Instructions for Form 8941 - Introductory Material Future Developments Reminders Exception for eligible small employers in certain counties. Waiver for Hawaii. General Instructions Purpose of Form Eligible Small Employers 1. You paid premiums for employee health insurance coverage under a qualifying arrangement. 2. You had fewer than 25 full-time equivalent employees (FTEs) for the tax year. 3. You paid average annual wages for the tax year of less than $56,000 per FTE. Employers treated as a single employer. Credit Period Employer Premiums Paid State premium subsidy or tax credit. Wellness programs. Tobacco surcharges. Dependent coverage. Portion of premiums paid. Health Insurance Coverage Qualifying Arrangement State or local law. Wellness program. Tobacco surcharge. Dependent coverage. Arrangements with composite billing. Arrangements with list billing and only employee-only coverage. Arrangements with list billing and other tiers of coverage. Employer-computed composite rate. More than one plan. State subsidies and credits. State Premium Subsidy and Tax Credit Limitation Payroll Tax Limitation for Tax-Exempt Eligible Small Employers Premium Deduction Reduced More Information Specific Instructions Line A Waiver for Hawaii. Exception for eligible small employers in certain counties. Line C Column (a), Individuals Considered Employees Excluded employees. Former employees. Leased employees. Seasonal employees. Household and other nonbusiness employees. Ministers. Column (b), Employee Hours of Service Employee hours of service. Actual-hours-worked method. Days-worked equivalency method. Weeks-worked equivalency method. Column (c), Employee Wages Paid Column (a), Enrolled Individuals Considered Employees Column (b), Employer Premiums Paid Column (c), Adjusted Average Premiums Column (d), Enrolled Employee Hours of Service Line 10 Line 15 Line 17 Cooperatives. Estates and trusts. Line 19 Instructions for Form 8941 - Notices Paperwork Reduction Act Notice. Instructions for Form 8941 - Additional Material Average Premiums Needed To Figure Adjusted Amounts on Worksheet 4 Instructions for Form 8941 (2021) Credit for Small Employer Health Insurance Premiums Section references are to the Internal Revenue Code unless otherwise noted. 2021 Instructions for Form 8941 - Introductory Material Future Developments For the latest information about developments related to Form 8941 and its instructions, such as legislation enacted after they were published, go to IRS.gov/Form8941. Reminders Exception for eligible small employers in certain counties. Certain small employers whose principal business address is in a county with no qualified health plan through a Small Business Health Options Program (SHOP) Marketplace may be able to claim the credit for small employer health insurance premiums. For more information, see Exception for eligible small employers in certain counties in the instructions for line A. Waiver for Hawaii. Employers in Hawaii can’t claim this credit for insurance premiums paid for health plan years beginning after 2016. For more information, see Waiver for Hawaii in the instructions for line A. General Instructions Purpose of Form Eligible small employers (defined below) use Form 8941 to figure the credit for small employer health insurance premiums for tax years beginning after 2009. For tax years beginning after 2013, the credit is only available for a 2-consecutive-tax-year credit period. The maximum credit is generally a percentage of premiums the employer paid during the tax year for certain health insurance coverage the employer provided to certain employees enrolled in a qualified health plan offered through a Small Business Health Options Program (SHOP) Marketplace. But the credit may be reduced by limitations based on the employer’s full-time equivalent employees, average annual wages, adjusted average premiums, and state premium subsidies and tax credits. .For information about insurance plans offered through a SHOP Marketplace, visit Healthcare.gov.. For tax-exempt eligible small employers, the maximum credit is 35% of premiums paid, is limited to the amount of certain payroll taxes paid, and is claimed as a refundable credit on Form 990-T, Exempt Organization Business Income Tax Return. A tax-exempt eligible small employer is an eligible small employer described in section 501(c) that is exempt from taxation under section 501(a). A tax-exempt employer not described in section 501(c) is generally not eligible to claim this credit. However, a tax-exempt farmers’ cooperative subject to tax under section 1381 may be able to claim the credit as a general business credit, as discussed next. For all other eligible small employers, the maximum credit is 50% of premiums paid and can be taken against both regular and alternative minimum tax. The credit is claimed as part of the general business credit on Form 3800. .Partnerships, S corporations, cooperatives, estates, trusts, and tax-exempt eligible small employers must file this form to claim the credit. All other taxpayers must not complete or file this form if their only source for this credit is a partnership, S corporation, cooperative, estate, or trust. Instead, they must report this credit directly on line 4h in Part III of Form 3800, General Business Credit.. Eligible Small Employers You’re an eligible small employer for the tax year if you meet the following three requirements. 1. You paid premiums for employee health insurance coverage under a qualifying arrangement. A qualifying arrangement is generally an arrangement that requires you to pay a uniform percentage (not less than 50%) of the premium cost for each enrolled employee’s health insurance coverage (defined later). However, an arrangement that requires you to pay a uniform premium for each enrolled employee (composite billing) and offers different tiers of coverage (for example, employee-only, dependent, and family coverage) can be a qualifying arrangement even if it requires you to pay a uniform percentage that is less than 50% of the premium cost for employees not enrolled in employee-only coverage. In addition, an arrangement that requires you to pay a separate premium for each employee based on age or other factors (list billing) can be a qualifying arrangement even if it requires you to pay a uniform percentage that is less than 50% of the premium cost for some employees. For details, see Employer Premiums Paid, Health Insurance Coverage, and Qualifying Arrangement, later. 2. You had fewer than 25 full-time equivalent employees (FTEs) for the tax year. You may be able to meet this requirement even if you had 25 or more employees. For example, an employer with 48 employees that are each half-time employees has 24 FTEs and can claim the credit. For details, see Worksheets 1 and 2. .Although the term “eligible small employer” is defined in the Internal Revenue Code to include employers with “no more than” 25 FTEs, the phaseout of the credit amount operates in such a way that an employer with exactly 25 FTEs is not, in fact, eligible for the credit. . 3. You paid average annual wages for the tax year of less than $56,000 per FTE. For details, see Worksheets 1 and 3. .If you had more than 10 FTEs and average annual wages of more than $27,000, the FTE and average annual wage limitations (discussed later) will separately reduce your credit. This may reduce your credit to zero even if you had fewer than 25 FTEs and average annual wages of less than $56,000.. Employers treated as a single employer. Treat the following employers as a single employer to figure the credit. Employers who are corporations in a controlled group of corporations. Employers who are members of an affiliated service group. Employers who are partnerships, proprietorships, etc., under common control. See Regulations sections 1.414(c)-2, 1.414(c)-3, and 1.414(c)-4. Tax-exempt employers under common control. See Regulations section 1.414(c)-5. For details, see section 45R(e)(5)(A) and Regulations section 1.45R-2(b). .No more than one Form 8941 can be filed with a tax return, unless the exception described in Example 2 below applies.. Example 1. You’re a sole proprietor with two separate businesses and you file a separate Schedule C (Form 1040) for each business. You must treat both businesses as a single employer to figure the credit. You will file one Form 8941 for both businesses. Example 2. You and your spouse are both sole proprietors and file a separate Schedule