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Select Medical Holdings Employees: Handling Single-Stock Concentration with a Section 351 Strategy

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Healthcare Provider Update: Healthcare Provider for Select Medical Holdings: Select Medical Holdings operates primarily through its network of specialized rehabilitation hospitals and outpatient rehabilitation clinics. Their healthcare services focus on providing rehabilitation services for critical illness, physical therapy, and long-term acute care hospitals, making them a significant player in the healthcare sector. Potential Healthcare Cost Increases in 2026: As we approach 2026, significant increases in healthcare costs are anticipated, primarily driven by expected record hikes in Affordable Care Act (ACA) premiums. With states facing premium increases exceeding 60%, many individuals may experience out-of-pocket premium hikes of up to 75%, drastically affecting affordability. Contributing factors include the potential expiration of federal premium subsidies and rising medical costs from hospitals and providers. This perfect storm of financial pressures underlines the urgent need for consumers to prepare for the impending increase in healthcare expenses. Click here to learn more

'Select Medical Holdings employees with concentrated stock positions should understand that strategies like a Section 351 exchange can offer flexibility in managing large unrealized gains while preserving long-term planning options.' – Tyson Mavar, a representative of The Retirement Group, a division of Wealth Enhancement.

'Select Medical Holdings employees facing concentrated stock exposure may find that a Section 351 exchange provides an effective way to mitigate risk and maintain control over the timing of potential tax liabilities.' – Wesley Boudreaux, a representative of The Retirement Group, a division of Wealth Enhancement.

In this article, we will discuss:

  1. When a Section 351 exchange can help diversify concentrated stock positions without an immediate tax bill.

  2. The core eligibility rules (80% control test) and basis/step-up mechanics that drive tax deferral.

  3. Sample case studies (James & Sarah) illustrating the numbers and outcomes.

The Strategic Potential of Section 351: An Analysis of a Multi-Stock Case in Tax-Deferred Reorganization

A sizable amount of the wealth of many high-earning professionals at Select Medical Holdings may be invested in a small number of highly valued equities, including company shares accumulated through restricted stock units (RSUs), the employee stock purchase plan (ESPP), or equity awards earned due to long tenure. While rebalancing may seem out of reach due to the tax ramifications of selling these positions, investors can make tax-deferred contributions of appreciated assets to a new business entity through a Section 351 exchange. When an investor wants to manage several sizable, embedded gains at once, this tactic may be especially useful.

Think about James, a client with a $10 million portfolio. The value of one stock investment, which he purchased for $50,000, has increased to $1 million, or 10% of his total portfolio. At a long-term capital gains rate that can reach 23.8% for certain high-income taxpayers (20% maximum long-term capital gains rate plus the 3.8% Net Investment Income Tax), selling this position would result in a $950,000 capital gain and an estimated $226,100 tax bill. The amount available for reinvestment would be reduced by this tax.

Section 351(a) of the Internal Revenue Code provides: “If property is transferred to a corporation by one or more persons solely in exchange for stock in such corporation and immediately after the exchange such person or persons are in control (as defined in section 368(c)) of the corporation, no gain or loss shall be recognized.” Under Section 368(c), “control” generally means ownership of at least 80% of the voting power and 80% of each class of non-voting shares.

The transferor or transferors must own at least 80% of the new corporation’s stock right after the exchange to qualify for this treatment. This can be done for investors with sizable portfolios by joining a larger seeding group or acting as the principal seeder of a new entity.

In a Section 351 transaction, any built-in gains are preserved because the shareholder’s basis in the received stock typically carries over from the contributed property. If the shares are held until death, a step-up in basis under Section 1014 may eliminate the deferred gain.

Another client example involves Sarah, who has a $13 million portfolio. She owns two appreciated stocks:

  • Stock A: Originally $300,000, now worth $3 million.

  • Stock B: Initial cost basis $500,000, now worth $3 million.

At a long-term capital gains rate that can reach 23.8% for certain high-income taxpayers, the aggregate unrealized gain of $5.2 million would translate into an estimated tax of roughly $1,237,600 if sold today, which can constrain portfolio adjustments.

For employees of Select Medical Holdings holding concentrated positions, taking part in a Section 351 exchange can reduce concentration risk and defer recognition of these gains without an immediate tax bill. If assets receive a step-up in basis at death, the deferred gain may be fully eliminated under current law, and deferral can provide flexibility in managing future tax obligations.

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Sources:

1.  Internal Revenue Service.  Revenue Ruling 2003-51 . Internal Revenue Bulletin 2003-21, 2003. PDF.

2.  Friedel, David B., and Yaw O. Awuah. “ Sec. 351 Control Requirement: Opportunities and Pitfalls .”  The Tax Adviser , 1 July 2014. Web.

3.  Internal Revenue Service. “ Net Investment Income Tax (NIIT) .”  IRS.gov , last reviewed 1 July 2025. Web.

4.  Internal Revenue Service.  Publication 551: Basis of Assets . December 2024 revision, posted 18 February 2025. PDF.

5.  FINRA Investor Education Foundation (FINRA). “ Concentrate on Concentration Risk .”  FINRA.org , 15 June 2022. Web.

What is the 401(k) plan offered by Select Medical Holdings?

The 401(k) plan offered by Select Medical Holdings is a retirement savings plan that allows employees to save a portion of their paycheck before taxes are taken out.

Does Select Medical Holdings match employee contributions to the 401(k) plan?

Yes, Select Medical Holdings provides a matching contribution to employee 401(k) accounts, subject to certain limits and conditions.

What is the eligibility requirement to participate in Select Medical Holdings' 401(k) plan?

Employees of Select Medical Holdings are typically eligible to participate in the 401(k) plan after completing a specified period of service, as outlined in the plan documents.

How can employees of Select Medical Holdings enroll in the 401(k) plan?

Employees can enroll in the Select Medical Holdings 401(k) plan by completing the enrollment process through the designated online portal or by contacting the HR department for assistance.

What types of investment options are available in the Select Medical Holdings 401(k) plan?

The Select Medical Holdings 401(k) plan offers a variety of investment options, including mutual funds, target-date funds, and other investment vehicles, allowing employees to choose based on their risk tolerance.

Can employees of Select Medical Holdings take loans against their 401(k) savings?

Yes, Select Medical Holdings allows employees to take loans against their 401(k) savings, subject to the terms and conditions of the plan.

What happens to the 401(k) plan if an employee leaves Select Medical Holdings?

If an employee leaves Select Medical Holdings, they have several options for their 401(k) savings, including rolling over the balance into an IRA or a new employer's plan.

Are there any fees associated with the Select Medical Holdings 401(k) plan?

Yes, there may be administrative fees and investment-related fees associated with the Select Medical Holdings 401(k) plan, which are disclosed in the plan documents.

How often can employees change their contribution rates to the Select Medical Holdings 401(k) plan?

Employees can typically change their contribution rates to the Select Medical Holdings 401(k) plan at any time, subject to the plan's guidelines.

Does Select Medical Holdings provide financial education regarding the 401(k) plan?

Yes, Select Medical Holdings offers resources and financial education to help employees make informed decisions about their 401(k) savings and investments.

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