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Instrucciones del formulario 990-BL

Instrucciones para el Formulario 990-BL, Información y Rendimiento de Impuestos Inicial para Confianzas de Beneficio de Pulido Negro y Ciertas Personas Relacionadas (Utilice con la revisión de diciembre de 2013 del Formulario 990-BL)

Rev. enero 2020

Formularios relacionados

  • Formulario 990-BL - Información y aumento inicial de la devolución de impuestos para las fideicomisos de prestaciones pulmonares negras y ciertas personas relacionadas
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Department of the Treasury  
Internal Revenue Service  
Instructions for  
Form 990-BL  
(Rev. January 2020)  
Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain  
Related Persons  
(Use with the December 2013 revision of Form 990-BL)  
Section references are to the Internal Revenue Code unless  
otherwise noted.  
liable for sections 4951 and 4952 taxes reports both taxes on  
one return.  
If no tax is due under section 4951 or 4952, do not file  
Schedule A (Form 990-BL).  
Future Developments  
For the latest information about developments related to  
Form 990-BL and its instructions, such as legislation enacted  
after they were published, go to IRS.gov/Form990bl.  
Your Area Director will tell you what procedures to follow if  
the trust or any related persons incur any liability for  
additional taxes and penalties based on sections 4951 and  
4952.  
General Instructions  
Form 990-BL will not be automatically mailed to persons  
required to file it. Go to IRS.gov/forms to view, download, or  
print all of the forms and publications you may need. You can  
also download and view popular tax publications and  
instructions on mobile devices as an eBook at no charge. Or  
you can go to IRS.gov/orderforms to place an order and have  
forms mailed to you within 10 business days.  
Purpose of Form  
The Black Lung Benefits Revenue Act of 1977 (the Act)  
amended the Code to impose excise tax on the sale of coal  
by the producer and established a trust fund (funded by the  
coal tax and certain other revenues) to be available for  
expenses of providing medical benefits where not paid by the  
appropriate mine operator.  
An organization claiming an exempt status under section  
501(c)(21) prior to the establishment of exempt status should  
file this return if its application for recognition of exemption is  
pending (including appeal of a proposed adverse decision).  
Form 990-BL generally is used by black lung benefit trusts  
to meet the reporting requirements of section 6033. If initial  
taxes are imposed on the trust or certain related parties,  
trusts also must file Schedule A (Form 990-BL), Initial Excise  
Taxes on Black Lung Benefit Trusts and Certain Related  
Persons.  
Accounting Period  
The return must be on the basis of the established annual  
accounting period of the organization. If the organization has  
no established accounting period, the return should be on the  
basis of the calendar year.  
Who Must File  
The trustee must file Form 990-BL for a trust exempt from tax  
under section 501(a) and described in section 501(c)(21),  
unless the trust normally has gross receipts in each tax year  
of not more than $50,000.  
Accounting Methods  
Gross income, receipts, and disbursements must be figured  
by the method of accounting regularly used by the  
organization in maintaining its books and records, unless  
otherwise specified in the instructions.  
A trust that normally has gross receipts of $50,000 or less  
may file an annual electronic notice instead of filing Form  
on “Annual Reporting & Filing,” and then click on “Annual  
electronic notice (e-Postcard) for small exempt  
When and Where To File  
This return, including Schedule A (Form 990-BL) if tax is due,  
must be filed on or before the 15th day of the 5th month  
following the close of the filer's tax year. If the regular due  
date falls on a Saturday, Sunday, or legal holiday, file on the  
next business day. File it at the following address:  
organizations” for more information.  
The initial excise taxes imposed on black lung benefit  
trusts, trustees, and disqualified persons under sections  
4951 and 4952 are reported on Schedule A (Form 990-BL).  
Department of the Treasury  
Internal Revenue Service Center  
Kansas City, MO 64999  
A black lung benefit trust required to file an annual  
information return and liable for tax under section 4952  
should complete Form 990-BL and attach a completed  
Schedule A (Form 990-BL). A trust liable for section 4952 tax  
but not otherwise required to file Form 990-BL should  
complete the identification and signature area of Form  
990-BL and attach a completed Schedule A (Form 990-BL).  
