Pennsylvania PA Organ & Bone Marrow Donor Tax Credit

PA Organ & Bone Marrow Donor Tax Credit
Pennsylvania Organ & Bone Marrow Donor Tax Credit (REV-984)
IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
(SU) 11-22 (FI)

REV-984
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SECTION A.

OFFICIAL USE ONLY

PENNSYLVANIA ORGAN &
BONE MARROW DONOR
TAX CREDIT

BUSINESS FIRM INFORMATION

Entity Name (please print)

Revenue ID/Social Security Number (SSN) Federal Employer Identification Number (FEIN)

Street Address

State

City

ZIP Code

Entity Type:
Sole Proprietorship

Partnership

Estate/Trust

Bank or Trust Company

Title Insurance Company

PA S Corporation

Corporation

Limited Liability Company

Insurance Company

Mutual Thrift

SECTION B.

CALCULATION OF CREDIT

MM/DD/YYYY

MM/DD/YYYY

1. Tax period beginning date ______________________ Tax period ending date ______________________
2. Number of employees donating an organ or bone marrow during the current tax year ________________
3. Use the table below to itemize each employee’s compensation paid during an absence to donate an organ or bone marrow.
If more than three employees donated an organ or bone marrow, please include a separate schedule detailing the information
shown below for additional employees.
MM/DD/YYYY
MM/DD/YYYY
EMPLOYEE
LAST NAME, FIRST NAME

SSN

ABSENCE
BEGINNING DATE

ABSENCE
ENDING DATE

EMPLOYEE
COMPENSATION

a.

$

b.

$

c.

$

4. TOTAL

$

5. Use the table below to itemize cost of temporary replacement help. If more than three replacements were temporarily employed,
please include a separate schedule detailing the information shown below for additional occurrences.
MM/DD/YYYY
MM/DD/YYYY
TEMPORARY HELP

FEIN/SSN

SERVICE
BEGINNING DATE

SERVICE
ENDING DATE

COST OF TEMPORARY
HELP PAID

a.

$

b.

$

c.

$

6. TOTAL

$

7. Total Organ & Bone Marrow Donor Tax Credit requested (Line 4 plus Line 6)
Total compensation paid in the commonwealth
8. Apportionment factor divided by
Total compensation paid everywhere

$

9. Pennsylvania Organ & Bone Marrow Donor Tax Credit (Line 7 times Line 8)

$

SECTION C.

.

CERTIFICATION

Under penalties of perjury, I declare that I have examined this return, including any accompanying schedules and statements, and to the
best of my knowledge and belief it is true, correct, and complete. THIS FORM MUST BE SIGNED BY A CORPORATE OFFICER.
Officer’s Signature

Officer’s Name (Please Print)
Telephone Number

PLEASE SIGN AFTER PRINTING

Email Address

Preparer’s Name (Please Print)
Preparer’s Street Address

Reset Entire Form

Title

Preparer’s FEIN/SSN

Preparer’s Telephone Number
City

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Date

MM/DD/YYYY

Date

MM/DD/YYYY

State

NEXT PAGE

ZIP Code

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Instructions for REV-984

REV-984 IN (SU) 11-22

Pennsylvania Organ & Bone Marrow Donor Tax Credit

GENERAL INFORMATION

LINE INSTRUCTIONS

To claim the PA Organ & Bone Marrow Donor Tax Credit, a
taxpayer must provide one or more paid leaves of absence
to employees for the specific purpose of donating an organ
or bone marrow. The qualifying leave of absence period per
employee cannot exceed five days.

Enter the business firm’s name, address, Revenue
ID/SSN and FEIN.

