Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

Small_Employer_Health_Insurance_Tax_Credit

VIEWS: 3 PAGES: 10

									              START HERE: Please complete the instructions for each column of row 9 starting with column A and moving to the right.                                                           Cell Legend
            Related or commonly-controlled businesses must be aggregated for purposes of this calculation. Watch Tests 1, 2, 3 and 4 below.                                                   Calculated
                                                                                                                                                                                              Instructions
NAME(S):                                             Insert Company Name Here                                                                                                    Insert Data in Cells of this Color
                   2010 CREDIT FOR SMALL EMPLOYER HEALTH INSURANCE PREMIUMS
                                      Use for completing 2010 Form 8941
                                                                                                                            Qualified
                                                                                                           FICA Wages =     Premiums
                                                                                          Qualifying         Qualifying      Paid by         Percentage of          Single or       State of          Qualifying
   Employee Type                           Name                       Payroll Hours        Hours              Wages         Employer         Year Covered            Family       Employment          Premiums



                                                                                                           Enter FICA
                                                                                                           wages without
                                                                                                           regard to FICA
                                                                                                           wage base of
                                                                                                           $106800 for
                                                                                                                     Enter the
                                                                                                           each eligible
                                                                                                                     percentage of
                                                                                                           employee. Do
Review Basic Credit                                                                                    Enter
                                                                                                           NOT enter the year
Eligibility below. If                                                                                  employer-paid (based on
                                                                                                           wages for any                                                                         (Formula
you may be eligible, Enter eligible employees only (include                                            qualified
                                                                                                           seasonal  payroll                                                                     based on Note
please continue by    eligible employees not participating in                                          premiums;
                                                                                                           employee  periods) the                                                                5) This
completing the        health insurance and former employees Enter total                                also enter    employee was
                                                                                                           working less                                                                          formula
spreadsheet.          who terminated employment during the    hours                                    seasonal      covered by
                                                                                                           than 120 days.                                                                        requires a
                      year)                                   (see note 10)                            employees     employer paid                                               Enter the       Single/ Family
Enter percentages of (see notes 1 & 2 below)                  Do NOT enter                Then, review <120 days     insurance (see                                              State each      code in
employer-paid                                                 hours for any Review TEST2 TEST3 &       worked        note 12). Enter                                             empl'ee         column M and
premiums in TEST1 If you need additional rows, "copy" entire seasonal        below for    TEST4 below employer-paid without the                                  Enter S or F    enrolls for     a state code in
box below. Review rows from the middle of the below chart employee           continued    for cont'd   qualified     decimal (for                                for Single or   coverage by column N for
TEST1 for continued and "insert copied rows" into the middle working less credit          credit       premiums      example 100                                 Family          using the drop- each
eligibility.          of the chart.                           than 120 days. eligibility. eligibility. (see note 11) not 1.00)                                   Coverage        down options employee.
                                                                            (a)              (b)                (c)            (d)                ----                 ----            ----                  (e)
Full & Part-time      Employee 1                                                  2,000            2,000          32,000             6,000               100.0          F               IL                         4,924
Employees             Employee 2                                                  2,400            2,080          64,000                 0                95.0          F               IL                              0
                      Employee 3                                                  2,200            2,080          48,000             6,000               100.0          S               IL                         4,158
                      Employee 4                                                  2,080            2,080          33,000             6,000                50.0          S               IL                         2,079
                      Employee 5                                                  1,700            1,700          28,000             6,000                10.0          F               IL                           492
Note: Owners & family Employee 6                                                  1,800            1,800          30,000                 0               100.0          S               IL                              0
members of owners are                                                                                  0                                                                                                              n/a
not eligible. See                                                                                      0                                                                                                              n/a
NOTES 1 & 2 below.                                                                                     0                                                                                                              n/a
                                                                                                       0                                                                                                              n/a
                                                                                                       0                                                                                                              n/a
                                                                                                       0                                                                                                              n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
                                                                                                   0                                                                             n/a
Seasonal Employees Employee 7                                                 1,120            1,120          16,000           6,000            15.0    S         il            624
(If annual employment Employee 8 - less than 120 days worked                                       0                           6,000            10.0    F         il            492
is 120 days or less                                                                                0                                                                             n/a
leave hours and wages                                                                              0                                                                             n/a
                      Total "employees" for Form, line 1:    8
                      # of "employees" for Form, line 13:    6
TOTALS:               # of "employees" for Form, line 14:    4               13,300           12,860        251,000           36,000   ------          ------   ------       12,770


