SOC                           CODE
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                                                                                                                                                                                                                                                                                                                                                                                                                          $ 0.00                                                                                             
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             )          3RD MONTH 
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                                                                                                                                                                                                                                                                                                                                                                            TOTAL REMITTANCE DUE
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                                                                                                                                                        YOUONLINECAN0.FILEBOXAT26504THISDES.NC.GOVREPORT                                                                                                                                                                                                                                                                                                                                                                                                                                   )2           2ND MONTH                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
                                                                                                                                                                                                                                    NC DEPT. OF COMMERCE DIVISION OF EMPLOYMENT SECURITY P. RALEIGH, NC 27611-6504                                                                                                                                                                                                                                                                                                                         (1

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      SEASONAL
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        1ST MONTH                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   DATE                        Date format: mm/dd/yyyy
                                                                                                                                                                                                                                                                                                                                                                                                     QTR-YR                                                         NUMBER OF COVERED WORKERS WHO WORKED DURING OR RECEIVED       PAY FOR THE PAYROLL PERIOD WHICH INCLUDES THE 12TH OF THE MONTH                                              (11)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             (30)
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                                                                                                                                                                                                                 EMPLOYER ID NUMBER 
                                                                                                                                                                                   (7)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                HOURS             WORKED
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                                                                                                                                                                                                                                                                                                                                                                                                                                           INITIAL                                                                           LPP.W
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      OUT OF                        STATE          CODE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
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                                                                                                                                                                                                                 DUE DATE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  WAGES        $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                                         $ 0.00               $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                ACCOUNT NUMBER $ 0.00                                    $ 0.00                            $ 0.00                                                                                                                 (29)
                                                                                                                                                                                   (6)                                                                                                                                                              Date format: mm/dd/yyyy                                                                COLL                                                                              LFP.W
                                                                                                                                                                                                                                                                                                                                                                                                                                 AGENCY USE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           TAXABLE 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      9)(1            OUT OF STATE

                                                                                                                                                                                                                                                                                                                                                                                                                                                   DATE                                                                      R/CK                                                                                                                                                                                                                                                                                                                                                                                      
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                               $ 0.00                                    $ 0.00                            $ 0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      GROSS                   WAGES 
                                                                                                                                                                                                                                                                                            DO NOT USE THIS FORM IF REPORTING 10 OR MORE WAGE ITEMS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              (18)
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WAGEQUARTERLYEMPLOYER'S                                                                                                                                                            REPORT TAXDate format:ANDmm/dd/yyyy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       )MI
                                                                                                                                                        INDICATES A REQUIRED FIELD                QUARTER ENDING                                                                                                                                                                                                 TAX RATE                                                                                                                                                                                                                                                                                                                                                                                                                                                                    (17
                                                                                                                                                        *                          (5)                                                                                                                                                                                                                           (8)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             TOTALS

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             ONLINE AT                                                                                                                                                                                                               TITLE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          GRAND TOTALS                                                                                                          (28)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            DUE DATE 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        YOU CAN FILE THIS REPORT                     TOTALS FROM NCUI101B
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                NAME 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  -                                                                                                                                                                                                                                                           FIRST
EMPLOYER'S QUARTERLY TAX AND(16)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      *                                 WAGE REPORT 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                This report must be filed and paid by the due date to avoid penalties and interest.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  HERE:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   NUMBER 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      NAME                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                            A PENALTY WILL BE APPLIED TO  ANY REPORTS THAT CONTAIN 10 OR MORE WAGE ITEMS
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      LAST 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         (15)                          *                                                                                               QUARTER ENDING                                                                                                                                                                                                                                                                                                                                                                                                  HE  INFORMATION  CONTAINED  IN  THIS  REPORT  IS  TRUE  AND  CORRECT  TO  THE  BEST  OF  MY  KNOWLEDGE.T     SIGNATURE                                                   
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  CHECK THIS BOX IF THE ADDRESS HAS CHANGED
                                                                                                                                                                                                                                    EMPLOYER LEGAL NAME                                                                                                                                         EMPLOYER ADDRESS                                                                                                                                                                                                                                                  ENTER YOUR FEDERAL TAX                                                                                                   IF ANY CHANGES OCCURRED IN THE OWNERSHIP, TELEPHONE NUMBER OR  ADDRESS, COMPLETE FORM NCUI 101-A.                          SSN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          70/24
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                                                                                                                                                                                                                                                                                                  LOCATION                           SUMMARY
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                                                                                                                                                                                                                                                                                          SEASONAL
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                                                                                                                                                                                                                                                                                                  EMPLOYEE/                          OFFICER
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                                                                                                                                                                                                                                                                                          HOURS                          WORKED
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                                                                                                                                                                                                                                                                                                  OUT OF                             STATE          CODE
                                                                                                                                                                                                                                                                          (20)

