2018 W-2 and EARNINGS SUMMARY

Employee Reference Copy This blue Earnings Summary section is included with your W-2 to help describe portions in more detail.
Wage and Tax
W-2 Statement
Copy C for employee’s records.
2018
OMB No. 1545-0008
The reverse side includes general information that you may also find helpful.
1. The following information reflects your final 2018 pay stub plus any adjustments submitted by your employer.
d Control number Dept. Corp. Employer use only Gross Pay Social Security UT. State Income Tax
2213.75 137.25 51.31
504703 LOSA/1LK 000607 A 1331 Tax Withheld Box 17 of W-2
c Employer’s name, address, and ZIP code Box 4 of W-2 SUI/SDI/FLI
ARS-FRESNO LLC Box 14 of W-2
Fed. Income 21.45 Medicare Tax 32.10
2204 S EL CAMINO REAL Tax Withheld Withheld
OCEANSIDE CA 92054 Box 2 of W-2 Box 6 of W-2

2. Your Gross Pay was adjusted as follows to produce your W-2 Statement.
Batch #01805
Wages, Tips, other Social Security Medicare UT. State Wages,
e/f Employee’s name, address, and ZIP code Compensation Wages Wages Tips, Etc.
Box 1 of W-2 Box 3 of W-2 Box 5 of W-2 Box 16 of W-2
ADAM OLSEN
251 BROADWAY Gross Pay 2,213.75 2,213.75 2,213.75 2,213.75
#110 Reported W-2 Wages 2,213.75 2,213.75 2,213.75 2,213.75
SALT LAKE CITY UT 84111
b Employer’s FED ID number a Employee’s SSA number
33-0922878 529-97-4644
1 Wages, tips, other comp. 2 Federal income tax withheld
2213.75 21.45
3 Social security wages 4 Social security tax withheld
2213.75 137.25
5 Medicare wages and tips 6 Medicare tax withheld
2213.75 32.10
7 Social security tips 8 Allocated tips

9 Verification Code 10 Dependent care benefits 3. Employee W-4 Profile. To change your Employee W-4 Profile Information, file a new W-4 with your payroll dept.
ffb5-7c4b-6acd-5f3c
11 Nonqualified plans 12a See instructions for box 12

12b
ADAM OLSEN Social Security Number:529-97-4644
14 Other 251 BROADWAY Taxable Marital Status: SINGLE
12c
12d #110 Exemptions/Allowances:
____________________
13 Stat emp. Ret. plan 3rd party sick pay SALT LAKE CITY UT 84111 FEDERAL: 2
STATE: 2
15 State Employer’s state ID no. 16 State wages, tips, etc.
UT 12699020003WTH 2213.75
17 State income tax 18 Local wages, tips, etc.
51.31
19 Local income tax 20 Locality name ¤ 2018 ADP, LLC

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
2213.75 21.45 2213.75 21.45 2213.75 21.45
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
2213.75 137.25 2213.75 137.25 2213.75 137.25
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
2213.75 32.10 2213.75 32.10 2213.75 32.10
d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only
504703 LOSA/1LK 000607 A 1331 504703 LOSA/1LK 000607 A 1331 504703 LOSA/1LK 000607 A 1331
c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code
ARS-FRESNO LLC ARS-FRESNO LLC ARS-FRESNO LLC
2204 S EL CAMINO REAL 2204 S EL CAMINO REAL 2204 S EL CAMINO REAL
OCEANSIDE CA 92054 OCEANSIDE CA 92054 OCEANSIDE CA 92054

b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number
33-0922878 529-97-4644 33-0922878 529-97-4644 33-0922878 529-97-4644
7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips

9 Verification Code 10 Dependent care benefits 9 Verification Code 10 Dependent care benefits 9 Verification Code 10 Dependent care benefits
ffb5-7c4b-6acd-5f3c
11 Nonqualified plans 12a See instructions for box 12 11 Nonqualified plans 12a
12 11 Nonqualified plans 12a

14 Other 12b 14 Other 12b 14 Other 12b

12c 12c 12c
12d 12d 12d
13 Stat emp. Ret. plan 3rd party sick pay 13 Stat emp. Ret. plan 3rd party sick pay 13 Stat emp. Ret. plan 3rd party sick pay

e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code
ADAM OLSEN ADAM OLSEN ADAM OLSEN
251 BROADWAY 251 BROADWAY 251 BROADWAY
#110 #110 #110
SALT LAKE CITY UT 84111 SALT LAKE CITY UT 84111 SALT LAKE CITY UT 84111
15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc.
UT 12699020003WTH 2213.75 UT 12699020003WTH 2213.75 UT 12699020003WTH 2213.75
17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc.
51.31 51.31 51.31
19 Local income tax 20 Locality name 19 Local income tax 20 Locality name 19 Local income tax 20 Locality name

Federal Filing Copy UT.State Reference Copy UT.State Filing Copy

Wage and Tax Wage and Tax Wage and Tax
W-2 Statement
Copy B to be filed with employee’s
OMB
2018 No. 1545-0008
Federal Income Tax Return.
W-2 Statement 2018
OMB No. 1545-0008
Copy 2 to be filed with employee’s State Income Tax Return.
W-2 Statement OMB
2018
Copy 2 to be filed with employee’s State Income Tax Return.
No. 1545-0008
Instructions for Employee Box 12. The following list explains the codes shown in box 12. You may P—Excludable moving expense reimbursements paid directly to a
need this information to complete your tax return. Elective deferrals member of the U.S. Armed Forces (not included in box 1, 3, or 5)
Box 1. Enter this amount on the wages line of your tax return. (codes D, E, F, and S) and designated Roth contributions (codes AA, Q—Nontaxable combat pay. See the instructions for Form 1040 for
Box 2. Enter this amount on the federal income tax withheld line of BB, and EE) under all plans are generally limited to a total of $18,500 details on reporting this amount.
your tax return. ($12,500 if you only have SIMPLE plans; $21,500 for section 403(b) R—Employer contributions to your Archer MSA. Report on Form 8853,
Box 5. You may be required to report this amount on Form 8959, plans if you qualify for the 15-year rule explained in Pub. 571). Archer MSAs and Long-Term Care Insurance Contracts.
Additional Medicare Tax. See the Form 1040 instructions to Deferrals under code G are limited to $18,500. Deferrals under code H
are limited to $7,000. S—Employee salary reduction contributions under a section 408(p)
determine if you are required to complete Form 8959. SIMPLE plan (not included in box 1)
Box 6. This amount includes the 1.45% Medicare Tax withheld on all However, if you were at least age 50 in 2018, your employer may T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified
Medicare wages and tips shown in box 5, as well as the 0.9% have allowed an additional deferral of up to $6,000 ($3,000 for section Adoption Expenses, to compute any taxable and nontaxable amounts.
Additional Medicare Tax on any of those Medicare wages and tips 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount
above $200,000. is not subject to the overall limit on elective deferrals. For code G, the V—Income from exercise of nonstatutory stock option(s) (included in
limit on elective deferrals may be higher for the last 3 years before you boxes 1, 3 (up to social security wage base), and 5). See Pub. 525,
Box 8. This amount is not included in box 1, 3, 5, or 7. For Taxable and Nontaxable Income, for reporting requirements.
information on how to report tips on your tax return, see your Form reach retirement age. Contact your plan administrator for more
information. Amounts in excess of the overall elective deferral limit must W—Employer contributions (including amounts the employee elected to
1040 instructions. contribute using a section 125 (cafeteria) plan) to your health savings
be included in income. See the instructions for Form 1040.
You must file Form 4137, Social Security and Medicare Tax on account. Report on Form 8889, Health Savings Accounts (HSAs).
Unreported Tip Income, with your income tax return to report at least 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 Y—Deferrals under a section 409A nonqualified deferred compensation plan
the allocated tip amount unless you can prove that you received a
smaller amount. If you have records that show the actual amount of in military service. To figure whether you made excess deferrals, Z—Income under a nonqualified deferred compensation plan that fails to
tips you received, report that amount even if it is more or less than consider these amounts for the year shown, not the current year. If no satisfy section 409A. This amount also is included in box 1. It is subject
the allocated tips. On Form 4137 you will calculate the social year is shown, the contributions are for the current year. to an additional 20% tax plus interest. See the Form 1040 instructions.
security and Medicare tax owed on the allocated tips shown on your A—Uncollected social security or RRTA tax on tips. Include this tax on AA—Designated Roth contributions under a section 401(k) plan
Form(s) W-2 that you must report as income and on other tips you Form 1040. See the Form 1040 instructions. BB—Designated Roth contributions under a section 403(b) plan
did not report to your employer. By filing Form 4137, your social B—Uncollected Medicare tax on tips. Include this tax on Form 1040. DD—Cost of employer-sponsored health coverage. The amount
security tips will be credited to your social security record (used to See the Form 1040 instructions. reported with code DD is not taxable.
figure your benefits). C—Taxable cost of group-term life insurance over $50,000 (included in EE—Designated Roth contributions under a governmental section
Box 9. If you are e-filing and if there is a code in this box, enter it boxes 1, 3 (up to social security wage base), and 5) 457(b) plan. This amount does not apply to contributions under a tax-
when prompted by your software. The only valid characters are the D—Elective deferrals to a section 401(k) cash or deferred arrangement. exempt organization section 457(b) plan.
letters A-F and the digits 0-9. This code assists the IRS in validating Also includes deferrals under a SIMPLE retirement account that is part FF—Permitted benefits under a qualified small employer health
the W-2 data submitted with your return. The code is not entered on of a section 401(k) arrangement. reimbursement arrangement
paper-filed returns. E—Elective deferrals under a section 403(b) salary reduction agreement GG—Income from qualified equity grants under section 83(i)
Box 10. This amount includes the total dependent care benefits that F—Elective deferrals under a section 408(k)(6) salary reduction SEP HH—Aggregate deferrals under section 83(i) elections as of the close
your employer paid to you or incurred on your behalf (including of the calendar year
amounts from a section 125 (cafeteria) plan). Any amount over G—Elective deferrals and employer contributions (including nonelective
$5,000 also is included in box 1. Complete Form 2441, Child and deferrals) to a section 457(b) deferred compensation plan Box 13. If the “Retirement plan” box is checked, special limits may apply
Dependent Care Expenses, to compute any taxable and nontaxable H—Elective deferrals to a section 501(c)(18)(D) tax-exempt to the amount of traditional IRA contributions you may deduct. See Pub.
amounts. organization plan. See the Form 1040 instructions for how to deduct. 590-A, Contributions to Individual Retirement Arrangements (IRAs).
Box 11. This amount is (a) reported in box 1 if it is a distribution J—Nontaxable sick pay (information only, not included in box 1, 3, or 5) Box 14. Employers may use this box to report information such as
made to you from a nonqualified deferred compensation or state disability insurance taxes withheld, union dues, uniform payments,
K—20% excise tax on excess golden parachute payments. See the health insurance premiums deducted, nontaxable income, educational
nongovernmental section 457(b) plan, or (b) included in box 3 and/or Form 1040 instructions.
5 if it is a prior year deferral under a nonqualified or section 457(b) assistance payments, or a member of the clergy's parsonage allowance
plan that became taxable for social security and Medicare taxes this L—Substantiated employee business expense reimbursements and utilities. Railroad employers use this box to report railroad
year because there is no longer a substantial risk of forfeiture of your (nontaxable) retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax, Medicare tax
right to the deferred amount. This box shouldn’t be used if you had a M—Uncollected social security or RRTA tax on taxable cost of and Additional Medicare Tax. Include tips reported by the employee to
deferral and a distribution in the same calendar year. If you made a group-term life insurance over $50,000 (former employees only). See the employer in railroad retirement (RRTA) compensation.
deferral and received a distribution in the same calendar year, and the Form 1040 instructions. Note: Keep Copy C of Form W-2 for at least 3 years after the due date
you are or will be age 62 by the end of the calendar year, your N—Uncollected Medicare tax on taxable cost of group-term life for filing your income tax return. However, to help protect your social
employer should file Form SSA-131, Employer Report of Special insurance over $50,000 (former employees only). See the Form 1040 security benefits, keep Copy C until you begin receiving social
Wage Payments, with the Social Security Administration and give instructions. security benefits, just in case there is a question about your work
you a copy. record and/or earnings in a particular year.
Department of the Treasury - Internal Revenue Service

