Health Care Financing



Our attorneys provide sophisticated counsel on structuring health care finance transactions, including nonprofit law and tax implications of tax-exempt financings, master indenture and other security structures, and securities law compliance. We also assist clients in gaining access to alternative financing sources such as private equity funds and venture capital firms.

Our Approach

Access to capital remains necessary for health care organizations to thrive. Our experience as counsel on a wide range of projects and financing techniques—together with our knowledge of tax and securities law—enables us to advise clients on the best transaction structure and documentation for their needs. We have served as borrower’s counsel, underwriter’s and disclosure counsel, and bank counsel for health care providers, banks, underwriters, issuers, and indenture trustees. We also represent health care organizations subject to Internal Revenue Service audits and those in financial distress regarding compliance with financial covenants and the restructuring of their debt obligations.

Our national Health Care practice strengthens our Health Care Finance team. We understand the business of health care and the complex legal landscape that providers face in an industry undergoing massive reinvention and transformation. Our team has a rich understanding of the health industry’s dynamics regarding business, regulations, and competition. The attorneys and resources in our Health Care practice support the many areas of law affecting health care providers, including licensing and certificates of need, government investigations and compliance counseling, information technology and privacy, reimbursement and managed care contracting, and hospital/physician alignment strategies. This depth of knowledge is invaluable when performing due diligence on behalf of our clients and addressing any disclosure or other legal issues that may arise.

Post-issuance compliance and enforcement

Our client relationships do not end when the original financing transaction is complete. We handle post-issuance compliance and enforcement issues, including continuing disclosure compliance, program administration, IRS audits, SEC investigations, arbitrage rebate calculation, and investment placement and management. We counsel health care organizations affected by adverse financial conditions that affect their ability to comply with financial covenants and health care laws and regulations, including those who are unable to pay or who have defaulted on debts and are seeking bankruptcy or other workout scenarios.

We are ranked nationally for health care in Chambers USA: America’s Leading Lawyers for Business 2019. Additionally, we are recognized by U.S. News/Best Lawyers “Best Law Firms” 2020 as National Tier 1 in health care law.

We Work With

  • Hospitals and health systems, including academic medical centers, critical access and rural hospitals, Catholic and other faith-based hospitals and health systems, and hospital districts and other government-owned health care facilities
  • Continuing care retirement communities
  • Assisted living facilities
  • Skilled nursing facilities
  • Physician practices

Recent Experience

  • Represented a large financial institution in connection with the public offering of over $635 million of tax-exempt and taxable bonds issued on behalf of three different hospitals. The transaction allowed these health care systems to refinance existing indebtedness and to construct and equip new health care facilities.  Our representation included advising our clients regarding the structure of each transaction, drafting various public offering documents and negotiating disclosure and purchase agreements.
  • Represented a hospital in connection with its borrowing of over $195 million of tax-exempt bonds issued on its behalf to construct and equip a new general acute care hospital tower.
  • Served as counsel to the underwriters in a $484 million refunding for an Illinois academic medical center and affiliated hospital system.
  • Represented one of the largest Catholic health systems in the Midwest in a $285 million financing for a replacement hospital and expansion projects at four other facilities.
  • Represented a large Catholic health system with the consolidation of the master trust indentures of its pre-merger legacy organizations. We negotiated with bondholders and bank creditors holding approximately $1 billion of outstanding bonds. We also advised this client regarding the remediation of tax-exempt bonds following the sale of certain bond-financed facilities.
  • Served as bond counsel to two local economic development corporations in an $81 million financing for one of the largest hospital systems in New York.
  • Served as special corporate counsel to one of the largest integrated health systems serving the Intermountain West with an $80 million variable rate financing requiring no third-party liquidity support.

Hospitals partner with industry to co-create digital tools

Modern Healthcare | July 25, 2020

In this article on how hospitals are co-developing tools with tech companies, Long Island office managing partner and Health Care partner Allan Cohen is quoted on the factors for hospitals to consider when selecting the right partner and the ways in which hospitals are investing in startups.

University of Chicago and several Illinois health systems prepping deals

The Bond Buyer | March 03, 2020

This article mentions Nixon Peabody as borrower’s counsel for NorthShore University Health System’s plan to sell new-money and refunding debt next week. Chicago Project Finance and Public Finance partner Julie Seymour and associate Gretchen Sherwood were the deal attorneys.

Health systems' scale not linked to better revenue

Modern Healthcare | September 11, 2018

In this article on a study by Navigant Consulting that explores the size of health systems and their revenue, Chicago Project Finance and Public Finance partner Tom Fahey is quoted for his outlook on M&A activity.

Nursing shortage will continue to pinch hospital margins

Modern Healthcare | March 06, 2018

Chicago public finance partner Tom Fahey provides commentary in this article about the financial strain on hospital systems caused by the ongoing nursing shortage.

Contacts

Julie K. Seymour

Partner

jkseymour@nixonpeabody.com

Phone: 312-977-4353

Thomas M. Fahey

Partner

tmfahey@nixonpeabody.com

Phone: 312-977-4376

Kenneth C. Lind

Partner
Team Leader, Project Finance and Public Finance

klind@nixonpeabody.com

Phone: 212-940-3005

  • Received (served as borrower’s counsel) The Bond Buyer’s 2017 Healthcare Deal of the Year Award: Presence Health
  • Recognized by U.S. News-Best Lawyers 2020 as a National Tier 1 leader for public finance law
  • Recognized by U.S. News-Best Lawyers 2020 as a Metro Tier 1 leader for public finance law in Chicago, Los Angeles, Rochester, and Washington, D.C.
  • Recognized by U.S. News-Best Lawyers 2019 as a National Tier 1 leader for public finance law
  • Consistently ranked in the Top 10 as bond counsel, underwriter’s counsel, disclosure counsel, and special tax counsel by Thomson Reuters
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