                                                                                                                                                                                                                                                                                                                                            WAGES
                                                                                                                                                                                                                                                                                                                                                        $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00               $ 0.00                                                         $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                     $ 0.00
                                                                                                                                                                                                                                           QTR-YR              
                                                                                                                                                                                                                     (5)                                                                                  OUT OF STATE                      TAXABLE 
                                                                                                                                                                                                                                                                                      (19)
                                                                                                                                                                                                                                                                                                   
                                                                                                                                                                                                                                                                                                                                                        $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00               $ 0.00                                                         $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00                                    $ 0.00               $ 0.00
                                                                                                                                                                                                                                                                      8) GROSS                                                 WAGES 
                                                                                                                                                                                                                                                                      (1                                                *

                                                                                                                                                                                                                                                               )MI
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           TOTALS
                            CONTINUATION SHEET FOR
                                                                                  REPORT OF EMPLOYEES WAGES
                                                                                                                        RETURN THIS PAGE IF NEEDED TO COMPLETE REPORT
                                                                                                                                                                                                                                                                                                    NAME 
                                                                                                                                                                                                                                                                                                  FIRST
                                                                                                                                                                                                                                                               (16)                                                    *

                                                                                                                                                                                                                                                                                                  NAME
                                                                                                                                                                                                                                                                                                  LAST 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                                                                                                                                                                                                          (15)                                          *                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      -B

                                                                                                                                                                                                                                           EMPLOYER LEGAL NAME
                                                                                                                                                                                                                     (1)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         NCUI 101

                                                                                                                                                                                                                                                                                                  SSN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    70/24
                                                                                                                                                                                                                                                                          (14)                                          *
                                                                                                           0. BOX 26504                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  REV 
NC DEPT. OF COMMERCE                              DIVISION OF EMPLOYMENT SECURITY                          P.           RALEIGH, NC 27611-6504                                    TYPE INFO AS SHOWN ON FORM NCUI 101

                                                    Instructions to Calculate the Taxable Wage Amount 
         1: Enter all wages paid to all employees, including part-time and temporary, in this calendar quarter. 
                If the legal business is: 
                (A) CORPORATION, the wages paid to all employees who performed services in North Carolina should be reported. Corporate officers are employees and their wages
                and/or draws are reportable.
                (B)  A PARTNERSHIP, the draws or payments made to general partners should not be reported.
                (C)  A PROPRIETORSHIP, the draws or payments made to the legal owner of the business (the proprietor) should not be reported. W age paid to the children of the
                proprietor under the age of 21 years, as well as wages paid to the spouse or parents of the proprietor, should not be reported.
                Special payments given in return for services performed, I.E., commissions, bonuses, fees, prizes, are wages and reportable under the Employment Security Law of 
                North Carolina. These payments (or dollar value of the gifts/prizes) are to be included in the payroll of each employee by the employer for the calendar quarter(s) in 
                which they are given. If no wages were paid, enter NONE. 
         2: Enter the amount of wages paid during this quarter that is in excess of the applicable North Carolina taxable wage base. This entry cannot be more than line 1. Example: 
         An employer using the 2023 taxable wage base of $29,600 and reporting one employee, John Doe, earning $8,000 per quarter. 
                Note: For instructions on how to compute excess wages for employees with out-of-state wages refer 
                to Employer Tax FAQs | DES (nc.gov) on the DES website at  des.nc.gov.

                                          1ST QTR              2ND QTR                3RD QTR                                    4TH QTR 

                ITEM 1:                   $8,000.00            $8,000.00              $8,000.00                                  $8,000.00 

                ITEM 2:                      -0-               -0-                                        -0-                    $2,400.00 

                ITEM 3:                   $8,000.00            $8,000.00              $8,000.00                                  $5,600.00 
         3:  Subtract Item 2 from Item 1. THE RESULTS CANNOT BE A NEGATIVE AMOUNT.                                                             0.00
         4:  Multiply Item 3 by the tax rate shown on the face of this report. (Example: .012% = .00012) 
                If the tax due is less than $5.00, you do not have to pay it, but you must file a report. 

                               Note:  Numbers 5, 6 and 7 MUST BE COMPUTED ONLY IF THE REPORT IS NOT FILED  (POSTMARKED) BY THE DUE DATE.    

         5:  Enter Interest – If Filing Late 
              Multiply the tax due (Item 4) by the current interest rate for each month, or fraction thereof, past the due date. “The applicable interest rate may be obtained by    
         contacting the Employer Call Center.”

         6:     Enter Penalty – Late Filing
           Multiply the tax due (Item 4) by 5% (.05) for each month, or fraction thereof, past the due 
          date.  The maximum late filing penalty is 25% (.25). 

         7: Enter Penalty – Late Payment
          Mul�  ply the tax due (Item 5) by 10% (.1). 

         8   :    Add lines 4, 5, 6 and 7 and enter this amount in Total Remittance Due Box on the NCUI101.                                    $ 0.00

REV 07/24

                 INSTRUCTIONS FOR COMPLETING FORM NCUI 101, EMPLOYERS QUARTERLY TAX AND WAGE REPORT 
                 NCGS 96-9.15(d) Employers reporting 10 or more wage items must go to des.nc.gov to file your report online. Failure to 
                 do so will result in a penalty. 

1. Enter the legal name of the business.

2. Enter the address of the employer.

3. Check box if address has changed.

4. Enter FEIN (Federal Employer Identification Number).

5. Enter the quarter end date in the format of MM/DD/YYYY.

6. Enter the quarter due date in the format of MM/DD/YYYY.

7. Enter the NCDES Employer ID.

8. Enter the employer tax rate.

9. Indicate quarter/year. 

10. Enter the total remittance due.

11. Enter the number of employees who worked or received pay for any part of the pay period that includes the 12th of the
         month for the 1st month of the quarter.

12. Enter the number of employees who worked or received pay for any part of the pay period that includes the 12th of the month for the
  
         2nd month of the quarter.

                                                                th
13. Enter the number of employees who worked or received pay for any part of the pay period that includes the 12  of the month
         for the 3rd month of the quarter. 

14. Enter the SSN for the employee. If you do not have a SSN for the employee use a 9 digit dummy number beginning with 9. For
         multiple employees that do not have SSNs for use a different number, for example 911-11-1111 and 911-11-1112. Also, continue using the
         same number for that individual in subsequent quarters.

15.      Enter the last name of the employee. 
16. Enter the first name of the employee.

17. Enter the middle initial of the employee. (Optional)

18. Enter the gross wages subject to NC SUTA for the
        employee.
REV 07/24

Wages Include: 
•   All employees, including part-time and temporary.

•   Special payments given in return for services performed, I.E., commissions, bonuses, fees, prizes, are wages
    and reportable under the Employment Security Law of North Carolina

•   If the legal business is:
   CORPORATION, the wages paid to all employees who performed services in North Carolina
    should be reported. Corporate officers are employees and their wages and/or draws are
    reportable.

   A PARTNERSHIP, the draws or payments made to general partners should not be reported.

   A PROPRIETORSHIP, the draws or payments made to the legal owner of the business (the
    proprietor) should not be reported. Wages paid to the children of the proprietor under the age
    of 21 years, as well as wages paid to the spouse or parents of the proprietor, should not be
    reported.

19. Enter any gross wages subject to SUTA that have been reported to other states or territories for the quarter. (If Applicable)

20. Enter the postal code for the Out of State (OOS) wages. https://www.des.nc.gov/documents/files/ncsuits-wage-report-and-payment-file-         
specification/open (Specification and Record Layout for Wage Reporting, Adjustments and Payments -Section FIPS Code/Postal Code)

21. Enter the hours worked during the quarter for the employer. Maximum of 999 hours. Do not enter decimals. (Optional)

22. Indicate whether this employee is an employee or officer. (Optional)

23. If your account has been designated as seasonal by NCDES, indicate if the employee’s wages are seasonal for the calendar quarter with a yes or no.

24. Indicate whether the work location of the employee is the primary location or other location.

25. Enter the Standard Occupation Classification (SOC) Code of Employee (Optional) https://www.bls.gov/oes/current/oes_stru.htm

26. Follow line instructions 14 through 25 for all employees. If more than nine employees need to be listed, use the attached continuation  page.

27. The form must be signed by an authorized individual.

28. Enter the title of the individual signing the form.

29. Enter a contact telephone number of the individual signing the form.

30. Enter the date signed and mail the form to the address on the top of the NCUI101 along with your payment (if applicable).