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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
or other time or demand deposits in that bank or credit union constitutes Payment of benefits. For purposes of section 4951, a payment out of
a lending of money; assets or income of a trust described in section 501(c)(21) for the
The furnishing of goods, services, or facilities by a disqualified person purposes described in sections 501(c)(21)(A)(i)(I) and
to such a trust is not an act of self-dealing if the furnishing is without 501(c)(21)(A)(i)(IV) is not considered an act of self-dealing.
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 Taxable Expenditures (Section 4952)
expenses) by such a trust to a disqualified person for personal services
that are reasonable and necessary to carry out the exempt purpose of Taxable expenditure. For purposes of section 4952, the term “taxable
the trust is not an act of self-dealing if the compensation (or payment or expenditure” means any amount paid or incurred by a trust described in
reimbursement) is not excessive. See Regulations section 53.4951-1 for section 501(c)(21) other than for a purpose specified in that section.
additional information. Correction. The terms “correction” and “correct” mean, with respect to
Taxable period. The term “taxable period” means, with respect to any any taxable expenditure, placing the trust in a financial position not
act of self-dealing, the period beginning with the date on which the act of worse than that in which it would have been if the taxable expenditure
self-dealing occurs and ending on the earliest of: had not been made:
1. The date of mailing of a notice of deficiency under section 6212, 1. By recovering all or part of the expenditure to the extent recovery
with respect to the tax imposed by section 4951(a)(1), is possible, and
2. The date on which the tax imposed by section 4951(a)(1) is 2. When full recovery is not possible, by contributions by the person
assessed, or or persons whose liabilities for black lung benefit claims (as defined in
section 192(e)) are to be paid out of the trust.
3. The date on which correction of the act of self-dealing is
completed. Taxable period. The term “taxable period” means, with respect to any
taxable expenditure, the period beginning with the date on which the
Amount involved. The term “amount involved” means, for any act of taxable expenditure occurs and ending on the earlier 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 1. The date of mailing a notice of deficiency under section 6212
FMV of the other property received. However, in the case of services with respect to the tax imposed by section 4952(a)(1), or
described in section 4951(d)(2)(C), the amount involved is only the 2. The date on which the tax imposed by section 4952(a)(1) is
excess compensation. For purposes of the preceding sentence, the assessed.
FMV:
1. For the initial taxes imposed by section 4951(a), is determined as Specific Instructions
of the date on which the act of self-dealing occurs; and
Line 22. A “conformed” copy is one that agrees with the original
2. For additional taxes imposed by section 4951(b), is the highest document, and all amendments to it. If the copies are not signed, they
FMV during the taxable period. must be accompanied by a written declaration signed by an officer
authorized to sign for the organization certifying that they are complete
Correction. The terms “correction” and “correct” mean, for any act of and accurate copies of the original documents.
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 Chemically or photographically reproduced copies of articles of
it would be if the disqualified person were dealing under the highest incorporation showing the certification of an appropriate State official
fiduciary standards. need not be accompanied by such a declaration. See Rev. Proc. 68-14,
1968-1 C.B. 768, for additional information.
Disqualified person. The term “disqualified person” means, for a trust
described in section 501(c)(21), a person who is: 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
1. A contributor to the trust; taxes under section 4951 of the requirement to file a return for each year
2. A trustee of the trust; (or part of a year) and pay the applicable tax. The trust must also furnish
3. An owner of more than 10% of: the information required by Schedule A (Form 990-BL), Part I, Section A
(other than columns (g) and (h)) on its own return.
a. The total combined voting power of a corporation,
For exceptions to the self-dealing rules, see Special Rules and
b. The profits interest of a partnership, or Payment of Benefits, earlier.
c. The beneficial interest of a trust or unincorporated enterprise, Line 24. If you answered “Yes,” complete Part I, Section B (other than
which is a contributor to the trust; column (h)) and Part II of Schedule A (Form 990-BL). The trust must also
4. An officer, director, or employee of a person who is a contributor notify any trustees who may be liable for initial taxes under section 4952
to the trust; of the requirement to file Form 990-BL, Schedule A (Form 990-BL), and
5. The spouse, ancestor, lineal descendant, or spouse of a lineal to pay the tax.
descendant of an individual described in 1, 2, 3, or 4; Line 25. If you answered “No,” or if there were multiple acts or
6. A corporation of which persons described in 1, 2, 3, 4, or 5 own transactions giving rise to Chapter 42 taxes and all of them were not
more than 35% of the total combined voting power; corrected, attach an explanation of each uncorrected act including the
7. A partnership in which persons described in 1, 2, 3, 4, or 5 own names of all parties to the act, the date of the act, the amount involved,
more than 35% of the profits interest; or why the act has not been corrected, and the date you expect correction
to be made.
8. A trust or estate in which persons described in 1, 2, 3, 4, or 5
hold more than 35% of the beneficial interest. Line 26. List each of the organization's officers, directors, trustees, and
other persons having responsibilities or powers similar to those of
For purposes of items 3a and 6 above, indirect stockholdings are officers, directors, or trustees. List all of these persons even if they did
taken into account if they would be taken into account under section not receive any compensation from the organization. Show all forms of
267(c), except that, for purposes of this paragraph, section 267(c)(4) is compensation received by each listed officer, etc. Enter “-0-” in columns
treated as providing that the members of the family of an individual are (c), (d), and (e) if none was paid.
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 Note. If you pay any other person, such as a management service
by the rules for constructive ownership of stock provided in section company, for the services provided by any of your officers, directors,
267(c) (other than paragraph (3)), except that section 267(c)(4) is trustees, or key employees, report the compensation and other items on
treated as providing that the members of the family of an individual are line 26 as if you had paid the officer, etc. directly.
only those individuals described in item 5. 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.
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