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HomeMy WebLinkAboutInv# 941X2020 - DEPARTMENT OF THE TREASURY - 06/02/2023June 2, 2023 Department of the Treasury Internal Revenue Service Cincinnati, OH 45999-0005 Dear Sir/Madam, Enclosed are the amended 941 returns for quarters three and four of 2020. Additionally, we have included a refund payment of $53,722.81 for a check that was misapplied to our account in July 2021. Please feel free to contact me at 954-924-6800 ext. 3609 or via email at fdipaolo@daniabeachfl.gov if you have any questions or concerns. Sincerely, _)>-c_9~__/) Frank DiPaolo Chief Financial Officer Enclosures: 2020 amended 941 returns for quarters 3 and 4. Refund check in the amount of $53,722.81 . cc: Eve A. Boutsis, City Attorney CITY OF DANIA BEACH I 100 W Dania Beach Boulevard, Dania Beach, FL 33004 I DANIABEACHFL.GOV 954-924-6800 CITY OF DANIA BEACH 100 W Dania Beach Boulevard, Dania Beach, FL 33004 954-924-6800 DANIABEACHFL.GOV ti Inte1nal Revenue Service United States Department of the Treasrn·y This Product Contains Sensitive Taxpayer Data Account Transcript E'ORM NUMBER : 941 TAX PERIOD : Dec . 31 , 2 0 2 0 TAXPAYER IDENTIFICATION NUMBER : XX-XXX0302 -CITO DANI BEAC 100 W Request Date: Response Date: Tracking Number: ---ANY MINUS SI GN SHOWN BELOW SIGNIFIES A CRED IT AMOUNT --- ACCOUNT BALANCE: ACCRUED INTEREST : ACCRUED PENALTY: ACCOUNT BALANCE PLUS ACCRUALS (THIS IS NOT A PAYOFF AMOUNT): $8 ,489 .96 $275.58 AS OF : Oct . 17, 2022 $371 . 92 AS OF: Jan. 31, 2021 $9,137.46 ** INFORMATION FROM THE RETURN OR AS ADJUSTED** TAX PER TAXPAYER : $756,030.12 RETURN DUE DATE OR RETURN RECEIVED DATE (WHICHEVER IS LATER) Feb . 08 , 2021 PROCESSED DATE II CODE EXPLANATION OF TRANSACTION 150 Tax return filed n/a 29141-145-52758-1 650 Federal tax deposit TRANSACTIONS Jul. 19, 2021 CYCLE DATE 202126 07 -19-2021 10-09-2020 10-05-2022 10-05-2022 102722583283 0• 44,285 •92 666•97 8,264 •83 505•09 53 ,722•81 'I AMOUNT $756,030 .12 -$97 ,552.24 C + + + + * 650 E'ederal tax deposit 650 E'ederal tax deposit 650 E'ederal tax deposit 650 E'ederal tax deposit 650 E'ederal tax deposit 650 E'ederal tax deposit 599 Tax return secured 716 Credit you chose to apply from pr ior tax period 776 Interest credited to your account 846 Refund issued 18 6 E'ederal tax deposit penalty 181 Reduced or removed federal tax deposit penalty 290 Additional tax assessed n/a 17154-716-15029-l 290 Additional tax assessed n/a 83154-754-15151-l 777 Reduced or removed interest credited to your account 196 Interest charged for late payment 971 Tax period blocked from automated levy program 10-26-2020 ll-09-2020 ll-23-2020 12-07-2020 12-21-2020 01-04 -2021 06-28-2021 10-31-2020 07-19-2021 07 -19-2021 202141 11-01-2021 ll-01-2021 202146 12-06-2021 202151 01-10-2022 07-19-2021 202151 01-10-2022 02 -21-2022 This Product Contains Sensitive Taxpayer Data -$148,457.43 -$99 ,968 .00 -$ll0, 389. 63 -$105 ,481 .17 -$101 ,045.78 -$101,905.79 $0.00 -$44,285.92 -$666 .97 $53,722.81 $1,522 .15 -$1,522.15 $0.00 SoS -09 $8,264.83 $103 .90 $121.23 $0 .00 fij Inte1nal Revenue Service United States Depa1tment of the Treasury This Product Contains Sensitive Taxpayer Data Account Transcript FORM NUMBER: 941 TAX PERIOD : Sep. 30, 2020 TAXPAYER IDENTIFICATION NUMBER: XX-XXX0302 CITO DANI BEAC 100 W Request Date : Response Date : Tracking Number: ---ANY MINUS SIGN SHOWN BELOW SIGNIFIES A CREDIT AMOUNT ACCOUNT BALANCE : ACCRUED INTEREST: ACCRUED PENALTY : ACCOUNT BALANCE PLUS ACCRUALS (THIS IS NOT A PAYOFF AMOUNT): $48 ,888.76 $1 ,586 .88 AS OF : Oct. 17, 2022 $2 ,122.58 AS OF : Oct . 31, 2020 $52,598 .22 ** INFORMATION FROM THE RETURN OR AS ADJUSTED** TAX PER TAXPAYER : $640,751.35 RETURN DUE DATE OR RETURN RECEIVED DATE (WHICHEVER IS LATER) Nov . 12, 2020 PROCESSED DATE II CODE EXPLANATION OF TRANSACTION 150 Tax return filed n/a 2914 1-145-38118-1 650 Federal tax deposit TRANSACTIONS Jun. 28 , 2021 CYCLE DATE 202123 06-28-2021 07-06-2020 10-05-2022 10-05-2022 102722583283 11 AMOUNT $643,633 .97 -$99,504.98 650 E'ederal tax deposit 07 -20-2020 -$98 ,073.86 650 E'ederal tax deposit 08-03-2020 -$99,016.74 650 E'ederal tax deposit 08-17-2020 -$100,583.15 650 E'ederal tax deposit 08-31-2020 -$96,784.92 650 E'ederal tax deposit 09-14-2020 -$95,622.78 650 E'ederal tax deposit 09-28-2020 -$98 ,333.46 836 Credit you chose to apply to following tax period 's 10-31-2020 $44 ,285.92 taxes 186 E'ederal tax deposit penalty 202138 10-11-2021 $465.84 530 Balance due account currently not collectible -not due 10-30-2021 $0.00 to hardship 971 Tax period blocked from automated levy program 11-22-2021 $0.00 537 Account currently considered collectable 11-22-2021 $0.00 181 Reduced or removed federal tax deposit penalty 10-11-2021 -$465.84 290 Additional tax assessed 202146 12-06-2021 $0.00 n/a 17154-716-15028-l 290 Additional tax assessed 202151 01-10-2022 $47,168.54 n/a 83154-754-15148-l 196 Interest charged for late payment 202151 01-10-2022 $1 ,720.22 This Product Contains Sensitive Taxpayer Data I I Form 941 •X: Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund (Rev. April 2022) Department of the Treasury -Internal Revenue Service OMB No. 1545-0029 ~~:iloyer identification number Q GJ _ Q [J [J [J GJ [J GJ Name (not your trade name)I ~C_I_T_Y_O_F_D_A_N_IA_B_E_A_C_H ________________ --' Trade name (if any) Address J,oo WEST DANIA BEACH BLVD Number Street Suite or room number I ~D....,A_N_IA_B_E_A_C_H ___________ ___JI GJ LI __ 3_3_0_0_4 _ ___J City State ZIP code ._____I L--1 __ Foreign country name Foreign province/county Foreign postal code Read the separate instructions before completing this form. Use this form to correct errors you made on Form 941 or 941-SS. Use a separate Form 941 -X for each quarter that needs correction. Type or print within the boxes. You MUST complete all five pages. Don't attach this form to Form 941 or 941-SS unless you're reclassifying workers; see the instructions for line 42. ■@II Select ONLY one process. See page 6 for additional guidance, including information on how to treat employment tax credits and social security tax deferrals. ~ 1. Adjusted employment tax return. Check this box if you underreported tax amounts. Also check this box if you overreported tax amounts and you would like to use the adjustment process to correct the errors. You must check this box if you're correcting both underreported and overreported tax amounts on this form. The amount shown on line 27, if less than zero, may only be applied as a credit to your Form 941, Form 941-SS, or Form 944 for the tax period in which you're filing this form. D 2. Claim. Check this box if you overreported tax amounts only and you would like to use the claim process to ask for a refund or abatement of the amount shown on line 27. Don't check this box if you're correcting ANY underreported tax amounts on this form. ■Rfflfj Complete the certifications. Return You're Correcting ... Check the type of return you're correcting. ~941 D 941-SS Check the ONE quarter you're correcting. D 1: January, February, March D 2: April, May, June ~ 3: July, August, September D 4: October, November, December Enter the calendar year of the quarter you're correcting. I 2020 I ,:fYYY) Enter the date you discovered errors. [iQJ1 [Qi]/ I 2022 I (MM/ DD / YYYY) D 3. I certify that I've filed or will file Forms W-2, Wage and Tax Statement, or Forms W-2c, Corrected Wage and Tax Statement, as required. Note: If you're correcting underreported tax amounts only, go to Part 3 on page 2 and skip lines 4 and 5. If you're correcting overreported tax amounts, for purposes of the certifications on lines 4 and 5, Medicare tax doesn't include Additional Medicare Tax. Form 941-X can't be used to correct overreported amounts of Additional Medicare Tax unless the amounts weren't withheld from employee wages or an adjustment is being made for the current year. 4. If you checked line 1 because you're adjusting overreported federal income tax, social security tax, Medicare tax, or Additional Medicare Tax, check all that apply. You must check at least one box. I certify that: D a. De. I repaid or reimbursed each affected employee for the overcollected federal income tax or Additional Medicare Tax for the current year and the overcollected social security tax and Medicare tax for current and prior years. For adjustments of employee social security tax and Medicare tax overcollected in prior years, I have a written statement from each affected employee stating that he or she hasn't claimed (or the claim was rejected} and won't claim a refund or credit for the overcollection. The adjustments of social security tax and Medicare tax are for the employer's share only. I couldn't find the affected employees or each affected employee didn't give me a written statement that he or she hasn't claimed (or the claim was rejected) and won't claim a refund or credit for the overcollection. The adjustment is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I didn't withhold from employee wages. 5. If you checked line 2 because you're claiming a refund or abatement of overreported federal income tax, social security tax, Medicare tax, or Additional Medicare Tax, check all that apply. You must check at least one box. I certify that: D a. I repaid or reimbursed each affected employee for the overcollected social security tax and Medicare tax. For claims of employee social security tax and Medicare tax overcollected in prior years, I have a written statement from each affected employee stating that he or she hasn't claimed (or the claim was rejected} and won't claim a refund or credit for the overcollection. D e. I have a written consent from each affected employee stating that I may file this claim for the employee's share of social security tax and Medicare tax. For refunds of employee social security tax and Medicare tax overcollected in prior years, I also have a written statement from each affected empl oyee stating that he or she hasn't claimed (or the claim was rejected) and won't claim a refund or credit for the overcollection. ' The claim for social security tax and Medicare tax is for the employer's share only. I couldn't find the affected employees, or each affected employee didn't give me a written consent to file a claim for the employee's share of social security tax and Medicare tax, or each affected employee didn't give me a written statement that he or she hasn't claimed (or the claim was rejected) and won't claim a refund or credit for the overcollection. The claim is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I didn't withhold from employee wages. For Paperwork Reduction Act Notice, see the separate instructions. www.irs.gov/Form941X Cat. No. 17025J Form 941-X (Rev. 4-2022) Name (not your trade name) Employer identification number (EIN) CITY OF DANIA BEACH 59 6000302 Correcting quarter 3 (1, 2, 3, 4) Correcting calendar year (YYYY) 2020 Enter the corrections for this quarter. If any line doesn't apply, leave it blank. 