Healthcare Facilities

Healthcare Facilities

Overview

Cox, Castle & Nicholson represents a wide range of clients involved in real estate transactions and projects with a specific emphasis in the healthcare industry. We have extensive experience representing REITs, pension funds, hospitals, developers, private owner/operators, and investors of all types (including physician groups) in an assortment of healthcare related real estate transactions.

We regularly guide our clients through the process of partnering, acquiring, financing, developing, operating, licensing, and leasing all types of healthcare assets, including medical office buildings, hospitals, senior housing projects (including age restricted housing, assisted living, memory care, independent living and skilled nursing), ambulatory surgery centers, and other healthcare related facilities. Our long history representing clients in these types of transactions provides us with specific knowledge of, and sensitivity to, the issues and concerns of clients transacting in the real estate healthcare arena. 

Real Estate Acquisitions And Dispositions

We represent both buyers and sellers of healthcare assets throughout the United States, including on and off-campus medical office buildings, acute care and specialty hospitals, and senior housing facilities. The frequency with which we deal with complex healthcare real estate transactions affords us a distinct advantage in effectively and efficiently addressing our clients' concerns and objectives. We take great pride in understanding our clients' goals and objectives, and proactively work with our clients to achieve such goals and objectives effectively and creatively. 

Our attorneys place great emphasis on the long-term implications of each transaction. Accordingly, we work closely with each client to implement a customized and comprehensive due diligence and risk management program aimed at identifying and addressing potential problems. When appropriate, we also draw from the expertise of our attorneys who focus on specialized fields such as tax, environmental law, insurance, and regulatory compliance. 

Financing

We routinely assist our healthcare clients in obtaining all types of financing, both from traditional balance sheet lenders as well as from agency lenders such as Fannie Mae, Freddie Mac, and HUD. Our expertise includes the negotiation and documentation of acquisition loans, permanent and bridge loans, construction loans, ground lease financing, mezzanine financing, and financing to joint ventures. Always mindful of our clients' sensitivities (such as the allocation of loan recourse among joint venture partners or the impact that state licensure suspensions or downgrades could have on a credit facility), we are careful to guide our clients to resolutions that meet their particular needs. Once financing has been obtained, we also assist our clients in managing their lender relationships and responding to the needs of lenders, loan servicers, and joint venture partners. 

Entitlement And Development

We represent developers, hospitals, and investors in the entitlement and development of a wide variety of healthcare related real estate assets. Our attorneys have in-depth experience and knowledge in all facets of land use approvals including, general and specific plans, zoning, conditional use permits, variances, and related matters. In addition, we have expertise in all stages of the construction and development process, including negotiating construction contracts and implementing customized insurance programs. This expertise, coupled with our firm's overall acumen in real estate matters and our in-depth understanding of the healthcare industry, provides us with the ability to provide each client with comprehensive and integrated services at each stage of the entitlement and development process.

Leasing And Property Management

We have extensive experience in leasing all types of medical office products, from multi-tenant to single user buildings, as well as master leases with hospitals. We are familiar with issues raised by various federal laws regarding the health care industry, including the Stark Act and anti-referral statutes and HIPAA/patient privacy. We represent landlords in numerous leasing transactions throughout the United States. In addition, we have significant experience regarding property management of medical office buildings and senior housing communities, including single and multi-asset portfolios and have worked with a variety of property management companies and owner/operators.

Licensing

We assist clients with the highly regulated process of applying for, obtaining, renewing and transferring licenses and/or certifications for assisted living facilities for the elderly, skilled nursing facilities, and continuing care retirement communities from the applicable California regulatory departments and agencies, including the California Department of Public Health, the California Department of Social Services, and the California Health and Human Services Agency.

Joint Ventures

The attorneys in our Healthcare Facilities Practice frequently represent both investors (including REITs and public pension funds) and operators (including operators of senior housing communities and other healthcare facilities) in establishing their joint venture relationships in connection with the acquisition, ownership and operation of healthcare related real estate projects and portfolios. We offer particular expertise in planning, negotiating, documenting, forming, and implementing all types of joint ventures, including limited liability companies and partnerships, as well as providing guidance during partner disputes and litigation. In addition to equity investment through customary joint venture mechanisms, we structure a wide array of funding vehicles including master lease arrangements, mezzanine financing and management contracts containing equity components. The combination of our specific healthcare expertise, coupled with our firm's established history as a leader in negotiating joint venture transactions, allows us to utilize our knowledge of market terms and deal structures to facilitate the achievement of our clients' joint venture objectives. 

Additional Expertise

The depth and breadth of our firm's real estate capabilities enable us to draw on the special expertise of other firm attorneys in areas such as litigation, environmental matters, insurance coverage, and construction law to deliver comprehensive legal services to all of our clients. In particular, our healthcare clients benefit from such expertise as we regularly consult with many of these experts during the course of structuring healthcare transactions. Some areas of expertise which are often particularly beneficial to our healthcare clients include: 

  • Public Finance. Financing a wide range of public finance transactions, including tax-exempt and taxable municipal debt issuances for hospitals, senior housing communities, and other healthcare facilities.
  • Risk Management and Insurance. Insurance and risk management assessment, including the review and critique of property, liability and D&O insurance policies and acquisition, construction, operation, and disposition documentation.
  • Construction. Our transactional attorneys negotiate, and prepare construction contracts, architect agreements, engineering and design agreements, professional services agreements, purchase orders, payment and performance bonds, mechanics' liens, stop notices, notices of completion, consulting agreements, and construction management agreements in connection with the development of new healthcare facilities, and rehabilitation of existing healthcare facilities.
  • Litigation/Dispute Resolution. All facets of dispute resolution, including complex litigation, land use matters, construction defects, and other disputed matters relating to healthcare facilities.

Representative
Matters

<h3> Medical Office</h3>

Represented a public pension fund in the negotiation and documentation of a $267 million medical office/seniors housing joint venture platform, inclusive of both stabilized and development projects.

Represented a healthcare REIT in the acquisition of a $196 million portfolio of nine medical office buildings in New York, Florida, and Massachusetts. The transaction also included seven separate loan assumptions totaling more than $100 million.

Represented a healthcare REIT in the acquisition of a $161 million portfolio of sixteen medical office buildings located in South Carolina.

Represented a healthcare REIT in the acquisition of a portfolio consisting of seventeen medical office buildings and Healthcare Facility located on ground lease properties in Arizona for an aggregate purchase price of $107 million and negotiation of a loan assumption.

Represented a healthcare REIT in the acquisition of a majority interest in a partnership that owns a medical office building located in Houston. The transaction was structured so that the seller group (consisting of more than 20 physicians) was provided the right to remain in the partnership that owns the building, receive limited partnership units in the REIT's operating partnership ("UPREIT" structure), and/or receive cash.

Represented a healthcare REIT in the acquisition of a portfolio consisting of medical office buildings and surgery centers located in Kansas and Florida for an aggregate purchase price of $61,350,000 and negotiation of related acquisition financing.

Represented a healthcare REIT in the acquisition of a thirteen-building portfolio in Indiana for an aggregate purchase price of $90.1 million and negotiation of related acquisition financing.

Represented a healthcare REIT in the acquisition of a portfolio consisting of five medical office buildings located in Texas, Ohio, and Arizona for an aggregate purchase price of $59 million and negotiation of related acquisition financing.

Represented a healthcare REIT in the acquisition of a $54 million medical office building in Michigan on ground lease property.

<h3> Seniors Housing</h3>

Represented a seniors housing operator in the negotiation of a joint venture with a private equity fund, the concurrent acquisition of two assisted living and memory care facilities (one in Northern California, one in Southern California) with a combined purchase price of almost $32 million and the obtaining of a $23 million loan secured by the facilities.

Represented a national healthcare and senior living services provider to apply for and obtain licenses for 5 separate adult day care and residential care facilities for the elderly totaling approximately 527 beds in California in connection with the provider's acquisition of the existing facility operators. The licensing was conducted as part of the concurrent acquisition of the underlying real estate assets by a large healthcare REIT.

Represented an investment partner in connection with a $33.5 million acquisition of an assisted living and independent living portfolio located in the Pacific Northwest.

Represented a seniors housing operator in the negotiation of a master lease platform with a large healthcare REIT which included the commitment of up to $150 million for future acquisitions. The transaction also included the concurrent closing of the initial acquisition under the platform (a four-property portfolio which included independent living, assisted living, and skilled nursing located in the Midwestern United States) for a purchase price of $40,850,000.

Represented a seniors housing operator in the negotiation of a joint venture with a major life insurance company investment partner, together with the concurrent acquisition of an assisted living facility in Oregon for $39,450,000 and associated HUD financing.

Represented a seniors housing operator in the negotiation of an option to purchase two assisted living facilities for $20.6 million, together with related management agreements for the management of the communities, inclusive of operating benchmarks which trigger the related option rights.

Represented a healthcare REIT in the acquisition of a seniors housing portfolio in Florida for an aggregate purchase price of $52 million.

Represented a healthcare REIT in the acquisition of a seniors housing portfolio with facilities located in Texas and California on fee simple and ground lease properties for an aggregate purchase price of $39.6 million and negotiation of related acquisition financing.

<h3> Hospitals</h3>

Represented a group of private investors in the acquisition of a portfolio consisting of three hospitals and ancillary healthcare-related assets in Southern California.

Represented a healthcare REIT in the acquisition of four long-term acute care hospitals located in Georgia, Texas, and Florida for an aggregate purchase price of $10 million.

Attorneys &
Paralegals

Name Title City Phone  
Abrahamson, Scott R. Associate Los Angeles 310.284.2283
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Birkey, Scott B. Partner San Francisco 415.262.5162
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Caligari, Gregory B. Partner San Francisco 415.262.5111
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Fogg, Andrew K. Partner Los Angeles 310.284.2178
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Hughes, Perry S. Partner Los Angeles 310.284.2276
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Kinigstein, Kevin S. Partner Los Angeles 310.284.2191
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Lari, David P. Partner Los Angeles 310.284.2292
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Li, Stephen D. Partner Los Angeles 310.284.2232
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Migita, Gail S. Associate Los Angeles 310.284.2215
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Oehler, Greg G. Associate Los Angeles 310.284.2149
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Titcher, Paul J. Partner Los Angeles 310.284.2255
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Waite, David P. Partner Los Angeles 310.284.2218
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Weissburg, Adam B. Partner Los Angeles 310.284.2270
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Spotlight

Cox, Castle & Nicholson Attorneys Ranked In Chambers USA 2013

Cox, Castle & Nicholson’s Environmental and Real Estate practices were ranked among the best in California by Chambers... More»