De Novo Expansion
🛡️ Public data only — no PHI permitted on this instance.
De Novo Expansion Tracker
Greenfield buildout economics · site-type unit economics · market expansion queue · ramp curves · lease vs buy · organic/inorganic blend — 1,645 corpus deals
Active Sites
30
Planned Sites
63
Investment
$440M
Stab EBITDA Target
$146M
Portfolio Payback
3.02y
Site Types
10
Markets in Plan
12
Corpus Deals
1,645
De Novo ASC Ramp Curve
Site-Type Unit Economics
| Site Type | Capex ($M) | Working Cap ($M) | Total Inv ($M) | Stab EBITDA ($M) | Ramp (mo) | Payback (yr) | Y1 Rev ($M) | Y3 Rev ($M) |
|---|---|---|---|---|---|---|---|---|
| Ambulatory Surgery Center (single-OR) | $4.20 | $1.50 | $5.70 | $1.80 | 18 | 3.17 | $2.50 | $6.80 |
| Ambulatory Surgery Center (multi-OR) | $8.50 | $2.80 | $11.30 | $4.20 | 24 | 2.69 | $4.80 | $14.50 |
| Urgent Care Clinic | $1.20 | $0.40 | $1.60 | $0.55 | 12 | 2.91 | $1.40 | $3.50 |
| Primary Care Clinic (de novo) | $0.85 | $0.30 | $1.15 | $0.38 | 18 | 3.03 | $0.90 | $2.40 |
| Dental Office (de novo) | $1.40 | $0.50 | $1.90 | $0.62 | 18 | 3.06 | $1.20 | $3.20 |
| Dermatology Office | $1.10 | $0.40 | $1.50 | $0.48 | 15 | 3.13 | $1.10 | $2.80 |
| Physical Therapy Clinic | $0.35 | $0.15 | $0.50 | $0.22 | 9 | 2.27 | $0.70 | $1.50 |
| Infusion Suite (attached) | $1.80 | $0.60 | $2.40 | $0.95 | 12 | 2.53 | $2.00 | $4.80 |
| Behavioral Health Office | $0.55 | $0.20 | $0.75 | $0.28 | 12 | 2.68 | $0.85 | $1.90 |
| Fertility Clinic (de novo) | $3.80 | $1.20 | $5.00 | $1.85 | 24 | 2.70 | $3.20 | $8.50 |
Market Expansion Queue
| Market | Region | Population (000) | Competitors | Demand Score | Target Sites | Investment ($M) | Expected EBITDA ($M) |
|---|---|---|---|---|---|---|---|
| Austin-Round Rock, TX | Southwest | 2,450 | 4 | 88 | 6 | $42.50 | $14.20 |
| Phoenix-Mesa, AZ | West | 5,050 | 8 | 82 | 8 | $58.50 | $18.50 |
| Nashville, TN | Southeast | 2,100 | 5 | 85 | 5 | $35.20 | $11.80 |
| Raleigh-Durham, NC | Southeast | 2,000 | 6 | 80 | 4 | $28.50 | $9.50 |
| Tampa-St Pete, FL | Southeast | 3,300 | 9 | 78 | 7 | $48.50 | $16.20 |
| Denver-Aurora, CO | West | 2,950 | 7 | 82 | 6 | $42.50 | $14.80 |
| Charlotte, NC | Southeast | 2,700 | 6 | 79 | 5 | $34.50 | $11.50 |
| Minneapolis-St Paul, MN | Midwest | 3,700 | 10 | 72 | 4 | $28.50 | $9.20 |
| Salt Lake City, UT | West | 1,300 | 4 | 84 | 5 | $32.50 | $10.80 |
| Columbus, OH | Midwest | 2,150 | 7 | 75 | 4 | $26.50 | $8.80 |
| Jacksonville, FL | Southeast | 1,650 | 5 | 81 | 4 | $28.00 | $9.20 |
| Las Vegas, NV | West | 2,350 | 8 | 76 | 5 | $34.50 | $11.20 |
Month-by-Month Ramp — Representative ASC
| Month | Visits/Day | Revenue ($M) | Expense ($M) | EBITDA ($M) | Cumulative FCF ($M) |
|---|---|---|---|---|---|
