Bilingual mobile clinic visiting dark-fired tobacco farms during the August-October cut season — Green Tobacco Sickness and H-2A worker primary care across Pennyrile.

Christian is Kentucky's number-one dark-fired tobacco county at about $44.2 million in annual production (vintage pending verification). Kentucky processes about 1,174 H-2A contracts and 7,360 workers a year, concentrated in Pennyrile-region tobacco operations during the August-October cut season. Green Tobacco Sickness is OSHA-documented but uncovered by fixed-site primary care because Spanish-language access is the binding constraint. JennieCare, now under Deaconess after October 2025, covers employer-payer and TRICARE — not seasonal, H-2A, or Spanish-language scope. The recurring revenue mechanic combines employer retainer per H-2A workforce ($800 to $2,400 a season per worker for occupational-medicine surveillance, GTS treatment, and routine primary care) plus Medicaid and sliding-scale plus Kentucky Department of Agriculture tobacco-grower outreach.

Bilingual NP or PA family-medicine credentialing plus Kentucky medical license plus DEA registration plus OSHA-330 GTS surveillance training is the credentialing stack. The realistic founder profile is a returning bilingual NP or PA with prior community-health-center or family-medicine experience and Kentucky relocation tie. Capacity to anchor a Christian-County base plus replicate to the Pennyrile nine-county scope. The mobile clinic — van plus telehealth platform plus ETA-790 H-2A housing-address routing — is the delivery model, with a pop-up rotation indexed to the cut-season peak.

JennieCare is fixed-site, employer-payer, and TRICARE; partner-with framing is structurally additive. Cumberland Family Medical Center FQHC (Christian-County scope and HRSA designation pending verification) covers underserved primary care but does not specialize in mobile, seasonal, or H-2A scope. Pennyroyal Center's RISE wrap-around is the behavioral-health adjacency partner. The Kentucky Department of Agriculture's tobacco-grower outreach is the warm-introduction pathway. The realistic Christian-County competitor pool at the bilingual mobile occupational-medicine tier is structurally absent; the Spanish-language NP and PA pool inside the Pennyrile region is thin. The candidate competes against employer self-insurance models (large H-2A employers may run their own occupational-medicine programs) and against statewide telehealth providers (Spanish-language but not on-site at the cut-season peak).

This is the agriculture-side healthcare-services lane that prior county reports did not surface. The candidate frames JennieCare, Cumberland Family Medical Center, and Pennyroyal Center as additive partners. The candidate explicitly does not name any individual tobacco grower or H-2A employer in deficit framing — H-2A worker access is the structural challenge, not employer non-compliance. The $44.2 million dark-fired tobacco figure, the Christian-specific H-2A volume, the HRSA Cumberland Family Medical Center scope, and the Pennyroyal Center standalone CCBHC designation all sit in the disclosures list as pending verification.

Practice shape. A 1-to-2 NP or PA mobile-clinic practice plus 1 bilingual community-health worker staffs the cut-season peak from August through October. Clinical days during the peak run 5 days a week across 8 to 9 farms per week for 12 weeks — about 110 clinical days at the peak. Off-peak clinical days (November through July) run 2 to 3 days a week through telehealth plus a fixed-site Christian-County base for about 80 clinical days. Total runs about 190 clinical days a year.

Revenue mix Year 1 (solo NP or PA plus CHW). The three-payer blend includes H-2A employer retainer ($800 to $2,400 a season per worker, with 150 to 300 workers covered Year 1 yielding $120,000 to $720,000), Medicaid through UnitedHealthcare and Humana (60 to 90 patients at $120 average per encounter across 800 to 1,200 encounters a year yielding $96,000 to $144,000), and sliding-scale ($30 to $80 per encounter across 200 to 400 encounters yielding $6,000 to $32,000). Combined Year 1 gross runs $200,000 to $280,000 solo; $350,000 to $450,000 with a second NP or PA in Year 2.

Capital and startup. Mobile clinic vehicle (van plus clinical-equipment outfit plus telehealth platform) costs $80,000 to $150,000 to purchase or $1,800 to $3,500 a month to lease. Bilingual NP or PA base salary runs $95,000 to $140,000 a year plus a CHW at $42,000 to $60,000. Kentucky medical license plus DEA plus OSHA-330 GTS surveillance plus ETA-790 H-2A housing-address routing software runs $20,000 to $40,000 in Year 1. Marketing and Spanish-language community outreach runs $10,000 to $20,000 in Year 1.

Owner take-home. Founder NP or PA solo Year 2-3 take-home runs $80,000 to $180,000. Partnered practice (founder plus second NP or PA plus CHW) Year 3 founder take-home runs $100,000 to $200,000. A replication ring across the Pennyrile eight-county scope takes the practice to $600,000 to $1 million in gross by Year 4-5 with founder take-home $200,000 to $350,000.

• Christian County Health Department

  Local public health authority; partner-with intake

  Institution

  Direct phone and leadership pending verification. Realistic warm-intro for OSHA-330 GTS surveillance and Spanish-language community-outreach scope.
• Cumberland Family Medical Center FQHC

  Federally Qualified Health Center adjacency

  Institution

  Christian-County HRSA-designated scope pending verification. Partner-with intake.
• JennieCare (Jennie Stuart Medical Center outpatient clinics, post-Deaconess October 2025)

  Christian-area outpatient anchor; partner-with intake

  Active in market

  Jennie Stuart acquired by Deaconess October 1, 2025 under a $95 million floor commitment, an Epic conversion, and a $10 million foundation gift. JennieCare covers employer-payer and TRICARE; not seasonal, H-2A, or Spanish-language scope. Additive partner.
• Pennyroyal Center

  Regional behavioral-health adjacency; RISE wrap-around partner

  Institution

  CEO Joe Dan Beavers. Eight-county Pennyrile catchment. Behavioral-health adjacency for the GTS occupational-medicine candidate.
• Pennyrile Area Development District

  Nine-county regional development authority

  Institution

  Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, and Trigg. Pennyrile is distinct from Pennyroyal Center.
• Kentucky Department of Agriculture

  State agriculture authority; tobacco-grower outreach pathway

  Institution

  Tobacco-grower census, outreach, and dark-fired-grade USDA inspection adjacency. Warm-introduction pathway for grower-side relationship-tier intake.
• USDA Wage and Hour Division (H-2A program)

  Federal H-2A program administration

  Out-of-county

  ETA-790 housing-address data plus Labor Condition Application volume plus employer compliance audit. Founder-fit lane is downstream of WHD compliance.
• OSHA and Kentucky OSHA — Green Tobacco Sickness

  Occupational-illness regulatory authority

  Out-of-county

  OSHA-330 GTS surveillance is the founder-fit training stack. Kentucky OSHA enforcement scope includes tobacco-belt cut-season operations.
• UnitedHealthcare and Humana

  Medicaid managed-care successor counterparties after Anthem's January 1, 2025 exit

  Out-of-county

  Founder NPI credentialing required on both successors for the Medicaid component of the three-payer blend.
• Hopkinsville Community College Allied Health programs

  Bilingual NP, PA, and community-health-worker pipeline

  Institution

  Allied Health programs at HCC are a realistic supply base for bilingual community health workers. Specific scope pending verification.

The acquisition lane is build-it for the founder owner-operator scope. There is no existing Christian-resident dedicated bilingual mobile occupational-medicine and Spanish-language seasonal clinic practice — the demographic is structurally underserved. The realistic founder builds the practice de novo, anchors the bilingual NP or PA plus CHW staff stack, leases or purchases a mobile-clinic vehicle, and lands the first H-2A employer retainer through the Kentucky Department of Agriculture tobacco-grower warm-introduction pathway.

The highest-yield path is direct entry as a credentialed bilingual NP or PA founder LLC with a three-payer blend revenue mix. The founder stands up Kentucky medical license plus DEA plus OSHA-330 GTS surveillance training (3-to-6-month credentialing). Lease or purchase a mobile-clinic vehicle. Hire a CHW in Year 1 and a second NP or PA in Year 2. Build the H-2A employer retainer book through Kentucky Department of Agriculture and grower outreach. Replicate to the Pennyrile eight-county scope by Year 4-5.

Credentialing scope is moderate. Bilingual Spanish-English family-medicine NP or PA credentialing plus Kentucky medical license plus DEA registration plus OSHA-330 GTS surveillance training plus ETA-790 H-2A housing-address routing software. Mobile-clinic vehicle outfit plus telehealth platform integration. Total credentialing and outfit timeline 6 to 9 months from a clean start; faster for an existing Kentucky-resident NP or PA pivoting from fixed-site practice. Kentucky commercial insurance binds in 1 to 2 weeks for clean credit.

• — $44.2 million Christian-County dark-fired tobacco production figure — vintage pending verification at UK CBER and USDA NASS.
• — Kentucky H-2A contract and worker volume specific to Christian County — pending verification at USDA Wage and Hour Division ETA-790 and the Kentucky Department of Agriculture.
• — Cumberland Family Medical Center FQHC scope at Christian County — HRSA designation and service-area scope pending verification.
• — JennieCare post-Deaconess vendor consolidation timeline — Indiana-acquirer vendor playbook unknown; partner-with conversation pending direct intake at JennieCare leadership.
• — Pennyroyal Center standalone CCBHC certification status — CARF accreditation confirmed; standalone designation not.
• — H-2A employer-retainer pricing — $800 to $2,400 a season per worker is an industry-range estimate; Christian-area pricing pending verification at grower-association outreach.
• — Spanish-language NP and PA recruiting pool depth in the Pennyrile region — pending verification; Hopkinsville Community College Allied Health, Murray State, and Austin Peay bilingual graduate intake pending.
• — OSHA Green Tobacco Sickness incident-rate data specific to Christian and Pennyrile — pending at Kentucky OSHA and Kentucky Department of Agriculture epidemiology.
• — Federal H-2A policy continuity — H-2A is structurally durable but specific 2026-2030 administrative changes (housing requirements, wage rates) could shift the demand vector.

Tonight, this week, this month — in that order. Each step produces a yes/no or a number, not a deeper understanding.