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a. Employee's SSN123-45-6879 |
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b. EIN (Employer Identification Number)46-1234567 |
1. Wages, tips, other compensation55,000.00 |
2. Federal income tax withheld4,000.00 |
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c. Employer's name, address and ZIP codeBESTEST HOSPITAL EVER, INC.123 PAYNE LANE POSTCALL, NY 11111 |
3. Social security wages60,000.00 |
4. Social security tax withheld3,720.00 |
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5. Medicare wages and tips60,000.00 |
6. Medicare tax withheld870.00 |
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7. Social security tips |
8. Allocated tips |
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d. Control number |
9. Verification code |
10. Dependent care benefits |
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e. Employee's name, address and ZIP codeDOCTORED B. MONEY80 WORKHOURS WAY SLEEPLESS HOLLOW, NY 11222 |
11. Nonqualified plans |
12a.C | 45.50 |
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13.Statutory employeeRetirement plan ☑️ Third-party sick day |
12b.E | 5,000.00 |
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14. OtherNY SDI 31.2 |
12c.DD | 9,800.5712d. |
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