Check here, and 17 If your business has closed or you stopped paying wages enter the final date you paid wages (mm/dd/yyyy) Check here. 19 20 21 18 If you are a seasonal employer and you do not have to file a return for every quarter of the year 19 Qualified health plan expenses allocable to qualified sick leave wages 20 Qualified health plan expenses allocable to qualified family leave wages 21 Qualified wages for the employee retention credit 22 Qualified health plan expenses allocable to wages reported on line 21 23 Credit from Form 5884-C, line 11, for this quarter 24 Qualified wages paid March 13 through March 31, 2020, for the employee retention credit (use this line only for the second quarter filing of Form 941) 25 Qualified health plan expenses allocable to wages reported on line 24 (use this line only for the second quarter filing of Form 941) 22 23 24 25 Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Yes. Designee's name and phone number No. Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. 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 taxpayer) is based on all information of which preparer has any knowledge. Sign your Print your name here Print your title here name here Date (mm/dd/yyyy) 04/10/2020 Best daytime phone (XXX-XXX-XXXX) Paid Preparer Use Only Check if you are self-employed Preparer's name PTIN Date (mm/dd/yyyy) Preparer's signature Firm's name (or yours if self-employed) EIN Address Phone City State (NN) ZIP code Page 2 Form 941 (Rev. 1-2020) you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 17 of Pub. 15. 16 Check one: : Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule depositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3. You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3 Tax liability: Month 1 Month 2 Month 3 Total liability for quarter 0.00 Total must equal line 12. You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941), Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Go to Part 3. Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. 17 If your business has closed or you stopped paying wages enter the final date you paid wages (mm/dd/yyyy) Check here, and Check here. 18 If you are a seasonal employer and you do not have to file a return for every quarter of the year 19 Qualified health plan expenses allocable to qualified sick leave wages 19 20 Qualified health plan expenses allocable to qualified family leave wages 20 21 Qualified wages for the employee retention credit 21 22 Qualified health plan expenses allocable to wages reported on line 21 22 23 Credit from Form 5884-C, line 11, for this quarter 23 24 Qualified wages paid March 13 through March 31, 2020, for the employee retention credit (use this 24 line only for the second quarter filing of Form 941) 25 Qualified health plan expenses allocable to wages reported on line 24 (use this line only for the 25 second quarter filing of Form 941) Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Designee's name and phone number Yes. No. Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. 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 taxpayer) is based on all information of which preparer has any knowledge. Sign your name here Date (mm/dd/yyyy) Print your name here Print your title here Best daytime phone (xxx-xxx-xxxx) 04/10/2020 Street Number Bridgewater City Suite or room number 05520 ZIP code VT State (NN) )4: October, November, December Instructions and prior-year forms are available at www.irs.gov/form941. Foreign country name Foreign Province/county Foreign Postal code 5e 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: June 12 (Quarter 2). September 12 (Quarter 3), or December 12 (Quarter 4) 2 Wages, tips, and other compensation 3 Federal income tax withheld from wages, tips, and other compensation X 4 If no wages, tips, and other compensation are subject to social security or Medicare tax This is a numeric cell, so please Column 1 1 enter numbers only. Column 2 5a Taxable social security wages X 0.124 0.00 5a(U) Qualified sick leave wages X 0.062 0.00 5a(ii) Qualified family leave wages x 0.062 0.00 5b Taxable social security tips X 0.124 0.00 5c Taxable Medicare wages & tips x 0.029 0.00 5d Taxable wages & tips subject to Additional Medicare Tax withholding X 0.009 0.00 5e Add Column 2 from lines 5a, 5b, 5c, and 5d 2 , , 0.00 5f Section 3121(a) Notice and Demand - Tax due on unreported tips (see instructions) 5f 6 Total taxes before adjustments. Add lines 3, 5e, and 5f 6 0.00 7 Current quarter's adjustments for fractions of cents 7 8 Current quarter's adjustments for sick pay 8 9 Current quarter's adjustments for tips and group-term life insurance 10 Total taxes after adjustments. Combine lines 6 through 9 10 0.00 11a Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11a 