a Employee’s social security number425-69-7178
Import Code: 2CZAFMZC
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
64-0829658
18188.57
1268.01
c Employer’s name, address, and ZIP code
3 Social security wages
4 Social security tax withheld
SAMS TOWN TUNICA
18789.48
1164.95
PO BOX 220
1477 CASINO STRIP BLVD.
ROBINSONVILLE, MS 38664
d Control number
e Employee’s first name and initial
Last name
Suff.
5 Medicare wages and tips
6 Medicare tax withheld
18789.48
272.45
7 Social security tips
8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a See instructions for box 12
C
o
d
e
1 of 1
Statutory
employee
13
RANESHIA L THOMAS
Retirement
plan
Third-party
sick pay
X
PO BOX 1521
14 Other
HLTH
TUNICA, MS 38676
D
600.91
12b
C
o
d
e
DD
3142.45
12c
C
o
d
e
1241.00
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Employer’s state ID number
16 State wages, tips, etc. 17 State income tax
MS
64-0829658
18188.57
18 Local wages, tips, etc. 19 Local income tax
20 Locality name
385.00
00000000000
Form
W-2 Wage and Tax Statement
Copy B—To Be Filed With Employee’s FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
202
Department of the Treasury—Internal Revenue Service
—————————————————————————————————————————————————————————————————————————
a Employee’s social security number
Import Code: 2CZAFMZC
425-69-7178
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
64-0829658
18188.57
1268.01
c Employer’s name, address, and ZIP code
SAMS TOWN TUNICA
3 Social security wages
4 Social security tax withheld
18789.48
1164.95
5 Medicare wages and tips
PO BOX 220
1477 CASINO STRIP BLVD.
6 Medicare tax withheld
272.45
18789.48
ROBINSONVILLE, MS 38664
7 Social security tips
8 Allocated tips
d Control number
9
10 Dependent care benefits
11 Nonqualified plans
12a
e Employee’s first name and initial
Last name
Suff.
C
o
d
e
1 of 1
13
RANESHIA L THOMAS
Statutory
employee
Retirement
plan
X
14 Other
HLTH
PO BOX 1521
TUNICA, MS 38676
Third-party
sick pay
D
600.91
12b
C
o
d
e
DD
3142.45
12c
1241.00
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Employer’s state ID number
16 State wages, tips, etc. 17 State income tax
MS
64-0829658
18188.57
18 Local wages, tips, etc. 19 Local income tax
20 Locality name
385.00
00000000000
Form
W-2 Wage and Tax Statement
Copy 2—To Be Filed With Employee’s State, City, or Local
Income Tax Return
202
Department of the Treasury—Internal Revenue Service
a Employee’s social security number
Import Code: 2CZAFMZC
425-69-7178
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
64-0829658
18188.57
1268.01
c Employer’s name, address, and ZIP code
3 Social security wages
4 Social security tax withheld
SAMS TOWN TUNICA
18789.48
1164.95
PO BOX 220
18789.48
5 Medicare wages and tips
1477 CASINO STRIP BLVD.
6 Medicare tax withheld
272.45
7 Social security tips
8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a
ROBINSONVILLE, MS 38664
d Control number
e Employee’s first name and initial
Last name
Suff.
C
o
d
e
1 of 1
13
RANESHIA L THOMAS
Statutory
employee
Retirement
plan
Third-party
sick pay
X
PO BOX 1521
14 Other
TUNICA, MS 38676
HLTH
D
600.91
12b
C
o
d
e
DD
3142.45
12c
C
o
d
e
1241.00
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Employer’s state ID number
16 State wages, tips, etc. 17 State income tax
MS
64-0829658
18188.57
18 Local wages, tips, etc. 19 Local income tax
20 Locality name
385.00
00000000000
Form
W-2 Wage and Tax Statement
Copy 2—To Be Filed With Employee’s State, City, or Local
Income Tax Return
202
Department of the Treasury—Internal Revenue Service
————————————————————————————————————————————————————————————————
a Employee’s social security number
Import Code: 2CZAFMZC
425-69-7178
OMB No. 1545-0008
This information is being furnished to the Internal Revenue Service. If you
are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
64-0829658
18188.57
1268.01
c Employer’s name, address, and ZIP code
3 Social security wages
4 Social security tax withheld
SAMS TOWN TUNICA
18789.48
1164.95
5 Medicare wages and tips
6 Medicare tax withheld
PO BOX 220
1477 CASINO STRIP BLVD.
ROBINSONVILLE, MS 38664
18789.48
272.45
7 Social security tips
8 Allocated tips
d Control number
9
10 Dependent care benefits
11 Nonqualified plans
12a See instructions for box 12
e Employee’s first name and initial
Last name
Suff.