| 1 | 8 | $0.068 | $0.053 | $+0.015 | $-11.34 |
| 2 | 15 | $0.127 | $0.099 | $+0.028 | $-11.36 |
| 3 | 22 | $0.186 | $0.145 | $+0.041 | $-11.37 |
| 4 | 32 | $0.271 | $0.211 | $+0.060 | $-11.36 |
| 5 | 42 | $0.356 | $0.277 | $+0.078 | $-11.33 |
| 6 | 55 | $0.466 | $0.363 | $+0.102 | $-11.28 |
| 7 | 68 | $0.576 | $0.392 | $+0.184 | $-11.14 |
| 8 | 80 | $0.678 | $0.461 | $+0.217 | $-10.97 |
| 9 | 92 | $0.779 | $0.530 | $+0.249 | $-10.78 |
| 10 | 102 | $0.864 | $0.587 | $+0.276 | $-10.55 |
| 11 | 112 | $0.949 | $0.645 | $+0.304 | $-10.29 |
| 12 | 118 | $0.999 | $0.680 | $+0.320 | $-10.03 |
| 13 | 125 | $1.059 | $0.656 | $+0.402 | $-9.67 |
| 14 | 132 | $1.118 | $0.693 | $+0.425 | $-9.30 |
| 15 | 138 | $1.169 | $0.725 | $+0.444 | $-8.90 |
| 16 | 144 | $1.220 | $0.756 | $+0.463 | $-8.49 |
| 17 | 150 | $1.270 | $0.788 | $+0.483 | $-8.06 |
| 18 | 155 | $1.313 | $0.814 | $+0.499 | $-7.61 |
| 19 | 160 | $1.355 | $0.840 | $+0.515 | $-7.14 |
| 20 | 162 | $1.372 | $0.851 | $+0.521 | $-6.67 |
| 21 | 164 | $1.389 | $0.861 | $+0.528 | $-6.20 |
| 22 | 165 | $1.398 | $0.866 | $+0.531 | $-5.71 |
| 23 | 165 | $1.398 | $0.866 | $+0.531 | $-5.23 |
| 24 | 165 | $1.398 | $0.866 | $+0.531 | $-4.75 |
Lease vs Buy Decision Matrix (10-Year NPV)
| Scenario | Upfront ($M) | Annual Cost ($M) | Tenure (yr) | NPV 10yr ($M) | Flexibility | Exit Value ($M) |
|---|---|---|---|---|---|---|
| Lease (market rate, 10-year) | $+0.45 | $0.48 | 10 | $-3.65 | 85 | $0.00 |
| Lease-to-Own | $+1.85 | $0.28 | 15 | $-1.85 | 72 | $3.85 |
| Own (cash purchase) | $+8.50 | $0.12 | 99 | $+5.85 | 45 | $9.80 |
| Own (debt-financed 70%) | $+2.55 | $0.52 | 99 | $+4.12 | 52 | $9.80 |
| Sale-Leaseback (post-buildout) | $-8.50 | $0.52 | 20 | $-0.85 | 78 | $0.00 |
Organic vs Inorganic Growth Blend
| Category | Deals | Investment ($M) | EBITDA Added ($M) | Avg Multiple | Payback (yr) |
|---|---|---|---|---|---|
| Platform Acquisition (Y0) | 1 | $285.00 | $22.00 | 12.95x | 4.8 |
| Bolt-On M&A (Y1-Y5) | 14 | $185.00 | $22.00 | 8.41x | 4.2 |
| De Novo ASCs (Y1-Y5) | 8 | $68.20 | $26.40 | 2.58x | 2.7 |
| De Novo UC / PC Clinics | 12 | $17.80 | $8.40 | 2.12x | 2.9 |
| Tuck-In Providers | 18 | $14.50 | $4.20 | 3.45x | 4.5 |
De Novo Thesis: 63 sites planned across 12 markets requires $440M investment for $146M stabilized EBITDA —
portfolio payback 3.02 years. De novo is a lower-multiple alternative to bolt-on M&A (2.5-3.0x vs 8-10x) but has longer ramp.
Sun Belt markets (Austin, Phoenix, Nashville, Raleigh) show strongest demand scores and lowest competitor density. ASC de novo is the highest-margin site type at 4.2x payback at scale.
Lease-to-own structures are most attractive for de novos — preserves capital during ramp and enables sale-leaseback at stabilization.