BKD’s exempt organization tax professionals prepare thousands of IRS Forms 990 every year. Throughout the course of the year, our tax professionals review thousands more Forms 990 prepared internally or by other professional accounting firms. 


As a result of these reviews, 1 fact remains clear: Many Forms 990 are prepared incorrectly or incompletely.


Because the Form 990 is a public document -- nearly all are posted on GuideStar.com and many organizations post them on their websites -- it is important that the Form 990 be prepared completely, correctly and consistently. 


An incorrect Form 990 could reflect negatively on the organization when reviewed by possible donors, the community or even the media. More importantly, an incorrect Form 990 might be viewed as an incomplete filing by the IRS, subjecting the organization to late filing and other penalties even though a Form 990 was filed.


Unfortunately, our exempt organization tax professionals discover numerous common errors and omissions. They range from inconsequential errors that should be corrected in future filings to serious errors that merit an amended filing. 


Here are some of the most common errors our tax professionals encounter.


Form 990, Page 1, Part I 


Page 1 of Form 990 includes summary information relating to the organization and creates a first impression for the reader. 


Many times, organizations include a lengthy summary of their most significant activity on Page 1. When this description is too long, most return preparation programs will carry over the description or print the description in its entirety at the end of the return in Schedule O. 


Organizations should consider a concise description that fits in the allotted space on the first page, so the reader can gain a clear idea of the organization’s most significant activity without searching through the voluminous disclosures in Schedule O.


Part I of Page 1 also includes summary information regarding the number of voting board members, employees and volunteers. Unpaid board members are considered volunteers for purposes of reporting the number of volunteers on Page 1. 


Organizations with unpaid board members often fail to count them as volunteers on Form 990.


Form 990, Part V 


Part V of Form 990 asks several questions that may result in additional IRS filings. In many cases, some of these questions are applicable to an organization while many questions are not applicable. Inapplicable questions should not be answered “yes” or “no.” 


Instead, these questions should be left blank according to the IRS instructions. Often, organizations answer nonapplicable questions as “no” in error. 


If a question is answered "no" when the question should be left blank, the organization appears to not be in compliance with that particular item.


Form 990, Part VI 


Total members of the governing body and total independent members of the governing body are often counted incorrectly on Form 990. 


The IRS instructions ask for the total number of voting members of the governing body, which may not be the same number listed in Part VII of Form 990. 


In addition, the concept of independent members of the governing body is defined differently for purposes of Form 990 completion. Often, members of the governing body who are compensated for services performed outside their service as a board member, as well as members of the governing body who have interested person transactions reported on Schedule L, are counted as independent board members in error.


Business and family relationships often are not disclosed as required in question 2. Exempt organizations that have large numbers of board members -- more than 20 -- or are located in rural areas are likely to have a business or family relationship with fellow board members. This question is often answered “no” in error.


Many organizations outsource management duties to another company or service provider. Part VI, Question 3 asks for additional information when a management company (related or not related to the organization) has been hired to perform specific services for the organization. 


When this question is answered “yes,” the required footnote in Schedule O is often missing or incomplete. More importantly, reporting of compensation paid to the management company as a highest-paid independent contractor in Part VII is omitted. 


 Compensation disclosures required for the individuals performing the duties often are not properly disclosed, and the expense generally is not reported correctly as a fee for services in Part IX.


Compensation Reporting Errors Form 990 Part VI & Schedule J 


Related compensation and overall compensation reporting, including the number of Forms W-2 and Forms 1099 filed with the IRS, often is not reported correctly among organizations included in a related group of Form 990 filers. 


Reporting compensation paid, or deemed to be paid, by the organization and paid, or deemed to be paid, by a related organization is required based on the thresholds outlined in Part VII for officers, directors, trustees, key employees and highest-paid employees (ODTKEs). 


