A year and a half ago, if Jon Garnaas was asked about the types of new projects Ladco Development Inc. was targeting, he would have listed several classes of commercial properties.

For the past 12 to 15 months, however, his West Des Moines-based development company has largely focused on one key area: health-care projects.

“We’ve got 30 projects in some way, shape or form in the development queue for the balance of 2010 and 2011,” said Garnaas, who founded Ladco in 1989. “Of those projects, 24 of them are health care.”

When completed, the projects already under way will expand the company’s current portfolio of more than 1.5 million square feet of commercial space under management to well in excess of 2 million square feet.

Though many of Ladco’s projects have been in Central Iowa, the majority of its newest projects, both in number and contract value, are now located outside the state. The largest of those include a 200,000-square-foot medical office complex under construction in Lakewood, Colo., and a 113,000-square-foot medical center being built in Aberdeen, S.D.

“The non-health-care real estate opportunities are few and far between; at this point they’re not expanding,” said Dave Bridgewater, Ladco’s chief operating officer. “In the new health-care environment, health systems are looking for more efficient ways to deliver their services, and they’re looking for new, efficient facilities. That’s giving us the opportunity to develop more health-care projects.”

Having quick access to capital has also helped Ladco secure additional health-care projects. For the past three years, the company has partnered with Healthcare Realty Trust Inc., a publicly traded real estate investment trust (REIT) based in Nashville, Tenn., to provide additional financing for 10 major projects.

“This is a very challenging financial environment,” Bridgewater said. “Probably one of the largest issues for developers is the ability to obtain efficient, cost-effective financing. The way we’ve structured our partnership, we have the capital from day one. When we sit down with a health system, we’re not dependent upon finding third-party financing, whereas some of our competitors are. So we’ve taken some of the uncertainty out of the process.”

Both the Colorado project, a $55 million medical office complex, and the South Dakota project, a $55 million medical center, were financed through the Healthcare Realty joint venture.

Healthcare Realty’s joint venture with Ladco is the single largest partnership it has formed with any developer, said Ryan Crowley, the REIT’s director of acquisitions. The joint venture currently holds nearly $100 million of health-care assets; the projects in Colorado and South Dakota now under construction will double that amount, “with more to come,” he said.

“The joint venture has afforded us the opportunity to expand into attractive markets in a region where we didn’t have a significant presence,” Crowley said.

“Rather than attempt to re-create the local knowledge and relationships that Ladco had cultivated over many years, we decided it would be more valuable to build a partnership with a proven market leader,” he said.

Garnaas, who served in several senior management positions in banking prior to launching Ladco 21 years ago, has grown the business from two employees into a regional commercial real estate firm with about 100 employees. Its partner companies include Ladco Capital Inc., Ball Construction Services LLC, Taylor Kelly LLC, Ball Industrial Services LLC, Ladco Asset Management and Orchestrate Management & Associates.

In Greater Des Moines, some of Ladco’s high-profile projects include the 13-story Davis Brown Tower, the Mercy Wellness Campus in Clive, the Hilton Garden Inn Des Moines in Urbandale and numerous other professional, medical, hospitality and mixed-used buildings.

Two years ago, Ladco moved to its newly constructed headquarters in Village of Ponderosa, one of eight commercial buildings it has constructed so far in that mixed-use development in West Des Moines.

Ladco has structured each of its projects as a single-asset limited liability company, retaining an ownership interest in each property as well as providing ongoing property management and asset management services.

Unlike many commercial property managers, vacancies have not been an issue for Ladco, which has always focused on “tenant-driven” projects, Garnaas said. “Our overall portfolio is about 93 percent occupied,” he said.

Healthcare Realty, which as of midyear had total investments of approximately $2.3 billion in 206 real estate properties, mortgages and joint ventures in 28 states, sees continued growth in health-care development.

“Health-care systems and patients alike are embracing the idea of providing health care in the lowest-cost setting available, and often that is in an outpatient facility,” Crowley said.

“We believe that the steady proliferation of outpatient campuses and medical office buildings are driven not only by their efficient, low-cost nature, but also by the aging of the country’s population and its increased focus on health and wellness.”

Garnaas said Ladco’s core of institutional and individual high-net-worth investors also favor health-care developments as investments.

“I would say that we have a core group of stable accredited investors who have been with us from the beginning; they’re kind of our friends and family,” he said. “They’ve brought us to where we are, and we look to continue to broaden and deepen that relationship with those investors.

Investors recognize medical projects as a stable alternative to the stock market, Bridgewater said. “What we provide them is stable returns over the life of their real estate investment,” he said. “They see it as just a nice, steady piece of their investment portfolio.”

Though Ladco will still consider bank financing, it’s nice to have a non-bank alternative, Garnaas said, though he added that Healthcare Realty will never replace its core of investors. “The REIT is basically a complement to those individuals, but we will never forget who brought us to the dance,” he said.