Good morning, and welcome to AirSculpt Technologies' first quarter 2022 earnings conference call. Currently, all participants are in a listen-only mode. As a reminder, today's call is being recorded, and we have allocated one hour for prepared remarks and Q&A. At this time, I'd like to turn the conference over to Dennis Dean, Chief Financial Officer at AirSculpt Technologies. Thank you. You may begin.
Good morning, everyone, and thanks for joining us to discuss AirSculpt Technologies' results for the first quarter. Joining me on the call today is our Founder and Chief Executive Officer, Dr. Aaron Rollins, and our Chief Operating Officer, Ron Zelhof. Before we begin, I would like to remind you that this conference call may include forward-looking statements. These statements may include our future expectations regarding financial results and guidance, market opportunities, and our growth. Risk and uncertainties that may impact these statements and could cause actual future results to differ materially from currently projected results are described in this morning's press release and the reports we will file with the SEC, all of which can be found on our website at investors.elitebodysculpture.com. We undertake no obligation to revise or update any forward-looking statements or information except as required by law.
During our call today, we will also reference certain non-GAAP financial measures. We use non-GAAP measures in some of our financial discussions as we believe they more accurately represent the true operational performance and underlying results of our business. A reconciliation of these measures can be found in our earnings release as filed this morning and in our most recent quarterly report when filed, which will also be available on our website. With that, I'll turn the call over to Dr. Aaron Rollins.
Thank you, Dennis. Good morning, and thank you all for joining us today. First, I wanna say the first quarter saw us reach the highest quarterly volume in revenue that we have ever achieved in the history of our company. For the quarter, we generated $39.5 million of revenue, reflecting outstanding growth of 51% over the prior year quarter. Additionally, going into the second quarter, the demand we are seeing is higher than we have ever experienced. We developed AirSculpt 10 years ago with one center in Beverly Hills. We now have a national network of 19 centers across 15 states, and we continued executing on our growth plans and opened a new location in Las Vegas during the quarter. We remain on target to execute on our de novo strategy of opening four centers this year, which speaks to the demand for our services domestically.
As we mentioned on our previous call, we also believe there is a great opportunity to also expand our network of centers internationally, and we anticipate opening a center in Toronto, Canada in the second half of this year. We look forward to continuing the momentum for the rest of 2022 and beyond, and we are excited about the opportunities ahead of us as we continue to expand into new markets and deliver incredible results for our patients and our investors. There is tremendous wind in our sails from favorable trends in the aesthetic space, especially in fat reduction and body contouring. A recent publication by The Aesthetic Society showed that liposuction surgical procedures increased to approximately 500,000 procedures in 2021 and is now the top aesthetic plastic surgical procedure performed today, surpassing breast augmentation.
These statistics are further evidence of the opportunity for us to increase our market share due to our superior results and technologies. We remain committed to driving AirSculpt's brand awareness. We believe most people who want body contouring services and fat removal don't know that we exist. We are focusing our plans to reach this group of customers by expanding our usage of celebrity influencers, earned, owned, and paid media content, as well as continued development of our social and digital media outreach. We believe these efforts to increase our brand awareness, along with the heavy demand for aesthetic services, will create exceptional value for our business. We have also been very active in building out our team. Due to our rapid pace of growth, we have taken a proactive approach of making investments in various areas of the company to position us for further growth.
Over the past six months, we have developed a dedicated physician recruiting department, and these efforts are performing exceptionally well. During the quarter, we added seven new surgeons to our network, which brings the number of physicians performing cases at our facilities to over fifty. As a result of our increased recruiting efforts, we recently hired our second surgeon trainer, which will allow us to train newly recruited surgeons more effectively as we strive to meet customer demand. During the quarter, we also expanded our clinical capabilities by adding a chief clinical officer to not only support our clinical operations, but also to lead our upcoming health research project. As we introduced on our previous call, we are excited to undertake a health research study on the effects our procedures have on a patient's metabolic parameters.
We are well into the process of designing the study, and we are on target to submit to the Institutional Review Board for approval later in the second quarter. We expect patient enrollment to begin this fall, and we anticipate having results from the study in 2023. Additionally, we have contracted with a national adult stem cell banking company, which will allow us to offer our patients the opportunity to bank their stem cells harvested from the fat removed during their AirSculpt procedure. We believe this is one additional way for us to further promote the health and wellness of our patients, and we plan to start offering this in the second quarter. I'm sure you all have questions on how the current inflationary environment and increasing interest rates will impact our business.
