name community address state eer-, 1read the separate instructions before you complete form 941....

,",, 941 tOf 2018: Employer's QUARTERLY Federal Tax Return(Rev. January 201 8) Department of the Treasury - lnternal Revenue Service

Employer identification number (ElN) 3B-3161108

Name (not your trade name) Citizens Dispute Resol-ution Servic

frade name (if any) Northern Community Mediation

Address

PetoskeyCity

EEr-, 1ZIP code

Foreign country name Foreign province,/county Foreign postal code

4:-.5 State Street.

Read the separate instructions before you complete Form 941. Type or print within the boxes.

1501,1,?OMB No. 1545-0029

[ 1r J"nr"ry, February, March

I z: nprit, May, June

I s,.lrty, August, September

! 4, O"tob"r, November, December

Go to www.lrs. govlForm94l forinstructions and the latest information.

REV 10/10/18 QBDT

IEEIE Answer these questions for this quaner.

1 Number of employees who received wages, tips, or other compensation for the pay periodincluding: Mar. 12 (Quarter 11, June 12 (Quarter 2), Sept 12 (Quarter 3), or Dec. 72 (Quarter 4) 1

2

3

4

5a Taxable social security wages .

5b Taxable social security tips

5c Taxable Medicare wages & tips.

5d Taxable wages & tips subject toAdditional Medicare Tax withholding

Wages, tips, and other compensation

Federal income tax withheld from wages, tips, and other compensation

lf no wages, tips, and other compensation are subject to social security or Medicare tax

44 , L33 .42

3,110.00

n Cnect and go to line 6.

Column 2

5 ,472 .54

1,279.97

6,752.4t

9 , 862 .41_

0.05

9 ,862.46

9 ,862.46

9 ,862 .46

Check one: n ooo,r,o n.*, r.trr. I-l Send a refund.

@Form 941 (Rev. 1-2018)

Column'l

44 , L33 .42

44 ,733 .42

x 0.124 =

x Q.124 =

x 0.029 =

x 0.009 =

5e

5f

6

7

8

I

10

11

12

13

Add Column 2lrom lines 5a, 5b, 5c, and 5d

section 3121(q) Notice and Demand-Tax due on unreponed tips (see instructions)

Total taxes before adjustments. Add lines 3, 5e, and 5f

Current quarter's adjustment for fractions of cents

Current quarter's adjustment for sick pay

Current quarter's adjustments for tips and group-term life insurance

Total taxes after adjustments. Combine lines 6 through 9

Qualified small business payroll tax credit for increasing research activities. Attach Form 8974

Tota! taxes after adjustments and credits. Subtract line 1 1 from line 10

Total deposits for this quarter, including overpayment applied from a prior quarter andoverpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter

5f

6

8

I

10

11

12

13

1414 Balance due. lf line 12 is more than line 13, enter the difference and see instructions

15 Overpayment. lf line 13 is more than line 12, enter the difference

) You MUST complete both pages of Form 941 and SIGN it.

4

For PrivacyAct and Paperwork Reduction Act Notice, see the back ofthe Payment Voucher. BAA

Report for this Quarter of 2018(Check one.|

5e

of Pub. 15.

16 Checkone: !

your

Citizens Dispute Resolution Servj-ce, Inc. 38-3161108Tell us about your deposit schedule and tax liability for this quarter.

Line 12 on this return is less than $2,500 or line 12 on the retum for the prior quarter was less than $2,500, and you didn'tincur a $100,000 next-day deposit obtigation during the current quarter. lf line 12 for the prior quarter was less than $2,500 butline 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. lf you are a monthly scheduledepositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go toPaft 3.

You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and totalliability for the quarter, then go to Part 3.

Tax liability: Month 1 3,943.90

Month 2

Month 3

Total liability for quafter

3,403.98

2 ,5]-4 .68

9 ,862 .46 Total must equal line 12.

n You were a semiweekly schedule depositor for any pafi of this quarter. Complete Schedule B (Form 941),Repod of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941.

Tell us about your business. lf a question does NOT apply to your business, leave it blank.

17 lf your business has closed or you stopped paying wages . ! Cfrect here, and

enter the final date you paid wages

18 lf you are a seasonal emptoyer and you don't have to file a retum for every quarter of the year I Check here.

tr

150a1?

lf you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11

May we speak with your third-pafi designee?

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructionsfor details.

n y"". Designee's name and phone number

Select a 5-digit Personal ldentification Number (PlN) to use when talking to the lRS.

E No.

Sign here. You MUST complete both pages of Form 941 and SIGN it. REV 10/10/18 08DT

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledgeand 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 yourname here

Print yourtitle here

Date Best daytime phone

Sign yourname here

Paid Preparer Use Only

Robyn L Rebec

Mason, Kammermann & Rohrback, P.C.

l-10 Park Avenue

Charlevoix

Check if you are self-employed trP0 13 948t6

Date 10/25/20]-8

38-27 53936

(na) 547 -4eaa

497 20

Preparer's name

Preparer's signature

Firm's name (or yoursif self-employed)

Address

City

EIN

Phone

ZIP code

eage2

State Er I

Form941 (Rev. 1-2018)

CLIINTS

,"., 941 tOf 2018: Employer's QUARTERLY Federal Tax Return(Rev. January 20 1 8) Department of the Treasury - lnternal Revenue Service

Employer idontifi cation number (ElN) 3B-3151108

Name (not your trade name) Citizens Dispute Resolution Servic

Trade name (if any) Northern Community Mediation

Address 4L5 State StreetSuite or room number

4977 0

Foreign country name For€ign postal code

Petoske

Foreign provinc€/cdnty

Read the separate instructions before you complete Form 941. Type or print within the boxes.

350r1,7OMB No. 1545-0029

! 1r J"nrary, February, March

I z: eprit, May, June

n s,.Jrty, August, September

! e: October, November, December

Go to www.ns. govlFormg4l lorinstructions and the latest information.

REV 06/12/18 QBDT

Answer these questions for this quarter.

1 Number of employees who received wages, tips, or other compensation for the pay periodincluding: Mar. 12 (Quarter 11, June 12 (Quarter 2) , Sept. 12 (Quarter 3), or Dec. /2 (Quafter 4) 1

22

3

4

5a Taxable social security wages .







39,277 .34

2,49 0. 00

I Cfrect and go to line 6.

Column 1

39 ,277 .34Column 2

4,870.39x 0.124 =

x 0.124 =

x 0.029 =

x 0.009 =

39,277 .34 L, 13 9 .04

5e

5f

6

7

8

I

'10

11

12

't3

Add Column 2 from lines 5a, 5b, 5c, and 5d

Section 3121(q) Notice and Demand-Tax due on unreported tips (see instructions)




Current quarter's adjustments for tips and group-term life insurance


Qualified small business pay'oll tax credit for increasing research activities. Attach Form 8974

Total taxes after adjustments and credits. Subtract line 11 from line 10

Total deposits for this quaner, indrding overpayncnt apCied frorn a prior quarter andoverprynrerts applied from Fomt 941-X 941-X (PR),WX, or 944-X (SB fled in the cr.nrent qr.rarter

5e

5f

6

5,009.43

I ,499 .43

-0.05

8,499.38

8,499.38

8,499.39

Check one: n epgytonextraum. n Send a rerund.

@trorm 941 (Rev.1-2018)

8

9

10

11

12

13

1414 Balance due. lf line 12 is more than line 13, enter the difference and see instructions

15 Overpayment. lf line 13 is more than line 12, enter the difference


5

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. BAA

Report for this Quarter of(Check one.)

your identification number (ElN)

Citizens Dispute Resolution Service, fnc. 38-3161-l_08

Tell us about your deposit schedule and tax liability for this quarter.

of Pub. 15.

16 Checkon"r f Line 12 on this return is less than $2,500 or line 12 on the retum for the prior quarter was less than $2,500, and you didn,tincur a $100,000 next-day deposit obligation during the current quarter. lf line 12 for the prior quarter was less than $2,500 butline 12 on this retum is $100,000 or more, you must provide a record of your federal tax liability. lf you are a monthly scheduledepositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go toPart 3.

You were a monthly schedule depositor for the entire quader. Enter your tax liability for each month and totalliability for the quarter, then go to Part 3.

Tax liability: Month 1 2,80 g. l_g

Month 2

Month 3

Total liability for quarter

2,909.L9

2 ,88]- .02

8,499.39 Total must equal line 12.

tr You were a semiweekly schedule depositor for any par4 of this quarter. Complete Schedule B (Form 941),Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form g41.

Tell us about your business. lf a question does NOT apply to your business, teave it blank.

17 lf your business has closed or you stopped paying wages . I cnect here, and


18 lf you are a seasonal employer and you don't have to file a return for every quader of the year I Check here.

E

350a1?

lf you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11

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 retum with the IRS? See the instructionsfor details.

E y"a. Designee's name and phone number

Select a S-digit Personal ldentification Number (PlN) to use when talking to the lRS.

E ruo.

Sign here. You MUST complete both pages of Form 941 and SIGN it. REV 06/12l18 QBDT

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledgeand 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 yourname here

Date

I ['l']DVPrint yourname here


Best daytime phone


Robyn L Rebec

110 Park Avenue

Charlevoix

Check if you are self-employed

P0l-3 948L6

Date

EIN 38-27 63936

(231)547-4e11-

497 20

Preparer's name



Address

City

Phone

ZIP code


Page 2

st"t" ltttt -l

rorm 941 fiev. 1-2018)

.,,, 941 tOf 2018: Emptoyer's QUARTERLY Federal Tax Return(Rev. January 201 8) Department of the Treasury - lnternal Revenue Service

Employer identifi cation number (ElN) 3B-316r_108

Citizens Dispute Resolution Servic

Trade name (if any) Northern Community Mediation

415 State StreetSuite or room number

Petoskey Elw, IZIP code

Foreign province/county Foreign postal code

1 5 0 1,1,7OMB No.1545-0029

Name (not your trade name) [ 1r J"nr"ry, February, March

I zr nprit, May, June

! s,.luty, August, September

f] +, o"tober, November, December

Go to www.irs. govlForm941 torinstructions and the latest information.

REV 04/04/18 QBDT

Foreign country name

Read the separate instructions before you complete Form 941 . Type or print within the boxes.

1

2

3

4

5e

5f

6

7

8

I

10

11

12

't3

Number of employees who received wages, tips, or oilrer compensation for the pay periodincluding: Mar. 12 (Quafterll,June /2(Quafter2) ,SepL12 (QuarterS), orDec. 12(Quarter4)




1

2

5a Taxable social security wages . .




Column 1

47 ,474 .23Column 2

5,885.80

47 ,474.23

3,357.00

I Cnecf and go to line 6.

7,263.55

t0 ,620 .55

0.01

L0 ,620 . 56

L0 ,520:55

L0 ,520 . 55

47,474.23 I ,37 6 .75

x 0.124 =

x 0.124 =

x 0.029 =

x 0.009 =

Add Column 2trom lines 5a, 5b, 5c, and 5d

Section 3121(q) Notice and Demand-Tax due on unrepoded tips (see instructions)




Current quader's adjustments for tips and group-term life insurance


Qualified small business payroll tax credit for increasing research activities. Attach Form 8974

Total taxes after adjustments and credits. Subtract line 11 from line 10

Total deposits for this quarter, indudng oveqtayment apCied frorn a prior quarter andoverpaymerts appliedfrorn Fam941-X 941-X(PR),94+\ a9a+XGD filed inthe ctrrent quarter

5f

6

I

9

10

11

12

13

14'|.4 Balance due. lf line 12 is more than line 13, enter the difference and see instructions

15 Overpayment. lf line l3 is more than line 12, enter the difference


Check one: l-lnppryton"rtrst., ,l-l Send a refund.

@(Rev. 1 -201 8)

4

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. BAA rorm 941

Repod for this Quarter of 2018(Check one.)

5e

your

Citizens Disput.e Resol-ution Service, Inc.Tell us about your deposit schedule and tax liability for this quarter.

of Pub. 15.

16 Check on.r l-l Line 12 on this retum is less than $2,500 or line '12 on the refum for the prior quarter was less than $2,500, and you didn,tincur a $100,000 next-day deposit obligation during the current quarter. lf line 12 for the prior quarter was less than $2,500 butline 12 on this retum is $100,000 or more, you must provide a record of your federal tax liability. lf you are a monthly scheduledepositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go toPart 3.

A You were a monthly schedule depositor for the entire quader. Enter your tax liability for each month and totalliability for the quarter, then go to Part 3.

Tax liability: Month 1 3,053.82

Month 2

Month 3

Total liability for quarter

2 ,849 .12

4,707 .62

]-0,620.55 Total must equal line 12.

tr 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 .

Tel! us about your business. lf a question does NOT apply to your business, teave it blank.

17 !f your business has closed or you stopped paying wages . f] cnecr here, and


18 lf you are a seasonal employer and you don't have to file a return for every quader of the year tr Check here.

Employer identifi cation number (ElN)

3B-3151108

150er7

!f you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 1'l

May we speak with your third-party designee?

for details.

E yu.. Designee's name and phone number

Select a S-digit Personal ldentification Number (PlN) to use when talking to the lRS.

E ruo.

Sign here. You MUST complete both pages of Form 941 and SIGN it. REV O4l04/18 QEDT

Under penalties of periury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledgeand 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 yourname here


Date Best daytime phone

Sign yourname here

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the rnstructions

ll I il\I5


110 Park Avenue

Charlevoix

Check if you are self-employed

PTINP013 948L6

Date 04/24/2oLB

EIN 38 -27 63936

(231) 547-49LL

49720

Preparer's name



Address

City

Phone

ZIP code

Robyn L Rebec


eage2

st"t" IEI-_-]

norm 941 (Rev. 1-2018)

name community address state eer-, 1read the separate instructions before you complete form 941....

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