Gallagher Company has gathered the information needed to complete its Form 941 for the quarter ended September 30, 2013. Using the information presented below, complete Part 1 of Form 941, reproduced on the shown below.

# of employees for pay period that included September 12-15 employees Wages paid third quarter-$89,352.18.

Federal income tax withheld in the third quarter-$10,195.00

Taxable social security and Medicare wages-$89,352.18

Total tax deposits for thequarter-$22,078.86

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41for 20-- Employer QUARTERLY Federal Tax Return OMB No. 1545-0029 Empioyor identfication number Report for this Quarter of 20- Chock on EIN Nama prot your trado namaj) |JAMES GALLAGHER Trade namo ny GALLAGHER 1:January, Fecruary, March COMPANY 2: Apri, May, June L 3 Juy. August, September 01 KEYSTONE Addross or toom Purtbst 95916 4:October, November, December Prior-yeer torms are avalable at www.rs.govfom941 SACRAMENTO CA Read the sep Part1: you compiate 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 (Ouarter i). June 12 (Ouarter 2), Sept. 12 (Ouarter 3, or Dec. 12 (Quarter 4) 1 2 Wages, tips, and other compensation 3 Income tax withheld from wages, tips, and other compensation 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 security wages 5b Taxable social security tips 5c Taxable Medicare wages & ips 5d Add Column 2 line 5a, Colurmn 2 line 5b, and Column 2 line 5c 5e Section 3121(4) Notice and Demand-Tax due on unreported tips (see instructions)5e 6 Total taxes before adjustments (add lines 3, 5d, and 5e) 7 Current quarter's adjustment for fractions of cents 8 Current quarter's adjustment for sick pay 9 Current quarter's adjustments for tips and group-term life insurance x.104- x 104- x029- 5d 10 Total taxes after adjustments. Combine lines 6 through 9 10 1 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayment applied from Form 941-X or Form 944-X . 12a COBRA premium assistance payments (see instructions 12b Number of individuals provided COBRA premium assistance 13 Add lines 11 and 12a 14 Balance due. lf line 10 is more than line 13, enter the difference and see instructions 15 Overpayment. If line 13 is more than line 10, enter the difference 12a 13 14 Check one. appysnd and You MUST complete both pages of Form 941 and SIGN it. Next For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher Cat. No. 170012 Fom 941 av.1-201