The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding in COVID-19 relief available to healthcare providers. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses due to the pandemic.

Provider Relief Fund Phase 4 payments will be based on lost revenues and expenditures between July 1, 2020, and March 31, 2021. In line with a Biden-Harris Administration commitment to supporting providers with greater needs, the PRF Phase 4 funding will reimburse smaller providers for their lost revenues and COVID-19 expenses at a higher rate than larger providers. PRF Phase 4 will also include bonus payments for providers who serve Medicaid, CHIP, and/or Medicare patients. According to the HHS, these bonus payments will be issued at the generally higher Medicare rates “to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.”

Similarly, HRSA will make ARP rural payments to providers based on the amount of Medicaid, CHIP, and/or Medicare services they provide to patients who live in rural areas, HHS noted in its September 10 release.

“In order to expedite and streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application,” the HHS release noted. “HRSA will use existing Medicaid, CHIP, and Medicare claims data in calculating payments. The application portal will open on September 29, 2021.”

In addition, HHS announced a “final” 60-day grace period for providers who fail to meet the September 30, 2021 deadline for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period do not change, “HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during the grace period.”

“We are staying abreast of developments and keeping our clients up to date, even as we await more information from HHS on these newly announced relief measures,” noted Michael DeLuca, director of HBK Healthcare Solutions. “We have worked with our healthcare practices and facilities throughout the pandemic, on their Paycheck Protection Program applications and reporting, their Employee Retention Credits filings, their access to various HHS relief programs, and their daily operational and financial challenges that have been exacerbated by the pandemic. We will remain steadfast in our commitment to serving our healthcare clients as they address the unprecedented and ongoing pandemic-related challenges.”

The year 2020 might be behind us, but the pandemic rages on, as does the flurry of legislation aimed at providing relief for affected businesses, including and sometimes specifically for physician practices. As we embark on what hopefully proves a year characterized by a return to some degree of operations normalcy, consider these five keys to your 2021 financial performance:

1. Strong financial position. Through a combination of government relief funds and austerity measures, physician practices generally were able to survive 2020, rebounding in terms of patient counts and strengthening their balance sheets as the year came to an end. Now, maintaining a strong financial position will be key to having the flexibility to keep your practice on solid footing for the long-term. That will include staying abreast of any reimbursement changes, any new government relief programs, and prudent provider cash flow management.


2. Revenue cycle management. At the beginning of December 2020, the Centers for Medicare and Medicaid Services (CMS) cut the CY 2021 PFS conversion factor by over 10 percent and provided significant changes in reimbursements to E&M visit codes and telemedicine services, to name a couple. Then with the passage of the Consolidated Appropriations Act (CAA) on December 27, the conversion factor was increased 3.75 percent, sequestration was suspended through March 31, 2021, the Geographic Practice Cost Index floor was reinstated through CY 2023, and implementation of the complex add-on E&M service code was delayed until CY 2024. Given the flutter of substantial changes in such a short period of time, now may be a good time to conduct a full coding review of your practice. Such a review is a good starting point for heightening your attention to detail with emphasis on your RCM operations and ensuring your coding, billing, and collection processes result in efficient and maximum reimbursement.


3. PPP: rounds one and two. Practices that received the Paycheck Protection Program (PPP) loans in 2020 and have not yet applied for loan forgiveness should work with their financial institutions to do so as soon as possible. Filing should be less cumbersome now as the thresholds for qualifying for the simplified forgiveness process have been raised to loans of up to $150,000. Most notably with the passage of the CAA, expenses incurred on forgiven amounts are now tax-deductible—with no basis consequences to shareholders or partners.
   
   To qualify for a second round Payment Protection Program loan, you have to have received and used—or will use—the funds from a first-round loan. As well, the business must have no more than 300 employees, down from 500 for the first round, and have gross receipts in any 2020 quarter of at least 25 percent less than the corresponding 2019 quarter. We still await potential further guidance on how funds received from other programs, like the Health and Human Services Provider Relief Fund, will affect your ability to qualify for a second PPP loan, but we are advising practices that may have suffered a 25 percent decrease in receipts in a 2020 quarter to reach out to your professional advisor for guidance.


