Tuesday, December 29, 2009

Dental Practice Value for a Deceased Dentist's Family

I have a close friend that passed away last week unexpectedly. He had a heart attack at age 54 with no prior symptoms. It really was a bummer. His wife has a prospect to buy the practice. He’s a good guy and it could work out perfectly. The big question is the value of the practice.

I've heard one formula for determining "good will" is to take the annual gross average for the past three years and multiply times 40% for the value of the "good will" of the practice. Equipment, etc. is not included with this value.

Please let me know your thoughts and comments. We need to get this deal "up and running" for the sake of this family ASAP.

There are many formulas and rules of thumb. However, instead of relying on the rule of thumb methods and potentially leaving a lot of value on the table, the spouse should hire someone who can assess the reasonable "range of value" without needing or having to pay for a full blown valuation report. There are many transition professionals that can provide this service, even brokers. If you decide to try a broker, simply let them know that at this time all you need is to have them assess the range of value, assuming you're pretty sure you have a buyer. If for some reason this buyer falls through, at least you've already have a relationship with a broker who may be able to find you another buyer quickly. Good luck.

Tim,

Could you do the valuation from the P&L and balance sheet, without seeing the practice?


Yes, I can determine a "range of value" from good financial information. It’s what I do for our buyer representation clients. I’ve never stepped foot in the office of most of my buyer representative clients, what do I know about the working condition of the equipment? I’m not an equipment vendor or specialist.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Monday, December 21, 2009

Dental Practice Purchase Price Allocation: Is Goodwill the Devil?

Sometimes we come across uninformed buyers that want the majority of their purchase price allocated to equipment because they can get an immediate tax write-off under Internal Revenue Code Section 179 of up to $125k and $250k in very recent years. However, part of our job is to understand and educate ourselves about the state/locality that the transaction will occur in and educate our buyer/client on ALL the tax considerations of price allocation, not just income tax.

Many, many years ago goodwill was the devil in the eyes of every buyer. Why?

There was a time when goodwill was NOT deductible under the tax code, therefore from a buyer’s perspective, any allocation to goodwill was NOT providing them with any income tax savings. However, goodwill was always treated as a capital asset and subject to capital gains to sellers, therefore, sellers wanted most (and in some cases ALL) of the price allocated to goodwill. I remember when this one issue, the allocation between goodwill and tangible assets, was the most stressful part of most transitions. Not anymore though.

Now, buyers can write off goodwill over 15 years, so in my mind, that was a decent compromise from an income tax perspective between buyers/sellers when negotiating the allocation.

Enter the Sec. 179 write-off issue where the IRS increased the write-off election from $25,000 to over $100,000 and in recent years $250,000. All of a sudden, buyers were reverting back to the "old ways" of trying to minimize goodwill while trying to maximize equipment/furniture/computers and other areas that would generate a faster tax deduction, let alone ANY deduction. STILL, sellers wanted their capital gains so this issue of price allocation was once again a hurdle, though a low one that could usually be jumped fairly quickly.

Then the long term capital gains rates were lowered to 15%, down from 20% and at one time 28% so sellers once again began pushing firmly for more goodwill allocation while the buyers wanted more equipment due to the ability to write off $100,000 under Sec. 179 immediately. When the IRS recently increased the Sec. 179 write-off to $250,000, those that were purchasing large practices where the value of equipment could easily reach that level, began pushing for the higher equipment allocation and price allocation once again became a struggle.

These days, states & local governments are finding other ways to tax businesses aside from income tax, which usually means higher sales tax, personal property tax, transactional tax, etc. Therefore, buyers need to be educated on how the allocation of the purchase price can affect them from EVERY tax perspective, not just income tax.

Take Maryland for example. We have a 6% sales tax (was 5% a couple of years ago) on the allocation to equipment/furniture/computers and supplies, so on an allocation of $100,000 to those items you just cost yourself $6,000 DUE AT SETTLEMENT. Then our counties also assess a personal property tax on business assets, and on $100,000 over 10 years, that's easily another $10k-$15k. So the buyer’s allocation to tangible assets/supplies might cost them more than $20,000 in other taxes compared to $100,000 allocated to goodwill where there is no sales or personal property tax in most jurisdictions....YET.

Keep in mind the income tax savings on $100,000 will likely be nearly the same over 15 years whether it's goodwill OR equipment, with the only difference coming from the income tax brackets the deductions are taken in. The income tax benefit with equipment and supplies is the ability to get those tax savings sooner rather than later. However, if you run the numbers out over 15 years (the life of goodwill under the tax code), the allocation to equipment/supplies will almost always cost you more due to the other taxes you incur, at least here in Maryland and other jurisdictions we've seen.

This is just one reason why buyers should consider seeking advice from an advisor that has many years of experience with practice transactions & transitions, this one area can keep a buyer from making a mistake AND save them money.

This first appeared on NewDocs.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Thursday, December 17, 2009

Is an LLC or and S-Corp Best for Owning the Dental Building?

I have heard it said that the best way to go about owning a building and practice is to have the building set up as an LLC and the practice as an S-Corp, with the LLC renting out the building to your S-Corp practice. Assuming this model is followed, would the following be legal:

Let’s say you own a building with enough space to house multiple businesses. You start off with your practice set up in one area/wing/whatever of the building and rent out the rest of it. Perhaps you plan to use the extra space in the future for expansion, but that really is not important. Commercial real estate hits a rough patch and your LLC comes dangerously close to failure. Your dental practice is still rather successful. Would it be legal to "renegotiate" and jack up the rental rate on your dental practice so as to help your commercial property LLC get through the tough times?

The basic question here is whether or not it is legal to essentially use the rate charged to your practice to mediate the bumps felt by your commercial property. (I suppose the reverse of this situation is possible as well, with you lowering the rate charged to a struggling practice by your successful commercial real estate... but this situation seems unlikely at best).

Or you could simply use the S-Corp profits and lend them to the LLC to keep it afloat. Assuming you're the sole owner of each both flow through to your ind. tax return so the net tax benefit will be the same.

Remember, the S-Corp needs to act in a prudent business fashion. If it's already paying "fair market" rent and you didn't own the LLC and the landlord asked you to renegotiate the lease to pay more rent, would you still do it? The answer is no.

Don't make it more complicated that it needs to be.

Our friend Jason Wood would like to add:

The only thing I will add to this excellent answer is a real world experience as to why it should be done this way as opposed to renegotiating the rent and putting it in writing. 

A client that contacted us after-the-fact had entered into an "above average rent" with his dental practice for the building that he owned.  Because it was a part of the lease there was a paper trail.  When he lost the building as a result of the economy we are in, the bank "relied" on the above market rental rate outlined in the lease to force the dentist to continue paying the above market rent. 

In other words, don't renegotiate your rent, do what Tim suggests instead.  Lend the LLC money personally so that if you lose the building it isn't attached to your separate entity.

Now that’s great information to know!

Thanks!

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Monday, December 14, 2009

Dental Production vs. Collection Problem

Can you tell me where I can find legal definitions of "production" and "collections" as they relate to dentistry?

 
I've just started working for a group practice. I have a contract (as an independent contractor) that states that I will be paid "30 percent of the production resulting from dental services provided by" me according to their standard fee schedule. I was happy with that until I discovered that they are trying to call their collections "production" and compensate me accordingly. (The word collections is not mentioned anywhere in my contract.)

 
Some of the things they are claiming according to this nomenclature are that when they run a promotion for a free exam (etc), since they are charging nothing, it doesn't count as "production" and I get paid nothing. If they discount a fee, it discounts what I get paid. They also said that if a patient defaults on their payment, that it retroactively counts against my "production" and is backed out of my pay. (Of course, since I'm not an owner, I have no say what promotions get run, or when.)

 
Naturally, I'm contesting all this, since it would basically give them carte blanche to not pay me for whatever they decide not to charge for. In school, production was always defined as "the procedures you perform" and collections as "what the patient/insurance actually pays." Is this incorrect? Can anyone help me find official definitions of these terms? I'm really hoping I don't have to involve an attorney.

 
Thanks!


First, different people use the term “production” very loosely. While one might expect it to mean the number based upon the practices fee schedule, many people simply use it to fit their needs. You’ve learned a very valuable lesson, which is (and this is for every associate and owner dentist):


Make sure you define these terms in your agreement. As an associate, if you get a contract that says you'll get 30% of production, insist that a definition be inserted that your dental attorney is comfortable with. The same goes for many other terms thrown around in agreements, compensation, professional expenses, full time and part time, just to name a few. Use examples if you must so it's very clear.


Check with the ADA as to their definitions. They put statistical information out there and they must have "standard" definitions for these terms.


Good luck. You’re right to contest this.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Wednesday, December 9, 2009

Fair Price for Dental Practice?

I've been working at this practice for 2½ years; since it first opened. My boss built it with plans for someone else to work in it, but that fell through, so I've been the sole dentist there. I am talking to him about buying it but can't decide if it is worth it. He wants all the money out of it that he put in, but based on production numbers, I don't see how this can work out for me.



Here's a little background…


We are the only office in a small town. I have built a good reputation in the town and it would be very nice to take over this practice and keep the patient base and the goodwill that I have earned there. I could probably build my own practice there (based on contractual issues that I won't get into here) but I really don't want to screw over my boss since we are friends. The balance on the practice loan is 489k and he says he put in 50k of his own and that he can't sell it for less than that.


Here are some (very basic) collection figures:


2007: 195k, based on 7 ½ months, mostly part time


2008: 515k


2009: should end up around 600k


I know that I haven't given much information, but that's all I have on hand right now. I just don't know where to go at this point. I'd rather not have to start another new practice from scratch since I've basically done that with this one. Any suggestions for what I should be doing next?


Thanks in advance for any help. I'm at my wits end.

The practice may or may not be worth what he's asking; there's not enough information to make that judgment.

If it's a 3-4 operation practice which should have only taken approximately $300k-$400k to open, I wonder where the other debt came from? Was it from supporting you and the practice for 2 ½ years maybe? If so, he's gotten some pretty nice tax breaks for his increased debt and I agree, that's not your problem and it may be overpriced.

One can't assess a practice like this on revenue alone though; that's very dangerous for both buyer and seller. If this were a 20-year-old practice with older equipment and older technology then I would agree, the price seems out of line. This is a 2 ½-year-old practice, maybe with new technology with revenue of $600k and growing, the price may be reasonable.

On the other hand, if it took over $600k in debt to open this 6 op practice with all the bells and whistles and it has the potential to be a $1 million practice within a year his price may be a bargain.

If this practice is only capable of doing about $600k, you don't want to buy it for that price for sure.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Friday, December 4, 2009

In-House Pre-Paid Dental Plan May Be Solution to Collection Issues

Our good friend, Dan Marut, recently published the below article on his excellent website, NewDocs and asked they we repost it on our blog. This is a must read.


Assault on Private Dental Practice


by Michael David McGuire

From business assaults by insurance companies... to issues related to patient treatment acceptance... to the increased cost of attracting a steady stream of new patients... the private practice dentist is dealing with a great deal more these days than at any time in past two decades. However, there is an innovative new idea... based on a tested and proven past concept... that can dramatically increase new patient flow and treatment plan acceptance, while increasing net practice income by 30% or more. This new approach is being nationally branded as Quality Dental Plan and is being offered by Operational Management System under their Complete Dental Plan turnkey marketing system (details at CompleteDentalPlan.com). This approach is now recognized by many as being one of the nation’s top solutions for helping increase income and profitability for private practice dentists, as well as giving new patients an additional reason to seek dental care.


“One of the things that we noticed early on as the economy began to sour was that more and more patients were having a difficult time following their suggested treatment plan and some putting off dental visits altogether,” said Samantha Miller, Office Administrator for Today’s Dentistry, a private practice dental office in Ashland, OR. “Part of the problem was the fact that people are worried about money and expense. We eliminated a great deal of this resistance virtually overnight by implementing the program offered by Quality Dental Plan.”

