F941 - 941 for 2010 Form(Rev October 2010 951110 Employers QUARTERLY Federal Tax Return OMB No 1545-0029 Department of the Treasury Internal

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Form 941 for 2010: (Rev. October 2010) Employer’s QUARTERLY Federal Tax Return Department of the Treasury — Internal Revenue Service 951110 OMB No. 1545-0029 (EIN) Employer identification number Name (not your trade name) Trade name (if any) Address Number Street Suite or room number City State ZIP code Report for this Quarter of 2010 (Check one.) 1: January, February, March 2: April, May, June 3: July, August, September 4: October, November, December 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 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 6e. Column 1 Column 2 *Report wages/tips for this quarter, including those paid to qualified new employees, on lines 5a–5c. The social security tax exemption on wages/tips will be figured on lines 6c and 6d and will reduce the tax on line 6e. 5a Taxable social security wages* . . × .124 = . 5b Taxable social security tips* . . . × .124 = . 5c Taxable Medicare wages & tips* . × .029 = . 5d Add Column 2 line 5a, Column 2 line 5b, and Column 2 line 5c . . . . . . . . . 5d . 6a Number of qualified employees first paid exempt wages/tips this quarter See instructions for definitions of qualified employee and exempt wages/tips. 6b Number of qualified employees paid exempt wages/tips this quarter 6c Exempt wages/tips paid to qualified employees this quarter . × .062 = 6d . 6e Total taxes before adjustments (line 3 + line 5d – line 6d = line 6e) . . . . . . . . . 6e . 7a Current quarter’s adjustment for fractions of cents . . . . . . . . . . . . . 7a . 7b Current quarter’s adjustment for sick pay . . . . . . . . . . . . . . . . 7b . 7c Current quarter’s adjustments for tips and group-term life insurance . . . . . . . 7c . 8 Total taxes after adjustments. Combine lines 6e through 7c . . . . . . . . . . . 8 . 9 Advance earned income credit (EIC) payments made to employees . . . . . . . 9 . 10 Total taxes after adjustment for advance EIC (line 8 – line 9 = line 10) . . . . . . . 10 . 11 Total deposits, including prior quarter overpayments . . . . . . . . . . . . 11 . 12a COBRA premium assistance payments (see instructions) . . . . . . . . . . . 12a . 12b Number of individuals provided COBRA premium assistance . . Complete lines 12c, 12d, and 12e only for the 2nd quarter of 2010. 12c Number of qualified employees paid exempt wages/tips March 19–31 12d Exempt wages/tips paid to qualified employees March 19–31 .
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This note was uploaded on 02/02/2012 for the course ACCO 3000 taught by Professor Rein during the Spring '11 term at American International.

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F941 - 941 for 2010 Form(Rev October 2010 951110 Employers QUARTERLY Federal Tax Return OMB No 1545-0029 Department of the Treasury Internal

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