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Nationwide Reach for Local Borrowers

CMAC applies the outcomes for over 300 independent medical groups in the most competitive markets across the US to every local market.

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Orthopedic & Sports Medicine Center of Oregon

Orthopedic

Oregon

2025 - In September 2024, Orthopedic & Sports Medicine Center of Oregon, a six-physician group in Portland, OR, was ready to move forward with its incumbent bank to finance its new $17.5MM MOB/ASC under what seemed to be favorable loan terms. However, after attending a recent CPOMP conference,...

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Texoma ENT & Allergy

Texas

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Gulf Coast Plastic Surgery

Plastic Surgery

Florida

2024 - This southern plastic surgery group had recently secured financing for a new construction project but sought to explore opportunities for better rates and terms. CMAC conducted a comprehensive analysis to highlight potential savings and completed an RFP process to secure competitive...

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The Eye Guys, Eye Physicians & Surgeons of Augusta, PC

Ophthalmology

Georgia

2024 - This southern ophthalmology group needed to fund two upcoming physician buyouts while also preparing for a new project on the horizon. Owning their property debt-free, the doctors chose to leverage up and refinance, using the cash-out to fund the buyouts and support future buy-ins....

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Legend Orthopedics / Augusta Aiken

Orthopedic

Georgia

2024 - The merger of two orthopedic practices in Georgia required the consolidation of the real estate holdings from both groups. CMAC supported the physicians in refinancing an existing building, allowing them to pull cash out, and securing personal loans to facilitate the resulting buy-ins....

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Balboa Nephrology

Nephrology

California

2024 - After an extensive search to find a suitable property, this Western nephrology group had finally identified a building to purchase to kick off its real estate ownership. CMAC assisted the practice to secure advantageous financing for the purchase and establish a new ownership structure...

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Orthopedic & Sports Medicine Center

Orthopedic

Indiana

2024 - OSMC approached CMAC Partners with the task of finding a solution for unaffordable partner buyouts that were imminently approaching. CMAC completed several rounds of analysis and presented various options to the physicians, working through the complex property structure to find a solution...

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Plastic Surgery Specialists of South Florida

Plastic Surgery

Florida

2024 - Plastic Surgery Specialists of South Florida, a returning client, approached CMAC after initiating conversation with its incumbent bank about a rapidly maturing loan. The group, needing to refinance its existing debt, wondered if CMAC could step in and secure a better outcome than the...

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Kansas City Bone & Joint Clinic

Orthopedic

Kansas

2024 - This midwestern orthopedic practice sought to purchase and renovate a building for a new MOB. As division of a previous client, the group turned to CMAC to help evaluate the opportunity and compare alternative offers they had received. CMAC performed a comprehensive analysis to help the...

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EYE-Q Vision Care

Ophthalmology

California

2024 - This western ophthalmology group engaged CMAC to assist in sourcing financing for a new MOB/ASC construction that would alleviate the need for additional space to support its growing practice. Despite the turbulent market, CMAC tenaciously worked to market the deal to lenders, pivoting...

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Heaton Eye Associates

Ophthalmology

Texas

2023 - This ophthalmology group approached CMAC with the initial objective of funding the acquisition and renovation of an 80,000 sq ft building without coming out of pocket. CMAC worked with the practice to create a strategy and ultimately achieve its goals by leveraging its existing buildings....

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Tower Clock Eye Center

Ophthalmology

Wisconsin

2023 - This ophthalmology group aimed to consolidate the ownership of several different real estate entities across multiple properties as well as secure financing to renovate an existing building into an ambulatory surgery center. CMAC strategized with the group to refinance its existing debt...

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Wake Internal Medicine Consultants

Internal Medicine

North Carolina

2023 - Following a previously unsuccessful venture into real estate ownership, this group decided to reconsider and purchase a 48,000 sq ft built-to-suit building. After signing a lease-to-buy agreement with its contractor, the group initially worked with CMAC on a consulting basis to test...

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Ogden Clinic

Multi-specialty

Utah

2023 - This Western multispecialty group decided to build a new medical office building and ambulatory surgery center to facilitate the expansion of its practice. Throughout the financing process, CMAC was able to maximize the appraised value and ultimately secure a loan to fund the entire...

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Wisconsin Institute of Urology

Urology

Wisconsin

2023 - This returning client aimed to refinance its existing debt and leverage up in order to facilitate more affordable buy-ins and buyouts. Additionally, the partners had become disappointed with their current lender relationship and felt they needed a new banking partner. CMAC modeled analyses...

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Shoreline Orthopaedics

Orthopedic

Michigan

2023 - This Michigan orthopedic group recently completed a two-phase project which concluded in a joint venture (JV) with a local hospital. The first phase was a $4,700,000 refinance of the group’s current building for cash out to provide equity for a construction loan. While the group...

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Southern Oregon Neurosurgical & Spine Associates, PC

Neurology

Oregon

2024 - This Pacific Northwest group recently closed on the financing for a two-phase medical real estate project. The group first needed to refinance the existing land loan which was floating at a very high rate before it could move forward with its planned MOB construction project. CMAC assisted...

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North Atlanta Vascular Clinic

Vascular

Georgia

2023 - This vascular clinic just outside of Atlanta, Georgia aimed to refinance its medical office building. As the group considered its financing options, it became clear that cash flow issues resulting from the building being less than 50% leased would create a challenge during this process....

