Federal Free Printable Form 990-BL (Rev. December 2013) for 2017 Federal Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons

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Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons
Form 990-BL (Rev. December 2013)

Form 990-BL Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons (Rev. December 2013) OMB No. 1545-0049 Under section 501(c)(21) of the Internal Revenue Code. ▶ Information about Form 990-BL and its instructions is available at www.irs.gov/form990bl. Department of the Treasury Internal Revenue Service For calendar year , or fiscal year beginning Name of trust , , and ending , Employer identification number (EIN) of trust Name of other person filing return Social security number (SSN) or EIN of other filer Number, street, and room or suite no. (If a P.O. box, see instructions.) If application pending, check here If address changed, check here . City or town, state or province, country, ZIP or foreign postal code Return filed by (check box that applies): Part I Revenue Expenses ▶ ▶ Trust (Open for public inspection—other than Part IV) Disqualified person (Not open for public inspection) Trustee (Not open for public inspection) Analysis of Revenue and Expenses Contributions received . . . . . . . . . . . . . . . . . . . . . . Investment income: a Interest on certain securities of the U.S., state, and local governments . . . . . . b Interest on time or demand deposits in a bank or insured credit union (described section 501(c)(21)(D)(ii)(III)) . . . . . . . . . . . . . . . . . . . . . . 1 . in . 2a 2b c Gross amount received from sale of assets . . . . . . . . Less cost or other basis and sales expenses . . . . . . . . Net gain or (loss) . . . . . . . . . . . . . . . . . . . . . . . d Other income (attach schedule) . . . . . . . . . . . . . . . . . . 3 Total revenue (add lines 1 through 2d) . . . . . . . . . . . . . . . . 4 Contributions to the Federal Black Lung Disability Trust Fund . . . . . . . . Premiums for insurance to cover liabilities described in section 501(c)(21)(A)(i)(I) 5 501(c)(21)(A)(i)(IV) . . . . . . . . . . . . . . . . . . . . . . . 6 7 8 9 10 11 12 Other payments to or for benefit of eligible coal miners, retired miners, or beneficiaries Compensation of trustees . . . . . . . . . . . . . . . . . . . . Other salaries and wages . . . . . . . . . . . . . . . . . . . . Administrative expenses not included on lines 7 and 8 (attach schedule) . . . . . Other expenses (attach schedule) . . . . . . . . . . . . . . . . . Total expenses (add lines 4 through 10) . . . . . . . . . . . . . . . Excess of revenue over expenses (subtract line 11 from line 3) . . . . . . . . Part II Assets . . FMV of assets at beginning of operator’s tax year . ▶ 1 2 Liabilities and Net Assets . . Balance Sheets 2c 2d 3 4 . . ▶ . . and . . . . . . . . 5 6 7 8 9 10 11 12 . . . . . . ▶ Beginning of year 13 14 15 16 17 18 19 20 Cash . . . . . . . . . . . Savings and interest-bearing accounts Investments in approved securities . Office supplies and equipment . . Other assets (attach schedule) . . Total assets (add lines 13 through 17) Liabilities (see instructions) . . . . Net assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .▶ . . 13 14 15 16 17 18 19 20 21 Total liabilities and net assets (add lines 19 and 20) . . . . . . 21 The books are in care of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ End of year Telephone number ▶ ▶ Located at ▶ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer or trustee) is based on all information of which preparer has any knowledge. ▲▲ Sign Here Paid Preparer Use Only Date Signature of officer or trustee Type or print name and title Print/Type preparer’s name Preparer's signature Date Firm’s name ▶ Firm's EIN Firm's address ▶ Phone no. May the IRS discuss this return with the preparer shown above? (see instructions) . For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. . . PTIN Check if self-employed . . . Cat. No. 10315Y . . . ▶ . Form . Yes 990-BL No (Rev. 12-2013) Form 990-BL (Rev. 12-2013) Page Questionnaire Part III 2 Yes No Have you made any changes not previously reported to the Internal Revenue Service in your governing instrument, or other similar instrument? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 23 If “Yes,” attach a conformed copy of the changes. Taxes on self-dealing (section 4951): a During the year did the trust (either directly or indirectly): (1) Engage in the sale, exchange, or leasing of property with a disqualified person? . . . . . . . (2) Borrow or lend money or otherwise extend credit to (or accept it from) a disqualified person? . . . (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? . . . . . . (4) Pay compensation to, or pay or reimburse expenses of, a disqualified person? . . . . . . . . (5) Transfer any income or assets to, or for use by or for the benefit of, a disqualified person? . . . . b If the answer is “Yes” to any of questions 23a(1) through 23a(5), were all of the acts in which you excepted acts as described in the instructions? . . . . . . . . . . . . . . . . . . . c 24 25 26 If the answer is “No” to question 23b, complete Schedule A (Form 990-BL), Part I, Section A. Taxes on taxable expenditures (section 4952): During the year did you pay, or incur a liability to pay, any amount for any purpose other than for payment of: (1) black lung benefits, (2) administrative expenses of the trust, (3) premiums for insurance covering liabilities for black lung benefits, (4) permitted benefits for retired miners, their spouses, and dependents, (5) permitted investments of trust funds, (6) transfer of funds to the Federal Black Lung Disability Fund or to the general fund of the U.S. Treasury, or (7) return of excess contributions to the coal mine operator who contributed them?. . . . . . . . . . . . . . . . . . . . . . . If the answer is “Yes,” complete Schedule A, Form 990-BL, Part I, Section B. Have you taken corrective action for any transaction that resulted in Chapter 42 taxes being reported on Schedule A, Form 990-BL? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If “Yes,” attach a detailed documentation and description of the corrective action taken and, if applicable, enter the fair market value of any property recovered as a result of the correction. ▶ $ For any uncorrected acts, attach explanation (see instructions). Officers, directors, trustees and their compensation, if any, for the tax year: (b) Title and time devoted to position (a) Name and Address Total . . Part IV 1 . . . . . . . . . . . . . . . . . . . . Statement With Respect to Contributors, etc. — . . . (d) Expense account, other allowances (c) Contributions to employee benefit plans . . . . . . . . . . . (e) Compensation (If not paid, enter zero.) ▶ (Not open for public inspection) Persons who contributed $5,000 or more in the taxable year (if more space is needed, attach schedule): Name 2 . . . . . . . . . . . . . . . engaged . . . Address During the period covered by this return did the trust receive any contributions in excess of the maximum allowable deduction for the contributor under section 192? . . . . . . . . . . . . . . . . . . Form 990-BL Yes No (Rev. 12-2013) Form 990-BL (Rev. 12-2013) Page 3 Schedule A—Initial Excise Taxes on Black Lung Benefit Trusts and Certain Related Persons Under sections 4951 and 4952 of the Internal Revenue Code NOT OPEN FOR PUBLIC INSPECTION For the calendar year , or fiscal year beginning Name of trust/person filing return (see instructions) , , and ending , EIN or SSN of filer (see instructions) Name of related section 501(c)(21) trust (if applicable) Trust Return filed by (see instructions, check box that applies): Part I (a) Act number Trustee Disqualified person Initial Taxes on Self-dealing (Section 4951) and Taxable Expenditures (Section 4952) SECTION A—Acts of Self-dealing and Tax Computation (Section 4951) (b) Date of act (c) Description of act 1 2 3 4 (d) Names of disqualified persons liable for tax (e) Names of trustees liable for tax (g) Initial tax on self-dealing disqualified person (10% of column (f)) (f) Amount involved in act (h) Tax on trustee (if applicable) (2½% of column (f)) Total (add lines 1 through 4, columns (g) and (h)) . . . . . . ▶ SECTION B—Taxable Expenditures and Tax Computation (Section 4952) (a) Item number (b) Amount (c) Date paid or incurred (e) Description of expenditure and purposes for which made (d) Name and address of recipient 1 2 3 4 (g) Tax imposed on trust (10% of column (b)) (f) Names of trustees liable for tax Total (Add lines 1 through 4, columns (g) and (h)) . Part II . . . . . . . . . . (h) Tax imposed on trustee (if applicable) (2½% of column (b)) ▶ Summary of Taxes 1 Enter amount of section 4951 tax on disqualified person from Part I, Section A, column (g) 2 Enter amount of section 4951 tax on trustee from Part I, Section A, column (h) . . . . . . 2 3 Enter amount of section 4952 tax on trust from Part I, Section B, column (g) . . . . . . . 3 4 Enter amount of section 4952 tax on trustee from Part I, Section B, column (h) . . . . . . 4 5 Total tax due (add lines 1 through 4) . . . . . ▶ 5 . . . . . . . . . . . . . . 1 Form 990-BL (Rev. 12-2013)
Extracted from PDF file 2016-federal-form-990-bl.pdf, last modified July 2009

More about the Federal Form 990-BL Corporate Income Tax TY 2016

We last updated the Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons in May 2017, so this is the latest version of Form 990-BL, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 990-BL directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 990-BL from the Internal Revenue Service in May 2017.

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About the Corporate Income Tax

The IRS and most states require corporations to file an income tax return, with the exact filing requirements depending on the type of company.

Sole proprietorships or disregarded entities like LLCs are filed on Schedule C (or the state equivalent) of the owner's personal income tax return, flow-through entities like S Corporations or Partnerships are generally required to file an informational return equivilent to the IRS Form 1120S or Form 1065, and full corporations must file the equivalent of federal Form 1120 (and, unlike flow-through corporations, are often subject to a corporate tax liability).

Additional forms are available for a wide variety of specific entities and transactions including fiduciaries, nonprofits, and companies involved in other specific types of business.

Historical Past-Year Versions of Federal Form 990-BL

We have a total of five past-year versions of Form 990-BL in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 990-BL

Form 990-BL (Rev. December 2013)

Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons 2015 Form 990-BL

Form 990-BL (Rev. December 2013)

Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons 2013 Form 990-BL

Form 990-BL (Rev. December 2013)

Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons 2012 Form 990-BL

Form 990-BL (Rev. December 2011)

Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons 2011 Form 990-BL

Form 990-BL (Rev. December 2011)


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