Health systems accumulate land: surface parking, a bought-out neighborhood, a site held for a tower that never got built. It is carried at historic cost, produces no income, and is the least examined line on a balance sheet under continuous margin pressure.
Medical office on campus. The classic. A developer builds the building on a ground lease, physicians occupy it, the system keeps the land and the adjacency without funding the construction.
Surface parking. The single most underused asset on most campuses. Structured parking plus a ground lease on the released land can fund a meaningful share of a capital plan.
Assembled land held for a project that stalled. Acquired for an expansion that is now indefinite, carried and taxed in the meantime. A ground lease produces income without foreclosing the expansion, if the parcel is chosen and the reversion drafted with that in mind.
Residential and senior housing adjacency. Land near a campus that has value to somebody else at a use the system has no interest in operating.
A sale-leaseback of an operating facility converts an owned asset into a long-term rent obligation on space the system must occupy. It raises more money and it reduces future freedom, because the occupancy commitment is the product being bought.
A ground lease on land the system does not operate raises less and commits less. It is the smaller, less reversible-looking transaction that is actually the more reversible one. Which is right depends on whether the constraint is the size of the number or the flexibility given up to get it.
Use restrictions, so the parcel cannot become something inconsistent with a hospital campus under a future tenant. Transfer and consent standards, objective enough to be financeable but real enough to matter. Parking, access and easement rights across the leased parcel, permanently. And expansion protection, whether that is a right of first offer, a defined reversion or simply choosing a parcel that is genuinely surplus.
Do not subordinate the fee. A foreclosure on the tenant's construction loan should never be able to reach a hospital's land.
Three things set the timeline and none of them are the real estate. Property tax exemption on the leased parcel usually changes once a taxable tenant occupies it, and somebody has to bear that. Outstanding tax-exempt bond covenants may restrict use of financed property. And the board and finance committee calendar is the calendar.
Not tax, legal or bond advice. Exemption treatment, private-use rules on tax-exempt financing and state charitable-property requirements vary and require your own counsel and bond counsel.
No. It concerns land the system is not operating on. Nothing about staffing, licensure or payer relationships changes.
No. A sale-leaseback sells a building the system occupies and commits it to long-term rent on space it must have. A ground lease conveys a leasehold in land the system does not operate.
Typically the leased parcel becomes taxable once a taxable tenant occupies it. Who bears that cost is a term to negotiate, not a surprise to discover.
They can. Private business use restrictions on bond-financed property are a real constraint and bond counsel should see the structure early.
Yes, through parcel selection, use restrictions, rights of first offer and carefully drafted reversion terms. Choosing a genuinely surplus parcel is the strongest protection.
No. A foreclosure on a tenant's construction loan should never be able to reach the system's land.
Send the parcel, its current use and whether bond covenants touch it. We will tell you what the land supports and what the control terms need to say.
Email us the property