Fillable Printable Form Mo-Shc - 2016 Self-Employed Health Insurance Tax Credit
Fillable Printable Form Mo-Shc - 2016 Self-Employed Health Insurance Tax Credit
Form Mo-Shc - 2016 Self-Employed Health Insurance Tax Credit
*16320010001*
16320010001
Missouri Department of Revenue
2016 Self-Employed Health Insurance Tax Credit
Department Use Only
(MM/DD/YY)
Social Security
Number
Name
Form
MO-SHC
Taxpayer
Qualifications and Instructions
If you are a self-employed individual and were not able to deduct all of your health care premiums from your federal adjusted gross income,
you may be eligible for a tax credit equal to the portion of your federal tax liability incurred due to the inclusion of your health care premiums in
your federal adjusted gross income. The self-employed health insurance tax credit is refundable.
Security Number
Name
Spouse’s Social
Calculate your tax credit by using either method below and enter the total on the Miscellaneous Income Tax Credits (Form MO-TC).
your credit.
Self-employed individuals with personal exemptions and itemized deductions limited on their federal return because their federal adjusted
gross income exceeded the limits established by the Internal Revenue Service should use the Regular Method. If you are filing a combined
return, and both spouses were self-employed and paid health insurance premiums, combine the amounts paid by both spouses when calculating
Short Method
2. Amount you paid for health insurance premiums which were included in federal adjusted gross income. .......
2
3. Subtract Line 2 from Line 1 ................................................................
3
4. Calculate an adjusted federal tax by comparing the amount on Line 3 with the federal tax tables .............
4
5. Federal tax from your Federal Form 1040, Line 44 .................................................
5
6. Subtract Line 4 from Line 5. This is your self-employed health insurance tax credit. Report on Form MO-TC ...
6
1. Federal taxable income from Federal Form 1040, Line 43 ..........................................
1
Regular Method
2. The amount you paid for health insurance premiums which were included in your federal adjusted gross income
2
3. Subtract Line 2 from Line 1. This is your revised federal adjusted gross income ..........................
3
1. Federal adjusted gross income from Federal Form 1040, Line 37 ......................................
1
over the limit, use the amount from Line 3 of this worksheet to recalculate the itemized deductions ............
4
4. Enter your standard or itemized deductions. If your itemized deductions were reduced because your income was
the limit, use the amount from Line 3 of this worksheet to recalculate the personal exemption ................
5
5. Enter your personal exemption amount. If your personal exemption was reduced because your income was over
7. Subtract Line 6 from Line 3. ...................................................................
7
6. Add lines 4 and 5 ...........................................................................
6
Enter the adjusted amount here ................................................................
8
8. Calculate an adjusted federal tax by computing the amount on Line 7 with the federal tax tables.
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*16320020001*
16320020001
Form MO-SHC (Revised 12-2016)
Regular Method (Continued From Page 1)
Visit http://www.dor.mo.gov/personal/individual/
for additional information.
Taxation Division Phone: (573) 751-3220
P.O. Box 27 TTY: (800) 735-2966
Jefferson City, MO 65105-0027 Fax: (573) 751-2195
E-mail: [email protected]
This form, pages one and two of Federal Form 1040, and Federal Schedule C, if applicable, must
be attached to the Miscellaneous Income Tax Credits (Form MO-TC) along with your tax return.
11. If you reduced your tax by any of the credits listed on Federal Form 1040, Lines 48–54, use the revised federal
and enter the total of all the credit amounts .......................................................
11
adjusted gross income from Line 3 on this worksheet to recalculate each of the credits to which you are eligible,
13. Total of Federal Form 1040, Lines 57-62 .........................................................
13
14. Add Lines 12 and 13. This is your revised federal tax liability. ........................................
14
12. Subtract Line 11 from Line 10 ..................................................................
12
15. Amount from Federal Form 1040, Line 63 ........................................................
15
16. Subtract Line 14 from Line 15. This is your self-employed health insurance tax credit. Report on Form MO-TC .
16
10. Add Lines 8 and 9 ...........................................................................
10
worksheet to recalculate the tax calculated on Form 6251, and enter the revised amount. ...................
9
9. If you paid an alternative minimum tax, use the revised federal adjusted gross income from Line 3 on this
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