4. Reporting requirements around HHS Provider Relief Funds. During 2020, most providers received an HHS Provider Relief Fund (PRF) payment through one or more of the agency’s General Distribution phases. Now, practices are required to submit a report on how those funds were used. Practices will need to substantiate how the PRF they received covered increased expenditures attributable to the coronavirus and related lost revenues during 2020. If a practice received a payment, or combined payments, in excess of $10,000, the practice must submit the initial report covering the 2020 year through the HHS portal between January 15 and February 15, 2021. Note that the funds are considered taxable income. Providers receiving the funds will be issued 1099-MISC for 2020, and a single audit will be required for providers who received more than $750,000.


5. Professional relationships. Practice leaders and administrators relied heavily on their professional advisors in 2020. You will continue to need the counsel of your financial advisors, lawyers, bankers, and others as we make our way through 2021. It is especially important that practices form and secure their relationships with advisors who have deep expertise in serving physician practices and who work with multiple practices and practice specialties and understand the complex needs of each..

We invite you to call us with your questions and concerns at 239-482-5522. Or email us at mdeluca@hbkcpa.com or jzarlenga@hbkcpa.com. HBK Healthcare Solutions is a dedicated team of healthcare provider subject matter experts within HBK CPAs & Consultants. Among more than 800 clients in the healthcare and social assistance businesses, we serve more than 300 private physician and dental practices. Our unique depth and breadth of experience in medical verticals manifests itself in a full complement of compliance and consulting services, a holistic financial solution.

2020 has been a difficult year for many businesses and Congress has enacted measures to help taxpayers increase deductible losses, potentially carryback those losses, deduct additional interest expense, and accelerate depreciation deductions via the CARES Act.

Another very realistic prospect is that 2020 tax rates are the lowest taxpayers may experience for at least the near future. It is unclear how much longer the tax cuts implemented by the Tax Cuts and Jobs Act will continue to be available as well as the preferential rates on qualified dividends and long-term capital gains.

Taking both circumstances into consideration, 2020 may be an opportune time to take advantage of a deemed dividend distribution election if a taxpayer’s business is organized as an S corporation and has accumulated earnings and profits.

Accumulated Earnings and Profits (AEP):

AEP is the historical profits (adjusted for various tax items) that have yet to be paid out of a C corporation as dividends. If that C corporation makes an election to be taxed as an S corporation, that AEP is frozen within the S corporation at the election’s effective date. The S corporation will then begin tracking its earnings in its “accumulated adjustment account” or AAA. S corporations can make distributions out of AAA without them being taxed as dividends to the shareholders. However, if the S corporation makes a distribution in excess of AAA and it has AEP, the distribution is a dividend taxable to the shareholders. In essence, the distributions come from the old C corporation earnings. The rules are designed this way under §1368 and the associated regulations to prevent those old earnings from escaping double taxation under the C corporation rules. Also, under the normal ordering rules distributions always come out of AAA first, before eroding AEP. Normally, taxpayers would want to avoid this from happening so double taxation will not trigger on the cash distributed to them from their S corporations.

Basis:

Another concept that is critical in this discussion is the shareholder basis. Unless an S corporation shareholder has a stock or debt basis in the entity, losses that pass through to the shareholder can not be deducted. Shareholders get basis by cash paid for the purchase of the stock, additional cash put into the entity, the income for the tax year earned, or cash directly loaned to the S corporation from the shareholder. Basis goes down by non-dividend distributions and losses incurred by the S corporation. So, if an S corporation is in a position in 2020 where losses incurred in operations exceed shareholder stock or debt basis, the losses could be limited in deductibility. This could then limit the ability to offset other income in 2020 (like wages) or utilize the very favorable net operating loss carryback rules via the CARES Act. These items can lead to refunds of precious cash for working capital in these difficult times.

Distribution of a Deemed Dividend Election:

So, what can be done to help a taxpayer in this situation?

1. Increase stock basis to be able to deduct operational losses without a capital injection


2. Decrease the AEP of the entity to avoid future double taxation


3. Utilize the currently low Federal tax rates on dividends.

The taxpayer can make an election to distribute a deemed dividend under Reg. 1.1368-1(f)(3). If the taxpayer elects to do so, an election is attached to a timely filed tax return stating that distributions will come out of AEP first, instead of AAA, and will then be immediately contributed by the shareholders back into the S corporation to increase stock basis.

Let us walk through an example to illustrate how this works in a practical manner.