While we can't predict the future, our current demand is stronger than we've ever seen in our history. We also have a very resilient business model, which has a low fixed cost structure coupled with a strong balance sheet to support our business. Now I wanna turn the call over to Ron Zelhof, our Chief Operating Officer. Ron?
Thank you, Dr. Rollins, and good morning, everyone. I'm going to share some information regarding our de novo and procedure room expansion projects. Before I do, I wanna say thank you to the AirSculpt team. You perform magnificently every day by bringing first-class results to the patients we treat, especially in the face of challenging times brought on by COVID. Now I'll provide you with a development update. As you know, we opened a center in Las Vegas in March, and up to this point, demand has exceeded our initial expectations. We've now opened three centers over a four-month period, and each of these centers are performing exceptionally well. As previously discussed, it takes approximately four months for a center to become cash flow positive.
While these new centers have a short-term negative impact to our margins, they give us a great platform for margin expansion as we grow revenue over the rest of the year. We expect to open our next center in Boston in June, which will be the first de novo that we have opened with three procedure rooms. Three procedure rooms not only allow us to meet the demand we anticipate in the market, but it also provide operational efficiencies as utilization increases. Looking to the rest of 2022, we have plans to open two additional facilities later in the second half of this year, one in Philadelphia and another in Toronto, Canada, which will be our first international facility. We are also diligently working on our centers for 2023, and we look forward to sharing some more about those markets in the coming months.
We have also been busy adding more procedure rooms to some of our existing centers. As mentioned on previous calls, our legacy centers were built with only one procedure room. Due to capacity constraints, we've been converting, or in some cases, relocating those centers to larger facilities. We relocated Sacramento in the fourth quarter of 2021, expanding this facility to three procedure rooms. Having the third room not only gives us increased capacity, but also allows us to operate on patients faster and more efficiently. In March, we added a procedure room to our Chicago facility, and I am pleased to say we relocated our Dallas center on May 2nd, and it also was expanded to three procedure rooms.
As discussed on previous calls, it typically costs less than $1 million to open a new facility, and so far, we have not seen a significant impact from inflation, nor have we encountered disruptions in our supply chain that would delay the opening of new facilities and procedure rooms that are scheduled later this year. We are so excited about the interest and demand we are seeing in existing markets and in our new markets. Due to our record volumes in revenue and to further prepare for our growth plans, we have been expanding our team in both clinical capabilities as well as our sales and operations to prepare for further growth acceleration. With that, I'll turn it back over to Dennis to provide additional details on our financial results and revised outlook. Dennis?
Thanks, Ron. First, I'll share some remarks on the first quarter and our liquidity, and then provide some thoughts on our outlook for the remainder of the year. Our revenue increased $13.4 million to $39.5 million, a 51% increase from the prior year quarter. Our cases increased 31.1% to 3,156. The increase is primarily a result of adding five de novo centers over the prior year quarter, which expanded our footprint to 19 centers as of March 31st, 2022. Additionally, we experienced same center increases in both volume and revenue per case. Our revenue per case was $12,530, a 15% increase over the prior year quarter. As a reminder, there are several variables that determine our pricing.
While it is primarily based on the length of time a patient is in the procedure room, which can vary due to the number of areas being treated, other factors include the volume of fat being removed and whether a procedure involves fat transfers. For the first quarter, fat transfers continue to make up greater than 20% of our procedures performed. Not every patient is a candidate for a fat transfer for a variety of reasons. However, we expect to maintain this percentage as case volumes grow. Same-center revenue increased 29% over the prior year quarter, driven by strong case growth and an increase in rate. Much of our same store growth can be attributed to favorable trends in the aesthetic space and to expanding our marketing and selling capabilities, especially AirSculpt TV, to increase brand awareness and to attract more patients into our centers.