C
o
d
e
1 of 1
13
RANESHIA L THOMAS
Statutory
employee
Retirement
plan
X
PO BOX 1521
14 Other
HLTH
TUNICA, MS 38676
Third-party
sick pay
D
600.91
12b
C
o
d
e
DD
3142.45
12c
1241.00
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Employer’s state ID number
16 State wages, tips, etc. 17 State income tax
MS
64-0829658
18188.57
18 Local wages, tips, etc. 19 Local income tax
20 Locality name
385.00
00000000000
Form
W-2 Wage and Tax Statement
Copy C—For EMPLOYEE’S RECORDS
(See Notice to Employee on the back of Copy B.)
202
Department of the Treasury—Internal Revenue Service
Notice to Employee
Do you have to file? Refer to the Instructions for Forms 1040 and 1040-SR to determine if you
are required to file a tax return. Even if you don’t have to file a tax return, you may be eligible for
a refund if box 2 shows an amount or if you are eligible for any credit.
Earned income credit (EIC). You may be able to take the EIC for 2021 if your adjusted gross
income (AGI) is less than a certain amount. The amount of the credit is based on income and
family size. Workers without children could qualify for a smaller credit. You and any qualifying
children must have valid social security numbers (SSNs). You can’t take the EIC if your
investment income is more than the specified amount for 2021 or if income is earned for
services provided while you were an inmate at a penal institution. For 2021 income limits and
more information, visit www.irs.gov/EITC. See also Pub. 596, Earned Income Credit. Any EIC
that is more than your tax liability is refunded to you, but only if you file a tax return.
Employee’s social security number (SSN). For your protection, this form may show only the last
four digits of your SSN. However, your employer has reported your complete SSN to the IRS and
SSA.
Clergy and religious workers. If you aren’t subject to social security and Medicare taxes, see
Pub. 517, Social Security and Other Information for Members of the Clergy and Religious
Workers.
Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and ask
your employer to correct your employment record. Be sure to ask the employer to file Form
W-2c, Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct
any name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your
copies of Form W-2c from your employer for all corrections made so you may file them with your
tax return. If your name and SSN are correct but aren’t the same as shown on your social security
card, you should ask for a new card that displays your correct name at any SSA office or by calling
800-772-1213. You may also visit the SSA website at www.SSA.gov.
Cost of employer-sponsored health coverage (if such cost is provided by the employer).
The reporting in box 12, using code DD, of the cost of employer-sponsored health coverage is
for your information only. The amount reported with code DD is not taxable.
Credit for excess taxes. If you had more than one employer in 2021 and more than $8,853.60 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to claim
a credit for the excess against your federal income tax. If you had more than one railroad employer
and more than $5,203.80 in Tier 2 RRTA tax was withheld, you may also be able to claim a credit. See
the Instructions for Forms 1040 and 1040-SR and Pub. 505, Tax Withholding and Estimated Tax.
Instructions for Employee
(See also Notice to Employee on the back of Copy B.)
Box 1. Enter this amount on the wages line of your tax return.
Box 2. Enter this amount on the federal income tax withheld line of your tax return.
Box 5. You may be required to report this amount on Form 8959, Additional Medicare Tax. See the
Instructions for Forms 1040 and 1040-SR to determine if you are required to complete Form 8959.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare wages and tips shown
in box 5, as well as the 0.9% Additional Medicare Tax on any of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in box 1, 3, 5, or 7. For information on how to report tips on your
tax return, see the Instructions for Forms 1040 and 1040-SR.
You must file Form 4137, Social Security and Medicare Tax on Unreported Tip Income, with your
income tax return to report at least the allocated tip amount unless you can prove with adequate
records that you received a smaller amount. If you have records that show the actual amount of tips
you received, report that amount even if it is more or less than the allocated tips. Use Form 4137 to
figure the social security and Medicare tax owed on tips you didn’t report to your employer. Enter this
amount on the wages line of your tax return. By filing Form 4137, your social security tips will be
credited to your social security record (used to figure your benefits).
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 is also included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to figure
any taxable and nontaxable amounts.
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from a nonqualified
deferred compensation or nongovernmental section 457(b) plan, or (b) included in box 3 and/or box 5
if it is a prior year deferral under a nonqualified or section 457(b) plan that became taxable for social
security and Medicare taxes this year because there is no longer a substantial risk of forfeiture of your
right to the deferred amount. This box shouldn’t be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 by the end of the calendar year, your employer should file Form SSA-131,
Employer Report of Special Wage Payments, with the Social Security Administration and give you a
copy.
Box 12. The following list explains the codes shown in box 12. You may need this information to
complete your tax return. Elective deferrals (codes D, E, F, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $19,500 ($13,500 if you only
have SIMPLE plans; $22,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $19,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2021, your employer may have allowed an additional deferral
of up to $6,500 ($3,000 for section
401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is not subject to the overall limit
on elective deferrals. For code G, the limit on elective deferrals may be higher for the last 3 years
before you reach retirement age. Contact your plan administrator for more information. Amounts in
excess of the overall elective deferral limit must be included in income. See the Instructions for Forms
1040 and 1040-SR.
Note: If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pension
contribution for a prior year(s) when you were in military service. To figure whether you made excess
deferrals, consider these amounts for the year shown, not the current year. If no year is shown, the
contributions are for the current year.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040 or 1040-SR. See
the Instructions for Forms 1040 and 1040-SR.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040 or 1040-SR. See the Instructions
for Forms 1040 and 1040-SR.
C—Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up to the social
security wage base), and 5)
D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also includes deferrals
under a SIMPLE retirement account that is part of a section 401(k) arrangement.
Instructions for Employee
Box 12 (continued)
E—Elective deferrals under a section 403(b) salary reduction agreement
F—Elective deferrals under a section 408(k)(6) salary reduction SEP
G—Elective deferrals and employer contributions (including nonelective deferrals) to a section
457(b) deferred compensation plan
H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See the
Instructions for Forms 1040 and 1040-SR for how to deduct.
J—Nontaxable sick pay (information only, not included in box 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Instructions for Forms 1040
and 1040-SR.
L—Substantiated employee business expense reimbursements (nontaxable)
M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over
$50,000 (former employees only). See the Instructions for Forms 1040 and 1040-SR.
N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (former
employees only). See the Instructions for Forms 1040 and 1040-SR.
P—Excludable moving expense reimbursements paid directly to a member of the U.S. Armed
Forces (not included in box 1, 3, or 5)
Q—Nontaxable combat pay. See the Instructions for Forms 1040 and 1040-SR for details on
reporting this amount.
R—Employer contributions to your Archer MSA. Report on Form 8853, Archer MSAs and LongTerm Care Insurance Contracts.
S—Employee salary reduction contributions under a section 408(p) SIMPLE plan (not included in
box 1)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption
Expenses, to figure any taxable and nontaxable amounts.
V—Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up to the social
security wage base), and 5). See Pub. 525, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a
section 125 (cafeteria) plan) to your health savings account. Report on Form 8889, Health
Savings Accounts (HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A.
This amount is also included in box 1. It is subject to an additional 20% tax plus interest. See
the Instructions for Forms 1040 and 1040-SR.
AA—Designated Roth contributions under a section 401(k) plan
BB—Designated Roth contributions under a section 403(b) plan
DD—Cost of employer-sponsored health coverage. The amount reported with code DD is not
taxable.