6. Wages, tips, and other compensation (Form 941, line 2) 7. Federal income tax withheld from wages, tips, and other compensation (Form 941, line 3) 8. Taxable social security wages (Form 941 or 941-SS, line Sa, Column 1) 9. Qualified sick leave wages* (Form 941 or 941 -SS, line Sa(i), Column 1) 10. Qualified family leave wages* (Form 941 or 941-SS, line Sa(ii), Column 1) 11. Taxable social security tips (Form 941 or 941-SS, line Sb, Column 1) 12. Taxable Medicare wages & tips (Form 941 or 941-SS, line 5c, Column 1) 13. Taxable wages & tips subject to Additional Medicare Tax withholding (Form 941 or 941 -SS, line Sd) 14. Section 3121(q) Notice and Demand-Tax due on unreported tips (Form 941 or 941 -SS, line Sf) 15. Tax adjustments (Form 941 or 941 -SS, lines 7 through 9) 16. Qualified small business payroll tax credit for increasing research activities (Form 941 or 941-SS, line 11 a; you must attach Form 897 4) 17. Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021 (Form 941 or 941-SS, line 11 b) 18a. Nonrefundable portion of employee retention credit* (Form 941 or 941 -SS, line 11 c) 18b. Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 11 d) 18c. Nonrefundable portion of COBRA premium assistance credit (Form 941 or 941-SS, line 11 e) 18d. Number of individuals provided COBRA premium assistance (Form 941 or 941-SS, line 11 f) 19. Special addition to wages for federal income tax 20. Special addition to wages for social security taxes 21. Special addition to wages for Medicare taxes Page 2 Column 1 Column 2 Column 3 Column 4 Total corrected amount {for ALL employees) 2,439,755 . Amount originally reported or as previously corrected {for ALL employees) 2,486,249 · Difference (If this amount is a negative number, use a minus sign.) Tax correction Use the amount in Column 1 when you prepare your Forms W-2 or Fonns W-2c. Copy Column I 3 here. . '---------' ~--·4_6~,4_9_4_-_3~71 X 0.124* = L..l __ ....:·2c.c,8;:;..;8c.::2:....·__:6c..c..,51 • If you're correcting your employer share only, use 0.062. See instructions. • Use line 9 only for qualified sick leave wages paid after March 31, 2020, for leave taken before April 1, 2021. ~-~I -~I -~I = ~' -~I x 0.062 = • Use line 10 only for qualified family leave wages paid after March 31 , 2020, for leave taken before April 1, 2021 . o. ool ~------'I =~' --~I x 0.124*=~' --~ • If you're correcting your employer share only, use 0.062. See instructions. ~------'I = ~I --~I x 0.029* = ~' --~ • 1t you're correcting your employer share only, use 0.0145. See instructions. ~------'I = ~I --~I x 0.009* =~I--~ • Certain wages and tips reported in Column 3 shouldn't be multiplied by 0.009. See instructions. 47,168 · 47,168 · Copy Column 3 here. Copy Column 3 here . See instructions See instructions See instructions 47,168 · • Use line 18a only for corrections to quarters beginning after March 31, 2020, and before January 1, 2022. See instructions See instructions See instructions See instructions See instructions Form 941-X (Rev. 4-2022) Name (not your trade name) Employer identification number (EIN) CITY OF DANIA BEACH 59 6000302 Enter the corrections for this quarter. If any line doesn't apply, leave it blank. (continued) 22. Special addition to wages for Additional Medicare Tax Column 1 Total corrected amount (for ALL employees) Combine the amounts on lines 7 through 22 of Column 4 Column2 Amount originally reported or as previously corrected (for ALL employees) Column 3 Difference {If this amount is a negative number, use a minus sign.) Correcting quarter 3 (1, 2, 3, 4) Correcting calendar year (YYYY) See instructions 2020 Column 4 Tax correction 44,285 · 23. 24. Deferred amount of social security tax* (Form 941 or 941-SS, line 13b) L----------'' ~~;ructions • Use this line to correct the employer deferral for the second quarter of 2020 and the employer and employee deferral for the third and fourth quarters of 2020. 25. Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021 (Form 941 or 941- SS, line 13c) 26a. Refundable portion of employee retention credit* (Form 941 or 2Gb. 26c. 27. 941-SS, I ine 13d) · Use line 26a only for corrections to quarters beginning after March 31, 2020, and before January 1, 2022. Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 13e) Refundable portion of COBRA premium assistance credit (Form 941 or 941-SS, line 13f) Total. Combine the amounts on lines 23 through 26c of Column 4 If line 27 is less than zero: See instructions See instructions See instructions See instructions 44,285 · • If you checked line 1, this is the amount you want applied as a credit to your Form 941 or 941-SS for the tax period in which you're filing this form. (If you're currently filing a Form 944, Employer's ANNUAL Federal Tax Return, see the instructions.) • If you checked line 2, this is the amount you want refunded or abated. If line 27 is more than zero, this is the amount you owe. Pay this amount by the time you file this return. For information on how to pay, see Amount you owe in the instructions. 28. Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021 (Form 941 or 941- SS, line 19) 29. Qualified health plan expenses allocable to qualified family leave wages for leave taken before April 1, 2021 (Form 941 or 941-SS, line 20) 30. Qualified wages for the employee retention credit* (Form 941 or 941-SS, line 21) 31 a. Qualified health plan expenses for the employee retention credit* (Form 941 or 941-SS, line 22) • Use line 30 only for corrections to quarters beginning after March 31, 2020, and before January 1, 2022. • Use line 31 a only for corrections to quarters beginning after March 31, 2020, and before January 1, 2022. 31b. Check here if you're eligible for the employee retention credit in the third or fourth quarter of 2021 solely because your business is a recovery startup business D 32. Page 3 Credit from Form 5884-C, line 11, for this quarter* (Form 941 or 941-SS, line 23) L___-' -L--1 -- I * Use line 32 only for corrections to quarters beginning after March 31, 2020, and before April 1, 2021. Form 941-X (Rev. 4-2022) Name (not your trade name) Employer identification number (EIN) CITY OF DANIA BEACH 59 6000302 •~,.--Enter the corrections for this quarter. If any line doesn't apply, leave it blank. (continued) 33a. 33b. 34. Qualified wages paid March 13 through March 31, 2020, for the employee retention credit* (Form 941 or 941-SS, line 24) Deferred amount of the employee share of social security tax included on Form 941 or 941-SS, line 13b* (Form 941 or 941-SS, line 24) Qualified health plan expenses allocable to wages reported on Form 941 or 941-SS, line 24* (Form 941 or 941-SS, line 25) Column 1 Column 2 Column 3 Total corrected amount (for ALL employees) Amount originally reported or as previously corrected (for ALL employees) • Use line 33a only for corrections to the second quarter of 2020. Difference (If this amount is a negative number, use a minus sign.) .____~I -~' _ ___,I = ~' _ ___, • Use line 33b only for corrections to the third and fourth quarters of 2020. • Use line 34 only for corrections to the second quarter of 2020. Caution: Lines 35-40 apply only to quarters beginning after March 31, 2021. 35. Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 23) 36. Qualified health plan expenses allocable to qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941 -SS, line 24) 37. Amounts under certain collectively bargained agreements allocable to qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 25) 38. Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 26) 39. Qualified health plan expenses allocable to qualified family leave wages for leave taken after March 31 , 2021 , and before October 1, 2021 (Form 941 or 941-SS, line 27) 40. Amounts under certain collectively bargained agreements allocable to qualified family leave wages for leave taken after March 31 , 2021, and before October 1, 2021 (Form 941 or 941-SS, line 28) Correcting quarter 3 (1, 2, 3, 4) Correcting calendar year (YYYY) 2020 Page 4 Form 941-X (Rev. 4-2022) Name (not your trade name) Employer identification number (EIN) Correcting quarter 3 (1, 2, 3, 4) Correcting calendar year (YYYY) CITY OF DANIA BEACH 59 6000302 2020 •·~·--•1111 Explain your corrections for this quarter. [R] 41. Check here if any corrections you entered on a line include both underreported and overreported amounts. Explain both your underreported and overreported amounts on line 43. 0 42. Check here if any corrections involve reclassified workers. Explain on line 43. 43. You must give us a detailed explanation of how you determined your corrections. See the instructions. See attached letter ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ■@fj Sign here. You must complete all five pages of this form and sign it. Under penalties of perjury, I declare that I have filed an original Form 941 or Form 941-SS and that I have examined this adjusted return or claim, 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. Print your I name hereYEIMY GUZMAN Print your I title hereDEPUTY FINANCE DIRECTOR Paid Preparer Use Only Preparer's name Preparer's signature '----------------------------' Firm's name (or yours if self-employed) Address City State Page5 Best daytime phone!~ _9_5_4_-9_2_4_-6_8_0_0_E_X_T_3_6_7_4~ Check if you're self-employed □ PTIN Date EIN Phone ZIP code Form 941-X (Rev. 4-2022) Type of errors you're correcting Underreported tax amounts ONLY Overreported tax amounts ONLY BOTH underreported and overreported tax amounts Page 6 Form 941-X: Which process should you use? Unless otherwise specified in the separate instructions, an underreported employment tax credit or social security tax deferral should be treated like an overreported tax amount. An overreported employment tax credit or social security tax deferral should be treated like an underreported tax amount. For more information, including which process to select on lines 1 and 2, see Correcting an employment tax credit or social security tax deferral in the separate instructions. Use the adjustment process to correct underreported tax amounts. • Check the box on line 1. • Pay the amount you owe from line 27 by the time you file Form 941-X. The process you use depends on when you file Form 941-X. The process you use depends on when you file Form 941 -X. If you're filing Form 941-X MORE THAN 90 days before the period of limitations on credit or refund for Form 941 or Form 941-SS expires ... If you're filing Form 941-X WITHIN 90 days of the expiration of the period of limitations on credit or refund for Form 941 or Form 941-SS ... If you're filing Form 941-X MORE THAN 90 days before the period of limitations on credit or refund for Form 941 or Form 941-SS expires ... If you're filing Form 941-X WITHIN 90 days of the expiration of the period of limitations on credit or refund for Form 941 or Form 941-SS ... Choose either the adjustment process or the claim process to correct the overreported tax amounts. Choose the adjustment process if you want the amount shown on line 27 credited to your Form 941 , Form 941-SS, or Form 944 for the period in which you file Form 941-X. Check the box on line 1. OR Choose the claim process if you want the amount shown on line 27 refunded to you or abated. Check the box on line 2. You must use the claim process to correct the overreported tax amounts. Check the box on line 2. Choose either the adjustment process or both the adjustment process and the claim process when you correct both underreported and overreported tax amounts. Choose the adjustment process if combining your underreported tax amounts and overreported tax amounts results in a balance due or creates a credit that you want applied to Form 941 , Form 941-SS, or Form 944. • File one Form 941-X, and • Check the box on line 1 and follow the instructions on line 27. OR Choose both the adjustment process and the claim process if you want the overreported tax amount refunded to you or abated. File two separate forms. 1. For the adjustment process, file one Form 941-X to correct the underreported tax amounts. Check the box on line 1. Pay the amount you owe from line 27 by the time you file Form 941 -X. 2. For the claim process, file a second Form 941-X to correct the overreported tax amounts. Check the box on line 2. You must use both the adjustment process and the claim process. File two separate forms. 1. For the adjustment process, file one Form 941-X to correct the underreported tax amounts. Check the box on line 1. Pay the amount you owe from line 27 by the time you file Form 941-X. 2. For the claim process, fi le a second Form 941-X to correct the overreported tax amounts. Check the box on line 2. Form 941-X (Rev. 4-2022) Form 941-X: Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund (Rev. April 2022) Department of the Treasury -Internal Revenue Service OMS No. 1545-0029 ~~:iloyer identification number Q GJ _ Q W W GJ GJ GJ GJ Name (not your trade name) ~'C_I_T_Y_O_F_D_A_N_IA_B_E_A_C_H ________________ __, Trade name (if any) Address 1100 WEST DANIA BEACH BLVD Number Street Suite or room number .... ID_A_N_IA_B_E_A_C_H ___________ __,j ~ 1~ __ 3_3_o_o4 __ ~ City State ZIP code Foreign country name Foreign province/county Foreign postal code Read the separate instructions before completing this form. Use this form to correct errors you made on Form 941 or 941 -SS. Use a separate Form 941-X for each quarter that needs correction. Type or print within the boxes. You MUST complete all five pages. Don't attach this form to Form 941 or 941-SS unless you're reclassifying workers; see the instructions for line 42. ■@II Select ONLY one process. See page 6 for additional guidance, including information on how to treat employment tax credits and social security tax deferrals. [R] 1. Adjusted employment tax return. Check this box if you underreported tax amounts. Also check this box if you overreported tax amounts and you would like to use the adjustment process to correct the errors. You must check this box if you're correcting both underreported and overreported tax amounts on this form. The amount shown on line 27, if less than zero, may only be applied as a credit to your Form 941 , Form 941-SS, or Form 944 for the tax period in which you're filing this form. D 2. Claim. Check this box if you overreported tax amounts only and you would like to use the claim process to ask for a refund or abatement of the amount shown on line 27. Don't check this box if you're correcting ANY underreported tax amounts on this form. ■@fj Complete the certifications. Return You're Correcting ... Check the type of return you're correcting. [Rj 941 D 941-SS Check the ONE quarter you're correcting. D 1: January, February, March D 2: April, May, June D 3: July, August, September [R] 4: October, November, December Enter the calendar year of the quarter you're correcting. I 2020 I CfYYY) Enter the date you discovered errors. [ii]1 ~/ I 2022 I (MM I DD / YYYY) [R] 3. I certify that I've filed or will file Forms W-2, Wage and Tax Statement, or Forms W-2c, Corrected Wage and Tax Statement, as required. Note: If you're correcting underreported tax amounts only, go to Part 3 on page 2 and skip lines 4 and 5. If you're correcting overreported tax amounts, for purposes of the certifications on lines 4 and 5, Medicare tax doesn't include Additional Medicare Tax. Form 941-X can't be used to correct overreported amounts