Tax-exempt organizations can use certain private delivery  
services (PDS) designated by the IRS to meet the “timely  
mailing as timely filing” rule for tax returns. Go to  
IRS.gov/PDS for the current list of designated services. For  
the IRS mailing address to use if you're using PDS, go to  
A trustee or disqualified person liable for section 4951 or  
4952 tax should complete the heading (omitting the check  
boxes for application pending, address change, and fair  
market value of assets) and signature area of Form 990-BL  
and attach a completed Schedule A (Form 990-BL). A trustee  
The PDS can tell you how to get written proof of the  
mailing date.  
Dec 20, 2019  
Cat. No. 10316J  
Private delivery services can’t deliver items to P.O.  
boxes. You must use the U.S. Postal Service to mail  
any item to an IRS P.O. box address.  
Public Inspection of Completed  
990-BL Returns and Approved  
Exemption Applications  
Through the IRS. Generally, the information reported on or  
with Form 990-BL, including most attachments, is available  
for public inspection (section 6104(b)). This applies both to  
information required by the form and to information furnished  
voluntarily. Approved applications for exemption from federal  
income tax also are available for public inspection.  
Exception. Part IV of Form 990-BL, Statement With  
Respect to Contributors, etc., and Schedule A (Form 990-BL)  
are not open to public inspection.  
The public inspection rules do not apply to Form 990-BL  
and the attached Schedule A (Form 990-BL) filed by a  
trustee or disqualified person to report initial taxes on  
self-dealing or taxable expenditures. The public inspection  
rules also do not apply to the trustee or disqualified person's  
SSN or EIN.  
Use Form 4506-A, Request for Public Inspection or Copy  
of Exempt or Political Organization IRS Form, to request a  
copy or to inspect an exempt organization return through  
IRS. There is a fee for photocopying, but not for inspection at  
an IRS office.  
!
CAUTION  
You may request an extension of time to file Form 990-BL  
by filing Form 8868, Application for Automatic Extension of  
Time To File an Exempt Organization Return.  
Rounding off to whole dollars. You may show the money  
items on the return and accompanying schedules as  
whole-dollar amounts. To do so, drop amounts less than 50  
cents and increase any amounts from 50 to 99 cents to the  
next dollar. For example, $1.39 becomes $1 and $2.50  
becomes $3.  
If you have to add two or more amounts to figure the  
amount to enter on a line, include cents when adding the  
amounts and round off only the total.  
Attachments. If you need more space, attach separate  
sheets showing the same information in the same order as  
on the printed forms. Show the totals on the printed forms.  
Enter the trust's employer identification number (EIN) (or  
the disqualified person's social security number (SSN)) on  
each sheet. Also, use sheets that are the same size as the  
forms and indicate clearly the line of the printed form to which  
the information relates.  
Penalties  
Through the organization—Annual return. An  
organization must, during the 3-year period beginning with  
the due date (including extensions) of the Form 990-BL (or, if  
later, the date it is actually filed), make its return available for  
public inspection. It also must provide copies of either all  
items that are available for public inspection or specifically  
identified items, if so requested. All parts of the return and all  
required schedules and attachments must be made available  
except Part IV of Form 990-BL and Schedule A (Form  
990-BL) as discussed above.  
If an organization fails to file timely, correctly, or completely, it  
will have to pay $20 for each day ($105 a day if it is a large  
organization) during which such failure continues, unless it  
can be shown that the failure was due to reasonable cause.  
The maximum penalty with respect to any one return is the  
smaller of $10,500 ($53,000 for a large organization) or 5%  
of the gross receipts of the organization for the year. All these  
amounts are subject to inflationary adjustments in later years.  
The figures will be updated in the next release of the  
instructions.  
Inspection and requests for copies must be permitted  
during regular business hours at the organization's principal  
office and at each of its regional or district offices. This  
provision applies to any organization that files Form 990-BL,  
regardless of the size of the organization and whether or not  
it has any paid employees. Also, copies must be provided the  
same business day they are requested unless unusual  
circumstances exist. In the case of unusual circumstances,  
the copies must be provided by the next business day after  
the day the unusual circumstances cease to exist, but in no  
event may the delay exceed 5 business days. See  
Regulations section 301.6104(d)-1 for what constitutes  
unusual circumstances and the definition of regional and  
district offices.  
The IRS may make written demand that the delinquent  
return be filed or the information furnished within a  
reasonable time after mailing of notice of the demand. The  
person failing to comply with the demand on or before the  
date specified in the demand will have to pay $10 for each  
day the failure continues, unless there is reasonable cause.  
The maximum penalty imposed on all persons for failures  
with respect to any one return shall not exceed $5,000. If  
more than one person is liable for any failures, all such  
persons are jointly and severally liable with respect to such  
failures. See section 6652(c). All these amounts are subject  
to inflationary adjustments in later years. The figures will be  
updated in the next release of the instructions.  
When a request for copies is made in writing, the copies  
generally must be sent within 30 days of the date the request  
was received.  
To avoid having to explain an incomplete return, if a part  
or line item does not apply, enter “N/A” (not applicable) or  
“-0-” if an amount is zero.  
Note. A black lung benefit trust does not have to comply with  
individual requests for copies if it makes this information  
widely available. This can be done by posting the application  
for tax exemption and/or an annual information return on a  
readily accessible Web page. However, an organization that  
makes its information available this way must advise  
requesters how the material may be accessed. See  
Regulations section 301.6104(d)-2 for specific instructions.  
Fee for copies. An organization may charge a reasonable  
fee for providing copies.  
There are penalties for willful failure to file and for filing  
fraudulent returns and statements. (See sections 7203, 7206,  
and 7207.)  
Large organization. A large organization is one that has  
gross receipts greater than $1,067,000 for the tax year.  
In the text under Penalties, the amounts under  
section 6652(c) are subject to an annual inflation  
!
CAUTION  
adjustment. The amounts used in this text apply for  
returns required to be filed in 2020. If filing a return required  
to be filed in 2021 or later, revised amounts may apply.  
-2-  
Before the organization provides the documents, it may  
require that the individual requesting copies of the  
documents pay the fee. If the organization has provided an  
individual making a request with notice of the fee, and the  
individual does not pay the fee within 30 days, or if the  
individual pays the fee by check and the check does not clear  
upon deposit, the organization may disregard the request.  
Additional information. See Regulations sections  
301.6104(d)-1 through 301.6104(d)-3 for additional  
information on reasonable fees for providing copies, not  
filling requests for copies when material is widely available,  
and other related information.  
Exemption application. Any section 501(c)(21)  
organization that submitted an application for recognition of  
exemption to the IRS after July 15, 1987, must make  
available for public inspection a copy of its application  
(together with a copy of any papers submitted in support of  
its application) and any letter or other document issued by  
the IRS in response to the application. As in the case of  
annual returns, the copy of the application and related  
documents must be made available for inspection during  
regular business hours at the organization's principal office  
and at each of its regional or district offices having at least  
three employees.  
Penalties for failure to comply with public inspection re-  
quirements. If a person does not comply with the  
requirement to permit public inspection of annual returns,  
there is a penalty of $20 for each day during which such  
failure continues, unless there is reasonable cause. The  
maximum penalty imposed on all persons for failures that  
apply to any one return is $10,500.  
If a person does not comply with the public inspection of  
applications requirement, there is a penalty of $20 a day for  
each day during which such failure continues, unless there is  
reasonable cause. There is no maximum penalty limitation  
(see section 6652(c)).  
Include the suite, room, or other unit number after the  
street address. If the Post Office does not deliver mail to the  
street address and the filer has a P.O. box, show the box  
number instead of the street address.  
Foreign address. Enter the information in the following  
order: city or town, state or province, and country. Follow the  
country's practice for entering the postal code, if any. Do not  
abbreviate the country name.  
“Return filed by.” Check only the box that applies to you.  
1. Check the “Trust” box when the return is filed by a  
black lung benefit trust as an information return, or tax return,  
or both.  
2. Check the “Trustee” box when the return is filed by a  
trustee because of liability for taxes under section 4951 or  
4952, or both.  
3. Check the “Disqualified person” box when the return is  
filed by a disqualified person who is liable for section 4951  
tax only.  
Taxpayer identification number. Enter the EIN of the  
black lung benefit trust. If the return is being filed by a trustee  
or disqualified person, also enter that person's SSN or EIN.  
Each trust should have only one employer identification  
number. If the trust has more than one number and has not  
been advised which one to use, you should notify the:  
Internal Revenue Service Center  
Attention: Entity Control, Stop 6273  
Ogden, UT 84201-0027  
Inform the IRS Center what numbers the trust has, the  
name and address to which each number was assigned, and  
the address of its principal office. The IRS will then advise  
you which number to use.  
Application pending, address change, and FMV of as-  
sets. Fill in these blocks only when a return must be filed for  
a trust. Enter the fair market value (FMV) of the trust's assets  
at the beginning of the operator's tax year within which the  
trust's tax year begins.  