As mentioned above, Quality Dental Plan is the brand name for a patient pre-payment membership plan developed, offered and marketed nationally to dentists by CompleteDentalPlan.com. Although the core concept behind the plan offers plan members a lower price for a menu of dental services created and priced by the local doc, the net result is that the local dental office actually sees an increase in patient revenue since all dental fees must be paid, in advance, at time of treatment to qualify for the discount that the local doc has established. “We tracked the decreasing value of uncollected fees from patients over a six month period,” Miller said, “and we noticed that uncollected fees often remained uncollected. This issue was completely eliminated once we implemented QDP in our office since all QDP member patients paid in advance for all services.”

Pre-pay so-called “membership plans” are not new to dentistry... and have a long history of proven success in private practice. However, what is new... and what QDP does so well... is to take this long-proven concept and wrap it in an easy to implement, turnkey system backed by national caliber marketing materials and a national marketing campaign.

“This is one of the smartest practice management tools that I have ever implemented in our office,” according to Dan Marut, DMD. “With QDP we set our own list of benefits, our own pricing structure and determine the fees that we are going to charge. A complete Implementation Guide was included... so set up was easy. The marketing materials are professionally created and were all customized by CompleteDentalPlan.com for our office.” The QDP branded promotional materials include customizable patient and local business letter templates, a brochure, postcard and radio commercial... all developed by a top New York-based marketing firm. CompleteDentalPlan.com also backs all QDP Member Dentists with strong implementation support, geographic exclusivity and help with local marketing.

“This is a complete turnkey set up,” said Dr. Marut. “We were able to fully implement... and start seeing the benefits of the plan... in less than a month. The Implementation Guide helped me and the front office team get up to speed with very little effort. All management and marketing systems were very easy to implement. The acceptance from patients was amazing.”

Other docs from around the nation have seen the value of implementing quality pre-pay membership plans like QDP. “I have never liked the way the insurance companies dictate to me and my office,” said private practice dentist Dr. Doug Paulus of Massillon, OH. “By having a majority of patients pay in advance for all services... this hassle has been almost completely eliminated. The patient pays less out of his or her pocket... and we increase practice income.” Dr. Carl Stubblefield of Boise, ID agreed. “Quality pre-paid membership plans like QDP can be a huge win-win for both us as doctors and for our patients.” In the specific case of QDP from CompleteDentalPlan.com, the local doc remains 100% in charge and collects 100% of all revenue generated from plan membership fees and fees for services. Dr. Daniel Siriphongs of San Andreas, CA indicated that pre-payment membership plans can greatly reduce administrative and collection costs. “This is a major side benefit,” he said. “Anything that introduces more new patients into the practice is a major plus.”

“It is awkward and uncomfortable for me, personally, to have the front office team have to try and collect on past due patient payment plans and unpaid bills,” said Dr. Wendy Crisafulli of Bothell, WA. “Any system that makes it easier for the patient to pursue treatment and eliminates those stressful collection calls for us is a major net positive. Without a doubt... this simple step increases our practice income.”

“On the face of it the so-called “self determined discounts” created by us and offered within the plan might look as if it would decrease practice revenue,” said Miller of Ashland, OR, “but the reality is that the discount for the patient is more than offset by the savings we realize from greatly increased treatment plan acceptance, increased collections and decreased administrative costs.. The QDP marketing systems also helps us very cost-effectively reach out to the community to attract new patients.” Another interesting innovation that CompleteDentalPlan.com is offering their QDP Member Dentists is a turnkey marketing system to reach business owners in their local community with a very affordable “dental plan” for their own employees. “The marketing approach that QDP offered was, I think, really brilliant in that they showed us how to reach out to the local community and help business owners find a great way to offer a really cost-effective dental benefit to their employees,” said Dr. Dan Marut, sighting a local retail store and a soft-serve yogurt shop as examples. “With one letter we brought in 20 new patients in one day with just one follow-up phone call. The business owner becomes a hero and her employees will have top rate dental care for less than they would have to pay for dental insurance.” In almost all cases, the cost of a QDP Business Membership for employees is fully tax deductible by the local business owner. “This has proven to be not only a great practice income building tool,” said Dr. Marut, “but also a really great public relations and marketing tool as well, that allows doctors to contribute to the overall wellbeing of their communities. I highly recommend it.”

For more information about how to become a QDP Member Dentist... and to lock in geographic exclusivity for your area... go to CompleteDentalPlan.com or call (323) 960-5029.

This first appeared on NewDocs.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Monday, November 30, 2009

What are 500 Dental Patient Records Worth?

The economy has been tough on a lot of offices here in Las Vegas. I just got a call from a nearby office and the doctor is closing down his practice due to the bad economy here in Vegas. He wanted to know if I would like to buy their patient records. He said that he has 500 patients, 70% of them are insured, and he has collected 288,000 in the past year. I have no idea what 500 patients are worth or how many we would lose in the transfer. Anyone have ideas on how to put a value on these patients? Is this a good idea?


20% of collections from those patients for each of the next two years.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Wednesday, November 25, 2009

New Dentist has Questions about Insurance Checks and 1099 Reporting

I recently started at a Medicaid office 2 days per week as an independent contractor. I work 2 days at another office as an employee and 1 day at a third office as an independent contractor. (Can you guess what city this is?) I have always done my own taxes with turbo tax (I enjoy it???). At the Medicaid office I will receive the Medicaid check, via my SSN and Medicaid ID number. I then will deposit it, keep my percentage and write a personal check to the office I am working at for their percentage.

I never received an insurance check directly before so what happens at the end of the year? Does Medicaid issue a 1099 to me?

Sounds like you will receive the 1099.

The office said I can deduct the amount I give to them. Is this true? What type of expense? What type of documentation would I need in case of an audit to prove this expense?

How does your contract define the payment back to them, rent? If so, it's rent expense. Your contract should define what this payment is and that's how you'll know how to report it. Yes, it should be deductible. Your proof if audited will be your contract and your cancelled checks.

I’m trying to plan now since my first Medicaid check is on its way.

As long as you're depositing ALL of your income, don't worry about what the 1099 says. It sounds like your gross income will exceed that since you're also getting income from other sources. Simply report ALL of your income and make sure you take every bit of deductible expenses you can and you'll be fine. DOCUMENTATION IS THE KEY.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Friday, November 20, 2009

Dental Practice Brokers

Tim, can ask you what types of qualifications you recommend that your clients look for when seeking a broker? Does a broker typically have to be licensed or have a particular type of education for you to recommend them?

