Q1 2021 Joint Corp Earnings Call
We expanded the corporate portfolio further we opened our second greenfield of the year in Yuma, Arizona and in addition, we acquired eight previously franchise clinics, all of which were expected to be immediately accretive to the bottom line.
Two of the clinics are and the Phoenix Scottsdale market, expanding our presence and our strong headquarters region.
Six of the clinics are and North Carolina. This transaction made possible by the recent repurchase of the regional developer rights for that territory.
<unk>, our foothold in the southeast.
All of these acquisitions were anticipated and included in our prior guidance of increasing company owned or managed clinics by 20% to 30 clinics and 2021 through a combination of both Greenfields and franchise clinic purchases.
Turning to slide seven.
And the first quarter of 2021, we sold 26 franchise licenses compared to 24 and the first quarter of 2028.
81% were sold by our regional developers or these are becoming more productive and their roles and we're attracting a higher quality of new franchisee well capitalized with a greater sophistication and multiunit experience gained from other systems.
We utilize the R&D strategy to accelerate growth.
Generally we enter a 10 year agreement with our dealers to assist with the sell and support of clinics.
<unk> have a goal to maximize the number of franchise clinics and their territory and of contractual obligation for the development of the minimum number of clinic, which is front loaded.
And when markets reach maturity is not unusual for the franchise or to repurchase the Rd rights.
As we discussed in our previous call in March we did so and two well run mature markets North Carolina and December 31, 2020, and Georgia on January one 2021 and the purchase price for these transactions totaled $2 4 million.
As a result of these R&D repurchases 69, franchised clinics and 37 signed franchise the license agreements for unopened clinics shifted from management by our DS two corporate management, thereby eliminating the Rd sales commission and royalties of 3% on gross sales for those clinics the transactions are immediately accretive.
And expand our margin contribution.
On March 31st 2021, 68% of our clinics were supported by our 21, Rds, which covered 57% of the metropolitan statistical areas of our Msas.
Today our.
Aggregate 10 year minimum development schedule for New Rd territories established since 2017 comes to 486 clinics.
This large foundation of kind of commitment bodes well for our continued clinic expansion and sales growth.
Turning to slide eight let's discuss marketing and.
And March we're pleased to attract a record number of new patients and our system. This is 11% greater than our previous system high which was the March of 2019.
And this is a significant development as the average number of new patients with the metric most negatively impacted by the pandemic and is a key ingredient for our growth of our membership model.
Many factors of driving our momentum from easing of COVID-19 related restrictions by local government to increases in local advertising spending by our franchisees to continued success of our brand building efforts to the growing market strength of our regional co ops and the innovations and our marketing technology platform.
In addition to new patient records, we also rolled out of new Grand opening program for our clinics and Q1, 2020, one and strengthening the awareness marketing and enhancing our digital tactics and lead nurturing as well as refreshing our advertising and signed our clinic signage.
During 2020, our average clinic breakeven sales levels was reached within six months of operation.
We expect the program to further strengthen our new clinic sales reps, while also enabling us to scale better with our accelerated pace of expansion.
Turning to slide nine and this review access our new it platform.
Access continues to be the most important initiatives of the year and I'm excited to say that we're getting closer to delivering version one point out initially it will be of lift and shift meaning that the first version, we're simply replicating the functionality of our current system.
Once that conversion is complete and were established on this powerful new sugar CRM platform and ultimately will provide an improved point of purchase systems financial systems business intelligence marketing automation and patient feedback capabilities. Among many other features.
We're now focused on training heavy users and finalizing our due diligence to minimize and system disruptions on the rollout.
It is essential that this new platform the fully tested and net every franchisee is prepared for acceptance of the new system.
We will complete this crucial project.
As we complete the crucial project, we will not jeopardize it by rushing of short cutting the process to meet and artificial timeline.
We continue to target summer 2021 for a formal rollout.
And with that Jake I'll turn it over to you. Thank you Peter.
Turning to slide 10 and.
Comparing first quarter of 2021 to first quarter 2020.
System wide sales for all clinics opened for any amount of time increased to $77 8 million up 28% year over year.
System wide comp sales for all clinics opened 13 months or more or 21% compared to 15% and the prior year.
System wide comp sales for mature clinics opened 48 months or more were 14% compared to 10% and the prior year.
Revenue was $17 5 million up $3 9 million or 29%.
The company owned or managed clinics contributed revenue of $9 5 million, increasing 30% from the same period a year ago.
Franchise, the operations contributed eight points.
$1 million.
Cost of revenue and $8 million up 19% over the same period last year.
Reflecting the increase and franchises and resulted in higher R&D royalties and commissions.
Selling and marketing expenses were $2 5 million up 21% over the same period last year and by an increase and advertising fund expenditures from a larger franchise base and an increase and local marketing expenditures by the company owned or managed clinics.
G&A expenses were $10 1 million compared to $8 $7 million the.
And the one $4 million increase was primarily due to higher payroll and related expenses as we scale our infrastructure for rapid growth.
G&A as a percentage of revenue in Q1, 2021 was 57% down from 64% and Q1 and 2020, reflecting improved leverage of our operating model.
Given the slower pace of Greenfield development and Q1, we believe it represents a proxy for mature operating system. However, with our planned accelerated greenfield openings and we do not expect the same level of operating leverage over the next several quarters.
Operating income was two point was two points here of $1 million compared to $753000 and 2020.
Income tax benefit was $364000 compared to $66000 and the prior year.
The income tax benefit was primarily driven.
By ex ex Tac excess tax benefits from the exercise of stock options.
Net income was $2 3 million or <unk> 16 per diluted share compared to $815000 or <unk> <unk> per diluted share and the first quarter of 2020.
We delivered total adjusted EBITDA of $3 5 million.
Which increased 108% compared to the same period last year.
Franchise clinic, adjusted EBITDA increased 35% to $3 $9 million.
Anthony owned or managed clinic, adjusted EBITDA increased 84% to $2 5 million.
Corporate expense is a component of adjusted EBITDA loss increased 13% to $2 9 million.
<unk>, our infrastructure investment as we scale for growth.
At March 31, 2021, our unrestricted cash was $17 8 million.
Compared to $26 million at December 31, 2020.
During the quarter, we voluntarily repaid our $2 7 million PPP loan and invested $2 3 million and corporate expansion, including $1 4 million for the January Rd territory repurchase and zero point of $9 million and Greenfield development and capital expenditures.
This was offset by cash inflows from operating activities of $2 3 million.
Onto slide 11 to review our guidance for 2021.
