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INSTRUCTIONS FOR SCHEDULE K-57
GENERAL INFORMATION LINES 1 through 12 – Schedule I (Plans after 12/31/2004)
K.S.A. 40-2246 allows an income tax credit to those employers Column (a): Enter number of eligible employees covered by this
that make contributions to a health savings account of an eligible plan for each month of the employer’s tax year.
covered employee after 12/31/2004. The credit is $70 per month per Column (b): If you established or made contributions during this tax
eligible covered employee for the first 12 months of participation, year which constitutes the FIRST 12 MONTHS of participation,
$50 per month per eligible covered employee for the next 12 multiply the number of eligible employees for each month of
months of participation and $35 per month per eligible covered participation by the lesser of $70 or the actual amount paid per
employee for the next 12 months of participation. employee.
Any small employer (defined by K.S.A. 40-2209d) having Column (c): If you established or made contributions during this tax
between 2 and 50 employees may establish a health benefit plan year which constitutes the NEXT 12 MONTHS of participation,
for the purpose of providing a plan as described under K.S.A. multiply the number of eligible employees for each month of
40-2240 covering such employer’s eligible employees and such participation by the lesser of $50 or the actual amount paid per
employees’ family members. For plans established prior to employee.
1/1/2005, a certificate issued by the Commissioner of Insurance Column (d): If you established or made contributions during this tax
entitling a “small employer” to claim the tax credit authorized by year which constitutes the NEXT 12 MONTHS of participation,
K.S.A. 40-2246 must have been obtained. multiply number of eligible employees for each month of
For tax year 2013, and all tax years thereafter, credits shall be 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
available to only corporations subject to the Kansas corporate
months.)
income tax (i.e., C corporations). Credits are not available to
individuals, partnerships, S corporations, limited liability companies, LINES 1 through 12 – Schedule II (Plans prior to 1/1/2005)
and other pass-through entities. Enter number of eligible employees covered by this
Column (e):
An eligible employee is one who is employed for an average of plan for each month of the employer’s tax year.
at least 30 hours per week and elects to participate in one of the
benefit plans provided under this act, and includes individuals who Column (f): Multiply number of eligible employees for each month
by $35.
are sole proprietors, business partners, and limited partners who
own the business. Eligible employee does not include individuals: LINE 13 – Add lines 1 through 12 and enter result. If the plan
1) engaged as independent contractors; 2) whose periods of was established after 12/31/2004 and Schedule I is complete,
employment are on an intermittent or irregular basis; or, 3) who proceed to line 18. If established prior to 1/1/2005 and Schedule
have been employed by the employer for fewer than 90 days. II is complete, proceed to line 14.
A health savings account means a trust created or organized LINE 15 – To figure maximum credit allowed multiply line 14 by 50%.
in the United States as a health savings account exclusively for the LINE 16 – Enter the lesser of line 13, column (f) or line 15.
purpose of paying the qualified medical expenses of the account LINE 17 – Check the appropriate box for the number of tax years
beneficiary, but only if the written governing instrument creating you have participated in this credit.
the trust meets the requirements specified by the Medicare,
prescription drug, improvement and modernization act of 2003, PART B – COMPUTATION OF ELIGIBLE EMPLOYEE AMOUNT
Pub. L. No. 108-173, 117 Stat. 2067. LINE 18 – If the plan was established after 12/31/2004 and you
As a condition to participate as a member of any small employer completed Schedule I, enter the amount from line 13, columns
health benefit plan, an employer shall have not contributed within (b), (c), and/or (d). If the plan was established prior to 1/1/2005
the preceding two years to any health insurance premium or health and you completed Schedule II, multiply line 16 by the appropriate
savings account on behalf of an employee who is to be covered percentage from line 17. Enter result here and on the appropriate
by the employer’s contribution other than a contribution by an line of Form K-120.
employer to a health insurance premium or health savings account
within the preceding two years solely for the benefit of the employer TAXPAYER ASSISTANCE
or the employer’s dependents. For questions or assistance in establishing a Small Employer
If the credit exceeds the current year’s tax liability, the unused Health Benefit Plan, contact the Kansas Insurance Department:
portion shall be refunded to the taxpayer. 420 SW 9th St
Addition Modification. The employer is required to reduce any Topeka KS 66612-1678
expense deduction that is included in federal taxable income for the Phone: 785-296-3071
tax year by the dollar amount of the credit. Fax: 785-296-7850
Documentation. Retain your monthly insurance billings with
your records as the Department of Revenue reserves the right to For assistance in completing this schedule contact the Kansas
request additional information as necessary. Department of Revenue:
Taxpayer Assistance Center
SPECIFIC LINE INSTRUCTIONS Scott Office Building
Begin by completing the information at the top of the schedule. 120 SE 10th Ave
PO Box 750260
PART A – COMPUTATION OF ELIGIBLE EMPLOYEE AMOUNT Topeka KS 66699-0260
(C Corporations only) Phone: 785-368-8222
Complete the appropriate schedule. If the employer established Fax: 785-291-3614
this plan after 12/31/2004, complete Schedule I. If it was established Additional copies of this credit schedule and other tax forms are
prior to 1/1/2005, complete Schedule II. available from our website at: ksrevenue.org
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