Healthcare/Wellness

Talladega College

April 19, 2018 by

Talladega College is the state of Alabama’s oldest Historically Black College (“HBCU”). Formed in 1869, today Talladega College has full-time enrollment of nearly 1,200 students, 97% of whom are Pell-grant eligible, and approximately 85% are 1st generation college students.

For 150-years, Talladega has provided quality education to its students and service to its community despite having no student center facilities whatsoever. Talladega students currently have no place to congregate, no central location in which to hold student group meetings or routine events such as graduation ceremonies and dances. This is a significant disadvantage in recruitment, says President Hawkins: “on weekend nights, students have nowhere to go to unwind, and are forced to sit on the steps outside their dorm rooms.”

In the face of this significant disadvantage, Talladega’s enrollment has grown 250% since 2009. Unfortunately, the College’s housing facilities are inadequate to cope with the sheer size of the student body. As a result, Talladega was forced to spend more than $300,000 on hotel rooms for 100 students from 2014-2017.

In June of 2014, Talladega College engaged Crescent to pursue NMTCs in conjunction with its overall financing plan for a new student center and residence hall. The student center was designed to not only serve Talladega students, but also to address the myriad issues affecting the residents living in the surrounding census tract, which is designated as medically-underserved and a Food Desert; the student center offers a new cafeteria and health clinic, both of which are open to the public.

The residence hall will consist of space for 203 beds (102 rooms), inclusive of rooms for undergraduate students, RA’s (resident advisers), handicapped accessible rooms, a housing director, as well as common study areas and lounges.

Having already secured a commitment from the USDA Rural Development Community Facilities program, Crescent worked to secure a construction loan, an investor commitment along with NMTC allocation. In April 2018, Crescent and Talladega College closed on $20.0M of NMTCs, utilizing allocation provided by United Bank, National Community Fund, and Trustmark Bank, leveraging a NMTC equity investment made by PNC Bank. The Federal NMTC subsidy helped cover nearly $3 million overruns resulting from commodity price escalation in the wake of Hurricanes Harvey and Irma. By covering this gap, the NMTC subsidy allows Talladega to create 46 new FTE jobs and to expand its work-release program with Childersburg Correctional Facility.

Smith County Memorial Hospital

February 15, 2018 by

Smith County Memorial Hospital (SCMH) has been a staple in Smith County, KS for nearly 70 years, providing a wide variety of healthcare services to the surrounding, medically underserved area. Operating out of a woefully outdated facility and serving a patient base that is comprised nearly 65% of Medicare/Medicaid patients, SCMH provides surgical, emergency, diagnostic, labor & delivery, nursing, occupational and physical therapy services.

Unfortunately, SCMH’s original 35,000 sf facility is nearly 70 years old as well, and has become entirely inadequate to meet modern standards for a medical facility: it is grandfathered into outdated Life Safety regulations, and its only ADA-compliant facility does not have a single bathroom. In the current SCMH facility, all inpatient rooms are forced to share bathrooms, and all patients must use a single communal shower room. Rather than undergoing a 9-phase, two-year renovation of its existing facility to bring it up to modern Life Safety code – and effectively halting all medical services during that period – in 2017, SCMH began developing a plan to relocate and construct a new state-of-the-art facility.

In early 2017, SCMH engaged Crescent to pursue NMTC’s as part of the financing plan for its new $30M critical access hospital, having already secured a construction loan from Kansas State Bank, as well as a take-out commitment from the USDA Rural Development loan program. In February, 2018, CGC and SCMH closed on $17.5M of NMTC’s, utilizing allocation provided by Community Hospitality Healthcare Services and Central Bank of Kansas City, leveraging a NMTC equity investment made by US Bank.

The new 61,698 sf Smith County Memorial Hospital will offer 16 inpatient beds, a 28-bed Long Term care unit, a 6,115 sf surgery suite, outpatient clinic services, radiology and lab services, cafeteria and food services, physical therapy, wellness facilities, and the required administrative, maintenance, and support services. Additionally, SCMH will carry over to the new facility all of its current programming and outreach programs, including its scholarship program, which covers education costs for potential nursing staff, lab and radiology techs, in exchange for full-time employment commitments after graduation.

