Instructions for

Form 990-BL

(Rev. January 2020)

Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain 

Related Persons

(Use with the December 2013 revision of Form 990-BL)

Department of the Treasury

Internal Revenue Service

Section references are to the Internal Revenue Code unless 

otherwise noted.

Future Developments

For the latest information about developments related to 

Form 990-BL and its instructions, such as legislation enacted 

after they were published, go to IRS.gov/Form990bl.

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 

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 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.

Dec 20, 2019 Cat. No. 10316J
Private delivery services can’t deliver items to P.O. 

boxes. You must use the U.S. Postal Service to mail 

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

You may request an extension of time to file Form 990-BL 

by filing Form 8868, Application for Automatic Extension of 

Time To File an Exempt Organization Return.

Rounding off to whole dollars. You may show the money 

items on the return and accompanying schedules as 

whole-dollar amounts. To do so, drop amounts less than 50 

cents and increase any amounts from 50 to 99 cents to the 

next dollar. For example, $1.39 becomes $1 and $2.50 

becomes $3.

If you have to add two or more amounts to figure the 

amount to enter on a line, include cents when adding the 

amounts and round off only the total.

Attachments. If you need more space, attach separate 

sheets showing the same information in the same order as 

on the printed forms. Show the totals on the printed forms.

Enter the trust's employer identification number (EIN) (or 

the disqualified person's social security number (SSN)) on 

each sheet. Also, use sheets that are the same size as the 

forms and indicate clearly the line of the printed form to which 

the information relates.

Penalties

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.

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 

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.

CAUTION

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CAUTION

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Public Inspection of Completed 

990-BL Returns and Approved 

Exemption Applications

Through the IRS. Generally, the information reported on or 

with Form 990-BL, including most attachments, is available 

for public inspection (section 6104(b)). This applies both to 

information required by the form and to information furnished 

voluntarily. Approved applications for exemption from federal 

income tax also are available for public inspection.

Exception. Part IV of Form 990-BL, Statement With 

Respect to Contributors, etc., and Schedule A (Form 990-BL) 

are not open to public inspection.

The public inspection rules do not apply to Form 990-BL 

and the attached Schedule A (Form 990-BL) filed by a 

trustee or disqualified person to report initial taxes on 

self-dealing or taxable expenditures. The public inspection 

rules also do not apply to the trustee or disqualified person's 

SSN or EIN.

Use Form 4506-A, Request for Public Inspection or Copy 

of Exempt or Political Organization IRS Form, to request a 

copy or to inspect an exempt organization return through 

IRS. There is a fee for photocopying, but not for inspection at 

an IRS office.

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.

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.

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Before the organization provides the documents, it may 

require that the individual requesting copies of the 

documents pay the fee. If the organization has provided an 

individual making a request with notice of the fee, and the 

individual does not pay the fee within 30 days, or if the 

individual pays the fee by check and the check does not clear 

upon deposit, the organization may disregard the request.

Additional information. See Regulations sections 

301.6104(d)-1 through 301.6104(d)-3 for additional 

information on reasonable fees for providing copies, not 

filling requests for copies when material is widely available, 

and other related information.

Exemption application. Any section 501(c)(21) 

organization that submitted an application for recognition of 

exemption to the IRS after July 15, 1987, must make 

available for public inspection a copy of its application 

(together with a copy of any papers submitted in support of 

its application) and any letter or other document issued by 

the IRS in response to the application. As in the case of 

annual returns, the copy of the application and related 

documents must be made available for inspection during 

regular business hours at the organization's principal office 

and at each of its regional or district offices having at least 

three employees.

Penalties for failure to comply with public inspection 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)).

In the text in the last two paragraphs, the amounts 

under section 6652(c) are subject to an annual 

inflation adjustment. The amounts used in this text 

apply for returns required to be filed in 2020. If filing a return 

required to be filed in 2021 or later, revised amounts may 

apply.

Any person who willfully does not comply with the public 

inspection requirements for the annual return or application is 

subject to an additional penalty of $5,000 for each return or 

application (see section 6685).

If more than one person is liable for any penalty, all such 

persons shall be jointly and severally liable for each failure.

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.

CAUTION

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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.

Foreign address. Enter the information in the following 

order: city or town, state or province, and country. Follow the 

country's practice for entering the postal code, if any. Do not 

abbreviate the country name.

“Return filed by.” Check only the box that applies to you.

