Urgent Care Feasibility Study Case: Elizabethtown, Kentucky, SBA 7(a)

Feasibility Study Company prepares studies like this one for owners, developers and their lenders: a dated market read, a competitor census, a priced build and a coverage test that says how much debt a clinic can carry. This page runs that work for one hypothetical project, a new independent urgent care clinic in Elizabethtown, Kentucky, financed with an SBA 7(a) loan. Ask us to run the same work on your site.

The subject is generic: a single-story clinic of about 4,500 square feet with on-site X-ray, on about 1.25 acres of commercial land along Ring Road. Every market figure is public and dated. Every model figure below is computed by the case engine from the inputs listed near the end, each of which carries either a source or the word assumption. The study belongs to our urgent care practice, the town sits in Kentucky, and the program rules are laid out on our SBA 7(a) and 504 page.

Urgent care demand follows people, not traffic: households within a short drive, workers who need care on a lunch hour or after a shift, and families without a same-day appointment elsewhere. Elizabethtown's base has four parts: a city adding residents quickly, a county with a large veteran population, the largest military installation in the region, and a sizable health care economy, whose 2022 Economic Census receipts appear in the table. The table sets out the public record for each.

A city that is filling in

The city grew far faster than the county around it, which barely moved over the same five years [1]. A household in town averages 2.31 persons, against 2.44 for the county [1], a smaller household than the county's. One in four residents of the city is under 18 [1], and children are a dependable source of walk-in visits: ear infections, sprains and strep arrive on evenings and weekends, when a pediatrician's office is closed. At the other end, 14.9% of city residents and 17.2% of county residents are 65 or older [1], a group that also uses same-day care but is more likely to be steered to a primary care office or a hospital.

Income is middle-market. The city's median household income of $60,760 sits below the county's $67,647 [1], and the per capita figures follow the same order, $35,019 against $37,638 [1]. For a clinic whose revenue depends on what insurers allow, income matters less than coverage. The research found Census series for uninsured and poverty rates, but it labels their vintage only as the latest available, so this study does not print them. The payer mix of the trade area is therefore a lender condition, and the model's revenue per visit says plainly that it is an assumption.

Fort Knox and the veteran base

Fort Knox covers 109,000 acres, serves a daytime workweek population of about 26,000 and receives upwards of 15,000 more visitors a day, and the Army ranks it 20th in population among 174 installations [3]. A regional public radio report put its workforce at 22,000, the largest employer in the region, and its 2024 economic impact at $5.6 billion, including a payroll of $1.3 billion [4]. During the federal shutdown of October 2025 that workforce was in limbo [4], a reminder that a military payroll is steady but not immune to Washington.

The veteran count is the sharper demand signal. Elizabethtown has 3,152 veterans and Hardin County 12,344 [1]. The independent competitor in town says it accepts Medicare, in-state Medicaid, TRICARE and VA coverage [16], which tells a new entrant what the payer panel has to look like. A veteran with VA eligibility may use the new VA clinic for primary care once it opens, and the walk-in clinic then competes for the acute visits that fall between appointments.

A volatile industrial neighbor

The region's other large employer is less steady. The BlueOval SK battery plant at Glendale produced its first batteries in August 2025 and was expected to lay off roughly 1,600 workers in December 2025, with Ford planning to bring energy-storage capacity online within 18 months and expecting 2,100 jobs at the restart [5]. A layoff notice filed on February 12, 2026 deferred a further reduction of about 10% to March 31, 2026, and the $11.4 billion joint venture behind the plant was being dissolved [6]. For an urgent care clinic the effect runs two ways. Laid-off workers typically lose employer insurance and become self-pay or Medicaid patients, and the plant's occupational medicine business, if any of it was going to local providers, is on hold. The model therefore keeps its employer-contract line small.

Where the hospital fits

Baptist Health Hardin is the regional hospital in town and describes a catchment that reaches well beyond the county, across central Kentucky [19]. Its emergency department is the alternative for any patient with an after-hours need and the means to wait. The health system also runs urgent care sites in town [13][14], and that arrangement gives its clinics a referral path the subject lacks. It is the main competitive fact in the file.

