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 (2020) Credit for Small Employer Health Insurance Premiums Section references are to the Internal Revenue Code unless otherwise noted. 2020 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 2020, 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 2020. Medicare taxes the tax-exempt employer was required to withhold from employees’ wages in calendar year 2020. Medicare taxes the tax-exempt employer was required to pay for calendar year 2020. 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 2020, 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 2020 if they properly claimed the credit under section 45R for all or part of 2019. 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 2020 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, 2017, or 2018 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 2020, 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 $27,600 from line 3 4. _____ 5. Divide line 4 by $27,600. 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 2020. Medicare taxes the tax-exempt employer was required to withhold from employees’ wages in calendar year 2020. Medicare taxes the tax-exempt employer was required to pay for calendar year 2020. 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 2020. Alabama County Employee- Only Dependent, Family, etc. Autauga 7,502 19,230 Baldwin 6,364 17,134 Barbour 6,364 17,134 Bibb 6,653 18,914 Blount 6,653 18,914 Bullock 6,364 17,134 Butler 6,364 17,134 Calhoun 6,836 18,615 Chambers 6,364 17,134 Cherokee 6,364 17,134 Chilton 6,653 18,914 Choctaw 6,364 17,134 Clarke 6,364 17,134 Clay 6,364 17,134 Cleburne 6,364 17,134 Coffee 6,364 17,134 Colbert 8,654 19,748 Conecuh 6,364 17,134 Coosa 6,364 17,134 Covington 6,364 17,134 Crenshaw 6,364 17,134 Cullman 6,364 17,134 Dale 6,364 17,134 Dallas 6,364 17,134 DeKalb 6,364 17,134 Elmore 7,502 19,230 Escambia 6,364 17,134 Etowah 6,447 18,794 Fayette 6,364 17,134 Franklin 6,364 17,134 Geneva 6,455 17,196 Greene 7,603 18,629 Hale 7,603 18,629 Henry 6,455 17,196 Houston 6,455 17,196 Jackson 6,364 17,134 Jefferson 6,653 18,914 Lamar 6,364 17,134 Lauderdale 8,654 19,748 Lawrence 7,893 19,596 Lee 6,298 15,915 Limestone 6,480 19,585 Lowndes 7,502 19,230 Macon 6,364 17,134 Madison 6,480 19,585 Marengo 6,364 17,134 Marion 6,364 17,134 Marshall 6,364 17,134 Mobile 7,238 18,375 Monroe 6,364 17,134 Montgomery 7,502 19,230 Morgan 7,893 19,596 Perry 6,364 17,134 Pickens 6,364 17,134 Pike 6,364 17,134 Randolph 6,364 17,134 Russell 7,136 18,051 Shelby 6,653 18,914 St. Clair 6,653 18,914 Sumter 6,364 17,134 Talladega 6,364 17,134 Tallapoosa 6,364 17,134 Tuscaloosa 7,603 18,629 Walker 6,653 18,914 Washington 6,364 17,134 Wilcox 6,364 17,134 Winston 6,364 17,134 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 6,048 17,726 Cochise 6,445 17,906 Coconino 6,048 17,726 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 17,726 Navajo 6,048 17,726 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 6,450 16,114 Ashley 6,450 16,114 Baxter 6,120 17,714 Benton 6,120 17,714 Boone 6,120 17,714 Bradley 6,450 16,114 Calhoun 6,538 22,348 Carroll 6,120 17,714 Chicot 6,450 16,114 Clark 5,127 17,075 Clay 