This guide outlines essential questions that healthcare institutions should consider when selecting an Energy-as-a-Service (EaaS) partner. It emphasizes the importance of transparent reporting for informed financial and operational decisions. The document details five critical questions that CFOs should ask, including whether the agreement can be structured off-balance sheet, which can enhance financial flexibility and preserve borrowing capacity. It also discusses the significance of guarantees that protect financial outcomes, ensuring accountability for savings projections. Additionally, the guide highlights the necessity of visibility and reporting, advocating for near real-time dashboards and ongoing financial reports. The impact on key financial metrics is addressed, noting that a well-structured EaaS agreement can improve various financial measures. Lastly, it stresses the need for the project scope to align with long-term operational priorities, including sustainability and capacity planning. This structured approach aims to assist institutions in making strategic decisions aligned with their financial goals.