Capital Development

Michigan Health Centers provide healthcare services to nearly 600,000 patients annually. They have also responded rapidly to the need for additional services in this time of increased unemployment, heightened numbers of uninsured, and increased Medicaid beneficiaries and underinsured. Further, Medicaid and health insurance expansion is anticipated with full implementation of the Affordable Care Act. However, substantial capital is required to make the necessary investments in facilities and capital equipment projects in order to continue to increase Michigan Health Centers; capacity to provide needed access to comprehensive, affordable high quality primary and preventive health care particularly for the medically underserved.

In response to this need, the Michigan Primary Care Association (MPCA) established a capital development work group. The workgroup has developed a capital development program to assist Michigan Health Centers by identifying capital development opportunities; potential sources of funding, finance and other assistance; planning and development information; potential financial consultants and experience developers. It has also sought and received grant funding from The Kresge Foundation to provide technical assistance in the development of innovative, signature projects, and to seek and develop additional sources of funding for these types of capital projects.

completed projects booklet icon     completed projects poster icon


Consulting Services for Facility Projects

Various organizations can provide consultation on facility improvement projects, including government agencies, development corporations, community development financial institutions (CDFIs) and other financial institutions, developers, and experienced Health Center chief executive officers and project managers. Possible sources of consulting services are listed below.

Michigan Primary Care Association
MPCA can provide information and general consultation regarding capital development. In addition, it has entered into an affiliation with The Kresge Foundation to assist in the development of projects meeting its criteria for consideration for funding. For additional information contact Neal Colburn at ncolburn@mpca.net or 517.827.0472.

Capital Development Assistance for Community Health Centers
Capital Link has provided planning and capital solutions for hundreds of Health Center building projects since 1998. It is a national nonprofit organization that assists Health Centers and Primary Care Associations in accessing capital for building and equipment purchases by providing extensive technical assistance throughout the entire capital development process, from initial idea through completion of a new facility or implementation of a capital equipment project. Capital Link also provides targeted loans to assist Health Centers in leveraging other sources of capital. It periodically provides informational webinars, which are posted in the webinar section of this webpage as they are available. For information on working with Capital Link contact:

Mark Lurtz, Senior Director of Marketing & Project Consulting
2158 Roselake Circle, Cottleville, MO 63376
Phone:  636.244.3082
mlurtz@caplink.org   
www.caplink.org/
www.nachc.com/hc-capital-development.cfm


Financial Institutions & Development Organizations

The Michigan Health & Hospital Association Service Corporation & Michigan State Finance Authority
Equipment, modernization, and new construction financing is offered on a tax-exempt basis through the Healthcare Loan Program (HeLP). Borrowing rates are typically 50 percent of the prime rate and healthcare organizations can achieve economies of scale by sharing program costs with other organizations. Funds are also available through tax-exempt private placements and a taxable commercial paper program. More than $1 billion dollars have been made available to Michigan health organizations through the use of these services. The program takes advantage of economies of scale through group participation; allowing each borrower to access low-cost financing without individually incurring all of the transaction costs associated with public financing. These loans may also be used for construction. Loans generally range from $500,000 to more than $20 million; with 20 year amortization; variable rate. However, this is dependent upon market conditions. Click here for more information, or contact Gary Henriksen or John Barton.

Gary Henriksen
Michigan Health & Hospital Association Service Corporation
6215 West St. Joseph Highway, Lansing, MI 48917
Phone: 517.323.3443
ghenriksen@mha.org

John Barton
Michigan Finance Authority
Treasury Building, Lansing, Michigan 48922
Phone:  517.241.9515
bartonj@michigan.gov

Capital Link
In addition to being a source of capital development consultation, Capital Link is also a Community Development Financial Institution (CDFI). (See CDFI section). In addition to working with commercial lenders, it periodically receives allocations of New Markets Tax Credits and integrates them into project financial strategies. Working nationally out of its offices in Massachusetts, California, District of Columbia, Maryland, Missouri, Washington, and West Virginia, to date Capital Link has assisted Health Centers in obtaining grants and loans for approximately 174 capital projects totaling over $721 million. Through this network, and as a National Association of Community Health Center (NACHC) partner, Capital Link is able to address individual Health Center capital project needs more readily. For information on working with Capital Link contact:

