Employer Annual Reporting Form Instructions

 

Reporting Deadline

All Employers covered by the Health Care Security Ordinance or the Fair Chance Ordinance are required to submit the 2017 Employer Annual Reporting Form by April 30, 2018.

Covered Employers who fail to submit the Employer Annual Reporting Form by the deadline may be subject to a penalty of $500 per quarter.

Before You Begin

You are not required to submit the 2017 Employer Annual Reporting Form if:

  • You employed fewer than 20 persons (including those employed outside of San Francisco) in each of the four calendar quarters of 2017, and you do not have a contract with the City and County of San Francisco; or 
  • You had no employees within the geographic boundaries of San Francisco (including employees working from home in San Francisco) in any quarter of 2017.

You do not need to notify the City that you are not required to submit the Form; no further action is requiredIf you received a mailing saying that you might be required to submit the Employer Annual Reporting Form, you do not need to request removal from the mailing list. The City is aware that some entities on the list may not be covered by these laws and may not be required to submit this form. 

The list was based on information you provided in your last tax filing or business registration   with the SF Treasurer and Tax Collector’s Office. You can update your Business Account Information with the San Francisco Treasurer and Tax Collector’s Office online here:

https://etaxstatement.sfgov.org/accountupdate/

Please read these instructions before you begin. Note that once you have begun the Annual Reporting Form online, you will not be able to save it and return to it later.

You may want to download a PDF iconPDF Preview of the 2017 Employer Annual Reporting Form so you can review and print out the questions before you start the form. 

To complete the 2017 Employer Annual Reporting Form, you will need information on:

  • Your seven-digit Business Account Number from the San Francisco Treasurer and Tax Collector;
  • The total number of persons performing work for compensation (including those outside of San Francisco) for each quarter within specific ranges (i.e. 0-19, 20-49, 50-100, etc.);
  • The number of employees covered by the Health Care Security Ordinance for each quarter;
  • Total health care expenditures made for each quarter of 2017, including:
    • Total payments for health insurance (medical, dental, vision as well as Taft-Hartley plan contributions);
    • Total contributions to the SF City Option (SF Covered MRAs, Healthy San Francisco and SF MRAs);
    • Total spending on other irrevocable health care expenditures, such as employer contributions to Health Savings Accounts. 
  • Surcharges collected from customers to cover, in whole or in part, the cost of complying with the HCSO.
  • Compliance with the Fair Chance Ordinance, including how arrest and conviction history information was used in hiring.

Tips for Completing the Annual Reporting Form

  • Once you have begun the Annual Reporting Form online, you will not be able to save it and return to it later. You may want to download a PDF icon PDF Preview.

  • Use the buttons at the bottom of the form to navigate forward and backwards. Do not use the back button in your internet browser - you may lose the answers on prior tabs. 

  • Do not submit two separate 2017 Annual Reporting Forms using the same Business Account Number unless you are submitting a correction. If multiple businesses or locations share the same Business Account Number, please combine the relevant data into a single Annual Reporting Form. If multiple forms are submitted for the same account number, the City will use the most recent submission.

  • Do not enter commas in numeric fields. Please enter zeroes where appropriate. Enter all dollar amounts in whole dollars; do not include cents. 

  • You may report multiple types of health care expenditures for each employee. For example, if you paid health insurance premiums and also paid into a HRA for a particular employee, the employee would be counted in responses on both the Health Insurance page and the Revocable Expenditure page.

  • Employees who worked for you throughout the year should be counted in each quarter.

  • Fill out the form completely.

  • If you cannot access the online form, please call (415) 554-7892.

Introductory Questions

These questions will help you determine whether you need to complete the 2017 Employer Annual Reporting Form. If you answer these questions accurately and you are not required to complete the form, you will be directed to a web page notifying you that you do not need to continue. 

1. Did any employees work an average of 8 or more hours per week (or 104 hours in a quarter) within the geographic boundaries of San Francisco (including tele-working from a home in San Francisco) during any quarter of 2017?  

Select “Yes” if any employee worked in City and County of San Francisco an average of 8 hours per week during any quarter of 2017. An average of 8 hours per week is equivalent to a total of 104 hours for the 13 weeks in a quarter.

You should select “Yes” even if your business’s/organization’s offices are outside of San Francisco but your employee(s) worked in San Francisco.

If you have employees who work some hours in San Francisco and some outside of San Francisco, calculate whether their time in San Francisco was an average of 8 hours per week in any quarter.

2.  Is the employer a for-profit or a non-profit employer?

Answer "non-profit" only if the employer is a non-profit entity under federal law, such as a 501c(3).

3.  What was the highest average number of persons performing work for compensation (worldwide) in any quarter of 2017?

Include all individuals who performed work for compensation for your business regardless of whether they worked inside or outside of San Francisco. Indicate the size of the business in each quarter.

In reporting business size, include all individuals who performed work for compensation, regardless of their status or classification as seasonal, permanent or temporary, managers, full-time or part-time, contracted (whether employed directly by the employer or through a temporary staffing agency, leasing company, professional employer organization, or other entity) or commissioned. Include owners who performed work for compensation in the count. 

If the number of persons who performed work for compensation for your business fluctuated during a quarter, answer this question based on the average number of persons who performed work each week during that quarter.

4.  Did any employees perform work for a contract with the City and County of San Francisco during calendar year 2017?

Check yes if any the organization/business held a contract with the City and County of San Francisco for work performed during 2017.

 

Business Account Number

Please enter your seven-digit San Francisco Business Account Number and click "Validate.”

This number can be found on the Business Registration Certificate(s) issued by the San Francisco Treasurer & Tax Collector. You can also find your Business Registration Certificate Number by searching the San Francisco Data website. See the "Find in this Dataset" search box at the top right of the page.

Please note:

  • If your Business Account Number is only six digits, please add a zero to the beginning of the number.
  • If you do not have a Business Registration Certificate, please visit the website of the Office of the Treasurer and Tax Collector to register your business before completing the Employer Annual Reporting Form. 

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Name and Address

For the Business dba Name, please fill in the trade name (dba) if different than the registered "Ownership Name" of the business.

For the address, please fill in the business address you would like us to use if we have questions regarding your 2017 Employer Annual Reporting Form.

Note that entering your current address your address here will not change it with the San Francisco Treasurer and Tax Collector’s Office.  You will still need to notify them of the change. You can make changes to your registration with the Treasurer and Tax Collector's Office here: 

https://etaxstatement.sfgov.org/accountupdate/

 

 

 

Business Type

Check the "nonprofit" check box if you are submitting the form on behalf of an IRS-recognized nonprofit organization, such as a 501(c) 3.

Check the "control group" check box if you are submitting the form on behalf of more than one entity in the same controlled group of corporations. A "controlled group of corporations" is as a combination of two or more corporations that are under common control as defined in Section 1563(a) of the United States Internal Revenue Code. If you are filing on behalf of a control group, it is your responsibility to maintain records regarding which businesses are included in this Annual Reporting Form.  

 

Business Size

Include all persons who performed work for compensation for your business regardless of whether they worked inside or outside of San Francisco. Indicate the size of the business in each quarter, based on the ranges provided.

In reporting business size, include all persons who performed work for compensation, regardless of their status or classification as seasonal, permanent or temporary, managers, full-time or part-time, contracted (whether employed directly by the employer or through a temporary staffing agency, leasing company, professional employer organization, or other entity) or commissioned. Include owners who performed work for compensation in the count.

If the number of persons who performed work for your business fluctuated during a quarter, answer this question based on the average number of persons who performed work each week during that quarter.

Note that this question asks for you to report on the business size within a range. Your confirmation email for the form will show the highest number in this range. For example, if you report a business size of 50-99, the confirmation email will show the business size of 99.

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Covered Employees

Count the total number of persons who were “Covered Employees” under the HCSO during the quarter. Covered Employees are those who:

  • Qualified as employees entitled to payment of the San Francisco minimum wage (pursuant to the Minimum Wage Ordinance, Chapter 12R of the San Francisco Administrative Code);
  • Were employed by your business for 90 calendar days after his or her first day of work (including any period of leave to which an employee is legally entitled); and
  • Regularly performed at least 8 hours of work per week for your business within the geographic boundaries of San Francisco. For an employee who was employed and whose hours fluctuated, count the employee if that person worked 104 hours in the quarter.

Covered Employees may include employees for whom you complied with the HCSO by providing health insurance, paying into the SF City Option, or making other health care expenditures.