       (See NOTEs 11 and 13 for what qualifies and how to calc
                                these %s)                      Alerts
      % Premiums Pd - Single Coverage                      80%                        Qualifying Premiums (NOTE 5)                                                       $   12,770
      For 2010, if the single-coverage % is less than 50%,
TEST1 STOP, no credit                                          continue               Multiplied by credit rate                                                                35%
      % Premiums Paid - Family Coverage                    40%                        Maximum Credit (NOTE 6)                                                            $    4,469


        Qualifying Payroll Hrs (NOTE 3)                   12,860                      Annual Wage Phase-out Adj. Percentage (NOTE 7)                                           64%
        Divided by:                                         2,080                     Annual Wage Phase-out Amount                                                       $   (2,860)
TEST2    If this # is 25 or more, STOP, no credit            6.18 continue
                                                                                      Annual FTE Phase-out Adj. Percentage (NOTE 8)                                             0%
        FTE Count (round down)                               6.00                     Annual FTE Phase-out Amount                                                        $       0


        Qualifying FICA Wages (NOTE 4)                 $ 251,000                      Maximum credit from Above                                                          $    4,469
        Divided by FTE Count                                6.00                      Less Annual Wage Phase-out from above                                              $   -2,860


TEST3 If this # is $50K or more, STOP, no credit       $ 41,833 continue              Less Annual FTE Phase-out from above                                               $        0
                                                                                      Total Allowable Credit (NOTE 9)                                                    $    1,609
        Avg. Annual Wages (round down)                 $ 41,000

      If total phase out is 100% or more, STOP,
TEST4 no credit                                              64% continue
BASIC CREDIT ELIGIBILITY:
     (1) No more than 25 full-time equivalent employees (FTEs);
       (2) Average annual wages per FTE < $50,000; and
       (3) Contribute a uniform percentage of at least 50% of the premiums paid for health care. For 2010, an employer that pays family-coverage premiums in an amount equal to at least 50% of the
       premium for single (employee-only) coverage for each employee enrolled in coverage is deemed to satisfy the uniformity requirement (even if the percentage of the family premiums paid is <50%).
       Please see additional IRS guidance if "Uniformity" is in question.
       NOTE: In measuring employee’s wages and FTEs, related or commonly controlled businesses must be aggregated. IRC §45R(e)(5)(A).

NOTE 1 – OWNERS (NOT ELIGIBLE): Sole proprietors, partners in a partnership, shareholders owning more than 2% of an S corporation, and any owners of more than 5% of other business types are
not eligible "employees."
NOTE 2 – FAMILY MEMBERS OF OWNERS (NOT ELIGIBLE) AND OTHER SPECIAL EMPLOYEES: A dependent, child, descendant of a child, sibling, step-sibling, parent, ancestor of a parent, step-
parent, niece, nephew, aunt, uncle, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, sister-in-law of an "owner," as defined in NOTE 1, is not an eligible "employee." In addition, the
following spouses of business owners cannot be treated as employees: (1) the employee-spouse of a shareholder owning more than 2% of an S corporation's stock, (2) the employee-spouse of an owner
of more than 5% of a business, (3) the employee-spouse of a partner owning more than a 5% interest in a partnership, and (4) the employee-spouse of a sole proprietor.
Leased employees [as defined in IRC Sec. 414(n) ] are counted in computing an employer's FTEs and average annual wages. However, premiums for health insurance coverage paid by a leasing
organization for a leased employee are not taken into account by the employer in computing the employer's credit.
NOTE 3 – FULL-TIME EQUIVALENT EMPLOYEES (FTEs): The number of FTE employees is derived from a computation of total payroll hours for the year divided by an assumed 2,080 hours per FTE,
rounded down to next lowest whole number. Generally, the payroll hours of all employees (full-time and part-time) are counted, not just those enrolled in the employer’s health insurance plan. Leased
employees are also included. Seasonal workers are excluded unless they work more than 120 days during the year.
NOTE 4 – TOTAL QUALIFIED WAGES: Divide total qualified wages by FTEs, round down to next lowest multiple of $1,000. Use FICA wages calculated without regard to the FICA wage base limitation
($106,800 for 2010-2011). Exclude wage payments which are exempt from FICA (cafe plans, PIK wages, etc.). Wages of seasonal workers are excluded unless they work more than 120 days during the
year.

NOTE 5 – EMPLOYER PAID HEALTH PREMIUMS: The premium considered for the credit is (1) the smaller of the premium paid (limited to the percentage paid by the employer); or (2) the state average
premium for the type of coverage paid by the employer (employee-only or family coverage), limited to the percentage paid by the employer and the percentage of the year covered. Only premiums paid by
employer (including vision, dental, etc.) are counted in calculating the credit. Do not count employee premium payments; any premium payments under cafeteria plans; or any contributions to HRAs, FSAs,
or HSAs. For Multiemployer or Church Plans, please see IRS guidance. However, premiums paid for seasonal workers, even those working 120 days or less, are included.
EXAMPLE: Illinois employer pays 80% of an employee’s 2010 premium for single individual health insurance coverage (total $6,000). The premium amount eligible for the credit is limited to the Illinois
state average for employee-only coverage, further limited by the percentage paid by the employer ($5,198 x 80% = $4,158).
NOTE 6 – MAXIMUM CREDIT AMOUNT: 35% of total employer-paid premiums as adjusted in Note 5 above.
NOTE 7 – PHASE-OUT OF CREDIT IF AVERAGE ANNUAL WAGES EXCEED $25,000: Pro-rata phase-out to extent average annual wages exceed $25,000. Phase-out = 4% per $1,000 above
$25,000. Phase-out complete at $50,000 of average annual wages.
NOTE 8 – PHASE-OUT OF CREDIT IF FTEs EXCEED 10: Pro-rata phase-out occurs as FTEs move from 10 to 25 FTEs. EXAMPLE: If 15 FTEs, phase-out percentage = 33.33%.

NOTE 9 – CREDIT AMOUNT: The credit is a general business credit eligible for 1-year carry back and 20-year carryforward if not totally utilized in the current year. However, for 2010, any unused credit
is not eligible for carry back as unused credits cannot be carried back to a year prior to the effective date of the credit. COMPUTATION NOTE: The two phase-out computations are computed
independently of each other.
NOTE 10 - EMPLOYEE HOURS: Determine employee hours based on any of three methods described below:
1) Actual hours of service for which payment is made including vacations, holidays, etc.
2) Days-worked equivalency, assuming 8 hours for each day for which the employee was credited with at least 1 hour of service
3) Weeks-worked equivalency, assuming 40 hours for each week for which the employee was credited with at least 1 hour of service
NOTE 11 - QUALIFIED HEALTH INSURANCE PERCENTAGES: Qualified heath insurance coverage must be purchased by the employer from a company licensed as an insurance company under
applicable state law. This includes traditional health insurance, dental vision, long-term care, home health care, coverage for specific diseases, hospital indemnity, Medicare supplemental, and other group
health plans. Nonqualified plans include coverage ONLY for accident or disability income insurance, liability insurance, workers compensation, or coverage for on-site medical clinics. Self-insured plans are
not eligible, and premiums paid pursuant to a salary reduction are not considered employer-paid.
The employer must pay a uniform percentage of the premium for each employee enrolled, and must do so for each insurance plan if the premiums for a particular plan are to qualify for the credit (i.e.
different types of plans are not aggregated to determine eligibility but must each individually be eligible to be included in the credit calculation).

NOTE 12 - QUALIFYING PREMIUM LIMITATION: The state average premiums are based on a full year of coverage. For employees who are not covered by the employer's plans for the entire year, the
state average premium must be pro-rated. This may apply to new hires, terminated, seasonal, newly enrolled, etc employees. Enter the percentage of the year the employee was covered by the employer
provided insurance.
NOTE 13 - VAREYING PERCENTAGES OF COVERAGE: If there are varying percentages of coverage (e.g. employer-paid percentage changes during the year, employer-paid percentage varies among
types of insurance coverage, employer-paid percentage varies among classes of employees, etc), specific calculations beyond the scope of this spreadsheet are required. Please consult with your tax
advisor for details.

NOTE: This spreadsheet was prepared by WIPFLi LLP to facilitate calculation of the Small Employer Health Insurance Tax Credit. WIPFLI LLP assumes no liability for use.
Users must have adequate knowledge of the applicable tax law. Anomalous (and perhaps incorrect) result will be generated by inserting inappropriate inputs. WIPFLI LLP provides
this template in an "as is" condition and provides no warranty with respect to the underlying calculations. If you have questions regarding the use of this spreadsheet,
please send an email to Rick Taylor (Rtaylor@wipfli.com), Nicole Meinhardt (Nmeinhardt@wipfli.com) or Scott Wegner (Swegner@wipfli.com)
                START HERE: Please complete the instructions for each column of row 9 starting with column A and moving to the right.                                                              Cell Legend
              Related or commonly-controlled businesses must be aggregated for purposes of this calculation. Watch Tests 1, 2, 3 and 4 below.                                                      Calculated
NAME(S):                                              Insert Company Name Here                                                                                                                     Instructions
                   2010 CREDIT FOR SMALL EMPLOYER HEALTH INSURANCE PREMIUMS                                                                                                              Insert Data in Cells of this Color
                                                             Tax Exempt Organizations *
                                                        Use for completing 2010 Form 8941
                                                                                              Qualifying        FICA Wages =         Qualified        Percentage of         Single or       State of        Qualifying
   Employee Type                             Name                         Payroll Hours        Hours              Qualifying         Premiums         Year Covered           Family       Employment        Premiums



                                                                                                                Enter FICA
                                                                                                                wages without
                                                                                                                regard to FICA
                                                                                                                wage base of
                                                                                                                $106800 for
                                                                                                                each eligible                         Enter the
                                                                                                                employee. Do                          percentage of
Review Basic Credit                                                                                             NOT enter          Enter              the year
Eligibility below. If                                                                                           wages for any      employer-paid      (based on                                          (Formula
you may be eligible,                                                                                            seasonal           qualified          payroll                                            based on Note
please continue by   Enter eligible employees only (include eligible                                            employee           premiums;          periods) the                                       5) This
completing the       employees not participating in health                Enter total                           working less       also enter         employee was                                       formula
spreadsheet.         insurance and former employees who                   hours                                 than 120 days.     seasonal           covered by                                         requires a
                     terminated employment during the year) (see          (see note 10)                                            employees          employer paid                      Enter the       Single/ Family
Enter percentages of notes 1 & 2 below)                                   Do NOT enter                          Then, review       <120 days          insurance (see                     State each      code in
employer-paid                                                             hours for any     Review TEST2        TEST3 &            worked             note 12). Enter                    empl'ee         column M and
premiums in TEST1 If you need additional rows, "copy" entire              seasonal          below for           TEST4 below        employer-paid      without the        Enter S or F    enrolls for     a state code in
box below. Review rows from the middle of the below chart and             employee          continued           for cont'd         qualified          decimal (for       for Single or   coverage by column N for
TEST1 for continued "insert copied rows" into the middle of the           working less      credit              credit             premiums           example 100        Family          using the drop- each
eligibility.         chart.                                               than 120 days.    eligibility.        eligibility.       (see note 11)      not 1.00)          Coverage        down options employee.
                                                                                (a)                (b)                 (c)                (d)               ----                ----           ----             (e)
Full & Part-time      Employee 1                                                    2,000               2,000             32,000              6,000              100.0           F             WI                   5,128
Employees             Employee 2                                                    2,400               2,080             64,000                  0               95.0           F              IL                       0
                      Employee 3                                                    2,200               2,080             48,000              6,000              100.0           S             WI                   4,178
                      Employee 4                                                    2,080               2,080             33,000              6,000               50.0           S              IL                  2,079
Note: Owners & family Employee 5                                                    1,700               1,700             28,000              6,000               10.0           F              IL                    492
members of owners are Employee 6                                                    1,800               1,800             30,000                  0              100.0           S              IL                       0
not eligible.                                                                                               0                                                                                                          n/a
See NOTES 1 & 2                                                                                             0                                                                                                          n/a
below                                                                                                       0                                                                                                          n/a
                                                                                                            0                                                                                                          n/a
                                                                                                            0                                                                                                          n/a
                                                                                                            0                                                                                                          n/a
                                                                                                            0                                                                                                          n/a
                                                                                                            0                                                                                                          n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
                                                                                                         0                                                                                              n/a
Seasonal Employees Employee 7                                                       1,120            1,120          16,000           6,000                15.0    S             il                     624
(If annual employment Employee 8 - less than 120 days worked                                             0                           6,000                10.0    F             il                     492
is 120 days or less                                                                                      0                                                                                              n/a
leave hours and wages                                                                                    0                                                                                              n/a
                      Total "employees" for Form, line 1:          8
                      # of "employees" for Form, line 13:          6
TOTALS:               # of "employees" for Form, line 14:          4               13,300           12,860         251,000          36,000       ------          ------       ------                12,993