Mark Lurtz, Senior Director of Marketing & Project Consulting
2158 Roselake Circle, Cottleville, MO 63376
Phone:  636.244.3082
mlurtz@caplink.org
www.caplink.org/
www.nachc.com/hc-capital-development.cfm

NCB Capital Impact
NCB Capital Impact, the non-profit affiliate of National Cooperative Bank, provides financial services and technical assistance to create more affordable cooperative homeownership, housing and services for the frail and elderly, and facilities for community-based health care centers and charter schools. Headquartered in the Washington, DC metro area, NCB Capital Impact has offices in Michigan, California, and New York. In the last 10 years alone, NCB Capital Impact has loaned or invested more than $600 million in its primary investment areas of education, affordable housing, health care, affordable assisted living, worker ownership, and community and economic development. NCB Capital Impact is also working with special development initiatives in Michigan. NCB Capital Impact is a CDFI and often incorporates New Market Tax Credits in its financial planning. (See CDFI program section). NMTCs can be an important compliment to traditional bank loans, and will help lower interest rates, reduce monthly payments, and create equity instead of debt. To date, NCB Capital Impact was awarded $319 million in New Markets Tax Credits (NMTC) to provide health care organizations, charter schools, and other community organizations affordable financing nationwide. For information contact:

Ian Wiesner, Loan Officer & Business Development Officer
NCB Capital Impact
2370 E. Stadium Blvd. #350, Ann Arbor, MI 48104
iwiesner@ncbcapitalimpact.org
Office:  734.929.4224
Cell:  313.405.4969

Nonprofit Finance Fund (NFF)
NFF provides financial resources in the form of loans, grants, and asset-building programs, in concert with management advice. NFF works directly and with funders to strengthen nonprofit organizations and the system by which they are funded. In Fall 2009, NFF was awarded $60 million in New Markets Tax Credits, which it is using to attract private capital. With this capital, NFF is providing loans at reasonable rates to nonprofits serving low-income communities. In total, NFF has received $130 million in New Markets Tax Credit allocations. (See CDFI section.) NMTC loans are available for community facility projects over $5 million that may that involve acquisition, substantial renovations, leasehold improvements, or new construction of community spaces such as charter schools, health clinics, community centers, arts and cultural spaces, and others. Click here for more information or contact:

Kevin Sweeney, Director, Midwest Region
645 Griswold St., Suite 2202, Detroit, MI 48226
Phone:  313.965.9145 x14
Cheryl.Baur@nffusa.org
www.nonprofitfinancefund.org
nonprofitfinancefund.org/midwest/midwest

Commercial Lenders
Health Centers may be able to use a number of different sources to finance their facility improvement project. Hopefully the financing will include a nice mix of public contributions, grant funds, and tax credits. What is not covered by these equity-creating dollars will need to be funded using commercial loans from traditional financial institutions, possibly combined with loan guarantees from HRSA, USDA, or other opportunities. CDFIs and developers can often assist in assembling these packages. Several are posted here. However, if you have recommendations about sources of commercial loans from institutions that appear to be supportive of Health Center development or simple market expansion, we invite you to share this, and we will post this information here.


Developers, Builders & Architects

A number of developers and builders have been recommended by Health Center peers. A listing is posted here for you to consider. This posting is not a MPCA endorsement. Health Centers are encouraged to complete their own due diligence. If there are recommendations for Health Center CEOs and project managers, we would be happy to post their contact information.

Hooker DeJong
David Layman, AIA, President/CEO
Hooker | DeJong, Inc.
Hooker | DeJong, Inc., Architects & Engineers
316 Morris Avenue, Studio Suite 410, Muskegon, MI 49440
davidl@hookerdejong.com
Phone: 231.722.3407
Cell: 231.740.1387
www.hookerdejong.com
www.hookerdejong.com/pg/people/

Frank Bednarek
frankb@hookerdejong.com
Phone:  231.722.3407

CMS Group
Todd McDonald, President
Kalamazoo Office: 444 West Michigan Avenue, Suite 100, Kalamazoo, MI 49007
Phone: 269.488.6597
Todd.McDonald@CSMgroup.com
www.csmgroup.com

Lori Green, Director of Business Development & Marketing
Phone: 269.4886597 phone
Cell:  269.207.3771

Gryphon Group, LLC
Tim Hunnicutt
225 S Bridge St., DeWitt, MI 48820
Phone: 517.669.6024x2
thunnicutt@gryphon-llc.com

