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After an intense overnight session, the US House of Representatives narrowly passed the "One Big Beautiful Bill Act" with a 215-214 vote, marking a significant milestone in fiscal policy reform. The bill, which now heads to the Senate for further consideration, proposes extensive tax changes alongside broader regulatory shifts. While House Republicans and the current administration champion the bill as a legislative victory, Democratic opposition remains strong, and modifications are expected before it reaches the president’s desk.

Major tax provisions

At the heart of the legislation is a sweeping restructuring of federal tax policy. The bill seeks to permanently extend key tax cuts from 2017, while also introducing temporary incentives aimed at stimulating economic growth.

• Locking in individual and estate tax cuts.
• Tax reductions from the 2017 Tax Cuts and Jobs Act (TCJA) will become permanent, preventing their previously scheduled expiration.
• The estate tax exemption will rise to $15 million, adjusted for inflation, allowing high-net-worth individuals to transfer wealth with fewer tax burdens.

Temporary benefits for workers and families (expiring in 2028)

Acknowledging the financial pressures facing American households, the bill introduces several temporary tax incentives:

• Exemptions on tips and overtime compensation, providing relief to service workers and those reliant on extra income.
• Tax-exempt status for interest on specific US-assembled automobile loans, potentially lowering borrowing costs.
• An increase in the standard deduction: an additional $1,000 for individual filers ($16,000 total) and $2,000 for joint filers ($32,000 total).
• A boost to the child tax credit, raising it by $500 to $2,500 per child for tax years 2025 through 2028.

Expanding deductions for high-tax states

One of the bill’s most anticipated revisions is its adjustment of the state and local tax (SALT) deduction cap:

• The cap will increase from $10,000 to $40,000 for households with adjusted gross incomes up to $500,000, alleviating tax burdens in high-tax states.
• For higher-income earners, the deduction gradually phases down, limiting revenue losses for the federal government.

Business tax reforms and incentives

Businesses are among the biggest beneficiaries of this legislation, with several key tax advantages aimed at stimulating investment and innovation.

Encouraging capital investments

• The bill restores 100% bonus depreciation for eligible assets acquired between January 20, 2025, and 2029, allowing businesses to fully deduct the cost upfront.
• The Section 179 deduction cap is raised to $2.5 million, encouraging companies to reinvest in equipment and infrastructure.
• Pass-through entities will see a qualified business income (QBI) deduction increase from 20% to 23%, reducing tax liabilities for small business owners.

Modernizing research and development (R&D) tax treatment

To foster innovation, the legislation reshapes R&D deductions:

• Businesses investing in domestic research can either deduct costs immediately or amortize them over 60 months.
• Foreign R&D costs remain unchanged, reflecting concerns about outsourcing innovation.

More favorable business interest deductions

Under IRC Section 163(j), companies can now add back depreciation, amortization, and depletion when calculating limits on interest deductions, helping firms that rely on capital financing.

Controversial provisions and policy shifts

While many business owners welcome the tax incentives, other aspects of the bill have sparked debate—particularly those affecting environmental initiatives and international taxation.

Scaling back clean energy tax credits

Several clean energy tax credits from the Inflation Reduction Act (IRA) are now subject to elimination or accelerated phase-out.

• Supporters argue that this move reduces unnecessary subsidies.
• Environmental groups warn that these rollbacks could slow the transition to renewable energy and discourage green investments.

Targeting "unfair foreign taxes"

A new provision, Proposed Section 899, is designed to address foreign tax policies:

• It imposes higher US tax rates on individuals from nations that impose restrictive or unfair taxes on American citizens or corporations.
• Critics view this measure as potentially fueling trade tensions and diplomatic disputes.

Excise tax on remittances

A 3.5% excise tax will now apply to remittances sent by non-US citizens to family members abroad.

While proponents frame this as a revenue-generating strategy, opponents argue that it disproportionately affects immigrant communities.

What happens next?

As the bill moves to the US Senate, its fate remains uncertain. While Republicans tout its provisions as an economic boost, Democratic lawmakers continue to scrutinize its potential effects on income inequality, environmental sustainability, and trade relations.

Taxpayers—whether individuals or businesses—should pay close attention as amendments emerge. With negotiations underway, the final legislation could see additional revisions, altering tax credits, deductions, and corporate incentives.

For now, those impacted by the bill should begin assessing how these provisions align with their financial strategies, preparing for potential tax shifts in the coming years.

