Business Registration Checklist¶

Overview¶

This checklist guides you through the process of legally registering your Direct Primary Care practice. The steps are presented in recommended order, though some can be completed in parallel.

Timelines vary by state; allow 2-8 weeks for full completion.

Prerequisites¶

Completed legal entity selection (see Choosing a Legal Entity)
Decided on business name
Identified registered agent (can be yourself or a service)
Budget for registration fees ($500-$2,000 depending on state)

Phase 1: Entity Formation¶

Choose and Reserve Business Name¶

Search state database for name availability
Search USPTO trademark database
Search domain name availability
Reserve name with state (if desired, usually optional)
Consider reserving similar domain names

Tips: - Name must typically include entity designation (LLC, PLLC, PC, etc.) - Some states require "Medical" or professional designation - Check state medical board for any naming restrictions

Resources: - State Secretary of State business name search - USPTO Trademark Search

Designate Registered Agent¶

Decide: self, attorney, or registered agent service
If using service, select and set up account
Obtain registered agent's official address

Registered Agent Requirements: - Must have physical address in state of formation (not P.O. Box) - Must be available during business hours to receive legal documents - Can be yourself if you have a physical office address

Cost: Free (yourself) to $50-$300/year (service)

File Formation Documents¶

Prepare Articles of Organization (LLC) or Articles of Incorporation (Corp)
File with Secretary of State
Pay filing fee
Receive confirmation/certificate

Typical Information Required: - Business name - Registered agent name and address - Principal office address - Member/organizer names - Purpose statement (may need to specify medical practice) - Effective date

Costs by State (approximate): | State | LLC Filing Fee | |-------|----------------| | California | $70 | | Texas | $300 | | Florida | $125 | | New York | $200 | | Delaware | $90 |

Timeline: Same-day to 2 weeks depending on state and expedite options

Create Operating Agreement (LLC) or Bylaws (Corp)¶

Draft operating agreement/bylaws with attorney
Define ownership percentages
Establish management structure
Define profit distribution
Include buy-sell provisions (if multiple members)
Sign and date
Store with business records

Key Provisions to Include: - Member/shareholder roles and responsibilities - Capital contribution requirements - Profit and loss allocation - Decision-making procedures - Procedures for adding/removing members - Dissolution procedures

Note: Even single-member LLCs should have an operating agreement to reinforce liability protection.

Phase 2: Federal Requirements¶

Obtain Employer Identification Number (EIN)¶

Apply online at IRS.gov (immediate)
Or submit Form SS-4 by mail/fax
Record EIN in secure location

When EIN is Required: - You have or will have employees - You operate as corporation or partnership - You file certain tax returns (employment, excise, alcohol/tobacco/firearms) - You have a Keogh plan - You withhold taxes on income paid to non-resident alien

Recommendation: Obtain an EIN even if not strictly required—most banks require it to open a business account.

Cost: Free Timeline: Immediate if online

Link: IRS EIN Application

Register with IRS for S-Corp Election (If Applicable)¶

Consult accountant on timing
File Form 2553 for S-Corp election
Must file within 75 days of formation OR by March 15 for current tax year
Receive IRS confirmation

Note: This step is only if you have decided to elect S-Corp taxation. Many practices wait until year 2 to make this election.

Phase 3: State Requirements¶

Register with State Tax Authority¶

Register for state income/franchise tax (if applicable)
Register for state sales tax (if selling products)
Determine state payroll tax requirements
Set up online account with state tax authority

DPC Note: Most DPC services are not subject to sales tax as they are medical services, but verify with your state. Some dispensed items may be taxable.

Obtain State Business License¶

Check state requirements for medical practices
File application
Pay fee
Display license as required

Note: Requirements vary significantly by state. Some states require specific licenses for medical practices beyond general business licenses.

Register with State Medical Board¶

Verify individual medical license is current
Register practice with state medical board (if required)
Comply with any practice notification requirements
Understand supervision requirements (if hiring mid-levels)

Important: Some states require notification when opening a new practice location or changing practice type.

Phase 4: Local Requirements¶

City/County Business License¶

Typical Costs: $25-$500 depending on location

Zoning Compliance¶

Verify office location is zoned for medical use
Apply for any required permits
Check signage regulations

Note: Home-based practices have additional zoning considerations. Most residential zones prohibit patient visits.

Building/Occupancy Permits¶

Obtain certificate of occupancy (usually landlord provides)
File for any required permits for tenant improvements
Schedule inspections if required

Phase 5: Financial Setup¶

Open Business Bank Account¶

Recommended Features: - No or low monthly fees - Online bill pay - Integration with accounting software - Business debit card - ACH capabilities

Tip: Consider a bank that integrates well with your accounting software (QuickBooks, Wave, etc.)

Obtain Business Credit Card¶

Apply for business credit card
Keep separate from personal expenses
Set up autopay for balance

Benefits: - Builds business credit history - Separates expenses cleanly - Potential rewards on business spending - Purchase protections

Set Up Accounting System¶

Choose accounting software (QuickBooks, Wave, Xero, etc.)
Connect bank accounts
Set up chart of accounts
Establish expense categories
Create system for receipt retention

Phase 6: Insurance¶

Professional Liability Insurance (Malpractice)¶

Research DPC-friendly malpractice carriers
Obtain quotes (typically need practice details)
Compare occurrence vs. claims-made policies
Select policy
Ensure coverage begins before seeing patients

Considerations: - DPC practices may qualify for lower premiums due to smaller panels - Ensure policy covers telehealth if you plan to offer it - Understand tail coverage requirements

General Liability Insurance¶

Obtain quotes for general liability
Coverage typically $1M per occurrence / $2M aggregate
Add property coverage if you own equipment
Consider bundled Business Owner's Policy (BOP)

Additional Insurance to Consider¶

Cyber liability insurance (for HIPAA breaches)
Workers' compensation (if hiring employees)
Business interruption insurance
Employment practices liability (if hiring)

Phase 7: DEA and Prescribing (If Applicable)¶

DEA Registration¶

Apply for DEA registration
Select schedules to prescribe
Pay fee ($888 for 3 years as of 2024)
Receive DEA certificate
Store securely; do not display publicly

Link: DEA Registration

State Controlled Substance Registration¶

Check if state requires separate registration
File application
Pay fee
Maintain compliance with state requirements

PDMP Registration¶

Register with state Prescription Drug Monitoring Program
Understand checking requirements
Integrate with workflow

Summary Checklist¶

Formation Documents¶

State and Local¶

State tax registration complete
State business license obtained
Medical board notification complete
City/county licenses obtained
Zoning verified

Financial¶

Business bank account open
Business credit card obtained
Accounting system set up

Insurance¶

Malpractice insurance active
General liability insurance active
Additional coverage evaluated

Prescribing¶

DEA registration complete
State controlled substance registration complete
PDMP registration complete

Timeline Estimate¶

Task	Typical Timeline
Entity formation	1-14 days
EIN	Same day (online)
State registrations	1-4 weeks
Local licenses	1-2 weeks
Bank account	1-3 days
Malpractice insurance	1-2 weeks
DEA registration	4-6 weeks

Total estimated time: 4-8 weeks (some tasks can run in parallel)

Resources¶

Your state's Secretary of State website
IRS Small Business Portal
Your state medical board website
DEA Diversion Control Division
Local chamber of commerce (for local requirements)

Next Steps¶

Once registration is complete, proceed to: - Startup Costs Overview - HIPAA Compliance Basics - Office Space Guide