TranquilityatFredericktown:AValueAddInvestment Proposition

EvaluationProposal

SubmittedBy: KorinnaS.Garbis JohnsHopkinsUniversity CaryBusinessSchool EdwardSt.JohnDepartmentofRealEstate Term:Fall2009

TABLEOFCONTENTS I.

II.

III.

IV.

V.

VI. VII. VIII.

Section1:Overview ExecutiveSummary Section2:MarketandSiteAnalysis Introduction RegionalData Demographics SiteAnalysis ExistingFacilityAnalysis Section3:DesignandConstruction Introduction ExistingFacilityRenovation ProposedDementiaWing Background DesignConsiderations Construction Section4:Regulation Zoning SitePlanReview Parking Section5:DevelopmentTeam OwnershipHistory DevelopmentTeam Section6:FinanceandInvestmentAnalysis Section7:Conclusion Section8:ListofExhibits ExhibitI Proforma(RentRollsandGeneralAssumptions) ExhibitII Proforma(CurrentCashFlowandAmortizationSchedule) ExhibitIII Proforma(CurrentCashFlowwithDementiaFloor) ExhibitIV Proforma(FutureCashFlowwithNewWing,Amortization Schedule,Assumptions,ConstructionBudget,Development Budget,DesignAnalysis,andDrawSchedule) ExhibitV Glossary ExhibitVI TaxMap ExhibitVII ZoningTables ExhibitVIII SummaryofAlzheimersFigures

 I.OVERVIEW BeforeweinvestigatethetotaldevelopmentprocessofavalueaddadditiontoTranquility AssistedLivingFacility,wemustfirstestablishitsorigins,thepartiesinvolved,andthe overalltimelineofdevelopment.KGConsulting,LLChasbeenretainedbyTranquilityI,LP toreviewtheassetsexistingoperationsandproduceavalueaddfeasibilitystudy.Several optionswereassessed:1)CurrentAsset;holdorsellinnextyear2)Operational,light cosmeticandDementiafloorchanges;holdorsellinayearand3)Newwingaddition;hold orsellintenyears.Theseoptionsprovideseveraloptionswithvaryingdegreesofrisk, investment,andpotentialreturnstotheinvestors. ExecutiveSummary: ClientTranquilityatFredericktown,LP TranquilityatFredericktownlocatedinFrederick,Marylandwasoriginallybuiltin1999, andisownedbyTranquility1,LP.Inanefforttoaddvaluetotheexistingfacility,the companywouldliketoexamineseveralpotentialoptionstodoso.TheEvaluationProposal willfirstexamineproposedoperationalchanges,existingfacilityupgrades.Anadditional optionwillanalyzetheplanning,design, financing,construction,marketingand deliveryofanewwingtothefacility.The newwingwillhaveonefloorof24roomsof Dementia,andtwofloorsof36roomsof AssistedLiving,for60totaladditional rooms.Thereafteranewloanwill refinancetheexistingloanaswellasthe constructionloan. ThedemandforresidentialcommunitiesforseniorsrisesastheU.S.populationcontinuesto age.Thisgrowthmeansthatnewadministratorsandstaffmembersoftenarelearningby trialanderrorthecomplicatedtaskofdeliveringhighqualityandconsistentservicesto

elderlypersons.Whilemanynewfacilitieshavebeensuccessful,othershavebeenplagued byavarietyofadministrativeandfinancialdifficulties. AssistedLivingcombinescongregatecarelivingwithpersonalassistancewithsometasks, suchasbathing,dressingandwalking.Residentmustbeambulatoryandnotinchronic needofassistance.AssistedLivingfacilitiesarenotnursinghomes,noraretheyintendedto providenursingcare.Theycanprovideoccasionalassistanceforresidentswhoare ambulatoryandmentallyalert.Monthlyfeelsgenerallyincludeshelter,meals, housekeeping,laundryservice,someutilitiesandpersonalassistance.ThestateofMaryland licensesfacilitiessuchasTranquilityinordertoprovidegreaterlevelsofcareandbetter qualityfortheresidents. Currenttrendsintheindustryincludethefollowing: a) b) assistedlivingresidentswillbecomeincreasinglyimpaired,bothphysicallyand cognitively thefuturelookofassistedlivingwillbedrivenbymarketforces,inthatthe industrywillrespondtowhatownersandinvestorsbelievewillfittheneedsand preferencesofmorewelloffeldersandtheirfamilies c) d) Giventheabovetrends,itisimperativethatTranquilityprepareandmakeappropriate changestotransformthefacility. Asahealthcareandresidentialoption,AssistedLivinghasasolidfuture.Accordingtothe journal,TheGerontologist,assistedlivingwillcontinuetobelargelyanoptionforwealthier elders;andsmallboardandcarehomes,theprimaryoptionformostlowincomeelders, willcontinuetoloseground.2
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assistedlivingresidenceswillremainlargelyunavailabletolowandmoderate incomeelders familieswillcarryonasthechiefproviderofinformaleldercarewiththeircare rolescontinuinginassistedlivingresidences1

National Real Estate Investor, http://nreionline.com/seniorshousing/assisted_living_occupancy_0727/ 2000, The Gerontologist, The Uncertain Future of Assisted Living Mary M. Ball, page, 580.

 II.MARKETANDSITESELECTIONANALYSIS Introduction: Thefacilityssuccessandpotentialgrowthisbasedontheselectionofanappropriate location.TranquilityssiteislocatedinFrederickCounty,Marylandjustoutsidethe FrederickCitylimit.Thefollowingsectionanalysesthecountyandcity,itsdemographics, andtheneedforadditionalDementiaCareFacilitiesinadditiontothecurrentAssisted LivingSupply. FrederickCounty,MarylandRegionalData Frederickcovers662squaremilesandisthelargestcountyareawiseinthestate.Ithas undergonetremendousgrowthinthepastfewyearsanditspopulationnownumbersclose to225,000.Thecountyisalsoamong thetop1.5percentofAmerica's wealthiestcounties,accordingtoa reportbytheU.S.CensusBureau. Withinitsbordersare12 municipalitiesandseveral communities.Thegeneralarea surroundingthesitecontainsmixed residentialandcommercialusesas wellasruralland.Awonderfulview ofnearbysmallmountainsandhills tothenorthandsouthispresent. TwoofFrederickCountysmost popularandscenicstateparks, SugarloafMountainandCunningham Fallsareeachlocatedapproximately 8and13milesfromthesite.TheCityofFrederickislocatedintheapproximatecenterof 5

FrederickCountyandhasdevelopedasabedroomcommunitytobothBaltimore,Maryland andWashington,DC.AlthoughmuchofFrederickCountyremainsruralincharacter,small citiesandtownshaveemerged,aremoreurbanizedandcontinuetogrow. TheCityofFrederickishometomorethan62,000residents,nearlyathirdofFrederick Countys2008populationof232,104.TheCountyhasthe2ndlargestpopulationintheState ofMarylandFrederickislocated44milesfromWashington,D.C.and52milesfrom Baltimore,Maryland.BothareanapproximateonehourawayfromFrederick.Frederick CountyisboundedtotheeastbyCarroll,HowardandMontgomeryCounties,tothesouthby MontgomeryCountyandthePotomacRiver,andtothewestbyWashingtonCounty, Maryland.TothenorthitisborderedbyAdamsCounty,Pennsylvania. Fredericksdiversityisgrowing,withnonCaucasianracesandethnicitiesrepresenting28% ofthepopulation.Frederickslocalworkforceof120,000isfurtherenhancedbycommuters fromneighboringMarylandcountiesaswellasLoudonCountyVA.,SouthernPennsylvania, andWestVirginia.TheCitysworkforceiswelleducated,with34%holdingaBachelors Degreeorhigher. Frederick,aspartoftheBethesdaGaithersburgFrederickmetroregion,wasrecently namedbyForbes.comasthe2ndsmartestregioninthecountry,islocatedlessthan1hour fromWashington,DCandBaltimore,MD,andhasthe2ndlargestpopulationintheStateof Maryland.Thebalancedandthrivingeconomy,highlyeducatedworkforceandqualityoflife isnothingshortofenviable.Emergingasaleadingnationallocationforthebioscience industry,FrederickislocatedwithintheMarylandBiotechCluster.Sixtyplusbioscience companieshavechosentheregiondueinparttoFortDetrickcallingtheCityhomeand employingalmost8,100personnel.Factorssuchasthesedrawinanevergrowingdiverse residentpopulation. BecauseofFrederickslocationatthenorthernendoftheI270TechnologyCorridor,there iscloseproximitytomorethan350thrivingbiosciencecompaniesthroughoutMaryland offeringextensivelocalsupportandnetworking.TheFrederickregionishometonearly400 ITcompaniesbecausethemajorityofthefiberopticnetworkssupplyingWashington,DC areroutedthroughFrederickCounty.Thereisawealthofregionalbusinessestobeserved 6

bythoseITcompaniesandthehipandlivelylifestyleisattractivetoprofessionalsofall ages. MarketAreaDefinition: TheMarketAreaforthisprojecthasbeendefinedasincludingportionsofFrederickand MontgomeryCounties,Maryland.ThebordersoftheMarketAreaareasfollows:

NorthernBorder:ThenorthernboundaryofFrederickCountywhichbordersthe PennsylvaniaStateline. EasternBorder:TheeasternedgeofFrederickCountyexcludingCensusTract 7516andtheeasternedgesofCensusTracts7007.07,7007.09,7001.01,7001.02, 7002.02inMontgomeryCounty.

SouthernBorder:ThesouthernboundaryofCityofGaithersburgfollowingRoute 28northwesttotheFrederickCountylineandthePotomacRiver(alsoboundary ofFrederickCounty).

WesternBorder:ThewestedgeFrederickCountyfromthePotomacRivertojust southofRoute70.

TrafficCounts: Thetrafficcountsnotedinthebelowgraphshowthehighvolumewhichpassesbyorin closeproximitytoTranquilitywhichisanassettoitslocation.

FrederickDemographics: Ataglance,thegeneraltrendisgrowthforFrederickCountyandFrederickCityoverthe pastdecade.From2000to2009,therewasan19%increaseinpopulation.Theprojection forthenextfiveyearsincludesa21%increase.AlthoughtherewasasharpMedian 7

Householdincomeincreaseby$12,966from2000to2009,therewillactuallybea.13% decreaseinthenextfiveyears. FrederickCity 2000TotalPopulation 2009TotalPopulation 2014TotalPopulation 20092014AnnualRate Income: Furtherdetailofthe2009Annual householdincomeforFrederick Countyisstrong.Theactual diversificationofincomelevelsitself includesthemajority,22.7%withan averagehouseholdincomeof$50,000 $74,000ayear.ThisbracketisXXof theareamedianincome.Next,the secondhighestis$75,000$99,000 with18.3%,andthethirdis$100,000 $149,000with14.2%.Thatmeans that55.2%ofthehouseholdsinthecountyareinanabovethemedianforthecounty.3 Age: ThemajorityofFrederickspopulationisinthemiddleagegroupsof2554,withthelargest percentageinthe2534agebracket(17.7%),andaclosesecondtothe3544agebracket (17.6).Thissurgeofayoungerdemographicisaresultoftheinsurgenceofnewhome buyersinthecountyinthepastdecade. Particularattentionmustbepaidtotheolderpopulationgivenourtargetdemographicof agingindividuals.Furtheranalysisindicatesthatthereisaslightdecreaseprojectedforthe 52,767 63,226 67,154 21% 2000MedianHHIncome 2009MedianHHIncome 2014MedianHHIncome 20092014AnnualRate $47,793 $60,759 $60,360 0.13%

ESRI

85+agebracketby2014,to2.0%,anddownto3.6%forthe7584bracketsfrom3.9% currentlyin2009.Ontheriseisthe6574%agebracketupto6.5%from5.2%in2009. Thebelowbargraphreflectstheprojectedpopulationchangedfrom20092014,whichisin mostcasesadeclinefromthe2009numbers.4

Asofthecensusof20005,therewere195,277people,70,060households,and51,914 familiesresidinginthecounty.Thepopulationdensitywas295peoplepersquaremile (114/km).Therewere73,017housingunitsatanaveragedensityof110/squaremile (43/km).Theracialmakeupofthecountywas89.33%White,6.36%BlackorAfrican

American,0.21%NativeAmerican,1.67%Asian,0.03%PacificIslander,0.92%fromother races,and1.47%fromtwoormoreraces.2.39%ofthepopulationwereHispanicorLatino ofanyrace.24.7%wereofGerman,12.9%American,12.3%Irishand10.1%English ancestryaccordingtoCensus2000.