On the strength of our Q1 performance, we're increasing our revenue expectations to be between $73, five and $77 5 million compared.
Compared to $58 $7 million and 2020.
Due to the delay and Greenfield clinic openings and the related earnings Depression are Q1 2021, adjusted EBITDA was higher than originally expected. Therefore, we are raising our 2021 adjusted EBITDA guidance to be between 11 and $12 $5 million.
Compared to $9 $1 million and 2020.
We continue to expect franchise clinic openings to be between 80, and 100 compared to 70 and 2020.
We continue to expect the company owned or managed clinic increases through a combination of both greenfields and acquisitions of franchise clinics to be between 20, and 30 compared to 4% and 2020.
We will continue to evaluate acquisitions Opportunistically. However, we will prioritize growth through Greenfield and franchise clinic openings as we drive towards our goal of the 1000 clinics opened by the end of 2023.
We are building greenfield strategically located within our clusters and and new markets. We now expect to accelerate openings and late Q2 and Q3 supported by the fact that we currently of 20 signed leases.
Sequentially, we expect increased corporate expenses and suppress total company earnings during the remainder of 2021. However, we're quite confident of the greenfields will be accretive and the long run.
Now I'll turn the call back over to you and Peter.
Thanks Jake.
Turning to slide 12 as discussed we are investing and our future, we'll make decisions that impact our short term profitability and favor for long term growth by increasing greenfield clinics that expand our market position and brand awareness.
And April we're pleased to welcome Mark Miller into the newly created position of Vice President of real estate and construction.
Mark is a proven leader with more than 30 years of experience accelerating unit growth for fortune 500 companies and industry leaders, such as Pan of restaurant group Cvs and Mcdonalds.
Mark will work closely with our vice President of franchise sales and development to bring additional expertise and horsepower to our already talented development team as we March toward our goal of reaching 1000 units in the month and operation by the end of 2023.
Speaking of this goal we believe that this is the only the starting point for a new phase of development. Our next phase of development.
1000 clinics of the known tipping point for franchise systems, and achieving national brand awareness.
And the scale of that magnitude of magnitude, we can more easily and effectively leverage our brand marketing and operational infrastructure, which we expect to drive growth at even faster pace.
This model and accelerated expansion has been proven repeatedly by household name franchise systems operating in a small box retail space of approximately 1000 per square feet.
The power of the franchising that it brings together and like minded people to build the brand and drive faster and expansion and increased market awareness and education and accelerated innovation.
Looking ahead, we have a map the identified more than 1800 clinic targets based on the analysis of actual patient demographic and psychographic to be clear. This is just the tip of the iceberg only 50% of the U S population knows where chiropractic care is if theres over 41000, private practitioners and the U S. Today.
And this group both of our largest competitor and most significant part of our hiring base.
And of similar healthcare market dental service organizations represent 12% of their field, whereas we estimate the joint accounts for only 1% of the car Practic care market today, and all chains, including franchises and account for only 3% of market share.
Naturally our success has spawned copycat, which has an expected evolution and the growth of any attractive and emerging category.
To combat the competition, we leverage our first mover advantage of every new clinics strengthens our brand we support our Rds and franchisees as the blaze, new trails and new markets.
We grow and nurture our marketing costs as they leverage their collective spend and their region. We secure the best sites and trade areas, we recruit and retain the best as we strive to be the employer brand of choice for doctors of the car Practic ultimately, we provide the best patient experience delivering on our brand pillars of the accessibility credibility.
And empathy.
Turning to slide 13, our model carries tremendous beauty and power and simplicity and focus we continue to expand faster than the chiropractic market as a whole as evidenced by our 10 year CAGR of 70% and the fact that 27% of our new patients who visit of the joint and 2020 had never seen a chiropractor.
Before.
<unk> truly is an essential health care service and.
So grateful for our entire system, our doctors are wellness coordinators of franchisees regional developers and corporate staff for their dedication to our mission of improving quality of life for our patients.
With that Rachel I'm ready to begin the Q&A.
Thank you Peter and as a reminder, the asking a question. Please press star and then the number line on your telephone keypad and the re draw your question vis vis the county.
Please standby, while we compile the Q&A roster.
Our first question comes from the line of Frank <unk> from Lake Street Capital Sir Your line is open.
Great. Thanks for taking my questions and congrats on another good quarter.
Thanks, Craig and thanks Frank.
Absolutely so starting with the increased commentary beyond the 1000 being just the starting point to the.
The growth of the joint over time can you bring us a little deeper into how youre thinking about all of this could unfold over the next three to five years. After you hit that 2000 23000.
<unk> thousand clinic, Mark and just given your experience and getting clinics since the 1000 point tipping point, explaining the importance of that and how you expect to accelerate growth from there when the base will be getting very large from that point forward.
Sure frankly of the two very great questions.
I'll take the second question first and Thats in terms of <unk>.
How do we expect.
To see that that expansion and we're already moving so quickly and and I would say the answer is the market itself is growing.
As I mentioned on the call that 27% of all of the patients who opened the door for the very first time to the joint last year had never seen a chiropractor before so this isn't simply trading off market share. So we know it's roughly of $16 billion market and we know we have roughly 1% of that market. What we're doing is redefining the market, we're expanding the market which is the.
Absolutely one of the most important parts of that accelerated growth yes.
And yes, we know we can get to the 1000 units and why a thousand units and so important as of this isn't that small box retail space.
Non of Procter and Gamble I don't have a $100 million to continue to change of toothpaste.
I have as and those other small box retail concept is that we have storefront and with that store friends. We educate the consumer to open that door for the first time in one of these is a really interesting service I'm going to use the all my gosh I'll tell my friends and I'll continue to use it and the you see that expand so those storefronts that becomes one of the most powerful accelerators of the.
And of the growth of this business or the building of that brand and that's why there is such a focus on getting those units out and open and if you look at and our growth patterns as where do you see most of our new growth coming from from our existing markets because what happens is and this again.
Space, where you've got your customers coming in and they love your product and service and the like Oh My Gosh. This is the amazing our new franchise why not so some of the leads that we get for the new franchisees come directly from being patients of our clinics. So as you have more clinics out there and you have more patients out there you have more leads we're interested in growing and you have of market is only expanding.
You can't have these incredible comps that are purely organically grown and so we just reported 21% comps in Q1, 'twenty, one 2020, one with mature units at over 48 months. During the 14% you can't have that kind of growth. If you don't have an extraordinarily spanning the market.
That's great and then my second question just wanted to ask about the guidance a little bit more specifically.
Given your previous years of seasonality, excluding 2020 due to COVID-19, there's been the cadence of our building throughout the year the likely strong quarter in Q4 with normally a pretty sizable bolus of open new franchise openings. So I wanted to ask just if there was.
Extra layer of conservatism built into the number of here given the strong start at $17 5 million for Q1.
So is there anything you're seeing that's giving you a little bit more conservatism here or is it just purely.
Keep it prudent and conservative and.
Continue your beat and raise mentality.
Well, Frank you spend enough time around us.
Yes.
And we're going to we're going to be thoughtful about the numbers, we put out there and that yes that we've had a remarkable response of the pandemic.
But we still are in the middle of the pandemic and theirs.
And things that are out there that could happen and we're not anticipating at this point.
And so we're thoughtful as though as we said we were increasing our guidance both on the adjusted EBITDA and in the growth sales.
Youre right to expect that would typically we have a much stronger fourth quarter than we do any other quarter.
Youre right.
And more and more times than not that our growth comes from our new franchise sales and more in the second half of the year than the first half of the year. So I mean, we really are anticipating those to continue to to ex.
Influence, where we go but we wanted to be really thoughtful about that.
Perfect. Thanks for taking my questions and congrats on a good quarter.
Thank you.
Thank you. Our next question comes from the line of Jeff Van <unk> from B Riley <unk>, Sir Your line is open.
Hi, everyone and let me add my congratulations on your strong metrics, it's great to see.
Thanks.
I guess my first of its kind of a multipart question. If you guys can bear with me but.
And I understand that some of this is a little tough to parse out but can.
Can you speak more about what youre seeing and markets that have broadly reopen and more recently versus markets that reopened earlier.
And in general how much tailwind do you think youre getting from people being vaccinated and also from stimulus checks if at all I'm just wondering on those things.
The interesting question and.
And I would tell you the one of the things that has been so significant as we look at our our experience through the pandemic and where we are today and obviously, we're moving and we're making great inroads through the use of vaccines, but it's not over.
Is how little the markets have been impacted by whether it was the market that was wide open or a market that was shut down and so we've got a lot of clinics and California. For example, which has been one of the more shutdown market, we have a lot of clinics, and Texas, and Florida, and Atlanta, and Georgia, which had been more open market and when we look at.
And try to compare okay did someone moved faster than the other.
Shockingly consistent across all of those markets now.
Now the one market, where I would say that we really did see a significant impact to separate from almost any other place that we've where we've talked about this before and that was the Colorado market and and Colorado, Unlike and any other market that we face is the <unk>.
Part of the Governor's directive was debt in.
And in order to protect the PPE.
And they wanted any medical service being shut down that was not providing acute care and so that the part of the directive was that we were shut down for I think 17 days and then they came back with the additional directed and said Okay. You can open but only on an appointment basis and so that had a significant impact on those 28 clinics and the Colorado market.
And that directive has now been changed and so that we're back to our non appointment basis, and Colorado, but if I'm looking across the country and trying to understand what are the factors that of influence the.
The performance of the clinics and is there a regional variance of cadence to that is I would say not very distinguishable outside of the Colorado market.
Okay.
Helpful and then just turning to the.
The eight clinics that you just bought.
I guess I'm wondering are you do you feel like Theres and increasing probability that more potential deals like that will come to the table or where the six units in north Carolina somewhat more of a function of having bought back of the Rd rights for that territory.
And wondering how you think about that.
Sure Jeff that's a good question I think and absolutely by buying back the North Carolina territory of created that opportunity.
But we look at those acquisitions as being an opportunistic part of our strategy. We do hold the right of first refusal and so if any clinics are changing hands or prospectively changing hands, we have the right to look at that deal and the <unk>.
Case of North Carolina, and it was and opportunity that came across at the right valuation and we capitalized on that so I think thats still remains and opportunistic strategy. If I acquire of unit. It doesn't add of net positive units and our unit growth total right. So that's why I think we're still strategically focused on opening the greenfield.
And supporting our franchisees and our D and as they open their units to try to reach that that scale and that thousand unit goal.
Okay.
Thanks for taking my questions and continued success.
Thank you very much.
Thank you. Our next question comes from the line of Anthony Vendetti from Maxim Group, Sir Your line is open.
Thanks.
Just on the follow up on the 1000.
And then a goal.
Is the is the cadence pretty much.
Equally throughout.
These next couple of years it looks like it's probably going to accelerate and then and then what's the the breakout likely to be in terms of franchise versus corporate owned.
Hey, Anthony two great questions and I would say absolutely there is an expectation of acceleration and certainly and the 30 plus years I have been building and managing franchise systems.
It is a very common experience because of again as I was talking earlier on one of the questions as it builds upon itself as you have more units out there you have more exposure you have more interest and the franchise of the market expanding and so that you absolutely see this accelerated year over year over year I would've expected us to had a much higher acceleration in 2012.
And if we had not had the pandemic. If you look at our numbers. So we sold 37 clinics and 2017, we sold 99 and 2018, we sold the 126% to 19 and I would have expected debt just to continue to go forward. If we werent hit by the pandemic, but even in that pandemic, we had 121 sales.
And so obviously with the numbers that we're posting and you can do the math, we're sitting here at 600 units. We've got till 2023 to say, we're getting the 1000 units open you can do it evenly and say okay. This is the number you have each year, but the way I would look at absolutely the year by year, we'll see an acceleration of the number of those with the opening.
To your question about the mix is that.
Right now as you know are the 89.
Percent franchise of 11% corporate.
And the speed of the franchise system growing it's going to be hard to push that number too hard or too much harder.
The corporate side of the larger without doing an acceleration of the.
The corporate Greenfields.
As we've talked on the call today is we expect to see an increase from what we've done in the past.
I think you can see and the numbers that we're getting better and better and running those corporate clinics and by being better and better brand and those corporate clinics theres, a greater interest and getting more of the mountain and the field.
We've given really broad range is when we talk about what will that percentage be and.
That's good somewhere between that let's say, 10% and 25%.
And so I know thats not real helpful for modeling, but I think thats, a reasonable range to be thinking through okay. What is the corporate clinic growth kind of look like.
And units.
Okay No that's helpful and then.
Obviously this is the big undertaking switching out your services and I think you mentioned, Peter and expected to be complete by end of June.
Well I said wilmar.
The summer Okay sorry.
Over the summer.
So maybe.
And it would be July August.
Key issues, sometimes take longer just like construction and unless you have.
