Security Service
Resume:
Form W-* Wage and Tax Statement
Copy C — For EMPLOYEE’S RECORDS
OMB No. 1545-0008
Department of Treasury -
Internal Revenue Service
Control
number
Employer’s name, address, and ZIP code
Employee’s name, address, and ZIP code
1 Wages, tips, other comp. 2 Federal income tax withheld 3 Social security wages 4 Social security tax withheld 5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
910 Dependent care benefits
11 Nonqualified plans 12a
12b
Statutory
employee
Retirement
plan
Third-party
13 sick pay 12c
12d
Employee’s social security no. 14
Employer ID number (EIN)
15 St. Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Copy B — To Be Filed With Copy 2 — To Be Filed With Employee’s State, City, or Local
Income Tax Return.
Copy 2 — To Be Filed With
Employee’s State, City, or Local
Income Tax Return.
Employee’s FEDERAL Tax Return.
This information is being furnished to the IRS.
Control
number
Control
number
Control
number
Employer’s name, address, and ZIP code Employer’s name, address, and ZIP code Employer’s name, address, and ZIP code Employee’s name, address, and ZIP code Employee’s name, address, and ZIP code Employee’s name, address, and ZIP code 1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld 3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips 910 Dependent care benefits 910 Dependent care benefits 910 Dependent care benefits 11 Nonqualified plans 12a 11 Nonqualified plans 12a 11 Nonqualified plans 12a 12b 12b 12b
Statutory
employee
Retirement
plan
Third-party
sick pay
Statutory
employee
Retirement
plan
Third-party
sick pay
Statutory
employee
Retirement
plan
Third-party
13 12c 13 12c 13 sick pay 12c
12d 12d 12d
Employee’s social security no. 14 Employee’s social security no. 14 Employee’s social security no. 14 Employer ID number (EIN) Employer ID number (EIN) Employer ID number (EIN) 15 St. Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 15 St. Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 15 St. Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 18 Local wages, tips, etc. 19 Local income tax 20 Locality name This information is being furnished to the IRS. 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. NTF 2585261 2 PYW2
Form W-2 Wage and Tax Statement
OMB No. 1545-0008
Department of Treasury -
Internal Revenue Service
Form W-2 Wage and Tax Statement
OMB No. 1545-0008
Department of Treasury -
Internal Revenue Service
Form W-2 Wage and Tax Statement
OMB No. 1545-0008
Department of Treasury -
Internal Revenue Service
2022 W-2 and Earnings Summary WHITNEY - PERF GUNS
086**-****-***** 086**-****-***** 086**-****-***** Wages, Tips, Other Comp.
Box 1 of W-2
Social Security Wages
Box 3 of W-2
Medicare Wages and Tips
Box 5 of W-2
Gross Pay $39,672.04 $39,672.04 $39,672.04
Less: Non-Taxable Earnings $0.00 $0.00 $0.00
Less: Retirement Deductions ($3,474.22) N/A N/A
Less: Other Pre-tax Deductions ($1,344.08) ($1,344.08) ($1,344.08) Less: Third Party Sick Pay $0.00 $0.00 $0.00
Less: Excess Wages N/A $0.00 N/A
Total Reported Wages $34,853.74 $38,327.96 $38,327.96 SANDRA L PRAZAK
SANDRA L PRAZAK SANDRA L PRAZAK SANDRA L PRAZAK
116 HCR 2415 N
116 HCR 2415 N 116 HCR 2415 N 116 HCR 2415 N
Fed Income
Box 2 of W-2
Social Security
Box 4 of W-2
Medicare
Box 6 of W-2
HILLSBORO TX 76645
HILLSBORO TX 76645 HILLSBORO TX 76645 HILLSBORO TX 76645 Tax Withheld $3,454.96 $2,376.33 $555.76
34853.74
34853.74 34853.74 34853.74
3454.96
3454.96 3454.96 3454.96
38327.96
38327.96 38327.96 38327.96
2376.33
2376.33 2376.33 2376.33
38327.96
38327.96 38327.96 38327.96
555.76
555.76 555.76 555.76
D
D D D
3474.22
3474.22 3474.22 3474.22
DD
DD DD DD
6103.44
6103.44 6103.44 6103.44
W
W W W
400.00
400.00 400.00 400.00
***-**-****
***-**-**** ***-**-**** ***-**-****
SANDRA L PRAZAK
116 HCR 2415 N
26-3474259
26-3474259 26-3474259 26-3474259
HILLSBORO, TX 76645
The Form W-2 Box 1 wages are the Gross Wages as of your last pay statement for the year minus any non-taxable earnings or deductions, plus any additional compensation received after the last pay statement. Gross pay may not match Box 1 wages due to deductions for retirement deferrals, health insurance, or other Sec. 125 cafeteria plan deductions, etc. DYNAENERGETICS US INC
DYNAENERGETICS US INC DYNAENERGETICS US INC DYNAENERGETICS US INC 11800 RIDGE PKWY, SUITE 300
11800 RIDGE PKWY, SUITE 300 11800 RIDGE PKWY, SUITE 300 11800 RIDGE PKWY, SUITE 300 BROOMFIELD CO 80021
BROOMFIELD CO 80021 BROOMFIELD CO 80021 BROOMFIELD CO 80021 Notice to Employee
Instructions for Employee (Continued from
back of Copy B.)
Instructions for Employee (Continued from
back of Copy 2.)
(Instructions for Employee continued on back of Copy 2.)
(Instructions for Employee continued on back of Copy C.)
(See also Notice to Employee on back of Copy B.)
Do you have to file? Refer to the Form 1040
instructions 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 2022 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 2022 or if income is earned for services provided while you were an inmate at a penal institution. For 2022 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 the Social Security Administration (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 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-***-****. 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 2022 and more than $9,114 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. See the Form 1040 instructions. If you had more than one
railroad employer and more than $5,350.80 in Tier 2 RRTA tax was withheld, you may be able to claim a
refund on Form 843. See the Instructions for Form
843.
Instructions for Employee
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 the 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 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 your employer’s 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 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 $20,500 ($14,000 if you only have SIMPLE plans;
$23,500 for section 403(b) plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals under code G are limited to $20,500. Deferrals under code H are limited to $7,000.
However, if you were at least age 50 in 2022, 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 Form 1040 instructions.
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
Form 1040 instructions.
B—Uncollected Medicare tax on tips. Include this
tax on Form 1040 or 1040-SR. See the Form 1040
instructions.
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.
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.
Box 12. (continued)
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 Form 1040
instructions 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 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 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. NTF 2585235 2 BW23UPI
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