PYA Principal Greg Gates, CPA, recently addressed financial professionals who work with healthcare providers at the 2013 Tennessee Society of Certified Public Accountants Healthcare Conference. Gates discussed the importance of being a proactive tax advisor.
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Gates Advocates for Proactive Tax Planning for Medical Practices
1. Proactive Tax Planning for
Medical Practices
Tennessee Society of CPA‟s Healthcare Conference
December 2, 2013
Presented by Greg B. Gates, CPA, J.D., Principal
PYA GatesMoore
Atlanta, GA
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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2. Characteristics of a Proactive Adviser
• Bring ideas to “the table” (arrows in your quiver)
• Contact clients with matters of benefit, interest, or concern
• Return client calls and emails TIMELY
• Annual review with staff
– What are we doing for the client they can do for themselves
– What are we not doing in advising the client that we should
• Bottom line: Take a real interest in the client and do not take them for
granted.
P.S. – “Anybody” can prepare a tax return.
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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3. Overview of ….
• Micro Captive Insurance Companies (CIC)
• Cash Balance Retirement Plans
Historically
• 401(k) Safe Harbor Profit Sharing Plans
• Medical Expense Reimbursement Plans (C Corporations)
• Conversion from LLC to S Corporation
• Deferred Income Tax Liability (C Corporations)
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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4. What a CIC is not ….
• Offshore (but it can be)
• A replacement for Professional Liability
Insurance (Malpractice)
• Life insurance
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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5. When meeting with a client regarding a CIC have
everyone in the room who may be a participant or a
„Naysayer‟
(“The confused mind always says „No‟.”)
e.g. Attorney
Investment Advisor
Other?
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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6. Captive Insurance Companies - 831(b)
Provides insurance
coverage for various risks
Medical Practice
CIC
Premium $‟s
Physician
Owners
$350K* to $1.2 million of
annual insurance
premiums
*Practical not statutory
Physicians
or Family
Members
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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7. Qualifying Factors
• First & foremost: this is an insurance
company
• $1.2 million ceiling on annual premium
income
• Design the insurance to fit practice needs
• Viable for medical practices with “excess
cash”
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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8. Introduction to 831(b)
Captive Insurance Companies
IRS 831(b) provides that:
• Insurance companies with less than $1.2 million of
annual premium pay $0 income tax on insurance
“profits” (premium income)
• Investment income is taxed as income to
C-Corporation
• 831(b) must be timely elected and cannot be
revoked without the permission of the Secretary
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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9. IRC Sec. 831(b) – Code Language
•
831(b) Alternative tax for certain small companies
•
(1) In general
•
In lieu of the tax otherwise applicable under subsection (a), there is hereby imposed for each
taxable year on the income of every insurance company to which this subsection applies a tax
computed by multiplying the taxable investment income of such company for such taxable year
by the rates provided in section 11(b)
•
(2) Companies to which this subsection applies
•
(A) In general
•
This subsection shall apply to every insurance company other than life (including interinsurers
and reciprocal underwriters) if –
•
(i) the net written premiums (or, if greater, direct written premiums) for the taxable year do not
exceed $1,200,000, and
•
(ii) such company elects the application of this subsection for such taxable year
•
The election under clause (ii) shall apply to the taxable year for which made and for all
subsequent taxable years for which the requirements of clause (i) are met. Such an election,
once made, may be revoked only with the consent of the Secretary.
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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10. Captive Insurance Company Policies
• Everything a practice currently self-insures:
– Deductibles (e.g., Medical Malpractice)
– Excess losses above coverage limits
• Loss of income as a result of:
– Losing key employee
– Loss of license/professional risks (professionals)
– Weather
– „Downtime‟ of clinical equipment, e.g., PET scanners, CT‟s, MRI‟s
• Liability risks for which practice does not insure
– Employee lawsuits – sexual harassment, wrongful termination,
discrimination, etc.
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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11. Examples of Captive Insurance
Policies Written
• Professional Liability
Coverage
• General Liability Gap
• HIPAA/Billing Audit Liability
• Professional Misconduct
• Contractual Liability
• Directors and Officers Liability
• Cyber Liability
• Punitive Damages
• Environmental Liability
• Loss of Key Employee
• Employment Practices
• Employee Dishonesty
Do Not Insure Things That Are Not Pertinent
e.g., Patent Infringement If You Have No Patents
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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12. The Ground Rules
• Premiums and policies must be market-comparable
• Actuarial support needed
• Insurance formalities complied with
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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13. Real Life Example - Results
Do Nothing with $1.2M
Captive 831(b)
• No risk management, asset
protection, buy-out/retirement
benefits of CIC
• Risk management, asset
protection, buy-out/retirement
benefits of CIC
• Earn money, income taxes
• Create trust to own CIC (or
have family members own)
• Taxable/tax deferred
investments
• CIC invests in tax deferred
investments
• Die, pay estate taxes
• Tax efficient withdrawals from
CIC
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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14. Tax Planning Benefits
1. Deductibility of premiums paid by Medical Practice –
IRC 162
– Assuming premiums are market comparable –
determined by an actuary
2. CIC is not taxed on first $1.2 million of annual premium
income
3. Distributions from CIC taxed at capital gain rates
4. Can transfer wealth if owners of CIC are family members
5. And… Asset Protection
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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15. Captive Insurance Companies - 831(b)
Provides insurance
coverage for various risks
Medical Practice
CIC Assets
Protected
CIC
Premium $‟s
Physician
Owners
$350K* to $1.2 million of
annual insurance
premiums
*Practical not statutory
Physicians
or Family
Members
Dividends
(Tax Savings)
If Owners Are Family
Members
(Wealth Transfer)
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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16. CIC team of Advisors
• Knowledgeable attorney
• Actuary
• CPA (need tax return and audit)
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December 2, 2013
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17. Cost for Establishment and
Maintenance of CIC
• $80,000 to establish
• $55,000 annual maintenance
– Audit fee of $8,500
– Tax Return fee of $2,500
• Capitalization
– Cash or letter of credit
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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18. Greater Tax Deferral Using
Cash Balance Plans
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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19. Why Cash Balance and Why Now?
1) The new tax targets
•
>$250,000
2) Catch-up
•
•
Make up for 401(k) losses
Make up for QDRO‟s
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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21. How Does Cash Balance
Differ from a DB Plan?
Defined Benefit Plans
• Complex formula
(contribution is actuarially determined)
Cash Balance Plans
• Account balance,
$100,000
• Unfamiliar/archaic
• Familiar: 401(k)
• Age-sensitive
• Less age-sensitive
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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23. How Do Cash Balance Plans Work?
Cash Balance
401(k)
Contribution
Earnings
Contribution
Interest
Crediting
Rate
(~5%)
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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24. Plan Investments
Earnings
…next year‟s contribution
Earnings
…next year‟s contribution
7-year make-up
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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25. Investment Dynamics
Too high:
•
•
•
Lower contribution
Smaller tax deduction
Potential excise tax
TARGET RETURN
Too low:
•
Greater expense / larger
contribution required
•
Underfunding limitations
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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26. CASE Small Practice
CASE STUDY: STUDY: Small Business
Owners
Age
Compensation
Doctor 1
62
$ 250,000
Doctor 2
41
250,000
49
63
31
29
41
25
33
48
22
30
$ 89,000
88,000
53,000
50,000
48,000
39,000
40,000
35,000
15,000
14,000
Employees
Jones
Keeler
Marion
Baldwin
Dupre
Ophir
Smith
Sabotin
Parotta
Keebler
Plan options?
