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Click here or scroll down to respond to this candidateDepartment of the Treasury -- Internal Revenue Serviced Control number 1 Wages, tips, other compensation 2 Federal Income tax withheld PHONE NUMBER AVAILABLE3OMB NO. Street Address .41 3227.685 Medicare wages and tips 6 Medicare tax withheldPHONE NUMBER AVAILABLEc Employer's name, address and ZIP codeSTATE OF WEST VIRGINIA1900 KANAWHA BLVD EASTCHARLESTON WV 253057 Social security tips 8 Allocated tips 90.00 0.0010 Dependent care benefits 11 Nonqualified plans C ode12aGSee instructions for box 12PHONE NUMBER AVAILABLECode12bDDCode12cCode12d6242.00b Employer identification number (EIN) a Employee's social security number 472045326 XXX-XX-XXXX13 StatutoryemployeeRetirementplanThird-partysick pay14 OtherXRETIREMENT 3065.19e Employee's name, address and ZIP code This information is being furnished to the InternalRevenue Services. If youare required to file a taxreturn, a negligencepenalty or other sanctionmay be imposed on youif this income is taxableand you fail to report it.JOSEPH A WILLISPO BOX 483CEDAR GROVE WV 25039FormW-215 State Employer's state ID number 16 State wages, tips, etc. WV 23057468 48734.220.00Wage and TaxStatement17 State income tax 18 Local wages, tips, etc.1784.87 0.002023 19 Local 0.00 income tax 20 Locality name 0.00 0.00Copy C-For EMPLOYEE'S RECORDS(See Notice to Employee on the back ofCopy B)0.00Department of the Treasury -- Internal Revenue Service d Control number 1 Wages, tips, other compensation 2 Federal Income tax withheld PHONE NUMBER AVAILABLE3OMB NO. 1545-0008 3 Social security wages 4 Social security tax withheld 52059.41 3227.685 Medicare wages and tips 6 Medicare tax withheldPHONE NUMBER AVAILABLEc Employer's name, address and ZIP codeSTATE OF WEST VIRGINIA1900 KANAWHA BLVD EASTCHARLESTON WV 253057 Social security tips 8 Allocated tips 90.00 0.0010 Dependent care benefits 11 Nonqualified plans C ode12a0.00 0.00 G 260.00Code12bDDCode12cCode12d6242.00b Employer identification number (EIN) a Employee's social security number PHONE NUMBER AVAILABLE13 StatutoryemployeeRetirementplanThird-partysick pay14 OtherXRETIREMENT 3065.19e Employee's name, address and ZIP codeJOSEPH A WILLISPO BOX 483CEDAR GROVE WV 25039FormW-215 State Employer's state ID number 16 State wages, tips, etc. WV 23057468 48734.220.00Wage and TaxStatement17 State income tax 18 Local wages, tips, etc.1784.87 0.002023 19 0.Local 00 income tax 20 Locality name 0.00 0.00Copy 2-To Be Filed With Employee'sState, City, or Local Income Tax Return. 0.00Department of the Treasury -- Internal Revenue Service d Control number 1 Wages, tips, other compensation 2 Federal Income tax withheld PHONE NUMBER AVAILABLE3OMB NO. 1545-0008 3 Social security wages 4 Social security tax withheld 52059.41 3227.685 Medicare wages and tips 6 Medicare tax withheldPHONE NUMBER AVAILABLEc Employer's name, address and ZIP codeSTATE OF WEST VIRGINIA1900 KANAWHA BLVD EASTCHARLESTON WV 253057 Social security tips 8 Allocated tips 90.00 0.0010 Dependent care benefits 11 Nonqualified plans C ode12aGSee instructions for box 12PHONE NUMBER AVAILABLECode12bDDCode12cCode12d6242.00b Employer identification number (EIN) a Employee's social security number PHONE NUMBER AVAILABLE13 StatutoryemployeeRetirementplanThird-partysick pay14 OtherXRETIREMENT 3065.19e Employee's name, address and ZIP codeJOSEPH A WILLISPO BOX 483CEDAR GROVE WV 25039FormW-215 State Employer's state ID number 16 State wages, tips, etc. WV 23057468 48734.220.00Wage and TaxStatement17 State income tax 18 Local wages, tips, etc.1784.87 0.002023 19 Local 0.00 income tax 20 Locality 0.name 00 0.00Copy B-To Be Filed With Employee'sFEDERAL Tax Return . This informationis being furnished to the Internal RevenueService.0.00Department of the Treasury -- Internal Revenue Service d Control number 1 Wages, tips, other compensation 2 Federal Income tax withheld PHONE NUMBER AVAILABLE3OMB NO. 1545-0008 3 Social security wages 4 Social security tax withheld 52059.41 3227.685 Medicare wages and tips 6 Medicare tax withheldPHONE NUMBER AVAILABLEc Employer's name, address and ZIP codeSTATE OF WEST VIRGINIA1900 KANAWHA BLVD EASTCHARLESTON WV 253057 Social security tips 8 Allocated tips 90.00 0.0010 Dependent care benefits 11 Nonqualified plans C ode12a0.00 0.00 G 260.00Code12bDDCode12cCode12d6242.00b Employer identification number (EIN) a Employee's social security number PHONE NUMBER AVAILABLE13 StatutoryemployeeRetirementplanThird-partysick pay14 OtherXRETIREMENT 3065.19e Employee's name, address and ZIP codeJOSEPH A WILLISPO BOX 483CEDAR GROVE WV 25039W-Form 215 State Employer's state ID number 16 State wages, tips, etc. WV 23057468 48734.220.00Wage and TaxStatement17 State income tax 18 Local wages, tips, etc.1784.87 0.002023 19 0.Local 00 income tax 20 Locality 0.name 00 Copy 2-To Be Filed With Employee's 0.00State, City, or Local Income Tax Return. 