11b Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1 11b 11c Nonrefundable portion of employee retention credit from Worksheet 1 11c TIC 11d Total nonrefundable credits. Add lines 11a, 11b, and 11c 11d 0.00 12 Total taxes after adjustments and credits. Subtract line 11d from line 10 12 0.00 13a Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter 13a 13b Deferred amount of the employer share of social security tax 13b 13c Refundable portion of credit for qualified sick and family leave wages from Worksheet 1 13c 13d Refundable portion of employee retention credit from Worksheet 1 13d 13e Total deposits, deferrals, and refundable credits. Add lines 13a, 135, 136, and 13d 13e 0.00 13f Total advances received from filing Form(s) 7200 for the quarter 131 13g Total deposits, deferrals, and refundable credits less advances. Subtract line 13f from line 13e 139 0.00 14 Balance due If line 12 is more than line 13e, enter the difference and see instructions 14 0.00 15 Overpayment. If line 13e is more than line 12. enter the difference Apply to next 12 0.00 Check one: Send a refund return 9 You MUST complete both pages of Form 941 and SIGN It. Next For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat. No. 17001Z Form 941 (Rev. 1-2020) THIS FORM IS A SIMULATION OF AN OFFICIAL U.S. TAX FORM. IT IS NOT THE OFFICIAL FORM ITSELF. DO NOT USE THIS FORM FOR TAV ENIRO A FAR ANIV DIINNADE ATUEN TUALI ENIRATIALIAI nn - Led..--- The first quarter tax return needs to be filed for Prevosti Farms and Sugarhouse by April 15, 2020. For the purpose of the taxes, assume the second February payroll amounts were duplicated for the March 6 and March 20 payroll periods and the new benefit elections went into effect as planned. The form was completed and signed on April 10, 2020. Benefit Information Health Insurance Life Insurance Long-term Care FSA 401(k) Gym Exempt Federal FICA Yes Yes Yes Yes Yes Yes Yes Yes Yes NO No No Owner's name: Toni Prevosti Address: 820 Westminster Road, Bridgewater, VT 05520. Phone: 802-555-3456 Number of employees: 8 Gross quarterly wages: $33,051.93 Federal income tax withheld: $992.00 401(k) contributions: $1,322.08 Insurance withheld: $4,297.00 Gym membership: $90.00 Monthly Deposits Month 1 Month 2 Month 3 Amount $ 0.00 $ 2,320.70 $ 3,084.70 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. Complete this question by entering your answers in the tabs below. Check here, and 17 If your business has closed or you stopped paying wages enter the final date you paid wages (mm/dd/yyyy) Check here. 19 20 21 18 If you are a seasonal employer and you do not have to file a return for every quarter of the year 19 Qualified health plan expenses allocable to qualified sick leave wages 20 Qualified health plan expenses allocable to qualified family leave wages 21 Qualified wages for the employee retention credit 22 Qualified health plan expenses allocable to wages reported on line 21 23 Credit from Form 5884-C, line 11, for this quarter 24 Qualified wages paid March 13 through March 31, 2020, for the employee retention credit (use this line only for the second quarter filing of Form 941) 25 Qualified health plan expenses allocable to wages reported on line 24 (use this line only for the second quarter filing of Form 941) 22 23 24 25 Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Yes. Designee's name and phone number No. Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. 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 taxpayer) is based on all information of which preparer has any knowledge. Sign your Print your name here Print your title here name here Date (mm/dd/yyyy) 04/10/2020 Best daytime phone (XXX-XXX-XXXX) Paid Preparer Use Only Check if you are self-employed Preparer's name PTIN Date (mm/dd/yyyy) Preparer's signature Firm's name (or yours if self-employed) EIN Address Phone City State (NN) ZIP code Page 2 Form 941 (Rev. 1-2020) you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 17 of Pub. 15. 16 Check one: : Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule depositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3. You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3 Tax liability: Month 1 Month 2 Month 3 Total liability for quarter 0.00 Total must equal line 12. You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941), Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Go to Part 3. Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. 17 If your business has closed or you stopped paying wages enter the final date you paid wages (mm/dd/yyyy) Check here, and Check here. 18 If you are a seasonal employer and you do not have to file a return for every quarter of the year 19 Qualified health plan expenses allocable to qualified sick leave wages 19 20 Qualified health plan expenses allocable to qualified family leave wages 20 21 Qualified wages for the employee retention credit 21 22 Qualified health plan expenses allocable to wages reported on line 21 22 23 Credit from Form 5884-C, line 11, for this quarter 23 24 Qualified wages paid March 13 through March 31, 2020, for the employee retention credit (use this 24 line only for the second quarter filing of Form 941) 25 Qualified health plan expenses allocable to wages reported on line 24 (use this line only for the 25 second quarter filing of Form 941) Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Designee's name and phone number Yes. No. Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. 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 taxpayer) is based on all information of which preparer has any knowledge. Sign your name here Date (mm/dd/yyyy) Print your name here Print your title here Best daytime phone (xxx-xxx-xxxx) 04/10/2020 Street Number Bridgewater City Suite or room number 05520 ZIP code VT State (NN) )4: October, November, December Instructions and prior-year forms are available at www.irs.gov/form941. Foreign country name Foreign Province/county Foreign Postal code 5e 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: June 12 (Quarter 2). September 12 (Quarter 3), or December 12 (Quarter 4) 2 Wages, tips, and other compensation 3 Federal income tax withheld from wages, tips, and other compensation X 4 If no wages, tips, and other compensation are subject to social security or Medicare tax This is a numeric cell, so please Column 1 1 enter numbers only. Column 2 5a Taxable social security wages X 0.124 0.00 5a(U) Qualified sick leave wages X 0.062 0.00 5a(ii) Qualified family leave wages x 0.062 0.00 5b Taxable social security tips X 0.124 0.00 5c Taxable Medicare wages & tips x 0.029 0.00 5d Taxable wages & tips subject to Additional Medicare Tax withholding X 0.009 0.00 5e Add Column 2 from lines 5a, 5b, 5c, and 5d 2 , , 0.00 5f Section 3121(a) Notice and Demand - Tax due on unreported tips (see instructions) 5f 6 Total taxes before adjustments. Add lines 3, 5e, and 5f 6 0.00 7 Current quarter's adjustments for fractions of cents 7 8 Current quarter's adjustments for sick pay 8 9 Current quarter's adjustments for tips and group-term life insurance 10 Total taxes after adjustments. Combine lines 6 through 9 10 0.00 11a Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11a 11b Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1 11b 11c Nonrefundable portion of employee retention credit from Worksheet 1 11c TIC 11d Total nonrefundable credits. Add lines 11a, 11b, and 11c 11d 0.00 12 Total taxes after adjustments and credits. Subtract line 11d from line 10 12 0.00 13a Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter 13a 13b Deferred amount of the employer share of social security tax 13b 13c Refundable portion of credit for qualified sick and family leave wages from Worksheet 1 13c 13d Refundable portion of employee retention credit from Worksheet 1 13d 13e Total deposits, deferrals, and refundable credits. Add lines 13a, 135, 136, and 13d 13e 0.00 13f Total advances received from filing Form(s) 7200 for the quarter 131 13g Total deposits, deferrals, and refundable credits less advances. Subtract line 13f from line 13e 139 0.00 14 Balance due If line 12 is more than line 13e, enter the difference and see instructions 14 0.00 15 Overpayment. If line 13e is more than line 12. enter the difference Apply to next 12 0.00 Check one: Send a refund return 9 You MUST complete both pages of Form 941 and SIGN It. Next For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat. No. 17001Z Form 941 (Rev. 1-2020) THIS FORM IS A SIMULATION OF AN OFFICIAL U.S. TAX FORM. IT IS NOT THE OFFICIAL FORM ITSELF. DO NOT USE THIS FORM FOR TAV ENIRO A FAR ANIV DIINNADE ATUEN TUALI ENIRATIALIAI nn - Led..--- The first quarter tax return needs to be filed for Prevosti Farms and Sugarhouse by April 15, 2020. For the purpose of the taxes, assume the second February payroll amounts were duplicated for the March 6 and March 20 payroll periods and the new benefit elections went into effect as planned. The form was completed and signed on April 10, 2020. Benefit Information Health Insurance Life Insurance Long-term Care FSA 401(k) Gym Exempt Federal FICA Yes Yes Yes Yes Yes Yes Yes Yes Yes NO No No Owner's name: Toni Prevosti Address: 820 Westminster Road, Bridgewater, VT 05520. Phone: 802-555-3456 Number of employees: 8 Gross quarterly wages: $33,051.93 Federal income tax withheld: $992.00 401(k) contributions: $1,322.08 Insurance withheld: $4,297.00 Gym membership: $90.00 Monthly Deposits Month 1 Month 2 Month 3 Amount $ 0.00 $ 2,320.70 $ 3,084.70 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. Complete this question by entering your answers in the tabs below