Healthcare Public Finance

Products and Services


Piper Sandler is a full-service investment banking company. As such, we provide the full gamut of financing products for healthcare providers.

Fixed rate bonds

Piper Sandler excels at selling fixed rate bonds. We save clients money by paying attention to details, whether it is maximizing serial bond use or carefully evaluating use of original issue discount and original issue premium structures. We typically price our financings with a 10-year par call or better and without interest rate penalty.

We also rigorously evaluate the use of credit enhancement. We won’t hesitate to structure an issue unenhanced if it saves a client money or provides greater flexibility. The high volume of transactions we underwrite gives us a keen insight into what bond insurers will accept to preserve borrower flexibility. Finally, we have a track record of pricing bond issues aggressively to produce the lowest interest cost possible. We provide clients with extensive market data to help them make informed decisions on pricing day. All of these factors provide significant value to our clients issuing fixed rate bonds.

Variable rate bonds

Piper Sandler is a national leader in variable rate debt. Piper Sandler was one of the first companies in the country to offer daily reset bonds, providing significantly lower yields than traditional weekly floating rate bonds. Piper Sandler has a dedicated short term trading desk that routinely bests its competition when clients compare our pricings to those remarketed by other companies. We remarket 156 daily and weekly issues totaling approximately $2.8 billion.* We have also developed a unique “just in time” variable rate structure that allows borrowers to access funds only when needed. We can provide further details about this proprietary product.

Investment of bond proceeds

We have a team of municipal investment specialists who invest or bid out investment products for our clients, including project funds, reserve funds and refunding escrows.

Taxable debt

For cases when a healthcare provider has funding needs that don’t qualify for tax-exempt debt, Piper Sandler can help with its significant taxable bond underwriting experience. Whether it is taxable floating notes or fixed rate taxable placements, we have a deep investor base and sound structuring expertise.

Refunding debt

In today’s low interest rate environment, healthcare providers can lower annual expenses by refinancing outstanding debt. Our seasoned analytical team has experience with the full array of current and advance refunding techniques used to lower and restructure debt service payments.

HUD 242

Piper Sandler has bona fide HUD 242 financing experience. We completed one of the nation’s first community hospital HUD 242 financings. We’ll help you navigate the process and evaluate the benefits of this unique program.

Interest rate swaps, caps and hedges

Piper Sandler offers its clients extensive derivative expertise in the range of interest rate swaps, including BMA swaps, LIBOR swap, basis swaps and constant maturity swaps. We also offer other hedging strategies such as rate locks, caps and swaptions. We act as principal for derivative transactions for our clients with a credit support rating of AA-/Aa3 as a swap counterparty.

Off-balance sheet financing

Piper Sandler has completed numerous off balance sheet financings for our clients. We have significant experience navigating the operating lease and accounting rules. We also know how to structure these transactions so they can be sold at favorable interest rates.

Escrow restructuring

Piper Sandler has saved clients meaningful dollars by restructuring inefficient refunding escrows. Our specialists are fully conversant in all IRS regulations and compliance with bond counsel requirements.

Private placements

When a borrower has a reason to bypass the public markets, Piper Sandler can complete a cost-effective and efficient private placement. We have cultivated a broad audience of private purchasers and have privately placed healthcare issues as large as $400 million. We’ll create competition to ensure an attractive rate for this structure.

Merger and advisory services

Piper Sandler has advised numerous clients on mergers and acquisitions. Partnering with other finance team professionals, we can help a provider maximize value on a sale of assets or advise on a purchase of another hospital or service. Piper Sandler also has the capability to provide interim acquisition funding.

Rating agency and credit procurement

Piper Sandler provides clients with extensive preparation and guidance when meeting with rating agencies, bond insurers or other credit enhancers. We’ve guided many clients through first-time ratings and achieved upgrades for many clients. With our high volume of healthcare underwritings, we can help borrowers anticipate questions or areas of concern. We’ll serve as your advisor and advocate throughout this important process.

Investor relations

Because Piper Sandler values long-term relationships, we’ll be there between financings. We actively assist clients with advice on communicating with investor and rating agency requests not associated with debt financings. We’ll help you communicate “the story” while complying with disclosure best practices and applicable securities laws.

Critical access hospitals

Piper Sandler has significant experience with Critical Access Hospitals (CAHs). We’ve completed debt offerings for more than 30 CAHs. We’ve financed major renovations and new hospital construction, with par amounts as large as $50 million.