NOTE: THESE ARE SUBSTITUTE WAGE AND TAX STATEMENTS AND ARE ACCEPTABLE FOR FILING WITH YOUR FEDERAL, STATE AND LOCAL/CITY INCOME TAX RETURNS.

This information is being furnished to the Internal

Revenue Service. If you are required to file a tax Notice to Employee
return, a negligence penalty or other sanction may
be imposed on you if this income is taxable and Do you have to file? Refer to the Form 1040 instructions
you fail to report it. to correct any name, SSN, or money amount error
to determine if you are required to file a tax return. Even reported to the SSA on Form W-2. Be sure to get your
IMPORTANT NOTE: if you don’t have to file a tax return, you may be eligible copies of Form W-2c from your employer for all
In order to insure efficient processing,
for a refund if box 2 shows an amount or if you are corrections made so you may file them with your tax
attach this W-2 to your tax return like this
eligible for any credit. return. If your name and SSN are correct but aren’t the
(following agency instructions): Earned income credit (EIC). You may be able to take the same as shown on your social security card, you should
EIC for 2018 if your adjusted gross income (AGI) is less ask for a new card that displays your correct name at any
than a certain amount. The amount of the credit is based SSA office or by calling 800-772-1213. You also may visit
on income and family size. Workers without children the SSA website at www.SSA.gov.
could qualify for a smaller credit. You and any qualifying Cost of employer-sponsored health coverage (if such
children must have valid social security numbers (SSNs). cost is provided by the employer). The reporting in box
You can’t take the EIC if your investment income is more 12, using code DD, of the cost of employer-sponsored
TAX RETURN than the specified amount for 2018 or if income is earned health coverage is for your information only. The amount
for services provided while you were an inmate at a penal reported with code DD is not taxable.
institution. For 2018 income limits and more information, Credit for excess taxes. If you had more than one
visit www.irs.gov/EITC. Also see Pub. 596, Earned employer in 2018 and more than $7,960.80 in social
THIS Income Credit. Any EIC that is more than your tax security and/or Tier 1 railroad retirement (RRTA) taxes
OTHER liability is refunded to you, but only if you file a tax
FORM were withheld, you may be able to claim a credit for the
W-2
W-2’S return. excess against your federal income tax. If you had more
Clergy and religious workers. If you aren’t subject to than one railroad employer and more than $4,674.60 in
social security and Medicare taxes, see Pub. 517, Social Tier 2 RRTA tax was withheld, you also may be able to
Security and Other Information for Members of the Clergy claim a credit. See your Form 1040 instructions and Pub.
and Religious Workers. 505, Tax Withholding and Estimated Tax.
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)

Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service