Entity Selection & Holding Companies for the U.S. PI Firms and Practices

Wherever you practice, the economics of personal injury are the same: money moves from insurers through settlements into trust accounts, fees, liens, and finally provider and client hands — and the accounting has to keep up.

As PI firms and practices in the U.S. grow — a second office, a surgery center, an imaging affiliate, a marketing company — the question stops being "what entity should I be?" and becomes "how should my entities fit together?" Getting this right is worth real money in taxes, liability protection, and eventual sale value. Getting it wrong compounds silently for years.

Entity selection: the first-order decision

• PLLC / PC taxed as S-corp is the workhorse for most single-owner firms and practices — payroll-tax savings on distributions above reasonable compensation, with pass-through simplicity.
• Partnerships / multi-member LLCs fit multi-partner firms where special allocations, differing draws, and buy-in/buy-out mechanics matter.
• C-corp is rarely right for the operating practice — but occasionally right for a management company retaining earnings for expansion.
• State wrinkles matter: professional entity rules, ownership restrictions (especially who may own medical practices), and state tax treatment differ across Georgia, Florida, Texas, California, and New York.

Why growing operations add a holding structure

Once you run multiple locations or lines of business, a parent/holding arrangement — with each location or function in its own entity underneath — typically delivers four things:

1. Liability isolation. A claim against one clinic or office doesn't reach the assets of the others. Real estate held in its own entity and leased to the operating companies keeps your buildings out of operating risk entirely.
2. Cleaner economics per location. Entity-level books show which location actually makes money — impossible to see when everything runs through one checkbook.
3. Tax flexibility. A management company can centralize admin, billing, and marketing and charge management fees to the operating entities; combined with the right elections, this creates legitimate planning room. (Intercompany fees must be defensible and documented — this is where amateur structures get in trouble.)
4. Sale and succession readiness. Buyers can acquire one location, one line, or the whole platform. Clean entity separation with consolidated reporting is exactly what sophisticated buyers and lenders want to see.

The catch: complexity must be administered

Every entity you add needs its own books, its own tax filings, intercompany agreements, and consolidated reporting that rolls it all up for you and your lenders. A holding structure without disciplined monthly accounting isn't asset protection — it's commingling with extra steps, and courts and the IRS treat it that way.

How we help

We design and administer these structures for PI firms and practices across every state: entity selection and elections, holding company design for multi-location operations, intercompany agreements and management-fee support, per-entity monthly financials with consolidated rollups, and the multi-entity tax planning that makes it all worth doing.