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The 2025 Home Health Value-Based Purchasing (HHVBP) payment adjustments have been finalized. Designed to reward those organizations that demonstrated better outcomes in patient satisfaction, quality of care, and hospitalizations/emergency department use, the result was a payment adjustment. This varied from -5% to 5% for participating home health agencies based on their 2023 performance data.

2025 payment adjustments

While each home health agency Centers for Medicare & Medicaid Services Certification Number (CCN) was given their payment adjustment for 2025, many agencies were left to ask: how did everyone else fare?

Within the large cohort*, 3,465 (53%) of agencies received an increase in payment and 3,018 (47%) received a decrease in payment. For the small cohort*, 327 agencies received an increase and 348 received a decrease. Nearly half (4809 or 40%) of home health agency CCNs were omitted from the HHVBP calculations due to Medicare size/insufficient data or recent Medicare certification date (new agency).

Total Performance Scores (TPS)

For the large cohort, agencies that were smaller in size (less than $3M) saw larger Total Performance Scores (TPS) overall than medium and larger agencies (over $3M in revenue). Of those agencies that received an increase in payment, 55% had less than $3M in annual Medicare revenue. Small agencies also outperformed medium and larger-sized agencies with OASIS and Claims Based measures. However, medium and larger agencies outperformed smaller agencies on the CAHPS-based outcomes.



As we unravel the 4,809 agency CCNs being exempt from this model, we must also question true market saturation rates and access to care for seniors, as these are based on CCN counts and not active patient counts.

We're here to guide you

BerryDunn has solutions to support all agency HHVBP needs, including our CAHPS Improvement Bundle, hospitalization analysis, outsourced OASIS solutions, and OASIS training and education. We also offer clients access to our HHVBP reporting using the national database to help clients better understand their performance compared to agencies across the country. For more information on our HHVBP services or becoming a client, contact Lindsay Doak.

*Cohorts: Determined prospectively, based on each HHA's unique beneficiary count in the prior calendar year (CY) as defined below: Smaller-volume cohort: the group of competing HHAs that had fewer than sixty (60) unique beneficiaries in the calendar year prior to the performance year; Larger-volume cohort: the group of competing HHAs that had sixty (60) or more unique beneficiaries in the calendar year prior to the performance year.

As the new year begins, your organization may be starting to plan for your next fundraising event. In addition to raising money for the organization, fundraising events are a wonderful way to build relationships within the community, raise awareness for a cause, and provide a meaningful experience to donors. Beyond the excitement and benefits of these events, there are important Form 990 reporting and compliance requirements that you must consider. Below are the most frequently asked questions we receive from our clients. We hope this helps you avoid some common pitfalls around fundraising events.

Contributions vs. fundraising revenue

For Form 990 reporting, it is important to distinguish between contributions and fundraising revenue generated by the event.

Fundraising event contributions typically consist of the following items:

• Donations: These include pledges or direct donations made by attendees during the event.
• Sponsorships: Corporate or individual sponsorships for the event.
• Ticket sales or admission fees: The payment to attend the event is considered a contribution if no goods or services are provided in return.

Fundraising revenue from an event typically consists of the following items:

• Ticket sales or admission fees: As noted above, if no goods or services are provided to attendees at the event, the entire cost of the ticket or admission fee is considered contribution revenue. However, if goods and services are provided to attendees, the Fair Market Value (FMV) of these goods and services is considered fundraising event revenue. The portion of the ticket price that exceeds the FMV of the goods and services provided (meals, entertainment, etc.) is considered a contribution (see example below under “Quid Pro Quo Contributions” section). This would also apply to sponsorships where the sponsor receives goods and services in conjunction with their payment.
• Merchandise sales: If any products are sold at the event, income from these sales would be reported as fundraising event revenue.
• Auction items: Similar to merchandise sales, the FMV of an auction item sold would be considered fundraising revenue. Any sale proceeds in excess of the FMV would be considered contribution revenue. The organization should maintain a list of the FMV of the auction items.

Please note that if the fundraising event includes a raffle, any proceeds from the raffle need to be broken out and reported separately. Raffle income is specifically noted as gaming revenue and should be reported in the gaming section on Form 990 Part VIII and Schedule G, Part III. Read more details on gaming requirements for not-for-profit organizations.

