MEDICAL SPAS REVIEW – A4M

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ANNE BOLDUC Group Publisher & President EDITOR IN CHIEF Guy J. Jonkman

EDITORIAL BOARD ROBERT M. GOLDMAN, MD, PhD, DO, FAASP World Chairman-International Medical Commission Co-Founder & Chairman of the Board-A4M Founder & Chairman-International Sports Hall of Fame Co-Founder & Chairman-World Academy of Anti-Aging Medicine President Emeritus-National Academy of Sports Medicine (NASM) DR. RONALD KLATZ, MD, DO, is the physician founder and President of the American Academy of Anti-Aging Medicine. In 1984, Dr. Klatz was a pioneer in the clinical specialty of preventative medicine: as a principal founder of the National Academy of Sports Medicine and researcher into elite human performance and physiology. Dr. Klatz is a best-selling author, and is columnist or Senior Medical Editor to several international medical journals. He is the inventor, developer, or administrator of 100-plus scientific patents, including those for technologies for brain resuscitation, trauma and emergency medicine, organ transplant and blood preservation.

DAVID B. MANDELL, JD, MBA, is a former attorney and author of ten books for clients, including For Doctors Only: A Guide to Working Less & Building More, as well a number of state books. He is a principal of the financial consulting firm OJM Group He has co-authored the Category I CME Monograph Risk Management for the Practicing Physician which has gone through 5 editions since 1998 & is certified for 5-hour business of medicine CME MANON PILON, Speaker, International Educator, SPA & Medical SPA Specialist – Mrs. Manon Pilon’s background spans over twenty-seven years of professional experience in SPA and MEDICAL SPA operation and management, marketing strategies, Medical Spa concept and development, and motivation methods. She is holding senior management positions in companies such as Europe Cosmétiques, CurAge Med, CurAge Spa, and Europelab. Founder of a private Aesthetics Professional School in Montreal, Canada.

SENIOR EDITOR Bernard Burt

SEND EDITORIAL INFORMATION info@MedicalSpasReview.com or P.O. Box 2699 Champlain NY 12919-2699

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Tax Returns

DAVID B. MANDELL, JD, MBA, is an attorney

DO YOU REALIZE THAT AFTER THE TAX INCREASES OF RECENT YEARS

PAIN RELIEF FOR NEXT TAX RETURN Four Tax-Saving Ideas You Can Do Now

and author of five national books for doctors, including For Doctors Only: A

By DAVID B. MANDELL, JD, MBA CAROLE FOOS, CPA

Guide to Working Less & Building More, as well a number of state books.

He is a principal of the financial consulting firm OJM Group www.ojmgroup.com, where CAROLE C. FOOS, CPA is a principal and lead tax consultant.

They can be reached at 877-656-4362 or

As a physician, do you realize that, after the tax increases of recent years -- between income, capital gains, Medicare, self-employment and other taxes -you likely spend between 45 to 55 percent of your working hours laboring for the IRS and your state?

That is a lot of time with patients for someone else’s benefit. Given this, shouldn’t your advisors be giving you creative ways to legally reduce your tax liabilities?

How many tax-reducing ideas does your CPA regularly provide you? If you are like most physicians, you get very few tax planning ideas from your advisors.

thousands of dollars annually with the right analysis and implementations. Issues here include:

Given these sobering facts, the purpose of this article is to show you four ways to potentially save and possibly motivate you to investigate these planning concepts early in the year when you can best take advantage of them. Let’s examine them now:

• Using the legal entity with maximum tax/benefits leverage – whether that is an S corporation, C corporation, LLC taxed as S, C, partnership or disregarded entity • Using a multi-entity structure to take advantage of two types of entities and their tax/benefit advantages • Managing the payment of salary, bonus, distribution, partnership flow-through to take advantage of maximum retirement benefits and minimize income, social security and selfemployment taxes • Considering benefit plans beyond the typical profitsharing/401(k) with which most medical practices start and end their benefit planning

1. Use the Right Practice Entity/Payment Structure/Benefit Plans These areas are where the vast majority of tax mistakes are made by doctors today – and where many of you reading this could benefit by tens of

2. Don’t Lose 17-44 percent of Your Returns to Taxes; Explore Investment Managers Who Manage with Taxes in Mind It is quite well known that most investors in mutual funds have no control of the tax hit they take on their

mandell@ojmgroup.com

YOU SPENT 45 TO 55% OF YOUR WORKING HOURS LABORING FOR THE IRS? funds.What you might not know is how harsh this hit can be. According to mutual fund tracker Lipper, “Over the past 20 years, the average investor in a taxable stock mutual fund gave up the equivalent of 17 to 44 percent of their returns to taxes.” 17-44 percent! Obviously, over 20 to 30 plus years of retirement savings, losing one sixth to about half of your returns to taxes can be devastating to a retirement plan. Nonetheless, too many physician investors settle for this awful taxation.

