First River Advisory L.L.C. is an independent financial advisor which, since its formation in 1995, has fashioned innovative and cost-effective capital formation and debt management solutions for non-profit health care organizations.  First River Advisory is registered as a Municipal Advisor (MA) with the U.S. Securities and Exchange Commission (SEC) and the Municipal Securities Rulemaking Board (MSRB), as required by Section 975(a) of the Dodd-Frank Wall Street Reform and Consumer Protection Act.

First River Advisory stands firmly on its clients' side.   First River Advisory is not affiliated in any manner with a bank, investment banking firm (broker/dealer), other financial institution or investment manager, and does not engage in any form of underwriting, trading, marketing or investing in securities.  As an independent MA, First River Advisory is singularly focused on being an advocate for its clients, and is accountable solely to its clients.  Although Dodd-Frank requires that an MA maintain a fiduciary duty standard only to certain types of clients, First River Advisory routinely applies this standard to all clients.

First River Advisory is a member of the National Association of Municipal Advisors (NAMA), an organization of independent MA firms which are not affiliated with broker/dealers.  First River Advisory is the only NAMA member that specializes in serving health care organizations.  Visit the NAMA Web Site for more information on the high ethical and professional standards to which First River Advisory adheres.

First River Advisory Services

First River Advisory can become a health care organization's trusted resource, providing independent and unbiased advice and recommendations in connection with:

  • financing a facilities improvement project or acquisition, even for organizations exhibiting weak credit characteristics more

  • dealing with banks that balk on extending credit, despite their desire for comprehensive relationships more

  • refuting contentions by M&A consultants that a merger or sale is essential because of a lack of access to capital more

  • managing more actively the risks associated with outstanding debt instruments more

  • determining if there are opportunities for improvement among outstanding debt instruments in terms of reduced costs, mitigated risks and/or less restrictive covenants more

  • understanding the debt situation inherited from prior management more

  • addressing outstanding bank financings or letters of credit having upcoming maturities or expiration dates, especially if the bank is resisting renewing more

  • developing presentations for rating agency surveillance calls which put the organization's best foot forward to earn an upgrade or avert a downgrade more

  • gaining a better understanding of the implications of strategic initiatives on outstanding bonds' ratings more

  • addressing the actual or imminent failure to comply with financial covenants and negotiating viable solutions with creditors more

  • relieving the burden of complying with continuing disclosure reporting obligations more

  • drafting the "Appendix A" to Official Statements for bond issues in a "staff extender" role more

  • developing affiliation strategies and, subsequently, assembling requests for proposals and evaluating submitted proposals more

  • arranging for the disposition of outstanding debt instruments in connection with asset sales to investor-owned companies more

  • developing and implementing policies for the utilization of interest rate derivatives (swaps, caps, etc.) more

  • managing more actively the risks associated with outstanding derivatives by maintaining closer surveillance on the financial condition of counterparties more

  • determining if there are opportunities for improvement among outstanding derivatives in terms of reduced costs, mitigated risks, reduced collateral requirements and/or less restrictive covenants more

  • understanding the derivatives situation inherited from prior management more

  • training to become more proficient in explaining any of this to governing boards and other lay audiences
First River Advisory, Capitol Formation and Debt Management Solutions for Health Care Organizations
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