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Tax Issues for Health Care Organizations

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.
 


Monday Schedule

 


Tuesday Schedule

     

Monday, October 23, 2023

7:00 am-5:15 pm

Registration and Check-In
Come to AHLA Registration area to print out your badge.

 
7:00-8:00 am

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

 
8:00-10:30 am General Session

8:00-8:15 am
Welcome and Introductions

Patricia Markus, AHLA President
Karen L.P. Wolfson, Program Planning Chair

8:15-9:15 am
1. IRS Update

Lynne Camillo, Deputy Associate Chief Counsel, EEE:EOET, Washington, DC
Geoffrey M. Campbell, Tax Law Specialist, Exempt Organizations Division, Internal Revenue Service, Washington, DC
Michael J. Gruccio, Attorney, Exempt Organizations, Internal Revenue Service, Office of Chief Counsel, Washington, DC
Robert Malone, Director, Exempt Organizations and Government Entities Division, Internal Revenue Service, Washington, DC
Laura Warshawsky, Deputy Associate Chief Counsel, EEE:EB, Washington, DC

More Information

  • FY 2023 Program Letter

  • EO Exam Updates

  • EO Determinations Updates

  • Clean Energy Credits

  • EO Guidance Update

  • EO Litigation Update

  • General Employment Tax Update

  • 2022-2023 Priority Guidance Plan Fourth Quarter Update

9:15-10:30 am
2. Capitol Hill Update

Ann Cammack, Senior Tax Counsel, Senate Finance Committee, Majority Staff, Washington, DC
Matthew Muma, Joint Committee on Taxation, Washington, DC
Casey R. Quinn, US House Committee on Ways & Means, Washington, DC
Alexander L. Reid, BakerHostetler, Washington, DC

More Information

  • House Committee on Ways and Means oversight plan to investigate tax-exempt organizations with regard to IRS monitoring and enforcement of noncompliance, abuse, and disclosure; hearing on nonprofit hospitals

  • Senate Finance Committee, letter from Senator Warren and Senator Wyden to McKinsey & Co. relating to work for Providence hospital to implement fee collection actions and compliance with 501(r)

  • Drug pricing and Medicare price negotiation, individual coverage, codification of Health Reimbursement Arrangements (HRAs), health plan price transparency, and the Medicare negotiations

 
10:30-11:00 am

Networking Coffee Break, sponsored by EY

 
11:00 am-12:15 pm Extended Concurrent Sessions

3. Unclaimed Property (not repeated)
Ryan W. Hartman, Crowe LLP, Phoenix, AZ
Sara A. Lima, ReedSmith, Philadelphia, PA
Scott D. Schitter, Vice President, Tax, Bon Secours Mercy Health, Cincinnati, OH

More Information

  • All fifty states and various territories have unclaimed property requirements. Health care companies can be subject to compliance requirements in any state where they have patients, providers, insurers, customers, shareholders, vendors, or employees

  • The health care specific reporting considerations, as well as best practices for risk mitigation, including voluntary disclosure programs

  • Audits in light of increasing focus on the health care industry, as well as relevant litigation and legislative developments

  • Unclaimed property opportunities such as refund claims and AR credit balance and exemption reviews

4. Community Benefit Reporting: Back in the Spotlight Again​
Mike Cincotta, Senior Manager, EY, Boston, MA
Julie Trocchio, Senior Director, Community Benefit and Continuing Care, Catholic Health Association, Chevy Chase, MD

More Information

  • Not-for-profit hospital community benefits are a well-defined set of activities mandated by Affordable Care Act (ACA) requirements and IRS rules

  • Yet, congress and some academics are questioning whether the rules are sufficient and whether they are enforced by IRS

  • The IRS definition of community benefit and how hospitals are required to assess community health needs, plan to meet identified needs and evaluate the impact of their plans

  • Requirements for IRS oversight of community benefit and how that enforcement has played out

  • How hospital legal, advocacy and communications departments can work together to tell the community benefit story

5. Tax Considerations and Implications of Health Care Joint Ventures Between For-Profit and Tax-Exempt Entities​
Robert W. Friz, PwC, Philadelphia, PA
Gerald M. Griffith, Jones Day, Chicago, IL
Jennifer R. Noel, Corporate Director of Tax, ChristianaCare, Wilmington, DE

More Information

  • Within the current health care landscape, it may be advantageous to enter joint ventures, partnerships, or other third-party arrangements that enable health care providers to best support their patients

