and interest at 1.00%. The note matures on April 16, 2022.   1,691,520    - 
           
Note payable in the amount of $1,115,000, dated March 25, 2020. The note is payable on or before September 25, 2021. The interest on the note accrues at a rate of 10% per annum and is payable on the maturity date or otherwise in accordance with the note.   690,000    - 
           
Unamortized debt issuance costs   (114,484)   - 
           
    5,704,551    3,531,619 
Less: current portion:   (4,471,874)   (1,422,554)
   $1,232,677   $2,109,065 

 

 17 

 

 

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

 

Years Ending December 31,  Amount 
     
2020 (six months)  $2,083,113 
2021   3,032,557 
2022   484,184 
2023   51,657 
2024   27,631 
Thereafter   25,409 
Total  $5,704,551 

 

Note 12 – Stockholders’ Equity

 

Prior to the Company’s conversion to a corporation, 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 6,582,737 shares of common stock with a $0.001 par value pursuant to the Company’s conversion from a limited liability company to a corporation.

 

On February 12, 2019, the Company completed a reverse split of its 6,582,737 shares of common stock 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, the Company completed an initial 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 34,000 shares of common stock for gross proceeds of $4,356,815. The Company also issued 449,217 shares of common stock for the conversion of its 4% convertible notes and 1,410,183 shares to satisfy deferred acquisition consideration payable in connection with its 2018 business acquisitions.

 

On April 19, 2019, the Company consummated the Merger Agreement and issued 1,002,306 shares of its common stock in Merger Consideration.

 

On July 15, 2019, the Company signed a $10 million share purchase agreement (the “Purchase Agreement”) with Lincoln Park Capital Fund, LLC (“Lincoln Park”), an Illinois limited liability company. In consideration for entering into the $10 million agreement, the Company issued to Lincoln Park 60,006 shares of Company common stock as a commitment fee. The Purchase Agreement limits our sales of shares of common stock to Lincoln Park to 1,669,359 shares of common stock, representing 19.99% of the shares of common stock outstanding on the date of the Purchase Agreement unless (a) stockholder approval is obtained to issue more than such amount or (b) the average price of all applicable sales of our common stock to Lincoln Park under the Purchase Agreement equals or exceeds the lower of (i) the closing price of our common stock on the Nasdaq Capital Market immediately preceding July 15, 2019 or (ii) the average of the closing price of our common stock on the Nasdaq Capital Market for the five business days immediately preceding July 15, 2019. As of June 30, 2020, pursuant to the Purchase Agreement, the Company sold an aggregate of 1,602,294 shares of common stock of the Company to Lincoln Park for aggregate proceeds to the Company of $2,424,053 (excluding the 60,006 shares issued to Lincoln Park as a commitment fee).

 

On June 18, 2020, 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 Purchasers an aggregate of 1,764,000 shares (the “Shares”) of its common stock, in a registered direct offering (the “Registered Direct Offering”). The Shares were offered by the Company pursuant to its shelf registration statement on Form S-3 (File No. 333-237455) originally filed with the SEC on March 27, 2020 (as amended, the “Registration Statement”), which was declared effective on April 3, 2020. The purchase price for one Share in the Registered Direct Offering was $1.50, and closing of the Registered Direct Offering occurred on June 22, 2020. The Company received $2.644 million in gross proceeds from the Registered Direct Offering. The Company used approximately $0.5 million of the gross proceeds for the repayment of certain indebtedness, and the remaining proceeds to the Company will be used to finance the costs of developing and acquiring additional outpatient medical clinics as part of the Company’s growth and expansion strategy and for working capital.

 

2018 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.

 

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Stock Options

 

As of June 30, 2020, the Company had issued stock options to purchase 452,872 shares of its common stock as non-qualified stock options to various employees of the Company. These 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. 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 with the following assumptions: a volatility rate of 32.2%, risk free rate of 2.4% and the expected term of 10 years.

 

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 May 21, 2020, the Company granted 10,000 RSUs to a director of the Company, which vested immediately. On June 30, 2020, 66,875 shares of common stock were issued pursuant to previously granted RSUs which had vested as of such date.

 

Note 13 – Retirement 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 50% of up to 6 % of total compensation for those employees making salary deferrals. The Company made contributions of $20,105 and $13,354 during the three months ended June 30, 2020 and 2019, respectively, and $39,795 and $20,761 during the six months ended June 30, 2020 and 2019, respectively.

 

Note 14 – Income Taxes

 

The provision for income taxes differs from the amount computed by applying the statutory federal income tax rate to income before provision for income taxes. The sources and tax effects of the differences are as follows:

 

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

 

At June 30, 2020, the Company had a net operating loss carryforward of approximately $3.7 million for federal 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 June 30, 2020. The principal differences between the operating loss for income tax purposes and reporting purposes are shares issued for services and share-based compensation and a temporary difference in depreciation expense.

 

Note 15 – Commitments and Contingencies

 

The Company is subject to extensive regulation, including health insurance regulations directed at ascertaining the appropriateness of reimbursement, preventing fraud and abuse and otherwise regulating reimbursement. To ensure compliance, various insurance providers often conduct audits and request patient records and other documents to support 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 results of the audit to make overpayment demands based on a wider population of claims than those examined in the audit.

 

From time to time the Company may become subject to threatened and/or asserted claims arising in the ordinary course of our business. Management is not aware of any matters, either individually or in the aggregate, that are reasonably likely to have a material impact on the Company’s financial condition, results of operations or liquidity.

 

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Note 16 - Subsequent Events

 

On July 27, 2020, the Company sold real estate located in Lexington, Kentucky in a sale-leaseback transaction for a sale price of $1,300,000. The proceeds from the sale were used to repay a $1,232,000 mortgage owed by the Company. Simultaneous with the sale, the Company also entered a five-year leaseback of the sold property.

 

In August 2020, the United States Food and Drug Administration (the “FDA”) approved its investigational new drug application. The Company plans to initiate enrollment for a Phase 1 clinical trial, to be conducted over a 12-month period.

 

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

 

The following discussion contains forward-looking statements that involve risks and uncertainties. Our actual results could differ materially from those anticipated in these forward-looking statements as a result of various factors, including those set forth previously under the caption “Risk Factors.” This Management’s Discussion and Analysis of Financial Condition and Results of Operations should be read in conjunction with our audited consolidated financial statements and related notes included elsewhere in 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 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 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”) and IMAC Management of Florida, LLC (“IMAC Florida”); 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”); and the following which prior to June 1, 2018 was held as a minority interest, IMAC Regeneration Center of St. Louis, LLC (“IMAC St. Louis”).

 

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 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, acquired eight and manage one outpatient medical clinics in Kentucky, Missouri, Tennessee, Illinois and Florida, and plan to further expand the reach of our facilities to other strategic locations throughout the United States. We have partnered with several active and former professional athletes, including Ozzie Smith, David Price, Tony Delk and Mike Ditka, in the branding of our IMAC Regeneration Centers. Our outpatient medical clinics emphasize our focus around treating sports and orthopedic injuries as an alternative to traditional surgeries for repair or joint replacement.

 

We own our medical clinics directly or have entered into long-term management services agreements to operate and control certain of our 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 or own the clinic. Accordingly, our managed clinics are owned exclusively by a medical professional within a professional service corporation (formed as a limited liability company or corporation) and are under common control with us 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.

 

Corporate Conversion

 

Prior to June 1, 2018, we were a Kentucky limited liability company named IMAC Holdings, LLC. Effective June 1, 2018, we converted into a Delaware 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.

 

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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 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 and so that our existing owners own shares of our common stock rather than membership interests in a limited liability company. Except as otherwise noted herein, the consolidated financial statements 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 price of the warrants is $5.00 per warrant. The units immediately 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 have been 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 sold in the initial public offering. The unit purchase options have an exercise price equal to 120% 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.

 

Significant financial metrics

 

Significant financial metrics of the Company for the second quarter of 2020 are set forth in the bullets below.

 

  Net loss of $2.0 million in the second quarter of 2020 compared to a net loss of $1.9 million in the second quarter of 2019.
  Adjusted EBITDA1 of ($1.2 million) in the second quarter of 2020 compared to ($1.2 million) in the second quarter of 2019.
 

Monthly revenues were negatively impacted by COVID-19. Monthly revenues for the second quarter of 2020 compared to the second quarter of 2019 were as follows: approximately $568,000, $828,000 and $1,177,000 in April, May and June of 2020, respectively, compared to $1,057000, $1,361,000 and $1,339,000 in April, May and June of 2019, respectively.

 

The Company had one-time expenses of $160,000 in the second quarter of 2020, consisting of: a pre-payment penalty of $75,000 under the Iliad Note and the increase of bad debt reserve for the sale of BioFirma receivable of $85,000.

     
  (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

 

In March 2020, federal, state and local government authorities issued orders and guidance in order to combat the spread of the COVID-19 outbreak. These actions have required or encouraged our patients to remain at home except for essential activities and may reduce patient visits to our clinics. For example, the governor of Kentucky ordered all chiropractic facilities in the state of Kentucky to close effective March 20, 2020, which caused us to close our Kentucky chiropractic facilities until such order was lifted on May 4, 2020. The full extent and duration of such actions and their impacts over the longer term remain uncertain and dependent on future developments that cannot be accurately predicted at this time, such as the severity and transmission rate of the COVID-19 outbreak and the extent and effectiveness of containment actions taken.

 

Our response plan has multiple facets and continues to evolve as the pandemic unfolds. 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, including the following:

 

  Launched telemedicine communications for remote patient engagement;
  Suspended operations in three Kentucky clinics to comply with government orders until we were allowed to resume operations on May 4, 2020; and
  Suspended operations at one clinic in Cook County, Illinois to comply with government orders until such order is lifted. The lease for this clinic expired June 30, 2020 and was not renewed.

 

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. Due to such conditions, beginning in the month of March 2020 we began to terminate or furlough employees to reduce costs associated with non-essential personnel, which resulted in a 27% reduction in workforce. As of June 30, 2020, 62% of the full and part-time workforce had returned from furlough.

 

CARES Act

 

The Company is continuing to closely monitor legislative actions at the federal, state and local levels including the Coronavirus Aid, Relief, and Economic Security Act (the "CARES Act") and other governmental assistance that might be available in response to the COVID-19 pandemic. As part of the CARES Act, the United States government initially announced that it would offer $100 billion of relief to eligible health care providers. On April 7, 2020, Centers for Medicare and Medicaid Services ("CMS") officials indicated they would distribute $30 billion of direct grants to hospitals, ASCs and other health care providers based on how much they bill Medicare. Payments received from these grants are not required to be repaid provided the recipients attest to and comply with certain terms and conditions, including limitations on balance billing and not using funds received from the grants to reimburse expenses or losses that other sources are obligated to reimburse.

 

The Company received approximately $416,000 of the grant funds distributed under the CARES Act Provider Relief Fund program during the six months ended June 30, 2020. Based on an analysis of the compliance and reporting requirements and the impact of the COVID-19 pandemic on our operating results through the end of the second quarter, these funds were recognized as a reduction in operating expenses under the caption Grant funds in the condensed consolidated statements of operations for the three- and six- months ended June 30, 2020. The recognition of amounts received is conditioned upon certification that payment will be used to prevent, prepare for and respond to the COVID-19 pandemic and shall reimburse the recipient only for healthcare related expenses or lost revenues that are attributable to the COVID-19 pandemic. Amounts are recognized as a reduction to operating costs and expenses only to the extent the Company is reasonably assured that underlying conditions are met.

 

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We cannot predict with certainty when public health and economic conditions will return to normal. A decline in patient visits and/or the possible suspension of operations mandated 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.

 

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 our 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.

 

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. Acquired intangible assets include trade names, non-compete agreements, customer relationships and contractual agreements.

 

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Goodwill

 

Our goodwill represents the excess of the purchase price over the fair value of the net identifiable assets acquired 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. There was no goodwill impairment for the years presented.

 

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. No impairments of goodwill were recorded for the six months ended June 30, 2020.

 

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. Starting in January 2020, we implemented wellness maintenance programs on a subscription basis. There are three membership plans offered with different levels of service for each plan. We recognize patient service revenue, net of contractual adjustments, which we estimate based on the historical trend of our cash collections and contractual write-offs in the period in which services are performed. Contractual adjustments represent discounts offered for patients serviced within a negotiated third-party payer contract.

 

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.

 

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 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.

 

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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 payor, 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

 

IMAC Holdings was taxed as a partnership through May 31, 2018. As a result, income tax liabilities were passed through to the individual members. Accordingly, no provision for income taxes were reflected in the consolidated financial statements for periods prior to May 31, 2018, at which time the Company converted from a limited liability company to a Delaware corporation. Subsequent to the Company converting to a Delaware corporation, IMAC Nashville, IMAC Texas, IMAC St. Louis continued as single-member limited liability companies that are disregarded entities for tax purposes and do not file separate returns. Their activity is included as part of IMAC Holdings Inc. Advantage Therapy, IMAC Illinois and IMAC Florida are also disregarded entities for tax purposes. BioFirma was a limited liability company taxed as a partnership. Effective October 1, 2019, BioFirma became wholly owned by IMAC Holdings and is a disregarded entity for tax purposes. IMAC Management is a C-corporation and is included in the consolidated return of IMAC Holdings as a subsidiary.

 

Any future benefit arising from losses have been offset by a valuation allowance. Accordingly, no provision for income taxes is reflected in the consolidated financial statements. The Company records a liability for uncertain tax positions when 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. At June 30, 2020 and December 31, 2019, 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 2017 are open and subject to examination by the taxing authorities.

 

Results of Operations for the Three and Six Months Ended June 30, 2020 Compared to the Three and Six Months Ended June 30, 2019

 

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 limited liability company or corporation) 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.

 

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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 “Critical Accounting Policies and Estimates - Revenue Recognition.”

 

Revenues for the three months ended June 30, 2020 and 2019 were as follows:

 

 

   Three Months Ended June 30, 
   2020   2019 
   (in thousands, unaudited) 
Revenues:          
Outpatient facility services  $2,510   $3,757 
Memberships   63    - 
Total revenues  $2,573   $3,757 

 

Revenues for the six months ended June 30, 2020 and 2019 were as follows:

 

   Six Months Ended June 30, 
   2020   2019 
   (in thousands, unaudited) 
Revenues:          
Outpatient facility services  $5,722   $6,527 
Memberships   160    - 
Total revenues  $5,882   $6,527 

 

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

 

  

Six Months Ended

June 30,

 
   2020   2019 
     
Revenues:          
Medical treatments   66%   57%
Physical therapy   31%   38%
Chiropractic care   3%   5%
    100%   100%

 

Patient service revenues decreased 32% to $2.6 million for the three months ended June 30, 2020, compared to $3.8 million for the three months ended June 30, 2019. This decrease was primarily due to the impact of COVID-19. April 2020 was greatly impacted by COVID-19 due to the temporary closing of our Kentucky offices from March 20, 2020 to May 4, 2020 and an overall decrease in services in other markets due to COVID-19. Patient service revenues decreased 10% to $5.9 million for the six months ended June 30, 2020, compared to $6.5 million for the six months ended June 30, 2019. This decrease is attributable to the IMAC Chicago and IMAC Florida acquisitions that occurred in April 2019 and January 2020, respectively, along with the impact of COVID-19.

 

See table below for monthly patient revenue as a percent of second quarter patient revenue for the three months ended June 30, 2020 compared to the three months ended June 30, 2019.

 

    Patient Revenues by Month      
    April           May           June             Total      
                                                 
2020   $ 568,000       22 %   $ 828,000       32 %   $ 1,177,000       46 %   $ 2,573,000   100 %
2019   $ 1,057,000       28 %   $ 1,361,000       36 %   $ 1,339,000       36 %   $ 3,757,000   100 %

 

Visits to our clinics are an indication of business activity. Visits decreased 25% for the three months ended June 30, 2020 compared to the three months ended June 30, 2019. Visits decreased from 35,225 in the three months ended June 30, 2019 to 26,335 in the three months ended June 30, 2020. This decrease is a direct impact of COVID-19 on the clinics.

