Executive Summary

IMAC delivered strong full-year growth with net patient revenue up 126% to $15.10M, while Q4 EBITDA margin improved to -18%, reflecting cost synergies and operating discipline .
Expansion and payer access were key positives: VA Community Care Network participation across multiple states and new OWCP approval post year-end broaden reimbursement pathways .
Portfolio scaling continued via acquisitions (Illinois expansion; Florida clinic post year-end) and brand ambassador centers, supporting volumes and awareness .
Balance sheet actions included a $1.115M secured note at 10% to fund growth initiatives (including a planned FDA IND), with restrictive covenants and equity proceeds sharing, a potential overhang for future financings .
Near-term catalysts: telehealth launch and wellness subscriptions amid COVID-19, OWCP approval, continuing footprint growth; lack of disclosed Q4 stand-alone revenue/EPS limits estimate benchmarking this quarter .

What Went Well and What Went Wrong

What Went Well

Accelerating scale: Net patient revenue rose 126% YoY to $15.10M; visits rose 117% to 138,639, enabled by acquisitions and same-store expansion .
Margin trajectory: EBITDA margin improved from -34% to -25% for FY19; Q4 EBITDA margin reached -18%, with management emphasizing cost synergies from acquired entities .
Payer access and government channels: VA Community Care Network participation across TN, KY, IL, MO and post-year OWCP approval expand eligible patient pools and reimbursement optionality .

Quoted management

“2019 was a banner year for IMAC as we flourished from accretive acquisition and same-store expansion...” .
“We improved EBITDA margin from -34% to -25% year over year, with the fourth quarter EBITDA at -18%.” .
“We will continue to focus on this financial metric by executing cost synergies from acquired entities...” .

What Went Wrong

Losses widened with scaling: Net loss attributable to IMAC increased to $6.50M ($0.84/share) vs. $3.05M ($0.47/share) in 2018; operating expenses more than doubled to $21.31M as infrastructure scaled .
Financing overhang: The March 25, 2020 secured note includes OID, redemption features, rights of first refusal on future debt, and equity proceeds sharing ($250K per $1M raised), potentially constraining future capital flexibility .
Limited quarterly disclosure: Q4 stand-alone revenue/EPS were not explicitly disclosed, reducing transparency for estimate benchmarking this quarter .

Financial Results

Revenue and EPS progression

Metric	Q2 2019	Q3 2019	Q4 2019	FY 2019
Net Patient Revenue ($USD Millions)	$3.76	$4.40	N/A	$15.10
Total Revenue ($USD Millions)	$3.76	N/A	N/A	$15.13
Net Loss ($USD Millions)	$(1.73)	$(1.50)	N/A	$(6.50)
EPS ($USD, basic/diluted)	$(0.21)	$(0.19)	N/A	$(0.84)

Notes: The company did not provide a discrete Q4 revenue/EPS figure in the Q4/FY release; FY totals are shown .

Margins and operating expenses

Metric	Q2 2019	Q3 2019	Q4 2019	FY 2019
EBITDA Margin %	N/A	N/A	-18%	-25%
Total Operating Expenses ($USD Millions)	$5.70	$6.00	N/A	$21.31

KPIs (volume and reach)

KPI	Q2 2019	Q3 2019	Q4 2019	FY 2019
Patient Visits	35,743	35,749	N/A	138,639
Procedures	84,843	82,232	N/A	N/A

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
None issued	N/A	N/A	N/A	N/A

Commentary: The company did not provide formal quantitative guidance (revenue, margins, or EPS) in the Q4/FY 2019 materials .

Earnings Call Themes & Trends

No Q4 2019 earnings call transcript was available. Themes below reflect Q2/Q3 releases and the Q4/FY press release.

Topic	Previous Mentions (Q2 2019, Q3 2019)	Current Period (Q4/FY 2019)	Trend
Geographic expansion	Added 3 Chicago-area clinics; total clinics 14; branded with Mike Ditka	Opened Ozzie Smith center in Springfield, MO; initiated Mike Ditka center in Arlington Heights, IL; first Florida clinic post year-end	Expanding footprint
Payer access (VA/OWCP)	VA CCN participation in TN, KY, MO announced	VA CCN expanded to TN, KY, IL, MO; OWCP approval post-year	Improving access
Telehealth/virtual care	Not highlighted	Telehealth launched; wellness subscriptions introduced amid COVID-19	New initiatives
Corporate self-insured program	Corporate accounts initiative launched; early employer wins; outcomes data presented	Not explicitly updated	Needs follow-up
Portfolio optimization	BioFirma sale for $320,800; retain discounted supply	Continued use of NeoCyte® under supply agreement	Streamlining
Cost synergies and margins	Scaling expenses; losses widened with public company costs	EBITDA margin improved; focus on synergies	Improving margin trajectory

Management Commentary

Prepared remarks emphasized scale and margin improvement: “2019 was a banner year… accretive acquisition and same-store expansion… established a strong foundation for our continued growth into 2020 and beyond” .
Margin focus: “We improved EBITDA margin from -34% to -25% year over year, with the fourth quarter EBITDA at -18%. We will continue to focus on this financial metric by executing cost synergies from acquired entities…” .
COVID-19 response: “We recently introduced our advanced telemedicine therapeutic offering… making contingency plans… leveraging governmental programs designed to aid businesses…” .
Growth thesis from earlier quarters: “We systematically added clinics in attractive geographies… leveraging marketing dollars and shifting professional staff to maximize patient visits and procedures” .
Payer channel strategy: “We anticipate further cost savings and increased revenue as we strengthen our already strong relationship with the U.S. Department of Veterans’ Affairs” .

Q&A Highlights

No Q4 2019 earnings call transcript was found; therefore, no Q&A highlights or clarifications can be provided from a call this quarter.

Estimates Context

Wall Street consensus (S&P Global) for Q4 2019 EPS and revenue was unavailable at the time of analysis due to data access limits. Values retrieved from S&P Global were not accessible; consensus comparisons cannot be made this quarter.
Given IMAC’s emerging growth profile and limited sell-side coverage historically, investors should expect estimate updates lagging formal disclosures. Any future guidance or quarterly breakouts would help analysts recalibrate models .

Key Takeaways for Investors

Scale-driven growth continues: 126% YoY net patient revenue growth with expanding clinic footprint and brand ambassador centers provides a base for sustained volume expansion .
Margin trajectory improving: FY EBITDA margin improved to -25%; Q4 at -18% as cost synergies from acquisitions flow through—watch for additional operating leverage as volumes normalize post-COVID .
Payer access catalyst: VA CCN (multi-state) and OWCP approval expand addressable, reimbursable patient pools, potentially supporting revenue quality and stability .
New channels: Telehealth and wellness subscriptions provide resilient revenue streams amid macro uncertainty; monitor adoption and retention metrics in 2020 .
Financing considerations: The secured note’s covenants (redemptions, ROFR, equity proceeds sharing) may constrain future capital raises; weigh dilution/repayment mechanics alongside growth investments .
Transparency gap: Lack of discrete Q4 revenue/EPS limits near-term estimate benchmarking; push for quarterly granularity to assess trajectory vs Q2/Q3 momentum .
Near-term focus: Execution on cost synergies, payer channel utilization, and telehealth ramp are likely to drive sentiment more than headline revenue until quarterly breakouts resume .

Sources:

Q4/FY 2019 press release and accompanying 8-K exhibits, including consolidated financial statements .
Q3 2019 8-K press release .
Q2 2019 8-K press release and tables .
Note purchase agreement and terms (March 25, 2020) .

IMAC Holdings, Inc. (BACK)·Q4 2019 Earnings Summary