  • However, these types of arrangements may trigger tax or other reporting consequences that should be considered and addressed at the outset

  • This session will discuss the various tax-related issues that may arise when implementing a joint venture or similar arrangement

  • Further, it will provide suggestions for addressing these issues in the negotiations so that resolutions may be memorialized in the organizing documents for the arrangement

 
12:15-1:45 pm

Lunch on your own or attend the Networking Lunch and Presentation

Are T/E Hospitals Doing Enough? Current Headline Discussion
Alicia Janisch, Deloitte Tax LLP, Detroit, MI
Preston J. Quesenberry, KPMG LLP, Washington, DC

More Information

Discuss the current headlines related to tax-exempt health care and if the industry is:

  • Providing benefits commensurate with tax savings

  • Subject to enough federal oversight

  • Relying on an overly broad definition of community benefit

  • Too aggressive on collections

This event is not included in the program registration. Additional fee of $65, limited attendance, pre-registration required. Continuing Education Credits are not available for the lunch.

 
2:00-3:00 pm Concurrent Sessions

6. Legal Ethics: Resolving Health Care Governing Board Conflicts of Interest​ (not repeated)​
Thomas K. Hyatt, Thomas K. Hyatt, PLLC, Washington, DC
Kimberly Kerry, Dentons US LLP, Oakland, CA

More Information

  • The starting point: Applying the fiduciary duties of care and loyalty

  • The intersection with the Rules of Professional Conduct

  • Financial conflicts of interest: Challenges and practical solutions

  • Dualities of interest: Determining and addressing adverse interests

  • Drafting considerations for governance policies, bylaws, disclosure forms, and director agreements

  • Case studies: The good, the bad, and the ugly

7. State Tax Issues for Health Care Organizations
Robert Romashko, Husch Blackwell LLP, Washington, DC
Rachel Scott, ArentFox Schiff, Chicago, IL

8. Transfer Pricing: What Is It and Why Your Organization Should Care… Or Be Worried?
Andrea Sype, Tax Manager, Mayo Clinic, Toledo, OH
Lara Witte, Plante Moran, Southfield, MI

More Information

  • Why transfer pricing matters and when it is needed

  • How to position your organization for success in an IRS audit and beyond

  • Recognize transfer pricing as a strategic tool to impact operations, management, and cash flow

 
3:00-3:30 pm 

Networking Coffee Break

 
3:30-4:30 pm Concurrent Sessions

9. Lessons Learned in 501(r) Noncompliance/Compliance: The Value of Vision, Vigilance, and Divulgence (not repeated)
Stephen M. Clarke, Managing Director, Exempt Organization Tax Services, Ernst & Young LLP, Washington, DC
Greg Melgares, Deputy General Counsel, Froedtert Health, Inc., Milwaukee, WI

More Information

  • Lessons learned from non-compliance with Section 501(r) of the Internal Revenue Code

  • Detection and correction of errors and related Form 990 Schedule H disclosures, education of key 501(r) stakeholders, and implementing 501(r) compliance procedures

  • 501(r) enforcement update, including 501(r) issues IRS has focused on in examinations and compliance checks

  • Interaction between M&A due diligence and 501(r) compliance matters

  • Common 501(r) compliance errors and misconceptions

10. Health Care Transactions and the "F" Word
Ashley Osak, Polsinelli PC, Los Angeles, CA
Tania Wang, M&A Tax Partner, Leo Berwick, San Francisco, CA

More Information

  • The corporate practice of medicine, highlighting why physician groups/health care practices are generally structured one way during operations

  • Current trends in physician practice group acquisitions and strategic affiliations

  • How the tax classification of physician groups/health care practices matters upon a sale, exit or restructuring, including the implementation of an F-reorg, the steps involved and why the reorganization must take place in order for the practice group to sell to a non-physician/non-licensed professional Buyer

  • Tax nuances associated with "friendly physician" structure and gray areas related to post-closing filing of taxes by physician groups and MSOs

11. Strategies to Address Unprecedented Operating and Financial Pressures While Also Advancing Innovation –Tax Considerations, Implications and Pitfalls​
Catherine Bernard, Director, Tax, Sanford Health, Sioux Falls, SD
Eb LeMaster, Kaufmann Hall, Chicago, IL

More Information

  • 2022 was one of the worst in health system history; labor costs are up, capital is more expensive to obtain, care continues to migrate to outpatient settings, and revenue growth is not keeping pace

  • In order to fortify balance sheets and avoid debt covenant issues, many health systems are monetizing non-core assets and ancillary businesses

  • As part of performance improvement efforts, rationalization of corporate costs and optimization of past mergers are leading to both severance and retention considerations

  • Despite industry pressures, health care systems must continue to pursue innovation, including telehealth, alternative investments and overseas opportunities

  • How health systems are responding to the unprecedented times and the related tax considerations, implications and pitfalls

 
4:45-5:15 pm

Open Forum Discussion

 
5:15-6:15 pm

Networking Reception
This event is included in the program registration. Attendees, speakers, and registered spouses and guests welcome.

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Tuesday, October 24, 2023

7:00 am-3:15 pm

Registration and Check-In
If you have not checked in, come to AHLA Registration area to print out your badge.

 
7:00-8:00 am

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

 
8:00-10:00 am General Session

8:00-9:00 am
12. State Charity Regulator Focus: Hospital Charity Care and other Attorney General Initiatives​
Courtney Aladro, Massachusetts Attorney General, Boston, MA
James G. Sheehan, New York Attorney General, New York, NY
Carol Washington, Charities Division Manager, Office of the Minnesota Attorney General, Minneapolis, MN

More Information

State Charity Regulator Focus:

  • Hospital Charity Care–statutory changes, reporting, regulatory compliance, and enforcement actions

  • Health Care Transactions–authority, statutory changes, recent examples

  • Health Care System governance issues–notable service line closures (e.g., birthing units), fiduciary duties of sole member entities, active parent boards, and mirror boards

  • Migration from not-for-profit to for-profit health facilities-oversight

  • Private equity concerns in health care organizations-revenue cycle, credit cards, debt collectors, quality of care

  • Fair billing generally

9:00-10:00 am
13. Inflation Reduction Act Incentive Opportunities​

Hannah Hawkins, KPMG  LLP, Washington, DC
Amber MacKenzie, Attorney Advisor, US Department of the Treasury, Washington, DC

More Information

The Inflation Reduction Act (IRA) made many of the clean energy tax credits refundable for certain tax-exempt and certain governmental hospitals and other health care organizations.  In, this session, the former Deputy Tax Legislative Counsel in Treasury’s Office of Tax Policy, who led the development of guidance and internal policy making on tax issues associated with renewable energy, oil and gas, and utilities, will provide an overview of these credits and the types of investments they incentivize and also discuss how to best identify and operationalize these opportunities for hospitals and other health care organizations. This session will also discuss recent guidance developments in this area as well as some best practices and traps for the unwary.

 
10:00-10:30 am

Networking Coffee Break

 
10:30-11:45 am Extended Concurrent Sessions

14. Executive Compensation 101: Strategies and Trends for Not-For-Profit Health Care Organizations​ (not repeated)
Calvin R. Chambers, Hall, Render, Killian, Heath & Lyman, P.C., Indianapolis, IN
Tom Pavlik, SullivanCotter, Inc., Chicago, IL

More Information

Executive compensation is one of the most important issues that a health care organization must address. Health care organizations need to balance their overall tax-exempt objectives with their need to recruit and retain skilled leaders to accomplish those objectives, spur future growth, and operate within their financial constraints. Panelists in this session will discuss:

  • Executive compensation trends, including market changes post-COVID

  • Important tax exemption considerations (private inurement/private benefit, intermediate sanctions law, excise taxes, Form 990 reporting)

  • Considerations for determining and documenting "reasonable compensation"

  • The mechanics for establishing a rebuttable presumption of reasonableness

4. Community Benefit Reporting: Back in the Spotlight Again (repeat)
Mike Cincotta, Senior Manager, EY, Boston, MA
Julie Trocchio, Senior Director, Community Benefit and Continuing Care, Catholic Health Association, Chevy Chase, MD

More Information

  • Not-for-profit hospital community benefits are a well-defined set of activities mandated by Affordable Care Act (ACA) requirements and IRS rules

  • Yet, congress and some academics are questioning whether the rules are sufficient and whether they are enforced by IRS

  • The IRS definition of community benefit and how hospitals are required to assess community health needs, plan to meet identified needs and evaluate the impact of their plans

  • Requirements for IRS oversight of community benefit and how that enforcement has played out

  • How hospital legal, advocacy and communications departments can work together to tell the community benefit story

