ERTC Survey | Finances Made Simple LLC

Consultant Name(Required)

Jon LaCasse

Stacey Doege

Thomas Brainsky

Other

Hidden

Consultant Name(Required)

First Last

Employee Information

What was the average number of employees in Q2-Q4 2020?

What was the average number of employees in Q1-Q3 2021?

Wage Information

What is the quarterly wage for W-2 employees? This information can be found in the quarterly wage report.

2020 Q2 - Number of Employees(Required)

2020 Q2 - Quarterly Payroll Amount(Required)

2020 Q3 - Number of Employees(Required)

2020 Q3 - Quarterly Payroll Amount(Required)

2020 Q4 - Number of Employees(Required)

2020 Q4 - Quarterly Payroll Amount(Required)

2021 Q1 - Number of Employees(Required)

2021 Q1 - Quarterly Payroll Amount(Required)

2021 Q2 - Number of Employees(Required)

2021 Q2 - Quarterly Payroll Amount(Required)

2021 Q3 - Number of Employees(Required)

2021 Q3 - Quarterly Payroll Amount(Required)

Quarterly Wage Information

What are the wages paid per quarter to any owner of 50% or greater? Note: This must be included in the payroll summary. If owners are 50/50, add both wages together below.

2020 Q2

2020 Q3

2020 Q4

2021 Q1

2021 Q2

2021 Q3

Wages Earmarked for PPP Forgiveness:

How much was received for the first round of PPP?

What amount went toward wages?

How much was received for the second round of PPP?

What amount went toward wages?

Was the business deemed non-essential during full or partial government shutdown?

Yes

Was the business deemed essential, but had trouble sourcing equipment, supplies, etc.?

Yes

What cover period was used when applying for forgiveness of the first PPP loan?

8 weeks

24 weeks

Cover Period: Start Date

MM slash DD slash YYYY

Cover Period: End Date

MM slash DD slash YYYY

What cover period was used when applying for forgiveness of the second PPP loan?

8 weeks

24 weeks

Cover Period: Start Date

MM slash DD slash YYYY

Cover Period: End Date

MM slash DD slash YYYY

COVID Impact Statement

To any questions that can be be answered as "YES" - Please provide as much detailed information as possible in the text box that appears. Be sure to include start and end dates where applicable.

Full Shutdown

Yes

Provide any relevant details about the full shutdown:

Partially Shutdown

Yes

Provide any relevant details about the partial shutdown:

Interrupted Operations

Yes

Provide any relevant details about the interrupted operations experienced:

Supply Chain Interruptions

Yes

Provide any relevant details about the supply chain interruptions experienced:

Inability to Access Equipment

Yes

Provide any relevant details about the inability to access equipment:

Limited Capacity to Operate

Yes

Provide any relevant details about the limited capacity to operate:

Inability to Work with Vendors

Yes

Provide any relevant details about the inability to work with vendors:

Reduction in Services or Goods Offered to Customers

Yes

Provide any relevant details about the reduction in goods/services offered:

Cut Down in Hours of Operation

Yes

Provide any relevant details about the reduction in hours of operation:

Shifting Hours to Increase Sanitation/Cleaning of Facility

Yes

Provide any relevant details about the shifting hours to clean/sanitize:

Employee Retention Tax Credit Survey

Company Information

Employee Information

Wage Information

Quarterly Wage Information

Wages Earmarked for PPP Forgiveness:

COVID Impact Statement