SPARK Senior Health · Investment Book · Stage 3 of 6
Financial Model
Revenue architecture, 10-clinic P&L, capital structure & investor returns
§3.1
Reimbursement Schedule
2026 CMS MPFS rates · HPSA bonus · blended PMPM
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§3.2
Member Ramp
18-month per-clinic ramp · 10-clinic portfolio
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§3.3
Expense Model
Per-clinic ops · MSO overhead · tech stack
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§3.4
5-Year P&L
Revenue · expenses · EBITDA · net income
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§3.5
Capital Structure
$2.5M raise · tranches · deployment timeline
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§3.6
Investor ROI
Returns · exit scenarios · MOIC analysis
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Scenario
25% pen · 18-mo ramp
Seed Raise
$2.5M Safe / Note
Portfolio PMPM
~$239 (base)
5-Yr Net Revenue
~$25M (Y5)
↓Begin
Stage 3 · Financial Model · Section 3.1
Revenue Model — Reimbursement Schedule
2026 CMS MPFS rates at NP 85% billing factor · 10% HPSA bonus on professional services · Duals segmented into FFS-accessible tiers · D-SNP excluded Year 1–2.
§ 3.1CMS MPFS 2026 · CF $33.40
GA Locality 03 · NP 85%
HPSA ×1.10 on E&M/AWV/TOC
✓ Tier 1 — Standard FFS
FFS Medicare Only
Full 2026 MPFS rates. Bill Medicare 80% + patient owes 20% coinsurance. No write-offs. Highest net revenue per visit.
PMPM: ~$239 blended (base)
✓ Tier 2 — SLMB Duals
SLMB Members
Medicaid pays Part B premium only. Patients owe full coinsurance same as Tier 1. Bill identically to standard FFS. No write-off required.
PMPM: Same as Tier 1
✓ Tier 3 — QMB Duals
QMB Members (~30% of panel)
Federal law: write off 20% coinsurance on visits/ancillary entirely. CCM/APCM/RPM unaffected — no patient cost-sharing on these codes. Higher complex CCM mix (avg 4+ chronic conditions).
Write-off: visit/Dx only · CCM/RPM = full rate
✗ Tier 4 — D-SNP · Phase 3+
D-SNP Duals
Enrolled in MA D-SNP plan. Require individual plan contracts — not accessible via direct CMS billing. Excluded from Year 1–2 model. NE GA HMO penetration is <4% — D-SNP volume is very small.
Excluded · Phase 3+ plan contracting
Visit & Professional Revenue — 2026 HPSA-Adjusted Rates
NP 85% × HPSA 1.10 · billed under supervising MD NPI · Novitas J-6 MAC
G0438 · AWV Initial
Per member per year · first year · attribution anchor
~$162
G0439 · AWV Subsequent
Annual · care plan update
~$109
G2211 · Longitudinal Add-On
Appended to qualifying E&M / AWV · 70% of visits
~$15
99212/99213 · E&M Established (level 2/3)
Most common visit type · chronic f/u
~$53 / ~$91
99214 / 99215 · E&M Established (level 4/5)
Complex chronic management
~$134 / ~$181
99203 / 99204 · E&M New Patient
First visit · new patient intake + AWV same day
~$125 / ~$184
99495 · TOC Moderate (14-day)
Post-discharge follow-up · HPSA bonus applied
~$178
99496 · TOC High (7-day)
High complexity discharge · requires face-to-face
~$239
Visit ramp: 4.0 visits/member/yr in clinic Year 1 → linear ramp months 13–24 → 6.5 visits/member/yr by clinic Year 2 steady state. Each clinic runs its own ramp clock independently.