Signature. The return must be signed by the authorized  
trustee or trustees and also by any person, firm, or  
corporation who prepared the return. If the return is prepared  
by a firm or corporation, it should be signed in the name of  
the firm or corporation.  
Paid preparer. Generally, anyone who is paid to prepare  
the return must sign the return and fill in the other blanks in  
the Paid Preparer Use Only area. An employee of the filing  
organization is not a paid preparer.  
In the text in the last two paragraphs, the amounts  
under section 6652(c) are subject to an annual  
!
CAUTION  
inflation adjustment. The amounts used in this text  
apply for returns required to be filed in 2020. If filing a return  
required to be filed in 2021 or later, revised amounts may  
apply.  
Any person who willfully does not comply with the public  
inspection requirements for the annual return or application is  
subject to an additional penalty of $5,000 for each return or  
application (see section 6685).  
If more than one person is liable for any penalty, all such  
persons shall be jointly and severally liable for each failure.  
The paid preparer must:  
Specific Instructions  
Sign the return in the space provided for the preparer's  
signature,  
Identification Area  
Enter the preparer information, and  
Give a copy of the return to the organization.  
The paid preparer also must enter the preparer's  
Period covered by the return. Enter the calendar year or  
fiscal year that corresponds to the accounting period being  
reported.  
identifying number and the firm's EIN. The preparer's  
identifying number is the preparer's taxpayer identification  
number (PTIN).  
Name and address. Enter the name and address of the  
trust.  
Because the Form 990-BL is a publicly disclosable  
If the return and a Schedule A (Form 990-BL) are filed by a  
trustee or disqualified person liable for tax under section  
4951 or 4952, then enter that person's name and address  
below the name of the trust.  
document, any information entered in this block will  
!
CAUTION  
be publicly disclosed (see Public Inspection of  
Completed 990-BL Returns and Approved Exemption  
Applications). Any paid preparer whose identifying number  
-3-  
must be listed on Form 990-BL can apply for and obtain a  
PTIN using Form W-12, IRS Paid Preparer Tax Identification  
Number (PTIN) Application and Renewal. For more  
information about applying for a PTIN online, visit the IRS  
website at IRS.gov/PTIN.  
Line 9. Enter the administrative expenses (including legal,  
accounting, actuarial, and trustee expenses) for the year  
other than salaries and wages paid to trustees and other  
employees.  
Line 10. Attach a schedule, listing by type and amount, all  
allowable deductions that are not deductible elsewhere on  
Form 990-BL. Enter the total of these deductions on line 10.  
See Regulations section 1.501(c)(21)-1 for additional  
information.  
Paid preparer authorization. On the last line of the  
Signature Block, check “Yes,” if the IRS can contact the paid  
preparer who signed the return to discuss the return. This  
authorization applies only to the individual whose signature  
appears in the Paid Preparer Use Only section of Form  
990-BL. It does not apply to the firm, if any, shown in that  
section. By checking “Yes,” to this box, the organization is  
authorizing the IRS to contact the paid preparer to answer  
any questions that arise during the processing of the return.  
Part II—Balance Sheets  
Complete the balance sheets on the basis of the accounting  
method regularly used by the trust in keeping its books and  
records.  
The organization also is authorizing the paid preparer to:  
Line 19. Enter only liabilities of the trust as of the first and  
last days of the tax year of the trust. Include payments for  
approved black lung claims that are due but not paid,  
accrued trustee fees, etc. Do not include amounts for black  
lung claims being contested, the present value of payments  
for approved claims, or the estimated liability for future  
claims.  
Line 21. Enter the total of lines 19 and 20. That figure must  
equal the figure for total assets reported on line 18 for both  
the beginning and end of year.  
Give the IRS any information missing from the return;  
Call the IRS for information about processing the return;  
and  
Respond to certain IRS notices about math errors, offsets,  
and return preparation.  
The organization is not authorizing the paid preparer to  
bind the organization to anything or otherwise represent the  
organization before the IRS.  
The authorization will automatically end no later than the  
due date (excluding extensions) for filing next year's Form  
990-BL. If the organization wants to expand the paid  
preparer’s authorization or revoke it before it ends, see Pub.  
947, Practice Before the IRS and Power of Attorney.  
Part III—Questionnaire  
General Instructions  
The Black Lung Benefits Revenue Act of 1977 imposes  
excise taxes and penalties on acts of self-dealing between  
trusts and disqualified persons, and on taxable expenditures  
made by the trusts. These taxes and penalties apply to the  
trust (section 4952), trustees (sections 4951 and 4952), and  
self-dealers (section 4951). The purpose of the questions is  
to determine whether there is any initial tax due under either  
of these two sections.  
Check “No,” if the IRS should contact the organization or  
its trustee rather than the paid preparer.  
Part I—Analysis of Revenue and  
Expenses  
Line 1. Enter the total contributions received under section  
192 from the coal mine operator who established the trust.  
Contributions to the trust must be in cash or property of  
the type in which the trust is permitted to invest (i.e., public  
debt securities of the United States, obligations of a state or  
local government that are not in default as to principal or  
interest, or time and demand deposits in a bank or insured  
credit union as described in section 501(c)(21)(D)(ii)).  
Definitions  
Self-dealing (Section 4951)  
Self-dealing. For purposes of section 4951, the term  
“self-dealing” means any direct or indirect:  
Sale, exchange, or leasing of real or personal property  
Line 2. Enter the amounts received during the year from the  
between a trust described in section 501(c)(21) and a  
disqualified person;  
sources listed in 2a, b, c, and d.  
Lending of money or other extension of credit between  
Line 4. Enter the amounts contributed by the trust to the  
Federal Black Lung Disability Trust Fund as provided for by  
section 3(b)(3) of Public Law 95-227.  
Line 5. Enter the amounts paid for insurance exclusively  
covering liabilities under sections 501(c)(21)(A)(i)(I), and  
501(c)(21)(A)(i)(IV). For details, see Regulations section  
1.501(c)(21)-1(d).  
such a trust and a disqualified person;  
Furnishing of goods, services, or facilities between such a  
trust and a disqualified person;  
Payment of compensation (or payment or reimbursement  
of expenses) by such a trust to a disqualified person; and  
Transfers to, or use by or for the benefit of, a disqualified  
person of the income or assets of such a trust.  
Line 6. Enter the amounts paid to or for the benefit of miners  
or their beneficiaries other than amounts included in lines 4  
or 5. Such payments could include direct payment of medical  
bills, etc., authorized by the Act and accident and health  
benefits for retired miners and their spouses and  
dependents.  
Special rules. For purposes of section 4951:  
The transfer of personal property by a disqualified person  
to such a trust is treated as a sale or exchange if the property  
is subject to a mortgage or similar lien;  
If a bank or an insured credit union is a trustee of the trust  
or otherwise is a “disqualified person” with respect to the  
trust, any amount invested in checking accounts, savings  
accounts, certificates of deposit, or other time or demand  
deposits in that bank or credit union constitutes a lending of  
money;  
Line 7. Enter the total amount of compensation for the year  
of all trustees. See Part III, line 26.  
Line 8. Enter the total of the salaries and wages of all  
employees other than those included in line 7.  
-4-  
The furnishing of goods, services, or facilities by a  
8. A trust or estate in which persons described in 1, 2, 3,  
4, or 5 hold more than 35% of the beneficial interest.  
disqualified person to such a trust is not an act of self-dealing  
if the furnishing is without charge and if the goods, services,  
or facilities so furnished are used exclusively for the  
purposes specified in section 501(c)(21)(A); and  
For purposes of items 3a and 6 above, indirect  
stockholdings are taken into account if they would be taken  
into account under section 267(c), except that, for purposes  
of this paragraph, section 267(c)(4) is treated as providing  
that the members of the family of an individual are only those  
individuals described in item 5. For purposes of items 3b and  
c, 7, and 8, the ownership of profits or beneficial interests is  
determined by the rules for constructive ownership of stock  
provided in section 267(c) (other than paragraph (3)), except  
that section 267(c)(4) is treated as providing that the  
members of the family of an individual are only those  
individuals described in item 5.  
The payment of compensation (and the payment or  
reimbursement of expenses) by such a trust to a disqualified  
person for personal services that are reasonable and  
necessary to carry out the exempt purpose of the trust is not  
an act of self-dealing if the compensation (or payment or  
reimbursement) is not excessive. See Regulations section  
53.4951-1 for additional information.  
Taxable period. The term “taxable period” means, with  
respect to any act of self-dealing, the period beginning with  
the date on which the act of self-dealing occurs and ending  
on the earliest of:  
1. The date of mailing of a notice of deficiency under  
section 6212, with respect to the tax imposed by section  
4951(a)(1),  
Payment of benefits. For purposes of section 4951, a  
payment out of assets or income of a trust described in  
section 501(c)(21) for the purposes described in sections  
501(c)(21)(A)(i)(I) and 501(c)(21)(A)(i)(IV) is not considered  
an act of self-dealing.  