No problem. What do I look for in a broker to whom I may refer a client?

First and foremost in my opinion is experience in brokering dental practices.

For example, there's a broker here in Maryland who's been in the business for as long as I've been doing this (which is 26 yrs). He's not a dentist and never was; however, he's done thousands of deals and that experience is priceless.

A good brokerage will have a HUGE inventory of sellers so that, as a buyer, you will know you'll be able to be somewhat selective with respect to where you want to look and the type of practice you want to buy.

For sellers, knowing that a broker has a HUGE inventory of practices for sale may scare you; however, simply know that because of this, they will also attract many more buyers than a broker with very few practices for sale. So you want to be listed by someone who can get you the most exposure, again, in my opinion.

I think the license thing is a state-by-state regulation. Still, having the license won't necessarily get a referral from me. I’m licensed to sell life, disability, health, annuities and certain investments. I'm not really active in those areas, and I wouldn't expect anyone, even my family, to refer someone to me for those products simply because I have a license. It's not what I do everyday, so how can I really be "good" in those areas? Again, experience!

"Formal" education isn't necessarily a factor. Certainly I expect a good broker to stay abreast of the current economic conditions, changes in transition structures, and tax issues that may impact specific structures. I don't expect them to know the tax code. Again, similar to me with insurances, I know enough to give me a base of knowledge to help provide clients direction in where they need to go for accurate advice. They don't expect me to know the finer details about each life insurance product by each life insurance company. I would expect a broker to know in general terms the impact of an asset purchase vs. a part stock\income shift purchase.

Does this help?

Tim,

 It is my experience that Attorney's and CPA's bill hourly, so they don't get commission on the price of the practice. So, they have no interest in blowing up the price of a practice as a Broker would, I would assume they work in the best interest of the party paying them aka the seller or buyer.

This may be an incorrect statement.....only my experience thus far in dealing with 3 CPA's and 2 Attorneys, so limited experience admittedly.

I'm glad I didn't assume, I thought you meant we didn't care if the practice was overpriced.

You're correct though, most do bill by the hour and I agree, they have a duty to work in the best interest of their client.

However, this is where we differ to most. Our buyer rep engagements are fixed price engagements structured in such a way that basically lets the buyer pay us for services received and there is an absolute cap. While we track our hours like every other CPA, we prefer to work with fixed price engagements when we can. There are consulting engagements where we simply cannot fix a price because there is no way to know what our involvement will be. With buyer rep engagements, we've done enough to know what we should charge. Most buyers are surprised when they learn this....actually pleasantly surprised.

Should a dental broker have experience in what they sell. Yes, that may be a good idea and a good reason to pick a dental broker that is a dentist and has experience at what they do.

A dental broker doesn't need to be a dentist to have the experience in what they sell.

That said, I have NO problems with a dentist that has learned the brokering trade with years of experience in that trade.

Again, I'll use me as an example: I'm a licensed insurance rep, but that does NOT make me a good insurance professional. I believe I would need many, many years of active insurance sales activity with a lot of training to make me a good insurance professional.
Just the way I see it.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Monday, November 16, 2009

Merging Two Dental Practices with Differing Amounts of Debt

I share a building with another dentist and his associate. We have discussed merging our practices. My concern is that I have much more practice debt than he does. Some of the debt is equipment/ operatory related and should not be an issue. But I have significant other debt related to start up and cash flow issues in the past.


Are your practices similar with respect to revenue?

How can this issue be reconciled should we elect to merge?

It depends on how you decide to "merge". You could simply decide to maintain your separate practice entities and form a third entity to be the main operating entity for revenue and shared expenses. You could elect at this time to keep your assets and debts in your separate entity until such time as the debt is no longer an issue. Similar to a space sharing arrangement, I would think. Any new asset acquisitions would go through the new entity.

We have a great location and if we combined and marketed the practice as a whole it could be very profitable I believe but I am just not sure how the difference in debt can be overcome.

I'm not sure it needs to be "overcome" at this point, you have yours, they have theirs. You form the new entity and decide how net profits will be split after operating expenses. You'll receive your share and use it to pay back your debt and\or any of your personal professional expenses and they'll do the same.

It doesn't have to be that complicated. It just needs careful planning and a lot of due diligence. The other benefit of keeping your assets and debts separate initially is that IF the merger fails, it should be easier to know which assets go where and the only assets you'll have to worry about are those that were purchased after the merger.

The point that I was trying to make was the logistics of the deal. All three doctors will have to form a new corporation and their compensations will have to reflect what debt each of them has.

I think you mean they'll have to form a new entity and I agree (corp, LLC, etc.).

However, I'm not sure why their respective debt would HAVE to determine their compensation. I think their compensation can be driven by their production, as is the case with most "partnerships" and in this case, how they "contribute" to the new entity and "what" they contribute will most likely impact their respective "ownership" interests in the new entity moreso their compensation.
Our friend, Jason Patrick Wood, the Dental Attorney adds:

Why do you keep saying "three"? The original post is owner and associate. I don't let associates into my business without paying, I don't think this doctor would either which leads me to the conclusion there will be 2 owners, not 3.

I also agree with Tim. Debt shouldn't even be a consideration when entering into a compensation formula, unless the debt is at a level which may materially interfere with the value of the asset being transferred into the partnership.

Another question I have however is, where is the cost savings? What are you going to do with your respective practices? What is the short/long term goal after the merger? If you are just going to tear down a wall and merge your practices, great. However, you still will most likely be overstaffed which should be another fun discussion. All of these issues IMO need to be worked out before you even start contemplating an actual agreement. Partnerships, when formed correctly, take time and openness to create a model that will work for you.

Yes, I meant that all three of them will form a new entity. And once their compensation agreement is set up, the doc with debt could use his salary as pre-tax dollars to pay off that debt. What're your thoughts?

