CareRide Medical Transportation

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Executive Summary

CareRide Medical Transportation is a non-emergency medical transportation company in Georgia. We drive people who cannot drive themselves, or who use a wheelchair, to medical appointments: dialysis, physical therapy, doctor visits, cancer treatment and discharge from the hospital. Our drivers are trained and screened, our vehicles are inspected and our wheelchair-accessible vans have ramps and securement systems that keep passengers safe. We are not an ambulance and do not provide emergency care.

A missed ride is a missed treatment. People on dialysis cannot skip sessions, and patients who miss follow-up visits end up back in the hospital. Medicaid pays for rides to covered appointments through regional transportation brokers, and dialysis centers, rehabilitation centers and nursing facilities need reliable partners. Too often rides are late, drivers are untrained, wheelchair vans are scarce and no one answers the phone. We will be a small company that arrives on time, treats riders with respect and tells the facility and the broker when something goes wrong.

Here is what our numbers show. We expect about 4,950 trips in Year 1, which brings in sales of $221,440, growing to about 36,000 trips and $1,874,394 by Year 5 as we add vehicles. We expect a loss of about $129,100 in Year 1 and a loss of about $63,600 in Year 2, because broker credentialing, insurance and a minimum crew cost money before trips build up. We expect about break-even in Year 3 (a loss of about $2,900) and a profit from Year 4 ($71,900), growing to about $202,800 by Year 5. Medical transportation is a thin-margin business with high insurance and fuel costs, so we plan carefully for utilization, claims and cash.

We need $440,000 in total. Of that, $152,000 is startup costs (three vehicles, equipment, licensing, legal help, driver training and the first insurance payment) and the rest is cash to pay drivers and bills while brokers take about a month to pay. I am putting in $130,000 of my own money, and I am asking for a $95,000 vehicle loan and a $215,000 SBA loan.

I am Terrence Hollis, the owner, a former paratransit driver trainer with 11 years of experience in public and private passenger transportation. These numbers are estimates based on the assumptions listed at the end of this plan, not promises.

Company Description

CareRide Medical Transportation is a small, independently owned non-emergency medical transportation (NEMT) company in Georgia, planned as a limited liability company (LLC). We start with three vehicles: two wheelchair-accessible vans and one ambulatory minivan. We serve people who are able to ride in a seat or in their own wheelchair, and we do not carry people on stretchers.

Our mission. To get every rider to treatment safely, on time and with dignity.

What we believe. A ride to a medical appointment is part of the person's care. Riders are often frail, anxious or tired, and many depend on us several times a week. We hire drivers who are patient, train them thoroughly and give each rider the same attention we would want for our own parents.

What we offer:
- Ambulatory rides. Door-to-door rides for people who can walk or transfer to a seat, with help to the door when needed.
- Wheelchair-accessible rides. Rides in vans with ramps or lifts and securement systems, for people who stay in their wheelchairs.
- Facility contracts. Standing schedules for dialysis centers, rehabilitation centers, nursing facilities and adult day programs, with reliable pickup times and written reports.
- Medicaid rides through brokers. Georgia's Medicaid program arranges rides to covered appointments through regional transportation brokers, who assign trips to enrolled providers. We will complete each broker's credentialing and follow its rules. Confirm the current brokers, rates and rules with the state Medicaid agency.
- Private-pay and health plan benefit rides. Rides paid by individuals and families, and rides arranged through health plans that offer transportation as a benefit.

What we do not do. We do not provide emergency transportation or medical care, and we do not carry stretcher patients, which usually requires an ambulance license. We do not guarantee a ride to anyone who has not scheduled one, and we do not promise volume from any broker or facility.

How we are run. I am the owner and operations manager, and I drive when needed. A part-time dispatcher handles scheduling in Year 1. We use dispatch software with live vehicle tracking, and an attorney and an accountant advise us. A small advisory group of a dialysis social worker, a rehabilitation director and a family caregiver tells us what is working.

Where things stand today. We have a draft safety and training program, a garage and lot lease option, quotes for three vehicles and introductions to two dialysis centers, one rehabilitation center and a nursing facility. We have no riders, no broker contracts and no facility contracts signed yet. Before we begin, our attorney will review our passenger forms, broker and facility contracts and ADA and privacy policies, and we will confirm any permits Georgia and our city require.

Problem & Opportunity

Many people in our area cannot drive or do not have a ride to their medical appointments. They are older, have a disability, use a wheelchair, are recovering from surgery, are on dialysis or chemotherapy, or live in a household without a car. A missed appointment can mean a missed treatment, a worse condition and another emergency room visit.

