• Idaho Urologic Institute

    Idaho – Urology Institute

     

    Idaho - Urology Institute

    • : Refinance
    • :$11,000,000
    • The partners of this large urologic practice in Idaho own and operate four properties, including an ASC. CMAC’s RFP resulted in:
      • Lowering the rate
      • Improving the guarantees
      • Creating a structure for partner buy-in, and
      • Improving cash-on-cash returns.

      CMAC was able to create a savings of over $1 MM for the physicians of the urology institute over the new term of its loan.

  • Olympia Orthopeadic Associates

    Washington – Orthopaedic Associates

    Washington - Orthopaedic Associates

    • : Refinance
    • : $17.25 MM
    • This orthopaedic group is one of the largest in Central Washington, owning three medical office locations totaling 75,000 sq.ft. The group is a 100% owner-occupied medical real estate who requested assistance from CMAC Partners on the refinancing of its medical real estates after negotiating with previous lenders for more than a year without the hoped-for outcome. CMAC created savings of more than $1 million for the group’s partners.
  • Ortho Physi Alaska

    Alaska – Orthopedic Group

    Alaska - Orthopedic Group

    • : New Construction
    • : $42,000,000
    • This orthopedic physicians group collaborated with a development group to construct a new, 60,000 sq ft Medical Office Building. They also refinanced an existing facility and purchased an ASC along with the necessary medical equipment for the new facility. The structure was highly complex with multiple moving parts and several ownership entities. CMAC secured the needed financing at below-market pricing, and due to the conservative nature of the group, was able to provide a long-term fixed option without utilizing an interest rate swap.
  • CVA-01

    Alabama – Cardiovascular Group

    Alabama - Cardiovascular Group

      • : New Construction
      • : $27MM
      • A thirty-physician cardiovascular specialty group decided to merge its 3 largest locations into one new main 74,000 sq ft medical campus. CMAC’s team of experts met with the executive committee to determine its needs and how best to structure the financing for the new development. CMAC analyzed and negotiated the highly technical financing proposals and then secured the final package which included 100% financing and a Federal Stimulus Bond component.

     

  • tri state ortho surgeons1

    Illinois – Orthopaedic Surgeons

    Illinois - Orthopaedic Surgeons

    • : New Construction to Permanent
    • : $51,000,000
    • An orthopaedic practice partnered with a local health system to build a 135,000 sq ft, four-story state-of-the-art orthopedic specialty hospital at an approximate cost of $64 million. CMAC successfully secured bank financing for the real estate and equipment at 80% LTC/LTV, no personal guarantees. CMAC negotiated a forward fix rate of 4.15% for 10 years with a 2 year interest only period.
  • Rothman-Institute-Limerick-PA

    Pennsylvania – Orthopaedic Institute

    Orthopaedic Institute - Pennslyvania

    • : Refinance
    • : $59MM
    • This orthopaedic institute, with in excess of 110 physicians, believes it is one of the largest and best orthopedic medical practices in the world with 22 locations (and growing) throughout the Philadelphia and South Jersey areas and a full range of Orthopaedic care and services. The orthopaedic institute has interest in three medical office buildings with combine values of over $30 million, and the majority interest in a joint venture with an orthopedic surgical hospital. CMAC Partners was able to negotiate reductions on the medical office buildings (closed a few months earlier) and caused a rate modification on the surgical hospital to create a savings of more than $3.4 million.
  • OrthoCarolina Charlotte 1

    North Carolina – Orthopedic Practice

    North Carolina - Orthopedic Practice

    • : Refinance and New Financing for Purchases
    • : $55,000,000
    • As one of the largest in North Carolina, this orthopedic practice has 111 providers, and 25 locations. CMAC Partners was successful in restructuring the practice’s existing $30MM real estate portfolio, creating improvements in the loan terms and a savings of over $2MM. In addition, the practice has acquired several other practices with existing real estate of over $25MM, in a relatively short time frame. While the practice is in the process of solidifying the integration of the new real estate, CMAC secured financing proposals that covered 100% of the purchase price.
  • pacific cataract1 2

    Washington – Cataract & Laser Institute

    Washington - Cataract & Laser Institute

    • : Refinance
    • : $30,000,000
    • This cataract & laser institute is a physician-owned, fully serviced Ophthalmology practice based in the state of Washington. The practice operates in six states from 18 locations. The proposals we received saved millions of dollars in interest expense and simplified their loan structure. Additionally, we secured savings for their more than $9MM in equipment debt.
  • Idaho Urologic Institute

    Idaho – Urology Institute

     

    Idaho - Urology Institute

    • : Refinance
    • :$11,000,000
    • The partners of this large urologic practice in Idaho own and operate four properties, including an ASC. CMAC’s RFP resulted in:
      • Lowering the rate
      • Improving the guarantees
      • Creating a structure for partner buy-in, and
      • Improving cash-on-cash returns.

      CMAC was able to create a savings of over $1 MM for the physicians of the urology institute over the new term of its loan.

  • Olympia Orthopeadic Associates

    Washington – Orthopaedic Associates

    Washington - Orthopaedic Associates

    • : Refinance
    • : $17.25 MM
    • This orthopaedic group is one of the largest in Central Washington, owning three medical office locations totaling 75,000 sq.ft. The group is a 100% owner-occupied medical real estate who requested assistance from CMAC Partners on the refinancing of its medical real estates after negotiating with previous lenders for more than a year without the hoped-for outcome. CMAC created savings of more than $1 million for the group’s partners.
  • Ortho Physi Alaska

    Alaska – Orthopedic Group

    Alaska - Orthopedic Group

    • : New Construction
    • : $42,000,000
    • This orthopedic physicians group collaborated with a development group to construct a new, 60,000 sq ft Medical Office Building. They also refinanced an existing facility and purchased an ASC along with the necessary medical equipment for the new facility. The structure was highly complex with multiple moving parts and several ownership entities. CMAC secured the needed financing at below-market pricing, and due to the conservative nature of the group, was able to provide a long-term fixed option without utilizing an interest rate swap.
  • CVA-01

    Alabama – Cardiovascular Group

    Alabama - Cardiovascular Group

      • : New Construction
      • : $27MM
      • A thirty-physician cardiovascular specialty group decided to merge its 3 largest locations into one new main 74,000 sq ft medical campus. CMAC’s team of experts met with the executive committee to determine its needs and how best to structure the financing for the new development. CMAC analyzed and negotiated the highly technical financing proposals and then secured the final package which included 100% financing and a Federal Stimulus Bond component.

     

  • tri state ortho surgeons1

    Illinois – Orthopaedic Surgeons

    Illinois - Orthopaedic Surgeons

    • : New Construction to Permanent
    • : $51,000,000
    • An orthopaedic practice partnered with a local health system to build a 135,000 sq ft, four-story state-of-the-art orthopedic specialty hospital at an approximate cost of $64 million. CMAC successfully secured bank financing for the real estate and equipment at 80% LTC/LTV, no personal guarantees. CMAC negotiated a forward fix rate of 4.15% for 10 years with a 2 year interest only period.
  • Rothman-Institute-Limerick-PA

    Pennsylvania – Orthopaedic Institute

    Orthopaedic Institute - Pennslyvania

    • : Refinance
    • : $59MM
    • This orthopaedic institute, with in excess of 110 physicians, believes it is one of the largest and best orthopedic medical practices in the world with 22 locations (and growing) throughout the Philadelphia and South Jersey areas and a full range of Orthopaedic care and services. The orthopaedic institute has interest in three medical office buildings with combine values of over $30 million, and the majority interest in a joint venture with an orthopedic surgical hospital. CMAC Partners was able to negotiate reductions on the medical office buildings (closed a few months earlier) and caused a rate modification on the surgical hospital to create a savings of more than $3.4 million.
  • OrthoCarolina Charlotte 1

    North Carolina – Orthopedic Practice

    North Carolina - Orthopedic Practice

    • : Refinance and New Financing for Purchases
    • : $55,000,000
    • As one of the largest in North Carolina, this orthopedic practice has 111 providers, and 25 locations. CMAC Partners was successful in restructuring the practice’s existing $30MM real estate portfolio, creating improvements in the loan terms and a savings of over $2MM. In addition, the practice has acquired several other practices with existing real estate of over $25MM, in a relatively short time frame. While the practice is in the process of solidifying the integration of the new real estate, CMAC secured financing proposals that covered 100% of the purchase price.
  • pacific cataract1 2

