Health Care Alliances and Conversions: A Handbook for Nonprofit Trustees / Edition 1

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In the past two decades countless nonprofit community hospitals and health care facilities have combined with for-profit institutions, joined large nonprofit systems, or converted to joint ventures with for-profit chains. As we enter the next millennium, this trAnd is accelerating.Health Care Alliances and Conversions provides nonprofit directors with all the practical advice they need to plan for their institution's future and to create decision-making systems that will eliminate their risk of personal liability. This advice is particularly timely when it comes to nonprofit hospital conversions and alliances.Health Care Alliances and Conversions provides nonprofit hospital directors and senior managers with practical guidance for understanding the numerous forms of conversions including the most controversial type of transactions—joint ventures with for-profit chains. The book is filled with the information and tools health care leaders need to plan for the future of their institutions and effectively evaluate their strategic partnering options.In clear, concise, and non-legal language, authors James R. Schwartz and H. Chester Horn, Jr.—the nation's leading experts in the health care conversion field—explain nonprofit directors' fiduciary duties in these complex conversion transactions and offer practical advice that can help facilitate this difficult decision-making process. The book clarifies nonprofit directors' and trustees' responsibilities to the communities they serve and offers solid recommAndations on how to manage the conversion process without damaging institutions' or directors' reputations.The authors describe how to create marketing and valuation strategies that will meet the legal standards enforced by government regulators. They also reveal the steps for quickly closing a deal and provide the keys to avoiding pitfalls that can block approval. Step by step the book outlines how trustees and directors can protect themselves from

The book contains black-and-white illustrations.

This book is a ground-breaking tool for board members and community representatives coping with the decision to convert their not-for-profit health care institutions to for-profit status.

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Editorial Reviews

From the Publisher
"James Schwartz and Chet Horn . . . are now the nation's leadingexperts on not-for-profit hospital sales and conversions. Readingthis book is truly learning at the knee of the master. It isindispensable for not-for-profit boards of directors." —from theForeword by Linda Miller, president, Volunteer Trustees Foundationfor Research and Education

"This book is a comprehensive primer in the arcane world ofnonprofit hospital asset conversions. It is a -must read' fornonprofit hospital trustees who are contemplating a sale, lease, orjoint venture with a for-profit company." —Bud Lee, president,California Association of Catholic Hospitals

"The guide for decision makers, a how-to-do-it manual for everynonprofit hospital director in America. Our country's health carewill be much improved if directors buy and read this book."—Phillip L. Isenberg, counsel with the firm of Hyde, Miller, Owen& Trost, Sacramento, California; former California StateAssemblyman and author of California's law regulating the sale orjoint venturing of nonprofit hospitals with for-profits

Provides nonprofit hospital directors and senior managers with practical guidance for understanding the numerous forms of hospital conversions and alliances, including joint ventures with for-profit chains, the most controversial type of transaction. Explains nonprofit directors' fiduciary duties in these complex conversion transactions, clarifies directors' and trustees' responsibilities to communities they serve, and offers recommendations on how to manage the conversion process without damaging reputations of the institution or its directors. Annotation c. Book News, Inc., Portland, OR (
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Product Details

  • ISBN-13: 9780787941772
  • Publisher: Wiley
  • Publication date: 11/6/1998
  • Series: Business and Management Series
  • Edition description: 1 ED
  • Edition number: 1
  • Pages: 198
  • Product dimensions: 0.63 (w) x 7.00 (h) x 10.00 (d)

Meet the Author

JAMES R. SCHWARTZ is deputy attorney general with the California Attorney General's Office. He is the author of the California Attorney General's Review Protocol for Ownership of Control Transfers of Non-Profit Health Facilities and the principal drafter of California's hospital conversion law. Since 1995, Schwartz has had primary responsibility for overseeing all conversions of nonprofit hospitals within the state of California. H. CHESTER HORN is a deputy attorney general in the Charitable Trusts Section of the California Attorney General's office. Horn drafted the regulations implementing California's hospital conversion law and is coauthor of Deal Makers, Deal Breakers. Horn has reviewed more than a dozen hospital conversions valued at more than $1.5 billion.

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Table of Contents

AcknowledgmentsThe AuthorsForewordIntroduction
Fiduciary Obligations
Duty of Obedience to Charitable PurposeStep 1: Find Out to WhetherYou Can Convert Your Hospital at AllStep 2: Determine How You CanSpAnd the Charity's Money
Duty of Loyalty
Duty of Due Care
Strategic Planning
Get the Board Involved Early
Identify the Legally Permissible OptionsDetermine RestrictionsAvoidCommon Errors
Assemble the Right Team of Experts to Work with Your Management,Identify the Problems, and RecommAnd Solutions
Shape Your Options to meet Your Goals and Work with YourCommunityMeeting Your GoalsEngaging the Community
Give Yourself Enough Time to Make a Reasoned Decision
Planning for the Post-Conversion Charity
Goal 1: Educate the Affected Community and Involve It in theDecision-making Process
Goal 2: Create a Structure for the Post-Conversion Charity That IsConsistent with Your State Law
Goal 3: Create a Charitable-SpAnding Plan for Your Post-ConversionFoundationThe Historical-Services OptionThe Charitable-ComponentOptionThe Supporting-Organization Option
Establish an Investment and Management Structure for the ConversionProceedsStep 1:Setting Your Investment GoalsStep 2: Selecting anInvestment AdviserStep 3: Establishing Written InvestmentGuidelines That Include DiversificationStep 4: MonitoringInvestment PerformanceStep 5: Negotiating Terms to Protect theCharity from Loss or Excessive Fees
Selling Your HospitalThe Sale ProcessGetting the Right Advice atthe Right Price: Marketing and Valuation Experts, NegotiatingExpert FeesAvoiding Conflicts of InterestObtaining a FormalValuation: Necessity, Timing, Source and CostUnderstandingValuation Advice: Fairness Opinions and Valuation Opinions,Valuation MethodologiesMarketing Your Hospital: Soliciting Interestby Buyers, Getting the Bidding Started, Auction Sales: Optimizingthe Possibility of Obtaining Fair Market Value, Single-BidderSales: "Shopping the Deal" and Protecting the Price, Choosing the"Best" OfferDocumenting the Agreement: Letter of Intent, DefinitiveAgreementConclusion
Joint VenturesKeys to a Successful Joint-Venture AgreementTheTypical Joint-Venture Model: Advantages, RisksPolicyAnalysisInvestment Analysis: What Percentage of Your Assets WillYou Invest? Will Your Returns Equal the Value of the Assets YouInvested? Could You Do Better Elsewhere? Process: Understanding theIssues, Get Fair Market Value, Make Sure the Deal Documents ProtectYouProtecting Yourself and Your Hospital: Understand theLimitations of Your Expert(s), Let the Market Work for You, PursueYour Values, Not Someone Else's, Evaluate Comparable Proposals, BeWary About Using Selection Criteria Other Than PriceStructuring theTransaction: Letter of Intent, Contribution and Sale Agreement,Operating Agreement, The "Put," Conclusion
Legal Protections for Directors and Trustees—and the Consequencesfor Failing to Use ThemLegal Protections: Business Judgemnet andCareful Conduct Rules, Delegation, Reliance, and Other SafeHarbors, Directors' and Officers' Liability Insurance,IndemnificationLegal Consequences: Charitable-Trust Civil Actions,Internal Revenue ServiceConclusion
AppAndix A: Glossary
AppAndix B: The Law of Fiduciary Duties Affecting Directors andTrustees of Nonprofit HospitalsDuty of Obedience to CharitablePurpose: Defining the Trust, Adapting the Trust to Changing Timesand Circiumstances, Restrictions on he bUse of ConversionProceedsDuty of Loyalty: General Standards, Trust-Law Standard,Corporate-LAw Standard, california standard, real-Life ExamplesDutyof Due Care: Standards in Practice: Good Faith, reasonable Inquiry,Dure Diligence, Process Protections

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