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ww w .mi d w e s tcl e an e nerg y . o rg Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18, 2014 Cliff Haefke
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Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Dec 14, 2015

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Page 2: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o Increase overall energy efficiency and reduce utility bill expenditures?

o Reduce carbon emissions?

o Increase energy reliability, decrease reliance on the grid, andsupport grid T&D?

o Show more energy savings and reduce more emissions thancomparably sized PV and wind technologies?

o Support nation’s energy goals and is commercially available today?

The Answer?

CHP6

What technology can…

Page 3: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o Healthcare organizations spend > $6.5B annually

o Every $1 a non-profit healthcare organization saves on energy isequivalent to generating $20 in new revenues for hospitals

o For-profit hospitals can raise their earnings per share 1¢ by reducingenergy costs just 5%

o CHP systems can reduce energy costs and carbon emissions

o CHP systems can maintain hospitals’ power and heat during man- made and natural disasters

o 200+ hospitals operate CHP systems today

o 7 of Top 16 U.S. hospitals use CHP according to US News

Why CHP in Hospitals?

1)ENERGY STAR - http://www.energystar.gov/ia/business/challenge/learn_more/Healthcare.pdf2) DOE CHP Installation Database

3)US News’ 2013-2014 Honor Roll of the Nation’s Top 18 Hospitals:(John Hopkins, Mass. General, Mayo Clinic, Cleveland Clinic, NY Presbyterian, NYU Langone, Indiana University)

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Page 4: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

US DOE CHP TechnicalAssistance Partnerships

(TAPs)o U.S. DOE CHP Technical Assistance Partnerships (TAPs) originally established in 2001 by U.S. DOE and ORNL to support DOE CHP Challenge (formally known as RACs and CEACs)

o Today the 7 TAPs promote the use of CHP, District Energy, and Waste Heat to Power Technologies

o Strategy: provide a technology outreach program to end users, policy, utility, and industry stakeholders focused on:

– Market analysis & evaluation

– Education & outreach

– Technical assistance

o Midwest Website: www.midwestCHPTAP.org

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Page 5: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

DOE CHP Technical Assistance Partnerships (CH P TAPs)

MIDWESTwww.midwestCHPTAP.org

PACIFICwww.pacificCHPTAP.org

Terry ClaphamCalifornia Center for Sustainable Energy 858-244-4872terry.clapham@energycenter. org

Gene KoganCalifornia Center for Sustainable Energy [email protected]

DOE CHP TechnicalAssistancePartnerships (TAPs):Program Contacts

Dave SjodingWashington State University [email protected] .edu Cliff Haefke

University of Illinois at Chicago312-355-3476

John CutticaUniversity of Illinois at Chicago [email protected]

· ·•SOUTHWEST

www.southwestCHPTAP.or

Christine BrinkerSouthwest Energy Efficiency Project [email protected]

Claudia TigheCHP Deployment LeadOffice of Energy Efficiency andRenewable EnergyU.S. Department of EnergyPhone: 202-287-1 899E-mail: [email protected]

Jamey EvansProject Officer. Golden Field OfficeOffice of Energy Efficiency andRenewable EnergyU.S. Department of EnergyPhone: 720-356-1536E-mail: jam [email protected]

Patti Welesko Garland

CHP Technical Support Coordinato r DOE CHP TAPs CoordinatorOak Ridge National Laboratory

Supporting. Office of Energy Efficiency Supporting. Office of Energyand Renewable EnergyU.S. Department of EnergyPhone: 202-586-3753E-mail: [email protected]

NORTHEASTwww.northeastCHPTAP.org

Tom Bourgeois Pace University [email protected] KosanovicUniversity of Massachusetts Amherst [email protected]

Jim FreihautThe Pennsylvania State University 814-863-0083jdf I I @psu.edu

SOUTHEASTwww.southeastCHPTAP.org

Isaac PanzarellaNorth Carolina State University [email protected]

Ted Bronson

Power Equipment AssociatesEfficiency and Renewable EnergyPhone: 630-248-8778E-mail: [email protected]

Page 6: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o CHP: The Concept

o CHP: The Business Case

o CHP Project Profiles

o Next Steps & Incentives

Outline

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Page 7: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Fuel Utilization by U.S. Utility Sector

Source: http://www1.eere.energy.gov/manufacturing/distributedenergy/pdfs/chp_report_12-08.pdf

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Page 8: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

CHP: A Key Part of Our Energy Futureo Form of Distributed

Generation (DG)

o An integrated systemo Located at or near a

building / facility

o Provides at least a portion of the electrical load and

o Uses thermal energy for:

– Space Heating / Cooling

– Process Heating / Cooling

– Dehumidification

CHP provides efficient, clean,

reliable, affordable energy – today and

for the future.

