The age and complexity of hospital real estate often result in zoning and land use issues that must be addressed in hospital M&A transactions. In larger transactions, purchasers and their lenders frequently obtain zoning reports prepared by one of the national companies, which summarize existing code requirements and potential non-compliance by the hospital. For smaller transactions, it is common for purchasers and their lenders to rely on a letter from the local Planning & Zoning office, which is often limited to confirmation of the zoning classification and whether there are outstanding zoning and land use violations. While zoning reports and letters are helpful in identifying potential issues, parties to a hospital M&A transaction must carefully analyze the findings to determine if there is a bona fide issue that needs to be addressed. Described below are several issues commonly encountered and how those issues might be addressed.