2015 YEAR-END W2/1099 . This W-2/1099 Year-End Book is distributed with the understanding that the information contained does not constitute legal, accounting or other professional advice. It is not intended to be responsive to any individual situation or concerns, as the contents of this book are intended for general informational purposes only. Readers are urged not to act upon the information contained in this book without first consulting competent legal, accounting or other professional advice regarding implications of a particular factual situation. Questions and additional information can be submitted to your Eide Bailly representative. © 2015 Eide Bailly LLP . Table of Contents Page I. Independent Contractor or Employee? a. b. c. d. e. f. Common-Law Employees Statutory Employees Statutory Nonemployees Factors Used by IRS in Determining Employee Status IRS Reclassification: Employer Liability Form SS-8 (Form Included) 8 8 9 10 12 15 II. 1099 Information Returns a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. s. t. General Requirements Normal and Extended Due Dates How to File Form 1099 with the IRS Substitute Statement to Recipients Backup Withholding Taxpayer Identification Number (TIN) Matching Truncating Payee Identification Number Electronic Filing Penalties for Noncompliance Form 1096 Annual Summary and Transmittal Form 1099-MISC 1. Rents 2. Royalties 3.

Other Income 4. Federal Income Tax 5. Fishing Boat Proceeds 6.

Medical and Health Care Payments 7. Nonemployee Compensation 8. Director’s Fees 9.

Substitute Payments in Lieu of Dividends or Interest 10. Payer Made Direct Sales 11. Crop Insurance Proceeds 12.

Foreign Tax 13. Foreign County or Possession 14. Excess Golden Parachute Payments 15.

Gross Proceeds Paid to Attorneys 16. Section 409A Deferrals and Income Form 1099-DIV Form 1099-INT Form 1099-OID Form 1099-R 1. Distribution Codes Chart Form 1099-PATR Form 1099-LTC Form 1099-SA Form 1042-S Form 1099-A 20 20 20 21 21 22 22 23 23 25 26 27 27 28 29 29 29 29 31 31 31 32 32 32 32 32 33 34 34 35 35 37 39 39 39 40 40 .

u. v. w. x. y. z. aa. bb. cc. dd. ee. ff. gg. hh. Form 1099-C Form 1099-B Form 1099-K Form 1042-S (Form Included) 1. Form 1042-S Codes Form 1042-T (Form Included) Form 8809 (Form Included) Form W-9 (Form Included) Points to Remember Guide to Information Returns Types of Payments Where to File Combined Federal/State Filing Program State Code Chart Correcting Information Returns Page 40 41 42 57 61 65 66 68 72 73 76 77 77 78 79 III. New Hire Reporting a. b. c. d. e. f. g. h. i. j. General Federal Requirements Employment Verification Rules SSA Social Security Number Verification Service State Verification Requirements Chart Penalties for Violation Deposit Requirements for Employment Taxes SSN “Randomization” State New Hire Reporting Information (from Child Support Enforcement Website) State/Employer Contact & Program Information (from Child Support Enforcement Website) State Medical Support Information (from Child Support Enforcement Website) 82 83 86 88 89 90 91 92 120 177 IV. Forms W-2 and W-3 a.

Who Must File Form W-2 b. Filing Instructions Per Box 1. Box 12 Codes c.

Common W-2 Reporting Errors d. Charging Fees for Duplicate Copies 1. Request for Duplicate Form W-2 (Form Included) e.

Form W-3 f. Electronic Filing g. Correcting Forms W-2/W-3 h.

Penalties i. Fringe Benefits and Special Reporting Issues 1. Taxable Fringe Benefits a.

When Fringe Benefits are Considered Paid b. Special Accounting Rule c. Depositing Taxes on Fringe Benefits d.

Withholding on Fringe Benefits e. Supplemental Wage Payments f. Employer-Paid Taxes 2.

Cafeteria Plans and Flexible Benefit Plans 198 199 202 206 206 207 208 209 211 212 215 215 215 216 216 216 219 220 . a. b. c. d. e. f. g. h. j. Effect of the Family and Medical Leave Act Flexible Spending Accounts Dependent Care Benefits Adoption Assistance Health Savings Accounts Employer-Provided Accident and Health Plan Health Insurance Premiums on 2% Shareholders New W-2 Reporting Requirement 1. IRS Reporting Chart 3. Group-Term Life Insurance Coverage a. Uniform Premium Table 4.

Whole-Life Insurance a. Premium Table 5. Deferred Compensation Plans a.