C (Form 1040) for each of your separate businesses. Neither spouse was an employee of the other spouse or participated in the management of the other spouse’s business at any time during the tax year. No more than 50% of the gross income of either business was derived from royalties, rents, dividends, interest, and annuities and you otherwise meet the requirements listed in Regulations section 1.414(c)-4(b)(5)(ii). Don’t treat both businesses as a single employer to figure the credit. If you and your spouse are both eligible small employers, you can file two Forms 8941 with a jointly filed Form 1040 or 1040-SR. Credit Period For tax years beginning after 2013, the credit period during which the credit can be claimed is a 2-consecutive-tax-year period beginning with the first tax year in which: An eligible small employer (or any predecessor) files an income tax return with an attached Form 8941 with line A checked “Yes” and a positive amount on line 12, or A tax-exempt eligible small employer (or any predecessor) files Form 990-T with an attached Form 8941 with line A checked “Yes” and a positive amount on line 12. Employer Premiums Paid Only premiums you paid for health insurance coverage under a qualifying arrangement (discussed later) for individuals considered employees are counted when figuring your credit. State premium subsidy or tax credit. If you’re entitled to a state tax credit or a state premium subsidy paid directly to you for premiums you paid, don’t reduce the amount you paid by the credit or subsidy amount. Also, if a state pays a premium subsidy directly to your insurance provider, treat the subsidy amount as an amount you paid for employee health insurance coverage. Wellness programs. A wellness program is generally an insurance program of health promotion or disease prevention. If you pay part or all of the cost of an employee’s participation in a wellness program, treat the amount you paid toward the employee’s participation as an amount you paid for employee health insurance coverage. Tobacco surcharges. A tobacco surcharge is generally an additional amount charged for insurance for a tobacco user. If you pay part or all of an employee’s tobacco surcharge, you can’t use the amount you paid to figure your employer premiums paid. Dependent coverage. Dependent coverage is generally coverage offered separately to an individual who is or may become eligible for coverage under the terms of a group health plan because of a relationship to a participant-employee, whether or not a dependent of the participant-employee. Dependent coverage doesn’t include coverage, such as family coverage, which includes coverage of the participant-employee. If you pay part or all of the cost of an employee’s dependent coverage, use the amount you paid to figure your employer premiums paid. Portion of premiums paid. If you pay only a portion of the premiums and your employees pay the rest, only the portion you pay is taken into account. For this purpose, any premium paid through a salary reduction arrangement under a section 125 cafeteria plan isn’t treated as an employer paid premium. For more information on cafeteria plans, see section 1 of Pub. 15-B, Employer’s Tax Guide to Fringe Benefits. Example 3. You offer health insurance coverage to employees under a qualifying arrangement that requires you to pay 60% of the premium cost for employee-only coverage for each employee enrolled in any health insurance coverage you provide to employees. The total premium for each employee enrolled in employee-only coverage is $5,200 per year or $100 ($5,200 ÷ 52) for each weekly payday. The total premium for each employee enrolled in family coverage is $13,000 per year or $250 ($13,000 ÷ 52) for each weekly payday. Each payday you contribute $60 (60% of $100) toward the premium cost of each employee enrolled in employee-only coverage and withhold the remaining $40 from the employee's paycheck to obtain the $100 total weekly premium. Each payday you contribute $60 (the same amount you pay toward the premiums of employees enrolled in employee-only coverage) toward the premium cost of each employee enrolled in family coverage and withhold the remaining $190 from the employee’s paycheck to obtain the $250 total weekly premium. To determine the premiums you paid during the tax year, multiply the number of pay periods during which the employee was enrolled in the health insurance coverage by $60. For example, you would’ve paid $3,120 ($60 × 52) for an employee who was enrolled for the entire tax year. You would’ve paid $600 ($60 × 10) for an employee who was only enrolled for 10 pay periods. You will need an additional set of calculations if the premium amounts changed during the tax year. Health Insurance Coverage For tax years beginning after 2013, health insurance coverage generally means coverage provided to employees enrolled in a qualified health plan offered through a Small Business Health Options Program (SHOP) Marketplace. For an exception that applies to certain employers in certain counties, see the instructions for line A, later. If this exception applies, health insurance coverage means coverage, as defined under Health Insurance Coverage in the 2013 Instructions for Form 8941. .A stand-alone dental plan offered through a SHOP exchange will be considered a qualified health plan for purposes of the credit.. .Employer premiums paid for health insurance coverage can be counted in figuring the credit only if the premiums are paid under a qualifying arrangement.. Qualifying Arrangement A qualifying arrangement is generally an arrangement that requires you to pay a uniform percentage (not less than 50%) of the premium cost for each enrolled employee's health insurance coverage (defined earlier). An arrangement that offers different tiers of coverage (for example, employee-only and family coverage) is generally a qualifying arrangement if it requires you to pay a uniform percentage (not less than 50%) separately for each tier of coverage you offer. However, an arrangement can be a qualifying arrangement even if it requires you to pay a uniform percentage that is less than 50% of the premium cost for some employees. For more information about the following exceptions, see Regulations section 1.45R-4. State or local law. You will be treated as satisfying the uniform percentage requirement if your failure to otherwise satisfy the requirement was solely attributable to additional contributions you made to certain employees to comply with state or local law. Wellness program. If a plan of an employer provides a wellness program, for purposes of meeting the uniform percentage requirement, the following applies. Any additional amount of the employer contribution attributable to an employee’s participation in the wellness program over the employer contribution with respect to an employee that doesn’t participate in the wellness program isn’t considered in calculating the uniform percentage requirement. This is true whether the difference is due to a discount for participation or a surcharge for nonparticipation. The employer contribution for employees who don’t participate in the wellness program must be at least 50% of the premium (including any premium surcharge for nonparticipation). However, for purposes of figuring the credit, the employer contributions are taken into account, including those contributions attributable to an employee’s participation in a wellness program. Tobacco surcharge. Any additional amount you or your employee pay to cover a tobacco surcharge isn’t taken into account in figuring the uniform percentage requirement. Amounts you or your employee pay to cover a tobacco surcharge aren’t considered premiums paid for health insurance coverage when figuring this credit. Dependent coverage. Premiums you pay for dependent coverage aren’t subject to the uniform percentage requirement. You aren’t required to pay a uniform percentage (not less than 50%) for dependent coverage. Arrangements with composite billing. An arrangement that requires you to pay a uniform premium for each enrolled employee (composite billing) and offers different tiers of coverage can be a qualifying arrangement even if it requires you to pay a uniform percentage that is less than 50% of the premium cost for employees not enrolled in employee-only coverage. It is a qualifying arrangement (assuming employee-only coverage is the least expensive tier of coverage) if it requires you to pay each of