The reason it is important to distinguish between contribution and fundraising revenue derived from an event is because they are reported separately on the Form 990. On Schedule G, Part II, and the Statement of Revenue (Part VIII) of the Form 990, contributions from a fundraising event are subtracted from the gross receipts of the event to arrive at gross income. All expenses associated with the fundraising event are then subtracted from gross income to calculate net income from the event.

If most of the revenue from the event(s) is made up of contributions, it may result in showing a “net loss” from the event(s) on Form 990 Part VIII and on Schedule G, Part II. This can be deceiving to the readers of the form because, in most cases, the fundraising event(s) will have generated net income if contribution revenue were to be included as part of gross income from the event(s). This is simply a quirk to the Form 990 reporting and should not be a concern to the organization if their fundraising event(s) is showing a “net loss” on the Form 990.

There is an upside to reporting fundraising event revenue this way. Fundraising event contributions will now be included as part of the organization’s total contributions on Form 990, Part VIII. This is beneficial to organizations who complete the Schedule A, Part II, or Part III Public Support Tests, as an increase to total contributions will increase the overall public support percentage of the organization.

Quid Pro Quo contributions

A quid pro quo contribution is a payment made to a charity by a donor partly as a contribution and partly for goods or services provided by the charity. Quid pro quo contributions are quite common for fundraising events, specifically larger events like an annual gala or golf tournament.

If the organization receives a quid pro quo contribution in excess of $75, the organization is required to notify the donor of the FMV of the goods and services they received for their contribution. This is typically done in the form of a written donor acknowledgment letter.

For example: An organization hosts a golf tournament and charges $150 per attendee to play. In exchange, the attendee gets a round of golf, use of a golf cart, and food/drinks during the event. The FMV of everything provided by the charity to the attendees totals $100. In this case, only $50 is tax deductible as a charitable contribution ($150 paid minus $100 FMV of goods and services received) and the $100 of value received must be relayed to the attendee. In this example, the organization would recognize $100 of fundraising revenue and $50 of contribution revenue per attendee on their Form 990.

When determining the value, the IRS allows you to use any reasonable method to estimate the FMV of goods and services provided to a donor, if the method is applied in good faith. The rule of thumb when determining FMV is to use the price that is charged to ordinary consumers on the open market. In our golf tournament example above, you could use the price that is offered to the general public for a round of golf (with use of cart), and the food/drinks provided when determining the FMV. For any goods or services not commercially available, you can estimate the FMV using similar or comparable goods or services. If necessary, you can consult with vendors or experts to accurately assess the FMV.

It is important to note that the value reported to the donor must be based on the FMV of goods and services received and not the costs incurred by the organization.

Just a few things for you to consider when planning your next fundraising event. Should you have any questions about your specific situation, please contact our not-for-profit tax team.

Amara's Law states, “We overestimate the impact of technology in the short term and underestimate its effect in the long run.” Ten years ago, I confidently told people I wasn’t worried about my daughter learning to drive because I thought self-driving cars would be common by then. Today, my daughter is driving, and it will likely be many years before fully autonomous vehicles are prevalent on the roads.

Looking back over my lifetime, the technological changes have been astounding—from the black-and-green computer screens of MS-DOS to immersive 4K virtual worlds, and from BASIC’s simple if/then programming to neural networks containing vast amounts of the world’s knowledge. Even more remarkable are the changes my 96-year-old grandmother has witnessed. Machine-sliced bread was invented in 1928, the year she was born, the same year as the first fully electronic television system, IBM®’s Type 4 Tabulator, and the first rocket-powered aircraft.

The predictions I share below are adapted from a session I presented on "Parks and Recreation in the Age of AI." While these predictions for the future of parks and recreation are grounded in current technological trends, I offer them with humility. I will overestimate some impacts and underestimate others. In 2035, I may look back and laugh at this article. Regardless, I remain confident in one thing: parks and recreation will remain vital—likely even more so—providing spaces for human connection, physical health, and mental well-being in a rapidly changing world.

