Income Tax Third-Party
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 2585828 3 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
0LK30 7729 00000
2023 W-2 and Earnings Summary Healthcare AL
0LK30 7729 01373
0LK30 7729 01373 0LK30 7729 01373 0LK30 7729 01373 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 $9,827.65 $9,827.65 $9,827.65
Less: Non-Taxable Earnings $0.00 $0.00 $0.00
Less: Retirement Deductions $0.00 N/A N/A
Less: Other Pre-tax Deductions $0.00 $0.00 $0.00
Less: Third Party Sick Pay $0.00 $0.00 $0.00
Less: Excess Wages N/A $0.00 N/A
Total Reported Wages $9,827.65 $9,827.65 $9,827.65 NADEGE LAURENT
NADEGE LAURENT NADEGE LAURENT NADEGE LAURENT
220 REX CT
220 REX CT 220 REX CT 220 REX CT
Fed Income
Box 2 of W-2
Social Security
Box 4 of W-2
Medicare
Box 6 of W-2
PALM SPRINGS FL 33461
PALM SPRINGS FL 33461 PALM SPRINGS FL 33461 PALM SPRINGS FL 33461 Tax Withheld $88.28 $609.31 $142.50
9827.65
9827.65 9827.65 9827.65
88.28
88.28 88.28 88.28
9827.65
9827.65 9827.65 9827.65
609.31
609.31 609.31 609.31
9827.65
9827.65 9827.65 9827.65
142.50
142.50 142.50 142.50
DD
DD DD DD
2.08
2.08 2.08 2.08
***-**-****
***-**-**** ***-**-**** ***-**-****
NADEGE LAURENT
220 REX CT
81-3106690
81-3106690 81-3106690 81-3106690
PALM SPRINGS, FL 33461
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. COMMUNITY PAYROLL LLC
COMMUNITY PAYROLL LLC COMMUNITY PAYROLL LLC COMMUNITY PAYROLL LLC 4301 ANCHOR PLAZA PARKWAY SUITE 300
4301 ANCHOR PLAZA PARKWAY SUITE 300 4301 ANCHOR PLAZA PARKWAY SUITE 300 4301 ANCHOR PLAZA PARKWAY SUITE 300 TAMPA FL 33634
TAMPA FL 33634 TAMPA FL 33634 TAMPA FL 33634
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 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 have
valid social security numbers (SSNs). You can’t take the EIC if your investment income is more than the specified amount for 2023 or if income is earned
for services provided while you were an inmate at a penal institution. For 2023 income limits and more information, visit www.irs.gov/EITC. See also Pub. 596. 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. 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 2023 and more than $9,932.40 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 $5,821.20 in Tier 2 RRTA tax was withheld, you may be able to claim a refund on Form 843. See the Instructions for Form 843.
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. 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 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 $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.
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) 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.
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 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 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.
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.
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 2585802 3 BW23UPI
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