Class A Security

Location:

Ogden, UT

Posted:

June 04, 2023

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Form ***-X:

(Rev. February ****)

Adjusted Employer’s ANNUAL Federal Tax Return or Claim for Refund

Department of the Treasury — Internal Revenue Service OMB No. 1545-2007 Employer identification number (EIN)

—

Name (not your trade name)

Trade name (if any)

Address

Number Street Suite or room number

City State ZIP code

Read the instructions before you complete this form. Use this form to correct errors made on Form 944 or Form 944-SS. Use a separate Form 944-X for each year that needs correction. Type or print within the boxes. You MUST complete all three pages. Do not attach this form to Form 944.

Return You Are Correcting ...

Check the type of return you are

correcting:

944

944-SS

Enter the calendar year you are

correcting:

(YYYY)

Enter the date you discovered errors:

(MM / DD / YYYY)

Part 1: Select ONLY one process.

1. Adjusted employment tax return. Check this box if you underreported amounts. Also check this box if you overreported amounts and you would like to use the adjustment process to correct the errors. You must check this box if you are correcting both underreported and overreported amounts on this form. The amount shown on line 20, if less than zero, may only be applied as a credit to your Form 944, Form 941, or Form 941-SS for the tax period in which you are filing this form. 2. Claim. Check this box if you overreported amounts only and you would like to use the claim process to ask for a refund or abatement of the amount shown on line 20. Do not check this box if you are correcting ANY underreported amounts on this form. Part 2: Complete the certifications.

3. I certify that I have 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 are correcting underreported amounts only, go to Part 3 on page 2 and skip lines 4 and 5. 4. If you checked line 1 because you are adjusting overreported amounts, check all that apply. You must check at least one box. I certify that:

a. I repaid or reimbursed each affected employee for the overcollected social security and Medicare taxes for prior years. I have a written statement from each employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.

b. The adjustment of social security tax and Medicare tax is for the employer’s share only. I could not find the affected employees or each employee did not give me a written statement that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.

c. The adjustment is for federal income tax, social security tax, and Medicare tax that I did not withhold from employee wages. 5. If you checked line 2 because you are claiming a refund or abatement of overreported employment taxes, check all that apply. You must check at least one box.

I certify that:

a. I repaid or reimbursed each affected employee for the social security and Medicare taxes overcollected in prior years. I have a written statement from each employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.

b. I have a written consent from each affected employee stating that I may file this claim for the employee’s share of social security and Medicare taxes overcollected in prior years. I also have a written statement from each employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection. c. The claim for social security tax and Medicare tax is for the employer’s share only. I could not find the affected employees, each employee did not give me a written consent to file a claim for the employee’s share of social security and Medicare taxes, or each employee did not give me a written statement that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.

d. The claim is for federal income tax, social security tax, and Medicare tax that I did not withhold from employee wages. Next ■

For Paperwork Reduction Act Notice, see the instructions. Cat. No. 20335M Form 944-X (Rev. 2-2012) Name (not your trade name) Employer identification number (EIN) Correcting Calendar Year (YYYY) Part 3: Enter the corrections for the calendar year you are correcting. If any line does not apply, leave it blank. Column 1

Total corrected

amount (for ALL

employees)

—

Column 2

Amount originally

reported or as

previously corrected

(for ALL employees)

Column 3

Difference

(If this amount is a

negative number,

use a minus sign.)

Column 4

Tax correction

Wages, tips and other

Compensation (from line 1 of

Form 944)

—

Use the amount in Column 1

when you prepare your Forms

W-2 or Forms W-2c.

Income tax withheld from wages,

tips, and other compensation

(from line 2 of Form 944)

—

Copy

Column 3

here .

Taxable social security wages

(from line 4a, Column 1 of Form

944 or Form 944-SS)

—

.124* =

*If you are correcting a 2011 return, use .104. If you are correcting your employer share only, use .062. See instructions. 9.

Taxable social security tips

(from line 4b, Column 1 of Form

944 or Form 944-SS)

—

.124* =

*If you are correcting a 2011 return, use .104. If you are correcting your employer share only, use .062. See instructions. 10.

Taxable Medicare wages and

tips (from line 4c, Column 1 of

Form 944 or Form 944-SS)

—

.029* =

*If you are correcting your employer share only, use .0145. See instructions. 11

Number of qualified employees

paid exempt wages/tips April 1–

December 31, 2010 (from line 5a

of Form 944 or Form 944-SS)*

— =

*Complete lines 11a

and 11b only for

corrections to the

2010 Form 944 or

Form 944-SS.

Exempt wages/tips paid to

qualified employees April 1–

December 31, 2010 (from line 5b

of Form 944 or Form 944-SS)*

—

.062 =

12. Tax adjustments (from line 6 of

Form 944 or Form 944-SS) .

—

Copy

Column 3

here .

13. Special addition to wages for

federal income tax

—

See

instructions .

14. Special addition to wages for

social security tax

—

See

instructions .

15. Special addition to wages for

Medicare taxes

—

See

instructions .

