Strengthening Medical Practices Through Physician-Owned Real Estate

Colorado | Cardiology Group | Refinance
Georgia | Orthopedic Practice | Refinance

Project Objectives: Refinance, Partner Integration, & Cash Out
Loan Amount: $7,515,000
An orthopedic practice in Georgia refinanced its MOB and ASC to facilitate new partner integration. The loan was structured with a low fixed rate over a 10-year term without any personal guarantees to the individual owners. The group was able to leverage up to 90% loan-to-value and pull out over $2.7 MM of cash.
Georgia | Orthopedic Practice | Refinance
Georgia | Orthopedic Practice | Refinance

Project Objectives: Refinance, Partner Integration, & Cash Out
Loan Amount: $7,515,000
An orthopedic practice in Georgia refinanced its MOB and ASC to facilitate new partner integration. The loan was structured with a low fixed rate over a 10-year term without any personal guarantees to the individual owners. The group was able to leverage up to 90% loan-to-value and pull out over $2.7 MM of cash.
Delaware | Orthopedic Group | Construction Finance
Delaware | Orthopedic Group | Construction Finance

Project Objectives: Construction Financing
Loan Amount: $8,380,000
An orthopaedic group in Delaware financed its new construction project at 100% loan-to-value. The loan is based on a 10-year term. A portion of the debt is fixed with an interest rate swap while the remainder floats on a Libor based index. The group was able to negotiate a lower interest rate than previously proposed with its incumbent lender for both the fixed-rate and floating portions of the loan.
Wyoming | Orthopedic Center | Refinance
Wyoming | Orthopedic Center | Refinance

Project Objectives: Refinance
Loan Amount: $10,240,000
A Wyoming orthopedic center refinanced its Medical Office Building to achieve improved rates and to free capital to be used in a new construction project. The incumbent bank made substantial improvements, providing a 10-year low fixed rate while eliminating personal guarantees.
Florida | Orthopedic Group | Refinance
Florida | Orthopedic Group | Refinance

Project Objectives: Refinance, Cash Out, & Mitigate Personal Guarantees
Loan Amount: $13,950,000
A Florida orthopedic group refinanced its medical office building at a substantially lower interest rate while staying with the incumbent bank. The financing provides cash out for the group to facilitate new partner buy-in and reduces the level of personal guarantees.
Colorado – Ophthalmology Center
Colorado - Ophthalmology Center

Financing Type: Refinance
Amount: $12,600,000
An ophthalmology group in Colorado refinanced its eye center with an average fixed rate over 10 years of 3.75%. The financing is without personal recourse and provides cash out for the individual partners.
Montana – Orthopedic Center
Montana - Orthopedic Center

Financing Type: Expansion
Amount: $26,000,000
An orthopedic center in Montana closed financing on loans that enabled the physician-partners to construct a $16 million surgery center expansion and purchase all equipment with no cash out of pocket. Highlights of the financing include fixed rates at very aggressive levels for the two-year construction period and the first 10 years of the permanent loan term as well as the elimination of all personal guarantees.
Texas – Ear, Nose and Throat Group
Texas - Ear, Nose and Throat Group

Financing Type: Refinance
Amount: $7,000,000
This ENT group refinanced their medical office building and stripped out several million dollars of cash to facilitate new partner buy-in. In the refinance, a burn-off provision of personal guarantees was structured to eliminate recourse after two years. The loan was closed with a national bank at an aggressive rate for ten years.
Idaho – Orthopaedic Group
Idaho - Orthopaedic Group

Financing Type: Expansion/Remodel
Amount: $11,394,000
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.
Washington – Cataract & Laser Institute
Washington - Cataract & Laser Institute

Financing Type: Refinance
Amount: $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.
North Carolina – Orthopedic Practice
North Carolina - Orthopedic Practice

Financing Type: Refinance and New Financing for Purchases
Amount: $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.
Pennsylvania – Orthopaedic Institute
Orthopaedic Institute - Pennslyvania

Financing Type: Refinance
Amount: $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.
Illinois – Orthopaedic Surgeons
Illinois - Orthopaedic Surgeons

Financing Type: New Construction to Permanent
Amount: $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.
Alabama – Cardiovascular Group
Alabama - Cardiovascular Group

Financing Type: New Construction
Amount: $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.
Alaska – Orthopedic Group
Alaska - Orthopedic Group

Financing Type: New Construction
Amount: $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.
Washington – Orthopaedic Associates
Washington - Orthopaedic Associates

Financing Type: Refinance
Amount: $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.
Idaho – Urology Institute
Idaho - Urology Institute

Financing Type: Refinance
Amount:$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.