Medicaid covers rides to medical appointments for people who qualify, and states arrange this through regional transportation brokers. In practice, riders and facilities report late pickups, long waits for a ride home, drivers who do not know how to help a wheelchair user and trips that do not show up. Wheelchair-accessible vans are expensive and scarce, so these riders often wait longest. Standing appointments, such as dialysis three times a week, need a dependable crew.

For small providers, entering the market is hard. A new company needs vehicles, commercial auto insurance (which is costly for passenger transportation), a safety and drug testing program, broker credentialing that can take months and cash to pay drivers while brokers pay on a delay. Brokers do not guarantee trips, and a new provider has to prove itself. Many small operators run out of money before the volume builds.

Facilities have their own problem. A dialysis center or nursing facility needs patients to arrive on time, and a late or missed ride disrupts staff schedules. Facilities want a partner who answers the phone, communicates and has backup vehicles.

Original Medicare does not generally pay for rides to non-emergency appointments, though some Medicare Advantage plans offer rides as a benefit. Families pay out of pocket when no program applies.

We want to be clear about what we know and do not know. Demand for medical transportation is growing as the population ages, and rates and rules are set by states and brokers, who can change them. We will use the most recent numbers from the Census Bureau, the state and the Medicaid agency in our final plan and will not overstate them. We do not know how many trips a broker will assign to a new provider, which is why our plan builds in a slow start and relies on facility contracts for steady trips.

Products & Services

CareRide will provide safe, on-time rides to medical appointments with trained drivers, inspected vehicles, live tracking and clear communication.

How it works, step by step:
1. Booking. Brokers send trips through their systems, facilities and families call or book online, and we confirm every ride by phone, text or portal. For standing rides, such as dialysis, we set up a recurring schedule.
2. Dispatch. A dispatcher groups trips into efficient routes where the broker and the riders allow shared rides, assigns the right vehicle, and tracks every vehicle live.
3. Pre-trip inspection. Every driver inspects the vehicle each day, including lights, tires, brakes, the ramp or lift and the securement straps, and records it in the app. Any vehicle with a safety problem is taken out of service.
4. Pickup. Drivers arrive at the scheduled time, ring the bell or knock, help the rider to the vehicle (door-through-door help when the program requires it) and secure the rider and any wheelchair.
5. Ride. Drivers drive smoothly, follow the route, keep the rider informed and never leave a rider unattended.
6. Drop-off and return. The driver walks or wheels the rider to the check-in point, confirms the return time and records the trip. We monitor late returns and call the facility early if a delay is likely.
7. Communication. We tell the rider, the facility and the broker right away about delays, and we keep a written record of every complaint and how it was fixed.
8. Billing. We submit trip records to brokers and invoice facilities and private-pay riders on a schedule, and we follow up on every unpaid trip.
9. Quality. We track on-time pickups, missed trips, complaints, vehicle downtime and driver turnover, review every incident and publish our goals to our partners.

Why this approach is strong. We start small, with a safety program and training built before the first trip, and we depend on facility contracts for steady volume while broker trips build. We stay lean by leasing the vehicles we add after the first three. We treat every rider as a person, not a trip.

Market Analysis

Who we serve: people who need a ride to medical care and cannot drive or take other transportation, and the brokers, facilities and health plans that pay for those rides.

Our primary group is Medicaid members and other riders who use ambulatory and wheelchair rides to dialysis, rehabilitation, specialty care and primary care. We will use the most recent numbers from the Census Bureau, the state and the Medicaid agency for our service area in our final plan.

Our facility customers are dialysis centers, rehabilitation and physical therapy centers, nursing and assisted living facilities, adult day programs and cancer centers. These facilities have standing schedules and need dependable rides. Facility contracts are the steadiest part of our plan.

Our private-pay and health plan customers are families who pay for rides for a parent, people recovering from surgery and Medicare Advantage and other health plans that offer ride benefits.

How we sized our plan. Each vehicle can make about 3,000 trips a year when fully used (about 12 trips a day). We plan for 3 vehicles and 4,950 trips in Year 1, which is 55% use, because broker credentialing and trip assignments take time. We plan for 10,200 trips in Year 2 with 5 vehicles (68% use), and 36,000 trips in Year 5 with 15 vehicles (78% use). Of Year 1 trips, about 45% are ambulatory broker rides, 30% are wheelchair broker rides, 17% are facility contract rides and 8% are private-pay and health plan rides. Wheelchair and private-pay rides bring in more revenue per trip.

Growth depends on winning broker assignments and facility contracts, so treat the later years as goals, not promises. We do not accept a trip we cannot cover safely, and we tell brokers early when we are full.

