Case Study · Florida · Urgent Care · SBA 7(a)
Urgent Care Feasibility Study, Florida — An SBA 7(a) Worked Case
This is how our independent feasibility study company and urgent care feasibility consultant team analyzed a new-build freestanding urgent care center underwritten to an SBA 7(a) credit, from trade-area payer mix and net collected revenue through the debt-service coverage a lender must document. It is a representative, anonymized worked example of the methodology — not a specific client deal — set in a growing suburban submarket of a major Florida metro, where a going-concern healthcare business is valued on reimbursement, not footfall.
A de-novo urgent care pad in a growing Florida suburb.
A sponsor came to our feasibility study company with a ground-up freestanding urgent care center and an SBA 7(a) lender that needed the projected cash flow independently tested before it would commit. The subject is a roughly 4,000-square-foot medical building on a hard-corner retail pad, adjacent to a grocery-anchored center on a commercial arterial, in a fast-growing suburban submarket of a major Florida metro. The program is an urgent care clinic with on-site x-ray and an occupational-medicine line, staffed on an advanced-practice model with a physician medical director — a structure Florida permits because nurse practitioners have held full practice authority there since 2020.10
Because an urgent care center is a going-concern healthcare operating business rather than passive real estate, the lender's question is not “what is the dirt worth” but “can this specific site generate the patient volume, payer mix, and net collected revenue to service this specific loan.”1 A second structural fact shapes the whole file: under the corporate practice of medicine, the SBA borrower is a management-services organization tied to a friendly professional corporation, and the lender's collateral is the management contract, equipment, and real estate — not the medical practice or its payer contracts.13 Our scope was the independent demand, payer-mix, competition, and debt-service analysis that supports that credit.
Representative and anonymized. Every figure below is illustrative of a typical engagement of this type; the site, submarket, and parties are composited, not a real named borrower, address, or completed transaction.
Trade-area payer mix and patient volume.
The demand read starts with the trade-area payer mix and patient volume, not footfall past the door. The ten-minute drive time holds roughly 78,000 residents growing about 3 percent a year, and — decisively — the growth suburb skews commercially insured against the Medicare-weighted Florida average.
Revenue is modeled as net collected revenue by payer, not gross charges, because charges, allowed, and collected are three different numbers. The national median net collected revenue per commercial visit was $163.91 for November 2024 through October 2025, ranging from $112.90 to $299.38 across states, while Medicaid and self-pay collect far less.1 Commercial insurers reimburse roughly 150 to 300 percent of Medicare for identical work, so the trade-area payer mix — not population alone — decides viability.6 On this submarket's commercial-leaning composition (about 55 percent commercial, 25 percent Medicare, 12 percent Medicaid, 8 percent self-pay), the blended net collected revenue lands near $168 per visit once on-site x-ray and procedures are included. Volume is a game against a high fixed-cost base: breakeven runs near 25 to 30 patients per day and the UCA median is about 35, so the model carries a stabilized clinic volume near 38 patients per day — a strong-site placement modestly above the median — plus an occupational-medicine line whose workers'-comp and employer business pays more reliably and dampens seasonality.3
| Demand driver | Basis | Supported figure |
|---|---|---|
| Trade-area population (10-min drive) | ~78,000 residents, growing ~3%/yr | Rising commercial-skew base |
| Urgent-care utilization | ~330 visits per 1,000 residents/yr2 | ≈ 25,700 in-area visits/yr |
| Stabilized clinic volume | ~38 patients/day × 360 days (above the ~35/day UCA median)3 | ≈ 13,680 visits/yr |
| Blended net collected revenue/visit | ~55% commercial at ~$164 median; Medicare, Medicaid & self-pay lower16 | ≈ $168/visit incl. ancillary |
| Occupational medicine & employer | Area employer base; workers'-comp reliability | ≈ $0.50M/yr |
Volume and revenue-per-visit logic grounded in Experity net-collected-revenue data and urgent-care utilization economics; see sources 1, 2, 3, and 6. Figures are illustrative of the engagement type.
A growth pocket under-served inside a saturated state.
