Pennsylvania 1099 Loans for Healthcare Contractors: Travel Techs, Locums, and Per-Diem Income Scenarios

A practical guide for mortgage brokers and loan officers packaging Non QM approvals for Pennsylvania’s 1099 healthcare earners

Search intent and audience

This guide is written for mortgage brokers and loan officers in Pennsylvania who structure Non QM loans for clinicians and allied health professionals paid primarily on 1099 arrangements. These borrowers include travel surgical techs, sonographers, respiratory therapists, locum tenens physicians and advanced practice providers, and per-diem RNs who build income from multiple facilities or agencies. The emphasis is on how to translate deposit patterns, agency contracts, stipends, and gaps between assignments into a clean, reproducible income narrative that underwriters can re-create in minutes. Throughout, position NQM Funding as a trusted Non QM Lender and start intake with Get a Non-QM quick quote to keep documentation consistent from the first touch.

Why 1099 healthcare income fits a Non QM path

Traditional full-document underwriting assumes W-2 wages, steady hours, and a single employer. That framework breaks down when a clinician’s year is built from short assignments, rotating shifts, multiple agencies, and stipend-heavy pay. A Non QM approach lets you qualify based on real cash flow using bank statements or a CPA-prepared profit and loss, rather than fighting with tax returns that compress a variable year into one number. By focusing on deposits, you can separate taxable earnings from reimbursed expenses, normalize agency timing quirks, and present a monthly income figure that reflects how the borrower actually earns.

Pennsylvania borrower profiles that benefit

Travel allied health professionals often follow demand across the Commonwealth. A respiratory therapist might spend twelve weeks in Philadelphia during a respiratory surge, then pivot to a contract in Pittsburgh or Hershey. A travel sonographer may split the year between Lehigh Valley and outpatient clinics in Lancaster. Locum tenens physicians and APPs cover service gaps at hospital systems across the state, while per-diem nurses build earnings from multiple PRN pools in academic medical centers and community hospitals. Home health clinicians and therapists in Westmoreland, York, or Bucks counties face census fluctuations that make W-2 logic feel mismatched. Non QM 1099 programs are built for these realities because they size income to deposits and contract continuity rather than to a single employer’s pay stub.

Choosing the income method: bank statements, P&L, or hybrid

Start by mapping the clinician’s cash flow. If deposits have recently stepped up due to higher bill rates or more shifts, a short window such as two or three months may capture the new run rate, provided you can show it is sustainable with contracts or confirmed PRN shifts. If the pattern swings seasonally or the borrower moves between day, night, and weekend differentials, a twelve month window smooths volatility. A twenty-four month window can make sense for locums whose schedules were irregular during a credentialing backlog. A CPA-prepared P&L provides context for expense categories such as malpractice, licensing, and travel. Many lenders will allow a hybrid approach where bank statements document deposits and a CPA letter or P&L justifies the expense factor. The Bank statement mortgageresource helps borrowers understand how deposits are counted, which items are excluded, and how expense assumptions are applied.

Normalizing healthcare deposits so the math is reproducible

Underwriters move quickly when the statement math is transparent. Begin by separating taxable earnings from non-taxable reimbursements and stipends. Agency pay stubs and contracts typically break out hourly or per-shift rates, housing stipends, meal per diems, and travel reimbursements. Count the earnings that represent pay for clinical services. Exclude pure reimbursements and pass-through travel funds. If the agency bundles housing and meals within a single direct deposit, prepare a brief table that shows the stipend portion for each pay period based on the contract. Credentialing or completion bonuses should be identified by date and amount and treated conservatively unless they recur predictably. Remove intra-account transfers and owner contributions. If the clinician runs expenses through a separate credit card or business account, confirm that counted deposits represent revenue rather than loan proceeds or transfers. Clear labeling is the fastest way to preserve pricing and reduce conditions.

Locums and per-diem nuances: proving continuance without overpromising hours

Continuance is about plausibility, not perfection. Locum tenens schedules fluctuate as departments adjust census, but there is usually a core of recurring service lines. Provide executed contracts or renewed engagement letters showing anticipated weekly shifts or block schedules. If multiple agencies are involved, list the agencies, specialties, and typical shift counts. Do not guarantee hours you cannot control. For per-diem clinicians, show twelve months of deposits and provide PRN confirmation letters from the top two facilities. If there were gaps due to credentialing or onboarding, acknowledge them and highlight that the borrower maintains a license in good standing with no disciplinary actions and that gaps have closed. Underwriters appreciate honesty paired with reserves that cushion downtime.

Expense factors and overhead for 1099 clinicians

Contractors have real costs. Malpractice premiums, tail coverage, CMEs, state licensing, DEA renewals, scrubs and small equipment, health insurance, parking, and travel all impact net income. Expense factors should fit the specialty and the way the borrower works. A hospitalist rotating among two facilities with low out-of-pocket travel may justify a lower expense factor than a rural locums provider who flies weekly and maintains temporary housing. A travel respiratory therapist who receives housing stipends and reimbursed mileage may show lower out-of-pocket costs, while a per-diem RN who self-books lodging near a distant hospital may carry more expenses. Use invoices, policy declarations, and schedule summaries to justify the factor. When in doubt, choose conservative assumptions and let reserves and liquidity carry the approval.

Reserves strategy that covers assignment gaps

Reserves are the easiest compensating factor for a 1099 healthcare file. Present reserves in months of PITIA after deducting funds to close. Separate business operating accounts from personal reserves and provide a preparer note when business funds are being counted to confirm owner access without impairing operations. For travelers, target a cushion that spans the longest typical credentialing or onboarding gap. If the borrower works a winter assignment in Erie and takes a short break before spring in Allentown, your memo should explain that timeline and show reserves sufficient to carry the mortgage through the break. Co-borrowers who are also clinicians should provide a combined reserve view and a per-borrower source list to avoid double counting the same dollars across files.

Rates and structures that match variable schedules

Fixed-rate loans offer simplicity and pair well with clinicians whose income is relatively steady across the year. Hybrid ARMs can reduce early payments during a growth period or while the borrower builds a new rotation. Interest-only periods, when available, can bridge expected credentialing gaps and allow targeted principal curtailments after completion bonuses. Whatever the note, the payment plan belongs in your narrative: month-one PITIA, reserve depth in months, timing of anticipated curtailments, and any refinance checkpoints once schedules stabilize. A plan that accounts for onboarding and seasonality strengthens approvals.

Risk layering and compensating factors

Avoid stacking high leverage with thin reserves and a short statement window. If leverage is elevated or the property carries added complexity such as a condo with high dues, widen the income window, be conservative on stipend recognition, and add reserves. If credit depth is thin because the borrower relies on automatic payments and has few open tradelines, include alternative credit references and clean housing history. If the clinician is early in 1099 work after moving from W-2, document the clinical experience and early performance data from the first assignments. Transparency is a compensating factor on its own.

Documentation checklist that clears conditions quickly

Use a standard intake. Full PDF bank statements for the selected window, all pages. Agency or locum contracts that show pay rate, stipend structure, and assignment dates. PRN confirmation letters or scheduling screenshots if appropriate. Merchant or payroll summaries where deposits come through a third-party processor. Malpractice declarations and proof of licensing and board certifications. A one-page income worksheet that lists counted deposits, exclusions, stipend normalization, and the resulting monthly income. Initiate every file through Get a Non-QM quick quote so clinicians receive exact upload instructions and you get uniform statements.

Compliance and Ability-to-Repay without tax returns

Non QM underwriting still follows Ability-to-Repay principles. Funds must be sourced and seasoned. Names must match across applications, contracts, and statements. If business reserves are counted, include a CPA note confirming access. If deposits include agency reimbursements, either exclude them or clearly separate them from taxable pay using the contract. Your memo should state that the qualifying income is calculated from reproducible deposits and verified contracts, not from optimistic future hours. Present the underwriter with a believable, conservative picture that stands even if the borrower’s schedule flexes.

Pennsylvania location notes for local SEO

Philadelphia metro has dense hospital clusters anchored by Penn Medicine, Jefferson, and Temple. Condos in Center City, University City, and the Main Line will carry HOA dues and master-policy deductibles that belong in the payment model. A travel technologist staying in West Philly may prefer a second-home condo near transit, while a per-diem RN working across several Main Line hospitals may favor a townhome with lower dues in Ardmore or Bryn Mawr. Include association budgets and any special assessments when modeling PITIA so the monthly affordability story is accurate.

Pittsburgh centers care around UPMC and Allegheny Health Network. Rowhomes in Lawrenceville and Bloomfield can have unique insurance and tax details, and some older housing stock requires realistic maintenance reserves. When a locum provider rotates between Oakland and Shadyside, housing flexibility matters; your memo should show how the property choice and payment structure fit a schedule that can toggle among sites with little notice.

Harrisburg and Hershey operate on academic and specialty calendars. A locum anesthetist covering Hershey Medical may face credentialing windows that affect early months. Model reserves that cover those weeks and include insurance quotes and tax estimates for Dauphin County properties. In Central Pennsylvania, single family homes may have well and septic responsibilities; note these costs because they influence DSCR if the borrower later purchases rentals.

Lehigh Valley’s Allentown, Bethlehem, and Easton form a corridor with strong travel nurse and allied health demand. Township-by-township property taxes vary; include accurate estimates in the PITIA model. If the borrower is eyeing condos near new hospital developments, add HOA budgets and master insurance details to the intake.

Scranton and Wilkes-Barre serve NEPA’s hospital systems with seasonal census swings. For clinicians who also buy short-term rentals near Poconos gateways, keep those property acquisitions separate in a DSCR lane and be explicit about local STR ordinances. Erie and northwest Pennsylvania experience winter conditions that affect access and insurance deductibles; your memo should reflect increased owner expenses and realistic reserves.

