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 $55,000 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 (2019) Credit for Small Employer Health Insurance Premiums Section references are to the Internal Revenue Code unless otherwise noted. 2019 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, can be taken against both regular and alternative minimum tax, and 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 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 $55,000 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 $55,000. 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 or 1040-SR) 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 or 1040-SR) 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, use the amount you paid to figure your employer premiums paid. 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 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 taken into account in calculating the uniform percentage requirement, 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 the following amounts. 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 the following amounts. 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 2019, 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 2019. Medicare taxes the tax-exempt employer was required to withhold from employees’ wages in calendar year 2019. Medicare taxes the tax-exempt employer was required to pay for calendar year 2019. 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 2019, 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 2019 if they properly claimed the credit under section 45R for all or part of 2018. 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 2019 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 in 2014, 2015, 2016, or 2017 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 $55,000 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 2019, 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 $27,100 from line 3 4. 5. Divide line 4 by $27,100. 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 11, 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 2019. Medicare taxes the tax-exempt employer was required to withhold from employees’ wages in calendar year 2019. Medicare taxes the tax-exempt employer was required to pay for calendar year 2019. 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 2019. Alabama County Employee- Only Dependent, Family, etc. Autauga 7,496 19,230 Baldwin 6,299 17,134 Barbour 6,299 17,134 Bibb 6,653 18,549 Blount 6,653 18,549 Bullock 6,299 17,134 Butler 6,299 17,134 Calhoun 6,642 18,615 Chambers 6,299 17,134 Cherokee 6,299 17,134 Chilton 6,653 18,549 Choctaw 6,299 17,134 Clarke 6,299 17,134 Clay 6,299 17,134 Cleburne 6,299 17,134 Coffee 6,299 17,134 Colbert 8,558 19,748 Conecuh 6,299 17,134 Coosa 6,299 17,134 Covington 6,299 17,134 Crenshaw 6,299 17,134 Cullman 6,299 17,134 Dale 6,299 17,134 Dallas 6,299 17,134 DeKalb 6,299 17,134 Elmore 7,496 19,230 Escambia 6,299 17,134 Etowah 5,846 18,202 Fayette 6,299 17,134 Franklin 6,299 17,134 Geneva 6,414 16,386 Greene 7,603 16,924 Hale 7,603 16,924 Henry 6,414 16,386 Houston 6,414 16,386 Jackson 6,299 17,134 Jefferson 6,653 18,549 Lamar 6,299 17,134 Lauderdale 8,558 19,748 Lawrence 7,893 19,596 Lee 6,298 15,915 Limestone 6,480 18,506 Lowndes 7,496 19,230 Macon 6,299 17,134 Madison 6,480 18,506 Marengo 6,299 17,134 Marion 6,299 17,134 Marshall 6,299 17,134 Mobile 7,203 17,779 Monroe 6,299 17,134 Montgomery 7,496 19,230 Morgan 7,893 19,596 Perry 6,299 17,134 Pickens 