Care Management — APCM & CCM 2026 Rates
No HPSA bonus on care management codes · billed to Medicare only · no patient cost-sharing
G0558 · APCM QMB/Dual 2+ chronic
~30% of panel · 80% enroll · 92% billing success
~$91/mo
G0557 · APCM Standard FFS 2+ chronic
~15% of panel · 75% enroll · 92% success
~$41/mo
G0556 · APCM Low acuity 0–1 chronic
~8% of panel · 60% enroll · 95% success
~$13/mo
99490 · CCM non-complex ≥20 min
55% of CCM panel · ~45% of panel total
~$56/mo
99487 · CCM complex ≥60 min
35% of CCM panel · 82% billing success
~$123/mo
99439 · CCM add-on 20 min
No monthly limit on units
~$43/mo
RPM — 2026 Codes & COGS
Tenovi 4G cellular · $55 device COGS/enrolled/mo · 88% 16-day threshold success
99454 · Device supply 16+ days
85% of enrolled hit 16-day threshold
~$41/mo
99445 · Device supply 2–15 days (NEW 2026)
15% of enrolled — partial month coverage
~$22/mo
99457 · Treatment mgmt first 20 min
88% of enrolled · interactive communication required
~$44/mo
99458 · Treatment mgmt add-on 20 min
40% of enrolled · no monthly limit
~$35/mo
COGS deducted: $55/enrolled RPM member/month (Tenovi device + 4G data). Deducted directly against RPM gross revenue in model. Net RPM after COGS: ~$27/enrolled/month at full maturity.
Blended PMPM Architecture
Revenue per enrolled member per month at full enrollment maturity. Base scenario: 25% FFS penetration, 18-month ramp, base PMPM ceiling ~$239 engine-computed post-HPSA. A 2.5% claim denial write-off is applied to gross portfolio revenue. HPSA 10% bonus is embedded in E&M/AWV/TOC rates above — not added separately.
~$126
E&M Visits
(6.5/yr at M24+)
~$62
CCM / APCM blend
(recurring monthly)
~$14
RPM net
(after $55 COGS)
~$239
Blended PMPM
Base scenario terminal
Stage 3 · Financial Model · Section 3.2
Member Ramp — 18-Month Per-Clinic Ramp · 10-Clinic Portfolio
Conservative 18-month ramp per clinic from first patient to full panel (1,000 cap). Each clinic runs its own independent ramp clock. Portfolio grows as new clinics open per the 3-year expansion sequence.
§ 3.218-month ramp · 25% pen
1,000 member cap/clinic
10 clinics · Y1–Y3
Per-Clinic Enrollment Phase Milestones
Month 1 → 18 per clinic · independent clock · transport enables faster ramp vs mobile model
Pre-Launch · Months −3 to 0
0 members · formation & buildout
Lease execution, ADA buildout, PECOS enrollment (90-day lead), staff hire sequence, EHR go-live, community partner outreach to churches and senior centers.
Revenue: $0 · Capital draw phase
Pilot · Months 1–6
First visits → CCM enrollment begins
AWV at first visit establishes attribution. CCM consent + care plan within 30 days. RPM devices provisioned. First CMS claims submitted ~Month 1–2. First CMS payments arrive 30–45 day lag. Transport van in daily operation.
Revenue ramp: $0 → $15K–$25K/mo
Scale · Months 7–12
CCM/APCM/RPM enrollment accelerates
Care coordinator adds panel management capacity. APCM and CCM enrollment stabilizes at 80–90% of eligible members. RPM threshold compliance at 88%. HPSA bonus paid quarterly. Second NP hiring initiated if panel exceeds 550.
Revenue ramp: $25K → $90K+/mo · clinic-level EBITDA positive ~Mo 8
Maturity · Months 13–18
Full panel · ~950–1,000 members
Visit rate ramps from 4.0 to 6.5/member/yr. PMPM reaches ceiling (~$239 base at M24+). E&M, CCM, APCM, RPM all at steady state. Ancillary revenue fully phased in (POCUS, spirometry at M6). Second NP at 650+ members.
Terminal revenue: ~$226K/mo at M24 · ~$2.7M/yr annual run rate
Portfolio Enrollment Trajectory
10 clinics · 25% FFS penetration · 18-month ramp per clinic · 1,000 member cap
Year
Active Clinics
Members (EOP)
Net Revenue
Y1
3 (Habersham, Lumpkin, Stephens)
~1,533 (ramp phase)
~$1.44M
Y2
6 (+White, Rabun, Union)
~4,401
~$7.78M
Y3
10 (+Fannin, Gilmer, Gordon, Chattooga)
~7,438
~$16.05M
Y4–5
10 (steady state · no new clinics)
~8,809 (full maturity)
~$23–25M
Per-Clinic Terminal Economics (Base)
At full enrollment maturity · ~950 members · ~Month 18 of clinic life
Enrolled members (near 1,000 cap)~950
Monthly net revenue~$226K
Annual run rate~$2.7M/yr
Terminal PMPM~$239
Clinic-level EBITDA breakeven~Month 8 of clinic life
Per-clinic ops (annual)$157,218/yr
Annual CMS savings documented~$7.98M/yr (at 950 members)
Enrollment Mix at Terminal State (Per Clinic)
~950 members · base scenario · APCM/CCM/RPM program enrollees
G0558 APCM enrolled
~228 QMB/Dual members · ~$91/mo · $20.7K/mo
CCM enrolled (99490/99487)
~299 members · ~$56–123/mo · $22–37K/mo
G0557/G0556 APCM enrolled
~151 members · $41/13 per mo · $6.2K/mo
RPM enrolled
~390 members · ~$27 net/mo · $10.5K/mo
Stage 3 · Financial Model · Section 3.3
Expense Structure — Clinic + MSO + Tech
Three cost layers: per-clinic operations (stage-driven clinical staff + fixed clinic ops), MSO overhead (central leadership + operations), and dynamic tech stack (scales with clinics, members, providers, and revenue).
§ 3.3Per-clinic ops: $157,218/yr
Driver: $56,250 loaded
MSO Y1: $1,572K total
Per-Clinic Operating Costs
$157,218/yr per active clinic · excludes clinical staff & driver
Clinic lease (~2,200 sq ft)$30K–$45K/yr
Malpractice insurance$12,000/yr
Supplies + consumables (exam, lab)$24,000/yr
Utilities + internet (fiber $400/mo)$9,600/yr
Biohazard hauler ($90/mo) + MoCA$1,218/yr
Other recurring clinic ops~$35K/yr
Total$157,218/yr
Driver (1 per active clinic)
Base salary$45,000
Benefits ×1.25 loaded$56,250/yr
GAAP depreciation note: CapEx is funded from raise tranches and not in Total. Model uses simplified D&A proxies ($500/clinic/mo equipment + $650/clinic/mo vehicle) = $13,800/yr vs GAAP ~$25,700/yr. CPA validation recommended.
MSO and Clinical Overhead — Annual
Central leadership + clinical ops · all salaries ×1.25 benefits · year-over-year totals
Clinic
Y1 Total Clinic~$1,102,000
Y2 Total Clinic~$3,437,000
Y3–Y5 Total Clinic (steady state)~$6,150,000
MSO
Y1 MSO Operations (fully itemized)$171,500
Y1 Total MSO (Staff + Ops)$1,571,500
Y2 Total MSO~$2,691,188
Y3–Y5 Total MSO (steady state)~$3,425,079
Tech Stack Cost — Dynamic Scaling
Scales with providers · enrolled members · revenue · clinics · staff
Provider-based ($850/provider/mo)
EHR (Athelas AIR / Athenahealth)$750/provider/mo
Commure Ambient AI documentation$100/provider/mo
Member + Revenue-based
Chronic Care IQ (CCM/APCM platform)$6/enrolled/mo
Commure RCM (revenue cycle)4% of net collections
Clinic-based
Fiber + cellular LTE failover$400/clinic/mo
Klara + Doxy.me + Samsara~$575/clinic/mo
Bamboo PatientPing (flat portfolio)$1,500/mo flat
Compliancy Group (flat)$400/mo flat
Rippling + Proton + Notion (per staff)~$34/employee/mo
Tenovi RPM in COGS, not OpEx. Device cost ($55/enrolled/mo) is deducted directly against RPM gross revenue — not double-charged in the tech stack line. Looker Studio analytics = $0.
