In an effort to better understand the current and emerging capital plans and needs of health centers across the country, Capital Link, with support from HRSA, is conducting a national assessment. 

The information provided will be used to inform policy makers, funders, capital sources, and the general public of the priority capital needs of the health center sector. This information will be invaluable to the development of capital funding sources from which your health center may benefit.

Please contribute to this effort by completing the short assessment. It should only take a few minutes of your time. All participants will be entered in a drawing to win a $200 Amazon gift card. 

 
UPDATE - The deadline to participate is Friday, January 8, 2021. Please complete one assessment per health center.
 
Results will be summarized in a report that will be made available to all health centers nationally. While your individual response will not be publicly disclosed without your prior written consent, we plan to share aspects of state and national data with PCAs, HCCNs, and other stakeholders as we work collaboratively to support health center needs.  

Thank you for your participation.

For health centers that received SBA PPP loans of $2 million or more…

Tips for Completing the 3510 Loan Necessity Questionnaire

The Small Business Administration (SBA) is requiring that lenders issue “Loan Necessity Questionnaires” to borrowers that received a Paycheck Protection Program (PPP) loan of $2 million or greater and have applied for forgiveness, in order to solicit supplemental information regarding the necessity of the loan request. There are two versions of the questionnaire, one for for-profit borrowers (SBA Form 3509) and one for non-profits (SBA Form 3510). Health centers should receive the non-profit Form 3510 from their PPP lender. The questionnaires have not been posted to the SBA’s website but you can ACCESS THE 3510 FORM HERE >

Form 3510 must be completed and returned along with the required supporting documentation to the lender within 10 business days. Failure to do so may result in the SBA’s determination of ineligibility and request for repayment of the loan or “other available remedies.”

The questionnaire requires borrowers to provide extensive information and backup documentation regarding receipts, expenses, operations, required closures, liquidity, and more. Health center leaders we’ve been in contact with who are seeking guidance about this form have come up short. They are finding that Form 3510 does not allow the opportunity to provide context surrounding the situation that resulted in their health center’s loan necessity. They are concerned that the lack of context may hinder their loan forgiveness.

Recognizing that the strategic measures health centers are taking to weather this pandemic while also providing communities with access to care should be a key consideration for the SBA in determining loan forgiveness, Capital Link has the following suggestions for health center borrowers related to Form 3510:

  • Keep contemporaneous records: It is unlikely that the SBA will reject a loan forgiveness request based solely on the answers obtained through Form 3510, without at least offering you an opportunity to contest the decision. Make sure you have, and continue to keep, a narrative of your thought process at the time of application and as you allocate expenses toward the PPP loan as a method of documenting the decisions you made and the uncertainties you faced. This written narrative will serve as a record of your thinking and needs as the pandemic evolves, which could be provided if the SBA asks for additional information. The SBA should theoretically take into account what a prudent person would do in your situation—when you were working to keep your doors open and keep staff and patients safe over this extended period of time.
  • Include additional documentation with the form: It may not be feasible, depending on how your bank requires you to submit the form, but it is worth finding out if you can add an attachment that proactively “tells your story” as a way to bring more context to the submission.
  • Consult your bank officer: Since Form 3510 is being issued to borrowers by lenders and not directly by the SBA, it may be beneficial to contact your bank officer to explain how you have used the PPP funds and to request their advice regarding how you might best provide further context about the work you have been doing during the pandemic. While loan forgiveness is ultimately the SBA’s decision, it doesn’t hurt to make sure your bank is aware of your concerns. You are likely a major customer of the bank, and they will want to keep you happy and financially stable if at all possible. They have a direct line to the SBA; the more they know about your situation, the more they may be able to advocate for you, even if that is not their specific role.

Please note that it is quite possible that new guidance may be forthcoming from the SBA or individual banks related to Form 3510. Recently, Capital Link worked with NACHC to provide comments on Form 3510 during the comment period provided by the SBA. You can read the comments here. We will post anything we learn here on our COVID-19 webpage as it becomes available.

Lastly, Capital Link estimates that approximately 375 health centers received loans of $2M+ and will be subject to this request. If you experience challenges with the form and/or are turned down by the SBA for loan forgiveness, please let us know by emailing us This email address is being protected from spambots. You need JavaScript enabled to view it.. We look forward to assisting you in obtaining the loan forgiveness you need and deserve as you continue to battle COVID-19.

As community health centers across the country navigate how to best serve their communities as well as adapt and maintain operations during this devastating pandemic, they are facing unprecedented financial challenges. Capital Link has been listening and responding to health center’s concerns. This article contains some of the suggestions and insight we’ve been sharing to support health centers’ efforts to balance financial and operational sustainability with patient and staff care.

With the election now behind us, health centers have ongoing concerns regarding future policy, value-based care, 340B, telehealth, patient engagement, public expectations, and staff and community safety. For the foreseeable future, there is a significant number of unknowns.

Although the road we are on at times seems daunting, there are many useful resources available to assist health centers in finding the best funding sources for their organizations. Similar to a natural disaster, COVID-19 presents opportunities for action and ways of supporting our communities and one another. In order to move forward, keeping each health center’s individual needs in mind, organizations should plan for different scenarios, changing business models, and capital needs in the midst of the continued uncertainty of this crisis.

Health centers should evaluate: What is the obvious need? What do our patients and communities require? What information or resources are available? Maintaining resources, relationships, and reserves allows one to manage through the crisis and often come out stronger. It’s critical that health centers evaluate multiple possible scenarios and maintain awareness of your organization’s capacity—including strategic agility, emergency preparedness, and the availability of relevant data for decision-making.

Developing Your Priorities and Requirements for the Short and Long Terms

There are currently many lenders offering flexible terms for loans and repayment, which health centers may want to consider in order to assure adequate access to cash in an uncertain operating environment. Begin analyzing your needs by conducting a cash flow analysis, asking, “How long can we operate in our current position?” Determine the best and worst case scenarios—start small with what you know, and add on as appropriate. Use ranges rather than specific numbers and examine your environment—what might recover, and what might not?

Capital Renovations to Ensure Safety and Meet Staff and Patient Needs and Expectations

Consider how you might incorporate what you have learned during the pandemic into your center’s physical space and operational processes. What have you learned so far? What do you know now that you didn’t before? What do your patients and staff want and need in terms of your physical and/or virtual footprint? What has worked well, and what not so well? What creativity has expressed itself in the form of more efficient processes? How can you make these changes permanent? What spaces or equipment were you lacking that you wish you had? Did you work with new partners and did that change your space requirements? Which impromptu changes in your physical space do you want to make permanent?

Capital planning remains an important part of your strategic plan. This doesn’t always mean a new facility but rather using your current space more effectively: phasing, renovations, and having a “Plan A” and “Plan B” ready for when capital dollars make themselves available. For example, many centers are considering renovations to existing facilities to accommodate increased use of telehealth, reduce infection risk in common areas and dental suites, and adding negative-pressure rooms to care for contagious patients more safely.

Though we can’t predict the future, we can at least help shape it by sharing our experiences and resources with one another and provide ongoing support, collaboration and guidance. By combining our knowledge of what has worked in the past with what we have learned today, we can help provide a more promising tomorrow.

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