6,209 19,137 Cleburne 5,886 16,588 Cleveland 6,450 16,114 Columbia 6,538 22,348 Conway 5,886 16,588 Craighead 6,209 19,137 Crawford 6,021 18,584 Crittenden 6,209 19,137 Cross 6,209 19,137 Dallas 6,450 16,114 Desha 6,450 16,114 Drew 6,450 16,114 Faulkner 5,886 16,588 Franklin 6,021 18,584 Fulton 6,209 19,137 Garland 5,127 17,075 Grant 5,886 16,588 Greene 6,209 19,137 Hempstead 6,538 22,348 Hot Spring 5,127 17,075 Howard 6,538 22,348 Independence 6,209 19,137 Izard 6,209 19,137 Jackson 6,209 19,137 Jefferson 6,450 16,114 Johnson 6,021 18,584 Lafayette 6,538 22,348 Lawrence 6,209 19,137 Lee 6,450 16,114 Lincoln 6,450 16,114 Little River 6,538 22,348 Logan 6,021 18,584 Lonoke 5,886 16,588 Madison 6,120 17,714 Marion 6,120 17,714 Miller 6,538 22,348 Mississippi 6,209 19,137 Monroe 6,450 16,114 Montgomery 5,127 17,075 Nevada 6,538 22,348 Newton 6,120 17,714 Ouachita 6,538 22,348 Perry 5,886 16,588 Phillips 6,450 16,114 Pike 5,127 17,075 Poinsett 6,209 19,137 Polk 6,021 18,584 Pope 5,886 16,588 Prairie 5,886 16,588 Pulaski 5,886 16,588 Randolph 6,209 19,137 Saline 5,886 16,588 Scott 6,021 18,584 Searcy 6,120 17,714 Sebastian 6,021 18,584 Sevier 6,538 22,348 Sharp 6,209 19,137 St. Francis 6,209 19,137 Stone 6,209 19,137 Union 6,538 22,348 Van Buren 5,886 16,588 Washington 6,120 17,714 White 5,886 16,588 Woodruff 6,209 19,137 Yell 5,886 16,588 California County Employee- Only Dependent, Family, etc. Alameda 7,649 22,491 Alpine 7,436 18,868 Amador 7,436 18,868 Butte 7,436 18,868 Calaveras 7,436 18,868 Colusa 7,436 18,868 Contra Costa 8,093 22,307 Del Norte 7,436 18,868 El Dorado 6,881 20,484 Fresno 6,633 22,121 Glenn 7,436 18,868 Humboldt 7,436 18,868 Imperial 6,376 18,072 Inyo 6,376 18,072 Kern 7,202 18,566 Kings 6,633 22,121 Lake 7,436 18,868 Lassen 7,436 18,868 Los Angeles 7,135 21,647 Madera 6,633 22,121 Marin 7,057 19,020 Mariposa 7,778 20,227 Mendocino 7,436 18,868 Merced 7,778 20,227 Modoc 7,436 18,868 Mono 6,376 18,072 Monterey 7,301 19,546 Napa 7,057 19,020 Nevada 7,436 18,868 Orange 7,256 23,118 Placer 6,881 20,484 Plumas 7,436 18,868 Riverside 7,232 19,737 Sacramento 6,881 20,484 San Benito 7,301 19,546 San Bernardino 7,232 19,737 San Diego 6,411 18,778 San Francisco 7,867 25,686 San Joaquin 7,778 20,227 San Luis Obispo 7,193 20,308 San Mateo 9,354 25,434 Santa Barbara 7,193 20,308 Santa Clara 8,304 24,507 Santa Cruz 7,301 19,546 Shasta 7,436 18,868 Sierra 7,436 18,868 Siskiyou 7,436 18,868 Solano 7,057 19,020 Sonoma 7,057 19,020 Stanislaus 7,778 20,227 Sutter 7,436 18,868 Tehama 7,436 18,868 Trinity 7,436 18,868 Tulare 7,778 20,227 Tuolumne 7,436 18,868 Ventura 7,193 20,308 Yolo 6,881 20,484 Yuba 7,436 18,868 Colorado County Employee- Only Dependent, Family, etc. Adams 6,490 19,791 Alamosa 8,108 20,892 Arapahoe 6,490 19,791 Archuleta 7,782 22,728 Baca 8,108 20,892 Bent 8,108 20,892 Boulder 5,932 20,656 Broomfield 6,490 19,791 Chaffee 8,108 20,892 Cheyenne 8,108 20,892 Clear Creek 6,490 19,791 Conejos 8,108 20,892 Costilla 8,108 20,892 Crowley 8,108 20,892 Custer 8,108 20,892 Delta 7,782 22,728 Denver 6,490 19,791 Dolores 7,782 22,728 Douglas 6,490 19,791 Eagle 7,401 22,402 El Paso 6,109 19,408 Elbert 6,490 19,791 Fremont 8,108 20,892 Garfield 7,401 