Schedule

• Now that the One Big Beautiful Bill Act (OBBBA) is in the rearview mirror, Congress has another bite at the apple. What will they think of next?
• Several provisions in OBBBA affect nonprofit hospitals and academic medical centers, including changes to the excise tax on executive compensation, increasing the tax on university net investment income, and changes to the deduction for charitable contributions
• Beyond nonprofit tax changes, OBBBA reduces federal spending on Medicaid, alters Affordable Care Act eligibility and enrollment, and modifies Medicaid provider taxes
• The reduction of insured individuals, increased hospital costs, and reduced federal funding pose significant challenges. Will the next bill make matters better or worse?

Join us for a dynamic panel discussion featuring leading experts in tax and community benefit as they delve into the evolving landscape of community benefit reporting. Our panelists will share insights, best practices, and practical guidance on effectively demonstrating community impact while navigating increasing scrutiny around tax-exempt status. Topics will include:
 

• Strategies for robust and transparent community benefit reporting
• Key tax implications for nonprofit hospitals and healthcare organizations
• The significance of tax-exempt status
• Current issues, policy developments, and regulatory scrutiny facing exempt hospitals

This session is designed to keep attendees ahead of reporting expectations and defend tax-exempt health care organizations in a shifting and uncertain environment.

• State tax exemptions are not automatic: Non-profit hospitals must meet and document specific requirements, which are becoming more stringent in some states
• Charity care and community benefit: These are increasingly central to maintaining exemptions
• Variation: Requirements and enforcement vary widely by state and sometimes by locality

It’s a brave new world with AI storming into virtually every industry, including health care, consultancies and the practice of law. New challenges come with the new technology, including hallucinations, risks of inadvertent or unintentional disclosures of confidential information, amplification of bias, and more. This session will be part legal ethics, part governance, part what the heck is AI and more particularly, generative AI?

• Level Set—what is generative artificial intelligence (GenAI)?
• Examples of how attorneys (and other professionals) are using GenAI
• Attorneys’ duties under the Rules of Professional Conduct concerning use of GenAI
• Sampling of state bar guidelines for use of GenAI
• Key elements of firm policies on the use of GenAI

Health systems routinely engage in transactions, mergers, etc.. During the negotiation and due diligence, there are points and considerations that are easy to miss or gloss over. This presentation is meant to highlight common issues and provide thoughts on how to fix them after the fact, or better, to keep them in mind and plan or contract around them. The presentation focuses on how to get different departments proactively discussing issues and making the post-deal transition smoother. We will discuss some of the surprises often encountered in connection with absorption of newly acquired entities and how to manage them, including:

• What’s on the org chart? 
• Are Supporting Organizations supporting the right supported organizations?
• Did 501(r) policies get updated, approved and implemented?
• Are tax filings filed?
• Were each state’s property tax requirements accounted for?
• Were the Foundation and its assets properly updated?

• Overview of acquisition agreements and other health care transactions, including a walk-through of typical provisions and their significance
• The importance of due diligence (tax and more), including how disclosures impact the agreement and parties
• Understanding representations, conditions, covenants, and indemnification provisions (so many words, so little time!)
• Tax deliverables, FIRPTAs, tax prorations, allocations, tax return preparation and filing, tax elections, tax cooperation, access to records, tax payments–who is responsible for what, before and after the closing?
• Pre- and post-closing conduct of business–covenants, conditions, consents
• Post-closing disputes and indemnification, and why all those words really do matter

In recent years, hospitals’ reporting of community benefit expenditures on the Form 990 has come under increased scrutiny by Congress, the IRS, media, and public watchdog groups. Given this scrutiny, many hospitals are taking a second look at their community benefit reporting to determine whether they are completely and accurately capturing all of the community benefit they are providing.  This panel aims to assist in this effort by engaging in a detailed, line-by-line examination of each of the categories of community benefit reported on Schedule H of the Form 990, reviewing:

• Common questions and areas of uncertainty that arise when completing Part I of the Schedule H (line 7)
• Common areas of under- and over-reporting
• Practical difficulties in obtaining the necessary data for community benefit reporting;
• Challenges in determining the costs of financial assistance, Medicaid, and subsidized health services
• Issues associated with reporting community benefit on group returns