Qualified Plans b. Nonqualified Plans 1. Nonqualified Deferred Comp Examples 6.

Personal Use of Company Vehicle a. Annual Lease Value Method 1. Annual Lease Value Table 2.

Annual Lease Value Worksheet (Form Included) b. Cents-Per-Mile Method c. Commuting Value Method 7.

Qualified Transportation Fringe Benefits 8. Employee Relocation Expense Reimbursements 9. De Minimis Fringe Benefits 10.

Employer-Provided Cell Phone 11. Educational Assistance 12. Differential Military Pay 13.

Loans to Employees 14. Employee Discounts 15. Third-Party Sick Pay 16.

Employee Business Expense Reimbursement 17. Wages Paid After Death 18. Special Rules for Various Fringe Benefits Chart 19.

State Taxation of Salary Deferrals Chart 2015 - 2016 Changes 1. Returned Wage Reports 2. FUTA Credit Reductions Because of State Loans 3.

Credit Reductions States 4. FUTA Credit Reduction Rate Chart 5. Patient Protection & Affordable Care Act 6.

Publication 1542 – Per Diem Rate Tables – No Longer Updated Page 225 226 228 229 231 232 233 233 235 237 238 240 241 242 242 246 250 252 253 254 255 256 256 257 258 259 262 262 264 265 266 267 271 273 274 275 277 277 277 277 278 278 278 V. Appendix – Misc Contact Information, Forms, & Charts a. List of SSA Regional Employer Service Liaison Officers b.

Other Websites and Information c. 2015/2016 Rate Chart 281 283 284 . d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. s. t. Selected State Withholding Tax Department Contact Information State Annual Reconciliation Returns Chart State Supplemental Tax Rates Chart State Reciprocity Agreements Chart 1. Available Reciprocity Forms a. District of Columbia Certificate of Nonresidence (Form Included) b. Illinois Employee’s Statement of Nonresidence (Form Included) c.

Indiana Certificate of Residence (Form Included) d. Iowa Employee’s Statement of Nonresidence (Form Included) e. Kentucky Certificate of Nonresidence (Form Included) f.

Maryland Employee’s Withholding Exemption Certificate (Form Included) g. Michigan Employee’s Withholding Exemption Certificate (Form Included) h. Minnesota Reciprocity Exemption (Form Included) i.

Montana Employee Certificate of North Dakota Residence(Form Included) j. New Jersey Employee Certificate of Nonresidence (Form Included) k. North Dakota Reciprocity Exemption (Form Included) l.

Ohio Employee’s Statement of Residency (Form Included) m. Pennsylvania Employee’s Statement of Nonresidence (Form Included) n. Virginia Personal Exemption Worksheet (Form Included) o.

West Virginia Employee Withholding Exemption Certificate (Form Included) p. Wisconsin Nonresident Employee’s W/H Reciprocity (Form Included) State 2015/2016 Unemployment Insurance Wage Base Chart State 2015/2016 Disability Insurance Wage Base and Tax Rate Chart State Pay Date Requirements Chart State Rules for Final Paycheck Deadline Chart Form W-4 (Form Included) Form 941 (Form Included) Form 940 (Form Included) Form 943 (Form Included) Form 944 (Form Included) Form 945 (Form Included) Form 941-X (Form Included) Quarterly Reconciliation Worksheet (Form Included) Retention Requirements of Payroll Records Page 286 288 290 291 292 294 295 296 297 298 300 301 302 303 304 305 306 307 308 310 311 311 312 315 317 319 323 328 332 335 339 343 345 . I. INDEPENDENT CONTRACTOR OR EMPLOYEE? . Independent Contractor or Employee? The business relationship between the organization and the person performing the services must first be analyzed to determine how payments should be treated. The person performing the services may be classified as a common law employee, statutory employee, statutory non-employee, or an independent contractor. Common-Law Employees Under common-law rules, anyone performing services for an organization is the organization’s employee if the organization can control what will be done and how it will be done. This is so even when the organization gives the employee freedom of action. What matters is that the organization has the right to control the details of how the services are performed.

If there is an employer-employee relationship, it makes no difference how it is labeled. The substance of the relationship, not the label, governs the worker’s status. Nor does it matter whether the individual is employed full-time or part-time.

For employment tax purposes, no distinction is made between classes of employees. Superintendents, managers, and supervisory personnel are all employees. An officer of a corporation is generally an employee. An officer who performs no services or only minor services, and who neither receives nor is entitled to receive any pay, is not considered an employee.