Parks and Recreation in 2035: A practitioner's perspective

Rapid advancements in artificial intelligence (AI), robotics, quantum computing, and augmented reality will redefine how society functions by 2035. These changes will uniquely impact parks and recreation, challenging and empowering them to serve their communities in new ways. AI promises to improve efficiency and deliver data-driven insights while shifting relationships and climate challenges will require innovative solutions. Parks will continue to play a critical role as spaces for human connection, health, trust, and resilience in a technology-driven world.

1. AI and robotics will revolutionize park operations

Advances in AI and robotics will automate tasks like mowing fields, cleaning facilities, and monitoring safety. This will improve efficiency while allowing staff to shift focus to strategic planning and community engagement.

2. Technology will present new safety risks and tools

AI-powered tools, such as drones and robotic devices, introduce both safety risks and solutions for parks and events. While these technologies pose new threats to patron safety, they also enable faster and more effective emergency responses, especially in remote or hard-to-reach areas. Drones, cameras, and AI-enhanced monitoring systems will significantly improve safety measures but raise ongoing concerns about data privacy, surveillance, and ethical use.

3. Job roles will shift toward technology management

The rise of AI and robotics will disrupt traditional roles, requiring parks to retrain staff for technology-based positions like managing automated systems and AI tools.

4. Parks will blend technology and nature

Parks will integrate advanced technologies like AI, AR, and VR into programming to create immersive experiences, such as interactive trails, educational opportunities, and virtual fitness programs. These tools will also provide nature-based experiences for individuals with limited mobility or confined to hospitals and care facilities.

5. Parks will combat sedentary lifestyles and mental health challenges

Despite advancements in healthcare, technology will continue to contribute to loneliness, sedentary behavior, and screen addiction. Parks will remain critical for encouraging physical activity, building human connections, and promoting mental well-being. Programs and spaces will counter digital overload by emphasizing outdoor experiences and community engagement.

6. Parks will lead climate resilience efforts

Parks and public lands will be increasingly valued for their environmental benefits, including air quality and cooling solutions to combat extreme weather impacts. AI and sensors will assist with tracking ecosystems, threats such as wildfires, and responding to environmental changes.

7. AI will unlock data-driven decision-making

AI systems will analyze patron behavior, resource usage, and operational data, enabling parks to make smarter, real-time decisions about programming, maintenance, and engagement.

8. Parks and recreation provides positive public engagement with government

Public trust in all levels of government has declined over the last two decades. By fostering meaningful community engagement, shared experiences, and positive interactions with public employees, parks and recreation will play an important role in building relationships and rebuilding public confidence.

9. Parks will provide spaces for authentic human connection

In a digital age dominated by virtual interactions and AI companions, parks will remain essential as places for face-to-face interaction, teamwork, and shared experiences that build real human relationships.

10. Ethical AI adoption will require thoughtful implementation

As technology advances, parks must adopt AI tools transparently and ethically. Leaders will need to balance innovation with community expectations around privacy, fairness, and trust.

As technology evolves at an unprecedented pace, parks and recreation professionals will face both challenges and opportunities by 2035. AI, robotics, augmented reality, and even quantum computing may reshape park operations, programming, and safety measures. At the same time, parks will address the negative impacts of technology—promoting human connection, active lifestyles, and climate resilience. Parks and recreation will remain essential as spaces that balance technological innovation with the timeless values of community, health, and nature.

The role of artificial intelligence, augmented reality, and spatial computing in creating this article

This article began as a presentation I delivered at multiple conferences. Building on that foundation, I created a first draft in Grammarly to refine initial ideas. ChatGPT 4o analyzed the draft content for gaps and helped succinctly combine overlapping points. I then used ChatGPT 4o Canvas for collaborative editing, applying prompts like: “Base the paragraph entirely on the draft text below. Use the author’s words, tone, and style whenever possible, but make minor grammar and flow improvements.” During this process, I worked from a virtual monitor superimposed over my real-world surroundings with XR glasses.

Innovative strategies for parks, recreation, and libraries 

BerryDunn's consultants work with you to improve operations, drive innovation, identify improvements to services based on community need, and elevate your brand and image―all from the perspective of our team’s combined 100 years of hands-on experience. We provide practical park solutions, recreation expertise, and library consulting. Learn more about our team and services. 

