This is an example of a Form 8941, Credit for Small Employer Health Insurance Premiums with field descriptors.A. Did you pay premiums during your tax year for employee health insurance coverage you provided through a Small Business Health Options Program (SHOP) Marketplace? Field contains 21CBX.B. Enter the employer identification number (EIN) used to report employment taxes for individuals included on Line 1 below if different from the identifying number listed below. Field contains 21LNB.C. Previous Forms 8941 filed checkbox. Field contains 21BXC.1. Enter the number of individuals you employes during the tax year who are considered employees for purposes of this credit (total from Worksheet 1, column (a)) field contains 21LN12. Enter the number of full-time employees you had for the tax year. If you entered 25 or more, skip Lines 3 through 11 and enter -0- on Line 12 Field contains 21LN13. Average annual wages you paid for the tax year. If you entered $58,000 or more, skip Lines 4 through 11 and enter -0- on Line 12 Field contains 2103.4. Premiums you paid during the tax year for employees included on Line 1 for health insurance coverage under a qualifying arrangement (see instructions) Field contains 21045. Premiums you would have entered on Line 4 if the total premium for each employee equaled the average premium for the small group market in which you offered health insurance coverage (see instructions) Field contains 210510. Enter the total amount of any state premium subsidies paid and any state tax credits available to you for premiums included on Line 4 (see instructions) Field contains 211013. If Line 12 is zero, skip Lines 13 and 14 and go to Line 15. Otherwise, enter the number of employees included on Line 1 for whom you paid premiums during the tax year for health insurance coverage under a qualifying arrangement (see instructions) Field contains 211314. Enter the number of full-time equivalent employees you would have entered on Line 2 if you only included employees included on Line 13. Field contains 211415. Credit for small employer health insurance premiums from partnerships, S corporations, cooperatives, estates, and trusts (see instructions). Field contains 2115.17. Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see instructions). Field contains 2116.