Our Mission is to Optimize your Healthcare Services!
Clients We Serve
Nonprofit Specialty Clinics
Clinics focused on women's health, infectious disease, or reproductive care often face heightened donor reporting expectations and complex fund restrictions. We streamline cost allocation models and support robust tracking for restricted grants, ensuring that clinics maintain both compliance and agility in managing revenue sources.
Health & Social Service Organizations
Hospice, Palliative, & Long-term Care Facilities
Behavior and Mental Health Providers
Federally Qualified Health Centers (FQHCs)
Local Doctor & Dental Offices
Audits for Healthcare Organizations
For healthcare organizations, audit and assurance are more than regulatory checkboxes—they are instruments of strategic accountability. Our approach is specifically attuned to the realities of providers managing federal grants, community mandates, and operational complexity.
We perform audits under Government Auditing Standards (Yellow Book) with a focus on entities funded by HRSA, SAMHSA, and other federal agencies. Whether conducting a full financial statement audit, a Uniform Guidance Single Audit, or a program-specific compliance review, we tailor each engagement to fit the organization’s structure, service lines, and risk profile. The outcome is a defensible audit that supports continued funding and board-level governance.
What sets our audit process apart is our risk-based planning methodology. We align our procedures with your revenue streams, internal systems, and care delivery model—ensuring that findings are not just accurate, but actionable. For federally qualified health centers (FQHCs) and behavioral health providers, this includes verification of key revenue-cycle data elements, internal control evaluations, and benchmark comparisons for metrics such as cost per visit or denial rates.
Beyond the audit opinion, we deliver clear, instructive management letters that go beyond compliance. These documents highlight opportunities to enhance internal monitoring, optimize grant utilization, and mitigate operational risk. Leadership and board members benefit from presented findings, which we contextualize with peer data and emerging sector trends—an approach that actively supports mission and strategy.
We also work closely with organizations to ensure they are prepared long before an audit begins. Our pre-audit readiness reviews, often conducted ahead of HRSA Operational Site Visits, help teams identify gaps in documentation, reporting, and internal controls. This early-stage support reduces stress, lowers disruption, and enhances long-term audit performance.
Clients choose Sutton LLP because we embed continuity into every engagement. Our consistent staffing model preserves institutional memory and deepens client relationships, avoiding the inefficiencies of rotating audit teams. Combined with our continual training on healthcare regulations and our presence at HRSA and AICPA forums, this model ensures clients benefit from both stability and real-time compliance insight.
The value of our audit and assurance services is not just in the report—it’s in the visibility, governance, and strategic clarity they bring to your organization. We don’t just validate the past. We equip you to lead forward.
Tax Compliance for Healthcare Organizations
In a nonprofit healthcare environment defined by complexity and public trust, proactive tax compliance is not just a legal requirement—it’s a strategic advantage. We support our clients through an integrated tax approach that safeguards their exempt status, reduces risk exposure, and strengthens the financial narratives shared with funders, boards, and regulatory agencies.
Our work begins with the preparation and strategic review of Form 990, a document that now serves as both a statutory filing and a tool for public transparency. We help healthcare organizations highlight program efficiency, clarify governance structures, and align disclosures with grant expectations. For example, our review enabled a long-term care provider to emphasize cost metrics that directly supported a successful foundation funding application.
We advise on Unrelated Business Income Tax (UBIT) exposure in areas common to healthcare nonprofits—such as pharmacy operations, co-located services, and rental income from shared facilities. By identifying structural vulnerabilities and proposing alternatives, we’ve helped organizations like behavioral health agencies minimize UBIT liability while preserving operational flexibility.
Our team also supports clients with state-level compliance, including nonprofit registrations, local tax exemptions, and sales tax applicability. From multistate expansion evaluations to clarifying charitable use of real estate, we provide guidance that aligns operational decisions with regulatory obligations across jurisdictions.
Where innovation meets complexity—such as joint ventures with for-profit partners—we deliver entity structure analysis and documentation strategies that uphold the organization’s tax-exempt purpose while enabling new service lines or capital investments. This includes modeling tax implications around new clinics, ancillary medical services, or affiliate arrangements.
We routinely collaborate with executive teams and boards to align tax positioning with broader institutional planning. Our tax reviews surface early insight into how growth decisions, facility expansions, or revenue shifts will impact compliance and reporting. In this way, tax becomes a forward-looking tool, not just a historical obligation.
Finally, when challenges arise, our experienced advisors offer IRS and state audit support, helping clients prepare documentation, outline governance practices, and preserve public charity classification. Through early risk identification and integrated team coordination, we ensure the tax dimension contributes to operational readiness and strategic stability.
Federal and State Regulatory Compliance
Maintaining compliance across federal and state regulatory environments is essential for nonprofit healthcare organizations seeking continued funding and operational stability. At Sutton LLP, we provide embedded compliance support that anticipates regulatory expectations and transforms oversight into preparedness.
We assist clients with Uniform Guidance compliance (2 CFR Part 200), particularly around the allowability, documentation, and drawdown of federal grant expenditures. Whether the funding source is SAMHSA, HRSA, or another HHS agency, we help organizations develop consistent financial reporting practices that align with grant terms and audit expectations. This includes support with program-specific reporting, reconciliation of federal drawdowns, and standardized cost allocation.
Our approach extends to state-level compliance, where we guide healthcare providers through charitable registration filings, Medicaid rate documentation, and programmatic licensing requirements. Because licensing obligations and reporting structures differ across jurisdictions, we equip clients with tailored compliance calendars and internal policy templates aligned to relevant statutes.
To stay ahead of evolving regulations, we facilitate quarterly compliance monitoring sessions, providing management and compliance officers with an updated risk profile and a clear action plan. These reviews often lead to early identification of documentation gaps or policy misalignments—reducing exposure during regulatory audits or state surveys.
When agencies initiate audits or site visits, we offer proactive support through mock site assessments modeled after HRSA Operational Site Visits, Medicaid reviews, or state program audits. Post-review, we assist in developing and tracking corrective action plans (CAPs), ensuring clients respond with credibility and follow-through.
This structured, year-round engagement allows organizations to shift from reactive to responsive—embedding compliance into operations without derailing the mission. Because in healthcare, regulatory strength underpins program resilience.
Internal Controls & Risk Mitigation for Healthcare Organizations
Strong internal controls are not just a compliance requirement—they are a strategic asset to nonprofit healthcare organizations navigating fiscal pressure, evolving regulations, and complex service delivery systems. At Sutton LLP, we work alongside leadership teams to build internal control environments that are both practical and protective, tailored to the financial and operational realities of healthcare providers.
We begin with comprehensive risk assessments, conducted annually, that examine high-impact areas such as segregation of duties, cash handling, vendor payments, and electronic fund transfers. These control reviews are built around your existing workflows and include targeted testing to identify policy gaps, inefficiencies, or exposure to fraud. When findings emerge, we don’t just report; we partner to design feasible improvements and deliver implementation support aligned with your internal capacity.
Our teams collaborate directly with CFOs, controllers, compliance officers, and internal auditors, ensuring internal controls reinforce not only audit readiness but also organizational resilience. For example, a behavioral health client cut audit findings from six to one in a single year after we redesigned its grant expense approval flow and equipped program managers with new decision-making protocols.
In high-risk revenue cycle areas—such as billing, collections, and denial management—we assist with risk mapping and recommend automated controls that strengthen accuracy and accountability. Our tailored solutions often include workflow redesigns and cross-functional staff training to reinforce consistency across departments.
Where systems and cybersecurity intersect with finance, we coordinate with IT and InfoSec teams to evaluate user access controls, review segregation within system permissions, and assess vulnerabilities in data-sensitive environments. As technology adoption accelerates, this integration is essential to minimizing risks tied to exposure, breach, or unauthorized transactions.
We also support governance by enhancing board-level risk awareness. Our work frequently includes designing oversight dashboards, board training on internal control roles, and workshop sessions for finance and audit committees. These engagements help leadership teams move from reactive to proactive—embedding risk management into ongoing strategy.
The outcomes of our work speak in measurable terms: fewer audit findings, improved procedural clarity, increased funder confidence, and a sustainable platform for decision-making. Whether through ongoing advisory relationships or discrete project work, our goal remains the same—building internal controls that protect your mission while enabling you to operate with clarity and control.
Our Experience with Healthcare Organizations
Our experience is rooted in decades of working alongside healthcare organizations that operate within some of the most intricate regulatory and funding environments in the nonprofit sector. From multi-jurisdictional FQHC networks to hybrid healthcare-social service models, we bring industry fluency and strategic precision to every engagement.
We routinely support clients navigating overlapping funding streams—including Medicaid reimbursements, federal grants, and philanthropic dollars—where detailed cost allocation and compliance alignment are critical. This includes reproductive health providers managing Title X funding alongside foundation grants, as well as behavioral health organizations blending state contracts with service-linked billing.
In organizations undergoing structural transformation, our steady advisory presence often becomes the anchor point for financial resilience. When a long-term care facility experienced executive turnover amid Medicare payment changes, we led internal control redesigns and forecasting efforts that stabilized operations during leadership transition and policy shifts.
We also work extensively with healthcare entities delivering co-located or bundled services—for example, clinics combining primary care with housing or food assistance. These providers face not only billing complexity but multidimensional compliance demands. Our interdisciplinary teams integrate financial, regulatory, and operational perspectives to ensure that service innovation doesn’t come at the cost of oversight readiness.
Our effectiveness in these environments stems from a commitment to specialization. Every member of our healthcare team receives annual training in Uniform Guidance, state Medicaid frameworks, and emerging healthcare finance trends. We actively engage with relevant regulatory forums—including HRSA grant workshops and the AICPA Health Care Industry Conference—to bring clients up-to-date strategic intelligence.
“Complexity is not a constraint—it’s the context in which our clients serve. Our job is to turn that complexity into clarity.”
By maintaining continuity on client accounts and sharing insights across teams, we preserve institutional knowledge that helps our clients anticipate risks and seize opportunity. The result is not just technical compliance, but a foundation for confident decision-making in the face of change.
Strategic Advisory and Consulting
Healthcare organizations often reach critical junctures—leadership transitions, loss of major funding, affiliate mergers, or targeted growth opportunities—that require more than financial reporting. They demand clear-sighted strategy and financially grounded planning. That’s where our advisory practice delivers the greatest value.
We engage directly with executive teams, CFOs, and boards to help clients interpret financial signals, test scenarios, and shape durable strategies. Whether you’re evaluating a multi-site expansion or restructuring after the departure of a founding CEO, we build integrated planning frameworks that unify operational vision with financial feasibility.
Our services include:
- Margin and cash flow analysis to identify pressure points and preserve financial flexibility
- Scenario planning and pro forma modeling to support expansions, service pivots, or investment decisions
- Organizational redesign consulting during structural shifts or leadership transitions
- Sustainability budgeting models to address declining reimbursements or funding volatility
- Board-facing training and strategy briefings to foster a shared understanding of financial risk and opportunity
Each engagement is anchored by customized tools—multi-year forecasting models, executive-ready dashboards, or grant-aligned deliverables—that transform complexity into actionable insight. Advisory relationships are typically long-term, with regular virtual sessions or on-site workshops aligned to fiscal milestones and strategic goals.
When a community health clinic contemplated a second location, our forecasting model provided the clarity to move forward—resulting in a 30% increase in patient reach.
For a long-term care facility facing public funding cuts, we structured a sustainability plan that safeguarded core programs and reinforced donor trust.
Because the audience for strategic insight is diverse, our communication frameworks are designed accordingly. CFOs receive working financial models to drive budget decisions, while boards gain high-level dashboards that support governance and long-term planning.
Strategy becomes sustainable when it’s financially rooted and institutionally understood. That’s the value of Sutton LLP’s consulting practice: empowering healthcare leaders to make decisions that hold up to scrutiny—today and into the future.
Commitment to Mission Driven Organizations'
At Sutton LLP, our work with healthcare organizations starts with mission alignment. We intentionally work with providers whose goals—access, equity, and holistic care for underserved populations—mirror the values we hold as a firm. This alignment is not symbolic; it’s operationalized in how we hire, train, and serve.
Our teams are selected based on more than technical qualifications—they are matched to clients based on shared values and sector familiarity. Many of our advisors bring backgrounds in nonprofit or healthcare settings, bringing a mission-first mindset to each engagement. We train every new team member not just on healthcare finance standards, but on the social impact context in which our clients operate. Professional development plans include certifications such as Certified Healthcare Financial Professional (CHFP) and grant compliance workshops to deepen this expertise.
We avoid the revolving-door staffing model common in the industry. Instead, we invest in long-term client relationships led by consistent teams who build trust and preserve institutional memory. That continuity allows us to go beyond required filings or audits. When a client needed help reframing their grant reporting to showcase community outcomes, we stepped in—not because it was in scope, but because it mattered to advancing their mission.
Internally, we reward staff who invest in the bigger picture—those who contribute to community events, offer extra advisory input during crisis planning, or collaborate with clients on public impact strategies. Our commitment is also external: we sponsor and participate in coalitions focused on nonprofit financial sustainability and health equity, ensuring the client voice shapes the regulatory and funding landscape.
Our role extends beyond compliance. We serve as thought partners helping organizations tie their financial story to their mission impact. Through annual impact surveys and leadership debriefs, we reflect with our clients on how our work helped them expand access, maintain critical programs, or strengthen funder confidence. These qualitative outcomes are how we measure our success.
We’re often told by clients, “you understand our mission like an insider.” That’s by design. Because at Sutton LLP, mission isn’t an abstract principle—it’s the lens through which we deliver every service, every time.