16. Subtotal. Combine the amounts on lines 7–15 of Column 4 . . . . . . . . . . . . . . . . . . . 17.

Advance earned income credit

(EIC) payments made to

employees (from line 8 of Form

944 only for years ending before

January 1, 2011)

—

See

instructions .

COBRA premium assistance

payments (from line 11a of Form

944 or Form 944-SS before 2011

or line 9a for 2011)

—

See

instructions .

Number of individuals provided

COBRA premium assistance (from

line 11b of Form 944 or Form 944-SS

before 2011 or line 9b for 2011)

— =

Number of qualified employees

paid exempt wages/tips March

19–31, 2010 (from line 11c of

Form 944 or Form 944-SS)*

— =

*Complete lines 18c

and 18d only for

corrections to the

2010 Form 944 or

Form 944-SS.

Exempt wages/tips paid to

qualified employees March 19–

31, 2010 (from line 11d of Form

944 or Form 944-SS)*

—

.062 =

19. Total. Combine the amounts on lines 16–18d of Column 4. Continue to next page . . . . . . . . . . . . . Next ■

Page 2 Form 944-X (Rev. 2-2012)

Name (not your trade name) Employer identification number (EIN) Correcting Calendar Year (YYYY) Part 3: Continued

20. Total. Amount from line 19 on page 2 . . . . . . . . . . . . . . . . . . . . . . . . . If line 20 is less than zero:

• If you checked line 1, this is the amount you want applied as a credit to your Form 944 for the tax period in which you are filing this form.

(If you are currently filing a Form 941 or Form 941-SS, Employer’s QUARTERLY Federal Tax Return, see the instructions.)

• If you checked line 2, this is the amount you want refunded or abated. If line 20 is more than zero, this is the amount you owe. Pay this amount when you file this return. For information on how to pay, see Amount you owe in the instructions.

Part 4: Explain your corrections for the calendar year you are correcting. 21. 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 23. 22. Check here if any corrections involve reclassified workers. Explain on line 23. 23. You must give us a detailed explanation of how you determined your corrections. See the instructions. Part 5: Sign here. You must complete all three pages of this form and sign it. Under penalties of perjury, I declare that I have filed an original Form 944 or Form 944-SS and that I have examined this adjusted return or claim and any schedules or statements that are attached, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other Sign than your taxpayer) is based on all information of which preparer has any knowledge. name here

Date

Print your

name here

Print your

title here

Best daytime phone

Paid Preparer Use Only Check if you are self-employed Preparer’s name PTIN

Preparer’s signature Date

Firm’s name (or yours if

self-employed) EIN

Address Phone

City State ZIP code

Page 3 Form 944-X (Rev. 2-2012)

Type of errors Form 944-X: Which process should you use? you are

correcting

Underreported

amounts

ONLY

Use the adjustment process to correct underreported amounts.

• Check the box on line 1.

• Pay the amount you owe from line 20 when you file Form 944-X. Overreported

amounts

ONLY

The process you

use depends on

when you file

Form 944-X.

If you are filing Form 944-X

MORE THAN 90 days before the

period of limitations on credit or

refund for Form 944 or Form

944-SS expires . . .

Choose either process to correct the overreported

amounts.

Choose the adjustment process if you want the

amount shown on line 20 credited to your Form 944, 941, or 941-SS for the period in which you file Form 944-X. Check the box on line 1.

Choose the claim process if you want the amount

shown on line 20 refunded to you or abated. Check

the box on line 2.

If you are filing Form 944-X

WITHIN 90 days of the expiration

of the period of limitations on

credit or refund for Form 944 or

Form 944-SS . . .

You must use the claim process to correct the

overreported amounts. Check the box on line 2.

BOTH

underreported

and

overreported

amounts

The process you

use depends on

when you file

Form 944-X.

If you are filing Form 944-X

MORE THAN 90 days before the

period of limitations on credit or

refund for Form 944 or Form

944-SS expires . . .

Choose either the adjustment process or both the

adjustment process and the claim process when you

correct both underreported and overreported amounts. Choose the adjustment process if combining your

underreported amounts and overreported amounts

results in a balance due or creates a credit that you want applied to Form 944, 941, or 941-SS.

• File one Form 944-X, and

• Check the box on line 1 and follow the instructions on line 20.

Choose both the adjustment process and the

claim process if you want the overreported amount

refunded to you or abated.

File two separate forms.

1. For the adjustment process, file one Form 944-X to correct the underreported amounts. Check the

box on line 1. Pay the amount you owe from line 20 when you file Form 944-X.

2. For the claim process, file a second Form 944-X to correct the overreported amounts. Check the

box on line 2.

If you are filing Form 944-X

WITHIN 90 days of the

expiration of the period of

limitations on credit or refund

for Form 944 or Form 944-SS. . .

You must use both the adjustment process and claim process.

File two separate forms.

1. For the adjustment process, file one Form 944-X to correct the underreported amounts. Check the

box on line 1. Pay the amount you owe from line 20 when you file Form 944-X.

2. For the claim process, file a second Form 944-X to correct the overreported amounts. Check the

box on line 2.

Form 944-X (Rev. 2-2012)

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