Many times, compensation reporting is incomplete. Designations as to the ODTKE’s role with the organization are not checked or are checked in error. The IRS includes complete definitions of each role as an officer, director, trustee, key employee or highest-paid employee, including definitions of current and former ODTKEs, which often are overlooked, resulting in incorrect reporting. 


In addition, required footnotes (now included in Part VII for 2012) disclosing the hours worked per week for related organizations are often incomplete or omitted.


Schedule J reporting is required when compensation exceeds a certain threshold. Page 1 of Schedule J includes various questions regarding benefits provided to ODTKEs, and each question requires additional disclosure when checked. Many benefits are not checked on Page 1 even though a disclosure is made in Part III, or benefits are indicated in Part I but the disclosure required in Part III is lacking or completely omitted.


Part II of Schedule J often is completed in error, as well. Allocations of amounts reported in Box 5 of Form W-2 as base, bonus and other compensation often are omitted by reporting 100 percent of the amount as base compensation. 


Deferred compensation reporting can be misunderstood and includes employee retirement plan deferrals (included in Box 5 of Form W-2, causing duplicate reporting of the amount). Deferred compensation often omits accrued bonuses not paid within two and a half months after year-end and other employer deferral items. 


The increase in actuarial value of a defined benefit plan accounts is a common deferred compensation reporting omission. In addition, for years when a deferred compensation amount becomes taxable and reportable on Form W-2, organizations fail to report the double reporting in Column F.


When completing Part VII, Section B, organizations often include nonservice-provider vendors among the five highest-paid independent contractors listing in error.


Form 990 Parts VIII & IX 


While reporting revenue and expenses of an exempt organization should be routine, many times items of revenue or expense are not properly reported. Common reporting issues include:


  • Reporting fees paid for services rendered (contract services) incorrectly.
  • Contributions and revenue reported in the incorrect column.
  • Security sales, fundraising and/or gaming events not reported properly.
  • Incorrect or lacking allocations of a reasonable amount of expense to either management G&A or fundraising expense.
  • Related rental revenue not reported as program related revenue on Line 2.
  • Incorrectly recognizing membership dues as contributions (Line 1) or program-related (Line 2).
  • Missed reporting of amounts paid to disqualified persons or their family members -- generally compensation paid to a family member of an ODTKE reported on Schedule L -- on Line 6 of Part IX.

Schedule A Public Charity Status 


Schedule A reports the public charity status of an organization. Many times, organizations select the wrong public charity type in Part I. For organizations classified as publicly supported, one of the public support tests included in Part I or Part II must be completed. 


These computations often are completed inaccurately with incorrect amounts reported throughout. A common error is the omission or incorrect computation of excluded support on Line 5 of Part II or Line 7 of Part III.


Schedule H Hospitals 


Schedule H is completed by organizations licensed as a hospital under state law and provides information regarding financial assistance and community benefits. Schedule H also is the mechanism to report compliance with the new exemption requirements for tax-exempt hospitals under new Section 501(r). 


Accurate completion of Schedule H is essential to maintaining the exempt status of a hospital organization. Unfortunately, reporting errors on Schedule H are too broad and numerous for the confines of this article; BKD will present additional information on Schedule H in the near future.


Schedule K Supplemental Information on Tax-Exempt Bonds 


Schedule K reports information regarding tax-exempt financing. Schedule K is completed for exempt bond issues exceeding $100,000 and issued after December 31, 2002. Included in Schedule K are numerous questions assessing the compliance with several IRS requirements. 


Incorrectly completing Schedule K could trigger additional inquiry from the IRS. Many times, organizations and practitioners do not understand Schedule K and its purpose contributing to the reporting errors. 


Organizations should take care to complete Schedule K completely and accurately and consider engaging bond counsel to assist with completion or review of Schedule K.


Schedule L Transactions with Interested Persons 


Schedule L reports a variety of transactions with interested persons. Many organizations define interested persons too narrowly and only inquire as to possible transactions with board members. 


