Form 990-BL, Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons

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Instructions for Form 990-BL

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Instructions for
Form 990-BL

Department of the Treasury
Internal Revenue Service

(Rev. December 2008)
Information and Initial Excise Tax Return for Black Lung Benefit Trusts and
Certain Related Persons
Section references are to the Internal Revenue Code unless
otherwise noted.

Phone Help
If you have questions and/or need help completing this form, please call
1-877-829-5500. This toll free telephone service is available Monday
through Friday.

General Instructions
Purpose of Form
Form 990-BL is generally 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 must also 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 $25,000.
A trust that normally has gross receipts of $25,000 or less must file
an annual electronic notice. Seewww.irs.gov/eo 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 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).
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 the persons
required to file it but may be requested from the Forms Distribution
Center for your state by calling 1-800-TAX-FORM (1-800-829-3676).
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 with the Internal
Revenue Service, 201 W. River Center Blvd., Covington, KY 41011.
You may request an extension of time to file Form 990-BL by filing Form
8868, Application for 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
If an organization fails to file timely, correctly, or completely, it will have
to pay $20 for each day ($100 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 $10,000 ($50,000 for a large organization)
or 5% of the gross receipts of the organization for the year.
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).
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.
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 million for the tax year.

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 are also 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.

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Instructions for Form 990-BL

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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.

Specific Instructions
Identification Area

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 must also 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.

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.
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.
“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.

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 five
business days. See Regulations section 301.6104(d)-1 for what
constitutes unusual circumstances and the definition of regional and
district offices.

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, Utah 84201-0027. Inform
them 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.
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. The signature of the
preparer is not required if the return is prepared by a regular full-time
employee of the filer.

When a request for copies is made in writing, the copies must
generally be sent within 30 days of the date the request was received.
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 World Wide
Website. 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.
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.

The IRS is not authorized to redact the paid preparer’s social
security number if such SSN is entered in the paid preparer’s
CAUTION block. Because the Form 990-BL is a publicly disclosable
document, any information entered in this block will be publicly
disclosed (see Public Inspection of Completed 990-BL Returns and
Approve Exemption Applications). Accordingly, any paid preparer
whose identifying number must be listed on the Form 990-BL may wish
to apply for and obtain a PTIN using Form W-7P, Application for
Preparer Tax Identification Number.

!

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. An organization that submitted its
exemption application on or before July 15, 1987, must also comply
with this requirement if it had a copy of its application on July 15, 1987.
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.

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)).
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), 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.
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.

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 $10,000.
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)).
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.

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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.

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

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.

For purposes of 3a and 6, 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 5. For purposes of 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 5.
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.

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.
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;
• 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.
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.

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.
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.

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

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

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Instructions for Form 990-BL

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taxes under section 4951 of the requirement to file a return for each
year (or part of a year) and pay the applicable tax. The trust must also
furnish the information required by Schedule A (Form 990-BL), Part I,
Section A (other than columns (g) and (h)) on its own return.

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

For exceptions to the self-dealing rules, see Special Rules and
Payment of Benefits on page 3.

General Instructions

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 must
also 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.

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).

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.

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:
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.
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.

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.
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.

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 21/2% 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.
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 who knowingly agreed to the
expenditure must pay a tax of 21/2% of the amount of the taxable
expenditure unless such agreement was not willful and was due to
reasonable cause.
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.

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 are generally liable for
filing Forms 941 and 940 to report social security, withholding, and
Federal unemployment taxes.

Part IV—Statement With Respect to
Contributors, etc.
Note. This part is not open for public inspection.
Line 1. List the names and addresses of all persons whose
contributions during the tax year totaled $5,000 or more.
In determining whether a person has contributed $5,000 or more,
include only contributions of $1,000 or more from such person.
Separate and independent contributions need not be included if less
than $1,000. If a contribution is in the form of property and the fair
market value is readily ascertainable, the description and fair market
value must be submitted. If the fair market value of the property is not
readily ascertainable, you may submit an estimated value.
The term “person” includes individuals, fiduciaries, partnerships,
corporations, associations, trusts, and exempt organizations.
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).

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 is also liable for section 4952
initial taxes because of taxable expenditure involvement, enter the

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Page 5 of 5

Instructions for Form 990-BL

9:36 - 4-MAR-2009

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

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.”

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on these forms to carry out the Internal Revenue laws of the United
States. Our legal right to ask for the information on this form is Internal Revenue Code sections 4951 and 4952.You are required to give us the
information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of tax. Section 6109
requires filers and paid preparers to provide their identifying numbers on the return. If you do not provide the information we ask for, or provide false
or fraudulent information, you may be subject to penalties. We may disclose this information to the Department of Justice for civil or criminal litigation,
and to cities, states and the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws. We may also
disclose this information to other countries under a tax treaty, to Federal and state agencies to enforce Federal non-tax criminal laws, or to Federal
law enforcement and intelligence agencies to combat terrorism.
You are not 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 may become material in
the administration of any Internal Revenue law. Generally, tax returns and tax return information are confidential, as required by section 6103.
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
form

Preparing and sending the form
to the IRS

16 hrs., 30 min.

3 hrs., 22 min.

3 hrs., 48 min.

7 hrs., 10 min.

18 min.

25 min.

Form

Recordkeeping

990-BL
Sch. A (Form 990-BL)

If you have comments concerning the accuracy of these time estimates or suggestions for making this form and related schedule simpler, we
would be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP,
1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send the tax form to this address. Instead, see Where To File on page 1.

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