Transaction Structures

Membership Substitution Transactions: Why Are They So Misunderstood?

Membership substitution transactions are the most common form of business combination transaction in the nonprofit hospital industry. They are also widely misunderstood and the source of many mistakes. Many large 501(c)(3)s have become more acquisitive as a result of economic pressures of the ACA.…

February 14th, 2017| Transaction Structures|

Affiliations: Matching Objectives and Risks

Affiliations_Matching Objectives and Risks - January 2016Affiliations are contractual arrangements between two or more hospital partners in which they agree to work together on projects. No ownership or control is exchanged in affiliations; however, the term is sometimes used euphemistically, or incorrectly, to describe business combinations. These sorts of agreements have existed for many decades as non-profit hospitals have pursued contractual approaches to improve qualitative, operational, or financial performance.…

January 15th, 2016| M & A, Transaction Structures|

The Hospital Joint Venture Handbook

The Hospital Joint Venture Handbook

This joint venture handbook is based upon a series of articles that we began writing for The Governance Institute in the summer of 2014. One year later, many of the “new frontiers” in hos­pital joint ventures that we outlined have continued to evolve at a rapid rate, and new forms of creative partnerships are announced on a regular basis.…

Building a Hospital Joint Venture: A Blueprint for Success

Building a Hospital Joint VentureThis is the third and final article in a series examining the uses of health system joint ventures, the process of developing a joint venture, and expected trends related to these transactions.

In the first two articles, we looked back into the history of joint ventures (JVs), the factors leading to their emergence, and the potential benefits of a JV to a non-profit hospital or health system.…

New Frontiers in Hospital Joint Ventures

New Frontiers in Hospital Joint VenturesThis article is the second in a series examining the uses of joint ventures, the process of developing a joint venture, and expected trends related to these transactions.

In our first article, we examined the history of joint ventures (JVs) and summarized some of the potential benefits to a non-profit hospital or health system considering a JV.…

November 13th, 2014| Transaction Structures|

The Rise of the Hospital Joint Venture

Rise of the Hospital Joint Venture CoverSince the enactment of the Affordable Care Act in 2010, more and more hospitals and health systems have entered into some sort of affiliation, whether through acquisition, membership substitution, joint venture, or clinical affiliation. This trend is a result of the mounting pressures hospitals and health systems face in the current healthcare environment.…

September 15th, 2014| Transaction Structures|

The Governance Institute Special Section: The Expanding Range of Strategic Alternatives Available in Hospital System Mergers and Acquisitions

Expanding Range of Strategic Alternatives Cover

Hospital and health system boards are in a difficult position. The business of governing acute care health systems has become increasingly complex in recent years as board governance and industry structure have lagged.

The sector has evolved from a strictly charitable function to a major industry that comprises 5 percent of gross domestic product (GDP).…

August 1st, 2014| Transaction Structures|

The Expanding Range of Strategic Alternatives Available in Hospital System Mergers and Acquisitions

The Expanding Range of Strategic Alternatives_JuniperThe business of governing acute care health systems has become increasingly complex in recent years as board governance and industry structure have worked to keep up with the pace of reform and consolidation.  The sector has evolved from a largely charitable function to a major industry that comprises 5 percent of the gross domestic product. …

June 24th, 2014| Transaction Structures|

Protecting Corporate Value in Affiliation Transactions

HFM April 2014 CoverHospital leaders are increasingly interested in affiliations, or relationships with other healthcare organizations that do not involve ownership changes. Affiliations can take many forms, including management agreements, clinical affiliations, purchasing cooperatives, and joint operating agreements. But they also pose unique risks.…

April 1st, 2014| Transaction Structures|

New Models for Community Hospital Joint Ventures

New Models for Community Hospital Joint Ventures CoverJoint ventures between investor-owned and nonprofit health care organizations are not new; in fact, they have occurred for at least 25 years. Until recently, nonprofits were employing this type of transaction to address their need for capital without “selling out” and losing control over a vital community asset.…

November 8th, 2012| Transaction Structures|