Health care providers continue to face ripple effects created by the global economic crisis of the past few years.

Amid lingering concerns about the stability of the municipal market, hospital systems and other health care providers must strive to maintain strong credit ratings and be prepared to respond to changing risks to their strategic initiatives, operations and capital structure.

Our Health Care Tax-Exempt Finance team marshalls a broad range of resources and experience to help clients of all sizes raise capital and mitigate financing risks in this unpredictable environment.

We offer a complete range of health care financing services. These services extend beyond the traditional roles of bond counsel and underwriter's counsel.

As borrower's counsel, our lawyers often assist clients with products and transactions in addition to bonds.

 Representative transactions include:

• bond issuances, including multi-modal products
• direct placements with lending banks
• open market tenders
• private placements
• liquidity products
• swap transactions
• covenant analysis
• lines of credit and revolving loan agreements
• taxable and tax-exempt lease financing
• HUD financing

A multi-disciplined, integrated team

We bring together in one firm a rare combination of nationally recognized services that are essential to successful tax-exempt health care financing transactions.

• One of the most experienced tax-exempt bond teams in the nation, having served in a wide range of roles on major financings. We are consistently ranked among the top 10 public finance firms in the nation.
• One of the largest and oldest health care teams in the country with extensive experience in health care operations and transactions, regulatory matters and litigation. Some of our health care lawyers and staff previously worked in the health care industry.
• A large tax department with a national reputation for its experience in federal, state and local tax matters. It includes tax-exempt finance lawyers and lawyers who focus on exempt organizations, tax compliance, tax controversy and tax litigation cases.

Public finance

Over the past decade, we have acted as bond counsel, issuer's counsel, underwriter's counsel, disclosure counsel or special tax counsel in more than 175 health care debt offerings, raising more than $15 billion for numerous health systems, hospitals, medical schools, nursing homes, continuous care retirement communities, special purpose entities, state agencies and other health care organizations across the U.S.

Health care

As an integral part of the financing team, lawyers in our Health Care team utilize their industry knowledge to assist in performing "due diligence" and analyzing, mitigating and disclosing risks presented by increasingly complex and rapidly changing state and federal health care funding and regulatory regimes.

The health care team has extensive experience representing clients in regulatory, administrative, business and tax matters and litigation. Lawyers in the group are strategically located across the nation in Austin, Dallas, Houston, Los Angeles, Minneapolis, San Antonio, St. Louis and Washington, D.C.

Tax

Our Tax team includes tax-exempt finance lawyers who also are positioned in offices around the country. They communicate regularly to update one another on current issues and trends in tax-exempt finance techniques, as well as IRS audit and compliance programs, post issuance compliance programs and questions that borrowers are currently asking. They regularly advise exempt organizations on tax compliance apart from financing and handle both exempt organization and tax-exempt bond audits.

Diverse health care financing experience

The lawyers in our Health Care Tax-exempt Finance team are highly experienced, serving as bond counsel, borrower's counsel and underwriter's counsel in health care financings in Alabama, Arizona, California, Louisiana, Montana, Mississippi, Nevada, New Mexico, New York, North Carolina, Oklahoma, Tennessee, Texas, Utah, Washington and Wyoming.

The types of tax-exempt health care finance transactions on which we have worked are diverse, ranging from simple fixed rate bond issues to complex financings with multiple components. Representative examples of our lawyers's health care financing experience include serving as:

• Underwriters counsel on a $950 million dailyrate demand bond transaction supported by self-liquidity
• Bond counsel in the amendment of a $400 million bond transaction to wrap a bank insurance policy with two bank letters of credit and convert from an auction made to variable rate demand obligations
• Bond counsel on a $390 million bond transaction in which five series of bonds were offered in fixed and variable rate modes, including the Windows Interest Rate Mode, and supported by various banks, and two series of index floating rate bonds were privately placed with a bank purchaser
• Underwriter's counsel on an approximately $366 million bond transaction in which seven series of bonds were issued in various variable rate modes and supported by self liquidity and various bank products
• Bond counsel on $360 million multi-modal bonds that were publicly offered and directly placed with multiple bank lenders to finance and refinance prospects at five hospitals in three counties.
• Underwriter's counsel on a $345 million bond transaction in conjunction with a hospital's multi-system corporate restructuring
• Borrower's counsel on a $230 million bond transaction in which a children's hospital supported the variable rate demand obligations with self-liquidity
• Underwriter's counsel on a $172 million bond conversion of several series of auction rate securities
• Bond counsel on a $166 million bond transaction for a continuous care retirement community
• Bond counsel and borrower's counsel on a $160 million direct placement of index floating bonds with a bank purchaser
• Underwriter's counsel on a $30 million bond transaction for a regional medical center
• Underwriter's counsel on a $27.5 million conversion to fixed rate bonds for a special purpose entity involving a local medical center
• Bond counsel on a $7.5 million bond transaction on behalf of a county-based industrial development corporation for an assisted living facility

Our national rankings in public finance

• The Bond Buyer ranked the firm 7th in the nation as bond counsel in 2010, helping to issue $13.84 billion par amount of bonds in 363 issues. (2011)
• The Bond Buyer ranked the firm 7th in the nation as underwriters counsel in 2010, helping to market $8 billion par amount of bonds in 220 issues. (2011)
• The Bond Buyer ranked the firm 2nd in the nation as disclosure counsel in 2010, helping to offer $9.21 billion par amount of bonds in 81 issues. (2011)
• The firm is among the top 10 municipal bond firms in the two categories the American Lawyer's Corporate Scorecard ranks for the year: bond counsel and underwriter's counsel. (2011)

Our national rankings in health care

• Best Lawyers listed 11 of our lawyers as Best Lawyers in the health care law service area (2010).
• Chambers USA Guide listed the firm as a leader on the national level in the health care area. (2010)
• Chambers USA Guide recognized nine of our lawyers as leading health care lawyers. (2010)

Please contact any of the lawyers below for more information about our tax-exempt financing capabilities for the health care industry: