Bookkeeping and tax for medical businesses • Personal tax returns for individuals

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How do quarterly estimated payments actually work?

The US tax system is pay-as-you-go. If you run a business, you cannot wait until April 15 to pay all the tax you owe. The IRS expects you to pay throughout the year, and they charge penalties if you wait too long, even if you pay everything you owe by the filing deadline.

Estimated payments are due four times a year. April 15 covers income earned January through March, June 15 covers April and May, September 15 covers June through August, and January 15 of the following year covers September through December. These dates apply to both federal and most state estimated payments.

The penalty catches people off guard. You might think you’ll just pay the full balance when you file in April. The problem is the IRS charges a penalty for each quarter you underpaid, calculated like interest on the amount you should have paid. So even if you write a check for everything you owe on April 15, you still owe penalties for not paying during the year. The penalty rate changes periodically and has been running around 8% annually, though current rates should be verified with the IRS.

Safe harbor rules make the amounts predictable. You can avoid penalties entirely by paying at least 100% of last year’s tax liability spread across the four quarterly payments. If your adjusted gross income was above $150,000, the threshold is 110% of last year’s tax. This means you don’t have to guess what your current year’s profit will be. Look at last year’s total tax, divide by four, and pay that amount each quarter. If you end up owing more at filing time, you pay the balance without penalties because you met safe harbor.

For clinicians who work a W-2 job alongside their business, there’s another useful strategy. You can increase the withholding on your W-2 paycheck to cover the tax on your business income. W-2 withholding is treated as if it were paid evenly throughout the year, even if you increase it in December. So if you realize in October that your business had a strong year and you’re behind on estimates, bumping up your W-2 withholding for the rest of the year can catch you up without quarterly payment penalties. This applies to many medical business owners who earn W-2 income at their clinical job while running a practice or agency on the side.

Hunter Green CPA calculates estimated payment amounts and schedules them as part of ongoing tax work for medical business owners nationwide. The Bookkeeping and Tax Package bundles monthly bookkeeping with tax return preparation and includes this planning, since clean books make accurate estimates possible. When the books are current all year, the estimated payments reflect what is actually happening in the business.

If you’re unsure what you should be paying or whether your current approach is right, book a consultation to review your situation.

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More Questions

What deductions do medical business owners commonly miss?

Medical business owners often miss vehicle and mileage expenses, continuing education costs, professional insurance premiums, and retirement contributions. The common thread is poor documentation throughout the year.

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What changed with 1099 rules, and what do I file this January?

The $2,000 reporting threshold applies to payments made in 2026, not 2025. This January, you still file 1099s for contractors who received $600 or more. The first filings under the new threshold happen in January 2027.

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Where do caregiver overtime rules stand right now?

The federal rules are in flux. The DOL has proposed reinstating the companionship exemption for agencies, but the change is not final and many states require overtime regardless. The safe approach is to budget and pay as if overtime applies.

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Is December too late to lower this year's taxes?

December is late but not useless. You can still make equipment purchases, establish certain retirement plans, time expenses, and correct estimated payments. January is when the door truly closes.

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My side business made real money this year. Why is my refund gone?

Your business profit stacks on top of your W-2 clinical income and gets taxed at your highest marginal rate, plus self-employment tax. The W-2 withholding that used to produce refunds was never meant to cover this extra layer.

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How long do I need to keep receipts and financial records?

Keep most business financial records for seven years to cover the IRS's standard audit window and extended periods for income understatement. Payroll records need at least four years. Cloud bookkeeping with digital receipt storage makes retention automatic rather than a filing cabinet project.

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Hunter Green CPA provides bookkeeping, tax preparation, and tax strategy for medical business owners across the United States. Alongside its business services, the firm prepares personal tax returns for individuals and families. Based in Oak Park, Illinois and led by Mason Hunter, a CPA with 10 years of tax experience and a background in corporate tax management.

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