 

Starting in January 2020, we implemented wellness maintenance programs on a subscription basis. As of June 30, 2020, there were 637 active memberships. All active memberships at our Kentucky locations were paused in April 2020 due to an order of the governor of Kentucky to close all elective care facilities in Kentucky. Therefore, similar to visits, there was a significant decrease in memberships in April 2020, followed by an increase in memberships of 48% in June 2020, for a total of 637 active memberships. The average number of active members in the second quarter of 2020 was 511 compared to 343 for the average number of members in the first quarter of 2020.

 

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  2020   2019   Change from Prior Year   Percent Change from Prior Year 
                 
Three Months Ended June 30  $405,000   $928,000   $(523,000)   (56)%
Six Months Ended June 30   785,000    1,364,000    (579,000)   (42)%

 

Cost of revenues (patient expense) decreased for the three and six months ended June 30, 2020 as compared to June 30, 2019. This decrease was driven by the decrease in patient visits due to COVID-19, improvements in supply management and changes in the patient mix of services provided.

 

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

 

Salaries and Benefits  2020   2019   Change from Prior Year   Percent Change from Prior Year 
                 
Three Months Ended June 30  $2,334,000   $2,593,000   $(259,000)   (10)%
Six Months Ended June 30   5,260,000    4,658,000    602,000    13%

 

Salaries and benefits expenses for the three months ended June 30, 2020, as compared to the three months ended June 30, 2019, decreased due to the reduction in workforce as a result of closure of our clinics due to COVID-19. For the six months ended June 30, 2020, as compared to the six months ended June 30, 2019, salaries and benefits expenses increased due to our April 2019 acquisition of clinics in the Chicago, Illinois areas.

 

Share-based compensation consists of the value of equity incentive grants issued to employees, directors and board members which have vested during the period.

 

Share-based Compensation  2020   2019   Change from Prior Year   Percent Change from Prior Year 
                 
Three Months Ended June 30  $122,000   $172,000   $(50,000)   (29)%
Six Months Ended June 30   203,000    175,000    28,000    16%

 

Share-based compensation decreased from $172,000 to $122,000 for the three months ended June 30, 2020, as compared to the three months ended June 30, 2019.

 

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

 

Advertising and Marketing  2020   2019   Change from Prior Year   Percent Change from Prior Year 
                 
Three Months Ended June 30  $174,000   $349,000   $(175,000)   (50)%
Six Months Ended June 30   416,000    696,000    (280,000)   (40)%

 

Advertising and marketing expenses decreased for the three and six months ended June 30, 2020, as compared to the three and six months ended June 30, 2019. The decrease was due to reduced marketing spending as a result of the impact of the COVID-19 outbreak on consumer engagement.

 

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

 

General and Administrative  2020   2019   Change from Prior Year   Percent Change from Prior Year 
                 
Three Months Ended June 30  $1,208,000   $1,430,000   $(222,000)   (16)%
Six Months Ended June 30   2,445,000    2,407,000    38,000    2%

 

G&A decreased in the three months ended June 30, 2020 as compared to the three months ended June 30, 2019. In the second quarter of 2019 there was a significant amount of travel expenses with the acquisition of IMAC Chicago in April 2019, compared to the second quarter of 2020 that had a limited amount of travel due to COVID-19. There was also a decrease in overall G&A expenses during the second quarter of 2020 due to the temporary closing of 4 clinics due to COVID-19 and lower volume of patient visits. For the six months ended June 30, 2020 as compared to the six months ended June 30, 2019, G&A is comparable. G&A in the first quarter of 2020 had an increase of $259,000 compared to the first quarter of 2019, which was a result of the acquisitions of IMAC Chicago in April 2019 and IMAC Florida in January 2020. As mentioned above, the second quarter of 2020 then had a decrease of $222,000 in G&A compared to the second quarter of 2019. Together, these changes resulted in the first six months of 2020 and 2019 having comparable G&A.

 

Depreciation is related to our property and equipment purchases to use in the course of our business activities. Amortization is related to our business acquisitions.

 

Depreciation and Amortization  2020   2019   Change from Prior Year   Percent Change from Prior Year 
                 
Three Months Ended June 30,  $454,000   $397,000   $57,000    14%
Six Months Ended June 30,   904,000    683,000    221,000    32%

 

Depreciation and amortization increased for the three and six months ended June 30, 2020 compared to the three and six months ended June 30, 2020. The increase in depreciation and amortization expense resulted from the 2019 acquisition of the clinics managed by IMAC of Illinois and the January 2020 acquisition of CHSF.

 

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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.

 

Analysis of Cash Flows

 

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

 

During the six months ended June 30, 2020, net cash used in operations increased to $3.0 million compared to $1.7 million for the six months ended June 30, 2019. This difference was primarily attributable to the change in accounts payable and accrued expenses during the six months ended June 30, 2020.

 

Net cash used in investing activities during the six months ended June 30, 2020 and 2019 was $454,000 and $389,000, respectively. This was primarily driven by the acquisition of CHSF in January 2020 and the acquisition of the proprietary license fee.

 

Net cash provided by financing activities during the six months ended June 30, 2020 was $5.9 million, including proceeds from notes payable, net of related fees, which totaled $2.9 million, and proceeds from the issuance of common stock of $3.8 million. Net cash provided by financing activities during the six months ended June 30, 2019 was $4.1 million, including proceeds from our initial public offering, net of related fees.

 

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, 2020     June 30, 2019     June 30, 2020     June 30, 2019  
GAAP loss attributable to IMAC Holdings, Inc.   $ (2,030,688 )   $ (1,900,768 )   $ (3,764,233 )   $ (3,499,955 )
Interest income     (39 )     (5 )     (39 )     (5 )
Interest expense     134,921       85,210       211,125       115,881  
Beneficial conversion interest expense     -       -       -       639,159  
Share-based compensation expense     121,945       171,590       203,029       175,339  
Depreciation and amortization     453,651       396,989       904,146       682,556  
Loss on extinguishment of debt     109,544       -       109,544       -  
Loss on sale of assets     21,225       -       21,225       -  
Adjusted EBITDA   $ (1,189,441 )   $ (1,246,984 )   $ (2,315,203 )   $ (1,887,025 )

 

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Liquidity and Capital Resources

 

As of June 30, 2020, we had $2.8 million in cash and deficiency in working capital of $3.9 million. As of December 31, 2019, we had cash of $373,689 and deficiency in working capital of $3.5 million. The increase in working capital deficiency was primarily due to the increase in the current portion of notes payable, which accounted for $1.4 million in the notes payable balance as of June 30, 2020.

 

We believe our cash at June 30, 2020, including proceeds from the Iliad Note, PPP Note and the Registered Direct Offering, will be sufficient to meet our cash, operational and liquidity requirements for at least 12 months.

 

As of June 30, 2020, we had approximately $8.8 million in current liabilities. The Iliad Note represents $576,000 and the PPP Note represents $744,000 of our current liabilities. Of our remaining current liabilities as of June 30, 2020, approximately $1.2 million was represented by a mortgage on our Lexington, Kentucky property (which was subsequently repaid on July 24, 2020), and $1.8 million owed under the note payable to The Edward S. Bredniak Trust. Lastly, we have approximately $1.4 million in current liabilities outstanding to our vendors and under operating lines of credit, which we have historically paid down in the normal course of our business.

 

As of June 30, 2020, we had an accumulated deficit of $13.8 million. 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.

 

On July 15, 2019, we signed the $10 million Purchase Agreement with Lincoln Park. We also entered into a registration rights agreement (the “Registration Agreement”) with Lincoln Park in which we agreed to file a registration statement related to the transaction with the SEC covering the shares of our common stock that may be issued to Lincoln Park under the Purchase Agreement.

 

Pursuant to the Purchase Agreement, we have the right, in our sole discretion, over a 36-month period to sell shares of common stock to Lincoln Park, subject to certain limitations contained in the Purchase Agreement, in amounts up to 50,000 shares per regular sale, which may be increased to up to 100,000 shares depending on certain conditions as set forth in the Purchase Agreement (and subject to adjustment for any reorganization, recapitalization, non-cash dividend, stock split, reverse stock split or other similar transaction as provided in the Purchase Agreement), up to the aggregate commitment of $10 million (“Regular Purchases”). In addition to Regular Purchases and subject to the terms and conditions of the Purchase Agreement, we in our sole discretion may direct Lincoln Park on each purchase date to make “accelerated purchases” and “additional accelerated purchases” on the following business day as provided in the Purchase Agreement. However, in no event may we sell any number of shares that would result in Lincoln Park beneficially owning more than 4.99% of our outstanding common stock.

 

There are no upper limits on the per share price Lincoln Park may pay to purchase our common stock; however, we may not sell more than $1,000,000 in shares of common stock to Lincoln Park per Regular Purchase. The purchase price of the shares related to the $10 million of future funding will be based on the prevailing market prices of our shares without any fixed discount. Furthermore, we control the timing and amount of any future sales, if any, of shares of common stock to Lincoln Park.

 

The Purchase Agreement limits our sales of shares of common stock to Lincoln Park to 1,669,359 shares of common stock, representing 19.99% of the shares of common stock outstanding on the date of the Purchase Agreement unless (a) stockholder approval is obtained to issue more than such amount or (b) the average price of all applicable sales of our common stock to Lincoln Park under the Purchase Agreement equals or exceeds the lower of (i) the closing price of our common stock on the Nasdaq Capital Market immediately preceding July 15, 2019 or (ii) the average of the closing price of our common stock on the Nasdaq Capital Market for the five Business Days immediately preceding July 15, 2019.

 

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The Purchase Agreement contains customary representations, warranties, covenants, closing conditions and indemnification and termination provisions by, among and for the benefit of the parties. Additionally, Lincoln Park has agreed not to cause or engage in any manner whatsoever, any direct or indirect short selling or hedging of our common stock. The Purchase Agreement does not limit our ability to raise capital from other sources at our sole discretion, provided that we have agreed not to enter into any “variable rate” transactions with any third party for the 36-month period following the execution of the Purchase Agreement.

 

In consideration for entering into the $10 million agreement, we issued to Lincoln Park 60,006 shares of our common stock as a commitment fee and will issue up to an additional 60,006 shares pro rata, when and if Lincoln Park purchases, at the Company’s sole discretion, the $10 million aggregate commitment. The Purchase Agreement may be terminated by us at any time at our discretion without any cost to us. The proceeds received by us under the Purchase Agreement may be used for any corporate purpose at our sole discretion.

 

As of June 30, 2020, pursuant to the Purchase Agreement, the Company sold an aggregate of 1,602,294 shares of common stock of the Company to Lincoln Park for aggregate proceeds to the Company of $2,424,053 (excluding the 60,006 shares previously issued to Lincoln Park as a commitment fee).

 

On March 25, 2020, the Company entered into a note 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 aggregate initial principal amount of $1,115,000, which is payable on or before the date that is 18 months from the issuance date. The Initial Principal Amount includes an original issue discount of $100,000 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 Note, the Holder paid an aggregate purchase price of $1,000,000. Interest on the Note accrues at a rate of 10% per annum and is payable on the Maturity Date or otherwise in accordance with the Note. The Note may be prepaid by the Company (with the payment of a premium), may be required by the Holder to be redeemed by the Company for up to $200,000 per month after the six-month anniversary of the issuance of the Note (subject to certain deferral rights), and is subject to customary events of default (with a default interest rate of up to 22%). The Note transaction documents also give the Holder a right of first refusal to future debt issuances and a right to the first $250,000 of every $1 million of proceeds from future sales of equity by the Company. The Note is secured by the assets of the Company, other than the Company’s owned real property, intellectual property and accounts receivable, pursuant to a security agreement. The Company will use the proceeds of the Note for certain growth initiatives including an IND filing with the FDA.

 

On June 18, 2020, the Company entered into the Securities Purchase Agreement with institutional accredited investors pursuant to which the Company offered for sale to the Purchasers an aggregate of 1,764,000 shares of its common stock in a registered direct offering. The Shares were offered by the Company pursuant to its shelf registration statement on Form S-3 (File No. 333-237455) originally filed with the SEC on March 27, 2020 and declared effective on April 3, 2020. The purchase price for one Share in the Registered Direct Offering was $1.50, and closing of the Registered Direct Offering occurred on June 22, 2020. The Company received $2.644 million in gross proceeds from the Registered Direct Offering. The Company used approximately $0.5 million of the gross proceeds for the repayment of certain indebtedness, and the remaining proceeds to the Company will be used to finance the costs of developing and acquiring additional outpatient medical clinics as part of the Company’s growth and expansion strategy and for working capital.

 

Contractual Obligations

 

The following table summarizes our contractual obligations by period as of June 30, 2020:

 

   Payments Due by Period 
   Total   Less Than 1 Year   1-3 Years   4-5 Years   More Than 5 Years 
Short-term obligations  $2,544,499   $2,544,499   $-   $-   $- 
Long-term obligations, including interest   3,661,888    -    3,605,911    46,221    9,756 
Finance lease obligations, including interest   86,323    10,903    65,417    10,003    - 
Operating lease obligations   4,772,622    577,124    3,005,782    901,837    287,878 
   $11,065,331   $3,132,526   $6,677,110   $958,061   $297,634 

 

Off-Balance Sheet Arrangements

 

As of June 30, 2020, the Company did not have any off-balance sheet arrangements.

 

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Impact of Inflation

 

We believe that inflation has not had a material impact on our results of operations for the three and six months ended June 30, 2020 and 2019. We cannot assure you that future inflation will not have an adverse impact on our operating results and financial condition.

 

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 interim 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 June 30, 2020. 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 in Internal 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 in Internal 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 June 30, 2020.

 

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.

 

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 2019 Annual Report on Form 10-K filed with the SEC on March 26, 2020. There have been no material changes to such risk factors, except as set forth below. The risk factors set 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 our businesses. We do not believe that there have been any other material additions or changes to the risk factors previously disclosed in our fiscal 2019 Annual Report on Form 10-K, although we may disclose changes to such factors or disclose additional factors from time to time in our future filings with the SEC. Additional risks and uncertainties not presently known to us or that we currently deem immaterial also may impair our business operations.

 

Our business and results of operations will be, and our financial condition may be, impacted by the COVID-19 outbreak and such impact could be materially adverse.

 

The global spread of the COVID-19 outbreak has created significant volatility, uncertainty and economic disruption. The extent to which the COVID-19 outbreak impacts our business, operations and financial results is uncertain and will depend on numerous evolving factors that we may be able to accurately predict, including:

 

  the duration and scope of the pandemic;
  governmental, business and individual actions taken in response to the pandemic and the impact of those actions on national and global economic activity;
  the actions taken in response to economic disruption;
  the impact of business disruptions and reductions in employment levels on our patients and the resulting impact on their demand for our orthopedic therapies and other medical treatments;
  the increase in business failures amount suppliers and other businesses with which we collaborate;
  our patients’ ability to pay for orthopedic therapies and other medical treatments; and
  our ability to provide our orthopedic therapies and other medical treatments, including as a result of our employees or our patients working remotely and/or closures of our medical clinics.

 

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, 2019 and could materially adversely affect our business, financial condition and results of operations.

 

ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

 

None.

 

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ITEM 3. DEFAULTS UPON SENIOR SECURITIES

 

None.

 

ITEM 4. MINE SAFETY DISCLOSURES

 

Not applicable.

 

ITEM 5. OTHER INFORMATION

 

None.

 

ITEM 6. EXHIBITS

 

Exhibit Number   Description
     
2.1   Agreement 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).
     
2.2   Amendment 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).

 

 34 

 

 

10.1   Contract of Purchase and Sale, dated June 5, 2020 (filed as Exhibit 10.1 to the Company’s Current Report on Form 8-K filed with the SEC on June 11, 2020 and incorporated herein by reference).
     