For purposes of the PA Organ & Bone Marrow Donor Tax
Credit, a “business firm” is defined as an entity subject to PA
personal income tax, PA corporate net income tax, bank and
trust company shares tax, domestic title insurance
companies shares tax, insurance premiums tax, or mutual
thrift institutions tax. Business firms also include any natural
person as such or as a member of a partnership or a
shareholder in a PA S corporation, as well as estates and
trusts and beneficiaries of estates and trusts.
A taxpayer must apply for the PA Organ & Bone Marrow
Donor Tax Credit by the 15th day of the fourth month
following the close of the business firm’s taxable year. The
department will notify all taxpayers of the approved amount
of PA Organ & Bone Marrow Donor Tax Credit. The taxpayer
may apply the approved credit against PA personal income
tax, PA corporate net income tax, bank/trust company
shares tax, domestic title insurance companies shares tax,
insurance premiums tax, or mutual thrift institutions tax for
the taxable year in which the leave of absence was granted.
Any unused credits may be carried over to no more than
three succeeding taxable years. Credits may not be carried
back and are not refundable. The credit cannot be applied
against any tax withheld by an employer from an employee
under Article III of the Tax Reform Code.
A pass-through entity is a partnership or PA S corporation
as defined in Section 301 of the Tax Reform Code. The PA
Organ & Bone Marrow Donor Tax Credit applicable to a
pass-through entity may be claimed by each partner,
member or shareholder on a pro-rata basis in proportion to
the partner, member or shareholder’s portion of the passthrough entity’s income.
A business firm that is taxed in more than one state is
required to apportion the credit to determine the proportion
of the credit that may be claimed in Pennsylvania. The
apportionment of the credit is determined by multiplying the
available credit by a payroll factor. The numerator of the
factor is the total amount paid in the commonwealth during
the tax period for compensation and the denominator of
which is the total compensation paid everywhere during the
tax period.

Check the block associated with the structure that best
identifies the business firm (check more than one if
applicable).

LINE 1
Enter the beginning and ending dates of the business firm’s
tax period.

LINE 2
Enter the number of employees donating an organ or bone
marrow during the tax period.

LINE 3
Enter the employee name, SSN, beginning date of leave of
absence, ending date of leave of absence and gross
compensation per employee donating an organ or bone
marrow during the tax period.
LEAVE OF ABSENCE – The period, not exceeding five
working days or the hourly equivalent of five working days
per employee, during which a business firm provides a paid
leave of absence to the employee for the purpose of organ
or bone marrow donation. The leave of absence does not
include a period during which an employee utilizes any
annual leave or sick days that the employee has been
given by the employer.
EMPLOYEE COMPENSATION – Gross compensation for
purposes of calculating the credit includes salaries and
other regular hourly wage payments paid for the period of
absence. Compensation for the period of absence does not
include bonuses paid for prior (or future) performance of
services during the period of absence, sales commissions
paid for prior performance of services during the period of
absence, non-cash compensation paid during the period of
absence (such as personal use of company vehicles),
stock options exercised during the period of absence,
distributions or payments of previously deferred
compensation paid during the period of absence, payments
for employee health plans, reimbursements of expenses

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and other items of compensation not included in the normal
compensation of an employee.

LINE 4
Enter total employee compensation paid for the leaves of
absence.

LINE 5
Enter the temporary help, FEIN or SSN, beginning date of
service, ending date of service and cost of temporary help
paid per employee referenced above.
TEMPORARY HELP – Agency or, if not using an agency,
individual hired to cover the leave of absence of the
employee donating an organ or bone marrow.
COST OF TEMPORARY HELP PAID – Invoice amount
paid to a temporary help agency or gross compensation
paid to an individual.

LINE 6
Enter total temporary help paid for the leaves of absences
of the employees donating an organ or bone marrow.

LINE 7
Organ & Bone Marrow Donor Tax Credit before
apportionment (Line 4 plus Line 6)

LINE 8
Apportionment Factor – Apportionment is determined by
multiplying the available credit by a payroll factor. The
numerator of the factor is the total amount paid in the
commonwealth during the tax period for compensation and
the denominator of which is the total compensation paid

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everywhere during the tax period. The apportionment factor
is equal to 1.0 for business firms whose total compensation
paid is entirely in the Commonwealth of Pennsylvania.

LINE 9
PA Organ & Bone Marrow Donor Tax Credit (Line 7
multiplied by Line 8, apportionment factor)

REQUIRED ATTACHMENTS
For each employee identified on Line 3, include:
1. Employee pay statement for absence period and
periods immediately preceding and following the
absence period.
2. Letter from a physician describing the procedure and
dates of absence; must reference the employee’s full
name.
For each temporary help occurrence identified on Line 5,
include:
1. Invoice statement from temporary help agency; must
show cost per day, not to exceed five days.
2. Pay statement to temporary help employee; must list
beginning and ending date of service, not to exceed five
days.
The department may contact the taxpayer for additional
documentation necessary to verify the tax credit.
Send completed applications (including signature) to:
PA DEPARTMENT OF REVENUE
OFFICE OF ECONOMIC DEVELOPMENT
11TH FLOOR STRAWBERRY SQUARE
HARRISBURG PA 17128
For more information, contact the Office of Economic
Development at [email protected].

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