22,402 Gilpin 6,490 19,791 Grand 7,782 22,728 Gunnison 7,782 22,728 Hinsdale 7,782 22,728 Huerfano 8,108 20,892 Jackson 7,782 22,728 Jefferson 6,490 19,791 Kiowa 8,108 20,892 Kit Carson 8,108 20,892 La Plata 7,782 22,728 Lake 7,782 22,728 Larimer 7,842 17,707 Las Animas 8,108 20,892 Lincoln 8,108 20,892 Logan 6,452 19,153 Mesa 6,247 18,275 Mineral 8,108 20,892 Moffat 7,782 22,728 Montezuma 7,782 22,728 Montrose 7,782 22,728 Morgan 6,452 19,153 Otero 8,108 20,892 Ouray 7,782 22,728 Park 6,490 19,791 Phillips 6,452 19,153 Pitkin 7,401 22,402 Prowers 8,108 20,892 Pueblo 6,909 18,542 Rio Blanco 7,782 22,728 Rio Grande 8,108 20,892 Routt 7,782 22,728 Saguache 8,108 20,892 San Juan 7,782 22,728 San Miguel 7,782 22,728 Sedgwick 6,452 19,153 Summit 7,401 22,402 Teller 6,109 19,408 Washington 6,452 19,153 Weld 6,519 20,915 Yuma 6,452 19,153 Connecticut County Employee- Only Dependent, Family, etc. Fairfield 8,215 22,318 Hartford 7,690 20,581 Litchfield 7,478 22,054 Middlesex 8,289 21,538 New Haven 8,748 21,530 New London 6,262 16,977 Tolland 7,379 15,494 Windham 8,445 27,550 Delaware County Employee- Only Dependent, Family, etc. All 8,444 23,587 District of Columbia County Employee- Only Dependent, Family, etc. All 7,071 22,894 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 7,291 20,593 Calhoun 7,197 20,787 Charlotte 8,184 23,859 Citrus 7,199 19,641 Clay 6,623 20,828 Collier 6,543 20,510 Columbia 7,858 22,655 DeSoto 7,292 21,687 Dixie 7,073 19,151 Duval 7,059 20,947 Escambia 7,575 19,577 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 20,406 Holmes 7,262 20,832 Indian River 6,943 19,312 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 8,289 23,046 Levy 7,075 21,653 Liberty 7,211 21,544 Madison 7,995 21,842 Manatee 7,419 20,547 Marion 6,342 18,693 Martin 7,619 22,929 Miami-Dade 7,671 23,473 Monroe 8,165 23,652 Nassau 7,901 18,734 Okaloosa 7,623 27,260 Okeechobee 8,056 22,815 Orange 6,830 19,653 Osceola 8,112 22,721 Palm Beach 8,029 23,416 Pasco 7,366 19,962 Pinellas 7,005 22,139 Polk 6,725 20,680 Putnam 7,340 21,416 Santa Rosa 6,952 18,849 Sarasota 6,807 18,517 Seminole 7,594 18,876 St. Johns 8,328 24,303 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 7,427 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 8,036 19,774 Atkinson 7,013 19,504 Bacon 5,784 17,208 Baker 7,132 20,481 Baldwin 7,411 19,588 Banks 7,658 19,049 Barrow 7,359 18,509 Bartow 6,646 19,111 Ben Hill 7,286 20,627 Berrien 7,286 20,627 Bibb 6,078 17,514 Bleckley 6,078 17,514 Brantley 5,784 17,208 Brooks 7,286 20,627 Bryan 8,036 19,774 Bulloch 8,036 19,774 Burke 6,803 18,522 Butts 6,646 19,111 Calhoun 7,132 20,481 Camden 5,784 17,208 Candler 8,036 19,774 Carroll 6,646 19,857 Catoosa 6,536 18,934 Charlton 5,784 17,208 Chatham 8,036 19,774 Chattahoochee 5,900 18,654 Chattooga 7,357 18,983 Cherokee 6,646 19,111 Clarke 7,359 18,509 Clay 7,132 20,481 Clayton 6,646 19,111 Clinch 7,286 20,627 Cobb 6,646 19,111 Coffee 7,013 19,504 Colquitt 7,286 20,627 Columbia 6,803 18,522 Cook 7,286 20,627 Coweta 6,646 19,111 Crawford 6,078 17,514 Crisp 7,132 20,481 Dade 6,536 18,934 Dawson 7,658 19,049 Decatur 7,286 20,627 DeKalb 6,646 19,111 Dodge 6,078 17,514 Dooly 6,078 17,514 Dougherty 