the following amounts if you make the relevant tier of coverage available. A uniform percentage (not less than 50%) of the premium cost for each employee (if any) enrolled in employee-only coverage. A uniform amount that is no less than the amount you would’ve paid toward employee-only coverage for each employee (if any) enrolled in family coverage. A uniform amount that is no less than the amount you would’ve paid toward employee-only coverage for each employee (if any) enrolled in any other tier of coverage (figured separately for each tier). Arrangements with list billing and only employee-only coverage. An arrangement that requires you to pay a separate premium for each employee based on age or other factors (list billing) that only provides employee-only coverage can be a qualifying arrangement even if it requires you to pay a uniform percentage that is less than 50% of the premium cost for some employees. It is a qualifying arrangement if it requires you to pay either of the following amounts. A uniform percentage (not less than 50%) of the premium charged for each employee enrolled in the employee-only coverage. A uniform percentage (not less than 50%) of your employer-computed composite rate (defined later) for your employee-only coverage for each employee enrolled in the employee-only coverage. Arrangements with list billing and other tiers of coverage. An arrangement that requires you to pay a separate premium for each employee based on age or other factors (list billing) that provides other tiers of coverage can be a qualifying arrangement even if it requires you to pay a uniform percentage that is less than 50% of the premium cost for some employees. It is a qualifying arrangement (assuming employee-only coverage is the least expensive tier of coverage) if it requires you to pay each of the following amounts if you make the relevant tier of coverage available. A uniform percentage (not less than 50%) for each employee enrolled in employee-only coverage, as discussed under Arrangements with list billing and only employee-only coverage above. A uniform amount that is either equal to the amount you would’ve paid toward employee-only coverage (as discussed above), a uniform percentage (not less than 50%) of the premium charged, or a uniform percentage (not less than 50%) of your employer-computed composite rate (defined below) for your family coverage, for each employee (if any) enrolled in family coverage. A uniform amount that is either equal to the amount you would’ve paid toward employee-only coverage (as discussed above), a uniform percentage (not less than 50%) of the premium charged, or a uniform percentage (not less than 50%) of your employer-computed composite rate (defined below) for any other tier of coverage, for each employee (if any) enrolled in any other tier of coverage (figured separately for each tier). Employer-computed composite rate. The employer-computed composite rate for a tier of coverage is the average rate determined by adding the premiums for that tier of coverage for all employees eligible to participate in the health insurance plan (whether or not they actually receive coverage under the plan or under that tier of coverage) and dividing by the total number of such eligible employees. More than one plan. Different types of health insurance plans are generally not aggregated for purposes of meeting the qualifying arrangement requirement. For example, if you offer a major medical insurance plan and a stand-alone vision plan, you generally must separately satisfy the requirements for a qualifying arrangement with respect to each type of coverage. For exceptions, see Regulations section 1.45R-4(c). State subsidies and credits. For this purpose, if you’re entitled to a state tax credit or a state premium subsidy paid directly to you for premiums you paid, don’t reduce the amount you paid by the credit or subsidy amount. Also, if a state pays a premium subsidy directly to your insurance provider, treat the subsidy amount as an amount you paid for employee health insurance coverage. State Premium Subsidy and Tax Credit Limitation Your credit may be reduced if you’re entitled to a state tax credit or a state premium subsidy for the cost of health insurance coverage you provide under a qualifying arrangement to individuals considered employees. The state tax credit may be refundable or nonrefundable and the state premium subsidy may be paid to you or directly to your insurance provider. Although a state tax credit or premium subsidy paid directly to you doesn’t reduce the amount of your employer premiums paid, and although a state premium subsidy paid directly to an insurance provider is treated as an employer premium you paid, the amount of your credit can’t be more than your net premium payments. Net premium payments are employer premiums paid (discussed earlier) minus the amount of any state tax credits you received or will receive and any state premium subsidies paid either to you or directly to your insurance provider for premiums for health insurance coverage you provide under a qualifying arrangement to individuals considered employees. Payroll Tax Limitation for Tax-Exempt Eligible Small Employers The credit for tax-exempt eligible small employers can’t exceed the amount of certain payroll taxes. For tax years beginning in 2021, payroll taxes, for this purpose, mean only the following taxes. Federal income taxes the tax-exempt employer was required to withhold from employees’ wages in calendar year 2021. Medicare taxes the tax-exempt employer was required to withhold from employees’ wages in calendar year 2021. Medicare taxes the tax-exempt employer was required to pay for calendar year 2021. Premium Deduction Reduced You must reduce your deduction for the cost of providing health insurance coverage to your employees by the amount of any credit for small employer health insurance premiums allowed with respect to the coverage. More Information For more information about this credit, see the following. Section 45R. Regulations sections 1.45R-0 through 1.45R-5. IRS.gov/Affordable-Care-Act/Employers/Small-Business-Health-Care-Tax-Credit-and-the-SHOP-Marketplace. Specific Instructions .Partnerships, S corporations, cooperatives, estates, trusts, and tax-exempt eligible small employers must file this form to claim the credit. All other taxpayers must not complete or file this form if their only source for this credit is a partnership, S corporation, cooperative, estate, or trust. Instead, they must report this credit directly on line 4h in Part III of Form 3800.. Use Worksheets 1 through 7 to figure the amounts to report on various lines of Form 8941. Use Worksheets 1, 2, and 3 to figure the amounts to report on lines 1, 2, and 3 of Form 8941. Use Worksheet 4 to figure the amounts to report on lines 4, 5, and 13 of Form 8941. Use Worksheets 5, 6, and 7 to figure the amounts to report on lines 8, 9, and 14 of Form 8941. Line A Answer “Yes” if one of the following applies. You paid premiums for employee health insurance coverage you provided through a SHOP Marketplace or through a direct enrollment process, if available in your state. You qualify for an exception to this requirement, as discussed below. If you answer “Yes” because you paid premiums for employee health insurance coverage you provided through a SHOP Marketplace, enter the Marketplace identifier, if any. If you answer “No,” don’t file Form 8941 unless you’re filing it for a partnership, S corporation, cooperative, estate, trust, or tax-exempt eligible small employer that received from another entity a credit that must be reported on line 15. For more information, see the instructions for line 15. Waiver for Hawaii. Hawaii has received a 5-year State Innovation Waiver under section 1332 of the Affordable Care Act. Employers in Hawaii can’t participate in the SHOP Marketplace or claim the credit for insurance premiums paid for health plan years beginning after 2016. For more information on the waiver, visit CMS.gov. Exception for eligible small employers in certain counties. For calendar year 2021, SHOP Marketplaces in certain counties across the United States didn’t have qualified health plans available for employers to offer to employees. However, relief is available, which allows eligible small employers with a principal business address in those counties to claim the credit for 2021 if they properly claimed the credit under section 45R for all or part of 2020. For