10.2   Form of lease for Lexington, Kentucky location (filed as Exhibit 10.2 to the Company’s Current Report on Form 8-K filed with the SEC on June 11, 2020 and incorporated herein by reference).
     
10.3   Form of Securities Purchase Agreement dated June 18, 2020 (filed as Exhibit 10.1 to the Company’s Current Report on Form 8-K filed with the SEC on June 18, 2020 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.
     
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*   XBRL Instance Document
     
101.SCH*   XBRL Taxonomy Extension Schema
     
101.CAL*   XBRL Taxonomy Extension Calculation Linkbase
     
101.LAB*   XBRL Taxonomy Extension Labels Linkbase
     
101.PRE*   XBRL Taxonomy Extension Presentation Linkbase
     
101.DEF*   XBRL Taxonomy Extension Definition Linkbase

 

* 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.

 

 35 

 

 

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: August 14, 2020 By: /s/ Jeffrey S. Ervin
    Jeffrey S. Ervin
   

Chief Executive Officer

(Principal Executive Officer, Duly Authorized Officer)

 

 36 

 

 

EX-31.1 2 ex31-1.htm

 

EXHIBIT 31.1

 

CERTIFICATION OF

PRINCIPAL EXECUTIVE OFFICER

PURSUANT TO SECTION 302

OF THE SARBANES-OXLEY ACT OF 2002

 

I, Jeffrey S. Ervin, certify that:

 

1. I have reviewed this quarterly report on Form 10-Q of IMAC Holdings, Inc.;
   
2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
   
3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;
   
4. I am responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:
   
  a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;
     
  b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
     
  c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
     
  d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting;
     
5. I have disclosed, based on my most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):
   
  a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and
     
  b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

 

August 14, 2020

 

/s/ Jeffrey S. Ervin  
Jeffrey S. Ervin  

Chief Executive Officer

(Principal Executive Officer)

 

 

   
EX-31.2 3 ex31-2.htm

 

EXHIBIT 31.2

 

CERTIFICATION OF

PRINCIPAL FINANCIAL OFFICER

PURSUANT TO SECTION 302

OF THE SARBANES-OXLEY ACT OF 2002

 

I, Sheri Gardzina, certify that:

 

1. I have reviewed this quarterly report on Form 10-Q of IMAC Holdings, Inc.;
   
2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
   
3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;
   
4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:
   
  a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;
     
  b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
     
  c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
     
  d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting;
     
5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):
   
  a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and
     
  b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

 

August 14, 2020

 

/s/ Sheri Gardzina  
Sheri Gardzina  

Interim Chief Financial Officer

(Principal Financial and Accounting Officer)

 

 

   
EX-32.1 4 ex32-1.htm

 

EXHIBIT 32.1

 

CERTIFICATION OF

PRINCIPAL EXECUTIVE OFFICER

PURSUANT TO 18 U.S.C. SECTION 1350

(SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002)

 

In connection with the accompanying Quarterly Report on Form 10-Q of IMAC Holdings, Inc. for the period ended June 30, 2020, I, Jeffrey S. Ervin, Chief Executive Officer of IMAC Holdings, Inc., hereby certify pursuant to 18 U.S.C. § 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that to the best of my knowledge:

 

  (1) such Quarterly Report on Form 10-Q of IMAC Holdings, Inc. for the period ended June 30, 2020, fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and
     
  (2) the information contained in such Quarterly Report on Form 10-Q of IMAC Holdings, Inc. for the period ended June 30, 2020, fairly presents, in all material respects, the financial condition and results of operations of IMAC Holdings, Inc. at the dates and for the periods indicated.

 

This certification has not been, and shall not be deemed, “filed” with the Securities and Exchange Commission.

 

August 14, 2020

 

/s/ Jeffrey S. Ervin  
Jeffrey S. Ervin  

Chief Executive Officer

(Principal Executive Officer)

 

 

A signed copy of this written statement required by Section 906 has been provided to IMAC Holdings, Inc. and will be retained by IMAC Holdings, Inc. and furnished to the Securities and Exchange Commission or its staff upon request.

 

   
EX-32.2 5 ex32-2.htm

 

EXHIBIT 32.2

 

CERTIFICATION OF

PRINCIPAL FINANCIAL OFFICER

PURSUANT TO 18 U.S.C. SECTION 1350

(SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002)

 

In connection with the accompanying Quarterly Report on Form 10-Q of IMAC Holdings, Inc. for the period ended June 30, 2020, I, Sheri Gardzina, Interim Chief Financial Officer of IMAC Holdings, Inc., hereby certify pursuant to 18 U.S.C. § 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that to the best of my knowledge:

 

  (1) such Quarterly Report on Form 10-Q of IMAC Holdings, Inc. for the period ended June 30, 2020, fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and
     
  (2) the information contained in such Quarterly Report on Form 10-Q of IMAC Holdings, Inc. for the period ended June 30, 2020, fairly presents, in all material respects, the financial condition and results of operations of IMAC Holdings, Inc. at the dates and for the periods indicated.

 

This certification has not been, and shall not be deemed, “filed” with the Securities and Exchange Commission.

 

August 14, 2020

 

/s/ Sheri Gardzina  
Sheri Gardzina  

Interim Chief Financial Officer

(Principal Financial and Accounting Officer)

 

 

A signed copy of this written statement required by Section 906 has been provided to IMAC Holdings, Inc. and will be retained by IMAC Holdings, Inc. and furnished to the Securities and Exchange Commission or its staff upon request.

 