EE—Designated Roth contributions under a governmental section 457(b) plan. This amount
does not apply to contributions under a tax-exempt organization section 457(b) plan.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of
traditional IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual
Retirement Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance
taxes withheld, union dues, uniform payments, health insurance premiums deducted,
nontaxable income, educational assistance payments, or a member of the clergy’s parsonage
allowance and utilities. Railroad employers use this box to report railroad retirement (RRTA)
compensation, Tier 1 tax, Tier 2 tax, Medicare tax, and Additional Medicare Tax. Include tips
reported by the employee to the employer in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 for at least 3 years after the due date for filing your income tax
return. However, to help protect your social security benefits, keep Copy C until you begin
receiving social security benefits, just in case there is a question about your work record and/or
earnings in a particular year.
b Employer identification number (EIN)
c Employers name, address, and ZIP code
12a See instructions for box 12
64-0829658
C
o
d
e
SAMS TOWN TUNICA
D
12b
C
o
d
e
C
o
d
e
$
4430.16
Last name
1 of 1
Suff.
1 Wages, tips, other compensation
12e
C
o
d
e
1265.35
4 Social security tax withheld
20944.76
5 Medicare wages and tips
$
C
o
d
e
2 Federal income tax withheld
20288.52
3 Social security wages
1298.58
6 Medicare tax withheld
303.70
20944.76
12d
RANESHIA L THOMAS
$
$
This information is being furnished to the
Internal Revenue Service.
7 Social security tips
8 Allocated tips
9 Verification code
10 Dependent care benefits
11 Nonqualified plans
13 Statutory
employee
Retirement
plan
Third-party
sick pay
X
Copy B To Be Filed With 14 Other
Employees FEDERAL HLTH
Tax Return
PO BOX 1521
TUNICA, MS 38676
1080.00
Import Code: 6YRYKPC2 a Employees social security number
425-69-7178
f Employees address and ZIP code
15 State Employers state ID number
MS
656.24
12c
PO BOX 220
1477 CASINO STRIP BLVD.
ROBINSONVILLE, MS 38664
e Employees first name and initial
DD
$
16 State wages, tips, etc.
64-0829658
17 State income tax
20288.52
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
384.00
00000000000
Department
of the TreasuryInternal
Revenue
Service
Form W-2 Wage and Tax Statement 2019 – Reissued Statement
Department
of the Treasury-Internal
Revenue
Service
b Employer identification number (EIN)
c Employers name, address, and ZIP code
12a
64-0829658
C
o
d
e
SAMS TOWN TUNICA
D
12b
C
o
d
e
DD
C
o
d
e
Last name
Suff.
12e
C
o
d
e
4430.16
1265.35
4 Social security tax withheld
3 Social security wages
20944.76
5 Medicare wages and tips
1298.58
6 Medicare tax withheld
303.70
20944.76
$
$
7 Social security tips
8 Allocated tips
9 Verification code
10 Dependent care benefits
11 Nonqualified plans
13 Statutory
employee
Retirement
plan
Third-party
sick pay
X
Copy 2 To Be Filed With
14 Other
Employees STATE, CITY or HLTH
LOCAL Income Tax Return
PO BOX 1521
TUNICA, MS 38676
MS
$
2 Federal income tax withheld
20288.52
$
C
o
d
e
RANESHIA L THOMAS
f Employees address and ZIP code
15 State Employers state ID number
656.24
12d
1 of 1
Copy Copy
B To B
Be
WithWith
Employees
ToFiled
Be Filed
Employee’sFEDERAL
FEDERALTax
TaxReturn
Return
1 Wages, tips, other compensation
$
12c
PO BOX 220
1477 CASINO STRIP BLVD.
ROBINSONVILLE, MS 38664
e Employees first name and initial
OMB
# 1545-0008
OMB
# 1545-0008
1080.00
Import Code: 6YRYKPC2 a Employees social security number
425-69-7178
16 State wages, tips, etc.
64-0829658
18 Local wages, tips, etc.
17 State income tax
20288.52
19 Local income tax
20 Locality name
384.00
00000000000
Department
of the
Revenue
OMB
# 1545-0008
Form W-2 Wage and Tax Statement 2019-Reissued Statement
Department
ofTreasuryInternal
the Treasury-Internal
RevenueService
Service OMB
# 1545-0008
b Employer identification number (EIN)
c Employers name, address, and ZIP code
12a
64-0829658
C
o
d
e
D
SAMS TOWN TUNICA
12b
PO BOX 220
1477 CASINO STRIP BLVD.
ROBINSONVILLE, MS 38664
12c
C
o
d
e
e Employees first name and initial
DD
C
o
d
e
Suff.
