Maine Credit for Wellness Programs

Credit for Wellness Programs
2023 Wellness Programs Credit Worksheet
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Credit for Wellness Programs
Worksheet for Tax Year 2023
36 M.R.S. § 5219-FF

Enclose with Form 1040ME, Form 1041ME, or Form 1120ME.

Taxpayer Name:________________________________________ EIN/SSN: _________________
Note:	 In the case of pass-through entities (such as partnerships, LLCs, S corporations, and trusts) making eligible expenditures,

the partners, members, shareholders, beneficiaries, or other owners are allowed a credit in proportion to their respective
interests in these entities. Enter name and ID number of the entity on the lines below. Also enter your ownership percentage
in the pass-through entity for the tax year. Attach a copy of the federal Schedule K-1 issued to you by the pass-through entity.

	
Name of Pass-through Entity	
EIN/SSN	
Ownership
	Percentage
_____________________________________________________ 	 ______________________ 	 _____________ %
1.	 Number of Employees (on an average monthly basis)............................................................ 1.___________________
2.	 Multiply line 1 by $100.00........................................................................................................ 2.___________________
3.	 Total expenditure made during the taxable year to develop, institute and maintain
	
a wellness program.................................................................................................................. 3.___________________
4.	 Amount of unused credit on 2022 credit worksheet, line 5, carried forward to 2023............... 4.___________________
5.	 Line 3 plus line 4...................................................................................................................... 5.___________________
6.	 Enter the smallest of line 2, 5, or $2,000. Enter here and on Form 1040ME,
	
Schedule A, Other Tax Credits Worksheet, line 8; Form 1041ME,
	
Schedule A, line 11; or Form 1120ME, Schedule C, line 1k..................................................... 6.___________________
7.	 Provide a brief description of the qualified wellness program. ____________________________________________
	_____________________________________________________________________________________________
	_____________________________________________________________________________________________
8.	 Provide a brief list of expenditures for development, institution, and maintenance of the qualified wellness program.
	_____________________________________________________________________________________________
	_____________________________________________________________________________________________
Unused credit amounts on line 3 may be carried forward for up to five years.
Note: MRS may request additional information supporting the credit claimed before the return can be processed.

Worksheet Instructions
An employer with 20 or fewer employees (calculated on an average monthly basis) may qualify for the credit for wellness
programs. An employer is a taxpayer that employs one or more individuals performing services for the taxpayer within
Maine.
The credit is equal to expenditures made during the taxable year to develop, institute and maintain a wellness program. The
total credit (including the carryover of unused credit amounts from prior years) is limited to the lesser of $100 per employee
or $2,000, and may not reduce tax liability to less than zero. Any unused credit amounts on line 3 may be carried forward
for up to 5 years.
A wellness program is a program that improves employee health, morale and productivity. This includes, but is not limited
to, health education programs, behavioral change programs and incentive awards to employees who engage in regular
physical activity. Behavioral change programs include counseling, seminars or classes on nutrition, stress management, or
smoking cessation.
Note: Maine taxable income must be increased by the amount of any expenditures included on line 3 above that were used
to reduce federal taxable income. See 36 M.R.S. §§ 5122(1)(EE) and 5200-A(1)(X).

Revised: December 2023