   
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Debt discount notes payable Business acquisition via stock issuance Accounting Policies [Abstract] Description of Business Summary of Significant Accounting Policies Organization, Consolidation and Presentation of Financial Statements [Abstract] Capital Requirements, Liquidity and Going Concern Considerations Risks and Uncertainties [Abstract] Concentration of Credit Risks Receivables [Abstract] Accounts Receivable Business Combinations [Abstract] Business Acquisitions Property, Plant and Equipment [Abstract] Property and Equipment Goodwill and Intangible Assets Disclosure [Abstract] Intangibles Assets and Goodwill Leases [Abstract] Operating Leases Debt Disclosure [Abstract] Line of Credit Notes Payable Equity [Abstract] Stockholders' Equity Retirement Benefits [Abstract] Retirement Plan Income Tax Disclosure [Abstract] Income Taxes Commitments and Contingencies Disclosure [Abstract] Commitments and Contingencies Subsequent Events [Abstract] Subsequent Events Principles of Consolidation Use of Estimates COVID-19 Pandemic Revenue Recognition Patient Deposits Fair Value of Financial Instruments Cash and Cash Equivalents Accounts Receivable Allowance for Doubtful Accounts, Contractual and Other Discounts Property and Equipment Intangible Assets Goodwill Long-Lived Assets Advertising and Marketing Net Loss Per Share Income Taxes Schedule of Patient Revenue, Net Schedule of Concentration Risk Schedule of Accounts Receivable Schedule of Assets Acquired and Liabilities Assumed Schedule of Property and Equipment Schedule of Intangible Assets Schedule of Future Amortization of Intangible Assets Schedule of Operating Lease Right of Use Assets Schedule of Operating Lease Cost Schedule of Future Minimum Lease Payments Schedule of Notes Payable Schedule of Principal Maturities of Notes Payable Schedule of Statutory Federal Income Tax Rate Collaborative Arrangement and Arrangement Other than Collaborative [Axis] Percentage of voting interest acquired Purchase price of debt reserve, percentage Releif fund received Cash equivalents Advertising and marketing expense Uncertain tax positions Patient revenue, net Working capital Net loss Net cash (used in) operating activities FDIC insured amount Cash and cash equivalents in excess of FDIC Concentration of credit risk, percentage Gross accounts receivable Less: allowance for doubtful accounts Accounts receivable, net Trading Activity [Axis] Cash and Cash Equivalents [Axis] Percentage of outstanding membership units Payments to acquire business gross Membership interests description Business acquisition, purchase price Number of restricted stock issued, shares Number of restricted stock issued, value Purchase price of acquisition Property & equipment Customer lists Other assets Net Assets Acquired Depreciation Long-Lived Tangible Asset [Axis] Statistical Measurement [Axis] Estimated Useful Life in Years Estimated Useful Life Total property and equipment, gross Less: accumulated depreciation Property and equipment Construction in progress Total property and equipment, net Amortization of intangible assets Intangible assets, estimated useful life Intangible assets, cost Intangible assets, Accumulated Amortization Intangible assets, net Intangible assets, including goodwill, cost Total intangible assets and goodwill 2020 (six months) 2021 2022 2023 2024 Thereafter Total Mortgage interest rate term Right of use assets, net of amortization Operating lease expense 2020 (six months) 2021 2022 2023 2024 Thereafter Total Amount representing imputed interest Total operating lease liability Current portion of operating lease liability Operating lease liability, non-current Variable Rate [Axis] Line of credit, maturity date Line of credit, interest rate Line of credit balance Initial principal amount Debt maturity term Original issue discount Repayments of notes payable Purchase price of notes Note interest rate Prepayment of redemption premium Default interest rate Debt issuances cost Proceeds from future sales of equity Loans payable principal amount Loan maturity date Notes payable Unamortized debt issuance costs Less: current portion Debt instrument face amount Debt instrument interest rate Debt instrument maturity date Number of installments Debt instrument, periodic payment Debt instrument balloon payment Debt instrument maturity date, description 2020 (six months) 2021 2022 2023 2024 Thereafter Total Number of units authorized Number of units issued Number of units outstanding Conversion of units into shares, shares Shares issued price per share Reverse split of common stock outstanding Number of shares issued during period, shares Gross proceeds from initial public offering Payment for indebteness Stock issued during period, conversion of securities Debt instrument, interest rate Stock issued during period, acquisitions Payment in purchase agreement Value of common stock as commitment fee Number of shares of common stock of commitment fee Sale of shares Outstanding shares percentage Number of common stock share sold, value Reserving for issuance Outstanding stock options to purchase stock Vesting period Vesting percentage Vesting description Volatility rate Risk free rate Expected term Outstanding restricted stock of its common stock Number of shares vested Share issued pursuant to previous grand RSUs Matching contributions, percentage of match Matching contributions, percent of employees' gross pay Matching contributions, amount Operating loss carryforward, net Operating loss carryforward, description Deferred tax benefit at the federal statutory rate Valuation allowance Statutory federal income tax rate Proceeds from sale of real estate Payment of mortgage Advantage Hand Therapy and Orthopedic Rehabilitation, LLC [Member] Advantage Theraphy [Member] Advantage Therapy and BioFirma [Member] Asset Purchase Agreement [Member] BioFirma LLC [Member] BioFirma [Member]. Business acquisition, purchase price. CMA of Kentucky and IMAC St. Louis [Member] Chicago [Member] Chiropractic Equipment [Member] Contractual Adjustments [Member] Deferred compensation, current. Deferred compensation, net of current portion. Definite Lived Assets [Member] Edward S. Bredniak [Member]. 4% Convertible Notes [Member] 401(k) Plan [Member] Illinois [Member]. IMAC Kentucky [Member] IMAC Management of Progressive, LLC [Member] IMAC Nashville [Member] IMAC of St. Louis, LLC [Member] IMAC Regeneration Center of Kentucky [Member] IMAC Regeneration Center of Nashville, P.C [Member] IMAC St. Louis, LLC [Member] IMAC St. Louis [Member] ISDI Holdings II and PHR Holdings [Member] Iliad Research &amp; Trading, L.P. [Member] Increase decrease in lease incentive obligation. Increase decrease in patient deposits. Insurance Payment [Member] Intangible assets, including goodwill, cost. Integrated Medicine and Chiropractic Regeneration Center PSC [Member] Lexington Kentucky [Member] Liability to issue common stock, current portion. Liability to issue common stock, net of current portion. Lincoln Park Capital Fund, LLC [Member]. Lines of Credit [Text Block] Management Service Agreement [Member] Medical Equipment [Member] Medicare Payment [Member] Merger Agreement [Member] Mortgage interest rate term. Non Compete Agreement [Member] Non-Qualified Stock Options [Member] Notes Payable Eight [Member] Notes Payable Five [Member] Notes Payable Four [Member] Notes Payable [Member] Notes Payable Nine [Member]. Notes Payable One [Member] Notes Payable Seven [Member] Notes Payable Six [Member] Notes Payable Three [Member] Notes Payable Two [Member] Number of installments. Outstanding shares percentage. Patient deposits [Policy Text Block] Patient expenses. Patient Payment [Member] Percentage of outstanding membership units. Physical Therapy Equipment [Member] Progressive [Member] Purchase Agreement [Member] Schedule of Operating Lease Right of Use Assets [Table Text Block] Schedule of Patient Revenue, Net [Table Text Block] Self Care Regeneration LLC [Member] Signs [Member] SpeakLife [Member] Springfield, Missouri [Member] Number of shares of common stock of commitment fee . Number of shares of stock issued for exercise of warrants. Value of common stock as commitment fee. Value of shares of stock issued for exercise of warrants. Stock Options [Member] 2018 Business Acquisitions [Member] 2018 Incentive Compensation Plan [Member] UCI [Member] Various Employees [Member] Warrants to Purchase Common Stock [Member] Working capital. Debt discount notes payable. IMAC Management of Illinois, LLC [Member] IMAC Management of Florida, LLC [Member] Secured Promissory Note [Member] Financial Institution [Member] Employee [Member] Advantage Therapy, LLC [Member] Pinnacle Bank [Member] Paycheck Protection Program Note [Member] Patient revenue, net CARES Act Provider Relief Fund [Member]. Payment To Purchase License Fee. Customer lists. Property and equipment. Securities Purchase Agreement [Member] Registered Direct Offering [Member] Grant funds. Purchase price of debt reserve, percentage. COVID-19 Pandemic [Policy Text Block] Eligible Health Care Providers [Member] Centers for Medicare and Medicaid Services [Member] Assets, Current Other Assets Assets Liabilities, Current Liabilities Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest Liabilities and Equity Operating Expenses Operating Income (Loss) Interest Expense Nonoperating Income (Expense) Income (Loss) from Continuing Operations before Income Taxes, Noncontrolling Interest Net Income (Loss) Attributable to Noncontrolling Interest Shares, Outstanding Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property Increase (Decrease) in Accounts Receivable Increase (Decrease) in Other Current Assets Increase (Decrease) in Security Deposits Increase (Decrease) in Accounts Payable and Accrued Liabilities IncreaseDecreaseInPatientDeposits Payments to Acquire Property, Plant, and Equipment PaymentToPurchaseLicenseFee Net Cash Provided by (Used in) Investing Activities Payments of Debt Issuance Costs Repayments of Lines of Credit Repayments of Debt and Lease Obligation Net Cash Provided by (Used in) Financing Activities Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations Accounts Receivable [Policy Text Block] Property, Plant and Equipment, Policy [Policy Text Block] Goodwill and Intangible Assets, Goodwill, Policy [Policy Text Block] Income Tax, Policy [Policy Text Block] Accounts Receivable, Allowance for Credit Loss, Current Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Other Noncurrent Assets Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net Accumulated Depreciation, Depletion and Amortization, Property, Plant, and Equipment PropertyPlantAndEquipmentIncludingAccumulatedDepreciation Finite-Lived Intangible Assets, Net Lessee, Operating Lease, Liability, to be Paid, Remainder of Fiscal Year Lessee, Operating Lease, Liability, to be Paid, Year One Lessee, Operating Lease, Liability, to be Paid, Year Two Lessee, Operating Lease, Liability, to be Paid, Year Three Lessee, Operating Lease, Liability, to be Paid, Year Four Lessee, Operating Lease, Liability, to be Paid, after Year Five Lessee, Operating Lease, Liability, to be Paid Lessee, Operating Lease, Liability, Undiscounted Excess Amount Unamortized Debt Issuance Expense Long-Term Debt, Maturity, Remainder of Fiscal Year Long-Term Debt, Maturity, Year One Long-Term Debt, Maturity, Year Two Long-Term Debt, Maturity, Year Three Long-Term Debt, Maturity, Year Four Long-Term Debt, Maturity, after Year Five Long-term Debt Effective Income Tax Rate Reconciliation, Percent EX-101.PRE 11 imac-20200630_pre.xml XBRL PRESENTATION FILE XML 12 R1.htm IDEA: XBRL DOCUMENT v3.20.2
Document and Entity Information - shares
6 Months Ended
Jun. 30, 2020
Aug. 14, 2020
Cover [Abstract]    
Entity Registrant Name IMAC Holdings, Inc.  
Entity Central Index Key 0001729944  
Document Type 10-Q  
Document Period End Date Jun. 30, 2020  
Amendment Flag false  
Current Fiscal Year End Date --12-31  
Entity Current Reporting Status Yes  
Entity Interactive Data Current Yes  
Entity Filer Category Non-accelerated Filer  
Entity Small Business Flag true  
Entity Emerging Growth Company true  
Entity Ex Transition Period false  
Entity Shell Company false  
Entity Common Stock, Shares Outstanding   11,839,973
Document Fiscal Period Focus Q2  
Document Fiscal Year Focus 2020  
XML 13 R2.htm IDEA: XBRL DOCUMENT v3.20.2
Condensed Consolidated Balance Sheets (Unaudited) - USD ($)
Jun. 30, 2020
Dec. 31, 2019
Current assets:    
Cash $ 2,802,769 $ 373,689
Accounts receivable, net 1,489,872 1,258,325
Deferred compensation, current portion 263,859 312,258
Other assets 336,958 633,303
Total current assets 4,893,458 2,577,575
Property and equipment, net 3,293,992 3,692,009
Other assets:    
Goodwill 2,040,696 2,040,696
Intangible assets, net 7,081,218 7,169,072
Deferred equity costs 143,655 170,274
Deferred compensation, net of current portion 356,085 549,563
Security deposits 451,284 499,488
Right of use asset 3,600,198 3,719,401
Total other assets 13,673,136 14,148,494
Total assets 21,860,586 20,418,078
Current liabilities:    
Accounts payable and accrued expenses 2,543,165 2,909,666
Patient deposits 351,142 189,691
Notes payable, current portion, net of deferred loan costs 4,471,874 1,422,554
Finance lease obligation, current portion 17,853 17,473
Line of credit 79,961 79,961
Liability to issue common stock, current portion 326,356 421,044
Operating lease liability, current portion 980,967 1,025,247
Total current liabilities 8,771,318 6,065,636
Long-term liabilities:    
Notes payable, net of current portion 1,232,677 2,109,065
Finance lease obligation, net of current portion 57,542 66,565
Liability to issue common stock, net of current portion 362,979 578,866
Operating lease liability, net of current portion 3,482,242 3,660,654
Other non-current liabilities 30,000
Total liabilities 13,936,758 12,480,786
Stockholders' equity:    
Preferred stock - $0.001 par value, 5,000,000 authorized, nil issued and outstanding at June 30, 2020 and December 31, 2019
Common stock - $0.001 par value, 30,000,000 authorized, 11,839,973 and 8,913,258 shares issued and outstanding at June 30, 2020 and December 31, 2019, respectively 11,834 8,907
Additional paid-in capital 24,079,504 20,050,634
Accumulated deficit (13,806,283) (10,042,050)
Non-controlling interest (2,361,227) (2,080,199)
Total stockholders' equity 7,923,828 7,937,292
Total liabilities and stockholders' equity $ 21,860,586 $ 20,418,078
XML 14 R3.htm IDEA: XBRL DOCUMENT v3.20.2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares
Jun. 30, 2020
Dec. 31, 2019
Statement of Financial Position [Abstract]    
Preferred stock, par value $ 0.001 $ 0.001
Preferred stock, shares authorized 5,000,000 5,000,000
Preferred stock, shares issued
Preferred stock, shares outstanding
Common stock, par value $ 0.001 $ 0.001
Common stock, shares authorized 30,000,000 30,000,000
Common stock, shares issued 11,839,973 8,913,258
Common stock, shares outstanding 11,839,973 8,913,258
XML 15 R4.htm IDEA: XBRL DOCUMENT v3.20.2
Condensed Consolidated Statements of Operations (Unaudited) - USD ($)
3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Total revenue $ 2,572,580 $ 3,756,755 $ 5,894,136 $ 6,526,583
Operating expenses:        
Patient expenses 405,367 927,778 785,184 1,363,907
Salaries and benefits 2,334,249 2,593,209 5,260,399 4,657,832
Share-based compensation 121,945 171,590 203,029 175,339
Advertising and marketing 174,350 349,328 416,167 696,344
Grant funds (415,978) (415,978)
General and administrative 1,208,457 1,429,822 2,444,595 2,407,191
Depreciation and amortization 453,651 396,989 904,146 682,556
Total operating expenses 4,282,041 5,868,716 9,597,542 9,983,169
Operating loss (1,709,461) (2,111,961) (3,703,406) (3,456,586)
Other income (expense):        
Interest income 39 5 39 5
Other income (expenses) 665 (15,290)
Beneficial conversion interest expense (639,159)
Loss on extinguishment of debt (109,544) (109,544)
Loss on disposal of assets (21,225) (21,225)
Interest expense (134,921) (85,210) (211,125) (115,881)
Total other (expenses) (265,651) (84,540) (341,855) (770,325)
Net loss before income taxes (1,975,112) (2,196,501) (4,045,261) (4,226,911)
Income taxes
Net loss (1,975,112) (2,196,501) (4,045,261) (4,226,911)
Net loss (income) attributable to the non-controlling interest (55,576) 295,733 281,028 726,956
Net loss attributable to IMAC Holdings, Inc. $ (2,030,688) $ (1,900,768) $ (3,764,233) $ (3,499,955)
Net loss per share attributable to common stockholders Basic and diluted $ (0.20) $ (0.23) $ (0.38) $ (0.50)
Weighted average common shares outstanding Basic and diluted 10,184,294 8,106,177 9,897,773 7,018,559
Patient Revenues, Net [Member]        
Total revenue $ 2,572,580 $ 3,756,755 $ 5,881,649 $ 6,526,583
Management Fees [Member]        
Total revenue $ 12,487
XML 16 R5.htm IDEA: XBRL DOCUMENT v3.20.2
Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($)
Common Stock [Member]
Additional Paid-In Capital [Member]
Non-Controlling Interest [Member]
Accumulated Deficit [Member]
Total
Balance at Dec. 31, 2018 $ 4,534 $ 1,233,966 $ (1,625,840) $ (3,544,820) $ (3,932,160)
Balance, shares at Dec. 31, 2018 4,553,623        
Common stock issued for initial public offering proceeds, net of related fees $ 850 3,503,314 3,504,164
Common stock issued for initial public offering proceeds, net of related fees, shares 850,000        
Issuance of common stock in connection with convertible notes $ 449 2,245,636 2,246,085
Issuance of common stock in connection with convertible notes, shares 449,217        
Issuance of common stock in connection with acquisitions $ 1,410 7,247,798 7,249,208
Issuance of common stock in connection with acquisitions, shares 1,410,183        
Exercise of warrants $ 10 49,490 49,500
Exercise of warrants, shares 9,900        
Net income (loss) (431,223) (1,599,187) (2,030,410)
Balance at Mar. 31, 2019 $ 7,253 14,280,204 (2,057,063) (5,144,007) 7,086,387
Balance, shares at Mar. 31, 2019 7,252,923        
Balance at Dec. 31, 2018 $ 4,534 1,233,966 (1,625,840) (3,544,820) (3,932,160)
Balance, shares at Dec. 31, 2018 4,553,623        
Net income (loss)         (4,226,911)
Balance at Jun. 30, 2019 $ 8,317 18,676,639 (2,352,796) (7,044,775) 9,287,385
Balance, shares at Jun. 30, 2019 8,316,798        
Balance at Mar. 31, 2019 $ 7,253 14,280,204 (2,057,063) (5,144,007) 7,086,387
Balance, shares at Mar. 31, 2019 7,252,923        
Issuance of common stock in connection with acquisitions $ 1,002 4,072,436 4,073,438
Issuance of common stock in connection with acquisitions, shares 1,002,306        
Exercise of warrants $ 62 307,783 307,845
Exercise of warrants, shares 61,569        
Issuance of employee stock options 16,216 16,216
Net income (loss) (295,733) (1,900,768) (2,196,501)
Balance at Jun. 30, 2019 $ 8,317 18,676,639 (2,352,796) (7,044,775) 9,287,385
Balance, shares at Jun. 30, 2019 8,316,798        
Balance at Dec. 31, 2019 $ 8,907 20,050,634 (2,080,199) (10,042,050) 7,937,292
Balance, shares at Dec. 31, 2019 8,913,258        
Issuance of common stock $ 1,096 1,376,122 1,377,218
Issuance of common stock, shares 1,095,840        
Issuance of employee stock options 38,359 38,359
Net income (loss) (336,604) (1,733,545) (2,070,149)
Balance at Mar. 31, 2020 $ 10,003 21,465,115 (2,416,803) (11,775,595) 7,282,720
Balance, shares at Mar. 31, 2020 10,009,098        
Balance at Dec. 31, 2019 $ 8,907 20,050,634 (2,080,199) (10,042,050) 7,937,292
Balance, shares at Dec. 31, 2019 8,913,258        
Net income (loss)         (4,045,261)
Balance at Jun. 30, 2020 $ 11,834 24,079,504 (2,361,227) (13,806,283) 7,923,828
Balance, shares at Jun. 30, 2020 11,839,973        
Balance at Mar. 31, 2020 $ 10,003 21,465,115 (2,416,803) (11,775,595) 7,282,720
Balance, shares at Mar. 31, 2020 10,009,098        
Issuance of common stock $ 1,831 2,576,820 2,578,651
Issuance of common stock, shares 1,830,875        
Issuance of employee stock options 37,569 37,569
Net income (loss) 55,576 (2,030,688) (1,975,112)
Balance at Jun. 30, 2020 $ 11,834 $ 24,079,504 $ (2,361,227) $ (13,806,283) $ 7,923,828
Balance, shares at Jun. 30, 2020 11,839,973        
XML 17 R6.htm IDEA: XBRL DOCUMENT v3.20.2
Consolidated Statements of Cash Flows - USD ($)
6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Cash flows from operating activities:    
Net loss $ (4,045,261) $ (4,226,911)
Adjustments to reconcile net loss to net cash used in operating activities:    
Depreciation and amortization 904,146 682,556
Beneficial conversion interest expense 639,159
Share based compensation 203,029 175,339
Loss on disposition of assets (16,577)  
(Increase) decrease in operating assets:    
Accounts receivable, net (210,707) (259,712)
Other assets 299,721 (98,685)
Security deposits 48,204 (70,773)
Increase (decrease) in operating liabilities:    
Accounts payable and accrued expenses (329,056) 675,820
Patient deposits 161,451 861,409
Lease incentive obligation (57,262)
Net cash used in operating activities (2,985,049) (1,679,060)
Cash flows from investing activities:    
Purchase of property and equipment (10,511) (389,469)
Purchase of license fee (243,750)
Acquisition of IMAC Florida (Note 6) (200,000)
Net cash used in investing activities (454,261) (389,469)
Cash flows from financing activities:    
Proceeds from initial public offering, net of related fees 3,839,482
Proceeds from warrants exercised 357,345
Proceeds from issuance of common stock 3,774,617
Proceeds from notes payable 2,891,520 100,000
Payments on notes payable (719,104) (54,377)
Payments of debt issuance costs (70,000)
Proceeds from line of credit 20,000
Payments on line of credit (150,000)
Payments on finance lease obligation (8,643) (6,835)
Net cash provided by financing activities 5,868,390 4,105,615
Net increase in cash 2,429,080 2,037,086
Cash, beginning of period 373,689 194,316
Cash, end of period 2,802,769 2,231,402
Supplemental cash flow information:    
Interest paid 56,058 30,671
Non cash financing and investing:    
Debt discount notes payable 115,000
Business acquisition via stock issuance $ 3,771,978
XML 18 R7.htm IDEA: XBRL DOCUMENT v3.20.2
Description of Business
6 Months Ended
Jun. 30, 2020
Accounting Policies [Abstract]  
Description of Business

Note 1 – Description of Business

 

IMAC Holdings, Inc. and its affiliates (collectively, the “Company”) provide orthopedic 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 open two (2) medical clinics located in Tennessee and opened or acquired through management service agreements thirteen (13) medical clinics located in Kentucky, Missouri, Illinois and Florida at June 30, 2020. The Company has partnered with several well-known sports stars such as Ozzie Smith, David Price, Tony Delk and Mike Ditka in opening its medical clinics, with a focus around treating sports injuries.

 

Effective June 1, 2018, the Company converted from IMAC Holdings, LLC a Kentucky limited liability company 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.

 

During February 2019, the Company completed an initial public offering (“IPO”) of securities. See Note 12 – Stockholder’s Equity.

XML 19 R8.htm IDEA: XBRL DOCUMENT v3.20.2
Summary of Significant Accounting Policies
6 Months Ended
Jun. 30, 2020
Accounting Policies [Abstract]  
Summary of Significant Accounting Policies

Note 2 – Summary of Significant Accounting Policies

 

Principles of Consolidation

 

The accompanying 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.S. Securities and Exchange Commission (“SEC” or the “Commission”). The information contained in these condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements and notes thereto for the fiscal year ended December 31, 2019 included in the Company’s Annual Report on Form 10-K filed with the SEC on March 26, 2020.

 

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 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”) and IMAC Management of Florida, LLC (“IMAC Florida”); 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”); and the following which prior to June 1, 2018 was held as a minority interest, IMAC Regeneration Center of St. Louis, LLC (“IMAC St. Louis”).

 

In June 2018, the Company consummated certain transactions resulting in the acquisition of the outstanding equity interests in IMAC St. Louis and Clinic Management Associates of KY, LLC (“CMA of KY”), an entity which consolidates Integrated Medical and Chiropractic Regeneration Center, PSC (“IMAC Kentucky”) due to control by contract. These entities 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. On October 1, 2019, the Company acquired the 30% of BioFirma’s membership interests which were not previously held by the Company, resulting in the Company owning 100% of the membership interests of BioFirma. Substantially all the assets of BioFirma were sold effective December 31, 2019; however as of June 30, 2020, the acquirer of the assets had not paid the purchase price and the Company had established a bad debt reserve of 100% of the purchase price.

 

In April 2019, the Company consummated certain transactions resulting in the acquisition of the outstanding equity interest in ISDI Holdings II, Inc., an Illinois corporation (“ISDI Holdings II”), and PHR Holdings, Inc., an Illinois corporation (“PHR Holdings”), entities which consolidate the results of Progressive Health and Rehabilitation, Ltd (“Progressive”) and Illinois Spine and Disc Institute, Ltd (“ISDI”) due to control by contract. These entities are included in the condensed consolidated financial statements from the date of acquisition.

 

In November 2019, IMAC Illinois entered into a management agreement for an occupational and physical therapy practice in Rockford, Illinois. This entity is included in the condensed consolidated financial statements due to control by contract from the date of entry into the management agreement.

 

In January 2020, the Company consummated an agreement for the acquisition of Chiropractic Health of Southwest Florida, Inc. (“CHSF”) in Bonita Springs, Florida. This entity is included in the condensed consolidated financial statements from the date of acquisition.

 

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

 

On January 30, 2020, the World Health Organization (WHO) announced a global health emergency because of a new strain of coronavirus originating in Wuhan, China (the “COVID-19 outbreak”) and the risks to the international community as the virus spread globally beyond the point of origin. On March 20, 2020 the WHO classified the COVID-19 outbreak as a pandemic, based on the rapid increase in exposure globally.

 

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 for fiscal year 2020 beyond the results presented in these condensed consolidated financial statements and this quarterly report.

