Notice to Employee figure the social security and Medicare tax owed on tips you didn’t report to your

figure the social security and Medicare tax owed on tips you didn’t report to your employer. Enter this J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
Do you have to file? Refer to the instructions for Forms 1040 and 1040-SR to determine if you are amount on the wages line of your tax return. By filing Form 4137, your social security tips will be K—20% excise tax on excess golden parachute payments. See the instructions for Forms 1040 and
required to file a tax return. Even if you do not have to file a tax return, you may be eligible for acredited to your social security record (used to figure your benefits). 1040-SR.
refund if box 2 shows an amount or if you are eligible for any credit. Box 10. This amount includes the total dependent care benefits that your employer paid to you or L—Substantiated employee business expense reimbursements (nontaxable)
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to $50,000 (former employees only). See the instructions for Forms 1040 and 1040-SR. .
income (AGI) is less than a certain amount. The amount of credit is based on income and family size.
N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (former
Workers without children could qualify for a smaller credit. You and any qualifying children must compute any taxable and nontaxable amounts.
employees only). See the instructions for Forms 1040 and 1040-SR.
have valid social security numbers (SSNs). You can't take the EIC if your investment income is more Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from a nonqualified P—Excludable moving expense reimbursements paid directly to a member of the U.S. Armed Forces
than the specified amount for 2020 or if income is earned for services provided while you were an deferred compensation or nongovernmental section 457(b) plan, or (b) included in box 3 and/or 5 if it (not included in boxes 1, 3, or 5)
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC. is a prior year deferral under a nonqualified or section 457(b) plan that became taxable for social Q—Nontaxable combat pay. See the instructions for Forms 1040 and 1040-SR for details on
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to security and Medicare taxes this year because there is no longer a substantial risk of forfeiture of your reporting this amount.
you, but only if you file a tax return. right to the deferred amount. This box shouldn't be used if you had a deferral and a distribution in the R—Employer contributions to your Archer MSA. Report on Form 8853, Archer MSAs and
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub. same calendar year. If you made a deferral and received a distribution in the same calendar year, and Long-Term Care Insurance Contracts.
517, Social Security and Other Information for Members of the Clergy and Religious Workers. you are or will be age 62 by the end of the calendar year, your employer should file Form SSA-131, S—Employee salary reduction contributions under a section 408(p) SIMPLE plan (not included in box
Employer Report of Special Wage Payments, with the Social Security Administration and give you a 1)
Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and ask your
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
employer to correct your employment record. Be sure to ask the employer to file Form W-2c, copy.
compute any taxable and nontaxable amounts.
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any Box 12. The following list explains the codes shown in box 12. You may need this information to V—Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up to social
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of complete your tax return. Elective deferrals (codes D, E, F, and S) and designated Roth contributions security wage base), and 5). See Pub. 525, Taxable and Nontaxable Income, for reporting
Form W-2c from your employer for all corrections made so you may file them with your tax return. (codes AA, BB, and EE) under all plans are generally limited to a total of $19,500 ($13,500 if you only requirements.
If your name and SSN are correct but aren't the same as shown on your social security card, you have SIMPLE plans; $22,500 for section 403(b) plans if you qualify for the 15-year rule explained in W—Employer contributions (including amounts the employee elected to contribute using a section
should ask for a new card that displays your correct name at any SSA office or by calling Pub. 571). Deferrals under code G are limited to $19,500. Deferrals under code H are limited to 125 (cafeteria) plan) to your health savings account. Report on Form 8889, Health Savings Accounts
800-772-1213. You may also visit the SSA website at www.SSA.gov. $7,000. (HSAs).
Cost of employer-sponsored health coverage (if such cost is provided by the employer). The However, if you were at least age 50 in 2020, your employer may have allowed an additional Y—Deferrals under a section 409A nonqualified deferred compensation plan
reporting in Box 12, using Code DD, of the cost of employer-sponsored health coverage is for your deferral of up to $6,500 ($3,000 for section 401(k)(11) and 408(p) SIMPLE plans). This additional 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
information only. The amount reported with Code DD is not taxable. deferral amount is not subject to the overall limit on elective deferrals. For code G, the limit on elective
instructions for Forms 1040 and 1040-SR.
Credit for excess taxes. If you had more than one employer in 2020 and more than $8,537.40 in deferrals may be higher for the last 3 years before you reach retirement age. Contact your plan AA—Designated Roth contributions under a section 401(k) plan
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to administrator for more information. Amounts in excess of the overall elective deferral limit must be BB—Designated Roth contributions under a section 403(b) plan
claim a credit for the excess against your federal income tax. If you had more than one railroad included in income. See the instructions for Forms 1040 and 1040-SR. DD—Cost of employer-sponsored health coverage. The amount reported with Code DD is not
employer and more than $5,012.70 in Tier 2 RRTA tax was withheld, you also may be able to claim a Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pension taxable.
credit. See the instructions for Forms 1040 and 1040-SR and Pub. 505, Tax Withholding and contribution for a prior year(s) when you were in military service. To figure whether you made EE—Designated Roth contributions under a governmental section 457(b) plan. This amount does not
Estimated Tax. excess deferrals, consider these amounts for the year shown, not the current year. If no year is apply to contributions under a tax-exempt organization section 457(b) plan.
shown, the contributions are for the current year. FF—Permitted benefits under a qualified small employer health reimbursement arrangement
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040 or 1040-SR. See GG—Income from qualified equity grants under section 83(i)
Instructions for Employee the instructions for Forms 1040 and 1040-SR. HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 1. Enter this amount on the wages line of your tax return. B—Uncollected Medicare tax on tips. Include this tax on Form 1040 or 1040-SR. See the instructions Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
Box 2. Enter this amount on the federal income tax withheld line of your tax return. IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
for Forms 1040 and 1040-SR.
Box 5. You may be required to report this amount on Form 8959, Additional Medicare Tax. See the Arrangements (IRAs).
C—Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up to social Box 14. Employers may use this box to report information such as state disability insurance taxes
Instructions for Forms 1040 and 1040-SR to determine if you are required to complete Form 8959. security wage base), and 5) withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare wages and tips shown D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also includes deferrals under educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
in Box 5, as well as the 0.9% Additional Medicare Tax on any of those Medicare wages and tips above a SIMPLE retirement account that is part of a section 401(k) arrangement. Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
$200,000. tax, Medicare tax, and Additional Medicare Tax. Include tips reported by the employee to the
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on E—Elective deferrals under a section 403(b) salary reduction agreement
employer in railroad retirement (RRTA) compensation.
your tax return, see the instructions for Forms 1040 and 1040-SR. F—Elective deferrals under a section 408(k)(6) salary reduction SEP
Note: Keep Copy C of Form W-2 for at least 3 years after the due date for filing your income tax
You must file Form 4137, Social Security and Medicare Tax on Unreported Tip Income, with G—Elective deferrals and employer contributions (including nonelective deferrals) to a section 457(b) return. However, to help protect your social security benefits, keep Copy C until you begin
your income tax return to report at least the allocated tip amount unless you can prove with adequate deferred compensation plan receiving social security benefits, just in case there is a question about your work record and/or
records that you received a smaller amount. If you have records that show the actual amount of tips H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See the instructions earnings in a particular year.
you received, report that amount even if it is more or less than the allocated tips. Use Form 4137 to for Forms 1040 and 1040-SR for how to deduct.
This information is being furnished to the Internal Revenue Service.
Form W-2 Wage and Tax Statement 2020 Copy C, for employee's records 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.
d Control number Void c Employer's name, address, and ZIP code
Department of the Treasury - Internal Revenue Service
0940-14101262 0000000041-ROCK 2 KIDS CREATIVE 404 INC OMB No. 1545-0008

