A Hazard-resident healthcare-services composite running a DMEPOS supplier lane into the ARH Hazard discharge-planner channel, a behavioral-health sub-contracting lane (LCSW, LPCC, LMFT, and peer-support) into Kentucky River Community Care and Kentucky Mountain Health Alliance, and an occupational-medicine adjunct routed through workers' compensation, DOT physicals, and OSHA medical-surveillance demand.

Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) against the ARH Hazard discharge-planner channel and the 10-county home-health and skilled-nursing bench. ARH Hazard at 358 beds runs a continuous post-acute discharge cadence. For a regional-tertiary facility at that bed count the working assumption is roughly 14,000 to 18,000 annual discharges, of which a meaningful fraction require home-DMEPOS — oxygen concentrators, hospital beds, mobility devices, CPAP and BiPAP supplies, wound-care, ostomy, enteral nutrition, and ambulatory aids. CMS Medicare DMEPOS supplier enrollment is the principal regulatory gate, with a $50,000 CMS-required surety bond plus accreditation through a CMS-deemed accreditor at startup. Kentucky Medicaid DMEPOS is a secondary payer with bilateral state credentialing. The 10-county catchment plus the post-acute SNF and ALF roster plus the home-health agency bench (Certificate of Need gated) give the lane multi-buyer volume. A DMEPOS supplier with an ARH discharge-planner relationship capturing 1.5 to 2.5 percent of annual discharges, plus home-health and SNF referrals, generates roughly $600,000 to $1.4 million in annual mature revenue at the 32-to-42-percent gross margin typical of regional DMEPOS.

Behavioral-health sub-contracting into KRCC and KMHA. Perry carries Health Professional Shortage Area (HPSA) mental-health designation. Most rural Kentucky CMHCs run mixed in-house and contracted-clinician panels to absorb caseload swings. KRCC's eight-county footprint at $5.95 million across 20 HUD awards, plus an implied $20-to-$50 million in annual operating revenue across substance-use intensive-outpatient, outpatient mental health, supported housing, crisis services, and 1915(c) HCBS waiver lines, supports a sub-contractor bench. Kentucky Medicaid managed-care reimburses Licensed Clinical Social Worker (LCSW), Licensed Professional Clinical Counselor (LPCC), and Licensed Marriage and Family Therapist (LMFT) work at per-encounter rates. Peer support is reimbursable under Kentucky Medicaid managed-care contracts at per-encounter rates, credentialed via the Kentucky Certified Peer Support Specialist regime under KRS 209A and 908 KAR. A master's-prepared LCSW, LPCC, or LMFT contracted into the KRCC outpatient pipe at 25 to 35 billable encounters per week, plus a sub-bench of one to three certified peer-support specialists, generates roughly $160,000 to $340,000 annual revenue solo, or $280,000 to $520,000 at small-group.

Occupational-medicine adjunct through workers' compensation, DOT physicals, and OSHA medical surveillance. The post-2022 and February-2025 flood-recovery construction surface, the Abandoned Mine Lands (AML) reclamation sub-trade bench, the Hal Rogers Parkway $20 million McConnell corridor, and the Hazard-area industrial bench generate continuous occupational-medicine demand. Pre-employment physicals; FMCSA National Registry of Certified Medical Examiners (NRCME) DOT physicals; drug-and-alcohol-screen collection; workers' compensation injury-care entry visits; return-to-work fit-for-duty exams; and OSHA medical-surveillance examinations. The customer base spans ARH Hazard, AMR, the post-flood sub-trade bench, KYTC District 10 corridor contractors, AML specialty contractors, and the Pine Ridge Regional Industrial Authority tenant roster. The revenue base is principally employer-pay-direct or workers'-compensation-insurer-direct, independent of Medicaid managed-care rate-setting. An NRCME-credentialed clinician contracted part-time, with DOT-collector certification and OSHA medical-surveillance competence, layered onto the DMEPOS or behavioral-health lane, runs roughly $80,000 to $220,000 incremental annual revenue without a full clinic footprint.

Composite logic. The founder targets DMEPOS as the primary revenue surface (a supplier with the ARH discharge-planner relationship and the 10-county catchment). Behavioral health layers as a parallel revenue stream (LCSW, LPCC, or LMFT contracted into KRCC with adjacent KMHA primary-care behavioral-health-integration scope). Occupational medicine carries as adjunct revenue through workers' compensation and DOT-physical channels. The composite is what banker discipline requires. DMEPOS alone exposes the operator to ARH cost-management cycles even on the discharge-planner side. Behavioral health alone is below product floor at solo scale. The stack delivers multi-buyer revenue diversification that survives senior-debt underwriting.