What are the top three areas of improvement right now for your business? In this third article of our series, we will focus on how to increase business value by aligning values, decreasing risk, and improving what we call the “four C’s”: human capital, structural capital, social capital, and consumer capital.

To back up for a minute, value acceleration is the process of helping clients increase the value of their business and build liquidity into their lives. Previously, we looked at the Discover stage, in which business owners take inventory of their personal, financial, and business goals and assemble information into a prioritized action plan. Here, we are going to focus on the Prepare stage of the value acceleration process.

Aligning values may sound like an abstract concept, but it has a real world impact on business performance and profitability. For example, if a business has multiple owners with different future plans, the company can be pulled in two competing directions. Another example of poor alignment would be if a shareholder’s business plans (such as expanding the asset base to drive revenue) compete with personal plans (such as pulling money out of the business to fund retirement). Friction creates problems. The first step in the Prepare stage is therefore to reduce friction by aligning values.

Reducing risk

Personal risk creates business risk, and business risk creates personal risk. For example, if a business owner suddenly needs cash to fund unexpected medical bills, planned business expansion may be delayed to provide liquidity to the owner. If a key employee unexpectedly quits, the business owner may have to carve time away from their personal life to juggle new responsibilities. 

Business owners should therefore seek to reduce risk in their personal lives, (e.g., life insurance, use of wills, time management planning) and in their business, (e.g., employee contracts, customer contracts, supplier and customer diversification).

Intangible value and the four C's

Now more than ever, the value of a business is driven by intangible value rather than tangible asset value. One study found that intangible asset value made up 87% of S&P 500 market value in 2015 (up from 17% in 1975). Therefore, we look at how to increase business value by increasing intangible asset value and, specifically, the four C’s of intangible asset value: human capital, structural capital, social capital, and consumer capital. 

Here are two ways you can increase intangible asset value. First of all, do a cost-benefit analysis before implementing any strategies to boost intangible asset value. Second, to avoid employee burnout, break planned improvements into 90-day increments with specific targets.

At BerryDunn, we often diagram company performance on the underlying drivers of the 4 C’s (below). We use this tool to identify and assess the areas for greatest potential improvements:

By aligning values, decreasing risk, and improving the four C’s, business owners can achieve a spike in cash flow and business value, and obtain liquidity to fund their plans outside of their business.

If you are interested in learning more about value acceleration, please contact the business valuation services team. We would be happy to meet with you, answer any questions you may have, and provide you with information on upcoming value acceleration presentations.

This article is the second in a four-part series based on the book A Field Guide to Business Valuation, written by BerryDunn’s Seth Webber and Casey Karlsen. 

In Part I of this four-part valuation overview series, we talked about the “valuation rocket ship.” The valuation rocket ship is an illustration to conceptualize the components of a business valuation. The market approach, which we'll explore in this article, is one of three different ways to estimate the value of a company. In its simplest form, the market approach is fairly straightforward. Below is a very basic model for how a valuation could be applied:

This model is called the market approach because the EBITDA multiple is estimated based on a comparison to sales of similar companies.

Application of the market approach to valuation

If you have ever had a house appraised, you have a level of familiarity with the market approach. When real estate appraisers value a house, they look for similar houses (i.e., comparables, or “comps”) that have sold and calculate the price per square foot of these comparables. They then select a reasonable price per square foot from the range indicated by the comparables and multiply this figure by the square footage of the house being valued, indicating its value.

The market approach in business valuations follows the same basic procedures. However, price per square foot is not a meaningful indicator of business value. Extremely valuable businesses may have small facilities, and less valuable companies may have sprawling facilities. Therefore, instead of using a price per square foot, the valuation analyst uses more relevant denominators, such as annual revenue or EBITDA.

There are two primary market approach methods: the guideline completed transaction method and the guideline public company method. The guideline completed transaction method relies on the prices of recently sold similar companies, as illustrated in the example above. The guideline public company method uses the stock prices of similar publicly traded companies. By summing up the market value of all outstanding stock and debt, valuation analysts calculate the total value of publicly traded companies from the disparate ownership interests.