Florida is a mature, competitive urgent-care state, and the honest read is not an empty market. But the newest rooftops in this master-planned corridor are arriving faster than new clinics, and the existing supply is older and concentrated in the in-town core, not the growth edge where the subject sits.
| Competitor | Type | Scope | Distance | Read |
|---|---|---|---|---|
| Competitor A | Health-system-affiliated UC | X-ray, broad hours | 0.9 mi | Nearest; ED-feeder, commercial-contracted |
| Competitor B | Independent physician-owned UC | X-ray, aging fit-out | 1.7 mi | Established; thin occ-med |
| Competitor C | Retail / pharmacy clinic | NP-only, no imaging | 1.1 mi | Narrow scope; not a full UC substitute |
| Competitor D | National franchise UC | X-ray, occ-med | 2.6 mi | Cross-town, different catchment |
| Competitor E | Freestanding ED (not UC) | Emergency facility fees | 3.2 mi | ~10x visit cost; a different business |
Competitive set surveyed for the engagement; anonymized. A freestanding ED is not an urgent-care comparable — it bills emergency facility fees at roughly ten times an urgent-care visit and must never be benchmarked against one.8
Only two full-scope urgent care centers sit within about 1.7 miles, and the nearer retail clinic is a narrow, imaging-free, nurse-practitioner-only format rather than a true substitute for a clinic with on-site x-ray, extended hours, and an occupational-medicine program. A rigorous study does not stop at the standing set: because Florida largely repealed certificate of need and does not gate urgent care, supply is market-driven, so the analysis scans announced and permitted clinics as well.11 The read here is a genuinely under-served growth pocket — rooftop growth on the master-planned edge is outpacing new clinic openings, and the subject fills the gap rather than splitting a saturated in-town trade area. That easy-entry backdrop is also the risk, which is why the model leans on trade-area capture and payer mix rather than any regulatory moat.
Florida macro: easy entry, expensive cover.
The state backdrop is a mixed one for a de-novo urgent care: fast entry and a favorable labor regime, offset by the nation's most expensive property insurance and a mature, Medicare-weighted statewide market. A defensible Florida study is built to those specifics, not to national defaults.
Florida largely repealed certificate of need for general hospitals in 2019 and for specialty hospitals in 2021, and ambulatory surgery and urgent care are not CON-gated, so supply is set by the market rather than a permit gate — quick to enter, but with elevated saturation risk and no regulatory protection for an incumbent.11 On the labor line, Florida's grant of full practice authority to nurse practitioners since 2020 makes an advanced-practice staffing model legal and materially cheaper than in scope-restrictive states, though a friendly-professional-corporation structure under the corporate practice of medicine is still required.1013
The offsetting reality is cost of cover. Florida property insurance runs roughly 2.8 times the U.S. average, premiums rose about 49.5 percent from 2020 to 2025, and commercial named-storm deductibles of 2 to 10 percent of insured value must be modeled as first-dollar risk on current Florida carrier quotes — a real drag on the net operating income of an owned building that a national assumption would understate.12 The financing channel, by contrast, is deep: Florida is a top-three SBA state by 7(a) volume, served by two district offices spanning 67 counties, with Live Oak Bank the number-one national 7(a) lender in fiscal 2025 and 504 credits routing through statewide Certified Development Companies.14 Seasonal in-migration adds first-quarter volume that aligns with respiratory season, reinforcing the case for reserving against the summer trough rather than annualizing the peak.
Why the payer mix, and the pad, support the volume.
Household income, commercial-insurance penetration, daytime employment, and rooftop growth all point the same direction, and the pad's visibility and access convert that demand into visits.
The ten-minute-drive trade area carries a median household income near $82,000 and a younger, family-heavy profile than the Florida retiree coast, which is what lifts the commercial share of the payer mix toward 55 percent — the single most important revenue input, because commercial visits pay two to four times Medicaid or self-pay for identical work.6 Growth near 3 percent a year means trailing Census counts understate the captive base, a common exurban distortion a careful study corrects for rather than extrapolates.
Site geometry does the rest. The subject occupies a hard-corner retail pad with high visibility and signalized access on a commercial arterial, next to a grocery anchor that generates its own convenience traffic. A daytime employment base of logistics, retail, and light-industrial employers supports the occupational-medicine line that stabilizes both seasonality and payer-mix risk, and the combination of on-site x-ray, extended hours, and a full clinical scope differentiates the subject from the imaging-free retail clinic and the aging independent nearby. That is why the model credits the subject with a strong-site volume placement rather than an average one.
The SBA 7(a) structure.
