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Form 990bl: Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons

Use Tax Form 990bl: Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons as a stand alone tax form calculator to quickly calculate specific amounts for your 2017 tax return. Form 990bl: Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons is also integrated into our comprehensive US Tax Calculator where you can complete and save your calculations for later use. Alternatively you can use one of our Combined Federal and State Tax Estimator to quickly calculate your salary, tax and take home pay.

Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons
Part I Analysis of Revenue and Expenses
Revenue11
2
a2a
b2b
c
2c
d2d
33
Expenses44
55
66
77
88
99
1010
1111
1212
Part II Balance Sheets Beginning of year End of year
Assets1313
1414
1515
1616
1717
1818
Liabilities
and Net
Assets
1919
2020
2121
Part III Questionnaire
22
23If “Yes,” attach a conformed copy of the changes.
Taxes on self-dealing (section 4951):
aDuring the year did the trust (either directly or indirectly):
Engage in the sale, exchange, or leasing of property with a disqualified person?
Borrow or lend money or otherwise extend credit to (or accept it from) a disqualified person?
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Pay compensation to, or pay or reimburse expenses of, a disqualified person?
Transfer any income or assets to, or for use by or for the benefit of, a disqualified person?
b
c
24
If the answer is “Yes,” complete Schedule A, Form 990-BL, Part I, Section B.
25

For any uncorrected acts, attach explanation (see instructions).
26Officers, directors, trustees and their compensation, if any, for the tax year:





Part IV Statement With Respect to Contributors, etc. — (Not open for public inspection)
  Persons who contributed $5,000 or more in the taxable year (if more space is needed, attach schedule):
2
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
Part I Initial Taxes on Self-dealing (Section 4951) and Taxable Expenditures (Section 4952)
SECTION A—Acts of Self-dealing and Tax Computation (Section 4951)
1
2
3
4
1
2
3
4
Part II Summary of Taxes
11
22
33
44
55

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