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For those involved with the health care industry, an understanding of the underlying principles of health care finance is a must. The new Third Edition of Health Care Finance: A Primer addresses all the basics, from a discussion of the particular needs of various types of healthcare entities, to specific financial arrangements and the attending documents that are integral to them. In addition, the publication includes sample documents for various types of loans, and sample representations and warranties for life sciences companies and healthcare facilities.

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Table of Contents

TABLE OF CONTENTS


Chapter 1   Introduction

1.1   Healthcare Finance is More Important than Ever

1.2   Cost of Capital



Chapter 2  Legal and Economic Issues in Healthcare Lending

2.1   Healthcare Laws

2.2   Payment Issues



Chapter 3   Types of Potential Healthcare Providers Needing Capital

3.1   Hospitals

3.2   Long-Term Care Facilities

3.3   Life Science Companies

3.4   Medical Device and Equipment Manufacturers

3.5   Other Healthcare Providers and Service Companies



Chapter 4   Various Financing Concepts and How They Work

4.1   Cash Flow Financing

4.2   Asset-Based Financing

4.3   Lockbox Lending

4.4   Real Estate Financing

4.5   Equipment Financing and Capital Leases

4.6   HUD Lending for Long-Term Care Facilities

4.7   FHA Section 242 Mortgage Program

4.8   Construction Loans

4.9   Sale-Leaseback Arrangements

4.10   Vendor Financing

4.11   Bond Financing

4.12   Mezzanine Financing

4.13   Special Issues with Acquisition Financing



Chapter 5   Legal Concepts and Documents Relevant to Most Healthcare Transactions

5.1   Term Sheet; Commitment

5.2   Due Diligence

5.3   Structure of the Transaction

5.4   Credit Agreement/Loan Agreement

5.5   Promissory Note

5.6   Legal Opinions

5.7   Deposit Account Control and Restriction Agreement

5.8   Pledge Agreements

5.9   Landlord Waivers

5.10   Commonly Negotiated Loan Provisions

5.11   Post-Default Complications Unique to Healthcare

5.12   Special California Rules



Chapter 6   Four Prototypical Deals and Their Related Documents

6.1   Type 1 – Cash Flow Loans

6.2   Type 2 – Real Estate Based Loans

6.3   Type 3 – Asset Based Loans

6.4   Type 4 – Equity Deals



Chapter 7   Potential Credit Enhancement and Risk Reduction Sources

7.1   Letters of Credit

7.2   Insurance

7.3   Guaranties

7.4   Interest Rate Risk Protection for Variable Rate Loans: Derivatives, Swaps, and Other Hedging Devices

7.5   Cross-Default and Collateralization Provisions

7.6   Equity Infusions

7.7   Subordinated and Mezzanine Debt

7.8   Syndication

7.9   Capital Markets & Securitization



Chapter 8   Conclusion



Appendix A   A Short Primer on Debt, Equity, and Legal Terminology



Appendix B   Sample Opinion Long-Term Care Facility (Real Estate Loan)


Appendix C   Sample Asset-Based Opinion of Counsel


Appendix D   Example Representations and Warranties for Life Science Companies


Appendix E   Example Representations and Warranties for Healthcare Facilities


Appendix F   Flow of Funds Chart-Revolving Loan


Appendix G   Revocable Standing Medicare/Medicaid Deposit Account Service Agreement


Appendix H   Government Healthcare Receivables Deposit Account Agreement


Index