Assisted Living
Audits, HUD 232 reporting support, entity structuring, and tax services for assisted living facilities, senior living communities, and CCRCs.
Overview
Assisted living and senior living operators run a business that blends housing, hospitality, and care. Revenue may come from private pay residents, long-term care insurance, and, in many states, Medicaid waiver programs that cover services for eligible residents. Many communities are financed with HUD Section 232 insured mortgages or conventional bank debt, and many are owned through structures that separate the operating company from the real estate. Pease Bell works with assisted living facilities, senior living communities, and continuing care retirement communities on the audit, tax, and advisory work that comes with that mix.
Our healthcare team has served providers for about 20 years and works with roughly 600 facilities in about 35 states, so we understand how senior living fits alongside skilled nursing and other care settings. We audit financial statements for owners and lenders, help communities meet HUD 232 reporting expectations, and advise on how OpCo and PropCo entities are structured and taxed. The goal is financial information your lenders, investors, and regulators can rely on.
How We Help Assisted Living Communities
Financial Statement Audits
Audits and reviews of assisted living and senior living financial statements for owners, boards, and lenders, including resident revenue, resident deposits, lease accounting, and other areas that lenders review closely.
HUD 232 Reporting Support
Annual audits and reporting support for communities with HUD Section 232 insured mortgages, coordinated with lender requirements so submissions tie to your books and arrive complete.
OpCo and PropCo Structuring
Advice on separating operating companies from real estate holding entities, including intercompany leases, financial reporting for each entity, and how the structure affects taxes and lender covenants.
Medicaid Waiver Considerations
Help understanding the financial reporting and revenue tracking that come with participating in state Medicaid waiver programs, so service revenue and resident billing are recorded and supported correctly.
CCRC Accounting
Support for continuing care retirement communities on entrance fee accounting, refund obligations, and the related disclosures that lenders, boards, and residents’ representatives often review closely.
Senior Living Tax Services
Federal and state tax compliance and planning for operators and owners, including pass-through entities, real estate depreciation, cost segregation considerations, and multi-state filings for owners with communities in more than one state.
Challenges We Help Assisted Living Operators Address
- ✓Meeting HUD 232 and lender reporting requirements on schedule
- ✓Accounting for entrance fees and refundable deposits at CCRCs
- ✓Keeping OpCo and PropCo books, leases, and taxes aligned
- ✓Tracking private pay and Medicaid waiver revenue accurately
- ✓Rising labor and operating costs that pressure covenant compliance
Featured Insights
Frequently Asked Questions
Do assisted living facilities need an audit?
Many do. Lenders, including those with HUD Section 232 insured mortgages, commonly require annual audited financial statements, and investors or boards may ask for them as well. Some state programs may also have reporting expectations. Pease Bell audits assisted living and senior living communities and can help you understand which reporting requirements apply to your financing and ownership structure.
Can assisted living facilities use HUD 232 financing?
Yes. HUD’s Section 232 program insures mortgages for residential care facilities, and assisted living facilities are among the property types it covers, along with skilled nursing facilities. Borrowers take on ongoing obligations such as annual audited financial statements. We help HUD 232 financed communities meet those reporting requirements at a general accounting and audit level.
What is an OpCo/PropCo structure in senior living?
An OpCo/PropCo structure separates the business that operates a community (OpCo) from the entity that owns the real estate (PropCo), usually connected by a lease. Owners use it for liability, financing, and investment reasons. It creates separate accounting, intercompany lease, and tax considerations, which Pease Bell can help you plan for and report on consistently.
How do Medicaid waivers affect assisted living accounting?
In many states, Medicaid home and community-based services waivers pay for care services for eligible assisted living residents, while room and board is typically paid another way. That split means revenue must be tracked by payer and service type. We help operators set up reporting that supports this revenue and holds up during audits.
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