A director of a corporation is not an employee with respect to services performed as a director. Partners are not employees. Statutory Employees: Workers may be treated as employees by statute (“statutory employees”) even if they are independent contractors under the common law rules. If the worker falls within any one of the following four categories and meets the three conditions below, they must be treated as an employee for certain employment tax purposes. 1) A driver who distributes beverages (other than milk) or meat, vegetable, fruit, or bakery products; or who picks up and delivers laundry or dry cleaning, if the driver is the organization’s agent or is paid on commission. 2) A full-time life insurance sales agent whose principal business activity is selling life insurance or annuity contracts, or both, primarily for one life insurance company. 3) An individual who works at home on materials or goods that the organization supplies and that must be returned to the organization or to a person named by the organization, if the organization also furnishes specifications for the work to be done. 4) A full-time traveling or city salesperson who works on the organizations behalf and turns in orders to the organization from wholesalers, retailers, contractors, or operators of hotels, restaurants, or other similar establishments. The goods sold must be merchandise for resale or supplies for use in the buyer’s business operation.

The work performed for the organization must be the salesperson’s principal business activity. Withhold social security and Medicare taxes from the wages of statutory employees if all three of the following conditions apply. 1) The service contract states or implies that substantially all the services are to be performed personally by them. . 2) They do not have a substantial investment in the equipment and property used to perform the services (other than an investment in transportation facilities, such as a car or truck). 3) The services are performed on a continuing basis for the same payer. For FUTA tax, the term “employee” means the same as it does for social security and Medicare taxes, except that it does not include statutory employees in categories 2 and 3 above. Thus any individual who is an employee under category 1 or 4 above is also an employee for FUTA tax purposes and subject to FUTA tax. Federal income tax is not withheld from the wages of statutory employees; however the wages are still reported in Box 1 of Form W-2. Be sure to check “Statutory Employee” in Box 13. Statutory Nonemployees: There are three categories of statutory nonemployees: direct sellers, licensed real estate agents, and certain companion sitters. Direct sellers and licensed real estate agents are treated as self-employed for all federal tax purposes, including income and employment taxes, if: ï‚· Substantially all payments for their services as direct sellers or real estate agents are directly related to sales or other output, rather than to the number of hours worked and ï‚· Their services are performed under a written contract providing that they will not be treated as employees for federal tax purposes. o Direct sellers include persons falling within any of the following three groups: 1) Persons engaged in selling (or soliciting the sale of) consumer products in the home or place of business other than in a permanent retail establishment. 2) Persons engaged in selling (or soliciting the sale of) consumer products to any buyer on a buy-sell basis, a deposit-commission basis, or any similar basis prescribed by regulations, for resale in the home or at a place of business other than in a permanent retail establishment. 3) Persons engaged in the trade or business of delivering or distributing newspapers or shopping news (including any services directly related to such delivery or distribution). Direct selling includes activities of individuals who attempt to increase direct sales activities of their direct sellers and who earn income based on the productivity of their direct sellers. Such activities include providing motivation and encouragement; imparting skills, knowledge, or experience; and recruiting. o Licensed Real Estate Agents include individuals engaged in appraisal activities for real estate sales if they earn income based on sales or other output. o Companion sitters include individuals who furnish personal attendance, companionship, or household care services to children, or individuals who are elderly or disabled.

A person engaged in the trade or business of putting the sitters in touch with individuals who wish to employ them (a companion sitting placement service) will not be treated as the employer of the sitters if that person does not receive or pay the salary or wages of the sitters and is compensated by the sitters or the persons who employ them on a fee basis. Companion sitters . who are not employees of a companion sitting placement service are generally treated as selfemployed for federal tax purposes. Determining who is an employee: The primary method used to determine whether an employee-employer relationship exists is the “common law” test. The central focus of the common law test is determining who has the right to control two basic elements: (1) what must be done – i.e., the results of the work, and (2) how it must be done – i.e., the method by which the work or services are performed. Under this test, a worker is considered an employee subject to payroll tax withholding if the employer has the right to control both the result to be accomplished and the method or means by which the result is achieved. If the employer has the right to control or direct only the result of the work – and not the method or means used to accomplish the result – the individual generally qualifies as an independent contractor. The common law test can be difficult to apply to specific cases or situations.

Proper application of the test requires an employer to consider a number of factors or characteristics of the work in question to determine whether an employer-employee relationship exists. The two primary characteristics that typically indicate that an individual is an employee are: (1) the employer has the right to discharge the worker, and (2) the employer supplies the worker with tools and a place to work. On the other hand, individuals such as lawyers, physicians, and contractors who offer their services to the general public in the pursuit of an independent trade, business, or profession normally are not considered employees. Keep in mind, however, that no one factor or set of factors is automatically controlling.