Cost Structure — Composition at Scale
Labor is the dominant cost at scale (~55–65% of OpEx). The critical structural advantage: CCM/APCM/RPM revenue scales with enrolled members while care coordinator capacity (300–600 members/FTE) keeps labor growth sublinear. Each incremental member adds ~$239 revenue but only marginal additional staff cost — creating powerful operating leverage as the panel deepens.
~60%
Clinical + MSO
labor (loaded)
~15%
Tech stack
(dynamic)
~18%
Clinic ops
+ COGS
~7%
G&A /
insurance / other
Stage 3 · Financial Model · Section 3.4
5-Year P&L — Annual Portfolio Summary
10-clinic portfolio · base scenario · 25% FFS penetration · 18-month ramp · base PMPM ceiling. Revenue, EBITDA, and net income across Years 1–5. CPA validation required before investor distribution.
§ 3.4Base scenario · SPARK Senior Health v3k
25% pen · 18-mo ramp
All figures estimated
5-Year Portfolio P&L — Base Scenario
25% penetration · 18-month ramp · PMPM ceiling $239 · 10 clinics Y1–Y3 · all figures estimated
See financial model for live calculations
Line Item Year 1 Year 2 Year 3 Year 4 Year 5
OPERATING CONTEXT
Active clinics (EOP)36101010
Total enrolled members (EOP)~1,533~4,401~7,438~9,500~9,500
REVENUE
E&M visits (HPSA-adjusted · 4.0→6.5/yr ramp)~$595K~$3.54M~$7.89M~$11.81M~$13.26M
Annual Wellness Visit (G0438/G0439 + G2211)~$189K~$746K~$1.35M~$1.78M~$1.83M
APCM G0558 (QMB/Dual · ~$91/mo enrolled)~$216K~$1.06M~$2.03M~$2.83M~$2.94M
CCM (99490/99487 · 82% success · 55/35 mix)~$215K~$1.06M~$2.02M~$2.82M~$2.93M
APCM G0557/G0556 (standard + low acuity)~$52K~$255K~$487K~$679K~$705K
TOC + other (5%/yr hospitalization rate)~$11K~$54K~$104K~$146K~$152K
Subtotal Membership Revenue~$1.28M~$6.71M~$13.88M~$20.06M~$21.82M
RPM gross (99454/99445/99457/99458)~$206K~$1.28M~$2.58M~$3.75M~$3.97M
RPM device COGS (Tenovi $55/enrolled/mo)~($127K)~($788K)~($1.59M)~($2.32M)~($2.45M)
Lab (i-STAT POC) + ancillary gross~$212K~$1.39M~$2.84M~$4.18M~$4.44M
Lab / vaccine / supply COGS~($88K)~($577K)~($1.18M)~($1.74M)~($1.85M)
Claim denial write-off (2.5% gross)~($42K)~($234K)~($483K)~($700K)~($756K)
TOTAL NET REVENUE~$1.44M~$7.78M~$16.05M~$23.23M~$25.18M
OPERATING EXPENSES
MSO Staff (CEO/CGO/COO/CIO/billing + additions)~($1.40M)~($2.38M)~($2.99M)~($2.99M)~($2.99M)
MSO Operations (office · mktg · IT · legal · compliance)~($172K)~($309K)~($434K)~($434K)~($434K)
Per-clinic clinical staff + driver (stage-driven)~($709K)~($2.52M)~($4.66M)~($5.90M)~($5.97M)
Per-clinic operations (lease · supplies · malpractice · utils)~($393K)~($917K)~($1.49M)~($1.57M)~($1.57M)
Tech stack (EHR · CCM platform · RCM · connectivity · HR)~($169K)~($638K)~($1.22M)~($1.66M)~($1.75M)
TOTAL OPERATING EXPENSES (before D&A)~($2.84M)~($6.76M)~($10.79M)~($12.55M)~($12.72M)
EBITDA~($1.41M)~$1.01M~$5.26M~$10.68M~$12.46M
D&A (clinic equip $500/mo + transport $650/mo per clinic)~($35K)~($81K)~($131K)~($138K)~($138K)
Interest on debt (7% on outstanding)~($165K)~($389K)~($774K)~($774K)~($774K)
NET INCOME (pre-tax)~($1.60M)~$308K~$3.44M~$7.72M~$9.12M
~Mo 8
Single-clinic EBITDA breakeven (Clinic 1, Habersham — from first patient)
~Y2