BerryDunn's tax consulting and compliance team brings deep experience and extensive resources to each client’s unique tax situation. We work closely with you to develop comprehensive, coordinated strategies to ensure tax compliance, limit exposure, and optimize performance. Learn more about our team and services. 

Read this if you work in management at a higher education institute or another nonprofit organization. 

On May 5, 2025, the US Department of Education (ED) issued a Dear Colleague Letter (DCL) to higher education institutions. The DCL outlined current default rates for federal student loans and the expected impact on these rates with the resumption of collection efforts on defaulted loans. ED suspended collection efforts on these loans in March 2020 to help combat the economic crisis created by the COVID-19 pandemic. According to ED, an estimated 25% of individuals currently in repayment are in default or significantly delinquent. It’s important to take a closer look at the impact increased default rates could have on higher education institutions and other nonprofit organizations, and how to remain compliant. 

Impact on higher education institutions 

Federal regulations require higher education institutions to track and maintain low cohort default rates (CDR). If an institution has a CDR higher than 40% in a single year or exceeds 30% for three consecutive years, the institution will lose their eligibility to receive federal student assistance. ED’s resumption of collection efforts on defaulted federal student loans is expected to increase institutions’ CDR.  

The DCL emphasizes the role institutions play in contacting former students to remind them of their responsibility to repay their federal student loans. If an institution were to become ineligible to receive its annual federal student assistance, funding would severely impact the institution’s ability to continue operations.  

The CDR regulation is three years in arrears, which means the 2026 default rate will include students who entered into repayment in 2023. Based on this, institutions should: 

• Start contacting former students in repayment before 2026 to help them avoid defaults 
• Monitor their CDR continuously to mitigate the risk of becoming noncompliant with federal regulations and to reduce the risk of losing eligibility to receive federal student assistance funding 

Impact on other nonprofit organizations 

While higher education institutions bear the direct impact of increased default rates on federal student loans, other nonprofit organizations should also be aware of how these defaults could affect their operations. Many former students with federal student loans work at nonprofit organizations, which often receive various forms of federal assistance. These organizations must verify that federal funds are not paid to businesses or individuals, including employees, who are suspended or debarred by the federal government. This is because suspension or debarment can result from defaulting on federal student loans, as well as for other reasons.  

As more individuals are expected to default, the list of those debarred or suspended from receiving federal payments could grow. Nonprofits are required to periodically review their vendors and employees to verify they are not suspended or debarred. If identified as such, these vendors and employees would be ineligible to receive any payment for goods or services, including wages and Medicaid, through federal funding. 

It's crucial for nonprofit organizations to regularly monitor the suspension and debarment list, which frequently changes, to maintain compliance. Organizations can support their employees by communicating the importance of making student loan payments and avoiding default. Helping employees understand how their student loan payments can impact their employment may encourage timely payments and prevent defaults.  

With collection on default federal student loans back in effect, it’s imperative that higher education institutions and other affected nonprofits follow these strategies to ensure compliance. Learn more about BerryDunn’s team and services. 

Read this if your company is considering financing through a sale leaseback.

In today’s economic climate, some companies are looking for financing alternatives to traditional senior or mezzanine debt with financial institutions. As such, more companies are considering entering into sale leaseback arrangements. Depending on your company’s situation and goals, a sale leaseback may be a good option. Before you decide, here are some advantages and disadvantages that you should consider.

What is a sale leaseback?

A sale leaseback is when a company sells an asset and simultaneously enters into a lease contract with the buyer for the same asset. This transaction can be used as a method of financing, as the company is able to retrieve cash from the sale of the asset while still being able to use the asset through the lease term. Sale leaseback arrangements can be a viable alternative to traditional financing for a company that owns significant “hard assets” and has a need for liquidity with limited borrowing capacity from traditional financial institutions, or when the company is looking to supplement its financing mix.

Below are notable advantages, disadvantages, and other considerations for companies to consider when contemplating a sale leaseback transaction:

Advantages of using a sale leaseback

Sale leasebacks may be able to help your company: 

• Increase working capital to deploy at a greater rate of return, if opportunities exist
• Maintain control of the asset during the lease term
• Avoid restrictive covenants associated with traditional financing
• Capitalize on market conditions, if the fair value of an asset has increased dramatically
• Reduce financing fees
• Receive sale proceeds equal to or greater than the fair value of the asset, which generally is contingent on the company’s ability to fund future lease commitments

Disadvantages of using a sale leaseback

On the other hand, a sale leaseback may:

