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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
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