Fractional leadership · Tax director
Fractional tax director for med spas and aesthetics practices.
Most med spas get tax once a year, after the fact. A fractional tax director gives the practice what a larger company has in-house: someone who plans entity structure, owner compensation, equipment timing, multi-state registrations and the MSO management fee before year-end, projects the liability each quarter and answers the IRS when it writes. Balance Partners provides fractional tax director services to med spas nationwide, led by Jenny Gao, CPA and IRS Enrolled Agent.
Who this is for
Tax planned before the year ends — not discovered after.
Best fit: med spas past roughly $1 million in annual revenue, with two or more locations, or with an MSO alongside a professional entity — and owners who want a finance leader in the room without a full-time hire.
Not a fit for pre-revenue startups, practices that only want a tax return filed, or owners shopping on price alone. Those needs are better served by Med Spa Core or by a local preparer.
What you receive
Deliverables, not hours.
Quarterly tax strategy meeting and projection
A current-year projection from closed books each quarter, safe-harbor estimates recalculated, and the decisions that change the number documented.
Entity and compensation design
S-corp election timing, reasonable-compensation analysis with written support, distributions policy and how the QBI deduction's health-SSTB rules apply to your facts.
MSO / professional-entity tax treatment
Management fee set and documented for tax, intercompany payments timed for deductibility between related entities, both returns prepared from reconciled books.
Equipment and improvement timing
Section 179, 100% bonus depreciation and state add-backs modeled against the year's income before you sign a device lease or finance a build-out.
Multi-state nexus and registrations
Sales tax on retail shipped across state lines, payroll registrations for remote staff and second locations, and state income or franchise tax where the practice operates.
Retirement plan design
SEP-IRA, solo or group 401(k), cash balance and defined-benefit options sized to the owner's compensation and the staff census, coordinated with payroll.
Owner-level planning
The business return and the owner's personal return planned together: estimates, basis tracking, health insurance for more-than-2% shareholders, and the tax side of buying or selling a practice.
IRS and state notice handling
Notices answered, penalty abatement requested where the facts support it, and representation before the IRS by an Enrolled Agent when it is needed.
In practice
What a fractional tax director engagement looks like in practice
An illustration, not a client: a nurse-practitioner-owned practice runs an MSO that bills a professional corporation a flat $20,000 a month, pays the owner a $60,000 salary on $900,000 of profit, bought a $140,000 laser in December without telling anyone, and just received a notice for a 2024 payroll deposit. The tax director work in the first quarter: document the management fee and align its timing with the related-party rules; set a defensible salary and a distributions schedule; model the laser under Section 179 against this year's income and the state's rules; recalculate all four estimates; and resolve the notice. Each of those is a line in a written plan with a date, and each is revisited at the next quarterly meeting.
How it starts
Diagnostic first, then a written scope.
Fit call
Twenty minutes on locations, entities, providers, systems and the decisions in front of you.
Diagnostic
We read the QuickBooks file, POS exports, payroll and prior returns and tell you in writing what has to be fixed before leadership-level work is worth paying for.
Written scope and flat fee
Deliverables, cadence, what you provide, and one monthly fee. Month-to-month after onboarding, thirty days' written notice.
Cadence
Close by the tenth business day, then the monthly or quarterly meeting with a one-page summary of what was decided and what happens next.
How pricing works
Scoped after a diagnostic. One flat monthly fee.
We do not publish a price for fractional leadership work because the fee depends on entities, locations, states, inventory and the cadence you want. Every engagement gets a written scope and a flat monthly fee before work starts, month-to-month after onboarding with thirty days' written notice. The foundation tier, Med Spa Core, starts at $1,500 a month; see how pricing works.
Questions
Common questions
What does a fractional tax director do that my tax preparer does not?
A preparer reports the year after it ends. A tax director plans it while it is happening: entity structure, owner pay, equipment timing, the MSO fee, state registrations and quarterly projections, then prepares the returns from a plan rather than from a shoebox. The difference shows up in April as no surprises.
How much does a fractional tax director cost?
Engagements are scoped after a diagnostic of your entities, states, equipment plans and prior returns, and quoted as a flat fee under a written scope. We do not publish a price because the work ranges from a quarterly planning cadence for a single-entity practice to full multi-entity, multi-state planning. Business tax planning and preparation is already included in the Med Spa Core tier for most single-entity practices.
Can you represent us before the IRS?
Yes. Jenny Gao is an IRS Enrolled Agent, federally authorized to represent taxpayers before the IRS, in addition to being a Florida-licensed CPA. Notices, examinations and penalty abatement requests are handled under the same engagement.
How does the QBI deduction work for a med spa?
The Section 199A deduction is 20% of qualified business income, but health is a specified service trade or business, so above the 2026 income thresholds the deduction phases out for health-SSTB income. Whether a particular med spa, or its MSO, is a health SSTB depends on facts about who performs the services and how the entities are structured; that analysis is part of the tax director work.
Do you plan for an MSO and a professional corporation together?
Yes. The management fee, the intercompany payments, which entity employs whom, and how income lands on the owners' returns are planned as one picture, because a fee that is deductible in one entity and taxable in the other only works if both sets of books and both returns agree.
What happens in a year with a big equipment purchase?
We model the device before you buy it: 100% bonus depreciation or Section 179, the Section 179 taxable-income limit, state add-backs or decoupling, and the effect on this year's estimates and next year's. Then the purchase date is chosen deliberately, and the estimates are adjusted the same week.
The other two roles
Fractional leadership, three ways.
Each role can be engaged alone or together as a single med spa finance office — controller, CFO and tax director under one fee, with Med Spa Core as the base.
From the library
Guides that go with this work
Request a fit call
Twenty minutes on your practice and the decisions ahead of it. If the leadership tier is more than you need, we will say so and point you to Med Spa Core.
Request a 20-Minute Fit Call →