Portfolio-level EBITDA positive — approaching breakeven mid-Year 2 with 6 active clinics
~33%
Y3 EBITDA margin — all 10 clinics active; recurring revenue model driving strong operating leverage
Stage 3 · Financial Model · Section 3.5
Capital Structure — Seed · Series A · Self-Sustaining
Three-tranche capital structure sized to the 10-clinic expansion plan. Seed funds Years 1 clinics and MSO. Series A (M13) bridges to portfolio profitability. Year 3 is self-sustaining — funded from Y2 operating cash flow with no external raise required.
§ 3.5Seed: $2.5M Safe/Note · M1
Series A: $1.2M · M13
Self-sustaining · M25
Seed Round — $2,500,000
Month 1 · Safe or convertible note
Raise received$2.5M
CapEx deployed (clinic buildouts · equipment · vehicles)($0.6M)
Operating shortfall (loss months only)($1.6M)
Operating surplus (profitable months)—
Implied working capital buffer$0.3M
Cumulative cash balance at year-end$0.3M
Series A — $1,200,000
Month 13 · Priced equity · trigger: WC buffer ≤ $1M
Raise received$1.2M
CapEx deployed (clinic buildouts · equipment · vehicles)($0.6M)
Operating shortfall (loss months only)($0.6M)
Operating surplus (profitable months)$0.9M
Implied working capital buffer$0.0M
Cumulative cash balance at year-end$1.2M
Self Sustaining
Month 25 · No external raise required · portfolio funds expansion from operating cash flow
Raise received—
CapEx deployed (clinic buildouts · equipment · vehicles)($0.8M)
Operating shortfall (loss months only)—
Operating surplus (profitable months)$3.4M
Implied working capital buffer($0.8M)
Cumulative cash balance at year-end$3.8M
Cash Flow Milestones
M0 → first sustainable revenue · CMS 30–45 day payment lag
M0–M2
Formation
Entity · PECOS · buildout · staff hire
Capital draw
M3–M5
Launch
First visits · first claims · CMS lag
$0 → $15K/mo
M6–M12
Ramp
CCM/RPM enrolled · HPSA bonus
$15K → $90K/mo
M13+
Scale
3 clinics mature · Series A · C4–C6
Portfolio breakeven
Illustrative Cap Table at Series A
Safe or convertible note converts at Series A · investors hold equity in MSO only
Founders
~70%
Seed Safe or Convertible Note Investors
~20%
ESOP (Options Pool)
~10%
Non-Dilutive Pathway — CMMI Innovation Award
At 400 enrolled members · $3.36M documented CMS savings · Making Care Primary or ACCESS initiative
At 400 enrolled members with documented outcomes, SPARK Senior Health demonstrates $3.36M/year in CMS savings ($8,400 × 400). This qualifies for a CMMI Innovation Award application — converting demonstrated savings into non-dilutive expansion capital. Application window: Month 18–24 post-launch. The CMMI pathway is a structural advantage of the fixed-clinic model: documented chronic disease outcomes (HTN control, HbA1c, readmission rates) are the evidence base CMS needs. CMMI funding further strengthens the self-sustaining Year 3 thesis.
Stage 3 · Financial Model · Section 3.6
Investor ROI — Scenarios, CMS Value & Exit Paths
Three return scenarios across portfolio scale assumptions · CMS savings ROI for CMMI documentation · exit pathways and likely acquirers. The dual ROI narrative: investor returns and federal savings are the same outcome.