details, see Notice 2018-27, 2018-20, I.R.B. 580, available at IRS.gov/irb/2018-20_IRB#NOT-2018-27. .To see whether a particular county has coverage available through a SHOP Exchange for 2021 and beyond, go to Healthcare.gov/small-business and enter “plans and prices” in the search box.. Line C Answer “Yes” if a tax return you (or any predecessor) filed for a tax year beginning after 2013 and before 2020 included a Form 8941 with line A checked “Yes” and line 12 showing a positive amount. For more information, see Credit Period, earlier. If you answer “Yes,” don’t file Form 8941 unless you’re filing it for a partnership, S corporation, cooperative, estate, trust, or tax-exempt eligible small employer that received from another entity a credit that must be reported on line 15. An entity that qualifies for this exception shouldn’t report any amount on line 12. For more information, see the instructions for line 15. Worksheet 1. Information Needed To Complete Line 1 and Worksheets 2 and 3 If you need more rows, use a separate sheet and include the additional amounts in the totals below. (a) Individuals Considered Employees (b) Employee Hours of Service (c) Employee Wages Paid 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 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. Excluded employees. The following individuals aren’t considered employees when you figure this credit. Hours and wages of these employees and premiums paid for them aren’t counted when you figure your credit. The owner of a sole proprietorship. A partner in a partnership. A shareholder who owns (after applying the section 318 constructive ownership rules) more than 2% of an S corporation. A shareholder who owns (after applying the section 318 constructive ownership rules) more than 5% of the outstanding stock or stock possessing more than 5% of the total combined voting power of all stock of a corporation that isn’t an S corporation. A person who owns more than 5% of the capital or profits interest in any other business that isn’t a corporation. Family members or a member of the household who isn’t a family member but qualifies as a dependent on the individual income tax return of a person listed above. Family members include a child (or descendant of a child), a sibling or step-sibling, a parent (or ancestor of a parent), a step-parent, a niece or nephew, an aunt or uncle, or a son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law. A spouse of any owner or family member listed above is also considered a family member for this purpose. Former employees. Premiums paid on behalf of a former employee with no hours of service may be treated as paid on behalf of an employee for purposes of figuring the credit provided that, if so treated, the former employee is also treated as an employee for purposes of the uniform percentage requirement. Leased employees. Don’t use premiums paid by the leasing organization to figure your credit. Also, a leased employee who isn’t a common law employee is considered an employee for credit purposes if he or she does all the following. Provides services to you under an agreement between you and a leasing organization. Has performed services for you (or for you and a related person) substantially full time for at least 1 year. Performs services under your primary direction or control. But don’t use hours, wages, or premiums paid with respect to the initial year of service on which leased employee status is based. Seasonal employees. Employees who perform labor or services on a seasonal basis and perform labor or services for you 120 or fewer days during the tax year aren’t considered employees in determining FTEs and average annual wages. But premiums paid on their behalf are counted in determining the amount of the credit. Seasonal workers include retail workers employed exclusively during holiday seasons. Seasonal workers also include workers employed exclusively during the summer. Household and other nonbusiness employees. Household employees and other employees who aren’t performing services in your trade or business are considered employees if they otherwise qualify, as discussed above. A sole proprietor must include both business and nonbusiness employees to determine FTEs, average annual wages, and premiums paid. Ministers. A minister performing services in the exercise of his or her ministry is treated as self-employed for social security and Medicare purposes. However, for credit purposes, whether a minister is an employee or self-employed is determined under the common law test for determining worker status. Self-employed ministers aren’t considered employees. Column (b), Employee Hours of Service Enter the total hours of service for the tax year for each employee listed in column (a). Don’t enter more than 2,080 hours for any employee. But enter -0- for seasonal employees who worked 120 or fewer days during the tax year. Employee hours of service. An employee’s hours of service for a year include the following. Each hour for which the employee is paid, or entitled to payment, for the performance of duties for the employer during the employer’s tax year. Each hour for which an employee is paid, or entitled to payment, by the employer on account of a period of time during the employer’s tax year during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty, or leave of absence (except that no more than 160 hours of service are required to be counted for an employee on account of any single continuous period during which the employee performs no duties). To figure the total number of hours of service you must take into account for an employee for the year, you can use any of the following methods. Actual-hours-worked method. Determine actual hours of service from records of hours worked and hours for which payment is made or due (payment is made or due for vacation, holiday, illness, incapacity, etc., as described above). Days-worked equivalency method. Use a days-worked equivalency whereby the employee is credited with 8 hours of service for each day for which the employee would be required to be credited with at least 1 hour of service under the rules described above. Weeks-worked equivalency method. Use a weeks-worked equivalency whereby the employee is credited with 40 hours of service for each week for which the employee would be required to be credited with at least 1 hour of service under the rules described above. Column (c), Employee Wages Paid .Complete Worksheet 2 before you complete column (c) of Worksheet 1. Do not complete column (c) if Worksheet 2, line 3, is 25 or more. . Enter the total wages paid for the tax year for each employee listed in column (a). But enter -0- for seasonal employees who worked 120 or fewer days during the tax year. Wages, for this purpose, mean wages subject to social security and Medicare tax withholding determined without considering any wage base limit. Worksheet 2. Information Needed To Complete Line 2 (FTEs) Your credit is reduced if you had more than 10 full-time equivalent employees (FTEs) for the tax year. If you had 25 or more FTEs for the tax year, your credit is reduced to zero. 1. Enter the total employee hours of service from Worksheet 1, column (b) 1. _____ 2. Hours of service per FTE 2. 