Employer Annual Reporting Form Instructions

 

1. Reporting Deadline

All Employers covered by the Health Care Security Ordinance or the Fair Chance Ordinance are required to submit the 2018 Employer Annual Reporting Form by April 30, 2019.

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

Employers who became covered by the Fair Chance Ordinanceas of October 1, 2018 (employers with 5-19 employees and no City contracts) are not required to complete the 2018 Employer Reporting Form. These employers will be required to report for the first time in April 2020.

 

 

2. Before You Begin

You are not required to submit the 2018 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 2018, 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 2018.

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 2018 Employer Annual Reporting Form so you can review and print out the questions before you start the form. 
 

3. 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 iconPDF 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 2018 Employer Annual Reporting Forms using the same San Francisco 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.

  • If you are filing on behalf of multiple entities in a "controlled group of corporations" with common ownership, and each entity has a separate San Francisco Business Account Number, you can choose to file separate forms for each entity. Alternately, you can choose to aggregate the information for all of the entities into a single submission (see the "Business Type" section below).

  • 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 the SF City Option for a particular employee, the employee would be counted in responses on both the Health Insurance page and the SF City Option 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.

4. Introductory Questions

These questions will help you determine whether you need to complete the 2018 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 in San Francisco for an average of 8 hours per week or more (104 hours per quarter) during any quarter of 2018? Include employees who worked from home in San Francisco.

Select “Yes” if any employee worked inside the geographic boundaries of the City and County of San Francisco for an average of 8 hours per week during any quarter of 2018. 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 entity?

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

3) How many people performed work for the employer each week? Include all workers worldwide.

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 people who performed work for compensation for your business fluctuated during, follow these instructions:

  • Review the number of people who performed work for compensation in each week of the year.
  • Average the number of workers per week across the 13 weeks of each calendar quarter. For example, if the employer had 18 workers for the first 10 weeks of a quarter and 22 workers for the last 3 weeks of a quarter, the average for that quarter would be 18.15 workers.

((18 workers x 10 weeks)+(22 workers x 3 weeks))/13 weeks = 18.15 average

  • For this question, answer based on the quarter with the highest average number of workers. For example, if the employer had an average of 19 workers for quarter 1, quarter 2, and quarter 3, and an average of 24 workers for quarter 4, select the answer "20-49."

 

4) Did the employer have a contract to perform work for the City and County of San Francisco during 2018?

Check yes if any the organization/business held a contract with the City and County of San Francisco for work performed during 2018.

 

5. 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. Use 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, add a zero to the beginning of the number.
  • If you do not have a Business Account Number, please visit the website of the Office of the Treasurer and Tax Collector to register your business as soon as possible. You must obtain a register your business and obtain a Business Account Number before completing the Employer Annual Reporting Form. 
  • If you are submitting aggregated information for a controlled group of multiple entities, enter the Business Account Number for any one of those entities.

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6. 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 2018 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/

 

 

 

7. 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 checked the "control group" box, enter the Business Account Numbers for the entities in the controlled group of corporations other than the one entered previously. This will allow OLSE confirm that the required forms have been submitted for all of the included Business Account Numbers.

 

8. 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 people who performed work for compensation for your business fluctuated during a quarter, follow these instructions:

  • Review the number of people who performed work for compensation in each week of the quarter
  • Average the number of workers per week across the 13 weeks of the calendar quarter. For example, if the employer had 18 workers for the first 10 weeks of a quarter and 22 workers for the last 3 weeks of a quarter, the average for that quarter would be 18.92 workers.

((18 workers x 10 weeks)+(22 workers x 3 weeks))/13 weeks = 18.92 average

  • Select an answer for each quarter based on the average for 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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9. 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 $97,722 per year or $46.98 per hour in 2018.
  • 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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10. Health Insurance

Did the employer spend money on health insurance premiums for employees covered by the HCSO? (Includes medical, dental, and vision premiums. Also includes payments for health benefits to a labor management trust fund.)

If your company/organization paid for medical, dental, or vision insurance premiums, paid for a self-funded health plan, or paid into a labor management trust fund pursuant to a collective bargaining agreement, check yes.

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 and:

  • 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 labor management trust fund pursuant to a collective bargaining agreement; or
  • Who were enrolled in your self-insured plan(s).

Do not count spouses/dependents for this count.

Note: The number of covered employees who received health insurance spending cannot be higher than the total number of "covered employees" listed in the “Employees” tab of the form. If you enter a higher number, you will get an error message.