Source: http://www1.eere.energy.gov/manufacturing/distributedenergy/pdf s/chp_clean_energy_solution.pdf

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Page 9: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

CHP Technology Components

Prime Mover

Reciprocating Engines Combustion

Turbines Microturbines

Steam Turbines Fuel

Cells

Electricity

On-Site Consumption

Sold to Utility

Fuel

Natural Gas Propane Biogas

Landfill Gas Coal

Steam Waste Products

Others

Generator

Heat Exchanger

Thermal

Steam Hot Water

Space Heating Process Heating Space Cooling

Process Cooling Dehumidification

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Page 10: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Emerging Drivers for CHP

o Benefits of CHP recognized by

policymakerso President Obama signed an Executive Order to accelerate investments in industrial EE and CHP on 8/30/12 that sets national goal of 40 GW of new CHP installation over the next decade

o State Portfolio Standards (RPS, EEPS, Tax Incentives, Grants, standby rates, etc.

o Favorable outlook for natural gas supply and price in North America

o Opportunities created byenvironmental drivers

o Energy resiliency and criticalinfrastructure

DOE / EPA CHP Report (8/2012)

Executive Order: http://www.whitehouse.gov/the-press- office/2012/08/30/executive-order-accelerating-

investment-industrial-energy-efficiencyReport: http://www1.eere.energy.gov/manufacturing/distr

ibutedene rgy/pdfs/chp_clean_energy_solution.pdf

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Page 11: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

CHP Is Used at the Point of Demand4,200 CHP Sites

(2012)

82,400 MW –installed capacity

Saves 1.8 quads of fuel each year

Avoids 241 M metric tons of CO2 each year

87% of capacity – industrial

71% of capacity – natural gas firedSource: ICF International

Page 12: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o Concern about energy costs

o Concern about power reliability

o Concern about sustainability and environmental impacts

o Long hours of operation

o Existing thermal loads

o Central heating and coolingplant

Favorable Characteristics forCHP Applications

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o Future central plant replacement and/or upgrades

o Future facility expansion ornew construction

projects

o EE measures alreadyimplemented

o Access to nearby renewable fuels

o Facility energy champion

Page 13: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Over 200 hospitals are using CHP today…

Source: ICF CHP Installation Database, 2013

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State # Sites Capacity (MW)

AR 1 8.5

AZ 2 1.7

CA 50 170.8

CT 12 28.5

FL 7 24.9

HI 3 1.5

IA 4 5.5

IL 13 41.4

IN 2 3.5

MA 9 108.8

MD 1 15.0

ME 2 5.1

MI 6 11.6

MN 4 30.1

MO 1 5.0

State # Sites Capacity (MW)

MS 1 4.2

NC 2 5.8

NH 2 9.2

NJ 8 11.1

NV 1 1.0

NY 39 56.1

OH 3 2.2

PA 11 83.9

RI 7 30.1

TN 2 3.5

TX 7 72.4

VA 3 3.2

VT 2 0.5

WI 7 11.7

Page 14: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o 212 facilities generating 756.6 MW

CHP Systems (#) CHP Gen Capacity (MW)

Existing CHP Installations inU.S. Hospitals

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Boiler / SteamTurbine CombinedCycleGas Turbine

Recip Engine

Fuel Cell

Microturbine

Other

Waste Heat

Boiler / Steam Turbine CombinedCycleGas Turbine

Recip Engine

Fuel Cell

Microturbine

Other

Waste Heat

Source: ICF CHP Installation Database, 2013

Page 15: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o Sizes TYPICALLY range from 100s of kWs to several MWs (dependingon facility size and usually below 10 MW)

o Common CHP prime mover types in hospitals are reciprocating engines, combustion turbines, and/or steam turbines (mostly fueled by natural gas)

o Most hospital CHP systems are sized for the thermal load requirements with the resulting electric power generated used to first offset the power purchased from the utility grid (excess power can be sold to the utility)

o CHP systems do not replace the need for emergency generator sets to meet the “life critical loads” of a hospital