0.00Notice to EmployeeDo you have to file?Refer to the Form 1040instructions to determine if you are required to file a tax return. Even if you dont 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 totake the EIC for 2023 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 havevalid social security numbers (SSNs). You canttake the EIC if your investment income is more than the specified amount for 2023 or if income isearned for services provided while you were aninmate at a penal institution. For 2023 income limits and more information, visit www.irs.gov/EITC. Seealso Pub. 596, Earned Income Credit. Any EIC thatis more than your tax liability is refunded toyou, but only if you file a tax return.Employees social security number (SSN). Foryour protection, this form may show only the lastfour digits of your SSN. However, your employerhas reported your complete SSN to the IRS and theSocial Security Administration (SSA).Clergy and religious workers. If you arentsubject to social security and Medicare taxes, see Pub. 517.Corrections. If your name, SSN, or address isincorrect, correct Copies B, C, and 2 and ask your employer to correct your employment record. Besure to ask the employer to file Form W-2c,Corrected Wage and Tax Statement, with the SSAto correct any name, SSN, or money amount errorreported to the SSA on Form W-2. Be sure to getyour copies of Form W-2c from your employer forall corrections made so you may file them with your tax return. If your name and SSN are correct butarent the same as shown on your social securitycard, you should ask for a new card that displaysyour correct name at any SSA office or by callingPHONE NUMBER AVAILABLE You may also visit the SSA websiteat www.SSA.gov.Cost of employer-sponsored health coverage(if such cost is provided by the employer). Thereporting in Box 12, using Code DD, of the cost of employer-sponsored health coverage is for yourinformation only. The amount reported with CodeDD is not taxable.Credit for excess taxes. If you had more than oneemployer in 2023 and more than $9,932.40 insocial security and/or Tier 1 railroad retirement(RRTA) taxes were withheld, you may be able toclaim a credit for the excess against your federal income tax. See the Form 1040 instructions. If you had more than one railroad employer and morethan $5,821.20 in Tier 2 RRTA tax was withheld,you may be able to claim a refund on Form 843.See the Instructions for Form 843.(See also Instructions for Employee on the back of Copy C.)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. 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 boxes 1, 3, 5, or 7. For information on how to report tips on your tax return, see the Form 1040 instructions.You must file Form 4137 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 didnt 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 your employers plan limit is also included in box 1. See Form 2441.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 shouldnt 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, EmployerReport of Special Wage Payments, with the SocialSecurity 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 $22,500($15,500 if you only have SIMPLE plans; $25,500 for section 403(b) plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals under code G are limited to $22,500. Deferrals under code H are limited to$7,000. (Instructions for Employee continued on the back of Copy C.)Instructions for Employee(continued from back of Copy B)However, if you were at least age 50 in 2023, your employer may have allowed an additional deferral of up to $7,500 ($3,500 for section 401(k)(11) and408(p) SIMPLE plans). This additional deferralamount 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 Form 1040 instructions.Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pensioncontribution for a prior year(s) when you were inmilitary service. To figure whether you made excess deferrals, consider these amounts for the yearshown, not the current year. If no year is shown, the contributions are for the current year.AUncollected social security or RRTA tax on tips. Include this tax on Form 1040 or 1040-SR. See theForm 1040 instructions.BUncollected Medicare tax on tips. Include thistax on Form 1040 or 1040-SR. See the Form 1040instructions.CTaxable cost of group-term life insurance over$50,000 (included in boxes 1, 3 (up to the socialsecurity wage base), and 5)DElective deferrals to a section 401(k) cash ordeferred arrangement. Also includes deferrals under a SIMPLE retirement account that is part of asection 401(k) arrangement.EElective deferrals under a section 403(b) salary reduction agreementFElective deferrals under a section 408(k)(6)salary reduction SEPGElective deferrals and employer contributions(including nonelective deferrals) to a section 457(b) deferred compensation planHElective deferrals to a section 501(c)(18)(D) tax- exempt organization plan. See the Form 1040instructions for how to deduct.JNontaxable sick pay (information only, notincluded in boxes 1, 3, or 5)K20% excise tax on excess golden parachutepayments. See the Form 1040 instructions.LSubstantiated employee business expensereimbursements (nontaxable)MUncollected social security or RRTA tax ontaxable cost of group-term life insurance over$50,000 (former employees only). See the Form1040 instructions.NUncollected Medicare tax on taxable cost ofgroup-term life insurance over $50,000 (formeremployees only). See the Form 1040 instructions.PExcludable moving expense reimbursementspaid directly to a member of the U.S. ArmedForces (not included in box 1, 3, or 5)QNontaxable combat pay. See the Form 1040instructions for details on reporting this amount. REmployer contributions to your Archer MSA.Report on Form 8853, Archer MSAs and Long-Term Care Insurance Contracts.SEmployee salary reduction contributions undera section 408(p) SIMPLE plan (not included in box1)TAdoption benefits (not included in box 1).Complete Form 8839, Qualified AdoptionExpenses, to figure any taxable and nontaxableamounts.VIncome from exercise of nonstatutory stockoption(s) (included in boxes 1, 3 (up to the social security wage base), and 5). See Pub. 525,Taxable and Nontaxable Income, for reportingrequirements.WEmployer contributions (including amountsthe employee elected to contribute using a section 125 (cafeteria) plan) to your health savingsaccount. Report on Form 8889, Health SavingsAccounts (HSAs).YDeferrals under a section 409A nonqualifieddeferred compensation planZIncome under a nonqualified deferredcompensation plan that fails to satisfy section409A. This amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form 1040 instructions.AADesignated Roth contributions under asection 401(k) planBBDesignated Roth contributions under asection 403(b) planDDCost of employer-sponsored healthcoverage. The amount reported with Code DDis not taxable.EEDesignated Roth contributions under agovernmental section 457(b) plan. This amountdoes not apply to contributions under a tax-exempt organization section 457(b) plan.FFPermitted benefits under a qualified smallemployer health reimbursement arrangementGGIncome from qualified equity grants undersection 83(i)HHAggregate deferrals under section 83(i)elections as of the close of the calendar yearBox 13. If the Retirement plan box is checked,special limits may apply to the amount oftraditional IRA contributions you may deduct. SeePub. 590-A, Contributions to Individual Retirement Arrangements (IRAs).Box 14. Employers may use this box to reportinformation such as state disability insurancetaxes withheld, union dues, uniform payments,health insurance premiums deducted, nontaxableincome, educational assistance payments, or amember of the clergys parsonage allowance andutilities. Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1tax, Tier 2 tax, Medicare tax, and AdditionalMedicare Tax. Include tips reported by theemployee to the employer in railroad retirement(RRTA) compensation.Note. Keep Copy C of Form W-2 for at least 3years after the due date for filing your income tax return. However, to help protect your socialsecurity benefits, keep Copy C until you beginreceiving social security benefits, just in casethere is a question about your work record and/orearnings in a particular year.Employer's Name, Address and ZIP CodeSTATE OF WEST VIRGINIA1900 KANAWHA BLVD EASTCHARLESTON WV 25305Employee's Name, Address and ZIP CodeJOSEPH A WILLISPO BOX 483CEDAR GROVE WV 25039 |