All the facts and circumstances of a particular situation must be taken into account in determining whether an individual worker should be treated as an employee or as an independent contractor. Factors Used by IRS in Determining Employee Status: The general rule for determining if a worker is an independent contractor is if the organization for which the services are performed, has the right to control or direct only the result of the work and not the means or methods of accomplishing the result. Facts that provide evidence of the degree of control and independence fall into three categories, behavioral control, financial control, and type of relationship. Behavioral Control: May be demonstrated by facts which illustrate that there is a right to direct or control how the worker performs the specific tasks for which he/she is engaged. Types and Degree of Instructions – An individual who must comply with another person’s instructions about when, where, or how to work is generally considered an employee. This applies even if the business simply has the right to require compliance, but does not exercise that right. Types of instructions that will tend to classify a worker as an employee include direction as to which tools or equipment to use, which workers to hire to assist with the work, where to purchase supplies or services, which work must be performed by a specified individual, which routines or patterns must be used, and which order or sequence of work must be followed, as well as a requirement to obtain approval before taking certain actions.

Instructions given in order to be in compliance with governmental agencies or industry governing bodies will be given little weight in determining worker status. More detailed instructions indicate the worker is an employee. Less detailed instruction affirms less control, indicating the workers is more likely to be and independent contractor. .

Evaluation – An evaluation system measuring the details of how work is performed would point to an employee. If the evaluation system measures only the end result, the individual could be either an independent contractor or employee. Training – Periodic or ongoing training provided by a business about procedures to be followed and methods to be used indicates that the business wants the services performed in a particular manner and is evidence of an employer-employee relationship. However, information about the business’ policies or products or about applicable governmental statutes or regulations are not considered training for worker status determination purposes, nor are training programs that are voluntary and for which no compensation is given. Independent contractors ordinarily use their own methods to perform services. Financial Control: May be demonstrated by facts which illustrate that there is a right to direct or control the economic aspects of the worker’s activities.

Whether or not the worker is personally economically dependent on the business has no bearing on this category of evidence, nor does the worker’s general economic status. Significant Investment – An independent contractor often has a significant investment in the facilities or tools used in performing the services for someone else. However; although a significant investment is not necessary for independent contractor status, the rental or purchase of items at fair market value will give a greater weight to the consideration of a worker as an independent contractor. Unreimbursed Expenses – The extent to which a worker chooses to incur expenses and bear their cost impact the worker’s opportunity for profit or loss and lends evidence towards the worker’s status as an independent contractor. Businesses may pay portions of the expenses of an independent contractor, so the focus should be on unreimbursed expenses, especially fixed, ongoing costs that are incurred regardless of whether work is performed.

Examples include rent and utilities, training, advertising, wages of assistants, licensing, insurance, and travel. Minor tool expenses generally do not lend evidence toward an independent contractor status. Services Available to the Relevant Market – Independent contractors often advertise and maintain a visible location in order to be available to work for the relevant market. However, the absence of these activities is a neutral fact, as an independent contractor may rely on word of mouth or may be under a long-term contract. Method of Payment – Employees generally are paid by the hour, day, week, or month, indicating a guaranteed return for labor.

Independent contractors typically are paid a flat fee or on a time and material basis for performance of a task. The frequency under which payments are made is not relevant. However, it is customary in certain types of businesses, such a law or accounting, to pay independent contractors by the hour. Opportunity for Profit or Loss – This is probably the most important type of evidence within the category of financial control, and the other four items (significant investment, unreimbursed expenses, services available, and method of payment) all have an impact on this one.

However, not all four are required in order for there to be an opportunity for profit or loss. Most important in this type of evidence is whether the worker is free to make business decisions affecting his/her own profit or loss. To the extent the worker makes such decisions, more weight will be given toward the status of independent contractor.

Examples include decisions regarding types and quantity of inventory, capital investment, and purchase or lease of premises and equipment. If the . individual has the possibility of incurring a loss, they are an independent contractor. The fact that a worker may receive more money by working longer hours does not enter into consideration. Relationship of the Parties: The relationship of how the worker and business perceive each other in terms of their intent concerning control will be considered by IRS auditors. Intent of Parties/Written Contracts – A written agreement describing the worker as an independent contractor is viewed as evidence of the parties’ intent, but is not, in itself, sufficient evidence for determining worker status. However, the contract may specify items that are relevant, such as methods of compensation, expenses to be reimbursed, or how work will be performed. If it is otherwise impossible for IRS to determine a worker’s status, the intent of the parties may be used to resolve the issue. Employee Benefits – Providing a worker with benefits traditionally associated with employee status will lend weight to the determination of the worker as an employee.

