990-BL Instructions for Form 990-BL

Instructions for
Form 990-BL

Department of the Treasury
Internal Revenue Service

(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.

Future Developments

If no tax is due under section 4951 or 4952, do not file
Schedule A (Form 990-BL).

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.

General Instructions
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.
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.

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.
A trust that normally has gross receipts of $50,000 or less
may file an annual electronic notice instead of filing Form
990-BL. See IRS.gov/Charities & Other Non-Profits and click
on “Annual Reporting & Filing,” and then click on “Annual
electronic notice (e-Postcard) for small exempt
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).
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).
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
Dec 20, 2019

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.
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.
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).

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.

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.

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:
Department of the Treasury
Internal Revenue Service Center
Kansas City, MO 64999
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
IRS.gov/PDSstreetAddresses.
The PDS can tell you how to get written proof of the
mailing date.

Cat. No. 10316J

!

CAUTION

Public Inspection of Completed
990-BL Returns and Approved
Exemption Applications

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.

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.

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.

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.
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.
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.

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.
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.
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-

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.

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.

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.

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.

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:

Penalties for failure to comply with public inspection requirements. 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)).

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 assets. 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.

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.

!

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.

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.

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.
The paid preparer must:
• Sign the return in the space provided for the preparer's
signature,
• Enter the preparer information, and
• Give a copy of the return to the organization.
The paid preparer also must enter the preparer's
identifying number and the firm's EIN. The preparer's
identifying number is the preparer's taxpayer identification
number (PTIN).

Specific Instructions
Identification Area
Period covered by the return. Enter the calendar year or
fiscal year that corresponds to the accounting period being
reported.
Name and address. Enter the name and address of the
trust.
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.

Because the Form 990-BL is a publicly disclosable
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.
The organization also is authorizing the paid preparer to:
• 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.
Check “No,” if the IRS should contact the organization or
its trustee rather than the paid preparer.

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.

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.

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.

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
between a trust described in section 501(c)(21) and a
disqualified person;
• Lending of money or other extension of credit between
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 2. Enter the amounts received during the year from the
sources listed in 2a, b, c, and d.
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).
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
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
• 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.

8. A trust or estate in which persons described in 1, 2, 3,
4, or 5 hold more than 35% of the beneficial interest.
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.

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),
2. The date on which the tax imposed by section 4951(a)
(1) is assessed, or
3. The date on which correction of the act of self-dealing
is completed.

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.

Taxable Expenditures (Section 4952)
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.

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. 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. For additional taxes imposed by section 4951(b), is the
highest FMV during the taxable period.

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:
1. By recovering all or part of the expenditure to the
extent recovery is possible, 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.
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
2. The date on which the tax imposed by section 4952(a)
(1) is assessed.

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,
for a trust described in section 501(c)(21), a person who is:
1. A contributor to the trust;
2. A trustee of the trust;
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;
7. A partnership in which persons described in 1, 2, 3, 4,
or 5 own more than 35% of the profits interest; or

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.
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
requirement to file a return for each year (or part of a year)
-5-

Part IV—Statement With Respect to
Contributors, etc.

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.
For exceptions to the self-dealing rules, see Special Rules
and Payment of Benefits, earlier.

Note. This part is not open for public inspection.
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:
• 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 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.
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.

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
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.

Instructions for Schedule A (Form
990-BL)
Initial Excise Taxes on Black Lung Benefit
Trusts and Certain Related Persons
General Instructions

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.

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.

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.

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).

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.

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
payments received by each person listed.
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
Unemployment (FUTA) Tax Return, to report social security,
withholding, and federal unemployment taxes.

Section A (Section 4951). Enter the information required in
columns (b) through (f). Enter “N/A” in columns (g) and (h).
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.
-6-

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.

Part II—Summary of Taxes

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.

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.

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.

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:
Form

Recordkeeping

Learning about the law or the Preparing and sending the form
form
to the IRS

990-BL

16 hr., 30 min.

3 hr., 22 min.

3 hr., 48 min.

Sch. A (Form 990-BL)

7 hr., 10 min.

18 min.

25 min.

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.

-7-