Kansas Small Employer Health Insurance Contribution Credits

Small Employer Health Insurance Contribution Credits
K-57 Kansas Small Employer Healthcare Credit Rev. 8-19
K-57

KANSAS

191518

SMALL EMPLOYER HEALTHCARE CREDIT

(Rev. 8-19)

For the taxable year beginning, _____________________ , 20

_____

; ending

Name of taxpayer (as shown on return)

__________________________ ,

20

_______

.

Employer ID Number (EIN)

Date you began participation in this plan: ______________________________________________
Those employers who started a small employer health benefit plan on or after January 1, 2005 must answer the following question:
Did this employer contribute to any health insurance premium or health savings account on behalf of an employee who is to be covered
by the employer’s contribution within the preceding two years of the effective date of the employer’s small employer health benefit plan?

o No o Yes

(If yes, you do not qualify for this credit.)

PART A — COMPUTATION OF ELIGIBLE EMPLOYEE AMOUNT (C Corporations only)
Complete the appropriate schedule. If the employer established this plan after December 31, 2004, complete Schedule I. If the
employer established this plan prior to January 1, 2005, complete Schedule II.

SCHEDULE II

SCHEDULE I
(a)
Number of eligible
employees for the month

(By Tax Year)

(b)
FIRST 12 MONTHS
Multiply amount in (a) by
the lesser of $70 or the
actual amount paid per
employee.

(c)
NEXT 12 MONTHS
Multiply amount in (a) by
the lesser of $50 or the
actual amount paid per
employee.

(d)
NEXT 12 MONTHS
Multiply amount in (a) by
the lesser of $35 or the
actual amount paid per
employee.

(e)
Number of eligible
employees for the month

(f)
Maximum allowed.
Multiply amount in (e) by $35.

1. 1st month
2. 2nd month
3. 3rd month
4. 4th month
5. 5th month
6. 6th month
7. 7th month
8. 8th month
9. 9th month
10.10th month
11.11th month
12.12th month
13.Total
If you completed SCHEDULE I, proceed to LINE 18.
If you completed SCHEDULE II, proceed to LINE 14.
14. Enter actual expense for the tax period.

14.

________________________

15. Maximum credit allowed (multiply line 14 by 50% and enter the result here).

15.

________________________

16. Enter the lesser of line 13, column (f) or line 15.

16.

________________________

17. Year of participation: 1st & 2nd year o 100%

3rd year o 75%

4th year o 50%

5th year o 25%

PART B — COMPUTATION OF CREDIT
18. Credit allowable for this tax year. From SCHEDULE I – enter amount from line 13, columns (b), (c),

and/or (d). From SCHEDULE II – multiply line 16 by the appropriate percentage from line 17 and
enter result. Enter this amount on the appropriate line of Form K-120.

18.

________________________

INSTRUCTIONS FOR SCHEDULE K-57
GENERAL INFORMATION
K.S.A. 40-2246 allows an income tax credit to those employers
that make contributions to a health savings account of an eligible
covered employee after 12/31/2004. The credit is $70 per month per
eligible covered employee for the first 12 months of participation,
$50 per month per eligible covered employee for the next 12
months of participation and $35 per month per eligible covered
employee for the next 12 months of participation.
Any small employer (defined by K.S.A. 40-2209d) having
between 2 and 50 employees may establish a health benefit plan
for the purpose of providing a plan as described under K.S.A.
40-2240 covering such employer’s eligible employees and such
employees’ family members. For plans established prior to
1/1/2005, a certificate issued by the Commissioner of Insurance
entitling a “small employer” to claim the tax credit authorized by
K.S.A. 40-2246 must have been obtained.
For tax year 2013, and all tax years thereafter, credits shall be
available to only corporations subject to the Kansas corporate
income tax (i.e., C corporations). Credits are not available to
individuals, partnerships, S corporations, limited liability companies,
and other pass-through entities.
An eligible employee is one who is employed for an average of
at least 30 hours per week and elects to participate in one of the
benefit plans provided under this act, and includes individuals who
are sole proprietors, business partners, and limited partners who
own the business. Eligible employee does not include individuals:
1) engaged as independent contractors; 2) whose periods of
employment are on an intermittent or irregular basis; or, 3) who
have been employed by the employer for fewer than 90 days.
A health savings account means a trust created or organized
in the United States as a health savings account exclusively for the
purpose of paying the qualified medical expenses of the account
beneficiary, but only if the written governing instrument creating
the trust meets the requirements specified by the Medicare,
prescription drug, improvement and modernization act of 2003,
Pub. L. No. 108-173, 117 Stat. 2067.
As a condition to participate as a member of any small employer
health benefit plan, an employer shall have not contributed within
the preceding two years to any health insurance premium or health
savings account on behalf of an employee who is to be covered
by the employer’s contribution other than a contribution by an
employer to a health insurance premium or health savings account
within the preceding two years solely for the benefit of the employer
or the employer’s dependents.
If the credit exceeds the current year’s tax liability, the unused
portion shall be refunded to the taxpayer.
Addition Modification. The employer is required to reduce any
expense deduction that is included in federal taxable income for the
tax year by the dollar amount of the credit.
Documentation. Retain your monthly insurance billings with
your records as the Department of Revenue reserves the right to
request additional information as necessary.

SPECIFIC LINE INSTRUCTIONS
Begin by completing the information at the top of the schedule.
PART A – COMPUTATION OF ELIGIBLE EMPLOYEE AMOUNT
(C Corporations only)
Complete the appropriate schedule. If the employer established
this plan after 12/31/2004, complete Schedule I. If it was established
prior to 1/1/2005, complete Schedule II.

LINES 1 through 12 – Schedule I (Plans after 12/31/2004)
Column (a): Enter number of eligible employees covered by this
plan for each month of the employer’s tax year.
Column (b): If you established or made contributions during this tax
year which constitutes the FIRST 12 MONTHS of participation,
multiply the number of eligible employees for each month of
participation by the lesser of $70 or the actual amount paid per
employee.
Column (c): If you established or made contributions during this tax
year which constitutes the NEXT 12 MONTHS of participation,
multiply the number of eligible employees for each month of
participation by the lesser of $50 or the actual amount paid per
employee.
Column (d): If you established or made contributions during this tax
year which constitutes the NEXT 12 MONTHS of participation,
multiply number of eligible employees for each month of
participation by the lesser of $35 or the actual amount paid per
employee. (The total of columns b, c and d should be only 12
months.)
LINES 1 through 12 – Schedule II (Plans prior to 1/1/2005)
Column (e): Enter number of eligible employees covered by this
plan for each month of the employer’s tax year.
Column (f): Multiply number of eligible employees for each month
by $35.
LINE 13 – Add lines 1 through 12 and enter result. If the plan
was established after 12/31/2004 and Schedule I is complete,
proceed to line 18. If established prior to 1/1/2005 and Schedule
II is complete, proceed to line 14.
LINE 15 – To figure maximum credit allowed multiply line 14 by 50%.
LINE 16 – Enter the lesser of line 13, column (f) or line 15.
LINE 17 – Check the appropriate box for the number of tax years
you have participated in this credit.
PART B – COMPUTATION OF ELIGIBLE EMPLOYEE AMOUNT
LINE 18 – If the plan was established after 12/31/2004 and you
completed Schedule I, enter the amount from line 13, columns
(b), (c), and/or (d). If the plan was established prior to 1/1/2005
and you completed Schedule II, multiply line 16 by the appropriate
percentage from line 17. Enter result here and on the appropriate
line of Form K-120.

TAXPAYER ASSISTANCE
For questions or assistance in establishing a Small Employer
Health Benefit Plan, contact the Kansas Insurance Department:
420 SW 9th St
Topeka KS 66612-1678
Phone: 785-296-3071
Fax: 785-296-7850
For assistance in completing this schedule contact the Kansas
Department of Revenue:
Taxpayer Assistance Center
Scott Office Building
120 SE 10th Ave
PO Box 750260
Topeka KS 66699-0260
Phone: 785-368-8222
Fax: 785-291-3614
Additional copies of this credit schedule and other tax forms
are available from our website at: ksrevenue.gov