2. The date on which the tax imposed by section 4951(a)  
(1) is assessed, or  
Taxable Expenditures (Section 4952)  
3. The date on which correction of the act of self-dealing  
is completed.  
Taxable expenditure. For purposes of section 4952, the  
term “taxable expenditure” means any amount paid or  
incurred by a trust described in section 501(c)(21) other than  
for a purpose specified in that section.  
Correction. The terms “correction” and “correct” mean, with  
respect to any taxable expenditure, placing the trust in a  
financial position not worse than that in which it would have  
been if the taxable expenditure had not been made:  
Amount involved. The term “amount involved” means, for  
any act of self-dealing, the greater of the amount of money  
and the fair market value (FMV) of the other property given or  
the amount of money and the FMV of the other property  
received. However, in the case of services described in  
section 4951(d)(2)(C), the amount involved is only the  
excess compensation. For purposes of the preceding  
sentence, the FMV:  
1. By recovering all or part of the expenditure to the  
extent recovery is possible, and  
1. For the initial taxes imposed by section 4951(a), is  
determined as of the date on which the act of self-dealing  
occurs; and  
2. When full recovery is not possible, by contributions by  
the person or persons whose liabilities for black lung benefit  
claims (as defined in section 192(e)) are to be paid out of the  
trust.  
2. For additional taxes imposed by section 4951(b), is the  
highest FMV during the taxable period.  
Taxable period. The term “taxable period” means, with  
respect to any taxable expenditure, the period beginning with  
the date on which the taxable expenditure occurs and ending  
on the earlier of:  
1. The date of mailing a notice of deficiency under  
section 6212 with respect to the tax imposed by section  
4952(a)(1), or  
Correction. The terms “correction” and “correct” mean, for  
any act of self-dealing, undoing the transaction to the extent  
possible, but in any case, placing the trust in a financial  
position not worse than that in which it would be if the  
disqualified person were dealing under the highest fiduciary  
standards.  
Disqualified person. The term “disqualified person” means,  
2. The date on which the tax imposed by section 4952(a)  
for a trust described in section 501(c)(21), a person who is:  
(1) is assessed.  
1. A contributor to the trust;  
2. A trustee of the trust;  
Specific Instructions  
Line 22. A “conformed” copy is one that agrees with the  
original document, and all amendments to it. If the copies are  
not signed, they must be accompanied by a written  
declaration signed by an officer authorized to sign for the  
organization certifying that they are complete and accurate  
copies of the original documents.  
Chemically or photographically reproduced copies of  
articles of incorporation showing the certification of an  
appropriate state official need not be accompanied by such a  
declaration. See Rev. Proc. 68-14, 1968-1 C.B. 768, for  
additional information.  
3. An owner of more than 10% of:  
a. The total combined voting power of a corporation,  
b. The profits interest of a partnership, or  
c. The beneficial interest of a trust or unincorporated  
enterprise, which is a contributor to the trust;  
4. An officer, director, or employee of a person who is a  
contributor to the trust;  
5. The spouse, ancestor, lineal descendant, or spouse of  
a lineal descendant of an individual described in 1, 2, 3, or 4;  
6. A corporation of which persons described in 1, 2, 3, 4,  
or 5 own more than 35% of the total combined voting power;  
Line 23. If you answered “Yes,” to 23a(1), (2), (3), (4), or (5)  
and “No,” to 23b, notify each self-dealer and trustee who may  
be liable for initial taxes under section 4951 of the  
7. A partnership in which persons described in 1, 2, 3, 4,  
or 5 own more than 35% of the profits interest; or  
requirement to file a return for each year (or part of a year)  
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and pay the applicable tax. The trust also must furnish the  
information required by Schedule A (Form 990-BL), Part I,  
Section A (other than columns (g) and (h)) on its own return.  
Part IV—Statement With Respect to  
Contributors, etc.  
For exceptions to the self-dealing rules, see Special Rules  
Note. This part is not open for public inspection.  
and Payment of Benefits, earlier.  
Statement with respect to contributors, etc. For returns  
filed for tax years ending on or after December 31, 2018,  
Form 990-BL filers are no longer required to report the  
names and addresses of persons who contributed $5,000 or  
more in the tax year. Accordingly, filers will enter “N/A” on  
line 1 of Part IV of Form 990-BL for each such contribution.  