Context from the Census register

The table below adds five-year American Community Survey estimates for the county and the Elizabethtown metropolitan area. They differ slightly from the estimates above because they average 2020 to 2024 and, for the metro, measure a different geography.

Seen together, the county has 44,622 households [1], of which renters occupy a large minority [2], and a median home value near the metro's [2]. That is a household base with ordinary means and many renters, who are less likely to have an established family doctor. The metro's income and housing figures sit within a few percent of the county's [2], so the choice of geography does not change the read.

The subject is a hypothetical pad of about 1.25 acres on the Ring Road corridor, in a commercial district that permits a clinic. Which district the parcel lies in is a condition to confirm. The research could not retrieve a parcel identifier, flood zone, utility territory or zoning district from the county property valuation office, FEMA or the city's mapping tools, so the paragraphs below describe the rules that would apply and what each would cost.

Zoning and approvals

Under the city code, a clinic is a permitted use by right in both the C-2 Neighborhood Commercial and the C-3 Regional Commercial districts [20][21]. In C-2, a drive-through facility needs board approval, so a clinic with a pickup window would face a conditional use there [21]. A correctly zoned site needs development-plan review and a certificate of occupancy before use. The C-3 code sets a parking ratio for medical and dental clinics by floor area [20]; the site plan translates it into a stall count. A rezoning adds a planning commission hearing and two council readings. The nearby veterans clinic shows how that can go: the commission rejected the rezoning on a split vote in July 2025, the city council approved it in August, and the federal contract followed about a week later [9][10].

Frontage and traffic

Ring Road (KY 3005) is the city's northern bypass, meeting US 31W (N. Dixie Hwy) and KY 251, and the state has an extension to a new I-65 interchange in design [8]. The Kentucky Transportation Cabinet publishes a count map for Elizabethtown, but the station values did not extract, so no Ring Road count is in the file. As a substitute, I-65 carried 48,800 vehicles a day south of KY 222 and 53,700 north, approaching Elizabethtown, in 2022 [7]. That is highway traffic, not the corridor's, and it is a substitute only; a station count for Ring Road at the site is the first traffic condition.

Utilities

Hardin County Water District No. 2 publishes a tariff, issued March 25, 2025, that sets a tap fee of $1,600 for a standard 5/8 by 3/4 inch meter and charges larger meters at actual labor and material cost [22]. Whether the district serves the parcel is a condition to confirm. A clinic with a fire line or irrigation may need more than a standard meter, so $1,600 is a floor. The city's engineering page states a sewer connection fee per business tenant, without a date [23]. Natural gas comes from the city's own municipal utility [24]. Electric service could come from Kentucky Utilities or from Nolin RECC, whose territory is set by the state commission [25]; which serves the parcel is unknown. All of these fees are small beside the site work allowance in the model, and the real exposure is a line that does not reach the parcel.

Property tax, flood and environment

The city publishes a real property rate for tax year 2025, and a second source gives a slightly different figure [26]. The county and the school districts publish their own rates, but a combined rate for any parcel was not found as a single number, and neither was the assessment ratio. The model therefore uses a planning level for property tax and the actual levy is a lender condition. The flood zone for the subject was also not found; the city publishes a flood zone map application that should be read for the parcel. A clinic that handles medical waste and sits among other commercial uses should carry a Phase I environmental assessment regardless.

Labor is the largest cost and the one that does not flex with volume. The model keeps one advanced practice provider on duty for 12 hours a day, every day, at $65.00 an hour before payroll costs, plus a flat supervising physician fee. Behind the provider it staffs 3 support employees each hour at $24.00, because a clinic with an X-ray room needs a technician as well as a medical assistant and a front desk. A manager and 20.0% for payroll taxes and benefits complete the staff. No competitor publishes its staffing, and no Kentucky wage series is in the research, so all of these are planning figures.