7,132 20,481 Douglas 6,646 19,111 Early 7,286 20,627 Echols 7,286 20,627 Effingham 8,036 19,774 Elbert 7,359 18,509 Emanuel 6,803 18,522 Evans 8,036 19,774 Fannin 6,991 18,208 Fayette 6,646 19,111 Floyd 7,357 18,983 Forsyth 6,646 19,111 Franklin 7,658 19,049 Fulton 6,646 19,111 Gilmer 7,357 18,983 Glascock 6,803 18,522 Glynn 5,784 17,208 Gordon 7,357 18,983 Grady 7,286 20,627 Greene 7,359 18,509 Gwinnett 6,646 19,111 Habersham 7,658 19,049 Hall 7,658 19,049 Hancock 7,411 19,588 Haralson 6,646 19,857 Harris 5,900 18,654 Hart 7,658 19,049 Heard 6,646 19,857 Henry 6,646 19,111 Houston 6,078 17,514 Irwin 7,286 20,627 Jackson 7,359 18,509 Jasper 6,646 19,111 Jeff Davis 7,013 19,504 Jefferson 6,803 18,522 Jenkins 6,803 18,522 Johnson 7,013 19,504 Jones 6,078 17,514 Lamar 6,646 19,111 Lanier 7,286 20,627 Laurens 7,013 19,504 Lee 7,132 20,481 Liberty 8,036 19,774 Lincoln 6,803 18,522 Long 8,036 19,774 Lowndes 7,286 20,627 Lumpkin 7,658 19,049 Macon 5,900 18,654 Madison 7,359 18,509 Marion 5,900 18,654 McDuffie 6,803 18,522 McIntosh 5,784 17,208 Meriwether 5,900 18,654 Miller 7,286 20,627 Mitchell 7,132 20,481 Monroe 6,078 17,514 Montgomery 7,013 19,504 Morgan 7,359 18,509 Murray 6,991 18,208 Muscogee 5,900 18,654 Newton 6,646 19,111 Oconee 7,359 18,509 Oglethorpe 7,359 18,509 Paulding 6,646 19,111 Peach 6,078 17,514 Pickens 7,357 18,983 Pierce 5,784 17,208 Pike 6,646 19,111 Polk 7,357 18,983 Pulaski 6,078 17,514 Putnam 6,078 17,514 Quitman 5,900 18,654 Rabun 7,658 19,049 Randolph 7,132 20,481 Richmond 6,803 18,522 Rockdale 6,646 19,111 Schley 7,132 20,481 Screven 8,036 19,774 Seminole 7,286 20,627 Spalding 6,646 19,111 Stephens 7,658 19,049 Stewart 5,900 18,654 Sumter 7,132 20,481 Talbot 5,900 18,654 Taliaferro 6,803 18,522 Tattnall 8,036 19,774 Taylor 5,900 18,654 Telfair 7,013 19,504 Terrell 7,132 20,481 Thomas 7,286 20,627 Tift 7,286 20,627 Toombs 7,013 19,504 Towns 7,658 19,049 Treutlen 7,013 19,504 Troup 5,900 18,654 Turner 7,286 20,627 Twiggs 6,078 17,514 Union 7,658 19,049 Upson 5,900 18,654 Walker 6,536 18,934 Walton 6,646 19,111 Ware 5,784 17,208 Warren 6,803 18,522 Washington 7,411 19,588 Wayne 5,784 17,208 Webster 5,900 18,654 Wheeler 7,013 19,504 White 7,658 19,049 Whitfield 6,991 18,208 Wilcox 6,078 17,514 Wilkes 6,803 18,522 Wilkinson 7,411 19,588 Worth 7,132 20,481 Hawaii County Employee- Only Dependent, Family, etc. All 6,993 20,813 Idaho County Employee- Only Dependent, Family, etc. Ada 6,050 15,291 Adams 5,587 14,317 Bannock 6,358 16,504 Bear Lake 6,358 16,504 Benewah 6,197 14,300 Bingham 6,358 16,504 Blaine 6,095 16,987 Boise 5,587 14,317 Bonner 6,197 14,300 Bonneville 6,574 16,177 Boundary 6,197 14,300 Butte 6,358 16,504 Camas 6,095 16,987 Canyon 5,587 14,317 Caribou 6,358 16,504 Cassia 6,095 16,987 Clark 6,574 16,177 Clearwater 6,698 16,479 Custer 6,358 16,504 Elmore 5,587 14,317 Franklin 6,358 16,504 Fremont 6,574 16,177 Gem 5,587 14,317 Gooding 6,095 16,987 Idaho 6,698 16,479 Jefferson 6,574 16,177 Jerome 6,095 16,987 Kootenai 6,197 14,300 Latah 6,197 14,300 Lemhi 6,574 16,177 Lewis 6,698 16,479 Lincoln 6,095 16,987 Madison 6,574 16,177 Minidoka 6,095 16,987 Nez Perce 6,698 16,479 Oneida 6,358 16,504 Owyhee 5,587 14,317 Payette 5,587 