Assume ABC Company, Inc., an S corporation owned 100% by Shareholder A, incurs losses in 2020 of $100,000. Shareholder A materially participates in the business and is not considered passive. Like many closely-held businesses, Shareholder A takes distributions equal to income for most years and has a stock basis of $-0- at the beginning of 2020. However, Shareholder A has AEP in the S corporation of $125,000 from the periods before the S election (when ABC Company was a C corporation). Assume Shareholder A has no other taxable income or losses for 2020.

If the taxpayer chooses to do so, ABC will attach an election to its timely filed return for 2020, as well as a consent by the shareholders to make a deemed distribution of the AEP. The consequences of doing this are as follows:

1. ABC Company, Inc. has paid a taxable dividend to Shareholder A which will be taxed on Shareholder A’s personal tax return as a qualified dividend and be taxable at 15% assuming there is no other income on the return triggering the 20% rate or the Medicare Surtax.


2. Shareholder A is treated as contributing back the $125,000 immediately to ABC Company, Inc. which increase Shareholder A’s stock basis to $125,000. No cash or assets had to be paid out or distributed to achieve this.


3. Since there is now $125,000 of basis, Shareholder A can now deduct the full $100,000 operating loss. This deduction also shelters $100,000 of the dividend income so only $25,000 is subject to tax.


4. Now, ABC Company, Inc. no longer has AEP for future taxation, the deemed contribution back has freed up the losses and sheltered most of the dividend, and Shareholder A has taken advantage of the historically low Federal taxes rates on the dividend.

As 2020 comes to a close and financial result are determined, the opportunity to make this election should be kept in mind to fully take advantage of the tax rates in place and maximize deductible losses. Please consult your HBK tax professionals to discuss your specific situation and if this opportunity applies.

Tax Credit

As California is still in the midst of fighting the COVID-19 virus, it has already moved on to assisting small businesses with the recovery. Small businesses that lost at least half their gross receipts during the pandemic can get a $1,000 tax credit for every full-time employee they hire between July 1 and November 30, 2020.

Eligible businesses are those that had fewer than 100 employees before the pandemic began and experienced a loss of gross receipts of at least 50% in the second quarter of 2020 compared with the second quarter of 2019.

Businesses can reserve a $1,000 credit for each full-time employee they hire during the period for a maximum of $100,000 credit. Applications will be made through the Franchise Tax Board.

The credit can be claimed on the 2020 original state income tax return. The credit can be carried forward through 2025. If the business does not owe income tax, the credit can be applied towards sales and use tax.

The state funding for the credit is capped at $100 million.

Net Operating Loss Suspension

For larger taxpayers, it is important to note that California has suspended the Net Operating Loss Carryover which was passed as part of the state budget. For tax years beginning on or after January 1, 2020, and before January 1, 2023, California generally suspends NOL deductions. The suspension applies to both personal income and corporate taxpayers. It does not apply to taxpayers with net business income or modified adjusted gross income of less than $1 million.

For any NOL for which a deduction is denied because of the suspension, California will extend the carryover period. The extension period is:

• Three years for losses incurred in tax years beginning before Jan. 1, 2020.
• Two years for losses incurred in tax years beginning on or after Jan. 1, 2020, and before Jan. 1, 2021.
• One year for losses incurred in tax years beginning on or after Jan.1, 2021. and before Jan. 1, 2022.

If you have questions about the California Tax Credit for new jobs or the Net Operating Loss suspension, please contact your HBK advisor.

The U.S. Department of Health and Human Services (HHS) has made available and provided guidance for provider relief funds for dentists. The guidance and accompanying FAQs on how to apply for the funds were released July 7 and 10 respectively. Dental practices had previously been excluded from access to HHS relief funds. The deadline for applying is July 24.

A provider is eligible if they meet all six of the following requirements:

1. Did not receive payment from the initial $50 billion Medicare-focused General Distribution.
2. Did not receive payment from the $15 billion Medicaid and CHIP Distribution.
3. Did either file a federal income tax return for fiscal years 2017, 2018 or 2019, or is exempt from filing and has no beneficial owner who is required to file—for example, a state-owned hospital or healthcare clinic.
4. Did provide patient dental care after January 31, 2020.
5. Did not permanently cease providing patient dental care directly—or indirectly through included subsidiaries.
6. If the applicant is an individual, he or she has gross receipts or sales from providing patient dental care reported on IRS Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a statutory employee.

