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Tax Issues for Health Care Organizations 2022

Schedule

This program will be formatted as a traditional two day in-person program - we are excited for attendees to connect and network in person. The program will begin on Monday, October 24 at 8:00 am and end on Tuesday, October 25 at 3:15 pm. Visit on Continuing Education Information page for the number of credits available. 

AHLA is committed to providing a safe and healthy environment for program participants and staff. AHLA has adopted preventative measures to reduce the potential spread of the COVID-19 virus, including proof of vaccine or a negative PCR test, and is following guidance provided by the US Centers for Disease Control and local authorities. Attendees are also expected to do their part and abide by AHLA’s Duty of Care.


Faculty Information

 


Monday, October 24, 2022

7:00 am-5:30 pm

Registration and Check-In
Come to AHLA Registration area to print out your badge. We'll need your proof of vaccine or negative PCR test on the Clear Health App.

7:00 8:00 am

Continental Breakfast
 This event is included in the program registration. Attendees, faculty, and registered spouses and guests welcome

8:00-10:30 am GENERAL SESSION

8:00-8:15 am
Welcome and Introduction
Thomas Shorter, AHLA President
Karen Wolfson, Program Chair

8:15-9:15 am
1. IRS Update​
Rachel Leiser Levy
Rob Malone
2021-2022 Priority Guidance Plan Fourth Quarter Update, released August 17, 2022
Section 6104(c) Regulations
2022 Sch H Instructions, Parts I & II updates
General employment tax update
IRS Return to Office updates
FY 2023 Program Letter
EO Examination updates
EO Determination updates

9:15-10:30 am
2. Capitol Hill Update​
Alexander L. Reid (Moderator)
Nicholas Bath
Shawn Bishop
Zachary Brown
Vivek A. Chandrasekhar
Drew Crouch
 Major public policy initiatives in health care, such as the premium costs of health insurance under the Affordable Care Act
 The new excise tax on manufacturers who are not incompliance with the terms of the Medicare drug price negotiation program
 The fate and history of the drug price negotiation program
 Recent changes to the high deductible health plan safe harbor to allow for no deductible for insulin products
The expiring charitable contribution tax incentives, application of the corporate AMT to exempt organizations, and much more!

10:30-11:00 am

Networking Coffee Break

 
11:00 am-12:15 pm Extended Sessions

3. Community Benefit / 501 R (Interactive Session)
Karen Wolfson (Moderator)
Ray Bunyard
Robert W. Friz
Janice M. Smith

  • Why capturing community benefit expenditures is more important than ever
  • How traditional approaches to community benefit tracking may fall short and how to rethink those approaches
  • How to ensure that your section 501(r) compliance initiatives are not derailed
  • Current common section 501(r) compliance challenges and how to solve them
  • Achieving transparency: Understanding your peer hospitals and the potential reporting differences
 

4. When Exempt Organizations Meet Innovation – Equity Based Compensation and Other Alternatives (Interactive Session)
Gerald M. Griffith
Scott D. Schitter

  • When is reliance on benchmark data insufficient – identifying structural inurement and private benefit
  • Pros and cons of blockers
  • Emphasizing performance and return on investment over the long-term – when LTIPs may be preferable to equity compensation
  • Impact of Sections 4958 and 4960 excise taxes on joint venture compensation
  • Dealing with conflicts of interest
  • Form 990 disclosure implications of equity compensation
 
12:15-1:45 pm

Lunch on your own or attend the Networking Lunch, sponsored by Deloitte
ESG in the Tax-exempt, Health Care Environment​​

Charles Wilhoite, Alicia Janisch
The interactive discussion will focus on:
• Understanding ESG (Environmental Social Governance) and the landscape in the U.S.
• Understanding how ESG impacts health care operations and strategic planning in the tax-exempt environment
• Recognizing and taking advantage of ESG-related tax benefits currently available in the marketplace

This is not included in the program registration; there is an additional fee of $65; limited attendance; and pre-registration is required. Continuing Education Credits are not available.