Each partner (who could still maintain their existing entities to form a new one) could use their respective profits from the "partnership" to pay their respective debts and professional expenses. The expenses would naturally be tax deductible, debt would not.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Thursday, November 12, 2009

The Ugly Truth: Minimizing the Risk of Dental Office Embezzlement

Here is an article from our friend Sandy Pardue which we found timely. It is reprinted with permission of DentistryIQ.com


Nicole was a loyal employee for 18 years. The doctor relied on her and she made his life easy. He believed that if she were not there, everything would fall apart.

Nicole was the first to arrive in the mornings and the last to leave in the evenings. She worked through lunch and came in on weekends. She never asked for a raise or to be paid overtime. She knew more about the computer software and front desk protocols than anyone in the practice. She never took vacations and she wouldn’t dream of the doctor’s having to make the bank deposits. The patients loved her.

Things changed quickly one day when a patient stopped by to speak with the doctor. She had been in for surgery a few weeks earlier. When she pulled out her checkbook to pay for her visit, Nicole told her that she would stamp the check with the practice’s name and not to worry about filling it out. When the patient received the check back from the bank, she noticed the word “cash” written in place of the practice name. The check had not been deposited. The doctor had been missing cash from his wallet and this confirmed his suspicions that something was terribly wrong. He started investigating and learned that Nicole had embezzled several hundreds of thousands of dollars.

This true story may seem all too familiar to many readers. Embezzlement in dentistry is becoming more common. The longer you practice, the more likely it is that you will become a victim. This is an uncomfortable subject for most dentists, but it is the ugly truth. Embezzlement is costing U.S. businesses $652 billion annually, according to the Association of Certified Fraud Examiners. Dental groups are particularly vulnerable, since they rely on office managers and front desk staff to handle collecting, depositing, and disbursing money.

Do you...

** Perform background checks when hiring?

** Run credit checks on new employees?

** Drug test?

** Have bank statements and credit card statements sent to your home?

** Personally review the day sheet and adjustments?

** Compare the actual deposit receipt with the computer reports?

** Visit the financial area of your practice during the day?

** Have one person handling receivables and another person handling payables?

If you answered "No" to any of the above statements, you may be an easier target for the embezzler.

Attributes of embezzlers:

** Efficient

** Often long-term employee

** Loyal employee

** Doctor trusts them

** They are often part of doctor's extended family

** Intelligent

Symptoms of the embezzler:

** Receives telephone calls from creditors

** Having wages garnished

** Excessive spending, living beyond their means

** Asking for cash advances

** Personal problems such as a divorce, addictions, children with addictions

** Excessive use of alcohol, talk of going out partying and gambling

** Refusing to run a report you requested

** Not allowing others in their area

** Not wanting to miss work or take earned time off

** Employee quits unexpectedly

** Gets annoyed at reasonable questions being asked about bookkeeping

** Resists change

How they do it:

1. They steal cash; it’s hard to prove ownership and it’s easy to steal.

2. They deposit insurance checks in their own account.

3. They set up secret accounts in the practice’s name to which they have access.

4. They open a credit card account where the doctor has personal and business accounts. They pay their bills with the doctor’s checks.

5. They make adjustments on patient accounts.

6. Sloppy bookkeeping makes their theft harder to trace.

How we stop them:

There are ways to prevent staff from getting their hands in your “cookie jar.” I am frequently called in to practices as a consultant to help dentists detect and confirm embezzlement. These practices failed to implement necessary protocols. Don’t be a victim. Execute the following list of safeguards:

1. Hiring: Check references; do background checks, credit checks, and drug tests on every applicant. You should personally call the business owner when checking references. Do not talk to staff.

2. Write a policy on theft: Make it known that the office will have zero tolerance for theft. Let employees know that they are safe to report any suspicious activity. The dentist must set a good example for staff by not doing anything unethical or illegal. The dentist must insist on high ethical standards in the practice. I have seen dentists refuse to fire or press charges against staff for stealing hundreds of thousands of dollars because of their own dishonorable actions.

3. Computer software security: Each person in the practice should have his or her own confidential username and password. You should have a policy in your office manual that employees read and sign off on, agreeing to keep their passwords confidential. Any violation of this policy will result in termination of all parties involved. The policy should state that everyone will sign out anytime they leave their work area. The doctor should have two usernames, one that is used on a daily basis while working with patients and one with a higher security level for maintenance tasks.

4. Receipt book: Utilize a three-part carbon copy receipt book along with your computer receipts. The computer only knows what you tell it. A receipt should be written for every payment, whether cash or check. Most importantly, the receipts should be numbered and stored for future audits. You can use copies of the receipt to compare with the deposit slip and payments that were posted. It is used to verify that everything made it to the bank.

5. Enforce vacation policies: Office managers and staff should take five consecutive days off every year. Beware of any staff refusing to take vacations. I’ve seen a doctor try to give away a Caribbean cruise to have the opportunity to check for theft and the office manager refused the trip. Another red flag is when they never allow anyone in the financial area to help them or they resist anyone put there to monitor their work.

6. Sign your own checks: Always question the expense and do not sign checks without an official invoice attached. Every check should be for a legitimate expense.

7. Throw out the signature stamp: Do not allow a signature stamp in the office.

8. Investigate patient complaints about their account having errors.

9. Purchase a “Deposit Only” stamp: Every check that arrives via mail or presented by a patient in the office must be stamped “For Deposit Only.”

10. Arrange for all bank statements and credit card statements to be mailed to the doctor’s home: Look at the checks to make sure you recognize each one. Look for duplicate payments, extra payroll checks, and any electronic debits or transfers you don’t recognize.

11. Check merchant statements: One of the latest schemes is for employees to credit their own credit cards using the practice’s credit card terminal. You are receiving a monthly merchant statement; check it for credits. Credits should be a rare occurrence.

12. Beware of patient refunds: They process fictitious refunds using a patient’s name or a name they make up. Question all refunds. Ask for a printout of the patient’s ledger attached to the refund request. Also, when an employee gets the idea to refund credits to patients, make sure the unexpected checks end up in the patient’s hands and not the employee’s account.

13. Cash payments: All practices will receive cash from time to time. If cash is never listed on your deposit slips, this is a red flag. When cash is received, implement the receipt book and make it a cardinal rule that everyone gets a receipt. Have a written policy on how this should be handled. You may consider placing a small sign on the counter that patients will receive a receipt for all payments.