• Create a current tax obligation for capital gains; however, the company will be able to deduct future lease payments.
• Cause loss of right to receive any future appreciation in the fair value of the asset
• Cause a lack of control of the asset at the end of the lease term
• Require long-term financial commitments with fixed payments
• Create loss of operational flexibility (e.g., ability to move from a leased facility in the future)
• Create a lost opportunity to diversify risk by owning the asset

Other considerations in assessing if a sale leaseback is right for you

Here are some questions you should ask before deciding if a sale leaseback is the right course of action for your company: 

• What are the length and terms of the lease?
• Are the owners considering a sale of the company in the near future?
• Is the asset core to the company’s operations?
• Is entering into the transaction fulfilling your fiduciary duty to shareholders and investors?
• What is the volatility in the fair value of the asset?
• Does the transaction create any other tax opportunities, obligations, or exposures?

Accounting for sale leaseback transactions under Accounting Standards Codification (ASC) Topic 842, Leases, can be very complex with varying outcomes depending on the structure of the transaction. It is important to determine if a sale has occurred, based on guidance provided by ASC Topic 842, as it will determine the initial and subsequent accounting treatment.

The structure of a sale leaseback transactions can also significantly impact a company’s tax position and tax attributes. If you’re contemplating a sale leaseback transaction, reach out to our team of experts to discuss whether this is the right path for you.

To reduce federal debt and expenditures, the Trump administration mandated an unprecedented, large-scale layoff across federal agencies in February 2025. As a result, approximately 1,300 probationary employees at the Centers for Disease Control and Prevention (CDC), nearly 10% of its workforce, received dismissal notices.

The decision to cut probationary employees and the subsequent programming and staffing cuts in March 2025 worsened an already existing public health workforce shortage. Based on the 2021 Public Health Workforce Interests and Needs Survey (PH WINS), 27% of public health professionals planned to leave their organization, excluding those planning to retire, within the next five years. Research indicated that 24% of those public health professionals were planning to leave for non-governmental jobs, which impacts future governmental public health leadership and strains the overall workforce within public health agencies at all levels.

The CDC’s workforce boasts some of the top experts for disease control and health information, with over a third of the 13,000 employees holding a master’s or doctorate degree responsible for protecting Americans from outbreaks and other public health threats. In 2023, with public health agencies still recovering from the COVID-19 response, the CDC’s budget was slashed by $1.8 billion—a 22% reduction, with nearly 80% of the CDC’s base budget shared with state and local health departments.

In addition, the CDC recently pulled back $11.4 billion from state and local health departments, nongovernment organizations, and international recipients. While these funds were allocated in response to the COVID-19 pandemic, public health agencies depended on them for critical initiatives such as modernizing data systems, improving immunization access, and bolstering laboratory capacity to prepare for the next public health emergency.

Burnout in state public health agencies

Many of those working within public health agencies at the local and state levels are questioning how the restructuring and funding cuts at the federal level may impact their roles. Staff may be feeling discouraged as their coworkers are laid off and programs are shut down, halting the past few years of progress and investments. It is likely that with fewer resources, feelings of job insecurity, excessive workloads, and even moral injury, the remaining staff will face greater levels of burnout. Burnout was the number one reason for leaving the field cited by public health professionals in 2021.

With staff burnout, position turnover, and elimination of funding and resources, the existing workforce is scrambling to plug the gaps. State public health agencies rely on partnerships with federal agencies, such as the CDC, for guidance and expertise to address state and local public health challenges. The sudden dismissal of CDC employees coupled with program closures has dismantled training programs that were integral to bolstering the workforce of state and local public health departments. For example, the Public Health Associate Program trained, deployed, and supported recent college graduates and other early career workers for two years. As a result, public health agencies will be forced to shift responsibilities, priorities, and resources.

Future public health professionals, including those in college and postgraduate public health studies, are now facing doubts and questions regarding the stability of their chosen career path. In a recent survey by the Federal News Network, nearly 82% of federal employee respondents agreed that the mass federal terminations will make it harder to recruit young and mid-career employees and will overall result in an increased workload for an already understaffed workforce. Both experienced professionals and those considering public health careers are navigating an uncertain future within the public sector.

Migration of public health staff to the private sector 

The private sector (i.e., hospitals, not-for-profits, for-profits, and other areas outside government) offers a growing number of public health job opportunities, and federal workers are expected to naturally migrate to those jobs with roles ranging from consultants and epidemiologists to environmental specialists.

A Colombia University Mailman School of Public Health study found that most public health occupations in governmental agencies pay workers substantially less compared to workers in the same occupations in the private sector. In addition to better compensation, public health jobs in the private sector can potentially offer more dynamic work environments and faster career advancement.

