Everything behind the front desk, kept.
Ledger & Keel runs the back office for med spas: books, payroll, HR, taxes and compliance, with legal work handled by independent attorneys who know aesthetic medicine. One team and one monthly fee, built around how an MSO and a medical practice actually operate.
Now booking Illinois med spas for year-end.
Reserve a year-end spotWhat we keep
| When | Entry | Plan |
|---|---|---|
| Every treatment | Good-faith exams, delegation orders, MD reviews on file | Keel |
| Every payroll | Injector pay, commissions and classification checked | Operate |
| Every month | Books closed by day 10 for your MSO and practice | Operate |
| Every quarter | Sales tax, estimated taxes, policy and HIPAA reviews | Operate |
| Every year | Registered agent, annual reports, license renewals | Keel |
| Dec 31 | Books closed to year-end, equipment write-offs planned | Year-End Ready |
| Feb 1 | W-2s and 1099-NECs filed | Year-End Ready |
Year-End Ready, $1,950
Close 2026 cleanly before the deadlines arrive. We close your books to Dec 31, get W-2s and 1099s ready to file, plan write-offs for equipment you put in service this year, true up balances between your MSO and your practice, and spot-check your compliance records.
Move to a monthly plan by Jan 31 and onboarding is free.
Reserve a year-end spotMonthly plans
- Keel
- $490 a month
- Registered agent and filings for two entities, your compliance logbook, your HIPAA program and a quarterly consult with an independent attorney.
- Operate
- $1,490 a month
- Everything in Keel, plus books, payroll, HR, sales tax and year-end filings.
- Scale
- From $3,900 a month
- For multi-location spas and MSOs: business tax returns, a fractional controller and records ready for a lender or buyer.