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Name of person with self-employment income (as shown on Form 1040) Taxpayer Identification Number <br />Enter the total amount paid in 2018 for health insurance coverage established under your business (or the S-corporation <br />in which you were a more-than-2% shareholder) for 2018 for you, your spouse, and your dependents. Your insurance can <br />also cover your child who was under age 27 at the end of 2018, even if the child was not your dependent. But do not <br />For coverage under a qualified long-term care insurance contract, enter for each person covered the <br />Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Enter your net profit* and any other earned income from the trade or business under which the <br />insurance plan is established. Don't include Conservation Reserve Program payments exempt from <br />Enter the total of all net profits* from: Schedule C, line 31; Schedule C-EZ, line 3; Schedule F, line 34; or Sch K-1 (1065), <br />box 14, Code A; plus any other income allocable to the profitable businesses. Don't include Conservation Reserve <br />Program payments exempt from self-employment tax. Don't include any net losses shown on these schedules. <br />Divide line 4 by line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Subtract line 7 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Enter the amount, if any, from Schedule 1 (Form 1040), (or Form 1040NR), line 28 attributable to the same trade or <br />business in which the health insurance plan is established . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Enter your Medicare wages (Form W-2, box 5) from an S corporation in which you are a more-than-2% shareholder <br />and in which the health insurance plan is established . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Enter the amount from Form 2555, line 45, attributable to the amount entered on line 4 or 11 above, or <br />any amount from Form 2555-EZ, line 18, attributable to the amount entered on line 11 above . . . . . . . . . . . . . . . . . . <br />Subtract line 12 from line 10 or 11, whichever applies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />(or Form 1040NR), line 29. Don't include this amount in figuring any medical expense deduction on Schedule A <br />Any advance monthly payments of the HCTC that your health plan administrator received from the <br />2018Self-Employed Health Insurance Deduction Worksheet <br />Description Form/Schedule Unit number <br />1. <br />1. <br />2. <br />2. <br />3.3. <br />4. <br />4. <br />5. <br />5. <br />6.6. <br />8.8. <br />9. <br />9. <br />10.10. <br />11. <br />11. <br />12. <br />12. <br />13.13. <br />14.Self-employed health insurance deduction. Enter the smaller of line 3 or line 13 here and on Schedule 1 (Form 1040), <br />14. <br />Form 1040 <br />Any amounts paid from retirement plan distributions that were nontaxable because you are a <br />retired public safety officer. <br />Amounts for any month you were eligible to participate in a health plan subsidized by your or your <br />spouse's employer or the employer of either your dependent or your child who was under the age <br />of 27 at the end of 2018. <br />smaller of the following amounts. <br />a) Total payments made for that person during the year. <br />b) The amount shown below. Use the person's age at the end of the tax year. <br />$420 ----if that person is age 40 or younger <br />$780 ----if age 41 to 50 <br />$1,560 ----if age 51 to 60 <br />$4,160 ----if age 61 to 70 <br />$5,200 ----if age 71 or older <br />Don't include payments for any month you were eligible to participate in a long-term care <br />insurance plan subsidized by your or your spouse's employer or the employer of either your <br />self-employment tax. If the business is an S Corporation, skip to line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />7.Multiply Schedule 1 (Form 1040), (or Form 1040NR), line 27, by the percentage on line 6 . . . . . . . . . . . . . . . . . . . . . .7. <br />dependent or your child who was under the age of 27 at the end of 2018. If more than one person <br />is covered, figure separately the amount to enter for each person. Then enter the total of those amounts <br />* If you used either optional method to figure your net earnings from self-employment from any business, do not enter your net profit from the <br />business. Instead, enter the amount attributable to that business from Schedule SE (Form 1040), Section B, line 4b. <br />include the following. <br />Any qualified health insurance coverage payments that you included on Form 8885, line 4, to claim <br />Any payments for qualified long-term care insurance (see line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />IRS, as shown on Form 1099-H, Health Coverage Tax Credit (HCTC) Advance Payments <br />Any qualified health insurance coverage payments you paid for eligible coverage months for <br />which you received the benefit of the HCTC monthly advance payment program. <br />the HCTC or on Form 14095 to receive a reimbursement of the HCTC during the year. <br />(Form 1040) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />SHANON M LARIMER 302-86-8984 <br />BUSINESS MARKETING CONSULT/BRANDING C 1 <br />15,769 <br />15,769 <br />180,637 <br />180,637 <br />1.0000 <br />10,380 <br />170,257 <br />34,000 <br />136,257 <br />136,257 <br />15,769