Executive summary
Professional practices (such as medical practices) that seek investments are often constrained by state regulations that limit the ownership of professional practices to professionals. These practices often enter into management service organization (MSO)-professional corporation (PC) relationships through the mechanism of an MSO which, aside from providing management services, enables the non-professional investors to profit from the practice. For a summary of various tax issues arising from this common business relationship, see our article Who really owns that medical or professional practice?.
As part of this arrangement, the MSO often funds the PC via cash advances, often documented via notes or left undocumented entirely. These advances are generally eliminated in any financial reporting and often do not receive much attention until the amounts become large enough to require attention. However, the status of these advances as debt/liabilities of the PC requires close consideration.
A recent court case highlights the need for taxpayer attention to this matter. In Anaheim Arena Management LLC et al. v. Commissioner; No. 16724-19; T.C. Memo. 2025-68, the Tax Court analyzed in detail cash advances between a management company and an operating company to determine whether the advances were debt or equity. The Tax Court ultimately agreed with the IRS and disallowed the taxpayer’s claimed bad debt deduction. Although the advances were ostensibly documented as debt, the court looked at the substance of the arrangements and concluded they were not debt.
While this case addresses a bad debt deduction specifically, the status of related party advances as debt versus equity is critical to many tax determinations such as tax ownership, deductibility of interest expenses, dividend characterization and withholding taxes. Unlike other IRS wins in which a taxpayer did not altogether document its advances as debt, in this case, the taxpayer attempted to document the intercompany advances through promissory notes that contained interest rates and repayment schedules to ensure compliance with legal standards and proper classification of the advances. The court nonetheless ruled that the advances were not debt.
While Anaheim does not involve an MSO-PC fact pattern, it illustrates the sort of tax analysis applicable to cash advances between an MSO and PC. For prior RSM articles on cases involving cash advances treated as equity and not debt, see Tax Court denies bad debt deduction; advances were equity and not debt; and Tax Court once again denies related party bad debt deduction.