6,299 17,134 Pike 6,299 17,134 Randolph 6,299 17,134 Russell 7,136 18,051 Shelby 6,653 18,549 St. Clair 6,653 18,549 Sumter 6,299 17,134 Talladega 6,299 17,134 Tallapoosa 6,299 17,134 Tuscaloosa 7,603 16,924 Walker 6,653 18,549 Washington 6,299 17,134 Wilcox 6,299 17,134 Winston 6,299 17,134 Alaska County Employee- Only Dependent, Family, etc. Aleutians East 10,434 27,855 Aleutians West 10,434 27,855 Anchorage 9,537 28,132 Bethel 9,537 28,132 Bristol Bay 10,434 27,855 Denali 10,434 27,855 Dillingham 9,537 28,132 Fairbanks North Star 10,434 27,855 Haines 10,239 26,762 Hoonah-Angoon 10,239 26,762 Juneau 10,239 26,762 Kenai Peninsula 10,434 27,855 Ketchikan Gateway 10,239 26,762 Kodiak Island 10,434 27,855 Lake and Peninsula 10,434 27,855 Matanuska Susitna 10,434 27,855 Nome 10,434 27,855 North Slope 10,434 27,855 Northwest Arctic 10,434 27,855 Petersburg 10,239 26,762 Prince of Wales-Hyder 10,239 26,762 Sitka 10,239 26,762 Skagway 10,239 26,762 Southeast Fairbanks 10,434 27,855 Valdez Cordova 9,537 28,132 Wade Hampton 10,434 27,855 Wrangell City and Borough 10,239 26,762 Yakutat 10,434 27,855 Yukon Koyukuk 10,434 27,855 Arizona County Employee- Only Dependent, Family, etc. Apache 6,048 16,062 Cochise 6,445 17,906 Coconino 6,048 16,062 Gila 6,572 17,498 Graham 6,445 17,906 Greenlee 6,445 17,906 La Paz 7,570 19,901 Maricopa 5,993 17,317 Mohave 6,048 16,062 Navajo 6,048 16,062 Pima 5,732 17,791 Pinal 6,572 17,498 Santa Cruz 5,732 17,791 Yavapai 5,662 18,780 Yuma 7,570 19,901 Arkansas County Employee- Only Dependent, Family, etc. Arkansas 5,941 14,734 Ashley 5,941 14,734 Baxter 5,349 14,692 Benton 5,349 14,692 Boone 5,349 14,692 Bradley 5,941 14,734 Calhoun 6,135 18,778 Carroll 5,349 14,692 Chicot 5,941 14,734 Clark 5,127 15,166 Clay 6,168 17,023 Cleburne 5,748 14,866 Cleveland 5,941 14,734 Columbia 6,135 18,778 Conway 5,748 14,866 Craighead 6,168 17,023 Crawford 5,610 15,821 Crittenden 6,168 17,023 Cross 6,168 17,023 Dallas 5,941 14,734 Desha 5,941 14,734 Drew 5,941 14,734 Faulkner 5,748 14,866 Franklin 5,610 15,821 Fulton 6,168 17,023 Garland 5,127 15,166 Grant 5,748 14,866 Greene 6,168 17,023 Hempstead 6,135 18,778 Hot Spring 5,127 15,166 Howard 6,135 18,778 Independence 6,168 17,023 Izard 6,168 17,023 Jackson 6,168 17,023 Jefferson 5,941 14,734 Johnson 5,610 15,821 Lafayette 6,135 18,778 Lawrence 6,168 17,023 Lee 5,941 14,734 Lincoln 5,941 14,734 Little River 6,135 18,778 Logan 5,610 15,821 Lonoke 5,748 14,866 Madison 5,349 14,692 Marion 5,349 14,692 Miller 6,135 18,778 Mississippi 6,168 17,023 Monroe 5,941 14,734 Montgomery 5,127 15,166 Nevada 6,135 18,778 Newton 5,349 14,692 Ouachita 6,135 18,778 Perry 5,748 14,866 Phillips 5,941 14,734 Pike 5,127 15,166 Poinsett 6,168 17,023 Polk 5,610 15,821 Pope 5,748 14,866 Prairie 5,748 14,866 Pulaski 5,748 14,866 Randolph 6,168 17,023 Saline 5,748 14,866 Scott 5,610 15,821 Searcy 5,349 14,692 Sebastian 5,610 15,821 Sevier 6,135 18,778 Sharp 6,168 17,023 St. Francis 6,168 17,023 Stone 6,168 17,023 Union 6,135 18,778 Van Buren 5,748 14,866 Washington 5,349 14,692 White 5,748 14,866 Woodruff 6,168 17,023 Yell 5,748 14,866 California County Employee- Only Dependent, Family, etc. Alameda 7,400 19,186 Alpine 6,686 17,135 Amador 6,686 17,135 Butte 6,686 17,135 Calaveras 6,686 17,135 Colusa 6,686 17,135 Contra Costa 7,587 19,440 Del Norte 6,686 17,135 El Dorado 6,442 16,884 Fresno 6,269 18,185 Glenn 6,686 17,135 Humboldt 6,686 17,135 Imperial 6,023 15,609 Inyo 6,023 15,609 Kern 7,202 17,484 Kings 6,269 18,185 Lake 6,686 17,135 Lassen 6,686 17,135 Los Angeles 6,446 17,582 Madera 6,269 18,185 Marin 6,899 17,066 Mariposa 7,223 16,485 Mendocino 6,686 17,135 Merced 7,223 16,485 Modoc 6,686 17,135 Mono 6,023 15,609 Monterey 6,851 16,720 Napa 6,899 17,066 Nevada 6,686 17,135 Orange 6,923 19,303 Placer 6,442 16,884 Plumas 6,686 17,135 Riverside 6,189 16,406 Sacramento 6,442 16,884 San Benito 6,851 16,720 San Bernardino 6,189 16,406 San Diego 6,254 16,251 San Francisco 6,928 22,099 San Joaquin 7,223 16,485 San Luis Obispo 6,565 17,216 San Mateo 8,446 21,619 Santa Barbara 6,565 17,216 Santa Clara 7,816 20,093 Santa Cruz 6,851 16,720 Shasta 6,686 17,135 Sierra 6,686 17,135 Siskiyou 6,686 17,135 Solano 6,899 17,066 Sonoma 6,899 17,066 Stanislaus 7,223 16,485 Sutter 6,686 17,135 Tehama 6,686 17,135 Trinity 6,686 17,135 Tulare 7,223 16,485 Tuolumne 6,686 17,135 Ventura 6,565 17,216 Yolo 6,442 16,884 Yuba 6,686 17,135 Colorado County Employee- Only Dependent, Family, etc. Adams 6,473 18,805 Alamosa 8,108 18,152 Arapahoe 6,473 18,805 Archuleta 7,782 19,899 Baca 8,108 18,152 Bent 8,108 18,152 Boulder 5,932 18,751 Broomfield 6,473 18,805 Chaffee 8,108 18,152 Cheyenne 8,108 18,152 Clear Creek 6,473 18,805 Conejos 8,108 18,152 Costilla 8,108 18,152 Crowley 8,108 18,152 Custer 8,108 18,152 Delta 7,782 19,899 Denver 6,473 18,805 Dolores 7,782 19,899 Douglas 6,473 18,805 Eagle 7,401 19,560 El Paso 6,109 17,296 Elbert 6,473 18,805 Fremont 8,108 18,152 Garfield 7,401 19,560 Gilpin 6,473 18,805 Grand 7,782 19,899 Gunnison 7,782 19,899 Hinsdale 7,782 19,899 Huerfano 8,108 18,152 Jackson 7,782 19,899 Jefferson 6,473 18,805 Kiowa 8,108 18,152 Kit Carson 8,108 18,152 La Plata 7,782 19,899 Lake 7,782 19,899 Larimer 7,842 15,661 Las Animas 8,108 18,152 Lincoln 8,108 18,152 Logan 6,452 17,979 Mesa 6,247 17,485 Mineral 8,108 18,152 Moffat 7,782 19,899 Montezuma 7,782 19,899 Montrose 7,782 19,899 Morgan 6,452 17,979 Otero 8,108 18,152 Ouray 7,782 19,899 Park 6,473 18,805 Phillips 6,452 17,979 Pitkin 7,401 19,560 Prowers 8,108 18,152 Pueblo 6,909 18,542 Rio Blanco 7,782 19,899 Rio Grande 8,108 18,152 Routt 7,782 19,899 Saguache 8,108 18,152 San Juan 7,782 19,899 San Miguel 7,782 19,899 Sedgwick 6,452 17,979 Summit 7,401 19,560 Teller 6,109 17,296 Washington 6,452 17,979 Weld 6,266 18,203 Yuma 6,452 17,979 Connecticut County Employee- Only Dependent, Family, etc. Fairfield 7,969 22,318 Hartford 7,443 20,581 Litchfield 7,107 21,335 Middlesex 8,289 21,538 New Haven 8,154 21,310 New London 6,262 16,977 Tolland 7,371 15,494 Windham 7,732 27,150 Delaware County Employee- Only Dependent, Family, etc. All 7,718 21,577 District of Columbia County Employee- Only Dependent, Family, etc. All 6,547 21,926 Florida County Employee- Only Dependent, Family, etc. Alachua 7,824 18,767 Baker 6,819 18,340 Bay 6,104 16,525 Bradford 6,285 18,668 Brevard 7,268 19,268 Broward 6,504 19,677 Calhoun 6,436 18,498 Charlotte 7,602 21,853 Citrus 6,538 16,760 Clay 5,653 18,079 Collier 5,724 18,249 Columbia 7,619 20,834 DeSoto 6,496 19,377 Dixie 6,175 15,955 Duval 6,785 17,101 Escambia 7,011 16,923 Flagler 7,325 18,012 Franklin 6,390 19,561 Gadsden 6,099 18,111 Gilchrist 6,191 18,470 Glades 6,694 21,069 Gulf 7,505 19,997 Hamilton 6,404 18,448 Hardee 6,611 16,125 Hendry 7,605 21,272 Hernando 6,880 19,628 Highlands 7,233 22,204 Hillsborough 6,063 18,134 Holmes 6,664 18,530 Indian River 6,122 16,323 Jackson 5,893 15,950 Jefferson 7,343 17,863 Lafayette 6,707 17,496 Lake 7,765 20,508 Lee 6,462 18,925 Leon 7,004 20,060 Levy 6,257 19,545 Liberty 6,502 18,954 Madison 7,585 19,890 Manatee 6,495 20,547 Marion 5,798 16,598 Martin 6,960 20,401 Miami-Dade 6,882 20,551 Monroe 7,638 21,499 Nassau 7,343 16,112 Okaloosa 6,829 25,545 Okeechobee 7,498 20,433 Orange 6,644 17,215 Osceola 7,510 21,366 Palm Beach 7,054 19,831 Pasco 7,222 17,632 Pinellas 6,793 21,198 Polk 6,725 18,800 Putnam 6,547 19,304 Santa Rosa 6,248 15,808 Sarasota 6,314 17,419 Seminole 6,403 16,459 St. Johns 6,230 20,276 St. Lucie 6,195 16,453 Sumter 6,574 20,097 Suwannee 5,954 18,191 Taylor 7,698 20,766 Union 6,404 18,849 Volusia 6,515 18,059 Wakulla 6,279 18,762 Walton 6,203 15,878 Washington 6,572 19,403 Georgia County Employee- Only Dependent, Family, etc. Appling 7,234 17,746 Atkinson 7,013 19,504 Bacon 5,509 15,512 Baker 7,132 18,814 Baldwin 7,411 19,119 Banks 7,372 17,098 Barrow 6,145 17,934 Bartow 6,329 17,391 Ben Hill 7,286 20,529 Berrien 7,286 20,529 Bibb 6,078 17,514 Bleckley 6,078 17,514 Brantley 5,509 15,512 Brooks 7,286 20,529 Bryan 7,234 17,746 Bulloch 7,234 17,746 Burke 6,568 18,206 Butts 6,329 17,391 Calhoun 7,132 18,814 Camden 5,509 15,512 Candler 7,234 17,746 Carroll 6,588 19,520 Catoosa 6,368 17,840 Charlton 5,509 15,512 Chatham 7,234 17,746 Chattahoochee 5,758 18,095 Chattooga 7,357 18,355 Cherokee 6,329 17,391 Clarke 6,145 17,934 Clay 7,132 18,814 Clayton 6,329 17,391 Clinch 7,286 20,529 Cobb 6,329 17,391 Coffee 7,013 19,504 Colquitt 7,286 20,529 Columbia 6,568 18,206 Cook 7,286 20,529 Coweta 6,329 17,391 Crawford 6,078 17,514 Crisp 7,132 18,814 Dade 6,368 17,840 Dawson 7,372 17,098 Decatur 7,286 20,529 DeKalb 6,329 17,391 Dodge 6,078 17,514 Dooly 6,078 17,514 Dougherty 7,132 18,814 Douglas 6,329 17,391 Early 7,286 20,529 Echols 7,286 20,529 Effingham 7,234 17,746 Elbert 6,145 17,934 Emanuel 6,568 18,206 Evans 7,234 17,746 Fannin 6,022 16,060 Fayette 6,329 17,391 Floyd 7,357 18,355 Forsyth 6,329 17,391 Franklin 7,372 17,098 Fulton 6,329 17,391 Gilmer 7,357 18,355 Glascock 6,568 18,206 Glynn 5,509 15,512 Gordon 7,357 18,355 Grady 7,286 20,529 Greene 6,145 17,934 Gwinnett 6,329 17,391 Habersham 7,372 17,098 Hall 7,372 17,098 Hancock 7,411 19,119 Haralson 6,588 19,520 Harris 5,758 18,095 Hart 7,372 17,098 Heard 6,588 19,520 Henry 6,329 17,391 Houston 6,078 17,514 Irwin 7,286 20,529 Jackson 6,145 17,934 Jasper 6,329 17,391 Jeff Davis 7,013 19,504 Jefferson 6,568 18,206 Jenkins 6,568 18,206 Johnson 7,013 19,504 Jones 6,078 17,514 Lamar 6,329 17,391 Lanier 7,286 20,529 Laurens 7,013 19,504 Lee 7,132 18,814 Liberty 7,234 17,746 Lincoln 6,568 18,206 Long 7,234 17,746 Lowndes 7,286 20,529 Lumpkin 7,372 17,098 Macon 5,758 18,095 Madison 6,145 17,934 Marion 5,758 18,095 McDuffie 6,568 18,206 McIntosh 5,509 15,512 Meriwether 5,758 18,095 Miller 7,286 20,529 Mitchell 7,132 18,814 Monroe 6,078 17,514 Montgomery 7,013 19,504 Morgan 6,145 17,934 Murray 6,022 16,060 Muscogee 5,758 18,095 Newton 6,329 17,391 Oconee 6,145 17,934 Oglethorpe 6,145 17,934 Paulding 6,329 17,391 Peach 6,078 17,514 Pickens 7,357 18,355 Pierce 5,509 15,512 Pike 6,329 17,391 Polk 7,357 18,355 Pulaski 6,078 17,514 Putnam 6,078 17,514 Quitman 5,758 18,095 Rabun 7,372 17,098 Randolph 7,132 18,814 Richmond 6,568 18,206 Rockdale 6,329 17,391 Schley 7,132 18,814 Screven 7,234 17,746 Seminole 7,286 20,529 Spalding 6,329 17,391 Stephens 7,372 17,098 Stewart 5,758 18,095 Sumter 7,132 18,814 Talbot 5,758 18,095 Taliaferro 6,568 18,206 Tattnall 7,234 17,746 Taylor 5,758 18,095 Telfair 7,013 19,504 Terrell 7,132 18,814 Thomas 7,286 20,529 Tift 7,286 20,529 Toombs 7,013 19,504 Towns 7,372 17,098 Treutlen 7,013 19,504 Troup 5,758 18,095 Turner 7,286 20,529 Twiggs 6,078 17,514 Union 7,372 17,098 Upson 5,758 18,095 Walker 6,368 17,840 Walton 6,329 17,391 Ware 5,509 15,512 Warren 6,568 18,206 Washington 7,411 19,119 Wayne 5,509 15,512 Webster 5,758 18,095 Wheeler 7,013 19,504 White 7,372 17,098 Whitfield 6,022 16,060 Wilcox 6,078 17,514 Wilkes 6,568 18,206 Wilkinson 7,411 19,119 Worth 7,132 18,814 Hawaii County Employee- Only Dependent, Family, etc. All 6,207 18,141 Idaho County Employee- Only Dependent, Family, etc. Ada 5,405 15,191 Adams 5,053 14,317 Bannock 5,745 16,504 Bear Lake 5,745 16,504 Benewah 5,467 13,471 Bingham 5,745 16,504 Blaine 5,246 16,271 Boise 5,053 14,317 Bonner 5,467 13,471 Bonneville 6,016 15,461 Boundary 5,467 13,471 Butte 5,745 16,504 Camas 5,246 16,271 Canyon 5,053 14,317 Caribou 5,745 16,504 Cassia 5,246 16,271 Clark 6,016 15,461 Clearwater 5,780 16,479 Custer 5,745 16,504 Elmore 5,053 14,317 Franklin 5,745 16,504 Fremont 6,016 15,461 Gem 5,053 14,317 Gooding 5,246 16,271 Idaho 5,780 16,479 Jefferson 6,016 15,461 Jerome 5,246 16,271 Kootenai 5,467 13,471 Latah 5,467 13,471 Lemhi 6,016 15,461 Lewis 5,780 16,479 Lincoln 5,246 16,271 Madison 6,016 15,461 Minidoka 5,246 16,271 Nez Perce 5,780 16,479 Oneida 5,745 16,504 Owyhee 5,053 14,317 Payette 5,053 14,317 Power 5,745 16,504 Shoshone 5,467 13,471 Teton 6,016 15,461 Twin Falls 5,246 16,271 Valley 5,053 14,317 Washington 5,053 14,317 Illinois County Employee- Only Dependent, Family, etc. Adams 6,399 17,438 Alexander 6,467 21,320 Bond 6,204 17,569 Boone 6,523 19,271 Brown 6,399 17,438 Bureau 5,393 18,874 Calhoun 6,204 17,569 Carroll 6,523 19,271 Cass 6,399 17,438 Champaign 6,755 18,247 Christian 6,399 17,438 Clark 6,755 18,247 Clay 6,467 21,320 Clinton 6,204 17,569 Coles 6,755 18,247 Cook 6,786 20,268 Crawford 6,467 21,320 Cumberland 6,755 18,247 DeKalb 6,523 19,271 DeWitt 7,269 24,851 Douglas 6,755 18,247 DuPage 7,109 20,308 Edgar 6,755 18,247 Edwards 6,467 21,320 Effingham 6,467 21,320 Fayette 6,467 21,320 Ford 6,755 18,247 Franklin 6,467 21,320 Fulton 7,117 18,449 Gallatin 6,467 21,320 Greene 6,204 17,569 Grundy 7,928 20,461 Hamilton 6,467 21,320 Hancock 5,393 18,874 Hardin 6,467 21,320 Henderson 5,393 18,874 Henry 5,393 18,874 Iroquois 6,755 18,247 Jackson 6,467 21,320 Jasper 6,467 21,320 Jefferson 6,467 21,320 Jersey 6,204 17,569 Jo Daviess 6,523 19,271 Johnson 6,467 21,320 Kane 7,109 20,308 Kankakee 7,928 20,461 Kendall 7,928 20,461 Knox 7,117 18,449 Lake 6,435 23,338 LaSalle 7,117 18,449 Lawrence 6,467 21,320 Lee 6,523 19,271 Livingston 7,269 24,851 Logan 6,399 17,438 Macon 6,399 17,438 Macoupin 6,204 17,569 Madison 6,989 18,661 Marion 6,467 21,320 Marshall 7,117 18,449 Mason 6,399 17,438 Massac 6,467 21,320 McDonough 7,117 18,449 McHenry 6,435 23,338 McLean 7,269 24,851 Menard 6,399 17,438 Mercer 5,393 18,874 Monroe 6,989 18,661 Montgomery 6,204 17,569 Morgan 6,399 17,438 Moultrie 6,399 17,438 Ogle 6,523 19,271 Peoria 7,117 18,449 Perry 6,467 21,320 Piatt 6,755 18,247 Pike 6,399 17,438 Pope 6,467 21,320 Pulaski 6,467 21,320 Putnam 7,117 18,449 Randolph 6,204 17,569 Richland 6,467 21,320 Rock Island 5,393 18,874 Saline 6,467 21,320 Sangamon 6,399 17,438 Schuyler 6,399 17,438 Scott 6,399 17,438 Shelby 6,399 17,438 St. Clair 6,989 18,661 Stark 7,117 18,449 Stephenson 6,523 19,271 Tazewell 7,117 18,449 Union 6,467 21,320 Vermilion 6,755 18,247 Wabash 6,467 21,320 Warren 5,393 18,874 Washington 6,204 17,569 Wayne 6,467 21,320 White 6,467 21,320 Whiteside 5,393 18,874 Will 7,928 20,461 Williamson 6,467 21,320 Winnebago 6,523 19,271 Woodford 7,117 