1. Check the “Trust” box when the return is filed by a 

black lung benefit trust as an information return, or tax return, 

or both.

2. Check the “Trustee” box when the return is filed by a 

trustee because of liability for taxes under section 4951 or 

4952, or both.

3. Check the “Disqualified person” box when the return is 

filed by a disqualified person who is liable for section 4951 

tax only.

Taxpayer identification number. Enter the EIN of the 

black lung benefit trust. If the return is being filed by a trustee 

or disqualified person, also enter that person's SSN or EIN.

Each trust should have only one employer identification 

number. If the trust has more than one number and has not 

been advised which one to use, you should notify the:

Internal Revenue Service Center

Attention: Entity Control, Stop 6273

Ogden, UT 84201-0027

Inform the IRS Center what numbers the trust has, the 

name and address to which each number was assigned, and 

the address of its principal office. The IRS will then advise 

you which number to use.

Application pending, address change, and FMV of 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.

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).

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 Approved Exemption 

Applications). Any paid preparer whose identifying number 

CAUTION

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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.

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 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), 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.

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.

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.

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.

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;

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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.

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.

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, 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.

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.

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.

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 taxes under section 4951 of the 

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

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and pay the applicable tax. The trust also must furnish the 

information required by Schedule A (Form 990-BL), Part I, 

Section A (other than columns (g) and (h)) on its own return.

For exceptions to the self-dealing rules, see Special Rules 

and Payment of Benefits, earlier.

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.

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.

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.

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.

Part IV—Statement With Respect to 

Contributors, etc.

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.

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 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).

Instructions for Schedule A (Form 

990-BL)

Initial Excise Taxes on Black Lung Benefit 

Trusts and Certain Related Persons

General Instructions

Schedule A (Form 990-BL) is not open for public inspection. 

If you attach any exhibits to Schedule A (Form 990-BL), be 

sure to label them and write “Not open for public inspection” 

on them.

Purpose of form. Use Schedule A (Form 990-BL) only to 

report initial taxes under section 4951 or 4952. Schedule A 

(Form 990-BL) must be attached to a completed Form 

990-BL. It cannot be filed separately. If no taxes are due 

under section 4951 or 4952, do not file Schedule A (Form 

990-BL).

Specific Instructions

See Who Must File in the “General Instructions” and the 

“Specific Instructions” of Form 990-BL for completing the 

identification area of this schedule.

When filer is a trust. A trust filing this schedule for a year in 

which there are initial taxes due under section 4951 or 4952 

completes Part I as follows:

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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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.

Part I—Initial Taxes on Self-dealing and Taxable 

Expenditures

Disqualified persons and trustees who participate in acts of 

self-dealing with a section 501(c)(21) trust and who have tax 

years different from the trust should use their own tax years 

to figure the initial tax and file the return.

Initial Section 4951 taxes on self-dealer. An initial tax of 

10% of the amount involved is imposed for each act of 

self-dealing between a disqualified person and a section 

501(c)(21) trust, for each year (or part of a year) in the 

taxable period. The tax is paid by any disqualified person 

(other than a trustee acting only as such) who participated in 

the act of self-dealing.

Initial Section 4951 taxes on trustee. When a tax is 

imposed on an act of self-dealing, any trustee who knowingly 

participated in such an act must pay a tax of 2.5% of the 

amount involved in the act of self-dealing for each year (or 

part of a year) in the taxable period unless participation in the 

act was not willful and was due to reasonable cause.

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 

2.5% 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.

Part II—Summary of Taxes

Generally, no more than three lines in Part II will be 

completed on any return. However, when a trustee is liable 

for section 4951 initial taxes, both as a trustee and as a 

self-dealer, and also is liable for section 4952 initial taxes 

because of taxable expenditure involvement, enter the 

section 4951 taxes on lines 1 and 2 and enter the section 

4952 tax on line 4, with a total of the tax due on line 5. Pay in 

full with the return. Make the check or money order payable 

to the “United States Treasury”. In all other instances, follow 

“Specific Instructions” given above.

The payment of section 4951 tax for the tax year will not 

necessarily satisfy the entire initial tax liability for an act of 

self-dealing. A self-dealer who is liable for tax under section 

4951 must file Form 990-BL, Schedule A (Form 990-BL), and 

must pay the tax for each year (or part of a year) in the 

“taxable period.”

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 

form

Preparing and sending the 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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