Furthermore, while millions of federal workers were ordered to return to offices post-COVID, work-from-home (WFH) policies and trends remain steady in the private sector. WFH policies and expectations will impact federal agencies’ ability to recruit new talent and maintain a steady hiring pipeline. In five years, 30% of the workforce will be represented by Gen Z. A recent survey from Slack indicated 12% of workers want to return to the office full time, 51% of Millennials and Gen Z workers want hybrid roles that allow for most of their time spent working from home, and 30% of Gen Z want to stay remote full time.

Strategies for attracting top talent to the public health workforce

Public health agencies have a powerful opportunity to inspire the next generation of professionals to join the governmental workforce. To build a pipeline of committed talent, agencies must take proactive steps—establishing dynamic mentorship programs, creating hands-on internship opportunities, and sharing compelling success stories that highlight the profound impact and fulfillment of serving in public health.

Additionally, fostering a supportive workplace culture is essential. Agencies can prioritize employee well-being through innovative peer support initiatives designed to combat burnout, ensuring that professionals not only enter the field but thrive within it. By championing these strategic actions, public health agencies can cultivate a resilient, motivated workforce dedicated to protecting and improving community health.

Public health professionals are uniquely equipped to navigate complex environments. This resilient workforce has withstood a global pandemic, chronic staff turnover and shortages, and unstable federal funding throughout the past decade. Despite these challenges, public health workers remain motivated to prevent disease and injury, promote health and well-being, and protect their communities from health risks and threats.

The foundations of public health training—critical analysis, effective communication, and strategic problem-solving—provide public health workers the skills needed to navigate uncertainty, respond quickly, and survive difficult times. After all, public health has always moved forward despite the challenges and limited resources encountered along the way.

BerryDunn's public health consulting team is comprised of former state and local health agency leaders and public health professionals with administration, informatics, policy and program development, and project management expertise. Contact our team to learn more about how we can help you design public health strategies that take into account diversity, equity, and inclusion and help promote health, prevent disease, and improve the quality of life for your citizens.

The Supporting Affordability and Fairness with Every Bet (SAFE) Act is a proposed federal legislation designed to establish minimum standards for sports betting across the United States. It aims to ensure responsible gambling practices, protect consumers, and uphold the integrity of sports betting nationwide.

This article summarizes key compliance requirements outlined in the SAFE Bet Act and examines how the American Institution of Certified Public Accountants (AICPA) System and Organization Controls (SOC) 1 and SOC 2 standards help operators report internal controls over financial reporting (SOC 1) and security, availability, confidentiality, processing integrity, and privacy (SOC 2).

Key compliance requirements of the SAFE Bet Act

State sports wagering programs: States must implement federally compliant sports wagering programs, including measures to prevent underage gambling, promote responsible gambling, and support problem gamblers.

Artificial intelligence (AI) regulations: The act prohibits AI-driven tracking of gambling behaviors for personalized promotions and the use of AI to develop gambling products such as microbets.

National self-exclusion list: A national self-exclusion list allows individuals to voluntarily exclude themselves from sports betting, providing an essential tool for managing gambling-related risks.

Affordability checks: Bettors must undergo affordability checks to ensure wagers do not exceed 30% of their income, preventing excessive gambling and protecting vulnerable individuals.

Advertising restrictions: Strict regulations limit sports betting advertisements during primetime hours and live sporting events. Additionally, promotional terms like “bonus” and “no-sweat” are restricted to prevent misleading marketing.

Internal control development and reporting for sports wagering operators

Beyond compliance requirements, the SAFE Bet Act mandates that sports wagering operators document and maintain robust internal controls to ensure adherence to all applicable laws, regulations, and policies.

Section 103, paragraph 16, requires operators to submit an annual written system of internal controls to the state and undergo an independent third-party or regulatory audit at least once every three years.

With over 20 years of experience assisting gambling operators with independent third-party attestation reports, we have observed that most states now require annual independent audits. These audits typically assess controls related to financial reporting (SOC 1) and security, availability, confidentiality, processing integrity, and privacy (SOC 2).

SOC audits and SAFE Bet Act compliance

SOC audits reinforce sportsbook operators’ commitment to financial reporting, data security, privacy, and operational integrity, aligning with the SAFE Bet Act in several ways:

Security and privacy: Both SOC audits and the SAFE Bet Act prioritize consumer data protection. SOC 2 audits evaluate security and privacy controls, ensuring responsible data handling. The SAFE Bet Act mandates anonymized reporting and restricts AI-driven tracking, supporting privacy safeguards.

Compliance and transparency: SOC audits offer a structured method to evaluate and report compliance with security standards. Likewise, the SAFE Bet Act requires annual sports wagering reports, fostering transparency and accountability.

Consumer protection: Both frameworks emphasize consumer protection. SOC 2 audits assess controls for safeguarding data, while the SAFE Bet Act introduces affordability checks and advertising restrictions to prevent exploitation and promote responsible gambling.

BerryDunn can help you stay compliant with the SAFE Bet Act

The SAFE Bet Act establishes rigorous compliance standards for United States sports betting, focusing on responsible gambling, consumer protection, and integrity. SOC audits provide sportsbooks with a proactive approach to compliance, trust-building, and enhanced security measures.

BerryDunn has more than 25 years of specialized experience in providing auditing and consulting services to gaming, sportsbooks, and lottery clients. We provide the insight necessary to help you ensure the security and integrity of a successful gambling operation. Our professionals bring over two decades of expertise in assisting gambling clients with audit requirements, including SOC, NIST, PCI, and ISO 270001. Learn more about our team and services. 

This article is part two of a series to help businesses navigate trade strategies amidst tariff changes. Part one discussed Transfer pricing and tariffs: Strategic considerations for businesses. Next up: First sale declarations.    

In today's globalized economy, businesses face an ever-changing landscape of tariffs, trade policies, and international supply chain challenges. For companies navigating these complexities, foreign trade zones (FTZs) present a strategic opportunity to reduce costs, improve logistical efficiency, and enhance overall competitiveness. 

Understanding FTZs 

FTZs are specially designated areas under the supervision of US Customs and Border Protection. These zones exist outside the formal US customs territory for tariff purposes, allowing businesses to import goods without immediately incurring duties.  

Within an FTZ, companies can store, process, assemble, or manufacture products, postponing duty payments until the goods officially enter the US market. If products are re-exported instead, businesses may bypass US duties altogether. By leveraging FTZs, companies can exert greater control over their financial obligations, minimize risk, and streamline operations. 

Why should manufacturers consider FTZs? 

The benefits of utilizing an FTZ are particularly pronounced when dealing with volatile trade conditions, high tariffs, or complex customs procedures. Businesses operating in an FTZ can take advantage of several key benefits: 

• Duty deferral and reduction: Since duties are not paid until goods leave the FTZ, businesses can improve cash flow and allocate resources more effectively. Additionally, if goods undergo a manufacturing or assembly process within the zone, companies may pay reduced duties based on the finished product’s classification rather than the individual component costs. 
• Streamlined customs processing: FTZs offer logistical efficiencies by enabling businesses to consolidate shipments. This can result in expedited customs clearance, reduced paperwork, and overall smoother trade facilitation. 
• Re-exporting without US duties: Companies that import goods for re-export purposes can avoid US duties entirely, allowing them to maintain a competitive edge in international markets. 

In an era of uncertain trade policies, FTZs provide an essential tool for businesses seeking flexibility, predictability, and cost savings. 

How BerryDunn can help 

While the advantages of FTZs are compelling, the process of establishing operations within an FTZ requires careful planning and compliance. Regulations governing FTZs involve detailed application procedures, inventory tracking requirements, and operational best practices. 

Our team can help guide businesses through the FTZ approval process, ensure compliance, and maximize the full benefits these zones offer. From initial consultation to implementation and ongoing management, we help companies optimize their supply chain strategies while remaining compliant with US trade laws. 

Let’s talk strategy 

Trade policies fluctuate, and tariff changes can significantly impact business operations. Taking a proactive approach to mitigate these risks is essential. Foreign trade zones provide a critical advantage, turning potential obstacles into opportunities. 

If your company is looking to enhance efficiency, manage costs, and strengthen global trade operations, exploring FTZ solutions could be the right move. Contact us today to discuss how we can help your business navigate complexities and unlock valuable savings. 

Hospitals across the country are facing mounting financial pressures in delivering primary care services, often shouldering annual losses of 5–7%. Primary care providers are essential for the health of the community and for the financial health of the hospitals to which they refer patients for services. As hospitals strive to balance their budgets and sustain primary care, there are options for hospitals to take that could ease financial burdens while preserving provider presence in the communities they serve. This article explores actionable models and strategies to reimagine primary care delivery in a way that benefits both patients and hospital systems.