Total project cost lands at $4.50 million. The 7(a) program can finance the business, the build-out, the equipment, and working capital in a single loan, which is why an owner-occupied, de-novo urgent care routes here rather than to a fixed-asset-only 504.
| Cost component | Amount |
|---|---|
| Land (~1.1-acre retail pad) | $0.80M |
| Site work, utilities & parking | $0.45M |
| Building shell & core (4,000 sf medical) | $1.35M |
| Medical FF&E, x-ray & shielding, EMR/IT | $0.80M |
| Soft costs, design, permits & contingency | $0.45M |
| SBA-financed working capital & guaranty fee | $0.30M |
| Financing & closing costs | $0.35M |
| Total project cost | $4.50M |
| Item | Figure |
|---|---|
| SBA 7(a) loan (90%) | $4.05M |
| Borrower equity injection (10%) | $0.45M |
| Sponsor credentialing & ramp reserve (additional) | $0.50M |
| Total sponsor cash at risk | ≈ $0.95M |
| Term / amortization | 10-year term / 25-year amortization (blended) |
| Illustrative rate | ~10.25% (Prime + ~2.75%) |
| Annual debt service (amortizing) | ≈ $450k |
Structure per SBA 7(a) conventions under SOP 50 10 8; owner-occupancy 60% for new construction; single-loan 7(a) cap $5M. See sources 13 and 14.
The project is financed at 90 percent, a $4.05 million 7(a) loan against a 10 percent equity injection, and the loan sits comfortably under the $5 million single-loan 7(a) ceiling, so the structure works within one facility.13 One item does the most work, and it is the one SBA sizing most often gets wrong: the credentialing-and-ramp reserve. Because a de-novo center cannot bill commercial payers for 90 to 120 days — and some Medicaid programs for 180 to 270 — the sponsor funds an additional reserve of about $0.50 million beyond the SBA working-capital line, bringing total cash at risk to roughly $0.95 million.45 On a 25-year amortization at an illustrative 10.25 percent (Prime plus 2.75), annual debt service is about $450,000 — the number the projected coverage has to clear. The study exists to support exactly that: the debt-service coverage the lender must document, tested against an independent read of net collected revenue rather than the sponsor's own projection.
Feasible and bankable, on coverage the credit can document.
The stabilized model builds net collected revenue from two engines — patient services and occupational medicine — nets a high fixed-cost base, and carries coverage through a graded de-novo ramp to the healthcare convention and beyond.
| Line | Basis | Amount |
|---|---|---|
| Net patient service revenue | ~13,680 visits (≈38/day × 360) × ~$168 blended net collected/visit1 | ≈ $2.30M |
| Occupational medicine & employer | Employer contracts & workers'-comp; seasonality diversifier | ≈ $0.50M |
| Total net revenue | Patient service + occupational medicine | ≈ $2.80M |
| Provider & clinical labor | MD medical director, APP providers, MAs & front office | ≈ ($1.31M) |
| Supplies, occupancy, RCM, marketing & G&A | Drugs/supplies, owned-building occupancy (incl. FL wind insurance), billing/malpractice, marketing, EMR/IT12 | ≈ ($0.82M) |
| Net operating income (NOI) | Net revenue less operating expense; ~24% margin7 | ≈ $0.675M |
Modeled on net collected revenue by payer, not gross charges; the ~24% margin sits at the strong end of the 15–25% mature single-site range, lifted by owned real estate (no rent) and the occupational-medicine line. See sources 1, 6, 7, and 12.
| Year | Stage | NOI | Debt-service basis | DSCR |
|---|---|---|---|---|
| Year 1 | Credentialing & ramp (interest-only bridge) | ~$0.42M5 | Interest-only ~$0.42M | ≈1.00 |
| Year 2 | Building | ~$0.56M | Full amortizing ~$0.45M | 1.25 |
| Year 3 | Stabilized | ~$0.675M | Full amortizing ~$0.45M | 1.50 |
DSCR computed as NOI divided by the period debt-service obligation. Year 1 coverage is measured on the interest-only bridge; during the 90–120+ day credentialing gap the center is cash-flow negative, and the sponsor's capitalized credentialing-and-ramp reserve funds the operating shortfall until providers are enrolled and volume builds toward 30+ patients/day. See source 5.
The stabilized 1.50x coverage is the figure the lender documents, and it clears the roughly 1.25x coverage convention specialty-healthcare lenders apply with real headroom. By Year 2 the project already covers fully amortizing debt service at 1.25x. The Year 1 figure near 1.00x is intentional — it is the credentialing-and-ramp year — which is exactly why the structure carries an interest-only bridge and the additional reserve: the center cannot bill commercial payers for the first 90 to 120 days, months one through six are cash-flow negative, and the reserve funds that gap while volume builds toward 30-plus patients per day.5 Modeling mature volume in Year 1, gross charges instead of net collected revenue, or a commercial-heavy mix the trade area cannot support are the most common ways these pro formas fail review; here the ramp is deliberately graded and stressed 30 to 40 percent below the sponsor's assumption on a seasonality-adjusted monthly basis.3
On the equity side, the roughly $0.95 million of sponsor cash at risk earns growing levered free cash flow — nominal in the interest-only ramp year, building to about $185,000 a year once stabilized and net of a medical-equipment capital reserve, a cash-on-cash yield near 19 percent. The exit is valued on a going-concern basis, not a single leased-fee cap rate: an urgent care is an owner-operated business, so the analysis values it as a sum of parts — the operating business at roughly 1.0 times stabilized net revenue, consistent with the 0.55 to 1.1 times revenue single-site range, plus the owned real estate at a net-lease medical value near a 7 percent cap.89 That implies a gross going-concern value near $5.5 million in Year 10 and, after selling costs and the roughly $3.5 million outstanding SBA balance, about $1.8 million of net equity. Holding margins roughly flat rather than assuming platform-like scaling, the blended result is an illustrative levered equity IRR of about 20 percent over a 10-year hold.
Verdict: financially feasible and bankable. On independently derived net collected revenue, a stabilized 1.50x DSCR, and a ~20% levered equity IRR, the projections support the SBA 7(a) credit.
Net collected revenue, a graded ramp, and DSCR stress.
The engagement was scoped the way a credit committee reads it. As an independent feasibility consultant, our role is to test the sponsor's projection against the market, not to restate it — the value of the deliverable is precisely that it carries no stake in the outcome. We modeled net collected revenue by payer rather than gross charges, verified the trade-area payer mix against the commercial share the site can actually support, and graded the patients-per-day ramp on a seasonality-adjusted monthly basis, stressed 30 to 40 percent below the operator's own assumption.13
The credentialing gap was treated as a mandatory gating item: the working-capital reserve is sized to bridge the 90-to-120-day commercial credentialing window, and the corporate-practice structure was checked so the collateral is correctly identified as the management-services organization's contract, equipment, and real estate rather than the professional corporation's payer contracts.513 The coverage was then stress-tested against volume and reimbursement downside — the two variables an urgent care is most exposed to — to confirm the credit still holds if PPD or payer mix compress. One scope boundary is worth stating plainly: as the feasibility consultant, we reference, but do not perform, the Phase I environmental site assessment, which a de-novo medical build still warrants for medical-waste handling, x-ray shielding, and prior site use.
Representative engagement
This is an anonymized, illustrative worked example of our methodology, built on market data current to 2026; figures are representative of a typical engagement of this type and do not depict a specific client, site, or completed transaction.
Underwriting a Florida urgent care for an SBA loan? Start with the payer mix and the feasibility study.
Feasibility Study Company prepares independent urgent care feasibility studies for SBA 7(a) and 504 credits, built to the coverage standard your lender must document. A methodology briefing walks through the payer-mix demand, credentialing, ramp, and DSCR analysis behind a case like this one, calibrated to your Florida submarket and clinical model.
Request a methodology briefingData sources and dates.
The deal figures are illustrative of the engagement type; the market data that grounds each dimension is real and sourced, drawn from our standing Florida, Urgent Care & Freestanding ED, and SBA 7(a) & 504 analyses and the primary authorities they cite.
- Journal of Urgent Care Medicine, “Commercial Reimbursement in Urgent Care” (Experity EMR analysis of 17,410,492 commercially insured visits): national median net collected revenue per commercial visit of $163.91 for November 2024–October 2025, ranging $112.90–$299.38 by state (bottom quartile $130.30, top quartile $221.72); collected revenue on commercial claims only, distinct from gross charges and allowed amounts.
- IBISWorld, “Urgent Care Centers in the US” (2025): industry revenue of $44.3 billion in 2025, profit near 14.9% of revenue, and a fragmented field with no company above 5% share; center count roughly 14,097 as of May 2024 (Journal of Urgent Care Medicine / National Urgent Care Realty / Experity). Trade-area utilization is directional and must be verified locally.
- Urgent Care Association and Experity: breakeven commonly cited near 25 visits/day (12–23 depending on cost structure), with a UCA median of 35 patients/day; a well-located de-novo reaches cash-flow breakeven in 12–18 months only above ~30 PPD, and ramp assumptions are commonly 30–40% too optimistic on a seasonality-adjusted basis.
- Urgent Care Consultants (2026): build-out of roughly $600,000+ for a 3,000–4,000 sq ft center (plus $25,000–$50,000 x-ray shielding), total capital of $1.4 million+, and a working-capital reserve of $300,000–$500,000+ beyond build-out and equipment sized to bridge the credentialing and ramp gap.
- Medallion, 2026 State of Payer Enrollment (via Hospitalogy, May 2026), with NGA Healthcare, Medwave, RCMAXIS and TrueCare RCM (2026): credentialing and enrollment run 90–120 days for commercial payers (120–150+ for new practices), 60–90 days for Medicare (PECOS), and up to 180–270 days for some Medicaid programs; 69% of health systems lose $1,000–$5,000 per provider per day from enrollment delays, and many payers disallow retroactive billing.
- Vizient and PayerPrice (2025–2026): commercial reimbursement roughly 150–300% of Medicare (~230% on average), Medicaid roughly 50–70% of Medicare, and self-pay collections 20–30% of billed charges or less, producing a 2–4x revenue-per-visit spread by payer for identical work; UCAOA benchmark payer mix near 67% commercial / 17% Medicare and Medicaid / 12% self-pay, against a CT Acquisitions (2026) target of commercial above 50%.
- LBMC and FOCUS Investment Banking (2025): mature single-site EBITDA margins of 15–25% (best-in-class above 25%); Concentra reported a 20.9% adjusted EBITDA margin year-to-date through the third quarter of 2024.
- Scope Research (2025) and CT Acquisitions citing FOCUS Investment Banking (April 2025): single-site centers trade at roughly 0.55–1.1x revenue or ~3x seller's discretionary earnings, multi-site groups near 3.5x EBITDA, and premium scale or occupational-medicine platforms at 9–16x EBITDA (the Concentra/Nova Medical Centers deal at 9.4x EBITDA / 2.0x revenue); urgent care and freestanding EDs are distinct businesses, the FSED billing emergency facility fees at roughly ten times an urgent-care visit.
- The Boulder Group, Net Lease Medical Report: urgent care net-lease cap rates around 7.25% in 2019 within a net-lease medical sector then near 6.45%, with cap rates rising across net lease for nine-plus consecutive quarters into 2024; owned or net-leased real estate is valued separately from the operating business.
- American Association of Nurse Practitioners (September 2025): 27 states plus DC grant nurse practitioners full practice authority; Florida has had NP full practice authority since 2020, permitting an advanced-practice staffing model with a physician medical director.
- National Conference of State Legislatures (updated through 2025): certificate-of-need programs active in 35 states plus DC; Florida largely repealed CON for general hospitals in 2019 (HB 21) and for specialty hospitals in 2021, and ambulatory surgery centers and urgent care are not CON-gated, so Florida urgent-care supply is market-driven.
- Florida property-insurance data as compiled in the firm's Florida market analysis: Florida home insurance runs roughly 2.8x the U.S. average with premiums up about 49.5% from 2020 to 2025; commercial named-storm deductibles of 2–10% of insured value are modeled as first-dollar risk on current Florida carrier quotes, following stabilization after SB 2-A (signed December 16, 2022).
- U.S. Small Business Administration, SOP 50 10 8 (effective June 1, 2025) and 13 CFR 120.160(b): a feasibility study is discretionary but expected for special-purpose and ground-up projects; owner-occupancy of 51% (existing) or 60% (new construction); 7(a) finances the business, build-out, equipment, and working capital in one loan up to $5 million; corporate practice of medicine requires a management-services-organization / friendly-professional-corporation structure, and the lender's collateral is the management contract, equipment, and real estate, not the medical practice or its payer contracts.
- U.S. Small Business Administration Florida district structure as compiled in the firm's Florida market analysis: Florida is a top-three SBA state by 7(a) volume, served by two district offices (South Florida / Miami, 24 counties, and North Florida / Jacksonville, 43 counties); Live Oak Bank was the number-one national SBA 7(a) lender by dollar volume in fiscal 2025; 504 credits route through statewide Certified Development Companies including Florida First Capital Finance and the Florida Business Development Corporation.