§ 3.6EBITDA multiple basis
Revenue multiple basis
CMMI savings model
⚠ Conservative Case
Slower Ramp
18-month ramp · 3 clinics Year 1 only · no CMMI
1–2× by Yr 5
  • 3 clinics, slower enrollment velocity
  • ~1,533 members · PMPM ~$200
  • No Series A by Y2 → 3-clinic portfolio
  • EBITDA ~$800K Y5 (3 clinics)
  • Exit ~$3.5–5M · Seed 20% = ~$0.7–1M
  • Valuation: 4–5× EBITDA
✓ Base Case
Planned
25% pen · 18-mo ramp · 10 clinics · no CMMI modeled
4–5× by Yr 5
  • ~9,500 enrolled at Y4/Y5 maturity
  • ~$239 blended PMPM (base ceiling)
  • EBITDA ~$12.5M Y5
  • Exit ~$50–63M · Seed 20% = ~$10–12.5M
  • Valuation: 4–5× EBITDA or 1.2× revenue
  • Self-sustaining in Year 3
★ Growth Case
Accelerated
35% pen · 12-mo ramp · CMMI funding · +15% enrollment
10–12× by Yr 5
  • ~13,300 enrolled at maturity
  • ~$275 PMPM (growth ceiling)
  • CMMI award M18–24 non-dilutive
  • EBITDA ~$24–25M Y5
  • Exit ~$120–150M · Seed 20% = ~$24–30M
  • Valuation: 5–6× EBITDA
💰 CMS / CMMI ROI
Federal Value
CMS savings at scale vs. total revenue paid to Spark
4–6× CMS saves per $1 paid
  • 400 members → $3.36M savings/yr
  • Spark billed CMS ~$1.4M → +$1.9M net
  • 9,500 members → $79.8M savings/yr
  • Spark billed ~$25.2M (Y5) → +$54.6M net
  • 10-yr cumulative: ~$798M federal savings
  • CMMI case: strongest in rural primary care
Exit Pathways — Year 5–7
Valuation basis · most likely acquirers
Strategic Acquisition
NGHS, Wellstar, Piedmont, Navicent, or regional ACO acquires for rural reach + CMS attribution (9,500 members) + HPSA-county compliance moat + CMMI track record.
$50–75M · 4–6× EBITDA ($12.5M base)
CMMI Scale Contract
CMMI Innovation Award converts to multi-year performance contract at 400+ members. Expansion capital becomes federal funding. Non-dilutive and non-exit — but changes the growth trajectory permanently.
Non-dilutive · $2–10M/yr · Month 18–24
Private Equity Roll-Up
PE aggregator of rural primary care fixed-clinic models. Requires reproducible operations playbook and multi-county presence demonstrating the model's scalability to 49 other states.
$50–63M · 4–5× EBITDA ($12.5M base)
The Dual ROI Narrative
Why investor returns and CMS savings are the same story
For investors: A scalable, high-margin recurring revenue model in a structurally underserved market. CCM/APCM/RPM convert one-time visits into monthly subscription-like income. ~$239 PMPM steady state. 4–5× base case return by Year 5. Portfolio breakeven Year 2.
For CMS: Every dollar paid to SPARK Senior Health produces $4–6 in downstream savings through reduced ER visits, hospitalizations, and unmanaged chronic disease. At 9,500 members (full portfolio maturity), net federal benefit is ~$54.6M/yr. $798M over 10 years. The strongest CMMI innovation argument in rural primary care.
Thesis: The fixed clinic solves access. Transportation removes the last barrier. CCM/APCM/RPM solves chronic disease management. The CMS savings solve capital. Investors and the federal government are co-investors in the same outcome — each paying for the same activity, each receiving their respective return.
