Form 14581-A - Fringe Benefits Compliance Self-Assessment For Public Employers Page 3

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Page 3
c. Group-term life insurance provided by the employer
Yes
No
Follow Up
Note: The annual cost of $50,000 of group-term life insurance may be excludable from Social Security, Medicare and income tax for
each employee. The table for determining the cost of additional insurance is included in Publication 15-B.
The cost of group-term life insurance in excess of $50,000 is subject to Social Security and Medicare, but not to income tax withholding.
Comments
d. Meals provided by the employer
Yes
No
Follow Up
Note: Meals may be excludable from income in the following cases:
a) “De minimis” meals, for example, occasional group meals, or
b) Meals for the convenience of the employer, provided on the business premises.
Comments
e. Lodging provided for workers
Yes
No
Follow Up
Note: Lodging may be excludable if for employer’s convenience as a condition of employment, if on the employer’s business premises.
Lodging costs may also be excludable if paid for or reimbursed as working condition fringe.
See Publication 15-B for information on lodging as a fringe benefit.
Comments
f. Educational assistance provided to workers
Yes
No
Follow Up
Note: Educational assistance may be excludable if the plan is in writing and meets certain other tests:
a) Under educational assistance program (up to $5,250 per year), or
b) As a working condition fringe benefit.
See Publication 15-B and Publication 970, Tax Benefits for Education, for more information.
Comments
g. Achievement awards or length of service awards given to workers
Yes
No
Follow Up
Note: For more information, see Publication 535, Business Expenses.
Comments
h. Membership fees paid for any workers
Yes
No
Follow Up
Excludable if:
a) For professional and business-related organizations and reasonable business purpose; or
b) Use of athletic or recreation facilities, on employer premises by current or former employees or their family members.
Employer's payment of fees for employees' use of third-party owned facilities is generally taxable.
Comments
14581-A
Catalog Number 69844Y
Form
(6-2017)

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