Idaho – Urology Institute
Washington – Orthopaedic Associates
Washington - Orthopaedic Associates

Financing Type: Refinance
Amount: $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.
Alaska – Orthopedic Group
Alaska - Orthopedic Group

Financing Type: New Construction
Amount: $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.
Alabama – Cardiovascular Group
Alabama - Cardiovascular Group

Financing Type: New Construction
Amount: $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.
Illinois – Orthopaedic Surgeons
Illinois - Orthopaedic Surgeons

Financing Type: New Construction to Permanent
Amount: $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.
Pennsylvania – Orthopaedic Institute
Orthopaedic Institute - Pennslyvania

Financing Type: Refinance
Amount: $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.
North Carolina – Orthopedic Practice
North Carolina - Orthopedic Practice

Financing Type: Refinance and New Financing for Purchases
Amount: $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.
Washington – Cataract & Laser Institute
Washington - Cataract & Laser Institute

Financing Type: Refinance
Amount: $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 – Orthopaedic Group
Idaho - Orthopaedic Group

Financing Type: Expansion/Remodel
Amount: $11,394,000
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.
Texas – Ear, Nose and Throat Group
Texas - Ear, Nose and Throat Group

Financing Type: Refinance
Amount: $7,000,000
This ENT group refinanced their medical office building and stripped out several million dollars of cash to facilitate new partner buy-in. In the refinance, a burn-off provision of personal guarantees was structured to eliminate recourse after two years. The loan was closed with a national bank at an aggressive rate for ten years.
Montana – Orthopedic Center
Montana - Orthopedic Center

Financing Type: Expansion
Amount: $26,000,000
An orthopedic center in Montana closed financing on loans that enabled the physician-partners to construct a $16 million surgery center expansion and purchase all equipment with no cash out of pocket. Highlights of the financing include fixed rates at very aggressive levels for the two-year construction period and the first 10 years of the permanent loan term as well as the elimination of all personal guarantees.
Colorado – Ophthalmology Center
Colorado - Ophthalmology Center

Financing Type: Refinance
Amount: $12,600,000
An ophthalmology group in Colorado refinanced its eye center with an average fixed rate over 10 years of 3.75%. The financing is without personal recourse and provides cash out for the individual partners.
Florida | Orthopedic Group | Refinance
Florida | Orthopedic Group | Refinance

Project Objectives: Refinance, Cash Out, & Mitigate Personal Guarantees
Loan Amount: $13,950,000
A Florida orthopedic group refinanced its medical office building at a substantially lower interest rate while staying with the incumbent bank. The financing provides cash out for the group to facilitate new partner buy-in and reduces the level of personal guarantees.
Wyoming | Orthopedic Center | Refinance
Wyoming | Orthopedic Center | Refinance

Project Objectives: Refinance
Loan Amount: $10,240,000
A Wyoming orthopedic center refinanced its Medical Office Building to achieve improved rates and to free capital to be used in a new construction project. The incumbent bank made substantial improvements, providing a 10-year low fixed rate while eliminating personal guarantees.
Delaware | Orthopedic Group | Construction Finance
Delaware | Orthopedic Group | Construction Finance

Project Objectives: Construction Financing
Loan Amount: $8,380,000
An orthopaedic group in Delaware financed its new construction project at 100% loan-to-value. The loan is based on a 10-year term. A portion of the debt is fixed with an interest rate swap while the remainder floats on a Libor based index. The group was able to negotiate a lower interest rate than previously proposed with its incumbent lender for both the fixed-rate and floating portions of the loan.
Georgia | Orthopedic Practice | Refinance
Georgia | Orthopedic Practice | Refinance

Project Objectives: Refinance, Partner Integration, & Cash Out
Loan Amount: $7,515,000
An orthopedic practice in Georgia refinanced its MOB and ASC to facilitate new partner integration. The loan was structured with a low fixed rate over a 10-year term without any personal guarantees to the individual owners. The group was able to leverage up to 90% loan-to-value and pull out over $2.7 MM of cash.
Colorado | Cardiology Group | Refinance
Georgia | Orthopedic Practice | Refinance

Project Objectives: Refinance, Partner Integration, & Cash Out
Loan Amount: $7,515,000
An orthopedic practice in Georgia refinanced its MOB and ASC to facilitate new partner integration. The loan was structured with a low fixed rate over a 10-year term without any personal guarantees to the individual owners. The group was able to leverage up to 90% loan-to-value and pull out over $2.7 MM of cash.

Idaho – Urology Institute
Idaho - Urology Institute

Financing Type: Refinance
Amount:$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.
Washington – Orthopaedic Associates
Washington - Orthopaedic Associates

Financing Type: Refinance
Amount: $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.
Alaska – Orthopedic Group
Alaska - Orthopedic Group

Financing Type: New Construction
Amount: $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.
Alabama – Cardiovascular Group
Alabama - Cardiovascular Group

Financing Type: New Construction
Amount: $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.
Illinois – Orthopaedic Surgeons
Illinois - Orthopaedic Surgeons

Financing Type: New Construction to Permanent
Amount: $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.
Pennsylvania – Orthopaedic Institute
Orthopaedic Institute - Pennslyvania

Financing Type: Refinance
Amount: $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.
North Carolina – Orthopedic Practice
North Carolina - Orthopedic Practice

Financing Type: Refinance and New Financing for Purchases
Amount: $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.
Washington – Cataract & Laser Institute
Washington - Cataract & Laser Institute

Financing Type: Refinance
Amount: $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 – Orthopaedic Group
Idaho - Orthopaedic Group

Financing Type: Expansion/Remodel
Amount: $11,394,000
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.
Texas – Ear, Nose and Throat Group
Texas - Ear, Nose and Throat Group

Financing Type: Refinance
Amount: $7,000,000
This ENT group refinanced their medical office building and stripped out several million dollars of cash to facilitate new partner buy-in. In the refinance, a burn-off provision of personal guarantees was structured to eliminate recourse after two years. The loan was closed with a national bank at an aggressive rate for ten years.
Montana – Orthopedic Center
Montana - Orthopedic Center

Financing Type: Expansion
Amount: $26,000,000
An orthopedic center in Montana closed financing on loans that enabled the physician-partners to construct a $16 million surgery center expansion and purchase all equipment with no cash out of pocket. Highlights of the financing include fixed rates at very aggressive levels for the two-year construction period and the first 10 years of the permanent loan term as well as the elimination of all personal guarantees.
Colorado – Ophthalmology Center
Colorado - Ophthalmology Center

Financing Type: Refinance
Amount: $12,600,000
An ophthalmology group in Colorado refinanced its eye center with an average fixed rate over 10 years of 3.75%. The financing is without personal recourse and provides cash out for the individual partners.
Florida | Orthopedic Group | Refinance
Florida | Orthopedic Group | Refinance

Project Objectives: Refinance, Cash Out, & Mitigate Personal Guarantees
Loan Amount: $13,950,000
A Florida orthopedic group refinanced its medical office building at a substantially lower interest rate while staying with the incumbent bank. The financing provides cash out for the group to facilitate new partner buy-in and reduces the level of personal guarantees.
Wyoming | Orthopedic Center | Refinance
Wyoming | Orthopedic Center | Refinance

Project Objectives: Refinance
Loan Amount: $10,240,000
A Wyoming orthopedic center refinanced its Medical Office Building to achieve improved rates and to free capital to be used in a new construction project. The incumbent bank made substantial improvements, providing a 10-year low fixed rate while eliminating personal guarantees.
Delaware | Orthopedic Group | Construction Finance
Delaware | Orthopedic Group | Construction Finance

Project Objectives: Construction Financing
Loan Amount: $8,380,000
An orthopaedic group in Delaware financed its new construction project at 100% loan-to-value. The loan is based on a 10-year term. A portion of the debt is fixed with an interest rate swap while the remainder floats on a Libor based index. The group was able to negotiate a lower interest rate than previously proposed with its incumbent lender for both the fixed-rate and floating portions of the loan.
Georgia | Orthopedic Practice | Refinance
Georgia | Orthopedic Practice | Refinance

Project Objectives: Refinance, Partner Integration, & Cash Out
Loan Amount: $7,515,000
An orthopedic practice in Georgia refinanced its MOB and ASC to facilitate new partner integration. The loan was structured with a low fixed rate over a 10-year term without any personal guarantees to the individual owners. The group was able to leverage up to 90% loan-to-value and pull out over $2.7 MM of cash.
Colorado | Cardiology Group | Refinance
Georgia | Orthopedic Practice | Refinance

Project Objectives: Refinance, Partner Integration, & Cash Out
Loan Amount: $7,515,000
An orthopedic practice in Georgia refinanced its MOB and ASC to facilitate new partner integration. The loan was structured with a low fixed rate over a 10-year term without any personal guarantees to the individual owners. The group was able to leverage up to 90% loan-to-value and pull out over $2.7 MM of cash.

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.

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.

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, CEO
OrthoTennessee & OrthoForum

“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, 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, CEO
Virginia Eye Institute

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