Bruce Dietz
Bruce Dietz, Builder, developer
105 Glenridge Street, Alpena, MI 49707-4110
Office:  989.356.3812
Cell:  989.350.1099
brucedietz@hotmail.com

The Christman Company
The Christman Building
208 N. Capital Avenue
Lansing, MI 48933-1357
www.christmanco.com
John M. O’Toole, LEED AP
Vice President, Healthcare Services
Phone: 517.374.0848
Mobile: 248.866.4995
Fax: 517.482.3520

Steven Flum Inc.
Steven Flum, Architect
4147 Trumbull Ave., Suite 100
Detroit, MI 48208-2937
Office:  313.831.2844
sflum@ameritech.net

The Beresh Group
Bruce Beresh, President
11835 Brookfield
Livonia, MI 48150
Office:  734.427.4500
Cell:  734.341.2999
beberesh@bereshgroup.com


Foundations

Fundraising can be an important component for a facility improvement project. Money raised from public contributions increases Health Center equity, and reduces the amount of Health Center debt. Below are links to foundations’ web sites. It can be helpful to research foundations’ missions and requirements via their web sites and personal contact, and approach those that appear to have a stated interest in the type of project, location, and planned goals of your Health Center’s project.
Foundation listing:
Greater Lansing Foundation
http://staff.lib.msu.edu/harris23/grants/gtlansto.htm
c/o PNC Bank
120 North Washington Square, Suite 650
Lansing, MI 48933
Steven J. Peters
517.334.5299

The John R. and M. Margrite Davis Foundation (Michigan)
126 Babbs Hollow Road
Greenville, SC 29607
Raymond C. Cunningham Jr., President
843.671.1108

La-Z-Boy Foundation (Michigan, La-Z-Boy outlet communities)
1284 North Telegraph Road
Monroe, MI 48162-5138
Donald Blohm
313.242.1444 or 734.457.2005
http://www.la-z-boy.com/michigan/

Matilda R. Wilson Fund (Michigan, primarily Southeast MichiganI)
6th Floor at Ford Field
1901 St. Antoine Street
Detroit, MI 48226
Robin L. Oosterveen, Program Director
313.259.7777

Morley Foundation (Michigan, primarily Saginaw)
P.O. Box 2485
Saginaw, MI 48605 -2485
Mark Morley, President
989.791.0155


MPCA/Kresge Foundation Project

Michigan Primary Care Association (MPCA) was pleased to be the recipient of a $1 million grant from The Kresge Foundation for a 3-year facility development project. MPCA is using the funding to provide technical assistance to Michigan Health Centers with special focus on the development of innovative capital development projects that will contribute to improved access and outcomes, significantly raising the health status of the medically underserved.   

The Kresge Foundation and MPCA are working together and seeking collaborations with other foundations, organizations, agencies, and individuals to obtain resources to assist Health Centers in planning and financing needed facilities and capital projects. In an ongoing process to continue to raise the bar in innovation and improved outcomes, this collaboration seeks to support projects with these characteristics:
  • Innovation in project design
  • Green features (ex. LEED)
  • Community access and collaboration
  • Special population consideration (meeting needs of medically underserved)
  • Improved population health outcomes (planned metrics)
  • Positively impact the social determinants of health (housing, environment, nutrition, employment. etc.)  
The 3-year project is part of an overall strategy in which the Kresge Health Team helps create healthy environments and caring communities, and encourages emerging and promising practices with the goal of supporting innovative, cross-sector, interdisciplinary methods that address the cumulative impacts of social and environmental factors disproportionately affecting at-risk communities and their medically underserved populations.