Interested persons are defined differently depending on the type of transaction reported on Schedule L, and inquiries regarding these transactions should include not only officers, directors and trustees but also key employees, highest-paid employees and, in some cases, certain donors. 


Organizations should take care to inquire about interested-person transactions regarding all interested persons.


Once a transaction with an interested person is identified, the organization reports certain information in Schedule L. Business transactions tend to be the most often reported transaction on Schedule L. Part IV requests the name of the interested person (and not the ODTKE), the relationship and amount of the transaction. In many cases, the ODTKE of the organization is reported in error as the interested person.


Schedule O Miscellaneous Disclosures 


Schedule O is used to provide required disclosures based on the answers to certain questions contained in the core form of Form 990. The disclosures range from expanded program service descriptions and internal Form 990 review processes to availability of certain documents for public access and compensation-setting processes. 


Often the disclosures are incomplete, not updated for current reporting information or so lengthy the purpose of the disclosure is lost to the reader. 


Care should be taken to read each disclosure to ensure it answers the question or describes the issue completely, correctly and concisely.


Schedule R Related Organizations & Unrelated Partnerships 


Related organizations are reported on Schedule R of Form 990. The instructions to Schedule R provide detailed definitions for related organizations that should be reported in Schedule R. 


When an organization or entity is considered related to an exempt organization, related compensation and other items will be reported elsewhere in Form 990. 


Therefore, care should be taken to only report organizations or entities that meet the related definitions in the instructions. A common omission is the reporting of a supported or supporting organization as related in Schedule R.


Part I of Schedule R reports identifying information for disregarded related entities owned by the organization. Exempt organizations often use single-member limited liability companies (SMLLC) for a variety of reasons. These entities are 100 percent owned by the exempt organization and are disregarded for federal tax purposes. As such, the activity of the SMLLC should be included in the Form 990 as if the SMLLC did not exist. 


Many times, organizations fail to include the activity of the SMLLC in the Form 990 filing, or they report only the net income of the SMLLC in error.


Part V, Line 1 of Schedule R reports various transactions between the organization and related organizations reported elsewhere on Schedule R. Part V, Line 2 provides numerical information regarding the various transactions listed in Part I. 


The instructions to Schedule R direct only controlling entities to complete the numerical information requested in Line 2. Line 2 often is completed by noncontrolling organizations in error. 

Imagine an environment in which the potential of your organization’s human capital is harnessed to maximize performance, outcomes, and satisfaction. Your employees are committed and contributing. Your residents are vibrant and invested in your community and its future. Everyone feels proud to be associated with your organization on a consistent basis.

That’s community engagement. It’s a feeling you get when you walk onto a campus, it’s the way people interact with each other, and it’s a state of flow, where people truly enjoy what they are doing and what they contribute.  

Most senior living organizations experience this engaged environment from time to time – during a crisis when everyone rallies together and gives extra effort, when the campus receives special recognition or an award, or after a particularly difficult assignment or challenge has been successfully met. 

But what if you could create a culture of engagement where the majority of people living and serving in your community were in sync almost each and every day?

This would not only be a pleasant environment, but all would look forward to being together, and show up with anticipation of positive energy and outcomes; a place where the mission is lived at an intrinsic level and gratitude abounds. Is it too good to be true? 

Community engagement is the personal and emotional connection your employees, residents, family members, volunteers, donors, and local communities feel to your organization.

Engagement determines how much these stakeholders will give to defend it, refer it, appreciate it, support, and advance it. Engagement is the key to creating a flourishing enterprise where people work and live in harmony and synchronicity with profound enthusiasm, passion, and productivity. Where everyone is pulling in the same direction, with mutual intent, living daily in the possibilities of a thriving place to work and live.

How can this possibly happen? What does it take to help your employees approach their work and lives with high energy, enthusiasm and creativity?

Holleran, through its extensive research and proven methods, is committed to helping your organization achieve these high levels of engagement. We invite you to partner with us, so we can all thrive as a sector, prepare for the future, and elevate workplaces and living spaces to new heights of engagement.

Learn more in this white paper from Holleran

Jewish Federation of South Palm Beach County leadership and South Florida dignitaries gathered for a traditional “topping off” ceremony for the Sinai Residences of Boca Raton on Tuesday, March 3, 2015. 

It marks a celebration of an almost-finished construction site, an expression of hope for
the secure completion of the structure, and a blessing for the building and its
more than 450 future inhabitants. South Florida’s newest planned Life Care
Community is a $250 million project scheduled to open in November/December of
2015. 

The development, which broke ground one year ago, will feature 237 luxury
units tailored toward the active senior population of South Florida; 99 percent
is already reserved.

Jewish Federation board members, other leaders and senior staff, the Sinai Residences development team, local dignitaries and select future residents will be in attendance. Rabbi David Englander of B’nai Torah Congregation in Boca Raton will lead the blessings for the ceremony. 

An American flag that flew over the capitol in Washington, DC, and which was gifted to the Federation from U.S. Congressman Ted Deutch will be raised along with a pine tree -- both ceremonial traditions. To top off Sinai Residences, an Israeli flag will also be raised.

“The creation of Sinai Residences not only serves the need of the growing senior population in South Florida seeking out a safe, luxury and educational environment to live, but also helps the Federation generate revenue to enhance the vital human services and programs we support,” said Melvyn Lowell, COO, Jewish Federation of South Palm Beach County. “The goal is to create an environment that will attract the active, future residents who will become a part of the vibrant South Florida Jewish community.”

The Sinai Residences will offer the highest standard of engaged
senior living and feature a wealth of luxury services and amenities including
hospitality, recreational and social services, cultural and academic pursuits,
fitness programs, as well as gourmet dining with kosher dining available. 

The
Kosher dining experience will be overseen by a Mashgiach, and will be certified
as Glatt Kosher. Sinai Residences will also enjoy front-row access to the many
Federation-sponsored cultural, social and educational events. Fourteen varying floor
plans range in size from approximately 800 to 1,700 square feet.

As a CCRC or Continuing Care Retirement Community, Sinai residents
can age in place with security; housing, health care, amenities and services
are provided for them; and when residents pass on, heirs receive up to 95
percent of value of home. 

As a Life Care community, residents are guaranteed
access to every level of care at a predictable monthly cost, and with
refundable entry-fee options. Access to health care is also guaranteed to residents
from the moment they move-in, and for as long as they remain residents.

Sinai Residences of Boca Raton is located on the north side of the Jewish Federation of South Palm Beach County campus in Boca Raton, Florida. The Sinai Residences will fill nearly half of a 50 acre parcel that has been vacant on the Federation’s West Boca campus since it first officially opened in 1991. 

The project has already brought more than 400 full-time construction-related jobs to the area. Additionally, more than 150 full time employees will be needed once the Sinai Residences are complete.

“The impact of Sinai Residences already on the local economy has been undeniable,” said Aimee Kaye, President and Founding Partner of Sageview Consulting, a Human Resources firm that has been engaged to consult with the Sinai Residences team. “And as the Residences near completion, more skilled local workers in the hospitality, operations and service industries will be needed.”

The Sinai Residences development team, led by Greenbrier Development of Dallas, Texas, includes Suffolk Construction, Perkins-Eastman Architects, H.J. Sims
& Co
. investment bankers, among others. In addition, Life Care
Services, Inc. and Executive Director Chris Newport will manage the new
community.

Location of ceremony: Lunch at 11:30 a.m. at the Jewish Federation
of South Palm Beach County campus, Kay Auditorium, Mel and Elaine Stein Living
and Learning Center, 21150 95th Avenue, Boca Raton, FL. Following the ceremony,
media and photographers are invited to tour designated areas of the
construction site.

Images for download available here

We live in the age of the consumer when access to substantial, relevant and genuine content in a variety of mediums is expected. 

