Form 6069 - Return Of Excise Tax On Excess Contributions To Black Lung Benefit Trust Under Section 4953 And Computation Of Section 192 Deduction Page 2
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Form 6069 (Rev. 2-2012)
Page
General Instructions
Line 5. Enter excess contributions carried over
black lung benefit trust to which you made
from the prior tax year that were returned to the
excess contributions.
Section references are to the Internal Revenue
contributor in the current tax year.
Rounding Off to Whole-Dollar Amounts. You
Code unless otherwise noted.
Line 7. Excess contributions entered on this line
may show the money items on the return and
Purpose of Form. Form 6069 is primarily a
are carried over to the following tax year and
accompanying schedules as whole-dollar
worksheet (Schedule A) used to determine the
treated as a contribution for that tax year.
amounts. To do so, drop any amount less than
maximum allowable income tax deduction (under
Line 8. Make check or money order payable to
50 cents and increase any amount from 50 cents
section 192) for contributions made by coal mine
through 99 cents to the next higher dollar. For
the "United States Treasury" for the full amount
operators to tax-exempt black lung benefit
example, $1.39 becomes $1 and $2.50
due.
trusts. The form is also used to determine the
becomes $3.
Signature
amount of excise tax imposed under section
If you have to add two or more amounts to
4953 for contributions that are more than the
If you are filing for a corporation, the return must
figure the amount to enter on a line, include
maximum allowable deduction (see Schedule B).
be signed by the president, vice president,
cents when adding the amounts and round off
Who Must File. Any person who has incurred
treasurer, assistant treasurer, chief accounting
only the total.
liability for the excise tax on excess
officer or any other officer (such as tax officer)
contributions under section 4953 must file a
Schedule A
authorized to sign. If you are filing for a
return on Form 6069. File Form 6069 only to
partnership, one general partner must sign. If
If you are completing Schedule A only to figure
report the excise tax liability figured on Schedule
you are filing for a sole proprietorship, the owner
the maximum allowable deduction and do not
B. Do not file it if only Schedule A is completed.
must sign.
owe tax on excess contributions, keep this form
When and Where To File. File Form 6069 by the
with your records instead of filing it with the IRS.
If a receiver, trustee in bankruptcy, or assignee
15th day of the 5th month after the end of your
is in control of the operator’s property or
Line 1. The determination of amounts necessary
tax year. If the regular due date falls on a
business, that person must sign the return.
to cover payments for claims made under the
Saturday, Sunday, or legal holiday, file on the
Black Lung Benefits Acts of 1977 must be based
Generally, anyone who is paid to prepare the
next business day. File it with the Internal
on reasonable actuarial assumptions. On lines
return must sign it and fill in the "Paid Preparer
Revenue Service, 201 W. River Center Blvd.,
1a, 1b, and 1c, enter the annual amounts you
Use Only" area. The signature of the preparer is
Covington, KY 41011.
need to fund (with level funding) all claims
not required if the return is prepared by your
To request an extension of time to file Form
against you that were filed or expected to be
regular, full-time employee.
6069, file Form 8868, Application for Extension
filed by, or on behalf of, past or present
of Time To File an Exempt Organization Return.
employees for compensation because of
Privacy Act and Paperwork
Accounting Methods. Use the accounting
disability or death, due to pneumoconiosis,
Reduction Act Notice
method regularly used in keeping your books
under the Black Lung Acts.
and records.
Line 2a. Enter the total amount paid during the
We ask for the information on this form to carry
Accounting Period. Complete the return on the
year for any combination of the following:
out the Internal Revenue laws of the United
basis of your established accounting period. If
States. Section 4953 imposes a tax on excess
• All administrative and other incidental expenses
you do not have an established accounting
contributions to a Black Lung Benefit Trust. You
of operating the trust and processing claims
period, use the calendar year.
are required to give us the information. Section
against you (including legal, actuarial, and
Penalties and Interest. There are penalties for
6109 requires you to provide your taxpayer
trustee expenses).
late filing, willful failure to file, and for filing
identification number (EIN or SSN). We need it to
• All direct payments by the trust for claims
fraudulent returns and statements. See sections
ensure that you are complying with these laws
against you.