b Employer's identification number a Employee's social security number

2014 5TH AVE 1 Wages, tips, other compensation 2 Federal Income tax withheld
75-3139502 093-88-9527 NEW YORK NY 10035 5170.99 361.93
13 Statutory Retirement Third-party
Employee plan sick pay 3 Social Security wages 4 Social Security tax withheld

5170.99 320.60
12 See Instrs. for Box 12 14 Other e Employee's name, address, and ZIP code 5 Medicare wages and tips 6 Medicare tax withheld
NYSDI 12.53 5170.99 74.98
NYPFL 13.97 FANTISHA SANOGO 7 Social Security tips 8 Allocated Tips

1514 SEDGWICK AVE

10 Dependent care benefits 11 Nonqualified plans
BRONX NY 10453
Verification Code

15 State Employer's state I.D. No. 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

NY 753139502 5170.99 88.77 5170.99 66.47 NY NYC

Form W-2 Wage and Tax Statement 2020 Copy B, to be filed with employee's FEDERAL tax return
d Control number Void c Employer's name, address, and ZIP code
Department of the Treasury - Internal Revenue Service
0940-14101262 0000000041-ROCK 2 KIDS CREATIVE 404 INC OMB No. 1545-0008

b Employer's identification number a Employee's social security number

2014 5TH AVE 1 Wages, tips, other compensation 2 Federal Income tax withheld
75-3139502 093-88-9527 NEW YORK NY 10035 5170.99 361.93
13 Statutory Retirement Third-party
Employee plan sick pay 3 Social Security wages 4 Social Security tax withheld

5170.99 320.60
12 See Instrs. for Box 12 14 Other e Employee's name, address, and ZIP code 5 Medicare wages and tips 6 Medicare tax withheld
NYSDI 12.53 5170.99 74.98
NYPFL 13.97 FANTISHA SANOGO 7 Social Security tips 8 Allocated Tips

1514 SEDGWICK AVE

10 Dependent care benefits 11 Nonqualified plans
BRONX NY 10453
Verification Code

15 State Employer's state I.D. No. 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

NY 753139502 5170.99 88.77 5170.99 66.47 NY NYC

Form W-2 Wage and Tax Statement 2020 Copy 2, to be filed with employee's tax return for NY
d Control number Void c Employer's name, address, and ZIP code
Department of the Treasury - Internal Revenue Service
0940-14101262 0000000041-ROCK 2 KIDS CREATIVE 404 INC OMB No. 1545-0008

b Employer's identification number a Employee's social security number

2014 5TH AVE 1 Wages, tips, other compensation 2 Federal Income tax withheld
75-3139502 093-88-9527 NEW YORK NY 10035 5170.99 361.93
13 Statutory Retirement Third-party
Employee plan sick pay 3 Social Security wages 4 Social Security tax withheld

5170.99 320.60
12 See Instrs. for Box 12 14 Other e Employee's name, address, and ZIP code 5 Medicare wages and tips 6 Medicare tax withheld
NYSDI 12.53 5170.99 74.98
NYPFL 13.97 FANTISHA SANOGO 7 Social Security tips 8 Allocated Tips

1514 SEDGWICK AVE

10 Dependent care benefits 11 Nonqualified plans
BRONX NY 10453
Verification Code

15 State Employer's state I.D. No. 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

NY 753139502 5170.99 88.77 5170.99 66.47 NY NYC