• Explore potential UBI activities: Understand the diverse range of unrelated business income (UBI) activities hospitals can engage in, from electric vehicle charging stations to catering services
• Effective communication: Learn strategies to communicate with other hospital departments to avoid unexpected taxable surprises
• Business ventures and taxable services: Identify business ventures and services that generate UBI, including joint ventures and healthcare supply chain activities
• Supporting smaller hospitals: Discover when helping smaller hospitals may create UBI challenges
• Community-focused nonpatient activities: Examine nonpatient activities that benefit the community while potentially generating UBI
• Potpourri activities: Discuss the role of professional development, Group Purchasing Organizations (GPO), and Durable Medical Equipment (DME) in creating UBI

This session will focus on key tax considerations and planning strategies for the use of LLCs by tax-exempt health care organizations, including:

• Using LLCs for acquiring assets, new operating companies, and new tax-exempt or for-profit ventures
• LLCs and the check-the-box entity classification rules, employment tax reporting, qualification for tax-exemption, charitable contributions, and unrelated business taxable income
• Considerations for LLCs within an overall health care system structure, including alternative status of eligible entities, tax planning with for-profit subsidiaries, federal M&A planning opportunities, joint ventures, and investments activities
• LLCs and tax compliance considerations including tax identification numbers, Form W-9 reporting, Form 990 reporting, employment tax reporting, state and local taxes, and other key areas

• The cornerstones of post-issuance tax-exempt bond compliance throughout the lifecycle of a bond issuance
• Metrics on the types of projects financed by health care institutions and types of private business use that commonly occur
• Deep dive on navigating real world complexities related to calculating private business use. E.g., simultaneous use, indirect use, unrelated use, and equity application
• IRS enforcement trends related to tax-exempt bonds and a review of the examination process through an example of an IRS Information Document Request
• Practical considerations in implementing a sustainable process for maintaining post-issuance compliance and how leveraging a system-based approach can be critical for avoiding pitfalls

Join us for a crash course on what tax leaders need to know now about employment tax! Topics will include:

• Remote work and multistate employers
• Federal tax implications of state Paid Family and Medical Leave laws
• Payment on demand
• Employment tax implications of the recently passed legislation

• Current trends in IRS Examinations: Insights into how IRS examinations are evolving, including recent changes in enforcement and compliance focus
• Preparation strategies for organizations: Best practices for ensuring readiness for IRS examinations, including documentation, internal audits, and compliance checks
• Common pitfalls and challenges: Identifying frequent issues organizations face during examinations and how to avoid them
• Collaboration between legal and tax professionals: The importance of teamwork in navigating compliance and addressing examination findings effectively
• Real-world examples: Analyzing recent IRS examination cases to illustrate successful strategies and lessons learned

• Medicaid updates: Recent legislative proposals aimed at expanding Medicaid coverage and funding, including debates on eligibility criteria and state-level implementation challenges
• 340B Drug Pricing Program: Ongoing legislative and regulatory efforts to reform the 340B program, including potential changes to eligibility criteria, pricing transparency, and the implications for hospitals and clinics serving vulnerable populations
• Medicare policy changes: Recent and proposed changes to Medicare, such as adjustments to payment models, and CMS enforcement efforts
• Health care policy outlook: Broader health care policy trends and legislative priorities on Capitol Hill including those withing the One Big Beautiful Bill Act
• Regulatory updates: Recent regulatory changes affecting health care providers, including compliance requirements, reporting standards, and enforcement actions by federal agencies

• Quantifying What’s at Stake: Understand what is at-risk and why it’s critical for organizations to measure the value of their federal and state tax-exempt status
• Strategic Collaboration: Explore how tax and legal teams can partner with leadership to navigate emerging risks and trends—while strengthening the narrative around community benefit
• Avoiding State Surprises: Unpack unexpected state-level reporting requirements and learn proactive strategies to stay compliant and prepared
• Navigating Private Benefit & Inurement: Gain insights into identifying and managing private benefit and inurement risks across internal stakeholders

Health systems routinely engage in transactions, mergers, etc.. During the negotiation and due diligence, there are points and considerations that are easy to miss or gloss over. This presentation is meant to highlight common issues and provide thoughts on how to fix them after the fact, or better, to keep them in mind and plan or contract around them. The presentation focuses on how to get different departments proactively discussing issues and making the post-deal transition smoother. We will discuss some of the surprises often encountered in connection with absorption of newly acquired entities and how to manage them, including:

• What’s on the org chart? 
• Are Supporting Organizations supporting the right supported organizations?
• Did 501(r) policies get updated, approved and implemented?
• Are tax filings filed?
• Were each state’s property tax requirements accounted for?
• Were the Foundation and its assets properly updated?

