ASC's + Commercial Real Estate

They built a $10M ASC. Then sold the building and signed a 15-year lease to stay in it.

That's exactly what the physician group at Orthopedic & Spine Centers of Wisconsin just did in Middleton.

Cypress Exchange Properties acquired the newly built 12,000 sq ft, three-OR facility and packaged it into a Delaware Statutory Trust for 1031 exchange investors at 55% LTV.

The surgeons? They're now tenants in the building they developed, under a triple-net lease with 3% annual rent escalations and personal guaranties attached.

This is a real trade-off worth thinking through:

- You monetize the asset and free up capital

- But you lock in 15 years of rising rent

- And your name is on the guaranty

Owning the real estate versus recycling that capital into clinical growth is one of the biggest calls an ASC owner makes. And most only get to make it once.

Neither path is wrong. But the decision deserves more than a quick yes from your accountant.

If you've built or are building an ASC, how are you thinking about the real estate side of it?