University of the Incarnate Word – School of Osteopathic Medicine

January 8, 2018 by

The population of Texas is growing at a meteoric pace, severely straining the state’s healthcare system. As of the 2010 Census, Texas ranked 47^th out of 50 states in the number of primary care physicians per 100,000 inhabitants (70.0 per 100,000 as of the 2010 Census). This figure conceals an even worse reality for South Texas. Remove Bexar County (San Antonio) from regional physician counts, and the South Texas region is left with a rate of primary care physicians per capita nearly half again as worse (43 per 100,000) as the statewide figure. Furthermore, only 10% of physicians in Texas are Hispanic, while 40% of the overall population is so classified, making for inadequate cultural competency and poorer care outcomes.

The University of the Incarnate Word decided to tackle this serious and worsening problem by founding a new medical school. The new school’s osteopathic curriculum is based on the recommendations of the Carnegie Foundation’s Educating Physicians for the 21st Century report, which outlined four goals for medical education: standardization of learning outcomes and individualization of the learning process; integration of formal knowledge and clinical experience; development of habits of inquiry and innovation; and, focus on professional identity formation.

Where to locate this needed new institution? As chance would have it, an especially attractive facility to house the new school was on offer: the historic, recently-vacated campus of the former USAF School of Aerospace Medicine at the decommissioned Brooks Air Force Base. After successfully sourcing NMTC allocation and closing on two previous projects for the university, Crescent Growth Capital was hired again by UIW, this time to attempt a combined federal New Markets Tax Credit and Texas Historic Preservation Tax Credit financing to help fund the university’s School of Osteopathic Medicine.

In December, 2016, Crescent and UIW closed on a $6 milllion NMTC financing for the new medical school, utilizing allocation provided by Enhanced Capital and NMTC equity provided by Wells Fargo. Thirteen months later, Crescent delivered $1.65 million in Texas state historic tax credits to Enhanced Capital, having authored Parts A, B and C of the Texas Historic Preservation Tax Credit application and collaborated with the San Antonio Office of Historic Preservation to have the National Park Service certify SA OHP’s School of Aerospace Medicine local historic district. The completed rehabilitation restored the 1963 main building’s deleted courtyard entry on the south elevation and leveraged its mid-century modern design to create an appealing, contemporary home for the new school.

With its School of Osteopathic Medicine, the University of the Incarnate Word is now positioned to pursue its long-range goal of increasing the number of osteopathic physicians beginning their practice by at least 145 per year, helping to ameliorate the severe regional healthcare supply deficit. UIW will enroll 150 students per class, a significant share of whom will be Hispanic; graduates of the four-year program will receive the “Doctor of Osteopathic Medicine” degree (D.O.).

Los Barrios Unidos – Family Health Center

December 22, 2015 by

The mission of Los Barrios Unidos Community Clinic (LBUCC) is to proudly provide quality care to all people, creating a safe, affordable, and accessible healthcare experience. In 1972, the residents of several West Dallas neighborhoods united to open a community clinic in a portable building to serve a population disenfranchised from the economic and social services of the city due primarily to language and cultural differences.

LBUCC has flourished tremendously since its opening. 93% of LBUCC’s 21,000 patients are Hispanic and 74% are uninsured. Nearly 30 clinicians provide 70,000 patient visits each year. Patients are drawn from all parts of Dallas County although West Dallas, Oak Cliff and Grand Prairie are the core market areas. LBUCC proudly provides top-notch care to all people regardless of race, ethnicity, place of residence or even the ability to pay.

There is no shortage of need for affordable primary care in Dallas County, which is the second largest Metropolitan area in Texas in terms of size and population , and ranks ninth in the nation. 18.7% of Dallas County’s 2,368,139 residents or over 443,000 individuals live below 100% of the Federal Poverty Level (Census 2010).

In late 2014, Los Barrios Unidos engaged Crescent Growth Capital to facilitate the NMTC financing of its new Family Health Center, a new 21,400 square foot clinic offering 15 exam rooms, 3 open Team Stations with 4 modular workstations each, a large ground floor laboratory, a phlebotomy area, a massive 75-seat waiting area and plenty of storage.

In December, 2015, LBUCC and CGC closed on a $7MM federal NMTC financing, providing the funding necessary to construct the Family Health Center, using NMTC allocations provided by Primary Care Development Corporation and Capital One Bank. The NMTC subsidy drastically reduced LBUCC’s cost of capital, greatly reducing the ongoing debt burden for a non-profit FQHC whose patient base is nearly 3/4’s uninsured, while creating 24 new FTE jobs in one of Dallas’ most impoverished areas.