4 5

ESRI http://factfinder.census.gov

Inthecountythepopulationwasspreadoutwith27.60%undertheageof18,7.40%from 18to24,32.70%from25to44,22.60%from45to64,and9.60%whowere65yearsofage orolder.Themedianagewas36years.Forevery100femalestherewere96.90males.For every100femalesage18andover,therewere93.90males.6 55andOlderTrends Withinthenext25yearstheresidentsofFrederickCountyage55andolderareprojectedto growby51,360people,increasingfrom20%ofthetotalpopulationto28%.By2015,the55 andolderpopulationwilloutnumbertheschoolagedpopulationbyaratioof1:1.14. Whichmeansthatforeveryschoolagedchildthreewillbe1.14peopleolderthan55years ofage.Thegrowthintheelderlysegmentsofthepopulationisanationaldilemmaandhas raisedconcernsoverthefuturehousingneeds,andtheabilityoftheCountytosupportsuch anincreaseinthissegmentofthepopulation. By2030therewillbe94,793(1inevery3.6residents)peopleinFrederickCounty55and older.ThecauseforsuchanincreaseismainlyduetotheBabyBoomGenerationcomingof age.In2006,thefirstoftheBabyBoomersturned60yearsold.Thisgenerationlastedfor 18yearsandwithinthenext25yearsallBabyBoomerswillbebetweentheagesof66and 84.Anotherimpactonincreaseinthispopulationistheadvancedmedicalcareandbetter healthoftheelderlyresidents.Withinthepast4years(justinthe85andolderagecohort) thedeathratehasdecreasedfrom16.2to14.4.Migrationpatternswillalsoimpactthe growthoftheolderpopulationinneighboringgeographicareas.Historically,betweenthe agesof55to74residentsmovedoutofFrederickCountyforretirementandmovedback intotheCountyafterreaching75yearsofage,mostlikelytobeclosertofamilymembers. TheBabyBoomgenerationdoesnotseemtobefollowingthistypeofmigrationpatternand manymoreofthemprefertoageinplace. Thenewgenerationofelderly(55+)willhaveadifferentdemographicfacethanprevious generations.By2030,itisprojectedthatthe55andolderpopulationwillbemoreracially diversewith1inevery9personsbeingaminoritycomparedtothecurrentratioof1in

http://en.wikipedia.org/wiki/Frederick_County,_MD

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every16persons.Theincreasededucationalattainmentofthispopulationisbeing attributedtohigherlevelsofincome,betterhealth,andahigherstandardofretirement lifestyle.WithincreaseddivorceratesandlessfamiliesintheCounty,manyagingresidents mayfinditmoredifficultthanpreviousgenerationstofindtheneededfamilysupportin retirementortheirlateryearsinlife,makingtheissueofadequatehousingamajor concern.7 NationalMarkets: BelowisachartwhichnotesNationalOccupancyRatesforthisyearforstabilizedproperties (thosewhichhavebeenopen24monthsorlonger)ofmajorprovidersforthefirstquarter of2009.Occupancyisdefinedas:numberofoccupiedunitsorbedsdividedbynumberof totalavailableunitsorbeds"setup".NationalInvestmentCenterfortheSeniorHousing& CareIndustrybelievesthesearerepresentativeofmajornationalandregionalproviders.8 PropertyType MeanOccupancy% IndependentLiving AssistedLiving NursingHomes CCRCs AccordingtotheAssistedLivingFederationofAmerica(ALFA),netrenduncoveredintheir recentsurveyisthatthepersonpayingtherentischanging.In2009,66%ofassistedliving residentspaidthebillthemselves.Threeyearsago,52%ofresidentspaidthebill themselves,with34%paidforbythefamily.About6%ofresidentsgetsupportfromlong termcareinsurance,upfrom3%threeyearsago.Inaddition,residentprofilesare changing.Theaverageageofaresidentthisyearis86.9,upfrom85.3threeyearsago.The averageannualturnoverrateofresidentsis42%comparedwith38%threeyearsago.The averagelengthofstayforaresidentisabout28months. RegionalMarket ThemajorityAssistedLivingmetroareatrendslistedinthebelownotesthegeneraldecline ofoccupancyofallpropertiessinceitspeakof94.1in2006.Thiscanbeattributedtothe increasecostsofhealthcareandthedeclineofthenationaleconomy.Thesecondquarterof
2006, Age Restricted Community Report: Trends and Issue of the Aging Population 2006-Final Report, Frederick County, Maryland. Frederick County of Planning 8 National Investment Center, http://www.nic.org/research/kfi/occupancy.aspx
7

87 88 84 89

Numberof NumberofUnits(*Beds) Properties 539 78,047 1430 105,171 958 118,417 167 61,373

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2009hasthelowestpercentofgrowth,2.9%sincepriorto2006.Onlythreepropertiesare underconstruction,bringing207bedsontothemarket.Morespecifically,regionaltrends showthatFrederickhasthehigheststabilizedoccupancyof95.2%,exceedingDC, Montgomery,andFairfaxcounties.MontgomeryCountyhastheonlysignificantgrowthof inventoryintheregion.TheDistricthasthehighestaveragerentperunitof$5638,while Frederickisonthelowendof$4006perunitamonth.Therefore,Frederickcanaffordto absorbatleast60additionalbedsinthemarket,inparticular,dementiabeds.

MarketComps: Therearefivecompetitive communitieswhichwerebuiltin theinthelate1990sandearly 2000sandarelocatedinthe marketareaidentified:Sunrise, Somerford,Edenton,Country MeadowsandHeartfields. EdentonandCountryMeadows offerIndependentLiving, 12

DementiaCareaswellasAssistedLiving.AllfivecompetitorshaveanALZoptionavailable whichleavesTranquility,theoutlier,notabletoofficiallyabsorbthedementiademand, whichroutinelydetractsprospects.AllothercommunitieswhichofferDementiacare,are typically98%occupied.Theseothercommunitiesarebetterabletoservethecontinuation ofcarethatisneededforresidentsandtheirfamilies.Tranquilitymustmakea commitmenttodeliverqualitycaretoitsresidentsforthefamilies. Themarketcompsareapproximately95%occupied,whereascurrently,Tranquilityis about91%occupied.ItisdeterminedthatTranquilityslaggardappearance,inabilityto separateALZpatients,andcontinuedstaffingandmanagementproblemscontributetoits loweroccupancyrates.Operationalandcosmeticimprovementswillimmediatelyincrease occupancy. Occupanciesatdementiacarefacilitiesinthesubjectareastandat98%,anindicationthat housingforthosewhoneedasignificantamountofcareshouldcontinuetofarewell.9This isatypicalnationaloccupancytrendforDementiaaswell. RentalIncome Rentalincomeisbasedonablendedrateforeachroomtype,withaweightedaverage basedontypicaloccupancy.Forinstance,currentlyeachroomtypehasafeebasedona LevelofCare,andalsoisdependentonwhethertheroomissharedorprivate.In comparisontocountyaverages,$4006foundintheNICreport,Tranquilitysaveragesare belowstandard.Withfourroomtypes,threelevelsofcare,andeitheraprivateorshared scenario,therearepotentially24ratescenariostotakeintoaccount.Inordertoprojecta PotentialGrossIncome,ablendedratewasdeterminedasfollows:
RentalIncome:PotentialGrossIncomewithBlendedRates Typeof No.of Unit Beds MonthlyRate TotalMonthly EnglishRose 48 $3,435 $164,880 MountainLaurel 10 $3,606 $36,060 DayLily 10 $3,578 $35,780 Hollyhock 10 $3,578 $35,780 78 $272,500 Subtotal

TotalYearly $1,978,560 $432,720 $429,360 $429,360 $3,270,000

National Real Estate Investor, http://nreionline.com/seniorshousing/assisted_living_occupancy_0727/

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DementiaIncomeAnalysis Thepotentialfinancialanalysisofsimplyconvertingonewingoftheexistingfacilitymustbe analyzed.Thenorthwingofthesecondfloorcurrentlyhouses14roomswithyearly revenueofapproximately$542,264($45,272permonth).Inthisscenario,potentialyearly revenueforthisspacecouldexceed$1.1million(beforevacancyfactor)resultinginagross revenueincreaseof$550,736. ThepricingisderivedfromthebaseratesofcompetitorSomerfordPlace($140perday sharedand$160perdayprivate)withalevelthreeserviceplan(outof5)valuedat$15a dayanddoesnotassumeanyMedicaidrecipients.Itisimportanttokeepinmindthat Medicaidratesfallwellbelowtheabovereferencedprivateratesof$155and$175perday. Atamonthlyrateofroughly$2500,eachMedicaidrecipientwouldreduceoverallrevenue potentialbyapproximately$26,500peryear($2500versusaprivaterateof$4712per monthforasharedunit).SomerfordPlacesratesarewellbelowaverageDementiaCare rates.ForthisRentRollanalysis(seeExhibitI),$183perdaywasusedforanaverageof14 beds,whichis$5500amonth. However,theidealcapacityforaDementiaunitisapproximately24residents.Therefore theclosertothisnumberthattheunitcanoccupythebettertheeconomiesofscalewillbe, whichlendsitselftoafloorinanewWing.However,onefloor,ofonewingincludes14 beds. Itisanticipatedthatadditionalstaffingwouldcostapproximately$288,960includinga25% factorforbenefits(directcarestaff,nursing,housekeepingandactivities).Thisnumberis conservativeandcouldpossiblybedecreasedbycreativelyutilizingexistingstaffand resources.Itwouldalsobesafetoestimateanadditional$50,000$75,000peryearin miscellaneousexpensesincludingrawfood,suppliesandotherrecurringcosts.Assuch,net revenuepotentialonanannualbasiscouldreach$186,776. SiteAnalysis TranquilityatFredericktowneislocatedintheCityofFrederickinFrederickCounty.The parcelsizeistwocontiguousparcelstotaling3.6acres,1.1acresand2.5acresrespectively. Recently,onesinglefamilyhomewaspurchasedin2005bytheownershipforfuture 14

development.Itis.5acres.ZoningfortheparcelsareOpenSpaceandInstitutional.The closestmajorintersectiontothesiteisRoute180orJeffersonPike,andButterflyLane, whichis.1mileeastofthesite,andisahighlytraffickedlocation.Thepropertyisadjacent totheSeventhDayAdventistChurchandSchool.

Rental Home Owned by Tranquility LP

Additional Parking Tranquility Assisted Living Facility

ExistingFacilityAnalysis: Thefacilityissurroundedbylushmeadowlands.ViewsoftheCatoctinandSugarloaf MountainsandtheCityofFrederick,Marylandarevisible.Tranquilityislocallyownedand operatedbylifetimeFrederickCountyresidents,settingTranquilityapartfromother AssistedLivingFacilitiesinthearea. Tranquilitysmissionistoenhancethewellbeingandqualityoflifefortheirresidentsby providingahomelike,stimulating,andcompassionateenvironment.Tranquilityis committedtobeinganactivepartnerintheFrederickcommunity. 15

 Tranquilityaimsforthehigheststandardsofexcellencefortheirresidentsandisfocusedon providingchoicesthatwillpreservedignity,encourageindependenceandnurturethe spiritual,emotionalandphysicalwellbeingofeachresident. Facility: TranquilityatFredericktownewasdevelopedandconstructedin1999andopenedin2000. The44,976squarefootfacilityhas68rooms,58onebedrooms(privateunits),and10two bedrooms(companionsuites),for78totalbeds.However,thefacilityislicensedto operate90beds.Onebedroomsmaybesharedbytwopersons,aslongasthesquare footageisgreaterthantheregulatedlimitof90squarefeet.Thesamepolicyappliesto Dementiaonlyrooms. UnitMix: Type #ofBedsPerRooms Quantity A: 1bedrooms 48 B: 1bedrooms 10 C: 2bedrooms 5 D: 2bedrooms 5 Total 68 TOTALBEDS 48 10 10 10 78

Thefirstfloorincludesawingofroomstotheleftoffoftheentryway/receptionarea,and diningroomandkitchentotheright.Straightaheadarecommonareasincludingalibrary, TVroom,andaspacioussolariumwhichreceivessunlightthroughouttheday.Thesecond Floorincludesthenursingstation,bedroomsandacommunityroom.Againonthethird floorareroomsaswellasameditationroom. Thetypicalfloorlayouts: DayLilyModel TwoBedroom/Kitchenette