Our cost of services for the quarter as a percentage of revenue was 37.1% versus 33.6% in the same period last year. As Dr. Rollins and Ron both mentioned, due to our rapid growth, we have been making certain clinical additions to our nursing teams, which started last quarter and continued into the first quarter. These investments further enhance the quality and safety for our patients and better prepare us for future growth in both existing centers and the new centers we are developing. Our margins in the quarter were impacted approximately $400,000 or 100 basis points from these investments, which are now mostly complete, and we expect to begin leveraging these investments over time as revenues continue to grow at a strong pace.
Additionally, our cost of services were impacted by approximately $150,000 or 50 basis points related to increased staffing costs due to COVID. As Ron mentioned in his remarks, the opening of three de novos in the past four months also impacted our margins by approximately 130 basis points. We expect this impact to be short-lived as demand in these centers has been strong and will give us a platform for revenue growth later this year. Our advertising costs, which include our digital, social, and traditional advertising, were $4.8 million for the quarter, which is approximately 12.2% of our revenue. When combined with our marketing and sales personnel cost, our total customer acquisition costs for the quarter were approximately $2,200 per customer, down sequentially from $2,600 per customer.
Based on gross margin per case, which typically averages over $8,000, the return on our customer acquisition cost is nearly 4x , which we are extremely proud of. As a reminder, our marketing costs as a percentage of revenue and per customer rates can fluctuate quarter to quarter related to the timing of investments we make compared to the related revenue increases we achieved after making these investments. Our adjusted EBITDA was $9.8 million for the quarter. Just to remind everyone, this was our first full quarter as a public company. Adjusted EBITDA included approximately $2.3 million of public company-related costs, which did not exist in the prior year quarter as we were a private company. Normalizing the prior year to include these public company costs, our adjusted EBITDA growth rate would have been approximately 34%.
Additionally, our public company costs are approximately $650,000 more in the first quarter as compared to other quarters due to our annual SEC compliance requirements. Finally, our adjusted EBITDA margin for the first quarter was 24.8%, which was also impacted significantly due to public company-related costs. Moving on to liquidity and cash flow items. Our cash position as of March 31, 2022, was $27.2 million, and we have a $5 million revolver that is undrawn and has no outstanding letters of credit. Our long-term debt was approximately $83 million, and our leverage ratio at the end of the quarter, as calculated under our credit agreement, was 1.64x. Cash flow from operations for the quarter amounted to $7.1 million, which reflects approximately 72% adjusted EBITDA to cash conversion.
An attractive aspect of our business model is that we are 100% self-pay with no reimbursement risk. We receive all of our payments upfront, so we have no accounts receivable to collect. Additionally, our surgeons are contracted and receive payment only after a surgery is performed, which allows us to manage our operating cash flow very effectively. We also invested $4.3 million during the quarter, primarily related to opening our center in Las Vegas and our upcoming openings in Boston and Philadelphia and our procedure room expansion projects. Now I'll provide some information on our outlook for the remainder of the year.
As we think about revenue, we now expect to achieve between $175 million-$179 million for the full year, up from our prior forecast of $172 million-$176 million, and represents a 31%-34% increase over 2021 levels. We are maintaining our adjusted EBITDA outlook of $58 million-$60 million. From a modeling perspective, we expect to open four centers this year. As you heard, we opened a center in Las Vegas in March, and we expect to open Boston in late June. The remaining two center openings are expected to be late in the second half of the year. Also, as we have previously discussed, there is a slight element of seasonality in the business during the second quarter as patients prepare for the summer months.
Our first quarter tends to be a lighter quarter with volumes trending upward in March and through the second quarter. Just to remind everyone, as a result of our IPO, we reorganized into a C corp and are now estimating income taxes accordingly. Additionally, our stock-based compensation increased related to IPO equity grants that were issued as part of the creation of our 2021 stock incentive plan. These initial IPO-related grants have a three-year vesting period and are expected to impact net income significantly until they fully vest. Before we take questions, let me say this truly is a unique company that provides incredible results for our patients. We have an extremely attractive business model that provides an excellent return on invested capital and is being fueled by favorable trends in the aesthetic space, and we look forward to further capitalizing on these tailwinds.
With that, I would like to turn the call over to the operator for a few questions. Operator?
Thank you. At this time, we will be conducting a question and answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. Our first question is from the line of Josh Raskin with Nephron Research. Please go ahead.
