How I KISS My IRA [A Prudent Checklist]

Simplified Retirement Thoughts for Physicians in 2011

By Dr. David Edward Marcinko MBA CMP™

www.CertifiedMedicalPlanner.com

[Publisher-in-Chief]

As a reformed certified financial planner and stockbroker, and current CMP™ professional charter holder for more than a decade, I am always amazed at how complex and convoluted some medical colleages and other folks make IRAs and their retirement planning.

So, please allow me to offer this brief checklist of advice on how to KISS your IRA in 2011!

What to have in an IRA?

Assets that are expected to generate the greatest relative pretax returns, such as:

  • fixed-income investments expected to yield high returns
  • stocks with high dividend yields
  • stocks expected to be held short term
  • mutual funds that emphasize stocks paying high dividends
  • mutual funds that expect to hold stocks short term.

What not to have:

  • collectibles (e.g., art objects, antiques, and stamps)
  • tax-free, tax-deferred, or tax-sheltered vehicles (e.g., municipal bonds, Series EE U.S. savings bonds, or variable annuities)
  • investments in individual foreign securities or mutual funds that hold primarily foreign securities.

Activities to avoid:

  • borrowing from the account
  • creating unrelated business taxable income, which may result from ownership of an interest in a partnership or S corporation or from purchasing securities on margin or borrowing to acquire real estate.

Assessment

So, what’s in your IRA, doctor? Do you have a Keep It Simple and Sane [KISS] checklist? 

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Do you KISS your IRA like me? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Doctors – Are You Preparing for Retirement [A Voting Opinion Poll]?

ME-P Voting Poll with Survey

By Dr. David Edward Marcinko FACFAS,  MBA, CMP™

[Publisher-in-Chief]

www.CertifiedMedicalPlanner.com

As a physician-focused financial advisor, I know that for those medical professionals between the ages of 45 to 54, the thought of retirement should be popping up a few times these days.

And, for doctors between ages 55 and 64, the thought may be taking on urgent tones about now!

In fact, many of us are reconciling to the idea that it may be a fact that we have to either postpone our retirements or live a much simpler life during retirement. Whatever the thoughts may be, what’s driving them is our preparedness to retire.

And so, we’d appreciate your vote and comments, too!

Disclaimer: I am a reformed Certified Financial Planner®, Series 7 [stock-broker], 63 and 65 license holder, and RIA representative who also held all applicable insurance and security licenses.

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The ME-P Recommends: Financial Planning and Risk Management Handbooks

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On Medical Practice [Business] Succession Planning

A Process of Financial Steps

By Dr. David Edward Marcinko, MBA CMP™

[Editor-in-Chief]

http://www.CertifiedMedicalPlanner.org

Succession planning is a dynamic process requiring current ownership and management to plan the medical practice or company’s future, and then implement the resulting plan. As a financial planner and advisor myself, I see many doctors and clients approach business [practice] succession planning initially through retirement planning. Once they understand the issues and realities of the tax laws, they are much more amenable to working out a viable succession plan. Many doctors and other clients have not clearly articulated their goals, but have many pieces of the plan that need to be organized and analyzed by the financial planner to meet their objectives, including both personal and financial issues.

A Step-Wise Process

The steps necessary for successful succession planning are as follows:

• Gathering and analyzing data and personal information

• Contacting the doctor [client’s] other advisors

• Valuing the medical practice or business

• Projecting estate and transfer taxes

• Presenting liquidity needs

• Gathering additional corporate information

• Identifying dispositive and financial goals

• Analyzing the needs and desires of nonfamily key employees

• Identifying potential ownership, physician-executive and/or management successors

• Making recommendations, modifying goals, and providing methodologies

• Assisting the doctor-client in implementation

Gathering and Analyzing Data and Personal Information

The first step in data collection is talking to the doctor or client, and explaining the process of gathering data. Most successful financial planners use a questionnaire to be sure to address all important information. The planner should gain an understanding of the interrelationships between the practice, family and the business and address each of these areas as separate parts of the same equation. Finding out how the practice or business operates and why it operates that way can help the planner determine whether change is necessary and how to go about implementing it. Other important elements to address include the environment in which the practice [business] operates, potential flaws in the current structure and operations, appropriate levels of key-person life insurance coverage, investment asset diversification, prior estate planning efforts, and existing legal contracts that may need modification.

A Timely Process

It may take some time, from weeks to months, for the client to gather the required information. The planner should be encouraging and should periodically check on the doctor-client’s progress. If it appears that the client may not be motivated to complete the questionnaires independently, the planner should schedule an appointment to help the doctor-client finish. The client may create obstacles because he or she does not want to talk about death or relinquish control of the practice or business. These are delicate topics, and the financial planner cannot force the client to face them. Still, the consequences of not carrying out personal financial and estate planning can be explained.

Understanding the Practice or Business

To be most helpful to the doctor-client, the financial planner must understand the client’s medical practice or business. Reviewing the history of the company, getting acquainted with its current operations, and becoming familiar with the industry is important. By reviewing financial statements, income tax returns, business plans, and all pertinent legal documents, the planner will be able to identify key areas to focus on during the engagement. Understanding the patient or customer base of the business is also important. For example, exploring the impact of the principal’s death on the patient [customer] base helps the financial planner understand what changes could occur in the business after the physician-owner’s death.

Fair Market Valuation

Next, the planner must translate the balance sheet to current fair market values and analyze the debt, capital structure, and cash flows. A review of accounts receivable, inventory, and any fixed assets should be included to determine whether there is sufficient collateral for a leveraged buy-out or other estate planning technique for succession planning. Also, the cash flow should be reviewed to see if new fixed payments such as debt repayments or dividend distributions could be made.

Contacting the Doctor-Client’s Other Advisors

After gathering the documents, it’s a good idea for the planner to contact the client’s attorney, accountant or tax advisor, bank or trust officer, insurance advisor, investment advisor, stockbroker, and other business advisors. As many key advisers as possible should be contacted early in the engagement to create a spirit of cooperation. A planner will benefit by creating team harmony and establishing himself or herself as the team leader. Additionally, a planner could be engaged by these professionals in the future, and a planner is a valuable source of referrals.

Valuing the Medical practice of Business

The next step in the succession planning process is computing the value of the practice or business. It may surprise the planner to hear what the doctor or client perceives as the value of the [practice] business at the beginning of the engagement. Likewise, the client may be surprised to hear what value could be placed on the business for estate tax purposes. The goal in valuation is determining the price at which the business would change hands between a willing buyer and a willing seller, assuming:

• The buyer is not under any compulsion to buy.

• The seller is not under any compulsion to sell.

• Both parties have reasonable knowledge of the relevant facts.

Revenue Ruling 59-60 (1959-1, CB 237

The IRS issued Revenue Ruling 59-60 (1959-1, CB 237), which lists several factors to be used in valuing a business:

• Nature and history of the practice or business

• Economic outlook and condition of the healthcare industry

• Book value and financial condition of the practice or business

• Earning capacity of the practice or business

• Dividend-paying capacity of the practice or business

• Value of any goodwill or other intangibles

• Value of similar stocks traded on open markets

• Degree of control represented by the size of the block of stock interest

Highest and Best Use

The IRS computes a value based on the “highest and best use” of the practice or business. This means that the business will be valued by the IRS at the highest possible value that can be reasonably justified. Valuation methods include the asset approach, income approaches, and market approach.

• Asset approach:  This is primarily used for a business that is worth more if it is sold in pieces rather than as a whole. The tangible asset value is added to the intangible goodwill value.

• Income approaches:  A business as a going concern has value in its ability to produce profits in the future. These profits represent a return on the investment. The value of the business is a function of expected profits and desired rate of return.

— Discounted future earnings method:  Projected future earnings are discounted to present value.

— Discounted cash flow method:  Cash that the owner can withdraw from the business is discounted to present value.

— Capitalization of earnings method: Expected earnings are divided by the capitalization rate.

— Capitalization of excess earnings method.  Expected earnings that are not needed in the business are divided by the capitalization rate.

• Market approach: A business is worth what similar businesses sell for. Referred to as the comparable method of business valuation, this method should be used only when the comparable business is truly comparable.

Each of these primary methods has numerous variations that may provide a more desirable or justifiable value.

Assessment

When reviewing potentially taxable estates, the planner should analyze the opportunity to use favorable valuation discounts for loss of a key employee, lack of marketability, or possibly a minority discount for lack of control. Alternatively, planning recommendations can be made to avoid exposure to valuation premiums for control. The physician-owner may avail himself or herself of many of these discounts by reducing holdings to less than 50% prior to death.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Financial Planning and Risk Management Handbooks from iMBA, Inc

For Doctors and their Financial Advisors

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Conclusion

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Mental and Physical Well-Being for [Physician] Boomers and Their Retirement Plans

By Somnath Basu PhD MBA

President – AgeBander
Thousand Oaks, CA

A  Pew Research Center study[1] on the effects of financial stress on health finds 42.4% of respondents in a survey on the subject indicated that their health had been affect by financial problems. The study also found that 1 in 8 baby boomers were raising children, planning for retirement and at the same time caring for their elderly parents. This is the unfortunate reality for many baby boomers who face the implications of being a sandwich generation.

The Boomer Spectrum

For boomers across the spectrum of age (1945-64) financial stress has also contributed significantly to relational strife and has exacerbated many medical conditions. It has been linked to depression and sleep disorders and has been known to negatively affect the autoimmune and digestive system. For retirees who find themselves on a limited income with few options for augmenting that income the additional stress of financial problems has certainly  been detrimental to their mental, emotional and physical well being.  For such retirees who had an improper perception of their retirement needs the realization of the truth is definitely overwhelming. For others, who had thought they had planned ahead and were diligent, are now wrestling with guilt and remorse over their failure to provide for their retirement years. These individuals too are likely also facing fairly severe mental health conditions related to retirement security. Additionally these retirees will likely look back on the sacrifices they did make and feel these were in vain further exacerbating the state of their mental health. This in turn leads them also to resist reasonable advice because their fears make them more suspecting of any advice including the reasonable ones.

The Emotional Culprits

Two of the chief culprits have been the tendency of boomers (as a solace, all other generations suffer from these same problems though boomers have been most affected) to overestimate and have overconfidence about their financial knowledge and understanding of key financial concepts. Their lack of knowledge about overestimating themselves and being overconfident about their understanding of key financial concepts has proved to be detrimental to many a boomer’s health and well being in retirement. This is mainly due to these weaknesses leading them to not having enough funds for their retirement expense needs. A national collaborative strategy initiative on this problem has identified five action areas needed to help alleviate this problem – the need to educate consumers on the areas of financial policy, education, practice, research, and coordination. The reality is that when retirees are affected mentally, physically and emotionally (leading to overconfidence and over optimism), their financial decisions become faulty due to acting on their perceptions of retirement risk. This makes them tend to drastically under-estimate their retirement expenses. In such cases they experience or will experience significant reductions in their quality of retirement life. To ensure that expectations of retired life are realistic and risk perceptions are aligned to realistic and achievable goals are the first steps for boomers to ascend in order to improve the quality of their overall mental and physical health in retirement.

Objective Retirement Planning

An objective of planning for retirement thus becomes the need to find some kinds of lifelong guaranteed pensions since it is well known and understood that retirees who have such luxuries are many times more satisfied in retirement than their peers. The more satisfied in retirement the better mental and financial well-being one has. The main thrust in achieving such a mental state is to understand the importance of a secure and assured income that arrives in the bank consistently every period (such as monthly or bi-weekly).  

Perception too plays a big role in mental health as does the security of regular income. However, those receiving Social Security as their regular income are known to be less satisfied than others. Studies show that Social Security benefits carry a “hand-out stigma” for those who rely on them for their well being. From the boomers perspective, living a simpler life but funding retirement from a disciplined pension fund approach (using 401(k) funds, IRAs, personal financial portfolios, etc.) ensures the chances that their mental and physical well-being in retirement will not be reduced in any way by their financial well-being. Now is the time for boomers to exact such a lifestyle and bring in a certain semblance of stability in the vision for the rest of their lives.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What are your retirement plans and how does this essay impact on them; if at all? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Notes: [1] http://personalfinancefoundation.org/research/efd/Negative-Health-Effects-of-Financial-Stress.pdf

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Creditor and Asset Protection Strategies for Medical and Other Professionals

IRAs, Education IRA [Coverdell Accounts], 529 Plans, Qualified and Non-Qualified Annuities and Insurance – in the State of Ohio

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By Edwin P. Morrow III, J.D., LL.M., MBA, CFP®, RFC®
Wealth Specialist – Manager, Wealth Strategies Communications
Ohio State Bar Association Certified Specialist, Estate Planning, Probate and Trust Law – Key Private Bank – Wealth Advisory Services
10 W. Second St.
MailCode OH-18-00-2701
Dayton, OH 45402
(937) 285-5343 direct phone
(937) 422-8330 cell phone

Hi Ann and All ME-P Readers

Would you be interested in posting this article on creditor and asset protection and planning for retirement accounts and similar? It is highly useful for physicians and other professionals

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Assessment

Link: Creditor Protection for IRAs Annuities Insurance August 2010 NBI CLE[1]

Conclusion

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Using Charitable Gifts in Business Planning

The “S” Corporation

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By The Children’s Home Society of Florida Foundation

The most common type of corporation is a traditional “C” corporation. All companies whose stock is publicly traded are C corporations. C corporations pay tax on net income at the corporate level. When that income is distributed to shareholders in the form of dividends, the shareholders also pay tax. The result is that C corporation income is taxed twice – once at the corporate level and once at the shareholder level.

“S” Election

“S” corporations resemble C corporations except that they elect to be taxed differently. Not all corporations are eligible to make this election. To make the election, a corporation must have only one class of stock and less than 75 shareholders who are all individuals, estates and certain types of trusts and charities. IRC Sec. 1361. Charitable remainder trusts are not permissible holders of Subchapter S stock.

“Pass-Through” Taxation

An S corporation does not pay tax at the corporate level. Instead, the shareholders of an S corporation must include their share of the S corporation’s income, deductions and credits on the shareholder’s personal tax return – even if that income isn’t actually distributed. This is called “pass-through” taxation because the S corporation “passes” its income, deductions and credits “through” to its shareholders.

Inside and Outside Basis

The concept of tax basis appears regularly in the context of charitable giving. A person’s tax basis in an asset is generally equal to his or her investment in that asset. Often, tax basis is the amount a person paid for an asset (i.e. the asset’s “cost” to the owner). When the fair market value of an asset is more than its tax basis, the asset is appreciated and, if sold, will result in taxable gain to the owner. Charitable giving often allows the owner of an appreciated asset to bypass gain or defer part of the gain.

When working with S corporations, the concept of basis can be confusing. This is because there are two types of basis at issue. The first is the S corporation’s basis in its assets — this is often referred to as inside basis. The second is the shareholder’s basis in his or her S corporation stock – this is often referred to as outside basis.

When a shareholder sells his S corporation stock, the gain or loss on the sale is determined by the difference between the sale price and the outside basis. In the same way, when an S corporation disposes of an asset, the gain or loss to the S corporation is determined by the difference between the sale price and the S corporation’s inside basis in the asset.

 

Gifts of S Corporation Stock – Issues Relating to the Donor

Certain tax-exempt organizations are permissible shareholders of Subchapter S stock. Sec. 1361(c)(6). Therefore, an owner of S corporation stock can make a gift of the stock to a charitable organization and receive an income tax deduction. There are a few issues the donor needs to be aware of, however, before making a gift of Sub S stock to charity.

First, the donor’s ability to use the charitable deduction from the gift of the Sub S stock will be limited to the donor’s cost basis in his or her S corporation stock. Sec. 1366(d)(1) limits the amount of deductions and losses to the donor’s basis in stock and debt of the Sub S corporation. Often the donor of Sub S stock is also the person who established the business. Generally, the business was started with very little capital. Because of this, it is likely that the donor’s cost basis will be very low. If the donor’s basis in his or her stock is very low, the donor will only have a small charitable deduction.

The second issue for the donor to be aware of is minority discount. Generally, when a donor makes a gift of stock, the amount transferred to the charity represents a minority interest in the corporation. When a minority interest is given, it is very likely that the qualified appraiser will apply a discount to the value of the stock.

Finally, the donor of S corporation stock must be aware that there cannot be a binding agreement with the charity to repurchase the stock. If there is a binding agreement, the donor will have to recognize the income from the redemption of the stock and will not receive the benefit of a bypass of capital gain. Because S corporations are closely-held entities, there generally is not a large market for the sale of the stock. Therefore, it is very likely that the corporation will repurchase the stock. The repurchase is permissible, but a binding agreement before the gift is prohibited. Rev. Rul. 78-197.

Gifts of S Corporation Stock – Issues Relating to the Charity

While it is allowable for a charity to own Subchapter S stock, the tax benefits are not as advantageous as the ownership of C corporation stock. With C corporation stock, the charity is not taxable on any stock dividends, nor is it taxable on the gain when it sells the stock. This is not true with S corporation stock. Any income received by the charity for its ownership of Sub S stock is taxable to the charity as unrelated business taxable income. Sec. 512(e). In addition, when the charity sells the stock the gain from the sale is also taxable to the charity as unrelated business taxable income. Sec. 512(e)(1)(B)(ii). Because a charity is often established as a corporation itself, the tax on the gain will be taxed at corporate income tax rates. (corporations do not have a lower, favorable capital gains rate like individual taxpayers).

It is also important for a charity not to enter into a binding agreement with the donor for the sale of the stock. While there are no adverse tax consequences to the charity if such an agreement is made, there are adverse tax consequences to the donor as discussed above. If the charity is aware of the unfavorable tax consequences to the donor from having a binding agreement, it can prevent having an unhappy donor.

The S Corporation Unitrust

A charitable remainder unitrust or CRUT is not a permissible owner of Subchapter S stock. Therefore, if an S corporation shareholder were to transfer even one share of his or her S stock into a CRT, the S corporation election would be terminated and the corporation would become a C corporation the day after the transfer. This would mean that the corporation would be subject to two layers of tax: one at the corporate level and one at the shareholder level.

It is permissible, however, for the S corporation itself to establish a CRUT. Because the S corporation does not have a life expectancy, the CRUT must be established for a term of years not to exceed 20. The S corporation would fund the CRUT with some of its assets. However, it must be careful not to fund the CRUT with substantially all of its assets as discussed below. Because the S corporation is funding the CRUT, it would receive the charitable deduction and also would be the income beneficiary of the CRUT.

Even though the S corporation is entitled to the income tax deduction, because of its pass-through taxation the charitable deduction will flow through to the S corporation shareholders. As mentioned above, however, the deduction to the shareholders will be limited to the shareholders’ cost basis in their Sub S stock.

Potential Reg. 1.337(d)-4 Gain Recognition

When a corporation is liquidated, there is potential tax payable at the corporate level. If it were permissible for a corporation to distribute all of its assets to charity or to a charitable trust, then this tax could be avoided. In order to limit this type of transaction, Reg. 1.337(d)-4 requires recognition of gain at the corporate level if “substantially all” the assets are given to charity or to a charitable remainder trust.

Even though an S corporation is not subject to tax like a C corporation, if an S corporation liquidates the corporation must recognize gain as if the assets were sold. The S corporation does not pay taxes on the gain, but the gain passes through to the shareholders who must report the taxable gain.

The phrase “substantially all” is not defined in Sec. 337(b)(2) or in Reg. 1.337(d)-4. However, there are several other places in the Code in which the phrase “substantially all” is interpreted to mean 85%. Reg. 1.514(b)-1(b)(1)(ii). Reg. 53.4942(b)-1(c). Reg. 53.4946-1(b)(2). Reg. 1.401(k)-1(d)(1)(ii). While these regulations cover a variety of tax issues, it is significant that they uniformly interpret the phrase “substantially all” to mean 85%.

Since the exception under Sec. 337 refers to “an 80%” subsidiary, some counsel have also expressed the belief that “substantially all” could be interpreted to be 80%. Regardless, it is apparent that a transfer of perhaps 65% of assets to charity or to a charitable trust would be permissible under Sec. 337(b)(2). Cautious counsel would be prudent in remaining at or below that level with transfers to charity.

Financial Planning Strategies

While the use of a CRT is more limited with an S corporation then with a C corporation, there is still the possibility of utilizing a CRT when selling a business. For example, Tom and Suzie started a business years ago creating designer clothing for dogs. Tom and Suzie liked the idea of have a corporation to protect them from potential liabilities, but they did not like the idea of the double tax system. Therefore, they established their business as an S corporation. Tom and Suzie are the sole shareholders and are now planning to retire. Over the years they have supported a number of charities that assist in the prevention of cruelty to animals. Tom and Suzie are hoping to use some of the money they receive from the sale of the business to continue to support such charities.

Recently Tom and Suzie have had a number of inquires for the sale of their business. It seems that designer clothing and accessories for dogs has become a booming business. Tom and Suzie met with the gift planner from their favorite charity and like the idea of a CRUT that would pay them an income stream over their two lives. However, they discovered that because they have an S corporation they cannot transfer the stock to a CRT without losing their S election status. Tom and Suzie do not want to convert their business to a C corporation. Tom and Suzie can, however, have the S corporation use some of its assets to fund a CRUT that would pay for 20 years. However, they must take steps to ensure that the CRT is not disqualified.

First, Tom and Suzie have to carefully choose which assets the S corporation will use to fund the CRUT. The value of those assets cannot be substantially all of the value of the corporation. Further, they have to ensure that there is not any unrelated business taxable income while the assets are in the CRUT. Even $1 of unrelated business taxable income will disqualify the tax-exempt status of the CRUT. If Tom and Suzie decide to use any of the corporation’s equipment or inventory, the deduction of the CRUT will be limited to the corporation’s cost basis in those assets, which is very low. The S corporation does own the building and land on which it operates and the value of the land and building represents about 50% of the S corporation assets.

To make sure that the CRUT will work, Tom and Suzie enter into lease agreements with two of their key employees. Under the first lease, the employees will lease the operating assets of the S corporation. Under the second lease, the two employees will lease the building and land. Both leases are fixed payment leases. By establishing the leases, the S corporation can transfer some of its assets into the CRUT and avoid the unrelated business income tax problem.
Once the leases are established, the S corporation will transfer title of the real estate to the CRUT. To avoid potential self-dealing issues, Tom and Suzie decide to select their local bank to serve as trustee of the CRUT. Once the land is transferred to the CRUT, the trustee, along with Tom and Suzie, will negotiate for the sale of the assets and the land and building. After the sale is completed, the CRUT will receive the proceeds from the sale of the real estate and the S corporation will receive the proceeds from the sale of the operating assets.

The sale of the operating assets will trigger gain for the S corporation that will flow through to Tom and Suzie as the shareholders. It is important for Tom and Suzie to leave this cash in the S corporation. This is because the gain from the sale will increase Tom and Suzie’s cost basis in their S corporation stock. The increase in the cost basis will allow them to use more of the charitable deduction that will flow through to them from the S corporation. Over the years, the S corporation unitrust will make payments to the S corporation. So long as the S corporation was not a prior C corporation, the passive income from the CRUT will not pose any problems for the S corporation.

Tom and Suzie are very happy with the sale of their business and that they are able to provide a very nice gift to their favorite charity. They are also very happy that they now get to take a long needed vacation.

Assessment

There are a number of charitable strategies that can be used when selling a business. Tom and Suzie could have established a charitable gift annuity with their Sub S stock. They also could have used a gift and sale strategy. There are other options available to Tom and Suzie if they chose not to keep the S corporation alive for the 20 year term of the trust. This article is the first in a series that will explore the options of using businesses and business assets to fund charitable gifts. Throughout this series, planning options with C corporations, S corporations, partnerships, LLCs and sole proprietorships will be discussed.

Conclusion

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To Save or To Spend?

Understanding the Decision

By Somnath Basu PhD, MBA

Should we save or spend? What’s good for me and my family? Is the time right for us to be buoyant and optimistic about the future? How do we decide what fraction of our income to spend and how much to save? Isn’t spending a good thing for the economy as we are constantly being reminded about? If we do not spend now, how are we going to feel about all these unfulfilled wants and needs that we have especially when we see others around us fulfilling? How much should I spend for gifts during this holiday season – is that not a good idea to bring cheer to my family? It is a very perplexing set of questions that constantly sway our mind as we try to grapple with what we feel should otherwise be moderately simple decisions. In arriving at these seemingly easy decisions, consumers are facing some of the toughest issues in their everyday lives. It may be useful to dig a bit deeper into the issues related to spending and saving decisions so that we may understand a bit of their complexities and make prudent choices whose outcomes will clearly validate our reasons for doing so.

The Save or Spend Decision

If the decision to save or spend is problematic, it is because it is neither simple nor anything new. We have coped with these same decisions through many generations, and more. The understanding we have collectively arrived at is, however, worth visiting. When we spend, we receive immediate gratification. This “feel good” feeling is so good that we are willing to sacrifice a lot in order to attain this feeling. Saving, on the other hand, is bereft of any such immediate good feeling. The only good feeling that can accrue to us is that we have this “felt’ promise to ourselves that a moment in the future will feel better than both the loss of satisfaction from immediate gratification of wants and the hurt of having unsatisfied wants. Alternately, we may want to save because we feel threatened that a future situation may arise that may lead to more misery tomorrow than the joy gained today. Thus, the main question in trying to answer whether to save or not is whether it is a promise or a foreboding about the future.

Attitudinal Sea Change

Over the last 25 years, our attitude towards spending has undergone a sea change. Even until the early 1980s we were saving in double digits as a nation. Since then, we have slowly moved away from this psyche and have adapted our lifestyles towards spending and consumption on a scale we have never experienced before, historically. By 2006, we were actually spending about one percent more than what we were earning. This change was stimulated by many factors including the plentiful inflow of cheap products from China, a steady rise in income, a considerable increase in the promotion of mass consumption through enticing advertisements in practically all media, the access to cheap credit sources, increasing house prices and the accompanying ability to borrow from the increase in its equity value, etc. Above all else, this shift from saving to spending was overwhelmingly reinforced by the feeling of empowerment in being able to command goods and services for consumption and the enjoyment from the increase in our standards of living that came from our new found affluence. Whereas every generation before us (baby boomers) had sought to leave more for their kids than what they themselves inherited, we reasoned with ourselves that educating our children was sufficient for them to look after themselves. This attitude allowed us also to spend and consume more not only without guilt, but also with pleasure. More so than ever, we got addicted to spending. Nothing felt better than spending.

The Flash Crash of 2008-09

Then came the great recession of 2008-09! The economy plunged, companies laid off workers by the thousands, people who had bought homes even if they could not afford it, on the promise that house prices would never go down, lost their homes. Moreover, the cheap Chinese goods we got used to were being produced by our own national companies so that the economic rebound was now being hailed as a jobless recovery. We had outsourced away all we had for some corporate bottom line and had impoverished ourselves in the process. Only now, we had no savings for the rainy day that had befallen us.

Americans Saving Again

Perhaps one of the more pleasant surprises from this recession is that we turned the clock around on saving and in the short span of two or three years we have our savings level back at five percent. Why did it happen this way in spite of our government encouraging us to spend our way out of this recession? Primarily, this change has come about from the possibility of losing our jobs or enduring deep cuts in our incomes. This fear today is more real than ever before and it seems to have taught us a “savings” lesson that we have all learned. When deciding on whether and how much to spend, we should take absolutely no chances in first putting away a small nest egg for a rainy day or “emergency” fund, in more technical terms. It is imperative that we defend our families in the event of losses in job and income so that we can bear out whatever future storms come by our way. It is only after we have done so should we consider spending. A six-month contingency fund [even more for medical professionals, according to ME-P Editor Dr. David E. Marcinko] should be perhaps the most staple item in our household budget. It is heartening to see the resiliency that runs through our nation’s citizens as we collectively undo our habit of reckless spending.

Assessment

Once we have our emergency nest egg in place, we should consider our spending pleasure. Going “cold turkey” on spending is not advisable either; maybe a gradual weaning away from this compelling habit. Ask yourselves before you spend whether it is a “need” or a “want”. Healthy food and holiday cheer for the family, basic transportation expenses and healthcare are needs. Starbucks coffee is a want. As we prudently spend on needs and wean away from wants we also save. And saving is not only for our future “feel good” consumption. It is also for the immensely gratifying feeling that we will leave something for our children, through whom we will live in the future.

NOTE: Dr. Somnath Basu is a Professor of Finance at California Lutheran University and the Director of its California Institute of Finance. He is also the creator of the innovative AgeBander technology www.agebander.com for planning retirement needs.

Conclusion

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Common Physician Retirement Plan Payout Methods

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Targeting Portfolios and Medical Endowment Funds

[By Staff Reporters]

According to Wayne Firebaugh CPA, CFP® CMP™ recognizing the risk that market volatility represents to long-term portfolio portfolios or medical endowments utilize a variety of methods to calculate periodic payouts. These include the following:

  • Investment Yield: A portfolio/endowment using this method spends only its dividends and interest and re-invests any unrealized and realized gains. There would appear to be two primary disadvantages of this method. First, the payout amount will be extremely volatile as yields on equity and fixed income investments fluctuate. Second, the endowment manager could be encouraged to adopt a short-term focus on yield to the detriment of purchasing power preservation.
  • Percentage of the Prior Year’s Ending Market Value: An endowment/portfolio using this method would withdraw some fixed percentage of the prior year’s market value. As with the Investment Yield method, disbursements from the endowment can be somewhat volatile under this method.
  • Moving Average: This approach, which is most common among educational institutions, generally involves taking a percentage of a moving average of the endowment market value. The percentage commonly approximates 5% over a 3-year period.
  • Inflation Adjusted: This method simply adds some factor to the applicable rate of inflation for the institution/portfolio.
  • Banded Inflation or Corridor: This method is similar to the Inflation Adjusted method except that it establishes a corridor or band of minimum and maximum increases in an attempt to limit the volatility of disbursement amounts for the portfolio/endowment.

Mature Woman

Assessment

How does the above compare to the typical 4% withdrawal rate suggested by many FAs today … too much or too little?

Does a private MD “spend-down” or “conserve” principle like an endowment fund make sense?

Conclusion

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Understanding the Tactical Approach to Medical Endowment Fund Management

Guiding Long-Term Investment Decisions

By Staff Reporters

www.HealthcareFinancials.com

According to Wayne Firebaugh CPA, CFP® CMP™ many successful medical endowment funds will establish a “strategic” allocation policy that is intended to guide long-term (greater than one-year) investment decisions. This strategic allocation reflects the endowment’s thinking regarding the existence of perceived fundamental shifts in the market.

Asset Class Target Ranges

Most endowments will also establish a target range or band for each asset class. The day-to-day managers then have the flexibility to make tactical decisions for a given class so long as they stay within the target range.

Definition

The term “tactical” when used in the context of investment strategy refers to the manager’s ability to take advantage of short-term (under one year) market anomalies such as pricing discrepancies between different sectors or across different styles.

Historically, tactical decisions with respect to asset allocation were derided as “market timing.” However, market timing implies moving outside of the target ranges whereas tactical decision making simply addresses the opportunistic deployment of funds within the asset class target range.

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Assessment

www.CertifiedMedicalPlanner.com

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Schumer Proposes Permanent IRA Rollover

Provision on the Currency Exchange Rate Oversight Reform Act

By Children’s Home Society of Florida Foundation

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Senator Charles Schumer and 15 co-sponsors of the Currency Exchange Rate Oversight Reform Act of 2010 included provisions that would make four charitable deductions permanent. The bill is designed to modify the laws on currency transactions but it provided a platform to add in the four charitable provisions.

Assessment

The senators propose making permanent the IRA Charitable Rollover, the deduction for gifts of food inventory, the deduction for gifts of book inventory to public schools and the enhanced deduction for gifts of computers for educational purposes.

Editor’s Note: While there may not be prompt action on this bill, it is very encouraging that these 16 senators believe it is important to extend these four charitable provisions permanently. The IRA Charitable Rollover was the first of the four in the bill. That suggests that there is strong support in the Senate for permanent status for the rollover. And, as of the date of this publication, the House has passed the tax extenders including the Charitable IRA Rollover but the Senate has been unable to come to agreement on a bill. It is possible that the Senate may act in September to attach the 40 tax extenders to legislation. While that is the earliest possible date for passage of the IRA Charitable Rollover for 2010, it is still probable that the rollover will pass with an effective date of January 1, 2010.