3. Gain Tax-Deferral, Asset Protection through Cash Value Life Insurance Above, you learned about the 17-44 percent tax hit most investors take on their investments in stock mutual funds. Similar funds within a cash value life insurance policy will generate NO income taxes – because the growth of policy cash balances is not taxable. Also, nearly every state protects the cash values from creditors, although there is tremendous variation among the states on how much is shielded.

While a 17-44 percent tax bite is unpleasant, these numbers will likely be worse now as compared to the prior time period, as federal capital gains and dividend rates now reach 20 percent for some taxpayers (where they were 15 percent before) and the Affordable Care Act tax added another 3.8 percent for high income taxpayers as well. Of course, state taxes are an addition to these federal taxes. Such tax increases will only exacerbate the issue.

4. Consider Charitable Giving There are many ways you can make tax beneficial charitable gifts while benefiting your family as well.

The most common tool for achieving this “win-win”is the Charitable Remainder Trust (CRT). A CRT is an irrevocable trust that makes annual or more frequent payments to you (or to you and a family member), typically, until you die.What remains in the trust then passes to a qualified charity of your choice.

How to avoid this problem? Consider working with an investment firm that designs a tax-efficient portfolio for you and communicates with you each year to minimize the tax drag on that portfolio. In a mutual fund, you have only one-way communication – the fund tells you what your return is and what the tax cost is. Working with an investment management firm, you get two-way communication, as the firm works with you to maximize the leverage of different tax environments, offset tax losses and gains, and other tax minimization techniques.

Conclusion This article gives you a few tax-saving ideas. For larger practices with $3-5 million or more of revenue, there are additional techniques that could offer significantly greater deductions. These are outside the scope of this article, but are mentioned in the articles on our website and are topics of our free e-newsletter. If you want to save taxes, the most important thing you can do is start looking for members of your advisory team who can help you address these issues in advance.

Otherwise, you will be in this same position this April 15th…and next April 15th and the one after that.

Tax Returns

Income Tax

DAVID B. MANDELL, JD, MBA, is an attorney and author of five national books for doctors, including For Doctors Only: A Guide to Working Less & Building More, as well a number of state books.

He is a principal of the financial consulting firm OJM Group www.ojmgroup.com, where CAROLE C. FOOS, CPA is a principal and lead tax

YOUR MEDICAL SPA IS TAXED AS AN S-CORPORATION

A COMMON TAX MISTAKE COULD BE COSTING YOU THOUSANDS ANNUALLY

consultant.

By DAVID B. MANDELL, JD, MBA They can be reached at

CAROLE FOOS, CPA

877-656-4362 or mandell@ojmgroup.com

A

re you an owner of a medical practice taxed as a flow-through

The key difference between income earned as employee compensation (W-2) and that earned as a K-1 profit distribution is that you pay FICA (Medicare and Social

entity… such as an S-corporation?

Security) tax on the income earned as an employee but not

Most physicians are – in working with over 1,000

necessarily on K-1 profit distributions. While the large Social Security portion of FICA phases out after income of

doctors, we estimate that 70% of medical practices operate as S corporations.

$117,000 in 2014, the Medicare tax has no phase-out. Also, the Medicare tax increased from 2.9% to 3.8% in 2013 for higher income taxpayers, under the Affordable Care Act.

As such, you may be paid both as an employee of the practice – receiving a W-2 – and as an owner

While this is only a 3.8% tax, we have seen poor advice here cost physicians $10,000 or more each year, every year of their career. Over one’s career, this can amount to nearly

of the practice –through a K-1 distribution.

MEDI CAL SPAS • April/May 2015

half a million dollars of lost capital… for no good reason!

www.medicalspasreview.com

70% OF MEDICAL PRACTICES OPERATE AS S CORPORATIONS LET’S LOOK AT TWO EXAMPLES.

so many physicians come to us in the same position

DO YOU SEE YOURSELF IN ANY OF THESE?

–having all, or most, of their income treated as W-2 compensation when in fact much of it is earned because of

1. Dr. Smith is part of a three-doctor cardiology

the profitability of the practice rather than the doctor’s

practice. He earns about $400,000 annually as a

personal services.Wouldn’t all of us prefer to be in Dr. Jones’

cardiologist. He calls the two other doctors “partners” but

situation? If we are allowed to be – yes. So, the question

technically they are co-owners of the practice, an S-

really comes down to – what are the tax rules that govern

corporation. Each month, Dr. Smith gets paid $20,000. Then

this situation?

at the end of each six month period, he gets another $80,000 based on the practice’s performance. His

In discussions with a number of CPAs with over 15 years of

accountant deems both the monthly and semi-annual

experience, the consensus is that one should follow a simple

payments to be salary payments. Thus, he pays Medicare

rule: basically that one can reasonably be paid as a W-2

tax on all $400,000 for a tax of $12,950 at the new 3.8% rate

salary what one would need to pay an associate

on wages exceeding $250,000 and at 2.9% on the first

physician with the same training to come join your

$250,000 of wages. This, of course, is in addition to state

practice. The rest of your compensation can be

and federal income taxes, property taxes, etc. If he works for

characterized as distributions. One CPA, practicing for over

25 years earning the same income, he will have lost over

20 years, commented “this is what I do for my clients, and

$645,000 in Medicare taxes, assuming a 5% growth rate.

when the issue has been discussed in audits over the years, the IRS finds it very difficult to argue that our client should

2. Down the road, Dr. Jones is in the exact same economic situation. However, his CPA treats the monthly

be paid more on their W-2 than a staff member doing the same job.”

payments as W-2 wages and the semi-annual payments as K-1 distributions of the profit earned by the practice. Thus,

Looking again at the examples above, Dr. Smith could easily

he pays Medicare on $240,000 for a cost of $6,960. If Dr.

attract another cardiologist to his practice paying $250,000

Jones works for 25 years earning the same income, he will

salary. This would allow him to avoid Medicare tax on

have lost about $350,000 in FICA taxes, assuming a 5%

$150,000 – saving over $5,500 annually. Not coincidentally,

growth rate – an improvement of $295,000 over Dr. Smith.

Dr. Jones is in the right situation.

The above cases are hypotheticals and any change or

As hard as physicians work, throwing away hundreds of

deviation from the circumstances discussed above could

thousands of dollars over a career – for no good reason – is

affect the outcome. However, obviously, you would not want

a shame.Yet it happens every day. ■

to be Dr. Smith. Yet, we are continually astounded when see

www.medicalspasreview.com

MEDI CAL SPAS • April/May 2015

Income Tax

Investment Taxes

CAROLE FOOS, CPA IS AN ACCOUNTANT AND CO-AUTHOR OF FOR DOCTORS

ONLY: A GUIDE TO WORKING LESS & BUILDING MORE, AS WELL A NUMBER OF STATE BOOKS. SHE IS ALSO TAX CONSULTANT AT OJM GROUP

(WWW.OJMGROUP.COM).

ANDREW TAYLOR, CFP®

MEDICAL PRACTICES ARE MOVING INTO AN ERA OF HIGHER TAXES

SIX STEPS

TO REDUCE

TAXES

ON INVESTMENTS CAROLE C. FOOS, CPA ANDREW TAYLOR, CFP®

Individuals in the highest income tax brackets discovered unpleasant surprises this year when they learn of their

IS AN INVESTMENT ADVISOR AT

investment tax liability. In 2013 domestic equities provided investors with returns they have not witnessed since the

OJM GROUP.

late 1990s. This successful year for U.S. stocks was accompanied by the implementation of The American Taxpayer Relief Act of 2012 that caused an increase in the top marginal tax rate to 39.6%, an increase in long term capital

THEY CAN BE REACHED AT 877-656-4362 OR CAROLE@OJMGROUP.COM

gains and dividend tax rates to 20% for those same taxpayers, and a 3.8% surtax on net investment income (commonly referred to as the Medicare Tax). The confluence of these two events may mean higher taxes for you.

Proper tax planning becomes more critical as we move into an era of higher taxes. Five years of a rising stock market equates to many traditional investment vehicles holding large amounts of unrealized gains that can become realized gains if you are not careful. In this article, we will provide you with six suggestions that could save you thousands of dollars in investment taxes over the next several years.