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 EnglishRoseModel OneBedroomSuite MountainLaurelModel OneBedroomSuite Theexteriorisredbrickmasonry,inacolonialstyle.Thefacilityisthreefloorswith2/3of thefirstfloorprovidingcommonareaspace,and1/3reservedforrooms.Thereare78beds throughthespaceandnoreservedspaceforIndependentCare,AssistedCareorDementia. TheNursesStationisprovidedonthesecondfloor,adjacenttoacommunityroom. Currently,thereare30parkingspots,2ofwhichareHandicapped,offtothewestsideofthe buildingandawraparounddropoffporticowhichislocatedatthefrontentrance. TheexistingCountryVictoriandcorofthefacilityisdated.Thestyleisdatedandincludes darkcolorsofmaroon,navyblue,andforestgreen.Generalwearandtearisvisiblein commonareas.Currentlymismatchedlightfixturesandlightbulbsareutilizedand exchangedhaphazardly.Commonarearestroomsaremixingfixtures,andoperable handicapsupportsystems,i.egrabbars.Visiblesignsofpreviousleakscanbeseeninthe ceiling.Appropriatedrywallrepairandpaintisneeded.Thefurnitureinthediningroom includingtablesandchairsare10yearsold,andhasexperiencedahighlevelofwear. Additionalunrepairedwaterdamageisseenintheceiling. 17

ExistingManagement Theexistingmanagementofthefacilityhasbeenandiscurrentlyindependentlyrunbyits ownerswithmediocresuccess.Thirdpartymanagerswerepreviouslyunsuccessfully enlistedtoprovidesupportoverthepasttenyears.Tranquilityhasanaverageoccupancy rateof91%,andanaverageunleveredNOIof$789,963.Incomecouldbeincreasedif mandatedreviewsofpatientswereconductedaccordingtoregulation.Thosereviews routinelyreassessresidentshealthneedsandstandardofcare.Higherlevelsofcarecost more. Itappearsasthougharefinedapproachbyaseasonedandprofessionalthirdparty managementcompanywouldprovideaunifiedandseasonedapproachtoTranquilitys problemareas:residentrelations,operatingmethods,staffingratios,department management,costcontainment,salesandmarketingstrategies,techniquesoffinancial analysis,budgeting,andhumanresources.Inaddition,thenewExecutiveDirectorshould guidetheproposedchangesimmediately. Currently,adequatestaffinglevelsandtheneedforskillednursingpersonnelasaresultof theincreasingfrailtyofresidentsareoftheutmostimportancetoTranquility.Ensuringthe residentsqualityoflifeisimperativeandbolstersthevalueofanindividualizedcare approach.Thestaffmustbeidentifiedappropriatelyatalltimes.NursingAssistantsand Techsmustwearauniformandsomeformofidentificationforaprofessionalappearance. HealthServices TranquilityatFredericktowne,islicensedtoprovideassistedlivingandshorttermrespite care,bytheDepartmentofHealthandMentalHygiene.Adoctorisavailableandoncallat alltimesifaneedarises.Thedoctorcomeseveryweekinordertoreviewchartsandhealth plans.ThenewDirectoroftheFacilityisaRegisteredNurse,whichprovidesaclinical approachandemphasisonthemanagementandcareoftheresidents.Thelocalhospital includesFrederickMemorialHospitalwhichis2milesaway. 18

FoodService Timingiseverythingwithfoodserviceinseniorcommunities.Ifthefoodisconsistentlynot readyorofpoorquality,residentswillnotethetrendandgrowfrustratedandcomplain. Therefore,attentiontofoodqualityandserviceisimperativeforoverallresident satisfaction.Thepreparationshouldbewellorchestratedtomaximizeefficiencyinorderto promotelogicaldishupprogressionandfacilitiesquickandsmoothfilingoforders.10 Currently,$5.75isbudgeteddailyforeachpersonsfoodcosts.Nationalresearchfrom2007 indicatestheaveragecostis$3.79$4.95forassistedlivingfacilities.11Therangesvaryon howmanymealsareservedperday.OftenChefsdeductcostsforguestsandemployee mealstoyieldalowercostpermeal.Lunch,typicallytheheaviermealofthedayordinner, producesthemainmealandalsohalfofthedailycost.However,itshouldbenotedthat substitutingcanedgoodssuchasvegetableswhichischeaperisnolegitimatealternativeto freshfruitsandvegetables. FederalandStateRegulations Allassistedlivingfacilitiesacceptingstateorfederalfundsmustbelicensed.Forthose acceptingfederalfunds,mostoftheapplicableregulationsandrulesareincorporatedinto thoseapplicabletonursinghomesingeneral.Theyinclude:

TheNursingHomeReformActisabsorbedinamassivepieceoflegislationknownas theOmnibusBudgetReconciliationActof1987(OBRA1987).TheActimposesmore thanjustminimumstandards;itrequiresthatafacilityprovideeachpatientwitha levelofcarethatenableshimorher"toattainormaintainthehighestpracticable physical,mentalandpsychosocialwellbeing."Importantly,OBRA87makeseach stateresponsibleforestablishing,monitoring,andenforcingstatelicensingand federalstandards.UndertheAct,statesmustfund,staff,andmaintaininvestigatory andOmbudsmanunitsaswell.

2007: Senior Living Communities: Operations Management and Marketing for Assisted Living Facilities. Benjamin W. Pearce 11 2007: Senior Living Communities: Operations Management for Assisted Living Communities, Benjamin W. Pearce.

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ThePatientSelfDeterminationActof1990isabsorbedintheOmnibusBudget ReconciliationActof1990(OBRA1990).Applicabletomorethanjustnursing homes,itessentiallymandatesthatfacilitiesprovidewritteninformationtopatients regardingtheirrightsunderstatelawtoparticipateindecisionsconcerningtheir medicalcare.Thisincludestherighttoexecuteadvancedirectivesandtherightto acceptorrejectmedicalorsurgicaltreatments.Thefacilitiesmustalsoprovidea writtenpolicystatementregardingimplementationoftheserights,andmust documentineachpatient'srecordwhetherornotanadvancedirectivehasbeen executed.

ResidentRights StatesarerequiredtomandateadherencetoaBillsofRightsfornursinghomeresidents. Generally,thesamerightsattachtoresidentsinassistedlivingfacilitiesasthoseinnursing homes.Moststatedeclarationsofrightsparallelthefederalones,codifiedat42USC1395i 3(a)to(h);and1396r(a)to(h)(1988supplementtotheU.S.C.).Theyareenumeratedinthe sectionaddressingnursinghomes.12 Funding Publicsubsidiesforeldersinresidentialsettingstakedifferentcoursesindifferentstates. OlderpersonsqualifyingforlowincomesubsidiesmayapplytheirfederalSSIbenefits,as wellasanystatesupplementalSSIbenefits,towardassistedlivingchargesforroomand board.Medicaidgenerallypaysfornursingormedicalservicesprovidedtoqualified individuals.Inmoststates,thisisdonethroughHomeandCommunityBasedServices (HCBS)(Section1915(c))waivers.Waiverprogramsacknowledgethatmanyindividualsat highriskforbeinginstitutionalizedcanbecaredforintheirownhomesorcommunities, thuspreservingtheirindependenceandtiestofamilyandcommunity,atnomorecostthan thatofinstitutionalcare.Thus,apersoneligibleforinstitutionalcaremay"waive"thatright andapplythefundstowardhomecareorassistedlivingarrangements.Waiversare generallygrantedforthreeyearsandmayberenewedforfiveyears.

12

Legal Guide for Older Americans. American Bar Association. Random House, 1998.

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Finally,manystatesaredevelopingpoliciesthatcombineSSIwithMedicaidbenefitsto provideonelevelofcareappropriatefortheresident.Thisencourages"aginginplace" ratherthanthestressfulalternativeoffindinganotherfacilityshouldtheresident'shealth declineandheorsheneedsmorethanwhatassistedlivingcanoffer. InMaryland,AssistedlivingprogramsarecoveredunderMd.CodeAnn.,Title10.07.14. Facilitiesmaynotservepersonswhorequiremorethanintermittentnursingcare.Medicaid doesnotreimburseforassistedlivingbeyondtheexistingSeniorAssistedHousingProgram. Assistedlivingprogramshavethreelevelsofcaredistinctionsforpurposesofstaffing requirementsandservicesprovided.13 StateSurveyResults ThestateconductsSurveyReportswhichreviewthefacilityanditsoperations.Historically, Tranquilityhasstruggledtodowellduringtheseauditswhicharepostedandeasilylocated onlineforpotentialresidentstoview.Afacilitysurveyreport,calledaStatementof Deficiencies,iswrittenwhentheDepartmentofHealthandMentalHygiene,OfficeofHealth CareQuality(OHCQ)performsasurveyinanassistedlivingresidence.Surveysaredonefor severalreasonssuchasforaninitiallicensuretooperate,relicensure,complaint investigationsorothertypesofvisits.Thepurposeofthesurveysistoassurethesafetyand wellbeingoftheindividualsresidinginMarylandsassistedlivingresidences.Generally, therewillbeatleastonesurveyannuallyineachfacilityforlicensurecompliance. TheStatementofDeficienciesrecordsthesurveyfindingsandlistsanydeficienciesfound duringthesurvey.AdeficiencyisaviolationofStateregulationsgoverningassistedliving facilitiesfoundintheCodeofMarylandRegulations(COMAR)Chapter10.07.14.If deficienciesarefound,thePlanofCorrection(POC)iswrittenbytheassistedlivingprovider andsubmittedtoOHCQ.

13

State Assisted Living Policy: 1998. Mollica, Robert L., National Academy for State Health Policy, 1998.

21

Theauditshaveproducedthefollowingresults: SurveyDate 5/22/09 12/12/08 10/1/08 5/23/08 4/4/08 Themostrecentsurvey,whichwascompletedMay22,2009,included8deficiencies.While thatamountsisbetterthanapeakof29deficienciesinMay2008,ayearprior,thereisstill muchroomforimprovement.Thehistoricalproblemareaswhichneedimmediateattention includebasicfunctionsofanyAssistedLivingFacility.

NumberofDeficiencies 8 9 14 29 3

ThefacilityneedstoinsuretheDelegatingnursebeonsiteoroncall,observe residentevery45days,manageclinicaloversightandreviewassessments. TranquilityhasalreadyhiredanewDelegatingNursetocompleteallrequired functionsforthisjob.

TheAssistedLivingManager,orExecutivedirectorisresponsibleforthewritten serviceplanswhicharedevelopedforeachresident,includinghowoftenservicesare provided,howandbywhom.

Itisspecificallynotedthatserviceplansareinneedofimprovements.The deficienciesnotethatserviceplanswerenotedasdisorganizedandfragmented.New serviceswerenotaddedasneededorwereaddedwithoutsupporting documentationonhowstaffwastoprovidethecareandmonitoring.

Incidentreportshavenotbeencompletedthoroughly.Allreportsshouldinclude time,date,place,andindividualspresent;completedescriptionoftheincident; responseofthestaffatthetime;notification,includingnotificationtotheResident, orifappropriatetheresident's

22

Representative,Resident'sphysician,Program'sdelegatingnurse,Licensingorlaw enforcementauthorities,whenappropriate;andFollowupactivities,including investigationoftheoccurrenceandstepstopreventitsreoccurrence.

ResidentCareNotesmustbecompletedthoroughlyforeachresidentwhichincludes: Onadmissionandatleastweekly;withanysignificantchangesintheresident's condition,includingwhenincidentsoccurandanyfollowupactionistaken;When theresidentistransferredfromthefacilitytoanotherskilledfacility;onreturnfrom medicalappointmentsandwhenseeninhomebyanyhealthcareprovider;onreturn fromnonroutineleavesofabsence;andwhentheresidentisdischarged permanentlyfromthefacility,includingthelocationandmannerofdischarge.Staff shallwritecarenotesthatareindividualized,legible,chronological,andsignedby thewriter.

MedicationManagementandAdministrationmustbeproperlyadheredto.For instance,ifaresidentrequiresthatstaffadministermedicationsandthe administrationofmedicationshasbeendelegatedtoanunlicensedstaffperson,the assistedlivingmanagershallcomplybyarrangingforanonsitereviewbythe delegatingregisterednurseatleastevery45days.Thedelegatingnurseshallmake appropriaterecommendationstotheappropriateauthorizedprescriber,andthe assistedlivingmanagerordesignee.