– Can reduce the number and capacity of the emergency generators

– Can increase the total electric reliability for the hospital

Typical Hospital CHP SystemConfigurations

19Source:

http://www.midwestcleanenergy.org/Archive/pdfs/US HospitalGuidebook_111907.pdf

Page 16: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Emergency Generators

o Minimum requirement, sized to meet “life critical loads

o Hospitals are installing larger generators to protect more and more hospital loads

o Diesel fueled – high emissions & limited amount of stored fuel (hours versus days of operation)

o Not designed or capable of continuous operation for long periods of time – rarely operates

o Financial payback only in times ofemergency

Emergency Generators vs.

CHP SystemsCHP Systems

o Sized to meet thermal or electric loads – operates continuously to meet those loads

o Natural gas fueled – low emissions

o Does not replace emergency generator set for “life critical” loads

o Reduces overall size and capacity of emergency generator sets

o Emergency generator sets become backup to the backup; much higher reliability

o Good financial return

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Page 17: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o Reduces energy costs

o Increases energy efficiency, helps managecosts, maintains jobs, etc.

o Reduces risk of electric grid disruptions &enhances energy reliability

o Provides stability in the face of uncertain electricity prices

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CHP Benefits to Hospitals

Page 18: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profiles: Example CHP InstallationsExample Scenario CHP Facility

Hospital Utilities Expansion Northwest Community Hospital

Improved ENERGY STAR Building Score ProMedica Health System – Wildwood

Improved LEED Scoring – LEED Platinum Dell Children’s Medical Center of Central Texas

Alternative Financing Jesse Brown VA Medical Center

Addressing Momentary Power Interruptions Lake Forest Hospital

Disaster Relief – Hurricane Katrina Mississippi Baptist Medical Center

Disaster Relief – Super Storm Sandy Danbury Hospital

Disaster Prevention – Snow Storm Presbyterian Homes

Energy Independence Thermal Energy Corporation (TECO)

Energy Independence & Unique Partnerships Gundersen Lutheran Health System (La Crosse)

Energy Independence & Public / Private Partnerships Gundersen Lutheran Health System (Onalaska)

Page 19: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Utilities Expansion

Northwest Community HospitalArlington Heights, IL

Capacity: 4.6 MWFuel: Natural GasPrime Mover: Recip. EnginesInstalled: 1997 / 2005

"We said, ‘Well, if we're going to centralize it all, doesn't it make sense to do a CHP—and generate our own electricity, to reduce our demand load, and then capture the heat of those engines and utilize

all that for heating and/or cooling?' "Charlie Stevenson, Director of Plant Operations

Northwest Community Hospital

"The beauty of this CHP to him was not simply the return for the cogen system, but the fact that these savings would pay for the central energy plant too.”

Joe Sinclair, Ballard Engineering

Page 20: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Alternative Financing

Jesse Brown VA Medical Center Chicago, IL

Capacity: 3.4 MWFuel: Natural GasPrime Mover: Combustion TurbineInstalled: 2003

Energy Systems Group (ESG) raised $13 million funding for design, construction, and installation of the project by creating an owner trust,

which then sold bonds used for financing. In turn, the owner trust contracted with ESG to operate and maintain the CHP system for 25

years.

Source:http://www.distributedenergy.com/DE/Articles/Chicag o_VA_Hospital_Takes_Control_of_Its_Electrici_1838.aspx

Page 21: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Increased ENERGY STAR Building ScoreProMedica Health System - Wildwood Toledo, OH

Capacity: 130 kWFuel: Natural GasPrime Mover: MicroturbinesInstalled: 2013

Benefits includea reduction in annual

energy costs and greenhouse gas

emissions as well as a higher ENERGY

STAR building score

Source: www.gemenergy.com

Page 22: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:LEED Platinum

Dell Children’s Medical Center of Central Texas Austin, TX

Capacity: 4.6 MWFuel: Natural GasPrime Mover: Combustion TurbinesInstalled: 2009First healthcare facility in the

world to achieve a LEED Platinum certification by the U.S. Green

Building Council (USGBC)