12e
C
o
d
e
$
4430.16
2 Federal income tax withheld
20288.52
3 Social security wages
1265.35
4 Social security tax withheld
20944.76
1298.58
6 Medicare tax withheld
5 Medicare wages and tips
303.70
20944.76
$
$
7 Social security tips
8 Allocated tips
9 Verification code
10 Dependent care benefits
11 Nonqualified plans
13 Statutory
employee
Retirement
plan
Third-party
sick pay
X
Copy 2 To Be Filed With
14 Other
Employees STATE, CITY or HLTH
LOCAL Income Tax Return
PO BOX 1521
TUNICA, MS 38676
MS
656.24
$
C
o
d
e
RANESHIA L THOMAS
f Employees address and ZIP code
15 State Employers state ID number
1 Wages, tips, other compensation
$
12d
Last name
1 of 1
Copy 2 To Be Filed With Employee’s State, CITY or Local Tax Departments
1080.00
Import Code: 6YRYKPC2 a Employees social security number
425-69-7178
16 State wages, tips, etc.
64-0829658
17 State income tax
20288.52
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
384.00
00000000000
Department
of the
Revenue
OMB
# 1545-0008
Form W-2 Wage and Tax Statement 2019-Reissued Statement
Department
ofTreasuryInternal
the Treasury-Internal
RevenueService
Service OMB
# 1545-0008
b Employer identification number (EIN)
c Employers name, address, and ZIP code
12a See instructions for box 12
64-0829658
C
o
d
e
D
SAMS TOWN TUNICA
12b
PO BOX 220
1477 CASINO STRIP BLVD.
ROBINSONVILLE, MS 38664
12c
C
o
d
e
e Employees first name and initial
DD
C
o
d
e
$
656.24
$
4430.16
Last name
1 of 1
Suff.
$
1265.35
4 Social security tax withheld
20944.76
1298.58
6 Medicare tax withheld
303.70
20944.76
$
$
This information is being furnished to the Internal
Revenue Service. If you are required to file a tax
return, a negligence penalty or other sanction may
be imposed on you if this income is taxable and you
fail to report it.
RANESHIA L THOMAS
2 Federal income tax withheld
20288.52
5 Medicare wages and tips
12e
C
o
d
e
1 Wages, tips, other compensation
3 Social security wages
12d
C
o
d
e
Copy 2 To Be Filed With Employee’s State, CITY or Local Tax Departments
7 Social security tips
8 Allocated tips
9 Verification code
10 Dependent care benefits
11 Nonqualified plans
13 Statutory
employee
Third-party
sick pay
X
Copy C For EMPLOYEES 14 Other
RECORDS. (See Notice to HLTH
PO BOX 1521
TUNICA, MS 38676
Retirement
plan
1080.00
Employee on back.)
f Employees address and ZIP code
15 State Employers state ID number
MS
64-0829658
Import Code: 6YRYKPC2 a Employees social security number
425-69-7178
16 State wages, tips, etc.
17 State income tax
20288.52
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
384.00
00000000000
Wage
Statement
2013 Statement
Form
Department
of the TreasuryInternal
Revenue
Service
Form W-2
W-2 Wage
andand
Tax Tax
Statement
2019 – Reissued
Department
of the Treasury-Internal
Revenue
Service
22RRD091560
1A-cd
OMB # 1545-0008
OMB # 1545-0008
1B-cd
Copy C for Employees Records (See Notice
back.)
Copy C to
forEmployee
Employee’son
Records
Notice to Employee
Instructions for Employee
Do you have to file? Refer to the Form 1040 instructions to determine if you are
Box 1. Enter this amount on the wages line of your tax return.
Box 2. Enter this amount on the federal income tax withheld line of your tax return.
Box 5. You may be required to report this amount on Form 8959, Additional
Medicare Tax. See the Form 1040 instructions to determine if you are required to
complete Form 8959.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare
wages and tips shown in box 5, as well as the 0.9% Additional Medicare Tax on
any of those Medicare wages and tips above $200,000.
Box 8. This amount is not included in box 1, 3, 5, or 7. For information on how to
report tips on your tax return, see your Form 1040 instructions.