1. Account Registration Matters: If you are reading this

when you enter the distribution period of your investment

article you likely have a reasonable amount of investment

life cycle. Master Limited Partnerships offer a potentially

experience and have become familiar with the benefits of

advantageous income stream for a brokerage account,

security diversification in your portfolio. However, a

while it is generally preferable for qualified accounts to own

common mistake investors make is failure to implement a

high yield bonds and corporate debt, as they are taxed at

tax diversification strategy. Brokerage accounts, Roth IRAs,

ordinary income rates. There are countless additional

and qualified plans are subject to various forms of taxation.

examples we could discuss, but the lesson is it is important

It is important to utilize the tax advantages of these tools to

to review the pieces of your plan with an advisor who will

ensure they work for you in the most productive manner

consider

possible. A properly integrated approach is critical during

diversification as they relate to your specific circumstances.

your accumulation phase. Further, it is just as important

both

tax

diversification

and

security

6 SUGGESTIONS THAT COULD SAVE YOU THOUSAND OF DOLLARS 2. Consider Owning Municipal Bonds in Taxable

structured properly, the securities typically will not move in

Accounts: Most municipal bonds are exempt from federal

tandem. This divergence of returns among asset classes

taxation. Certain issues may also be exempt from state and

creates a tax planning opportunity. Domestic equities

local taxes. If you are in the highest federal tax bracket, you

experienced tremendous appreciation in 2013. However,

may be paying tax on investment income at a rate of 43.4%.

emerging market stocks, commodities, and multiple fixed

Under these circumstances, a municipal bond yielding 3%

income investments finished the year in the red. Astute

will provide a superior after tax return in comparison to a

advisors were presented with the opportunity to save clients

corporate bond yielding 5% in an individual or joint

thousands of dollars in taxes by performing strategic tax

registration, a pass through LLC, or in many trust accounts.

swaps prior to yearend. It is important to understand the

Therefore, it is important in many circumstances, to make

rules relating to wash sales when executing such tactics.

certain your long-term plan utilizes the advantages of

The laws are confusing, and if a mistake is made your loss

owning certain municipal bonds in taxable accounts.

could be disallowed. Make certain your advisor is well versed in utilizing tax offsets.

3. Be Cognizant of Holding Periods: Long term capital gains rates are much more favorable than short term rates.

5. Think Twice about Gifting Cash: This is not to

Holding a security for a period of 12 months presents an

discourage your charitable intentions. Quite the opposite is

opportunity to save nearly 20% on the taxation of your

true. However, a successful investor can occasionally find

appreciated position. For example, an initial investment of

themselves in a precarious position.You may have allocated

$50,000 which grows to $100,000, represents a $50,000

5% of your portfolio to a growth stock with significant

unrealized gain. If an investor in the highest tax bracket

upside. Several years have passed, the security has

simply delays liquidation of the position (assuming the

experienced explosive growth, and it now represents 15% of

security price does not change) the tax savings in this

your investable assets. Suddenly your portfolio has a

scenario would be $9,800. Although an awareness of the

concentrated position with significant gains, and the level

holding period of a security would appear to be a basic

of risk is no longer consistent with your long term

principal of investing, many mutual funds and managed

objectives. The sound practice of rebalancing your portfolio

accounts are not designed for tax sensitivity. High income

then becomes very costly, because liquidation of the stock

investors should be aware that the average client of most

could create a taxable event that may negatively impact

advisors is not in the highest federal tax bracket. Therefore,

your net return.

it is generally advantageous to seek the advice of a financial professional with experience executing an appropriate exit

By planning ahead of time, you may be to gift a portion of

strategy that is aware of holding periods.

the appreciated security to a charitable organization able to accept this type of donation. The value of your gift can be

4. Offset Gains by Realizing Loss: One benefit of

replaced with the cash you originally intended to donate to

diversifying across asset classes is that, if the portfolio is

the charitable organization and, in this scenario; your cash

Investment Taxes

Investment Taxes

PROPER TAX PLANNING BECOMES MORE CRITICAL TODAY will create a new cost basis. The charity has the ability to

successful investing. A poorly timed fund purchase can

liquidate the stock without paying tax, and you have

result in acquiring another investor’s tax liability. It is not

SPECIAL OFFERS:

removed a future tax liability from

FOR A FREE HARDCOPY OF

your portfolio. Implementing the

FOR DOCTORS ONLY: A

aforementioned gifting strategy

GUIDE TO WORKING LESS & BUILDING MORE, PLEASE CALL 877-656-4362.

