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Great Brook Valley Health Center

Great Brook Valley Health Center. MISSION STATEMENT

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Great Brook Valley Health Center

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  1. Great Brook Valley Health Center • MISSION STATEMENT • The Great Brook Valley Health Center is committed to creating access to high quality, comprehensive, health care for all people. Governed by its patients, the Health Center is dedicated to maintaining strong standards of excellence while respecting the diversity, dignity, and confidentiality of its patients and staff.

  2. Great Brook Valley Health Center • Founded in 1972 by a group of mothers from Great Brook Valley neighborhood • Still governed by its patients: of 11 Board Members, 7 are consumers • Board meets monthly, including: • Financial reports • Credentialing of clinicians • Policy decisions • Hire & evaluate President & CEO • Receive independent audit report

  3. An Interdisciplinary Model of Care • Primary Medical Care • Dental Care • Mental Health Care • Pharmacy • Social Services • Nutrition • Family Planning services • HIV counseling/testing • Mammography • Optometry • Podiatry

  4. Interdisciplinary Care • Medical Specialties • Ophthalmology • Dermatology • GYN • Pulmonology • Urology • Infectious Disease • Cardiology • External Programs • Lab • Child Care Room • Van • Satellite health center in Framingham opened in 3/04, and 4 school based health centers in the Worcester Public Schools • 3 dental satellites (Worcester, Clinton, Framingham)

  5. Percentage of Women Coming to at Least One Perinatal Dental Appointment

  6. NUMBER OF PATIENTS COVERED BY HEALTH CENTER IN THE CITY OF WORCESTER IN 2003, DISTRIBUTED WITHIN ONE MILE BUFFERS

  7. NUMBER OF PATIENTS COVERED BY HEALTH CENTER OUTSIDE THE CITY OF WORCESTER, DISTRIBUTED WITHIN FIVE MILE BUFFERS, 2003

  8. Blood Pressure in Control (<140/90) forHypertensive Patients without DiabetesApr 2005-Mar 2006N=1943 N=587 N=33 N=735 N=365 N=223 Other includes Asian; American Indian, and Middle Eastern and unreported. Χ2= 19.28 with 4 d.f. p< 0.001

  9. Blood Sugar Control (HBA1c<7) among Diabetic Patients, Apr 2005-Mar 2006N=822 N=16 N=485 N=121 N=101 N=99 Other includes Asian, American Indian, Middle Eastern, and Unreported. Χ2 = 11.21 for 4 d.f., p<0.25

  10. Great Brook Valley Health Center, Inc.

  11. Great Brook Valley Health Center, Inc.

  12. Great Brook Valley Health Center, Inc.

  13. Great Brook Valley Health Center, Inc.

  14. Great Brook Valley Health Center, Inc.

  15. Great Brook Valley Health Center, Inc.

  16. Great Brook Valley Health Center, Inc.

  17. Great Brook Valley Health Center, Inc.

  18. GREAT BROOK VALLEY HEALTH CENTERCapital Campaigns – 1992 & 1999 • Determining the Need • Competition • Feasibility Study to Guide Campaign • Case Statement • Projecting Future Revenues & Expenses • Projecting Costs of Project • Fund Raising • Financing Options

  19. Determining the Need • Service Needs – what your community needs • Staffing of the new site • Architect Selection • Owner’s Representative – do you need one? • Contractor – when to select? • Space Planning – what staff to involve? • Site Selection – do you have a choice? Do you own the site? Affect on lenders/funders? • Schematic Design • How much involvement in the “nitty gritty”

  20. COMPETITION • Service Competition • Location Competition • Access Issues (bus route, parking) • How do your clients know you/find you • Operating Revenue

  21. FEASIBILITY STUDY • Operationally will you survive • Financially can you raise the capital • How best to raise the capital • Community knowledge • Open, public campaign vs targeted • Major givers • Do you have experience – what kind of help do you need • GBVHC – confidential interviews with 45 key people by outside consultant

  22. CASE STATEMENT • Define your organization • Define your mission and services • Define the need you want to address • Define the project • Define the costs • Where to put “the ask” • K.I.S.S.