A very well oiled machine like you guys have at this point, but.
If we look at.
The advantages of.
Of this one.
And what metrics are you looking at the debt the practices of the clinics are going to see whats the whats the overall benefit.
Well, it's a great question and I think it's one that changes over time as I said on the call. This initially as the lift and shift so the impact I expect to have and the benefits. There are certain benefits that are going and built in and that first version, but the reality of it is all the we're trying to do is to take our homegrown platform and put it on this new platform and routes.
And all of the functionality that we have but on that new platform, then as we grow and build and improve it. There's a whole set of things that we can do that we are not able to accomplish and on our current homegrown platform and they have they are the ultimately Anthony affect every aspect of the business and it really simple and when the first things we want to do is get a.
The mobile check in and out there.
It's just it's.
We're still behind by not having that in place today and we haven't had the platform the allowed us to do it but we will now that's not going to come out and summer, but that will be one of the top priorities going forward, creating the patient portal. This whole issue. If you look at the 20 <unk> century of this marketing to you of an individual we can access who you are.
And target what do you want and what your issues are and craft the message to you, which improves the probability to.
<unk> marketing strategy and the way that we've never had access before I've always thought that this concept one of the most powerful assets. We have is our data and on this new platform and allows us to do so many things with that data that we simply can't do until we get to that newer platform. But these are all things coming down the road. This is <unk>.
The axis, one point out and.
And so I don't want you to get ahead of ourselves I know that this absolutely create the foundation that propels us into that 20, <unk> century, but we've got to get through this lift and shift.
Okay.
Great.
Turn it back to the queue.
Thank you.
Thank you once again to ask a question just press Star and then the number of line on your telephone keypad.
Okay.
Yes.
Okay.
Our next question comes from the line of Jeff Geiser from guys of Rosman. Please go ahead.
Hey, gentlemen, great quarter.
Just one quick question.
Is striving for the goal of 1002 thousand 23, the same as reaffirming guidance for 1000.
Yes, it is now and where it's driving but yes, we're putting out there because we believe that we can achieve it.
Great well I can't think of two other people I'd rather have it the helm great Board Great management. Thanks, so much for being great stewards of by clients' capital.
Thanks, a lot Jeff we appreciate the support.
With the suit.
Thank you and there are no.
Line for a question and I am now turning the call back to Peter Hutton, Sir. Please go ahead.
Thank you all for your time today. Please note that on June 2nd we plan to participate virtually and the Craig Hallum Annual conference.
Each quarter I closed with the patient story and this one reminds and educates us so often pain felt and one part of our bodies actually caused by an issue and another.
Another part of.
Patient from Phoenix wrote and I quote I woke up and I work at of computer All day, I started noticing pain and my upper arm and was having trouble lifting and my arms, one morning, I woke up and excruciating pain and could literally could not lift either of my arms I was and tears and Couldnt go to work my daughter had been going to the joint and was.
Very happy with their treatment, so I decided to give it a try my doctor was so comforting and kind of you took the time to go over and all of my symptoms and area of the pain.
Truly thoughts and I was having a problem with my family and it turned out to be my neck. We set up of plan that worked from a schedule and after every visit I'd feel better the pain and my arms went away and I can lift them without any problem and my mobility has come a long way I can't think of my Doctor and not end of quote.
Thank you and stay well adjusted.
This concludes today's conference call. Thank you for participating you may now disconnect.
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Okay.
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Good day and thank you for standing by welcome to the Joint Corp, first quarter 2021 financial results conference call. At this time all participants are in a listen only mode. After the speaker's presentation. There will be a question and answer session to ask the questions. During the session you will need the fresh start and then the number one and you tell us.
And please be advised the city's conference is being recorded if you require any further assistance. Please press star zero and I would now like to hand, the conference over to Moriah Shilton of L. A true Investor Relations. Please go ahead.
Thank you Rachel and we are on slide one good afternoon, everyone. This is moriah shilton of L. A to the Investor relations on.
On the call today.
<unk> and CEO, Peter Holt will review, our first quarter 2021 performance metrics and provide an update on the business.
CFO, Jake Singleton will detail our financial results and.
And then Peter will close with the summary, and open the call for questions. Please note. We are using a slide presentation that can be found at IR stop of the joint the Dotcom Force flash events.
Today after the close of the market. The joint Corp issued its financial results for the year and quarter ended March 31st 2021.
If you do not already have a copy of the press released it can be found and the Investor Relations section of the company's website.
As provided on slide two please be advised today's discussion includes forward looking statements, including statements concerning our strategy future operations and future financial position and plans and objectives of management.
Throughout today's discussion we will present, some important factors relating to our business that could affect these forward looking statements.
The forward looking statements are made based on our current predictions expectations estimates and assumptions and.
And off the subject to risks and uncertainties that may cause actual results to differ materially from the statements we make today.
Factors that could contribute to these differences include but are not limited to the continuing impact of the COVID-19 outbreak and the economy and our operations, including temporary clinic closures shortened business hours and reduced patient demand.
The failure to develop or acquire company owned or managed clinics as rapidly as we intend.
Our failure to profitably operate the company owned or managed clinics and then the other factors described in the risk factors and our annual report on form 10-K as filed with the SEC for the year ended December 31st 2020 as updated of revised for any material changes described and any subsequently filed quarterly reports and form 10-Q for other SEC.
Billings.
We anticipate filing on March 31st 2021, Thank you and May 7th.
As a result, we caution you against placing undue reliance on these forward looking statements and encourage you to review our filings with the SEC for a discussion of these factors and other risks that may affect our future results or the market price of our stock.
Finally, we're not obligating ourselves to revise our results or publicly release any updates to these forward looking statements and.
Light of new information or future events.
Management uses EBIT and EBIT, EBITDA, and adjusted EBITDA, which are non-GAAP financial measures.
These are presented because they are important measures used by management to assess the financial performance.
Management believes they provide a more transparent view of the company's underlying operating performance and operating trends and GAAP measures alone.
Reconciliation of net income the EBITDA.
EBITDA and adjusted EBITDA is presented in the press release the company defines EBITDA as net income or loss before net interest tax expense depreciation and amortization expenses.
The company defines adjusted EBITDA as EBITDA before acquisition related expenses bargain purchase gain net gain or loss on disposition or impairment and stock based compensation expenses.
Turning to slide three and it's my pleasure to turn the call over to Peter Holt.
Thank you, Brian and welcome everybody to the call I'm delighted to speak with you today, we've entered 2021, well positioned with the resilient business model and accomplished team operating at a very high level and a strong financial position during.
During the first quarter, we continued to execute our plan to accelerate growth and deliver strong results in April we celebrate our six hundreds of clinic openings.
And we continue to strive to reach our goal of the 1000 and clinics in operation by the end of 2023, let me be perfectly clear. This is just one of many milestones and just the beginning of our long term growth blueprint.
And for elaborate I will review, our operational and financial performance for the quarter.
I'd like to begin by welcoming and educating our news of the investors. The Georgia is revolutionizing access to car Practic care. Our core concept has remained steadfast.
Okay, and and convenient retail settings, we provide con shares of concierge style membership based services without the need for insurance of appointments with attractive pricing and convenient hours.
Our growth strategy is to build on our brand and increase awareness of the efficacy of car practic care attract new patients and opening more clinics.
We're already the largest and most of it up recognizable provider of carpet the care and the country.
Given the high level of fragmentation among car Practic care providers, we are of significant opportunity to continue increasing our market share as we redefine and expand the market itself.
Turning to slide four while Jack will discuss our financial results and mud and detail and the minute here are a few highlights of our strong first quarter 2021 results.
Revenue grew 29% compared to first quarter of 2020.
System wide sales grew $77 $8 million, increasing 28% compared to the first quarter last year.
Comp sales for clinics have been open for at least 13 full months grew 21% compared to the same period and 2020.
Adjusted EBITDA of more than doubled to $3 5 million.
And of March 31, and 2021, our unrestricted cash was $17 8 million compared to $20 $6 million of December 31 of 2020.
Turning to slide five and late March we held our virtual Awards annual Awards program, where we honored the top 2020 individual and clinic performances and our network.
Our clinics achieved new heights, even during the pandemic.
Of the 73, new clinics opened in 2000 2015 achieved go elite status, meaning that the acquired over 400 patients and recorded more than $30000 and sales and the first two months of operation.
In fact of 169 clinics achieved more than $550000 and sales and 2020 up 19% compared to 2019.
And that included non platinum clinics with over $1 million and sales up from four platinum critics of the previous year.
Our undisputed sales champion and Diamond and clinic status for the second year in a row with over $1 $5 million and annual sales.
All of this illustrates the degree to which our clinic teams of both franchise and corporate are motivated to achieve new levels of success.
I see the consumer demand they see the power of this business model they see the brand differentiation and they see our category leadership.
We acknowledge all of the outstanding performers and look forward to welcoming and even greater number of clinics into the ranks and 2021.
Turning to slide six let's review our portfolio.
Regarding clinics during Q1, we opened 12, new franchise clinics, and one greenfield compared to 16, and one and 2020, respectively.
We did not closing and clinics and this quarter.
At March 31, 2021 and we had 592 clinics and operation consisting of 527 franchise clinics and 65 company owned and managed clinics maintaining of the mix of 89% franchise and the 11% corporate.
We also had 260 franchise agreements and some level of development that compares to 253 at the end of December 31, and 2020 and reflects the increased interest and our franchise system.
We're on track with our prior guidance of opening between 80 and 100 franchise clinics this year.
On April 1st we expanded the corporate portfolio further.
We opened our second greenfield of the year in Yuma, Arizona and in addition, we acquired a previously franchise clinics all of which were expected to be immediately accretive to the bottom line.
Two of the clinics are and the Phoenix Scottsdale market, expanding our presence and our strong headquarters region.
Six of the clinics are and North Carolina. This transaction made possible by the recent repurchase of the regional developer rights for that territory broadens our foothold in the southeast.
All of these acquisitions were anticipated and included in our prior guidance of increasing company owned or managed clinics by 20% to 30 clinics and 2021 through a combination of both Greenfields and franchise clinic purchases.
Turning to slide seven.
And the first quarter of 2021, we sold 26 franchise licenses compared to 24 and the first quarter of 2020.
81% were sold by our regional developers or these are becoming more productive and their roles and we're attracting a higher quality of new franchisee well capitalized with a greater sophistication and multiunit experience gained from other systems.
We utilized the Rd strategy to accelerate growth generally we enter a 10 year agreement with <unk> to assist with the sell and support of clinics are these have a goal to maximize the number of franchise clinics and their territory and of contractual obligation for the development of the minimum number of clinic, which is front loaded.
When markets reach maturity, it's not unusual for the franchise or to repurchase of the Rd rights as.
As we discussed in our previous call in March we did so and two well run mature markets North Carolina and December 31, 2020, and Georgia on January one 2021, and the purchase price for these transactions totaled $2 $4 million.
As a result of these R&D repurchases of 69 franchise clinics and 37 signed franchise the license agreements for unopened clinics shifted from management by our DS two corporate management, thereby eliminating the Rd sales commission and royalties of 3% on gross sales for those clinics the transactions are immediately accretive.
And expand our margin contribution.
On March 31, 2021, 68% of our clinics were supported by our 21, Rds, which covered 57% of the metropolitan statistical areas of our Msas.
Today, our graduate our aggregate 10 year minimum development schedule for New Rd territories established since 2017 it comes to 486 clinics.
This large foundation of kind of commitment bodes well for our continued clinic expansion and sales growth.
Turning to slide eight let's discuss marketing and.
And March we're pleased to attract a record number of new patients and our system. This is 11% greater than our previous system high which was in March of 2019.
And this is a significant development as the average number of new patients was the metric most negatively impacted by the pandemic and is a key ingredient for a growth of our membership model.
Many factors of driving our momentum from easing of COVID-19 related restrictions by local governments to increases in local advertising spending by our franchisees to continued success of our brand building efforts to the growing market strength of our regional co ops and the innovations and our marketing technology platforms.
In addition to new patient records, we also rolled out of new Grand opening program for our clinics and Q1, 2020, one and strengthening the awareness marketing and enhancing our digital tactics and lead nurturing as well as refreshing our advertising and signed our clinic signage during.
During 2020, our average clinic breakeven sales levels was reached within six months of operation.
We expect the program to further strengthen our new clinic sales reps, while also enabling us to scale better with our accelerated pace of expansion.
Turning to slide nine let's review access our new it platform.
Access continues to be the most important initiatives of the year and I'm excited to say that we're getting closer to delivery version one point out initially it will be of lift and shift meaning that the first version, we're simply replicating the functionality of our current system. Once the conversion is complete and were established on this powerful new sugar CRM platform and ultimately we will.
Provide and improved point of purchase systems financial systems business intelligence marketing automation and patient feedback capabilities. Among many other features.