5. Tax Considerations and Implications of Health Care Joint Ventures Between For-Profit and Tax-Exempt Entities (repeat)
Timothy A. Galaz, PwC, Philadelphia, PA
Gerald M. Griffith, Jones Day, Chicago, IL
Jennifer R. Noel, Corporate Director of Tax, ChristianaCare, Wilmington, DE

More Information

  • Within the current health care landscape, it may be advantageous to enter joint ventures, partnerships, or other third-party arrangements that enable health care providers to best support their patients

  • However, these types of arrangements may trigger tax or other reporting consequences that should be considered and addressed at the outset

  • This session will discuss the various tax-related issues that may arise when implementing a joint venture or similar arrangement

  • Further, it will provide suggestions for addressing these issues in the negotiations so that resolutions may be memorialized in the organizing documents for the arrangement

 
11:45-12:45 pm

Lunch on your own

 
1:00-2:00 pm Concurrent Sessions

15. Bonds and Arbitrage (not repeated)
Edward Berkovitz, Director of Tax Reporting & Compliance, NYU Langone Health System, New York, NY
Samantha J. Duke, Senior Rebate Manager, Ice Miller LLP, Indianapolis, IN
Kendall A. Schnurpel, Deloitte, Indianapolis, IN

More Information

  • Post-issuance compliance matters for both private use and arbitrage, to include written post-issuance compliance procedures

  • IRS update, including how the additional funding from the Inflation Reduction Act might impact bond compliance efforts at the IRS

  • Common problem areas that trip up filers of the Form 990, Schedule K

  • The current interest rate environment and its impact on the arbitrage rebate exposure for issuers and borrowers

8. Transfer Pricing: What Is It and Why Your Organization Should Care… Or Be Worried? (repeat)
Andrea Sype, Tax Manager, Mayo Clinic, Toledo, OH
Lara Witte, Plante Moran, Southfield, MI

More Information

  • Why transfer pricing matters and when it is needed

  • How to position your organization for success in an IRS audit and beyond

  • Recognize transfer pricing as a strategic tool to impact operations, management, and cash flow

11. Strategies to Address Unprecedented Operating and Financial Pressures While Also Advancing Innovation –Tax Considerations, Implications and Pitfalls​ (repeat)
Catherine Bernard, Director, Tax, Sanford Health, Sioux Falls, SD
Eb LeMaster, Kaufmann Hall, Chicago, IL

More Information

  • 2022 was one of the worst in health system history; labor costs are up, capital is more expensive to obtain, care continues to migrate to outpatient settings, and revenue growth is not keeping pace

  • In order to fortify balance sheets and avoid debt covenant issues, many health systems are monetizing non-core assets and ancillary businesses

  • As part of performance improvement efforts, rationalization of corporate costs and optimization of past mergers are leading to both severance and retention considerations

  • Despite industry pressures, health care systems must continue to pursue innovation, including telehealth, alternative investments and overseas opportunities

  • How health systems are responding to the unprecedented times and the related tax considerations, implications and pitfalls

 
2:15-3:15 pm Concurrent Sessions

7. State Tax Issues for Health Care Organizations (repeat)
Robert Romashko, Husch Blackwell LLP, Washington, DC
Rachel Scott, ArentFox Schiff, Chicago, IL

10. Health Care Transactions and the "F" Word (repeat)
Ashley Osak, Polsinelli PC, Los Angeles, CA
​Tania Wang, M&A Tax Partner, Leo Berwick, San Francisco, CA

More Information

  • The corporate practice of medicine, highlighting why physician groups/health care practices are generally structured one way during operations

  • Current trends in physician practice group acquisitions and strategic affiliations

  • How the tax classification of physician groups/health care practices matters upon a sale, exit or restructuring, including the implementation of an F-reorg, the steps involved and why the reorganization must take place in order for the practice group to sell to a non-physician/non-licensed professional Buyer

  • Tax nuances associated with "friendly physician" structure and gray areas related to post-closing filing of taxes by physician groups and MSOs

^^Back to Top of Page

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 have adopted a new onsite registration system by providing seamless check-in and onsite badge printing.
  • Built-in extended time between sessions for moving from room to room, networking with colleagues, and personal break time.  
  • All program sessions will be recorded. Video of the presentations, along with the materials will be available to all attendees who register and can be watched to earn. 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.
  • For questions or more information, please email [email protected]
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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.

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