Terry Reilly Health Services

December 10, 2015 by

Forty-two years ago, Terry Reilly and his wife Rosie Delgadillo Reilly arranged with Dr. Clarence McIntyre for voluntary medical services for the migrant farm workers’ children who were being tutored at their home on Nampa’s north side. The experience helped to open the eyes of many local, regional, and national leaders to the plight of the large medically underserved population in the Treasure Valley area. Federal Public Health Services grant resources and strong local advocacy enabled the Reilly’s to found Community Health Clinics, Inc. as a vehicle to provide healthcare services to those who need it most. Today, the Federally-Qualified Health Center operates under the dba Terry Reilly Health Services (“TRHS”), and operates with the Mission of providing affordable, comprehensive health care to everyone, especially those facing barriers elsewhere, such as the uninsured, migrant and seasonal farm workers, and the homeless.

Despite the fact that 60% of TRHS’ patients are at or below the poverty level, just 28% are on Medicare/Medicaid, a discrepancy indicative of a State with one of the most poorly-ranked Medicaid programs in the nation. Nearly two-thirds of the 11,000 patients TRHS serves annually have no health insurance at all, presenting a significant fiscal challenge for the non-profit FQHC. Despite this apparent imbalance between services provided and service revenue received, TRHS has continued to grow both its patient encounters and its range of services.

In late-2014, Terry Reilly Health Services engaged Crescent Growth Capital to facilitate a NMTC financing that would provide the necessary working capital to allow the Federally-Qualified Health Center (“FQHC”) to provide an ever-expanding range of health services to Idaho’s most indigent populations. In December, 2015, TRHS and Crescent closed on a $6,000,000 NMTC facility, with allocation provided by Hampton Roads Ventures, and new markets tax credit investment provided by Capital One. The working capital facility will provide the FQHC with some much-needed operating capital to continue to serve the people of Nampa, Boise, and beyond.

Ursuline Academy – Fitness and Wellness Center

October 31, 2014 by

Ursuline Academy in New Orleans was founded in 1727, nine years after the city’s establishment. It is both the oldest continuously-operating school for girls and the oldest Catholic School in the United States. For 284 years, Ursuline Academy’s core values have rested upon consistent support for the advancement of women in society, regardless of their family’s station. This conviction has manifested itself repeatedly, and has included through the years a steadfast commitment to the education of African Americans and Native Americans, and an early recognition of the importance of sheltering battered women, among other groundbreaking stances.

In 2005, Hurricane Katrina threatened to extinguish this landmark institution. Floodwaters surged onto Ursuline’s State Street campus, and gale force winds tore holes in the roofs of the school’s historic buildings. Two years of consultations within the Ursuline community produced a compelling roadmap for institutional recovery. A key component of the school’s recovery plan was the construction of a multi-purpose fitness/wellness center. Notably, the Wellness Center was not intended to help Ursuline students alone; it was designed to serve the broader local community by promoting health, wellness, fitness, and good nutrition. The Fitness & Wellness Center’s design provided for the historic rehabilitation of the school’s circa 1935 gymnasium, an adaptive re-use embodying the highest aspirations of the green building movement – as there is no greener building than a re-used building. A new addition was also prescribed, with architecture that complemented but did not imitate that of the historic Ursuline campus.

Following upon its success structuring the financing for Ursuline’s Early Childhood Learning Center, Crescent Growth Capital was retained to arrange a dual New Markets Tax Credit/state historic tax credit financing. In October of 2011, CGC closed on a $5.5 million NMTC financing, permitting the start of construction. Authoring the state historic preservation certification applications for the project, CGC qualified the project for state historic tax credits, resulting in nearly $2.2 million in project costs being deemed Qualified Rehabilitation Expenses. Furthermore, CGC’s Part 2 application so effectively communicated the design of project architects Waggonner & Ball that no conditions were attached to the Part 2 approval issued by the Louisiana Division of Historic Preservation. In October of 2014, CGC completed its historic tax credit arranger services by accomplishing the monetization of the state historic tax credits on behalf of Ursuline Academy.

In the final analysis, Ursuline Academy received a total subsidy of over $1 million on their $6 million project.

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