 
2:00-3:00 pm

5. Spotlight on Captive Insurance Companies 
(not repeated)

Kristen E. Hazel
Elizabeth M. Mills

  • Structure and jurisdiction options for captives
  • Foundational tax principles for the insurer and the insured
  • Regulatory issues
  • Onshoring the offshore captive

 

 

6. Hot UBTI Topics
John Crawford
James J. Janssen

This session will review continuing and emerging UBTI questions facing healthcare organizations today, including, but not limited to, the following:

  • Continued impact of, and issues related to, section 512(a)(6)
  • IRS examination activity of NOLs and expense allocations
  • Impact of diversified revenue streams, including receipt of bundled payments from self-insured employers
  • Other hot UBTI topics
 

7. Managing the Tax Consequences of Alternative Investments​
Edward Jennings
Jennifer Richter

  • Strategies and 'best practices' to help health care systems and hospitals manage tax liabilities and risks regarding alternative investments
  • Liabilities and risks include federal and state unrelated business taxable income (UBTI) and related issues, such as, general business and foreign tax credits, including filing for refund claims, the newly released Schedules K-2 and K-3, business interest limitations, GILTI, etc.
  • Filing forms for foreign investments and reportable transactions, including prohibited tax shelter transactions.
  • Strategies include the use of blocker corporations
  • Best practices include conducting due diligence reviews, including memorandums and checklists, as well as trend analyses and forecasts to manage various 'silos'
  • The audience will leave with a better understanding of these tax implications and will appreciate developing relationships with their investment teams as well as external management firms who manage these risks and liabilities
 
3:15-4:15 pm

8. Legal Ethics: Conundrums in Nonprofit Governance
(not repeated)
Thomas K. Hyatt

This session will address common governance challenges and their related ethics questions in the representation of nonprofit organizations. Topics will include:

  • Who is the client?
  • Fiduciary duties of directors
  • Resolving financial and duality of interest conflicts
  • Does the board need its own counsel?
  • When lawyers serve on the board
  • Who should negotiate the CEO’s contract?
 

9. Give the People What They Want - True Choice Benefit Arrangements to Attract and Retain the Changing Workforce
Andrew Hedgpeth
Molly Hobbs

The priorities and expectations of today’s workforce are changing. At the core of these changes are the priorities and expectations of the employees benefit package. Some employees value a flexible work schedule, others want more time off, or more cash, or a higher hourly wage in lieu of benefits, still others desire a traditional benefits package. The options are almost endless. This presentation will focus on how organizations can develop strategies aimed to provide employees true “cash-in-lieu” or “opt-out” arrangements in their benefits selection.

With true choice arrangements also comes cautions to potential problems and challenges in meeting the requirements of the Internal Revenue Code, the Employee Retirement Income Security Act (“ERISA”), the Affordable Care Act (“ACA”), and several other federal laws. The presentation will address compliance with these legal requirements and provide specific program design examples and scenarios.

 

10. Remote Work: Implications, Challenges, and Trends​
Eira Jones
Rebecca Lyons

  • Key employment tax and reward implications of remote and hybrid working
  • Challenges/Future state trends for remote work
  • Remote work policy, governance and operational strategies organizations can deploy to better manage their remote work programs
 
4:30-5:30 pm

11. ACOs, HMOs, and Tax-Exempt Status
(not repeated)

Michael Fine
Preston Quesenberry

The IRS is currently litigating its denial of section 501(c)(4) status to an accountable care organization in Tax Court–the first time a court has considered the section 501(c)(4) status of a health care organization in more than 12 years. This panel will discuss:

  • The IRS and taxpayer’s arguments in that case and discuss their potential implications for other health care organizations claiming section 501(c)(4) status, such as health maintenance organizations
  • The IRS’s evolving positions on whether and when arranging and coordinating health care promotes social welfare and discuss what health care systems should consider when seeking and maintaining tax-exempt status for HMOs, ACOs, and similar entities
  • Whether and under what circumstances the presence of certain health insurance providers in a health care system might effectively exempt the system from excise tax under section 4960
 

12. Telemedicine
Cynthia Meise Jones
Justin C. Stringfield
John T. Woodruff

The COVID-19 pandemic accelerated hospitals’ and healthcare providers’ incorporation of telehealth and in particular telemedicine into their delivery of services – a process that had already been underway due to improvement in technology, growing consumer comfort with virtual interactions, and efforts to control costs.  This panel will address a number of tax issues associated telehealth services, including –

