IRS Form 941 Schedule D "Report of Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations"

What Is IRS Form 941 Schedule D?

This is a tax form that was released by the Internal Revenue Service (IRS) - a subdivision of the U.S. Department of the Treasury on June 1, 2011. Check the official IRS-issued instructions before completing and submitting the form.

Form Details:

  • A 2-page form available for download in PDF;
  • Actual and valid for filing 2020 taxes;
  • Editable, printable, and free;

Download a fillable version of IRS Form 941 Schedule D through the link below or browse more documents in our library of IRS Forms.

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Download IRS Form 941 Schedule D "Report of Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations"

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Schedule D (Form 941):
Report of Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations
(Rev. June 2011)
Department of the Treasury—Internal Revenue Service
OMB No. 1545-0029
Tax Year of Discrepancies
(Fill in)
Employer Identification Number (EIN)
Format: YYYY
Name (not your trade name)
Trade name (if any)
Type of Submission
(Check one)
Address
Number
Street
Suite or room number
Original
City
State
ZIP code
Corrected
Phone number
About this schedule
Each year the Internal Revenue Service (IRS) and the Social Security Administration (SSA) compare the totals on your Forms 941,
Employer’s QUARTERLY Federal Tax Return, with the totals on Forms W-2, Wage and Tax Statement, to verify that:
• The wages you reported on Forms 941 match those you reported on Forms W-2 (Copy A) so that your
employees’ social security earnings records are complete for benefit purposes; and
• You have paid the appropriate taxes.
Generally, the totals on your Forms W-2 (Copy A) should equal the totals you reported on Forms 941. Use this schedule if discrepancies
exist between the totals you reported on those forms ONLY as a result of an acquisition, statutory merger, or consolidation. In many cases,
the information on this schedule should help the IRS resolve discrepancies without contacting you. If you are an eligible employer
who elects to use the alternate procedure set forth in Rev. Proc. 2004-53, explained in the instructions, you should file this schedule.
Read the separate instructions before you fill out this schedule.
Part 1: Answer these background questions.
1. Are you filing this schedule —
After a statutory merger or consolidation? (See Rev. Rul. 62-60, 1962-1 C.B. 186 and Rev. Proc. 2004-53, 2004-2 C.B. 320.)
You are either:
An acquired corporation or
A surviving corporation.
OR
After an acquisition and you are using the alternate procedure under Rev. Proc. 2004-53, 2004-2 C.B. 320?
You are either:
A predecessor or
A successor.
2. The effective date of the statutory merger/consolidation or acquisition is
. . . . . . . . .
MM
/
DD
/
YYYY
3. The OTHER PARTY in this transaction is . . .
Other party’s EIN
Other party’s name
Trade name (if any)
Address
Number
Street
Suite or room number
City
State
ZIP code
Phone number
Next
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 38791Y
Schedule D (Form 941) (Rev. 6-2011)
Schedule D (Form 941):
Report of Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations
(Rev. June 2011)
Department of the Treasury—Internal Revenue Service
OMB No. 1545-0029
Tax Year of Discrepancies
(Fill in)
Employer Identification Number (EIN)
Format: YYYY
Name (not your trade name)
Trade name (if any)
Type of Submission
(Check one)
Address
Number
Street
Suite or room number
Original
City
State
ZIP code
Corrected
Phone number
About this schedule
Each year the Internal Revenue Service (IRS) and the Social Security Administration (SSA) compare the totals on your Forms 941,
Employer’s QUARTERLY Federal Tax Return, with the totals on Forms W-2, Wage and Tax Statement, to verify that:
• The wages you reported on Forms 941 match those you reported on Forms W-2 (Copy A) so that your
employees’ social security earnings records are complete for benefit purposes; and
• You have paid the appropriate taxes.
Generally, the totals on your Forms W-2 (Copy A) should equal the totals you reported on Forms 941. Use this schedule if discrepancies
exist between the totals you reported on those forms ONLY as a result of an acquisition, statutory merger, or consolidation. In many cases,
the information on this schedule should help the IRS resolve discrepancies without contacting you. If you are an eligible employer
who elects to use the alternate procedure set forth in Rev. Proc. 2004-53, explained in the instructions, you should file this schedule.
Read the separate instructions before you fill out this schedule.
Part 1: Answer these background questions.
1. Are you filing this schedule —
After a statutory merger or consolidation? (See Rev. Rul. 62-60, 1962-1 C.B. 186 and Rev. Proc. 2004-53, 2004-2 C.B. 320.)
You are either:
An acquired corporation or
A surviving corporation.
OR
After an acquisition and you are using the alternate procedure under Rev. Proc. 2004-53, 2004-2 C.B. 320?
You are either:
A predecessor or
A successor.
2. The effective date of the statutory merger/consolidation or acquisition is
. . . . . . . . .
MM
/
DD
/
YYYY
3. The OTHER PARTY in this transaction is . . .
Other party’s EIN
Other party’s name
Trade name (if any)
Address
Number
Street
Suite or room number
City
State
ZIP code
Phone number
Next
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 38791Y
Schedule D (Form 941) (Rev. 6-2011)
Tax Year of Discrepancies
Your EIN
(Fill in)
Name (not your trade name)
Format: YYYY
Other party’s EIN
Part 2: Tell us about the discrepancies with your returns.
Column A
Column B
Column C
Amount you reported to IRS
Amount you reported to SSA
The difference
=
for the tax year
for the tax year
Totals from Forms 941 as corrected
Totals from Forms W-2 (Copy A) as
by any Forms 941-X
corrected by any Forms W-2c (Copy A)
=
4. Social security wages
=
5. Medicare wages and tips
=
6. Social security tips
7. Federal income tax
=
withheld
8.
Advance earned income credit
=
(EIC) payments (for tax years
ending before January 1, 2011)
If you are filing for one transaction only, STOP here. If you are filing for more than one transaction, go to Part 3.
Part 3: Fill this part out ONLY if you are filing more than one Schedule D (Form 941) for any calendar year.
9. File one Schedule D (Form 941) for each separate transaction. This is schedule
of
. (Example: This is schedule 1 of 3.)
Column A
Column B
Column C
=
Amount you reported to IRS
Amount you reported to SSA
The difference
for the tax year for the
for the tax year for the
employees affected by the
employees affected by the
transaction reported on this
transaction reported on this
Schedule D (Form 941)
Schedule D (Form 941)
Totals from Forms 941 as corrected
Totals from Forms W-2 (Copy A) as
by any Forms 941-X
corrected by any Forms W-2c (Copy A)
=
10. Social security wages
=
11. Medicare wages and tips
=
12. Social security tips
13. Federal income tax
=
withheld
14.
Advance earned income credit
=
(EIC) payments (for tax years
ending before January 1, 2011)
2
Page
Schedule D (Form 941) (Rev. 6-2011)
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