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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27. All IRS-governed Plans:
2 basic rules
Employees
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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28. The
The Give to Get Give to Get
O w n ers
A ge
C o m p en sa tio n
Above the line
E m p loyees
Below the line
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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29. CASE STUDY: Basic Plan
Profit
Doctors
401(k)
TOTAL
Sharing
CONTRIBUTION
5% of pay
Doctor A
Doctor B
$ 22,500
17,000
$ 12,250
12,250
$ 34,750
29,250
$ 64,000
Employees
5% of pay
Jones
Keeler
Marion
Baldwin
Dupre
Ophir
Smith
Sabotin
Parotta
Keebler
4,450
4,400
2,650
2,500
2,400
1,950
2,000
1,750
750
700
Subtotal
$ 23,550
Total
Comparability
$ 23,550
$ 87,550
Percent to Doctors
73%
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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30. CASE STUDY: New Comparability
CASE STUDY
Doctors
401(k)
Profit *
Sharing
TOTAL
CONTRIBUTION
13% of pay
Doctor A
Doctor B
$ 22,500
17,000
$ 33,000
33,000
$ 55,500
50,000
$ 105,500
Employees
5% of pay
Jones
Keeler
Marion
Baldwin
Dupre
Ophir
Smith
Sabotin
Parotta
Keebler
4,450
4,400
2,650
2,500
2,400
1,950
2,000
1,750
750
700
Subtotal
$ 23,550
Total
Percent to Doctors
$ 23,550
$ 129,050
82%
* Assume new comparability (cross-tested) plan
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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31. CASE STUDY: Cash Balance Options
CASE STUDY: Cash Balance Options
Doctors
Age
401(k)
Profit
Sharing
Doctor A
62
$ 22,500
$ 33,000
Doctor B
41
17,000
33,000
Employees
Jones
Keeler
Marion
Baldwin
Dupre
Ophir
Smith
Sabotin
Parotta
Keebler
Cash
Balance
$0… $ 213,000
$0…
69,000
7.5% of pay
49
63
31
29
41
25
33
48
22
30
$ 6,675
6,600
3,975
3,750
3,600
2,925
3,000
2,625
1,125
1,050
$ 650
650
650
650
650
650
650
650
650
650
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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32. CASE Cash Balance Actual
CASE STUDY:STUDY: Cash BalanceActual
Profit
Doctors
TOTAL
Sharing
401(k)
Cash
Balance
CONTRIBUTION
Doctor A
$ 22,500
$ 33,000
$ 213,000
$ 268,500
Doctor B
17,000
33,000
25,000
75,000
Employees
7.5% of pay
Jones
Keeler
Marion
Baldwin
Dupre
Ophir
Smith
Sabotin
Parotta
Keebler
6,675
6,600
3,975
3,750
3,600
2,925
3,000
2,625
1,125
1,050
$ 650
650
650
650
650
650
650
650
650
650
7,325
7,250
4,625
4,400
4,250
3,575
3,650
3,275
1,775
1,700
Subtotal
$ 35,325
$ 6,500
$ 41,825
Total
Summary of Cash Balance
Contribution
Doctors
Staff –
Additional PSP
Cash Balance
$238,000
92.7%
11,775
6,500
$ 18,275
7.3%
$ 385,325
89%
Percent to Doctors
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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33. Is the Cash Balance Plan
Is the Cash Balance Plan tax-efficient?
Tax-efficient?
No Plan
$385,325
Plan
11% to employees
versus Uncle Sam
40% tax
($154,130)
40%
tax bracket
60% to
Owners
($231,195)
89% to
Owners
($343,500)
+$112,305
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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34. Practical Illustration
Total
Profit
Sharing
%'s
Cash Balance
Hypothetical
for Account
Balances
Summary
Practice 1 Totals
Doctors
Staff
Total
$105,750.00 56%
82,846.29 44%
$188,596.29 100%
$
Practice 2 Totals
Doctors
Staff
Total
$198,000.00 42%
271,082.97 58%
$469,082.97 100%
$
Combined
Doctors
Staff
Total
$303,750.00 46%
353,929.26 54%
$657,679.26 100%
$
$
$
$
Additional
Cash
Balance
Adjusted
Cash Balance
for Account
Balances
%'s
Total
for both
Plans
%'s
150,000.00
11,200.41
161,200.41
-$
1,623.66
1,623.66 $
150,000.00
12,824.07
162,824.07
92%
8%
100%
$ 255,750.00
95,670.36
$ 351,420.36
73%
27%
100%
300,000.00
34,381.80
334,381.80
-$
4,123.55
4,123.55 $
300,000.00
38,505.35
338,505.35
89%
11%
100%
$ 498,000.00
309,588.32
$ 807,588.32
62%
38%
100%
450,000.00
45,582.21
495,582.21
-$
5,747.21
5,747.21 $
450,000.00
51,329.42
501,329.42
90%
10%
100%
$ 753,750.00
405,258.68
$ 1,159,008.68
65%
35%
100%
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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35. Why Cash Balance Plans
Appeal to Medical Practices
1. There is direct tracking of contribution (what goes in, plus
interest, comes out).
2. Portable: If doctor retires or leaves the practice, rolled to
IRA or the new plan
3. There can be contribution flexibility among partners.
4. Liability among partners can be minimized.
5. There are options if cash flows decrease.
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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36. Seven Basic Features
You Need to Know
You Need to Know
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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37. Feature #1
The cash balance contribution is required.
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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38. Feature #2
Feature #1
Assets are portable.
Cash Balance
Plan
IRA
$
Rollover
Other Qualified
Plan
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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39. Feature #3
Feature #2
Contribution flexibility among partners
Doctors can have different amounts contributed for them.
Cash Balance Contribution
Doctor 1, age 50:
$112,000
Doctor 2, age 50:
$0
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December 2, 2013
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40. Feature #4
Feature #3
Contribution amounts can change,
but use caution.
What are doctors most concerned about
these days?
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December 2, 2013
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41. Feature #3
Feature #4 - Continued
What if the cash flows decrease?
1. Reduce 401(k) and/or Profit Sharing.
2. Amend plan to change contribution amounts. (3 years)
3. Freeze plan.
12/31
1/1
Plan amendment deadline
(1,000 hours/~June 15)
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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42. Feature #4
Feature #5
Funding of the Plan
Funding
deadline
Plan year
12/31/13
1/1/13
3/15/14
Funding
extension
9/15/14
Filing of the
practice tax return
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December 2, 2013
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43. Feature #6
Feature #5
Participation requirement
(How many people need to be in the CB Plan?)
• 40% of eligible participants
Example: 8/20 = 40%
OR
• 50 total
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December 2, 2013
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44. Feature #6
Feature #7
Non-discrimination testing primarily satisfied in the
Profit Sharing Plan
Owners
(gateway contributions
5%-7.5%)
401(k)
Profit
Sharing
Cash
Balance
TOTAL
CONTRIBUTION
Doctor 1
$ 22,500
$ 33,000
$ 213,000
$ 268,500
Doctor 2
17,000
33,000
25,000
75,000
Employees
7.5% of pay
Jones
Keeler
Marion
Baldwin
Dupre
Ophir
Smith
Sabotin
Parotta
Keebler
6,675
6,600
3,975
3,750
3,600
2,925
3,000
2,625
1,125
1,050
$ 650
650
650
650
650
650
650
650
650
650
7,325
7,250
4,625
4,400
4,250
3,575
3,650
3,275
1,775
1,700
Subtotal
$ 35,325
$ 6,500
$ 41,825
Total
$ 385,325
89%
Percent to Owners
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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45. Conclusion:
• See What Arrows Are In Your Quiver.
• Pull Them Out To Suit Clients Needs.
Be Proactive!
Prepared for Tennessee Society of CPA’s Healthcare Conference
December 2, 2013
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