Prepared for lenders, CDCs, and federal agencies to SBA SOP 50 10 8, USDA RD Instruction 5001, and conventional underwriting standards. Fiduciary duty runs to the lender and the agency, never the borrower. More than 4,000 studies since 1998 covering $40.2 billion in evaluated project value.
Critical access and rural hospital projects — replacements, conversions under the Rural Emergency Hospital designation, and service-line restorations — are underwritten on a different chassis than urban facilities: cost-based and designation-driven reimbursement, a service population defined by distance, and a payer mix that leans government. The study documents the designation status and its reimbursement consequences, sizes realistic volumes from the service area's actual utilization and outmigration history, and tests sustainability against the staffing economics that decide whether rural facilities live: physician coverage, traveling-clinician cost, and the recruitment plan behind both.
Volume modeling from service-area discharge and emergency-visit data with outmigration quantified, reimbursement modeled to the designation's actual rules rather than generic hospital ratios, swing-bed and outpatient lines built separately, and a federal-and-state support layer documented program by program.
Every Wert-Berater financial model is fully linked with no hardcoded values, so any reviewer can stress any input. Deliverables comprise a complete narrative report and the linked Excel model, with ten-year pro forma, sensitivity analysis at ±5, 10, and 15 percent, interest-rate stress from +0.5 to +3.0 percent, and ratio analysis benchmarked against RMA and IBISWorld data.
SBA engagements are prepared to SOP 50 10 8, including its debt-service-coverage minimums of 1.15x operating and 1.00x global. USDA engagements follow RD Staff Instruction 5001 across the Business & Industry, Community Facilities, REAP, and Value-Added Producer Grant programs. Conventional engagements are built to the lender's stated coverage standard, typically 1.20x. Rural hospitals are the archetypal USDA Community Facilities credit, with B&I serving for-profit structures; the 7 CFR 5001 factor framework and agency review expectations are native territory for the firm's rural practice.
The engagement extends the firm's standing rural community-facility record — schools, clinics, and senior care — into the hospital designation framework. Independence is non-negotiable: determinations follow the evidence and are not revised under pressure, and studies are built to pass lender, agency, and third-party review without exception items.
Qualify a project. Tell us about the project and the program. We will tell you the truth about it — scope, timeline, and fee confirmed before work begins.
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