The current landscape of primary care in hospitals

The national shortage of primary care providers has disproportionately impacted rural communities, leading to worsening access gaps. In addition, many small practices have struggled with mounting administrative burdens, burned-out physicians weary from long hours, and concerns over sustainable revenue. These challenges have driven hospitals to step in, offering indispensable resources such as EHR systems, IT support, malpractice insurance, and HR administration. Additionally, hospitals have benefited from enhanced reimbursement opportunities through provider-based billing and critical access hospitals through Method-II billing. Some of these benefits, like Medicare’s ongoing push to site-neutral payments and increased Medicare managed care, are eroding the benefits hospitals once enjoyed through and employed physician model.

However, the reality has often been more complex than anticipated. Physicians employed by hospitals increasingly seek work-life balance, leading to declines in the daily patient volumes. At the same time, patient appointments are backing up due to the complexity of cases and ongoing public health crises such as substance abuse epidemics. Commercial payors and employees are also steering patients toward less costly ancillary providers, further eroding the advantage of containing patients within the walls of the hospital through their primary care network. With fewer openings for new patients, communities have turned to urgent care centers and emergency departments for their primary care needs, further straining healthcare systems and exacerbating costs.

Exploring innovative models for primary care

The traditional model of employing primary care providers is not sustainable for many health systems. The costs, recruitment challenges, decreased reimbursement, and other pressures are forcing hospitals to evaluate other options. Not having a robust primary care network is not an option for hospitals and the communities they serve. The pendulum of employing as many primary care providers as possible is swinging due to the above-mentioned challenges and hospitals are starting to explore other partnerships to strengthen their financial health and communities access to primary care services.

One approach, for communities with Federally Qualified Health Centers (FQHCs), is to forge a new relationship. These federally funded clinics offer robust reimbursement for Medicare and Medicaid services, grants to support their operations, and behavioral health payments that are not available to hospitals. While hospitals cannot directly own FQHCs, innovative partnerships can form mutual win-win relationships for both the FQHC and hospital. FQHC partnerships are particularly effective in serving underserved populations, making them a strong option for hospitals aiming to achieve both financial stability and community health goals.

Our team works with a Maine health system that is an example of a hospital/FQHC partnership. The FQHC employs all primary care in the community. The two share many resources, like executive leadership and IT support. Through collaboration and partnership, each organization is able to focus on what they do best and what is best for the community.

Hospitals might also consider establishing FQHC Look-Alikes, which offer similar reimbursement advantages without formal federal funding. This model allows hospitals to maintain primary care access while sidestepping ownership restrictions. Successful implementations show that this approach can bridge gaps in underserved communities while helping to ensure operational feasibility.

For hospitals located in rural areas, Rural Health Clinics (RHCs) present another option. RHCs are designed to provide care through mid-level practitioners and can deliver targeted services that address the needs of specific rural populations. However, while RHCs enjoy favorable Medicare and Medicaid reimbursement rates, their scope is limited to rural areas, potentially excluding urban hospitals from reaping similar benefits. On the other hand, Critical Access Hospitals (CAHs), which receive cost-based reimbursement from Medicare, offer a more expansive opportunity for sustaining primary care in rural settings. Leveraging Method-II billing within CAHs can provide additional financial uplift.

The path forward for employed physician models

While alternative models like FQHCs and RHCs take time to establish, many hospitals may find value in retaining employed physician models and optimizing them to minimize losses. This could include:

• Streamlining coding and charge capture processes to prevent revenue leakage.
• Implementing scheduling templates to reduce appointment delays and ensure optimal utilization.
• Enhancing patient access through strategic no-show reduction initiatives and better liability collections.
• Revising compensation structures to align physician incentives with quality metrics and financial performance.
• Continuing to explore accountable care models
• Enhancing physician compensation models to reward both outcomes and productivity
• Reducing costs by eliminating unnecessary overhead and leveraging technology that decreases costs and improves access and productivity

Primary care is the heartbeat of any community-focused healthcare system, yet hospitals face mounting pressure to sustain these services without absorbing perpetual financial losses. Whether through partnerships with FQHCs, leveraging CAH designations, or refining employed physician models, the path forward requires creativity, collaboration, and a commitment to both fiscal and social responsibility. By understanding the unique needs of their communities and exploring innovative strategies, hospitals can strike a balance that ensures improved access, higher quality care, and minimized financial strain.

BerryDunn’s healthcare team understands the unique challenges that healthcare organizations are facing. From labor shortages to regulatory changes and financial viability, our team of audit, tax, clinical, and consulting professionals is committed to helping you meet and exceed regulatory requirements, maximize your revenue, minimize your risk, improve your operations—and most importantly—facilitate positive outcomes. Learn more about our team and services.