 

CARES Act

 

The Company is continuing to closely monitor legislative actions at the federal, state and local levels including the Coronavirus Aid, Relief, and Economic Security Act (the "CARES Act") and other governmental assistance that might be available in response to the COVID-19 pandemic. As part of the CARES Act, the United States government initially announced that it would offer $100 billion of relief to eligible health care providers. On April 7, 2020, Centers for Medicare and Medicaid Services ("CMS") officials indicated they would distribute $30 billion of direct grants to hospitals, ASCs and other health care providers based on how much they bill Medicare. Payments received from these grants are not required to be repaid provided the recipients attest to and comply with certain terms and conditions, including limitations on balance billing and not using funds received from the grants to reimburse expenses or losses that other sources are obligated to reimburse.

 

The Company received approximately $416,000 of the grant funds distributed under the CARES Act Provider Relief Fund program during the six months ended June 30, 2020. Based on an analysis of the compliance and reporting requirements and the impact of the COVID-19 pandemic on our operating results through the end of the second quarter, these funds were recognized as a reduction in operating expenses under the caption Grant funds in the condensed consolidated statements of operations for the three- and six- months ended June 30, 2020. The recognition of amounts received is conditioned upon certification that payment will be used to prevent, prepare for and respond to the COVID-19 pandemic and shall reimburse the recipient only for healthcare related expenses or lost revenues that are attributable to the COVID-19 pandemic. Amounts are recognized as a reduction to operating costs and expenses only to the extent the Company is reasonably assured that underlying conditions are met.

 

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. The fees for such services are billed either to the patient or a third-party payer, including Medicare. Starting in January 2020, the Company implemented wellness maintenance programs on a subscription basis. There are three membership plans offered with different levels of service for each plan. The Company recognizes service revenues based upon the estimated amounts the Company expects to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments 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 estimated amounts expected to be collected.

 

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 an 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. The company recognize other management service revenue in the period in which services are rendered. These revenues are earned by IMAC Nashville, IMAC Management and IMAC Illinois and are eliminated in consolidation to the extent owned.

 

The Company’s patient revenue consisted of the following for the three and six months ended June 30, 2020 and June 30, 2019:

 

    Three Months Ended     Six Months Ended  
    June 30, 2020     June 30, 2019     June 30, 2020     June 30, 2019  
                         
Patient revenues   $ 5,595,279     $ 8,887,819     $ 12,747,221     $ 16,176,841  
Contractual adjustments     (3,022,699 )     (5,131,064 )     (6,865,572 )     (9,650,258 )
Patient revenue, net   $ 2,572,580     $ 3,756,755     $ 5,881,649     $ 6,526,583  

 

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 rarely 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 approximate their respective fair values due to the short- 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.

 

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 no cash equivalents at June 30, 2020 and December 31, 2019.

 

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 is 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, 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 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.

  

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 income 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 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) 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. Acquired intangible assets include trade names, non-compete agreements, customer relationships and contractual agreements.

 

Goodwill

 

Our goodwill represents the excess of the purchase price over the fair value of the net identifiable assets acquired 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. There was no goodwill impairment for the years presented.

 

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

 

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-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 $174,350 and $349,328 for the three months ended June 30, 2020 and 2019, respectively and was $416,167 and $696,344 for the six months ended June 30, 2020 and 2019, 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. Diluted net loss per common share is determined using the weighted-average of common shares outstanding during the period, 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.

 

Income Taxes

 

Following the Company’s conversion to a Delaware corporation in 2018, IMAC Nashville, IMAC Texas, IMAC St. Louis continued as single-member limited liability companies (wholly owned by the Company) that are disregarded entities for tax purposes and do not file separate returns. Their activity is included as part of IMAC Holdings Inc. Advantage Therapy, IMAC Illinois and IMAC Florida are also disregarded entities for tax purposes. BioFirma was a limited liability company taxed as a partnership. Effective October 1, 2019, BioFirma became wholly owned by IMAC Holdings and is a disregarded entity for tax purposes. IMAC Management is a C-corporation and is included in the consolidated return of IMAC Holdings as a subsidiary.

 

Any future benefit arising from losses have been offset by a valuation allowance. Accordingly, no provision for income taxes is reflected in the condensed consolidated financial statements. The Company records a liability for uncertain tax positions when 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. At June 30, 2020 and December 31, 2019, 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 2017 are open and subject to examination by the taxing authorities.

XML 20 R9.htm IDEA: XBRL DOCUMENT v3.20.2
Capital Requirements, Liquidity and Going Concern Considerations
6 Months Ended
Jun. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Capital Requirements, Liquidity and Going Concern Considerations

Note 3 – Capital Requirements, Liquidity and Going Concern Considerations

 

The Company’s condensed consolidated financial statements are prepared in accordance with GAAP including 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 had a deficiency in working capital of approximately $3.9 million and $3.5 million at June 30, 2020 and December 31, 2019. The Company had a net loss of approximately $3.8 million and $3.5 million at June 30, 2020 and 2019, respectively, and used cash in operations of approximately $3.0 million and $1.7 million at June 30, 2020 and 2019, respectively. 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 June 30, 2020, the Company has received funding in the form of indebtedness and the issuance of common stock. Management plans to continue to raise funds and/or refinance our indebtedness to support our operations in 2020 and beyond. However, no assurances can be given that we 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.

XML 21 R10.htm IDEA: XBRL DOCUMENT v3.20.2
Concentration of Credit Risks
6 Months Ended
Jun. 30, 2020
Risks and Uncertainties [Abstract]  
Concentration of Credit Risks

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. The Company had approximately $1,724,713 of cash in excess of federally insured limits.

 

Revenue and Accounts Receivable

 

As of June 30, 2020 and December 31, 2019, the Company had the following revenue and accounts receivable concentrations:

 

    June 30, 2020     December 31, 2019  
    % of Revenue     % of Accounts Receivable     % of Revenue     % of Accounts Receivable  
    (Unaudited)              
Patient payment     33 %     29 %     47 %     40 %
Medicare payment     41 %     28 %     27 %     26 %
Insurance payment     26 %     43 %     26 %     34 %
XML 22 R11.htm IDEA: XBRL DOCUMENT v3.20.2
Accounts Receivable
6 Months Ended
Jun. 30, 2020
Receivables [Abstract]  
Accounts Receivable

Note 5 – Accounts Receivable

 

As of June 30, 2020 and December 31, 2019, the Company’s accounts receivable consisted of the following:

 

    June 30,
2020
    December 31,
2019
 
    (Unaudited)  
Gross accounts receivable   $ 1,518,854     $ 1,285,228  
Less: allowance for doubtful accounts     (28,982 )     (26,903 )
Accounts receivable, net   $ 1,489,872     $ 1,258,325  
XML 23 R12.htm IDEA: XBRL DOCUMENT v3.20.2
Business Acquisitions
6 Months Ended
Jun. 30, 2020
Business Combinations [Abstract]  
Business Acquisitions

Note 6 – Business Acquisitions

 

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.

 

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

 

On October 1, 2019, the holder of the 30% of the membership interests of BioFirma and the Company entered into an Assignment and Assumption of Interests of BioFirma LLC, pursuant to which the Company acquired the 30% of BioFirma’s membership interests which were not previously held by the Company, resulting in the Company owning 100% of the membership interests of BioFirma.

 

On December 31, 2019, the Company and BioFirma consummated the sale of substantially all of BioFirma’s assets pursuant to an asset purchase agreement with Self Care Regeneration LLC for a purchase price of $320,800, plus the assumption of certain of BioFirma’s liabilities, all of which were due to be paid to us no later than March 30, 2020. On March 31, 2020, the due date for the payment of the asset sale purchase price was extended to June 30, 2020. As of June 30, 2020, the acquirer of the assets had not paid the purchase price and the Company had established a bad debt reserve of 100% of the purchase price.

 

IMAC Illinois

 

On April 1, 2019, the Company and its wholly owned subsidiary IMAC Illinois entered into an Agreement and Plan of Merger (the “Merger Agreement”) for the acquisition of a practice management group that manages three clinics in the Chicago, Illinois area. The acquisition was completed on April 19, 2019. Pursuant to the Merger Agreement, the Company issued 1,002,306 restricted shares of the Company’s common stock (the “Merger Consideration”) valued at approximately $4.1 million. The Company has included the financial results of IMAC Illinois, which controls the three Chicago-area clinics, from April 19, 2019, the date of acquisition.

 

IMAC Florida

 

On January 13, 2020, the Company and its wholly owned subsidiary IMAC Florida consummated the acquisition of CHSF, a chiropractic practice in Bonita Springs, Florida. The transaction was completed as a purchase of the practice for $200,000. The Company has included the financial results of IMAC Florida, which controls CHSF, from January 13, 2020, the date of acquisition.

 

The following table summarizes the fair value of consideration paid and the allocation of purchase price to the fair value of net assets acquired for the acquisition of the IMAC Florida business:

 

    Florida  
Property & equipment   $ 50,358  
Customer lists     128,802  
Other assets     20,840  
    $ 200,000  
XML 24 R13.htm IDEA: XBRL DOCUMENT v3.20.2
Property and Equipment
6 Months Ended
Jun. 30, 2020
Property, Plant and Equipment [Abstract]  
Property and Equipment

Note 7 – Property and Equipment

 

The Company’s property and equipment consisted of the following at June 30, 2020 and December 31, 2019:

 

    Estimated
Useful Life in Years
  June 30,
2020
    December 31,
2019
 
                 
Land and building   40 (Building)   $ 1,175,000     $ 1,175,000  
Leasehold improvements   Shorter of asset or lease term     2,249,673       2,262,398  
Equipment   1.5 - 7     1,980,871       1,948,347  
Total property and equipment         5,405,544       5,385,745  
                     
Less: accumulated depreciation         (2,114,820 )     (1,693,736 )
          3,290,724       3,692,009  
Construction in progress         3,268       -  
Total property and equipment, net       $ 3,293,992     $ 3,692,009  

 

Depreciation was $218,818 and $173,394 for the three months ended June 30, 2020 and 2019, respectively and $437,661 and $328,276 for the six months ended June 30, 2020 and 2019, respectively.

XML 25 R14.htm IDEA: XBRL DOCUMENT v3.20.2
Intangibles Assets and Goodwill
6 Months Ended
Jun. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]  
Intangibles Assets and Goodwill

Note 8 – Intangibles Assets and Goodwill

 

The Company’s intangible assets and goodwill consisted of the following at June 30, 2020 and December 31, 2019:

 

        June 30, 2020  
    Estimated         Accumulated        
    Useful Life   Cost     Amortization     Net  
                       
Intangible assets:                            
Management service agreements   10 years   $ 7,940,398     $ (1,309,360 )   $ 6,631,038  
Non-compete agreements   3 years     301,000       (206,972 )     94,028  
Customer lists   3 years     134,882       (22,480 )     112,402  
Definite lived assets         8,376,280       (1,538,812 )     6,837,468  
Research and development         243,750       -       243,750  
Goodwill         2,040,696       -       2,040,696  
Total intangible assets and goodwill       $ 10,660,726     $ (1,538,812 )   $ 9,121,914  

 

 

        December 31, 2019  
    Estimated         Accumulated        
    Useful Life   Cost     Amortization     Net  
                       
Intangible assets:                            
Management service agreements   10 years   $ 8,019,199     $ (994,321 )   $ 7,024,878  
Non-compete agreements   3 years     301,000       (156,806 )     144,194  
Definite lived assets         8,320,199       (1,151,127 )     7,169,072  
Goodwill         2,040,696       -       2,040,696  
Total intangible assets and goodwill       $ 10,360,895     $ (1,151,127 )   $ 9,209,768  

 

Amortization was $234,833 and $223,595 for the three months ended June 30, 2020 and 2019, respectively, and $466,485 and $354,280 for the six months ended June 30, 2020 and 2019, respectively.

 

The Company’s estimated future amortization of intangible assets was as follows:

 

Years Ending December 31,      
       
2020 (six months)   $ 469,666  
2021     882,861  
2022     839,000  
2023     794,040  
2024     794,040  
Thereafter     3,057,861  
    $ 6,837,468  
XML 26 R15.htm IDEA: XBRL DOCUMENT v3.20.2
Operating Leases
6 Months Ended
Jun. 30, 2020
Leases [Abstract]  
Operating Leases

Note 9 – Operating Leases

 

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

 

Discount Rate Applied to Operating Leases

 

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, the Company used the ten year mortgage interest rate.

 

Right of Use Assets

 

Right of use assets included in the Company’s condensed consolidated balance sheet were as follows:

 

    June 30,
2020
    December 31,
2019
 
             
Non-current assets                
Right of use assets, net of amortization   $ 3,600,198     $ 3,719,401  

 

Total operating lease cost

 

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

 

   

Six Months
Ended

June 30, 2020

   

Six Months
Ended

June 30, 2019

 
                 
Operating lease expense   $ 618,508     $ 456,772  

 

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
Leases
 
       
Undiscounted future minimum lease payments:        
2020 (six months)   $ 577,124  
2021     1,035,714  
2022     1,030,098  
2023     939,971  
2024     601,468  
Thereafter     588,246  
Total     4,772,621  
Amount representing imputed interest     (309,412 )
Total operating lease liability     4,463,209  
Current portion of operating lease liability     (980,967 )
Operating lease liability, non-current   $ 3,482,242  
XML 27 R16.htm IDEA: XBRL DOCUMENT v3.20.2
Line of Credit
6 Months Ended
Jun. 30, 2020
Debt Disclosure [Abstract]  
Line of Credit

Note 10 – Line of Credit

 

Advantage Therapy has a $100,000 line of credit with a financial institution that matures on November 20, 2020. The line accrues interest at a variable rate which is currently 6.0% per annum. The line is secured by substantially all of IMAC Holding’s assets. This line of credit had a balance of $79,961 at June 30, 2020 and December 31, 2019.

XML 28 R17.htm IDEA: XBRL DOCUMENT v3.20.2
Notes Payable
6 Months Ended
Jun. 30, 2020
Debt Disclosure [Abstract]  
Notes Payable

Note 11 – Notes Payable

 

On March 25, 2020, the Company entered into a note purchase agreement with Iliad Research & Trading, L.P. (the “Holder”), pursuant to which the Company agreed to issue and sell to the Holder a secured promissory note (the “Note”) in an aggregate initial principal amount of $1,115,000 (the “Initial Principal Amount”), which is payable on or before the date that is 18 months from the issuance date (the “Maturity Date”). The Initial Principal Amount includes an original issue discount of $100,000 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 Note, the Holder paid an aggregate purchase price of $1,000,000. Interest on the Note accrues at a rate of 10% per annum and is payable on the Maturity Date or otherwise in accordance with the Note. The Note may be prepaid by the Company (with the payment of a premium), may be required by the Holder to be redeemed by the Company for up to $200,000 per month after the six-month anniversary of the issuance of the Note (subject to certain deferral rights), and is subject to customary event of default (with a default interest rate of up to 22%). The Note transaction documents also give the Holder a right of first refusal to future debt issuances and a right to the first $250,000 of every $1 million of proceeds from future sales of equity by the Company. The Note is secured by the assets of the Company, other that the Company’s owned real property, intellectual property and accounts receivable, pursuant to a security agreement.

 

On April 16, 2020, the Company entered into a loan with Pinnacle Bank as the lender (“Lender”) in an aggregate principal amount of $1,691,520 (the “Loan”) pursuant to the Paycheck Protection Program (the “PPP”) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The Loan is evidenced by a promissory note (the “PPP Note”) dated April 16, 2020 and matures on April 16, 2022. The PPP Note bears interest at a rate of 1.000% per annum, with the first six months of payments deferred. Principal and interest are payable monthly commencing on November 16, 2020 and may be prepaid by the Company at any time prior to maturity with no prepayment penalties. In order to be entitled to forgiveness, funds from the Loan may only be used for payroll costs, costs used to continue group health care benefits, mortgage payments, rent utilities, and interest on other debt obligations under the terms and conditions outlined by the PPP. The Company intends to use all or a significant majority of the Loan amount for the qualifying expenses. The Loan will not be deemed restricted issuance pursuant to the terms of the note purchase agreement entered into by the Company and Iliad Research & Trading, L.P. on March 25, 2020.