14. Cash loans: No one in the practice, including the doctor, is allowed to take cash out of funds received from patients or a petty cash box.

15. Adjustments: Every computer software program has an adjustment report that can be printed. Adjustments should be verified and approved by the doctor.

16. Install a security system and security cameras: Each person should receive a confidential security code. This allows you to track who is going in the practice after hours.

17. Insist that bank deposits are made daily: Deposits should be prepared and brought to the bank every day.

18. Learn your computer software: Know how to access reports, run audit and adjustment reports, and know how to look for deleted items.

19. Have regular audits: Your staff will see you keeping an eye on things and this is a huge deterrent to temptation.

20. Insurance checks: The embezzler takes the insurance checks which are payable to the practice and deposits them in their personal account via an ATM machine where there is no live teller.

21. Keep score: Track office production, collections, and adjustments in Excel. You will be able to detect financial misconduct early on. Look for an increase in accounts receivable without corresponding increase in production.

22. Receive the day sheet and daily deposit information at the end of each workday: This lets staff know that you are watching. Don’t let a day go by that you do not receive this report. If the report is not received, make a big production out of it.

23. Implement a drug-free workplace policy: Give your staff a 30-day notice and start doing routine drug testing.

24. Protect your patients: Take precautions to protect your patients’ personal information. Consider implementing a level of access.

25. Check your personal credit report: Do this at least once a year. Look for duplicate accounts with one creditor and accounts you are not aware of. We recently learned that a doctor was paying for cell phones for an entire family of an employee, unbeknownst to him.

26. Use QuickBooks: It will give you better control over expenses and enable you to detect irregularities early on.

27. Look at lab bills: Make sure you recognize the patient names and cases.

28. Employee termination: Any time you terminate an employee, you must change all security codes and passwords on the same workday.

29. Time clock theft: Review time clock reports before payday. Only one person should be able to make changes.

What to do if you suspect you have a thief in your practice:

1. Keep your suspicions to yourself.

2. Investigate.

3. Contact your attorney.

4. Contact your local police department and press charges. This prevents them from doing the same thing to another practice.


My purpose for sharing this information is to raise awareness in the dental community about a common occurrence in dental practices, and to provide dentists with tools to safeguard their practices. Most embezzlement schemes can be detected and prevented with internal systems, controls, and routine monitoring. Remember, the best defense is a good offense.

Feel free to contact me if you have any questions or need assistance with implementation of these safeguards.

Sandy Pardue is an internationally recognized lecturer, author, and practice management consultant. She has assisted hundreds of doctors with practice expansion and staff development over the past 15 years. She is known for her comprehensive and interesting approach to dental office systems, and offers a refreshing point of view on how to become more efficient and productive in a dental practice. Sandy is director of consulting with Classic Practice Resources. She is also a consultant to leading dental companies for product evaluation and design. She can be reached by e-mail at sandy@classicpractice.com

The original article can be found here.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Monday, November 9, 2009

How to Hire the Best Dental Associates

Our friends at ETS Dental recently posted this wonderful blog on their site. With their permission, I am reposting it here.


Confessions of a Dental Recruiter



Written by Mark Kennedy, Managing Director of ETS Dental.

Sooner or later, every practice is faced with seeking a new Associate, Partner or Owner. In the past twelve months ETS Dental has recruited and placed more than 200 Dentists with independent practices and clinics around the country and some of the lessons we’ve learned may be beneficial to you when it comes time to bring a new dentist into your practice.

The best candidate already has a job

As a whole, the population of Dentists is truly at full-employment. Most great candidates are employed, but passively seeking a better long-term opportunity. In fact, only one out of every 20 Dentists we place come as a direct result of an ad…the rest come from networking.

There’s a reason the best opportunities aren’t advertised

The best associate or partnership opportunities are rarely advertised. If a practice is losing a key associate it is typically in the best interest of the practice NOT to advertise this fact until a replacement is found. Some patients and key staff will certainly leave if they know their Dentist is leaving the practice.

The best time to start looking is early

There is an old Chinese saying, “The best time to plant a tree was 20 years ago. The second best time is today.”

Very few good candidates are desperate for change. The vast majority are willing to wait a few months or a few years. Likewise, no one practices forever…there is usually an identifiable window of opportunity when a partner would like to step back or retire…the closer a practice waits until that time, the more they limit their options.

Practice Owners with a plan hire the best Associates

Interview preparation is a two-way street. While much has been written to help the potential hire prepare for an interview, we have found it equally essential for interviewers to have specific communication goals to achieve through the interview process. Let’s face it, most dental practices conduct comparatively few interviews.

If you found the “perfect associate candidate,” I can guarantee you that your perfect candidate probably has multiple options. Have a plan in place. Do you have a sample contract? How will the associate be compensated? Would he or she be offered a buy-in? If you can’t answer these questions, you will lose the best candidates.

Relocation, relocation, relocation

More that 60 percent of the dentists we recruit and place relocate. Many are looking for the opportunity. Many are looking to get closer to the people or places they love. Dentists coming out of a residency or the military are nearly always located in a different city or state. When you are looking for a new associate, you probably won’t find them in your own back yard.

Whether you are a practice owner looking for a candidate or a Dentist seeking a long-term practice opportunity, the moral of the story is the same:

• Start looking far in advance.

• Work hard to find multiple options.

• Be prepared if the right opportunity or candidate comes available.

The best candidate or practice for you may be somewhere you don’t expect.

This blog originally appeared on the Dental Recruiter Blog.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Thursday, October 29, 2009

Ten Tips for Year-End Dental Tax Planning

Here I am at home today hoping I didn't pick up the swine flu bug that we think my 12 yr old is just getting over. So what can I do? Write a blog of course! I thought I'd do a follow-up from my August blog about planning, now that we're preparing for our round of year-end meetings.