You must file Form 4137, Social Security and Medicare Tax on Unreported Tip
Income, with your income tax return to report at least the allocated tip amount
unless you can prove that you received a smaller amount. If you have records that
show the actual amount of tips you received, report that amount even if it is more
or less than the allocated tips. On Form 4137 you will calculate the social security
and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By
filing Form 4137, your social security tips will be credited to your social security
record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted
by your software. The only valid characters are the letters A-F and the digits 0-9.
This code assists the IRS in validating the W-2 data submitted with your return.
The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer
paid to you or incurred on your behalf (including amounts from a section 125
(cafeteria) plan). Any amount over $5,000 also is included in box 1. Complete
Form 2441, Child and Dependent Care Expenses, to compute any taxable and
nontaxable amounts.
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from
a nonqualified deferred compensation or nongovernmental section 457(b) plan, or
(b) included in box 3 and/or 5 if it is a prior year deferral under a nonqualified or
section 457(b) plan that became taxable for social security and Medicare taxes this
year because there is no longer a substantial risk of forfeiture of your right to the
deferred amount. This box shouldn’t be used if you had a deferral and a
distribution in the same calendar year. If you made a deferral and received a
distribution in the same calendar year, and you are or will be age 62 by the end of
the calendar year, your employer should file Form SSA-131, Employer Report of
Special Wage Payments, with the Social Security Administration and give you a
copy.
Box 12. The following list explains the codes shown in box 12. You may need this
information to complete your tax return. Elective deferrals (codes D, E, F, and S)
and designated Roth contributions (codes AA, BB, and EE) under all plans are
generally limited to a total of $18,500 ($12,500 if you only have SIMPLE plans;
$21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub.571). Deferrals under code G are limited to $18,500. Deferrals under code H
are limited to $7,000.
required to file a tax return. Even if you don’t have to file a tax return, you may be
eligible for a refund if box 2 shows an amount or if you are eligible for any credit.
Earned income credit (EIC). You may be able to take the EIC for 2019 if your
adjusted gross income (AGI) is less than a certain amount. The amount of the credit
is based on income and family size. Workers without children could qualify for a
smaller credit. You and any qualifying children must have valid social security
numbers (SSNs). You can’t take the EIC if your investment income is more than the
specified amount for 2019 or if income is earned for services provided while you were
an inmate at a penal institution. For 2019 income limits and more information, visit
www.irs.gov/EITC. Also see Pub. 596, Earned Income Credit. Any EIC that is more
than your tax liability is refunded to you, but only if you file a tax return.
Clergy and religious workers. If you aren’t subject to social security and
Medicare taxes, see Pub. 517, Social Security and Other Information for Members of
the Clergy and Religious Workers.
Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and
2 and ask your employer to correct your employment record. Be sure to ask the
employer to file Form W-2c, Corrected Wage and Tax Statement, with the Social
Security Administration (SSA) to correct any name, SSN, or money amount error
reported to the SSA on Form W-2. Be sure to get your copies of Form W-2c from
your employer for all corrections made so you may file them with your tax return. If
your name and SSN are correct but aren’t the same as shown on your social security
card, you should ask for a new card that displays your correct name at any SSA
office or by calling 800-772-1213. You also may visit the SSA website at
www.SSA.gov.
Cost of employer-sponsored health coverage (if such cost is
provided by the employer).The reporting in box 12, using code DD, of the cost
of employer-sponsored health coverage is for your information only. The amount
reported with code DD is not taxable.
Credit for excess taxes. If you had more than one employer in 2019 and more
than $7,960.80 in social security and/or Tier 1 railroad retirement (RRTA) taxes were
withheld, you may be able to claim a credit for the excess against your federal
income tax. If you had more than one railroad employer and more than $4,674.60 in
Tier 2 RRTA tax was withheld, you also may be able to claim a credit. See your Form
1040 instructions and Pub. 505, Tax Withholding and Estimated Tax.
Instructions for Employee
However, if you were at least age 50 in 2019, your employer may have allowed an
additional deferral of up to $6,000 ($3,000 for section 401(k)(11) and 408(p) SIMPLE
plans). This additional deferral amount is not subject to the overall limit on elective
deferrals. For code G, the limit on elective deferrals may be higher for the last 3 years
before you reach retirement age. Contact your plan administrator for more
information. Amounts in excess of the overall elective deferral limit must be included
in income. See the instructions for Form 1040.
