§453 · Sell Dermatology Practice Defer Capital Gains

Selling Your Dermatology Practice Without the IRS / State Tax Hit

The dermatology MSO consolidation wave is one of the largest in healthcare — Schweiger Dermatology Group, Forefront Dermatology, Pinnacle Dermatology, Advanced Dermatology and Cosmetic Surgery, US Dermatology Partners, Riverchase Dermatology, Anne Arundel Dermatology, Epiphany Dermatology — paying 6-12x EBITDA. A $2M EBITDA practice = $12M-$24M sale.

§453 Mechanic — How the Money Flows

Buyer cash → Assignment Co. → A-rated carrier → You, on schedule

BUYER pays full cash at closing ASSIGNMENT CO. qualified entity, regulated purchases annuity A-RATED CARRIER Pacific Life · MetLife Independent Life · USAA SELLER (you) paid on chosen 5-30 yr schedule Closing day — one wire, one assignment Gain recognized proportionally each year per IRC §453 (Treas. Reg. §15A.453-1)

The math — $15M dermatology practice sale

StateState rateLump-sum tax10-yr §453 taxDelta
California13.3% + 1%~$5.70M (38%)~$4.30M (29%)$1.40M
New York10.9%~$5.30M~$4.00M$1.30M
New Jersey10.75%~$5.28M~$3.98M$1.30M
Texas / Florida / Tennessee0%~$3.57M~$2.69M$880K

Assumptions: $15M, 75% goodwill, 15% equipment ($2.25M — lasers, biopsy, Mohs), 10% inventory + product.

Dermatology-specific tax wrinkles

  1. MSO structure. Most consolidator deals run through MSO/Friendly PC structure. APA governs §453 mechanics.
  2. Clinical vs cosmetic revenue split. Clinical (insurance) lower multiple, cosmetic (cash pay) higher.
  3. Mohs surgery sub-practice. Separately valued; high-equipment, high-margin sub-business.
  4. Cosmetic product retail (Obagi, SkinCeuticals, ZO Skin Health). Inventory carve-out, ordinary income.
  5. Pathology lab carve-out. If practice owns dermpath lab, separately valued.
  6. Laser equipment §1245. Fraxel, V-Beam, Excimer, Picosure — high recapture exposure.

When this fits

  • $3M+ sale
  • MSO-platform buyer
  • Strong cosmetic + clinical mix

When it doesn't

  • Solo derm with minimal goodwill
  • Mostly equipment sale

How I work

Hans Goldstein, IRC §453 specialist. Pacific Life, MetLife, Independent Life, USAA Life — 50 states. Free fit-check.

Hans Goldstein, NPN 20602398

📄 Get the §453 Quick Reference PDF + free fit-check

4-page reference card on the §453 SIS mechanic, when it fits, §453-vs-DST comparison, and state-by-state math. Built for sellers and CPAs.

Drop your info — instant PDF download + within 1 business day Hans will email a preliminary read on which structure fits your deal. No retainer. Carrier compensates the broker — not you.

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📞 Hans Goldstein · 615-808-9731 · CA Insurance License #4322192 · Independent §453 specialist · Goldstein & Co. LLC

Educational. Not tax or legal advice.

Run your specific numbers

The calculator runs your sale through real 2026 federal + state tax brackets and shows §453 savings vs lump sum side-by-side.

Run the calculator → 615-808-9731

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