14,317 Power 6,358 16,504 Shoshone 6,197 14,300 Teton 6,574 16,177 Twin Falls 6,095 16,987 Valley 5,587 14,317 Washington 5,587 14,317 Illinois County Employee- Only Dependent, Family, etc. Adams 7,294 17,919 Alexander 7,805 23,378 Bond 6,987 19,098 Boone 7,565 19,271 Brown 7,294 17,919 Bureau 6,317 18,874 Calhoun 6,987 19,098 Carroll 7,565 19,271 Cass 7,294 17,919 Champaign 7,518 19,061 Christian 7,294 17,919 Clark 7,518 19,061 Clay 7,805 23,378 Clinton 6,987 19,098 Coles 7,518 19,061 Cook 7,432 21,993 Crawford 7,805 23,378 Cumberland 7,518 19,061 DeKalb 7,565 19,271 DeWitt 8,401 24,851 Douglas 7,518 19,061 DuPage 7,901 21,382 Edgar 7,518 19,061 Edwards 7,805 23,378 Effingham 7,805 23,378 Fayette 7,805 23,378 Ford 7,518 19,061 Franklin 7,805 23,378 Fulton 7,800 19,904 Gallatin 7,805 23,378 Greene 6,987 19,098 Grundy 8,001 20,461 Hamilton 7,805 23,378 Hancock 6,317 18,874 Hardin 7,805 23,378 Henderson 6,317 18,874 Henry 6,317 18,874 Iroquois 7,518 19,061 Jackson 7,805 23,378 Jasper 7,805 23,378 Jefferson 7,805 23,378 Jersey 6,987 19,098 Jo Daviess 7,565 19,271 Johnson 7,805 23,378 Kane 7,901 21,382 Kankakee 8,001 20,461 Kendall 8,001 20,461 Knox 7,800 19,904 Lake 6,690 23,338 LaSalle 7,800 19,904 Lawrence 7,805 23,378 Lee 7,565 19,271 Livingston 8,401 24,851 Logan 7,294 17,919 Macon 7,294 17,919 Macoupin 6,987 19,098 Madison 7,726 19,935 Marion 7,805 23,378 Marshall 7,800 19,904 Mason 7,294 17,919 Massac 7,805 23,378 McDonough 7,800 19,904 McHenry 6,690 23,338 McLean 8,401 24,851 Menard 7,294 17,919 Mercer 6,317 18,874 Monroe 7,726 19,935 Montgomery 6,987 19,098 Morgan 7,294 17,919 Moultrie 7,294 17,919 Ogle 7,565 19,271 Peoria 7,800 19,904 Perry 7,805 23,378 Piatt 7,518 19,061 Pike 7,294 17,919 Pope 7,805 23,378 Pulaski 7,805 23,378 Putnam 7,800 19,904 Randolph 6,987 19,098 Richland 7,805 23,378 Rock Island 6,317 18,874 Saline 7,805 23,378 Sangamon 7,294 17,919 Schuyler 7,294 17,919 Scott 7,294 17,919 Shelby 7,294 17,919 St. Clair 7,726 19,935 Stark 7,800 19,904 Stephenson 7,565 19,271 Tazewell 7,800 19,904 Union 7,805 23,378 Vermilion 7,518 19,061 Wabash 7,805 23,378 Warren 6,317 18,874 Washington 6,987 19,098 Wayne 7,805 23,378 White 7,805 23,378 Whiteside 6,317 18,874 Will 8,001 20,461 Williamson 7,805 23,378 Winnebago 7,565 19,271 Woodford 7,800 19,904 Indiana County Employee- Only Dependent, Family, etc. Adams 7,447 23,214 Allen 7,176 23,045 Bartholomew 7,632 22,560 Benton 7,559 25,391 Blackford 7,432 21,898 Boone 7,104 25,255 Brown 7,225 22,415 Carroll 6,908 25,729 Cass 6,893 21,199 Clark 6,454 21,081 Clay 7,068 22,156 Clinton 6,908 25,729 Crawford 6,454 21,081 Daviess 7,396 22,769 Dearborn 7,583 24,245 Decatur 7,632 22,560 DeKalb 7,447 23,214 Delaware 7,432 21,898 Dubois 7,396 22,769 Elkhart 7,585 22,494 Fayette 7,173 22,139 Floyd 6,454 21,081 Fountain 6,908 25,729 Franklin 7,583 24,245 Fulton 6,893 21,199 Gibson 8,317 24,463 Grant 7,432 21,898 Greene 7,396 22,769 Hamilton 7,104 25,255 Hancock 7,173 22,139 Harrison 6,454 21,081 Hendricks 7,104 25,255 Henry 7,173 22,139 Howard 6,893 21,199 Huntington 7,447 23,214 Jackson 7,632 22,560 Jasper 7,559 25,391 Jay 7,432 21,898 Jefferson 6,454 21,081 Jennings 7,632 22,560 Johnson 7,225 22,415 Knox 