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Analyzing lease/purchase options.

The authors' previous article, "Equipment Acquisition Using Various Forms of Leasing," covers information necessary for selecting among the different kinds of leases. This article explains how to reach a proper financial analysis, preferably using two phases. Using a representative example, the article guides the reader through the first phase and introduces the elements needing review in the second phase. Key elements include pretax aftertax and cash flow analyses. Different organizations use different yardsticks to measure the financials of a transaction, but in general, cash is king. Therefore, the most widely used comparison is the purchase versus lease IRR (internal rate of return) produced by measuring the cash flow of the purchase case compared to the cash flow of the lease case.

Capital Expenditures↗
PubMed1998

Equipment costs. Slow on the uptake.

The failure of hospitals to analyse the costs and benefits of equipment is costing the NHS millions. Hospitals should analyse the relative merits of buying and hiring special equipment, such as beds, for reducing pressure sores. The Department of Health should produce best buy guides for equipment.

Beds↗
PubMed1998

IRS issues guidance on tax-exempt bond requirements.

Enforcing compliance with rules governing facilities financed with tax-exempt bonds recently has become an IRS priority. Integrated delivery systems (IDSs) that include such facilities, therefore, should take steps to ensure that the private business use of those facilities does not exceed the legal threshold amount, thereby jeopardizing the tax-exempt status of the bonds. Management contracts, research agreements, and leases are arrangements with the greatest potential to result in noncompliance. Instituting a compliance program to monitor the use of bond proceeds and minimize the amount of private business use of facilities over the bond term can reduce an organization's risk of penalty.

Capital Financing↗
PubMed1998

Using real-estate-based financing to access capital.

One strategy employed by healthcare organizations to increase their market presence is the construction of new facilities. Accessing capital to fund such construction, however, has become more of a challenge. One relatively untapped source of building capital is real-estate-based financing. Nonrecourse mortgages, turnkey net leases, and synthetic leases can provide several advantages to healthcare organizations seeking capital, assuming issues related to building ownership, debt and balance sheet effects, and tax-exempt status have been thoroughly explored first.

Capital Financing↗
PubMed1998

IDS conversions to for-profit status: structuring the deal.

Not-for-profit integrated delivery systems (IDSs) may convert assets to for-profit status in a variety of ways, but typically choose from three basic conversion structures: sale of assets, joint ventures, and lease or management agreements. To select the optimal conversion structure, not-for-profit IDS executives should understand the forces driving their organization's desire or need to effect such a conversion and examine the legal, business, and political implications of each option in light of the organization's particular circumstances.

Community-Institutional Relations↗