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The Orthopedic Clinic of Daytona Beach

Orthopedic

Florida

2023 - This leading Florida orthopedic group closed on $16MM of financing at a competitive rate for the construction of a new MOB. The new location will be adjacent to its existing ASC property in order to facilitate practice growth. This competitive fixed interest rate was secured by CMAC...

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Orthopedic Specialists of SW Florida

Orthopedic

Florida

2022 - This southern orthopedic group wished to finance a new owner-occupied MOB to facilitate strong practice growth. From the time CMAC received bank proposals to the time of closing, rates increased by 0.85%. By maintaining competitive pressure, CMAC was able to work with the bank on behalf of...

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Medical Eye Specialists

Ophthalmology

Montana

2022 - This independent ophthalmology group in Montana planned to build a new medical office building and ambulatory surgery center and was seeking a high loan-to-value (LTV) loan. CMAC sent a request for proposals to over 15 banks. Despite the request for high LTV and challenges with...

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Ohio ENT & Allergy Physicians

ENT

Ohio

2022 - As practices grow in physician partners and expand in locations, the financing can often become fragmented. This ENT group’s success and steady growth led to six real estate loans for five properties with three different banks – all with different ownership groups. They wanted to...

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Precision Bone & Joint

Orthopedic

Florida

2021 - Six orthopedic surgeons from three different practices in South Florida came together to start a new ambulatory surgery center. The doctors hired experts to assist in this new endeavor, including an ASC consulting company and CMAC Partners to arrange construction financing. With the...

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Legacy Orthopedics & Sports Medicine

Orthopedic

Texas

2022 - This southern orthopedic group aimed to construct its first owner-occupied building for its growing practice. The doctors knew that adding the real estate investment as an ancillary revenue source would be helpful in recruiting incoming physicians. CMAC assisted in securing and negotiating...

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First Settlement Orthopaedics

Orthopedic

Ohio

2021 - The orthopedic surgeons needed some financing for an intra-company transfer of ownership shares for their Surgery Center. And they needed it fast; for tax purposes it was favorable to close before year-end. CMAC was pleased to (quickly) arrange this financing which closed in the nick of...

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Dallas Nephrology Associates

Nephrology

Texas

2021 - One of the largest teams of kidney specialists in the U.S., this 50-year-old practice wanted to form a new real estate entity to purchase its practice locations that were owned by subsets of doctors and retired doctors. It also wanted to create a structure that would allow new doctors to...

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Orthopaedic Associates of Muskegon

Orthopedic

Michigan

2022 - This orthopedic group had previously worked with CMAC to close on a $28MM cash-out refinance in order to facilitate the expansion of its existing medical office building into a surgery center. The group engaged CMAC again to help secure a second mortgage for this expansion and assist with...

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Signature Medical Group

Multi-specialty

Missouri

2021 - The orthopedic physicians of Signature Medical Group realized the real estate buy-in for incoming physicians had become unaffordable and prohibitive. Through a series of analyses, they decided their optimal outcome was to complete a cash-out refinance on their primary location that, at the...

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Nephrology Associates

Nephrology

Tennessee

2021 - Tennessee Nephrology Associates aimed to refinance debt related to a partial ownership of a dialysis company, lock in low long-term rates, and improve cash flow. CMAC went out to over 20 different banks and ultimately presented six competitive proposals to the group, with some offered...

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Tampa Bay Orthopaedic Specialists

Orthopedic

Florida

2010 - The six physician-owners of this building didn’t have the manpower to devote to their refinance project, so brought in CMAC to negotiate with more a dozen banks and sift through proposals. The thorough vetting process uncovered a bank which was new to the doctors, but fit their needs to...

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Springhill Medical Center

Hospital

Alabama

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Advanced Bone & Joint

Orthopedic

Missouri

The doctors enlisted CMAC to consult with them regarding different physician ownership options on a $19 MM new construction project. CMAC modeled different rental rates, buy-in costs and returns to give the physicians the needed data to structure their new investment.

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Audubon Medical Center

Multi-specialty

Colorado

2023 Closing - As part of CMAC’s routine client follow-up, this returning client realized that its loan, maturing the next year, should be refinanced sooner rather than later. Throughout the refinancing, the group experienced a complex change in leadership, including a decoupling with a local...

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Orthopaedic Associates

Orthopedic

Georgia

We were honored to assist these doctors refinance their medical real estate, cutting the monthly loan payment by 40%, lowering personal guarantees, and getting them out from under an interest rate swap with a large, negative value.

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Orthopedic Associates

Orthopedic

Missouri

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Baylis & Brown Orthopedics

Orthopedic

Florida

Formerly Orthopaedic Associates USA - 2015 - Due to a depressed real estate market in the region, the doctors were in the unenviable position of having debt on their medical condo of more than 1.5x the appraised value. A creative debt stack arranged by CMAC allowed them to refinance, lower...

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Palmetto Surgery Center

ENT

South Carolina

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PMC Regional Hospital

Hospital

Indiana

2017 - The physician-owners of this hospital building enjoyed an excellent relationship with their lender, yet in a declining interest rate environment, knew they no longer had the bank’s best pricing. CMAC was able to work with their banker to modify the existing loans and interest rate swaps...

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Pima Heart & Vascular

Cardiology

Arizona

2015 - The doctors had three real estate entities with five loans and wanted to consolidate into one new loan, however the new debt amount was nearly as much as the appraised value. CMAC stepped in and arranged a new loan, with a lowered interest rate, monthly payment, and personal guarantees. We...

