Form Il-601 - Medical Care Savings Account Penalty Payment - 2006
Download a blank fillable Form Il-601 - Medical Care Savings Account Penalty Payment - 2006 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Il-601 - Medical Care Savings Account Penalty Payment - 2006 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Use your 'Mouse' or 'Tab key' to move through the fields.
Illinois Department of Revenue
IL-601
Medical Care Savings Account Penalty Payment
What is the purpose of this form?
When will a penalty not be assessed?
This form is for the administrator of a Medical Care Savings Account
A penalty will not be assessed when an administrator reimburses an
to use to figure and pay any penalty that an employee may owe when
employee for eligible medical expenses or when
•
•
the employee withdraws money from this account, and
the employee withdraws money on the last business day of the
•
account administrator’s business year; or
the money is not eligible for withdrawal under the provisions of the
•
Medical Care Savings Account Act.
the employer mails a check to the former employee for the
balance of their account.
Who must file?
The administrator of a Medical Care Savings Account must file and pay
In these last two instances, money withdrawn may be used by
a penalty on behalf of an employee who withdraws money from this
the employee for any reason without being assessed a penalty.
account, and the money is not used to pay eligible medical expenses.
However, this amount must be included as income in the year of the
withdrawal on the employee’s Form IL-1040.
What are eligible medical expenses?
How much penalty will be assessed?
Eligible medical expenses include
•
A penalty of 10 percent will be assessed on the amount of the
expenses for medical care of the employee, their spouse, or their
employee’s withdrawal. The administrator must withhold the penalty
dependents as described under Section 213(d) of the Internal
and pay only the remainder of the withdrawal to the employee.
Revenue Code; and
•
expenses incurred to purchase a health coverage insurance
Where do I file and pay?
policy, certificate, or contract if the employee does not already
Mail your Form IL-601 to: Document Control and Deposit Manager,
have health insurance coverage.
Illinois Department of Revenue, P.O. Box 19014, Springfield,
However, medical expenses of the employee, spouse, or dependents
Illinois 62794-9014. Make your check or money order payable to:
are not eligible under this act when covered by another insurance
“Illinois Department of Revenue.”
policy. These policies include and are not limited to: automobile
insurance, worker’s compensation insurance, self-insured insurance,
Medical Care Savings Account
or another health coverage insurance policy, certificate, or contract.
Penalty Worksheet
When will a penalty be assessed?
A penalty will be assessed when an employee withdraws money from
1
Write the amount of the
a Medical Care Savings Account on any day other than the last
$
1
employee’s withdrawal
business day of the account administrator’s business year and uses
the money for purposes other than those described under “What are
2
Multiply Line 1 by 10% (.10).
eligible medical expenses?”
This is the amount of the
$
2
employee’s penalty.
When an employee withdraws money from this account and
that withdrawal is assessed a penalty, the withdrawal plus any
Write the amount from Line 2 on the payment voucher below.
interest earned on the account is considered income in the year of
Mail the voucher together with your check or money order to the
the withdrawal and must be included on the employee’s
Illinois Department of Revenue at the address below.
Form IL-1040, Individual Income Tax Return.
IL-601 (R-12/06)
Return only the bottom portion with your payment.
Illinois Department of Revenue
IL-601
Medical Care Savings Account Penalty Payment
.
___________
_____
$
__ __ __ - __ __ - __ __ __ __
________________
Penalty payment amount
Employee’s Social Security number
Year of withdrawal
________________________________________________
________________________________________________
Employee’s first name & initial
Employee’s last name
Employer’s name
________________________________________________
________________________________________________
Employer’s street address
Employee’s street address
________________________________________________
________________________________________________
Employer’s city
State
ZIP
Employee’s city
State
ZIP
________________________________________________
Make check or money order payable to: “Illinois Department of Revenue.”
Account Administrator’s name
Mail to: DOCUMENT CONTROL AND DEPOSIT MANAGER
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19014
SPRINGFIELD IL 62794–9014
This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is REQUIRED. Failure to
provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-3688
(R-12/06)
Print
Reset
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial