Fillable Form Mo-Shc - Self-Employed Health Insurance Tax Credit printable pdf download

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Missouri Department of Revenue

Form

Self-Employed Health Insurance Tax Credit

MO-SHC

Social Security Number

Name

Spouse’s Name

Spouse’s Social Security Number

If you are a self-employed individual and were not able to deduct all of your health care premiums from your federal adjusted gross income,

you may be eligible for a tax credit equal to the portion of your federal tax liability incurred due to the inclusion of your health care premiums in

your federal adjusted gross income. The self-employed health insurance tax credit is refundable.

Calculate your tax credit by using either method below and enter the total on

Form

MO-TC. Self-employed individuals with personal exemp-

tions and itemized deductions limited on their federal return because their federal adjusted gross income exceeded the limits established by

the Internal Revenue Service should use the Regular Method. If you are filing a combined return, and both spouses were self-employed and

paid health insurance premiums, combine the amounts paid by both spouses when calculating your credit. Attach completed MO-SHC, pages

1 and 2 of Federal Form 1040, and Federal Schedule C, if applicable, to

Form

MO-TC.

1. Federal taxable income from Federal Form 1040, Line 43 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Amount you paid for health insurance premiums which were included in federal adjusted gross income. . . . . . . . . . . . . . . . . . . . .

3. Subtract Line 2 from Line 1.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Calculate an adjusted federal tax by comparing the amount on Line 3 with the federal tax tables . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Federal tax from your Federal Form 1040, Line 44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Subtract Line 4 from Line 5. This is your self-employed health insurance tax credit. Report on

Form

MO-TC. . . . . . . . . . . . . . . .

Federal adjusted gross income from Federal Form 1040, Line 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The amount you paid for health insurance premiums which were included in your federal adjusted gross income . . . . . . . . . . . . .

Subtract Line 2 from Line 1. This is your revised federal adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter your standard or itemized deductions. If your itemized deductions were reduced because your income was

over the limit, use the amount from Line 3 of this worksheet to recalculate the itemized deductions . . . . . . . . . . . . . . . . . . . . . . . .

Enter your personal exemption amount. If your personal exemption was reduced because your income was over the

limit, use the amount from Line 3 of this worksheet to recalculate the personal exemption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add lines 4 and 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract Line 6 from Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Calculate an adjusted federal tax by computing the amount on Line 7 with the federal tax tables.

Enter the adjusted amount here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If you paid an alternative minimum tax, use the revised federal adjusted gross income from Line 3 on this

worksheet to recalculate the tax calculated on Form 6251, and enter the revised amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Add Lines 8 and 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11. If you reduced your tax by any of the credits listed on Federal Form 1040, Lines 47–53, use the revised federal

adjusted gross income from Line 3 on this worksheet to recalculate each of the credits to which you are eligible,

and enter the total of all the credit amounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12. Subtract Line 11 from Line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

13. Total of Federal Form 1040, Lines 56-60. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14. Add Lines 12 and 13. This is your revised federal tax liability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15. Amount from Federal Form 1040, Line 61. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

16. Subtract Line 14 from Line 15. This is your self-employed health insurance tax credit. Report on Form MO-TC. . . . . . . . . . . . . . 16

Form MO-SHC (Revised 11-2013)

Mail to:

Taxation Division

Phone: (573) 526-8733

P.O. Box 27

TDD: (800) 735-2966

Visit

for additional information.

Jefferson City, MO 65105-0027

Fax: (573) 751-2195

E-mail: