Permanent Entity Optimization & Structuring

With the One Big Beautiful Bill Act (OBBBA) cementing the 21% Corporate Rate and the 37% Individual Top Rate, the choice between a Professional Association (PA), S-Corp, or C-Corp is no longer a "set-and-forget" decision.

We analyze your practice through the lens of Section 199A Permanency. For medical practices (SSTBs), the 20% Qualified Business Income (QBI) deduction is now a permanent fixture, but it remains highly sensitive to the 2026 indexed phase-in thresholds ($544,000 for joint filers). Our goal is to engineer your distributions and reasonable compensation to ensure you remain below these cliffs, maximizing your effective tax savings.

The New SALT Landscape and PTE Strategy

The expansion of the SALT deduction limit to $40,000 through 2029 offers immediate relief, but it does not replace the power of the Pass-Through Entity (PTE) Tax Election. For partners in multi-physician practices, we implement PTE strategies that allow state taxes to be paid at the entity level: effectively bypassing the SALT cap entirely and treating state tax as a fully deductible business expense.

Advanced Wealth Acceleration & Protection

For practices with high-margin clinical revenue, standard 401(k) limits are often insufficient. We design and oversee:

• Defined Benefit & Cash Balance Plans: Leveraging high contribution limits to facilitate rapid wealth accumulation while significantly reducing current-year taxable income.
• Enhanced Depreciation (Section 168k/179): With the permanent restoration of 100% Bonus Depreciation and $2.5M Section 179 limits, we accelerate the recovery of investments in clinical equipment, imaging technology, and facility improvements.

Navigating the 2026 "Sunsets" and Regulatory Shifts

The 2026 legislative landscape introduces new challenges and opportunities:

• The 35% Itemized Deduction Cap: Even for those in the 37% bracket, the tax benefit of itemized deductions is now capped at 35%: making above-the-line business deductions more valuable than ever.
• R&D Amortization Repeal: The permanent repeal of Section 174 amortization is a significant win for practices involved in clinical trials or proprietary medical research, allowing for immediate expensing of research costs.

Operational Quality Assurance: The Frictionless Practice

We view bookkeeping and real-time compliance not as administrative chores, but as the Quality Assurance (QA) layer of your wealth strategy. Without precision-grade data, proactive planning is impossible. Our integrated back-office systems remove the friction of financial management, providing the clean data required to pivot your strategy as the annual fiscal environment shifts.

From Practice Management to Wealth Stewardship

As a medical professional’s net worth reaches the threshold of strategic complexity, the focus naturally shifts from business accounting to the preservation of a multi-generational legacy. We provide a seamless transition into Comprehensive Wealth Governance, acting as the Principal Architect to coordinate your private practice interests with estate stewardship, trust funding, and sophisticated tax mitigation.

How does the 2026 OBBBA impact the Section 199A QBI deduction for medical practices?

Medical practices can continue to deduct up to 20% of their business income, provided they manage reasonable compensation to stay below the $544,000 indexed phase-in thresholds for joint filers.

What is the most effective way to manage state tax liabilities under the new $40,000 SALT cap?

Multi-physician practices achieve greater savings by paying state taxes at the entity level via the PTE Tax Election: treating the payment as a fully deductible federal business expense.

Can my practice still utilize 100% Bonus Depreciation for equipment purchases in 2026?

Yes, 100% Bonus Depreciation has been permanently restored under the OBBBA: allowing for immediate recovery of costs in clinical equipment and facility improvements.

How does the 2026 35% Itemized Deduction Cap affect high-earning clinicians?

The tax benefit of itemized deductions is now effectively capped at 35%: making above-the-line business deductions more valuable than ever.

Does the permanent repeal of Section 174 R&D amortization apply to medical research?

Yes. The repeal allows practices involved in clinical research to immediately expense R&D costs: providing significant year-one liquidity.

Current Status: We are currently open to inquiries for our Q2 Summer 2026 Onboarding Window.