Concentration discipline as a design feature. A founder who places only on the direct hospital supply lane runs the single-customer concentration ratio above the 60-percent threshold that triggers SBA 7(a) auto-decline at credit review, against ARH system financial-health cyclicality that compounds the risk. The DMEPOS plus behavioral-health plus occupational-medicine rotation is the credit-structure discipline that keeps the lane financeable.

Per-engagement scope. A DMEPOS supplier serving ARH Hazard's discharge-planner channel at 1.5 to 2.5 percent capture of 14,000 to 18,000 annual discharges, plus home-health and SNF secondary referrals, runs $600,000 to $1.4 million annual revenue at maturity at a 32-to-42-percent gross margin. KRCC LCSW, LPCC, or LMFT sub-contracting at 25 to 35 billable encounters per week at Medicaid MCO rates, plus parallel KMHA primary-care behavioral-health-integration scope, runs $160,000 to $340,000 solo annual revenue at maturity, or $280,000 to $520,000 small-group. A peer-support specialist sub-bench of one to three certified specialists contracted into KRCC substance-use scope runs $60,000 to $180,000 incremental annual revenue at maturity. The occupational-medicine adjunct (NRCME, DOT-collector, and OSHA medical surveillance) layered on the DMEPOS or behavioral-health lane runs $80,000 to $220,000 incremental annual revenue at maturity. The bundled composite runs $850,000 to $1.9 million annual revenue at maturity.

Year 1: founder plus one part-time W-2 — a DMEPOS technician plus a part-time clinical FTE. Primarily DMEPOS supplier credentialing, plus a solo LCSW or LPCC encounter base. Revenue base $180,000 to $420,000. Founder take-home $60,000 to $100,000.

Year 2: a staffed delivery driver plus an associate clinician. Ramped discharge-planner-driven home DMEPOS, small-group behavioral-health expansion, and the occupational-medicine adjunct. Revenue base $480,000 to $1,000,000. Founder take-home $90,000 to $160,000.

Year 3 onward: DMEPOS at maturity, behavioral-health small-group at maturity, the peer-support sub-bench, and the occupational-medicine adjunct. Revenue base $850,000 to $1,900,000. Sustained founder take-home $140,000 to $220,000. Above $220,000 requires multi-county DMEPOS scale across the 10-county catchment with multiple delivery routes, or ARH-corporate wellness-program contracting at the system-wide 13-hospital level — both outside this candidate's envelope.

Founder-side capital $80,000 to $550,000. DMEPOS inventory float, delivery vehicle, and warehouse footprint run $60,000 to $180,000. CMS Medicare DMEPOS supplier enrollment, the $50,000 surety bond, CMS-deemed accreditation, and state Medicaid DMEPOS bilateral credentialing run $15,000 to $45,000 plus surety-bond posting. LCSW, LPCC, and LMFT clinical-licensure documentation, Kentucky Medicaid MCO panel credentialing across four to six MCOs, and EHR subscription run $8,000 to $30,000. Peer-support specialist certification per FTE runs $2,000 to $6,000 each. NRCME credentialing, DOT-collector certification, OSHA medical-surveillance training, and occupational-medicine equipment run $15,000 to $45,000. Year 1 founder plus one or two W-2 and a 90-day payroll float run $30,000 to $110,000 initial reserve. General-liability, professional-liability errors-and-omissions for LCSW, LPCC, and LMFT, healthcare-facility-elevated insurance, and DMEPOS product liability run $18,000 to $55,000 annually. Vendor-onboarding documentation across the ARH supplier portal, KMHA, KRCC, Mountain Comprehensive, AMR, Kentucky Medicaid MMIS, Kentucky eMARS, CMS DMEPOS enrollment, and HRSA FTCA runs $6,000 to $18,000. A 12-to-18-month working-capital reserve runs $30,000 to $90,000.

There is no platform-rollup arithmetic, no add-on EBITDA multiple, and no franchise posture. The capital range sits inside the owner-operator multi-lane healthcare-services composite envelope. Family-capital deployment plus SBA 7(a) lending plus an equipment-finance overlay is realistic.