of Additional Medicare Tax unless the amounts weren't withheld from employee wages or an adjustment is being made for the current year. 4. If you checked line 1 because you're adjusting overreported federal income tax, social security tax, Medicare tax, or Additional Medicare Tax, check all that apply. You must check at least one box. I certify that: D a. D e. I repaid or reimbursed each affected employee for the overcollected federal income tax or Additional Medicare Tax for the current year and the overcollected social security tax and Medicare tax for current and prior years. For adjustments of employee social security tax and Medicare tax overcollected in prior years, I have a written statement from each affected employee stating that he or she hasn't claimed (or the claim was rejected) and won't claim a refund or credit for the overcollection. The adjustments of social security tax and Medicare tax are for the employer's share only. I couldn't find the affected employees or each affected employee didn't give me a written statement that he or she hasn't claimed (or the claim was rejected) and won't claim a refund or credit for the overcollection. The adjustment is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I didn't withhold from employee wages. 5. If you checked line 2 because you're claiming a refund or abatement of overreported federal income tax, social security tax, Medicare tax, or Additional Medicare Tax, check all that apply. You must check at least one box. I certify that: D a. I repaid or reimbursed each affected employee for the overcollected social security tax and Medicare tax. For claims of employee social security tax and Medicare tax overcollected in prior years, I have a written statement from each affected employee stating that he or she hasn't claimed (or the claim was rejected) and won't claim a refund or credit for the overcollection. D e. I have a written consent from each affected employee stating that I may file this claim for the employee's share of social security tax and Medicare tax. For refunds of employee social security tax and Medicare tax overcollected in prior years, I also have a written statement from each affected employee stating that he or she hasn't claimed (or the claim was rejected) and won't claim a refund or credit for the overcollection. The claim for social security tax and Medicare tax is for the employer's share only. I couldn't find the affected employees, or each affected employee didn't give me a written consent to file a claim for the employee's share of social security tax and Medicare tax, or each affected employee didn't give me a written statement that he or she hasn't claimed (or the claim was rejected) and won't claim a refund or credit for the overcollection. The claim is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I didn't withhold from employee wages. For Paperwork Reduction Act Notice, see the separate instructions. www.irs.gov/Form941X Cat. No. 17025J Form 941-X (Rev. 4-2022) Name (not your trade name) Employer identification number (EIN) CITY OF DANIA BEACH 59 6000302 Correcting quarter 4 (1, 2, 3, 4) Correcting calendar year r,:fYYY) 2020 Enter the corrections for this quarter. If any line doesn't apply, leave it blank. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18a. 18b. 18c. Wages, tips, and other compensation (Form 941, line 2) Federal income tax withheld from wages, tips, and other compensation (Form 941, line 3) Taxable social security wages (Form 941 or 941-SS, line 5a, Column 1) Qualified sick leave wages• (Form 941 or 941-SS, line 5a(i), Column 1) Qualified family leave wages• (Form 941 or 941 -SS, line 5a(ii), Column 1) Taxable social security tips (Form 941 or 941-SS, line 5b, Column 1) Taxable Medicare wages & tips (Form 941 or 941-SS, line 5c, Column 1) Taxable wages & tips subject to Additional Medicare Tax withholding (Form 941 or 941-SS, line 5d) Section 3121(q) Notice and Demand-Tax due on unreported tips (Form 941 or 941 -SS, line 51) Tax adjustments (Form 941 or 941-SS, lines 7 through 9) Qualified small business payroll tax credit for increasing research activities (Form 941 or 941-SS, line 11 a; you must attach Form 897 4) Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021 (Form 941 or 941-SS, line 11 b) Nonrefundable portion of employee retention credit* (Form 941 or 941-SS, line 11 c) Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 11d) Nonrefundable portion of COBRA premium assistance credit (Form 941 or 941 -SS, line 11 e) 18d. Number of individuals provided COBRA premium assistance (Form 941 or 941-SS, line 111) 19. 20. 21 . Page 2 Special addition to wages for federal income tax Special addition to wages for social security taxes Special addition to wages for Medicare taxes Column 1 Total corrected amount (for ALL employees) Column 2 Amount originally reported or as previously corrected (for ALL employees) Column3 Difference (If this amount is a negative number, use a minus sign.) Column 4 Tax correction Use the amount in Column 1 when you prepare your Forms W-2 or Forms W-2c. Copy Column I 3 here . . L----------' x 0.124* = I~-----~ • If you're correcting your employer share only, use 0.062. See instructions. • Use line 9 only for qualified sick leave wages paid after March 31, 2020, for leave taken before April 1, 2021. ~~I -I~ -~I = '~-~I x 0.062= • Use line 1 O only for qualified family leave wages paid after March 31 , 2020, for leave taken before April 1, 2021. o. ool ~-~I = '~--~I x 0.124·=1~-~ • If you're correcting your employer share only, use 0.062. See instructions. ~-~I = ~I --~I x 0.029*= I~-~ * If you're correcting your employer share only, use 0.0145. See instructions. ~-~I = ~I --~I x 0.009*= I~-~ • Certain wages and tips reported in Column 3 shouldn't be multiplied by 0.009. See instructions. -8,264 . 8,264 . Copy Column 3 here . Copy Column 3 here . See instructions See instructions See instructions 8,264 · • Use line 18a only for corrections to quarters beginning after March 31, 2020, and before January 1, 2022. See instructions See instructions See instructions See instructions See instructions Form 941-X (Rev. 4-2022) Name (not your trade name) Employer identification number (EIN) CITY OF DANIA BEACH 59 6000302 •~1 . ..,,.. Enter the corrections for this quarter. If any line doesn't apply, leave it blank. (continued) 22. Column 1 Column 2 Column 3 Special addition to wages for Additional Medicare Tax Total corrected amount (for ALL employees) Combine the amounts on lines 7 through 22 of Column 4 Amount originally reported or as previously corrected (for ALL employees) Difference {If this amount is a negative number, use a minus sign.) Correcting quarter 4 (1, 2, 3, 4) Correcting calendar year (:{YYY) See instructions 2020 Column 4 Tax correction 8,264 · 23, 24. Deferred amount of social security tax* (Form 941 or 941 -SS, line 13b) .__ ______ __.I ~';;ructions • Use this line to correct the employer deferral for the second quarter of 2020 and the employer and employee deferral for the third and fourth quarters of 2020. 25. Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021 (Form 941 or 941- SS, line 13c) 26a. Refundable portion of employee retention credit* (Form 941 or 941 -SS, line 13d) · Use line 26a only for corrections to quarters beginning after March 31, 2020, and before January 1, 2022. 26b. Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 13e) 26c. Refundable portion of COBRA premium assistance credit (Form 941 or 941-SS, line 13f) 27. Total. Combine the amounts on lines 23 through 26c of Column 4 If line 27 is less than zero: See instructions See instructions See instructions See instructions 8,264 · • If you checked line 1, this is the amount you want applied as a credit to your Form 941 or 941-SS for the tax period in which you're filing this form. (If you're currently filing a Form 944, Employer's ANNUAL Federal Tax Return, see the instructions.) • If you checked line 2, this is the amount you want refunded or abated. If line 27 is more than zero, this is the amount you owe. Pay this amount by the time you file this return. For information on how to pay, see Amount you owe in the instructions. 28. Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021 (Form 941 or 941- SS, line 19) 29. Qualified health plan expenses allocable to qualified family leave wages for leave taken before April 1, 2021 (Form 941 or 941-SS, line 20) 30. Qualified wages for the employee retention credit* (Form 941 or 941 -SS, line 21) 31 a. Qualified health plan expenses for the employee retention credit* (Form 941 or 941-SS, line 22) • Use line 30 only for corrections to quarters beginning after March 31, 2020, and before January 1, 2022 . ._________.I -.___I-~' = .___I-~ • Use line 31a only for corrections to quarters beginning after March 31, 2020, and before January 1, 2022. 31b. Check here if you're eligible for the employee retention credit in the third or fourth quarter of 2021 solely because your business is a recovery startup business D 32. Page 3 Credit from Form 5884-C, line 11, for this quarter* (Form 941 or 941-SS, line 23) I • Use line 32 only for corrections to quarters beginning after March 31, 2020. and before April 1, 2021. Form 941-X (Rev. 4-2022) Name (not your trade name) Employer identification number (EIN) CITY OF DANIA BEACH 59 6000302 •~•---Enter the corrections for this quarter. If any line doesn't apply, leave it blank. (continued) 33a. 33b. 34. Qualified wages paid March 13 through March 31 , 2020, for the employee retention credit* (Form 941 or 941-SS, line 24) Deferred amount of the employee share of social security tax included on Form 941 or941-SS, line 13b* (Form 941 or 941-SS, line 24) Qualified health plan expenses allocable to wages reported on Form 941 or 941-SS, line 24* (Form 941 or 941-SS, line 25) Column 1 Total corrected amount {for ALL employees) Column2 Amount originally reported or as previously corrected {for ALL employees) • Use line 33a only for corrections to the second quarter of 2020. Column 3 Difference (If this amount is a negative number, use a minus sign.) • Use line 33b only for corrections to the third and fourth quarters of 2020. • Use line 34 only for corrections to the second quarter of 2020. Caution: Lines 35-40 apply only to quarters beginning after March 31, 2021. 35. Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941 -SS, line 23} 36. Qualified health plan expenses allocable to qualified sick leave wages for leave taken after March 31, 2021 , and before October 1, 2021 (Form 941 or 941-SS, line 24) 37. Amounts under certain collectively bargained agreements allocable to qualified sick leave wages for leave taken after March 31, 2021 , and before October 1, 2021 (Form 941 or 941-SS, line 25) 38. 