Conclusion

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Medical Endowment Fund Contingency Planning

Understanding Stock Market Volatility?

Source: www.HealthcareFinancials.com

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According to Wayne Firebaugh CPA, CFP®, CMP™ the many quantitative methods of stock, bond, derivatives, alternative assets and mutual fund investing would have suggested that the October 1987 crash was impossible; yet the flash-crash of 2008 still occurred.

The Improbable Happens

For example, Mark Rubenstein, a professor at University of California at Berkeley, noted that if annualized stock market volatility was assumed to be approximately 20% “(the historical average since 1928), the probability that the stock market could fall 29% in a single day is 10–160. So improbable is such an event that it would not be anticipated to occur even if the stock market were to last for 20 billion years. Indeed, such an event should not occur even if the stock market were to enjoy a rebirth for 20 billion years in each of 20 billion big bangs.”

Statistically Impossible

Although it was statistically impossible for it to happen, it did happen in 1987 and again 2008. The nature of crises is such that many will be unanticipated events with unexpected precipitators. As such, a medical endowment or physician’s portfolio contingency plan cannot address every conceivable event. What a contingency plan should address is the process for confronting these events. Most importantly, the plan should assign responsibility for actions and contain provisions to limit the ability of panic to impair long-term decisions.

Donor Trust is Core

Healthcare and all endowments have at their core donor trust. As such, it is important for an endowment’s contingency plan to include provisions for communicating promptly and forthrightly with the public. One only has to look at the Red Cross’ performance during the aftermath of the 9/11 tragedy to receive a lesson on an inappropriate approach. After donating more than $550 million to the Liberty Fund, donors learned that less than $175 million had been spent on direct aid for victims and that the Red Cross was allocating a large portion of the funds to other programs. After public outcry and congressional hearings, the Red Cross announced that all donations would be spent on direct victim relief.

Unfortunately, Dr. Bernadine Healy, the president of the Red Cross, resigned at least in part because of this controversy. These alleged violations of public confidence can have long-term impacts on an endowment’s donor base. Consider also the United Way whose national leader, William V. Aramony, was accused of fraud, embezzlement, and other charges in 1992. Even a decade later, inflation-adjusted contributions are lower than they were before the scandal even though charitable giving in general has doubled.

Assessment

The very nature of crises is such that pre-determined contingency plans generally allow more rapid and appropriate reaction. For an endowment, a well-considered contingency plan will include both an action (or standstill) plan and a public relations plan.

Note: Red Cross defends handling of September 11 donations on November 6, 2001: see: www.cnn.com

Conclusion

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A New Model for Planing Physician Retirement Needs

Understanding Age Banding

By Ann Miller RN, MHA

[Executive Director]

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From time to time, our readers send in e-books, files or e-chapters, pamphlets or other material they have created for client, educational or marketing use. Some of it may be worthwhile; some not so. Nevertheless, these publications are often a good place to start the conversation, or thought-process on related topics.

They will be occasionally offered as a complimentary membership feature of the Medical Executive-Post.

  • Age Banding [author]
  • Somnath Basu PhD, MBA  [www.clunet.edu/cif]
  • [Director California Institute of Finance]

Link: AgeBander

 

 

Disclaimer

No advice offered. We make no copyright claim to these works. Veracity and information should be considered time sensitive. Always consult a professional for your situation.

Assessment

Feel free to send in your own material for the benefit of all Medical Executive-Post readers and subscribers.

Conclusion

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Current Retirement Investment Options for Physicians

Understanding Build America Bonds

By Somnath Basu PhD, MBA [www.clunet.edu/cif]

[Director California Institute of Finance]

There is heartening news for those of us in retirement or approaching it. There’s a new type of bond called the Build America Bond or BAB. The BAB, along with an older and often ignored retirement investment, is viewed as positive developments for those saving for retirement. But, before a doctor, or any investor, jumps into these investments, some background information is required.

The Accumulation Phase

When people in their early careers save, their primary objective should be that their money grows healthily. They generally should invest in stocks which provides for longer run growth. This phase of our financial life can be called the “Accumulation Phase.”

The Preservation Phase

However, people in their mid- to end-careers (roughly between the ages of 40 – 65) start switching their objectives towards a more conservative future growth in their current savings, especially those associated with emergencies and retirement. This phase is usually identified as the “Preservation Phase” where individuals should begin switching their investments towards more fixed-income securities, such as bonds and bond funds. This idea of how reasonable people “should” behave is commonly known as the life-cycle hypothesis of investments.

The Decumulation Phase

Finally, people in retirement, those who are in the phase termed as the “Decumulation Phase,” should have a healthy dose of bond-type investments in their retirement portfolios.

Strange as it may be to some, this opinion about the investment life-cycle actually contains a lot of truth. If most people followed this basic rule, we would be better off this way than by any other method and especially in times like the recent financial tsunami that hit us. Those hit especially hard were people between the ages of 55 and older who held unhealthy amounts of stocks in their portfolios. Following this simplified version of retirement investments is both easy and effective.

All we do as we age is reduce our stock investments and increase our bond investments. While such a strategy reduces the growth of our wealth it also protects us from large to calamitous losses.

Unfortunately, the last 10 years or so have not been good for bond investments because bond prices have been at or near all-time highs and their returns near all-time lows. The following picture shows the rates one would earn by investing in the government’s (highest safety) 10-Year Treasury Note. Many bonds and mortgages (and subsequently the respective funds) use the 10-Year rate as the benchmark rate.

Graph: 10 T Year Note

As can easily be seen, these rates have come down steadily. A result has been the difficulty, of late, to find (the safer type) bond funds because they have been so expensive. However, one recent development in this field is worth mentioning: that is the emergence of a class of (stimulus-related) bonds known as the “Build America Bonds” or BABs, which for the first time in many years offers investors a very suitable entry to convert stocks into bonds. BABs, which were introduced in April 2009, are an innovative new tool for municipal financing created by the American Reinvestment and Recovery Act of 2009. BABs are taxable bonds for which the U.S. Treasury Department pays a maximum of 35 percent direct subsidy to the issuer to offset borrowing costs.

The second issue of note is that at this point, it is quite expensive to hold cash in money market type funds because of the dismal rates offered on very short-term products. An alternative that physicians and all investors should contemplate purchasing instead of CDs, and money market deposits, is a class of bonds, issued by the Government and known as Treasury Inflation Protected Securities, or TIPS. These investments sold directly by the government to you (at http://www.TreasuryDirect.gov) are excellent vehicles for holding funds as they guarantee that your money will hold its buying power over time and a bit more. TIPS are a great way to hold the capital you will need in the short term. The following picture shows the stability of the TIPS rate; a much safer and more stable investment opportunity than short term Bank CDs, recent money market funds, etc.

Graph: TIPS Rate

Build America Bonds [BAB]

The Build America Bonds program, created by the American Recovery and Reinvestment Act, allows state and local governments to obtain much-needed financing at lower borrowing costs for new capital projects such as construction of schools and hospitals, development of transportation infrastructure, and water and sewer upgrades, according to a recent U.S. Treasury Department press release. Under the Build America Bonds program, the Treasury Department makes a direct payment to the state or local governmental issuer in an amount equal to 35 percent of the interest payment on the bonds.

Here’s how BABs work according to the Treasury Department:

“The bonds, which allow a new direct federal payment subsidy, are taxable bonds issued by state and local governments that will give them access to the conventional corporate debt markets. At the election of the state and local governments, the Treasury Department will make a direct payment to the state or local governmental issuer in an amount equal to 35 percent of the interest payment on the Build America Bonds. As a result of this federal subsidy payment, state and local governments will have lower net borrowing costs and be able to reach more sources of borrowing than with more traditional tax-exempt or tax credit bonds. For example, if a state or local government were to issue Build America Bonds at a 10 percent taxable interest rate, the Treasury Department would make a payment directly to the government of 3.5 percent of that interest, and the government’s net borrowing cost would thus be only 6.5 percent on a bond that actually pays 10 percent interest.”

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Assessment

According to the Treasury Department, Build America Bonds have had a very strong reception from both issuers and investors.  From the inception of the program in April 2009 to March 31, 2010, there have been 1,066 separate Build America Bonds issuances in 48 states for a total of more than $90 billion. Read more about BABs at this site

http://www.treas.gov/press/releases/docs/BuildAmericaandSchoolConstructionBondsFactsheetFinal.pdf

Now, until the general level of interest rates go back to their normal states, it will be difficult to find another opportunity such as this one. This is especially true of investments that are made to local governments through their taxable investments. Municipal bonds are typically considered less risky. Add to this the partial guarantee of the Govt. and you have the makings of a very safe Bond fund providing an average yield of nearly 6% for medium-term duration. There has been a dearth of such fixed income investments in the Bond markets for quite a while. Thus, for doctors and all of us at or nearing retirement age, an exploration and investigation of BABs is an absolute must.

 

Editor’s Note: Somnath Basu PhD is program director of the California Institute of Finance in the School of Business at California Lutheran University where he’s also a professor of finance. He can be reached at (805) 493 3980 or basu@callutheran.edu. See the agebander at work at www.agebander.com

 

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[Doctor’s] Guide to Roth IRAs

Get Rich Slowly

By Ann Miller RN, MHA

[Executive Director]

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From time to time, our readers send in e-books, files or e-chapters, pamphlets or other material they have created for client, educational or marketing use. Some of it may be worthwhile; some not so.

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Guide to Roth IRAs [author]

  • JD Roth

Link: The GRS Guide to Roth IRAs

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Assessment

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New Agreement on IRA Charitable Rollovers

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Includes Tax Extenders
By Robert Giese
bob.giese@chsfl.org

After months of negotiation, Senate Finance Committee Chair Max Baucus (D-MT) and House Ways and Means Committee Chair Sander Levin (D-MI) have announced an agreement.

Passed House and Senate

The House and Senate both previously passed bills that would extend over 40 tax provisions, including the IRA Charitable Rollover. Because there were different tax offsets in the House and Senate bills, extended negotiations were required to find tax increases acceptable to both.

The House bill paid for the tax extenders by increasing the tax rate on hedge fund managers. Currently, the “carried interest” or income of hedge fund managers is taxed at capital gain rates. The House proposed to tax this income at the higher ordinary income rates.

American Jobs and Closing Tax Loopholes Act of 2010

Under the compromise published in the American Jobs and Closing Tax Loopholes Act of 2010 (H.R. 4213), the “carried interest” amounts will be subject to increased tax. For hedge fund managers, 75% of income is taxed at ordinary rates and 25% is taxed as long-term capital gain.

Vote this Week

The House plans to vote on the bill the week of May 24. Former Chair of the House Ways and Means Committee Charles Rangel (D-NY) stated, “For a lot of members, it’s a very difficult vote and they don’t want to take a vote unless they have assurance that the Senate is going to pass it.”

Assessment

Sen. Max Baucus indicated that he expected to find the 60 votes required for passage in the Senate. As is true in the House, a number of Senators who represent regions with financial service firms are concerned about the change in the tax on hedge fund managers. However, Sen. Baucus indicates that the votes are likely to be sufficient to pass the bill.

Editor’s Note: Because the tax extenders portion of the bill includes the educational deduction for teachers, a research and development credit for business and many other popular provisions, similar bills normally pass by large margins. Even with the tax offsets, it is probable that the bill will pass in the next few weeks. Charities should begin planning their fall IRA Charitable Rollover marketing campaigns. Because most individuals with larger IRAs take their required minimum distributions in the fall, there is still time to have a successful IRA Rollover Campaign in 2010.

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Conclusion

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Should the Government Mandate 401(k) Annuities?

About the Guaranteed Retirement Accounts Proposal
By Robert Giese
bob.giese@chsfl.org

Recent hearings in the House and Senate have focused on the need for 401(k) and IRA accounts to provide better retirement income. Vice President Joe Biden referred to these discussions in the White House Task Force on the Middle Class. He suggested creating “Guaranteed Retirement Accounts [GRAs].”

The guaranteed retirement accounts may replace conventional 401(k)s and could eventually provide annuity income to individuals.

Response to GAO Report

In response to a White House request, the General Accounting Office (GAO) released a report on April 28, 2010 that discussed some of these retirement issues. The GAO noted that a couple age 62 has at least a 47% probability that one of the two spouses will live to age 90. While life expectancy is in the mid-to-late 70s when one is born, the age at maturity increases as we grow older. Therefore, the average retirement age couple in America has a reasonable prospect that the survivor will live to be age 90.

GAO reports that Social Security is the primary support for lower income retired Americans. For the median retired person, Social Security is expected to provide approximately 47% of retirement income. The balance will come from savings or investments, a qualified plan such as a 401(k) or IRA and retirement earnings from employment.

Better than Conservative Investments?

The GAO report notes that an annuity may provide more income than a conservative investment, such as a bond or CD.

Assessment

Republican lawmakers this week wrote a letter to Treasury Secretary Timothy Geithner and expressed concern about the guaranteed retirement accounts. They noted that a number of the witnesses before the various committees would “dismantle the present private-sector 401(k) system” and replace it with the GRA.
Their letter expressed concern and opposition to any effort to “nationalize” the 401(k) system. The Republican lawmakers continued by noting that over 90% of households have a favorable opinion of 401(k) or IRA accounts.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Is this new vehicle really better than a bond or CD? Is it the correct vehicle for a long-term retirement strategy? Is it even appropriate for physicians and medical professionals?

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Retirement Plan Risks for Physician-Employers

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Advantages Well Known – Disadvantages Not So

By Brian J. Knabe, MD

[Certified Medical Planner™ candidate]

A source of risk often overlooked by the physician-employer is the risk involved in offering a retirement plan.

Medical practice owners, like other small business owners, find several advantages to starting a retirement plan. The plan can be used to allow the owners to save money in a tax-advantaged manner, and a generous retirement plan can help to attract and retain quality employees.

Administration Risks 

The recent “Great Recession” and turbulence in the stock market have highlighted the risks involved in administering these plans. There is a long history of fraud and neglect in the field of retirement savings plans, and a series of legislative efforts have been enacted to counter these abuses.

Current standards are based primarily on four federal laws, the Employee Retirement Income Security Act (ERISA), the Uniform Prudent Investors Act (UPIA), the Management of Public Employee Retirement Systems Act (MPERS), and the Pension Protection Act of 2006 (PPA).

ERISA Standards 

According to ERISA standards, you may be considered a fiduciary for a retirement plan if you meet any of the following tests:

  • You exercise discretionary authority or control over plan assets or plan management.
  • You are specifically identified in the written documents of a plan as a named fiduciary.
  • You have discretionary responsibility in the administration of the plan.
  • You manage the plan or its assets or render investment advice for a fee.

Recent court decisions have found fiduciaries to be personally liable, even for acts of which they were unaware or in areas not considered within their scope of responsibility. Acting with good intentions or in good faith is not an acceptable defense. Neither is ignorance of your responsibilities.

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Liability Mitigation 

The liability of the administrator (or business owner) can be diminished by taking these steps:

  • Act in a procedurally prudent manner.
  • Diversify investments to minimize the risk of large losses.
  • Provide sufficient information and education to employees to enable them to exercise control over their investments.
  • Offer a broad, diversified investment menu having at least three (preferably five or six) “core” alternatives, each of which must be diversified.

Assessment

The most efficient way to meet these and other requirements is to hire a retirement plan provider which is a certified as a fiduciary, and which accepts “co-fiduciary” status along with the practice owner.  The Centre for Fiduciary Excellence (CEFEX) offers certification as a fiduciary.

For more information, see www.savantcapital.com/cefex.

Savant Capital Management, Inc®

190 Buckley Drive

Rockford, IL 61107

Tel 815-227-0300

Fax 815-226-2195

bknabe@savantcapital.com

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Conclusion

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Modern Retirement Planning and “Banding” for Physicians

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The “AgeBander” Approach Presents a More Accurate Portrayal

[By Somnath Basu, PhD, MBA]

A convergence of mega-trends will forever change the face of retirement planning and raise its importance in the pantheon of physician retirement planning and most all employee benefits. Chief among them: longer life expectancy, advances in medicine, healthier lifestyles and mounting concern about years of abysmally low savings rates.

What it all Means in Practical Terms

What this means in practical terms for future retired physicians and most all retirees is the need for employers, service providers and financial advisers [FAs] to plot a more accurate and thoughtful course to planning for retirement that acknowledges the necessity of pursuing an “age-banded” approach. The idea behind this new approach is that individuals undergo various changes in lifestyles during retirement that last for finite or “age-banded”, periods.