Lancaster and York have expanding outpatient corridors. Townhome communities with HOA assessments are common; add those charges to the payment model along with any special assessment disclosures. For home health clinicians navigating rural routes, vehicles and fuel become meaningful expenses; account for this when justifying expense factors in income calculations.

When investment purchases qualify on property cash flow

Many clinicians working 1099 assignments also invest in rentals. If the property can carry itself, a coverage approach may be more efficient than personal-income underwriting. A DSCR lane qualifies the asset on its rent support, including realistic expenses, taxes, insurance, and HOA dues. That lets the borrower keep the 1099 income path focused on the primary or second home while acquisitions move forward at the property level. Align expectations with the Investor DSCR loan resource and keep the files distinct so reviews remain fast.

Foreign national or ITIN clinician scenarios

Pennsylvania’s health systems recruit internationally. Clinicians on certain visas or with ITINs can still be candidates for Non QM. Identity, funds path, and reserve depth carry these approvals. Provide passport or visa pages or ITIN, translated statements if needed, and a simple money map that shows wire paths into a U.S. account. Pair conservative leverage with thicker reserves to offset documentation friction. For product overview and intake, point to Foreign National mortgage options while keeping the 1099 income math conservative and clear.

Underwriting walk-through: three Pennsylvania examples

Travel sonographer using a twelve month window. The borrower works contracts in Allentown and Bethlehem with a two week credentialing gap midyear. Bank statements show deposits that average nine thousand two hundred dollars per month after removing housing and meal stipends identified in contracts. Expense factor justified with CPA letter at thirty percent due to modest out-of-pocket travel. Reserves equal eight months of PITIA after closing. Payment structure is a hybrid ARM with targeted principal curtailments after completion bonuses in June and December. The file reads as stable and reproducible.

Locum hospitalist with multi-agency coverage. Contracts in Pittsburgh and Harrisburg support alternating seven-on, seven-off blocks with occasional weekend surges. Deposits over twenty four months average nineteen thousand dollars per month excluding reimbursements. Expense factor runs higher due to travel and lodging, supported by invoices. Reserve map shows twelve months of PITIA across personal and business accounts with a preparer note confirming access. Note structure is fixed to keep payment steady despite schedule rotations. The narrative anticipates credentialing and aligns reserves accordingly.

Per-diem RN using a hybrid method. Twelve months of deposits from two PRN pools in Philadelphia and a community hospital in the suburbs average seven thousand four hundred dollars per month once transfers and reimbursements are removed. A CPA-prepared P&L corroborates typical expenses for licensing and uniforms. Reserves total six months of PITIA, which the borrower boosts to nine months with a planned curtailment after a completion bonus from a temporary step-up stint in telemetry. The underwriter can replicate the numbers from the one-page worksheet, and conditions remain light.

Broker talk tracks that replace “no doc”

Clinicians sometimes ask for a “no doc” loan because they fear paperwork. Replace that idea with specific, compliant language. Explain that this is a deposit-driven Non QM path designed for professionals who earn in irregular cycles. You will pick a bank statement window that reflects their actual run rate, label reimbursements and stipends so they are not double counted, and present reserves in months of PITIA that carry the mortgage through any off-assignment pauses. Promise clarity: full PDFs of statements, a one-page income math summary that a reviewer can copy, and a payment plan that aligns with contracts and credentialing. That script converts anxiety into action.

FAQ to preempt conditions

Which accounts can be used? Operating, personal, and agency direct-deposit accounts are fine if the revenue source is clear and transfers are excluded.

How do you treat housing and meal stipends? Use contracts to separate stipends from taxable pay. Exclude non-taxable reimbursements from qualifying income unless the program allows a documented allocation.

What if there are multiple agencies? List them and provide the top contracts or engagement letters. Show deposit continuity across agencies and a history of renewals.

Can completion or sign-on bonuses count? Treat them conservatively unless they appear annually under repeated agreements. Explain the timing if they will be used for curtailments rather than for qualifying income.

Do I need tax returns? The bank statement lane does not require tax returns for income, but you still need sourced funds, consistent identity, and a believable reserve plan.
What if there is a long credentialing gap. Keep reserves thick and choose a payment structure that bridges the gap. Document the onboarding timeline and the next scheduled start date.

Internal links and calls to action

Move readers from interest to action with a predictable path. Begin intake via Get a Non-QM quick quote to capture the preferred statement window, agency contracts, and license proofs. Teach deposit mechanics with the Bank statement mortgage page. If rental purchases are planned, align expectations with the Investor DSCR loan resource and keep those files distinct. For international clinicians, set identity and funds-path expectations using Foreign National mortgage options. Reinforce brand authority by positioning NQM Funding as a Non QM Loans partner that understands how 1099 healthcare income really works in Pennsylvania.