MPCA/Kresge Project Goals
The overall goal of the MPCA/Kresge project is to assist Health Centers in developing capital projects that include the characteristics noted above and positively impact the health of the community in an effective, multi-factorial manner, and work with Kresge and other foundations to develop a pool of capital, program-related investments (PRIs) and other commitments to provide needed project financial assistance. In order to achieve this, substantial care will be given to developing projects that focus on the achievement of sustained improved health status of the community’s population, also known as “Signature Projects”. These projects will require community collaboration and support from community organizations, government organizations, and providers of the required funding and finance. In order to accomplish this, the following activities are planned and in-process:
  • Maintain ongoing liaison with Kresge Foundation health program representatives
  • Collect, aggregate and document the facility needs of Michigan Health Centers
  • Collect documentation and develop presentations on the beneficial impact of Michigan Health Centers' health services (improved health status, quality care, lower cost)
  • Collect documentation of the economic impact of Michigan Health Centers
  • Provide information and educational opportunities in the planning, financing, and development of facility projects, webinars, presentations planning sources. etc.
  • Encourage and facilitate the planning and documentation of proposed Health Center “Signature Projects” meeting Kresge Foundation program characteristics
  • Facilitate an ongoing process of information collection and development of projects to be presented for possible funding
  • Present information and develop relationships with foundations and funding sources, advocating on behalf of Michigan Health Centers and encouraging them to contribute to a pool of capital, program-related investments (PRIs), general and targeted commitments for the development of Health Center facility projects
  • Present information and develop relationships with sources of project finance (banks, community development financial institutions, bonding authorities, loan guarantee programs etc.)
  • Research and maintain information on potential sources of federal and state grant funding and integrated development programs providing opportunities for grants, and special district designations providing grants and preferred financing opportunities
  • Develop working relationships with developers and builders with recommendation by the membership or with a preferred history of project development of Health Center appropriate facilities
  • Maintain a library of capital development resources and contacts conveniently available on the MPCA website or by request of the members, and provide technical assistance as needed
See Kresge Initiative Links section in Document Library below. The MPCA/Kresge Foundation project is an ongoing project 2011-2014. If you have questions, need more information or technical assistance, contact Neal Colburn, Director of Capital Development, MPCA at ncolburn@mpca.net or 517.827.0472.


Government Programs

Grants, Loans, Loan Guarantee Programs; Tax Credits, other programs and designations

Health Resources and Services Administration (HRSA)
Health Center Capital Development

Capital development grants support Health Center efforts to expand their capacity to provide primary and preventive health services to medically underserved populations in underserved communities. They are one-time awards supported with funds made available by the Affordable Care Act. More information

HRSA Loan Guarantee Program
The Loan Guarantee Program guarantees loans secured from non-Federal lenders and is not to be considered a direct loan or grant. This program is generally expected to operate as follows: the applicant for a loan guarantee under this Program will borrow funds secured from a non-Federal lender and guaranteed up to 90 percent by the Bureau of Primary Health Care (BPHC) to (1) develop a network or plan, and/or (2) operate a network or plan already in place. To be eligible for a loan guarantee under this Program, the network or plan must be owned or controlled by health centers (see Eligible Applicants and Definitions sections below). Under this Program, a network or plan may receive only one loan guarantee, except that upon showing of good cause the BPHC may make additional loan guarantees.
Health Care & Other Facilities (HCOF) Construction
HCOF provides congressional-directed funds to health facilities for construction-related activities and/or capital equipment purchases. Most projects are completed within three years, although some take as long as five years. More information
United States Department of Agriculture (USDA)
Community Facilities - Grants, Loans and Loan Guarantee Programs

USDA has loans, loan guarantees, and grants available for facility development and improvement projects in rural areas with underserved populations. Direct loans and grants may be made for essential community facilities. Loans and grants are available in areas wth populations of 20,000 or less. The loans have very favorable interest rates and extended terms. Click here for more information. Communities with populations under 50,000 may qualify for other grants, loans, and loan guarantee programs. Contact your local USDA office to discuss this.
USDA Community Facilities Loans and Grants
Community Programs provide loans and grants and loan guarantees for water and environmental projects, as well as community facilities projects. Water and environmental projects include water systems, waste systems, solid waste, and storm drainage facilities. Community facilities projects develop essential community facilities for public use in rural areas and may include hospitals, fire protection, safety, as well as many other community-based initiatives. More information
Community Programs can make and guarantee loans to develop essential community facilities in rural areas and towns of up to 20,000 in population. Loans and guarantees are available to public entities such as municipalities, counties, and special-purpose districts, as well as to non-profit corporations and tribal governments. Community Facilities Grants
Community Programs provides grants to assist in the development of essential community facilities in rural areas and towns of up to 20,000 in population. Grants are authorized on a graduated scale. Applicants located in small communities with low populations and low incomes will receive a higher percentage of grants. Grants are available to public entities such as municipalities, counties, and special-purpose districts, as well as non-profit corporations and tribal governments. Rural Community Development Initiative
To develop the capacity and ability of private, nonprofit community-based housing and community development organizations, and low income rural communities to improve housing, community facilities, community and economic development projects in rural areas.

Community Development Financial Institutions (CDFIs)
A certified Community Development Financial Institution (CDFI) is a specialized financial institution that works in market niches that are underserved by traditional financial institutions. CDFIs provide a unique range of financial products and services in economically distressed target markets, such as mortgage financing for low-income and first-time homebuyers and not-for-profit developers, flexible underwriting and risk capital for needed community facilities, and technical assistance, commercial loans and investments to small start-up or expanding businesses in low-income areas. CDFIs include regulated institutions such as community development banks and credit unions, and non-regulated institutions such as loan and venture capital funds. CDFI certification is a designation conferred by the CDFI Fund and is a requirement for accessing financial and technical award assistance from the CDFI Fund through the CDFI Program, Native American CDFI Assistance (NACA) Programs, and certain benefits under the BEA Program to support an organization's established community development financing programs. CDFI Information
Community Development Financial Institutions (CDFI) Fund
The CDFI Fund was created for the purpose of promoting economic revitalization and community development through investment in and assistance to community development financial institutions (CDFIs). One of the ways the CDFI Fund achieves its purpose is to promote access to capital and local economic growth through its New Markets Tax Credit (NMTC) Program by providing an allocation of tax credits to community development entities (CDEs) which enable them to attract investment from the private-sector and reinvest these amounts in low-income communities. New Markets Tax Credit Program
New Markets Tax Credits Program
The New Markets Tax Credit Program (NMTC Program) was established by Congress in 2000 to spur new or increased investments into operating businesses and real estate projects located in low-income communities. The NMTC Program attracts investment capital to low-income communities by permitting individual and corporate investors to receive a tax credit against their Federal income tax return in exchange for making equity investments in specialized financial institutions called Community Development Entities (CDEs). The credit totals 39 percent of the original investment amount and is claimed over a period of seven years (five percent for each of the first three years, and six percent for each of the remaining four years). The investment in the CDE cannot be redeemed before the end of the seven-year period. These credits can often be incorporated into the financial plan of significant facility projects. They are cost-effective in projects usually exceeding $5 million. These are generally arranged by organizations familiar with arranging financial packages for development projects, such as Community Development Financial Institutions (CDFIs) and developers of large projects. These credits may only be used in qualifying census tracts. Allocations of New Markets Tax Credits are limited and distributed to CDFIs periodically, so their availability changes. See Financial Institutions or Architects and Developers sections.
New Markets Tax Credits
Brownfields
The Brownfields Economic Development Initiative (BEDI) is a key competitive grant program that HUD administers to stimulate and promote economic and community development. BEDI is designed to assist cities with the redevelopment of abandoned, idled and underused industrial and commercial facilities where expansion and redevelopment is burdened by real or potential environmental contamination. For a BEDI application and/or guidebook to all HUD programs, please contact the Super NOFA Information Center at 1-800-HUD-8929. Persons with hearing or speech impairments may call the Center's TTY number at 1-800-HUD-2209. Questions regarding the BEDI program may be directed to David Kaminsky in HUD's Office of Economic Development at 202.402.4612. More information
Note: BEDI is primarily an economic development strategy. Buildings and sites with contamination that can be cleaned up and have the potential to create jobs are the primary focus. This includes contaminated rural parcels also. Projects are usually initiated by private developers working with local governments acting as grantees. Projects such as health center development can qualify.
This information is provided for reference as an option to explore in initial planning. Capital development professionals are familiar with the program and can assist you.

Historic Preservation: State of Michigan Preservation Office
For information on utilizing Historic Preservation Tax Credits click here or contact:
Robert McKay, Historical Architect
Phone:  517.3352727

For information on the review under Section 106 of the National Historic Preservation Act of 1966 Projects utilizing federal assistance (i.e. FQHCs) require review click here or contact:
Cultural Resources Protection Section of the SHPO
Phone:  517.335.2721

Michigan State Housing Development Authority (MSHDA)
Brian G. Grennell, Cultural Resources Protection Specialist
Michigan State Historic Preservation Office
702 W. Kalamazoo Street, P.O. Box 30740, Lansing, MI 48909-8240
Phone: 517.335.2721
Grennellb@michigan.gov


Capital Development Webinar Series

March 31, 2010
Creating Healthy Communities
Presented by Tim Hunnicutt, the Gryphon Group

April 8, 2010
Getting to Know Nonprofit Finance Fund
Presented by Cheryl Baur, Senior Associate, Nonprofit Fund Financial Services

September 20, 22, 26, 2011
Your Project is the One! Convincing The Funding Sources (CD Grant Series)
Presented by Terry Glasscock, Capital Link Senior Project Consultant
If your Health Center did not receive an award for either of the last two HRSA grant rounds, it’s important that you learn some of the secrets to what makes an exceptional application. This webinar reviews previous FIP and CD applications to identify areas to improve. The presenter then discusses the Centers that generally received awards, focusing on the elements common to the successful applications. Finally, the session covers the best methods of improving your chances for receiving an award this time.

October 18, 2011
Payer Mix and Patient Growth Forecasting        
Presented by Dave Kleiber, Capital Link Project Consultant
The Affordable Care Act has launched the health care delivery system onto a challenging and exciting new path. A major part of this transformation will be the expansion of Medicaid eligibility and the creation of new health insurance exchanges. Although these developments will provide coverage for millions of Americans, it isn’t easy to predict how many will seek care at Health Centers. It is imperative to plan for the changes to come; but translating new regulations into prospective new patient visits can be difficult. Presenters discuss tools to help estimate future Medicaid eligibility in your service area and the impact these sweeping reforms will have on your business model.

October 19, 2011
Secrets to Financing Your Capital Project: What Others Don't Know
Presented by Terry Glasscock, Capital Link Senior Project Consultant
If your Health Center is developing strategies to finance a capital project, this webinar will offer suggestions on keeping your costs low. The presenter coversthe many available funding sources, explain the financing structures that could cut your expected payments by 30% to 50%, and reviewing opportunities to have 20% of your project costs financed with funds you may never need to repay! This webinar also reviews how to assemble a successful financing application.

October 27, 2011
Planning Inside and Outside the Health Center: Strategic Community Assessment
Presented by Cindy Barr, Capital Link Operations and Facility Planning Consultant,
and Rebecca Polan, Capital Link Project Consultant
In an effort to be responsive to their patients, Health Centers often fall into the trap of forgetting to look outside of their current patient base to understand what other services they could offer to help the surrounding community. The focus of this session is to provide Health Center managers with tools for assessing the health needs of the broader community, including gathering health risk factors, market demand numbers, as well as information on competition. The session also covers how to take this information about the external environment and translate it into a new, more responsive program plan.

November 15, 2011
Presented by Ray German, BMG Associates, and Terry Glasscock, Senior Project Consultant, Capital Link
As the Affordable Care Act is implemented, the pressure is on for health centers to expand in time to accommodate expected patient growth. For many health centers, that will require dramatic expansions or new construction. Now that the final round of ACA capital funding is nearing an end, health centers seeking to grow will need new tools to strengthen their fundraising and capital campaign activities. This session reviews current trends among foundations and also offers guidance on how to develop a fundraising plan for your capital project. The webinar also offers tools to improve your existing capital campaign activities. If your fundraising can use a boost, this session is not to be missed!

November 17, 2011
Presented by Rebecca Polan, Project Consultant, Capital Link
The Affordable Care Act has encouraged health centers to serve 40 million patients by 2015. Meeting this challenge requires careful planning to make sure expansions are well-supported and strategically and financially sound. This session is designed to provide participants with a tour of the many market research resources available (many of them are free for all to use).Techniques are discussed for how to assess the size and location of the low-income, uninsured and underserved population, estimate the level of unmet need, and translate this information into workforce needs and a preliminary capital project budget.


Document Library

Direct links to online documents and information:

Capital Link
Overview
Events
Project Materials (free publications)
Program Applications & Guidance

The Center for Health Design
(Recommended as information source by The Kresge Foundation)
Overview
Clinic Design
Design Recommendations
Design Process
CHD – Clinic Design (Note downloads on right)
Improving the Patient Experience

HRSA – Access Technical Assistance
Technical Assistance Topics
Loan Guarantee Program
Health Center Loan Guarantee Program Application
Environmental Form
Federal Interest
PHS Health Facilities Planning Manual

Facility Guidelines Institute
Guidelines for Design and Construction of Health Care Facilities 2010 Edition (Read only online) Available for purchase $168 - click here

NACHC
Tips for Managing Facility Development Risks
Access Capital Report
NY Primary Care Development Corporation – Resource Links

Kresge Health Initiative
Overview
Kresge & Institute for Alternative Futures DRA Project 

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