ESAs allow big green renovations to happen without up front capital. The Kuakini Medical Centre, a 212 bed hospital in Honolulu, did a $5.8 million clean tech reno this way. The equipment is technically owned by an investment company that hired an engineering firm to create the design. Energy savings are guaranteed, and the engineers maintain the equipment for 20 years until the buyout. The hospital repays via monthly payments, but has zero up front cost, saves more on power than the payments, and has zero performance or maintenance risk. The project saves about $1.1 million on electricity annually.