Acquisition & Rollout — Direct Hospital Care

Don't build new. Roughly 700 U.S. hospitals are currently considered at risk of closing — that distress is the opportunity.

Acquisition Approach

Full facility purchase: e.g., a closed 45-bed rural hospital acquired for roughly $10 million, potentially with no money down via a 30-year lease and an SBA loan.

Profile of the Distressed Inventory

The at-risk inventory isn't evenly spread across all hospital sizes — it skews heavily toward the smallest tier, which lines up well with the flagship scale this plan already targets.

Concentrated in the smallest size band: nearly half of all rural hospitals have 25 or fewer beds, with only about 16% having more than 100.
Historical closures confirm the pattern: the typical closed rural hospital had 31 licensed beds and an average daily census of only about 12 patients — licensed for roughly 30 but usually running well under half full.
Chronic under-occupancy is the core financial problem, not location or quality: acute-care occupancy across rural hospitals overall runs around 37%. The buildings and communities are frequently fine — the fixed-cost staffing model is what's broken.
Compounding risk factors: for-profit ownership, non-Critical-Access status, location in a non-Medicaid-expansion state, and low surgical volume all correlate with higher closure risk on top of small size alone.
Practical sourcing target: candidate facilities in roughly the 25–40-bed range, running at 30–40% occupancy — the most numerous distressed asset type and the best structural fit for this model.

Template, Not a Single Site

The goal isn't to perfect one hospital — it's to build a repeatable template (a "playbook" or franchise model) deployable at dozens, then hundreds, of distressed rural sites. Given how many hospitals are at risk, the strategy is to choose a clear, unglamorous first candidate (no trauma center, no nearby lab) and prove the model there first.

Location Strategy for a Flagship Site

A flagship location benefits from being centrally located near a high-volume, low-cost airport with affordable nearby hotels, to attract cash-pay surgical patients from across the country. Candidate cities: Kansas City, Denver, Oklahoma City, St. Louis, Atlanta, Chicago. KC and Denver stand out because their airports sit outside the city core, leaving land available nearby for a purpose-built campus.