Erik Parrish CPA wrote a great blog about ROTH IRA's and the planning opportunities that are just around the corner in 2010. However, just before the corner is year-end 2009 and there's plenty of time left to review where you are so far in 2009 and what you might want to do to finish out the year to position yourself in the best possible income tax "light". Here are just a few ideas that we'll be discussing with our clients prior to 12/31/09:

1. For LLC's, PLLC's and sole proprietors, is it time to elect to be taxed as an S-corp? C-corp?

2. For those w/o a practice retirement plan what options remain for 2009 and when do you need to make a decision? Will that plan still be the best option for 2010? If not, what does the client need to do as of Jan. 1st and when do we discuss a different retirement plan for 2010?

3. For those with 401k/PS plans, what are the minimum & maximum amounts you can contribute and what makes the most sense. For 2010 and the 401k portion should you do the traditional deferral or the ROTH deferral?

4. For those clients that started or purchased a practice in 2009, when do we need to decide what type of depreciation we take for 2009? Do we take as much deductions we can in 2009 or hold off and use the in future years where they may be more valuable?

5. For those considering ROTH conversions inn 2010, what can/should they do in 2009 to plan for that conversion? What about those clients I mention in #4 above?

6. For clients looking to expand soon and given the option of doing it in 2009 or 2010, which would be better?

7. Are the clients taking full advantage of all the "perks" that the practice of dentistry provides, how do those deductions "compare" with their peers?

8. How is 2009 looking compared to prior years, compared to your peers 2009 numbers? What about specific key performance indicators, how do they compare with prior years and your peers for 2009?

9. Take a look at any other issue that could impact their business income tax picture for 2009, 2010 and beyond.

10. Review their individual income tax projection for issues that may impact them in 2009, 2010 and beyond like other income, potential capital gains & losses, itemized deductions, rental or vacation properties, 2nd homes, other tax favored investments like oil/gas partnerships, annuities, etc.

Each client really is different and while there are many tax strategies that nearly all clients should consider, there are very specific strategies for each client based upon their individual situation. An example of that are children, those clients that have them may have some additional tax strategies they should consider vs. those clients without kids.

I stopped at 10, there are so many more. Every one of us should make sure we review our own situation to ensure you're paying the least amount of tax under the law this year and in future years.


This first appeared on NewDocs.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Wednesday, October 21, 2009

Dental Practice Valuation for Deceased Dentist's Family

I have a close friend that passed away last week unexpectedly. He had a heart attack at age 54 with no prior symptoms. It really was a bummer. His wife has a prospect to buy the practice. He’s a good guy and it could work out perfectly. The big question is the value of the practice.

I've heard one formula for determining "good will" is to take the annual gross average for the past three years and multiply times 40% for the value of the "good will" of the practice. Equipment, etc. is not included with this value.

Please chime in thoughts and comments. We need to get this deal "up and running" for the sake of this family ASAP.


There are many formulas and rules of thumb. However, instead of relying on the rule of thumb methods and potentially leaving a lot of value on the table, the spouse should hire someone who can assess the reasonable "range of value" without needing or having to pay for a full blown valuation report. There are many transition professionals that can provide this service, even brokers. If you decide to try a broker, simply let them know that at this time all you need is to have them assess the range of value, assuming you're pretty sure you have a buyer. If for some reason this buyer falls through, at least you've already have a relationship with a broker who may be able to find you another buyer quickly.

Good luck.


Tim,

Could you do the valuation from the P&L and balance sheet, without seeing the practice?

Yes, I can determine a "range of value" from good financial information. It’s what I do for our buyer representation clients. I’ve never stepped foot in the office of most of my buyer representative clients, what do I know about the working condition of the equipment? I’m not an equipment vendor or specialist.

This post first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Friday, October 16, 2009

Dental Commercial Property and and S-Corp Election

This is our one hundredth post. Nice milestone.

I have heard it said that the best way to go about owning a building and practice is to have the building set up as an LLC and the practice as an S-Corp, with the LLC renting out the building to your S-Corp practice.

Assuming this model is followed, would the following be legal:


Let’s say you own a building with enough space to house multiple businesses. You start off with your practice set up in one area/wing/whatever of the building and rent out the rest of it. Perhaps you plan to use the extra space in the future for expansion, but that really is not important. Commercial real estate hits a rough patch and your LLC comes dangerously close to failure. Your dental practice is still rather successful. Would it be legal to "renegotiate" and jack up the rental rate on your dental practice so as to help your commercial property LLC get through the tough times? The basic question here is whether or not it is legal to essentially use the rate charged to your practice to mediate the bumps felt by your commercial property. (I suppose the reverse of this situation is possible as well, with you lowering the rate charged to a struggling practice by your successful commercial real estate... but this situation seems unlikely at best)


Or you could simply use the S-Corp profits and lend them to the LLC to keep it afloat. Assuming you're the sole owner of each both flow through to your ind. tax return so the net tax benefit will be the same.


Remember, the S-Corp needs to act in a prudent business fashion. If it's already paying "fair market" rent and you didn't own the LLC and the landlord asked you to renegotiate the lease to pay more rent, would you still do it? The answer is no.

Don't make it more complicated that it needs to be.

And our good friend, Jason Wood, the Dental Lawyer adds:
 
The only thing I will add to this excellent answer is a real world experience as to why it should be done this way as opposed to renegotiating the rent and putting it in writing.


A client that contacted us after-the-fact had entered into an "above average rent" with his dental practice for the building that he owned. Because it was a part of the lease there was a paper trail. When he lost the building as a result of the economy we are in, the bank "relied" on the above market rental rate outlined in the lease to force the dentist to continue paying the above market rent.

In other words, don't renegotiate your rent, do what Tim suggests instead. Lend the LLC money personally so that if you lose the building it isn't attached to your separate entity.

This first appeared on Dentaltown.

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Wednesday, October 14, 2009

Is Dentist Truly Being Paid on Production?

Can you tell me where I can find legal definitions of "production" and "collections" as they relate to dentistry?



I've just started working for a group practice. I have a contract (as an independent contractor) that states that I will be paid "30 percent of the production resulting from dental services provided by" me according to their standard fee schedule. I was happy with that until I discovered that they are trying to call their collections "production" and compensate me accordingly. (The word collections is not mentioned anywhere in my contract.)