IF YOU WOULD LIKE A FREE,

offers

the

potential

to

save

the life of your portfolio.

NOOK EBOOK VERSION OF

6. Understand your Mutual Fund’s

FOR DOCTORS ONLY,

Tax Cost Ratio: The technical detail

“HIGHLIGHTS” EDITION AT www.

behind a mutual fund’s tax cost ratio is beyond the scope of this article.

fordoctorsonlyhighlights

Our intent today is to simply bring

.com

this topic to your attention. Tax cost ratio represents the percentage of an investor’s assets that are lost to taxes.

Mutual funds avoid double taxation, provided they pay at least 90% of net investment income and realized capital gains to shareholders at the end of the calendar year. But, all mutual funds are not created equally, and proper research will allow you to identify funds that are

add diversification to a portfolio while creating the opportunity to

an

investor

to

experience a negative return in a

MUTUAL FUND

the receiving end of a capital gains

calendar year, yet find themselves on distribution. Understanding the tax

WILL ADD DIVERSIFICATION TO A PORTFOLIO

cost ratios of the funds that make up portions of your investment plan will enable you to take advantage of the many benefits of owning mutual funds.

WHILE CREATING The above steps are by no means the

THE OPPORTUNITY TO OUTPERFORM ASSET CLASSES

only tax strategies an experienced advisor can execute on behalf of their clients. This article highlights several strategies you should discuss with your advisor to determine if

WITH INEFFICIENT MARKETS.

YOU DO

NEED TO BE AWARE OF FUNDS WITH

tax efficient.

A well-managed mutual fund will

for

A WELL-MANAGED

thousands of dollars in taxes over

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PLEASE DOWNLOAD OUR

unusual

implementation is appropriate for your unique portfolio and overall financial

situation.

Successful

investing requires discipline that extends beyond proper security selection. While gross returns are important and should not be

EXCESSIVE TURNOVER.

outperform asset classes with

ignored, the percentage return you see on your statements does not tell the full story.

In

today’s

tax

environment,

inefficient markets. You do need to be aware of funds with

successful investors must choose an advisor who will help

excessive turnover. An understanding of when a fund pays

them look beyond portfolio earnings and focus on strategic

its capital gains distributions is a critical component of

after-tax asset growth. ■

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The report “World Analgesics Market - Opportunities and Forecasts, 2015-2022” projects that the world analgesics market would reach $26.4 billion by 20221. Pain sufferers have long regarded plant botanicals as a source of healing; there are more than 100 plants known to have pain relieving properties2. Consumers have sought retail brands of topical pain relief with menthol as an active ingredient3. There is a “new” botanical that consumers need to be aware of for pain relief: cannabidiol.

In a study published by the National Institutes of Health4, it is stated that, “The nonpsychoactive cannabinoid, cannabidiol (CBD), has great potential for the treatment of chronic and 'breakthrough’ pain.” The study also states, “Chronic pain relief can be best achieved through the transdermal route.”

Today, the United States faces a health epidemic: prescription opioid addiction. To address this problem, manufacturers are producing a new topical combination of CBD with menthol. These non-habit forming ingredients are a welcome solution for consumers who do not wish to pursue prescription opioid pain medications or are looking for an alternative to prescription pain medicine.

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CBD, known to be hydrophobic and lipophilic, does not dissolve or emulsify readily in water, but will dissolve in fat.

Bioavailability of CBD depends on the way that the cannabinoid is delivered into the human body. Today, science has enabled CBD to be water soluble as well as time-release.

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1 -http://www.prnewswire.com/news-releases/analgesics-market-is-expected-to-reach-264-billion-globally-by-2022-575688921.html 2 -http://www.motherearthliving.com/health-and-wellness/the-best-herbs-for-pain-relief.aspx 3 -http://health.usnews.com/health-products/top-rec-topical-analgesics-arthritis-joint-pain-135 4 -http://www.ncbi.nlm.nih.gov/pubmed/20545522 5 -https://www.psychologytoday.com/blog/the-teenage-mind/201105/history-cannabis-in-ancient-china 6 -https://en.wikipedia.org/wiki/Cannabinoid_receptor

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