Do not include your employees who met any of the following exemption criteria:

  • Persons who were managerial, supervisory, or confidential employees and also earned at least $95,101 (or $45.72 per hour) in 2017.
  • Persons who were eligible to receive Medicare coverage;
  • Persons who were eligible for TRICARE (the federal health care program for active duty and retired members of the uniformed services, their families, and survivors);
  • Persons who were “covered employees” under the San Francisco Health Care Accountability Ordinance (HCAO), which applies only to City Contractors and lessees (see Section 12Q of the San Francisco Administrative Code for more details about HCAO coverage);
  • Persons who were employed by a nonprofit corporation for up to one year as trainees in a bona fide training program consistent with federal law; or
  • Persons who voluntarily signed a revocable HCSO waiver form demonstrating that they received health care benefits through another employer (either as an employee or by virtue of being the spouse, domestic partner, or child of another person). The form is effective for one year from the date it is signed, or until revoked, and is available at the HCSO website.

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Health Insurance

If your company/organization paid health insurance premiums or paid into a union trust fund, check yes and fill in the questions that appear below.

If your company/organization did not pay for medical, dental, or other health insurance premiums or contribute to a union health/welfare trust fund for your employees covered by the HCSO, click "no" and move on to the next section.

For “Covered Employees,” include any employees covered by the HCSO:

  • For whom you paid a health insurance carrier to provide group coverage, including medical, vision and/or dental;
  • For whom you made contributions to a Taft-Hartley plan pursuant to a collective bargaining agreement or union contract; or
  • Who were covered under your self-insured plan.
  • Do not count spouses/dependents for this question
  • Note that number of covered employees who received health insurance premiums entered in this section cannot be higher than the total number of covered employees listed in the “Employees” section of the form.

For “Amount employer spent ($),” do include the dollar amounts spent on employees' spouses' or dependents' insurance. Do not count:

  • insurance premium contributions made by employees, or
  • expenditures for life insurance, workers’ compensation, or disability insurance.
  • Do not enter commas in numeric fields. Please enter zeroes where appropriate. Enter all dollar amounts in whole dollars; do not include cents. 

​Tip: Employers with self-insured plans may calculate these expenditures using either the COBRA-equivalent rate for the 2017 plan year or the average actual expenditure amounts. Note that the using the COBRA-equivalent rate will no longer be an acceptable way to calculate health care expenditures for 2018. For more information, see our Administrative Guidance on this topic.

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City Option (Healthy San Francisco and MRAs)

SF City Option is one way to comply with the Health Care Security Ordinance. Many employers are able to fully meet the expenditure requirements under the HCSO by providing health insurance for all of their covered employees. Some employers choose to contribute to SF City Option either because they do not provide health insurance for covered employees or they provide health insurance that fails to meet the minimum expenditure requirements.

 If your company/organization contributed to SF City Option (including the Healthy San Francisco, SF MRA, or SF Covered MRA programs) for one or more of your covered employees in 2017, check yes for the first question, and reply to the questions that appear below.

If your company/organization has not contributed to SF City Option for one or more of your covered employees in 2017, check “No” for the first question on this page and continue onto the next page.

If you answered "Yes," report the number of covered employees for whom you made contributions to SF City Option and the total dollar amount contributed for each quarter. 

To find this information, log into your SF City Option Employer Portal account at https://employerportal.healthysanfrancisco.org/ and click on “Manage Rosters” to review the paid roster for the four calendar quarters of 2017. While rosters do not explicitly show which quarter they are for, if payment was made on time each quarter, you can determine the quarter by the roster payment date (i.e. Q1 roster shows an April 2017 payment date, Q2 roster shows a July 2017 payment date, etc.). If the registered user for your company’s Employer Portal account is not available or is no longer with the company, you can contact SF City Option at employerservices@sfcityoption.org to request access to the account. OLSE does not have access to this information. 

Note that number of covered employees who received SF City Option contributions entered in this section cannot be higher than the total number of covered employees listed in the “Employees” section of the form.

Do not enter commas in numeric fields. Please enter zeroes where appropriate. Enter all dollar amounts in whole dollars; do not include cents. 

 

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Other Health Care Expenditures, such as HSA contributions

If your company/organization made other health care expenditures to satisfy the employer spending requirements of the HCSO, check “Yes.” Note that as of January 1, 2017 only irrevocable expenditures count toward the expenditure requirement. Irrevocable expenditures are those that have not been retained by and can never revert to the employer under any circumstance. See the HCSO Administrative Guidance on Irrevocable Expenditures for more information. 

Do not report any funds/spending that may revert to the employer at any point, such as Flexible Spending Account (FSA) funds or revocable Health Reimbursement Account (HRA) funds.

If you had no additional irrevocable health care expenditures, check “No,” and continue to the next section.

HSA contributions: the most common other irrevocable health care expenditure is contributions to Health Savings Accounts (HSAs). HSAs are tax-exempt reimbursement accounts that employees may use to cover out-of-pocket costs.  An employee must be covered under a high deductible health plan to have an HSA. Funds contributed to these accounts are owned by the employee and never revert to the employer. See IRS Publication 969 for more information. If your business made a lump-sum contribution on behalf of covered employees at the beginning of the calendar year for 2017, you may divide that lump sum across the 4 quarters of the year. OLSE treats these expenditures as early expenditures for for the 4 quarters of the year. 

MSA contribution: in rare cases, employers may contribute to Medical Savings Accounts (MSAs) for covered employees. See IRS Publication 969 for more information on these accounts.

Irrevocable Health Reimbursement Account: Report on contributions to Health Reimbursement Accounts only if the funds were paid to a third party and may never revert to the employer under any circumstance, including company bankruptcy, death of the employee, etc.

Other type of Health Care Expenditure: Describe the other type of irrevocable health care expenditure in the box provided.

Report the total number of employees who received employer-funds for these accounts, and the total employer contribution to those accounts. Do not count any money contributed by employees.

Note that you may include irrevocable administrative fees paid to a third party in the “Amount Employer Spent ($)” field. 

Note that number of covered employees who received Other Health Care Expenditures entered in this section cannot be higher than the total number of covered employees listed in the “Employees” section of the form.

Do not enter commas in numeric fields. Please enter zeroes where appropriate. Enter all dollar amounts in whole dollars; do not include cents. 

 

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Surcharge

If your company/organization added a surcharge to your customers’ bills to cover, in whole or in part, the cost of complying with the HCSO, select “Yes” and answer the questions that appear below the first question.

If you did not add a surcharge to your customers’ bills to cover the cost of complying with the HCSO, check “No” and continue to the next section. 

If your company/organization’s notification to customers (such as menu notification and/or a line item on receipts) described the surcharge as specifically intended for employees’ health care benefits (such as a “Healthy San Francisco surcharge” “or an “employee health care surcharge”), report the full amount collected through the surcharge.

If your notification to customers indicated that the surcharge covered health care costs in addition to other costs, such as a charge for “San Francisco Employer Mandates,” report only the portion of surcharge that was collected for health care costs.

Enter the language that you used to notify customers about the surcharge. This may have appeared on your menu, receipts, signs, etc. Examples include “Healthy SF surcharge,” “SF Employer Mandates,” etc.  

Do not enter commas in numeric fields. Please enter zeroes where appropriate. Enter all dollar amounts in whole dollars; do not include cents. 

 

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Fair Chance Ordinance Reporting

 

1) Include part-time, temporary, seasonal employees, as well as telecommuters who work within the geographic boundaries of San Francisco.

2) Report on whether your company or organization's employment application for jobs in San Francisco ask about arrest or conviction information.  This can include an online application template that is not specific to San Francisco, but that is used by applicants for San Francisco jobs.

3) Report on whether the company or organization conducted background checks on conviction and or arrest records before a live interview (including a telephone interview).

4) For more information on the types of information that employers may never ask about see the Fair Chance Ordinance FAQ (PDF) and review question #26. 

5) Report on whether you changed your job application process during calendar year 2017 to comply with the San Francisco Fair Chance Ordinance:

  • Yes, we changed our application and/or background check process. We changed how/whether/when we inquire about conviction and arrest histories.
  • No, our existing application and/or background check process was already compliant with the law. We do inquire about conviction and arrest histories, but how we do already complied with the requirements of the Fair Chance Ordinance.
  • No, we never considered arrest records or convictions, and we still do not.
  • No, we have not yet changed our process to comply with the law.

6) Please report on the number of people you hired with a conviction history during 2017.

7) Indicate if your business is not covered by some aspect of the background check provisions of the FCO. This may be the case if:

a) you are covered by federal or state law that specifies how you are to conduct background checks (such as in financial services industries, schools, etc); or

b) your employees provide services to minors, seniors, or disabled individuals, or your employees are drivers.  

If yes, select you company/organization's industry. 

Corrections / Resubmissions

If you made a mistake on your Annual Reporting Form, you may re-submit a corrected form. Start a new form at https://etaxstatement.sfgov.org/OLSE

The corrected submission will replace any form submitted previously with the same Business Registration Account Number.

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 This notice is intended to provide general information and does not establish policy or offer legal advice regarding the HCSO, Chapter 14 of the San Francisco Administrative Code. If you have any questions about your obligations under the ordinance, please visit www.sfgov.org/olse/hcso, call (415) 554-7892 or email hcso@sfgov.org.