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Southwest Florida Neurosurgical & Rehab Associates

Neurology

Florida

2015 - The physicians have brought in CMAC three times to assist with the group’s real estate financing. Most recently, the refinance was an opportunity to significantly reduce the doctors’ personal guarantees. On a previous engagement, CMAC calculated that the bank had miscalculated amounts...

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Surgery Center of Southern Oregon

Multi-specialty

Oregon

2014 - The five practices whose doctors were co-owners wanted to improve the loan terms and also pull out $4.5 MM to expand and renovate the ASC. They got three excellent loan proposals and challenged CMAC to do better. Mission accomplished with a closing less than four months later, with all the...

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The San Antonio Orthopaedic Group

Orthopedic

Texas

2014 - CMAC was pleased to assist the physician-owners of this 50,000 sf medical office building with a refinance to improve the loan terms and to provide cash to buy out a retired doctor. The refinance created a net savings of over $1 MM over the new loan term.

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Valley Medical Center

Multi-specialty

Idaho

A Division of Catalyst Medical Group

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Metrolina Nephrology Associates

Nephrology

North Carolina

2020 - This independent nephrology group was planning a new majority owner-occupied MOB and ASC construction project and engaged CMAC to fully vet the market and find the best deal. The group members also wanted a team of experts to guide and educate them through an unfamiliar process, explaining...

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Investment Real Estate Portfolio

Non-medical

New Mexico

2014 - While CMAC’s focus is medical real estate, we are sometimes asked to arrange financing for investment real estate. This high net worth client has twice hired CMAC to refinance portfolios of net lease properties like this one in Albuquerque. We closed on a “Reducing Revolver”...

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Spectrum Healthcare Partners

Orthopedic

Maine

2021-The Orthopedics Division-The physician-owners of the orthopedics division of Spectrum Healthcare Partners wanted to take advantage of the low interest rate environment and refinance the debt of their existing owner-occupied medical real estate. CMAC continued to provide support and analysis...

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Cardiovascular Institute of the South

Cardiology

Louisiana

2021 - The pre-eminent cardiovascular group of Louisiana and Mississippi sought to redefine its legacy real estate investment vehicle by more than doubling physician participation. CMAC executed a series of presentations to ultimately maximize involvement among CIS shareholders. The group...

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Louisiana Orthopaedic Specialists

Orthopedic

Louisiana

2015 - Often, medical practices do not choose the lowest rate when choosing among loan proposals. They are willing to pay a premium to stay with their incumbent bank when that relationship is strong. These orthopedic surgeons hired CMAC to issue a full RFP to gauge the market. The best proposals...

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Kennedy White Orthopedic Center

Orthopedic

Florida

2022 - As part of our routine client follow up, CMAC learned about challenges this group was facing with its new ASC construction project. Conversations with the incumbent bank had stagnated and the group was anxious to begin construction. The group realized that CMAC’s influence could help...

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Florida Heart Group

Cardiology

Florida

Now part of Advent Health Medical Group Cardiology at Orlando - 2011 - On three occasions, this group hired CMAC to consult on the financing of its medical facility. The doctors used an innovative, off-balance sheet structure that produced below-market interest rates. CMAC also assisted this...

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First State Orthopaedics

Orthopedic

Delaware

2019 - This orthopaedic group 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...

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Eye Surgeons Associates

Ophthalmology

Iowa

2022 - As part of CMAC’s client program, this ophthalmology group became aware of an opportunity to improve and extend its existing financing. With the need to refinance a loan for three properties, the practice partners hoped to create significant savings. Initially, the incumbent bank did not...

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Eye Institute of Pinellas

Ophthalmology

Florida

2011 - Banks often balk at high loan amounts compared to the value of the real estate. Twice, however, CMAC successfully arranged high LTV financing for this client, using creative structuring and fighting for higher appraised values. This well-respected ophthalmology group also retained our...

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EmergeOrtho – Triangle Region

Orthopedic

North Carolina

2006 - The doctor-owners of the hospital real estate wished to buy out their joint venture partner, and expand the facility, yet the lease did not provide enough cash to cover the debt needed. Enter CMAC’s Greg Warren who crafted a complex yet highly effective structure of loans, taxable bonds,...

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Depoe Eye Center

Ophthalmology

Georgia

2017 - The doctors brought in CMAC to quickly find financing on a multi-tenant building property with a looming loan deadline. Within four months we closed on a loan with an interest rate 2.5% lower than previous. The lower monthly payment provided welcome cash flow relief.

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Coral Ridge Gastroenterology Associates

Gastroenterology

Florida

2017 - During CMAC’s RFP process for this MOB/ASC, the Tenet ASC leased additional space, turning the property from majority owner-occupied to investment real estate with its stricter lending criteria. Despite that, the new loan was done at 89% LTV, with the monthly payment cut by 25%, and...

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Carolinas Center for Surgery

Multi-specialty

North Carolina

2016 - The physicians of this group have twice retained CMAC to refinance its debt and improve the terms. Most recently, the 100% LTV refinance generated over $4 MM in cash to distribute to the nine partners, while reducing the interest rate by over 1%. As an added bonus, three new physicians...

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Carolina Spine & Neurosurgery Center

Neurology

North Carolina

2012 - Due to a dip in real estate values in the area, this group found themselves with debt exceeding value by quite a bit. CMAC stepped in and was able to structure a refinance that required no cash out of pocket, reduced the rate by over 2.5% and shaved nearly $30,000 off the monthly payment.

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Blue Water Surgery Center

Multi-specialty

Florida

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Black Warrior Medical Center

Cardiology

Alabama

2014 - The doctors wanted to refinance this medical office building and lock in a new rate for 14 years. The CMAC RFP created leverage to reduce the rate by over 3.5% for the new 14-year term loan, while improving personal guarantees for the physician owners.

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Augusta Orthopedic & Sports Medicine Specialists

Orthopedic

Georgia

2014 – Augusta Orthopedics aimed to refinance its existing owner-occupied property and to finance a new ASC. The closing resulted in lowered interest rates and savings for the group. 2018 – The group returned to CMAC to refinance its MOB and now-constructed ASC and leverage up in order...

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Southern Oregon Orthopedics

Orthopedic

Oregon

2022 - With an expansion project in their sites, Southern Oregon Orthopedics strategically pulled about $6MM in cash out from its existing location to fund an ambulatory surgery center construction. This allowed the owners to lock in a favorable 10-year rate on their existing debt and did not...

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Puget Sound Orthopaedics

Orthopedic

Washington

2020 - A Division of Proliance Surgeons - The physicians were able to confirm, through the CMAC RFP process, that the interest rate proposed by their current bank was indeed the best in the market. A few more improvements, however, in terms of personal guarantees, amortization, and...

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Moore Orthopaedic Clinic & Outpatient Surgery Center

Orthopedic

South Carolina

Now Part of Prisma Health - 2016 - The sale of an independent practice to a hospital system can create problems with financing the physician-owned real estate, which is then no longer considered “owner-occupied” by banks. It becomes investment property and is afforded inferior loan...

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Canyon View Medical Group

Multi-specialty

Utah

2020 - The physicians of this multi-specialty group were pleased after CMAC was able to eliminate personal guarantees, pull out over $2.9 MM in cash for partner distribution, and consolidate seven loans into one. Even better, the interest rate was reduced by over 2%.

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Durant Medical Center

Multi-specialty

North Carolina

2007 - Six independent medical practices of different specialties came together to construct this 60,000 sf MOB so they could have satellite locations in this attractive market. The CEO of one practice said: "I can spend the same dollars that I am spending on leasing and actually own a building,...

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Tulsa Bone & Joint Associates

Orthopedic

Oklahoma

2018 - One of the largest specialty groups in the Midwest, Tulsa Bone and Joint financed its $16 MM expansion project while simultaneously improving the financing on its existing MOB/ASC. The customized package financed 100% of the construction costs for the expansion and allowed the refinancing...

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Sierra Pacific Orthopedics

Orthopedic

California

2024 - The group wanted to make buy-ins affordable for new members while minimizing tax consequences. CMAC developed a model that was self-perpetuating to serve the members into the future, while funding the buyout of retiring members at full price. In the process, CMAC restructured the...

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OrthoTennessee

Orthopedic

Tennessee

2014 - OrthoTennessee enlisted the help of CMAC to analyze the group’s existing debt structure for two of its real estate properties. The intent was to determine if it would be possible to secure new financing that could release them from the guarantees while maintaining or improving the...

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Lexington Clinic

Multi-specialty

Kentucky

2014 - Sometimes incumbent banks need outside pressure to improve terms on existing debt. Banks are not usually proactive in repricing loans as the credit profile improves or market rates fall. The physicians of Lexington Clinic brought in CMAC to obtain proposals from multiple other banks,...

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Michigan Orthopaedic Surgeons

Orthopedic

Michigan

2020 - Five orthopaedic groups, having earlier completed the merger of their practices, wished to fully consolidated their four properties and make the ownership equal among all the physicians. They hired CMAC, who crafted an innovative roll-up methodology involving a refinance at competitive...

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Idaho Urologic Institute

Urology

Idaho

2019 - One of the leading independent urology practices in the Northwest refinanced the debt on its MOB/ASC despite a negative swap value. In doing so, the practice replaced its existing lender who seemed to struggle with banking an independent specialty group. The improvement in loan terms...

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EmergeOrtho – Wilmington Region

Orthopedic

North Carolina

Formerly OrthoWilmington - 2012 - The two largest orthopedic groups in the area 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. The loan-to-value...

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Coastal Orthopedics

Orthopedic

Florida

2020 - As the premier Gulf Coast orthopedic group, Coastal Orthopedics initiated the ambitious objective of constructing two new medical real estate projects simultaneously to facilitate expansion. CMAC advocated a financing structure on behalf of the client that allowed several physicians the...

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Charleston ENT & Allergy

ENT

South Carolina

2019 - A leading ENT group in the Southeast has secured a $20.7 MM loan to refinance multiple real estate properties. Although the group had enjoyed “competitive” pricing from a national lender over the last several years, it was not as fair as the market would dictate. While best business...

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Central Park Ear, Nose and Throat

ENT

Texas

2018 - Central Park ENT refinanced its 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...

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OrthoMontana

Orthopedic

Montana

2021 - This well-respected northern orthopedic group aimed to refinance its debt for two properties in order to leverage up and provide cash to buyout its developer partner. In the process, CMAC helped the group reduce equity to facilitate future partner buy-ins, consolidate its real estate...

