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. 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 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)