39. Qualified family leave wages for leave taken after March 31 , 2021 , and before October 1, 2021 (Form 941 or 941-SS, line 26) Qualified health plan expenses allocable to qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 27) 40. Amounts under certain collectively bargained agreements allocable to qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941 or 941-SS, line 28) Correcting quarter 4 (1 , 2, 3, 4) Correcting calendar year (YYYY) 2020 Page 4 Form 941-X (Rev. 4-2022) Name (not your trade name) Employer identification number (EIN) Correcting quarter 4 (1, 2, 3, 4) Correcting calendar year (YYYY) CITY OF DANIA BEACH 59 6000302 2020 ■=.-..•,111 Explain your corrections for this quarter. ~ 41. Check here if any corrections you entered on a line include both underreported and overreported amounts. Explain both your underreported and overreported amounts on line 43. 0 42. Check here if any corrections involve reclassified workers. Explain on line 43. 43. You must give us a detailed explanation of how you determined your corrections. See the instructions. ■@Jj Sign here. You must complete all five pages of this form and sign it. Under penalties of perjury, I declare that I have filed an original Form 941 or Form 941-SS and that I have examined this adjusted return or claim, 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 X b;~;;;;~j""°"~~ aay ka~IOOge. ~~~;~• :::~:T:~:::.:E DIRECTOR Date Paid Preparer Use Only Preparer's name Preparer's signature ~--------------------------~ Firm's name (or yours if self-employed) Address City State Page 5 Best daytime phone ~I _95_4_-_92_4_-_6_80_0_E_XT_3_6_74~ Check if you're self-employed □ PTIN Date I I EIN Phone ZIP code Form 941-X (Rev. 4-2022) Type of errors you're correcting Underreported tax amounts ONLY Overreported tax amounts ONLY BOTH underreported and overreported tax amounts Page 6 Form 941-X: Which process should you use? Unless otherwise specified in the separate instructions, an underreported employment tax credit or social security tax deferral should be treated like an overreported tax amount. An overreported employment tax credit or social security tax deferral should be treated like an underreported tax amount. For more information, including which process to select on lines 1 and 2, see Correcting an employment tax credit or social security tax deferral in the separate instructions. Use the adjustment process to correct underreported tax amounts. • Check the box on line 1. • Pay the amount you owe from line 27 by the time you file Form 941-X. The process you use depends on when you file Form 941-X. The process you use depends on when you file Form 941-X. If you're filing Form 941-X MORE THAN 90 days before the period of limitations on credit or refund for Form 941 or Form 941-SS expires ... If you're filing Form 941-X WITHIN 90 days of the expiration of the period of limitations on credit or refund for Form 941 or Form 941-SS ... If you're filing Form 941-X MORE THAN 90 days before the period of limitations on credit or refund for Form 941 or Form 941-SS expires ... If you're filing Form 941-X WITHIN 90 days of the expiration of the period of limitations on credit or refund for Form 941 or Form 941-5S ... Choose either the adjustment process or the claim process to correct the overreported tax amounts. Choose the adjustment process if you want the amount shown on line 27 credited to your Form 941 , Form 941-SS, or Form 944 for the period in which you file Form 941-X. Check the box on line 1. OR Choose the claim process if you want the amount shown on line 27 refunded to you or abated. Check the box on line 2. You must use the claim process to correct the overreported tax amounts. Check the box on line 2. Choose either the adjustment process or both the adjustment process and the claim process when you correct both underreported and overreported tax amounts. Choose the adjustment process if combining your underreported tax amounts and overreported tax amounts results in a balance due or creates a credit that you want applied to Form 941, Form 941-SS, or Form 944. • File one Form 941-X, and • Check the box on line 1 and follow the instructions on line 27. OR Choose both the adjustment process and the claim process if you want the overreported tax amount refunded to you or abated. File two separate forms. 1. For the adjustment process, fi le one Form 941-X to correct the underreported tax amounts. Check the box on line 1. Pay the amount you owe from line 27 by the time you file Form 941-X. 2. For the claim process, file a second Form 941-X to correct the overreported tax amounts. Check the box on line 2. You must use both the adjustment process and the claim process. File two separate forms. 1. For the adjustment process, file one Form 941-X to correct the underreported tax amounts. Check the box on line 1. Pay the amount you owe from line 27 by the time you file Form 941-X. 2. For the claim process, file a second Form 941 -X to correct the overreported tax amounts. Check the box on line 2. Form 941-X (Rev. 4-2022)