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. Salary or Wage Quarter's Quarter's Quarter's Quarter's Quarter's Employee Jennifer Pasco Shelby Toland Casey Riordan Howard Cohen Rebecca Somerville Matthew Chalfont Sean Matthews Holly Perry Margaret Levine Mary Bullen Wages $26,000.00 19,500.00 Tips OASDI HI FIT $104,000/year 78,000/year 800/week 650/week 675/week 750/week 750/week 600/week 750/week 600/week $1,612.00 1,209.00 845.78 740.48 769.73 834.21 604.50 483.60 604.50 483.60 $337.00 $1,980.00 600.00 630.00 690.00 540.00 910.00 653.00 364.00 559.00 $117,975.00 $14,078.30 $8,187.40 $1,915.03 $8,216.00 282.75 1,290.00 197.73 173.29 180.05 195.13 141.44 113.10 141.44 113.10 10,400.00 $3,240.90 3,493.10 3,640.30 3,704.00 8,450.00 8,775.00 9,750.00 9,750.00 7,800.00 9,750.00 7,800.00 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' Federal Income Tax Weekly FICA Taxes Withheld on Wages Weekly FICA Taxes on Tips OASDI HI OASDI HI $632 per week Employees' $562.65 $131.61 Employees' $67.15 $15.70 Employer's 562.65 131.59 Employer's 67.14 15.70 Based on the information given, complete Form 941 on the following pages for Dawn Smedley 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 7a as a deduction or an addition as "Fractions of Cents." 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) 10 2 Wages, tips, and other compensation.. 3 Federal income tax withheld from wages, tips, and other compensation . . . . .. .. . 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 x 0.124 = x 0.124 x 0.029 = x 0.009 = 5a Taxable social security wages . 5d Taxable wages & tips subject to Additional Medicare Tax withholding Se Add Column 2 from lines Sa, Sb, 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 Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 12 Total taxes after adjustments and credits. Subtract line 11 from line 10. 13 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments 5f 12 13 applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter.. 14 Balance due. If line 12 is more than line 13, enter the difference and see instructions . 13 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments 13 applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter 14 Balance due. If line 12 is more than line 13, enter the difference and see instructions... 14 15 Overpayment. If line 13 is more than line 12, enter the difference Check one: O Apply to next return. Send a refund 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. 1-2017) Name (not your trade name) DAWN SMEDLEY Part 2: Employer identification number (EIN) 00-0003607 Tell us about your deposit schedule and tax liability for this quarter If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub 15. 16 Check one: Line 12 on this return is less than $2,500 or line 12 (line 10 if the prior quarter was the fourth quarter of 2016) 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 (line 10 if the prior quarter was the fourth quarter of 2016) 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: a. b. Month 1 Month 2 Month3