Thanks. Good morning, everyone. Two questions for you. The first one here is the boost in guidance for revenues of $3 million. How much of that is, you know, sort of Boston coming online faster? I think about, you know, each month being maybe $750,000-$800,000 of revenue. How much of that was better demand? Regarding the better demand, if you could just talk about what specifically is driving that geography-wise, product mix-wise.
Thanks for the question, Josh. I would say it's probably equally weighted if I were looking at it from the standpoint of the increase. We did bring Boston on a little bit earlier, but remember, when we bring those on, they tend to ramp up a little slower intentionally for quality purposes. The demand is really the main driver as far as us increasing the revenue guidance.
All right. Did I hear half and half or more, is it more demand?
I would weight it a little bit more on the demand side.
Okay. What specifically is driving that? Is that more, you know, higher cost procedures? It certainly looked like you saw that in pricing. Is it more fat transfers? Is there specific geographies that are outperforming?
It's really not related to what I would consider the activities that we're doing. It's really more of the industry itself. I mean, we've discussed a report that came out recently that just showed the massive demand for fat reduction type procedures and body contouring. You know, that is really what is putting this major wind behind us. We're extremely bullish from that standpoint, which is why we've kinda looked at it from the standpoint of saying demand is really the key driver here.
Thanks.
You know, our procedures, they fluctuate from month to month. I mean, we're not a high volume, you know, center. Our centers don't run a lot of volume. There could be some movement within our rates just due to the types of procedures that come in the door. There's nothing that we would call out significantly. I mean, you know, at certain months, we may do more chins, which are really short procedures, but they're very profitable procedures. While the rate might dip a bit, it really has no significant impact on what we think of from a bottom line perspective. We like where our business is. You called out fat transfers. You know, fat transfers aren't for everyone.
Not every patient is a candidate, and quite frankly, most patients aren't candidates for that for various reasons. 20% is kinda what we've been sorta calling out as what we expect to maintain as our volume grows, and that's where we expect to maintain. It's kinda where we've been over the last several quarters.
Just separately on the new centers, I'm assuming it's a little too early to know anything about Las Vegas, but you know, Miami, Salt Lake. I'm just curious, you know, it sounds like you're seeing a little bit of outperformance there. Anything particular there and maybe any lessons you've learned in terms of, you know, the newer openings that are gonna be helpful in the future?
Hey, Josh, it's Ron. How are you? All of our centers are performing slightly actually ahead of expectations, and we're extremely pleased with how they're performing right now. I think the biggest surprise might be our Miami Beach location. When we opened it, we were maybe concerned about pricing just because of some of the challenges maybe in the Miami, South Florida market area as far as you know these types of procedures. So that's been quite frankly a positive for us that the rate there hasn't seen significant pressure at all. We've actually been very successful in getting our rates.
All right. Perfect. Thanks.
Thank you. Our next question is from the line of Simeon Gutman. Please go ahead.
Thanks, everyone. Good morning.
Good morning.
I have two questions. Good morning. First on demand, and then second on some costs. First on demand, can you share with us what, I guess, forward bookings look like? I don't know if you'll touch on quarter to date, but that's fine. In light of the backdrop, which mostly is stock market changes and geopolitical worries, curious if there's any correlation to how demand is shaping up going forward. That was my first question.
Yeah. Thanks, Simeon. You're right. While we don't give a, you know, any sort of forward-looking specific information, what we would say, though, is that the first part of the second quarter is really going strong. We're very positive as to what we're seeing from the volumes and sales and bookings. We're, you know, extremely excited about, you know, what's ahead of us. Second quarter is looking really good so far.
Okay, great. Thanks. The second question is on cost and scaling. There were two buckets that I don't know if it's caught our attention, marketing spend and then surgeons, but especially the second trainer. Can you talk about how much of this is planned versus unplanned? As the business scales and grows, you know, what portion of this is proactive? For example, marketing, where you see an opportunity and you think it would have a good return versus there's a certain level that needs to be spent to support. At the same time, more surgeon trainers. You know, this is being scaled for the first time, right? You guys are doing it.
Are there areas, are you finding that the business needs more investment, or is this all planned as, you know, as the number of centers ramp up?
I can start. It's Aaron Rollins. I can start with some answers about our investments in the business. Getting our second surgery trainer, it was wonderful for us, and it was hoped for and planned. There's not many people that can do that, and we're really happy to have them. Having two full-time surgical trainers really allows us to scale at a different pace, and it allows us to maintain our quality and our safety in a way that we couldn't before. We're thrilled about that. It's money very, very well spent. We don't plan on hiring a third at this time. Dennis Dean, do you wanna fill in some more?
Yeah. I would say, you know, as I look at kind of the original outlook, you know, I think those costs, we've pulled forward a little bit earlier in the year compared to what we sort of expected to. Quite frankly, we did so because our revenue has been so strong and the demand's been so strong. You know, one of the things that we wanna do is prepare for growth. We wanna accelerate our growth not only in same store, but also in new facilities. You know, we've again, because of the demand, you know, we felt it was the right time to invest a little bit sooner.
Another thing is we're happy to say our customer acquisition costs went down to $2,200 per patient for the quarter. That's a strong return on CAC spend because our gross margin is at in excess of $8,000 per patient, which is close to a 4x return.
Thanks, everyone. Good luck.
Hey, thanks, Simeon.
Thank you. Our next question is from the line of Korinne Wolfmeyer with Piper Sandler. Please go ahead.
Hi, good morning, and thanks for taking the question. I'd like to, one, expand on kind of what's going on in the current macro environment. I'd just like to get your thoughts. I mean, I know demand is obviously trending very well, but, you know, as we hear more about, you know, consumer sentiment starting to decline both here in the U.S. and internationally and maybe consumers starting to cut spending, how are you viewing the resiliency of the broader aesthetics market through these conditions? How are you expecting the market to fare, you know, if we do continue to go into a downturn here?
This is Aaron Rollins. Thanks so much for the question. You know, I've been doing this my whole life, and I've been the CEO of AirSculpt now for over 10 years, and I can say with absolute certainty that I've never seen this level of demand. Our volumes have never been better. Our financing rate is exactly the same. I see demand actually accelerating. So that's all I can really tell you. So I feel great about the coming quarters here. These macro conditions have had no effect on our business. I mean, in fact, it's accelerating.
You know, I would add a little bit that we are a luxury brand, and so, you know, with that, our customer base tends to be a bit more resilient to some of these macro environment trends that we're seeing. Again, like Dr. Rollins says, from our demand that we're seeing, it's again. Let's say, knock on wood, we're excited about where we're going.
Great. Thank you.
We're not seeing cost pressures.
That's really good to hear. Helpful. Thank you. I really appreciate the color there. I'd just like to touch a bit on Renuvion. You didn't really mention it in the prepared remarks, but can you just give us any of the color on how that's been going? How many offices now have this technology? What has demand been? Can you just walk us through the economics of this procedure again, so we understand, you know, what's the add-on cost and what's the cost of bringing this on? Just any color there would be helpful.
Well, I can start. We're really happy to offer Renuvion. Ron, how many offices do we have it in to date?
Seven.
We have it in seven, and the way we're rolling it out is based on demand. If there's an office where patients are asking for it, and which we call AirSculpt+, then we immediately get them a machine. There are some offices that do a lot more of it than others, and it's really just based on patient demand for it. The economics are very good. I'm not sure. Dennis, do you wanna say what we're allowed to say about that?
Sure. We usually see about a $2,500 add-on, typically, for that. Obviously, it depends on the. Every case is different, but that's on average about what it looks like.
The good thing is for that $2,500 add-on, that's about 20 minutes more of operating room time. It's really good. I'd like to say, because we're a results-focused company, it actually works very well. I'm very happy with the technology. I think it's extremely safe. We have every plan to continue to roll it out based on demand from any individual office.
Great. Thank you.
Thank you. Our next question is from the line of Whit Mayo with SVB Leerink. Please go ahead.
Hey, thanks. Good morning. Dennis, I just wanted to go back to the topic of the increased investments and the timing. I totally appreciate the decision to, you know, pull the trigger on these. I don't think it's actually fully, you know, within your control when you find the right people, the right talent to join the team. That decision seems to oftentimes be made for you. Not really easy to put that into a budget. You guys don't give quarterly guidance, and we're getting a few questions here. If we would just kinda take all the puts and takes here of, like, how the quarter developed with these increased investments, how did it really compare with your internal plan?
Hey, thanks, Whit. You know, first, before we get into the investment side, I mean, we obviously get impacted heavily by being a public company. I just wanted to make sure that, again, we sort of reiterated that point, that we saw excellent, you know, adjusted EBITDA growth year over year when you account for those costs that we incur. I know that wasn't part of your question, Whit, but I think it's just such a significant number. We just need to continue to.
Right
to make sure everybody's calling that out as well. You know, Whit, and kinda like what I'd shared earlier, the demand is really what caused us to pull these costs forward. You know, again, as we've always talked about, quality, safety are paramount for us. That's caused us to really focus on bringing our nurses up to a higher standard in that we're hiring more RNs, whereas in the past we had LPNs. We put nurse managers in place. All of this is because as you grow a business like we are in the healthcare space, you can't sacrifice quality for rapid growth.
You know, we see the opportunities out in front of us for this growth, and so we invested these dollars, you know, primarily into the quarter. We feel like we're right at the point of maxing out from that standpoint, so we feel like the investments we've made in that arena are about, you know, where we need to be. We're gonna be able to leverage that number as we move forward through the year. We had probably a $400,000 impact, you know, in the quarter. You know, if we think of it from a sequential and over prior year, we had about a $400,000 or $500,000 impact there related to adding these, you know, nurses and other clinical items.
As Dr. Rollins talked about, you know, investing in, you know, our surgical trainers. I mean, those are that's critical in that, you know, if we're gonna be able to open up new centers and maybe open up new centers at a faster pace, we have got to be able to not only recruit the doctors, but also to train the doctors. Adding that second, you know, full-time dedicated physician trainer just speaks to how we see the volume out in front of us and the opportunities there. So those were two of the main. We did have a little bit of COVID impact, where we had overtime and duplicate staffing and those types of things. Most of that was in the first two months of the quarter.
We're not really seeing a lot of that, and hope that to be the case the remainder of the year, but we'll see. I know in the past we've been very resilient. We've been very effective in working around, you know, the COVID impact that we've had. We've been able to keep the revenue numbers going and by rescheduling cases in a timely fashion. We feel good about that, but that obviously hit us a bit in the quarter. From a margin percentage standpoint, you know, I don't think we've spoken to this very much on the call yet, but we opened three centers in the last four months. You know, that's a little bit heavier than what we've ever done in our history at one time, and that's driving our margins down.
The reason being is because, as you guys know, it takes us about three to four months for these centers to become cash flow positive. It gives us a great platform for, you know, EBITDA growth as we kinda run throughout the rest of the year. You know, that hit us for probably about 130 basis points in margins this quarter. We really feel good where we are. We're excited. Again, making these investments now just really prepares us for what we see coming down the line for us.
Yeah. No, I think I get it. It seems like you guys kind of come out of this quarter with a little bit more enthusiasm than when you entered the quarter. Can I just ask one other question on the relocations? Any way to size disruption that you historically feel when you do a relocation? I think you stagger these pretty efficiently. Just trying to get a sense if there is any expected disruption from a relocation such as, you know, Sacramento or whatever.
Sure. Hey, Whit, it's Ron. Number one, appreciate the question. The answer is no, we don't. The way we do it is we do it over a long weekend. The last one we did in Dallas, which was a large relocation for us, again, Friday afternoon comes along, Friday evening, and we're already, you know, been packing up, and then we move over the weekend, and we start the new cases on Monday. That's how we go ahead and do these. There's no disruption whatsoever.
Perfect. Thanks, guys.
I'd like to add that.
Yeah.
I'd just like to add that, I'm very happy to say that, we recently used all three procedure rooms in a relocated office for the first time at the same time, and that's really big for us.
Okay. Thanks, guys.
Okay. Thanks, Whit.
Thank you. Our next question is from the line of John Ransom with Raymond James. Please go ahead.
Hey, good morning. I guess this one is for Dennis. I mean, normally 2Q is your high water mark. Is that gonna be even more the case this year if we think about sequential revenues, just given the pre-openings and maybe the first quarter had some Omicron effect?