Example:

For example, doctors like most people spend more time and money on leisurely activities early on in retirement, while health care needs dominate the latter years. Further, the costs associated with these lifestyles also change at differential inflation rates than from the basic inflation rate. While the basic inflation rate is about 3%, the U.S. Census Bureau noted that annual recreation costs increased at 7.14% though most of the 1990s. Health care costs also increased by much higher rates than the basic rate. Since the traditional model bundles all costs (including leisure, health care, basic living, etc) and extrapolates at the basic rate, it tends to underestimate retirement expenses. The traditional model’s “static” approach to retirement can have dangerous implications since it may lead to under-funded retirement plans, especially those earmarked for the critical years.

A Flawed Model?

In a research paper published by the Association for Financial Counseling and Planning Education, I detailed the reasons why an age-banded approach is superior to the traditional view of retirement planning. This new model provides for a more accurate portrayal of retirement expenses and an algorithm to calculate the income-replacement ratio, as well as smaller resource requirements and greater flexibility in managing risk. It also allows easier incorporation of long-term care insurance (LTCI) and significantly reduces funding needs. Indeed, the funding needs of a husband and wife who are both age 60 and presumably five years away from retirement are reduced by more than 16% and contributions for a 35-year-old single woman are reduced by 42% compared with previous approaches.

Traditional Retirement Planning Weaknesses

There are five inherent weaknesses to the traditional approach to retirement planning. They include the assumption that all living expenses will increase at the overall rate of inflation as measured by the Consumer Price Index (CPI), bundling all expenses together and not allowing them to change based on the life-cycle, estimating those expenses as a fixed percentage (replacement ratio) of pre-retirement costs, investing in low-return assets and failing to consider contingencies such as LTCI benefits, which can have a significant impact on the amount of funding required for retirement.

Financial Advisory Estimates

When financial planners estimate how much income a client needs in retirement, the calculation hinges on their income just prior to retirement. The pre-retirement income is adjusted downward by 10% to 35%. This adjustment reflects the income necessary to maintain one’s standard of living and incorporates reductions in taxes and other work-related expenses that cease upon retirement. Unfortunately, there’s no objective way to estimate the replacement ratio. Aggressive financial planners typically use large ratios and conservative planners use smaller ones.

30-year Retirement Window

Under the age-banded model, an individual typically lives about 30 years in retirement (e.g., age 65 to 95) and experiences a lifestyle change every 10 years at 65, 75 and 85. Of course, both the retirement period and the width of the age bands are arbitrary but can be subjectively changed to fit each retiree as closely as possible. In addition, a number of steps are taken to produce a clearer picture of retirement costs by categorizing them based on taxes, living expenses, health care and leisure, as well as calculating anticipated expenses using the appropriate rate of inflation for each category, which is adjusted to reflect post-retirement lifestyle changes.

Those expenses are extrapolated through 30 years of retirement and the present value of post-retirement expenses are calculated at an amount deemed sufficient to finance the three following decade (each age band). Instead of discounting these values to the year of retirement (the traditional model), the age banding considers them to be three retirement portfolios that require funding.

Since the portfolio required to fund the expenses during the years 86 to 95 is 20 years behind the first band (66 to 75), investors can seek marginally higher rates of return to reflect the longer terms. Contributions toward these amounts can now be calculated.

Example:

For example, the couple mentioned earlier is able to seek higher rates of return for longer-term investment portfolios which more than mitigate the effects of escalating health care costs. In the case  of the 35-year-old single woman, since the funds required for these three portfolios are 30, 40 and 50 years away she should be willing to take on more risk since she has ample time to manage the portfolio risk.

The expenses for the age-banded method become considerably higher at the latter stages of retirement as compared to the traditional model. This is desirable since the over-funding is associated with an age at which one cannot afford to be out of funds. The higher estimate of the age band comes from higher inflation rates for health care and the incorporation of lifestyle changes that imply accelerated costs such as increased leisure spending upon retirement and higher health care costs in the latter years.

Thus, these higher costs are not only more realistic but they incorporate the dynamics of a retired life, unlike the traditional model. Incredible as it might seem, the ability to assume a marginally higher risk leads to an actual decrease in the funding requirements versus the traditional plan.

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Assessment

One caveat that doctors need to know, and that financial planners will need to keep in mind, is that their clients may be reticent to buy equities when markets are underperforming. Clear explanations are required regarding why it may still be beneficial for the long run and that the risk will be managed on an ongoing basis. But, the results will be well worth the effort for the multiple stakeholders involved in assuring that tomorrow’s retirees are able to live more comfortable after their working years. It’s a small price to pay for the peace of mind associated with knowing retirement expenses will be portrayed more accurately and plan participants will be afforded greater flexibility in managing their risk.

Table [Comparison of growth in retirement expenses]

Link: Age-Banded Retirement Planning FINAL[1]

Editor’s Note: Somnath Basu PhD is program director of the California Institute of Finance in the School of Business at California Lutheran University where he’s also a professor of finance. He can be reached at (805) 493 3980 or basu@callutheran.edu. See the agebander at work at www.agebander.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Financial advisors please chime in on the debate? Is Basu correct; why or why not? Review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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***

Doctors – Are You Ready to Retire?

Moneywise?

By Somnath Basu; PhD, MBA

For those of us between the ages of 45 to 54, the thought of retirement should be popping up a few times these days. And, for doctors between ages 55 and 64, the thought may be taking on urgent tones. Many of us are reconciling to the idea that it may be a fact that we have to either postpone our retirements or live a much simpler life during retirement. Whatever the thoughts may be, what’s driving them is our preparedness to retire.

Preparedness Components

So, we will now examine what the component (dos and don’ts) may be for physicians, and others, to assess whether they are on the right path in their preparations to retire. It is somewhat easier if we consider the preparedness issues of the expectant retirees along the two age groups we tagged earlier. It is possible that we may find that the proper components of our retirement plans may already exist for us and we need to give them a good and disciplined effort to carry us through in the retirement years. It is also important to note, in this vein, that as a nation, our savings rate has gone from -0.6% in 2006 to about 5% today. While most of the increase in savings is the result of people building back an emergency nest egg, we can also take heart in the fact that the savings habit has not become obsolete or even rusty, and given the proper motivation (e.g. a sub-standard retired lifestyle), we can alter our destinies by riding on the same savings wave.

The Possibilities

Let us begin by describing the possibilities for the younger group (ages 45-54) doctors and employees pondering their retirement moves. There are two aspects of retirement that needs consideration. First is the contemplation of the needs associated with retirement lifestyles and the corresponding financial requirements required to sustain such lifestyles.

The second is to consider our current lifestyles, living standards (consumption), our income and savings and to assess whether we are set to achieve our retirement lifestyle targets. To understand the many possibilities, we will examine some typical scenarios using data from the Employee Benefits Research Institute (EBRI). Note that all calculations are only approximations for a typical individual.

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Example:

If you are about 50 years of age, have worked and saved for about 20 years [401(k), or 403(b)] or other pension plan) and earn about $100,000 a year, you should have about $200,000 in your retirement account today. Assuming that Social Security (if the organization remains viable and makes its required payouts), covers about 27% of your needed retirement expenses. You could expect a Social Security payment of about $30,000 per year at age 65. This would mean that in about 15 years, you would need to generate an additional $80,000 per year from your own savings. While you may think that you are not consuming $110,000 worth of lifestyle today, it is useful to note that this estimate is in future (and inflated) dollar terms.

This brings us back to the second question of how much you may be consuming today. If you are paying about 25% as taxes and saving another 5%, then you are currently spending about $70,000 today. At a 3% inflation rate, in 15 years this amounts to a spending of $110,000 on an income of approximately $160,000.

Thus, if your 403(b) balance does not change from now till retirement and you estimate to plan for a 25 year retirement phase, then your 403(b) account will be equivalent to about an additional $8,000 per year, which itself will grow every year minimally at the inflation rate.

If you assume the 403(b) plan will itself grow at about 7% a year over the next 40 years (from ages 50 to 90) then at retirement (age 65) you’ll have about $550,000 and be able to withdraw about $50,000 per year. This will leave you with a shortfall of $30,000 per year. To be able to afford retirement to its fullest, you’ll need to save an additional $15,000 per year for the next 15 years. Before you begin thinking that is a doable task and start assessing which parts of current lifestyle to pare, note that many of the assumptions above may not hold true.

Average Rates of Return

For example, earning a 7% average rate of return over 40 years is no simple task; Social Security may not be able to deliver on its promise. Physician income and job security is a political issue. Paring current lifestyle is a bigger issue. Healthcare and leisure types of costs during retirement may increase by more than 3%, even as you consume more of these retirement lifestyle services.

Therefore, you may want to continue enjoying your current medical practice lifestyle and consider worrying about retirement about 10 years (or more) later or you may take stock of your current situation. If your situation is worse than the average portrayed above, a big issue for you is to keep your physical and mental health well balanced and not depressed and medicated; plan to postpone retirement and practice or work longer, albeit in good health.

Assessment

If you are about 60 years of age, have worked for about 25-30 years, earn $100,00 per year and have about $350,000 in your retirement accounts, your problems are more exacerbated and your fears (of postponing retirement, paring current or future lifestyle or not being able to make up shortfalls) are much more real. The strategies remain the same from earlier in that you have to make some urgent and difficult decisions. These are decisions that cannot be postponed any longer.

Note: First released “All Things Financial Planning Blog” on December 18, 2009.

Conclusion

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Hospital Capital Formation, Harry Markowitz and Modern Portfolio Theory

Strategic Risk Considerations for Physician-Executives and Healthcare CXOs

[By Calvin W. Wiese; MBA, CPA, CMA]

To most all financial advisors, wealth managers and stock-brokers, the work of Harry Markowitz and Modern Portfolio Theory [MPT] is not usually discussed in terms of hospital capital formation. But, perhaps it should!

Capital Investments Create Risk

Capital investments create risk. Risk is the uncertainty of future events. When hospitals make capital investments, they commit to costs that affect future periods. Those costs are known and relatively fixed. What are unknown are the benefits to be realized by those capital investments.

Defining Risk

For capital investments, risk is the certainty of future costs coupled with the uncertainty of future benefits. In some cases, while the future benefits are uncertain, there is a high degree of certainty that the benefits will exceed the costs. In these cases, risk can be very low. Risk may be better defined as the degree to which the uncertainty of unknown benefits will exceed the known and committed costs.

Asset Burdens and Benefits

When capital assets are purchased, both the burdens and the benefits of ownership are transferred to the owner. The burdens are primarily the costs associated with acquisition and installation. The benefits are primarily the revenues generated by operating the capital assets. Risk of ownership is created to the degree that the benefits are uncertain.

Understanding Risk

Hospital managers need to be skilled at putting hospital assets at risk. Without clear knowledge and understanding of the benefits and the burdens, hospitals can quickly find themselves at unacceptably high levels of risk. Risk must be continually assessed and evaluated in order to successfully put hospital assets at risk. Hospitals require many varied capital investments; their capital investments represent a risk portfolio. An effective combination of risky assets can often create risk that is less than the sum of the risk of each asset.

Modern Portfolio Theory

Of course, financial managers have know this for years as a basic principle of Modern Portfolio Theory (MPT), first introduced by Harry Markowitz, PhD, with the paper “Portfolio Selection,” which appeared in the 1952 Journal of Finance. Thirty-eight years later, he shared a Nobel Prize with Merton Miller, PhD, and William Sharpe, PhD, for what has become a broad theory for securities asset selection; and hospital assets may be viewed as little different.

Prior to Markowitz’s work, investors focused on assessing the rewards and risks of individual securities in constructing a portfolio. Standard advice was to identify those that offered the best opportunities for gain with the least risk and then construct a portfolio from them. Following this advice, a hospital administrator might conclude that a positron emission tomography (PET) scanning machine offered good risk-reward characteristics, and pursue a strategy to compile a network of them in a given geographic area. Intuitively, this would be foolish. Markowitz formalized this intuition.

Detailing the mathematics of diversity, he proposed that investors focus on selecting portfolios based on their overall risk-reward characteristics instead of merely compiling portfolios of securities, or capital assets that each individually has attractive risk-reward characteristics. In a nutshell, just as investors should select portfolios not individual securities, so hospital administrators should select a wide spectrum of radiology services, not merely machines.

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Assessment

Savvy hospital managers will mitigate ownership risk by constructing their portfolio of risky assets in a manner that lowers overall risk

Conclusion

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Questioning [Physician’s] Upward Social Mobility and the State of the Union Address

Broad Consensus Seems Impossible for Medical Professionals – and Everyman

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

While an undergraduate student at Loyola University in Maryland, I learned from my Jesuit teachers and philosophers that a couple of centuries ago, the decider of all matters of importance in Jerusalem was the Great Sanhedrin, or a council of 71 judges. The council met most every day except on festivals and the Sabbath. It functioned as sort of a combination of the Supreme Court, Congress and a political debate boiler room.

Incorrect Unanimity

As one might imagine, the Sanhedrin’s members normally disagreed as they hammered out their daily opinions; much like today’s political debates over healthcare reform. But occasionally they came to a unanimous decision, and they had an amazing and very wise rule when that occurred: The decision was immediately overturned because the sages believed that a unanimous conclusion among so many individuals just had to be wrong.

THINK: The US Senate and Congress

Rules for Upward Mobility

Anyway, I was thinking about the Sanhedrin’s rule after last night’s 2010 State of the Union address by President Barrack H. Obama while I was considering the current state of the economic union for doctors – specifically. The translation is easy for non-physicians [everyman] as well; so bear with me.

Anyway, I was struck by the fact that if there was one grand unified theory which gets at least 90-100% agreement from current generations of America’s medical and lay punditocracy – it is the rules for upward [medical professional] mobility.

These rules, especially for second generation Americans like me, were:

  • A medical degree [college education] leads to a lucrative profession [job] and a satisfying lifestyle.
  • [Working hard], or practicing long hours, means your income will grow.
  • Devotion to medicine, or your job, will produce a comfortable retirement.
  • Your children will follow your career path [job] and create a lasting legacy

The Paradigm Shift

Today, with a national unemployment rate hovering around 10%, doctors and everyman may need to reconsider the above unwritten rules that have governed our upward mobility since the end of World War II. As the son of a GM auto worker – I did decades ago – and still do.

For example, from 1945 to 2000, various private and public health insurance mechanisms were developed, along with the idea that health insurance was a fringe benefit in lieu of the wage and price controls instituted after the war. Today it is even considered a “right” by some.

Nevertheless, the doctor-class was a surrogate for the affluent American upper middle class lifestyle, and a type of perpetual prosperity machine that created wealth.

There were periodic general economic dislocations of course, like the recessions of the mid-1970s and early 1980s, and the rise of managed care in the early 1990s. But, wealth seemed to compound for physicians, and progress always resumed its upward trajectory. This was especially true for all medical professional during the “golden age of medicine” [circa 1965-1990, approx].

After all, wasn’t [isn’t] healthcare considered a recession proof business? Perhaps no more!

The Physician Net-Worth Numbers

Then: I was involved in study a few years ago [September 16, 2008] which determined that the average 47 year-old physician, earning $180,000 annually, needed to amass a net-worth of about $5.5-M in order to maintain the same lifestyle throughout retirement at age 65.

Link: http://www.hcplive.com/finance/publications/pmd/2005/92/3951

Link: www.CertifiedMedicalPlanner.com

Now: Today, with the DJIA down about 30% from its’ October 2008 high, is this retirement / employment scenario still possible? Are our opinions Sanhedrin-like?

And remember, the estate tax laws sunset back to their original rates in 2011. Moreover, many financial advisors, like me, believe income tax rates and brackets will increase going forward; along with increasingly onerous regulations for small businessmen and women like physicians and private medical practitioners. New business innovations of all stripes will also be adversely affected.

Full Disclosure: I am founder of the Certified Medical Planner™ online education program for financial advisors and medical management consultants.

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Assessment

And so, I ask, do the rules of upward mobility for physicians or everyman still apply; or have they changed?  Why or why not? If so, is the change permanent or temporary, and is it for the positive or negative. Please consider financial, societal and/or generational implications.