  23. FUTURE REVENUE/EXPENSES • Sources of income • Increases in visits/users • Rate structures • Expense increases • Personnel • Supplies • Facility operations

  24. GBVHC – Sept. 89 Projections FY89FY90YR1YR2YR3YR4YR5 Total Rev. $2.3M 2.2M 2.5M 2.8M 3.2M 3.6M 4.0M Oper. Exp. $2.2M 2.1M 2.4M 2.7M 3.0M 3.4M 3.8M ------- ------- ------- ------- ------- ------- ------- Surpls/Def $0.1M 0.1M 0.1M 0.1M 0.2M 0.2M 0.2M FY2008 Rev. $26.94M Exp. $26.88M

  25. COST OF THE PROJECT • Architect’s estimates • Contractor estimates • Owner’s Representative • Lender review • Subcontractor Bidding • GMP – what to include in the price • Contingency

  26. Uses of Funds - 1999 • Land $ 148,239 • Architect & Engineering 283,421 • Construction 2,763,257 • Landscaping 9,191 • Equipment 342,540 • Legal 62,080 • Financing Fees 60,969 • Interest 35,336 • Other 25,604 TOTAL $ 3,730,637

  27. FUND RAISING • Personal involvement – who? • What are the most likely sources • Foundations, corporate, government, staff, Board of Directors, individuals, lenders • Pyramid scheme • Challenge grant – e.g. Kresge • How “public” is the campaign • Hit the pavement

  28. GBVHC SOURCES OF FUNDS PHASE ONE (92) PHASE TWO (99) Federal Government $ 567,000 $ 701,051 Local Foundations 237,000 1,126,000 Local Businesses 75,865 33,940 Health Care Organizations 100,000 698,000 State/National Foundations -0- 226,000 Individuals 27,985 37,043 TOTALS $ 1,007,850 $ 2,822,034 Bond Financing 1,400,0001,215,202 TOTALS $ 2,407,850 $ 4,037,236

  29. FINANCING OPTIONS • Board designated funds – GBVHC had put money aside from Free Care Pool • Board & Staff • Foundations • Government • Corporations • Individuals • Debt financing

  30. DEBT FINANCING Who will help you with this? • Regular bank loan • Low interest bonds • HEFA, Mass Development, Capital Link, NCB Capital Impact • New Market tax Credits • Construction loans • Bridge loans

  31. NEW MARKET TAX CREDITSThe Basics • $15 billion program enacted on 12/21/2000 • $1 billion in GO Zone NMTC added in December 2005 • Represents the largest new federal investment in community-based development in 15 years • At least nine CHCs have obtained ~$123 million in NMTC financing in the last 2 years • Four MA CHCs have obtained financing through NMTC (and in some cases HTC) for a total of $95 million! • Courtesy of Capital Link and MLCHC

  32. NMTC: The Basics (continued) • Designed to attract investors to low income areas by providing a tax credit incentive to investors • Tax credits equal 39% over 7 years (5% in first 3 years, 6% for next 4 years) • “Leverage Model” typically provides loan capital at subsidized rate for 7 year period and likelihood of loan forgiveness for a portion of the debt after the tax credit compliance period • May be combined with federal guarantee programs or other financing • Courtesy of Capital Link and MLCHC

  33. Hypothtical CHC ProjectAssumes $10 million project; 30,000 SF Facility Hospitals / Grantors / Capital Campaign TE Bond Debt $3.7 million grants or forgivable loans Equity Investor $4 million Equity investment ~ $3.3 million CHCCF $3.9 - $5.15 million in tax credits (39% over 7 years) $3.7 million soft loan NMTC Fund LLC $11 million investment into CDE CDE LLC Fees & Reserves ~$1 million $10 million in loans “A-1 Loan”*: $4 million “A-2 Loan”**: $3.7 million “B Loan”**: $2.3 million Eligible CHC * Loan A-1 interest rate would be market plus the annual bank letter-of-credit fee (currently a total of approx. 5.7%) amortized over 25 years. ** Loan A-2 and Loan B would be at approximately 1-2% interest only for seven years; put/call option at the end of year 7 makes it likely that both loans would be forgiven at that time.

  34. NMTC: Eligibility • Location in Low Income Community • Type of Business • Gross Income Requirement • Collectibles and Non-qualified Financial Property • Courtesy of Capital Link and MLCHC

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