Examples of such benefits include paid vacation or sick pay, health insurance, life insurance, and a pension plan. The determination that a worker is an employee under certain state or federal laws, such as for unemployment benefits or for worker’s compensation coverage, shall have no impact on the IRS consideration. Permanency of the Relationship – Traditionally, the ability to immediately terminate the relationship on the part of either the business or the worker indicates an employee status, and the opposite was the case for an independent contractor. However, this is not universally the case anymore, and this type of evidence is used to a much lesser extent than it used to be, except in the case of a business’ ability to refuse payment for unsatisfactory work by an independent contractor. Employees usually are hired for an indefinite period, rather than for a specific project or period.

This is not to be confused with the potentially long-term (but definite) period of time for which independent contractors are often hired. Occasionally, employees are hired for definite periods of time (long- or short-term). For this reason, a relationship that is indefinite in length may be viewed as evidence of an employee status, but a relationship that is not indefinite is a neutral fact. Regular Business Activity – The fact that an individual’s services are a key aspect of the regular business of the organization may indicate that the individual is subject to a certain amount of control by the organization, which would lend evidence toward an employee status. However, this would need to be investigated.

The fact that the services performed are part of the regular business does not itself lend weight toward determination as an employee. IRS assistance is available by filing a Form SS-8: Employers or workers who have doubts about an individual’s status under the federal employment tax and income tax withholding laws can fill out Form SS-8 and send it to IRS. The agency will use the information provided on the form, along with any information that it can obtain from all parties involved, to determine the status of a worker. Even if it is not mailed to the IRS, it may be beneficial to complete the SS-8 form on the worker in question to help analyze if they are an employee or an independent contractor. IRS Reclassification: Employer Liability: You will generally be liable for social security and Medicare taxes and withheld income tax if you do not deduct and withhold these taxes because you treated an employee as a nonemployee.

You may be able to calculate your liability using special rates in Internal Revenue Code Section 3509 for the employee’s share of social security, Medicare taxes and federal income tax withholding. The applicable rates depend on whether you filed required Forms 1099. You cannot recover the employee share of social security, Medicare tax, or .

income tax withholding from the employee. You are liable for the income tax withholding regardless of whether the employee paid income tax on the wages. You continue to owe the full employer share of social security and Medicare taxes. See Internal Revenue Code section 3509 for details.

Also see the instructions for Form 941-X. Section 3509 rates are not available if you intentionally disregard the requirement to withhold taxes from the employee or if you withheld income taxes but not social security or Medicare taxes. Section 3509 is not available for reclassifying statutory employees and for wages paid to employees in the current year. If the employer issued required information returns, the section 3509(a) rates are: ï‚· For social security taxes; employer rate of 6.2% plus 20% of the employee rate of 6.2%, for a total rate of 7.44% of wages. (see the Instructions for Form 941-X). ï‚· For Medicare taxes; employer rate of 1.45% plus 20% of the employee rate of 1.45%, for a total rate of 1.74% of wages. ï‚· For income tax withholding, the rate is 1.5% of wages. ï‚· The rate is .18% for additional Medicare tax on excess wages over $200,000. If the employer did not issue required information returns, the section 3509(b) rates are: ï‚· For social security taxes; employer rate of 6.2% plus 40% of the employee rate of 6.2%, for a total rate of 8.68% of wages.

(see the Instructions for Form 941-X). ï‚· For Medicare taxes; employer rate of 1.45% plus 40% of the employee rate of 1.45%, for a total rate of 2.03% of wages. ï‚· For income tax withholding, the rate is 3.0% of wages. ï‚· The rate is .36% for additional Medicare tax on excess wages over $200,000. Relief Provisions: Under Section 530, an organization may receive relief from owing employment taxes if they meet the relief requirements. If the organization does not meet the relief requirements, the IRS will need to determine whether the workers are independent contractors or employees and whether the organization owes employment taxes for those workers. To receive the relief, all three of the following requirements must be met: ï‚· Reasonable basis – there was a reasonable basis for not treating the workers as employees. To establish reasonable basis, the following must be shown: o You reasonably relied on a court case about Federal taxes or a ruling issued to you by the IRS; or o Your business was audited by the IRS at a time when you treated similar workers as independent contractors and the IRS did not reclassify those workers as employees.