 

Set forth below is a summary of the Company’s outstanding debt as of June 30, 2020 and December 31, 2019:

 

    June 30,     December 31,  
    2020     2019  
             
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 which carries an interest rate of 10% per annum. The Note was amended in June 2019 and all outstanding balances are due January 5, 2021.   $ 1,750,000     $ 1,750,000  
                 
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.     86,107       99,628  
                 
$1.2 million mortgage loan with a financial institution. The loan agreement was originally for 6-months and carries an interest rate 3.35%. The loan matured in 2019. As of June 30, 2020, it was due on demand, with interest being paid monthly. This mortgage was repaid on July 24, 2020 (see Note 16 below).     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.     87,568       93,652  
                 
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 certain Company executives.     41,788       63,913  
                 
Note payable to an employee in the amount of $101,906 dated March 8, 2017. The note requires payment of five annual installments of $23,350, including principal and interest at 5%. The note matures on December 31, 2021, and is unsecured.     40,000       60,000  
                 
$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.     92,433       102,744  
                 
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.     107,119       129,182  
                 
Note payable to a financial institution in the amount of $1,691,520 dated April 16, 2020. The note requires 18 consecutive monthly installments, commencing on November 16, 2020, of $95,193 including principal and interest at 1.00%. The note matures on April 16, 2022.     1,691,520       -  
                 
Note payable in the amount of $1,115,000, dated March 25, 2020. The note is payable on or before September 25, 2021. The interest on the note accrues at a rate of 10% per annum and is payable on the maturity date or otherwise in accordance with the note.     690,000       -  
                 
Unamortized debt issuance costs     (114,484 )     -  
                 
      5,704,551       3,531,619  
Less: current portion:     (4,471,874 )     (1,422,554 )
    $ 1,232,677     $ 2,109,065  

 

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

 

Years Ending December 31,   Amount  
       
2020 (six months)   $ 2,083,113  
2021     3,032,557  
2022     484,184  
2023     51,657  
2024     27,631  
Thereafter     25,409  
Total   $ 5,704,551  
XML 29 R18.htm IDEA: XBRL DOCUMENT v3.20.2
Stockholders' Equity
6 Months Ended
Jun. 30, 2020
Equity [Abstract]  
Stockholders' Equity

Note 12 – Stockholders’ Equity

 

Prior to the Company’s conversion to a corporation, 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 6,582,737 shares of common stock with a $0.001 par value pursuant to the Company’s conversion from a limited liability company to a corporation.

 

On February 12, 2019, the Company completed a reverse split of its 6,582,737 shares of common stock 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, the Company completed an initial 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 34,000 shares of common stock for gross proceeds of $4,356,815. The Company also issued 449,217 shares of common stock for the conversion of its 4% convertible notes and 1,410,183 shares to satisfy deferred acquisition consideration payable in connection with its 2018 business acquisitions.

 

On April 19, 2019, the Company consummated the Merger Agreement and issued 1,002,306 shares of its common stock in Merger Consideration.

 

On July 15, 2019, the Company signed a $10 million share purchase agreement (the “Purchase Agreement”) with Lincoln Park Capital Fund, LLC (“Lincoln Park”), an Illinois limited liability company. In consideration for entering into the $10 million agreement, the Company issued to Lincoln Park 60,006 shares of Company common stock as a commitment fee. The Purchase Agreement limits our sales of shares of common stock to Lincoln Park to 1,669,359 shares of common stock, representing 19.99% of the shares of common stock outstanding on the date of the Purchase Agreement unless (a) stockholder approval is obtained to issue more than such amount or (b) the average price of all applicable sales of our common stock to Lincoln Park under the Purchase Agreement equals or exceeds the lower of (i) the closing price of our common stock on the Nasdaq Capital Market immediately preceding July 15, 2019 or (ii) the average of the closing price of our common stock on the Nasdaq Capital Market for the five business days immediately preceding July 15, 2019. As of June 30, 2020, pursuant to the Purchase Agreement, the Company sold an aggregate of 1,602,294 shares of common stock of the Company to Lincoln Park for aggregate proceeds to the Company of $2,424,053 (excluding the 60,006 shares issued to Lincoln Park as a commitment fee).

 

On June 18, 2020, 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 Purchasers an aggregate of 1,764,000 shares (the “Shares”) of its common stock, in a registered direct offering (the “Registered Direct Offering”). The Shares were offered by the Company pursuant to its shelf registration statement on Form S-3 (File No. 333-237455) originally filed with the SEC on March 27, 2020 (as amended, the “Registration Statement”), which was declared effective on April 3, 2020. The purchase price for one Share in the Registered Direct Offering was $1.50, and closing of the Registered Direct Offering occurred on June 22, 2020. The Company received $2.644 million in gross proceeds from the Registered Direct Offering. The Company used approximately $0.5 million of the gross proceeds for the repayment of certain indebtedness, and the remaining proceeds to the Company will be used to finance the costs of developing and acquiring additional outpatient medical clinics as part of the Company’s growth and expansion strategy and for working capital.

 

2018 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.

 

Stock Options

 

As of June 30, 2020, the Company had issued stock options to purchase 452,872 shares of its common stock as non-qualified stock options to various employees of the Company. These 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. 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 with the following assumptions: a volatility rate of 32.2%, risk free rate of 2.4% and the expected term of 10 years.

 

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 May 21, 2020, the Company granted 10,000 RSUs to a director of the Company, which vested immediately. On June 30, 2020, 66,875 shares of common stock were issued pursuant to previously granted RSUs which had vested as of such date.

XML 30 R19.htm IDEA: XBRL DOCUMENT v3.20.2
Retirement Plan
6 Months Ended
Jun. 30, 2020
Retirement Benefits [Abstract]  
Retirement Plan

Note 13 – Retirement 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 50% of up to 6 % of total compensation for those employees making salary deferrals. The Company made contributions of $20,105 and $13,354 during the three months ended June 30, 2020 and 2019, respectively, and $39,795 and $20,761 during the six months ended June 30, 2020 and 2019, respectively.

XML 31 R20.htm IDEA: XBRL DOCUMENT v3.20.2
Income Taxes
6 Months Ended
Jun. 30, 2020
Income Tax Disclosure [Abstract]  
Income Taxes

Note 14 – Income Taxes

 

The provision for income taxes differs from the amount computed by applying the statutory federal income tax rate to income before provision for income taxes. The sources and tax effects of the differences are as follows:

 

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

 

At June 30, 2020, the Company had a net operating loss carryforward of approximately $3.7 million for federal 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 June 30, 2020. The principal differences between the operating loss for income tax purposes and reporting purposes are shares issued for services and share-based compensation and a temporary difference in depreciation expense.

XML 32 R21.htm IDEA: XBRL DOCUMENT v3.20.2
Commitments and Contingencies
6 Months Ended
Jun. 30, 2020
Commitments and Contingencies Disclosure [Abstract]  
Commitments and Contingencies

Note 15 – Commitments and Contingencies

 

The Company is subject to extensive regulation, including health insurance regulations directed at ascertaining the appropriateness of reimbursement, preventing fraud and abuse and otherwise regulating reimbursement. To ensure compliance, various insurance providers often conduct audits and request patient records and other documents to support 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 results of the audit to make overpayment demands based on a wider population of claims than those examined in the audit.

 

From time to time the Company may become subject to threatened and/or asserted claims arising in the ordinary course of our business. Management is not aware of any matters, either individually or in the aggregate, that are reasonably likely to have a material impact on the Company’s financial condition, results of operations or liquidity.

XML 33 R22.htm IDEA: XBRL DOCUMENT v3.20.2
Subsequent Events
6 Months Ended
Jun. 30, 2020
Subsequent Events [Abstract]  
Subsequent Events

Note 16 - Subsequent Events

 

On July 27, 2020, the Company sold real estate located in Lexington, Kentucky in a sale-leaseback transaction for a sale price of $1,300,000. The proceeds from the sale were used to repay a $1,232,000 mortgage owed by the Company. Simultaneous with the sale, the Company also entered a five-year leaseback of the sold property.

 

In August 2020, the United States Food and Drug Administration (the “FDA”) approved its investigational new drug application. The Company plans to initiate enrollment for a Phase 1 clinical trial, to be conducted over a 12-month period.

XML 34 R23.htm IDEA: XBRL DOCUMENT v3.20.2
Summary of Significant Accounting Policies (Policies)
6 Months Ended
Jun. 30, 2020
Accounting Policies [Abstract]  
Principles of Consolidation

Principles of Consolidation

 

The accompanying 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.S. Securities and Exchange Commission (“SEC” or the “Commission”). The information contained in these condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements and notes thereto for the fiscal year ended December 31, 2019 included in the Company’s Annual Report on Form 10-K filed with the SEC on March 26, 2020.

 

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 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”) and IMAC Management of Florida, LLC (“IMAC Florida”); 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”); and the following which prior to June 1, 2018 was held as a minority interest, IMAC Regeneration Center of St. Louis, LLC (“IMAC St. Louis”).

 

In June 2018, the Company consummated certain transactions resulting in the acquisition of the outstanding equity interests in IMAC St. Louis and Clinic Management Associates of KY, LLC (“CMA of KY”), an entity which consolidates Integrated Medical and Chiropractic Regeneration Center, PSC (“IMAC Kentucky”) due to control by contract. These entities 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. On October 1, 2019, the Company acquired the 30% of BioFirma’s membership interests which were not previously held by the Company, resulting in the Company owning 100% of the membership interests of BioFirma. Substantially all the assets of BioFirma were sold effective December 31, 2019; however as of June 30, 2020, the acquirer of the assets had not paid the purchase price and the Company had established a bad debt reserve of 100% of the purchase price.

 

In April 2019, the Company consummated certain transactions resulting in the acquisition of the outstanding equity interest in ISDI Holdings II, Inc., an Illinois corporation (“ISDI Holdings II”), and PHR Holdings, Inc., an Illinois corporation (“PHR Holdings”), entities which consolidate the results of Progressive Health and Rehabilitation, Ltd (“Progressive”) and Illinois Spine and Disc Institute, Ltd (“ISDI”) due to control by contract. These entities are included in the condensed consolidated financial statements from the date of acquisition.

 

In November 2019, IMAC Illinois entered into a management agreement for an occupational and physical therapy practice in Rockford, Illinois. This entity is included in the condensed consolidated financial statements due to control by contract from the date of entry into the management agreement.

 

In January 2020, the Company consummated an agreement for the acquisition of Chiropractic Health of Southwest Florida, Inc. (“CHSF”) in Bonita Springs, Florida. This entity is included in the condensed consolidated financial statements from the date of acquisition.

 

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

Use of Estimates

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

COVID-19 Pandemic

 

On January 30, 2020, the World Health Organization (WHO) announced a global health emergency because of a new strain of coronavirus originating in Wuhan, China (the “COVID-19 outbreak”) and the risks to the international community as the virus spread globally beyond the point of origin. On March 20, 2020 the WHO classified the COVID-19 outbreak as a pandemic, based on the rapid increase in exposure globally.

 

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 for fiscal year 2020 beyond the results presented in these condensed consolidated financial statements and this quarterly report.

 

CARES Act

 

The Company is continuing to closely monitor legislative actions at the federal, state and local levels including the Coronavirus Aid, Relief, and Economic Security Act (the "CARES Act") and other governmental assistance that might be available in response to the COVID-19 pandemic. As part of the CARES Act, the United States government initially announced that it would offer $100 billion of relief to eligible health care providers. On April 7, 2020, Centers for Medicare and Medicaid Services ("CMS") officials indicated they would distribute $30 billion of direct grants to hospitals, ASCs and other health care providers based on how much they bill Medicare. Payments received from these grants are not required to be repaid provided the recipients attest to and comply with certain terms and conditions, including limitations on balance billing and not using funds received from the grants to reimburse expenses or losses that other sources are obligated to reimburse.

 

The Company received approximately $416,000 of the grant funds distributed under the CARES Act Provider Relief Fund program during the six months ended June 30, 2020. Based on an analysis of the compliance and reporting requirements and the impact of the COVID-19 pandemic on our operating results through the end of the second quarter, these funds were recognized as a reduction in operating expenses under the caption Grant funds in the condensed consolidated statements of operations for the three- and six- months ended June 30, 2020. The recognition of amounts received is conditioned upon certification that payment will be used to prevent, prepare for and respond to the COVID-19 pandemic and shall reimburse the recipient only for healthcare related expenses or lost revenues that are attributable to the COVID-19 pandemic. Amounts are recognized as a reduction to operating costs and expenses only to the extent the Company is reasonably assured that underlying conditions are met.

Revenue Recognition

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. The fees for such services are billed either to the patient or a third-party payer, including Medicare. Starting in January 2020, the Company implemented wellness maintenance programs on a subscription basis. There are three membership plans offered with different levels of service for each plan. The Company recognizes service revenues based upon the estimated amounts the Company expects to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments 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 estimated amounts expected to be collected.

 

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 an 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. The company recognize other management service revenue in the period in which services are rendered. These revenues are earned by IMAC Nashville, IMAC Management and IMAC Illinois and are eliminated in consolidation to the extent owned.

 

The Company’s patient revenue consisted of the following for the three and six months ended June 30, 2020 and June 30, 2019:

 

    Three Months Ended     Six Months Ended  
    June 30, 2020     June 30, 2019     June 30, 2020     June 30, 2019  
                         
Patient revenues   $ 5,595,279     $ 8,887,819     $ 12,747,221     $ 16,176,841  
Contractual adjustments     (3,022,699 )     (5,131,064 )     (6,865,572 )     (9,650,258 )
Patient revenue, net   $ 2,572,580     $ 3,756,755     $ 5,881,649     $ 6,526,583  
Patient Deposits

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 rarely 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

Fair Value of Financial Instruments

 

The carrying amount of accounts receivable and accounts payable approximate their respective fair values due to the short- 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.

Cash and Cash Equivalents

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 no cash equivalents at June 30, 2020 and December 31, 2019.

Accounts Receivable

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 is 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, 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 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.

Allowance for Doubtful Accounts, Contractual and Other Discounts

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 income when the recoveries are made.

Property and Equipment

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 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) for the year. Expenditures for maintenance and repairs are charged to expense as incurred.

Intangible Assets

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. Acquired intangible assets include trade names, non-compete agreements, customer relationships and contractual agreements.

Goodwill

Goodwill

 

Our goodwill represents the excess of the purchase price over the fair value of the net identifiable assets acquired 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. There was no goodwill impairment for the years presented.

 

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

Long-Lived Assets

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-lived assets for the years presented.

Advertising and Marketing

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 $174,350 and $349,328 for the three months ended June 30, 2020 and 2019, respectively and was $416,167 and $696,344 for the six months ended June 30, 2020 and 2019, respectively.

Net Loss Per Share

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. Diluted net loss per common share is determined using the weighted-average of common shares outstanding during the period, 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.

Income Taxes

Income Taxes

 

Following the Company’s conversion to a Delaware corporation in 2018, IMAC Nashville, IMAC Texas, IMAC St. Louis continued as single-member limited liability companies (wholly owned by the Company) that are disregarded entities for tax purposes and do not file separate returns. Their activity is included as part of IMAC Holdings Inc. Advantage Therapy, IMAC Illinois and IMAC Florida are also disregarded entities for tax purposes. BioFirma was a limited liability company taxed as a partnership. Effective October 1, 2019, BioFirma became wholly owned by IMAC Holdings and is a disregarded entity for tax purposes. IMAC Management is a C-corporation and is included in the consolidated return of IMAC Holdings as a subsidiary.

 

Any future benefit arising from losses have been offset by a valuation allowance. Accordingly, no provision for income taxes is reflected in the condensed consolidated financial statements. The Company records a liability for uncertain tax positions when 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. At June 30, 2020 and December 31, 2019, 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 2017 are open and subject to examination by the taxing authorities.

XML 35 R24.htm IDEA: XBRL DOCUMENT v3.20.2
Summary of Significant Accounting Policies (Tables)
6 Months Ended
Jun. 30, 2020
Accounting Policies [Abstract]  
Schedule of Patient Revenue, Net

The Company’s patient revenue consisted of the following for the three and six months ended June 30, 2020 and June 30, 2019:

 

    Three Months Ended     Six Months Ended  
    June 30, 2020     June 30, 2019     June 30, 2020     June 30, 2019  
                         
Patient revenues   $ 5,595,279     $ 8,887,819     $ 12,747,221     $ 16,176,841  
Contractual adjustments     (3,022,699 )     (5,131,064 )     (6,865,572 )     (9,650,258 )
Patient revenue, net   $ 2,572,580     $ 3,756,755     $ 5,881,649     $ 6,526,583  
XML 36 R25.htm IDEA: XBRL DOCUMENT v3.20.2
Concentration of Credit Risks (Tables)
6 Months Ended
Jun. 30, 2020
Risks and Uncertainties [Abstract]  
Schedule of Concentration Risk

As of June 30, 2020 and December 31, 2019, the Company had the following revenue and accounts receivable concentrations:

 

    June 30, 2020     December 31, 2019  
    % of Revenue     % of Accounts Receivable     % of Revenue     % of Accounts Receivable  
    (Unaudited)              
Patient payment     33 %     29 %     47 %     40 %
Medicare payment     41 %     28 %     27 %     26 %
Insurance payment     26 %     43 %     26 %     34 %
XML 37 R26.htm IDEA: XBRL DOCUMENT v3.20.2
Accounts Receivable (Tables)
6 Months Ended
Jun. 30, 2020
Receivables [Abstract]  
Schedule of Accounts Receivable

As of June 30, 2020 and December 31, 2019, the Company’s accounts receivable consisted of the following:

 

    June 30,
2020
    December 31,
2019
 
    (Unaudited)  
Gross accounts receivable   $ 1,518,854     $ 1,285,228  
Less: allowance for doubtful accounts     (28,982 )     (26,903 )
Accounts receivable, net   $ 1,489,872     $ 1,258,325  
XML 38 R27.htm IDEA: XBRL DOCUMENT v3.20.2
Business Acquisitions (Tables)
6 Months Ended
Jun. 30, 2020
Business Combinations [Abstract]  
Schedule of Assets Acquired and Liabilities Assumed

The following table summarizes the fair value of consideration paid and the allocation of purchase price to the fair value of net assets acquired for the acquisition of the IMAC Florida business:

 

    Florida  
Property & equipment   $ 50,358  
Customer lists     128,802  
Other assets     20,840  
    $ 200,000  
XML 39 R28.htm IDEA: XBRL DOCUMENT v3.20.2
Property and Equipment (Tables)
6 Months Ended
Jun. 30, 2020
Property, Plant and Equipment [Abstract]  
Schedule of Property and Equipment

The Company’s property and equipment consisted of the following at June 30, 2020 and December 31, 2019:

 

    Estimated
Useful Life in Years
  June 30,
2020
    December 31,
2019
 
                 
Land and building   40 (Building)   $ 1,175,000     $ 1,175,000  
Leasehold improvements   Shorter of asset or lease term     2,249,673       2,262,398  
Equipment   1.5 - 7     1,980,871       1,948,347  
Total property and equipment         5,405,544       5,385,745  
                     
Less: accumulated depreciation         (2,114,820 )     (1,693,736 )
          3,290,724       3,692,009  
Construction in progress         3,268       -  
Total property and equipment, net       $ 3,293,992     $ 3,692,009  
XML 40 R29.htm IDEA: XBRL DOCUMENT v3.20.2
Intangibles Assets and Goodwill (Tables)
6 Months Ended
Jun. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Intangible Assets

The Company’s intangible assets and goodwill consisted of the following at June 30, 2020 and December 31, 2019:

 

        June 30, 2020  
    Estimated         Accumulated        
    Useful Life   Cost     Amortization     Net  
                       
Intangible assets:                            
Management service agreements   10 years   $ 7,940,398     $ (1,309,360 )   $ 6,631,038  
Non-compete agreements   3 years     301,000       (206,972 )     94,028  
Customer lists   3 years     134,882       (22,480 )     112,402  
Definite lived assets         8,376,280       (1,538,812 )     6,837,468  
Research and development         243,750       -       243,750  
Goodwill         2,040,696       -       2,040,696  
Total intangible assets and goodwill       $ 10,660,726     $ (1,538,812 )   $ 9,121,914  

 

 

        December 31, 2019  
    Estimated         Accumulated        
    Useful Life   Cost     Amortization     Net  
                       
Intangible assets:                            
Management service agreements   10 years   $ 8,019,199     $ (994,321 )   $ 7,024,878  
Non-compete agreements   3 years     301,000       (156,806 )     144,194  
Definite lived assets         8,320,199       (1,151,127 )     7,169,072  
Goodwill         2,040,696       -       2,040,696  
Total intangible assets and goodwill       $ 10,360,895     $ (1,151,127 )   $ 9,209,768  
Schedule of Future Amortization of Intangible Assets

The Company’s estimated future amortization of intangible assets was as follows:

 

Years Ending December 31,      
       
2020 (six months)   $ 469,666  
2021     882,861  
2022     839,000  
2023     794,040  
2024     794,040  
Thereafter     3,057,861  
    $ 6,837,468  
XML 41 R30.htm IDEA: XBRL DOCUMENT v3.20.2
Operating Leases (Tables)
6 Months Ended
Jun. 30, 2020
Leases [Abstract]  
Schedule of Operating Lease Right of Use Assets

Right of use assets included in the Company’s condensed consolidated balance sheet were as follows:

 

    June 30,
2020
    December 31,
2019
 
             
Non-current assets                
Right of use assets, net of amortization   $ 3,600,198     $ 3,719,401  
Schedule of Operating Lease Cost

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

 

   

Six Months
Ended

June 30, 2020

   

Six Months
Ended

June 30, 2019

 
                 
Operating lease expense   $ 618,508     $ 456,772  
Schedule of Future Minimum Lease Payments

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

 

    Operating
Leases
 
       
Undiscounted future minimum lease payments:        
2020 (six months)   $ 577,124  
2021     1,035,714  
2022     1,030,098  
2023     939,971  
2024     601,468  
Thereafter     588,246  
Total     4,772,621  
Amount representing imputed interest     (309,412 )
Total operating lease liability     4,463,209  
Current portion of operating lease liability     (980,967 )
Operating lease liability, non-current   $ 3,482,242  
XML 42 R31.htm IDEA: XBRL DOCUMENT v3.20.2
Notes Payable (Tables)
6 Months Ended
Jun. 30, 2020
Debt Disclosure [Abstract]  
Schedule of Notes Payable

Set forth below is a summary of the Company’s outstanding debt as of June 30, 2020 and December 31, 2019:

 

    June 30,     December 31,  
    2020     2019  
             
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 which carries an interest rate of 10% per annum. The Note was amended in June 2019 and all outstanding balances are due January 5, 2021.   $ 1,750,000     $ 1,750,000  
                 
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.     86,107       99,628  
                 
$1.2 million mortgage loan with a financial institution. The loan agreement was originally for 6-months and carries an interest rate 3.35%. The loan matured in 2019. As of June 30, 2020, it was due on demand, with interest being paid monthly. This mortgage was repaid on July 24, 2020 (see Note 16 below).     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.     87,568       93,652  
                 
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 certain Company executives.     41,788       63,913  
                 
Note payable to an employee in the amount of $101,906 dated March 8, 2017. The note requires payment of five annual installments of $23,350, including principal and interest at 5%. The note matures on December 31, 2021, and is unsecured.     40,000       60,000  
                 
$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.     92,433       102,744  
                 
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.     107,119       129,182  
                 
Note payable to a financial institution in the amount of $1,691,520 dated April 16, 2020. The note requires 18 consecutive monthly installments, commencing on November 16, 2020, of $95,193 including principal and interest at 1.00%. The note matures on April 16, 2022.     1,691,520       -  
                 
Note payable in the amount of $1,115,000, dated March 25, 2020. The note is payable on or before September 25, 2021. The interest on the note accrues at a rate of 10% per annum and is payable on the maturity date or otherwise in accordance with the note.     690,000       -  
                 
Unamortized debt issuance costs     (114,484 )     -  
                 
      5,704,551       3,531,619  
Less: current portion:     (4,471,874 )     (1,422,554 )
    $ 1,232,677     $ 2,109,065  
Schedule of Principal Maturities of Notes Payable

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

 

Years Ending December 31,   Amount  
       
2020 (six months)   $ 2,083,113  
2021     3,032,557  
2022     484,184  
2023     51,657  
2024     27,631  
Thereafter     25,409  
Total   $ 5,704,551  
XML 43 R32.htm IDEA: XBRL DOCUMENT v3.20.2
Income Taxes (Tables)
6 Months Ended
Jun. 30, 2020
Income Tax Disclosure [Abstract]  
Schedule of Statutory Federal Income Tax Rate

The provision for income taxes differs from the amount computed by applying the statutory federal income tax rate to income before provision for income taxes. The sources and tax effects of the differences are as follows:

 

