Healthcare Finance

• Ongoing financial and strategic advisor
• Sale of long-term care portfolio
• Various bond issues including $1 billion new money bond issuance

Hackensack Meridian Health is a $7.8 billion revenue network of healthcare providers in New Jersey, based out of Edison. Raymond James has served as a financial and strategic advisor to HMH and its predecessor entities since the early 1990s on a host of financing, merger and acquisition, and other strategic engagements. In 2023, we served as strategic advisor on the sale of their long-term care portfolio, ultimately resulting in the sale of 13 facilities for a gross purchase price well in excess of per bed or unit valuation norms. In 2020, RJ served as financial advisor on a $1 billion new money bond issuance. In 2018, in connection with JFK Health System joining HMH, we advised on $300 million taxable bonds to refinance JFK’s prior indebtedness to be consistent with the new corporate credit structure and pay for new construction projects at JFK. In 2017 we served as financial advisor on a $1.7 billion comprehensive debt restructuring for the newly-formed system. The financing incorporated a “Corporate Parent” credit structure to streamline security and financial covenants.

• Financial advisor on 7 offerings
• Long-term client

Essentia Health is a $3.0 billion revenue physician led integrated health system with more than 12,000 employees, 14 hospitals, and 80 clinics, serving northern areas of Wisconsin, Minnesota, and eastern North Dakota. Raymond James has served as a long standing financial and strategic advisor to Essentia Health since 2018; RJ served as financial advisor on 7 offerings, in addition to advising on select strategic initiatives. In 2023, RJ served as a financial advisor on a $75.4 million multi-series new money and refunding issue and served as a swap advisor on an $82.7 million swap novation. In 2020, RJ served as financial advisor on a $256.4 million multi-series new money and refunding issue. In 2018, RJ served as financial advisor for an $800 million replacement hospital in Duluth, MN; we led a three-firm underwriting group and helped secure required consents for a new MTI with minimal covenants, allowing Essentia to maintain “A category“ ratings from S&P/Fitch.

• Creative replacement hospital financing
• $209 million through the public market and USDA

Samaritan Healthcare (“Samaritan”) is a 50-bed not-for-profit hospital district serving Grant County, WA, as well as patients from a much larger service area given its ability to treat higher acuity patients (the surrounding hospitals are all small, critical access hospitals). It is designated as a sole community provider by the Centers for Medicare and Medicaid Services with a Level 3 trauma center, 2 clinics and a Foundation. The hospital is in a growing rural community and its current facility is landlocked and over capacity. As a result, Samaritan Healthcare is building an approximately 172,000 square foot, 50-bed replacement hospital that will expand critical emergency and operating capabilities for the community. As Sole Underwriter & Placement Agent in 2023, Raymond James financed the $230 million replacement hospital project. In addition to a $73.2 million negotiated bond sale rated “Baa2” by Moody’s and supported by an unlimited tax general obligation pledge, the financing included $136.5 million of USDA Rural Development Community Facilities Direct and Guarantee Loans supported by either a revenue pledge or a general obligation. Raymond James privately placed interim financing for all of the USDA debt with four separate investors.

• Ongoing financial advisor since 2005
• Advised on 5 public deals and 8 private placements

Rochester Regional Health is a $3.6 billion revenue vertically integrated health care delivery system in upstate New York consisting of 9 acute care hospitals with 1,400 beds, 5 long-term care facilities, 11 urgent care sites and 3 ASCs, in addition to multiple ancillary and specialty services and a $150+ million revenue global lab practice. Raymond James has served as advisor to Rochester Regional (and its legacy organizations) since 2005. Raymond James has served as Financial Advisor to RRH on five public offerings. In addition, Raymond James has served as FA for eight private placements for Rochester Regional and its affiliates and have also advised on select strategic initiatives. Strategic advisory engagements have included the sale of senior housing and the acquisition of a toxicology business. Ongoing, we serve as RRH’s IRMA and provide it extensive financial modeling and long-range financial planning.

• Long-term underwriter
• 44 bond issues totaling $3.1 billion

Maine Health and Higher Educational Facilities Authority (“MHHEFA”) is an instrumentality of the state of Maine. The purpose of MHHEFA is to assist the State’s health care and higher educational institutions in the undertaking of projects involving the acquisition, construction, improvement, reconstruction, and equipping of facilities as well as the refinancing of existing indebtedness. Raymond James has served as an Underwriter to MHHEFA since 2010, serving as Sole, Senior, and Co Manager on 44 bond issuances totaling $3.1 billion. In 2023, Raymond James served as the Sole Managing Underwriter for MHHEFA’s $68.4 million Series 2023A Tax-exempt Bonds. In 2024, Raymond James served as the Sole Managing Underwriter for MHHEFA’s $86.4 million Series 2024A Tax-exempt Bonds.

• 30-year history as financial advisor
• Recently advised on a $413 million multi-series issue

West Virginia University Health System is the largest healthcare system in West Virginia with $6.0 billion in revenue and over 3,000 licensed beds across 24 hospitals. Raymond James has served as advisor to WVUHS since the late 1990s. In 2023, we served as financial advisor on a $413 million multi-series new money and refunding issue. In October 2020, we served as financial advisor on WVUHS’s $335 million taxable refunding bond issue. In August 2018, we advised WVUHS on a $568 million multi-series issue, including long-term tax-exempt and taxable fixed rate bonds and tax-exempt variable rate bonds that funded expansion projects and restructured existing debt.

• Financial advisor on 8 bond issues since 1990
• Recently advised Series 2022A $160 million tax-exempt fixed rate offering

Howard Hughes Medical Institute (“HHMI” or the “Institute”) is the nation’s largest private academic biomedical research institution, which was founded in 1953 by the aviator industrialist Howard R. Hughes. Our recent work as financial advisor to HHMI includes advising HHMI on their Series 2022A and 2019A bonds. In August 2022, Raymond James served as the Institute’s financial advisor in connection with its Series 2022A $160 million tax-exempt fixed rate offering. The proceeds from the Series 2022A bonds were used to fund capital improvements at Janelia Research Campus and refinance an existing taxable note. In June 2019, Raymond James assisted the Institute in the financing tax-exempt Series 2019A Capital Appreciation Bonds totaling $51.7 million. The proceeds from the Series 2019A bonds were used to finance capital improvements at Janelia Research Campus. Raymond James Healthcare Finance has represented the Institute since 1990 on eight separate financings.