Palmbrook Funding, a small-business funding broker in Rapid City, South Dakota, helps Pennington County medical and dental practices compare equipment financing, working capital and term loans for fit-outs. The county had 325 ambulatory health care employer establishments in 2023, including 85 physician and 62 dental offices (U.S. Census Bureau). The partner makes the call and writes the terms.
| Ambulatory health care employers | 325 in Pennington County, SD, 2023 |
|---|---|
| Offices of physicians | 85 offices with 1,437 people on payroll |
| Offices of dentists | 62 offices with 731 people on payroll |
| Ambulatory payroll | $285.5 million |
| Health care and social assistance | Largest county payroll, $711.0 million |
Health care in Pennington County, SD by the numbers
Health care and social assistance had the largest payroll of any sector in Pennington County in 2023: $711.0 million across 458 employer establishments and 11,398 employees. Within it, ambulatory health care, meaning outpatient practices, clinics and similar providers, counted 325 establishments, 4,083 employees and $285.5 million in payroll (U.S. Census Bureau, County Business Patterns 2023).
| Type | Establishments | Employees | Annual payroll | Under 5 employees |
|---|---|---|---|---|
| Every outpatient provider (NAICS 621) | 325 | 4,083 | $285.5 million | 177 |
| Offices of physicians (6211) | 85 | 1,437 | $126.9 million | 50 |
| Offices of dentists (6212) | 62 | 731 | $47.6 million | 16 |
Source: U.S. Census Bureau, County Business Patterns 2023. Dental offices skew larger than the county average: only 16 of 62 had fewer than five employees.
Practitioners without employees are counted separately: 439 ambulatory health care businesses had no paid staff in 2024, including 121 physician offices (U.S. Census Bureau, Nonemployer Statistics 2024).
Solo practitioners
Pennington County had 439 ambulatory health care businesses with no paid employees in 2024, with combined receipts of $25.8 million (U.S. Census Bureau, Nonemployer Statistics 2024). Many are solo therapists, counselors and other practitioners renting a room. Their funding needs are smaller, often a piece of equipment or a modest fit-out, and partners rely heavily on the practitioner's own credit and collections history.
Why practice payroll matters to a partner
Outpatient practices in Pennington County paid about $69,900 per employee on average in 2023 ($285.5 million across 4,083 employees, U.S. Census Bureau, County Business Patterns 2023), the highest of the four sectors our partners fund. Skilled staff are the practice's largest cost and the reason a slow month of insurance payments hurts. Partners look at whether collections cover payroll with room to spare, so a monthly collections report by payer is one of the most useful documents a practice can bring.
Dental offices in the county averaged about 12 employees each (731 employees across 62 offices), physician offices about 17 (1,437 across 85). Larger practices tend to have more predictable collections and more financing options.
Chairs, imaging and autoclaves
Dental chairs and delivery units, digital X-ray and imaging systems, sterilization and lab equipment, and practice-management software are common equipment financing requests. As a rule the equipment itself is the collateral. Technology that ages quickly may suit a fair-market-value lease; durable items suit a loan or a $1 buyout lease. Medical device financing works the same way, with the device as collateral.
Questions to ask about a practice equipment offer
- Is the offer a loan, a lease or an equipment finance agreement?
- Are installation, training and software included in the amount financed?
- What happens at the end of a lease: return, renew or buy, and at what price?
- Can the equipment be upgraded mid-term, and what does that cost?
- Is a personal guarantee required from each owner?
Vendor financing offered with the equipment is worth comparing with an outside partner's terms before you sign either.
The insurance gap and working capital
A practice books revenue at the appointment but collects it when insurers pay. Hiring a new hygienist or nurse, or a run of delayed claims, can open a gap between payroll and collections. Working capital covers a single gap; a line of credit suits a practice where claim timing swings month to month. Partners reviewing practice requests often ask for an accounts-receivable aging by payer.
Fit-outs, relocations and a second office
Building out a leased suite with plumbing to each operatory, cabinetry and shielding for imaging is a project with a known cost and a long payoff, which fits a term loan. Practices opening a second office need the same documents plus a sense of how the new location will fill its schedule.
Practice purchases and partner buy-ins
Practice acquisitions and partner buy-ins are financed case by case. Partners look at the practice's collections history, the buyer's credentials and credit, and the terms of the sale. We can talk through whether a request is ready, but valuations and legal structure are matters for your accountant and attorney.
A practice's funding file
- Bank statements alongside monthly collections reports
- Receivables aged by insurer and patient
- Equipment quotes from the vendor
- Lease for the practice space
- Each owner's licenses and credentials
Local Census statistics show where health care sits in the county economy, and funding by sector compares practices with other partner sectors.
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