7,396 22,769 Kosciusko 7,585 22,494 LaGrange 7,447 23,214 Lake 7,666 22,333 LaPorte 7,666 22,333 Lawrence 7,225 22,415 Madison 7,173 22,139 Marion 7,104 25,255 Marshall 7,585 22,494 Martin 7,396 22,769 Miami 6,893 21,199 Monroe 7,225 22,415 Montgomery 6,908 25,729 Morgan 7,104 25,255 Newton 7,559 25,391 Noble 7,447 23,214 Ohio 7,583 24,245 Orange 7,396 22,769 Owen 7,225 22,415 Parke 7,068 22,156 Perry 7,396 22,769 Pike 7,396 22,769 Porter 7,666 22,333 Posey 8,317 24,463 Pulaski 6,893 21,199 Putnam 6,908 25,729 Randolph 7,432 21,898 Ripley 7,583 24,245 Rush 7,632 22,560 Scott 6,454 21,081 Shelby 7,104 25,255 Spencer 7,396 22,769 St. Joseph 7,585 22,494 Starke 7,585 22,494 Steuben 7,447 23,214 Sullivan 7,068 22,156 Switzerland 7,583 24,245 Tippecanoe 6,908 25,729 Tipton 6,908 25,729 Union 7,173 22,139 Vanderburgh 8,317 24,463 Vermillion 7,068 22,156 Vigo 7,068 22,156 Wabash 7,447 23,214 Warren 7,559 25,391 Warrick 8,317 24,463 Washington 6,454 21,081 Wayne 7,173 22,139 Wells 7,447 23,214 White 7,559 25,391 Whitley 7,447 23,214 Iowa County Employee- Only Dependent, Family, etc. Adair 7,284 16,767 Adams 7,284 16,767 Allamakee 6,731 19,889 Appanoose 6,650 17,923 Audubon 7,284 16,767 Benton 6,647 18,721 Black Hawk 6,647 18,721 Boone 6,380 19,023 Bremer 6,731 19,889 Buchanan 6,647 18,721 Buena Vista 6,589 18,908 Butler 6,731 19,889 Calhoun 6,380 19,023 Carroll 6,380 19,023 Cass 7,284 16,767 Cedar 6,647 18,721 Cerro Gordo 6,731 19,889 Cherokee 6,589 18,908 Chickasaw 6,731 19,889 Clarke 7,284 16,767 Clay 6,589 18,908 Clayton 6,647 18,721 Clinton 6,647 18,721 Crawford 6,589 18,908 Dallas 6,458 18,089 Davis 6,650 17,923 Decatur 7,284 16,767 Delaware 6,647 18,721 Des Moines 6,650 17,923 Dickinson 6,589 18,908 Dubuque 6,647 18,721 Emmet 6,731 19,889 Fayette 6,731 19,889 Floyd 6,731 19,889 Franklin 6,731 19,889 Fremont 7,284 16,767 Greene 6,380 19,023 Grundy 6,380 19,023 Guthrie 7,284 16,767 Hamilton 6,380 19,023 Hancock 6,731 19,889 Hardin 6,380 19,023 Harrison 7,284 16,767 Henry 6,650 17,923 Howard 6,731 19,889 Humboldt 6,731 19,889 Ida 6,589 18,908 Iowa 6,647 18,721 Jackson 6,647 18,721 Jasper 6,458 18,089 Jefferson 6,650 17,923 Johnson 6,647 18,721 Jones 6,647 18,721 Keokuk 6,650 17,923 Kossuth 6,731 19,889 Lee 6,650 17,923 Linn 6,647 18,721 Louisa 6,650 17,923 Lucas 6,650 17,923 Lyon 6,589 18,908 Madison 6,458 18,089 Mahaska 6,650 17,923 Marion 6,458 18,089 Marshall 6,380 19,023 Mills 7,284 16,767 Mitchell 6,731 19,889 Monona 6,589 18,908 Monroe 6,650 17,923 Montgomery 7,284 16,767 Muscatine 6,650 17,923 O'Brien 6,589 18,908 Osceola 6,589 18,908 Page 7,284 16,767 Palo Alto 6,589 18,908 Plymouth 6,589 18,908 Pocahontas 6,589 18,908 Polk 6,458 18,089 Pottawattamie 7,284 16,767 Poweshiek 6,380 19,023 Ringgold 7,284 16,767 Sac 6,589 18,908 Scott 6,647 18,721 Shelby 7,284 16,767 Sioux 6,589 18,908 Story 6,380 19,023 Tama 6,380 19,023 Taylor 7,284 16,767 Union 7,284 16,767 Van Buren 6,650 17,923 Wapello 6,650 17,923 Warren 6,458 18,089 Washington 6,650 17,923 Wayne 6,650 17,923 Webster 6,380 19,023 Winnebago 6,731 19,889 Winneshiek 6,731 19,889 Woodbury 6,589 18,908 Worth 6,731 19,889 Wright 6,731 19,889 Kansas County Employee- Only Dependent, Family, etc. Allen 