In today's rapidly evolving business landscape, boards of directors are more than just stewards of governance—they are the strategic compass guiding an organization toward enduring success. As the challenges facing companies grow increasingly complex, from disruptive technological trends to shifting societal expectations, the board's role has never been more critical. 

This series is designed to empower board members with the insights and tools necessary to navigate change with confidence. Our experts, each a leader in their respective field, will share real-world examples, practical frameworks, actionable advice in a Q&A format, and lessons learned from their personal and professional journeys.  

Employee well-being: The key to a productive and healthy workforce 

Our board leadership series begins with BerryDunn’s Workforce and Well-being practice lead, Vienna Morrill, who shares insight on how well-being programs can contribute to a thriving workforce.  

Q: What’s the most important thing that boards need to know about employee well-being?  

A: A culture-first approach is essential—well-being programs and benefits are less meaningful unless employees feel empowered to use them. Leadership commitment is critical; having a visible leader championing well-being helps normalize it as part of the workday rather than as an afterthought. Manager engagement is equally important, as managers must understand the value of well-being and take responsibility for fostering it within their teams. Importantly, well-being cannot be just an HR initiative; it requires active participation from leaders, managers, and employees themselves. An organization’s well-being strategy should integrate well-being into every aspect of the employee experience, with multi-dimensional benefits that address physical, mental, social, financial, and career needs, and be aligned with broader initiatives related to employee engagement and experience. A maturity model—such as assessing your organization’s current well-being program—can further help boards identify gaps and drive continuous improvement. 

Q: How do you ensure that well-being initiatives are inclusive and accessible to employees with different needs, backgrounds, and work styles? 

A: Organizations need to know their people and seek input. By developing and maintaining psychological safety in the workplace, organizations are better positioned to get meaningful feedback from employees about their well-being needs and programming preferences. Psychological safety begins with an environment where people feel comfortable showing up as themselves. In today’s fast-paced world of work, this often requires greater intention around creating opportunities for people to get to know each other, develop connections, and build a sense of community.  

Additionally, if you have employees or teams who are actively involved in specific diversity and inclusivity initiatives, it’s important to include them in the well-being planning process. Often, these initiatives can work hand-in-hand and be mutually beneficial. If budgets are limited, it’s best to focus on embedding well-being into the overall employer brand and employee experience before focusing extensively on “above and beyond” programs, resources, and benefits. Building a culture where well-being is viewed as a normal, expected part of work naturally supports inclusivity, helping to ensure every employee has access to the resources and support they need. 

Q: For those organizations that continue to have a large remote or hybrid workforce, what are some ways to support the work-life balance of all employees? 

A: The physical workplace offers valuable opportunities to showcase your well-being strategy and reinforce the culture you want to cultivate. However, when much of your workforce is remote, frequently traveling, or outside a traditional office environment, your approach should be anchored in location-agnostic programming to ensure broad reach and inclusivity. For example, focus on delivering consistent, organization-wide messaging that highlights your commitment to employee well-being, and establish clear feedback channels to surface needs and guide continuous improvement.

One of the largest challenges for remote and hybrid employees is often the blurring of boundaries between work and life. Organizations can set clear boundaries for work hours by encouraging practices such as logging off from collaboration platforms after hours and establishing norms around calendar sharing and personal time. For those in the office, creating a healthy physical environment reinforces the overall commitment to well-being. Additionally, encouraging remote employees to take stretch breaks, engage in local professional communities, or visit the office periodically for meaningful engagement can help maintain a healthy balance.

Q: How do you incorporate movement and exercise into the daily routine of employees who work at desks for long hours? 

A: Encouraging movement is vital for desk-bound employees, as opportunities to step away from screens, stimulate circulation, and refresh focus are essential for physiological and psychological health. This is an area where leaders and managers can be particularly influential by modeling that it’s okay to step away from your desk – whether by openly sharing that they are taking a break for physical activity, inviting others to join them, or speaking to its importance. Organizations can promote the idea of taking assignments offline—such as walking while brainstorming or listening to podcasts during breaks—to integrate exercise into the workday. Allowing flexibility so that employees can take planned, consistent breaks to move can not only improve time management and clarity of thought but also counteract the negative effects of prolonged sitting. 

Q: What are some common financial challenges employees face, and how can employers support them through education or benefits programs? 