    Washington – Cataract & Laser Institute

    Washington - Cataract & Laser Institute

    • : Refinance
    • : $30,000,000
    • This cataract & laser institute is a physician-owned, fully serviced Ophthalmology practice based in the state of Washington. The practice operates in six states from 18 locations. The proposals we received saved millions of dollars in interest expense and simplified their loan structure. Additionally, we secured savings for their more than $9MM in equipment debt.
  • Idaho Urologic Institute

    Idaho – Urology Institute

     

    Idaho - Urology Institute

    • : Refinance
    • :$11,000,000
    • The partners of this large urologic practice in Idaho own and operate four properties, including an ASC. CMAC’s RFP resulted in:
      • Lowering the rate
      • Improving the guarantees
      • Creating a structure for partner buy-in, and
      • Improving cash-on-cash returns.

      CMAC was able to create a savings of over $1 MM for the physicians of the urology institute over the new term of its loan.

  • Olympia Orthopeadic Associates

    Washington – Orthopaedic Associates

    Washington - Orthopaedic Associates

    • : Refinance
    • : $17.25 MM
    • This orthopaedic group is one of the largest in Central Washington, owning three medical office locations totaling 75,000 sq.ft. The group is a 100% owner-occupied medical real estate who requested assistance from CMAC Partners on the refinancing of its medical real estates after negotiating with previous lenders for more than a year without the hoped-for outcome. CMAC created savings of more than $1 million for the group’s partners.
  • Ortho Physi Alaska

    Alaska – Orthopedic Group

    Alaska - Orthopedic Group

    • : New Construction
    • : $42,000,000
    • This orthopedic physicians group collaborated with a development group to construct a new, 60,000 sq ft Medical Office Building. They also refinanced an existing facility and purchased an ASC along with the necessary medical equipment for the new facility. The structure was highly complex with multiple moving parts and several ownership entities. CMAC secured the needed financing at below-market pricing, and due to the conservative nature of the group, was able to provide a long-term fixed option without utilizing an interest rate swap.
  • CVA-01

    Alabama – Cardiovascular Group

    Alabama - Cardiovascular Group

      • : New Construction
      • : $27MM
      • A thirty-physician cardiovascular specialty group decided to merge its 3 largest locations into one new main 74,000 sq ft medical campus. CMAC’s team of experts met with the executive committee to determine its needs and how best to structure the financing for the new development. CMAC analyzed and negotiated the highly technical financing proposals and then secured the final package which included 100% financing and a Federal Stimulus Bond component.

     

  • tri state ortho surgeons1

    Illinois – Orthopaedic Surgeons

    Illinois - Orthopaedic Surgeons

    • : New Construction to Permanent
    • : $51,000,000
    • An orthopaedic practice partnered with a local health system to build a 135,000 sq ft, four-story state-of-the-art orthopedic specialty hospital at an approximate cost of $64 million. CMAC successfully secured bank financing for the real estate and equipment at 80% LTC/LTV, no personal guarantees. CMAC negotiated a forward fix rate of 4.15% for 10 years with a 2 year interest only period.
  • Rothman-Institute-Limerick-PA

    Pennsylvania – Orthopaedic Institute

    Orthopaedic Institute - Pennslyvania

    • : Refinance
    • : $59MM
    • This orthopaedic institute, with in excess of 110 physicians, believes it is one of the largest and best orthopedic medical practices in the world with 22 locations (and growing) throughout the Philadelphia and South Jersey areas and a full range of Orthopaedic care and services. The orthopaedic institute has interest in three medical office buildings with combine values of over $30 million, and the majority interest in a joint venture with an orthopedic surgical hospital. CMAC Partners was able to negotiate reductions on the medical office buildings (closed a few months earlier) and caused a rate modification on the surgical hospital to create a savings of more than $3.4 million.
  • OrthoCarolina Charlotte 1

    North Carolina – Orthopedic Practice

    North Carolina - Orthopedic Practice

    • : Refinance and New Financing for Purchases
    • : $55,000,000
    • As one of the largest in North Carolina, this orthopedic practice has 111 providers, and 25 locations. CMAC Partners was successful in restructuring the practice’s existing $30MM real estate portfolio, creating improvements in the loan terms and a savings of over $2MM. In addition, the practice has acquired several other practices with existing real estate of over $25MM, in a relatively short time frame. While the practice is in the process of solidifying the integration of the new real estate, CMAC secured financing proposals that covered 100% of the purchase price.
  • pacific cataract1 2

