Practice rents from professional's own real estate LLC — rent flows to owner tax-favored, building appreciates outside practice.
Professional forms a separate LLC (WY/NV/DE for protection) that owns the building; practice signs arms-length lease. Benefits: (1) rent is deductible to practice (37% bracket) but flows to owner-landlord (potentially §199A QBI, though passive rules apply), (2) building depreciation shelters rental income, (3) building appreciation is capital gain, not ordinary, (4) at practice sale, real estate is separately sellable at max value, (5) asset protected from malpractice. Setup: appraisal, arms-length lease, no self-rental election traps, market rent.
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Practice pays $2.85M/yr premium to owner-controlled captive; captive receives tax-free (small insurance co election).
Combine a defined-benefit cash balance plan with 401(k)+profit share — total deductible contributions $400K+/yr for older owners.
Professional practice (PLLC) contracts with owner's Management LLC for admin, IP, real estate — shifts income to lower-rate entity.
At sale, allocate purchase price to professional's PERSONAL goodwill (patient/client relationships) — capital gain, one level of tax.
MSO owned by non-professionals contracts with PC for management — recapitalize practice with outside capital legally.
Pass-Through Entity Tax lets practice deduct 100% of state income tax federally, bypassing $10K SALT cap.
C-corp (or spouse-hired setup) can reimburse 100% of family medical expenses tax-free — bypasses 7.5% AGI floor.
Solo practitioner uses solo 401(k) with after-tax contributions + in-plan Roth conversion = $69K/yr into Roth (2024).