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the legal issue — tax rules: property purchase 
Thinking of Buying Space for your Practice? 
Take Note of Significant Tax Exemptions. 
Tracy Altemus, CCIM 
Zandra O’Keefe, CPA 
Should I lease, buy or build to suit? That is a question that many physicians consider. The idea of making 
payments to a facility you own as opposed to paying rent to a landlord can certainly be an attractive option for 
some that have the financial wherewithal. That said, it tends to make sense if the payments you are making and 
your related tenant improvement investment are equivalent or less than what you would pay leasing from someone else and 
- even more importantly - that you have an exit strategy (e.g., future sales potential with appreciation in value as an added 
bonus). There are many factors to consider when making the decision to lease or own. An attorney, accountant, banker and 
real estate broker can prove invaluable in helping you gather the information needed to help you evaluate options. 
Lease? 
Buy? ???? Build? 
38 • Round-up • August 2014 • A monthly publication of the MCMS
the legal issue — tax rules: property purchase 
If you do decide to own, we recommended that your 
operating entity (i.e., medical practice), sign a lease with 
your building related ownership entity, and charge fair mar-ket 
value rent (consider compliance with STARK law reg-ulations, 
if applicable),1 even if both entities have common 
ownership. One benefit of this structure is that the operat-ing 
entity generally can deduct the rent as a business 
expense. The ownership entity records rent as income, 
deducts depreciation and pays the loan payment, if applica-ble, 
and any net income can be distributed to the owner(s) 
after operating capital retention needs are met. Typically, 
either party can pay the deductible operating expenses, but 
the responsible party should be specifically identified in the 
lease. Selecting the appropriate entity is also important; an 
LLC or partnership is often the entity of choice.2,3 
Another recent tax benefit you may be able to take 
advantage of: if you lease an office where a related person 
or company owns at least 80% of the landlord entity, you 
may be eligible for a transaction privilege sales tax exemp-tion 
on commercial lease rent.4 This applies throughout 
Arizona, and several cities subscribe to this exemption, as 
well. It can save you between 2% - 3% of your rent, which 
can translate to thousands of dollars per year. 
If you own a commercial building, you will need to 
understand and comply with the new IRS tangible property 
regulations taking effect in 2014; the time to plan is now. 
Consider engaging an expert to: optimize depreciation 
deductions, perform a cost segregation study and tactically 
plan to avoid potential dry income effects to owners.5 Dry 
income results when an owner is allocated taxable income 
without a corresponding cash distribution. Unintended 
income allocations can result over time when partners are 
entering and exiting the partnership, depreciation deduc-tions 
are allocated up front and debt remains to be paid in 
the future. Partners who remain invested can incur dry 
income without proper ongoing management. 
Remember also to consult a real estate insurance and 
valuation expert to help you determine the coverage that 
best suits your needs. The policy should be based on an 
accurate replacement value, which is updated at least every 
other year and when values substantially change. A CPA 
firm can provide you with integrated tax, insurance and 
other professional advisory services to provide seemless 
advice in helping you make the best decision.6,7 
Each situation is different. Talk with experts to help 
you strategize the optimal structure for your particular situ-ation; 
answer questions about the sales tax exemption or to 
discuss your commercial real estate needs. 
ru 
Tracy Altemus is Executive 
Vice President, Healthcare 
Brokerage Services at 
Ensemble Real Estate 
Solutions, a preferred partner 
with MCMS. 
Tracy is involved in leasing, 
sales and development of 
healthcare facilities. She 
assists her clients with everything from leasing space, 
acquisition and sales to providing real estate consulting 
services. Email her at taltemus@ensemblere.com. 
Zandra O’Keefe is a 
Managing Director for CBIZ 
and shareholder of Mayer 
Hoffman McCann, PC. She 
provides accounting, tax plan-ning 
and compliance services 
as well as extensive business 
management consulting to a 
diverse group of closely held 
businesses, their owners and high net worth individuals 
for the Phoenix office tax division. Contact her at 
zokeefe@cbiz.com. 
1. http://starklaw.org/investment.htm 
2. http://www.cbiz.com/page.asp?pid=8632 
3. http://www.cbiz.com/page.asp?pid=9606 
4. http://www.azdor.gov/News/tabid/74/newsid530/457/House-Bill- 
2324Commercial-Lease-Exemption/Default.aspx 
5. http://www.cbiz.com/page.asp?pid=11126 
6. http://www.cbiz.com/page.asp?pid=10938 
7. http://www.cbiz-onesource.com/valuationgroup/page.asp?pid=1368 
Copyright © 2014, CBIZ, Inc. All Rights Reserved. To ensure compli-ance 
with requirements imposed by the IRS, we inform you that unless 
specifically indicated otherwise, any tax advice in this communication 
is not written with the intent that it be used, and in fact it cannot be 
used, to avoid penalties under the Internal Revenue Code, or to pro-mote, 
market, or recommend to another person any tax related matter. 
A monthly publication of the MCMS • August 2014 • Round-up • 39

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Thinking of Buying Space for your Practice?

  • 1. the legal issue — tax rules: property purchase Thinking of Buying Space for your Practice? Take Note of Significant Tax Exemptions. Tracy Altemus, CCIM Zandra O’Keefe, CPA Should I lease, buy or build to suit? That is a question that many physicians consider. The idea of making payments to a facility you own as opposed to paying rent to a landlord can certainly be an attractive option for some that have the financial wherewithal. That said, it tends to make sense if the payments you are making and your related tenant improvement investment are equivalent or less than what you would pay leasing from someone else and - even more importantly - that you have an exit strategy (e.g., future sales potential with appreciation in value as an added bonus). There are many factors to consider when making the decision to lease or own. An attorney, accountant, banker and real estate broker can prove invaluable in helping you gather the information needed to help you evaluate options. Lease? Buy? ???? Build? 38 • Round-up • August 2014 • A monthly publication of the MCMS
  • 2. the legal issue — tax rules: property purchase If you do decide to own, we recommended that your operating entity (i.e., medical practice), sign a lease with your building related ownership entity, and charge fair mar-ket value rent (consider compliance with STARK law reg-ulations, if applicable),1 even if both entities have common ownership. One benefit of this structure is that the operat-ing entity generally can deduct the rent as a business expense. The ownership entity records rent as income, deducts depreciation and pays the loan payment, if applica-ble, and any net income can be distributed to the owner(s) after operating capital retention needs are met. Typically, either party can pay the deductible operating expenses, but the responsible party should be specifically identified in the lease. Selecting the appropriate entity is also important; an LLC or partnership is often the entity of choice.2,3 Another recent tax benefit you may be able to take advantage of: if you lease an office where a related person or company owns at least 80% of the landlord entity, you may be eligible for a transaction privilege sales tax exemp-tion on commercial lease rent.4 This applies throughout Arizona, and several cities subscribe to this exemption, as well. It can save you between 2% - 3% of your rent, which can translate to thousands of dollars per year. If you own a commercial building, you will need to understand and comply with the new IRS tangible property regulations taking effect in 2014; the time to plan is now. Consider engaging an expert to: optimize depreciation deductions, perform a cost segregation study and tactically plan to avoid potential dry income effects to owners.5 Dry income results when an owner is allocated taxable income without a corresponding cash distribution. Unintended income allocations can result over time when partners are entering and exiting the partnership, depreciation deduc-tions are allocated up front and debt remains to be paid in the future. Partners who remain invested can incur dry income without proper ongoing management. Remember also to consult a real estate insurance and valuation expert to help you determine the coverage that best suits your needs. The policy should be based on an accurate replacement value, which is updated at least every other year and when values substantially change. A CPA firm can provide you with integrated tax, insurance and other professional advisory services to provide seemless advice in helping you make the best decision.6,7 Each situation is different. Talk with experts to help you strategize the optimal structure for your particular situ-ation; answer questions about the sales tax exemption or to discuss your commercial real estate needs. ru Tracy Altemus is Executive Vice President, Healthcare Brokerage Services at Ensemble Real Estate Solutions, a preferred partner with MCMS. Tracy is involved in leasing, sales and development of healthcare facilities. She assists her clients with everything from leasing space, acquisition and sales to providing real estate consulting services. Email her at taltemus@ensemblere.com. Zandra O’Keefe is a Managing Director for CBIZ and shareholder of Mayer Hoffman McCann, PC. She provides accounting, tax plan-ning and compliance services as well as extensive business management consulting to a diverse group of closely held businesses, their owners and high net worth individuals for the Phoenix office tax division. Contact her at zokeefe@cbiz.com. 1. http://starklaw.org/investment.htm 2. http://www.cbiz.com/page.asp?pid=8632 3. http://www.cbiz.com/page.asp?pid=9606 4. http://www.azdor.gov/News/tabid/74/newsid530/457/House-Bill- 2324Commercial-Lease-Exemption/Default.aspx 5. http://www.cbiz.com/page.asp?pid=11126 6. http://www.cbiz.com/page.asp?pid=10938 7. http://www.cbiz-onesource.com/valuationgroup/page.asp?pid=1368 Copyright © 2014, CBIZ, Inc. All Rights Reserved. To ensure compli-ance with requirements imposed by the IRS, we inform you that unless specifically indicated otherwise, any tax advice in this communication is not written with the intent that it be used, and in fact it cannot be used, to avoid penalties under the Internal Revenue Code, or to pro-mote, market, or recommend to another person any tax related matter. A monthly publication of the MCMS • August 2014 • Round-up • 39