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Wooster Orthopaedic & Sports Medicine Center

Orthopedic

Ohio

2008 - CMAC was honored to assist this client arrange innovative financing for the construction of a new medical office building with a surgery center at a rate approximately 1% lower than conventional debt.

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Orthopaedic Associates of Central Maryland

Orthopedic

Maryland

A Division of The Centers for Advanced Orthopaedics - 2015 - Arranging new financing for an ongoing construction project mid-term can be a challenge. CMAC stepped in to help the physicians improve the terms on the construction debt, with new funds to cover cost overruns. We closed seven...

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The Doctors’ Clinic

Multi-specialty

Oregon

2014 - The CMAC RFP process identified a few banks that would remove the personal guarantees from the real estate loan. The doctors had the luxury of selecting among the proposals to reduce their interest rate and monthly payment, with the security of a long-term fixed rate.

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The Bone & Joint Group

Orthopedic

Tennessee

2014 - The doctors have twice brought in CMAC to negotiate on their behalf with the group’s long-time banker in order to improve the loan terms and eliminate personal guarantees on the real estate debt. The leverage created by the possibility of the CMAC RFP process often produces improvements...

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Texas Orthopedics Sports & Rehabilitation Associates

Orthopedic

Texas

2013 - Imagine being stuck in a loan where debt exceeds appraised value by several million dollars, and feeling like you had no options. In the case of the Texas Orthopedics real estate LLC, however, we were able to help them refinance their debt with significantly improved rates and terms. ...

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Tanner Clinic

Multi-specialty

Utah

2021 - This large multi-specialty group aimed to improve the financing terms it held with its long-time banking partner. Because of the strong bank relationship, the physician-owners wished to give the lender every chance to win the CMAC competitive bidding process. CMAC sent RFPs to multiple...

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Syracuse Orthopedic Specialists & Family Practice Associates

Family Practice

New York

2016 - CMAC was privileged to assist these two practices to finance 100% of the cost of a to-be-constructed MOB, with a structure that provided a two-year interest-only period. Most of the principal repayment was pushed to later years.

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Rothman Orthopaedic Institute

Orthopedic

Pennsylvania

2015 - Prior to CMAC’s involvement, Rothman had done a very good job of securing favorable financing that was already better than the market. But CMAC was able to bring greater competitive pressure from banks outside of the Northeast, as well as from banks within the Philly market, that had...

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Premier Family Medical

Multi-specialty

Utah

2020 - This group was born from the merging of two leading primary care groups, each holding an impressive and continually expanding real estate portfolio. The group needed to unify its real estate investments in order to optimize its network and streamline decision-making. CMAC executed a...

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OrthoTexas

Orthopedic

Texas

2017 - The physician-owners of this practice location used the CMAC RFP process to gather the very best loan proposals for their rather unique situation. The refinance provided cash out to partners and funds to buy out a former partner while lowering personal guarantees.

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Orthopaedic Associates of Michigan

Orthopedic

Michigan

2017 - With a looming loan maturity, and two new proposals in hand, the physicians turned to CMAC to fully explore all options. After just three months, we closed on a loan with a new bank showing savings of nearly $600,000 on just the main real estate loan. The physicians were able to pull out...

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Orthopaedic Associates & Emerald Coast Eye Institute

Ophthalmology

Florida

This Florida orthopedic group refinanced its medical office at a substantially lower interest rate while staying with the incumbent bank. The financing provided cash out for the group to facilitate new partner buy-in and reduced the level of personal guarantees.

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ORA Orthopedics

Orthopedic

Illinois

2024 - This Midwestern orthopedic group sought financing for a new state-of-the-art medical office building and ambulatory surgery center to support its continued growth. Having previously collaborated with CMAC Partners, the group turned to CMAC once again to leverage its expertise in securing...

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Ocala Eye

Ophthalmology

Florida

2008 - CMAC Partners was honored to assist the physicians of Ocala Eye improve the interest rates on five real estate loans, with extra funds to finance the transfer of ownership on one of the properties.

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OAK Orthopedics

Orthopedic

Illinois

2021 - A Division of Illinois Bone & Joint Institute - This exciting new practice location will also house a state-of-the-art surgery center, allowing the physicians of OAK Orthopedics to serve their community by providing even more accessible and comprehensive care for every orthopedic...

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North Carolina Eye, Ear, Nose & Throat

ENT

North Carolina

2016 - After hiring CMAC to arrange financing for the purchase of the practice’s headquarters, the physicians engaged us again several years later to handle its refinance. We negotiated a 10-year loan with an all-in rate of less than half of the prior rate, with improved personal guarantees and...

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Magruder Laser Vision

Ophthalmology

Florida

2023 - This long-standing client returned to CMAC for guidance in financing the construction of a new 10,000 sq ft medical office building and ambulatory surgery center. This two-part project was initiated with the purchase of a semi-developed land parcel, which prohibited the group from...

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Lowcountry Orthopaedics & Sports Medicine

Orthopedic

South Carolina

2013 - This client hired CMAC twice to assist in the refinance of several high-LTV practice locations. In the process, new physicians entered the real estate entity, the personal guarantees were improved, and interest rates were lowered significantly.

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Hope Orthopedics of Oregon

Orthopedic

Oregon

2017 - The physicians of this group have twice used the leverage of CMAC to improve the rates and terms on their medical real estate debt. Most recently, CMAC refinanced the practice’s primary medical office building, enabling the physicians to pull out over $2 MM of cash, while shedding...

