$1$

$\backslash$table$[[,$Exempt$],[$Benefit Information,Federal,FICA$],[$Health Insurance,Yes,Yes$],[$Life Insurance,Yes,Yes$],[$Long$-$term Care,Yes,Yes$],[$FSA$,$Yes,Yes$],[401(k),$Yes,No$],[$Gym$,$No$,$No$]]$

Owner's name

Address

Phone

Number of employees

Gross quarterly wages $($exclusive of fringe benefits$)$

Federal income tax withheld

$401(k)$ contributions

Section $125$ withheld

Gym Membership $($add to all taxable wages, not included above$)$

Toni Prevosti

$820$ Westminster Road, Bridgewater, VT $05520.$

$802-555-3456$

$8$

$$38,720\mathrm{.}96$

$$469\mathrm{.}00$

$$1,514\mathrm{.}27$

$$4,080\mathrm{.}00$

$$90\mathrm{.}00$

$$0\mathrm{.}00$

$$2,691\mathrm{.}49$

$$3,091\mathrm{.}35$

Required:

Complete Form $941$ for Prevosti Farms and Sugarhouse. Prevosti Farms and Sugarhouse was assigned EIN $22-6654454.$

Note: Instructions on format can be found on certain cells within the forms.

Answer is not complete.how