For “Amount employer spent ($),” include the following:

  • total dollar amounts spent on insurance premiums for employees and their spouses/domestic partners and dependents in each quarter (with the exception of some self-funded insurance plans - see below).
  • total amounts contributed to a labor management trust fund for health insurance for covered employees, their spouses/domestic partners, and their dependents in each quarter.

Do not include:

  • any insurance premium contributions made by employees.
  • expenditures for life insurance, workers’ compensation, or disability insurance, or Flexible Spending Accounts (FSAs).
  • any expenditures for a self-funded health insurance plan for which the employer paid claims as they are incurred. If the employer provided this type of plan, leave zeroes in the "Amount employer spent ($)" fields here. You will need to complete the Self-Funded Plan Addendum to the Employer Annual Reporting Form. See below.

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

Please check all of the types of expenditures you made (including self-funded plans):

Check the boxes for all types of benefits for which the employer made health care expenditures. Include self-funded plan benefits.

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11. Self-Funded Plan Addendum to the Employer Annual Reporting Form

If the employer provided one or more self-funded insurance plan(s) for employees covered by the HCSO, and if the employer paid health claims as they were incurred, the employer is required to complete and submit the Self-Funded Plan Addendum to the Employer Annual Reporting Form.

Expenditures for these types of plans are calculated on annual basis under HCSO Rule 5.9(b) and 5.10. Please review the HCSO self-funded plan webinar and the self-funded calculation instructions for more information.

This Self-Funded Addendum is a Microsoft Excel form. Download it here. Complete it and email it to hcso@sfgov.org with the subject line "Self-funded Plan Form."

Enter the 7-digit San Franciso Business Account Number and Business Name as registered.

Self-funded Insurance Plans

Indicate the "Type of Plan" for each self-funded insurance plan for which the employer paid claims as they were incurred.

Enter the annual average hourly expenditure for each plan, based on the instructions in the HCSO self-funded plan webinar and the self-funded calculation instructions.

Top-off Payments for Self-Insured Plans

Indicate whether the employer made "top-off" payments to any employees covered by the HCSO after reviewing self-funded health plans and determining that additional expenditures were required to satisfy the HCSO employer spending requirement.

Types of Top-off Payments

If you answered "Yes" to the previous question, indicate which types of top-off payments the employer made, the total amount of that type of top-off expenditures made to employees covered by the HCSO, and the number of employees covered by the HCSO who received benefits from that type oftop-off payment.

Email your completed Self-Funded Insurance Addendum to  hcso@sfgov.org with the subject "Self-Funded Plan Form" by April 30, 2019.

 

12. SF City Option

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 2018, 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 2018, 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 2018. 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 2018 payment date, Q2 roster shows a July 2018 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. 

Do not include any "top-off" payments you made to supplement self-funded insurance plans here. See the "Self-Funded Plan Addendum" section above.

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13. 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.

OLSE-directed self-audit: If you received direction from Office of Labor Standards Enforcement staff to remedy past non-compliance with the HCSO, check this box. Enter the total value of HCSO remedy payments for the quarter in which you made those payments.

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. 

Do not include any "top-off" payments you made to supplement self-funded insurance plans here. See the "Self-Funded Plan Addendum" section above.

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14. 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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15. 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) The Fair Chance Ordinance was amended effective October 1, 2018. Prior to that date, employers could inquire into an applicant's arrest or conviction record after a live interview. As of OCtober 1, 2018, employers could only inquire into arrest or conviction records after making a conditional offer of employment to an applicant.

  • Report on whether the company or organization conducted background checks on conviction and or arrest records before a live interview (including a telephone interview) prior to October 1, 2018.
  • Report on whether the company or organization conducted background checks on conviction and or arrest records before making a conditional offer of employment on or after October 1, 2018.

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. 

Note that there is no question 5 is listed on this form. That number has been reserved for the purposes of comparing with prior years' data.

6) Please report on the number of people you hired with a conviction history during 2018.

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. 

16. 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.  Corrected forms must be received by the filing deadline, April 30, 2019.

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17. Late Submissions

The OLSE does not grant extensions for Employer Annual Reporting Forms. The due date for all employers is April 30, 2019. 

The online form will be available after the deadline through May 31st. 2019, and late forms can be submitted through that date. No submissions will be accepted after May 31st, 2019. It is preferable to submit a late form than to submit no form at all. Employers who submit no form may be subject to penalties of $500 per quarter.

 

 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.