During the third calendar quarter of 20--, Bayview Inn, owned by Diane R. Peters, 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.

Employee		Salary or Wage		Quarter's Wages		Quarter's Tips		Quarter's OASDI		Quarter's HI		Quarter's FIT
Grant Frazier		$78,000/year		$19,500.00				$1,209.00		$282.75		$1,500.00
Joseph LaVange		52,000/year		13,000.00				806.00		188.50		1,100.00
Susanne Ayers		800/week		10,400.00		$2,240.90		783.77		183.30		750.00
Howard Cohen		650/week		8,450.00		2,493.10		678.47		158.73		740.00
Lee Soong		675/week		8,775.00		2,640.30		707.72		165.49		660.00
Mary Yee		750/week		9,750.00		2,704.00		772.20		180.70		900.00
Helen Woods		750/week		9,750.00				604.50		141.44		800.00
Koo Shin		600/week		7,800.00				483.60		113.10		1,100.00
Aaron Abalis		750/week		9,750.00				604.50		141.44		800.00
David Harad		600/week		7,800.00				483.60		113.10		750.00
				$104,975.00		$10,078.30		$7,133.36		$1,668.55		$9,100.00

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

July		August		September
5 weekly paydays		4 weekly paydays		4 weekly paydays

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

Employees	Weekly			Weekly
Federal Income Tax	FICA Taxes Withheld on Wages			FICA Taxes on Tips
	OASDI		HI	OASDI		HI
$700 per week	Employees'	$500.65	$117.11	Employees'	$48.07	$11.24
	Employer's	500.65	117.09	Employer's	48.07	11.24

Based on the information given, complete Form 941 on the following pages for Diane R. Peters. Phone number: (901) 555-7959 Date filed: October 31, 20--

Note: Lines 5a and 5c of Form 941, tax on total taxable wages, are computed by multiplying by the combined tax rate for both employer and employee.

Small differences due to rounding may occur between this total and the total taxes withheld from employees each pay period and the amount of the employer's taxes calculated each pay period. This difference is reported on line 7 as a deduction or an addition as "Fractions of Cents."

If a box does not require an amount, leave it blank. If required, round your answers to nearest cent. Use a minus sign to indicate a deduction. Assume that company deposits taxes on monthly basis.

Hint: Line 7 instructions. Fill in Form 941 through line 6, and then fill in Part 2, line 16, item b. Take that information and fill in line 13. Note that Lines 12 and 13 must equal. If the amounts are not the same, correct by entering amount to make equal on line 7. Line 7 differences are caused by how calculations are made on Form 941 and the amounts withheld from employee's earning plus the employer's payroll tax amounts each pay.

_Form 941 for 20--: ^{(Rev. January 2019)}

Employer's QUARTERLY Federal Tax Return ^{Department of the Treasury Internal Revenue Service}

_{OMB No. 1545-0029}

Employer identification number (EIN)

0

0

0

0

0

3

6

0

7

Name (not your trade name)

DIANE R. PETERS

Trade name (if any)

BAYVIEW INN

Address

404 UNION AVE.

Number

Street

Suite or room number

MEMPHIS

TN

38112

City

State

ZIP code

Foreign country name

Foreign province/county

Foreign postal code

Report for this Quarter of 20-- (Select one.)

July, August, September Go to www.irs.gov/Form941 for instructions and the latest information.

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 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)

1

2

Wages, tips, and other compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

3

Federal income tax withheld from wages, tips, and other compensation . . . . . . . . . . . . . . . . . . . . . . . . .

3

4

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 . . . . .		x 0.124 =
5b	Taxable social security tips . . . . . . . .		x 0.124 =
5c	Taxable Medicare wages & tips . . . . .		x 0.029 =
5d	Taxable wages & tips subject to Additional Medicare Tax withholding		x 0.009 =

5e

Add Column 2 from lines 5a, 5b, 5c, and 5d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5e

5f

Section 3121(q) Notice and DemandTax due on unreported tips (see instructions) . . . . . . . . . . . . . . .

5f

6

Total taxes before adjustments. Add lines 3, 5e, and 5f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6

7

Current quarter's adjustment for fractions of cents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

8

Current quarter's adjustment for sick pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

9

Current quarter's adjustments for tips and group-term life insurance . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

10

Total taxes after adjustments. Combine lines 6 through 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

11

Qualified small business payroll tax credit for increasing research activities. Attach Form 8974

11

12

Total taxes after adjustments and credits. Subtract line 11 from line 10

12

13

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 . .

13