6651, 7203, 7206, and 7207.
and to allow us to figure and collect the right
amount of tax. Failure to provide this information
• All payments of premiums exclusively for
Interest at the annual rate provided by law is
in a timely manner, or providing false
insurance to cover your liability for claims filed
charged on any tax shown on line 8, Schedule
under the Black Lung Acts.
information, may subject you to penalties.
B, that is not paid by the due date of the return.
Routine uses of this information include giving it
• All payments of accident and health benefits for
Definitions
to the Department of Justice for civil and
retired miners and their spouses and
criminal litigation, and to cities, states, and the
The term “Black Lung Acts” refers to Part C of
dependents to the extent allowed by section
District of Columbia for use in the administration
Title IV of the Federal Mine Safety and Health
501(c)(21)(C).
of their taxes. We may also disclose this
Act of 1977, and any state law that provides
Line 2b. Enter the fair market value of the trust’s
information to federal and state agencies to
compensation for disability or death due to
assets at the beginning of your tax year.
enforce federal nontax criminal laws and to
pneumoconiosis (black lung disease). A black
combat terrorism.
Schedule B
lung benefit claim is a claim for compensation
for disability or death due to pneumoconiosis
You are not required to provide the information
Complete Schedule B only if your contributions
under the Black Lung Acts.
requested on a form that is subject to the
to black lung benefit trusts for the current tax
Paperwork Reduction Act unless the form
Unless otherwise indicated, the term “trust” as
year are more than the maximum allowable
displays a valid OMB control number. Books or
used in the instructions means the tax-exempt
deduction under section 192 or if you made
records relating to a form or its instructions must
section 501(c)(21) trust or trusts to which you
excess contributions in the preceding tax year
be retained as long as their contents may
made contributions for which you claimed a
that are carried over to the current tax year. The
become material in the administration of any
deduction under section 192.
contributor must pay a tax in the current tax year
Internal Revenue law. Generally, tax returns and
on excess contributions carried over from the
Specific Instructions
return information are confidential, as required by
preceding tax year unless the trust returns the
Code section 6103.
excess contributions to the contributor or the
No deduction is allowed under section 192(a) for
The time needed to complete and file this form
contributor offsets excess contributions by
any contribution to a trust other than a
will vary depending on individual circumstances.
reduced contributions in the current tax year.
contribution in cash or in items in which the trust
The estimated average time is:
may invest under section 501(c)(21)(A)(ii)(II).
Line 1a. When an excess contribution is made
Recordkeeping .
.
.
.
.
7 hr., 10 min.
to a section 501(c)(21) trust in the current tax
Payments made for a particular tax year that
year and the trust returns part or all of the
are made no later than the due date (including
Learning about the
current year’s excess contribution in the same
extensions) of your income tax return for that tax
law or the form .
.
.
.
.
1 hr., 17 min.
year, show only the net contribution for the year
year are considered to have been made on the
Preparing the form .
.
.
.
1 hr., 27 min.
on this line (for example, current year’s
last day of that tax year.
Copying, assembling, and
contribution less current year’s excess
Period To Be Covered by Return. Fill in the
sending the form to the IRS .
.
.
16 min.
contribution returned). At your request, a black
spaces at the top of the form to show the
lung benefit trust will repay excess contributions
If you have comments concerning the
calendar year or fiscal year of the accounting
(but not more than the excess) made to the trust
accuracy of these time estimates or suggestions
period you are reporting.
for a tax year. The repayment is not an act of
for making this form simpler, we would be happy
Name and Address. Enter your name, address,
self-dealing or a taxable expenditure reportable
to hear from you. You can write to the Internal
and employer identification number in the
on Schedule A (Form 990-BL).
Revenue Service, Tax Products Coordinating
appropriate spaces. In the spaces for the name
Committee, SE:W:CAR:MP:T:M:S, 1111
Line 2. Enter excess contributions carried over
and employer identification number of the related
Constitution Ave. NW, IR-6526, Washington, DC
from Schedule B, Form 6069 for the previous
trust, enter the identifying information for the
20224. Do not send the tax form to this office.
year.
Instead, see When and Where To File above.
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