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July 2012


by Andrew D. Schwartz, CPA

For doctors in practice, making a lot of decisions every day is just part of the deal.  While some practice management issues come with only one obvious solution, most require that you spend time researching a variety of options only to learn that there is more than one correct answer.  Selecting the best type of entity for your practice is one of those issues with multiple correct answers.

If you are in the process of opening or purchasing a practice, now is the time to determine which type of entity would work best for your practice over the long-term.  Or, if you have owned a practice for a number of years, why not take this opportunity to determine if you have selected the best type of entity for your situation.  Let’s take a look a pros and cons of the various entities available to healthcare professionals in practice.

Most Popular Entity Selection

Most healthcare professionals operate their practice as a Sole Proprietorship, a Limited Liability Company (LLC), or an S-Corporation.  Different rules apply to the different type of entity.  The first question, however, is why even bother to create an entity for your practice.  Why not just go with a sole proprietorship or a general partnership?

If you are involved with partners in your practice, setting up an entity is a must.  While asset protection laws vary by state, running your practice as an S-Corp or LLC should protect your personal assets from your business partner’s mistakes.  Without forming an entity, you would be running the practice as a General Partnership which offers no protection to that risk.

For practices with one owner, setting up an entity helps keep your practice separate from your personal finances.  Some people who own a practice and also own the real estate where their practice is located actually end up establishing two entities - one to hold the assets of the practice and a second to hold the real estate.

 The Basics

Let’s start by looking at two major characteristics for these three options.  While Single Member LLCs and S-Corporations are separate legal entities, only an S-Corp comes with the requirement of filing a separate tax return each year.  Sole proprietors and Single Member LLCs report their income and expenses on a Schedule C filed as part of the owner’s individual income tax return. 


Type of Entity

Separate Legal Entity

Files Own Tax Return

Sole Proprietorship



Single Member LLC






Benefits of S-Corporations

When your practice is set up as a sole proprietorship or LLC, you pay Social Security and Medicare taxes on 100 percent of the income that you report on your tax return.  By setting up your practice as an S-Corp, you have the option of taking a portion of the profits as an “S-Corp Distribution” instead of as salary.  By doing so, you avoid paying these two taxes.  Currently, the maximum combined tax rate for these two taxes is 13.3%.  Take a salary of more than $110,100 (in 2012), and the rate drops to 2.9%. 

Keep in mind that the rules require that you pay yourself no less than a “reasonable salary” and then only take the excess income as S-Corp distributions.  Have the S-Corp issue you a distribution of $50k instead of a paycheck and you’ll save from between $1,450 and $6,650 in Social Security and Medicare taxes, depending on your total annual salary from the practice and other sources.

Pitfalls of an S-Corporation

There are some pitfalls with S-Corps to consider.  For starters, expect to pay higher accounting fees since the S-Corp needs to file its own tax return each year.  You should also look into the minimum tax that an S-Corp will need to pay in your home state as well as any other states where you operate your practice.

When it comes to deducting certain types of expenses, staying away from the S-Corp might be prudent.  It’s actually easier for people who operate their practice as a Sole Proprietor or LLC to claim the home office deduction or to deduct their automobile expenses. 

If there are multiple owners to the practice, maintaining an LLC allows the owners to claim any professional expenses not run through the practice directly against their share of the practice income.  For practices set up as an S-Corp, each owner would need to claim these expenses as a miscellaneous itemized deduction, which are only allowable to the extent they exceed 2% of each owner’s income and then are capped for any owner subject to the Alternative Minimum Tax (AMT).

And you need to be careful if you earn a good salary working outside of your practice, and also own a profitable practice.  Since an S-Corp is required to pay its owners a reasonable salary, there is a chance that someone earning more than the FICA max might end up paying extra Social Security taxes if your salary from all sources exceeds $110,100.  Yes, you will get back the Social Security taxes withheld from your pay, but you don’t get back the Company match of 6.2%.  The cost of this tax could be as high as $6,93 ($110,100 * 6.2%).

Deducting Losses

It’s not uncommon for healthcare professionals to lose money in years that they open a practice from scratch, purchase an existing practice, or expand their current practice.  Assuming you borrow money to fund these transactions, the type of entity determines how much of these losses the you can claim each year.

To maximize the upfront losses you can claim, an S-Corp might not be the best choice.  If you set up your practice as an S-Corp, you can only claim losses to the extent of the money you invested into the practice.  Guaranteeing loans or other liabilities is not sufficient to allow you to claim these losses.

Running your practice as an LLC or a Sole Proprietorship allows you to claim larger losses up front.  The only catch is that you need to be personally liable for paying off these loans.

If you borrow money to purchase, open, or expand a practice, the S-Corp tends to be the better option with respect to managing the tax burden while repaying the loans.  Since the losses are not allowable up front for the S-Corp, those suspended losses are released as you generate profits to pay down the loans.  With an LLC or a Sole Proprietor, you’ll claim the losses in the early years which will not provide you with any tax shelter as you pay down your loans.

Other Considerations

Do you have children under the age of 18?  If so, going with the Single Member LLC or Sole Proprietor will let you take advantage of a quirky tax break.  While you get to deduct “reasonable” wages paid to your child for services provided, neither you nor your child owes Social Security or Medicare taxes on wages paid. Plus, he or she does not owe any federal income taxes on the first $5,800 of wages earned (in 2011).   (We wrote about this opportunity in our May 2007 Newsletter.)

This is true arbitrage.  You move money from your practice’s bank account to your child’s bank account, and the government gives you a tax break on that money.  You can also contribute money into a Roth IRA for your child based on the wages you report.  Assuming the Roth rules don't change during your child's lifetime, your child will benefit from decades of compounded growth within these tax-free investment accounts.

Caveat employer.  Keep in mind that you are only supposed to pay your child a fair wage for services actually performed.  You will also need to complete and file quarterly and annual payroll tax forms, as well as prepare a W-2 form for your child.

Flexibility of an LLC

LLCs are very flexible entities.  With an LLC, you can start as a disregarded Entity, and your practice will be treated as a Sole Proprietorship for tax purposes.  When the time is right, you can then elect treat your LLC as an S-Corp by filing a Form 8832.  The beauty of this strategy is that you can continue to use same EIN and NPI, and don’t need to re-credential with any insurance companies you submit claims to.

Entity Selection Scorecard

Choosing the correct entity for your practice is a tough decision.  You should definitely reach out to a lawyer and an accountant who are familiar with your state’s rules and regulations prior to making your final decision. 

Even so, here is an Entity Selection Scorecard to help you with your decision:







Save Medicare Taxes on Earnings





Possibly avoid paying quarterly estimates





Minimize accounting fees and state corporate taxes





Maximize deductible losses funded by debt





Manage taxes better during loan repayment





Pay child under the age of 18 tax-free





Ability to deduct 100% of expenses not paid by practice





Avoid doubling up on FICA Taxes





S.P. = Sole Proprietor, S LLC = Single Member LLC, M LLC - Multiple Member LLC



R-2012-23, Feb. 16, 2012

WASHINGTON –– The Internal Revenue Service today issued its annual “Dirty Dozen” ranking of tax scams, reminding taxpayers to use caution during tax season to protect themselves against a wide range of schemes ranging from identity theft to return preparer fraud.

The Dirty Dozen listing, compiled by the IRS each year, lists a variety of common scams taxpayers can encounter at any point during the year. But many of these schemes peak during filing season as people prepare their tax returns.

“Taxpayers should be careful and avoid falling into a trap with the Dirty Dozen,” said IRS Commissioner Doug Shulman. “Scam artists will tempt people in-person, on-line and by e-mail with misleading promises about lost refunds and free money. Don’t be fooled by these scams.”

Illegal scams can lead to significant penalties and interest and possible criminal prosecution. The IRS Criminal Investigation Division works closely with the Department of Justice to shutdown scams and prosecute the criminals behind them.

The following is the Dirty Dozen tax scams for 2012:

  • Identity Theft
  • Phishing
  • Return Preparer Fraud
  • Hiding Income Offshore
  • “Free Money” from the IRS & Tax Scams Involving Social Security
  • False/Inflated Income and Expenses
  • False Form 1099 Refund Claims
  • Frivolous Arguments
  • Falsely Claiming Zero Wages
  • Abuse of Charitable Organizations and Deductions
  • Disguised Corporate Ownership
  • Misuse of Trusts

More information on these Tax Scams is available at,,id=254383,00.html.



by Andrew D. Schwartz, CPA

At my firm this year, we instituted a Book Club for the first time.  We are currently reading The 7 Habits of Highly Effective People by Stephen R Covey.  We are scheduled to discuss one habit per month for the remainder of the year.  I highly recommend that you read this book if you haven't done so already, or re-read this book if it's been a while since you last read it.

When reading about Habit 2, Begin With The End in Mind, I was struck by this passage from the book:

Management is a bottom line focus:  How can I best accomplish certain things?  Leadership deals with the top line: What are the things I want to accomplish?  In the words of both Peter Drucker and Warren Bennis, 'Management is doing things right; leadership is doing the right things.'  Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.

I found these words to be quite meaningful because I read them following a somewhat heated discussion I had with a staff member.  She was upset with me because I wasn't able to find time to help her with an client issue that she was trying to resolve.  She was looking for me to help her get this issue right. (Ultimately we met later that morning and everything worked out fine for our client.)

After reading this passage, I gave some thought to the roles I need to play at my 12 person CPA firm.  My first idea was to define these terms: leader, manager, supervisor, coach, and mentor.  According to


A person or thing that leads. Also, a guiding or directing head, as of an army,  movement, or political group.


A person who has control or direction of an institution, business, etc., or of a part, division, or phase of it. Also, a person who controls and manipulates resources and expenditures.


A person who supervises workers or the work done by others. defines supervises as: oversees a process, work, workers, etc. during execution or performance.


To give instruction or advice to in the capacity of a coach; instruct.


A wise and trusted counselor or teacher. Also, an influential senior sponsor or supporter.



At a professional practice the size of my firm, my brother and I are the primary source of these five positions to most of our ten-person staff.  We are not only the leaders and the managers of the firm, but, in most cases,  are also the supervisors, coaches, and mentors.

If you are in a position of responsibility, I'm sure you struggle with which of these roles you play with respect to your direct reports and/or to other staff members who you interact with on a regular basis; especially when you factor in how busy you are trying to provide great care to your patients as well as running your practice. 

If you have already come up with solutions to this practice management dilemma that you would like to share with other readers of this newsletter, please e-mail me at




Income Taxes

Saving and Investing



  • If you changed jobs, give one of our CPAs a call to discuss filling out new W-4 Forms
  • Now's the time to work through your 2012 income tax projection
  • Update your monthly cash flow budget
  • If your Keogh or Solo 401(k) accounts are worth more than $250,000, or if you have employees in your plan, Form 5500-EZ due by 7/31/12
  • Review, update or create your healthcare proxy.  Need Help?.


2011 & 2012 TAX FACTS

  • For 2011, the standard deduction for a single individual is $5,800 and for a married couple is $11,600. A person will benefit by itemizing once allowable deductions exceed the applicable standard deduction. Itemized deductions include state and local income taxes (or sales taxes), real estate taxes, mortgage interest, charitable contributions, and unreimbursed employee business expenses.
  • For 2011, the personal exemption is $3,700. Individuals will claim a personal deduction for themselves, their spouse, and their dependents. 
  • The maximum earnings subject to social security taxes is $110,100 for 2012, up from $106,800 for 2011.
  • The standard mileage rate is $.555 per business mile as of July 1, 2011, up from $.51 per mile for the first six months of 2011.
  • The maximum annual salary deferral into a 401(k) plan or a 403(b) plan is $17,000 in 2012, up from $16,500 in 2011.  And if you'll be 50 or older by December 31st, you can contribute an extra $5,500 into your 401(k) or 403(b) account that year.
  • The maximum annual contribution to your IRA is $5,000 for 2012.  And if you turn 50 by December 31st, you can contribute an extra $1,000 that year.  You have until April 15, 2013 to make your 2012 IRA contributions. 


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This Month's Topics

Choose The Best Type Of Entity For Your Practice

IRS Releases the Dirty Dozen Tax Scams for 2012

Take Me To Your Leader (and Manager and Supervisor and Coach and Mentor)

The FICA Refund for Medical Residents 

2011 & 2012 Tax Facts

Tax and Financial Planning Calendar for July 2012


Browse our index of previous months' newsletter topics

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In a shocking development, the IRS recently announced that they will be honoring the FICA tax refunds submitted by residency programs and individual doctors.  The catch is that only FICA taxes paid prior to 4/1/05 qualify.

For more information, go to our April 2010 Newsletter, our January 2009 Newsletter, or our February 2001 Newsletter or read through the IRS' Chief Counsel Advice Memorandum on this issue.

Let's work together to keep current on this hugely valuable tax break.  Please post whatever you read or hear regarding this FICA issue on our new Message Board we set up just for this topic.

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