Association of Washington Public Hospital Districts
Skip Navigation Links
Our Members
News & Events
Publication & Resources
Contact Us
Access To Capital

999 Third Avenue
Suite 1400
Seattle, WA 98104
Driving Directions

Intro | TOC | I | II | III | Appendices 

A Guide To Capital Funding Options For Public Hospital Districts, Rural Hospital And/Or Critical Access Hospitals In Washington State

A publication funded by the Association of Washington Public Hospital Districts and developed by consulting firms The Lakes Group and Moss Adams LLP.


The majority of Public Hospital Districts in the State of Washington are, or will shortly, be in the need of capital financing to replace aging physical plants, operating systems and clinical equipment to meet the increasing safety and environment of care standards required by state, federal and accrediting agencies. In additions, there is a mandate for information systems (IS) that provide privacy (HIPAA) financial, clinical and operational interfaces required by state and federal agencies as well as third party payers and liability insurers. All of these requirements are and will have a major impact on hospitals and health systems due to the cost.

The need for capital outside of existing institutional financial reserves to address these mandatory upgrades is additionally impacted by the continuing decrease in third party reimbursement for clinical services and reduced returns on investment income.

For these reasons, the Association of Washington Public Hospital Districts leadership decided to seek assistance in developing this guide to assist AWPHD members to find and access capital funds to replace or upgrade aging physical plants, operating systems, clinical equipment and/or information systems.


Information in this resource directory has been gathered from numerous resources and is intended to be a guide for hospitals to identify potential sources of capital financing. These resources are listed for reference only and are not intended as endorsement by the Association of Washington Public Hospital Districts or the consulting firms of The Lakes Group or Moss Adams LLP.

While this directory is as comprehensive, regarding funding mechanisms, as the researchers could make it, it is not exhaustive, either to funding mechanisms or funding resources. The directory includes detailed financing information for only one or two sources for each particular type of funding mechanism, rather than attempting to include information for every source. If other funding mechanisms or funding sources are identified by AWPHD members/staff, or if other financial sources feel they have been overlooked, this information should be forwarded to the Executive Director, AWPHD to be considered as potential addenda to this publication. There is a blank resource template in Appendix 2 of this resource guide that can be used to provide the information recommended for addenda to this AWPHD publication.

It should also be noted that capital funding from state and federal government resources is a very fluid resource. As this publication went to print, there were some legislative actions at the federal level that focused on assisting rural facilities to maintain financial viability and improve physical plants and information systems. AWPHD and WSHA resources will monitor these actions and provide timely feedback to the membership if this legislative support becomes a reality.

This guide is intended to provide accurate information, but it should not be used as a replacement for or override individual institutions’ financial advisors or auditing firms.


The Association of Washington Public Hospital District would like to thank the following contributors to this publication: