Independent Operator Target Universe

Description

Every Medicare-certified hospital, skilled nursing facility, home health agency and hospice in the US that is not part of a sponsor platform, a listed operator or a multi-site chain, with location, ownership structure and size from the latest cost report. One row per facility. The starting list for add-on sourcing, de novo versus buy analysis, and market maps of who is still independent in a geography.

A facility is in the universe when, in the current CMS ownership snapshot:

1. at least one owner with an ownership role is on file (a facility with no ownership-role owner filed is unknown, not independent, and is excluded);
2. no owner with an ownership role is classed as a financial sponsor (CMS's private-equity flag on any filing by that owner, or a fund-vehicle owner name; see the ownership map dictionary);
3. the operator crosswalk maps it to no operator (no listed operator, REIT-run operator, nonprofit system, tracked private or sponsor-backed chain); and
4. no organizational owner holds more than three facilities of record across the four facility types.

This is exactly the independent = true slice of pe_facility_ownership in the Facility Ownership and PE Sponsor Map; join on ccn to the full ownership detail and the owner list.

• Source: CMS All Owners and Enrollments files for hospitals, SNFs, home health agencies and hospices (data.cms.gov; monthly for hospitals and SNFs, quarterly for home health and hospice); CMS Care Compare for facility names and locations; CMS HCRIS hospital cost reports and the SNF and hospice cost reports for beds, revenue and net income; the Healthparse operator crosswalk to exclude mapped operators.
• Refresh cadence: monthly. Ownership loads on the 2nd, ahead of the monthly marketplace export on the 3rd.
• Row count: 16,515 facilities (2026-10-24 export of the 2026-09-29 snapshot).
• Vintage: 2026-09-29 (the CMS ownership snapshot date).
• Coverage: 8,012 home health agencies, 4,416 SNFs, 2,832 hospices and 1,255 hospitals. Largest states: CA 4,069, TX 2,113, FL 1,026, OH 918, IL 685.
• History: the current snapshot. A facility leaves the universe when a sponsor or chain files as its owner; the dated change is in the Deal Feed. Monthly CMS snapshots back to 2022 can be loaded as a backfill on request, to see which facilities were independent at a past date.

Ownership structure in the universe:

Table: independent_operator_targets

Example queries (SQL)

-- 1. Add-on screen: independent hospices in Texas and Oklahoma, largest first.
SELECT ccn, facility_name, city, state, owner_count, revenue, net_income, financials_fy
FROM independent_operator_targets
WHERE facility_type = 'hospice' AND state IN ('TX', 'OK')
ORDER BY revenue DESC NULLS LAST;

-- 2. Market map: independent share of each facility type by state.
SELECT f.state, f.facility_type,
       count(*) AS facilities,
       count(*) FILTER (WHERE f.independent) AS independent,
       round(100.0 * count(*) FILTER (WHERE f.independent) / count(*), 1) AS pct_independent
FROM pe_facility_ownership f
WHERE f.state IS NOT NULL
GROUP BY 1, 2
ORDER BY 1, 2;

-- 3. Small owner groups (two or three facilities): roll-up candidates that
--    bring more than one site.
SELECT largest_org_owner, count(*) AS facilities_here,
       string_agg(facility_name || ' (' || coalesce(state, '?') || ')', '; ') AS sites
FROM independent_operator_targets
WHERE largest_org_owner_facilities >= 2
GROUP BY 1
ORDER BY 2 DESC;

-- 4. Independent hospitals with 25 to 100 beds and positive net income.
SELECT ccn, facility_name, city, state, beds, revenue, net_income
FROM independent_operator_targets
WHERE facility_type = 'hospital' AND beds BETWEEN 25 AND 100 AND net_income > 0;

Known limits

• Independent means "no sponsor, chain or mapped operator on file", not "verified standalone". A facility owned through entities whose names do not read as fund vehicles, whose filers never ticked the CMS PE box, and whose parent the crosswalk does not map, lands here. Diligence the cap table (pe_facility_owners) before outreach.
• Ownership roles only. A facility run under a management contract by a chain, but owned by a local entity, is in the universe.
• Three-facility threshold is counted on the CMS file. An owner with three Medicare-certified facilities and a dozen non-Medicare sites (assisted living, clinics) still qualifies.
• Home health revenue is null. No HHA cost reports are loaded.
• SNF financials are FY2021 or earlier for now. The FY2022 and FY2023 SNF cost reports are being reloaded. Hospital and hospice figures use the latest year filed.
• Facilities with no ownership-role owner filed are excluded, not counted as independent. About 6,000 such facilities sit outside both this universe and the sponsor-backed set.
• 835 rows have no state. About half are hospital units and sub-providers in neither Care Compare nor HCRIS.
• Current snapshot only. Facilities that were independent and have since been acquired are not here; they appear in the Deal Feed.