We're now focused on training heavy users and finalizing of due diligence to minimize schism system disruptions on the rollout.
It's essential that this new platform the fully tested and then every franchisee is prepared for acceptance of the new system.
We will complete this crucial project as we complete this crucial project, we will not jeopardize it by rushing of short cutting the process to meet and artificial timeline.
We continue to target of summer 2021 for a formal rollout.
And with that Jake I'll turn it over to you. Thank you Peter.
Turning to slide 10 and.
Comparing first quarter of 2021 to first quarter 2020.
System wide sales for all clinics opened for any amount of time increased to $77 8 million up 28% year over year.
System wide comp sales for all clinics opened 13 months or more or 21% compared to 15% and the prior year.
System wide comp sales for mature clinics opened 48 months or more were 14% compared to 10% and the prior year.
Revenue was $17 5 million up $3 9 million or 29%.
The company owned or managed clinics contributed revenue of $9 5 million, increasing 30% from the same period a year ago.
Franchised operations contributed eight point.
$1 million.
Cost of revenue and $8 million up 19% over the same period last year.
Reflecting the increase and franchises the resulted in higher R&D royalties and commissions.
Selling and marketing expenses were $2 5 million up 21% over the same period last year and by an increase and advertising fund expenditures from a larger franchise base and an increase and local marketing expenditures by the company owned or managed clinics.
G&A expenses were $10 1 million.
Compared to $8 7 million.
The $1 4 million increase was primarily due to higher payroll and related expenses as we scale our infrastructure for rapid growth.
G&A as a percentage of revenue in Q1, 2021 was 57% down from 64% and Q1 and 2020, reflecting improved leverage of our operating model.
Given the slower pace of Greenfield development and Q1, we believe it represents a proxy for mature operating system. However, with our planned accelerated greenfield openings, we do not expect the same level of operating leverage over the next several quarters.
Operating income was two point was two points here of $1 million compared to $753000 and 2020.
Income tax benefit was $364000 compared to $66000 and the prior year.
And the income tax benefit was primarily driven.
<unk> Tec excess tax benefits from the exercise of stock options and net income was $2 3 million or <unk> 16 per diluted share compared to $815000 or <unk> <unk> per diluted share and the first quarter of 2020.
And we delivered total adjusted EBITDA of $3 5 million.
Which increased 108% compared to the same period last year.
Franchise clinic, adjusted EBITDA increased 35% to $3 9 million.
Anthony owned or managed clinic, adjusted EBITDA increased 84% to $2 5 million.
Corporate expense is a component of adjusted EBITDA loss increased 13% to $2 $9 million, reflecting.
Reflecting our infrastructure investment as we scale for growth.
At March 31, 2021, our unrestricted cash was $17 $8 million.
Compared to $26 million at December 31, 2020.
During the quarter, we voluntarily repaid our $2 7 million PPP loan and invested $2 3 million and corporate expansion, including $1 $4 million for the January Rd territory of repurchase and.
Zero point of $9 million, and Greenfield development and capital expenditures.
This was offset by cash inflows from operating activities of $2 3 million.
On to slide 11 to review our guidance for 2021.
On the strength of our Q1 performance, we're increasing our revenue ex expectations to be between $73, five and $77 5 million compared.
Compared to $58 $7 million and 2020.
Due to the delay and Greenfield clinic openings and the related earnings Depression, our Q1, 2020 one adjusted EBITDA was higher than originally expected. Therefore, we are raising our 2021 adjusted EBITDA guidance to be between 11 and $12 5 million.
Compared to $9 $1 million and 2020.
We continue to expect franchise clinic openings to be between 80, and 100 compared to 70 and 2020.
We continue to expect the company owned or managed clinic increases through a combination of both greenfields and acquisitions of franchise clinics to be between 20, and 30 compared to four and 2020.
We will continue to evaluate the acquisitions Opportunistically. However, we will prioritize growth through Greenfield and franchise clinic openings as we drive towards our goal of a 1000 clinics opened by the end of 2023.
We are building greenfield strategically located within our clusters and and new markets. We now expect to accelerate openings and late Q2 and Q3 supported by the fact that we currently of 20 signed leases and.
Consequently, we expect increased corporate expenses and suppressed total company earnings during the remainder of 2021. However, we're quite confident of the greenfields will be accretive and the long run.
I will now turn the call back over to you Peter.
Thanks Jake.
Turning to slide 12 as discussed we are investing and our future we will make decisions that impact our short term profitability and favor for long term growth by increasing greenfield clinics and expand our market position and brand awareness.
And April we're pleased to welcome Mark Miller into the newly created position of Vice President of real estate and construction Mark.
<unk> is a proven leader with more than 30 years' experience accelerating unit growth for Fortune 500 companies and the industry leaders, such as Panda restaurant group Cvs and Mcdonalds.
Mark will work closely with our vice President of franchise sales and development to bring additional expertise and horsepower to our already talented development team as we March toward our goal of reaching the 1000 units and operation by the end of 2023.
Speaking of this goal we believe that this is the only the starting point for a new phase of the development. Our next phase of development 1000 clinics of the known tipping point for franchise systems and achieving national brand awareness.
And that scale of that magnitude of magnitude, we can more easily and effectively leverage our brand marketing and operational infrastructure, which we expect to drive growth at even faster pace.
This model of the accelerated expansion has been proven repeatedly by household name franchise systems operating in the small box retail space of approximately 1000 square feet.
The power of the franchising that it brings together like minded people to build the brand and drive faster and expansion and increased market awareness and education and accelerated innovation.
Looking ahead, we have a map of identifies more than 800 clinic targets based on the analysis of actual patient demographic and psychographic to be clear. This is just the tip of the iceberg only 50% of the U S population knows where chiropractic care is yes, there's over 41000 private practitioners and the U S today, making.
And this group both of our largest competitor and most significant part of our hiring base.
And of similar healthcare market dental service organizations represent 12% of their field, whereas we estimate the joint accounts for only 1% of the car Practic care market today, and I'll change the including franchise systems accounts for only 3% of market share.
Naturally our successes spawned copycat, which has an expected evolution and the growth of any attractive and emerging category.
To combat the competition, we leverage our first mover advantage of every new clinics strengthens our brand we support our Rds and franchisees as the blaze, new trails, and new markets, we grow and nurture our marketing costs as they leverage their collective spend and their region. We secure the best sites and trade areas, we recruit and retain the best as we can.
<unk> to be the employer brand of choice for doctors of the car Practic of.