Page 23: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Addressing Instantaneous Power InterruptionsLake Forest HospitalLake Forest, IL

Capacity: 3.2 MWFuel: Natural GasPrime Mover: Recip. EnginesInstalled: 1997

Annual Instantaneous Power Interruptions were reduced from

50 down to 2 due to CHP installation

Page 24: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Disaster Relief, Hurricane Katrina

Mississippi Baptist Medical Center Jackson, MS

Capacity: 4.2 MWFuel: Natural GasPrime Mover: Combustion TurbinesInstalled: 1991

The independence provided by the CHP system allowed MBMC to continue operation

relatively unaffected during Hurricane Katrina in 2005. As soon as power reliability

became a factor MBMC performed a load shed, switched off of the power grid, and

continued operation in turbine-only mode. MBMC was the only hospital in the Jackson

metro area to remain nearly 100% operational. After approximately 50 hours, the power

reliability issue was addressed and MBMC connected to the power grid and returned to

normal operation.

Source: http://www.southeastcleanenergy.org/resources/reports/CHP-MBMC.pdf

Page 25: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Disaster Relief, Super Storm Sandy

Danbury HospitalDanbury, Connecticut

Capacity: 4.5 MW / 3 MW StandbyFuel: Natural Gas / DieselPrime Mover: Combustion Turbine / Recip. Engine BackupsInstalled: 2011During the storm, the facility operated without any loss of

power and, despite most of the businesses in the

surrounding area being without power for several days,

Danbury Hospital still had lights and heat. The CHP facility

enabled the hospital to be fully functional during the storm

and continued conducting business and providing the

critical and necessary health care for patients.Source: http://www.newstimes.com/news/article/D anbury-Hospital-generates-power-for-its- patients-1345938.php#photo-829406

Page 26: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Addressing Extended

Power OutagesPresbyterian HomesEvanston, IL

Capacity: 2.4 MWFuel: Natural GasPrime Mover: Recip. EnginesInstalled: 2001

“The environment we provide to elderly adults had everything to do with our decision to pursue

power generation. Loss of power isn’t an option.

Lives depend on it.”- Keith Stohlgren, V/P Operations

“We had no power for nine hours one cold, winter day during an ice storm. The loss of power

forced us to take immediate, aggressive measures to ensure the comfort and safety of

our residents.”– Nancy Heald Tolan, Director of

Facilities Management

Ice storm in winter of 1998 knocked out power for 9 hours.• 600 senior residents were

transferred to safety• CHP installed to avoid future

outages

Page 27: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:100% Energy Independence

Thermal Energy Corporation (TECO) Houston, TX

Capacity: 48 MWFuel: Natural GasPrime Mover: Comb. TurbinesInstalled: 2010

TECO operates the largest chilled water district energy system in the U.S. at the largest medical center in the world, the Texas Medical Center.

The CHP system can operate as a baseload system to serve 100% of the TECO plant peak electrical load and 100% of TECO customers’ peak process and

space heating loads.

Page 28: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Energy Independence & Unique Partnerships

Gundersen Lutheran& City BreweryLa Crosse, IL

Capacity: 633 kWFuel: BiogasPrime Mover: Recip. EngineInstalled: 2009

Hospital owns CHP system at local brewery. Heat from CHP system used to heat digester, electricity is sold to utility, and electric sales/credit go to

hospital.

Page 29: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Project Profile:Public & Private Partnerships

Gundersen Lutheran& County LandfillOnalaska, IL

Capacity: 1.2 MWFuel: Landfill GasPrime Mover: Recip. EngineInstalled: 2011Instead of simply generating

electricity at landfill, landfill gas is piped 2 miles to hospital where CHP

system provides all required electricity and thermal energy.

Claim to be first energy independent hospital in U.S.

Page 30: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Advanced Manufacturing Office (AMO) manufacturing.energy.gov34

CHP TAP Project Development

Technical Assistance

Screening and Preliminary

Analysis

Feasibility Analysis

Investment Grade Analysis

Procurement, Operations,

Maintenance, Commissioning

Uses available site information.Estimate: savings, Installation costs, simple paybacks, equipment sizing and type.

Quick screening questions with spreadsheet payback calculator.

3rd Party review of Engineering Analysis.Review equipment sizing and choices.

