In 2015, Small Nation purchased a building that had been vacant for five years. The purchase price: $19,000. Before its decline, the building had housed a dance studio, and we originally anticipated attracting another with a simple, updated renovation. Dance studios are community-energizing businesses. Young people and their parents make weekly stops downtown that create life experiences and memories, deeply rooting their love for the town where they were raised. Every day after their lessons, families grab a meal together, a gift for someone special, or some post-ballet ice cream, supporting the other businesses downtown. Our original plan was a safe addition to our planned tenant mix on the block, which included specialty retail and a coffee shop in the buildings we had purchased next door. A brand new idea that came to us out of the blue changed our plans… and opened the door to a completely different way of thinking about how creative development can directly affect the community as a whole.


Part of our Small Biz Success Blueprint™ includes communicating closely with our local community. Before recruiting a business tenant, the possibilities are put through a strategic filter. Asking the community for their ideas and input is crucial to the Small Nation development process. When we reached out to the community via social media about the Columbus Avenue block, Dr. Ryan Kauffman responded: Had we considered a medical practice downtown? Of course, we had not. It’s just not a typical tenant type for small towns, and the cost of interior buildout might outweigh the potential for a return on our investment. Normally, we wouldn’t have considered a physician a viable candidate for this space. But Dr. Kauffman had a new idea for a medical practice business model that quickly changed our minds.

In small towns, filling a community’s needs sometimes means thinking differently. For this particular location, that meant turning medical care — one the largest established industries in the nation — into a model that served smalltown residents in a way that was truly needed. Rather than following the typical medical practice model that requires high overhead and expensive health insurance premiums, Hickory Medical Direct Primary Care would offer primary care services for a low monthly fee, providing dedicated, affordable care for our small town’s residents.


At Small Nation, part of our development process includes asking two cornerstone questions: “ What is this building’s highest and best use?” And “What tenants will immediately add value to the downtown and cause an increase in traffic?” Hickory Medical answered both questions. By considering a completely different tenant type, we were able to help a small business fill a need in our community in a very personal way while still gaining the foot traffic numbers we were hoping for. We, in collaboration with our architect, engineers, and the physicians, moved forward with a design-build process to design and convert the open space into a medical facility.

The renovation of the building included the conversion of the open space into a lobby/office area and four private patient rooms requiring plumbing for wash sinks. At the same time, we converted the vacant second floor into a spacious loft apartment, which required the installation of new interior stairs to the upper floor to allow for two means of egress, as well as additional structure support and a full HVAC redesign for both units. Redevelopment of the building took four months, with a $275,000 total renovation budget. The addition of the loft apartment brings in $1,250.00 in additional monthly rental revenue for the project.

In 2021, Marie Barth, APRN-CNP and her husband took over Hickory Medical, bringing on Tara Klofta, APRN-CNP soon following. Hickory Medical Direct Primary Care is one of the first practices of its kind in the state of Ohio.

Their practice provides highly personalized, focused care to patients who otherwise might not be able to afford the services they need through larger providers. Affordable health care is imperative everywhere, especially in small towns where many folks are self-employed or do not have access
to health care insurance through their employers. The practice has received overwhelming support from the community because of their convictions to do the right thing for their patients at all costs.

Serving as many people as possible with the best affordable care is a game-changing idea that has benefited everyone involved. We are all connected in some way, and working together helps us serve each other in a meaningful way. And like so many of our projects, it’s not just the bricks and mortar that make a difference. It’s the people who work together to bring solutions to their community.