18,449 Indiana County Employee- Only Dependent, Family, etc. Adams 7,447 20,133 Allen 6,518 18,284 Bartholomew 7,220 18,807 Benton 6,934 20,683 Blackford 7,432 17,837 Boone 6,974 20,636 Brown 6,293 19,033 Carroll 6,908 21,591 Cass 6,893 18,619 Clark 6,454 17,410 Clay 7,068 19,132 Clinton 6,908 21,591 Crawford 6,454 17,410 Daviess 7,396 19,890 Dearborn 6,523 20,034 Decatur 7,220 18,807 DeKalb 7,447 20,133 Delaware 7,432 17,837 Dubois 7,396 19,890 Elkhart 7,205 19,301 Fayette 6,074 20,055 Floyd 6,454 17,410 Fountain 6,908 21,591 Franklin 6,523 20,034 Fulton 6,893 18,619 Gibson 8,317 20,280 Grant 7,432 17,837 Greene 7,396 19,890 Hamilton 6,974 20,636 Hancock 6,074 20,055 Harrison 6,454 17,410 Hendricks 6,974 20,636 Henry 6,074 20,055 Howard 6,893 18,619 Huntington 7,447 20,133 Jackson 7,220 18,807 Jasper 6,934 20,683 Jay 7,432 17,837 Jefferson 6,454 17,410 Jennings 7,220 18,807 Johnson 6,293 19,033 Knox 7,396 19,890 Kosciusko 7,205 19,301 LaGrange 7,447 20,133 Lake 7,139 19,655 LaPorte 7,139 19,655 Lawrence 6,293 19,033 Madison 6,074 20,055 Marion 6,974 20,636 Marshall 7,205 19,301 Martin 7,396 19,890 Miami 6,893 18,619 Monroe 6,293 19,033 Montgomery 6,908 21,591 Morgan 6,974 20,636 Newton 6,934 20,683 Noble 7,447 20,133 Ohio 6,523 20,034 Orange 7,396 19,890 Owen 6,293 19,033 Parke 7,068 19,132 Perry 7,396 19,890 Pike 7,396 19,890 Porter 7,139 19,655 Posey 8,317 20,280 Pulaski 6,893 18,619 Putnam 6,908 21,591 Randolph 7,432 17,837 Ripley 6,523 20,034 Rush 7,220 18,807 Scott 6,454 17,410 Shelby 6,974 20,636 Spencer 7,396 19,890 St. Joseph 7,205 19,301 Starke 7,205 19,301 Steuben 7,447 20,133 Sullivan 7,068 19,132 Switzerland 6,523 20,034 Tippecanoe 6,908 21,591 Tipton 6,908 21,591 Union 6,074 20,055 Vanderburgh 8,317 20,280 Vermillion 7,068 19,132 Vigo 7,068 19,132 Wabash 7,447 20,133 Warren 6,934 20,683 Warrick 8,317 20,280 Washington 6,454 17,410 Wayne 6,074 20,055 Wells 7,447 20,133 White 6,934 20,683 Whitley 7,447 20,133 Iowa County Employee- Only Dependent, Family, etc. Adair 7,241 16,767 Adams 7,241 16,767 Allamakee 6,731 18,689 Appanoose 6,650 16,174 Audubon 7,241 16,767 Benton 6,647 18,063 Black Hawk 6,647 18,063 Boone 6,380 16,316 Bremer 6,731 18,689 Buchanan 6,647 18,063 Buena Vista 6,589 16,992 Butler 6,731 18,689 Calhoun 6,380 16,316 Carroll 6,380 16,316 Cass 7,241 16,767 Cedar 6,647 18,063 Cerro Gordo 6,731 18,689 Cherokee 6,589 16,992 Chickasaw 6,731 18,689 Clarke 7,241 16,767 Clay 6,589 16,992 Clayton 6,647 18,063 Clinton 6,647 18,063 Crawford 6,589 16,992 Dallas 6,458 16,580 Davis 6,650 16,174 Decatur 7,241 16,767 Delaware 6,647 18,063 Des Moines 6,650 16,174 Dickinson 6,589 16,992 Dubuque 6,647 18,063 Emmet 6,731 18,689 Fayette 6,731 18,689 Floyd 6,731 18,689 Franklin 6,731 18,689 Fremont 7,241 16,767 Greene 6,380 16,316 Grundy 6,380 16,316 Guthrie 7,241 16,767 Hamilton 6,380 16,316 Hancock 6,731 18,689 Hardin 6,380 16,316 Harrison 7,241 16,767 Henry 6,650 16,174 Howard 6,731 18,689 Humboldt 6,731 18,689 Ida 6,589 16,992 Iowa 6,647 18,063 Jackson 6,647 18,063 Jasper 6,458 16,580 Jefferson 6,650 16,174 Johnson 6,647 18,063 Jones 6,647 18,063 Keokuk 6,650 16,174 Kossuth 6,731 18,689 Lee 6,650 16,174 Linn 6,647 18,063 Louisa 6,650 16,174 Lucas 6,650 16,174 Lyon 6,589 16,992 Madison 6,458 16,580 Mahaska 6,650 16,174 Marion 6,458 16,580 Marshall 6,380 16,316 Mills 7,241 16,767 Mitchell 6,731 18,689 Monona 6,589 16,992 Monroe 6,650 16,174 Montgomery 7,241 16,767 Muscatine 6,650 16,174 O'Brien 6,589 16,992 Osceola 6,589 16,992 Page 7,241 16,767 Palo Alto 6,589 16,992 Plymouth 6,589 16,992 Pocahontas 6,589 16,992 Polk 6,458 16,580 Pottawattamie 7,241 16,767 Poweshiek 6,380 16,316 Ringgold 7,241 16,767 Sac 6,589 16,992 Scott 6,647 18,063 Shelby 7,241 16,767 Sioux 6,589 16,992 Story 6,380 16,316 Tama 6,380 16,316 Taylor 7,241 16,767 Union 7,241 16,767 Van Buren 6,650 16,174 Wapello 6,650 16,174 Warren 6,458 16,580 Washington 6,650 16,174 Wayne 6,650 16,174 Webster 6,380 16,316 Winnebago 6,731 18,689 Winneshiek 6,731 18,689 Woodbury 6,589 16,992 Worth 6,731 18,689 Wright 6,731 18,689 Kansas County Employee- Only Dependent, Family, etc. Allen 6,232 19,378 Anderson 5,741 16,956 Atchison 5,741 16,956 Barber 6,516 19,415 Barton 6,167 20,132 Bourbon 6,232 19,378 Brown 5,741 16,956 Butler 5,446 16,175 Chase 5,446 16,175 Chautauqua 5,446 16,175 Cherokee 6,232 19,378 Cheyenne 6,167 20,132 Clark 6,516 19,415 Clay 5,210 15,803 Cloud 5,210 15,803 Coffey 5,741 16,956 Comanche 6,516 19,415 Cowley 5,446 16,175 Crawford 6,232 19,378 Decatur 6,167 20,132 Dickinson 5,210 15,803 Doniphan 5,741 16,956 Douglas 5,741 16,956 Edwards 6,516 19,415 Elk 5,446 16,175 Ellis 6,167 20,132 Ellsworth 5,210 15,803 Finney 6,516 19,415 Ford 6,516 19,415 Franklin 5,741 16,956 Geary 5,210 15,803 Gove 6,167 20,132 Graham 6,167 20,132 Grant 6,516 19,415 Gray 6,516 19,415 Greeley 6,167 20,132 Greenwood 5,446 16,175 Hamilton 6,516 19,415 Harper 5,446 16,175 Harvey 5,446 16,175 Haskell 6,516 19,415 Hodgeman 6,516 19,415 Jackson 5,741 16,956 Jefferson 5,741 16,956 Jewell 5,210 15,803 Johnson 6,519 18,536 Kearny 6,516 19,415 Kingman 5,446 16,175 Kiowa 6,516 19,415 Labette 6,232 19,378 Lane 6,167 20,132 Leavenworth 6,519 18,536 Lincoln 5,210 15,803 Linn 5,741 16,956 Logan 6,167 20,132 Lyon 5,741 16,956 Marion 5,446 16,175 Marshall 5,741 16,956 McPherson 5,446 16,175 Meade 6,516 19,415 Miami 6,519 18,536 Mitchell 5,210 15,803 Montgomery 5,446 16,175 Morris 5,210 15,803 Morton 6,516 19,415 Nemaha 5,741 16,956 Neosho 6,232 19,378 Ness 6,167 20,132 Norton 6,167 20,132 Osage 5,741 16,956 Osborne 6,167 20,132 Ottawa 5,210 15,803 Pawnee 6,516 19,415 Phillips 6,167 20,132 Pottawatomie 5,741 16,956 Pratt 6,516 19,415 Rawlins 6,167 20,132 Reno 5,446 16,175 Republic 5,210 15,803 Rice 5,446 16,175 Riley 5,210 15,803 Rooks 6,167 20,132 Rush 6,167 20,132 Russell 6,167 20,132 Saline 5,210 15,803 Scott 6,167 20,132 Sedgwick 5,446 16,175 Seward 6,516 19,415 Shawnee 5,741 16,956 Sheridan 6,167 20,132 Sherman 6,167 20,132 Smith 6,167 20,132 Stafford 6,516 19,415 Stanton 6,516 19,415 Stevens 6,516 19,415 Sumner 5,446 16,175 Thomas 6,167 20,132 Trego 6,167 20,132 Wabaunsee 5,741 16,956 Wallace 6,167 20,132 Washington 5,210 15,803 Wichita 6,167 20,132 Wilson 5,446 16,175 Woodson 6,232 19,378 Wyandotte 6,519 18,536 Kentucky County Employee- Only Dependent, Family, etc. Adair 5,792 16,225 Allen 5,792 16,225 Anderson 5,857 16,336 Ballard 7,830 18,655 Barren 5,792 16,225 Bath 6,144 20,621 Bell 6,491 18,733 Boone 6,339 15,093 Bourbon 5,857 16,336 Boyd 6,144 20,621 Boyle 5,857 16,336 Bracken 6,144 20,621 Breathitt 6,491 18,733 Breckinridge 5,975 16,269 Bullitt 5,975 16,269 Butler 5,792 16,225 Caldwell 7,830 18,655 Calloway 7,830 18,655 Campbell 6,339 15,093 Carlisle 7,830 18,655 Carroll 5,975 16,269 Carter 6,144 20,621 Casey 5,792 16,225 Christian 7,439 17,897 Clark 5,857 16,336 Clay 6,491 18,733 Clinton 5,792 16,225 Crittenden 7,830 18,655 Cumberland 5,792 16,225 Daviess 7,439 17,897 Edmonson 5,792 16,225 Elliott 6,144 20,621 Estill 5,857 16,336 Fayette 5,857 16,336 Fleming 6,144 20,621 Floyd 6,491 18,733 Franklin 5,857 