  • Whether and under what circumstances telemedicine may generate UBTI
  • State and local tax issues, including when telemedicine services cross state boundaries
  • International tax issues when telemedicine services cross international borders, including the potential for foreign tax liability and foreign reporting obligations

Our discussions will focus on three types of telemedicine services commonly delivered:

  • Virtual patient care delivery
  • Virtual consults
  • Remote patient monitoring
 

13. Tax Issues in Current Health Care Transactions–Still There (Even if Late to the Party)
Travis F. Jackson
Linda Moroney

  • Recent transaction volume and trends
  • Relevant tax concepts–qualification for exemption, public charity status, private benefit/inurement and excess benefit, conflicts of interest, unrelated business income, required tax filings, 501(r), and more
  • Models currently being used for M&A transactions, other strategic affiliations, and joint ventures
  • Case studies of transaction models and structures–issue spotting, potential alternatives, and risk mitigation strategies
 
5:30-6:30 pm

Networking Reception, sponsored by EY
This event is included in the program registration. Attendees, faculty, and registered spouses and guests welcome.

 


Tuesday, October 25, 2022

7:00 am-3:15 pm

Registration and Check-In
If you have not already checked in, come to AHLA Registration area to print out your badge. We'll need your proof of vaccine or negative PCR test on the Clear Health App.

 
7:00-8:00 am

Continental Breakfast
This event is included in the program registration. Attendees, faculty, and registered spouses and guests welcome.

 
8:00-10:00 am GENERAL SESSION

8:00-9:00 am
14. Non-Profit Corporate Governance with State Attorney's Office
Courtney Aladro
Yael Fuchs

9:00-10:00 am
15. IRS Examinations​
Meghan Biss
Casey Lothamer

 
10:00-10:30 am
Networking Coffee Break
 
10:30-11:30 am

9. Give the People What They Want –True Choice Benefit Arrangements to Attract and Retain the Changing Workforce
(repeat)

Andrew Hedgpeth
Molly Hobbs

The priorities and expectations of today’s workforce are changing. At the core of these changes are the priorities and expectations of the employees benefit package. Some employees value a flexible work schedule, others want more time off, or more cash, or a higher hourly wage in lieu of benefits, still others desire a traditional benefits package. The options are almost endless. This presentation will focus on how organizations can develop strategies aimed to provide employees true “cash-in-lieu” or “opt-out” arrangements in their benefits selection.

With true choice arrangements also comes cautions to potential problems and challenges in meeting the requirements of the Internal Revenue Code, the Employee Retirement Income Security Act (“ERISA”), the Affordable Care Act (“ACA”), and several other federal laws. The presentation will address compliance with these legal requirements and provide specific program design examples and scenarios.

 

10. Remote Work: Implications, Challenges, and Trends​
(repeat)

Eira Jones
​Rebecca Lyons

  • Key employment tax and reward implications of remote and hybrid working
  • Challenges/Future state trends for remote work
  • Remote work policy, governance and operational strategies organizations can deploy to better manage their remote work programs
 

13. Tax Issues in Current Health Care Transactions–Still There (Even if Late to the Party)
(repeat)

Travis F. Jackson
Linda Moroney

  • Recent transaction volume and trends
  • Relevant tax concepts–qualification for exemption, public charity status, private benefit/inurement and excess benefit, conflicts of interest, unrelated business income, required tax filings, 501(r), and more
  • Models currently being used for M&A transactions, other strategic affiliations, and joint ventures
  • Case studies of transaction models and structures–issue spotting, potential alternatives, and risk mitigation strategies
 
11:30 am-12:30 pm
Lunch on your own
 
12:45-1:45 pm

6. Hot UBTI Topics
(repeat)

John Crawford
James J. Janssen

This session will review continuing and emerging UBTI questions facing healthcare organizations today, including, but not limited to, the following:

  • Continued impact of, and issues related to, section 512(a)(6)
  • IRS examination activity of NOLs and expense allocations
  • Impact of diversified revenue streams, including receipt of bundled payments from self-insured employers
  • Other hot UBTI topics
 

7. Managing the Tax Consequences of Alternative Investments​
(repeat)

Edward Jennings
Jennifer Richter

  • Strategies and 'best practices' to help health care systems and hospitals manage tax liabilities and risks regarding alternative investments
  • Liabilities and risks include federal and state unrelated business taxable income (UBTI) and related issues, such as, general business and foreign tax credits, including filing for refund claims, the newly released Schedules K-2 and K-3, business interest limitations, GILTI, etc.
  • Filing forms for foreign investments and reportable transactions, including prohibited tax shelter transactions.
  • Strategies include the use of blocker corporations
  • Best practices include conducting due diligence reviews, including memorandums and checklists, as well as trend analyses and forecasts to manage various 'silos'
  • The audience will leave with a better understanding of these tax implications and will appreciate developing relationships with their investment teams as well as external management firms who manage these risks and liabilities
 

12. Telemedicine
(repeat)

Cynthia Meise Jones
Justin C. Stringfield
John T. Woodruff

The COVID-19 pandemic accelerated hospitals’ and healthcare providers’ incorporation of telehealth and in particular telemedicine into their delivery of services – a process that had already been underway due to improvement in technology, growing consumer comfort with virtual interactions, and efforts to control costs.  This panel will address a number of tax issues associated telehealth services, including –

  • Whether and under what circumstances telemedicine may generate UBTI
  • State and local tax issues, including when telemedicine services cross state boundaries
  • International tax issues when telemedicine services cross international borders, including the potential for foreign tax liability and foreign reporting obligations

Our discussions will focus on three types of telemedicine services commonly delivered:

  • Virtual patient care delivery
  • Virtual consults
  • Remote patient monitoring
 
2:00-3:15 pm Extended Sessions

3. Community Benefit / 501 R (Interactive Session)
(repeat)

Karen Wolfson (Moderator)
Ray Bunyard
Robert W. Friz
Janice M. Smith

  • Why capturing community benefit expenditures is more important than ever
  • How traditional approaches to community benefit tracking may fall short and how to rethink those approaches
  • How to ensure that your section 501(r) compliance initiatives are not derailed
  • Current common section 501(r) compliance challenges and how to solve them
  • Achieving transparency: Understanding your peer hospitals and the potential reporting differences
 

4. When Exempt Organizations Meet Innovation – Equity Based Compensation and Other Alternatives (Interactive Session)
(repeat)

Gerald M. Griffith
Scott D. Schitter

  • When is reliance on benchmark data insufficient – identifying structural inurement and private benefit
  • Pros and cons of blockers
  • Emphasizing performance and return on investment over the long-term – when LTIPs may be preferable to equity compensation
  • Impact of Sections 4958 and 4960 excise taxes on joint venture compensation
  • Dealing with conflicts of interest
  • Form 990 disclosure implications of equity compensation
 

 

In-Person Program Format

How It Works

  • We will offer in-depth breakout sessions where speakers and attendees can interact and collaborate with each other in-person.
  • We consider the health and safety of all those onsite at in-person programs our top priority. AHLA will follow guidance and requirements issued by the CDC as well as by state and local government.. 
  • All attendees, who register for the in-person program, will be required to commit to our Duty of Care agreeing to follow the protocols we establish and monitor their own health for the health and safety of all. 
  • We have adopted a new onsite registration system by providing seamless check-in, onsite badge printing, and safety supplies to all attendees to use while in attendance.
  • Built-in extended time between sessions for moving from room to room, networking with colleagues, and personal break time.  
  • Socially distanced seating arrangements in breakout rooms, regular cleaning in and around meeting spaces, and appropriate signage/floor decals to reinforce spatial distancing and other safety reminders.
  • All program sessions will be recorded. Video of the presentations, along with the materials will be available to all attendees who register to apply for additional On Demand Continuing Education Credits. Those that cannot attend in-person can purchase the eProgram and apply for Continuing Education Credits. More information on our ePrograms.

Benefits of the In-Person Program

  • Step out from behind your computer and network face-to-face with other health law professionals.
  • Interact with colleagues at in-depth breakout sessions.
Program Accessibility and Special Needs

AHLA is committed to ensuring equitable access to our educational content. We are continually improving the user experience for everyone and offering accessibility accommodations for our in-person programs.

Learn More

Thank You to Our Tax Issues for Health Care Organizations Sponsors

Deloitte logoEY logoKPMG logoNtracts logoPWC logoWillamette Management Assoc logowithum logo

If your organization is interested in sponsoring AHLA's Tax Issues for Health Care Organizations program, please contact Valerie Eshleman.