2,080 3. Full-time equivalent employees. Divide line 1 by line 2. If the result isn’t a whole number (0, 1, 2, etc.), generally round the result down to the next lowest whole number. For example, round 2.99 down to 2. However, if the result is less than one, enter 1. Report this number on Form 8941, line 2 3. _____ Worksheet 3. Information Needed To Complete Line 3 (Average Annual Wages) Your credit is reduced if you paid average annual wages of more than $27,000 for the tax year. If you paid average annual wages of $56,000 or more for the tax year, your credit is reduced to zero. 1. Enter the total employee wages paid from Worksheet 1, column (c) 1. _____ 2. Enter FTEs from Worksheet 2, line 3 2. _____ 3. Average annual wages. Divide line 1 by line 2. If the result isn’t a multiple of $1,000 ($1,000, $2,000, $3,000, etc.), round the result down to the next lowest multiple of $1,000. For example, round $2,999 down to $2,000. Report this amount on Form 8941, line 3 3. _____ Worksheet 4. Information Needed To Complete Lines 4, 5, and 13 and Worksheet 7 If you need more rows, use a separate sheet and include the additional amounts in the totals below. (a) Enrolled Individuals Considered Employees (b) Employer Premiums Paid (c) Adjusted Average Premiums (d) Enrolled Employee Hours of Service 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Totals: Column (a), Enrolled Individuals Considered Employees Enter the name or other identifying information for each individual listed in column (a) of Worksheet 1 who was enrolled in health insurance coverage you provided to employees during the tax year under a qualifying arrangement. For details, see Health Insurance Coverage and Qualifying Arrangement, earlier. Column (b), Employer Premiums Paid Enter the total employer premiums paid for the tax year for each employee listed in column (a). For details, see Employer Premiums Paid, earlier. Column (c), Adjusted Average Premiums Your credit is reduced if the employer premiums paid are more than the employer premiums that would’ve been paid if individuals considered employees were enrolled in a plan with a premium equal to the average premium for the small group market in the rating area in which the employee enrolls for coverage. The rating area in which an employee enrolls for coverage is generally the rating area where your business is located (based on your primary business address). You will generally have selected a plan in your rating area that covers all employees located within or outside your rating area. However, if you have multiple businesses or operations in multiple states, and have set up plans in more than one SHOP Marketplace, the average premiums may be different for employees enrolled in each SHOP Marketplace. Enter, for each employee listed in column (a), the premiums you would’ve paid if the employee had enrolled in a plan or plans with a total premium equal to the average premium for the small group market in the rating area in which the employee enrolls for coverage. To find the average premium for the small group market in a rating area for tax years beginning in 2021, see the average premium tables at the end of these instructions. Family coverage includes any coverage other than employee-only coverage. Example 4. Assume the same facts that were used in Example 3. The $60 you contribute each payday toward employee health insurance coverage is 60% ($60 ÷ $100) of the weekly premium for each employee enrolled in employee-only coverage and 24% ($60 ÷ $250) of the weekly premium for each employee enrolled in family coverage. In this situation, the total average premium limitation amounts that apply are 60% of the applicable average premium amounts for each employee enrolled in employee-only coverage and 24% of the applicable average premium amounts for each employee enrolled in family coverage. You have an employee enrolled in employee-only coverage who enrolled for coverage in your local rating area. The applicable employee-only average premium amount for the rating area is $4,940 or $95 ($4,940 ÷ 52) for each weekly payday. The amount you would’ve paid toward this employee’s health insurance coverage based on the average premiums is $57 (60% of $95) each payday. To determine the premiums you would’ve paid for this employee during the tax year if the employee had enrolled in an average premium plan, multiply the number of pay periods during which your employee was enrolled in the health insurance coverage by $57. For example, you would’ve paid $2,964 ($57 × 52) if the employee was enrolled for the entire tax year. You would’ve paid $570 ($57 × 10) if the employee was only enrolled for 10 pay periods. You’ll need an additional set of calculations if the premium amounts changed during the tax year. Column (d), Enrolled Employee Hours of Service . Don’t complete column (d) of Worksheet 4 if Form 8941, line 12, is zero.. Enter the amount from column (b) of Worksheet 1 for each employee listed in column (a) of Worksheet 4. Worksheet 5. Information Needed To Complete Line 8 (If Line 2 Is More Than 10) 1. Enter the amount from Form 8941, line 7 1. _____ 2. Enter the number from Form 8941, line 2 2. _____ 3. Subtract 10 from line 2 3. _____ 4. Divide line 3 by 15. Enter the result as a decimal (rounded to at least 3 places) 4. _____ 5. Multiply line 1 by line 4 5. _____ 6. Subtract line 5 from line 1. Report this amount on Form 8941, line 8 6. _____ Worksheet 6. Information Needed To Complete Line 9 (If Line 3 Is More Than $27,000) 1. Enter the amount from Form 8941, line 8 1. _____ 2. Enter the amount from Form 8941, line 7 2. _____ 3. Enter the amount from Form 8941, line 3 3. _____ 4. Subtract $27,800 from line 3 4. _____ 5. Divide line 4 by $27,800. Enter the result as a decimal (rounded to at least 3 places) 5. _____ 6. Multiply line 2 by line 5 6. _____ 7. Subtract line 6 from line 1. Report this amount on Form 8941, line 9 7. _____ Line 10 Enter the total amount of any state premium subsidies paid and any state tax credits available to you for premiums included on line 4. For details, see State Premium Subsidy and Tax Credit Limitation, earlier. Worksheet 7. Information Needed To Complete Line 14 (If Line 12 Is More Than Zero) 1. Enter the total enrolled employee hours of service from Worksheet 4, column (d) 1. _____ 2. Hours of service per FTE 2. 2,080 3. Divide line 1 by line 2. If the result isn’t a whole number (0, 1, 2, etc.), generally round the result down to the next lowest whole number. For example, round 2.99 down to 2. However, if the result is less than one, enter 1. Report this number on Form 8941, line 14 3. _____ Line 15 Enter any credit for small employer health insurance premiums from: Schedule K-1 (Form 1065), box 15 (code P); Schedule K-1 (Form 1120-S), box 13 (code P); Schedule K-1 (Form 1041), box 13 (code G); and Form 1099-PATR, Taxable Distributions Received From Cooperatives, box 12, or other notice of credit allocation. .Partnerships, S corporations, cooperatives, estates, trusts, and tax-exempt eligible small employers report the above credits on line 15. All other filers figuring a separate credit on earlier lines also report the above credits on line 15. All others not using earlier lines to figure a separate credit must report the above credits directly on Form 3800, Part lll, line 4h.. Line 17 Cooperatives. A cooperative described in section 1381(a) must allocate to its patrons the credit in excess of its tax liability. Therefore, to figure the unused amount of the credit allocated to patrons, the cooperative must first figure its tax liability. While any excess is allocated to patrons, any credit recapture applies as if the cooperative had claimed the entire credit. If the cooperative is subject to the passive activity rules, include on line 15 any credit for small employer health insurance premiums from passive activities disallowed for prior years and carried forward to this year. Complete Form 8810, Corporate Passive Activity Loss and Credit Limitations, to determine the allowed credit that must be allocated to patrons. For details, see the Instructions for Form 8810. Estates and trusts. Allocate the credit on line 16 between the estate or trust and the beneficiaries in the same proportion as income was allocated and enter the beneficiaries’ share on line 17. If the estate or trust is subject to the passive activity rules, include on line 15 any credit for small employer health insurance premiums from passive activities disallowed for prior years and carried forward to this year. Complete Form 8582-CR, Passive Activity Credit Limitations, to determine the allowed credit that must be allocated between the estate or trust and the beneficiaries. For details, see the Instructions for Form 8582-CR. Line 19 Enter the total amount of certain payroll taxes. Payroll taxes, for this purpose, mean only the following taxes. Federal income taxes the tax-exempt employer was required to withhold from employees’ wages in calendar year 2021. Medicare taxes the tax-exempt employer was required to withhold from employees’ wages in calendar year 2021. Medicare taxes the tax-exempt employer was required to pay for calendar year 2021. Instructions for Form 8941 - Notices Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of tax. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. The time needed to complete and file this form will vary depending on individual circumstances. The estimated burden for individual and business taxpayers filing this form is approved under OMB control number 1545-0074 and 1545-0123 and is included in the estimates shown in the instructions for their individual and business income tax return. The estimated burden for all other taxpayers who file this form is shown below. Recordkeeping 8 hr., 8 min. Learning about the law or the form 1 hr., 2 min. Preparing and sending the form to the IRS 2 hr., 5 min. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. See the instructions for the tax return with which this form is filed. Instructions for Form 8941 - Additional Material Average Premiums Needed To Figure Adjusted Amounts on Worksheet 4 The following tables list the average premiums for the small group market in each rating area generally listed by county for each state for tax years beginning in 2021. Alabama County Employee- Only Dependent, Family, etc. Autauga 7,526 19,230 Baldwin 6,565 17,489 Barbour 6,565 17,489 Bibb 6,653 18,914 Blount 6,653 18,914 Bullock 6,565 17,489 Butler 6,565 17,489 Calhoun 6,836 18,615 Chambers 6,565 17,489 Cherokee 6,565 17,489 Chilton 6,653 18,914 Choctaw 6,565 17,489 Clarke 6,565 17,489 Clay 6,565 17,489 Cleburne 6,565 17,489 Coffee 6,565 17,489 Colbert 8,654 19,748 Conecuh 6,565 17,489 Coosa 6,565 17,489 Covington 6,565 17,489 Crenshaw 6,565 17,489 Cullman 6,565 17,489 Dale 6,565 17,489 Dallas 6,565 17,489 DeKalb 6,565 17,489 Elmore 7,526 19,230 Escambia 6,565 17,489 Etowah 6,447 18,794 Fayette 6,565 17,489 Franklin 6,565 17,489 Geneva 7,388 18,433 Greene 7,603 18,629 Hale 7,603 18,629 Henry 7,388 18,433 Houston 7,388 18,433 Jackson 6,565 17,489 Jefferson 6,653 18,914 Lamar 6,565 17,489 Lauderdale 8,654 19,748 Lawrence 7,893 19,596 Lee 6,298 15,915 Limestone 6,480 19,585 Lowndes 7,526 19,230 Macon 6,565 17,489 Madison 6,480 19,585 Marengo 6,565 17,489 Marion 6,565 17,489 Marshall 6,565 17,489 Mobile 7,468 18,918 Monroe 6,565 17,489 Montgomery 7,526 19,230 Morgan 7,893 19,596 Perry 6,565 17,489 Pickens 6,565 17,489 Pike 6,565 17,489 Randolph 6,565 17,489 Russell 7,136 18,051 Shelby 6,653 18,914 St. Clair 6,653 18,914 Sumter 6,565 17,489 Talladega 6,565 17,489 Tallapoosa 6,565 17,489 Tuscaloosa 7,603 18,629 Walker 6,653 18,914 Washington 6,565 17,489 Wilcox 6,565 17,489 Winston 6,565 17,489 Alaska County Employee- Only Dependent, Family, etc. Aleutians East 12,011 27,855 Aleutians West 12,011 27,855 Anchorage 11,303 28,132 Bethel 11,303 28,132 Bristol Bay 12,011 27,855 Denali 12,011 27,855 Dillingham 11,303 28,132 Fairbanks North Star 12,011 27,855 Haines 11,771 28,003 Hoonah-Angoon 11,771 28,003 Juneau 11,771 28,003 Kenai Peninsula 12,011 27,855 Ketchikan Gateway 11,771 28,003 Kodiak Island 12,011 27,855 Lake and Peninsula 12,011 27,855 Matanuska Susitna 12,011 27,855 Nome 12,011 27,855 North Slope 12,011 27,855 Northwest Arctic 12,011 27,855 Petersburg 11,771 28,003 Prince of Wales-Hyder 11,771 28,003 Sitka 11,771 28,003 Skagway 11,771 28,003 Southeast Fairbanks 12,011 27,855 Valdez Cordova 11,303 28,132 Wade Hampton 12,011 27,855 Wrangell City and Borough 11,771 28,003 Yakutat 12,011 27,855 Yukon Koyukuk 12,011 27,855 Arizona County Employee- Only Dependent, Family, etc. Apache 6,840 20,297 Cochise 6,558 17,906 Coconino 6,840 20,297 Gila 6,671 17,498 Graham 6,558 17,906 Greenlee 6,558 17,906 La Paz 7,826 19,901 Maricopa 6,811 18,849 Mohave 6,840 20,297 Navajo 6,840 20,297 Pima 6,452 17,791 Pinal 6,671 17,498 Santa Cruz 6,452 17,791 Yavapai 6,286 18,780 Yuma 7,826 19,901 Arkansas County Employee- Only Dependent, Family, etc. Arkansas 6,501 16,114 Ashley 6,501 16,114 Baxter 6,230 18,525 Benton 6,230 18,525 Boone 6,230 18,525 Bradley 6,501 16,114 Calhoun 6,566 22,348 Carroll 6,230 18,525 Chicot 6,501 16,114 Clark 5,127 17,075 Clay 6,267 19,137 Cleburne 6,051 16,588 Cleveland 6,501 16,114 Columbia 6,566 22,348 Conway 6,051 16,588 Craighead 6,267 19,137 Crawford 6,078 18,584 Crittenden 6,267 19,137 Cross 6,267 19,137 Dallas 6,501 16,114 Desha 6,501 16,114 Drew 6,501 16,114 Faulkner 6,051 16,588 Franklin 6,078 18,584 Fulton 6,267 19,137 Garland 5,127 17,075 Grant 6,051 16,588 Greene 6,267 19,137 Hempstead 6,566 22,348 Hot Spring 5,127 17,075 Howard 6,566 22,348 Independence 6,267 19,137 Izard 6,267 19,137 Jackson 6,267 19,137 Jefferson 6,501 16,114 Johnson 6,078 18,584 Lafayette 6,566 22,348 Lawrence 6,267 19,137 Lee 6,501 16,114 Lincoln 6,501 16,114 Little River 6,566 22,348 Logan 6,078 18,584 Lonoke 6,051 16,588 Madison 6,230 18,525 Marion 6,230 18,525 Miller 6,566 22,348 Mississippi 6,267 19,137 Monroe 6,501 16,114 Montgomery 5,127 17,075 Nevada 6,566 22,348 Newton 6,230 18,525 Ouachita 6,566 22,348 Perry 6,051 16,588 Phillips 6,501 16,114 Pike 5,127 17,075 Poinsett 6,267 19,137 Polk 6,078 18,584 Pope 6,051 16,588 Prairie 6,051 16,588 Pulaski 6,051 16,588 Randolph 6,267 19,137 Saline 6,051 16,588 Scott 6,078 18,584 Searcy 6,230 18,525 Sebastian 6,078 18,584 Sevier 6,566 22,348 Sharp 6,267 19,137 St. Francis 6,267 19,137 Stone 6,267 19,137 Union 6,566 22,348 Van Buren 6,051 16,588 Washington 6,230 18,525 White 6,051 16,588 Woodruff 6,267 19,137 Yell 6,051 16,588 California County Employee- Only Dependent, Family, etc. Alameda 8,242 22,491 Alpine 8,171 19,175 Amador 8,171 19,175 Butte 8,171 19,175 Calaveras 8,171 19,175 Colusa 8,171 19,175 Contra Costa 8,093 22,307 Del Norte 8,171 19,175 El Dorado 6,881 20,484 Fresno 6,633 22,121 Glenn 8,171 19,175 Humboldt 8,171 19,175 Imperial 6,764 19,134 Inyo 6,764 19,134 Kern 7,202 18,566 Kings 6,633 22,121 Lake 8,171 19,175 Lassen 8,171 19,175 Los Angeles 7,135 21,647 Madera 6,633 22,121 Marin 7,057 19,416 Mariposa 7,778 20,227 Mendocino 8,171 19,175 Merced 7,778 20,227 Modoc 8,171 19,175 Mono 6,764 19,134 Monterey 8,014 21,969 Napa 7,057 19,416 Nevada 8,171 19,175 Orange 7,573 23,118 Placer 6,881 20,484 Plumas 8,171 19,175 Riverside 7,561 19,737 Sacramento 6,881 20,484 San Benito 8,014 21,969 San Bernardino 7,561 19,737 San Diego 6,433 18,778 San Francisco 7,867 26,196 San Joaquin 7,778 20,227 San Luis Obispo 7,235 20,308 San Mateo 9,354 25,434 Santa Barbara 7,235 20,308 Santa Clara 8,304 24,507 Santa Cruz 8,014 21,969 Shasta 8,171 19,175 Sierra 8,171 19,175 Siskiyou 8,171 19,175 Solano 7,057 19,416 Sonoma 7,057 19,416 Stanislaus 7,778 20,227 Sutter 8,171 19,175 Tehama 8,171 19,175 Trinity 8,171 19,175 Tulare 7,778 20,227 Tuolumne 8,171 19,175 Ventura 7,235 20,308 Yolo 6,881 20,484 Yuba 8,171 19,175 Colorado County Employee- Only Dependent, Family, etc. Adams 7,344 21,656 Alamosa 8,633 23,653 Arapahoe 7,344 21,656 Archuleta 8,143 24,827 Baca 8,633 23,653 Bent 8,633 23,653 Boulder 6,913 22,089 Broomfield 7,344 21,656 Chaffee 8,633 23,653 Cheyenne 8,633 23,653 Clear Creek 7,344 21,656 Conejos 8,633 23,653 Costilla 8,633 23,653 Crowley 8,633 23,653 Custer 8,633 23,653 Delta 8,143 24,827 Denver 7,344 21,656 Dolores 8,143 24,827 Douglas 7,344 21,656 Eagle 7,847 24,678 El Paso 6,539 22,503 Elbert 7,344 21,656 Fremont 8,633 23,653 Garfield 7,847 24,678 Gilpin 7,344 21,656 Grand 8,143 24,827 Gunnison 8,143 24,827 Hinsdale 8,143 24,827 Huerfano 8,633 23,653 Jackson 8,143 24,827 Jefferson 7,344 21,656 Kiowa 8,633 23,653 Kit Carson 8,633 23,653 La Plata 8,143 24,827 Lake 8,143 24,827 Larimer 8,694 19,692 Las Animas 8,633 23,653 Lincoln 8,633 23,653 Logan 6,930 21,955 Mesa 7,498 20,992 Mineral 8,633 23,653 Moffat 8,143 24,827 Montezuma 8,143 24,827 Montrose 8,143 24,827 Morgan 6,930 21,955 Otero 8,633 23,653 Ouray 8,143 24,827 Park 7,344 21,656 Phillips 6,930 21,955 Pitkin 7,847 24,678 Prowers 8,633 23,653 Pueblo 6,909 18,542 Rio Blanco 8,143 24,827 Rio Grande 8,633 23,653 Routt 8,143 24,827 Saguache 8,633 23,653 San Juan 8,143 24,827 San Miguel 8,143 24,827 Sedgwick 6,930 21,955 Summit 7,847 24,678 Teller 6,539 22,503 Washington 6,930 21,955 Weld 7,424 26,016 Yuma 6,930 21,955 Connecticut County Employee- Only Dependent, Family, etc. Fairfield 8,215 23,998 Hartford 7,723 21,840 Litchfield 7,478 23,655 Middlesex 8,289 21,936 New Haven 8,748 24,357 New London 7,390 19,471 Tolland 7,379 17,769 Windham 8,445 31,308 Delaware County Employee- Only Dependent, Family, etc. All 8,444 23,587 District of Columbia County Employee- Only Dependent, Family, etc. All 8,036 23,874 Florida County Employee- Only Dependent, Family, etc. Alachua 8,141 20,991 Baker 7,456 20,822 Bay 7,014 19,289 Bradford 7,019 20,950 Brevard 7,746 21,890 Broward 7,307 20,593 Calhoun 7,197 20,787 Charlotte 8,184 23,859 Citrus 7,199 19,641 Clay 6,623 20,828 Collier 6,835 24,981 Columbia 7,858 22,655 DeSoto 7,292 21,687 Dixie 7,073 19,151 Duval 7,059 20,947 Escambia 7,575 19,604 Flagler 7,911 21,062 Franklin 7,209 22,002 Gadsden 6,968 20,814 Gilchrist 6,775 20,814 Glades 7,542 23,373 Gulf 8,044 22,150 Hamilton 7,132 20,720 Hardee 7,067 