16,336 Fulton 7,830 18,655 Gallatin 6,339 15,093 Garrard 5,857 16,336 Grant 6,339 15,093 Graves 7,830 18,655 Grayson 5,975 16,269 Green 5,792 16,225 Greenup 6,144 20,621 Hancock 7,439 17,897 Hardin 5,975 16,269 Harlan 6,491 18,733 Harrison 5,857 16,336 Hart 5,792 16,225 Henderson 7,439 17,897 Henry 5,975 16,269 Hickman 7,830 18,655 Hopkins 7,439 17,897 Jackson 5,857 16,336 Jefferson 5,975 16,269 Jessamine 5,857 16,336 Johnson 6,491 18,733 Kenton 6,339 15,093 Knott 6,491 18,733 Knox 6,491 18,733 LaRue 5,975 16,269 Laurel 6,491 18,733 Lawrence 6,144 20,621 Lee 6,491 18,733 Leslie 6,491 18,733 Letcher 6,491 18,733 Lewis 6,144 20,621 Lincoln 5,857 16,336 Livingston 7,830 18,655 Logan 5,792 16,225 Lyon 7,830 18,655 Madison 5,857 16,336 Magoffin 6,491 18,733 Marion 5,975 16,269 Marshall 7,830 18,655 Martin 6,491 18,733 Mason 6,144 20,621 McCracken 7,830 18,655 McCreary 5,792 16,225 McLean 7,439 17,897 Meade 5,975 16,269 Menifee 6,144 20,621 Mercer 5,857 16,336 Metcalfe 5,792 16,225 Monroe 5,792 16,225 Montgomery 5,857 16,336 Morgan 6,144 20,621 Muhlenberg 7,439 17,897 Nelson 5,975 16,269 Nicholas 5,857 16,336 Ohio 7,439 17,897 Oldham 5,975 16,269 Owen 5,857 16,336 Owsley 6,491 18,733 Pendleton 6,339 15,093 Perry 6,491 18,733 Pike 6,491 18,733 Powell 5,857 16,336 Pulaski 5,792 16,225 Robertson 6,144 20,621 Rockcastle 5,857 16,336 Rowan 6,144 20,621 Russell 5,792 16,225 Scott 5,857 16,336 Shelby 5,975 16,269 Simpson 5,792 16,225 Spencer 5,975 16,269 Taylor 5,792 16,225 Todd 7,439 17,897 Trigg 7,439 17,897 Trimble 5,975 16,269 Union 7,439 17,897 Warren 5,792 16,225 Washington 5,975 16,269 Wayne 5,792 16,225 Webster 7,439 17,897 Whitley 6,491 18,733 Wolfe 6,491 18,733 Woodford 5,857 16,336 Louisiana Parish Employee- Only Dependent, Family, etc. Acadia 6,678 17,671 Allen 6,833 20,137 Ascension 6,303 18,182 Assumption 6,672 16,751 Avoyelles 6,784 15,197 Beauregard 6,833 20,137 Bienville 7,150 18,227 Bossier 7,150 18,227 Caddo 7,150 18,227 Calcasieu 6,833 20,137 Caldwell 7,386 17,471 Cameron 6,833 20,137 Catahoula 6,784 15,197 Claiborne 7,150 18,227 Concordia 6,784 15,197 DeSoto 7,150 18,227 East Baton Rouge 6,303 18,182 East Carroll 7,386 17,471 East Feliciana 6,303 18,182 Evangeline 6,678 17,671 Franklin 7,386 17,471 Grant 6,784 15,197 Iberia 6,678 17,671 Iberville 6,303 18,182 Jackson 7,386 17,471 Jefferson 6,367 16,795 Jefferson Davis 6,833 20,137 Lafayette 6,678 17,671 Lafourche 6,672 16,751 LaSalle 6,784 15,197 Lincoln 7,386 17,471 Livingston 6,303 18,182 Madison 7,386 17,471 Morehouse 7,386 17,471 Natchitoches 7,150 18,227 Orleans 6,367 16,795 Ouachita 7,386 17,471 Plaquemines 6,367 16,795 Pointe Coupee 6,303 18,182 Rapides 6,784 15,197 Red River 7,150 18,227 Richland 7,386 17,471 Sabine 7,150 18,227 St. Bernard 6,367 16,795 St. Charles 6,367 16,795 St. Helena 6,303 18,182 St. James 6,367 16,795 St. John Baptist 6,367 16,795 St. Landry 6,678 17,671 St. Martin 6,678 17,671 St. Mary 6,678 17,671 St. Tammany 6,367 16,795 Tangipahoa 6,303 18,182 Tensas 7,386 17,471 Terrebonne 6,672 16,751 Union 7,386 17,471 Vermilion 6,678 17,671 Vernon 6,784 15,197 Washington 6,303 18,182 Webster 7,150 18,227 West Baton Rouge 6,303 18,182 West Carroll 7,386 17,471 West Feliciana 6,303 18,182 Winn 6,784 15,197 Maine County Employee- Only Dependent, Family, etc. Androscoggin 6,100 15,419 Aroostook 7,616 19,083 Cumberland 5,921 16,534 Franklin 6,100 15,419 Hancock 7,616 19,083 Kennebec 5,989 16,501 Knox 5,989 16,501 Lincoln 5,989 16,501 Oxford 5,989 16,501 Penobscot 6,100 15,419 Piscataquis 6,100 15,419
