Schedule B (Form 941) — Document 30-5, No. 1:23-cr-00210-RDB

Summary

Document 30-5 in Case 1:23-cr-00210-RDB, filed March 19, 2025: a Schedule B (Form 941) Report of Tax Liability for Semiweekly Schedule Depositors (Rev. 1-2017), preceded by a Form 941 section for PEI STAFFING LLC with Part 2 on the deposit schedule and tax liability for the quarter. The Schedule B reports tax liability for Month 1 of 156,596.92, Month 2 of 169,071.44 and Month 3 of 32,897.54. Its line for the total liability for the quarter reads 358,565.90.

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Case 1:23-cr-00210-RDB Document 30-5 Filed 03/19/25 Page2of3

450217

Name (not your tradename) Employer identification number (EIN)

PEI STAFFING LLC 27-3294970

[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 on the return for the prior quarter was less than $2,500, and you didn't
incur a $100,000 next-day deposit obligation during the current quarter. If line 12 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 fedral tax liability. 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 io
Part 3.

[} Youwerea 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 L |

Month 2 L J

Total liability for quarter | | Total must equal line 12.

[X] Youwere 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.

Month 3

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

18 If you are a seasonal employer and you don’t have to file a return for every quarter ofthe 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.
[X] yes. Designee’s name and phone number | LISA HUFF | | 216-831-8900
Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS. | 34010 |
L] No.

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

Under penalties of perjury, | declare that | 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.

Print your

Sign your { ' name here | Lisa Huff |
name here | ee Print your |
Lar blot iz title hore | Fi duciary |

pate [10-15-2019] | 216 831-8900

Best daytime phone

Paid Preparer Use Only Check if you are self-empioyed een... [J
Date | |

|

Preparer’s signature |

Firm’s name (or yours
if self-employed)

Address |
City [_ State ZIP code [

Page 2 Form 941 (Rev. 1-2019)

EIN

Phone i

TL

402 22-Oct-2019 12:04 224083 1122
Case 1:23-cr-00210-RDB

Schedule B (Form 941):

Report of Tax Liability for Semiweekly Schedule Depositors

(Rev. January 2017)

Employer identification number

(EIN)

Calendar year

27-3294970

Name (notyourtradename) PRET STAFFING LLC

2019

Document 30-5

Department of the Treasury -- Internal Revenue Service

(Also check quarter)

Filed 03/19/25

Page 3 of 3

OMB No. 1545-0029

Report for this Quarter ...
(Check one.)

[| 1: January, February, March

[| 2: April, May, June

3: July, August, September

CJ 4: October, November, December

Use this schedule to show your TAX LIABILITY for the quarter; don’t use it to show your deposits. When you file this form with Form 941 or
Form 941-SS, don’t change your tax liability by adjustments reported on any Forms 941-X or 944-X. You must fill out this form and attach it to
Form 941 or Form 941-SS if you’re a semiweekly schedule depositor or became one because your accumulated tax liability on any day was
$100,000 or more. Write your daily tax liability on the numbered space that corresponds to the date wages were paid. See Section 11 in

Pub. 15 for details.
Month 1

|| Tax liability for Month 1

156,596.92

Tax liability for Month 2

169,071.44

_|| Tax liability for Month 3

32,897.54
|

3| || lid 37340.54),[_ |
a| Fe 38990 . 68 ao] loa |
5 | 39804 .27] 19| dol loo| 6.74]

Month 2

al Fr re 150.07), |
e| Jal lool lad 8386.47]

Month 3

1| _ Jol il. 94|,7| —_Jos|

Fill in your total liability for the quarter (Month 1+ Month 2+Month3) &
Total must equal line 12 on Form 941 or Form 941-SS.

Total liability for the quarter
358,565.90

For Paperwork Reduction Act Notice, see separate instructions.

IRS.gov/form941

402 22-Oct-2019 12:04 224083 1122

Schedule B (Form 941) (Rev. 1-2017)


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