Executive Summary

Q3 2020 showed sequential recovery with net patient revenue of $3.48M (+35% q/q) but remained down 20% y/y due to COVID-19 and mix shift; net loss per share improved to $0.12 vs $0.20 in Q2 and $0.19 y/y .
Record billable patient visits (37,992, +8% y/y) and 20% q/q growth in wellness memberships (762) alongside sharp reductions in patient expenses (-55% y/y) and G&A (-27% y/y), reflecting cost controls and service-mix changes to spine care .
Strategic and financing updates: Phase 1 trial enrollment opened for Parkinson’s bradykinesia; sale-leaseback reduced debt; PPP forgiveness application submitted; additional financing executed post-quarter (October) to bolster liquidity .
No formal guidance was issued; Street consensus via S&P Global was unavailable for BACK this quarter, limiting an estimates comparison. Where estimates are not shown, coverage appears limited and/or unavailable.

What Went Well and What Went Wrong

“Record billable patient volume of 37,992 visits in the third quarter of 2020, up 8% year-over-year,” driven by operational execution despite COVID headwinds .
Cost discipline: G&A down 27% y/y to $0.96M and patient expenses down 55% y/y to $0.43M, aided by centralized purchasing and a spine-heavy mix reducing per-visit cost burden .
Strategic progress: “opening of enrollment in its Phase 1 clinical study of umbilical cord-derived mesenchymal stem cells for bradykinesia due to Parkinson’s Disease,” enhancing asset value beyond clinics .

Revenue still below prior year due to pandemic and lower average charge per visit ($91.55 vs $124.24 y/y) as knee services (higher-cost) shifted to spine (lower-cost) .
Net loss persisted at $(1.43)M attributable to IMAC; operating loss $(1.31)M, underscoring profitability challenges despite sequential improvement .
Liquidity/controls risks: Working capital deficiency ($2.2M), going concern language, and material weaknesses in internal control over financial reporting remained outstanding .

Metric	Q3 2019	Q2 2020	Q3 2020
Revenue ($USD Millions)	$4.36	$2.57	$3.48
Diluted EPS ($USD)	$(0.19)	$(0.20)	$(0.12)
Operating Loss ($USD Millions)	$(1.64)	$(1.71)	$(1.31)
Net Loss attributable to IMAC ($USD Millions)	$(1.55)	$(2.03)	$(1.43)
Net Income Margin % (calc.)	(35.6%)	(79.0%)	(41.1%)

Segment/Revenue Mix (Q3 2020):

Revenue Component	Q3 2020
Outpatient Facility Services ($USD Millions)	$3.356
Memberships ($USD Millions)	$0.122
Total Revenue ($USD Millions)	$3.478

Key KPIs and Operating Metrics:

KPI	Q3 2019	Q2 2020	Q3 2020
Total Visits	35,749	N/A	39,345
Billable Visits	35,061	N/A	37,992
Avg. Charge per Visit ($USD)	$124.24	N/A	$91.55
Wellness Memberships (period-end)	N/A	637	762
Patient Expenses ($USD)	$950,517	$405,367	$428,615
G&A ($USD)	$1,311,315	$1,208,457	$961,521

Notes:

Adjusted EBITDA improved y/y: $(0.73)M in Q3 2020 vs $(0.94)M in Q3 2019 (non-GAAP reconciliation provided) .
CARES Act grant funds recognized as reduction in operating expenses ($416k for nine months) supported Q2/Q3 operating lines .

Metric	Period	Previous Guidance	Current Guidance	Change
Revenue	FY/Q4	None provided	None provided	Maintained (no formal guidance)
Margins/OpEx	FY/Q4	None provided	None provided	Maintained (no formal guidance)
Tax Rate	FY/Q4	None provided	None provided	Maintained (no formal guidance)
Segment-specific	FY/Q4	None provided	None provided	Maintained (no formal guidance)

IMAC did not issue formal financial guidance in Q3 2020 press release or 10-Q .

Topic	Previous Mentions (Q1 2020)	Previous Mentions (Q2 2020)	Current Period (Q3 2020)	Trend
Telemedicine/Remote Care	Telemedicine launched; clinic suspensions in KY and IL due to orders	Continued operations with recovery; membership base at 637 by June	Ongoing recovery in visits; record billable visits	Improving utilization
COVID-19 Impact	Workforce reduction; negative revenue impact expected in Q2	Revenue down y/y; government aid received; sequential recovery starts	Y/y revenue −20%; sequential revenue +35%; patient mix shift to spine	Sustained headwinds; sequential improvement
Regulatory/Clinical	No trial; IND work funded via note	FDA authorized Phase 1 trial for Parkinson’s bradykinesia	Enrollment opened in Phase 1 trial	Advancing clinical program
Cost Structure/OpEx	Elevated G&A from acquisitions	Expense synergies, grant funds offset; G&A $1.21M	G&A down to $0.96M; patient expenses down 55% y/y	Cost discipline improving
Financing/Liquidity	Note purchase (Iliad), PPP pending	Equity raise ($2.64M gross), PPP received ($1.69M)	PPP forgiveness application; new October note ($2.69M) post-quarter	Liquidity actions ongoing
Governance	—	—	Board refresh (three resignations; three appointments)	Board changes completed

Note: A Q3 2020 earnings call slides deck was available (Nov 5, 2020), but full call transcript was not located in filings repositories .

CEO strategic focus: “Proprietary advancements give IMAC the potential to dramatically improve the non-opioid treatment landscape... derive asset value beyond its brick and mortar locations” (on Phase 1 Parkinson’s trial and board additions) .
Operational discipline: “Net patient revenue of $3.5 million… up 35% sequentially… G&A costs decreased by 20 percent sequentially… led to a 23% improvement in operating loss,” highlighting recovery and cost controls .
Mix-driven economics and balance sheet: “Patient visits increased 44% q/q while patient expenses decreased 55%... shift to spine patients lowered average charge and treatment expense… notes payable reduced by ~$1.2M to $4.5M; PPP loan anticipated at least partial forgiveness” .

Earnings call transcript was not available in filings; analysis references the press release, 10-Q MD&A, and the earnings slides to infer operational themes and financial trajectory .
No additional formal guidance clarifications were disclosed in filed materials .

Wall Street consensus estimates via S&P Global for Q3 2020 were unavailable for BACK; as a result, no formal comparison vs consensus is presented. Where estimates would normally be shown, coverage appears limited/unavailable this quarter.
Implication: Focus shifts to sequential trends and operating improvements (visits, mix, OpEx) rather than a beat/miss framework .

Sequential momentum: Revenue up 35% q/q and EPS loss narrowed, indicating post-COVID recovery, albeit still below pre-pandemic levels; the mix shift reduced price per visit but improved cost per visit and total patient expenses .
Structural cost progress: G&A and patient expenses declined materially y/y; adjusted EBITDA improved vs Q3 2019, supporting path toward breakeven with higher utilization .
Clinical optionality: Phase 1 Parkinson’s bradykinesia trial enrollment adds upside optionality and potential asset value beyond clinic operations .
Balance sheet watch: Working capital deficit and ongoing net losses persist; liquidity actions (sale-leaseback, PPP, notes, ATM) mitigate near-term risk but increase financing complexity; going concern language and control weaknesses warrant caution .
Near-term trading catalysts: Continued visit recovery, PPP forgiveness outcome, clinical trial updates, and additional cost synergy realization; absence of guidance elevates event-driven volatility .
Medium-term thesis: Execution on service mix optimization, subscription memberships growth, and disciplined OpEx management can continue narrowing losses; clinical and partnership developments could re-rate optionality if milestones progress .