IOW: Is President Barack H. Obama correct?

Conclusion

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The DB[k] Pension Plan

A New Combination Plan

By Staff Reporters

Did you know that The Pension Protection Act of 2006 will provide for a new kind of hybrid pension plan for employers with 500 or fewer employees?

What it is – How it works

According to PensionRights.org, until now, employee contributions to traditional pension plans have not been tax deferred. For that reason, few pension plans require or permit employee contributions. Instead, many employers supplement their pension plans with separate 401(k) plans which permit employees to defer taxes on their contributions.

The DB/K Plan

The new “DB/K plan” will combine a traditional defined benefit pension plan with a 401(k) savings plan. The plan will provide a low employer-paid guaranteed lifetime monthly retirement benefit that could be supplemented by voluntary tax deferred contributions by employees. The minimum pension benefit, payable to employees who work 3 or more years for the employer, will be equal to the lesser of 1 percent of average pay during the last five years of work multiplied by the number of years of service with the employer, or 20 percent of the average pay in the employee’s consecutive highest 5 years of earnings.

Assessment

The 401(k) component of the plan requires the employer to match at least 50% of an employee’s contributions up to 4% of the employee’s salary. The provision will take effect in 2010.

Read Section 903 of The Pension Protection Act of 2006 Public Law 109-280

Visit: www.PensionRights.org

Conclusion

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Investment Returns Drop for Nonprofit Healthcare Organizations

A Commonfund Report

By Roy Chernus
SK Communication, LLC for Commonfund

Did you know that nonprofit healthcare organizations reported average investment returns which dropped [minus] -21.2% in fiscal year 2008, ending December 31st 2008?

Results

Attached below is a press release with findings from the 2009 Commonfund Benchmarks Study of Healthcare Organizations. The 143 participating healthcare organizations represented total investable and Defined Benefit plan assets of $113.8 billion, comprising investable assets of $81.6 billion and $32.2 billion in DB plan assets.

Assessment
www.commonfund.org/Commonfund/Archive/CF+Institute/2009+0921+CBS+Healthcare+Press+Release.htm

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How Much Do “Financial Advisors” Pay for Doctor [Any Client] Prospect Leads?

More Than you Think in this Murky Advertising World – but – Are Matching Services Effective? 

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Dr. David E. Marcinko MBA

Recently, I received the sixth telephone cold call from one Mr. Tim Smith [866 952 4065], in as many months, regarding a service called Prospect Match of Concord California. It purports to match financial advisors with pre-screened clients [like affluent doctors] in my area.

Of course, because of their high quality selection process, only three advisors are “needed” in my locale. I also received this email sales-service pitch.

The Introductory e-mail Sales Pitch

We are hosting a live presentation with Ilene Hirsch of ProspectMatch, and new agent Wayne Dunlap will show you a service that will prospect for you—even in a terrible economy. See How Wayne Dunlap invested $1,094 in his business to earn $39,560 and does it again and again. Join us for 30 minutes and learn how Wayne:

  • Outsources his prospecting, and was
  • Introduced to 73 new prospects; resulting in 23 appointments and in 9 sales. 

Thank you
Eric Palmer (800) 290-7226
www.Brokersalliance.com 

About Prospect Match

“ProspectMatch helps financial professionals who are wasting time and earning too little. If you are earning less than $100,000 a year, you’re either not serious, or doing the wrong things and we can show you what to do. If you are earning $100,000-$300,000 annually, you’ve figured some things out. But those who use our systems see their income top $500,000 annually because they spend their days doing marketing the right way, talking to motivated affluent prospects and they sell the right way.”

Link: www.ProspectMatch.com

Costs

The blog states that there is a one time non-refundable registration [fixed-cost] fee of $149; so that prospects meeting their selection criteria are assigned to me exclusively. For each prospect match, the charge is an additional $20 [variable-cost] fee. This is known as a hybrid business cost model.   

Assessment

Here are a few interesting thoughts and co-incidences for further ME-P subscriber consideration and commentary:

  • The site is a pre or post-retiree sales lead generator for the 45 +age market for annuities; typically the most commission loaded and profitable financial product in the industry today. The fear of Obama-care may be self-promoting for annuities. 
  • It appears to be geared more for insurance sales agents; not RIAs or fiduciaries.
  • The service appears to help mitigate the so-called national “do-not-call” prohibitions. 
  • Explanatory sales booklets and other customized self-promotional literature are available for an additional surcharge, along with other premium upgrade services.
  • We have been getting more than the usual number of contacts recently, either to buy our ME-P mailing list [not for sale-confidentially assured], or to purchase an AMA. APMA or ADA mailing list for doctors, podiatrists and dentists. These folks are apparently unaware of our medical affiliations.
  • How do you feel about being called a “prospect” or book-of-business?
  • I am not – and have never been – a member of the Financial Planning Association [FPA], and I haven’t been a certified financial planner for the last three years; having quit that organization in abject disgust after more than a decade [read related posts – why?]. So, how and why did they target me? Big mistake, too.

Disclosure

I am not a member of the AMA; 82% of eligible [cogent and modern] physicians are not. But, I am founder of the www.CertifiedMedicalPlanner.com for fiduciary advisors and medical management consultants.

ConclusionProspecting Advisors  

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What are the good and bad points of this service? Has any FA used it and what is your experience with it? As a doctor, how do you feel about being targeted as a “prospect” by a third-party head-hunter? Be sure to give the website a click and tell us what you think? 

We will try to contact Tim, or other representative of this advertising/marketing program, for an email interview. Let’s be objective.

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Current Milestones in Retirement Planning For Physicians

What if You Are Behind Your Target Goals?

By: Alexander M. Kimura; MBA, CFP®

By: Robert J. Greenberg; CFP®

By: Richard P. Moran; CFP®fp-book

The stock market has been in a terrible place for your money and retirement planning, since October 2007. Perhaps even the last decade or so for some physicians. But, if none of your assumptions have changed and you feel that you can make up the difference in the next year, you probably can use the same retirement cash flow plan. As a rule of thumb, if you’re less than 10 percent off of your goal, you may not need to do anything. This is rare in the investing climate today!

So, if you have fallen so far behind that each year’s target seems unachievable, you will probably need to make some changes. However, before you change your planning and investing, you need to see why you’re behind.

Examine Expenses

If you haven’t saved as much as you expected, take a look at your expenses [personal and office] and see where you can cut down. Remember, you need to pay yourself first before you spend on luxuries. Contribute as much as possible to your qualified retirement plan at work, too.

Examine Returns

Next, you need to look at your investment returns. Since the stock market has been in one of its inevitable “corrections” for several years, this can significantly impact your balances. Remember, your return assumptions are based on averages that should include the bad and good years. If you’re close to retirement and have a large shortfall, then you may need to increase the risk in your investment portfolio in order to meet your goals. If the market falls more, or stays down for some time, increasing risk by buying more stocks forces you to “buy low” which should pay off over time.

Assessment

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As a doctor, you can always delay retirement and work a few more years. Fortunately, medicine is one profession where experience earns an economic premium.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How will you make up any retirement shortfall? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Superannuation Demographics for Financial Advisors

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“Live Long and Prosper”

By Dr. David Edward Marcinko; MBA, CMP™

By Thomas A. Muldowney; MSFS, CLU, CFP®, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™Senior Citizens

The words of Mr. Spock!

Recently, during my promotional speaking tour for the summer of 2009, I had the occasion to visit a few nursing and related homes for the elderly, sick, infirmed and aged. This harkened warm thoughts back to my time at Temple University in Philadelphia, PA as a young medical student. So, as a health economist and former certified financial planner, I recruited some folks and did some research on the domestic aging population to refresh my understanding of the facts and figures; especially in light of the current healthcare reform political debates [DEM].

Just the Facts  

According to the U.S. Bureau of the Census, there were almost 49 million people in the United States who were over age 60 in 2001. There are approximately 4 million people over the age of 85 living in the US and there are over 60,000 people older than age 100 estimated as of July 1st 2004. For every100 middle aged persons in the United States there are at present about 114 persons over the age of 65. This statistic will change as we move forward through time. In the year 2025, there will be about 253 people over age 65 for every 100 middle-aged people.

Enter the Baby Boomers

Beginning on January 1, 2006 at midnight and every 12 seconds thereafter for fifteen years, a baby boomer will have a birthday and cross over the age threshold of age 60. In the next 30 years, the 60+ age group will more than double, becoming 25% of the total population, and will have to be supported by a proportionately smaller workforce. Research published in June 2005 by AARP (based on data from 2002) estimates that: ‘‘In 2002, roughly $140 billion was spent on nursing home and home health care, with 24% of these costs being paid out of pocket” (O’Brien and Elias, 2004).

Aging Boomers

As the baby boom generation ages, the care needs will expand precipitously. Add to this, scientific and technological improvements in healthcare. These very same people will need more expensive healthcare and more expensive custodial care, and they will need it for an even longer period of time. Who will pay for this expanded need is not so clear. What is clear is that it will take money and lots of it to make these payments.

Money Preservation Variables

There are only three variables associated with the accumulation or preservation of money: ‘‘time, money and rate of return.’’ Time is reduced to the following two questions ‘‘How long until I will need my money?’’ and ‘‘How long will I live?’’ an uncertainty to be sure. Rate of return is either a function of the financial markets or the successful maintenance of a Long Term Care Insurance [LTCI] plan. Because of the volatility in the financial markets, the ‘‘money’’ question is equally as uncertain. In order to accumulate sufficient assets; an aging physician must ’tradeoff’ many other alternatives such as ’lifestyle.’

Assessment

What is certain is this—financial planning is important. More important is the implementation.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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What is a Zero-Based Budget?

A Most Cruel – but Needed – Endeavor

[By Staff Reporters]fp-book2

A zero-based budget means you start with the absolute essential expenses and then add-back expenses from there until you run out of money. This is an extremely effective, yet rigorous, exercise for most doctors and medical professionals; and can be used personally or at the office.

Triage and Prioritize

Your first personal financial item should be retirement plan contributions, then your mortgage and other debt payments, and then other required fixed expenses. From the office perspective, the first budget item should be salary expenses for both you and your staff. Operating assets and other big ticket items come next, followed by the more significant items on your net income statement. Some doctors even review their P&L statements quarterly, line by line, in an effort to reduce expenses. Then, you add discretionary personal or business expenses that you have some control over.

More Month than Money

Now, do you run out of money before you reach the end of the month, quarter, or year? Then you better cut back on entertainment at home or that fancy new, but unproven piece of office or medical equipment. This sounds Draconian until you remind yourself that your choice is either (1) entertainment now but no money later or; (2) living a simpler lifestyle now as you invest so you’re able to enjoy yourself at retirement.

Assessment

When you were a young doctor, budgeting may have seemed a task needed far into the future; but at midlife, you are staring retirement right in the face.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

 

Product DetailsProduct DetailsProduct Details

About Fiduciary Benchmarks, Inc

Independent Custom Benchmark Groups

By Staff Reportersfp-book1

Department of Labor [DOL] regulations under ERISA, and specifically pending section 408(b)(2), requires that retirement plan sponsors obtain fee disclosures for their plans and that all fees be “reasonable” for services provided.

Fiduciary Benchmarks, Inc. [FBi] was launched to support plan sponsors, advisors, consultants, record-keepers and other plan service providers in addressing this obligation. Fiduciary Benchmarks helps document a thorough and objective process and well-informed decisions. This is an increasingly important topic for hospitals, healthcare systems, CXOs, CFOs, sponsoring medical entities and many modern physician-executives.

Background

Fiduciary Benchmarks, Inc was founded in October 2007 with the express purpose of providing pension and retirement plan benchmarking services. The genesis of the firm was recognition by FBi principals that the marketplace did not have an efficient and affordable way to help plan sponsors meet their fiduciary obligation to determine if plan fees are reasonable.

Progressing Past Current Approaches

Existing marketplace approaches to assessing fee reasonableness (including the use of simple averages books, issuing RFIs, participating in a mock RFPs or actually taking a plan to market) were falling short in terms of validity and/or the time, effort and disruption involved. These gaps continue today.

FBi Modern Approaches

FBi spent more than a year sharing their methodology and reports with the marketplace. They solicited and considered feedback from record-keepers and TPAs, advisors, consultants, independent auditors and ERISA attorneys. As a result, products are claimed to be well vetted and improved.

Link: http://www.fiduciarybenchmarks.com

Fiduciary Report [The Duty to Use Outside Sources]

“Fiduciaries are not expected to be experts. They may reasonably rely on the assistance of others in performing required investigation of and data gathering process. One of the key issues in determining whether reliance on the expert is reasonable is whether the expert is independent and unbiased.”

-Fred Reish

Assessment

In order to remain independent and conflict free, FBi does not perform any traditional investment consulting, plan monitoring and/or record-keeper search work. FBi offers benchmarking services, where desired, by plan sponsors, directly. Fiduciary Benchmarks, Inc. is a completely independent company.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated; especially from FAs, wealth managers, CPAs, CFAs and CMPs™? Experienced customer opinions are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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PODIATRISTS: www.PodiatryPrep.com
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

 

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Long-Term Care Insurance

A Review for Doctors and Advisors

By Gary A. Cook; MSFS, CLU, ChFC, LUTC, RHU, CFP®, CMP™ (Hon)

insurance-book6

Long-term care (LTC) insurance is considered one of the newest forms of personal coverage insurance.  LTC insurance is designed to transfer the financial risk associated with the inability to care for oneself because of a prolonged illness, disability, or the effects of old age.  In particular, it is designed to insure against the financial cost of an extended stay in a nursing home, assisted living facility, Adult Day Care Center, hospice or home health care.  It has been estimated that two out of every five Americans now over the age of 65 will spend time in a nursing home.  As life expectancy increases, so does the potential need for LTC. One unfortunate consequence of being the “new kid on the block” is the lack of actuarial data specifically collected for this style of policy.  This results in policy premiums being underpriced to sustain the claims currently being experienced.  During the first half of 2003, at least three insurance companies stopped writing these policies because of their losses.  Those insurers remaining in this market are expected to increase premiums quickly.  Unless these policies can be profitable for the company, their future will be an uncertain one.

Medicare

Any discussion of LTC must begin with an understanding of what Medicare is designed to cover.  Currently, the only nursing home care that Medicare covers is skilled nursing care and it must be provided in a Medicare-certified skilled nursing facility.  Custodial care is not covered. Most LTC policies have been designed with these types of coverage, or the lack thereof, in mind. To qualify for Medicare Skilled Nursing Care, an individual must meet the following conditions: 

  • Be hospitalized for at least three days within the 30 days preceding the nursing home admission;
  • Be admitted for the same medical condition which required the hospitalization; and
  • The skilled nursing home care must be deemed rehabilitative.

Once these requirements are met, Medicare will pay 100 percent of the costs for the first 20 days.  Medicare covers days 21 to 100 along with a daily co-payment, which is indexed annually.  After the initial 100 days, there is no additional Medicare coverage. Medicare Home Health Services cover part-time or intermittent skilled nursing care, physical therapy, medical supplies and some rehabilitative equipment.  These are generally paid for in full and do not require a hospital stay prior to home health service coverage.

biz-book

Critical LTC Policy Features

According to the U.S. Department of Health and Human Services and the Health Insurance Association of America, there are seven features that should always be included in a good long LTC policy: 

  • Guaranteed renewable (as long as premiums are paid, the policy cannot be canceled).
  • Covers all levels of nursing care (skilled, intermediate and custodial care).
  • Premiums remain level (individual premiums cannot be raised due to health or age, but can be raised only if all other LTC policies as a group are increased).
  • Benefits never reduced.
  • Offers inflation protection.
  • Full coverage for Alzheimer’s Disease (earlier contracts tried to eliminate this coverage).
  • Waiver of premium (during a claim period, further premium payments will not be required).

In addition, there are another seven features considered to be worthwhile and are included in the better LTC policies: 

  • Home health care benefits
  • Adult day care and hospice care
  • Assisted living facility care
  • No prior hospital stay required
  • Optional elimination periods
  • Premium discounts when both spouses are covered
  • Medicare approval not a prerequisite for coverage.

ADLs

Most LTC policies provide benefits for covered insured’s with a cognitive impairment or the inability to perform a specified number of Activities of Daily Living (ADLs). These ADLs generally include those listed below and the inability to perform two of six is generally sufficient to file a claim:

1. Bathing:  Washing oneself in either a tub or shower, or by sponge bath, and includes the task the getting into and out of the tub or shower without hands-on assistance of another person.