Competitive Landscape

Other choices for rides to medical appointments in our area, and what makes us different.

- Large national transportation companies and broker-owned fleets. They have brand recognition and many contracts, and they may be hard to reach, short of wheelchair vans or slow to answer. We compete on reliability, communication and care.
- Other small NEMT providers. Some are excellent and some cut corners on training, insurance and inspections. We compete on safety, professionalism and credentialing.
- Public transit and paratransit. These are important and inexpensive, though they require advance scheduling and may not offer door-through-door help or reach every facility. We refer riders to them when they fit.
- Taxis and ride apps. They are quick for people who can walk and transfer on their own. They generally do not offer wheelchair-accessible vehicles or trained assistance.
- Ambulance companies. They provide medical transport for people who need monitoring or a stretcher. We do not compete with them, and we call 911 when a rider has an emergency.
- Family and friends. Most riders get help from family. We aim to support them, not replace them.

What makes us different.
- A written safety program with background checks, driving record checks, drug and alcohol testing, passenger assistance and CPR training for every driver.
- A small fleet that is inspected every day, with live tracking and a backup plan.
- Dependable facility contracts with written reports on every late ride.
- A dispatcher who answers the phone and calls the facility before a delay becomes a missed treatment.
- Wheelchair-accessible capacity at the start, not as an afterthought.

What we do not claim. We are new. We have no contracts yet, and larger companies have years of history and many vehicles. We plan to earn trust one ride at a time.

Marketing & Sales Strategy

How we will find riders, facilities and broker trips.

Facilities. We will visit dialysis centers, rehabilitation centers, nursing facilities and adult day programs, meet the social worker and the administrator, bring our insurance certificates and safety program, and offer a two-week trial of standing rides. We do not pay for referrals or give gifts to staff.

Brokers. We will apply to every Medicaid broker in our service area, complete credentialing and driver and vehicle checks, learn each broker's portal and rules and ask for a small first set of trips. We will keep our on-time rate high so brokers assign more.

Health plans. We will contact Medicare Advantage and managed care plans that offer ride benefits, and ask how to become a contracted provider.

Families. We will keep a simple website with online booking and clear prices, a phone line that is answered, a Google business listing with reviews, and printed cards for social workers, senior centers, churches and hospital discharge planners.

Community partners. We will work with the Area Agency on Aging, disability organizations, veterans' groups and rehabilitation clinics, and offer useful rider education.

Pricing. Broker rates are set by the contract, and our plan uses about $32 for an ambulatory trip and $58 for a wheelchair trip in Year 1. We plan about $46 for a facility contract trip and $64 for a private-pay or health plan trip. We will publish private-pay rates and terms in writing and replace these with real rates before we begin.

Operations Plan

How the business will run.

Setup (the 3 to 4 months before the first trip). We will form the LLC, buy commercial auto and general liability insurance (brokers often require at least $1 million in liability coverage; check each contract), buy and inspect the vehicles, install tracking and cameras, build the safety and drug testing program, apply for local and state permits, and apply for broker credentialing, which can take 60 to 120 days. We will not carry a rider until we hold the insurance and permits we need.

Vehicles. We buy three used vehicles in good condition: two wheelchair-accessible minivans with ramps (about $41,000 each) and one ambulatory minivan. Each has a pre-purchase inspection and a documented maintenance plan. Vehicles we add after the first three are leased at about $850 a month each, and that cost is built into the cost of each trip, so we do not tie up cash in more vehicles as we grow. We plan 3 vehicles in Year 1, 5 in Year 2, 7 in Year 3, 10 in Year 4 and 15 in Year 5.

Drivers. Every driver passes a criminal background check, a driving record check and a pre-employment drug test, takes part in random drug and alcohol testing, completes a defensive driving course, CPR and first aid, and a passenger assistance course that covers wheelchair securement, safe transfers and working with people who have dementia or limited vision and hearing. Drivers are employees, not contractors, and are paid hourly. We plan driver pay of about $16.00 an hour in Year 1; with payroll taxes and workers' compensation the cost is about $18.56 an hour.

Staffing. In Year 1: I serve as owner and operations manager and drive when needed, and a part-time dispatcher schedules trips. A full-time dispatcher joins in Year 2, a billing specialist in Year 3, a safety and driver trainer in Year 4, and a second dispatcher and a fleet coordinator in Year 5.

Safety. Drivers inspect vehicles every day, we service vehicles on the maker's schedule, we record and review every incident and we remove any vehicle that is not safe. We follow the vehicle maker's wheelchair securement instructions and do not allow shortcuts.