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Granger Medical Clinic

Multi-specialty

Utah

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Fox Valley Orthopaedics

Orthopedic

Illinois

2013 - This client has twice hired CMAC to improve its VRDB (variable rate demand bond) financing. Most recently, the challenge was improving in the face of appraised values lower than the outstanding debt. Despite this, CMAC negotiated superior terms and closed quickly.

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Fort Worth Heart/Fort Worth Brain & Spine

Cardiology

Texas

2020 - A leading Texas cardiology practice, having the not-so-unusual situation of multiple office buildings owned by different sets of doctors, recently accomplished something VERY unusual that ended with a positive outcome. Under a plan structured and coordinated by CMAC Partners, the groups...

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Eye Specialists of Mid-Florida

Ophthalmology

Florida

2020 - The physicians of this ophthalmology group own nearly a dozen practice locations serving patients throughout a wide swath of central Florida. CMAC has thrice been honored to assist the physicians in exploring financing options as they continue to expand their geographic footprint.

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Endoscopy Center of Ocala

Gastroenterology

Florida

2020 - Over the last 15 years, the physicians of this group have brought in CMAC several times to consult on its financing structure, terms, and interest rate swaps. Most recently, we successfully lobbied the bank to extend a 10-year loan on a surgery center building with a 6-year lease.

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Ear, Nose & Throat Center of Utah

ENT

Utah

2021 - This group enlisted CMAC to vet the market and secure improved loan terms for its current real estate. CMAC’s leverage not only allowed us to receive 12 competitive proposals but encouraged the incumbent bank to reduce its rate and create interest savings for the group. The group was...

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Breast Care Center at Physicians Medical Center

Oncology

Louisiana

2014 - The doctors of this group enjoyed a wonderful relationship with their long-time bank, but wanted to fully test the market before closing on their loan renewal. Through the CMAC RFP process, the doctors gained knowledge and leverage to renew at a rate more than 1% lower.

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Cascade Brain and Spine

Neurology

Washington

2020 - This client used real estate financing as a vehicle to allow a new physician to buy in affordably. In the process, the interest rate on the debt was reduced by more than 1% and the personal guarantees were lowered. CMAC was honored to assist the physicians with this transaction.

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Azalea Orthopedics, A Division of OrthoLoneStar

Orthopedic

Texas

2015 - Leveraging up to reduce the cost of buy-in for new partners is an excellent strategy for physician-owned real estate. CMAC was pleased to assist this group to refinance, strip out cash equity, and, in the process, dramatically reduce the interest rate and personal guarantees. The 15-year...

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Austin Diagnostic Clinic

Multi-specialty

Texas

2014 - This well-regarded practice had been enjoying excellent interest rates on its two medical properties. In a rising rate environment, however, is important to slow debt repayment to get the full benefit of low rates as market rates increase. CMAC negotiated longer amortizations, dramatically...

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Austin Area Obstetrics, Gynecology and Fertility

OB-GYN

Texas

2013 - The doctors wanted to do a thorough job of seeking out the best refinance offer; they went to a number of banks and gathered proposals. Then they hired CMAC to see if we could do better. The doctors were delighted when the CMAC RFP identified a bank which would provide an 11-year fixed...

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Ascension St. Vincent Orthopedic Hospital

Orthopedic

Indiana

2017 - The doctors wanted construction financing for a proposed 135,000 sf, physician-owned, specialty hospital, with the complication of TIF (Tax Increment Financing) funds. There was no corporate guarantee or lucrative depository relationship to offer bidding banks. The doctors also aimed to...

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Alabama Orthopaedic Clinic

Orthopedic

Alabama

2007 - CMAC was able to use its leverage as an issuer of taxable bonds to help this client vet the banking market and select among many aggressive debt proposals. The incumbent lender opted to quickly modify the existing debt at a substantially lower rate rather than risk losing the business to...

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Alyeska Vascular Surgery

Vascular

Alaska

2020 - This small practice aimed to refinance in order to lock in longer-term financing, improve the rate, and lower its monthly payment. The group had attempted to refinance itself but was unable to get to closing with any bank. CMAC stepped in to negotiate with the banks on behalf of the group...

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Willamette Ear, Nose, and Throat

ENT

Oregon

2020 - This practice turned to the equity in its real estate to produce cash out for the doctors during the COVID-19 crisis. In addition to the much needed dollars, the financing facilitated partner buy-ins and buyouts by reducing the equity required. The loan closed at a low, 10-year rate with...

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Urology Associates, PC

Urology

Tennessee

2019 - This prominent urology group refinanced its real estate in order to facilitate a multitude of buy-ins and buyouts while providing $5.5 MM cash out. The non-recourse financing was concluded with the incumbent bank, reducing the historical loan spread initially negotiated by the borrower....

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The Oregon Clinic – Gastroenterology South

Gastroenterology

Oregon

2022 - This group completed a two-part closing, first completing a building purchase and then closing a construction loan. The current tenant of the building requested an extension, causing a delay in the construction loan closing. Despite an initial low appraisal, CMAC was able to negotiate with...

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The Spine Hospital of Louisiana at The Neuromedical Center

Neurology

Louisiana

2013 - When a borrower loves its bank, it can be awkward to press for improvements in loan terms. The physicians of The Spine Hospital of Louisiana at The NeuroMedical Center brought in CMAC to negotiate on their behalf. We empowered the local banker with information about loan terms for similar...