Review specifications and bids,Limited operational analysis

Page 31: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o High level assessment to determine if site shows potential for a CHP project

– Qualitative Analysis

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• Energy Consumption & Costs

• Estimated Energy Savings &Simply Payback

• CHP System Sizing

– Quantitative Analysis• Understanding project drivers

• Understanding site peculiarities

DOE TAP CHP Screening Analysis

Annual Energy Consumption

Base Case CHP Case

Purchased Electricty, kWh 88,250,160 5,534,150Generated Electricity, kWh 0 82,716,010

On-site Thermal, MMBtu 426,000 18,872

CHP Thermal, MMBtu 0 407,128Boiler Fuel, MMBtu 532,500 23,590CHP Fuel, MMBtu 0 969,845

Total Fuel, MMBtu 532,500 993,435

Annual Operating Costs

Purchased Electricity, $ $7,060,013 $1,104,460Standby Power, $ $0 $0

On-site Thermal Fuel, $ $3,195,000 $141,539

CHP Fuel, $ $0 $5,819,071Incremental O&M, $ $0 $744,444

Total Operating Costs, $ $10,255,013 $7,809,514

Simple Payback

Annual Operating Savings, $ $2,445,499Total Installed Costs, $/kW $1,400Total Installed Costs, $/k $12,990,000

Simple Payback, Years 5.3

Operating Costs to Generate

Fuel Costs, $/kWh $0.070

Thermal Credit, $/kWh ($0.037)

Incremental O&M, $/kWh $0.009

Total Operating Costs to Generate, $/kWh $0.042

Page 32: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o 10% Federal Investment Tax Credit (ITC) for CHP

o DOE Better Buildings Challenge, Financial Allies have committed nearly $2B to fund EE projects*

o Waste Heat Recovery (WHR) is eligible in MidAmerican Energy Efficiency Resource Standard (EERS)

o 3rd Party Build-Own-Operators of CHP Opportunities?

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– How does the July 2014 Iowa Supreme Court Ruling on solar projects impact CHP 3rd Party Ownership?

* http://www4.eere.energy.gov/challenge/allies/financial-allies

Incentives and Financing

Page 33: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

o Healthcare organizations spend > $6.5B annually

o Every $1 a non-profit healthcare organization saves on energy isequivalent to generating $20 in new revenues for hospitals

o For-profit hospitals can raise their earnings per share 1¢ by reducingenergy costs just 5%

o CHP systems can reduce energy costs and carbon emissions

o CHP systems can maintain hospitals’ power and heat during man- made and natural disasters

o 200+ hospitals operate CHP systems today

o 7 of Top 16 U.S. hospitals use CHP according to US News

Why CHP in Hospitals?

1)ENERGY STAR - http://www.energystar.gov/ia/business/challenge/learn_more/Healthcare.pdf2) DOE CHP Installation Database3)US News’ 2013-2014 Honor Roll of the Nation’s Top 18 Hospitals:(John Hopkins, Mass. General, Mayo Clinic, Cleveland Clinic, NY Presbyterian, NYU Langone, Indiana University)

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Page 35: Www.midwestcleanenergy.org Combined Heat & Power (CHP) Opportunities for Hospital Facilities Iowa Society of Healthcare Engineers (ISHE) September 18,

Other Resourceso Powering the Future of Health Care – Financial

and Operational Resilience: A CHP Guide for Massachusetts Hospital Decision Makers (HCWH)

o Advanced Energy Design Guide for Large Hospitals (ASHRAE)

o Advanced Energy Design Guide for Small Hospitals and Healthcare Facilities (ASHRAE)

o Combined Heat & Power (CHP) Resource Guide forHospital Applications (Midwest CEAC)

o Guide to Using Combined Heat and Power for Enhancing Reliability and Resiliency in Buildings (DOE/EPA)

1 - http://www.greenribboncommission.org/downloads/CHP_Guide_091013.pdf2 - https://www.ashrae.org/standards-research--technology/advanced-energy-design-guide

s3 - https://www.ashrae.org/standards-research--technology/advanced-energy-design-guide

s4 - http://www.midwestchptap.org/Archive/pdfs/USHospitalGuidebook_111907.pdf5 - http://www1.eere.energy.gov/manufacturing/distributedenergy/pdfs/chp_for_reliability_guidance.pdf

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