Theabovereflectschangesthatmustbemadeimmediatelyandstrictlyadheredtobystaff. LeadershipfromanexperiencedExecutiveDirectorwithclinicalexperiencewouldbe helpfultosolidifyproceduresforTranquilitysstaff. AssistedLivingFederationofAmericahasproducedaguidelinethatexplainswhat consumerscanexpectfromanassistedlivingcommunity.Alsoincludedaresuggestionsfor locatingcommunities,aswellasavaluablechecklistwhichisincludedintheaddendum portionofthisreporttousewhenpotentialresidentsvisitandevaluateapotentialnew home.ItisprudentfortheMarketingDirectoratTranquilitytoaddresseachoneofthe questionsapotentialresidentmayhaveforafacilityincludinghowtheenvironmentsuits theprospect,andiftheservices,activitiesandaccommodationsaresufficient.Beloware thecurrentamenitiesandproposedamenitiesforthenewDementiaWing. 23

Amenities Thecurrentamenitiesofthefacilityincludethefollowing:

Customizedlifestyleplanstailoredtotheindividualneedsofeachresident RoutinewellnesschecksbyaRegisteredNurse Professionallicensednursesonsite7daysaweek 24houremergencycallsystem MedicationAdministration Incontinencecare TherapyServices Housekeeping Personallaundryandlinenservices Accommodationforspecialdietaryneeds Nutritious,homemademealsandsnacks Completesocialcalendar Holidaycelebrationsandcommunityoutings Spiritualservicesrespectfullyservingavarietyofdenominations Transportation Telephoneandcablehookups Beautyandbarbershop Spacious,comfortableareastoentertainfriendsandfamily,includingaprivate diningroomandfullkitchen. Greatroomwithelegantfireplaces

ProposedDementiaAmenities: Additionally,thebelowAmenitieswouldbeprovidedandmarketedtonewresidentsand theirfamilies.

Speciallyorientedstaff MedicallysupervisedCarePrograms Threewellbalancenutritiousmealsserveddaily Betweenmealsnacks 24

Monitoringofmedicationsandhealthconditions Residentemergencycallsystem Dailyhousekeepingandpersonallaundryservice Licensednursesareavailable Bathing,dressingandgroomingassistance Pharmacyservices Allutilitiesincludingcable(excepttelephone) Nondenominationalspiritualactivitiesandcounseling AssistancewithVeteranBenefits(VA)Applications

Basedonproposedamenities,canincreaserentstotheblendedamountof$3,270,000from thecurrentannualincomeof$3,055,320. OperatingBudgetAssumptions

Afterconstructioniscomplete,thefacilityssuccesswillhingeonitsongoingoperational budgetandabilitytogetpermanentfinancingbasedonprojectproforma.Therearea varietyofsourcesforparticipantrevenue.Revenuewillbeachievedthroughprivate individualsourcesaswellasMedicaid.Medicaid,orMedicalAssistance,isastateand federallyfundedhealthinsuranceprogramthatpayshealthcareproviderstocarefor indigentandmedicallyneedypersons.ToqualityforservicesunderMedicaid,onemust meetspecificfinancingandmedicalcriteria. IncalculatingtheYear1proforma,otherbudgetassumptionsinclude: Staffingreflectsstaggeredshifts,andadditionalstaffingforDementiaspecific care

Salariesandbenefitsarelargestbudgetitem Foodwillbethirdlargestbudgetitem AdditionalbudgetedexpensesforNewWing

Year1proformaprojectedNOI,$789,693basedon90%averageoccupancy,utilizingthe 78bedsasthetotalpossiblenumberofunitstovalueagainst(SeeExhibitIIforfullpro formaofexistingoperations).

25

TheCapRatethatwasused,10%isbasedonlocalandnationaldatatrends(seeBoxBelow). Capitalizationratesaredefinedas:forecastearnings(orNOIorEBITDA)dividedbymarket valuationof(orpricepaidfor)theenterprise.14MeanCapitalizationratesareweightedby thenumberofpropertytransactionsinvolved.Lowandhighvaluesrepresentarangeof reportedvalues.Thoughappraiserswererequestedtosubmitcapitalizationratesonlyfor transactionsthathaveclosedduringthequarter,datamayincludesometransactions proposedbutnotyetclosed,orfromrefinancingvaluations. NationalCapRates: Q3/09 PropertyType Independent Living AssistedLiving CapRatesQ2/09 PropertyType Independent Living AssistedLiving
*NICResearch&Data

Low% 7 7.2

Average% 8.1 9.4

High% 9.5 11.5

Numberof Transactions 22 50

Low% AverageMean% 8 8.2 8.5 9.5

High% 9.5 13.5

Numberof Transactions 14 33

14

National Investment Center, http://www.nic.org/research/kfi/capitalization.aspx

26

III:DESIGN
Introduction TheoveralldesignofanAssistedLivingFacilitymustaddressthegerontologicalissuesof theresidentsandbesensitivetotheuniqueneedsoftheelderly.Inaddition,itmust respondtotheirlifestyles,attitudesandexpectations.Theintentmustbetocreateahome likeatmospheretoavoidaninstitutionallook.Theproposedgoalisadesignthatsinviting: aestheticallypleasingandcomfortableforresidents,andappealingtotheirfamilies.Atthe sametime,itmustbeeconomicalandeasilymaintainedbythestaff. ExistingFacilityCosmeticUpgrades Theexistingfacilityhasnothadanysignificantchangesorupgradessinceitwasbuiltin 1999.Animmediateexaminationoftheexistingconditionofthefacilitywascompletedto assessneededimprovements.Basedonthecurrentdatedappearance,ithasbeen determinedthatcosmeticupgradesareimmediatelynecessary.Thereafteraplantoupdate thesespaceswasprepared. ExistingFacilityConditions
TVRoom FacilityEntrance

27


DinningRoom

ProposedInteriorUpgrades Preliminarily,anInteriorDesignerwas contactedandsuggestedaunifiedand approvedpalateselectionofpaintcolors shouldbeutilizedandcoordinatedwith newcarpet.Warmtonessuchas butternut,redandroyalblueshouldbe incorporatedintothefacilityinsteadof thecurrentcoldcolors.Accentwalls downthehallwayswillbeoffsetby contrastingfrontdoorcolorstocreate thefeelofanapartmenthome community,anddistancetheappearance ofahospitalornursingfacility.Sample picturesofawardwinningAssisted LivingandDementiaspacesareincluded inthissection. Thelightinginthefacilityshouldfollowa 28

subscribedscheduleforallfixturesandbulbswithwarmtonestoavoidtheindustrialfeelof coolwhitelightswhichhavebeeninterspersedwithwarmtones. Existingspaceshouldberetooledtocreatedestinationspotsfortheresidents.Currently, theentrancetothefacilityisthepreferreddestinationforsocializingamongsttheresidents insteadofthesunroom,TVroom,etc.However,aneffortshouldbemadetoutilizeother commonareassuchastheaforementionedTVroom,sunroomaswellasthelibrary, communityroomonthesecondfloorandsolariumonthe3rdfloor. Commonareasintheentrance,stairs, andhallwaysshouldhavenewlowVOC carpet.Hardwoodfloorsubstitute suchasPergoshouldreplaceexisting linoleuminbedrooms,nursingoffices, communityroom,andsolarium. Dependingoncolorandproduct,the woodalternativeistypicallymore expensivethanthelinoleum,butthe familiarhomelikeaffectthelookhas willbeapproachabletovisitorsandattractnewtraffic. ProposedDementiaRooms Incombinationwithothertherapiesandhighqualitycaregiving,adesignthatspecifically addressesDementia/Alzheimer'sdiseasecanhaveapositiveeffectontheextensionof independenceforthosewhosufferfromit.Therearetherapeuticeffectsofaconsciously andsensitivelydesignedandbuiltenvironmentspecificallyforthosewithDementia /Alzheimer's.Unfortunately,mostfacilitiescurrentlyhousingtheseresidentswere designedonanacutecaremedicalmodelthataccentuatestheinstitutionalaestheticwhile diminishingmostofthehumanizingaspectsofcaregiving. ThetermsdementiaandAlzheimer'sshouldnotbeusedinterchangeably.Thereare differencesbetweenthetwoconditions.Dementiaisthegraduallossofintellectualfunction. 29

Alzheimer'sisthemostcommonformofdementiamarkedbymemorylossinolderpeople andisdefinedcharacterizedbythegraduallossofseveralimportantmentalfunctions. Alzheimer'sstatisticsshowthatthediseasecanstrikeapersonasearlyas45,whereas dementiagenerallyoccursafterage70.Anotherwaytocomparedementiavs.Alzheimer's diseaseistorealizethatdementiaisamedicaltermusedtodescribeanumberofvarious conditionscharacterizedbythegraduallossofintellectualfunction. AsAlzheimer'smedicalresearchcontinuesatitscurrentrate,earlydiagnosisofAlzheimer's diseaseisbecomingmorecommonplace,publicawarenessofthedisease'ssymptomsis increasingatarapidrate,andnewdrugtherapiescontinuetoappeasethedisease's symptoms.Inafewshortyearstherewillbeapproximately14millionAmericansafflicted withAlzheimer's,therefore,therewillsoonbealargepopulationofindividualswhohave beendiagnosed,butwhoareintheearlystagesofthediseaseandremainintheearlystages ofthediseaseforalongerperiodoftime.Thisisthepopulationthatneedsandwilldemand theassistedlivingproductthatextendstheindependenceoftheindividualandmaintains thatindividual'sdignityofliving. Thechallengeistocreateadesignwhichprovidesenvironmentsthataddto,oratthevery leastmaintain,thesecurity,dignityandindependenceoftheindividual.Inaddition,itmust provideappropriatestimulationandflexibilityinrhythmandpatternsfortheindividual, andtodosowithinthecontextofanenvironmentthatisnotovertlyinstitutional,butisata scalethatallowsindividualtransitionfromthehome. DesignConsiderations:

Safety,security,wellbeingprovidingenoughdoubledoorexitsincaseofan emergency Barrierfreeandeasyaccesseasingmobilityaroundtheopenarea Reinforcedorientationandawarenessusingcolorsandtexturestodifferentiate edgesandlevelchanges Opportunitiesforsocialcontactenforcingasocialatmosphereandstimulating conversationamongstparticipants 30

Atmospherewarmandinvitingcomfortableareatospendtheday Independencefacilitatedenforcingconfidenceamongstparticipants Stimulationofsensesdifferentlighting,textures,andsmells Optionsandchoicesvarietyofactivities Supportforstaffandcaregiversprovidingenoughpreparationareaforstaffto effectivelycareforparticipants StreetLevelaidingmobilityandaccess Rampand/orelevatorswhenneededallowingmoredesignpossibilitiesofspace

ExistingDementiaatTranquility: Sinceopening,TranquilityAssisted LivingFacilityhaselectedtomeet theneedsofitsresidentswith memoryimpairmentsinan integratedsetting.Inrecentyears theacuitylevelofthetypical assistedlivingresidenthas increasedwhichhasmadeit difficulttooperatetheassisted livingfacilitywithoutaseparate DementiaUnit.Mostsignificantly,sitebasedstaffbelievesthatmarketingandsalesefforts arebeingnegativelyimpactedbynothavingasecuredDementiaunit. BasedontheaveragehighoccupancylevelsatcompetingDementiaunitsof98%inthe FrederickareaandconversationswiththeTranquilityleadershipstaffthereappearstobea needinthecommunityformoreDementiabeds.Furtherdiscussionregardingdementia demandisfoundintheMarketingSection. ItshouldalsobenotedthatTranquilityadministrationhasindicatedthatatleast910 currentresidentswouldbenefitfromaspecializedDementiaunit.Providedtheseresidents canaffordtheincreasedpriceofDementiacareandarewillingtotransitiontothenewunit, wecouldexpectanacceleratedrampupofaDementiaprogram.Therearetwooptionsof creatingaDementiaonlyspace. 31

OptionI:ExistingFacilityDementiaRelocation Oneshorttermoptionistotakethesecondfloor,northwingintheexistingbuildingand dedicateittoDementiacare.Assumingconstructioncostsof$50,000(whichincludes wanderguard/exitdoortechnology,equipmenttosupportfooddeliveryandcreationofa fencedinareaonthefacilitygrounds)andrampupcostsof$300,000,theprojectcouldpay foritselflessthan2years.Thisassumesstartingtheprogramwith8residentsandramping uponlyoneresidentpermonthwithallexpensesincludedwhichshouldbeanabsolute worstcasescenario.Theabilitytorampupatarateof2residentspermonthwillallowfor anapproximate12monthperiodtorecoupdevelopmentcosts.

TranquilitysSecondFloorNorthWing

OptionII:NewWingAddition Asecond,morethoroughoptionistobuildontothefacilitywitha19,280squarefoot addition.ThiswingontheEasternsideofthebuildingwouldinclude24Dementiarooms, 36AssistedLivingRoomsfromthreestories.Theadditionwouldtakethehallwherethe beautysalonisandextenditintotherearyardandintothenewEastwing.Securitydoor hardwarewouldbeinstalled,andasidefenceenclosedcourtyardexclusivelyfor Dementia/ALZpatients.Theutilizationofanewdementiadedicatedfloorwhilecombining twoadditionalstoriesofAssistedLivingRoomsisanefficientinvestment.Thereisan economyofscaleforthenewconstruction,bybuildingthreestoriesinsteadofonlyone leveladditionforDementiaonly. 32

Proposed New Wing

New Dining Area

New Dementia Wing

TheaveragesizeofexistingTranquilityroomsaverageabout288squarefeet,andcanbe about414foratwobedroomsuite.IndustryaveragestatesDementiadwellingunitsare between200300squarefeetonaverageandarelinkedtogenerouscommonspacesanda nursingstation.15However,Marylandlawstatesthatroomsshouldbeatleast80square feetoffunctionalspaceforasingleoccupancyroomand120squarefeetforadouble. Thenewwingproposedisdesignedforthreefloors.ThefirstfloorwouldbeaDementia floor,andthetoptwowouldbeassistedliving.Dementiaroomsarescheduledat approximately200squarefeetonaverage,for24beds,twelveunitsoneachfloor.The groundlevelfloorwillhaveanursingstationandlargecommunityspace. Additionally,theexistingdiningroomwouldbeincreasedinsize,butawallwith translucentglasswouldmaintaintheseparationbetweenthetwodinningspacesandallow
Victor Regnier, Design for Assisted Living; Guidelines for Housing the Physically and Mentally Ill. 2002, P.119.
15

33

lighttotransferintothemaindiningroom.Theproximitywouldallowfortransferoffood betweenlocations,andforadditionalassistancefromstaffifneeded.Thisspacewouldalso doubleascommunityspace.Providingappropriateandefficientdiningfacilitiesisacritical partofthedesignprocessconsideringitisthemoststaffintensiveperiodoftheday.Some considerationstofactorarethenumberofparticipantsservedatonetime,providingmore thanenoughspaceforwalkersandwheelchairs(morethantheruleofthumb),and encouragingsocialinteractionbydistinguishingthespacewithoutoverwhelming participants.

DementiaroomSF/perroom TotalRoomsperfloor TotalDementiaRoomSF CirculationSpace CommonAreaSF FloorPlate NewRoomSF/perroom 2ndand3rdfloorplateroom quantity TotalAdditionalSF Floor1:Dementia Floor2:RegularAL Floor3:RegularAL Total DesignData 200 24 4800 960 2000 5760 288 18 19280 NumberofRooms 24 18 18 60

Thetoptwofloorswouldhave36roomsor18roomsoneachfloor.Eachroomisscheduled tobeaonebedroomEnglishRosestyleat288feet.Thetotalsquarefootageproposedfor allthreefloorsis19,280squarefeet.Adesignschedulefortheproposedspaceisincluded inExhibitIV. Theadditionwillbesteelframewithbrickexteriorconstructiononaconcretefoundation. Limitedsitedevelopmentisrequiredbeyondaseparatefencedandseparateaccesstoa Dementiaspecificspaciouscourtyardspace.AnadditionalelevatorwillberequiredforADA accessibility.UtilizingtheexistingelevatorforproposedWinguseisfeasiblegiventraffic flowanddesignconsiderations,includinganadditionalemergencyexitatthetailendofthe neweastwing. 34

ConstructionManagementControls Theprojectwilluseadesignbuildconstructiondeliverysystemwherethedesignand constructionaspectsarecontractedwithasingleentity,usuallythegeneralcontractor.This willallowTranquilitytominimizeprojectriskbyoverlappingthedesignandconstruction phasesoftheproject.Thebenefitstotheownerinclude:increasedaccountabilityofthe designer/contractor,singlesourceofprojectdeliveryandenhancedcommunicationwithno middlelayerofprojectmanagement.Ownershipandcontractorwillmostlikelyagreetoan AIAcontractstipulatingthecostofworkplusadesignbuildersfeewithaguaranteed maximumpriceensuringtheprojectiscompletedunderbudgetandontime. Schedule Thefollowingscheduledetailsaproposedconstructionschedulespanningfor12months. Italsoincludesapreliminarytwomonthscheduleforthecosmeticimprovements.The scheduleshowseachstepoftheplanning,designandconstructionprocess.Construction loandrawsarealsoincludedintheproformas,ExhibitIV.
Site Plan Approval Issuance Building Design & Permit Upgrades-Phase I Completion -Phase I Preconstruction Construction-Phase II Site Preparation Foundations and Structure Framing and Envelope MEP Dryw all/Finishes Site Improvements Inspections Substantial Completion- Phase II Final Completion- Phase II 30 30 1 15 5 90 90 120 60 30

Proposed Timeline
120 60 1 30 335

1/1/10

1/31/10

3/2/10

4/1/10

5/1/10

5/31/10

6/30/10

7/30/10

8/29/10

9/28/10 10/28/10 11/27/10 12/27/10 1/26/11

2/25/11

3/27/11

4/26/11

35

Phases:
o

DesignPhaseContinual Siteplananddesigndocumentsarecontinuedrefinedthroughouttheentire processwiththeguidanceofTranquilityandzoningofficials. SpecializedConsultantstoprovidecommentaryondesign. Receiverecommendationsongeneralcontractors. Uponapprovalofdesigndocumentation,demolition,foundation,andfullbuilding permitswillbepulled. ConstructionPhase8months Duetothespecializednatureofthefacility,theprojectwillutilizethe design/bid/buildscenario.Inordertoexpeditetheentireprojecttimeline,the constructionphasewillbeginpriortohavingfinaldesigndocuments.Projectwill thenbebidandawardedtoaqualifiedcontractorataguaranteedmaximum price.

o o o

AdvertisingandMarketing3monthspriortoopening Newcollateralcreatedforadvertisingtonewresidents.Marketwithhospitals, thecountyandotherfacilities. Stabilization12monthsafteropening Currentoperationshaveatotalofatleast910residentswhocouldqualifyfor Dementiacare,whichcouldgiveaheadstarttostabilization,whichis60beds,for thenewwing.

ConstructionandSoftCosts Theconstructioncostswhichweregeneratedweredeterminedbyproducinganestimate basedondiscussionswithindustryspecificexperts.Ourconstructioncompany,Hamel Buildersinferredthatatypicalestimateinourlocationforanassistedlivingfacilitywould beapproximately$120persquarefoot.

HardCosts BaseBuildingandFees TotalHardCosts $2,474,634 $2,474,634 PSF $120.00 $120.00

Softcostswerederivedbycallingconsultantsandexpertstoretrievehardquotesfor projectsofthissize.Totalsoftcostsfortheproposednewwingadditionareprojectedtobe $732,489.ThecompletechartislocatedinExhibitIV. 36

IV:REGULATION ZONING TheZoningforTranquilityatFredericktownisfoundontheZoningMap,forTaxMap77, whichnotesthelocationiszonedORI:Office/Research/Industrial.

ZoningDistrict:OpenSpaceandInstitutional Uses RC AssistedLivingFacility A R1 R3 R5 R8 R12 R16 PS PS PS PS PS PS VC PS HS GC ORI PS LI GI

AssistedLivingFacilitiesaredefinedasPSwhichmeansPrincipalpermittedusesubject tositedevelopmentplanapproval.Thisuserequiressitedevelopmentplanreviewand approvalbyPlanning.Reviewandapprovalcomethrough1of3procedurestoensurethat theproposeddevelopmentcomplieswiththerequirementsofthischapter.Inourcase,a Type1procedureappliestoprovidefordevelopmentreviewinvolvingstandardsfordesign orreviewofusespermittedbythischapterwhichmaybecomplexinnaturerequiring interpretationofCountyComprehensivePlanpoliciesortherequirementsoftheFrederick CountyCode.TheTypeIapplicationshallbecirculatedformultiagencyreviewpriorto 37

PlanningCommissionreview.TypeIPlanningCommissionreviewandapprovalis requiredformodificationstoaPlanningCommissionapprovedsitedevelopmentplan involvinganincreaseinbuildingheightornumberoffloors,requestsforreductioninopen spacesquarefootage,changeinthetypeorsquarefootageofanamenityandmodifications thatincreasethenumberofrequiredparkingandloadingspaces. Eachapplicationinvolvingsitedevelopmentplanapproval,togetherwiththerequiredand otherrequiredplansubmissions,including,butnotlimitedtoadequatepublicfacilities ordinancestudies,forestresourceordinanceplans,sightdistancestudies,stormwater managementconcepts.TheDivisionofPermittingandDevelopmentReviewshallnotaccept anapplicationifitisdeterminedthattheinformationsubmittedisincomplete. AftertheDivisionofPermittingandDevelopmentReviewdeemsthattheapplicationis complete,thesitedevelopmentplanwillbescheduledforaTechnicalAdvisoryCommittee (TAC)meetingforreviewbyagencyrepresentativesandrepresentativesoftheapplicant. TheapplicantmaynotfileforazoningcertificateandbuildingpermitwiththeOfficeof PermitsandInspectionsbeforereceivingsiteplanapproval.Applicationsforsiteplan reviewshallbevoidifapprovalhasnotbeenreceivedwithin3years,beginningonthedate theapplicationwasaccepted.Avoidapplicationshallhavenofurtherstatusandmustbe resubmitted. ForallTypeIPlanningCommissionsiteplanreviewapplications,theapplicantshallplace asignwithin10feetofeachpropertylinethatabutsapublicroad.Ifthepropertydoesnot abutapublicroad,asignshallbeplacedinsuchamannersothatitmaybemostreadily seenbythepublic.TheDivisionofPermittingandDevelopmentReviewwillprovidethe requiredsignanditmustbeplacedonthepropertyatleast30dayspriortotheinitial PlanningCommissionmeetingatwhichtheTypeIPlanningCommissionsitedevelopment planistobeconsidered. ThebelowcodeindicatesthatInstitutionalfacilitieswithaminimumlotareaof12,000 squarefeet,needalotwidthofatleast200feet,afrontyard,sideyardandrearyardset backof40feetaswellasaheightofatleast30feet. 38

UseClassification MinLotArea MinLotArea LotWidth FrontYard SideYard RearYard Height perUnit Institutional Parking: ForInstitutionalzonedproperties,codeindicatesthatTranquilitywouldneedonespotfor each2beds.Tranquilitycurrentlyhas30parkingspotsfor90beds,andiscurrently utilizingtheSharedParkingprovisionofthecode. Sanitariums,homesfortheaged,nursinghomes,childrenhomes, asylums,andsimilaruses 1foreach2beds 12,000 200 40 40 40 30'

However, given the space requirements, Tranquility has requested and received approval to utilize the Shared Parking provision of the code. Tranquility is next door to a Seventh Day Adventist Church and Community center with ample weekly parking available. Under the Shared Parking Code, 1-19-6.240, a partial reduction in the total number of required off-street parking spaces may be granted where the applicant can demonstrate the sufficient provision of shared parking facilitiesbasedoncharacteristicsofuses,hourlyparkingdemandstudiespublishedbythe InstituteofTransportationEngineeringorotherappropriatesource,orother documentationasdeterminedbythePlanningCommissionortheirauthorized representatives. Asharedparkingplanmayutilizeonstreetparking,community/commonparking,parking areaslocatedonthesameparcelastheproposeduse,adjacenttotheproposeduse,ortwo parcelsthatarenotadjacent,subjecttothefollowingprovisionsaslongasthefacilityisno fartherthan500feetfromthebuildingorusetobeservedandmaximumof50%ofthe requiredoffstreetparkingmaybelocatedoffsite.Applicantsneedtosubmitofavicinity mapreflectingtheproposedsharedparkingareas,parkingspaces,andhoursofoperation, pedestrianaccessbetweenparkingarea,anduses,aswellasadetailedexplanationofthe proposedsharedparkingplan.Inaddition,asafe,convenientpedestrianconnectionmust existorbeconstructedbetweenthebuildingsorusesandtheparkingareaandtheparties

39

involvedintheuseofthesharedparkingplanshallprovideevidenceofanagreementfor suchuseandparkingplanbyalegalinstrumentapprovedbytheCountyAttorney. Therefore,withthe60potentialadditionalbedsforanewWing,Tranquilitywouldneeda totalof75spotsfor150totalbeds.20morespotscanbelocatedandstrippedalongroad entrancetothefacility.Theremaining25spotscouldbeallocatedfromtheSharedParking attheadjacentSeventhDayAdventistChurch.Thatequals75spotsneededifanewwingis built. StateLicenseApplication Currently,Tranquilityislicensedtooperate90bedsoutofthefacility.Inorderto increasethecapacityupto150,andinordertoprovideanofficialDementia/Alzheimers SpecialCareUnitorprogram,certainrequirementsmustbemet.Duringthe2002 GeneralSession,SenateBill(SB)746,entitledAlzheimersSpecialCareUnitorProgram, wasenactedintolaw.AssistedLivingProgramsofferingservicestoindividualswith Alzheimersorarelateddisorderneedtodevelopaprogramdescriptionasoutlinedin thelaw.Theinstructionsfortherequiredsubmissionincludesthefollowingare completedfortheOfficeofHealthCareQuality:

Awrittendescriptionofthespecialcareunitorprogramusingadisclosureform thathasbeen adoptedbytheDepartmentofHealth&MentalHygiene; Astatementofthephilosophyormission; DescriptionofhowservicesintheSpecialCareUnitdifferfromtherestofthe program; Stafftrainingandstaffjobtitles; Admissionprocedures,includingscreeningcriteria; Assessmentandserviceplanningprotocol; Staffingpatterns; Adescriptionofthephysicalenvironmentandanyuniquedesignfeatures appropriatetosupportthefunctioningofcognitivelyimpairedindividuals; Adescriptionofactivities,includingfrequencyandtype; 40

ChargestoresidentsforservicesprovidedbytheAlzheimersSpecialCareUnitor Program; Dischargeprocedures;and Anyservices,training,orotherproceduresthatareoverandabovethosethatare providedintheexistingassistedlivingprogram.

41

V:DEVELOPMENTTEAM
TranquilityLPwillorganizeadevelopmentteamwithvariousconsultantsandspecialiststo completetheproposedproject.PartofTranquilityssuccesscanbeascribedtothelocal rootsofitsowners.Thehistoryoftheprojectandbiographicalinformationaboutthe ownersisincludedbelow.Thereafterisalistofteammemberswithabriefdescriptionof thevariousroles. OwnershipandHistory: AchainofassistedlivingfacilitiesinitiallytargetedTranquilityssitebecauseofitsprime locationatthecrossroadsofmanymajorthoroughfaresinonofMaryland'sfastestgrowing areas.Whentheirdealfellthrough,twoFrederickCountyresidentssawanopportunityto buildanassistedlivingcommunitydedicatedtoservingthelocalcommunity.The investmentteamtheyassembledsoughttoofferafacilitythatcouldbereasonablypriced andtakecareofFrederickseldercitizens. Together,thesefourpartners,withequalownership,tookTranquilityatFredericktowne fromasolidideatoacomfortable,stateoftheartfacilityin1999.Theowners'rootsinthe Frederickcommunityisabenefitbecauseitgivesthemauniqueperspectiveonallthisarea hastoofferandmakesthemaccessibletoTranquilitysresidents,staffandadministration. Theownershipteamisavailabletomakequickdecisionsbasedonwhattheyfeelisright. Theirapproachprovidesanaccessibletouchincomparisontocompetingmarket competition.However,theircombinedlackofclinicalexperienceisagreatshortcoming giventhetightregulatoryenvironmentsurroundingthehealthcareindustryinMaryland. ManagementTeam TheOwnersmustimmediatelyidentifyaThirdPartyManagementfirmwiththerequired experiencetoassistthem.Thisteamshouldhavetheabilitytoworkwithonsitestaffto accomplishOwnershipsgoals.Currentmarketdatafromcompsmustbeavailableatall timeincludingestimatesforroomrentalratesandoccupancybyroomtypeandlevelof 42

care.Financialanalysismustbecompletedincludinggenerationofincomefromallsources, andvalueaddpotential.Appropriatestaffingincludespropertrainingandmanagementof staff,andassurancethatstaffisadheringtopoliciesandprocedures.TheManagermust guideTranquilitythroughtheprocessofongoingcompliancewiththestateandadherence toapplicablerulesandregulations.Generalbusinessimprovementadviceandsuggestions areneededinordertocontinuetomaintaintheAsset.Additionaloversightincludesthe followingfunctions:

BusinessManagementAdministrationandAccounting RegulatoryCompliance Marketing PersonalandClinicalCareManagement FoodServices Housekeeping MaintenancePropertyManagement ActivitiesandSocialServices Transportation PersonnelAdministrationandHumanResourcesManagement StaffRecruitment,Selection,OrientationandTraining Quality Assurance

DesignConsultants

Architect:Thearchitectwilldesignthemostefficientyetcostefficientyetcost effectivebuildingandlayoutconducivetoDementiawingsatAssistedLiving Facilities.Thefirmwillcreateadesignincompliancewiththecountysbuilding codesandtheareasmasterplan.

MechanicalPlumbing,ElectricalEngineer:Thesespecializedengineerswill orchestratethevariousmechanical,plumbingandelectricalsystemsduringthe designprocess.TheywillcalculatebuildingrequirementssuchasHVAC,plumbing lines,electricalneeds,etc.

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StructuralEngineer:Thestructuralengineerprovidesstructuralelementsforthe buildingsfoundation.Theirmaingoalistokeepthebuildingsstructuresafewithout overdesign.

OtherKeyPlayers

GeneralContractor:TheGCwillleadtheexecutionoftheconstruction.Tranquilitywill workcloselywiththearchitectandgeneralcontractortomeetprojectdeadlinesand budgetconstraints.

HamelBuilders: TheGCwhichhasbeenidentifiedforthisprojectisIndustryleader,HamelBuilders. Originallyfoundedin1988,underHamelCommercial,Inc.,HamelBuildershas developedintooneoftheMidAtlanticsmostvaluedandrespectedconstruction servicesproviders,specializingintherenovationandnewconstructionofmultifamily housing.Afullservicebuilderwithconstructionmanagementanddesignbuild capabilities,HamelBuildershasestablishedareputationinthebuildingindustryforour strengthofcharacter,aswellas,professionalismandbuildingexpertise. WithcorporateofficesinElkridge,MDandWashington,DC,Hamelmaintainsapresence throughouttheregion,havingconstructedmorethan15,000unitsofmultifamily residential,affordablehousing,adaptivereuse,seniorliving,historic,andmixeduse development,includingover3,000residentinplacerenovations. AccordingtoHamelsEstimatingDirector,AssistedLivingFacilities,liketheproposed construction,costanaverageof$120psf.Inaddition,Hamelwastheoriginalfirmto handleTranquilitysconstructionin1999.

Subcontractors:Thespecializedworkmaybecontractedouttosmallercontractors. PermitExpeditor:Anexpeditorusesitscountyconnectionstoensurebuilding permitsarepulledefficiently.

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SpecializedSenior/IndependentLivingConsultants:Aconsultantcanhelpidentify designorconstructionelementsspecifictoseniorcase(i.estimulatingcolorchoices, texturegrades,andbathing/bathroomdesigns).

ADAConsultants:Aconsultantcanadviseondesignelementsforthosewithvisual, auditory,ormobilitydisabilities(i.erampdesigns,signage,guardrailplacement,etc).

JV/EquityPartner ItispossiblethatthePartnershipwillnotbeabletoproducetherequiredequityneeded forthenewwingaddition.Anoptionistoinviteanequitypartnertoproducetherequired cashneededforthedealtoproceed.However,itmayalsobefeasibleforoneofthefour existingownerstoactasanequitypartner,andreceiveanadditionalpreferredreturn. Ifthenewwingisbuiltatotalof$1,062,863ofequityisneededtoclosetheloan,ata65% LTV.Inthisscenario,itisproposedthattheequitypartnerproduce70%oftheneeded equityandtheexistingownershipproduce30%. Thereturntotheequitypartnerisatotal21.22%IRRfroma11%preferredreturn,20% cashslitfromNOI,anda10%splituponsale.Itwasdeterminedthatanincreasecutofthe cashflowsplitto20%ofNOIfrom10%wouldmakethedealmoreattractivetooutside investors.DetailscanbefoundinExhibitIV.

ReportingStructure Currently,theExecutiveDirectorreportsdirectlytotheOwners.Thereisamonthly Ownersmeetingwhereoperationsandfinancialsarereviewed.OneoftheOwners,Russ H.,istheelectedPresidentofthePartnershipandavailabletoansweranyrequestsfromon sitemanagement.Proposedchangestotheexistingreportingstructureforthefacility operationsarerequired.Weeklyandmonthlymanagementreportsnotingoperational conditionsareimperativetoauditperformance.OncethenewThirdPartyManagementor Consultantsareretained,theirresponsibilitywillbetoactasintermediarybetween OwnershipandStaff.ThiswillprovideanimpartialbufferbetweenOwnership expectationsandStaffshortcomings.

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VI:FINANCEANDINVESTMENTANALYSIS
Thebelowassumptionsarebasedonoperatingexpensedata,rentalincome, developmentcostsandgeneralassumptionsfromtheprevioussectionsandarealso locatedinExhibitI,II,IIIandIV. ExitScenarios Threedifferentexitstrategieswereexaminedforthepurposesofthisreport.Each scenariohasmeritanditsowninherentrisksandreturns.Currently,theownershipis seekingtoaddvaluetotheexistingfacilityandisinterestedinallfeasibleoptions, includingasaleinthenearfuture.Apotentialsalewouldbetoacompetitoror operator/owneroperation.Thebasicoperatingbudgetassumptionsarethesamefor allscenarios.Eachscenariotakesintoaccountadditionalservicesoffered,suchas dementiaandadditionalcostsassociatedwiththoseoperations. 1) CurrentFinancialCondition:HoldorSell AthoroughfinancialanalysiswascompletedtoexamineTranquilitysexisting financialposition. ExistingFinancialCondition

Currently,TranquilityisstillundertheoriginalHUDpermanentloanfromApril29, 2000.Theprincipalamountwas$6,200,000ofwhich$5,801,000isstillowed.Itisa 40yearamortizedloanata7.79%interestrate.ThetermexpiresinApril2010.If alternativefinancingisntavailable,itispossibleHUDwillpermitarenewalofthe existingloanatthattime.However,achievingalowerinterestratethroughrefinance wouldimmediatehelpcashflow. Thefacilityisabletomeetitsnotepaymentsmonthly.ItisprojectedtheyearendNOI foroperationsbeforedebtservicesisprojectedtobe$740,139.Although2009has beenapromisingyearforTranquility,theassethashistoricallysufferedwithfaltering financials.

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 Athoroughexaminationofallincome,includinglevelsofcareandotherincome indicatedoperationswasnotcapturingfullrentpotentialbyplacingresidentsata lowerlevelofcare.Bycorrectlycapturinglevelsofcare,andmaximizingshortterm, highyieldingrespitestays,Tranquilitywillfinanciallybenefit. Accordingtotheproformatheunleveragedpresentvalueata10%TerminalCapRate isproducinga9.15%IRR.Currently,theprojectvalueoftheassetis$7,896,932. 2) Operational,CosmeticandDementiaupgrades:HoldorSellin2011 Cosmeticchangesareneededimmediately,andaplantoupgradethefacilitywas prepared.Operationalchanges,includinghiringappropriateexperiencedstaffto managethefacilityarerecommended,aswellascorrectingallstatemandated requirementswhichareindicatedinthemostrecentstatesurvey.Thesecondfloor, Northwingisidentifiedastheperfectlocationfora14bedDementiawing.A $300,000investmentforappropriatehardware,andmodificationstotheexisting wingwasincludedinthefinancialanalysis.Withthosechanges,anexistingneed, whichhasgreatdemand,Dementia,wouldberesolved.Dementiaroomsareslatedat $5500aroomamonth.TheadditionalincomefromtheDementiaroomsproducesa potentialgrossincomeof$3,558,143.Projectedoperatingexpenses,$2,620,726are greaterstartingin2010whenDementiaserviceswouldbeoffered. Theinherentvalueaddedbythesechangesisrealizedbyaprojected16.11%IRR,anda Year2(2011)NOIof$833,314.Withmodificationstoonehalfofonefloor,ownership willnothavetogotoregulatorstotheirlicense,whichisanothershorttermbenefit.If theinvestmentismadetoincorporatethesechanges,itwouldbeprudenttoholdthe assetuntilthemarketequalizes.CompleteanalysisisfoundinExhibitIII. 47

3) NewWing:HoldorSellin10Years Anewwingwouldincludeonfloorof24Dementiarooms,twofloorsof36total assistedlivingroomsandadditionalDementiacommonareaonthefirstfloorfor 19,280additionalsquarefeet.Itmadesensetoaccommodateeconomiesofscaleby buildingthreestoriesinsteadofjustonewingofDementiabyitself.Thedeductionis thatifthebudgetincludesaroofforonestory,thatcostissavedandnottripledby addingtwomorefloors. Theproposedconstructionbudgetshows$3,207,288intotalcostsnotincludingFFE estimates.Thisestimateisbasedonanestimatedconstructioncostassumptionof $120persquarefoot.Afulldiscussionofthehardandsoftcostscanbefoundinthe DesignandConstructionsection,aswellasExhibitIV. Equity/DebtAnalysisandStrategy TranquilityILPdevelopmentbudgetforthenewwingis$3,207,288andwillbudget approximately$744,004inneededraisedequity,or70%oftheneededequityforthe constructionloan.Theremaining30%wouldbeproducedbytheownership.There areseveraloptionsofhowtoraisethecapital,eitherfromthemselves,orthrough outsidepartners.Equitypartnerswouldgettheiroriginalinvestment,11%interest onthatinvestment,20%oftheNOI,andalso10%ofthefuturesaleproceeds.TheIRR fortheJVpartneris21.2%,atolerablelevelgivenmarketconditions. Asthecapitalmarketscurrentlyexist(ordontexist)atQ42009,availabilityofdebtis scarcethroughtraditionallenders.BasedonconversationswithaCommercialLoan specialistatBB&T,anyconstructionloanonTranquilitygivencurrentfinancialswill havea65%LTC,beatapproximately8%interestrateandtherewillbearecourse guaranteebasedonthenetworthoftheowners.However,thereisapossibilityof utilizingTranquilitysrelationshipwithlocalbankstoprocureamoreattractive constructionorminipermfinancing.

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Thepotentialgrossincome(PGI)inyearoneis$3,886,766whichisprojectedtogrow toaPGIinyear10of$5,056,887.Rentalincomeandpotentialgrossincomeis discussedfurtherintheMarketingsectionandRentRollcomputationislocatedin ExhibitI.Proposedpermanentfinancingwouldultimatelytakeout100%ofthe constructionloanwhichis$3,036,751.Projecting$439,478inannualdebtservice(at 6.5%interestrateand30yearamortization),Year1NOI$1,074,093wouldprojecta 1.83DCR.Therewillbea10yearballoon.Accordingtotheproforma,the unleveragedpresentvalueata10%TerminalCapRateis$10,747,930producinga 46.53%IRRfortheOwners,anda21.22%IRRfortheEquitypartners. 4)AlternativeLandAcquisition Afourthscenariowhichisnotpreviouslydiscussedorimmediatelyfeasiblebasedon currentdemandwasidentified.Thereisanadditionalsinglefamilyhomenextto Tranquility.Thesinglefamilyhomeisonestory,1.5bathrooms,andtwobedrooms. Givencomparablesales,apurchasepriceof$300,000shouldbeaccountedfor.The additionalhalfacre,alongwiththeothersinglefamilypropertynextdoorwhich Tranquilityhasalreadypurchasedandgonethroughtheprocessofsubdivisionwould createatotallandareaofapproximately3.0acres. 6512JeffersonPikeFrederickMD21730 Datathrough09/30/2009 HomeValueIndex $219,900 1YearChange 9.1% Medianlistprice($) $239,900 Mediansaleprice($) $228,000 TotalhomessoldinSep 111 ThisadditionallandbordersJeffersonPike,anditsplacementobscuresTranquilitys directviewofthebusyartery.Bycontrollingthispieceofproperty,theunflattering housecouldberazed,gradeofthelandcouldbebroughtdown,andanewassetcould bedeveloped.Apotentialusecouldbeamedicalofficefocusedtomeetgerontological needs,orasmallIndependentLivingMultiFamilybuilding. 49

Rental Home Owned by Tranquility LP

6512 Jefferson Pike

Additional Parking Tranquility Assisted Living Facility

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VII:CONCLUSION:
Ashiftininvestorattitudetowardseniorhousingisevident.Whileopportunityfunds havebeenpursuingtherealestateassetclassforsometime,coreinvestorsthosein searchofstabilizedassetsarenowincreasinglywillingtostepuptotheplate. MostrecentlyattheNICNationalConferenceinSeptember2009,itwasmentionedthat whileseniorhousingmaybedownalongwiththebroadercommercialrealestate market,itismoreresilientthanotherrealestateinvestmentclassesinthecurrent economicenvironmentbaseduponitsabilitytoincreasetherentsandwithstand decreasesinoccupancy.16Participantsexpressedconcernthatwiththecurrent downtrendinconstructionfinancing,theremaybealackofnewseniorhousing inventoryduringthenextfewyearsasthatmarkethasallbutstopped,whichsupports Tranquilitysexpansionplans. Giventhecurrentstateoftheeconomy,thereislesscertaintyregardingwhat prospectiveresidentswillwantandbeabletoafford.Newfinancingforthesetypesof projectswillpresentitschallenges.Thiswillfurtherlimitchoicesofconsumerswho needlongtermcare. Thecurrenttrendsintheindustryareforproviderstoconfiguretheiroperationsto attractconsumerswithabroadrangeofcareneeds.Assistedlivingwillcontinuetobe largelyanoptionforwealthierelders.Smallboardandcarehomes,theprimaryoption formostlowincomeelderswillcontinuetoloseground. Theuncertaintyinthemarkettodayassurestheinabilityfornewprojectstogainthe financingandsupportneeded,whichwillensuretheexistingsupplywillexhaust
16

http://seniorhousingnews.com/2009/09/28/nic-conference-highlights-challenges-and-opportunities-forcoming-year-in-senior-housing/

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demandforAssistedLivingneeds.Therefore,Tranquilitysownersshouldplanto diversifytheircurrentmodeltoprepareforinevitablemarketdemand. Recommendation: Theanalysispresentedinthisreportindicatesaninfusionofcapitalinvestmentwill createimmediatevaluebyupdatingthefacilityandallowingtranquilitytooffera service,Dementiacarethatisinhighdemand.Thereareinherentbenefitstoinitiate planstoproceedwithOption3,thenewwing.Theconstructioncostslowerarelower today,andtherearenonewdevelopmentsinthepipelinefor2010.Bythetimethe newwingwastocomeonline,Tranquilitywouldbeaheadofitscompetition.Giventhe currentstateoftheeconomy,itmakessensetotaketheinhouse,Option2renovation approachimmediatelyandplanforanewwingadditiontocommencein12months. Buildinganewwingandupgradingtheoperationsofthefacilityultimatelywillbring thehighestandbestvaluetotheexistingpartnership.Theexistingpartnerswillkeep theircurrentinvestmentfromachievingmediocrereturns.Withmoreequity investment,thenewreturnontheirinvestmentwillsurgeto46.53%IRR.Inaddition, thepossibilityofa21.22%IRRforapotentialJVequitypartnerduetoa20%splitof NOIand10%proceedsfromafuturesaleisappealingenoughtoattractaJVpartner, givenwhatcurrentrealestateandinvestmentsareachieving.

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VIII:EXHIBITS

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

ExhibitV

69

70

71

72

73

74

ExhibitVI

75

76

77

ExhibitVII

78

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ZoningDistrict:OpenSpaceandInstitutional

Uses RC AssistedLivingFacility

A R1 R3 R5 R8 R12 R16 PS PS PS PS PS PS

VC PS

HS

GC ORI PS

LI

GI

SinceAssistedLivingFacilitiesarePS,itisdefinedasPrincipalpermittedusesubjecttosite developmentplanapproval.See1192.160,and1193.300through1193.300.4 Whichmeansthatthefollowingproceduremustbefollowed: DIVISION3.SITEPLANREVIEW 1193.300.PURPOSEANDINTENT. (A)TheBoardofCountyCommissionershasdeterminedthatcertainusesrequiresite developmentplanreviewandapprovalbythePlanningCommission(see1192.160). (B)Siteplanreviewisintendedtopromotesafeandefficientdevelopmentthat maximizescompatibilityandconnectionswithexistingoranticipatedsurroundinglanduses andthenaturalenvironmentthroughcarefulconsiderationofsitedevelopment, transportationandparking,publicutilities,naturalfeatures,andcommonareas,asrequired bythischapter. (Ord.0922526,7142009) 1193.300.1REVIEWANDAPPROVALPROCEDURES. (A)Ausesubjecttositedevelopmentplanapprovalasrequiredin1195.310(Use Table)orsubjecttothesiteplanreviewprocessasotherwiserequiredinthischaptershall bereviewedthrough1of3procedurestoensurethattheproposeddevelopmentcomplies withtherequirementsofthischapter.The3proceduresare: (1)TypeIPlanningCommission.ThepurposeoftheTypeIPlanningCommission processistoprovidefordevelopmentreviewinvolvingstandardsfordesignorreviewof usespermittedbythischapterwhichmaybecomplexinnaturerequiringinterpretationof CountyComprehensivePlanpoliciesortherequirementsoftheFrederickCountyCode.The TypeIapplicationshallbecirculatedformultiagencyreviewpriortoPlanningCommission review.TypeIPlanningCommissionreviewandapprovalisrequiredforallofthe following:

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(a)Applicationsforsitedevelopmentplanapprovalwherereviewandapprovalis notprovidedforthroughtheTypeIILimitedorTypeIIIAdministrativesiteplanreview processes. (b)ModificationstoaPlanningCommissionapprovedsitedevelopmentplan involvinganincreaseinbuildingheightornumberoffloors;modificationstolandscapingor screeningthatreducethenumberofplantingsoropacityrequiredintheinitialTypeI PlanningCommissionapproval;requestsforreductioninopenspacesquarefootage;change inthetypeorsquarefootageofanamenity;andmodificationsthatincreasethenumberof requiredparkingandloadingspaces. (2)TypeIILimited.ThepurposeoftheTypeIILimitedprocessistoprovidefor developmentreviewandapprovalbyPlanningCommissionauthorizedrepresentatives basedonstandardsspecifiedinthezoningordinance.TheTypeIILimitedapplicationshall beprocessedatstafflevelandcirculatedformultiagencyreview.TypeIILimited applicationsshallberestrictedtomodificationsprovidedthroughtheTypeIII AdministrativeprocessoranyoneormoreofthefollowingminormodificationstoPlanning Commissionapprovedsitedevelopmentplansprovidedthatthemodificationdoesnot requirePlanningCommissionreviewofadequatepublicfacilities,forestresourceordinance, orstormwatermanagementrequirements: (a)Minormodificationstoutilitylocation; (b)Minormodificationstoparkingandloadingdesignrequiredbyphysicalsite constraintsthathasnodetrimentalimpactuponorthatimprovesbicycle,pedestrianand trafficsafetyorcirculation; (c)Buildingfootprintmodifications: 1.Between201squarefeetand2,000squarefeetnotresultinginanincreasein squarefootage;or 2.Nottoexceedatotalof2,000squarefeetor10%ofthesquarefootage approvedbythePlanningCommission,whicheverisless; (d)Minorlandscapingmodificationsthatdonotconstituteamaterialalterationof thePlanningCommissionapprovedsitedevelopmentplanandthatdonotrequireaTypeI PlanningCommissionapprovalasprovidedin1193.300.1(A)(1);

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(e)Minormodificationstopedestrianpathwaylocation,openspaceoramenity designtoimproveaccess,safety,orefficiency,thatdonotrequireTypeIPlanning Commissionapprovalasprovidedin1193.300.1(A)(1). (3)TypeIIIAdministrative.ThepurposeoftheTypeIIIAdministrativeprocessis toprovidefordevelopmentreviewandapprovalbyPlanningCommissionauthorized representativesbasedonstandardsspecifiedinthezoningordinance.TheTypeIII applicationshallbeprocessedasastafflevelsingleagencyreviewandshallberestrictedto anyoneormoreofthefollowingminormodifications,providedthatthemodificationdoes notrequireadequatepublicfacilities,forestresourceordinance,orstormwatermanagement review: (a)AchangeinuseapprovedbytheZoningAdministrator; (b)Buildingfootprintmodificationsofnotmorethan200squarefeetprovided thatthereisnoincreaseinoverallbuildingfootprintsquarefootage; (c)Changeofpermittedandapprovedsigns; (d)Minorlandscapingmodificationsinvolvingsubstitutionofspeciesthatdonot requireTypeIPlanningCommissionapprovalasprovidedin1193.300.1(A)(1);or (e)OtherminormodificationsasestablishedbytheZoningAdministrator. (B)AnapplicantmayrequestaTypeIPlanningCommissionreviewatanytimeduring aTypeIILimitedorTypeIIIAdministrativereviewprocess. (C)PlanningCommissionauthorizedrepresentativesmayrequireaTypeIPlanning CommissionorTypeIILimitedreviewforasitedevelopmentplanapplicationpermitted throughtheTypeIILimitedorTypeIIIAdministrativereviewprocess,whereitis determinedthattheproposedmodificationmayhaveanadverseimpactonsurrounding properties,publicfacilities,orisinconsistentwiththeinitialTypeIPlanningCommission approval. (D)Eachapplicationinvolvingsitedevelopmentplanapproval,togetherwiththe requiredfee(1192.130)andotherrequiredplansubmissions,including,butnotlimitedto adequatepublicfacilitiesordinancestudies,forestresourceordinanceplans,sightdistance studies,stormwatermanagementconceptsandtheinformationdescribedbelow,shallbe submittedtotheDivisionofPermittingandDevelopmentReview.TheDivisionofPermitting

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andDevelopmentReviewshallnotacceptanapplicationifitisdeterminedthatthe informationsubmittedisincomplete. AftertheDivisionofPermittingandDevelopmentReviewdeemsthattheapplicationis complete,thesitedevelopmentplanwillbescheduledforaTechnicalAdvisoryCommittee (TAC)meetingforreviewbyagencyrepresentativesandrepresentativesoftheapplicant. TheapplicantmaynotfileforazoningcertificateandbuildingpermitwiththeOfficeof PermitsandInspectionsbeforereceivingsiteplanapproval.Applicationsforsiteplan reviewshallbevoidifapprovalhasnotbeenreceivedwithin3years,beginningonthedate theapplicationwasaccepted.Avoidapplicationshallhavenofurtherstatusandmustbe resubmitted. (1)ForallTypeIPlanningCommissionsiteplanreviewapplications,theapplicant shallplaceasignwithin10feetofeachpropertylinethatabutsapublicroad.Iftheproperty doesnotabutapublicroad,asignshallbeplacedinsuchamannersothatitmaybemost readilyseenbythepublic. (a)TheDivisionofPermittingandDevelopmentReviewshallprovidetherequired sign(s). (b)Thesign(s)shallbeplacedonthepropertyatleast30dayspriortotheinitial PlanningCommissionmeetingatwhichtheTypeIPlanningCommissionsitedevelopment planistobeconsidered. (c)Thesign(s)shallbeaffixedtoarigidboard,protectedfromtheweather,and maintainedatalltimesbytheapplicantuntiltheinitialPlanningCommissionmeetingis held. (d)Theapplicantshallfileanaffidavitcertifyingthatthesign(s)hasbeenposted andmaintainedfortherequiredtimeperiod. (2)Ifanypersonremovesortamperswithapostedsignduringtheabove30day postingperiod,thatperson,uponconviction,shallbeguiltyofamisdemeanor,asprovidedin 1192.220. (E)ThePlanningCommissionmayattachconditionstotheapprovalofasite developmentplaninordertoensurethattheproposalwillconformtotheprovisionsofthis chapter.

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(F)Approvalofasitedevelopmentplansubmittedundertheprovisionsofthisdivision shallexpire3yearsafterthedateofthedecisionbythePlanningCommissionorits authorizedrepresentativesunlessconstructionhasbegunasdefinedby"startof construction"in11911.100.Thelengthofsiteplanapprovalmaynotexceedthelengthof theapprovalundertheAdequatePublicFacilitiesOrdinance(APFO)ifAPFOapprovalis required. (Ord.77178,4073(B),(C),1241977;Ord.8219263,971982;Ord.8511343,326 1985;Ord.8722454,841987;Ord.9406101,5311994;Ord.9617169,861996; Ord.0021263,1,7182000;Ord.0221317,10152002;Ord.0527388,10252005; Ord.0826502,10142008;Ord.0922526,7142009) 1193.300.2CONCEPTPLAN. (A)WherespecifiedwithintheZoningOrdinance,conceptplanapprovalshallbe requiredasthefirststepinthedevelopmentapprovalprocess(1197.500(D)). (B)Theconceptplanshallincludethefollowingelements: (1)AnapplicationinaformacceptabletotheDivisionofPermittingandDevelopment Review; (2)Amapdrawnat1inchequals100feetorgreaterscaleshowingpropertylines,all existingnaturalandmanmadefeatures,andavicinitymap; (3)Amapidentifyingthetypeandlocationofallproposedusesincluding: (a)Thegeneralizedlocation,footprint,andexteriorelevationofallproposed buildingsincludingheight,numberofstories,numberofattachedunits,andthelocationof doorsandwindows; (b)Allproposedparkinglocationsandgeneralizedinformationregardingtheuse ofanalternateparkingplanincludingshared,joint,community,orothermeans; (c)Thegeneralizedlocationofallroadways,sidewalks,andotherpublicorprivate facilitiesadjacenttoandnecessaryfordevelopmentofthesite; (4)Existingstructuresonalllotsfacingandadjacenttotheproposeddevelopment includingtheheight,setbacks; (5)Photographsofthesubjectparcelandallfacingandadjacentlotsandstructures usedtodetermineheightandsetbacks. (Ord.0727467,6192007;Ord.0826502,10142008) 84

1193.300.3SITEPLANREVIEWAPPLICATION. Anapplicationsubmittedforsiteplanreviewshallincludethefollowinginformation: (A)Amapofthesubjectpropertyataconvenientscale; (B)Avicinitymapatascaleof1inchequals2,000feetormoretotheinch,indicating thelocationofthepropertywithrespecttosurroundingpropertyandstreets.Themapwill showallstreetsandhighwayswithin2,000feetoftheapplicant'sproperty; (C)Atopographicmapoftheproperty,ataminimumof5footcontourintervals,unless otherwisespecified,showingtheexistingandproposedregradingsurfaceofthelandandthe locationofnaturalfeatures,suchasstreams,rockoutcrops,andwoodedareas; (D)InaccordancewiththeDivisionofPermittingandDevelopmentReviewchecklist requirementsasitedevelopmentplanshowingallexistingandproposedimprovements includingbutnotlimitedto:proposeduse;locationandheightofallbuildings;locationof existingandproposedrightsofway;locationanddimensionsofallparkingareas,drive aisles,andtruckloadingareaswithaccessandegressdrivesthereto;locationofsidewalks, pedestriancrossings,andexistingorplannedtransitstops;locationandtypeofanyoutdoor storage;locationandtypeofanyrecreationfacilities;proposedgrading,landscaping,and screeningplans;descriptionofproposedmethodtoprovidebufferareasandlandscaping whererequired;location,designandheightofoutdoorlightingfacilities;buildingelevation forthepurposeofdepictingthelocation,size,andtypeofallsigns;andthelocation,sizeand typeofallproposedstormwatermanagementfacilities; (E)Acomputationofthetotalareasofthelot,includingthebuildingfloorarea,building floorareaforeachtypeofproposeduse,theroadsandparking,greenarea,landscapedand screenedareas,recreationareasasrequired,andtotallotcoverage; (F)Commercialorindustrialuseswilldesignate: (1)Thespecificusesproposedandthenumberofemployeesforwhichbuildingsare designed; (2)Thetypeofpowertobeusedforanymanufacturingprocesses; (3)Typeofwastesorbyproductstobeproducedbyanyprocessandproposed methodofdisposalofsuchwastesorbyproducts;and

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(4)SuchotherinformationasmayberequiredbythePlanningCommissionorits authorizedrepresentativestodeterminecompliancewiththerequirementswiththischapter andtheimpactofaparticularuseonadjoiningproperties; (G)(1)Soiltype(s)informationshallbeprovidedandappropriateboundariesshown. Intheevent"wetsoils"arelocatedonorwithin100feetofanyproposedresidentialsite plan,asoilsdelineationreportshallbepreparedbyasoilsscientistorprofessionalengineer registeredintheStateofMaryland.ThePlanningCommissionmaywaivethisrequirementif the"wetsoils"arelocatedwithinopenspaceareas.Thesoilsreportshallbesubmittedfor reviewbySCDpriortoapprovalofthesiteplanbythePlanningCommissionorits authorizedrepresentativesunlessasoilsreportwascompletedearlierwithinthe developmentreviewprocess. (2)Ifresidentialstructure(s)withbasementsareproposedwithin"wetsoils"a geotechnicalreportisrequiredtobesubmittedbyaprofessionalengineerregisteredinthe StateofMaryland.Anoteshallbeplacedonthesiteplanthatallconstructionshallbein accordancewiththefindingsofthegeotechnicalreport. (3)Siteplansmaybepreparedandsubmittedbyanapplicant.Thesubmitted information,iffounddeficientorinerror,mayberequiredtoberesubmittedoverthe certificationofanengineer,architect,landscapearchitect,landsurveyororothercertified professional.Siteplanswillbepreparedtoascaleofnotsmallerthan1inchequals100feet, unlessapprovedbytheDivisionofPermittingandDevelopmentReview;thesheetorsheets shallbenolessthan18inchesby20inchesnormorethan24inchesby36inches,including a11/2inchmarginforbindingalongtheleftedge.Asiteplanmaybepreparedononeor moresheets,inwhichcase,matchlinesandanindexsheetshallbeprovided. (Ord.77178,4073(B),(C),1241977;Ord.8219263,971982;Ord.8511343,326 1985;Ord.8722454,841987;Ord.9406101,5311994;Ord.9617169,861996; Ord.0021263,1,7182000;Ord.0221317,10152002;Ord.0527388,10252005; Ord.0826502,10142008;Ord.0922526,passed7142009) 1193.300.4APPROVALCRITERIA. SitedevelopmentplanapprovalshallbegrantedwhenthePlanningCommissionorits authorizedrepresentativesfindthattheapplicationfordevelopmenthasmetthefollowing criteriabaseduponthestandardsandprovisionsofthischapter: 86

(A)Sitedevelopment.Existingandanticipatedsurroundinglanduseshavebeen adequatelyconsideredinthedesignofthedevelopmentandnegativeimpactshavebeen minimizedthroughsuchmeansasbuildingplacementorscale,landscaping,orscreening, andanevaluationoflighting.Anticipatedsurroundingusesshallbedeterminedbasedupon existingzoningandlandusedesignations. (B)Transportationandparking.Thetransportationsystemandparkingareasare adequatetoservetheproposeduseinadditiontoexistingusesbyprovidingsafeand efficientcirculation,anddesignconsiderationthatmaximizesconnectionswithsurrounding landusesandaccommodatespublictransitfacilities.Evaluationfactorsinclude:onstreet parkingimpacts,offstreetparkingandloadingdesign,accesslocationanddesign,vehicular, bicycle,andpedestriancirculationandsafety,andexistingorplannedtransitfacilities. (C)Publicutilities.Wheretheproposeddevelopmentwillbeservedbypubliclyowned communitywaterandsewer,thefacilitiesshallbeadequatetoservetheproposed development.Whereproposeddevelopmentwillbeservedbyfacilitiesotherthanpublicly ownedcommunitywaterandsewer,thefacilitiesshallmeettherequirementsofandreceive approvalfromtheMarylandDepartmentoftheEnvironment/theFrederickCountyHealth Department. (D)Naturalfeatures.Naturalfeaturesofthesitehavebeenevaluatedandtothegreatest extentpracticalmaintainedinanaturalstateandincorporatedintothedesignofthe development.Evaluationfactorsincludetopography,vegetation,sensitiveresources,and naturalhazards. (E)Commonareas.Iftheplanofdevelopmentincludescommonareasand/orfacilities, thePlanningCommissionasaconditionofapprovalmayreviewtheownership,use,and maintenanceofsuchlandsorpropertytoensurethepreservationofsuchareas,property, andfacilitiesfortheirintendedpurposes. (Ord.77178,4073(D),1241977;Ord.0826502,10142008;Ord.0922526,passed 7142009)

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