Department of the Treasury

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

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

CAUTION any item to an IRS P.O. box address.

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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.

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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.

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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

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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.

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• 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)

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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.

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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.

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.

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