• Overview of acquisition agreements and other health care transactions, including a walk-through of typical provisions and their significance
• The importance of due diligence (tax and more), including how disclosures impact the agreement and parties
• Understanding representations, conditions, covenants, and indemnification provisions (so many words, so little time!)
• Tax deliverables, FIRPTAs, tax prorations, allocations, tax return preparation and filing, tax elections, tax cooperation, access to records, tax payments–who is responsible for what, before and after the closing?
• Pre- and post-closing conduct of business–covenants, conditions, consents
• Post-closing disputes and indemnification, and why all those words really do matter

• Current real estate tax exemption law and cases for health systems and universities-Appeal of Pottstown Hospital (Pa. 5/30/25) state and local legislation
• Scholarship and advocacy on hospital tax exemption, community benefit, state and local laws 
• Voluntary PILOT, “voluntary contributions,” service fees, service agreements, nonprofit assessment agreements, community benefits agreements, gifts programs; sample agreements - Cities of Boston, Baltimore, Ithaca, Palo Alto, Providence, Pittsburgh
• “Entangled and commingled” activities with for-profit entities, private equity, parent/affiliates
• Community advocacy and initiatives to tax exempt hospital and university property-Duke, New York mayoral nominee Mamdani

• Explore potential UBI activities: Understand the diverse range of unrelated business income (UBI) activities hospitals can engage in, from electric vehicle charging stations to catering services
• Effective communication: Learn strategies to communicate with other hospital departments to avoid unexpected taxable surprises
• Business ventures and taxable services: Identify business ventures and services that generate UBI, including joint ventures and healthcare supply chain activities
• Supporting smaller hospitals: Discover when helping smaller hospitals may create UBI challenges
• Community-focused nonpatient activities: Examine nonpatient activities that benefit the community while potentially generating UBI
• Potpourri activities: Discuss the role of professional development, Group Purchasing Organizations (GPO), and Durable Medical Equipment (DME) in creating UBI

This session will focus on key tax considerations and planning strategies for the use of LLCs by tax-exempt health care organizations, including:

• Using LLCs for acquiring assets, new operating companies, and new tax-exempt or for-profit ventures
• LLCs and the check-the-box entity classification rules, employment tax reporting, qualification for tax-exemption, charitable contributions, and unrelated business taxable income
• Considerations for LLCs within an overall health care system structure, including alternative status of eligible entities, tax planning with for-profit subsidiaries, federal M&A planning opportunities, joint ventures, and investments activities
• LLCs and tax compliance considerations including tax identification numbers, Form W-9 reporting, Form 990 reporting, employment tax reporting, state and local taxes, and other key areas

In recent years, hospitals’ reporting of community benefit expenditures on the Form 990 has come under increased scrutiny by Congress, the IRS, media, and public watchdog groups. Given this scrutiny, many hospitals are taking a second look at their community benefit reporting to determine whether they are completely and accurately capturing all of the community benefit they are providing.  This panel aims to assist in this effort by engaging in a detailed, line-by-line examination of each of the categories of community benefit reported on Schedule H of the Form 990, reviewing:

• Common questions and areas of uncertainty that arise when completing Part I of the Schedule H (line 7)
• Common areas of under- and over-reporting
• Practical difficulties in obtaining the necessary data for community benefit reporting;
• Challenges in determining the costs of financial assistance, Medicaid, and subsidized health services
• Issues associated with reporting community benefit on group returns

Join us for a crash course on what tax leaders need to know now about employment tax! Topics will include:

• Remote work and multistate employers
• Federal tax implications of state Paid Family and Medical Leave laws
• Payment on demand
• Employment tax implications of the recently passed legislation

• Current trends in IRS Examinations: Insights into how IRS examinations are evolving, including recent changes in enforcement and compliance focus
• Preparation strategies for organizations: Best practices for ensuring readiness for IRS examinations, including documentation, internal audits, and compliance checks
• Common pitfalls and challenges: Identifying frequent issues organizations face during examinations and how to avoid them
• Collaboration between legal and tax professionals: The importance of teamwork in navigating compliance and addressing examination findings effectively
• Real-world examples: Analyzing recent IRS examination cases to illustrate successful strategies and lessons learned