2. Dressing:  Putting on or taking off all necessary and appropriate items of clothing and/or any necessary braces or artificial limbs without hands-on assistance of another person.

3. Toileting:  Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene without hands-on assistance of another person.

4. Transferring:  Moving in and out of a bed, chair or wheelchair without hands-on assistance of another person.

5. Eating:  The ability to get nourishment into the body without hands-on assistance of another person once it has been prepared and made available.       

6. Continence:  The ability to voluntarily maintain control of bowel and/or bladder function, or in the event of incontinence, the ability to maintain a reasonable level of personal hygiene without hands-on assistance of another person.

Other Issues

Another issue concerning ADLs is whether the covered insured requires “hands-on” assistance or merely needs someone to “stand-by” in the event of difficulty.  Obviously, LTC policies that read the latter are considered more liberal.

fp-book1

Long-Term Care Taxation

Some LTC policies have been designed to meet the required provisions of the Kassenbaum-Kennedy health reform bill, passed in 1996, and subsequently are “Tax Qualified Policies”.  Insured’s who own policies meeting the requirements are permitted to tax deduct some of the policy’s premium, based on age, income and the amount of total itemized medical expenses.  The major benefit of the tax-qualified LTC policy is that the benefit, when received, is not considered taxable income.  There are several initiatives in Congress, however, which would expand and simplify these deductibility rules. 

Assessment

Regardless, the medical professional or financial advisor [FA] should investigate the opportunity afforded them through their current form of business, or client use, for any purchase of a LTC policy. And, small businesses may be permitted to deduct LTC premiums on a discriminatory basis.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What have we missed, and who might wish to update this post?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Selecting an Assisted-Living Facility

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Checklist for Financial Planners

[By Staff Reporters]

Thousands of boarding homes cater to the elderly. Their operators promise to provide at least a place to sleep and food to eat. Beyond that, the services and assistance offered will vary from facility to facility. This checklist will help the financial planner or his or her client find a facility that is appropriate in all respects to the client’s resources and needs. Unlike nursing homes, assisted-living facilities often operate without any scrutiny from public agencies. Furthermore, Medicaid often will not be a source of funds.

The Checklist

The items the financial planner and client should consider when selecting a facility are listed below.

      1.   Determine the client’s willingness to live in a group environment.

      2.   Avoid unlicensed facilities, particularly if Medicaid-provided services may be needed in the future.

      3.   Review the facility’s inspection report.

      4.   Review the facility’s service contract and house rules. Look for answers to the following questions:

            a.         Where will the resident live?

                        Are there any types of ownership rights?

                        What flexibility is there with respect to furnishings?

                        Will the same unit be available after a hospital stay?

            b.         What meals are included?

                        Will the facility provide appropriate meals and a special diet?

            c.         What form of transportation does the resident currently use?

                        What transportation is provided by the facility?

                        Can residents shop, dine, attend services or visit doctors?

            d.         What help does the facility provide during a medical emergency?

                        What type of staff training is provided or required? Is there 24-                        hour-a-day staffing?

            e.         What provisions are there for privacy? When are rooms cleaned and when can staff access the rooms?

            f.          What is the basic cost and what are the costs for extras?

                        What is included in each?

                        What provisions for fee increases are there?

            g.         Can a resident see his or her own doctor?

                        Does the facility offer transportation for appointments?

            h.         Who’s in charge of administering and scheduling medication?

                        Can medication and other supplies be purchased at the facility?

            i.          What happens if the resident’s health begins to fail?

                        Does the facility provide additional services to help with ADLs?

            j.          What is the procedure for transfers from one unit to another?

                        Does the resident have any opportunity to express an opinion?

            k.         What’s required if a contract is terminated by facility or resident?

                        What is the provision with respect to refunded fees?

                        Is there a required minimum stay?

Assessment

What have we missed?

Conclusion

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How to Select a Nursing Home

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Checklist for Financial Planners

[By Staff Reporters]fp-book6

The following will enable the financial planner to assist the client in choosing a nursing home.

The Checklist

1.   Review the client’s requirements. An assisted-living facility may suffice instead of a true nursing home, which is required by the frail and elderly needing daily medical care.

2.   Pick a location close to home and relatives. Frequent visits are crucial, not only to combat loneliness but also to ensure resident receives proper attention.

3.   Read inspection report (state survey). If the financial planner encounters difficulties in obtaining a current report, he or she should assume that the home has something to hide. Don’t expect perfection. Nursing homes provide a difficult service for difficult residents. If a home is unresponsive to inquiry regarding items in a report, assume a similar response to concerns about the quality of care being provided in the future.

4.   Tour the facility on an unannounced basis at different times on different days. Stroll through corridors and look and listen. Trust senses and instincts. Items to consider should include:

·         Appearance of residents’ rooms. Outward decor of facility can be misleading, so the planner should inspect the residents’ rooms. To what extent can the rooms be personalized? If rooms are shared, how are good roommate matches made?

·         Smells. High-quality homes have no lingering stench of urine or air freshener to cover up bad care and unusually high incidences of incontinence due to lack of attention by staff.

·         Safety hazards. Be especially aware of items in corridors that can be obstacles to those with unsteady gait and poor eyesight.

·         Sufficient staff members who are pleasant and respectful to residents. Are staff members responsive to residents’ needs? Are staff members warm in their interactions with all residents, even those requiring the heaviest supervision? Are aides helping residents with walking or exercise of their arms and legs?

·         Residents’ attitudes toward facility’s service. Talk with residents and staff to determine attitudes toward the facility’s service. Does the facility have a family counsel to provide it with input?

·         Grooming. A clear sign of neglect is failure to keep residents clean, well dressed, and well groomed.

·         Physical restraints. Nursing homes that have eliminated restraints also have improved quality of life and more social contact among residents. Ties, belts, vests, and high bed rails are an easy but unsatisfactory solution to managing residents. Count number of residents that are restrained; ask what percentage are restrained and why.

·         Food. Visit at meal time and sample the food to make sure it is palatable. The setting for meals should be attractive and pleasant, and food should be served at the proper temperature. Staff should be available to help residents who are not able to feed themselves. Review menus and determine the amount of concern for nutrition.

·         Activities. A wide variety of activities should be provided, and the participation level should be high. Bored residents in front of a television may be a sign of a home’s failure to stimulate its residents.

·         Dignity. Residents should be handled in ways that respect their dignity. For example, are residents properly clothed in public?

·         Bed sores. Bed sores are a sign of poor care. Review inspection reports and see if they are mentioned, or talk to residents or their families about this topic.

·         Special care units. Such units are often used as an expensive marketing device. The special care units may not be designed well and may indicate a lack of outdoor facilities.

5.   Review the facility’s policy on medical care. Will residents be seen by their personal doctors or by staff physicians? Does the home have good infection control and immunization plans? What sort of access to dentists and eye doctors is there?insurance-book9

6.   Perform financial analysis. The planner should gain a complete understanding of what the client’s and/or his or her family’s financial commitments are and how they will be met.

·         Determine the financial strength of the nursing home, particularly if client funds are to be advanced.

·         Consider a single lifetime payment in lieu of monthly rental payments.

·         Consider exclusions in contract. For example, nursing home insurance coverage should include loss of personal property and personal injury.

·         Determine what services the client will require, what is covered under the facility’s general fee, and what services are provided for an extra fee. Determine what the extra fee will be for each additional service that will be required. Family members should not agree to pay these charges because this could delay Medicaid funding.

·         Analyze pricing structure in general and what the pattern of increases in fees has been.

·         Determine residents’ rights in eviction proceedings for nonpayment of rent, in returning to nursing home after hospital stay, and in having Medicaid make payments on behalf of resident.

·         Determine residents’ rights to appeal decisions and what the appeal procedures are.

7.   Obtain and check references, including families of current residents, local hospitals, doctors, and government agencies, particularly the ombudsman at state departments for aging.

Assessment

What have we missed?

Conclusion

In any case, early planning is the key to supporting both your kids’ futures and your retirement. Making logical college funding decisions, rather than emotional ones, creates a win/win for everyone.

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Paradigm Shift to “Defined Health Contributions” from “Defined Health Benefits” Plans

What it is – How it Works

By Staff Reporters

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In the past, according to Robert James Cimasi MHA AVA CMP™ of Health Capital Consultants LLC in St. Louis MO, many employers had defined retirement benefits for employees. Today, most retirement benefits are in the form of 401K plans where companies make defined contributions, effectively shifting the financial risk of paying for retirement to employees.

Defined Health Contributions

Defined health contributions are similar to employer-funded defined retirement contributions like 401K plans. Currently, employers pay for some portion of about half of Americans’ health insurance. Traditional employer-funded plans are those for which the employee simply fills out a form; that is, an employer will offer one or possibly two health insurance plans, and the employee fills out application paperwork. The employer administers the plan and may charge the employee a portion of the monthly premium or pay the entire premium themselves. A defined contribution plan allows companies to shift the financial risk of paying for rising health insurance costs.

Defined Health Benefits

Although part of the “benefit” of a health benefit plan is that the employer also takes care of all the administrative paperwork related to the insurance, companies are increasingly uninvolved in the administration process, opting instead to let the employee decide which plan out of many choices suits them best. For example, if an employer typically spends about $5,000 per employee per year on health benefits, the employer would use that money as a “defined contribution.” The employee then has $5,000 to spend per year on benefits, but instead of using the employer-defined health plan, the employee may choose from a variety of HMOs, preferred provider organizations PPOs, or other health plans. If the insurance premiums rise above this amount, the employee must make up the difference.

dhimc-book24Defined Contribution Package

Many employers are currently offering a defined contribution package to their employees. The definition of “defined contributions,” however, can range from one in which employers are completely uninvolved in the administration of benefits and simply give their employees cash or vouchers for the amount contributed that they can use to buy coverage, to a more “defined choice model” where employers offer a variety of health options at differing price levels along with a premium dollar contribution, and a variety of other options in between.

Risk Shifting

Thus, defined contributions shift the financial risk from the employer to the employee. Defined care is not a replacement for managed care, but will probably cause managed care to adapt under these new systems. That is, HMOs, PPOs and other managed care plans still appear to be the main choices in a defined care environment, so they are in fact a part of the system.

Assessment

Another challenge with a defined health benefit program is that the concept of risk-pooling becomes more difficult. In traditional employer-sponsored plans, rates are usually based on the pool of employees; a chronically ill employee who tries to find insurance independently may face rates drastically higher than if they had participated in an employer-sponsored plan.

MORE: www.CertifiedMedicalPlanner.org

Conclusion

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The Gay Doctor Dilemma

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Understanding Domestic Partnership Problems

[By Staff Reporters]fp-book16

Legal Strangers

In spite of many changes to state laws and with a few exceptions, for all intents and purposes, unmarried physician couples are still considered strangers to one another. The unmarried partner has no right to make health care decisions, no right to Social Security survivor benefits, and no inheritance rights without proper documentation. An unmarried partner generally has no standing to seek damages for the “wrongful death” of a spouse, nor any standing for any other contractual rights.

Tax Treatment

Unmarried couples do not get the same tax treatment—such as the ability to file a joint tax return—as do married couples. While this may not necessarily mean higher taxes for married couples, it can make deductions difficult to determine for unmarried couples. Nor can an unmarried couple use the spousal Individual Retirement Account deductions for a nonworking spouse. An unmarried couple may not use a family partnership for tax purposes.

Non-Tax Benefits

Unmarried partners do not have the benefits that spouses have when a relationship ends or one partner dies. Domestic partners may not receive alimony or child support, except in special cases. A partner may not receive pension rights, and generally will not receive employer benefits, except in certain companies and municipalities. One partner who is forced to quit practice when the other partner is transferred may not receive unemployment benefits, while a spouse can. Unmarried partners may not qualify to get residency status for a non-citizen partner to avoid deportation.

Estates and Gift Problems

Estate tax law allows married couples an unlimited deduction for estate and gift tax purposes. Unmarried couples do not get this benefit, and may be taxed on what would otherwise be a tax-free transfer. If one partner dies intestate (without a will) the couple’s joint property would not necessarily go to the survivor. A married couple can give away $26,000 per recipient each year without gift tax consequences, but an unmarried individual with a high income is limited to $13,000, per recipient per year, even when living with a partner.

Personal Benefits

Domestic partners may be kept from visiting a partner in a prison or in the hospital or any other place restricted to “immediate family” members. Without specific legal permission, such as a durable power of attorney, the blood relatives of the partner who is ill can keep the domestic partner from seeing his or her mate. Except in a few municipalities and companies, domestic partners may not be eligible for bereavement leave when one partner dies.

Conclusion

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Asset Allocation Methods for Physician-Investors

What’s Old … is New Again?

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chiefdem23

Asset allocation policies, incorporating the risk/return fundamental equation, have traditionally been classified under the following approaches: Principal Stability and Income, Income, Income-Oriented, Balanced, Growth, and Aggressive Growth.

Traditional Concepts

In all forms of traditional asset allocation and diversification policy approaches, the physician-investor is presumed to diversify within the chosen asset class in order to reduce the potential for specific or unsystematic risk.

Principal stability and income approach

Objective: Income, liquidity, and stability of principal.

Investment: Shorter-term fixed income securities with a large concentration in money market exposure to enhance liquidity and price stability. Accounts tend to maintain cash equivalent reserve balance of 30–50% of the portfolio.

Income approach

Objective: Maximum income.

Investment: 100% fixed income exposure.

Income portfolios arise from the traditional notion that an investor should spend only income and reinvest capital gains. Sometimes this is a legal requirement, as in a trust that has an income beneficiary distinct from the principal beneficiary.

Income-oriented approach

Objective: Income and some capital growth.

Investment: Accounts tend to maintain 15–35% in equity investments; balance of investment in fixed income.

Income and growth approach

Objective: Capital growth and income using a balanced approach to limit volatility.

Investment:  Accounts tend to maintain 45–65% equity exposure; balance of investment in fixed income.

Income and growth portfolio policies generally refer to both the fixed income and equity portions of the portfolios. Because of the income bias, the overall stock portion of the portfolio will usually have a dividend yield greater than the market yield. This method allows the portfolio manager to invest in some no- or low-dividend yielding issues.

Growth approach

Objective: Capital growth with income as a secondary objective.

Investment: Accounts tend to maintain between 65%–85% equity exposure; balance of investment in fixed income, usually cash reserves.

Aggressive growth approach

Objective: Long-term capital growth.

Investment: Accounts maintain 100% equity exposure. Exposure to variety of equity types normal (small capitalization, international, emerging markets, etc).

fp-book15

Assessment Of course, the above is much more accurate during stable economic times, than it is today; don’t you think? Are newer concepts required today … or is past … prologue.

Link: https://healthcarefinancials.wordpress.com/2008/10/25/new-wave-thoughts-on-investing/

Conclusion

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Independent Medical Practitioner as Solo Primary Care Surrogate

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Doctors Facing a Bleak Future Business and Financial Planning Model

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem2

According to Physicians News, on March 19, 2009, the demand for family physicians is growing. Proposals for health system reform focus on increasing the number of primary care physicians in America. Yet, despite these trends, the number of future physicians who chose family medicine dipped this year, according to the 2009 National Resident Matching Program. What gives?

NRMP

The National Resident Matching Program [NRMP] recently announced that a total of 2,329 graduating medical students matched to family medicine training programs. This is a decrease in total student matches from 2008, when 2,404 family medicine residency positions were filled.

Primary Care Demand Explodes

Meanwhile, demand for primary care physicians continues to skyrocket. For example, in its most recent recruitment survey, Merritt Hawkins, a national physician recruiting company, reported primary care physician search assignments had more than doubled from 341 in 2003 to 848 last year. 

The Decline of Solo Medical Practitioners

Regular readers and subscribers to this Medical Executive- Post are aware of the declining number of solo medical practitioners; we have been sounding the alarm here, in our books, journal, speaking engagements and elsewhere for years now.dhimc-book4

In fact, the statistic that we often cite is that more than 40% of the nation’s physicians are employed doctors; not employers as in the past. This business model shift has occurred over the past decade or so, and has accelerated of late. The decline in solo and independent doctors has occurred elsewhere as well, but much more slowly [i.e., dentistry, podiatry and osteopathy] as these specialties have been somewhat isolated from the traditional allopathic mainstream.

