Instructions For Form 8941 - Credit For Small Employer Health Insurance Premiums - 2010 Page 7
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8Worksheet 4. Information Needed To Complete
Worksheet 5. FTE Limitation
Lines 4 and 5 and Worksheet 7
1. Enter the amount from Form 8941, line 7 . . 1.
If you need more rows, use a separate sheet and include the
additional amounts in the totals below.
2. Enter the amount from Form
8941, line 2 . . . . . . . . . . . . . . 2.
(a)
(c)
(d)
3. Subtract 10 from line 2 . . . . . . 3.
Enrolled
(b)
Employer
Enrolled
4. Divide line 3 by 15. Enter the
Individuals
Employer
State
Employee
result as a decimal (rounded to
Considered
Premiums
Average
Hours of
at least 3 places) . . . . . . . . . . . 4.
Employees
Paid
Premiums
Service
5. Multiply line 1 by line 4 . . . . . . . . . . . . . . . 5.
1.
6. Subtract line 5 from line 1. Report this
2.
amount on Form 8941, line 8 . . . . . . . . . . . 6.
3.
Line 9
4.
If the average annual wages reported on line 3 are
5.
$25,000 or less, your credit is not reduced by the
6.
average annual wage limitation. Enter on line 9 the
amount from line 8. If line 3 is more than $25,000, enter
7.
on line 9 the reduced credit amount shown on Worksheet
8.
6, line 7.
9.
Worksheet 6. Average Annual Wage Limitation
10.
11.
1. Enter the amount from Form 8941, line 8 . . . 1.
2. Enter the amount from Form
12.
8941, line 7 . . . . . . . . . . . . . . . . 2.
13.
3. Enter the amount from Form
14.
8941, line 3 . . . . . . . . . . . . . . . . 3.
4. Subtract $25,000 from line 3 . . . . 4.
15.
5. Divide line 4 by $25,000. Enter
16.
the result as a decimal (rounded
17.
to at least 3 places) . . . . . . . . . . 5.
6. Multiply line 2 by line 5 . . . . . . . . . . . . . . . . 6.
18.
7. Subtract line 6 from line 1. Report this
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amount on Form 8941, line 9 . . . . . . . . . . . 7.
20.
Line 10
21.
Enter the total amount of any state premium subsidies
22.
paid and any state tax credits available to you for
23.
premiums included on line 4. For details, see State
Premium Subsidy and Tax Credit Limitation on page 5.
24.
Line 13
25.
Enter the total number of individuals shown in column (a)
of Worksheet 4. These are individuals considered
employees for whom you paid premiums during the tax
Totals:
year for health insurance coverage under a qualifying
arrangement.
Line 8
Line 14
If the number of FTEs reported on line 2 is 10 or less,
Enter the number of full-time equivalent employees
your credit is not reduced by the FTE limitation. Enter on
(FTEs) shown on line 3 of Worksheet 7. These are FTEs
line 8 the amount from line 7. If line 2 is more than 10,
for whom you paid premiums for health insurance
enter on line 8 the reduced credit amount shown on
coverage under a qualifying arrangement during the tax
Worksheet 5, line 6.
year.
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