Technology has given us the tools and consumer behavior has shown the power that well-developed content (blogs, articles, videos, testimonials, profiles, social media updates) has in motivating consumers to act.

In this webinar recording GlynnDevins reviews the 5 crucial steps necessary for senior living organizations to develop a content marketing program that aligns with organizational goals, effectively tells a story, creates consumer engagement and drives business.

The webinar covered:

  • How to develop a content strategy that aligns with the business goals of your organization.
  • How to efficiently create and manage content to streamline the process and drive messages across all platforms.
  • Which content and formats are generating the greatest engagement from senior living consumers.

According to an article by Katie Pitts, account supervisor at GlynnDevins, the following question has come up several times over the last year: “We’re an assisted living community; what do we need to do for marketing?” 

Across the country, we’ve seen assisted living and memory care construction has grown significantly over the past 5 years, and it’s expected to continue well into the future.

What does this mean for us? Two things. 

One, increased competition in many markets. Two, an increased need for communities to stand out from their competitors. 

Ten years ago, having a good reputation and a good location often did the trick for assisted living communities. 

Today, it goes much further than that. The first step, though, is getting noticed, and the best marketers are rising to the top.

When it comes to marketing a higher level of care, here are 3 things to consider:

1. A strong digital program is a must. Yes, some prospects or adult children in your market may be aware of your community. But there’s a good chance there are many others who don’t. 

Either way, we know someone looking for care will begin their search by going online, so visibility in the digital world is key. An effective search marketing campaign, engaging website, active presence on social media, online directories and reviews, display ads, email and more -- it can all be relevant. 

Put a digital program in place that consistently gives your community a name, and supports your other marketing and outreach efforts.

2. Identify your true differentiators. What really makes your assisted living or memory care community unique? 

Unfortunately, it’s not the weekly housekeeping or the on-site beauty salon. Think about the programs, staff or services you offer that no one else in your market can claim. Be distinctive. 

With so many choices, prospects need to know why they should choose you over the community down the street. Once you’ve identified your differentiators, your marketing should reflect that. And beyond this, each time a prospect comes through your door, create an experience that’s as just as memorable and unique.

3. Relationships are everything. As consumers, we buy from people we trust. You can’t welcome new residents without earning their trust first, and that of their loved ones. 

To instill confidence, find ways to support them through the sales process with solid solutions to overcome their objections. The same trust goes for generating referrals among professionals in your area. 

Because they have a lot of communities vying for their attention, plan regular visits and provide relevant information, so they see you as a credible, reliable provider -- a place they can feel good about sending their patients or clients to.

In what ways are you setting your assisted living or memory care community apart from the competition?

Seed capital needs are increasing for senior living organizations seeking growth opportunities, according to an article by Ziegler

For a new campus location, the amount of seed capital required to move from concept to permanent financing has steadily increased over the past decade. Fortunately, the availability of seed capital through the issuance of Bond Anticipation Notes has never been better. 

The deployment of seed capital generally falls into two phases. The first round is almost always funded by the sponsoring organization and ranges anywhere from $250 thousand to $1 million. 

This phase is focused on the basic identification of a new campus opportunity and up through the execution of an approved development plan. The next phase requires moving from development plan to permanent financing. 

This stage funds the architectural development and initial marketing of independent living units. Typically, an organization can plan to spend about $3-$15 million dollars in this stage. 

Total use of seed capital for new campus financings has increased over the past ten years. Since 2005, the average seed capital needs (at all stages) has ranged from about $5 to $20 million, depending on project size, location and the cost to control land. 

While this second phase also may be funded with corporate equity, the significant dollar amount prompts organizations to investigate broader funding options at this point. 

Tax-Exempt Bond Anticipation Notes (BANs) are a type of third-party seed capital that provides a fixed rate of return to investors. BANs accrete in value with semi-annual compounding and the interest and return of principal is paid to investors with the funds from the permanent financing. 

