The first quarter tax return needs to be filed for Prevosti Farms and Sugarhouse by April 15, 2017. For the purpose of the taxes, assume the second February payroll amounts were duplicated for the March 10 and March 24 payroll periods and the new benefit elections went into effect as planned. The form was completed and signed on April 10, 2017 Exclude: Federal PICA Benefit Information Health Insurance Life Insurance Long-term Care FSA 401 () Gym Yes Yes Yes Yes Yes No Yes Yes Yes No No Owner's name: Toni Prevosti Address: 820, Westminster Road, Bridgewater, VT, 05520. Phone: 802-555-3456 Number of Employees: 8 Quarterly wages: $35,135.45 Federal income tax withheld: $1,054.00 401(k) contributions: $1,405.42 Insurance withheld: $4,568.00 Gym membership: $90.00 Monthly Deposits Month1 Month2 Month 3 Amount 0.00 2,459.48 3,271.35 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. Complete this question by entering your answers in the tabs below 941 PG 1 941 PG 2 Page 2 of Form 941. (Round your answers to 2 decimal places.) 941 PG1 941 PG2 Page 1 of Form 941. (Round your answers to 2 decimal places.) Form 941 for 2017: Employer's QUARTERLY Federal Tax Return Department of the Treasury Internal Revenue Service 950117 OMB No. 1545-0029 Employer identification number (EIN) Name (not your trade name) Trade name (if any) Address 2-6654454 oni Prevosti revosti Farms and Sugarhouse estminster Road Report for this Quarter 2017 (Check one.) January, February, March April, May, June July, August, September 2: 20 3: Number Street Suite or room number ewater VT 05520 October, November, December Ci State (NN ZIP code Instructions and prior-year forms are available at www.irs.gov/form941 Foreign Foreign Foreign Postal code Read the separate instructions before wou complete Form 941. Type or print within the boxes Part 1: Answer these questions for this quarter 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) 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 5a Taxable social security wages 5b Taxable social security tips 5c Taxable Medicare wages & tips 5d Taxable wages & tips subject to Additional Medicare Tax x .124 x .124 x .029 x .009 0.00 0.00 0.00 0.00 5e Add Column 2 from lines 5a, 5b, 5c, and 5d 5f Section 3121(q) Notice and Demand-Tax due on unreported tips 6 Total taxes before adjustments. 7 Current quarter's adjustments for fractions of cents 8 Current quarter's adjustments for sick pay 9 Current quarter's adjustments for tips and group-term life insurance 10 Total taxes after adjustments. 11 Qualified small business payroll tax credit for increasing research activites. 12 Total taxes after adjustments and credits. 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, 944-X (PR), or 944-X (SP) filed in the current quarter 14 Balance due. 5e 5f 0.00 (see instructions) Add lines 3, 5e, and 5f 0.00 Combine lines 6 through 9 10 0.00 Attach Form 8974 Subtract ine 11 from line 10 12 0.00 13 If line 12 is more than line 13, enter the difference and see instructions 14 0.00 Apply to next 15 Overpayment. If line 13 is more than line 12, enter the difference 0.00 Check one: Send a refund. return 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) 941 PG 1 941 PG 2 Page 2 of Form 941. (Round your answers to 2 decimal places.) Name (not your trade name) Toni Prevosti Employer identification number (EIN) 22-6654454 Part 2: 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 did not incur a $100,000 next-day deposit obligation during the current quarter. If ine 12 (ine 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 iability. 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 0.00 2,459.48 3,271.35 5,730.83 Total must equal line 12. Total liability for quarter 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 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 Check here, and enter the final date you paid wages ( mm/ddlyyyy) 18 If you are a seasonal employer and you do not have to file a return for every quarter of the year Check here. 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 Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS No 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 Print your name here Toni Prevosti Print your title here Best daytime phone (xxx-xxx-xxxx) er Date (mm/ddlyyyy) 802-555-3456