6,886 19,378 Anderson 5,741 16,956 Atchison 5,741 16,956 Barber 6,516 19,415 Barton 6,172 20,132 Bourbon 6,886 19,378 Brown 5,741 16,956 Butler 5,511 16,298 Chase 5,511 16,298 Chautauqua 5,511 16,298 Cherokee 6,886 19,378 Cheyenne 6,172 20,132 Clark 6,516 19,415 Clay 5,509 15,803 Cloud 5,509 15,803 Coffey 5,741 16,956 Comanche 6,516 19,415 Cowley 5,511 16,298 Crawford 6,886 19,378 Decatur 6,172 20,132 Dickinson 5,509 15,803 Doniphan 5,741 16,956 Douglas 5,741 16,956 Edwards 6,516 19,415 Elk 5,511 16,298 Ellis 6,172 20,132 Ellsworth 5,509 15,803 Finney 6,516 19,415 Ford 6,516 19,415 Franklin 5,741 16,956 Geary 5,509 15,803 Gove 6,172 20,132 Graham 6,172 20,132 Grant 6,516 19,415 Gray 6,516 19,415 Greeley 6,172 20,132 Greenwood 5,511 16,298 Hamilton 6,516 19,415 Harper 5,511 16,298 Harvey 5,511 16,298 Haskell 6,516 19,415 Hodgeman 6,516 19,415 Jackson 5,741 16,956 Jefferson 5,741 16,956 Jewell 5,509 15,803 Johnson 6,630 18,536 Kearny 6,516 19,415 Kingman 5,511 16,298 Kiowa 6,516 19,415 Labette 6,886 19,378 Lane 6,172 20,132 Leavenworth 6,630 18,536 Lincoln 5,509 15,803 Linn 5,741 16,956 Logan 6,172 20,132 Lyon 5,741 16,956 Marion 5,511 16,298 Marshall 5,741 16,956 McPherson 5,511 16,298 Meade 6,516 19,415 Miami 6,630 18,536 Mitchell 5,509 15,803 Montgomery 5,511 16,298 Morris 5,509 15,803 Morton 6,516 19,415 Nemaha 5,741 16,956 Neosho 6,886 19,378 Ness 6,172 20,132 Norton 6,172 20,132 Osage 5,741 16,956 Osborne 6,172 20,132 Ottawa 5,509 15,803 Pawnee 6,516 19,415 Phillips 6,172 20,132 Pottawatomie 5,741 16,956 Pratt 6,516 19,415 Rawlins 6,172 20,132 Reno 5,511 16,298 Republic 5,509 15,803 Rice 5,511 16,298 Riley 5,509 15,803 Rooks 6,172 20,132 Rush 6,172 20,132 Russell 6,172 20,132 Saline 5,509 15,803 Scott 6,172 20,132 Sedgwick 5,511 16,298 Seward 6,516 19,415 Shawnee 5,741 16,956 Sheridan 6,172 20,132 Sherman 6,172 20,132 Smith 6,172 20,132 Stafford 6,516 19,415 Stanton 6,516 19,415 Stevens 6,516 19,415 Sumner 5,511 16,298 Thomas 6,172 20,132 Trego 6,172 20,132 Wabaunsee 5,741 16,956 Wallace 6,172 20,132 Washington 5,509 15,803 Wichita 6,172 20,132 Wilson 5,511 16,298 Woodson 6,886 19,378 Wyandotte 6,630 18,536 Kentucky County Employee- Only Dependent, Family, etc. Adair 6,272 19,247 Allen 6,272 19,247 Anderson 6,226 19,187 Ballard 8,670 19,250 Barren 6,272 19,247 Bath 7,159 20,621 Bell 6,994 21,247 Boone 6,339 16,734 Bourbon 6,226 19,187 Boyd 7,159 20,621 Boyle 6,226 19,187 Bracken 7,159 20,621 Breathitt 6,994 21,247 Breckinridge 6,775 18,840 Bullitt 6,775 18,840 Butler 6,272 19,247 Caldwell 8,670 19,250 Calloway 8,670 19,250 Campbell 6,339 16,734 Carlisle 8,670 19,250 Carroll 6,775 18,840 Carter 7,159 20,621 Casey 6,272 19,247 Christian 8,172 20,031 Clark 6,226 19,187 Clay 6,994 21,247 Clinton 6,272 19,247 Crittenden 8,670 19,250 Cumberland 6,272 19,247 Daviess 8,172 20,031 Edmonson 6,272 19,247 Elliott 7,159 20,621 Estill 6,226 19,187 Fayette 6,226 19,187 Fleming 7,159 20,621 Floyd 6,994 21,247 Franklin 6,226 19,187 Fulton 8,670 19,250 Gallatin 6,339 16,734 Garrard 6,226 19,187 Grant 6,339 16,734 Graves 8,670 19,250 Grayson 6,775 18,840 Green 6,272 19,247 Greenup 7,159 20,621 Hancock 8,172 20,031 Hardin 6,775 18,840 Harlan 6,994 21,247 Harrison 6,226 