The result is a cost base that barely moves between Year 1 and Year 3. Operating costs run $1,365,581 in Year 1 and $1,530,775 in Year 3, while revenue grows from $1,255,600 to $1,941,800. That arithmetic is why the ramp decides the loan: the clinic pays a full week of staff from the first day, and only the variable lines, supplies and billing, move with visits.

Property tax is a planning level of 1.10% of land, building and site cost; the actual levy is a lender condition [26]. Utilities, insurance, software, marketing and repairs are allowances. The model reserves 5.0% of equipment cost each year for replacement of the X-ray unit and analyzers. Net operating income is ($109,981) in Year 1, $229,508 in Year 2 and $411,025 in Year 3.

The loan is tested under SOP 50 10 8.1 with Technical Policy Updates, in force for applications received from October 1, 2026 [28]. A start-up puts in at least 10% of project cost, and its projected coverage must reach 1.15x within two years, which is why Year 2 is the test year here. A single 7(a) loan tops out at $5 million, and the sponsor's 10.0% equity proposal sits well under that line. Because land and building are more than half of the proceeds, the whole loan can run 25 years.

The rate is Prime of 7.00% on the October 9, 2026 H.15 release [30] plus the maximum variable-rate spread SBA allows at this loan size, 10.00% in all. A lender may price lower, and the final rate is set at pricing. SBA guarantees 75.0% of a loan this size [27], and the FY2027 upfront guaranty fee follows the schedule in the program's fee notice [29].

A clinic business is also a going concern, and its value rests on cash flow, not on the building alone. Our hub on urgent care feasibility explains why payer contracts and credentialing, not square footage, set that value. Whether a feasibility study is needed is decided case by case: 13 CFR 120.160(b): SBA may require professional appraisals, a survey, or a feasibility study [31]. On a ground-up medical project with a start-up borrower, a lender may ask for one.

As proposed, coverage is -0.28x in Year 1, 0.57x in the Year 2 test and 1.03x at stabilization. Annual debt service of $398,222 is nearly as large as the clinic's stabilized income, and Year 2 income covers little more than half of it. The proposal fails the test the program applies to a start-up, and the failure does not come from weak demand. It comes from asking a business with a long ramp to carry a mortgage-sized loan on day one.

The engine restructures by raising equity until Year 2 coverage meets the floor. At 54.4% equity, debt service falls to $199,214 and Year 2 coverage reaches 1.15x, rising to 2.06x in Year 3. That is a loan of $1,826,910, a little over half of what the sponsor asked for. It clears the floor by a hair in the test year, so a lender should treat it as the upper bound, not a target.

There are three ways to reach a structure like this, and the lender should ask which one the sponsor intends. The sponsor can bring the cash. The sponsor can lease a building instead of building one, which removes land and construction from the budget and turns them into rent; this case does not model a lease, and a clinic in an existing space would need its own study. Or the sponsor can find evidence that volume ramps faster than the model assumes, such as signed employer contracts or an acquired patient panel. What does not work is the original request.

Contact Feasibility Study Company to test your own clinic site against the coverage floor before the lender does. We do not predict what a lender will decide; we show the lender the work.

The two drivers in this table are the two that decide the Elizabethtown case. Rows move walk-in visits up and down by up to a fifth in every year. Columns move collected revenue per visit across the range shown in the column headers. The table reads Year 2, the test year, on the restructured loan, and its range runs from -1.00x to 3.69x.

The spread is wide because the clinic carries fixed staffing: a change in revenue falls almost entirely on income. At the base revenue per visit, a one-step shortfall in visits takes Year 2 below the floor, and so does a one-step shortfall in collected revenue per visit at base volume. A one-step gain in visits, or in collected revenue per visit, clears it comfortably. Together, a one-step drop in visits and a one-step drop in revenue per visit does not even cover debt service. The practical lesson is that the payer mix and the panel are worth more than the building: a sponsor should spend on credentialing and contracts first.