Form 941 for 2019 — PEI STAFFING LLC, Case 1:23-cr-00210-RDB, Document 30-6

Summary

Document 30-6 in Case 1:23-cr-00210-RDB, filed March 19, 2025: Form 941 for 2019 in the name of PEI STAFFING LLC, titled Employer's QUARTERLY Federal Tax Return (Rev. January 2019). The return has lines for the number of employees, wages, tips, and other compensation, federal income tax withheld, taxable social security and Medicare wages, total taxes after adjustments and credits, and total deposits for the quarter. Its second section covers the deposit schedule, with the box for a semiweekly schedule depositor marked [X], the business questions, and a third-party designee.

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Case 1:23-cr-00210-RDB Document 30-6 Filed 03/19/25

rom 9411 for 2019: Employer's QUARTERLY Federal Tax Retu

(Rev. January 2019) Department of the Treasury—Internal Revenue Service

rn

Page 1 of 3

450117
OMB No. 1545-0029

Name (not your trade name) | Pex STAFFING LLC |

Address 1201 MILFORD MILL ROAD SUITE 202 |

Employer identification number (EIN) | 27-3294970 | Report for this Quarter of 2019
(Check one.)

| 1: January, February, March

Trade name (if any) | | [] 2: April, May, June
[| 3: July, August, September

Number Street Suite or room number 4: October, November, December
| PIKESVILLE | | MD | 21208 | Go to www.irs.gov/Form941 for
- instructions and the latest information.
City State ZIP code

Foreign country name Foreign province/county Foreign postal code

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

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) 4 | 128 |
2 Wages, tips, and other compensation 2 | 493,594.11 6|
3 Federal income tax withheld from wages, tips, and other compensation nn 3| 26,415. 36|
4 If no wages, tips, and other compensation are subject to social security or Medicare tax [| Check and go to line 6.
Column 1 Column 2
5a Taxable social securitywages ss | 493,594.16| x 0.124 = | 61,205.68|
5b Taxable social security tips |. | 00| x 0.124 = | 00]
5c Taxable Medicare wages &tips | 493,594.16 x 0.029 = | 14,314.24|
5d Taxable wages & tips subject to
Additional Medicare Tax withholding | . od] x 0.009 = | 00|
5e Add Column 2 from lines 5a, 5b, 5c, and 5d 5e | 75,519. 92
5f Section 3121(q) Notice and Demand - Tax due on unreported tips (see instructions) |. 5f | .0 0|
6 Total taxes before adjustments. Add lines 3, 5e, and 5f 6 | 101,935.2 3|
7 Current quarter's adjustment for fractions of cents 7 | .8 2|
8 Current quarter's adjustment for sick pay 8 | .0 0|
9 Current quarter's adjustments for tips and group-term life insurance 9 | .0 0|
10 Total taxes after adjustments. Combine lines 6 through 9 10 | 101,936.1 0|
11 Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11 | 0 0|
12 Total taxes after adjustments and credits. Subtract line 11 from line 10 12 | 101,936.1 0|
13 Total deposits for this quarter, including overpayment applied from a prior quarter and 13 | 101, 936.1 0]
overpayments applied from Form 941-X, 941-X (PR), 944-X or 944-X (SP) filed in the current quarter £ -
14 Balance due. If line 12 is more than line 13, enter the difference and see instructions : 00|

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

> You MUST complete both pages of Form 941 and SIGN it.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.

402 07-Feb-2020 18:17 238051 1122

Check one: | Jappty to next return. | _|sena a refund.

Form 941 (Rev. 1-2019)
Case 1:23-cr-00210-RDB Document 30-6 Filed 03/19/25 Page 2 of3

45021?

Name (not your trade name) Employer identification number (EIN)

PEI STAFFING LLC 27-3294970

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 to
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 | |

Month 2 | |

Month 3 | |

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

[X] 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.

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

sesetsnnestnsenaees [_] Check here.

18 If you are a seasonal employer and you don't have to file a return for every quarter of the year

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.
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 |
|_| 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 Namerere LEMployer Copy |
name here Print your

ttle here | Employer Copy |

Date [01-29-2020 216 831-8900

Best daytime phone |

Paid Preparer Use Only Check if you are self-employed —ocnnenne [|
Preparer's name | | PTIN | |
Preparer's signature | | Date | |
i'seltemployed) EIN | |
Address | | Phone | |
City | State ; ZIP code | |
Page 2 Form 941 (Rev. 1-2019)

402 07-Feb-2020 18:17 238051 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)

Department of the Treasury -- Internal Revenue Service

27-3294970

Name (not yourtradename) PRT STAFFING LLC

Calendar year

2019

Document 30-6

(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

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

7| 140.61) 49| |al I31| |
a| | sal |aal |

Month 2

Month 3

1| || 47.4547 |os| |

Fill in your total liability for the quarter (Month 1 + Month 2 + Month 3) &
Total must equal line 12 on Form 941 or Form 941-SS.

Tax liability for Month 1
33,456.28

Tax liability for Month 2
39,457.86

Tax liability for Month 3
29,021.96

Total liability for the quarter
101,936.10

For Paperwork Reduction Act Notice, see separate instructions.

IRS.gov/form941

402 07-Feb-2020 18:17 238051 1122

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

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