Some of the things they are claiming according to this nomenclature are that when they run a promotion for a free exam (etc), since they are charging nothing, it doesn't count as "production" and I get paid nothing. If they discount a fee, it discounts what I get paid. They also said that if a patient defaults on their payment, that it retroactively counts against my "production" and is backed out of my pay. (Of course, since I'm not an owner, I have no say what promotions get run, or when.)


Naturally, I'm contesting all this, since it would basically give them carte blanche to not pay me for whatever they decide not to charge for. In school, production was always defined as "the procedures you perform" and collections as "what the patient/insurance actually pays." Is this incorrect? Can anyone help me find official definitions of these terms? I'm really hoping I don't have to involve an attorney.


Thanks!

 
First, different people use the term “production” very loosely. While one might expect it to mean the number based upon the practices fee schedule, many people simply use it to fit their needs. You’ve learned a very valuable lesson, which is (and this is for every associate and owner dentist):


Make sure you define these terms in your agreement. As an associate, if you get a contract that says you'll get 30% of production, insist that a definition be inserted that your dental attorney is comfortable with. The same goes for many other terms thrown around in agreements, compensation, professional expenses, full time and part time, just to name a few. Use examples if you must so it's very clear.

Check with the ADA as to their definitions. They put statistical information out there and they must have "standard" definitions for these terms.

Good luck. You’re right to contest this.

This first appeared on Dentaltown.

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Can Dentist Carry Losses Back to Prior Years?

Two questions:



1. Do I have to pay taxes for purchases made over the Internet from other states?  I thought I have heard many times that congress intentionally set a law that inhibits taxes for these purchases to encourage the growth of the Internet.  Has that ended? Was it for non-business purchases only?


2. Started up this year from scratch, so I have tons of write-offs and not a lot of income.  I think I remember hearing somewhere that you can go back to the previous year and get some refunds off that return since this year was so bad.  That doesn't seem right though, am I remembering that incorrectly? 
 
You're allowed to carry back certain losses to previous years, so you heard correctly. What you need to determine is whether or not it's best to carry back those losses if they exist, or carry them forward by not taking as many deductions this year to create a loss.
 
This first appeared on Dentaltown.

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Monday, October 5, 2009

What Happens When A Dentist Renovates Their Office Now?

Our friends at Dental Office Designers have sent us another article about the advantages of renovating your office now. Click here to view the article.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Friday, October 2, 2009

Dentist Has Questions About Creating Associate Agreement

I am in serious discussions for the first time in my life with a new dentist who wants to move to the small town I practice in, and work with me. Thank God, as I am and have been swamped for years. He is willing to come on a trial basis, and bring his family. My practice is in a town getting ready to grow dramatically, and is very technologically advanced, so I will have alot to teach him, which is, frankly, probably one of the reasons he wants to come.

I like him and I think this could work but I have absolutely NO experience in this. I know we need a written agreement but I have no idea what is fair to him, how compensation should be structured and how a buy in should be managed....input would be appreciated so I can start this process fairly for both of us.


Thanks
 
You should consider hiring someone that helps owners with associates and buy-ins to help you though the process, not to mention a dental specific attorney for the contracts. some steps to consider:


1. In addition to the base compensation, what professional expenses will you pay, which professional expenses will you expect them to pay?

2. Who pays for health insurance? The malpractice? If it is split, how?

3. If you have a retiremet plan, how will that impact your cost of the associate?

4. How many days initially do you went them to work? What hours? Any specific days? What happens as they get busier?

5. How "new" is the dentist? Do they have any track record on their production ability? If so, estimate that based upon a daily production figure and estimate what that means to your practice in terms of collections.

6. How will it impact your hygiene department? Maybe it won't.

7. Will you be ok cutting back your schedule? How much ?

8. Do some cash flow projections to see how it will impact you. Prepare a best case & worst case scenario. Consider the additional costs: assistants, front desk, supplies, lab, etc...

9. If buy-in is to be considered, what will be the valuation date? Should there be some increase in that price for normal growth NOT associated with the new doctor?

10. What type of entity are you now & should you consider alternatives based upon another doctor in the practice with a potential buy-in?
I figure these 1st 10 steps will keep you busy for now. The first several steps can be the basis for a letter of understanding that you & the associate should agree to. This will be given to your attorney for the employment agreement.
 
This first appeared on Dentaltown.

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Tuesday, September 29, 2009

Which Dental Associate Collections vs. Lab Fees Scenario is Best?

With all else being equal, what is the better deal for an associate?

A. 30% of collections, no lab fees
B. 33% of collections, 33% of lab fees

In other words, how much (in terms of a %) does no lab fees make a difference? I understand that alot depends on how much you send to the lab, but looking for a ballpark range.


You do need to assume what the typical lab cost is as a % of revenue. If it typically runs 5-8% in a GD practice lets assume 7% as a nice round #. Now we also know the typical GD practice generates 75% of its revenue from dentistry (not hygiene), so lets take a million dollar practice, where $750k is from dentistry. Lab expense would be $70k (7% of $1mill), so 70/750=9.33%.


Now, lets assume you make 30% of collections which are $100,000, you'd make $30,000.


33% of collections is $33,000, however, 33% of your lab (9,330 x 33%)= $3080 and 33,000-3080 = $29,920.


So 30% of collections is better.... in this case - assuming 9.33% lab expense.

How much lab related work will you be doing?

The less lab the more the 33% less 33% lab looks better.


BTW, some also do 100,000-9330=90670x33% = 29,921. Same result, different path, that's all.

This first appeared on Dentaltown.

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Monday, September 21, 2009

Paying a Dental Associate as a W-2 and as a 1099?

The issue of employee vs. IC has always been a highly debated topic, especially in the dental world.


While the debates almost always revolve around associate dentists, owners should also know that the issue can also arise with other IC's they pay.

For example, I got a call yesterday from a client where one of his assistants wants to make more money and offered to clean the office after hours instead of having him pay the cleaning company.

So the question is, when doing the cleaning would this person be an employee or an IC? It'll depend on the circumstances surrounding this specific situation and the person/company (hint, hint) doing the cleaning.

Anyway, below is a link to some recent material from the IRS concerning the issue, which is what prompted this blog.

Enjoy!

IRS Regulations About W-2 vs 1099


This first appeared on NewDocs.

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