Line 24. If you answered “Yes,” complete Part I, Section B  
(other than column (h)) and Part II of Schedule A (Form  
990-BL). The trust also must notify any trustees who may be  
liable for initial taxes under section 4952 of the requirement  
to file Form 990-BL, Schedule A (Form 990-BL), and to pay  
the tax.  
Note. Under regulations proposed by the Treasury  
Department and the IRS, certain organizations would not  
have to report the names and addresses of their contributors  
on Schedule B. These organizations must continue to:  
Line 25. If you answered “No,” or if there were multiple acts  
or transactions giving rise to Chapter 42 taxes and all of them  
were not corrected, attach an explanation of each  
uncorrected act including the names of all parties to the act,  
the date of the act, the amount involved, why the act has not  
been corrected, and the date you expect correction to be  
made.  
Collect the names and addresses of their contributors,  
Keep this information in their records and books, and  
Make the information available to the IRS upon request.  
Line 2. If the trust receives contributions that are more than  
what the contributor can deduct under section 192, the  
person making the excess contributions may be required to  
file Form 6069, Return of Excise Tax on Excess  
Line 26. List each of the organization's officers, directors,  
trustees, and other persons having responsibilities or powers  
similar to those of officers, directors, or trustees. List all of  
these persons even if they did not receive any compensation  
from the organization. Show all forms of compensation  
received by each listed officer, etc. Enter “-0-” in columns (c),  
(d), and (e) if none was paid.  
Contributions to Black Lung Benefit Trust Under Section  
4953 and Computation of Section 192 Deduction, and pay  
the tax imposed by section 4953(a).  
Note. If you pay any other person, such as a management  
service company, for the services provided by any of your  
officers, directors, trustees, or key employees, report the  
compensation and other items on line 26 as if you had paid  
the officer, etc. directly.  
Column (b). In column (b), a numerical estimate of average  
hours per week devoted to the position is required for a  
complete answer. Phrases such as “as needed” or “as  
required” are unacceptable.  
Column (c). Include all forms of deferred compensation  
(whether or not funded and whether or not the deferred  
compensation plan is a qualified plan under section 401(a))  
and payments to welfare benefit plans on behalf of the  
officers, etc.  
Column (d). Enter expense allowances or reimbursements  
that the recipients must report as income on their separate  
income tax returns. Examples include amounts for which the  
recipient did not account to the organization or allowances  
that were more than the payee spent on serving the  
organization. Include payments made under indemnification  
arrangements, the value of the personal use of housing,  
automobiles, or other assets owned or leased by the  
organization (or provided for the organization's use without  
charge), as well as any other taxable and nontaxable fringe  
benefits. Get Pub. 525, Taxable and Nontaxable Income, for  
details.  
Instructions for Schedule A (Form  
990-BL)  
Initial Excise Taxes on Black Lung Benefit  
Trusts and Certain Related Persons  
General Instructions  
Schedule A (Form 990-BL) is not open for public inspection.  
If you attach any exhibits to Schedule A (Form 990-BL), be  
sure to label them and write “Not open for public inspection”  
on them.  
Purpose of form. Use Schedule A (Form 990-BL) only to  
report initial taxes under section 4951 or 4952. Schedule A  
(Form 990-BL) must be attached to a completed Form  
990-BL. It cannot be filed separately. If no taxes are due  
under section 4951 or 4952, do not file Schedule A (Form  
990-BL).  
Specific Instructions  
See Who Must File in the “General Instructions” and the  
“Specific Instructions” of Form 990-BL for completing the  
identification area of this schedule.  
When filer is a trust. A trust filing this schedule for a year in  
which there are initial taxes due under section 4951 or 4952  
completes Part I as follows:  
Column (e). Enter salary, fees, bonuses, and severance  
Section A (Section 4951). Enter the information required in  
payments received by each person listed.  
columns (b) through (f). Enter “N/A” in columns (g) and (h).  
Black lung benefit trusts that pay salaries, wages, or other  
compensation to officers or other employees generally are  
liable for filing Form 941, Employer's Quarterly Federal Tax  
Return, and Form 940, Employer's Annual Federal  
Section B (Section 4952). Enter the information required in  
columns (b) through (g). Enter “N/A” in column (h).  
When filer is a self-dealer, Section A only. A self-dealer  
liable for initial taxes under section 4951 completes this  
schedule by entering the information required by columns (b)  
through (g) of Section A, Part I. Enter “N/A” in column (h).  
Enter only the “prorated” portion of column (g) on line 1 of  
Part II.  
