Alexander B. Foster

Associate

Fax: 404.873.8599
Atlanta
171 17th Street NW
Suite 2100
Atlanta, Georgia 30363

Biography

Alex is an associate in the Healthcare practice. He is a member of the firm’s Diversity Committee, Associates Committee, Hospitals & Health Systems, and Healthcare Real Estate industry teams. Alexander frequently authors articles on healthcare topics and has been published in American Health Lawyers Association publications.

Alex focuses his practice on providing transactional and regulatory counseling for a variety of clients in the healthcare and life sciences industry, including health systems, nursing homes, hospitals, ambulatory surgery centers, assisted living facilities, hospices, physician groups, and other healthcare providers. He also represents domestic and foreign private equity investors in health care, REITs and other investors in health care real estate, developers of health care facilities, management companies, and lenders. Alexander provides guidance on federal and state issues relating to compliance, facility licensure, certificate of need, Medicare and Medicaid reimbursement, and a variety of healthcare transactions. He also advises clients in the negotiation and preparation of acquisition, divestiture and joint venture agreements, corporate governance, shareholder agreements, employment agreements and separation arrangements, corporate practice of medicine issues, and other general business and operational matters. Alexander also has experience advising pharmaceutical, biologic, medical device, cosmetic and food companies on legal and regulatory matters relating to the U.S. Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA).

Alex graduated from the University of Georgia, receiving a Bachelor of Arts in Political Science and a Bachelor of Science in Psychology, and the University of Virginia, receiving a Juris Doctor. During law school, Alexander clerked for the United States Attorney’s Office for the Northern District of Georgia and the Centers for Disease Control and Prevention Office of General Counsel.

Experience

  • Represented a publicly traded REIT in a $1.125 billion acquisition and restructuring of a senior housing provider that operates 96 senior-living communities as well as pharmacies in the Midwest.

  • Represented a private equity client in its acquisition of a leading national provider of business support services to 350 dental offices in 17 states. AGG’s team worked to deliver regulatory diligence and transaction regulatory support, as well as credit facility-driven post-transaction regulatory work.

  • Advised a leading owner-operator of integrated senior healthcare campuses in multiple facility refinancings (including with HUD) in a number of states, including Indiana, Kentucky, Michigan, and Ohio. AGG assisted with determining any filing requirements for the refinancings, the compilation of filings, and the opinion-writing process for the many facilities, including nursing facilities, assisted living facilities, residential care facilities, and homes for the aged.

  • Advised a large pharmacy operator in its acquisition of more than 20 Missouri pharmacies out of bankruptcy. In order to effect the acquisition, AGG handled preparation of transaction documents, filings, and interactions with the U.S. Drug Enforcement Administration, Centers for Medicare and Medicaid Services, State Board of Pharmacy, and the State Medicaid Agency. AGG also reviewed the purchase agreement from both a healthcare regulatory and FDA-perspective.

  • Represented a healthcare operator in its acquisition of a Georgia continuing care retirement community (CCRC) and provided transaction support, including limited diligence, the filing of certificate of need, Medicare, Medicaid, and multiple licensure applications, as well as ancillary license applications, structuring advice, and negotiated regulatory components of the underlying deal documents. The CCRC had a skilled nursing facility, assisted living community, personal care home, and independent living component and was regulated by both the Georgia Department of Community Health and Office of Insurance and Safety Fire Commissioner. The transaction required a unique focus on the nursing facility’s certificate of need, which was initially obtained in the 1990s during changing certificate of need requirements. The client ultimately received a favorable determination from the Georgia CON agency and closed the transaction on its originally scheduled closing date.

  • Assisted a national REIT in its minority investment in a portfolio of a variety of healthcare providers, including assisted living, memory care, hospice, and private-pay in-home care. The providers were located in multiple states, including Arizona, California, Illinois, Texas, Utah, Washington, and Wisconsin. AGG’s involvement included in-depth diligence, including a review of the providers’ licenses, permits, certifications, and accreditations, PEPPER reports, government investigations and surveys, hospice cap calculations, compliance program, background screening, HIPAA, medical directorships, admission agreements, commercial payor audits, and corporate practice of medicine. AGG also assisted with preparing the underlying investment agreement and related disclosure schedules.

  • Represented a longstanding long-term care provider in its sale of over 50 facilities, which included skilled nursing, assisted living, and independent living facilities in 11 states, including Florida, Georgia, Louisiana, Maryland, New Jersey, New York, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia. AGG prepared all filings associated with the stock transfer of the providers, including all pre- and post-closing filings, and advised on regulatory components of the deal document. The transaction was valued at over $400 million.

  • AGG advised on an asset transaction for a skilled nursing facility operator which operates senior-care facilities in several small Georgia communities. Because the transaction involved a hospital authority owner of the real estate, AGG handled the filing of a full certificate-of-need application, a 60-day process that requires gathering a significant amount of information and data.

  • Advised a private equity client on its acquisition of a national operator of more than 100 outpatient physical therapy clinics with a strong presence in the Southeast. AGG’s role included healthcare regulatory diligence, regulatory input for the transaction documents, and interfacing with lender counsel and reps and warranties underwriters.

  • Advised Griffin-American Healthcare REIT III, Inc. and NorthStar Healthcare Income, Inc. in their $1.125 billion joint-venture acquisition of controlling interest in Trilogy Investors LLC, the parent company of Trilogy Health Services LLC, a leading owner-operator of integrated senior healthcare campuses, operating approximately 100 properties comprised of more than 10,000 beds throughout Indiana, Ohio, Michigan and Kentucky.

  • Advised a longstanding private equity client on all regulatory aspects of a consensual receivership with three different operating companies in 8 states. AGG oversaw the transition of the facilities to new operators during the receivership. The affected facilities were located in Wisconsin, Minnesota, Idaho, Oregon, Washington, West Virginia, Delaware and Pennsylvania.

  • Assisted in the expedited sale of Midwest-based ambulance provider.

  • Implemented an interim management agreement structure for a client seeking to expeditiously exit a state.

  • Obtained Certificate of Need approval and initial licensure and Medicaid enrollment of one of the nation’s first assisted living projects funded with affordable housing tax credits.

  • Represented a hospice provider in the acquisition of a hospice company with more than 60 locations in 14 states.

  • Represented a private investment management firm in an $870 million acquisition of the real estate and transfer of operations to 4 separate operating entities for over 160 senior care facilities across 12 states, including both skilled nursing and assisted living facilities.

  • Represented a private investment management firm in an acquisition of a 5,000-person community-based organization that provides services and support for people with developmental and intellectual disabilities across the U.S.

  • Represented one of the nation’s largest private post-acute care providers in a merger with a publicly traded post-acute care provider resulting in a combined publicly traded company with annual revenues of $5.5 billion.

Credentials

  • University of Virginia School of Law, Juris Doctor — 2014
    • Health Law Association, Health Awareness Committee
    • Virginia Sports and Entertainment Law Journal
    • Virginia Journal of Criminal Law
  • University of Georgia, Bachelor of Arts - Political Science — 2011,

    magna cum laude

  • University of Georgia, Bachelor of Science - Psychology — 2011,

    magna cum laude

    • Phi Beta Kappa
  • State of Georgia 2014

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