Ultimately, we provide the best patient experience delivering on our brand pillars, and the accessibility credibility and empathy.
Turning to slide 13, our model carries tremendous beauty and power and its simplicity and focus we continue to expand faster than the chiropractic market as a whole as evidenced by our 10 year CAGR of 70% and the fact of 27% of our new patients who visited the joint and 2020 has never seen a car price.
Before.
Car Practic care truly as an essential health care service I'm, so grateful for our entire system. Our doctors are wellness coordinators franchisees regional developers and corporate staff for their dedication to our mission of improving quality of life for our patients.
But that Rachel I'm ready to begin the Q&A.
Thank you Peter and as a reminder, the asking a question. Please press star and then the number one on your telephone keypad and the re draw your question the press the pound key.
Please standby, while we compile the Q&A roster.
Yeah.
Our first question comes from the line of Frank <unk> from Lake Street Capital Sir Your line is open.
Great. Thanks for taking my questions and congrats on another good quarter.
Thanks, very much thanks Frank.
Absolutely so starting with the.
The increase commentary beyond the 1000 being just the starting point to the.
The growth of the joint over time can you just bring us a little deeper into how youre thinking about how this could unfold over the next three to five years. After you hit that 2000 23000.
<unk> thousand clinic, Mark and just given your experience and getting clinics to the 1000 point tipping point, explaining the importance of that and how you expect to accelerate growth from there when the base will be getting very large from that point forward.
Sure Frank of the two very great questions.
I'll take the second question first and Thats in terms of how do we.
Specced.
You see that that expansion and we're already moving so quickly and and I would say the answer is the market itself is growing.
As I mentioned on the call that 27% of all of the patients who opened the door for the very first time to the joint last year had never seen a chiropractor before so this isn't simply of trading off market share. So we know it's roughly of $16 billion market and we know we have roughly 1% of that market. What were doing is redefining the market, we're expanding the market.
Which is absolutely one of the most important parts of that accelerated growth.
Yes, we know we can get to the 1000 units and why a thousand units and so important is that this isn't that small box retail space.
Not a procter and gamble I don't have of $100 million to get you the change of toothpaste.
I have as and those others small box retail concepts and so we have storefront and with that store friends, we educate a consumer to open that door for the first time and one of these is a really interesting service I'm going to use the Oh My gosh I'll tell my friends and I'll continue to use it and the you will see that expense. So it's those storefronts that becomes one of the most powerful accelerators of the broad.
And of the growth of this business or the building of that brand and that's why there is such a focus on getting those units out and open and if you look at and our growth patterns as where do you see most of our new growth coming from from our existing markets because what happens is and this again.
Space, where you've got your customers coming in and they love your product and service and the like Oh. My Gosh. This is amazing are your franchise why not so some of the leads that we get for the new franchisees come direct from being patients of our clinics. So as you have more clinics out there and you have more patients out there you have more leads who are interested in growing and you have of market is the only expanding.
The cats have these incredible comps that are purely organically grown. So we just reported 21% comps in Q1, 'twenty, one 2020, one with mature units at the over 48 months. During the 14% you kind of have that kind of growth. If you don't have an extraordinarily spanning the market.
That's great and then and my second question just wanted to ask about the guidance a little bit more specifically.
Given your previous years of seasonality, excluding 2020% of COVID-19, there's been the cadence of our building throughout the year the likely strong quarter in Q4 with normally a pretty sizable bolus of open new franchise openings. So I wanted to ask just if there was.
Extra layer of conservatism built into the number of here given the strong start at $17 5 million for Q1.
So is there anything you're seeing that's giving you a little bit more conservatism here or is it just purely.
Keep it prudent and conservative and.
Continue your beat and raise mentality.
Well, Frank you spend enough time around us.
Yes.
We're going to we're going to be thoughtful about the numbers, we put out there and that yes that we've had a remarkable response of the pandemic.
But we still are in the middle of the pandemic and there is there is there.
The things that are out there that could happen that we're not anticipating at this point.
And so that we're thoughtful as the as we said we are increasing our guidance both on the adjusted EBITDA and and the gross sales.
Youre right to expect that would typically we have a much stronger fourth quarter than we do any other quarter.
Youre right.
More and more times than not that our growth comes from the new franchise sales and more in the second half of the year than the first half of the year. So I mean, we really are anticipating those to continue to to ex.
The influence where we go but we wanted to be really thoughtful about that.
The.
Perfect. Thanks for taking my questions and congrats on a good quarter.
Thank you.
Thank you. Our next question comes from the line of Jeff Van <unk> from B Riley Sir Your line is open.
Hi, everyone and let me add my congratulations on your strong metrics, it's great to see.
Thank you.
I guess my first of its kind of a multipart question. If you guys can bear with me but.
And I understand that some of this is a little tough to parse out but can.
Can you speak more about what youre seeing and markets that have broadly reopen and more recently versus markets that reopened earlier.
And in general how much tailwind do you think youre getting from people being vaccinated and also from stimulus checks if at all just wondering on those things.
The interesting question and I.
And I would tell you the one of the things the has been so significant as we look at our our experience through the pandemic and where we are today and obviously, we're moving and we're making great inroads through the use of vaccines, but it's not over.
Is how little the markets have been impacted by weather. It was the market that was wide open or a market that was shut down and so we've got a lot of clinics and California. For example, which has been one of the more shut down market, we have a lot of clinics, and Texas, and Florida, and Atlanta, and Georgia, which had been more open market and when we look at.
And try to compare okay did someone move faster than the other.
Shockingly consistent across all of those markets.
And now the one market, where I would say that we really did see a significant impact to separate from almost any other place that we've where we've talked about this before and that was the Colorado market and then Colorado, Unlike and any other market that we face is the <unk>.
Part of the Governor's directive was that in.
In order to protect the PPE as they were.
They wanted any medical service being shutdown that was not providing acute care and so that's the part of the direct it was that we were shut down for I think 17 days and then they came back with the additional director of the said Okay. You can open but only on an appointment basis and so that had a significant impact on those 28 clinics and the Colorado market.
And that directive has now been changed and so that we're back to our non appointment basis, and Colorado, but if im looking across the country and trying to understand what are the factors that of influence the.
The performance of the clinics and is there a regional variance of cadence to that is I would say not very distinguishable outside of the Colorado market.
Okay.
Helpful and then just turning to the.
And the eight clinics that you just bought.
I guess Im wondering are you do you feel like Theres and increasing probability that more potential deals like that will come to the table or what are the six units in North Carolina somewhat more of a function of having bought back of the Rd rights for that territory.
