How an Aesthetic Medicine Physician Built a Tax Strategy Around a Growing Practice and Positioned for $15K–$25K in Annual Savings

The Challenge: A New Self-Employed Practice Without a Tax Strategy to Match

Dr. Solenko had built a thriving aesthetic medicine practice, delivering care through her own clinic and as a contracted provider across several telehealth platforms. The shift to fully self-employed income, however, surfaced gaps that a standard return preparer wasn't positioned to close:

• Full exposure to self-employment tax. With income flowing entirely through 1099 work and her PLLC, every dollar of profit was now subject to the 15.3% self-employment tax.
• Charitable giving left on the table. The household gave roughly $15K a year in cash, missing the larger benefit available through more deliberate structuring.
• Untapped business deductions. Retirement, health insurance, and home office deductions available to a practice owner weren't being captured.
• Multi-state complexity. Work performed across state lines created a filing requirement and double-taxation risk without proper coordination.
• Compliance without forward planning. Prior filings were accurate but reactive, with no strategy designed around the new self-employed structure.

Without a plan built for the new model, the practice would keep overpaying on self-employment tax and forgoing deductions available to it every year.

Gelt's Strategic Approach: A Strategy Built Around the Practice

Gelt began with a full diagnostic of both the practice and the household, then layered strategies so each one reinforced the next rather than chasing a single deduction.

S-Corp Election, Timed to the Income

The centerpiece is an S-Corp election for the PLLC, which lets Dr. Solenko take a reasonable salary and treat the remaining profit as a distribution outside self-employment tax. Rather than electing reflexively, Gelt modeled the threshold at which the savings clearly outweigh the added cost and complexity, and positioned the election to take effect once income reliably clears that line, projecting roughly $15K in annual self-employment tax savings at the practice's income level.

Charitable Giving Through a Donor-Advised Fund

For a household giving consistently each year, Gelt recommended a donor-advised fund funded with appreciated stock rather than cash. This approach captures an immediate deduction while sidestepping capital gains on the appreciation, turning existing generosity into a more efficient tax outcome.

Retirement and Owner Deductions

Gelt designed a path toward a Solo 401(k), which offers dramatically higher contribution room than a personal IRA once the practice structure supports it. Alongside it, the firm captured the self-employed health insurance deduction and a properly documented home office deduction, both available to the practice but previously unused.

Multi-State and Cash Flow Coordination

Gelt coordinated the resident and non-resident state filings to claim the credit that prevents the same income from being taxed twice, and set up clean bookkeeping for the practice to support every deduction with documentation.

Results & Implementation Roadmap

Immediate (0–60 Days)

• Establish the PLLC's EIN and align contractor paperwork
• Stand up dedicated bookkeeping for the practice
• Coordinate resident and non-resident state filings to avoid double taxation

90–120 Days

• Capture home office, health insurance, and retirement deductions for the current year
• Open and fund a donor-advised fund with appreciated stock

Ongoing Strategy

• Revisit the S-Corp election against year-end income to confirm timing
• Layer in a Solo 401(k) as the practice structure matures
• Build long-term, tax-advantaged savings for the children

Together, the S-Corp planning, donor-advised fund, and owner-level deductions are projected to generate roughly $15,000–$25,000 in annual savings once fully implemented, with the structure designed to scale as the practice grows.

Client Testimonial

“Going fully out on my own was exciting and a little overwhelming on the tax side. Gelt turned it into a clear plan, what to do now, what to set up next, and why each piece mattered. I finally feel like my taxes are working with the practice instead of against it.”
— Dr. Mara Solenko, Founder, Lumen Aesthetics PLLC

Conclusion

Dr. Solenko's case reflects a turning point many practice owners reach: the move to self-employment unlocks real tax opportunities, but only with a structure built to capture them. By pairing well-timed entity planning with deductions and giving strategies designed around the practice, the firm helped convert a new and uncertain situation into a confident, repeatable plan, the kind of foundation a growing practice can build on for years.