Other third-party seed capital vehicles provide a fixed dollar return (for example, 50 cents of return for each dollar invested) and tend to be more expensive for borrowers, depending on how long the seed capital is outstanding. Interest rates on BANs for senior living organizations range from 10%-15% on an annual basis.  

While BANs may seem complicated, they are not an unusual financing tool in the larger municipal bond market. Over $200 billion in BANs have been issued in the municipal market since 2000 for all kinds of projects. For senior living providers, over $60 million in BANs have been issued in the public markets since 1990; nearly half of the volume has occurred post-crisis since 2011.      

Unlike early stage seed capital, investors in BANs will expect that certain development milestones have been reached at the time of the BAN financing. Land should be under contract or option. Permits and regulatory approvals required to begin marketing should be in place. A preconstruction budget and development/market plan should be complete and available for review. 

During the BAN marketing period, agreements will be reached with investors as to the marketing and development milestones that will be monitored for the continued release of funds through permanent financing. BAN investors recognize that changes in the project, such as unit mix, size or configuration, may evolve as actual marketing provides real-time information about the demands of the market. 

One important benefit to using BANs for seed capital needs is that the transaction brings the likely investors of the permanent financing into the project at an earlier stage. Most of the investors in recent BAN issues are the same traditional tax-exempt mutual fund and asset management firms that are the largest buyers of not-for-profit new campus CCRC financings. 

At permanent financing, the project is likely to benefit in the market from having a base of potential investors who are already active in the project and knowledgeable about the organization. 

While this is a significant benefit at the time of permanent financing, it means that BAN investors are likely to behave more like long-term investors instead of short-term investors. 

Before investing in BANs, investors will want to understand the primary market characteristics, operating assumptions, anticipated debt structure, and sponsor commitment to the community, so they may be confident that a permanent financing and long-term community success is achieved.  

This article was written by Amy Castleberry, CFA, senior vice president at Ziegler, and is used here with permission. 

The following article from Medline appeared in McKnight’s Long Term Care News.

I recently had the opportunity to attend the 2015 Biennial Conference sponsored by the National Pressure Ulcer Advisory Panel (NPUAP). 

There, passionate researchers and clinicians from around the world attended. All held a shared goal of improving skin integrity and the health of those we serve. 

The skin is the largest organ of the body, but many times it's the least thought about or cared about until there is an issue. The goal is not having an issue.

When I attend a conference, I always look for pearls of knowledge I can utilize in my practice. The latest research held some fantastic PEARLS:  

 

  • P = Preserve.
  • E = Eat.
  • A = Assess.
  • R = Roots.
  • L = Lift.
  • S = Special.

 

Pearl 1: Preserve

Role of Microclimate: Microclimate is the convergence of temperature, humidity, and airflow at the patient/support interface, or where the skin meets the point of contact. 

In essence, the best way to think about it is mini greenhouses occurring on the skin, except we know that the greenhouse effect is not a good thing for skin. 

It breaks the skin down, causing it to become more fragile and susceptible to breakdown. Learning: Keeping skin clean and dry has been well understood; keeping skin clean, dry, moisture-free and at the right temperature is the new work we must embark upon. 

Pearl 2: Eat

Role of Nutrition: Protein is critical for the cells to stay strong and heal themselves. Proteins such as beef, pork, chicken and eggs have high levels of leucine, which is needed for tissue accretion. Researchers say protein supplements best for skin health and healing include whey.  

Utilizing lab values such as albumin levels is less important as a good assessment of eating habits and nutritional intake. Learning: Look at the person; watch what he or she is eating and not eating. Malnourishment happens at all ages, but more so with the elderly. 

Pearl 3: Assess

Role of Assessment: Assessment must take three levels of risk into consideration. The first level is skin status and activity/mobility. What is the overall health of skin? Keeping your eyes on the skin and knowing its level of performance is the first step of understanding skin performance. 