    Washington – Cataract & Laser Institute

    Washington - Cataract & Laser Institute

    • : Refinance
    • : $30,000,000
    • This cataract & laser institute is a physician-owned, fully serviced Ophthalmology practice based in the state of Washington. The practice operates in six states from 18 locations. The proposals we received saved millions of dollars in interest expense and simplified their loan structure. Additionally, we secured savings for their more than $9MM in equipment debt.

Who We Are

CMAC is a commercial financing firm that specializes in working with physician-owned medical real estate. Our team is led by a former Wall Street banker with more than 20 years of experience working with hundreds of private medical practices across the country.

WhatWEDo

What We Do

CMAC secures over $500 million of capital annually for our medical real estate clients.  We review thousands of bank proposals from across the country giving us the data and access to guarantee the best pricing and terms in your market. Ultimately, we deliver better-than-market results for our clients through – Leverage, Data, and Expertise.

Recent Works

  • Lexington-Clinic1

    Kentucky – Multi-Specialty Medical Clinic

    Kentucky - Multi-Specialty Medical Group

    • : Real Estate and Equipment Refinance
    • : $35,000,000
    • This clinic is a multi-specialty group practice comprised of approximately 200 providers offering care in more than 30 specialties. It is owned by 114 doctors equally with over 20 locations. CMAC was hired to improve the existing debt structure to create interest savings over the remaining terms. The debt portfolio was approximately $35MM, which included real estate, equipment, and operating lines. CMAC was successful in renegotiating the existing capital structure with the clinic’s incumbent lender. The negotiations created cash flow improvement by re-amortizing, and significant interest savings.
  • The NeuroMedical Center_Baton Rouge

    Louisiana – Neuromedical Surgical Hospital

    Louisiana - Neuromedical Surgical Hospital

    • : Refinance
    • : $13,000,000
    • This physician-owned 23-bed surgical hospital opened on October 1, 2004. It has four operating rooms and three pain procedure rooms. It also has an in-house lab and sleep center. The client had recently gone to its bank and obtained a modest interest rate improvement. CMAC was hired, went back to the same bank and leveraged a 75 bps reduction, saving over a half million dollars in interest costs.

  • Lafayette Surgical

    Louisiana – Specialty Surgical Hospital

    Louisiana - Specialty Surgical Hospital

    • : Refinance
    • : $6,000,000
    • This specialty surgical hospital is a 20-bed physician-owned hospital built in 2004. It has eight operating rooms and two procedure rooms that accommodate 8,000 total cases annually. The related real estate entity is owned by 23 doctor-members. The principals of the hospital engaged CMAC in the midst of their refinancing process. Through its efforts, CMAC was able to make considerable improvement to the proposals that were in hand and closed the financing within a defined period of time necessitated by a retired physician buy-out.

  • Springhill-Health-Services

    Alabama – Surgical Hospital

    Alabama - Surgical Hospital

    • : Refinance
    • : $28,000,000
    • This private 252-bed hospital, complete with a medical-surgical healthcare facility serving a large region of Alabama. CMAC was called in after the hospital had negotiated a substantial reduction from its then current bank. As a result of CMAC’s efforts both the incumbent and competing banks offered rates and terms considerably lower than the hospital had done on its own, generating a savings of about $2MM over the 10-year term. Additionally, personal guarantees were not required.

  • Texas Ortho

    Texas – Orthopedic and Sports Rehab Center

    Texas - Orthopedic and Sports Rehab Center

    • : Refinance
    • :$12,000,000
    • This orthopedic group has seven locations throughout Texas and is comprised of 27 orthopedic partners. The group hired CMAC to assist in refinancing multiple high rate loans that were scheduled to come due in the next couple years. The executive team had concerns about refinancing at a later date in a higher interest rate environment. The major hurdles on this project were to overcome a low appraisal and the negative value of an interest rate swap. CMAC was able to obtain financing at 115% LTV on a 7 year term at 2.95% from a regional bank. The new loan structure created long term security and a significant cash flow savings.

  • Arkansas Surgical Hospital

    Arkansas – Surgical Hospital

    Arkansas - Surgical Hospital

      • : Loan Modification
      • :$32,000,000
      • A physician-owned surgical hospital in Arkansas had just modified their real estate financing with their incumbent lender prior to meeting CMAC. After CMAC’s analysis of the modification, it was determined that their bank’s pricing and terms were still out of the market compared to other similar credits in the region. CMAC used its knowledge of the commercial lending markets and leveraged additional improvements, saving the borrower over $2MM in interest costs.

  • CVA-01

    Alabama – Cardiovascular Group

    Alabama - Cardiovascular Group

    • : New Construction
    • :$27MM
    • This 30 physician cardiovascular specialty group decided to merge its 3 largest locations into one new main 74,000 sq ft medical campus. CMAC’s team of experts met with the executive committee to determine its needs and how best to structure the financing for the new development. CMAC negotiated and analyzed the highly technical financing proposals and then secured the final package which included 100% financing and a Federal Stimulus Bond component.

  • Raleigh Ortho

    North Carolina – Orthopaedic Center

    North Carolina - Orthopaedic Center

    • : New Construction
    • :$30,000,000
    • This orthopaedic center is considered one of the premier orthopedics groups in North Carolina. The development project was a joint venture between Rex Hospital and physician partners from the orthopaedic center. This 83,000-square foot medical office space combines clinic space for the orthopaedic practice and an ASC which is shared by the hospital and orthopaedic surgeons. CMAC secured financing for 100% LTV fixed for 7 years below 3.18%.

  • orthowilm

    North Carolina – Orthopedic Center

    North Carolina - Orthopedic Center

      • : Merger/Refinance
      • : $16,000,000
      • The two largest orthopedic groups in Wilmington were planning to merge operations but wanted to keep real estate entities separate. CMAC was hired to secure financing to cover both properties and overcome the low property values at that time. CMAC was successful in obtaining a loan spread of 134bps over Libor, fixed for 7 years at 2.45%.  The loan-to-value of 125% was covered by structuring two loans on each property.

  • hope-ortho

    Oregon – Orthopedic Clinic

    Oregon - Orthopedic Clinic

    • : Refinance/New Acquisition/Improvements
    • :$11,000,000
    • This orthopedic clinic had obtained a proposal from their current lender at 4.75% for 7 years. CMAC determined that the proposal was about a percent over what we had recently obtained for similar credits. CMAC vetted the market issuing RFP’s to about a dozen local and regional lenders and was successful in securing financing at a rate of 3.48% for 7 years, saving the borrower over $500,000 in interest costs.
  • St. Louis Eye Surgery

    Missouri – Eye and Laser Surgery Center

    Missouri - Eye and Laser Surgery Center

    • : Refinance and New Construction
    • : $14MM
    • This eye and laser surgey center in Missouri is a 38,000 sf owner-occupied MOB with ASC, with current debt of $8 MM. The physician partners wished to finance an extensive renovation, as well as a 15,000 sf expansion to the building costing roughly $6 MM, but would not have final project costs for several months. CMAC was able to obtain financing as a two-stage transaction. CMAC ’s banking partner approved the existing refinancing and committed to providing the capital needed for the to-be-determined project.
  • OrthoCarolina-Winston

    OrthoCarolina – Winston

    OrthoCarolina - Winston

    • Scott Guyton, CEO
    • : Refinance
    • : $8.4MM
    • Over a one year period, OSC had negotiated their current real estate loan with their incumbent bank.  They had brought in CMAC with the purpose to review the terms of the deal and give an analysis.  CMAC was able to determine that the bank was presenting them with “out of market pricing,” compared to similar borrowers within other markets.  Once they had engaged us, we were able to present to the local bankers from OS the recent proposals from its own bank, but with more competitive terms and pricing.  This allowed the local banker to request similar pricing from his credit officer.  Once this was granted and the modification was complete, CMAC doubled the savings that had already been created.  The partners saved hundreds of thousands of dollars.
  • Triangle Orthopaedic Associates

    North Carolina – Orthopaedic Group

    North Carolina - Orthopaedic Group

    • : Refinance
    • : $10.6MM
    • After this orthopaedic group had been through a series of intensive negotiations to reduce their rate, CMAC produced an additional reduction in the rate by leveraging its bond alternative. In response, the bank lowered the rate in order to compete with the bonds. The group benefited from the new rate, generating additional savings of $450,000 over the term of the loan.
  • A.-Tulsa-Bone-and-Joint-Exterior

    Oklahoma – Orthopedic Group

    Oklahoma - Orthopedic Group

    • : Refinance
    • : $18MM
    • After this orthopedic group shopped the market looking to make improvements on their existing loan portfolio, CMAC was hired to find additional savings and better terms. CMAC used its leverage to create a competitive bidding environment which led to a saving of hundreds of thousands of dollars.
  • Pinnacle Eye Center

    Colorado – Ophthalmology Center

    Colorado - Ophthalmology Center

    • : New Construction
    • : $16,000,000
    • This $16MM MOB which houses four ophthalmology specialty practices in Colorado. CMAC found that their bank had provided a rate and terms that were as good as others seen in the Colorado market, but not as good as what CMAC had achieved with this same bank in recent deals in other states. Once CMAC brought this additional information to the local bank, that banker was able to replicate the non-regional terms, a higher LTV and a savings in interest and fees of more than $1,300,000.

  • OrthoCarolina Charlotte

    North Carolina – Orthopedic Practice

    North Carolina - Orthopedic Practice

    • : Refinance and New Financing for Purchases
    • : $55MM
    • As one of the largest in North Caolina, this orthopedic practice has 111 providers, 25 locations, and revenues of over $250MM. CMAC Partners was successful in restructuring the practice’s existing $30MM real estate portfolio, creating improvements in the loan terms and a savings of over $2MM. In addition, the practice has acquired several other practices with existing real estate of over $25MM, in a relatively short time frame. While the practice is in the process of solidifying the integration of the new real estate, CMAC was able to secure financing proposals that covered 100% of the purchase price.
  • Lewiston Ortho photo 1

    Idaho – Orthopaedic Practice

    Idaho - Orthopaedic Practice

    • : Expansion/Remodel
    • : $11,400,000
    • CMAC Partners arranged nearly 100% financing for a new expansion/remodel project through multiple loan facilities with a local credit union. The 10-year fixed interest rate is CMAC’s lowest of the year for a construction loan.
  •  

    Client Experiences

    “Thanks to the CMAC team for all your help.  This transaction was a bit arduous because there were so many moving parts and I appreciate your advice and counsel in helping us work through all the issues.”
 Glenn Sumner, CEOOrthoTennessee
    “Thanks to the CMAC team for all your help. This transaction was a bit arduous because there were so many moving parts and I appreciate your advice and counsel in helping us work through all the issues.” Glenn Sumner, CEO
    OrthoTennessee & OrthoForum
    “Thanks, great job. Clearly see the value of your services.”
 Mike West, CEORothman Institute
    “Thanks, great job. Clearly see the value of your services.” Mike West, CEO
    Rothman Institute
    “CMAC was incredible to work with. They were professional throughout the entire process.  Their efficiency and thoroughness was amazing. Every person I worked with exceeded my expectations.  I would not hesitate to use CMAC on future projects.”
 Kayo Elliot, CEOAthens Orthopedic Clinic
    “CMAC was incredible to work with. They were professional throughout the entire process. Their efficiency and thoroughness was amazing. Every person I worked with exceeded my expectations. I would not hesitate to use CMAC on future projects.” Kayo Elliot, CEO
    Athens Orthopedic Clinic
    “I want to thank you and your team again for the results you’ve managed to achieve thus far with our refinance. The executive committee was very pleased with the proposals and it was an easy decision to move forward. I think our bank choices offer outstanding options for VEI. I don’t think we can go wrong with either one. Looking forward to next steps in the process."
 Brad Smith, CEOVirginia Eye Institute
    “I want to thank you and your team again for the results you’ve managed to achieve thus far with our refinance. The executive committee was very pleased with the proposals and it was an easy decision to move forward. I think our bank choices offer outstanding options for VEI. I don’t think we can go wrong with either one. Looking forward to next steps in the process.” Brad Smith, CEO
    Virginia Eye Institute

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