Unemployment (FUTA) Tax Return, to report social security,  
withholding, and federal unemployment taxes.  
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who knowingly agreed to the expenditure must pay a tax of  
2.5% of the amount of the taxable expenditure unless such  
agreement was not willful and was due to reasonable cause.  
When filer is a trustee, Sections A and B. A trustee liable  
for initial taxes under sections 4951 and 4952 completes this  
schedule by entering the required information in columns (b)  
through (h) (other than (g)) of Section A and/or Section B,  
Part I. For Section A, enter the “prorated” portion of column  
(h) on line 2 of Part II. For Section B, enter the “prorated”  
portion of column (h) on line 4 of Part II.  
Liability for tax. A person's liability for tax as a self-dealer  
or trustee under sections 4951 and 4952 is joint and several.  
Therefore, if more than one person is liable for tax on an act  
of self-dealing as a self-dealer or trustee, they may prorate  
the tax among themselves. The IRS may assess a deficiency  
against one or more self-dealers or trustees liable for the tax  
under section 4951 or 4952, regardless of the apportionment  
of tax shown on the return, if the amount paid by all those  
who are liable for a particular transaction, is less than the  
total tax due for that transaction.  
Part I—Initial Taxes on Self-dealing and Taxable  
Expenditures  
Disqualified persons and trustees who participate in acts of  
self-dealing with a section 501(c)(21) trust and who have tax  
years different from the trust should use their own tax years  
to figure the initial tax and file the return.  
Initial Section 4951 taxes on self-dealer. An initial tax of  
10% of the amount involved is imposed for each act of  
self-dealing between a disqualified person and a section  
501(c)(21) trust, for each year (or part of a year) in the  
taxable period. The tax is paid by any disqualified person  
(other than a trustee acting only as such) who participated in  
the act of self-dealing.  
Initial Section 4951 taxes on trustee. When a tax is  
imposed on an act of self-dealing, any trustee who knowingly  
participated in such an act must pay a tax of 2.5% of the  
amount involved in the act of self-dealing for each year (or  
part of a year) in the taxable period unless participation in the  
act was not willful and was due to reasonable cause.  
Part II—Summary of Taxes  
Generally, no more than three lines in Part II will be  
completed on any return. However, when a trustee is liable  
for section 4951 initial taxes, both as a trustee and as a  
self-dealer, and also is liable for section 4952 initial taxes  
because of taxable expenditure involvement, enter the  
section 4951 taxes on lines 1 and 2 and enter the section  
4952 tax on line 4, with a total of the tax due on line 5. Pay in  
full with the return. Make the check or money order payable  
to the “United States Treasury”. In all other instances, follow  
“Specific Instructions” given above.  
The payment of section 4951 tax for the tax year will not  
necessarily satisfy the entire initial tax liability for an act of  
self-dealing. A self-dealer who is liable for tax under section  
4951 must file Form 990-BL, Schedule A (Form 990-BL), and  
must pay the tax for each year (or part of a year) in the  
“taxable period.”  
Initial Section 4952 taxes on trust. An initial tax of 10% of  
the amount of the expenditure is imposed on each taxable  
expenditure from the assets of a section 501(c)(21) trust. The  
tax is paid by the trustee out of the assets of the trust.  
Initial Section 4952 taxes on trustee. When a tax is  
imposed on the trust for a taxable expenditure, any trustee  
Paperwork Reduction Act Notice. We ask for the information on these forms to carry out the Internal Revenue laws of the  
United States. You are required to give us the information. We need it to ensure that you are complying with these laws.  
The organization isn't required to provide the information requested on a form that is subject to the Paperwork Reduction Act  
unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as  
long as their contents can become material in the administration of any Internal Revenue law. The rules governing the  
confidentiality of Form 990-BL are covered in section 6104.  
The time needed to complete and file this form and related schedules will vary depending on individual circumstances. The  
estimated average times are:  
Learning about the law or the Preparing and sending the form  
Form  
Recordkeeping  
16 hr., 30 min.  
7 hr., 10 min.  
form  
to the IRS  
3 hr., 48 min.  
25 min.  
990-BL  
3 hr., 22 min.  
18 min.  
Sch. A (Form 990-BL)  
If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we  
would be happy to hear from you. You can send us comments from IRS.gov/FormComments. Or you can write to the Internal  
Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224.  
Don't send your return to this address. Instead, see When and Where To File, earlier, for the location for filing your return.  
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