Perfusion and oxygenation of the skin need to be assessed. Decreasing performance makes skin more vulnerable; throw in poor nutritional intake and increased moisture to the skin and the studies show the skin starts to break down and become more fragile. 

Lastly, the factors of increased age, health status and body temperature, along with decreased sensory perception and hematological measures are all risk factors that impact skin integrity. Learning: Assessment is more than a tool. 

It is taking multifocal contributors into account to determine the level of skin health of a person.

Pearl 4: Roots

While conducting a root cause analysis (RCA) is not new in theory nor in practice, the tool is not being utilized to assure quality improvement and advancement of standards of practice.  Pressure ulcers have to be looked at in their totality. 

Learning: Look back in time to understand where the injury might have occurred. Do a tracer on the pressure ulcer.  

Follow backward to see where there might be opportunities for improvement. Study the Swiss cheese model: Did you have a series of events that contributed to the pressure ulcer? Do you have failure of your support surfaces due to age?

Pearl 5: Lift

Lifting saves skin. It is important to decompress the area that has pressure on it. So lift not only the cheeks (not the facial cheeks!), but also the heels, head and abdomen. Lift those areas that have pressure upon them. For those who are obese, you have to lift the skin off of the skin as well. 

That is where abdomen and other skin folds have to be lifted, allowing blood flow to nourish the skin. Learning: Lifting is essential for healthy skin and prevention of breakdown. 

Pearl 6: Special

Skin needs to feel special, and hydration is critical for the skin to feel that way. Hydration needs to occur both internally and externally. Utilizing a skin moisturizer that is formulated to provide nutrients to the skin is one of the best preventative measures to be taken. 

Don't massage or vigorously rub skin that is at risk for a pressure ulcer. Learning: Skin needs to be fed with the right moisturizer. Utilizing the right product replaces intercellular lipids and promotes moisture barrier functions of the skin. 

The research is very clear around the PEARLS: Persevere, Eat, Assess, Roots, Lif, and Special. Utilization of the PEARLS can compel better skin health. 

Martie Moore is chief nursing officer at Medline Industries and a member of NPUAP's Corporate Advisory Council.

Peconic Landing, a continuing care retirement community (CCRC) located in Greenport, NY, on Long Island's North Fork, began construction of a $43 million expansion in December 2014. 

Peconic Landing currently consists of 250 independent living apartments and cottages which are structured as a cooperative, 26 enriched housing (assisted living) units and 44 skilled nursing beds all on a 145-acre site that fronts Long Island Sound. 

In 2010 Peconic Landing's leadership initiated plans to expand its health center offerings in order to better serve its residents. 

The key objectives of the expansion were to add a neighborhood of nursing beds to ensure availability of health care for Peconic Landing's residents in a state-of-the-art environment, and to complete the continuum of care by adding a memory support assisted living neighborhood.

In 2011 Peconic Landing engaged Greenbrier to complete a Campus Expansion Plan to recommend expansion strategies that would meet key objectives and improve financial performance. 

Greenbrier was subsequently engaged in 2012 to assist Peconic Landing in the implementation of the expansion strategies which ultimately included development of a 16-bed rehabilitation nursing neighborhood and supporting facilities, a 16-bed memory support neighborhood and 46 new independent living apartments which serve as the financial engine for the healthcare expansion.

A first-rate project team was assembled to execute the expansion strategy including Perkins Eastman, Lecesse Construction, Asbury Group, Bohacz Associates, Kowalik Consulting and HJ Sims who placed the financing and provided financial advisory services.

Peconic Landing and its team navigated a difficult New York regulatory environment. Regulatory approvals were ultimately received in late 2014 which enabled Peconic Landing to initiate construction activities. Closing of permanent financing is scheduled for early March 2015 which will consist of a $16.5 million short-term taxable construction loan from Citizens Bank and the issuance of $19.55 million BBB- rated tax-exempt bonds. 

The taxable financing is required to fund the addition of the cooperative units while the tax-exempt debt will fund the health care project which is owned by the non-profit. Initial occupancy is planned for March 2016.