Note: If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up
pension contribution for a prior year(s) when you were in military service. To figure
whether you made excess deferrals, consider these amounts for the year shown, not
the current year. If no year is shown, the contributions are for the current year.
A- Uncollected social security or RRTA tax on tips. Include this tax on Form 1040.
See the Form 1040 instructions.
B- Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
C- Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up
to social security wage base), and 5)
D- Elective deferrals to a section 401(k) cash or deferred arrangement. Also includes
deferrals under a SIMPLE retirement account that is part of a section 401(k)
arrangement.
E- Elective deferrals under a section 403(b) salary reduction agreement
F-Elective deferrals under a section 408(k)(6) salary reduction SEP
G-Elective deferrals and employer contributions (including nonelective deferrals) to a
section 457(b) deferred compensation plan
H-Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See the
Form 1040 instructions for how to deduct.
J-Nontaxable sick pay (information only, not included in box 1, 3, or 5)
K-20% excise tax on excess golden parachute payments. See the Form 1040
instructions.
L-Substantiated employee business expense reimbursements (nontaxable)
M-Uncollected social security or RRTA tax on taxable cost of group-term life
insurance over $50,000 (former employees only). See the Form 1040 instructions.
N-Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000
(former employees only). See the Form 1040 instructions.
P- Excludable moving expense reimbursements paid directly to a member of the U.S.
Armed Forces (not included in box 1, 3, or 5)
Q- Nontaxable combat pay. See the instructions for Form 1040 for details on
reporting this amount.
R- Employer contributions to your Archer MSA. Report on Form 8853, Archer MSAs
and Long-Term Care Insurance Contracts.
S- Employee salary reduction contributions under a section 408(p) SIMPLE plan
(not included in box 1)
T- Adoption benefits (not included in box 1). Complete Form 8839, Qualified
Adoption Expenses, to compute any taxable and nontaxable amounts.
V- Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up
to social security wage base), and 5). See Pub. 525, Taxable and Nontaxable
Income, for reporting requirements.
W- Employer contributions (including amounts the employee elected to contribute
using a section 125 (cafeteria) plan) to your health savings account. Report on
Form 8889, Health Savings Accounts (HSAs).
Y- Deferrals under a section 409A nonqualified deferred compensation plan
Z- Income under a nonqualified deferred compensation plan that fails to satisfy
section 409A. This amount also is included in box 1. It is subject to an additional
20% tax plus interest. See the Form 1040 instructions.
AA- Designated Roth contributions under a section 401(k) plan
BB- Designated Roth contributions under a section 403(b) plan
DD- Cost of employer-sponsored health coverage. The amount reported with code
DD is not taxable.
EE- Designated Roth contributions under a governmental section 457(b) plan. This
amount does not apply to contributions under a tax-exempt organization section
457(b) plan.
FF- Permitted benefits under a qualified small employer health reimbursement
arrangement
GG- Income from qualified equity grants under section 83(i)
HH- Aggregate deferrals under section 83(i) elections as of the close of the
calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the
amount of traditional IRA contributions you may deduct. See
Pub. 590-A,
Contributions to Individual Retirement Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability
insurance taxes withheld, union dues, uniform payments, health insurance
premiums deducted, nontaxable income, educational assistance payments, or a
member of the clergy’s parsonage allowance and utilities. Railroad employers use
this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax,
Medicare tax and Additional Medicare Tax. Include tips reported by the employee
to the employer in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 for at least 3 years after the due date for filing
your income tax return. However, to help protect your social security benefits,
keep Copy C until you begin receiving social security benefits, just in case there is
a question about your work record and/or earnings in a particular year.
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Assignment Details
2022SU Leadership Capstone (MSL-670-1A075)
Submission & Rubric
9:34 PM
Description
• Prompt: Identify and discuss the
strategies that you will use to develop
the competencies that you identified in
your paper for Unit 3. Be sure to specify
if these strategies fit into the education
or experience category, and specify
how they will inculcate the
competencies identified. Do not get
very specific about the action steps for
implementing the strategies yet; that
will come in a later unit.
◄ Pr...us
• Requirements: This paper will be at
least four pages long (1,000 words) and
have 2 references, one of which must
be peer-reviewed.
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