Instructions For Form 8941 - Credit For Small Employer Health Insurance Premiums - 2016 Page 5
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30Worksheet 1. Information Needed To
Waiver for Hawaii. Hawaii has received a 5-year State
Innovation Waiver under section 1332 of the Affordable
Complete Line 1 and Worksheets 2
Care Act. Employers in Hawaii cannot participate in the
and 3
SHOP Marketplace or claim the credit for insurance
premiums paid for health plan years beginning after 2016.
However, certain employers with a 2016 health plan year
If you need more rows, use a separate sheet and include
that continues into 2017 can claim the credit for part of
the additional amounts in the totals below.
their tax year beginning in 2017. For more information on
the waiver, visit CMS.gov.
(a)
(b)
(c)
Individuals
Employee
Employee
Exception for certain employers in Wisconsin. For
Considered
Hours of
Wages
calendar year 2016, SHOP Marketplaces in certain
Employees
Service
Paid
counties of Wisconsin did not have qualified health plans
available for employers to offer to employees. Transition
1.
relief allows employers with a principal business address
2.
in the counties listed below to claim the credit for their tax
3.
year beginning in 2016. Certain employers with a 2016
health plan year that continues into 2017 can claim the
4.
credit for part of their tax year beginning in 2017. For
5.
details, see Notice 2016-75, 2016-51 I.R.B. 832, available
at IRS.gov/IRB/2016-51_IRB#NOT-2016-75.
6.
Wisconsin: Pierce, Polk, and St. Croix counties.
7.
Line C
8.
9.
Answer “Yes” if a tax return you (or any predecessor) filed
for a tax year beginning in 2014 or 2015 included a Form
10.
8941 with line A checked “Yes” and line 12 showing a
11.
positive amount. For more information, see
Credit
Period,
earlier.
12.
13.
If you answer “Yes,” do not file Form 8941 unless you
are filing it for a partnership, S corporation, cooperative,
14.
estate, trust, or tax-exempt eligible small employer that
15.
received from another entity a credit that must be reported
on line 15. An entity that qualifies for this exception should
16.
not report any amount on line 12 . For more information,
17.
see the instructions for line 15.
18.
19.
20.
21.
22.
23.
24.
25.
Totals:
Column (a), Individuals Considered
Employees
Enter the name or other identifying information for all
individuals considered employees for purposes of this
credit.
In general, all employees who perform services for you
during the tax year are taken into account in determining
your FTEs, average annual wages, and premiums paid.
Rules that apply to certain types of employees are
discussed below.
-5-
Instructions for Form 8941 (2017)
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