The engine works. After a heavy January (annual/one-time expense loading), the practice printed five straight profitable months. March–April were peak ($58K and $74K operating net); May held at $54K.
Q2 revenue is softening — $194K → $170K → $158K. Part is Medicare payment timing, but the direction matches the referral funnel slowdown already documented in the Sara analysis. The new-referral engine (RSS tool, Lisa Sheremet relationship, Ruotolo) is the fix, not cost-cutting.
June's thin net ($12.4K operating, $2.5K after buildout) is expense timing — three payroll-adjacent Gusto runs, iFedora catch-up, anesthesia (LIAP $9.5K), and the first buildout invoices — against a lighter collections month. Not a trend yet; watch July.
Scope note: this is the PLLC operating account only. MSO-side flows aren't here, so consolidated Maywell revenue is higher than the $1.91M run rate shown.
Real H1 profitability is ~$41–67K, not $160K. The engine is still sound — March–May printed $28–56K/month all-in — but January and June are genuinely negative months once card load is included, and the margin story you tell Ruotolo or a lender should be the consolidated one, cleaned of personal spend.
The 7247 statements explain the balance: it rode a 0% intro APR that expired 3/28/26 — you built it to $41.6K free, paid $41.1K on 4/15 (well timed), but it's rebuilding at 16.74% now with minimum autopay. Repeat the April move once more and flip autopay to full balance, and the card problem is permanently solved.
The $23.5K of owner draws is the fix with the fastest payback: moving personal spend off the business cards instantly cleans both the P&L and the audit posture — no revenue required.
Sara's card ran $8.0K across H1 (all cycles, gross) — BD and marketing spend for an active employee; treat as part of the marketing/BD budget and tie it to referral attribution like the rest.
Marketing is ~$25.6K H1 on cards (Zocdoc $11.7K, Patient Procure $9.8K, Google Ads/print/QR) — now finally visible as a line. At ~$645 net per converted patient, that spend needs ~40 converted patients over six months to wash — a number the referral dashboard can now verify. Tie it to the referral dashboard.
| Metric | Jan | Feb | Mar | Apr | May | Jun | H1 |
|---|---|---|---|---|---|---|---|
| Included Revenue | 118,163 | 133,435 | 182,658 | 193,528 | 170,014 | 157,970 | 955,769 |
| Included Operating Expense | 163,803 | 126,005 | 124,568 | 119,640 | 116,500 | 145,609 | 796,125 |
| Operating Net | (45,640) | 7,430 | 58,090 | 73,888 | 53,514 | 12,362 | 159,644 |
| Buildout / Capex (NYC lead shielding) | — | — | — | — | — | 9,879 | 9,879 |
| Net after capex | (45,640) | 7,430 | 58,090 | 73,888 | 53,514 | 2,482 | 149,765 |
| Operating Margin | -38.6% | 5.6% | 31.8% | 38.2% | 31.5% | 7.8% | 16.7% |
| Review (expense, mostly John Zelles + Gusto fees) | 8,887 | 6,344 | 5,608 | 5,587 | 8,372 | 7,217 | 42,015 |
| Excluded (card payments, transfers) | 14,857 | 25,839 | 13,660 | 55,131 | 16,804 | 43,838 | 170,130 |
People are ~62% of operating expense ($162K of $262K in May–Jun). That's normal for a clinician-led pain practice, but it means the two PA hires and Abby's MNT line each need a visible revenue attach — you already built the collections model to price this.
Clinical services & supplies ($50.9K) is the second block: Lin Health, FlightHealth, iFedora RCM, anesthesia (LIAP), EMG, Epimed. iFedora appearing twice in June ($10.3K total) is worth a look given the ~$1M underperformance previously identified with them.
IDR fees ($8.4K in two months) are an investment, not overhead — ~50 pending cases at $4–6K average with the 80th-percentile UCR benchmark intact. Track recovery per filing.
Revenue concentration: 82% of May–Jun deposits arrive via the Athena payer batches, 15% direct Medicare. Fullscript (supplements vertical) is live but immaterial ($27.54) — the online store needs product and promotion before it moves a number.
Fix 7247 today: pay the $21,724 from checking (it held $58–112K all quarter) and flip autopay to full statement balance like 0736. That alone stops ~$300+/month of interest — a guaranteed 16.74% return.
Commingling on 0736: Fortunoff Backyard $7,788, Peter Andrews $7,624, London Jewelers $2,352, kids' clothing and groceries ran through the business Ink. Chase prints the business-use-only notice on the statement; commingling also weakens the PLLC liability shield and muddies the tax file. Move personal spend to a personal card; if any item was genuinely business (office furniture?), document it now.
Marketing spend is real and growing: Zocdoc ~$3.6K + ~$3.9K across the two 0736 cycles plus Google Ads on the 0507 card. Worth tying to the referral dashboard so cost-per-new-patient is a tracked number, not a feeling.
Documentation support is a ~$37K/H1 line hiding across vendors: EZ MD scribes (Melissa & Katherine's South America team, $15.7K) + ScribeRunner (2 Pakistan scribes, ~$13.1K) + VirtualCare Assistant VMAs ($8.0K) + MedWriter AI. That's ~$6.2K/month on documentation — the exact line the MedWriter-AI-scribe transition in the 30/60/90 roadmap is meant to shrink. Now you have the baseline to measure it against.
Sara remains employed; this is her BD/marketing card. Earlier draft flagged it in error. Routine receipt hygiene only; Algin parking perk correctly ended after Feb.
$21,724 revolving at 16.74%, $495 interest YTD. One transfer from checking ends it; changing autopay keeps it ended.
≈$18.4K of personal-looking items in two cycles. Move to a personal card; document anything defensible as business.
Month-end cash $58.8K ≈ two weeks of opex, with buildout and two PA hires incoming. Set a $100K floor on 1680, and open a modest LOC while the numbers look good — credit is cheapest when you don't need it.
Plainview goes to $9.2K full rent, NYC steps $2K→$4K→$6K+ by Oct: total rent roughly doubles to ~$17.95K/mo (incl. Roca now $1,750) just as two PA salaries start. The interactive growth model at /forecast-model.html (Brian, Deb, Steven access) shows the ramp math and the Birnhak negotiation lever.
$194K → $170K → $158K. If July prints below ~$160K, the referral-engine work (RSS distribution, Lisa Sheremet, Ruotolo close) moves from strategic to urgent.
$10.3K paid in June against the previously identified ~$1M billing underperformance. Ask for a collections-lift report before Q3 renewal.
$8.4K of filing fees in May–Jun is high-ROI with ~50 cases pending at $4–6K and the UCR benchmark intact for another year. Track recovery per filing so ROI is provable for the Ruotolo/Series A story.
Convert to invoiced vendor payments so the P&L stops carrying a $42K/half-year Review bucket.
$9.9K of lead shielding tagged in June. Continue for Chloe/Hit invoices and equipment so operating margin stays readable through the 32nd & Lex construction.