Before beginning the on-line application: Please read the guidance documents for the Wellness Tax Credit prior to completing the form. They can be found at this site: http://www.mass.gov/wellnesstaxcredit
The entire application must be completed in one on-line session. Therefore please print out the application and complete it in hard copy prior to filling in the on-line application.
1. Have the person with legal authority review the hard copy application as to its accuracy and honesty and sign the document.
2. Maintain the signed-hard copy of the application for your records.
Amount cannot exceed $10,000. The law states:
"the credit allowed . . . shall be equal to 25 per cent of the costs associated with implementing a program . . . with a maximum credit of $10,000 per business in any 1 fiscal year."
Eligible costs for a Wellness Tax Credit: Expenses related to employee wellness that are directly incurred by the eligible business qualify as dollars spent on wellness. If elements of a wellness program are provided as part of an insurance program, documentation will be required to identify the retail value of the services provided. The following are considered eligible program costs:
I hereby swear or affirm under the penalties of perjury that the above named business:
Yes, I authorize the Massachusetts Department of Public Health, the Department of Revenue and the Executive Office of Labor and Workforce Development to share my application and tax return information for purposes of administering the Wellness Tax credit.
I hereby swear or affirm under the penalties of perjury that I have the legal
authority to bind the business entity and that the information above is true
and accurate to the best of my knowledge and belief.