• ARH Hazard Regional Medical Center

  358-bed regional-tertiary acute-care hospital, ARH system

  Active in market

  100 Medical Center Drive, Hazard. CEO Brian Springate since October 2022. The discharge-planner relationship is the access point for the DMEPOS lane. Direct hospital supply is not pursued.
• ARH corporate office (Lexington)

  Enterprise procurement counterparty for the 13-hospital ARH system

  Out-of-county

  Founder credentials at both Lexington corporate and the Hazard operating site for national-distributor master agreements.
• Kentucky Mountain Health Alliance (KMHA)

  Independent Health Care for the Homeless and FQHC Community Health Center

  Active in market

  279 East Main Street, Hazard. PHS-deemed FTCA, PCMH Behavioral Health Distinction. Not an ARH captive.
• Kentucky River Community Care (KRCC)

  Regional CMHC across the eight-county KRADD footprint

  Active in market

  115 Rockwood Lane, Hazard. Outpatient mental health, substance-use treatment, 1915(c) HCBS waiver pass-through, and supported housing.
• Mountain Comprehensive Health Corporation

  FQHC under PHS Section 330; FTCA-deemed; 340B-eligible

  Active in market

  Perry-resident operating site.
• AMR Hazard

  EMS prime under Global Medical Response

  Out-of-county

  Sub-trade adjacency to workers'-comp routing, DOT-physical referral, and post-acute transport coordination.
• CMS Region IV (Atlanta)

  DMEPOS supplier-enrollment counterparty under 42 CFR 424 Subpart P

  Out-of-county

  cms.gov. CMS-deemed accreditors include BOC, ABC, HQAA, NABP, TJC, ACHC, and CHAP.
• Kentucky CHFS Department for Medicaid Services

  Kentucky Medicaid DMEPOS bilateral credentialing and MCO contract administration

  Out-of-county

  chfs.ky.gov/dms.
• Kentucky CHFS Department for Behavioral Health, Developmental and Intellectual Disabilities

  KRCC oversight, CMHC contracting authority, and SAMHSA State Opioid Response pass-through

  Out-of-county

  chfs.ky.gov/dbhdid.
• Kentucky Medicaid MCO panel

  LCSW, LPCC, and LMFT credentialing channel for the behavioral-health lane

  Out-of-county

  Aetna Better Health, Anthem BCBS KY, Humana Healthy Horizons, Passport by Molina, UnitedHealthcare Community Plan, and WellCare.
• Kentucky Board of Social Work

  LCSW licensure under KRS 335

  Out-of-county

  sw.ky.gov. LMFT and LPCC licensure routes through companion boards.
• Kentucky Certified Peer Support Specialist program

  Peer-support credentialing under KRS 209A and 908 KAR

  Out-of-county

  Sub-bench credentialing for the behavioral-health lane.
• HRSA Bureau of Primary Health Care

  KMHA and Mountain Comprehensive Section 330 grant administration, UDS reporting, and FTCA deemed status

  Out-of-county

  bphc.hrsa.gov.
• SAMHSA

  CCBHC, State Opioid Response, and MAT-expansion grant administration

  Out-of-county

  samhsa.gov. KRCC substance-use scope pass-through.
• Kentucky CHFS Office of Inspector General

  SNF, ALF, home-health, and hospice licensing authority

  Out-of-county

  chfs.ky.gov/oig.
• FMCSA National Registry of Certified Medical Examiners

  DOT-physical credentialing under 49 CFR 391 Subpart E

  Out-of-county

  nationalregistry.fmcsa.dot.gov.
• Hazard Community and Technical College Allied Health

  State Registered Nurse Aide and allied-health workforce pipeline

  Institution

  hazard.kctcs.edu.
• Kentucky River Area Development District (KRADD)

  Area Agency on Aging and HCBS-waiver coordination

  Institution

  941 North Main Street, Hazard.

The founder profile is mid-career healthcare-services with one of three on-ramps. First, a DMEPOS, hospital-discharge-planning, or home-health background with CMS DMEPOS supplier-enrollment fluency and a Kentucky Medicaid bilateral-credentialing track record, leading on DMEPOS and adding behavioral-health sub-contracting through a partner clinician. Second, a master's-prepared LCSW, LPCC, or LMFT with Kentucky Medicaid MCO panel experience and willingness to add DMEPOS supplier credentialing across a 9-to-15-month founder launch. Third, a two-principal partnership pairing one operator from each background to split the DMEPOS and behavioral-health lanes at launch. Perry, Knott, Letcher, or Leslie labor-shed residence, plus recruiting reach into the HCTC Hazard State Registered Nurse Aide (SRNA) pipeline and the KRCC clinical-workforce pipeline, materially lowers customer-trust friction at all five surfaces.

Relationship portfolio at launch: the ARH Hazard discharge-planning office, Director of Materials Management, and Director of Case Management; the ARH corporate Lexington enterprise-procurement contact; the KMHA Executive Director, Director of Clinical Operations, and billing-and-credentialing contact; the KRCC Director of Clinical Operations, Director of Substance Use, Director of Supported Housing, and Director of HCBS waiver coordination; Mountain Comprehensive Health Corporation regional clinical and operations leads; AMR Hazard operations; the CMS Region IV DMEPOS supplier-enrollment contact and the CMS-deemed accreditor of record; the Kentucky CHFS Department for Medicaid Services bilateral credentialing contact and the six MCO panel credentialing contacts (Aetna Better Health, Anthem BCBS KY, Humana Healthy Horizons, Passport by Molina, UnitedHealthcare Community Plan, and WellCare); the FMCSA NRCME credentialing contact; and HCTC Allied Health plus Kentucky Board of Social Work credentialing leads. Twelve to twenty named contacts by end of Year 1.

Entity and credentialing posture. Kentucky business registration, KOSHA workers' comp, general-liability, professional-liability, product-liability, and healthcare-facility-elevated insurance. CMS DMEPOS supplier enrollment, CMS-deemed accreditation, and the $50,000 surety bond. Kentucky Medicaid DMEPOS bilateral credentialing and six-MCO Kentucky Medicaid managed-care credentialing for LCSW, LPCC, and LMFT scope, plus peer-support credentialing under KRS 209A and 908 KAR. NRCME for the occupational-medicine adjunct, plus DOT-collector certification and OSHA medical-surveillance competence. EHR subscription and HIPAA-compliant document management. An Eastern Kentucky healthcare-services-experienced broker of record structures the multi-coverage stack.

The practice operates as an owner-operator multi-lane composite. National DMEPOS and behavioral-health platforms — Lincare, Apria, Rotech, AdaptHealth, and the national behavioral-health managed-services tier — bid at master-vendor scope and run Eastern Kentucky routes from Lexington or Knoxville hubs. The sub-prime, discharge-planner-routed, Hazard-resident-clinician-routed, and workers'-compensation-routed scope sits below their floor. The Hazard-resident operator carrying the three-lane composite, the five-surface vendor-onboarding documentation, and same-shift mobilization is what national platforms cannot replicate.

• — ARH Hazard 2026 bed-count confirmation, service-line capex pipeline, and supplier-portal threshold structure.
• — ARH Hazard local-procurement spend envelope, supplier-portal threshold, and master-agreement carve-outs.
• — ARH Hazard EHR rollout status.
• — ARH-System per-diem rate.
• — ARH Hazard annual discharge volume (working 14,000 to 18,000), post-acute discharge mix, and home-DMEPOS routing share.
• — ARH IRS Form 990 and most recent audited financials.
• — KMHA corporate of record, PHS-deemed FTCA status, and 2026 Executive Director and CEO names.
• — KMHA HRSA UDS reports, vendor-portal structure, and Perry-resident clinical-site roster.
• — KRCC headquarters confirmation at 115 Rockwood Lane, 990, Perry-resident facility roster, and clinical-panel structure (in-house vs. contracted-clinician share).
• — KRCC Medicaid Waiver scope, Kentucky MCO panel structure, and HCBS-waiver pass-through volume.
• — Mountain Comprehensive Health Corporation Perry-resident clinical-site count, address roster, and service-line scope.
• — AMR Hazard operating-site verification and Global Medical Response national-account procurement-routing share.
• — Kentucky Medicaid managed-care MCO panel current roster and LCSW, LPCC, and LMFT credentialing cadence.
• — CMS DMEPOS supplier-enrollment current requirements, surety-bond face value, and CMS-deemed accreditor roster.
• — HPSA mental-health designation current tier for Perry.
• — Incumbent regional multi-lane composite operator scan.

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