The challenge for the design team of the new Aurora Medical Center in Grafton, Wis., was providing a LEED Silver hospital while demonstrating a payback of the additional first cost. The design team targeted areas of highest energy use in standard health-care facilities, including fan energy, reheat, heating/cooling plant energy and lighting and then optimized the savings compared to first cost for a series of energy-efficient options. The result is a building that can be optimized to provide more than $340,000 in annual savings with a simple payback of less than four years.