         (See NOTEs 11 and 13 for what qualifies and how to calc
                                 these %s)                         Alerts
       % Premiums Paid - Single Coverage                       80%                          Qualifying Premiums (NOTE 5)                                                                $           12,993
      For 2010, if the single-coverage % is less than 50%, STOP, no
TEST1 credit                                                        continue                Multiplied by credit rate                                                                                 25%
      % Premiums Paid - Family Coverage                         40%                         Maximum Credit (NOTE 6)                                                                     $            3,248


       Qualifying Payroll Hours (NOTE 3)                         12,860                     Annual Wage Phase-out Adj. Percentage (NOTE 7)                                                             64%
       Divided by:                                                2,080                     Annual Wage Phase-out Amount                                                                $           (2,079)
TEST2 If this # is 25 or more, STOP, no credit                     6.18 continue
                                                                                            Annual FTE Phase-out Adj. Percentage (NOTE 8)                                                              0%
       FTE Count (round down)                                      6.00                     Annual FTE Phase-out Amount                                                                 $               0


       Qualifying FICA Wages (NOTE 4)                        $ 251,000                      Maximum credit from Above                                                                   $            3,248
       Divided by FTE Count                                       6.00                      Less Annual Wage Phase-out from above                                                       $           -2,079

TEST3 If this # is $50K or more, STOP, no credit             $   41,833 continue            Less Annual FTE Phase-out from above                                                        $                0
                                                                                            Total Allowable Credit (NOTE 9)                                                             $            1,169
       Avg. Annual Wages (round down)                        $   41,000
                                                                                            Total Taxes Considered Payroll Taxes (NOTE 14)                                           INPUT $        2,000
      If total phase out is 100% or more, STOP, no
TEST4 credit                                                       64% continue
                                                                                            Lesser of the Allowable Credit or 2010 Taxes Considered Payroll Taxes (NOTE 14)                 $       1,169

* 501( c) tax-exempt employers qualify for the credit, but an employer that is an agency or instrumentality of the federal government, or of a state, local or Indian tribal government, is not a
qualified employer unless it is an organization described in Code section 501(c ) that is exempt from tax under Code section 501(a).
BASIC CREDIT ELIGIBILITY:
       (1) No more than 25 full-time equivalent employees (FTEs);
       (2) Average annual wages per FTE < $50,000; and
       (3) Contribute a uniform percentage of at least 50% of the premiums paid for health care. For 2010, an employer that pays family-coverage premiums in an amount equal to at least 50% of the
       premium for single (employee-only) coverage for each employee enrolled in coverage is deemed to satisfy the uniformity requirement (even if the percentage of the family premiums paid is <50%).
       Please see additional IRS guidance if "Uniformity" is in question.
       NOTE: In measuring employee’s wages and FTEs, related or commonly controlled businesses must be aggregated. IRC §45R(e)(5)(A).


NOTE 1 – OWNERS (NOT ELIGIBLE): Sole proprietors, partners in a partnership, shareholders owning more than 2% of an S corporation, and any owners of more than 5% of other business types are not
eligible "employees."
NOTE 2 – FAMILY MEMBERS OF OWNERS (NOT ELIGIBLE) AND OTHER SPECIAL EMPLOYEES: A dependent, child, descendant of a child, sibling, step-sibling, parent, ancestor of a parent, step-parent,
niece, nephew, aunt, uncle, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, sister-in-law of an "owner," as defined in NOTE 1, is not an eligible "employee." In addition, the following
spouses of business owners cannot be treated as employees: (1) the employee-spouse of a shareholder owning more than 2% of an S corporation's stock, (2) the employee-spouse of an owner of more than
5% of a business, (3) the employee-spouse of a partner owning more than a 5% interest in a partnership, and (4) the employee-spouse of a sole proprietor.
Leased employees [as defined in IRC Sec. 414(n) ] are counted in computing an employer's FTEs and average annual wages. However, premiums for health insurance coverage paid by a leasing organization
for a leased employee are not taken into account by the employer in computing the employer's credit.
NOTE 3 – FULL-TIME EQUIVALENT EMPLOYEES (FTEs): The number of FTE employees is derived from a computation of total payroll hours for the year divided by an assumed 2,080 hours per FTE,
rounded down to next lowest whole number. Generally, the payroll hours of all employees (full-time and part-time) are counted, not just those enrolled in the employer’s health insurance plan. Leased
employees are also included. Seasonal workers are excluded unless they work more than 120 days during the year.

NOTE 4 – TOTAL QUALIFIED WAGES: Divide total qualified wages by FTEs, round down to next lowest multiple of $1,000. Use FICA wages calculated without regard to the FICA wage base limitation
($106,800 for 2010-2011). Exclude wage payments which are exempt from FICA (cafe plans, PIK wages, etc.). Wages of seasonal workers are excluded unless they work more than 120 days during the year.
NOTE 5 – EMPLOYER PAID HEALTH PREMIUMS: The premium considered for the credit is (1) the smaller of the premium paid (limited to the percentage paid by the employer); or (2) the state average
premium for the type of coverage paid by the employer (employee-only or family coverage), limited to the percentage paid by the employer and the percentage of the year covered. Only premiums paid by
employer (including vision, dental, etc.) are counted in calculating the credit. Do not count employee premium payments; any premium payments under cafeteria plans; or any contributions to HRAs, FSAs, or
HSAs. For Multiemployer or Church Plans, please see IRS guidance. However, premiums paid for seasonal workers, even those working 120 days or less, are included.
EXAMPLE: Illinois employer pays 80% of an employee’s 2010 premium for single individual health insurance coverage (total $6,000). The premium amount eligible for the credit is limited to the Illinois state
average for employee-only coverage, further limited by the percentage paid by the employer ($5,198 x 80% = $4,158).
NOTE 6 – MAXIMUM CREDIT AMOUNT: 35% of total employer-paid premiums as adjusted in Note 5 above.
NOTE 7 – PHASE-OUT OF CREDIT IF AVERAGE ANNUAL WAGES EXCEED $25,000: Pro-rata phase-out to extent average annual wages exceed $25,000. Phase-out = 4% per $1,000 above $25,000.
Phase-out complete at $50,000 of average annual wages.
NOTE 8 – PHASE-OUT OF CREDIT IF FTEs EXCEED 10: Pro-rata phase-out occurs as FTEs move from 10 to 25 FTEs. EXAMPLE: If 15 FTEs, phase-out percentage = 33.33%.
NOTE 9 – CREDIT AMOUNT: The credit is a general business credit eligible for 1-year carry back and 20-year carryforward if not totally utilized in the current year. However, for 2010, any unused credit is not
eligible for carry back as unused credits cannot be carried back to a year prior to the effective date of the credit. COMPUTATION NOTE: The two phase-out computations are computed independently of each
other.
NOTE 10 - EMPLOYEE HOURS: Determine employee hours based on any of three methods described below:
1) Actual hours of service for which payment is made including vacations, holidays, etc.
2) Days-worked equivalency, assuming 8 hours for each day for which the employee was credited with at least 1 hour of service
3) Weeks-worked equivalency, assuming 40 hours for each week for which the employee was credited with at least 1 hour of service
NOTE 11 - QUALIFIED HEALTH INSURANCE PERCENTAGES: Qualified heath insurance coverage must be purchased by the employer from a company licensed as an insurance company under applicable
state law. This includes traditional health insurance, dental vision, long-term care, home health care, coverage for specific diseases, hospital indemnity, Medicare supplemental, and other group health plans.
Nonqualified plans include coverage ONLY for accident or disability income insurance, liability insurance, workers compensation, or coverage for on-site medical clinics. Self-insured plans are not eligible, and
premiums paid pursuant to a salary reduction are not considered employer-paid.
The employer must pay a uniform percentage of the premium for each employee enrolled, and must do so for each insurance plan if the premiums for a particular plan are to qualify for the credit (i.e. different
types of plans are not aggregated to determine eligibility but must each individually be eligible to be included in the credit calculation).
NOTE 12 - QUALIFYING PREMIUM LIMITATION: The state average premiums are based on a full year of coverage. For employees who are not covered by the employer's plans for the entire year, the state
average premium must be pro-rated. This may apply to new hires, terminated, seasonal, newly enrolled, etc employees. Enter the percentage of the year the employee was covered by the employer provided
insurance.