18,671 Hendry 8,068 23,309 Hernando 7,636 21,653 Highlands 7,693 23,786 Hillsborough 6,699 20,708 Holmes 7,262 20,832 Indian River 6,943 19,405 Jackson 6,718 18,756 Jefferson 7,826 20,388 Lafayette 7,206 19,409 Lake 8,231 22,177 Lee 7,413 22,034 Leon 8,389 24,467 Levy 7,075 21,653 Liberty 7,211 21,544 Madison 7,995 21,842 Manatee 7,583 20,547 Marion 6,342 19,289 Martin 7,619 22,929 Miami-Dade 7,671 23,473 Monroe 8,165 23,652 Nassau 7,901 18,835 Okaloosa 7,623 27,260 Okeechobee 8,056 22,815 Orange 6,830 19,653 Osceola 8,112 22,721 Palm Beach 8,207 24,447 Pasco 7,366 20,034 Pinellas 7,005 22,139 Polk 6,725 20,680 Putnam 7,340 21,416 Santa Rosa 6,952 18,942 Sarasota 6,807 18,517 Seminole 7,594 18,876 St. Johns 9,412 24,636 St. Lucie 7,232 19,964 Sumter 7,459 22,769 Suwannee 6,687 20,690 Taylor 8,290 22,921 Union 7,237 21,396 Volusia 7,443 20,111 Wakulla 6,944 21,188 Walton 7,307 19,391 Washington 7,346 21,567 Georgia County Employee- Only Dependent, Family, etc. Appling 8,993 24,273 Atkinson 7,013 20,446 Bacon 6,388 19,799 Baker 7,846 23,360 Baldwin 7,700 21,179 Banks 8,299 21,521 Barrow 7,964 19,863 Bartow 7,366 20,580 Ben Hill 7,286 20,627 Berrien 7,286 20,627 Bibb 6,954 18,181 Bleckley 6,954 18,181 Brantley 6,388 19,799 Brooks 7,286 20,627 Bryan 8,993 24,273 Bulloch 8,993 24,273 Burke 6,959 18,720 Butts 7,366 20,580 Calhoun 7,846 23,360 Camden 6,388 19,799 Candler 8,993 24,273 Carroll 7,089 21,387 Catoosa 7,029 20,867 Charlton 6,388 19,799 Chatham 8,993 24,273 Chattahoochee 6,546 18,862 Chattooga 7,794 21,273 Cherokee 7,366 20,580 Clarke 7,964 19,863 Clay 7,846 23,360 Clayton 7,366 20,580 Clinch 7,286 20,627 Cobb 7,366 20,580 Coffee 7,013 20,446 Colquitt 7,286 20,627 Columbia 6,959 18,720 Cook 7,286 20,627 Coweta 7,366 20,580 Crawford 6,954 18,181 Crisp 7,846 23,360 Dade 7,029 20,867 Dawson 8,299 21,521 Decatur 7,286 20,627 DeKalb 7,366 20,580 Dodge 6,954 18,181 Dooly 6,954 18,181 Dougherty 7,846 23,360 Douglas 7,366 20,580 Early 7,286 20,627 Echols 7,286 20,627 Effingham 8,993 24,273 Elbert 7,964 19,863 Emanuel 6,959 18,720 Evans 8,993 24,273 Fannin 7,329 20,158 Fayette 7,366 20,580 Floyd 7,794 21,273 Forsyth 7,366 20,580 Franklin 8,299 21,521 Fulton 7,366 20,580 Gilmer 7,794 21,273 Glascock 6,959 18,720 Glynn 6,388 19,799 Gordon 7,794 21,273 Grady 7,286 20,627 Greene 7,964 19,863 Gwinnett 7,366 20,580 Habersham 8,299 21,521 Hall 8,299 21,521 Hancock 7,700 21,179 Haralson 7,089 21,387 Harris 6,546 18,862 Hart 8,299 21,521 Heard 7,089 21,387 Henry 7,366 20,580 Houston 6,954 18,181 Irwin 7,286 20,627 Jackson 7,964 19,863 Jasper 7,366 20,580 Jeff Davis 7,013 20,446 Jefferson 6,959 18,720 Jenkins 6,959 18,720 Johnson 7,013 20,446 Jones 6,954 18,181 Lamar 7,366 20,580 Lanier 7,286 20,627 Laurens 7,013 20,446 Lee 7,846 23,360 Liberty 8,993 24,273 Lincoln 6,959 18,720 Long 8,993 24,273 Lowndes 7,286 20,627 Lumpkin 8,299 21,521 Macon 6,546 18,862 Madison 7,964 19,863 Marion 6,546 18,862 McDuffie 6,959 18,720 McIntosh 6,388 19,799 Meriwether 6,546 18,862 Miller 7,286 20,627 Mitchell 7,846 23,360 Monroe 6,954 18,181 Montgomery 7,013 20,446 Morgan 7,964 19,863 Murray 7,329 20,158 Muscogee 6,546 18,862 Newton 7,366 20,580 Oconee 7,964 19,863 Oglethorpe 7,964 19,863 Paulding 7,366 20,580 Peach 6,954 18,181 Pickens 7,794 21,273 Pierce 6,388 19,799 Pike 7,366 20,580 Polk 7,794 21,273 Pulaski 6,954 18,181 Putnam 6,954 18,181 Quitman 6,546 18,862 Rabun 8,299 21,521 Randolph 7,846 23,360 Richmond 6,959 18,720 Rockdale 7,366 20,580 Schley 7,846 23,360 Screven 8,993 24,273 Seminole 7,286 20,627 Spalding 7,366 20,580 Stephens 8,299 21,521 Stewart 6,546 18,862 Sumter 7,846 23,360 Talbot 6,546 18,862 Taliaferro 6,959 18,720 Tattnall 8,993 24,273 Taylor 6,546 18,862 Telfair 7,013 20,446 Terrell 7,846 23,360 Thomas 7,286 20,627 Tift 7,286 20,627 Toombs 7,013 20,446 Towns 8,299 21,521 Treutlen 7,013 20,446 Troup 6,546 18,862 Turner 7,286 20,627 Twiggs 6,954 18,181 Union 8,299 21,521 Upson 6,546 18,862 Walker 7,029 20,867 Walton 7,366 20,580 Ware 6,388 19,799 Warren 6,959 18,720 Washington 7,700 21,179 Wayne 6,388 19,799 Webster 6,546 18,862 Wheeler 7,013 20,446 White 8,299 21,521 Whitfield 7,329 20,158 Wilcox 6,954 18,181 Wilkes 6,959 18,720 Wilkinson 7,700 21,179 Worth 7,846 23,360 Hawaii County Employee- Only Dependent, Family, etc. All 7,628 21,523 Idaho County Employee- Only Dependent, Family, etc. Ada 6,050 16,519 Adams 5,587 15,087 Bannock 6,987 17,973 Bear Lake 6,987 17,973 Benewah 6,197 16,093 Bingham 6,987 17,973 Blaine 6,095 18,948 Boise 5,587 15,087 Bonner 6,197 16,093 Bonneville 6,574 18,278 Boundary 6,197 16,093 Butte 6,987 17,973 Camas 6,095 18,948 Canyon 5,587 15,087 Caribou 6,987 17,973 Cassia 6,095 18,948 Clark 6,574 18,278 Clearwater 6,778 16,818 Custer 6,987 17,973 Elmore 5,587 15,087 Franklin 6,987 17,973 Fremont 6,574 18,278 Gem 5,587 15,087 Gooding 6,095 18,948 Idaho 6,778 16,818 Jefferson 6,574 18,278 Jerome 6,095 18,948 Kootenai 6,197 16,093 Latah 6,197 16,093 Lemhi 6,574 18,278 Lewis 6,778 16,818 Lincoln 6,095 18,948 Madison 6,574 18,278 Minidoka 6,095 18,948 Nez Perce 6,778 16,818 Oneida 6,987 17,973 Owyhee 5,587 15,087 Payette 5,587 15,087 Power 6,987 17,973 Shoshone 6,197 16,093 Teton 6,574 18,278 Twin Falls 6,095 18,948 Valley 5,587 15,087 Washington 5,587 15,087 Illinois County Employee- Only Dependent, Family, etc. Adams 7,685 19,139 Alexander 8,097 25,949 Bond 7,369 22,013 Boone 7,981 22,362 Brown 7,685 19,139 Bureau 6,673 20,301 Calhoun 7,369 22,013 Carroll 7,981 22,362 Cass 7,685 19,139 Champaign 8,290 21,185 Christian 7,685 19,139 Clark 8,290 21,185 Clay 8,097 25,949 Clinton 7,369 22,013 Coles 8,290 21,185 Cook 7,630 23,937 Crawford 8,097 25,949 Cumberland 8,290 21,185 DeKalb 7,981 22,362 DeWitt 8,401 24,851 Douglas 8,290 21,185 DuPage 7,901 23,738 Edgar 8,290 21,185 Edwards 8,097 25,949 Effingham 8,097 25,949 Fayette 8,097 25,949 Ford 8,290 21,185 Franklin 8,097 25,949 Fulton 7,908 21,322 Gallatin 8,097 25,949 Greene 7,369 22,013 Grundy 8,001 20,461 Hamilton 8,097 25,949 Hancock 6,673 20,301 Hardin 8,097 25,949 Henderson 6,673 20,301 Henry 6,673 20,301 Iroquois 8,290 21,185 Jackson 8,097 25,949 Jasper 8,097 25,949 Jefferson 8,097 25,949 Jersey 7,369 22,013 Jo Daviess 7,981 22,362 Johnson 8,097 25,949 Kane 7,901 23,738 Kankakee 8,001 20,461 Kendall 8,001 20,461 Knox 7,908 21,322 Lake 6,757 24,199 LaSalle 7,908 21,322 Lawrence 8,097 25,949 Lee 7,981 22,362 Livingston 8,401 24,851 Logan 7,685 19,139 Macon 7,685 19,139 Macoupin 7,369 22,013 Madison 7,872 20,961 Marion 8,097 25,949 Marshall 7,908 21,322 Mason 7,685 19,139 Massac 8,097 25,949 McDonough 7,908 21,322 McHenry 6,757 24,199 McLean 8,401 24,851 Menard 7,685 19,139 Mercer 6,673 20,301 Monroe 7,872 20,961 Montgomery 7,369 22,013 Morgan 7,685 19,139 Moultrie 7,685 19,139 Ogle 7,981 22,362 Peoria 7,908 21,322 Perry 8,097 25,949 Piatt 8,290 21,185 Pike 7,685 19,139 Pope 8,097 25,949 Pulaski 8,097 25,949 Putnam 7,908 21,322 Randolph 7,369 22,013 Richland 8,097 25,949 Rock Island 6,673 20,301 Saline 8,097 25,949 Sangamon 7,685 19,139 Schuyler 7,685 19,139 Scott 7,685 19,139 Shelby 7,685 19,139 St. Clair 7,872 20,961 Stark 7,908 21,322 Stephenson 7,981 22,362 Tazewell 7,908 21,322 Union 8,097 25,949 Vermilion 8,290 21,185 Wabash 8,097 25,949 Warren 6,673 20,301 Washington 7,369 22,013 Wayne 8,097 25,949 White 8,097 25,949 Whiteside 6,673 20,301 Will 8,001 20,461 Williamson 8,097 25,949 Winnebago 7,981 22,362 Woodford 7,908 21,322 Indiana County Employee- Only Dependent, Family, etc. Adams 7,478 23,214 Allen 7,885 24,189 Bartholomew 7,972 22,560 Benton 8,165 25,391 Blackford 8,053 21,898 Boone 7,971 25,255 Brown 8,081 23,034 Carroll 7,797 26,016 Cass 7,663 21,199 Clark 6,966 21,081 Clay 7,068 22,156 Clinton 7,797 26,016 Crawford 6,966 21,081 Daviess 7,669 22,769 Dearborn 8,289 24,245 Decatur 7,972 22,560 DeKalb 7,478 23,214 Delaware 8,053 21,898 Dubois 7,669 22,769 Elkhart 8,340 22,494 Fayette 7,510 22,139 Floyd 6,966 21,081 Fountain 7,797 26,016 Franklin 8,289 24,245 Fulton 7,663 21,199 Gibson 9,570 24,463 Grant 8,053 21,898 Greene 7,669 22,769 Hamilton 7,971 25,255 Hancock 7,510 22,139 Harrison 6,966 21,081 Hendricks 7,971 25,255 Henry 7,510 22,139 Howard 7,663 21,199 Huntington 7,478 23,214 Jackson 7,972 22,560 Jasper 8,165 25,391 Jay 8,053 21,898 Jefferson 6,966 21,081 Jennings 7,972 22,560 Johnson 8,081 23,034 Knox 7,669 22,769 Kosciusko 8,340 22,494 LaGrange 7,478 23,214 Lake 8,474 22,352 LaPorte 8,474 22,352 Lawrence 8,081 23,034 Madison 7,510 22,139 Marion 7,971 25,255 Marshall 8,340 22,494 Martin 7,669 22,769 Miami 7,663 21,199 Monroe 8,081 23,034 Montgomery 7,797 26,016 Morgan 7,971 25,255 Newton 8,165 25,391 Noble 7,478 23,214 Ohio 8,289 24,245 Orange 7,669 22,769 Owen 8,081 23,034 Parke 7,068 22,156 Perry 7,669 22,769 Pike 7,669 22,769 Porter 8,474 22,352 Posey 9,570 24,463 Pulaski 7,663 21,199 Putnam 7,797 26,016 Randolph 8,053 21,898 Ripley 8,289 24,245 Rush 7,972 22,560 Scott 6,966 21,081 Shelby 7,971 25,255 Spencer 7,669 22,769 St. Joseph 8,340 22,494 Starke 8,340 22,494 Steuben 7,478 23,214 Sullivan 7,068 22,156 Switzerland 8,289 24,245 Tippecanoe 7,797 26,016 Tipton 7,797 26,016 Union 7,510 22,139 Vanderburgh 9,570 24,463 Vermillion 7,068 22,156 Vigo 7,068 22,156 Wabash 7,478 23,214 Warren 8,165 25,391 Warrick 9,570 24,463 Washington 6,966 21,081 Wayne 7,510 22,139 Wells 7,478 23,214 White 8,165 25,391 Whitley 7,478 23,214 Iowa County Employee- Only Dependent, Family, etc. Adair 8,299 18,911 Adams 8,299 18,911 Allamakee 7,379 21,093 Appanoose 7,262 18,678 Audubon 8,299 18,911 Benton 6,970 19,956 Black Hawk 6,970 19,956 Boone 6,380 19,492 Bremer 7,379 21,093 Buchanan 6,970 19,956 Buena Vista 7,388 19,924 Butler 7,379 21,093 Calhoun 6,380 19,492 Carroll 6,380 19,492 Cass 8,299 18,911 Cedar 6,970 19,956 Cerro Gordo 7,379 21,093 Cherokee 7,388 19,924 Chickasaw 7,379 21,093 Clarke 8,299 18,911 Clay 7,388 19,924 Clayton 6,970 19,956 Clinton 6,970 19,956 Crawford 7,388 19,924 Dallas 6,825 20,228 Davis 7,262 18,678 Decatur 8,299 18,911 Delaware 6,970 19,956 Des Moines 7,262 18,678 Dickinson 7,388 19,924 Dubuque 6,970 19,956 Emmet 7,379 21,093 Fayette 7,379 21,093 Floyd 7,379 21,093 Franklin 7,379 21,093 Fremont 8,299 18,911 Greene 6,380 19,492 Grundy 6,380 19,492 Guthrie 8,299 18,911 Hamilton 6,380 19,492 Hancock 7,379 21,093 Hardin 6,380 19,492 Harrison 8,299 18,911 Henry 7,262 18,678 Howard 7,379 21,093 Humboldt 7,379 21,093 Ida 7,388 19,924 Iowa 6,970 19,956 Jackson 6,970 19,956 Jasper 6,825 20,228 Jefferson 7,262 18,678 Johnson 6,970 19,956 Jones 6,970 19,956 Keokuk 7,262 18,678 Kossuth 7,379 21,093 Lee 7,262 18,678 Linn 6,970 19,956 Louisa 7,262 18,678 Lucas 7,262 18,678 Lyon 7,388 19,924 Madison 6,825 20,228 Mahaska 7,262 18,678 Marion 6,825 20,228 Marshall 6,380 19,492 Mills 8,299 18,911 Mitchell 7,379 21,093 Monona 7,388 19,924 Monroe 7,262 18,678 Montgomery 8,299 18,911 Muscatine 7,262 18,678 O'Brien 7,388 19,924 Osceola 7,388 19,924 Page 8,299 18,911 Palo Alto 7,388 19,924 Plymouth 7,388 19,924 Pocahontas 7,388 19,924 Polk 6,825 20,228 Pottawattamie 8,299 18,911 Poweshiek 6,380 19,492 Ringgold 8,299 18,911 Sac 7,388 19,924 Scott 6,970 19,956 Shelby 8,299 18,911 Sioux 7,388 19,924 Story 6,380 19,492 Tama 6,380 19,492 Taylor 8,299 18,911 Union 8,299 18,911 Van Buren 7,262 18,678 Wapello 7,262 18,678 Warren 6,825 20,228 Washington 7,262 18,678 Wayne 7,262 18,678 Webster 6,380 19,492 Winnebago 7,379 21,093 Winneshiek 7,379 21,093 Woodbury 7,388 19,924 Worth 7,379 21,093 Wright 7,379 21,093 Kansas County Employee- Only Dependent, Family, etc. Allen 7,460 19,378 Anderson 6,137 19,264 Atchison 6,137 19,264 Barber 6,516 20,210 Barton 6,919 21,412 Bourbon 7,460 19,378 Brown 6,137 19,264 Butler 6,295 18,161 Chase 6,295 18,161 Chautauqua 6,295 18,161 Cherokee 7,460 19,378 Cheyenne 6,919 21,412 Clark 6,516 20,210 Clay 6,086 17,604 Cloud 6,086 17,604 Coffey 6,137 19,264 Comanche 6,516 20,210 Cowley 6,295 18,161 Crawford 7,460 19,378 Decatur 6,919 21,412 Dickinson 6,086 17,604 Doniphan 6,137 19,264 Douglas 6,137 19,264 Edwards 6,516 20,210 Elk 6,295 18,161 Ellis 6,919 21,412 Ellsworth 6,086 17,604 Finney 6,516 20,210 Ford 6,516 20,210 Franklin 6,137 19,264 Geary 6,086 17,604 Gove 6,919 21,412 Graham 6,919 21,412 Grant 6,516 20,210 Gray 6,516 20,210 Greeley 6,919 21,412 Greenwood 6,295 18,161 Hamilton 6,516 20,210 Harper 6,295 18,161 Harvey 6,295 18,161 Haskell 6,516 20,210 Hodgeman 6,516 20,210 Jackson 6,137 19,264 Jefferson 6,137 19,264 Jewell 6,086 17,604 Johnson 7,265 20,490 Kearny 6,516 20,210 Kingman 6,295 18,161 Kiowa 6,516 20,210 Labette 7,460 19,378 Lane 6,919 21,412 Leavenworth 7,265 20,490 Lincoln 6,086 17,604 Linn 6,137 19,264 Logan 6,919 21,412 Lyon 6,137 19,264 Marion 6,295 18,161 Marshall 6,137 19,264 McPherson 6,295 18,161 Meade 6,516 20,210 Miami 7,265 20,490 Mitchell 6,086 17,604 Montgomery 6,295 18,161 Morris 6,086 17,604 Morton 6,516 20,210 Nemaha 6,137 19,264 Neosho 7,460 19,378 Ness 6,919 21,412 Norton 6,919 21,412 Osage 6,137 19,264 Osborne 6,919 21,412 Ottawa 6,086 17,604 Pawnee 6,516 20,210 Phillips 6,919 21,412 Pottawatomie 6,137 19,264 Pratt 6,516 20,210 Rawlins 6,919 21,412 Reno 6,295 18,161 Republic 6,086 17,604 Rice 6,295 18,161 Riley 6,086 17,604 Rooks 6,919 21,412 Rush 6,919 21,412 Russell 6,919 21,412 Saline 6,086 17,604 Scott 6,919 21,412 Sedgwick 6,295 18,161 Seward 6,516 20,210 Shawnee 6,137 19,264 Sheridan 6,919 21,412 Sherman 6,919 21,412 Smith 6,919 21,412 Stafford 6,516 20,210 Stanton 6,516 20,210 Stevens 6,516 20,210 Sumner 6,295 18,161 Thomas 6,919 21,412 Trego 6,919 21,412 Wabaunsee 6,137 19,264 Wallace 6,919 21,412 Washington 6,086 17,604 Wichita 6,919 21,412 Wilson 6,295 18,161 Woodson 7,460 19,378 Wyandotte 7,265 20,490 Kentucky County Employee- Only Dependent, Family, etc. Adair 6,633 19,790 Allen 6,633 19,790 Anderson 6,360 19,187 Ballard 8,670 19,250 Barren 6,633 19,790 Bath 7,159 20,621 Bell 7,208 21,247 Boone 6,339 17,457 Bourbon 6,360 19,187 Boyd 7,159 20,621 Boyle 6,360 19,187 Bracken 7,159 20,621 Breathitt 7,208 21,247 Breckinridge 6,863 18,840 Bullitt 6,863 18,840 Butler 6,633 19,790 Caldwell 8,670 19,250 Calloway 8,670 19,250 Campbell 6,339 17,457 Carlisle 8,670 19,250 Carroll 6,863 18,840 Carter 7,159 20,621 Casey 6,633 19,790 Christian 8,314 20,031 Clark 6,360 19,187 Clay 7,208 21,247 Clinton 6,633 19,790 Crittenden 8,670 19,250 Cumberland 6,633 19,790 Daviess 8,314 20,031 Edmonson 6,633 19,790 Elliott 7,159 20,621 Estill 6,360 19,187 Fayette 6,360 19,187 Fleming 7,159 20,621 Floyd 7,208 21,247 Franklin 6,360 19,187 Fulton 8,670 19,250 Gallatin 6,339 17,457 Garrard 6,360 19,187 Grant 6,339 17,457 Graves 8,670 19,250 Grayson 6,863 18,840 Green 6,633 19,790 Greenup 7,159 20,621 Hancock 8,314 20,031 Hardin 6,863 18,840 Harlan 7,208 21,247 Harrison 6,360 19,187 Hart 6,633 19,790 Henderson 8,314 20,031 Henry 6,863 18,840 Hickman 8,670 19,250 Hopkins 8,314 20,031 Jackson 6,360 19,187 Jefferson 6,863 18,840 Jessamine 6,360 19,187 Johnson 7,208 21,247 Kenton 6,339 17,457 Knott 7,208 21,247 Knox 7,208 21,247 LaRue 6,863 18,840 Laurel 7,208 21,247 Lawrence 7,159 20,621 Lee 7,208 21,247 Leslie 7,208 21,247 Letcher 7,208 21,247 Lewis 7,159 20,621 Lincoln 6,360 19,187 Livingston 8,670 19,250 Logan 6,633 19,790 Lyon 8,670 19,250 Madison 6,360 19,187 Magoffin 7,208 21,247 Marion 6,863 18,840 Marshall 8,670 19,250 Martin 7,208 21,247 Mason 7,159 20,621 McCracken 8,670 19,250 McCreary 6,633 19,790 McLean 8,314 20,031 Meade 6,863 18,840 Menifee 7,159 20,621 Mercer 6,360 19,187 Metcalfe 6,633 19,790 Monroe 6,633 19,790 Montgomery 6,360 19,187 Morgan 7,159 20,621 Muhlenberg 8,314 20,031 Nelson 6,863 18,840 Nicholas 6,360 19,187 Ohio 8,314 20,031 Oldham 6,863 18,840 Owen 6,360 19,187 Owsley 7,208 21,247 Pendleton 6,339 17,457 Perry 7,208 21,247 Pike 7,208 21,247 Powell 6,360 19,187 Pulaski 6,633 19,790 Robertson 7,159 20,621 Rockcastle 6,360 19,187 Rowan 7,159 20,621 Russell 6,633 19,790 Scott 6,360 19,187 Shelby 6,863 18,840 Simpson 6,633 19,790 Spencer 6,863 18,840 Taylor 6,633 19,790 Todd 8,314 20,031 Trigg 8,314 20,031 Trimble 6,863 18,840 Union 8,314 20,031 Warren 6,633 19,790 Washington 6,863 18,840 Wayne 6,633 19,790 Webster 8,314 20,031 Whitley 7,208 21,247 Wolfe 7,208 21,247 Woodford 6,360 19,187 Louisiana Parish Employee- Only Dependent, Family, etc. Acadia 7,541 18,078 Allen 7,717 20,137 Ascension 7,533 19,568 Assumption 7,514 17,764 Avoyelles 8,112 17,923 Beauregard 7,717 20,137 Bienville 7,794 19,283 Bossier 7,794 19,283 Caddo 7,794 19,283 Calcasieu 7,717 20,137 Caldwell 7,876 17,471 Cameron 7,717 20,137 Catahoula 8,112 17,923 Claiborne 7,794 19,283 Concordia 8,112 17,923 DeSoto 7,794 19,283 East Baton Rouge 7,533 19,568 East Carroll 7,876 17,471 East Feliciana 7,533 19,568 Evangeline 7,541 18,078 Franklin 7,876 17,471 Grant 8,112 17,923 Iberia 7,541 18,078 Iberville 7,533 19,568 Jackson 7,876 17,471 Jefferson 7,139 18,432 Jefferson Davis 7,717 20,137 Lafayette 7,541 18,078 Lafourche 7,514 17,764 LaSalle 8,112 17,923 Lincoln 7,876 17,471 Livingston 7,533 19,568 Madison 7,876 17,471 Morehouse