Providers who wish to apply for the funds will need their 2019 or most recently filed practice federal tax return, their Q1 2020 Form 941 payroll tax return, and the HHS-provided full-time equivalent worksheet. Go the HHS website and click on “Apply for Funding” under the “Enhanced Provider Relief Fund Payment Portal.” 

We encourage you to contact HBK Healthcare Solutions with any questions.

Last week, Minor League Baseball officially announced that the 2020 season will be canceled due to the COVID-19 pandemic. Unlike the major league teams who can generate significant revenue from television contracts and can play the games without fans, minor league teams rely largely on fans in the seats for their revenue. Other than the signage advertising around the ballpark, the revenue comes from ticket sales, food concessions, private events, merchandise sales and parking. All of which require fans to come out to the ballpark.

The COVID-19 pandemic hit minor league baseball like the perfect financial storm. Minor league baseball is not a seasonal business. Once the 2019 baseball season ended, the teams’ front office staff immediately got started preparing for the 2020 season. They are out in their communities selling and renewing season tickets, group events, advertising and promotions like fireworks nights or on-field promotions. And like all businesses, they must outlay expenses to generate revenue. The teams began spending money on the 2020 season in the fall of 2019 with the understanding that the cash collections will begin slowly in the new year and ramp-up to the peak once the games begin in April. And, if I may point out the obvious; the cash collections shut down in March leaving the teams with substantial cash flow issues.

We are working with all our minor league team clients assisting them as best we can through this difficult season. They are projecting losses from hundreds of thousands of dollars to several million dollars. There are discussions about obtaining other sources of cash to get them to next Spring’s influx of cash like the Paycheck Protection Program, the Economic Injury Disaster Loan, the Main Street Lending Program or securing lines of credit. Every team that we consult with is making very difficult decisions about laying off the full-time front office personnel. Every team is proactively contacting their advertisers and season ticket holders discussing 2020 refunds or reaching new levels of creativity to hold onto the 2020 money and offering additional perks for the 2021 season. They are working on generating revenue through alternative uses of the ballpark once their state allows crowds large enough for movie nights, small concerts or high school graduations, while conforming to all the social distancing and sanitary protocols. These events will provide some cash flow and benefit the community.

In so many communities throughout the country, the minor league team is a summertime fixture. Cities have invested millions of dollars in state-of-the-art stadiums to generate hundreds of jobs, a sense of community and a place for families, friends and co-workers to gather and interact. Gather and interact, the rally ending double-play of the COVID-19 pandemic. The ballpark is where high school and college students work in the concession stands to make some “kicking around” money and retired baseball lovers can work as ushers or ticket takers to supplement their fixed income. The local vendors who supply the ballpark and team with the goods and services to host several thousand people each game have been financially harmed by no baseball this year. And like ripples in the pond, it goes on and on.

One of the core values of the minor league baseball industry is charitable giving in their communities. It is safe to say that all teams have a charitable arm of their business and many have created an active charitable organization with dedicated employees and volunteers. These organizations raise money year-round to support local charities and causes in their communities. Fundraising activities in the ballpark include 50-50 raffles, tennis ball toss, player jersey raffles and many other unique ideas.

Outside the ballpark, many teams hold a wintertime “hot stove “dinner honoring local sports and community heroes. Not to sound like a broken record, but these local organizations and causes will suffer without baseball this year.

The owners and operators of minor league baseball teams are caring and creative people. While none of us can predict how the COVID-19 pandemic will end, I have confidence that because of people who work in minor league baseball, this industry will survive albeit under the conditions of “the new normal.” We look forward to next April when we will hopefully hear the roar of the crowd and the crack of the bat fill these stadiums.

Join HBK’s Joe Ledford and Amy Reynallt to learn hints, tips, and tricks to optimize cash flow that may have been affected by the pandemic. Information regarding cash forecasting has also been discussed.

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Survive to Thrive – Cash Management Tips and Tricks

As the world begins to adjust to a “new normal” in a post COVID-19 world, companies are shifting to allowing more employees to work from home on a permanent basis. Employees who have worked successfully from the comfort of home do not see the need to go to an office, and this provides opportunities for employers to downsize their current buildings, reducing rent and overhead costs. However, this leads to new state tax issues that must be addressed.

During the midst of the crisis, many states took a very taxpayer-friendly approach and announced that having an employee who normally worked in one state but was now working from home in another state would not create nexus. They also took the position that the income would be considered earned by the employee in the jurisdiction where it was normally earned. Basically, their approach was “let’s pretend this pandemic never happened,” allowing employers to get their employees out to a safe working environment without having to concern themselves with any lasting state tax implications.

As more states begin to open during this pandemic, states and cities are going to be facing the harsh reality of unprecedented deficits. Unlike the federal government, most states must pass a balanced budget which includes making up for prior year shortfalls. They will be looking to refill the coffers. Raising taxes could be a solution, but for many states this is an election year and raising taxes is not a pragmatic decision with their citizens still recovering financially. A politically noncontroversial way to raise taxes would be to tax nonvoters.

Nexus
If you are not a State and Local Tax professional, you may not be familiar with the term “nexus.” The simple definition is connection or “touches” with a state. For tax purposes, a business must have some sort of connection to a state before it is required to file an income tax return or have an obligation to collect sales tax. The connection required differs based on the type of tax. There is a federal law that protects businesses from a state’s income tax if the only presence in the state is for the mere solicitation of tangible personal property. This law is not applicable to other types of taxes, such as franchise or sales tax. The solicitation of services or real property is also not protected. Therefore, a sales employee could be based in a state and not subject a business to state income tax if their only function is solicitation of tangible personal property. As soon as their services go beyond mere solicitation, the business could be subject to income tax. Additionally, the activities of that salesperson may protect the employer from an income tax obligation, but having an employee performing work in a state regardless of their job description will certainly trigger sales tax implications in that state.

Income Tax Nexus
An employee working from home, performing administrative functions for the business, is not protected under federal law. As we move beyond the crisis, businesses may be looking to reduce costs by downsizing their occupancy costs. They may continue to allow employees to work from home, which is different from the location of the business. If this situation occurs, businesses will need to consult with their tax advisors to determine their obligations.

If a business is considering allowing its employees to work from home, there are some matters they need to examine:

• Are the duties of the employee protected from income tax exposure?
• Will the employee give them nexus in a state in which they did not previously have nexus?
• How are they taxed? Are they taxed as a C Corporation, a Pass-Through Entity?
• If they are a pass-through entity, will the owners be able to utilize the credit available for taxes paid in another state?
• How does the other state source revenue – cost of performance or market-based?
• Will the entity be subject to a franchise tax in the state?
• What other registration and filing requirements will the business have?
• What employment rules must be followed in a state?

Employee Considerations
An employee working from home for an out of state company also needs to consider their own income tax exposure. If the employer allows them to split their time between the office and home, and they live in a different state than the office, they will be subject to tax in both states and will need to track their days worked in each state. The employee may have tax withheld in multiple states, thus requiring them to file income tax returns in multiple states. Employees may have opportunities to get a credit against taxes paid in any additional states or be refunded taxes withheld in an additional state depending on the circumstances.

Whether or not an employer has an obligation to withhold on an employee is dependent upon the states at issue. Some states, such as New York, have the convenience of the employer test. Under this test, for example, a telecommuting employee’s income is apportioned entirely to the state in which the taxpayer’s employer is located. New York has upheld the test several times in appeal. There are currently five other states that impose the convenience of the employer test: Connecticut, Delaware, Nebraska, New Jersey, and Pennsylvania. The application of the convenience of the employer test can lead to double taxation where the employer’s state applies the test and the state from which the employee resides does not.

Conclusion
It is important to examine these issues before deciding whether employees should be able to continue to work remotely. Tax is the land of unintended consequences. The employer may intend to offer more flexibility in order to attract and maintain qualified employees or reduce expenses, only to be subject to additional taxes. These matters should not be ignored, getting ahead of state tax issues allows for a smoother transition as the business grows and expands into multiple taxing jurisdictions. If you would like to discuss the state tax consequences of remote employees, please reach out to your HBK Advisor.

Join HBK Tax Advisory Group’s Amy Dalen and Ben DiGirolamo as they present an individual and business tax planning update.

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In this webinar, we will discuss a road map to help businesses survive, maintain, recover, and thrive, including helpful hints and tools that business owners should know.

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