19,187 Hart 6,272 19,247 Henderson 8,172 20,031 Henry 6,775 18,840 Hickman 8,670 19,250 Hopkins 8,172 20,031 Jackson 6,226 19,187 Jefferson 6,775 18,840 Jessamine 6,226 19,187 Johnson 6,994 21,247 Kenton 6,339 16,734 Knott 6,994 21,247 Knox 6,994 21,247 LaRue 6,775 18,840 Laurel 6,994 21,247 Lawrence 7,159 20,621 Lee 6,994 21,247 Leslie 6,994 21,247 Letcher 6,994 21,247 Lewis 7,159 20,621 Lincoln 6,226 19,187 Livingston 8,670 19,250 Logan 6,272 19,247 Lyon 8,670 19,250 Madison 6,226 19,187 Magoffin 6,994 21,247 Marion 6,775 18,840 Marshall 8,670 19,250 Martin 6,994 21,247 Mason 7,159 20,621 McCracken 8,670 19,250 McCreary 6,272 19,247 McLean 8,172 20,031 Meade 6,775 18,840 Menifee 7,159 20,621 Mercer 6,226 19,187 Metcalfe 6,272 19,247 Monroe 6,272 19,247 Montgomery 6,226 19,187 Morgan 7,159 20,621 Muhlenberg 8,172 20,031 Nelson 6,775 18,840 Nicholas 6,226 19,187 Ohio 8,172 20,031 Oldham 6,775 18,840 Owen 6,226 19,187 Owsley 6,994 21,247 Pendleton 6,339 16,734 Perry 6,994 21,247 Pike 6,994 21,247 Powell 6,226 19,187 Pulaski 6,272 19,247 Robertson 7,159 20,621 Rockcastle 6,226 19,187 Rowan 7,159 20,621 Russell 6,272 19,247 Scott 6,226 19,187 Shelby 6,775 18,840 Simpson 6,272 19,247 Spencer 6,775 18,840 Taylor 6,272 19,247 Todd 8,172 20,031 Trigg 8,172 20,031 Trimble 6,775 18,840 Union 8,172 20,031 Warren 6,272 19,247 Washington 6,775 18,840 Wayne 6,272 19,247 Webster 8,172 20,031 Whitley 6,994 21,247 Wolfe 6,994 21,247 Woodford 6,226 19,187 Louisiana Parish Employee- Only Dependent, Family, etc. Acadia 7,541 17,671 Allen 7,717 20,137 Ascension 7,533 18,621 Assumption 7,514 16,842 Avoyelles 7,930 16,248 Beauregard 7,717 20,137 Bienville 7,794 18,227 Bossier 7,794 18,227 Caddo 7,794 18,227 Calcasieu 7,717 20,137 Caldwell 7,876 17,471 Cameron 7,717 20,137 Catahoula 7,930 16,248 Claiborne 7,794 18,227 Concordia 7,930 16,248 DeSoto 7,794 18,227 East Baton Rouge 7,533 18,621 East Carroll 7,876 17,471 East Feliciana 7,533 18,621 Evangeline 7,541 17,671 Franklin 7,876 17,471 Grant 7,930 16,248 Iberia 7,541 17,671 Iberville 7,533 18,621 Jackson 7,876 17,471 Jefferson 7,139 16,795 Jefferson Davis 7,717 20,137 Lafayette 7,541 17,671 Lafourche 7,514 16,842 LaSalle 7,930 16,248 Lincoln 7,876 17,471 Livingston 7,533 18,621 Madison 7,876 17,471 Morehouse 7,876 17,471 Natchitoches 7,794 18,227 Orleans 7,139 16,795 Ouachita 7,876 17,471 Plaquemines 7,139 16,795 Pointe Coupee 7,533 18,621 Rapides 7,930 16,248 Red River 7,794 18,227 Richland 7,876 17,471 Sabine 7,794 18,227 St. Bernard 7,139 16,795 St. Charles 7,139 16,795 St. Helena 7,533 18,621 St. James 7,139 16,795 St. John Baptist 7,139 16,795 St. Landry 7,541 17,671 St. Martin 7,541 17,671 St. Mary 7,541 17,671 St. Tammany 7,139 16,795 Tangipahoa 7,533 18,621 Tensas 7,876 17,471 Terrebonne 7,514 16,842 Union 7,876 17,471 Vermilion 7,541 17,671 Vernon 7,930 16,248 Washington 7,533 18,621 Webster 7,794 18,227 West Baton Rouge 7,533 18,621 West Carroll 7,876 17,471 West Feliciana 7,533 18,621 Winn 7,930 16,248 Maine County Employee- Only Dependent, Family, etc. Androscoggin 7,192 18,426 Aroostook 8,765 22,414 Cumberland 6,617 20,113 Franklin 7,192 18,426 Hancock 8,765 22,414 Kennebec 6,448 17,487 Knox 6,448 17,487