A: Financial well-being starts with ensuring fair and competitive salaries that address factors like pay equity, cost of living, and benefits affordability. Employers can further support their teams by offering resources, tailored education, and benefits that assist with managing debt, saving for the future, and mitigating financial stress. A holistic approach might include personalized financial counseling, credit and debt management resources, and incentives such as matching student loan repayments through 401(k) contributions. Additionally, employers should make sure that employees are aware of and know how to access online tools and resources integral to their existing benefit platforms, empowering them to make informed financial decisions. 

About Vienna 

Vienna has long valued well-being, a passion born from early struggles with focus, fatigue, and depression that spurred her to explore how lifestyle habits impact both physical and mental vitality. Through a journey of personal growth, she discovered that nurturing the body with proper nutrition, hydration, sleep, and exercise could transform everyday energy and resilience. Over time, her perspective broadened to include the importance of community, meaningful relationships, and living authentically in alignment with one’s values. In her previous work as an IT Management Consultant, she observed that even routine technical challenges carried deep human implications, reinforcing her belief that employee well-being is a dynamic, personalized pursuit. Combining personal insights with professional experience, she has become a strong advocate for fostering holistic well-being in the workplace, convinced that a healthier team is the key to sustained business success. 

BerryDunn partners with organizations to create work environments where business success and personal growth coexist and where people are confident knowing their workplace positively contributes to their well-being. We take a comprehensive approach to our workforce and well-being work, considering how business needs, organizational capacity, and the employee experience work together to drive your business forward. Learn more about our team and services. 

Nonprofit audit committees play a pivotal role in maintaining transparency and accountability. Their responsibilities include financial oversight, compliance, reporting guidelines, risk management, external audits, internal audits, and ethical standards. Have you ever wondered what kinds of questions the audit committee should be asking of management and each other? Consider the following list of sample questions as a starting place.

Sensitive areas

Audit committees must ensure ethical standards and financial integrity across all aspects of the organization.

• Executive compensation: Is it reasonable and compliant with IRS guidelines?
• Travel and expense approvals: Are there any questionable items?
• Loans and related-party transactions: Are these legal and appropriate?
• Conflict of interest policies: Are they robust and effective?

Accounting and financial reporting

A strong financial framework requires thorough oversight of internal controls, reporting accuracy, and audit recommendations.

• Internal controls: Are they adequate, especially in managing contributions?
• Auditor recommendations: Are they being implemented?
• Financial statements: Are there significant changes or new revenue sources?
• Budgeting practices: Are all liabilities recorded accurately?

Program activities

Nonprofits must ensure that their resources are effectively allocated to fulfill their mission and serve community needs.

• Expense allocation: What percentage of expenses goes to program services?
• Unit costs: How do they compare to similar organizations?
• Community needs: Are they reassessed periodically?

Fundraising

Sustainable funding is key to a nonprofit’s success, requiring well-managed donor outreach and revenue diversification.

• Solicitations: How many are sent to donors?
• Cost-effectiveness: Are fundraising efforts efficient?
• Funding sources: Is there a diversity of funding sources?
• Board contributions: Do all board members contribute to fundraising campaigns?

Investment management

Managing investments wisely ensures financial stability and mitigates potential risks.

• Return on investments: How does it compare to market indices?
• Risk management: How are market fluctuations and potential losses managed?

Tax and regulatory matters

Compliance with IRS regulations and maintaining tax-exempt status are essential for nonprofit credibility.

• IRS compliance: Is the organization compliant with IRS regulations?
• Unrelated business income: Are potential liabilities assessed?
• Tax-exempt status: Is it properly maintained?

Nonprofit environment

External factors such as economic conditions and reputational risks can impact long-term stability.

• External factors: How do demographic trends and economic conditions affect the organization?
• Reputational risks: What strategies are in place to mitigate these risks?
• Insurance coverage: Is it adequate against various liabilities?

External auditors' relationship

Maintaining independent auditors and transparency strengthens credibility and financial reporting.

• Independence: Are external auditors independent?
• Transparency: Are audit fees and potential conflicts disclosed?

Internal audit oversight

Regular internal audits ensure financial accountability and effective risk management.

• Audit plans: Are they approved and effectively overseen?
• Enterprise risk management: Is it robust and comprehensive?

By addressing these questions, audit committees can help safeguard the nonprofit organization's integrity and financial health, ensuring it continues to serve its mission effectively.

As auditors and consultants to nonprofits of all sizes throughout the US, BerryDunn's not-for-profit team has a clear understanding of industry best practices. We provide the vital strategic, financial, and operational support necessary to help you fulfill your missions. Learn more about our team and services.