and Solutions for FQHC Leaders Maximizing Value in Uncertain Times

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1 Real lestate t Strategy t and Solutions for FQHC Leaders Maximizing Value in Uncertain Times

2 Four key questions for maximizing value in capital projects 1. Do you have a sustainable vision? 2. Do you have a systematic process? 3. Does your CHC have the skill sets to maximize value 4. How can you use time as an ally?

3 Do you have a sustainable vision?

4 Is your real estate vision based on a sustainable business plan? No margin, no mission Patient Need Demographics Competition Institutional infrastructure Hospitals ACO s Insurers Federal regs/grants State regs/grants Real estate to satisfy need Revenue stream

5 Do you have a systematic process?

6 Manage the process. Don t tjust look for space. Finding space is usually just Plan 20 40% of the process Negotiate Investigate Implement 2011.

7 Planning tip Project schedule boosts your control Relationships among key project phases Resources needed Time Personnel Cost

8 Checkpoints. Document needs; identify the team Prove alternatives and ability to manage risk Document financial terms

9 Does your CHC have the skill sets needed to maximize value

10 Real estate specific skills Real estate market knowledge Financing options (loans, grants, bonds, NMTC, lease with option, build-to-suit suit, lease) Location knowledge Building knowledge Current deal terms Real estate negotiating skill Money (deal terms) Operational terms Real estate contracting skill Architect General contractor CM/GMP Stipulated sum Real estate project management

11 Go-it-alone communications flow All communications directed at CEO. Communications between ee consultants t may be episodic. Potential for silos, dropped balls. CHC CEO Architect GC Broker Furniture broker/consultant Financial consultant Real Estate lawyer?

12 Project lead qualifies consultants, assembles team, structures tasks, leads communication. Communication among team members is regular, frequent, transparent. Communication is focused on client goals. Structured project communications flows Owner s Rep CHC CEO Architect GC Broker Furniture consultant/broker Financial Consultant Real estate lawyer

13 Project Type Leadership time for select projects Negotiated market-rate lease renewal Search for space to lease; lease, build-out Duration ua (weeks) Hours /project leadership Increase in hrs/wk for CHC leadership Increase in days/wk for CHC leadership Renovation of existing facility (15,000 sq. ft)

14 Additional days/week for the practice leader Sun. Sat. Extra time Fri. Thurs. Wed. Tues. Normal work day Mon. Negotiated lease renewal Search for new space Renovation, existing facility

15 For a lease Avoid the pitfall of hidden costs Negotiate the non-rent terms For a purchase, beware of existing conditions Asbestos, easements, title For new construction, beware of context issues Utility availability and costs Non-obvious site conditions Community demands

16 How can you use time as an ally?

17 Start early. Allow more time than you think you need months Standard d clinical i l projects 10, sq. ft. 100,000 sq. ft., existing structure; smaller facilities: 12 months months Greenfield development, depending on condition of site, nature of building and developer experience 3-6months Lease of swing space for gap needs; assumes as-is or nearly as-is use; almost always a distraction Early start t favors you; rushed ddecisions i favor seller/landlord Allow time to walk

18 Critical project phases are sacrificed when projects are fast-tracked Time All lowed to Manage Proj ject 36 month schedule 24 month schedule 18 month schedule 12 month schedule The time needed for tenant work cannot costeffectively be shortened, so tenants who fail to allow adequate time, sacrifice the time needed for site searches, financial negotiations and lease negotiations Strategy Programming Site Searches Financial negotiations Financial analysis Financial negotiations Financial analysis Financial negotiations Lease negotiations Architectural Designs Build-out Move-in Bi-Week Periods from Project Inception to Move-in

19 Manage the process for maximum results Define your needs; create a sustainable plan Assemble an effective team Skill sets Alignment Time Communication Follow a systematic process Transparency Manage expectations Goals in view Controls Use time as an ally Act Plan Define

20 Control of the real estate process Transparent to leadership team, Board and funding sources Buy-in from all constituents No surprises Superior transactions Reduced risk Lower costs Better fit for CHC needs Results

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