NOTE 13 - VARYING PERCENTAGES OF COVERAGE: If there are varying percentages of coverage (e.g. employer-paid percentage changes during the year, employer-paid percentage varies among types
of insurance coverage, employer-paid percentage varies among classes of employees, etc), specific calculations beyond the scope of this spreadsheet are required. Please consult with your tax advisor for
details.
NOTE 14 - TOTAL TAXES CONSIDERED PAYROLL TAXES: This is the amount of (1) federal income taxes the tax-exempt employer was required to withhold from employees' wages in calendar year 2010;
(2) Medicare taxes the tax-exempt employer was required to withhold from employees' wages in calendar year 2010; and (3) Medicare taxes the tax-exempt employer was required to pay for calendar year
2010. This will be the amount from 2010 Form W-3, Box 2 plus the amounts from Form 941, Line 5c, Column 2, for each quarter (March, June, September, and December) [approximately the same as Form W-
3, Box 6 X 2].

Total payroll taxes - 2010 Form W-3 line 2 + Line 5c from all 4 quarters of Form 941
Note: The Medicare tax from (Form W-3, line 6) X 2 will approximate Form 941,
Line 5c from all 4 quarters

NOTE: This spreadsheet was prepared by WIPFLi LLP to facilitate calculation of the Small Employer Health Insurance Tax Credit. WIPFLI LLP assumes no liability for use.
Users must have adequate knowledge of the applicable tax law. Anomalous (and perhaps incorrect) result will be generated by inserting inappropriate inputs. WIPFLI LLP provides
this template in an "as is" condition and provides no warranty with respect to the underlying calculations. If you have questions regarding the use of this spreadsheet,
please send an email to Rick Taylor (Rtaylor@wipfli.com), Nicole Meinhardt (Nmeinhardt@wipfli.com) or Scott Wegner (Swegner@wipfli.com)
2010 Small Employer Benchmarch Premiums - Rev. Rul. 2010-13

                                             Employee-
                                               only     Family
           State        State Abbreviation   Coverage Coverage
Alaska                          AK               $6,204  $13,723
Alabama                         AL                4,441   11,275
Arkansas                       AR                 4,329    9,677
Arizona                         AZ                4,495   10,239
California                     CA                 4,628   10,957
Colorado                       CO                 4,972   11,437
Connecticut                     CT                5,419   13,484
District of Columbia           DC                 5,355   12,823
Delaware                       DE                 5,602   12,513
Florida                         FL                5,161   12,453
Georgia                        GA                 4,612   10,598
Hawaii                          HI                4,228   10,508
Iowa                            IA                4,652   10,503
Idaho                           ID                4,215    9,365
Illinois                        IL                5,198   12,309
Indiana                         IN                4,775   11,222
Kansas                          KS                4,603   11,462
Kentucky                        KY                4,287   10,434
Louisiana                       LA                4,829   11,074
Massachusetts                  MA                 5,700   14,138
Maryland                       MD                 4,837   11,939
Maine                          ME                 5,215   11,887
Michigan                        MI                5,098   12,364
Minnesota                      MN                 4,704   11,938
Missouri                       MO                 4,663   10,681
Mississippi                    MS                 4,533   10,501
Montana                        MT                 4,772   10,212
North Carolina                 NC                 4,920   11,583
North Dakota                   ND                 4,469   10,506
Nebraska                       NE                 4,715   11,169
New Hampshire                  NH                 5,519   13,624
New Jersey                      NJ                5,607   13,521
New Mexico                     NM                 4,754   11,404
Nevada                         NV                 4,553   10,297
New York         NY   5,442   12,867
Ohio             OH   4,667   11,293
Oklahoma         OK   4,838   11,002
Oregon           OR   4,681   10,890
Pennsylvania     PA   5,039   12,471
Rhode Island     RI   5,887   13,786
South Carolina   SC   4,899   11,780
South Dakota     SD   4,497   11,483
Tennessee        TN   4,611   10,369
Texas            TX   5,140   11,972
Utah             UT   4,238   10,935
Virginia         VA   4,890   11,338
Vermont          VT   5,244   11,748
Washington       WA   4,543   10,725
Wisconsin        WI   5,222   12,819
West Virginia    WV   4,986   11,611
Wyoming          WY   5,266   12,163

								
To top