Deferred tax benefit at the federal statutory rate     21 %
Valuation allowance     -21 %
      0 %
XML 44 R33.htm IDEA: XBRL DOCUMENT v3.20.2
Summary of Significant Accounting Policies (Details Narrative) - USD ($)
1 Months Ended 3 Months Ended 6 Months Ended
Apr. 07, 2020
Apr. 30, 2020
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Dec. 31, 2019
Oct. 01, 2019
Aug. 31, 2018
Purchase price of debt reserve, percentage         100.00%        
Grant funds     $ (415,978) $ (415,978)      
Cash equivalents            
Advertising and marketing expense     174,350 $ 349,328 416,167 $ 696,344      
Uncertain tax positions            
CARES Act Provider Relief Fund [Member] | Centers for Medicare and Medicaid Services [Member]                  
Releif fund received $ 30,000,000,000                
CARES Act Provider Relief Fund [Member] | Eligible Health Care Providers [Member]                  
Releif fund received   $ 100,000,000,000              
Advantage Hand Therapy and Orthopedic Rehabilitation, LLC [Member]                  
Percentage of voting interest acquired                 100.00%
BioFirma LLC [Member]                  
Percentage of voting interest acquired             100.00% 30.00% 70.00%
XML 45 R34.htm IDEA: XBRL DOCUMENT v3.20.2
Summary of Significant Accounting Policies - Schedule of Patient Revenue, Net (Details) - USD ($)
3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Patient revenue, net $ 2,572,580 $ 3,756,755 $ 5,881,649 $ 6,526,583
Patient Revenues, Net [Member]        
Patient revenue, net 5,595,279 8,887,819 12,747,221 16,176,841
Contractual Adjustments [Member]        
Patient revenue, net $ (3,022,699) $ (5,131,064) $ (6,865,572) $ (9,650,258)
XML 46 R35.htm IDEA: XBRL DOCUMENT v3.20.2
Capital Requirements, Liquidity and Going Concern Considerations (Details Narrative) - USD ($)
3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]          
Working capital $ 3,900,000   $ 3,900,000   $ 3,500,000
Net loss $ (2,030,688) $ (1,900,768) (3,764,233) $ (3,499,955)  
Net cash (used in) operating activities     $ (2,985,049) $ (1,679,060)  
XML 47 R36.htm IDEA: XBRL DOCUMENT v3.20.2
Concentration of Credit Risks (Details Narrative)
Jun. 30, 2020
USD ($)
Risks and Uncertainties [Abstract]  
FDIC insured amount $ 250,000
Cash and cash equivalents in excess of FDIC $ 1,724,713
XML 48 R37.htm IDEA: XBRL DOCUMENT v3.20.2
Concentration of Credit Risks - Schedule of Concentration Risk (Details)
6 Months Ended 12 Months Ended
Jun. 30, 2020
Dec. 31, 2019
Revenue [Member] | Patient Payment [Member]    
Concentration of credit risk, percentage 33.00% 47.00%
Revenue [Member] | Medicare Payment [Member]    
Concentration of credit risk, percentage 26.00% 27.00%
Revenue [Member] | Insurance Payment [Member]    
Concentration of credit risk, percentage 28.00% 26.00%
Accounts Receivable [Member] | Patient Payment [Member]    
Concentration of credit risk, percentage 41.00% 40.00%
Accounts Receivable [Member] | Medicare Payment [Member]    
Concentration of credit risk, percentage 29.00% 26.00%
Accounts Receivable [Member] | Insurance Payment [Member]    
Concentration of credit risk, percentage 43.00% 34.00%
XML 49 R38.htm IDEA: XBRL DOCUMENT v3.20.2
Accounts Receivable - Schedule of Accounts Receivable (Details) - USD ($)
Jun. 30, 2020
Dec. 31, 2019
Receivables [Abstract]    
Gross accounts receivable $ 1,518,854 $ 1,285,228
Less: allowance for doubtful accounts (28,982) (26,903)
Accounts receivable, net $ 1,489,872 $ 1,258,325
XML 50 R39.htm IDEA: XBRL DOCUMENT v3.20.2
Business Acquisitions (Details Narrative) - USD ($)
6 Months Ended
Oct. 01, 2019
Apr. 19, 2019
Aug. 02, 2018
Jun. 30, 2020
Jan. 13, 2020
Dec. 31, 2019
Purchase price of debt reserve, percentage       100.00%    
BioFirma [Member]            
Membership interests description On October 1, 2019, the holder of the 30% of the membership interests of BioFirma and the Company entered into an Assignment and Assumption of Interests of BioFirma LLC, pursuant to which the Company acquired the 30% of BioFirms' membership interests which were not previously held by the Company, resulting in the Company owning 100% of the membership interests of BioFirma.          
Self Care Regeneration LLC [Member] | Asset Purchase Agreement [Member]            
Business acquisition, purchase price           $ 320,800
BioFirma LLC [Member]            
Percentage of outstanding membership units     70.00%      
Payments to acquire business gross     $ 1,000      
IMAC Management of Illinois, LLC [Member]            
Number of restricted stock issued, shares   1,002,306        
Number of restricted stock issued, value   $ 4,100,000        
IMAC Management of Florida, LLC [Member]            
Purchase price of acquisition         $ 200,000  
XML 51 R40.htm IDEA: XBRL DOCUMENT v3.20.2
Business Acquisitions - Schedule of Assets Acquired and Liabilities Assumed (Details) - Florida [Member]
Jun. 30, 2020
USD ($)
Property & equipment $ 50,358
Customer lists 128,802
Other assets 20,840
Net Assets Acquired $ 200,000
XML 52 R41.htm IDEA: XBRL DOCUMENT v3.20.2
Property and Equipment (Details Narrative) - USD ($)
3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Property, Plant and Equipment [Abstract]        
Depreciation $ 218,818 $ 173,394 $ 437,661 $ 328,276
XML 53 R42.htm IDEA: XBRL DOCUMENT v3.20.2
Property and Equipment - Schedule of Property and Equipment (Details) - USD ($)
6 Months Ended
Jun. 30, 2020
Dec. 31, 2019
Total property and equipment, gross $ 5,405,544 $ 5,385,745
Less: accumulated depreciation (2,114,820) (1,693,736)
Property and equipment 3,290,724 3,692,009
Construction in progress 3,268
Total property and equipment, net $ 3,293,992 3,692,009
Land and Building [Member]    
Estimated Useful Life in Years 40 years  
Total property and equipment, gross $ 1,175,000 1,175,000
Leasehold Improvements [Member]    
Estimated Useful Life Shorter of asset or lease term  
Total property and equipment, gross $ 2,249,673 2,262,398
Equipment [Member]    
Total property and equipment, gross $ 1,980,871 $ 1,948,347
Equipment [Member] | Minimum [Member]    
Estimated Useful Life in Years 1 year 6 months  
Equipment [Member] | Maximum [Member]    
Estimated Useful Life in Years 7 years  
XML 54 R43.htm IDEA: XBRL DOCUMENT v3.20.2
Intangibles Assets and Goodwill (Details Narrative) - USD ($)
3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]        
Amortization of intangible assets $ 234,833 $ 223,595 $ 466,485 $ 354,280
XML 55 R44.htm IDEA: XBRL DOCUMENT v3.20.2
Intangibles Assets and Goodwill - Schedule of Intangible Assets (Details) - USD ($)
6 Months Ended 12 Months Ended
Jun. 30, 2020
Dec. 31, 2019
Intangible assets, net $ 6,837,468  
Intangible assets, including goodwill, cost 10,660,726 $ 10,360,895
Goodwill 2,040,696 2,040,696
Total intangible assets and goodwill $ 9,121,914 9,209,768
Customer Lists [Member]    
Intangible assets, estimated useful life 3 years  
Intangible assets, cost $ 134,882  
Intangible assets, Accumulated Amortization (22,480)  
Intangible assets, net 112,402  
Definite Lived Assets [Member]    
Intangible assets, cost 8,376,280 8,320,199
Intangible assets, Accumulated Amortization (1,538,812) (1,151,127)
Intangible assets, net 6,837,468 $ 7,169,072
Research and Development [Member]    
Intangible assets, cost 243,750  
Intangible assets, Accumulated Amortization  
Intangible assets, net $ 243,750  
Management Service Agreement [Member]    
Intangible assets, estimated useful life 10 years 10 years
Intangible assets, cost $ 7,940,398 $ 8,019,199
Intangible assets, Accumulated Amortization (1,309,360) (994,321)
Intangible assets, net $ 6,631,038 $ 7,024,878
Non-Compete Agreement [Member]    
Intangible assets, estimated useful life 3 years 3 years
Intangible assets, cost $ 301,000 $ 301,000
Intangible assets, Accumulated Amortization (206,972) (156,806)
Intangible assets, net $ 94,028 $ 144,194
XML 56 R45.htm IDEA: XBRL DOCUMENT v3.20.2
Intangibles Assets and Goodwill - Schedule of Future Amortization of Intangible Assets (Details)
Jun. 30, 2020
USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]  
2020 (six months) $ 469,666
2021 882,861
2022 839,000
2023 794,040
2024 794,040
Thereafter 3,057,861
Total $ 6,837,468
XML 57 R46.htm IDEA: XBRL DOCUMENT v3.20.2
Operating Leases (Details Narrative)
6 Months Ended
Jun. 30, 2020
Leases [Abstract]  
Mortgage interest rate term 10 years
XML 58 R47.htm IDEA: XBRL DOCUMENT v3.20.2
Operating Leases - Schedule of Operating Lease Right of Use Assets (Details) - USD ($)
Jun. 30, 2020
Dec. 31, 2019
Leases [Abstract]    
Right of use assets, net of amortization $ 3,600,198 $ 3,719,401
XML 59 R48.htm IDEA: XBRL DOCUMENT v3.20.2
Operating Leases - Schedule of Operating Lease Cost (Details) - USD ($)
6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Leases [Abstract]    
Operating lease expense $ 618,508 $ 456,772
XML 60 R49.htm IDEA: XBRL DOCUMENT v3.20.2
Operating Leases - Schedule of Future Minimum Lease Payments (Details) - USD ($)
Jun. 30, 2020
Dec. 31, 2019
Leases [Abstract]    
2020 (six months) $ 577,124  
2021 1,035,714  
2022 1,030,098  
2023 939,971  
2024 601,468  
Thereafter 588,246  
Total 4,772,621  
Amount representing imputed interest (309,412)  
Total operating lease liability 4,463,209  
Current portion of operating lease liability (980,967) $ (1,025,247)
Operating lease liability, non-current $ 3,482,242 $ 3,660,654
XML 61 R50.htm IDEA: XBRL DOCUMENT v3.20.2
Lines of Credit (Details Narrative) - USD ($)
6 Months Ended
Jun. 30, 2020
Dec. 31, 2019
Line of credit $ 79,961 $ 79,961
Advantage Theraphy [Member]    
Line of credit $ 100,000  
Line of credit, maturity date Nov. 20, 2020  
Line of credit, interest rate 6.00%  
Line of credit balance $ 79,961 $ 79,961
XML 62 R51.htm IDEA: XBRL DOCUMENT v3.20.2
Notes Payable (Details Narrative) - USD ($)
6 Months Ended
Apr. 16, 2020
Mar. 25, 2020
Jun. 30, 2020
Jun. 30, 2019
Repayments of notes payable     $ 719,104 $ 54,377
Iliad Research & Trading, L.P [Member] | Secured Promissory Note [Member]        
Initial principal amount   $ 1,115,000    
Debt maturity term   18 months    
Original issue discount   $ 100,000    
Repayments of notes payable   15,000    
Purchase price of notes   $ 1,000,000    
Note interest rate   10.00%    
Debt issuances cost   $ 250,000    
Proceeds from future sales of equity   1,000,000    
Iliad Research & Trading, L.P [Member] | Secured Promissory Note [Member] | Maximum [Member]        
Prepayment of redemption premium   $ 200,000    
Default interest rate   22.00%    
Pinnacle Bank [Member] | Paycheck Protection Program Note [Member]        
Note interest rate 1.00%      
Loans payable principal amount $ 1,691,520      
Loan maturity date Apr. 16, 2022      
XML 63 R52.htm IDEA: XBRL DOCUMENT v3.20.2
Notes Payable - Schedule of Notes Payable (Details) - USD ($)
Jun. 30, 2020
Apr. 16, 2020
Mar. 25, 2020
Dec. 31, 2019
Notes payable $ 5,704,551     $ 3,531,619
Unamortized debt issuance costs (114,484)    
Less: current portion (4,471,874)     (1,422,554)
Notes payable, net of current portion 1,232,677     2,109,065
Notes Payable [Member]        
Notes payable 1,750,000     1,750,000
Notes Payable One [Member]        
Notes payable 86,107     99,628
Notes Payable Two [Member]        
Notes payable 1,232,500     1,232,500
Notes Payable Three [Member]        
Notes payable 87,568     93,652
Notes Payable Four [Member]        
Notes payable 41,788     63,913
Notes Payable Five [Member]        
Notes payable 40,000     60,000
Notes Payable Six [Member]        
Notes payable 92,433     102,744
Notes Payable Seven [Member]        
Notes payable 107,119     129,182
Notes Payable Eight [Member]        
Notes payable 1,691,520 $ 1,691,520  
Notes Payable Nine [Member]        
Notes payable $ 690,000   $ 1,115,000
XML 64 R53.htm IDEA: XBRL DOCUMENT v3.20.2
Notes Payable - Schedule of Notes Payable (Details) (Parenthetical)
1 Months Ended 6 Months Ended
Apr. 16, 2020
USD ($)
Integer
Mar. 25, 2020
USD ($)
Sep. 25, 2019
USD ($)
Integer
Mar. 01, 2019
USD ($)
Integer
Nov. 15, 2017
USD ($)
Integer
Mar. 08, 2017
USD ($)
Integer
Aug. 01, 2016
USD ($)
Integer
May 04, 2016
USD ($)
Integer
Jun. 30, 2019
Jun. 30, 2020
USD ($)
Dec. 31, 2019
USD ($)
Notes payable                   $ 5,704,551 $ 3,531,619
Notes Payable [Member]                      
Notes payable                   1,750,000 1,750,000
Notes Payable One [Member]                      
Notes payable                   86,107 99,628
Notes Payable One [Member] | Financial Institution [Member]                      
Notes payable         $ 200,000            
Debt instrument interest rate         5.00%            
Debt instrument maturity date         May 15, 2023            
Number of installments | Integer         66            
Debt instrument, periodic payment         $ 2,652            
Debt instrument balloon payment         $ 60,000            
Notes Payable Two [Member]                      
Notes payable                   1,232,500 1,232,500
Notes Payable Two [Member] | Financial Institution [Member]                      
Debt instrument face amount                   $ 1,200,000  
Debt instrument interest rate                   3.35%  
Debt instrument maturity date                   Jul. 24, 2020  
Debt instrument maturity date, description                   The loan matured in 2019  
Notes Payable Three [Member]                      
Notes payable                   $ 87,568 93,652
Notes Payable Three [Member] | Financial Institution [Member]                      
Notes payable             $ 131,400        
Debt instrument interest rate             5.00%        
Debt instrument maturity date             Jul. 01, 2026        
Number of installments | Integer             120        
Debt instrument, periodic payment             $ 1,394        
Notes Payable Four [Member]                      
Notes payable                   41,788 63,913
Notes Payable Four [Member] | Financial Institution [Member]                      
Notes payable               $ 200,000      
Debt instrument interest rate               4.25%      
Debt instrument maturity date               May 04, 2021      
Number of installments | Integer               60      
Debt instrument, periodic payment               $ 3,881      
Notes Payable Five [Member]                      
Notes payable                   40,000 60,000
Notes Payable Six [Member]                      
Notes payable                   92,433 102,744
Notes Payable Six [Member] | Advantage Therapy, LLC [Member]                      
Notes payable       $ 112,800              
Debt instrument interest rate       5.00%              
Debt instrument maturity date       Jun. 01, 2024              
Number of installments | Integer       60              
Debt instrument, periodic payment       $ 2,129              
Notes Payable Seven [Member]                      
Notes payable                   107,119 129,182
Notes Payable Seven [Member] | Financial Institution [Member]                      
Notes payable     $ 140,000                
Debt instrument interest rate     5.39%                
Debt instrument maturity date     Sep. 19, 2022                
Number of installments | Integer     36                
Debt instrument, periodic payment     $ 4,225                
Notes Payable Eight [Member]                      
Notes payable $ 1,691,520                 1,691,520
Debt instrument interest rate 1.00%                    
Debt instrument maturity date Apr. 16, 2022                    
Number of installments | Integer 18                    
Debt instrument, periodic payment $ 95,193                    
Notes Payable Nine [Member]                      
Notes payable   $ 1,115,000               690,000
Debt instrument interest rate   10.00%                  
Debt instrument maturity date   Sep. 25, 2021                  
Edward S. Bredniak [Member] | Notes Payable [Member]                      
Debt instrument face amount                   2,000,000  
Notes payable                   $ 379,676  
Debt instrument interest rate                   10.00%  
Debt instrument maturity date                 Jan. 05, 2021    
Employee [Member] | Notes Payable Five [Member]                      
Notes payable           $ 101,906          
Debt instrument interest rate           5.00%          
Debt instrument maturity date           Dec. 31, 2021          
Number of installments | Integer           5          
Debt instrument, periodic payment           $ 23,350          
XML 65 R54.htm IDEA: XBRL DOCUMENT v3.20.2
Notes Payable - Schedule of Principal Maturities of Notes Payable (Details)
Jun. 30, 2020
USD ($)
Debt Disclosure [Abstract]  
2020 (six months) $ 2,083,113
2021 3,032,557
2022 484,184
2023 51,657
2024 27,631
Thereafter 25,409
Total $ 5,704,551
XML 66 R55.htm IDEA: XBRL DOCUMENT v3.20.2
Stockholders' Equity (Details Narrative) - USD ($)
1 Months Ended 3 Months Ended 6 Months Ended
Jun. 18, 2020
Aug. 13, 2019
Jul. 15, 2019
May 21, 2019
Apr. 19, 2019
Feb. 12, 2019
Jun. 01, 2018
Feb. 28, 2019
Jun. 30, 2020
Mar. 31, 2020
Jun. 30, 2019
Mar. 31, 2019
Jun. 30, 2020
Jun. 30, 2019
May 31, 2018
Number of units authorized                 400       400    
Number of units issued                 365       365    
Number of units outstanding                 365       365    
Conversion of units into shares, shares             6,582,737                
Shares issued price per share             $ 0.001                
Reverse split of common stock outstanding           4,533,623                  
Gross proceeds from initial public offering               $ 4,356,815         $ 3,839,482  
Payment in purchase agreement                         $ 200,000  
Share issued pursuant to previous grand RSUs                         66,875    
Restricted Stock Units (RSUs) [Member]                              
Outstanding restricted stock of its common stock       $ 277,500                      
Number of shares vested   30,000   10,000                      
Non-Qualified Stock Options [Member] | Various Employees [Member]                              
Outstanding stock options to purchase stock                         452,872    
Vesting period                         4 years    
Vesting percentage                         25.00%    
Vesting description                         These 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. Stock based compensation for stock options is estimated at the grant date based on the fair value calculated using the Black-Scholes method.    
Volatility rate                         32.20%    
Risk free rate                         2.40%    
Expected term                         10 years    
2018 Incentive Compensation Plan [Member]                              
Reserving for issuance                             1,000,000
Merger Agreement [Member]                              
Number of shares issued during period, shares         1,002,306                    
Purchase Agreement [Member] | Lincoln Park Capital Fund, LLC [Member]                              
Payment in purchase agreement     $ 10,000,000                        
Value of common stock as commitment fee     $ 10,000,000                        
Number of shares of common stock of commitment fee     60,006                        
Sale of shares     1,669,359                   1,602,294    
Outstanding shares percentage     19.99%                        
Number of common stock share sold, value                         $ 2,424,053    
2018 Business Acquisitions [Member]                              
Stock issued during period, acquisitions               1,410,183              
4% Convertible Notes [Member]                              
Stock issued during period, conversion of securities               449,217              
Debt instrument, interest rate               4.00%              
Common Stock [Member]                              
Number of shares issued during period, shares                 1,830,875 1,095,840          
Stock issued during period, conversion of securities                       449,217      
Stock issued during period, acquisitions                     1,002,306 1,410,183      
Initial Public Offering [Member] | Common Stock [Member]                              
Number of shares issued during period, shares               850,000              
Initial Public Offering [Member] | Warrants to Purchase Common Stock [Member]                              
Number of shares issued during period, shares               1,700,000              
Initial Public Offering [Member] | Stock Options [Member]                              
Number of shares issued during period, shares               34,000              
Registered Direct Offering [Member] | Securities Purchase Agreement [Member]                              
Shares issued price per share $ 1.50                            
Number of shares issued during period, shares 1,764,000                            
Gross proceeds from initial public offering $ 2,644,000                            
Payment for indebteness $ 500,000                            
XML 67 R56.htm IDEA: XBRL DOCUMENT v3.20.2
Retirement Plan (Details Narrative) - 401(k) Plan [Member] - USD ($)
3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Matching contributions, percentage of match     50.00%  
Matching contributions, percent of employees' gross pay     6.00%  
Matching contributions, amount $ 20,105 $ 13,354 $ 39,795 $ 20,761
XML 68 R57.htm IDEA: XBRL DOCUMENT v3.20.2
Income Taxes (Details Narrative)
6 Months Ended
Jun. 30, 2020
USD ($)
Income Tax Disclosure [Abstract]  
Operating loss carryforward, net $ 3,700,000
Operating loss carryforward, description 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 June 30, 2020.
XML 69 R58.htm IDEA: XBRL DOCUMENT v3.20.2
Income Taxes - Schedule of Statutory Federal Income Tax Rate (Details)
6 Months Ended
Jun. 30, 2020
Income Tax Disclosure [Abstract]  
Deferred tax benefit at the federal statutory rate 21.00%
Valuation allowance (21.00%)
Statutory federal income tax rate 0.00%
XML 70 R59.htm IDEA: XBRL DOCUMENT v3.20.2
Subsequent Events (Details Narrative) - Subsequent Event [Member] - Lexington, Kentucky [Member]
Jul. 27, 2020
USD ($)
Proceeds from sale of real estate $ 1,300,000
Payment of mortgage $ 1,232,000
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