I think on a sequential basis, John, you know, how we're seeing it is, you know, obviously Q2 is gonna ramp up significantly. I mean, that's been our history. You know how we look at. You know, I'm looking at the mid-40 range for revenue actually for the next two quarters and then, you know, upper 40s for the fourth quarter on a revenue perspective. Obviously the fourth quarter is getting benefit from additional ramp and some new centers that we'll bring online, you know, throughout the year. But that's kinda how I see it laying out for the remaining quarters from a revenue perspective.
I know you mentioned the extra audit costs, or that's not the right word, but the extra public company costs in the first quarter. How should we think about your fixed costs kind of 1 Q to 2 Q if we fully quarterize, if you will, the investment that you made? What's the kinda step up taking those two things into consideration?
Sure. One thing I would make a point is also if you look at the numbers on a sequential basis, Q4, we were only public for two months, and our public company costs run on average about $650-$700 a month. That's a sequential impact that we bore in the first quarter that we didn't necessarily see in the fourth quarter. Now, that's gonna run with us, and in the first quarter, we usually see about a $650,000-$700,000 increase over future quarters because of the annual SEC requirements.
Gotcha. Was there anything else in the first quarter that maybe you layered in the expense mid-quarter that'll be a full pull or we should kinda run with what you just said?
I think from that standpoint I would run with it. I mean, again, we've made the majority, if not all of our, you know, our clinical investments, so we feel good about that. Now we're just again, you know, have prepared for that growth that's coming up.
Last one for me. Could you remind us, dot-com, kinda what your expectations are for the balance of the year? Is there any seasonality to it? What's the full amount you need to invest before it levels off? I know that was part of the pre-IPO discussion, but maybe just level set everybody for that.
There's not really gonna be what I would consider a significant seasonality to that. Most of what we see on the stock comp line is due to the original IPO grants that took place. It's about $7.3 a quarter. But what I would also add to that just for modeling purposes is that, you know, due to 162(m) requirements for tax purposes and the deductibility of various executive comp, you know, we won't get the benefit, if you will, from an income tax perspective, for that, and so that will definitely impact our, you know, our effective income tax rate this year.
How long are you gonna be running at this level until you fully absorb the pre-IPO grant?
You will be running for three years, and we're basically six months into it, so about another two and a half years, John.
Okay. Very good. Just remind me, if you would, I know you haven't seen, I guess two other things. First of all, how far out are your bookings typically?
Well, that really
Do you wanna take that one?
Yeah, go ahead.
Our bookings run, depending on facility, there can be anywhere from just two weeks to, you know six to eight weeks. It just depends on our one-room existing legacy centers, those tend to be a little longer. On our newer centers, it's not long at all.
Okay. Now you're sitting here almost mid-quarter, I mean, you've got probably maybe three weeks of bookings, so you've got pretty solid visibility on 2Q, without referring to your comments, just to state the Captain Obvious.
Right.
Yeah, right. We do have some pretty good view on it, John.
Yeah. Okay. Lastly, you know, maybe I'm just thinking about this 'cause I'm in Tampa, and I know you've got one in Orlando, but do you think, you know, if we look down the road three years or something, the company might think about, you know, densifying a little bit, or maybe like doing a couple of days a week if there's a satellite market an hour and a half away? How do you think about something like that? You know, when you think about building this out, have you thought any more about like, well, maybe we can put more of these out there than we thought we did?
I'll take that. Thank you. You know, we're currently building our support teams both clinically and operationally to increase our growth point. We don't wanna jeopardize quality and results for the sake of growing faster, and that's why we're making these investments in the business now is because we do see that opportunity moving forward.
If your, you know, your quote, unquote secondary markets, so not the traditional super MSAs, but places like Charlotte and Orlando, have they ramped consistent with some of your bigger market openings?
Frankly, our mid-markets are performing exceptionally well. Some recent openings have really exceeded my ramping predictions and the ramp up and the performance is better than I've ever seen in this business.
Great. That's it for me. Thank you.
Hey, thanks, John.
Thanks.
Thank you. Ladies and gentlemen, we have reached the end of the question and answer session, and I would like to turn the call back to Dr. Rollins for closing remarks.
Thank you. I'd like to conclude by thanking you all for listening, and I'd like to thank all of our employees and doctors for such excellent work. I couldn't be more excited about our growth and our performance, and I'm looking forward to the future. Thank you all.
Thank you. This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation.