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Chasing the (Healthcare) Dream

Teliah Gienger

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#22
Update:

Today the first money has come in for building the company. This is opposed to money used for salary to get here, which cost me a few percentage points of equity. The wire was initiated maybe an hour ago.

It has been a rough process since leaving my prior venture in October. If you had told me it would take this long, I suppose I would have believed you. I never really had a timeline in mind, I just knew that a lot of work was coming.

As far as updates since I last posted, here are some developments:
  1. Lawyer: I hired a lawyer for formation expertise, and to help me raise money from unaccredited investors. A process that I think is worthwhile to have friends/family along for the ride. It requires extra steps with the SEC (see: rule 504 or 506). I'm not done with it yet, but I am close.
  2. CPA: We have a family friend who helps build healthcare companies and he's been very helpful in getting moving. Knows the tax efficiency of items, and will help me as I operate the company.
  3. State Gov't: Finally heard back on the requirements for the application & licensure. It isn't a nebulous cloud of uncertainty any more. Although I figured out what I needed from online sources, not everything was online. I'm now going through final motions here.
  4. A second prescriber: I have a second prescriber on board. She seems great.
Now just to execute. So close to the finish line here. Which is really the starting line. But for me, the finish line of all this hard work.

"The man who moves a mountain begins by carrying away small stones." - Confucius

The next phase isn't nearly as hard. Managing a healthcare company isn't as difficult as building one. The rest is going to be very fun. ;)
Oh man...I love a good CPA. We didn't have a great one right away in the business and it cost us a decent amount of money.
 
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Thread starter #23
I am a few days away from a full policies & procedures manual that allows me to obtain a license & operate a clinic in the state of Pennsylvania. Which is everything in healthcare.

Healthcare isn't like any other industry I can think of. From a creation perspective, it is similar to a software app or website - in that you have to do all the work up front so that you are able to have any sort of operations. But rather than have instructions for a computer to execute, mine are for a team of people to use for instruction. And everything they do has to be written out in detail.

But rather than just have staff be relied on to know how to collect vitals or act in a fire drill, it all has to be on paper. I won't bore you with the details, but in aggregate, I have about 300 pages of policies written at 10.5 font, single-spaced, and formatted perfectly. The work has taken me the better part of 2.5 years. It has also taken a lot of my health.

And I'm nearing the finish line. My work has shifted from that of "entrepreneur" to that of "CEO". I am:
  • Making capital-allocation decisions
  • Reviewing legal documentation: which is fascinating because I have full control over the three companies I've formed
  • Coordinating with my first employees
  • Deciding on final aspects of our internal culture, design, and website
The legal piece I'm dealing with is fascinating because it is unique. It will be two companies that work together to operate healthcare clinics. I also have a third company that coordinates with both of them, as well as outside investors. In writing out operating agreements for these entities, there is no boilerplate for certain items within them. I have to draft what I want, as someone with voting control

But most importantly, and in addition to that bullet-point list above, I'm looking ahead. This work I have will enable me to operate in a lot of other areas of healthcare. Addiction medicine needs serious attention, but there are many ways to expand and I am not writing off any of them. I have added a junior partner who is helping me on this journey. He's getting up to speed quickly. And I'm getting excited.

I look forward to this phase being over, so that I can focus on my health. This journey has been grueling and I would not recommend it. But I have the rest of my life ahead of me to heal and to cater to the softer side of life.
 
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Sam

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#24
I am a few days away from a full policies & procedures manual that allows me to obtain a license & operate a clinic in the state of Pennsylvania. Which is everything in healthcare.

Healthcare isn't like any other industry I can think of. From a creation perspective, it is similar to a software app or website - in that you have to do all the work up front so that you are able to have any sort of operations. But rather than have instructions for a computer to execute, mine are for a team of people to use for instruction. And everything they do has to be written out in detail.

But rather than just have staff be relied on to know how to collect vitals or act in a fire drill, it all has to be on paper. I won't bore you with the details, but in aggregate, I have about 300 pages of policies written at 10.5 font, single-spaced, and formatted perfectly. The work has taken me the better part of 2.5 years. It has also taken a lot of my health.

And I'm nearing the finish line. My work has shifted from that of "entrepreneur" to that of "CEO". I am:
  • Making capital-allocation decisions
  • Reviewing legal documentation: which is fascinating because I have full control over the three companies I've formed
  • Coordinating with my first employees
  • Deciding on final aspects of our internal culture, design, and website
The legal piece I'm dealing with is fascinating because it is unique. It will be two companies that work together to operate healthcare clinics. I also have a third company that coordinates with both of them, as well as outside investors. In writing out operating agreements for these entities, there is no boilerplate for certain items within them. I have to draft what I want, as someone with voting control

But most importantly, and in addition to that bullet-point list above, I'm looking ahead. This work I have will enable me to operate in a lot of other areas of healthcare. Addiction medicine needs serious attention, but there are many ways to expand and I am not writing off any of them. I have added a junior partner who is helping me on this journey. He's getting up to speed quickly. And I'm getting excited.

I look forward to this phase being over, so that I can focus on my health. This journey has been grueling and I would not recommend it. But I have the rest of my life ahead of me to heal and to cater to the softer side of life.
You do need to go hard sometimes, glad you're going to be able to care of yourself a lot better in the near future!
 

Teliah Gienger

Well-known member
Messages
233
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309
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Location
Easton, WA
#25
I am a few days away from a full policies & procedures manual that allows me to obtain a license & operate a clinic in the state of Pennsylvania. Which is everything in healthcare.

Healthcare isn't like any other industry I can think of. From a creation perspective, it is similar to a software app or website - in that you have to do all the work up front so that you are able to have any sort of operations. But rather than have instructions for a computer to execute, mine are for a team of people to use for instruction. And everything they do has to be written out in detail.

But rather than just have staff be relied on to know how to collect vitals or act in a fire drill, it all has to be on paper. I won't bore you with the details, but in aggregate, I have about 300 pages of policies written at 10.5 font, single-spaced, and formatted perfectly. The work has taken me the better part of 2.5 years. It has also taken a lot of my health.

And I'm nearing the finish line. My work has shifted from that of "entrepreneur" to that of "CEO". I am:
  • Making capital-allocation decisions
  • Reviewing legal documentation: which is fascinating because I have full control over the three companies I've formed
  • Coordinating with my first employees
  • Deciding on final aspects of our internal culture, design, and website
The legal piece I'm dealing with is fascinating because it is unique. It will be two companies that work together to operate healthcare clinics. I also have a third company that coordinates with both of them, as well as outside investors. In writing out operating agreements for these entities, there is no boilerplate for certain items within them. I have to draft what I want, as someone with voting control

But most importantly, and in addition to that bullet-point list above, I'm looking ahead. This work I have will enable me to operate in a lot of other areas of healthcare. Addiction medicine needs serious attention, but there are many ways to expand and I am not writing off any of them. I have added a junior partner who is helping me on this journey. He's getting up to speed quickly. And I'm getting excited.

I look forward to this phase being over, so that I can focus on my health. This journey has been grueling and I would not recommend it. But I have the rest of my life ahead of me to heal and to cater to the softer side of life.
This is so impressive Andrew! Super proud of you!
 
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Thread starter #26
I am in the final stages of signing a lease for my first location. Negotiation has been interesting - the landlord wanted a personal guarantee from me to ensure he isn't outlaying excessive capital to update the unit (which has been empty for a few years now). To combat this, I offered to cover some of the renovation costs. Now I'm scratching my head at what renovating a 2,500 sq. ft. space will be. Carpets & ceiling updates are easy enough. But I'm also putting in some walls and adjusting a few other things accordingly. Any input would be appreciated :p

But that lease negotiation was a good experience as a young person. I may not be getting the same arrangement a seasoned person or existing company would get, but that's to be expected. I'm glad I found a lever I could pull to avoid the personal guarantee.

In other news, it seems I found more capital than I needed to get open. I've been talking to my investors to see if they might want to put in less money than they originally envisioned, or to have some of it wait on the sidelines in case it takes longer to get to a break-even point than I'm expecting. I don't want to sell too much equity too early, which is what would happen now if I took all the interested money in the door.

I feel really lucky about the physician I'm partnering with. He cares more about patients than about our company, which lets each of us focus on what we do best. He is also looking to slowly exit the specialty he's worked in most of his career, in favor of more addiction services.

With policies & procedures in hand, application for our license completed, a physician partner acting long-term as medical director, multiple investors backing the company, and a lease nearly finalized, I'm damn close. I also have some mock-ups of our logo and website. And my business partner has been steadily getting up to speed and helping in multiple areas - this is his first business.

Overall progress has been great. Keeping the good vibes flowing.
 

cvans

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#27
Awesome work, Andrew! Looks like you're pretty set for success.
You should post your logo concepts too, because they're amazing :)

So you got yourself a business partner, or is this referring to the physician?
 
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Thread starter #28
Awesome work, Andrew! Looks like you're pretty set for success.
You should post your logo concepts too, because they're amazing :)

So you got yourself a business partner, or is this referring to the physician?
Thanks!

And Both. A junior business partner who is new to business (he's a good friend), and I'm partnering with this physician as my Medical Director. Sorry for using the same word with both. I consider physicians I work with as partners, depending on their level of commitment.
 