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Tennessee Orthopaedic Alliance

Orthopedic

Tennessee

2018 - This large Middle Tennessee orthopedic group closed a $7.5 MM loan for the construction and permanent financing of a new satellite office. The loan terms provided for a generous interest-only period following construction. This allowed reduced payments and maintained positive cash flows...

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Tallahassee Orthopedic Clinic

Orthopedic

Florida

2022 - A long-standing client with a relationship of nearly twenty years, Tallahassee Orthopedic Clinic engaged CMAC once again to refinance and leverage up a building with little remaining debt. Their intent was to take the cash out to fund future expansion. The group also wanted a line of...

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South Florida Orthopaedics & Sports Medicine

Orthopedic

Florida

2017 - As a result of CMAC’s RFP, the practice’s 32,000 sq ft state-of-the-art facility for orthopedic care was financed with its incumbent bank, which improved its pricing by 1.25%; resulting in savings of over $750,000. The bank also increased its loan amount from 80% loan-to-cost (LTC) to...

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Slocum Center for Orthopedics & Sports Medicine

Orthopedic

Oregon

2019 - This practice operates out of a state-of-the-art, 80,000 sf medical office building, specially built for Slocum, with ownership held equally by the developer and the Slocum group. Because the developer borrowed bank funds directly and then lent half to the physician group on a sub-note,...

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Reno Orthopedic Clinic

Orthopedic

Nevada

2019 - CMAC was honored to assist this client secure construction financing to significantly expand its primary site and also to refinance a satellite office. Following negotiations, all equity invested prior to construction was returned to the physicians at the closing of the loan, resulting in...

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Princeton Orthopaedic Associates

Orthopedic

New Jersey

2018 - The doctors faced a looming loan maturity and asked CMAC to quickly refinance to improve rates and remove the personal guarantees. Just three months later, after a speedy CMAC RFP process, the improved loans were closed. The CEO commented: “A very professional effort. I thought the...

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Premier Bone & Joint Centers

Orthopedic

Wyoming

2022 - After learning about their positive swap unwind, this client returned to CMAC to secure $7,000,000 of new debt, on top of the group’s existing $18,700,000 financing. The objective of the incremental debt was to reduce buy-ins and payoff partner buyouts. Acknowledging the close...

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OrthoAlaska

Orthopedic

Alaska

2022 - This long-standing client turned to CMAC once again – this time for expertise in the merger of shares between the doctors of the original and acquired practice. With a significant swap unwind that increased equity positions and an appraisal that indicated increased value, CMAC completed...

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Orthopedic Associates of Lancaster

Orthopedic

Pennsylvania

2019 - CMAC assisted the physicians in the refinance their four practice locations to improve the interest rate and monthly payment, extend the term, and provide a structure to aid in future partner buy-ins and buy-outs. Despite the very close relationship between the practice and its bank,...

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OrthoCarolina

Orthopedic

North Carolina

2019 - This large orthopedic group, a client that had previously hired CMAC to arrange real estate debt, approached CMAC with the objective of finding a new banking partner for its very substantial depository business. CMAC created a reduction of over $500,000 of treasury expense annually. Along...

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OrthoArkansas

Orthopedic

Arkansas

2020 - This group ordered an appraisal through their incumbent lender under the assumption they would receive a fair building valuation. When the value came in far below their expectations, their expansion project was thrown into turmoil, and the project would have required a cash infusion of...

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North Carolina Specialty Hospital

Hospital

North Carolina

2008 - The physician-owners of the hospital real estate wished to buy out their joint venture partner and expand the facility, yet the lease did not provide enough cash to cover the debt needed. Enter CMAC’s Greg Warren who crafted a complex yet highly effective structure of loans, taxable...

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Missoula Bone & Joint

Orthopedic

Montana

2018 - Missoula Bone and Joint closed financing on loans that enabled the physician-partners to construct a $16 MM surgery center expansion and purchase all equipment with no cash out of pocket. Highlights of the financing included the elimination of all personal guarantees, a 18-month...

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Lewiston Orthopedics

Orthopedic

Idaho

A Division of Catalyst Medical Group - 2018 - CMAC Partners helped arrange nearly 100% financing for a new expansion/remodel project through multiple loan facilities with a local credit union. The 10-year fixed interest rate was CMAC's lowest of that year for a construction loan.

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Lafayette Surgical Specialty Hospital

Hospital

Louisiana

2013 - The physician-owners had some specific needs and preferences with this refinance project, such as not wanting to personally guarantee, not wanting the hospital operating entity to guarantee, and not wanting to move its depository business. CMAC was able to custom craft a financing...

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Flagstaff Bone & Joint

Orthopedic

Arizona

2019 - This practice embarked on not one, but two, brand new construction projects and called in CMAC to help them find a bank with the most attractive terms. CMAC advocated on their behalf to secure longer than normal loan terms and amortizations, coupled with loan amounts that covered 100% of...

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Eye Institute of West Florida

Ophthalmology

Florida

2014 - Banks often balk at high loan amounts compared to the value of the real estate. But twice CMAC successfully arranged high LTV financing for this client, using creative structuring and fighting for higher appraised values. This well-respected Ophthalmology group also retained our services...

