RCampbell 2020 W2

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Form W-2 Wage and Tax Statement 2020 OMB No.

OMB No. 1545-0008 Department of the Treasury - Internal Revenue Service


Control number Employer identification number COPY B To Be Filed With Employee's FEDERAL Tax Return
2384917632 59-6000344
Employer's name, address and zip code Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
City of Jacksonville XXX-XX-8662 113695.03 20710.58
117 West Duval Street 7 Social security tips 3 Social security wages 4 Social security tax withheld
Suite 375
Jacksonville FL 32202
8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld
119428.20 1731.71
Employee's first name and init Last Name Suffix
9 10 Dependent care benefits 11 Nonqualified plans
Robert C Campbell
4480 Bay Harbour Dr 12a C | 6.72 14 Other
Jacksonville FL 32225 13 Statutory Employee
Pens 5733.17
12b |
Retirement Plan
12c |
Third-party sick pay
Employee's address and ZIP code 12d |
15 State 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

This information is being furnished to the Internal Revenue Service

Form W-2 Wage and Tax Statement 2020 OMB No. 1545-0008 Department of the Treasury - Internal Revenue Service
Control number Employer identification number COPY C For Employee's Records (See Notice to Employee on back of
2384917632 59-6000344 Copy B)
Employer's name, address and zip code Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
City of Jacksonville XXX-XX-8662 113695.03 20710.58
117 West Duval Street 7 Social security tips 3 Social security wages 4 Social security tax withheld
Suite 375
Jacksonville FL 32202
8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld
119428.20 1731.71
Employee's first name and init Last Name Suffix
9 10 Dependent care benefits 11 Nonqualified plans
Robert C Campbell
4480 Bay Harbour Dr 12a C | 6.72 14 Other
Jacksonville FL 32225 13 Statutory Employee
Pens 5733.17
12b |
Retirement Plan
12c |
Third-party sick pay
Employee's address and ZIP code 12d |
15 State 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

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.

Form W-2 Wage and Tax Statement 2020 OMB No. 1545-0008 Department of the Treasury - Internal Revenue Service
Control number Employer identification number Copy 1 To Be Filed With Employee's State, City, or Local Income Tax
2384917632 59-6000344 Return
Employer's name, address and zip code Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
City of Jacksonville XXX-XX-8662 113695.03 20710.58
117 West Duval Street 7 Social security tips 3 Social security wages 4 Social security tax withheld
Suite 375
Jacksonville FL 32202
8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld
119428.20 1731.71
Employee's first name and init Last Name Suffix
9 10 Dependent care benefits 11 Nonqualified plans
Robert C Campbell
4480 Bay Harbour Dr 12a C | 6.72 14 Other
Jacksonville FL 32225 13 Statutory Employee
Pens 5733.17
12b |
Retirement Plan
12c |
12d | Third-party sick pay
Employee's address and ZIP code
15 State 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

This information is being furnished to the Internal Revenue Service

Form W-2 Wage and Tax Statement 2020 OMB No. 1545-0008 Department of the Treasury - Internal Revenue Service
Control number Employer identification number Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return
2384917632 59-6000344
Employer's name, address and zip code Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
City of Jacksonville XXX-XX-8662 113695.03 20710.58
117 West Duval Street 7 Social security tips 3 Social security wages 4 Social security tax withheld
Suite 375
Jacksonville FL 32202
8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld
119428.20 1731.71
Employee's first name and init Last Name Suffix
9 10 Dependent care benefits 11 Nonqualified plans
Robert C Campbell
4480 Bay Harbour Dr 12a C | 6.72 14 Other
Jacksonville FL 32225 13 Statutory Employee
Pens 5733.17
12b |
Retirement Plan
12c |
12d | Third-party sick pay
Employee's address and ZIP code
15 State 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

This information is being furnished to the 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 do not 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 2020 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 cannot take the EIC if your investment
income is more than the specified amount for 2020 or if income is earned for services provided while you were an inmate at a penal institution. For 2020 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 are not subject to social security and Medicare taxes, see Publication 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 are not
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
2020 and more than $8,357.40 in social security and/or Tier I 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 $5,012.70 in Tier 2 RRTA tax was withheld, you also may 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
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 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 should not 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 2020, 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 for how to deduct.
B - Uncollected Medicare tax on tips. Include this tax on Form 1040 or 1040-SR. See the Instructions for Forms 1040 and 1040-SR for how to deduct.
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 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 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 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.
Included in Box 14, if applicable, are amounts paid to you as qualified sick or family leave wages under the Families First Coronavirus Response Act. Specifically, up to three types of
paid qualified sick or family leave wages are reported in Box 14: Sick leave wages subject to the $511 per day limit because of care you required (Code "Qual EPSLA 511"), Sick leave
wages subject to the $200 per day limit because of care you provided to another (Code "Qual EPSLA 200") and Emergency family leave wages (Code "Qual EFMLEA"). If you have
self-employment income in addition to wages paid by your employer, and you intend to claim any qualified sick leave or qualified family leave equivalent credits, you must report the
qualified sick or family leave wages on Form 7202, Credits for Sick Leave and Family Leave for Certain Self-Employed Individuals, included with your income tax return and reduce (but
not below zero) any qualified sick or family leave equivalent credits by the amount of these qualified leave wages. If you have self-employment income, you should refer to the instructions
for your individual income tax return for more information.
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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