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Sam

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#29
I am in the final stages of signing a lease for my first location. Negotiation has been interesting - the landlord wanted a personal guarantee from me to ensure he isn't outlaying excessive capital to update the unit (which has been empty for a few years now). To combat this, I offered to cover some of the renovation costs. Now I'm scratching my head at what renovating a 2,500 sq. ft. space will be. Carpets & ceiling updates are easy enough. But I'm also putting in some walls and adjusting a few other things accordingly. Any input would be appreciated :p

But that lease negotiation was a good experience as a young person. I may not be getting the same arrangement a seasoned person or existing company would get, but that's to be expected. I'm glad I found a lever I could pull to avoid the personal guarantee.

In other news, it seems I found more capital than I needed to get open. I've been talking to my investors to see if they might want to put in less money than they originally envisioned, or to have some of it wait on the sidelines in case it takes longer to get to a break-even point than I'm expecting. I don't want to sell too much equity too early, which is what would happen now if I took all the interested money in the door.

I feel really lucky about the physician I'm partnering with. He cares more about patients than about our company, which lets each of us focus on what we do best. He is also looking to slowly exit the specialty he's worked in most of his career, in favor of more addiction services.

With policies & procedures in hand, application for our license completed, a physician partner acting long-term as medical director, multiple investors backing the company, and a lease nearly finalized, I'm damn close. I also have some mock-ups of our logo and website. And my business partner has been steadily getting up to speed and helping in multiple areas - this is his first business.

Overall progress has been great. Keeping the good vibes flowing.
Awesome update!!!
 

Kylon

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#30
Bro really glad to hear things are progressing along nicely. Haha yeah I remember my first lease negotiation. Fun stuff.

Heard you talked to Auren as well! He said he really enjoyed the conversation.
 
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Thread starter #31
Thanks guys. I appreciate you being interested in what I'm up to. It's been a really weird, long year.

I'm at a point now where compensation & commitment negotiations/discussions have largely completed. There is little doubt that the hardest part of 1) regulations and 2) finding a first doctor/medical director are there. My stress and anxiety levels have fallen sharply, but they were high for quite some time. It's strange to watch your body not handle a situation. Starting companies isn't all rainbows and cotton candy.

I'm now searching actively for an alternative to the clinic office space I had in mind. I've realized there's a better part of the city to get started, and I've been looking at leasing somewhere around 3,000-5,000 sqft. I also have considered buying a building if the right one shows up. As with all things entrepreneurship, if your business is compelling enough, you should be able to find more funding.

If anyone here reads this and has input for commercial real estate: whether it's negotiation, structuring a deal, etc. I'd appreciate if you reached out! Otherwise I'm just going to see how this last leg comes together. Very excited with how close we are now.

Also @Kylon Auren is great. I've since reached out to him after our long talk. I hope to stay in touch with him and compare notes on integrating behavioral health with other areas of healthcare.
 

Gerrit

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#32
I'm now searching actively for an alternative to the clinic office space I had in mind. I've realized there's a better part of the city to get started, and I've been looking at leasing somewhere around 3,000-5,000 sqft. I also have considered buying a building if the right one shows up. As with all things entrepreneurship, if your business is compelling enough, you should be able to find more funding.
.
Reading this I realize I miss read our conversation. You're relocating before even starting. How does that work with your current space? Are you not bound to a contract for using that?
 
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Thread starter #33
@Gerrit
Yes, relocating before starting. I have not yet signed a lease. I have a draft lease in hand for the original planned location, but I am now looking at other locations. I have not seen patients yet anywhere.

We need a signed lease to apply for our license. Makes sense - you need a location to be able to practice. I am nailing down this final detail. Visiting properties this week.
 

Sam

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#35
Thanks guys. I appreciate you being interested in what I'm up to. It's been a really weird, long year.

I'm at a point now where compensation & commitment negotiations/discussions have largely completed. There is little doubt that the hardest part of 1) regulations and 2) finding a first doctor/medical director are there. My stress and anxiety levels have fallen sharply, but they were high for quite some time. It's strange to watch your body not handle a situation. Starting companies isn't all rainbows and cotton candy.

I'm now searching actively for an alternative to the clinic office space I had in mind. I've realized there's a better part of the city to get started, and I've been looking at leasing somewhere around 3,000-5,000 sqft. I also have considered buying a building if the right one shows up. As with all things entrepreneurship, if your business is compelling enough, you should be able to find more funding.

If anyone here reads this and has input for commercial real estate: whether it's negotiation, structuring a deal, etc. I'd appreciate if you reached out! Otherwise I'm just going to see how this last leg comes together. Very excited with how close we are now.

Also @Kylon Auren is great. I've since reached out to him after our long talk. I hope to stay in touch with him and compare notes on integrating behavioral health with other areas of healthcare.
Are you in touch with Luke Faulconer?
 
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