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Johnston, R.I., Respiratory Therapy Business Expands Quickly.

Knight Ridder/Tribune Business News December 5, 2002 By Greg Coppa, Providence Journal, R.I. Knight Ridder/Tribune Business News Dec. 5–Bernard F. Lambrese started out 16 months ago with two employees in a small office in Johnston.

His business, Respiratory Solutions, Inc. now employs 40 people. The home respiratory-therapy provider plans to move to bigger offices in Lincoln and to open more satellite offices during the next year that will bring employment to 100. see here american home patient

The company’s growth has been financed in a series of steps, typical of small-business start-ups, said James P. Tiernan, senior vice president at Bank Rhode Island, a lender to Respiratory Solutions.

“Small business grows from money from founders, to angel investors, to a company like the Business Development Company of Rhode Island, to a bank loan,” he said.

Lambrese, 47, president and chief executive officer, and three other founders launched Respiratory Solutions in July 2001 by contributing a total of $300,000. In return, each received an equity stake.

Other steps in the financing plan included:

–A bridge loan from the partners of $250,000 for working capital.

–Another $400,000 in financing from Business Development Company of Rhode Island (BDCRI), a local organization that makes loans to companies that banks are not yet ready to finance. The $400,000 included a $250,000 line of credit for working capital and a $150,00 term loan for equipment purchases. In return, BDCRI received the rights to get a small equity stake.

–Equity financing of $1 million in August 2002 from several “angel” investors. They include Alan Solomont, Bruce Cerullo, and Patrick Ryan, all knowledgeable in the health-care industry. Cerullo and Ryan are on RSI’s board of directors and provide mentoring to company managers and access to a network of potential customers.

–A $1-million line of credit for working capital recently approved by Bank Rhode Island. The money replaced the working capital loan from BDCRI, which is now negotiating with Lambrese on an increased investment.

Dan Haggerty, Bank Rhode Island’s senior business lender, said, “Mr. Lambrese has identified a very profitable niche in the health-care industry and assembled an experienced team of health-care professionals to service it.” Respiratory Solutions provides a variety of respiratory therapy and home health-care services. The biggest part of the business is supplying oxygen.

The company also provides medications, treatments and devices, such as a nebulizer, which treats chronic obstructive pulmonary diseases (COPD), including emphysema and chronic bronchitis.

Lambrese said one treatment available to patients is for Obstuctive Sleep Apnea (OSA). The company also provides OSA patients with a treatment known as “continuous positive airway pressure” or CPAP. Basically, the patient wears a mask at night, which pushes lightly pressurized air into the airways, keeping them open. american home patient

Annual sales at Respiratory Solutions are about $3 million to $4 million. The company operates from a main office in Johnston and three satellite offices in Norwood and Georgetown, Mass., and in Falmouth, Maine.

Plans call for moving from the 2,000-square-foot office in Johnston to a 7,500-square-foot space in Lincoln in February.

The management team Lambrese has assembled includes several from a company called EvoCare, in East Providence, that he and his wife, Kelly, previously owned.

They sold the home infusion-therapy provider in 1998 to publicly traded American Home Patient. The Lambreses later became partners in a clinical research company, and remain equity holders, before starting Respiratory Solutions.

Lambrese has put together a management team that includes:

–Kelly Lambrese, a registered nurse with expertise in clinical operations and reimbursement, a key job because the company depends on government and insurance reimbursements.

–Peter Fontaine, also a registered nurse, who was vice president for business development at EvoCare and retains that title at RSI.

–Joseph Zangrilli, a respiratory therapist who specializes in developing home pulmonary-treatment programs.

–Audrey Hammond, the vice president for pharmacy services, who manages an in-house pharmacy that was recently licensed.

Lambrese said the company’s in-house pharmacy allows the company to provide medications with the treatments and services it offers.