When a regional health system determined that it wanted to syndicate new member units in an ambulatory surgery center (ASC), Stout was engaged to determined the fair market value of the center's equity for regulatory compliance purposes. The ASC was underutilized and produced only modest cash flow value based on a traditional discounted cash flow methodology. However, the center owned a difficult-to-obtain certificate of need (CON) required to commence operations, which created a barrier to entry for potential competitors. Stout separately determined the fair market value of the certificate of need using the Greenfield Approach. The CON value was incorporated into the overall determination of equity value using an Asset Approach. Our analysis was used by the health system for its planning purposes in setting the member unit offer price to local physicians.