Emergencies. Drivers are trained to call 911 for any medical emergency or crash, then our dispatcher. Riders with an emergency are never transported in our vehicles.

Billing and payment. Brokers pay on their own schedule, often 30 to 45 days after the trip is billed, so we hold cash to cover the wait. Facilities and private-pay riders are invoiced regularly. In our plan customers pay on average about 37 days after service.

Privacy. We follow HIPAA and keep trip records, which can reveal a person's health, in a secure system with limited access.

Insurance. We carry commercial auto liability and physical damage, general liability, workers' compensation and cyber insurance, and we require every broker to see our certificates. Commercial auto insurance is our largest single cost, about $9,500 per vehicle per year in the plan; get real quotes before you commit.

Management & Organization

The people who will run CareRide.

Terrence Hollis, owner and operations manager. A former paratransit driver trainer with 11 years of experience in public and private passenger transportation, including four years teaching passenger assistance and wheelchair securement. He leads contracts, safety, dispatch and finance, drives when needed and is the contact for brokers and facilities. (Replace this paragraph with your own background.)

Dispatcher and scheduler (part-time in Year 1, full-time from Year 2). Takes bookings, assigns trips, tracks vehicles and handles problems in real time.

Drivers. Hourly employees whose pay is included in the cost of each trip. We plan about as many drivers as vehicles in Year 1.

Billing and claims specialist (from Year 3). Submits trips to brokers, bills facilities and follows up on unpaid trips.

Safety and driver trainer (from Year 4). Runs driver training, vehicle inspections and incident reviews.

Fleet and maintenance coordinator (from Year 5). Manages leases, repairs and downtime.

Outside advisors. A transportation or healthcare attorney, an accountant and an insurance broker who knows passenger transportation.

Staff pay in this plan is a full year per person: owner and operations manager $48,000, part-time dispatcher $22,000, full-time dispatcher $38,000, billing and claims specialist $40,000, safety and driver trainer $52,000, fleet and maintenance coordinator $46,000. Replace them with the pay you can offer where you live.

Milestones Narrative

Our goals and when we plan to reach them.

- Before opening (4 to 6 months ahead): meet at least 10 facility social workers and administrators and get at least 3 letters of interest from dialysis or rehabilitation facilities, get insurance quotes, form the LLC, get an EIN, apply for broker credentialing, complete a pre-purchase inspection on each vehicle and open a business bank account. Buy the vehicles only after the letters and the insurance quotes are in hand.
- Year 1: 3 vehicles and about 4,950 trips, finishing with $221,440 in sales and a loss of about $129,100.
- Year 2: 5 vehicles, a full-time dispatcher and about 10,200 trips; $476,437 in sales and a loss of about $63,600.
- Year 3: 7 vehicles, a billing specialist and about 15,750 trips; $766,264 in sales and a loss of about $2,900.
- Year 4: 10 vehicles, a safety and driver trainer and about 23,400 trips; $1,181,416 in sales and a profit of about $71,900.
- Year 5: 15 vehicles, a second dispatcher and a fleet coordinator and about 36,000 trips; $1,874,394 in sales and a profit of about $202,800.
Growth depends on winning contracts and broker assignments, so treat the later years as goals, not promises.

What we check every week: on-time pickups, missed trips, complaints, trips per vehicle per day, vehicle downtime, incidents, unpaid broker invoices and cash in the bank.

Funding Request

How much we need and how we will use it. Total we are raising: $440,000.

How we got that number. The Funding Need Calculator in this plan adds up three things:
- Startup costs of $152,000, listed item by item in the Startup Costs section: $82,000 for two used wheelchair-accessible vans, $22,000 for the ambulatory minivan, $6,500 for tablets, tracking and cameras, $4,500 for securement and safety equipment, $4,000 for the garage lease deposit, $3,500 for spare parts and supplies, $3,800 for licenses and permits, $10,000 for legal and compliance help, $4,200 for lettering and a website, and $11,500 for driver screening, training and the first insurance payment.
- The cash the business uses before it breaks even, about $101,217: because we pay drivers every week, brokers pay about a month later and trips build slowly.
- A cash cushion of about $36,400: three months of Year 1 operating costs.
- Together that comes to about $289,617, rounded up to the nearest $500: $290,000.
We are raising $150,000 more than that, $440,000 in all, to cover the loan payments and the extra cash that Years 2 and 3 take while trips build. With this funding, the lowest year-end cash balance is about $30,300, at the end of Year 3.

Where the money comes from:
- My own money: $130,000.
- Vehicle loan for the first three vehicles and equipment: $95,000.
- SBA 7(a) working capital loan: $215,000.

Kind of funding we are looking for. A vehicle loan from a lender that finances commercial passenger vehicles, with the vehicles as collateral (something the lender can claim if the loan is not repaid), plus an SBA 7(a) loan through a bank or community lender for working capital.

How we will pay it back. We expect a loss of about $129,100 in Year 1 and a loss of about $63,600 in Year 2, a break-even to small loss in Year 3 (a loss of about $2,900), then a profit from Year 4 ($71,900), growing to about $202,800 by Year 5. With this funding, the business has money in the bank at the end of every year of the plan. The vehicle loan is planned at 10.5% interest over 6 years, so payments are about $1,784 a month, and the SBA loan at 12.75% over 10 years, so payments are about $3,179 a month. Together that is about $4,963 a month, and it is already included in our cash flow. We chose these as cautious planning rates; ask the lender for the real rates, which may be lower or higher.

What we are offering the lender: the vehicles as collateral and my personal guarantee (my promise to repay from my own money if the business cannot).

A smaller first step, if needed. If we cannot raise the full amount right away, we can start smaller and grow into this plan:
- Phase 1: start with one wheelchair-accessible van and one ambulatory vehicle, serve facility contracts and private-pay riders while broker credentialing is pending, and keep the owner driving.
- Phase 2: once you have steady income and facility relationships, add vehicles and follow this plan.
To plan the smaller start, make a copy of this plan (use Duplicate) and lower the numbers to match.

All numbers in this plan are estimates. We will update them as real results come in.

Appendix Notes

Documents to attach before you send this plan:

- Your resume (one page is fine) and your driver's license and driving record.
- A personal financial statement (a list of what you own and what you owe; lenders usually provide a form).
- Business registration papers and your EIN (your business tax number from the IRS, free at irs.gov).
- Insurance quotes or proof of insurance, including commercial auto liability, general liability and workers' compensation.
- Vehicle purchase quotes and pre-purchase inspection reports.
- Your safety program, driver hiring standards and drug and alcohol testing program.
- Your passenger forms, ADA policy and privacy policy, reviewed by an attorney.
- Signed letters of interest from future facility customers.
- Your broker credentialing applications and the status of each.
If you don't have any of this yet, no worries - let's continue.

The assumptions behind our numbers (change them in the Financials section to match your own):
- Ambulatory broker rides: about $32 a trip in Year 1, rising to $36; about $24 a trip in direct costs (driver time $14, fuel $2.70, maintenance and tires $1.35, commercial auto insurance $6 spread over each trip), rising to $28; about 2,230 trips in Year 1, growing to 13,680.
- Wheelchair-accessible broker rides: about $58 a trip in Year 1, rising to $65; about $34 in direct costs (driver time $21, escort help $1.50, fuel $3.30, maintenance $2.20, insurance $6), rising to $39; about 1,480 trips in Year 1, growing to 9,720.
- Facility contract rides: about $46 a trip in Year 1, rising to $52; about $26 in direct costs, rising to $30; about 840 trips in Year 1, growing to 7,920.
- Private-pay and health plan benefit rides: about $64 a trip in Year 1, rising to $72; about $28 in direct costs, rising to $32; about 400 trips in Year 1, growing to 4,680.
- Fleet and use: 3, 5, 7, 10 and 15 vehicles at about 3,000 trips each per year at full use, with use of 55%, 68%, 75%, 78% and 80%. Vehicles after the first three are leased at about $850 a month; driver pay about $16.00 an hour plus 16% for payroll taxes and workers' compensation; commercial auto insurance about $9,500 per vehicle per year, rising 3% a year.
- Pay (a full year, per person): owner and operations manager $48,000, part-time dispatcher $22,000, full-time dispatcher $38,000, billing and claims specialist $40,000, safety and driver trainer $52,000, fleet and maintenance coordinator $46,000.
- Other yearly costs in Year 1: dispatch, routing and tracking software, phones and data $14,400, garage, parking and office rent and utilities $12,000, general liability, professional, cyber and office insurance $7,200, broker credentialing, driver screening, drug testing and training $9,600, facility and referral outreach $7,200, accounting, legal and billing service $8,400, vehicle permits, inspections and lift certifications $4,800, office supplies and miscellaneous $3,600, payroll taxes and benefits for office staff $8,400. These grow between 6% and 28% a year.
- Startup costs and equipment ($152,000 in Year 1, then $4,000, $4,000, $6,000 and $8,000) are spread evenly over five years in the plan's books.
- Brokers and customers pay about 37 days after service. Income tax at 21%.
- Every dollar amount is an estimate. Replace them with your own quotes and research.

Startup Costs