Chris Taylor, North Carolina Medical Commission

Chris Taylor has served as adviser to the North Carolina Medical Commission for the past 17 years and has helped shape billions of dollars of bond sales to help make health care more affordable for people throughout the state.

Hospitals throughout the country are experiencing tremendous financial difficulties. However, Taylor said that although some of the medical facilities that have had debt issued for them by the commission are not doing as well as they have in the past, the agency is proud that none of the issuers have ever defaulted on that debt.

"Health care is still in better position in North Carolina than in most states," Taylor said. "Facilities in the state are doing a good job of responding to the challenges of providing care in today's market."

He said the most prevalent problems stem from the effects of the federal Balanced Budget Act and limited relief from Congress. The failure of many hospitals to provide adequate and ongoing disclosure only compounds the problem, he said, as do the number of insurers shying away from health care and the reduction in the number of letter-of-credit providers for health care bond transactions.

Since its inception three decades ago, the commission has issued $5.9 billion of debt, with $3.6 billion outstanding at year-end. Last year it issued bonds for 11 projects totaling roughly $276 million. Among the new financings completed by the commission last year was a tax-exempt operating lease for approximately $5 million. Taylor said the bond community should expect to see the agency bring a tax-exempt real estate lease deal in the next two years, such as for the sale and leaseback of buildings.

He said that this year the commission will probably bring to market nine issues totaling approximately $424 million. It has already sold roughly $230 million for debt, mostly for Wake Medical Hospital in Raleigh. This year's proceeds will be used for hospital and continuing-care retirement centers.

Taylor, a certified public accountant, works with the commission on bond deals taken to the market by health care issuers. His role as adviser entails working with bond attorneys and the IRS on tax matters that could arise on outstanding debt, as well as new issues. Typical projects include refundings, in addition to capital programs for hospitals and CCRCs.