In both the guideline completed transaction method and the guideline public company method, the analyst performs the following steps:

1. Identify sales of similar companies or calculate the value of similar publicly traded companies.
2. Calculate relevant valuation multiples by dividing the value of each guideline company by a denominator such as revenue, operating income, EBITDA, or other value drivers.
3. Select an appropriate valuation multiple(s) from the range of indicated multiples and multiply it by the subject company's financial fundamentals, indicating business value.

There are many nuances to valuing a business using the market approach, but these steps summarize the basic market approach framework.

Strengths of the market approach

A foundational text for in the business valuation community is Revenue Ruling 59-60, which defines fair market value as “the price at which the property would change hands between a willing buyer and a willing seller…”¹ The market approach can provide a convincing indication of value because it is based on exactly that—an actual transaction involving people buying and selling similar businesses.

The market approach may also be more easily understood than other valuation approaches for readers who don’t have a background in finance. In the income approach, business value is estimated by discounting or capitalizing the benefit stream of a business. If the reader is not familiar with the estimation and application of income approach variables, they may find the market approach to be more understandable and therefore reliable. The income approach is also heavily reliant on projected future cash flows, an area of uncertainty and potential bias.

Even when the income approach is applied, the market approach can be used as an indicator of reasonability. Credibility is enhanced if a valuation analyst uses two or more different processes to get similar indications of value.

Weaknesses of the market approach

While one of the strengths of the market approach is how well it relates conceptually to the definition of fair market value, it also highlights a potential weakness of the market approach. Many transactions occur because the acquirers expect to achieve synergistic benefits from the transaction. These synergies may be priced into the transaction, potentially inflating the transaction price above fair market value. Therefore, it is possible for the market approach to indicate investment value rather than fair market value. It is also difficult to know what motivated a sale. Without knowing the intent of the buyers and sellers, it is difficult to determine whether a transaction reflects fair market value or investment value.

It is often difficult to locate companies that are reasonably similar to the subject company. People often start businesses because they see a need that isn’t being met—that is, there aren’t any companies like the one they want to start. The point of a business is to be different than its competitors. While differentiation is great for creating a competitive advantage, it makes it difficult to find similar companies. Even if a market supports multiple similar businesses, these companies may not have ever sold. As a result, valuation analysts often struggle to identify guideline companies.

Identifying guideline public companies has its own set of challenges. Publicly traded companies often diversify their operations to reduce risk. The lack of pure-play public companies may limit the number of guideline companies available to the analyst. Further, publicly traded companies are often significantly larger than privately held companies, posing additional comparability challenges.

Another common limitation when applying the market approach is the lack of data from completed transactions. Financial data is often incomplete as it may have never been disclosed by either party in the sale of a business. Much of the data necessary for the market approach is also from subscription-based databases. If analysts choose to forgo this cost, they may lack sufficient data to apply the market approach.

The consideration paid in completed transactions is another potential weakness in the market approach. Consideration may include stock of the acquiring party, earn-outs, non-compete agreements, and other items. Adjusting these to a cash equivalent can be a subjective exercise. And where there is subjectivity, there is room for error.

Another area of subjectivity and potential errors is in the selection of valuation multiples. When valuing a house, the price per square foot of the selected comparables is typically in a much narrower range than the range of multiples when valuing a business. Analyst judgement is required to select a valuation multiple from the reported range. Analysts may err by selecting a multiple that is not warranted by the subject company’s operational risk profile and/or historical and projected financial performance.

At a high level, the application of the market approach is a straightforward three-step process: (1) identify sales of similar companies, (2) calculate relevant valuation multiples, and (3) select and apply an appropriate valuation multiple.

The discussion above should provide high-level clarity as to the application of the market approach. Keep in mind the strengths and weaknesses of the market approach when formulating an opinion about the usefulness of this indication of value.

BerryDunn’s Business Valuation Group partners with clients to bring clarity to the complexities of business valuation while adhering to strict development and reporting standards. We render an independent, objective opinion of your company’s value in a reporting format tailored to meet your needs. We thoroughly analyze the financial and operational performance of your company to understand the story behind the numbers. We assess current and forecasted market conditions as they impact present and future cash flows, which in turn drives value. Learn more about our team and services. 

¹ Revenue Ruling 59-60, 1959-1 CB 237; Estate Tax Regulations §20.2031-1(b); Gift Tax Regulations §25.2512-1.