Stage 3 · Financial Model · Summary
Stage 3 Key Findings & Open Items
Financial model established across reimbursement schedule, member ramp, expense structure, 5-year P&L, capital structure, and investor return scenarios. Two open items require resolution before investor distribution.
∑Stage 3 Summary
6 sections complete
~$239
Blended PMPM at full maturity · base scenario · post-HPSA
~Mo 8
Single-clinic EBITDA breakeven · Clinic 1 from first patient
$2.5M
Seed raise · Safe or convertible note · Month 1
~Y2
Portfolio-level EBITDA breakeven · 6 active clinics
4–5×
Investor return · Year 5 base case · Seed 20% of $50–63M exit
$79.8M
Annual CMS savings at full portfolio maturity (9,500 members)
Stage 3 Chapter Recap
Six sections · what was established
3.1Reimbursement schedule — 2026 MPFS rates at NP 85% × HPSA 1.10 for E&M/AWV/TOC. APCM G0558 ~$91/mo, CCM 99490 ~$56/mo, RPM net ~$27/mo after COGS. Blended PMPM ~$239 base. Member tiers segmented: Standard FFS = Tier 1, SLMB = bill same, QMB = write-off visit/Dx only (CCM/RPM unaffected), D-SNP = excluded Y1–2.
3.2Member ramp — 18-month per-clinic ramp clock (independent). ~1,533 enrolled Y1, ~4,401 Y2, ~7,438 Y3, ~8,809 Y4/Y5. Clinic-level EBITDA positive ~Month 8. Per-clinic terminal revenue ~$226K/mo (M24+).
3.3Expense structure — Total $157,218/yr per clinic. Driver $56,250/yr loaded. MSO Y1 $1.572M → Y2 $2.691M → Y3+ $3.425M steady. Tech stack dynamically scales with clinics/members/providers/revenue. Labor ~60% of total OpEx at scale.
3.45-year P&L — Y1 net (~$1.60M loss); Y2 EBITDA positive (~$1.01M); Y3 $5.26M EBITDA; Y4 $10.68M; Y5 $12.46M. Net income positive from Y2. EBITDA margin ~49% at Y5.
3.5Capital structure — Seed $2.5M safe or convertible note (M1). Series A $1.2M (M13, WC ≤ $1M trigger). Year 3 self-sustaining (M25, funded from Y2 operating cash flow — no external raise). Illustrative cap table: Founders 70%, Seed 20%, ESOP 10%. CMMI non-dilutive pathway at 400 members.
3.6Investor ROI — 1–2×/4–5×/10–12× conservative/base/growth. CMS ROI $4–6 saved per $1 billed; $79.8M/yr at full portfolio. Three exit pathways: strategic acquisition $20–40M, CMMI scale contract, PE roll-up $15–30M.
Open Items — Resolve Before Investor Distribution
🔢
CPA / Financial Model Validation
All P&L figures are projection-basis estimates from SPARK Senior Health Financial Model. A licensed healthcare CPA should validate PMPM assumptions, GAAP depreciation schedule (model proxy vs actual ~$25,700/yr per clinic), benefits load, and payment lag scenarios before investor presentations. The live financial model HTML is the authoritative source — use it for live calculations.
💰
Safe / Convertible Note Terms & Investor Rights
Final cap, discount rate, and MFN clause for the $2.5M safe or convertible note need attorney review. Series A ($1.2M) trigger metrics (WC ≤ $1M at M12) should be confirmed against actual ramp projections before investor presentations. Year 3 is self-sustaining — no external raise required. Terms must be finalized with securities counsel.
🏥
HPSA Billing Counsel Confirmation
The HPSA 10% bonus structure — E&M/AWV/TOC billed under supervising physician NPI for the bonus — requires confirmation from healthcare billing counsel before go-live. If NP bills independently rather than incident-to/under MD NPI, the bonus is forfeited. This is the single highest-value billing assumption in the model and must be validated.
Next → Stage 4
Legal, Compliance & Structure
Corporate structure · MSO/PC design · CMS enrollment · Georgia compliance · shareholder documents · OIG audit program