Wondering how you think about that.
Sure Jeff It's a good question I think it absolutely by buying back the North Carolina territory of created that opportunity.
But we look at those acquisitions as being an opportunistic part of our strategy. We do hold the right of first refusal. So if any clinics are changing hands or prospectively changing hands, we have the right to look at that deal.
And the case of North Carolina, and it was and opportunity that came across at the right valuation and we capitalized on that so I think thats still remains and opportunistic strategy. If I acquire of unit. It doesn't add of net positive units and our unit growth total right. So that's why I think we're still strategically focused on opening the greenfield.
Supporting our franchisees and Rd and as they open their units to try to reach that scale and that thousand unit goal.
Okay.
And for taking my questions and continued success.
Thank you very much.
Thank you. Our next question comes from the line of Anthony Vendetti from Maxim Group, Sir Your line is open.
Thanks.
Just on the follow up on the 1000.
Clinic goal.
Is the is the cadence pretty much.
Equal throughout.
These next couple of years it looks like it's probably going to accelerate and then and then what's the breakout likely to be in terms of franchise versus corporate owned.
Hey, Anthony two great questions and I would say absolutely there is an expectation of acceleration and certainly and the 30 plus years I have been building and managing franchise systems.
That is a very common experience because again as I was talking earlier on one of the questions as it builds upon itself as you have more units out there you have more exposure you have more interest and the franchise of the market expanding and so that you absolutely see this accelerated year over year over year I would've expected us to had a much higher acceleration in 2000.
If we had not had the pandemic if you look at our numbers. So we sold 37 clinics and 2017, we sold 99 and 2018, we sold the 126% and 19 and I would have expected debt just to continue to go forward. If we werent hit by the pandemic, but even in the pandemic, we hit of 121 cell.
And so obviously with the numbers that we're posting and you can do the math, we're sitting here at 600 units. We've got till 2023 to say, we're getting the 1000 units open you can do it evenly and say okay. This is the number you have each year, but the way I would look at it.
Absolutely a year by year, we'll see an acceleration of the <unk>.
<unk> of those openings.
To your question about the mix is that.
Right now as you know are the 89%.
Percent franchise of 11% corporate.
The speed of the franchise system growing it's going to be hard to push that and number two hard or too much harder.
Corporate side of the larger without doing an acceleration of the.
The corporate Greenfields.
As we've talked on the call today is we expect to see an increase from what we've done in the past.
I think you can see and the numbers that we're getting better and better and running those corporate clinics and by being better and better of running those corporate clinic Theres, a greater interest and getting more of the mountain and the field.
We've given really broad range is when we talk about what will that percentage be and.
That's good somewhere between that let's say, 10% and 25%.
And so I know thats not real helpful for modeling, but I think thats a reasonable range to be thinking through is kind of what is the corporate clinic growth going to look like.
And users.
Okay No that's helpful and then.
Obviously this is the big undertaking switching out your services and I think you mentioned Peter the expected to be complete by end of June.
Well I said wilmar.
The summer Okay alright.
However, the summer.
Some of it.
The be July August.
The issue, sometimes take longer just like construction and unless you have.
A very well oiled machine like you guys have at this point, but.
If we look at.
The advantages of.
Of this one.
What metrics are you looking at the debt the.
And the practices of the clinics are going to see whats the whats the overall benefit.
Well, it's a great question and I think it's one that changes over time as I said on the call that this initially as the lift and shift so the impact I expect to have and the benefits. There are certain benefits that are getting built in and that first version, but the reality of it is also we're trying to do is to take our homegrown platform and put it on this new platform and retained.
And all of the functionality that we have but on that new platform, then as we grow and build and improve it. There's a whole set of things that we can do that we're not able to accomplish and on our current homegrown platform and they have they are the ultimately Anthony affect every aspect of the business and I mean, it really simple and when the first things we want to do as good of.
The mobile check in and out there.
It's just it's we're still behind.
And by not having that in place today, and we haven't had the platform that allowed us to do it but we will now that's not going to come out and summer, but that will be one of the top priorities going forward, creating the patient portal.
If you look at the 20 <unk> century, as this market and to you as an individual we can access who you are and target what you want or what your issues are and craft the message to you which improves the probability to.
And your whole marketing strategy and the way that we've never had access before.
And I always thought that this concept one of the most powerful assets. We have is our data and on this new platform. It allows us to do so many things with that data that we simply can't do until we get to that newer platform. But these are all things coming down the road. This is the.
Access one point of.
And so I don't want you to get ahead of ourselves I know that this absolutely creates the foundation that propels us into that 20, <unk> century, but we've got to get through this lift and shift.
Okay.
Sounds great.
Turn it back to the queue.
Thank you.
Thank you once again to ask a question just fresh start and then the number of line on your telephone keypad.
Yes.
Thank you.
Okay.
Our next question comes from the line of Jeff Geiser from Geyser wealth manager. Please go ahead.
Hey, gentlemen, great quarter.
Just one quick question.
Is striving for the goal of 1002 thousand 23, the same as reaffirming guidance for 1000.
Yes, it is and where it's driving but yes, we're putting in and out there because we believe that we can achieve it.
Great well I can't think of two other people I'd rather have it the helm great Board Great management. Thanks, so much for being great stewards of my clients capital.
Thanks, a lot Jeff we appreciate the support.
And we'll talk with you soon.
Thank you and there are no lines.
The lines for a question and I am now turning the call back to Peter Hutton, Sir. Please go ahead.
Thank you all for your time today. Please note that on June 2nd we plan to participate virtually and the Craig Hallum Annual conference each.
The quarter I closed with the patient story and this one reminds and educates us that so often pain felt and one part of our body is actually caused by an issue of another.
The other part.
Patient from Phoenix wrote and I quote I woke up and I work at of computer All day, I started noticing pain and my upper arm and was having trouble lifting my arms, one morning, I woke up and excruciating pain and could literally could not lift either of my arms I was and tiers and Couldnt go to work my daughter had been going to the joint and was.
And happy with their treatment, so I decided to give it a try my doctor was so comforting and kind. If you took the time to go over all of my symptoms and area of the pain.
Truly thoughts and I was having a problem with my staff and it turned out to be my neck. We set up of plan that worked from a schedule and after every visit I'd feel better the pain and my arms went away and I can lift them without any problem and my mobility has come a long way I can't Thank my Doctor and not end of quote.
Thank you and stay well adjusted.
This concludes today's conference call. Thank you for participating you may now disconnect.