A.) Gross employer paid insurance premiums for the year (Do not include salary reduction premiums under cafeteria plans) $
B.) If premiums paid were less than 50% of employee total premium uniformly for all then STOP you do not qualify for the credit.
C.) Less premiums paid for seasonal employees -
D.) Less premiums paid for owners, 2% shareholders, partners, members and 5% "C" corp shareholders and family members of same -
E.) Net Qualifying Premiums paid $
F.) Total hours worked for all employees for the year
G.) Less seasonal employee hours -
H.) Less hours of owners and their family members -
I.) Net qualifying hours =
J.) Line I/2080 = Full time equivalent employees, round down to next whole number. If greater than 24 STOP you do not qualify for the credit.
K.) Gross wages paid for all employees $
L.) Less seasonal wages -
M.) Less owner/officer wages & their family's wages -
N.) Total qualifying wages =
O.) Average qualifying wages divide (Line N/Line J). If greater than $49,000 STOP you do not qualify for the credit. Round down to the nearest $1,000 $
P.) Tentative credit (Line e times 35%) If line j is 10 or under AND line O is $25,000 or less STOP this is your credit-enter it on line X, However if line J is more than 10 or line O is more than $25,000 continue to line Q. $
Q.) If line J is 10 or under do not complete this line, skip to line T. If line J is over 10 enter total number of (Line J ___ -10)=
R.) 15
S.) Divide (Line Q/Line R) times (Line P) =
T.) If line O is $25,000 or less do not complete this line, skip to line W. If line O is more than $25,000 enter (Line O____________ -25,000)= $
U.) 25,000
V.) Divide (Line T/Line U) times (Line P) =
W.) Add line S plus line V $
X. ) Subtract line W from line P-this is your net credit (cannot be less than zero) $
