During the third calendar quarter of 20--, the Beechtree Inn, owned by Dawn Smedley, employed the persons listed below. Also given are the employees' salaries or wages and the amount of tips reported to the owner. The tips were reported by the 10th of each month. The federal income tax and FICA tax to be withheld from the tips were estimated by the owner and withheld equally over the 13 weekly pay periods. The employer's portion of FICA tax on the tips was estimated as the same amount.

Employees are paid weekly on Friday. The following paydays occurred during this quarter:

Taxes withheld for the 13 paydays in the third quarter follow:

Based on the information given, complete Form 941 on the following pages for Dawn Smedley. Phone number: (901) 555-7959

Transcribed Image Text:

Quarter's Quarter's uarter's Quarter's Salary or Wage $104,000lyear Tips Jennifer Pasco Shelby Toland 26,000.00 $1,612.00 337.00 $1,980.00 10,400.00 3,240.90 845.78 Howard Cohen Rebecca Somerville 3,493.10 675/weel Mary Bullen 117,975.00 14,078.30 8,187.40 1,15.0 8,216.00 July August September 4 weekly paydays 5 weekly paydays4 weekly paydays Employees Federal Income Tax Weekly FICA Taxes Withheld on Wages Weekly FICA Taxes on Tips HI OASDI Employees' $562.65 Employer's 562.65 HI $15.70 15.70 OASDI 131.61 Employees' $67.15 Employer's 67.14 $632 per week 131.59 Fom 941 for 20--: Employer's QUARTERLY Federal Tax Return anuary 2015 OMB No. 1546-0020 Report for this Quarter of 20-- Cheok one Employor idanttication numbar (EN DANN SMEDLEY 1:January, February, March 2 April, May, June 3: July, August. September 4: October, November, December Nama hot your trada nama) 404 UNION AVE nstructions and prior year forms are avallable at www.irs.gowrom947 MEMPHIS TN 38112 courty name postal codka Read the separate instructions before you complete Form 941. Type or print within the boxes. Part 1 Answer these questions for this quarter 1 Number of employees who received wages, tips, or other compensation for the pay period including: Mar. 12(Quarter ), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4 1 2 Wages, tips, and other compensation 3 4 Federal income tax withheld from wages, tips, and other compensation If no wages, tips, and other compensation are subject to social security or Medicare tax Check and go to line 6. Column 1 Column 2 5a Taxable social security wages . . 5b Taxable social security tips. . 5c Taxable Medicare wages & tips. . 5d Taxable wages& tips subject to x.124- x.124- x.029- Additional Medicare Tax withholding x.009- 5e Add Column 2 from lines 5a, 5b, 5c, and 5d 5f Section 3121(q) Notice and Demand-Tax due on unreported tips (see instructions 6 Total taxes before adjustments. Add lines 3, 5e, and 5f 7 Current quarter's adjustment for fractions of cents 8 Current quarter's adjustment for sick pay 9 Current quarter's adjustments for tips and group-term life insurance 10 Total taxes after adjustments. Combine lines 6 through 9 11 Total deposits for this quarter, including overpayment applied from a prior quarter and 5e 5f 10 overpayments applied from Form 941-X, 941-X PRI, 944-Х, 944-Х (PR), or 944-X (SP) filed in the current quarter 12 Balance due. If line 10 is more than line 11, enter the difference and see instructions 12 13 Overpayment. If line 11 is more than line 10, enter the differenca Check one: LIApplytonutstrn. sardaratund. You MUST complete both pages of Form 941 and SIGN it. Next For Prtvacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher Form 941 (Rov. 1-2015) identfication number (EIN) DANN SMEDLEY 00-0003607 Part 2 Tell us about your deposit schedule and tax liability for this quarter It you are unsure about whether you are a monthly schedule deposltor or a semiweekly schedule deposltor, see Pub. 15 (Circular E), section 11. Lino tO on this return is loss than $2,500 or line tO on the return for the prior quarter was less than $2.500, and you ฉัd not incur a 100,000 next-day daposit obligation during the current quartor. If ino 10 for the prior quartar was lass than $2,s00 but ina 10 on this raturn you ara a monthly schadula daposior, complate tha daposi 14 Check one: 3100,000 or mora, you must provids a record your fedaral tax schodulo balow; i you aro a saniwookdy schadula dapositor, attach Schodulo B Form 941). Go to Purt 3. You were a monthly schedule depositor for the entire quarter. Enter your tax llablity for each month and total llablity for the quarter, then go to Part 3. Tax llablity: Month 1 Month 2 Month 3 Total lability for quarter Total must equal line 10. You were a semlweekly schedule deposltor for any part of this quarter. Complete Scheaule B (Form 941), Report of Tax Llability for Semiweekly Schedule Depositors, and attach it to Fom 941 Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. 15 If your business has closed or you stopped paying wages Check here, and enter the final date you pald wages 16 If you are a seasonal employer and you do not have to Tile a return for every quarter of the year Check here. Part 4: May we speak with your third-party designee? Do you want to allow an employee, a pald tax preparer, or another person to discuss this retum wtth the IRS? See the Instructions for detalls Yes. Daslgnee's name and phone number Select a 5-digit Personal Identinication Number (PIN) to use when talking to the IRS. No. Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it of per ury, l declare that I ha ฉ axamrad this ratum, including accompanying schedules and statements, and tot a best of my know dge and baliof, it is trua, correct, and complata Declaration of proparor (othar than taxpayar) is basad on all iniormation of which proparor has any Print your name here Print your title here Sign your name here Date Best daytime phone Paid Preparer Use Only Preparer's name Preparer's signature Arm's name (or Check It you are self-employed PTIN Date EIN AddresS Phone City State zP code Paga Form 941 Rav. 1-2015)