KeepWell Health Union

Capital Memo

Capped-return, mission-aligned capital for a downtown San Francisco primary care clinic with catastrophic coverage via reinsurance. Built to be stable, not extractive.

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Executive Summary
Nonprofit • Predictable cash flow

What we’re building

A nonprofit healthcare cooperative operating direct primary care at a fixed $500 PMPM, with catastrophic risk covered via reinsurance.

Initial raise$1.5–$1.8M
Clinic cap1,500–3,000

Why it works

  • Transparent pricing employers can budget.
  • Membership caps preserve care quality.
  • Reinsurance limits tail-risk exposure.
  • Surplus reinvested into care and reserves.
The Problem & Solution
Access • Continuity • Cost control

Employers face

  • Rising premiums and unpredictable renewals
  • Long waits, fragmented care, low utilization
  • Opaque pricing and poor outcome visibility

KeepWell provides

  • Same/next-day access + proactive care
  • Direct-employed clinicians, stable panels
  • Catastrophic coverage via stop-loss reinsurance
Business Model
$500 PMPM • Employer-paid

Revenue

Employer-paid membership at $500 PMPM per enrolled member.

Break-even~500 members
Reinsurance$80–$100 PMPM

Costs

  • Reinsurance (stop-loss + aggregate)
  • Clinicians + care team payroll
  • Clinic ops (rent, labs, supplies, tech)
  • Reserves and debt service
Capital Instruments
Capped-return • Non-dilutive

1Revenue-Based Notes

Repayments tied to monthly revenue, with a capped return (e.g., 1.2×–1.4× principal). No equity, no control.

2Community Bonds & PRIs

Fixed-rate community bonds (3–6%, 3–5 years) and Program-Related Investments for foundations seeking recyclable impact capital.

Risk Mitigation
Stop-loss • Reserves • Caps
  • Stop-loss reinsurance with aggregate protection.
  • Membership caps enforced by policy and governance.
  • 6–9 months operating reserves target.
  • Phased expansion: open clinic #2 when waitlist pressure appears.