Going forward, this solitary model seems to be a good thing, and a fortunate result of the un-intended consequence of previously keeping these folks out of the healthcare mainstream.

The Decline of Independent Medical Practitioners

Now, in the March 2009 issue of Healthcare Finance News, we learn that the number of hospital owned physician practices has been climbing over the last four years, according to the Medical Group Management Association [MGMA]. Think: PHOs back-in-the-day. ho-journal3

And, while this trend only marginally affects patients and patient care, it is quite disruptive to physicians, their families, personal wealth accumulation, retirement and estate planning endeavors.

For example, according to Professor Hope Rachel Hetico, RN, MHA, CMP™ of our firm www.MedicalBusinessAdvisors.com

“The professional good-will valuation component of a medical practice is being decimated. Today, some practices are being bought and sold for tangible asset value, only.

Assessment

Therefore, allow me to identify this emerging trend which suggests independent medical practice as reflective of solo primary medical care. In other words, as independence goes the way of the “dodo-bird”, so goes primary care practitioners precisely at a time when the later is needed more than the former.

Why? Employed doctors stay that way by making money for their employer and hospital-bosses. Specialists make more money than primary care doctors. So, if you want to stay an employed doctor; which specialty would you pursue?

Answer: The NRMP class this year spoke out loud and clear. Any specialty but primary care!

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Conclusion

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About Healthcare Employee Cash-Balance Plans

What they Are – How they Work

By Staff Reportershuman-drones

Motivated by cost savings, an increasing number of hospitals, healthcare systems and large healthcare organizations are converting their traditional legacy defined benefit pension plans to cash balance plans. While the trend seems sudden, it is not surprising. Healthcare related companies are reaping substantial savings from cash balance plans. And for the most part, younger doctors and other employees are enthusiastic about the plans.

However, older employees (age 50 or above) realize  that in switching from a traditional defined benefit [legacy] plan to a cash balance plan, their retirement benefits decreased, initiating an onslaught of overwhelmingly negative publicity. Indeed, several years ago, Congress rushed to pass legislation requiring employers to provide benefits computations to affected employees.

Overview

Even though many defined-benefit plans are under/over-funded, they are calculated on an actuarial basis and are quite costly to maintain. And because plan costs can vary from one year to the next, budgeting is difficult.

However, if a healthcare company terminates a pension plan, replacing it with a defined contribution plan such as a profit sharing plan, all employees must be 100% vested, any surplus is subject to income tax, and a portion of the surplus is subject to an additional excise tax even if all of it is transferred to a succession plan. A cash balance plan is a pension plan, so the change is viewed as an amendment to the pension plan. This is true even though in many respects the cash balance plan operates like a defined contribution plan.

The Cash Balance Planfp-book13

A cash balance plan works in the following manner: The sum accrued in a hospital’s employee’s defined benefit plan is converted to a lump sum cash value; the employer agrees to make specified contributions to the employee’s account based on compensation; and the account earns a specified rate of interest, say 5%. The employee receives regular statements showing the current cash value of his or her account. [The amount is listed as a lump sum amount even though it is usually paid as an annuity].

If the hospital or other employer already has a defined benefit pension plan and converts it to a cash balance plan, there is no tax on the surplus. The reason, as noted above, is that a cash balance plan is treated as a pension plan. Thus, the employer merely amended its pension plan and can use the existing surplus to provide the required contributions, which are usually less than the actuarial costs of maintaining a traditional pension plan. And, in the former bull market this recent decade, many employers did not have to make contributions at all. Today, of course, the opposite may be true.

Example

Let’s say the average earnings on an investment is 15%, and the rate of interest payable to the plan is 5%. In recent years, many funds have earned 15% or more if they invested in an index fund. It was thought that, if continued, it would be quite some time before some employers are required to make any contributions out of their own funds. Not so today, however.

Clearly, the savings can be substantial, and the costs of maintaining the plan are easily budgeted for. These advantages convinced some public utilities, telephone companies, financial, hospitals and healthcare institutions to convert their plans to cash balance plans.  

Impact on Employees

The cash balance plan is actually a hybrid plan—a cross between a traditional defined benefit pension plan and a defined contribution plan. But one of the key differences between the cash balance plan and a defined benefit plan is the manner in which the benefits are calculated. In a traditional defined benefit plan, an employee’s retirement benefit grows slowly in the early years and more rapidly as he or she approaches retirement. By contrast, a cash balance plan increases growth in the early years and decreases growth in later years of employment.

Youngsters

Younger healthcare employees usually liked the change; before the recent financial meltdown. Their accounts were portable; they grew quickly; and could be rolled over into an IRA or into a new employer’s plan. And, their account balances were listed as lump sums, so they know precisely how much they’ve accumulated. Today unfortunately, they have mostly been decimated.

Oldsters

Older healthcare employees initially liked the concept because the values of their pensions (on an actuarial basis) were converted to dollar amounts so they could see how much had accrued in their accounts without having to calculate an anticipated pension award. But, after further review, it was evident that upon retirement the cash bonus plans would yield smaller pensions than the defined benefit plans. Opinions differ today?

Health Workers in the Middle

When a hospital or similar entity converts from a defined benefit plan to a cash balance plan, employees their late 40s may see their pensions reduced by 25% or more while older employees see reductions of up to 50%. If the formula for calculating benefits under the defined benefit plan is 2% times years of service, and high-five compensation, then each year of service increases an employee’s pension. More importantly each time high-five compensation increases, the amount is accrued back to the employee’s original date of employment. So, as a hospital employee gets older, the high five-has tremendous impact. An employee who is age 60 can actually accrue most of his or her pension in the last five years of employment.

www.HealthDictionarySeries.com

dhimc-book5

No “Mo”

Cash balance plans don’t have that type of momentum [“Mo”]. The company contributes a certain amount based upon compensation and a specified interest rate. Usually, the interest rate is based on the 30-year treasury rate (approximately 2.5%).

Closing the Gap

Some employers are offering a grandfathered benefit designed to reverse the penalty for older workers. For example, employees within 10 years of retirement (usually age 65) will receive the greater of the cash balance plan or the pension under the original plan. This reduces the cost savings for the company.

Some employers increase the contribution percentage for employees based on age (i.e., 7% of compensation is contributed for employees aged 40—rather than the standard 5%—and 9% of compensation for those aged 50).

Assessment

Finally, some hospital employees are offered special “sweetners” in the form of additional lump sum credits when converting from an existing plan to a cash plan. The best benefit provides that all existing employees will receive the greater of the old plan or the new plan upon retirement. Only a small number of employers typically adopt this approach.

Conclusion

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Integrating Financial and Medical Practice Succession Planning

Some Steps to Consider

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dr-david-marcinko8

Medical practice succession planning is a dynamic process requiring current physician ownership and management to plan for the future and implement the resulting plan. Many doctors approach succession planning initially through retirement planning. Once they understand the issues and realities of the tax laws, they are much more amenable to working out a viable succession plan. At the Institute of Medical Business Advisors Inc, we find that some physician-clients have not clearly articulated their goals, but have many pieces of the plan that need to be organized and analyzed to meet their objectives; including both personal and financial issues.

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A Step Wise Process

The steps necessary for successful succession planning are as follows: 

  • Gathering and analyzing data and personal information
  • Contacting the doctor’s other advisors
  • Valuing the practice according to USPAP and IRS guidelines
  • Indentifying the right qualified physician purchaser
  • Projecting estate and transfer taxes
  • Presenting liquidity needs
  • Gathering additional corporate information
  • Identifying dispositive and financial goals
  • Analyzing the needs and desires of non-key employees

An Integrated Approach 

Succession planning can help address financial and nonfinancial issues in a timely manner. Proper planning can also help the doctor accomplish goals with effective, appropriate strategies that satisfy family needs as well as tax issues. Here is a triad approach:

1. First: Address financial and nonfinancial issues in a timely manner

As with other estate planning engagements, there is no due date for succession planning. The owner of a medical practice is busy growing and managing the office. S/he is often not focused on the desirable outcomes in an orderly practice succession. For example, if family members are involved in the practice, there is a good chance that personal issues will need to be addressed. These nonfinancial issues can be just as important as financial concerns when building a comprehensive, workable succession plan.

2. Next: Focus on taxes

Taxes are important because the medical practice probably represents the largest concentration of wealth in the doctor’s estate. When planning for estates with large amounts of wealth, doctors frequently ignore personal issues. It’s important not to make the critical error of maximizing tax savings but destroying the practice through a poor succession plan.

3. Finally: Identify and reach goals

When the physician-owner has addressed succession planning issues in a timely manner, s/he has the opportunity to develop the most effective objectives to accomplish goals. Given enough time, the doctor can even modify goals to reflect changes in the economic environments, as well changes in his or her personal life.

Assessment 

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Medical practices exhibit particular strengths and weaknesses not typically found in publicly owned companies or non-professional family businesses. For example, many times the doctor doesn’t realize the type and amount of planning that needs to be done to transfer the business to a new doctor for maximum value. That is why doctors often need the advice of professionals to define goals and formulate medical practice succession strategies.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Product DetailsProduct DetailsProduct Details

Understanding Life Insurance Sales Compensation

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How Agents and Brokers are Paid for Selling Policies

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

[ME-P Publisher-in-Chief and Managing Editor]dave-and-hope1

The recent AIG, and related insurance debacles, have prompted several of our cost-conscience doctor clients to rethink insurance agent sales commissions and related perks.  We trust this brief review is helpful to all concerned.

Life insurance company agents

Life insurance agents are appointed by the insurer with the authorization to solicit and deliver contracts of insurance. The agent’s power under life insurance is more limited than that of a property and casualty agent because an agent cannot bind a life insurance carrier to an individual risk, as opposed to a property and casualty agent who can bind his or her insurance company.

Agent Commissions

Agents are compensated primarily on a commission basis from the insurance company they represent. Compensation is higher for the first year a policy is in force. Thereafter, the agent may receive compensation for renewal—a percentage of the annual premiums—and much smaller compensation during subsequent years. If the agent achieves a certain level of production, the agent may receive additional bonuses or other types of compensation. Think: Million Dollar Round Table; or Million Dollar Club Producer.

Commission Rates

Commissions for agents typically run 50% to 55% on cash value products and 40% on term products. Agents’ commissions generally are lower than brokers because they are housed by the insurer, and therefore most of the agents’ expenses are reimbursed or paid by the insurance company.

The Fringe Benefits

The agent also receives fringe benefits from the company, such as health insurance, life insurance, disability insurance, a retirement plan, or a cafeteria-type plan. Usually, agents must maintain a specified level of first-year commissions in order to continue employment with the company.

fp-book6

Life Insurance Brokers

A broker represents the client directly and can show illustrations from many different companies because theoretically there is no allegiance to any one particular company.

Dual Agent-Managers

Some brokers who may act both as general agents and agency managers (individuals who oversee an office of insurance representatives) usually earn commissions as stated above and overrides on first-year premiums to as much as 40%. There is a separate scale on renewals from the sales staff. These overrides are in addition to basic commissions earned either through the broker selling a product on his or her own or as manager of the office. In addition, brokers may earn subsidies for their office and production bonuses.

insurance-book4

Assessment

One advantage that life insurance agents have is that some direct writing companies employ only agents to represent them and sell their products. A broker may not have access to sell certain lines of companies that an agent does.

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

Conclusion

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2009 HCG Medical Staff Salary Survey

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The Health Care Group

[By Cheryl Sprows]salary-survey

Personnel costs continue to be the highest expense item for most medical, dental and other practices.

The Health Care Group’s® 2009 Staff Salary Survey is designed to help you structure an effective staff compensation package that will benefit your medical practice or clinic.

Published annually, the 2009 Staff Salary Survey provides salary and fringe benefit information for 38 different job positions:

  • Compare the salaries your practice is paying its staff members.
  • Establish salary classes.
  • Learn the market rate of pay for new hires. 
  • Evaluate your practice’s benefit package.

To make the search for location-specific information easier, the summary reports for each position are organized by Geographic Region and Metropolitan Statistical Area. They are also presented by Practice Specialty and by Practice Gross Revenue.

Link: www.healthcaregroup.com

Multi Use Potential

The information in the Staff Salary Survey can be put to a wide range of uses, such as comparing your practice’s salary amounts and benefits to the national and regional averages in the Survey. These data are also vital to benchmarking salary and pay-related expenses in a medical, dental or other practice.

Economic Trend Analysis

Data can also be used for trend analysis. Despite tightening reimbursements and continuing overall economic stagnation in health care, practices still need to reward good workers by giving raises to employees who warrant them. A productive and motivated staff is a practice’s best investment. Some practices recognize the need to raise salaries higher than the “average” increase. Because it is a “seller’s market” with respect to qualified and experienced employees in many regions of the country, both initial salaries and annual increases may need to be higher to attract and retain staff.

Fringe Benefits

Medical, dental and other practices continue to provide good fringe benefits for full-time and regular part-time employees. With so many practices needing a mix of full-time and part-time employees, providing benefits to regularly scheduled part-time staff is essential.

Assessment

Personnel costs continue to be a significant expense item for most practices. The Health Care Group’s 2009 Staff Salary Survey is designed to help you structure an effective and fair staff compensation package that will benefit your practice and employees. Click below to view the Table of Contents for the 2009 Staff Salary Survey:

Link: http://thehealthcaregroup.com/TOC/2009SSSTOC.pdf

To Order

Choose one of the following methods to order the 2009 Staff Salary Survey:

1. Online: direct link

https://www.thehealthcaregroup.com/pc-18-4-staff-salary-survey.aspx

2. Telephone: (800) 473-0032, extension 3350 (have your credit card information available)

3. Mail: Send completed Publication Order Form to:

THE HEALTH CARE GROUP
140 W. Germantown Pike, Suite 200
Plymouth Meeting, PA 19462-1421

4. Fax: Fax completed Publication Order Form to: (610) 828-3658

Click below link to view and print Publication Order Form for mail and fax orders.

https://www.thehealthcaregroup.com/temp/2009PubOrderformFeb2009.pdf

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Physician Retirement Threats and Opportunities

Investing Vehicle Updates for Modernity

By Steven Podnos; MD, MBA, CFP®

coins

Most physicians count on their retirement plans for the bulk of their financial security. Yet, few of us understand the intricate workings of these plans, and are therefore misled or at the least miss out on a number of cost savings and benefits. Here are some examples to consider, especially during this time of financial upheaval:

1. Jim L, an endocrinologist in private practice, works with his wife as office manager and has four other employees.  Jim had a “free” prototype profit sharing plan with a well known brokerage and has been putting 15% of his total employee compensation away every year in order to fund about $35,000 dollars a year into his own plan.  He pays his wife $60,000 dollars a year in order to get a $9,000 dollar annual contribution for her, but at a social security cost of the same $9,000 dollars.  His plan is invested in a variety of “loaded” mutual funds and stocks at the brokerage, and he was not really sure how it was doing in terms of performance.

Change:

The plan was changed to a customized 401k/profit sharing plan using a Third Party Administrator at a cost of 2500 dollars.  Jim’s wife lowered her salary to $20,000 dollars, which saved over $5,000 dollars a year in social security taxes.  Yet Jim and his wife were now able to contribute over $65,000 dollars in pretax money (rather than $44,000 dollars in prior years.  His employee cost for the plan dropped from 15% of a $100,000dollar payroll to 6%, another annual savings of $9,000 dollars. 

2. Statewide Healthcare medical group had an insurance based “retirement” plan.  All of the investments allowed were wrapped in variable annuity/insurance wrappers with an annual expense ratio of between 2 and 4% annually. The plan was “free” to the group but did not allow any differentiation in benefits or contributions between the physicians and their employees

Change:

An unbundled 401k/profit sharing plan was designed that allowed physicians to contribute the maximum in salary deferral and profit sharing contributions. Using an age-weighted contribution formula, the physicians were able to put away 14% of their salary in the profit sharing plan as compared with a 5% contribution for employees.  The new investment portfolios carried an annual cost well below 1% annually and were actively monitored by a fee only fiduciary advisor, mostly relieving the group from the fiduciary responsibility for the fund investments.