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Columbia Orthopaedic Group

Orthopedic

Missouri

2019 - This Midwestern orthopedic center refinanced its current debt in addition to financing 100% of a $10MM expansion. The $35MM transaction also involved the redemption of its bond debt and resulted in a simpler and less expensive debt structure with interest savings of more than a...

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Charleston Radiologists

Radiology

South Carolina

2015 - On three different occasions, CMAC arranged or improved financing for this practice’s main office in Charleston. Fifteen years ago, CMAC introduced an out-of-town bank to this prestigious group of doctors who were awarded the lowest cost of financing offered by that bank in its history....

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EmergeOrtho – Foothills Region

Orthopedic

North Carolina

Formerly Carolina Orthopaedic Specialists - 2011 - The 14 physician-owners of COS, with three different real estate entities, hired CMAC to refinance debt on five practice locations plus medical equipment. The CMAC RFP created a hyper-competitive environment among the banks, and the doctors...

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California Eye Institute

Ophthalmology

California

2017 - This large medical office building, owned by physicians of the tenant groups, was struggling with ownership changes. Buy-ins were too expensive for new physicians and retired partners wanted to be bought out in full. CMAC arranged financing to make the ownership changes work for all the...

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Athens Orthopedic Clinic

Orthopedic

Georgia

2020 - The COVID-19 induced lending hiatus on medical buildings abruptly ended when an Orthopedic group in the Southeast closed its refinancing at a historically low rate. The low rate is fixed for 10 years without personal guarantees and provides more than $10M in cash out for the physicians....

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Arkansas Urology

Urology

Arkansas

2019 - CMAC helped this urologic group secure construction financing for a new owner-occupied clinic in addition to refinancing its current debt with its incumbent lender. The construction facility was interest-only for the first year followed by a 10-year term while the loan spreads on the...

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Arkansas Surgical Hospital

Hospital

Arkansas

2012 - The doctors had closed their hospital real estate loan just a few month prior to hiring CMAC. With a 3% prepayment penalty, the group was worried they were stuck. By sharing with their bank what other banks were offering similar clients in other markets, CMAC gave the banker the...

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OSS Health

Orthopedic

Pennsylvania

2022 - As a CMAC client, OSS Health received continuous monitoring of the loans they had previously closed. This led the group to realize their swaps were in the money. Since they were experiencing cash flow issues due to $10MM of buyouts owed to retiring doctors, they decided to refinance and...

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Pacific Cataract and Laser Institute

Ophthalmology

Washington

2017 - This Pacific Coast ophthalmology group aimed to refinance eight properties in order to improve loan terms and buy and renovate a ninth property. Securing flexible financing would allow the group to continue buying, selling, and renovating locations without having to negotiate financing and...

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Pinnacle Ophthalmic Building

Ophthalmology

Colorado

Retina Consultants of Southern Colorado Eye Associates of Colorado Springs Ron W. Pelton, MD & Steven H. Dewey - 2018 - This building is related to an ASC and four different ophthalmology practices. The groups refinanced their eye centers with an low average fixed rate over 10...

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Georgia Hand, Shoulder and Elbow, PC

Orthopedic

Georgia

"The CMAC team is highly professional and expert. Their experience in medical real estate allows them to identify valuable methods to improve both the financing and sale of properties. They are creative, reliable, informed and dedicated to improving the value of your project. They get the job...

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Cardiovascular Associates

Cardiology

Alabama

2010 - CardioVascular Associates of Birmingham (CVA), now part of Brookwood Baptist Health System, is one of the largest cardiology practices in the Southeast. CVA partnered with CMAC when it needed to finance a new 80,000 square foot facility in Birmingham. The doctors enjoyed the benefits of...

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South Denver Cardiology Associates

Cardiology

Colorado

2019 - This cardiology group in the Western U.S. refinanced its MOB, realizing nearly $9 MM in cash out for partner distribution. The lowered equity enabled new partners to buy in more affordably. The exceptional loan rate and extended 30-year repayment schedule create enhanced cash-on-cash...

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Connecticut Orthopaedics

Orthopedic

Connecticut

2017 - This well-respected, full-service orthopaedic practice, one of the largest in New England, refinanced several loans totaling approximately $33 MM. The complex structure of both swapped and floating rate debt combined with internally fixed loans closed with a 10-year term and a 25-year...

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Women’s Healthcare Associates

OB-GYN

Oregon

2018 - CMAC was proud to assist WHA with its financing of the Gateway birthing center via a 10-year loan with no personal guarantees to the owners. The new birthing center opened in February 2017 and joined WHA’s network of 15 clinics across the Portland area.

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Bend Surgery Center / Desert Orthopedics

Orthopedic

Oregon

2019 - More than $9.25 million cash was distributed to the physician-owners in a refinance that reduced the equity in order to ease partner buy-in. The loan closed at an exceptionally low rate fixed for 10 years without any personal guarantees from the partners or guarantees from the operating...

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Virginia Eye Institute

Ophthalmology

Virginia

2019 - CMAC was hired in 2015 to refinance and leverage up four practice locations while lowering interest rates and eliminating personal guarantees. The doctors enjoyed the $5.5 million equity that was converted to cash out. When they asked us to do it again four years later, it was a harder...

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Cancer Specialists of North Florida

Oncology

Florida

2016 - The old adage that "knowledge is power" may have no more meaningful application than when it is applied to bank loans. In particular, when it means taking the knowledge of what a specific bank may be offering in a particularly competitive part of the country and empowering other branches...

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