Falls are a major health problem for older adults, including those living in senior living communities. More than one-third of adults age 65 and older fall annually, with up to 30% experiencing fall-related injuries that negatively impact functioning and independence (Centers for Disease Control and Prevention, 2012). 

The incidence of falls increases with advancing age, with 50% of those 80 years of age and older falling each year, according to a paper by Mather LifeWays and distributed by HealthStream.

Adults age 75 years and older who fall are up to five times more likely to be admitted to a long-term care (LTC) community for extended periods of one or more years (Centers for Disease Control and Prevention, 2012). 

Along with the potential physical injuries caused by falls, a number of older adults experience psychological distress of “fear of falling” that may further limit activity and mobility, which in turn, are risk factors for falls. 

Topics include:

  • Consequences and Costs of Falls
  • Falls Reduction Programming in Senior Living and Long-Term Care Communities
  • What Are Components of Effective Falls Reduction Programming for Senior Living and LTC Settings? 

Request the paper.

In 2014,
the Health Resources and Services Administration (HRSA) committed an additional
$6 million to increase 340B program integrity and oversight, according to an article from CliftonLarsonAllen.

The Office
of Pharmacy Affairs (OPA) used the funds to establish a program performance and
quality branch of the agency to augment the already established operational and
informatics branches. The additional branch will be primarily responsible for
developing audit reports and recertifying 340B covered entities.

Expect more
audits in 2015

The OPA has
stated that its goal in fiscal year 2015 is to double the number of audits
performed in previous years. In the OPA’s recently published ProgramIntegrity: FY 2014 Audit Results, it is
clear that HRSA is closely scrutinizing contract pharmacy arrangements and
focusing on diversion, duplicate discounts, and 340B database records.

Contract
pharmacy arrangements

HRSA's 2010
guidance allowed covered entities to contract with multiple outside pharmacies
to increase patient access to medications. The number of contract pharmacy
arrangements has grown significantly as a result, and as of January 2015, more
than 36,000 active contract pharmacy arrangements were listed in the HRSA 340B
database. Contract pharmacy arrangements involve a very intricate level of
oversight to ensure they have the proper internal controls in place to comply
with all of the 340B regulations and guidelines governing the program. HRSA has
asserted that covered entities are ultimately responsible for program
compliance.

Best
practices for 340B contract pharmacy compliance

Ensure there is a
written contract pharmacy agreement between the covered entity and the outside
pharmacy.

Register and
maintain accurate information about 340B contract pharmacy arrangements in the
340B database.

Understand state
Medicaid agency 340B billing requirements for Medicaid and/or Medicaid managed
care organizations regarding contract pharmacy arrangements to avoid potential
duplicate discounts.

Verify that all
Medicaid and National Provider Identifier (NPI) billing numbers, institutional
information, and contract pharmacy arrangements for carve-in entities are
accurately recorded in the HRSA Medicaid Exclusion File.

Do not utilize
contract pharmacies to dispense 340B qualified medications until the pharmacy
has been registered, certified, and is listed under the covered entity in the
340B database.

Maintain
comprehensive 340B policies and procedures addressing contract pharmacy
arrangements.

Develop a
well-defined process to validate patient eligibility.

Maintain a
comprehensive list of health care professionals’ NPI numbers for distribution
to the contract pharmacies and third party claims processors.

Maintain auditable
records at both the covered entity and the contract pharmacy.

Conduct regularly
scheduled self-audits of all aspects of the 340B process.

Engage an outside
vendor to perform an audit of the 340B contract pharmacy. OPA expects covered
entities to have an outside independent audit of both internal and contract
pharmacy processes at least annually.

Implement immediate
fixes to problems identified in the self-audit or independent audit process,
and immediately report any compliance breaches to HRSA.

This article was written by Cheryl Hetland, engagement director of health care, at CliftonLarsonAllen, and is used here with permission.

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