3. Kirk L, an orthopedic surgeon employed his wife and 5 employees in a busy practice.  He is 55 years of age and looking towards retirement in ten years.  He had a reasonably well designed 401k/profit sharing plan advisor which let him and his wife put away about 70-75 thousand dollars a year with an employee cost of about 15 thousand dollars. He was beginning to worry about not having enough savings to make his retirement goal.

Change:

Kirk and two of his younger employees were switched to a new Defined Benefit plan, but also continued in the 401k salary deferral plan. Kirk’s wife and the remaining employees stayed in the old plan and his wife’s salary was reduced to lower Social Security costs.  With the new plan, Kirk and his wife are now putting away about $200,000 dollars in pretax contributions annually at a marginally higher cost for the employees.

Poorly Designed Retirement Plans

None of these stories are unusual, in fact they are typical.  Most physician retirement plans are poorly designed, expensive and misunderstood.  Few existing plans are updated to capture the many positive changes made in tax law over the last decade.  Many plans are shoddily designed to catch the “quick” dollar, with financially terrible consequences to the physicians.

Qualified Plans

And so, I’ll review the most common types of retirement plans available to medical practices and discuss the pros, cons and specific opportunities each type for most practices. Note that most of these plans are considered “qualified” plans by the US Government.  Being qualified means that contributions to the plans are allowed to be deducted as business expenses and that the plan assets are generally protected from creditors.  In exchange, the government requires extensive paperwork and mandatory contributions for employees on the lower end of the salary scale. 

1. SEP-IRA

The SEP-IRA allows a fixed percentage of salary (up to 25% of W2 income) to be contributed to individual IRAs of most employees (including the physicians). There can be no discrimination in what percentage of compensation is used between owner/managers and lower paid employees, making this a relatively expensive plan in terms of employee funding. There is no component of salary deferral by employees, and all plan funding is immediately “vested” (belongs to the employee immediately if they leave employment).

The advantages of the SEP plan include a minimum of paperwork and ease of setup. Generally, SEP-IRA plans are used by small family owned businesses with few to no outside employees. It does work well for physicians that act as Independent Contractors (no employees) such as many Emergency Room physicians.  However, an individual contractor with an income of less than around $170,000 dollars can actually put more pre-tax money away in a Self-Employed 401k plan.

2. SIMPLE-IRA

This plan is another relatively easy one to set up and administer. It allows companies that have less than 100 employees to open individual IRA accounts for employees. The employees may defer salary in amounts of $10,500-$13,000 (depending on age), and the employer supplies a “match.” All money in the plan is immediately vested. The match is generally (but not always) a dollar for dollar matching contribution of up to 3% of the employee’s compensation.

For example, a company owner with a compensation of 100,000 dollars would be able to defer salary in an amount of up to $13,000 (if age 50 or older), and then have the company “match” 3% or $3,000 more. A SIMPLE IRA plan is a good choice for small businesses in which the owners are highly compensated, and few employees wish to defer salary. The disadvantages of the SIMPLE-IRA are immediate vesting for the matched funds, and relatively low total amounts of contributions compared to other qualified plans. 

NOTE:

I have seen these plans work well in small practices that wish to avoid paperwork, have few to no employees that wish to defer salary, and who don’t mind the limited ability to make contributions.  Note one unusual feature of this plan, in that the 3% match has no limits. I have seen one physician with a small group of employees and an income of $600,000 dollars per year put away 13,000 in salary deferrals and another ($600K X 3%) 18K in the match at no employee cost!

3. 401k/PROFIT SHARING PLAN

This is by far the most common type of qualified plan in existence.  These plans actually have three components:

 

a)       401k salary deferral-In 2008, employees may defer between 15,500 and 20,500 dollars. This money and earnings on it are not subject to Federal income tax until withdrawn in retirement, and are immediately vested.

b)       A “match”-this is an optional part of the plan in which an employer may offer to contribute a matching amount of dollars to give employees an incentive to participate.  Matching funds are usually subject to vesting on a time schedule.

c)       Profit sharing-like the match, this is a discretionary contribution by the employer of up to 25% of payroll and usually subject to vesting.

 

It is crucial to have a skilled plan designer customize a 401K plan for your individual practice.  The most common abuse of these plans is the use of “cookie cutter” prototype plans used by brokerages and insurance companies. These prototype plans are for the convenience and profit of the person “selling” the plan, and are a solid negative for the practice. Customization allows the physicians to have maximal participation at the lowest employee cost.

There is also a self employed 401k option for small practices that have no full time employees other than the physician and spouse. They operate in much the same way, but with little expense and much less paperwork.

4. DEFINED BENEFIT PLAN

Once common, these plans are now rarely used by most companies. They are based completely on company contributions to a fund (no salary deferral) that are actuarially designed to produce a set benefit amount at retirement. All the risk for providing the promised benefit is the responsibility of the employer, which is an advantage when the major beneficiary is the physician. Defined Benefit plans work best for practices in which the physician/employee ratio is low and the physician(s) is approaching age 50 or older. The advantage of this plan is allowing much higher contributions on a pretax basis, with the disadvantage of higher administrative costs. These plans work extremely well for high income businesses employing one individual (plus or minus a spouse) who is nearing age 50 or over. However, physician practices that employ a spouse or physicians of different ages can often use a Defined Benefit Plan in conjunction with a 401k/profit sharing plan to great benefit as in example three.

Assessment

Doctors have a tremendous opportunity to review and enhance the retirement plan options. Although the article focuses on these medical professionals and related occupations, much of the material applies to other professional and business clients.  A relationship with a good Third Party Administrator [TPA] and some independent study are invaluable to your ability to perform this function well.

Conclusion

Dr. Podnos is a fee-only financial planner and the author of “Building and Preserving Your Wealth, A Practical Guide to Financial Planning for Affluent Investors” (available at Amazon.com and bookstores). He can be reached at Steven@wealthcarellc.com And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Recent Elder Housing Updates

Legal Protections, Home Equity Resources and Housing Options

By Staff Reporters

insurance-book1

Recently, significant updates and expanded coverage of the housing market for the elderly has occurred. Several items include efforts to protect consumers, and senior medical professionals, from current difficulties in the housing market. For example, these include the following three updates:

1. FINRA on Reverse Mortgages

An alert issued by the Financial Industry National Regulatory Authority (FINRA), warns that:

“as more Americans near retirement age, some financial institutions are aggressively marketing reverse mortgages as an easy, cost-free way for retirees to finance lifestyles – or to pay for risky investments  that can jeopardize their financial futures.” 

FINRA’s position is that such vehicles should be used only as a last resort.

2. HECM on Primary Residences

The Home Equity Conversion Mortgage Demonstration (HECM) program, which was first authorized by Congress in 1987, helps elderly homeowners meet their financial needs and provides borrowers with insurance against lender default. Now, homeowners can also use a HECM to purchase a primary residence if they are able to use cash on hand to pay the difference between the HECM proceeds and the sales price plus closing costs for the property they are purchasing.

3. ERA Home-Keeper Program

As a result of the passage of the Housing and Economic Recovery Act of 2008, Fannie Mae announced the discontinuance of its Home Keeper reverse mortgage program, effective as of December 31, 2008.  Some state programs encourage the use of reverse mortgages, in contrast to federal warnings, as a financial tool to help elderly homeowners pay for home and community services so they can “age in place.”

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated, as we follow-up our four part series on: At Home or Nursing Home Care for Long Term Care. Comments from physicians and LTC insurance agents are especially valued.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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America’s Safest Hospitals

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[Behind the Numbers]

[By Staff Reporters]56382989

Did you know that at Missouri Baptist Medical Center in St. Louis, it only takes 90 seconds to save a life? While all hospitals keep staff on-call for emergencies, Missouri Baptist has implemented a rapid response program through which anyone, even family members, can call a team of clinicians to the bedside of a distressed patient within 90 seconds.

An Idea from Down-Under

As seen in Forbes, January 27, 2009, Missouri Baptist imported the idea from Australia, with an overall emphasis on safety that is evident not only in its innovative programs, but also in its numbers.

The Internal Data

According to reported internal data, only 48% of patients die as would be expected given their diagnoses. With outcomes like these, it’s no surprise that Missouri Baptist was designated by HealthGrades, a private hospital rating company in Golden, Colo., as one of the safest in the country. In its seventh annual study of “quality and clinical excellence”, known as Behind the Numbers, HealthGrades identified 270 hospitals out of 5,000 that collectively had a 28% lower mortality rate and 8% lower complication rate than the national average. The list reflects the top 5% of hospitals nationwide.

About HealthGrades

The HealthGrades [NASDAQ: HGRD] site promotes the firm as a leading healthcare ratings organization, providing ranking and profiles of hospitals, nursing homes and physicians to consumers, corporations, health plans and other hospitals. Millions of consumers and hundreds of the nation’s largest employers, health plans and hospitals rely on HealthGrades’ independent ratings, consulting and products to make healthcare decisions based on the quality of care. Founded in 1999, the firm has over 160 employees www.HealthGrades.com

Assessment

Now, what ever happened to governmental reporting, the Joint Commission, etc? Of course, after the IOM Report on Crossing the Quality Chasm in 2001, this type of service may be more important than ever.

Link: quality-chasm3

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Healthcare and the Recession

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Physician and Hospital Pricing Pressure

[By Staff Reporters]life-preserver

As reported in Modern Physician Online, by Dan Bowman, new metadata coming from the federal government suggests that the current financial meltdown and domestic recession has impacted hospital and physician charges, as implicated by their revenues.

USBLS on Physician Charges

According to data from the US Bureau of Labor Statistics [USBLS], retail prices charged by doctors rose 2.9 percent in 2008, compared with 4.1 percent the year before. Wholesale prices for physicians were up 1.2 percent last year, compared with 4 percent in 2007.

USBLS on Hospital Charges

Hospitals meanwhile, were up 5.9 percent in 2008, compared with 8.3 percent the year before. Wholesale prices for hospital services, for their part, were up 1.5 percent last year, falling from a 3.8 percent increase in 2007.

Assessment

Link: www.ModernHealthcare.com

Conclusion

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Hospice Care Flourishing

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Varying Program Types

[By Dr. David Edward Marcinko; MBA, CPHQ™, CMP™]

[By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP®, CMP™]

[By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™]dhimc-book3

According to the “Dictionary of Health Insurance and Managed Care”, hospices offer custodial and health care for terminally ill people with six months or so, to live. 

In and Out-patient Programs Available

While most hospice care can be provided at the patient’s home, there are inpatient care programs at some nursing homes depending on the circumstances of the patient. Hospice services are palliative and supportive.

Payment

Hospices are usually paid by Medicare or Medicaid.

Assessment

35.5% of Patients Receiving Hospice Care in The U.S. Stayed Less Than 7 Days.‏

Conclusion

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The Total Return Trust

Uniform Prudent Investment Standards

ho-journal11

By Dr. David Edward Marcinko; MBA, CMP™

By Tom Muldowney; MSFS, CFP®, AIF®, CMP™

By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™

The physician-investor dichotomy, income now versus growth for later, is not unique. Trusts; that have the potential to span decades, usually place the interests of the income beneficiary at odds with the remaindermen.

Conflicting Goals

Historically, trustees invested these irrevocable trust assets in bonds so as to generate the necessary income for the income beneficiary.  But this led to conflicts…investing in bonds provides little growth of either the investment asset base or the income generated thereon.  Interestingly, this has also placed the interests of the remaindermen at odds not only with the income beneficiary but with the trustees who have been charged with the duty of stewarding these assets for the benefit of both generations.  This conflict of the generations has led to some surprising results both in practice and in the courts.

“Total Return Trust”

Income beneficiaries want current cash flow, remaindermen want growth and trustees want to minimize the exposure to liability.  Notice the subtle difference … rather than “income” (dividends and interest) income beneficiaries want cash flow. They generally do not care about the source from which the cash flow was generated. Recognition of this subtle but important difference has led to the development of Uniform Prudent Investment Standards and the introduction of the “Total Return Trust.”

Uniform Prudent Investment Standards

The Uniform Prudent Investment Standards (agreed upon by legislatures of all 50 states) identify that for a trustee to be a “prudent investor”, investments that are allocated across a broad spectrum of investment asset classes, provides the greatest protection from investment risk. But; because this allocation across a broad spectrum must – by definition – include stocks, the potential for income in its technical sense (interest and dividends) must be reduced. The use of a “Total Return Trust” addresses and solves this problem.

Combination of Assets

A total return trust thus allows a trustee to manage a portfolio of assets commensurate only with the volatility risk that the trustee identifies is appropriate for the trust.  This gives the trustee the ability to invest in a combination of assets that include stocks, bonds and other investment assets.  The purpose of the total return trust includes safety and protection of the assets with a reasonable growth rate, from which a periodic ‘unitrust’ cash flow may be withdrawn for the income beneficiary.  Unitrust cash flow is based on the recognition that a stated percentage withdrawal from trust corpus, each year, may be made to the income beneficiary without regards to the source of that cash flow, whether it be from income, or from corpus. The Unitrust cash flow recognizes that from time to time volatility in the equity marketplace will cause the trust corpus to fluctuate, sometime below that amount that was originally invested.

Cash Flows

Using this technique, as long as assets of the trust portfolio grow and the long term cash flow withdrawal rate is less than the long term growth rate, several benefits to all of the parties will inure: Cash flow to the income beneficiary will be maintained; cash flow to the income beneficiary will  increase as the asset base increases;  asset growth will satisfy the needs of the remaindermen; the trustee will be secure in knowing that he has satisfied his fiduciary duty to serve both the income beneficiary and the remaindermen.  A substantial side benefit for the income beneficiary is that the cash flow will include not only income (dividends and interest) but will also include distributions of long term capital gains (which enjoy a lower annual tax rate.)

MORE:

https://www.crcpress.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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Re-formatting an Irrevocable Trust

UPIS and the Passage of Timecycle-of-life-2

By Dr. David Edward Marcinko; MBA, CMP™

By Tom Muldowney; MSFS, CFP®, AIF®, CMP™

By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™

Many trusts, written long ago for physicians, were established when interest rates were substantially higher, certainly higher than they are today. The passage of time and the re-call or maturity of those higher yielding bonds have left bond investors scouring the investment field for anything that will produce a decent income flow … Short of taking a lot of bond risk, they are found lacking.  Thus, these old ‘irrevocable’ income trusts face substantial hurdles in generating the necessary income flow for the income beneficiary and the necessary growth for the remaindermen.

Uniform Prudent Investment Standards [UPIS]

With the acceptance of the Uniform Prudent Investment Standards, many of the several states simultneously implemented trust standards that allow beneficiaries/remaindermen and trustees to request the ‘re-formation’ of these trusts from “Income’ trusts to “total return” trusts on (at least) a statutory basis. By ‘statutory basis’-  we mean that the trustee can reformat the trust and begin making cash flow payments made from total return. This ‘re-formation’ process minimizes or eliminates the problem of ‘income for the beneficiary’ versus ‘growth for the remaindermen.’

Available QTIP Election

How, then, can a physician-investor evaluate a situation in which a QTIP election is available?

The matters to be weighed will include the age and health of the surviving spouse; the projected size of the surviving spouse’s gross estate with and without the inclusion of the QTIP trust corpus; the amount of available unified credit; whether the decedent’s trust includes any precatory language that is intended to guide the trustee in balancing the rights of the surviving spouse with the rights of the trust remaindermen (‘precatory’ language is to provide guidance only…it does not have the force of law) for example, language allowing the trustee to favor the lifetime income beneficiary when making investment decisions); the amount of income that the surviving spouse needs or wants to have generated from the QTIP trust; the relationship between the surviving spouse and the remainderman of the trust (particularly as that relates to the amount of income that the surviving spouse would like to have generated by the QTIP trust and the pressure that would be put on the fiduciary to generate such income); and the likely asset allocation decisions that the trustee would make under the circumstances, given that there is not a single formula that must be applied but that a range of decisions probably are appropriate as the bank or trustee seeks to fulfill its fiduciary duties. In any event, when the long-term view is taken, the most appropriate QTIP election to make is a difficult decision and is best determined by examining a range of alternative outcomes for both the surviving spouse and the remainderman.

Assessment

Of course, this decision is easier if both spouses die before the estate tax return for the spouse who died has been filed (but not all participants are so willing to cooperate.) It has been suggested that with every case, to file an extension of time request for filing the estate tax return in order to delay making the election until the latest possible date.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. 

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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