You may not rely on an audit commenced after December 31, 1996, unless such audit included an examination for employment tax purposes of whether the individual involved (or any other individual holding a substantially similar position) should be treated as your employee; or o You treated the workers as independent contractors because you knew that was how a significant segment of your industry treated similar workers; or o You relied on some other reasonable basis. For example, you relied on the advice of a . business lawyer or accountant who knew the facts about your business. If you did not have a reasonable basis for treating the workers as independent contractors, you do not meet the relief requirements. ï‚· Substantive Consistency – In addition, you (and any predecessor business) must have treated the workers, and any similar workers, as independent contractors. If you treated similar workers as employees, this relief provision is not available. If you are paying an individual who is providing services as a test proctor or room supervisor assisting in the administration of college entrance or placements examinations, the substantive consistency requirement does not apply with respect to services performed after December 31, 2006, (and remuneration paid with respect to such services). The provision applies if the individual (1) is performing the services for a tax-exempt organization, and (2) is not otherwise treated as an employee of such organization for purposes of employment taxes. ï‚· Reporting Consistency – Finally, you must have filed all required federal tax returns (including information returns) consistent with your treatment of each worker as not being employees. This means, for example, that if you treated a worker as an independent contractor and paid him or her $600 or more, you must have filed Form 1099-MISC for the worker.

Relief is not available for any year and for any workers for whom you did not file the required information returns. Examples: 1. Kathy works for ABC, Inc. as a secretary from 8:00 to 5:00, Monday thru Friday. She learns that the company that was cleaning their offices has quit.

Kathy offers to clean the offices after working hours. The office manager agrees and shows Kathy where the vacuum and cleaning supplies are kept and instructs her to start cleaning at 7:00 pm and to be finished by 9:00 pm each evening. The manager also tells her that the nightly security guard will be checking on her periodically to make sure that she is there doing her work. Since Kathy has been given specific instructions on how to do the work, the hours in which to do it, will be supervised, and is provided with the necessary tools, she is an employee for payroll tax purposes.

Since she is also working 40 hours per week, she must also be paid overtime for her after hours work. 2. Bill also works for ABC, Inc as a shop foreman. Bill has his own cleaning service and cleans for several office buildings in the area. He discusses his services with the office manager and explains he has a cleaning crew.

He will bring his crew sometime between 7:00 pm and 6:00 am with their cleaning tools and supplies with them. The office manager agrees to the arrangement. Since Bill has an opportunity for profit or loss, a significant investment in supplies and labor, services are available to the market, and is not supervised or managed, he is an independent contractor. . Form SS-8 (Rev. May 2014) Department of the Treasury Internal Revenue Service OMB. No. 1545-0004 Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding For IRS Use Only: Case Number: Earliest Receipt Date: Information about Form SS-8 and its separate instructions is at www.irs.gov/formss8. Name of firm (or person) for whom the worker performed services Worker’s name Firm’s mailing address (include street address, apt.

or suite no., city, state, and ZIP code) Worker’s mailing address (include street address, apt. or suite no., city, state, and ZIP code) Trade name Firm's email address Worker's daytime telephone number Worker's email address Firm's fax number Firm's website Worker's alternate telephone number Worker's fax number Firm's telephone number (include area code) Firm’s employer identification number Worker’s social security number Worker’s employer identification number (if any) Note. If the worker is paid for these services by a firm other than the one listed on this form, enter the name, address, and employer identification number of the payer. Disclosure of Information The information provided on Form SS-8 may be disclosed to the firm, worker, or payer named above to assist the IRS in the determination process. For example, if you are a worker, we may disclose the information you provide on Form SS-8 to the firm or payer named above.

The information can only be disclosed to assist with the determination process. If you provide incomplete information, we may not be able to process your request. See Privacy Act and Paperwork Reduction Act Notice in the separate instructions for more information.

If you do not want this information disclosed to other parties, do not file Form SS-8. Click here to use the form. Parts I–V. All filers of Form SS-8 must complete all questions in Parts I–IV. Part V must be completed if the worker provides a service directly to customers or is a salesperson.

If you cannot answer a question, enter “Unknown” or “Does not apply.” If you need more space for a question, attach another sheet with the part and question number clearly identified. Write your firm's name (or worker's name) and employer identification number (or social security number) at the top of each additional sheet attached to this form. Part I 1 General Information This form is being completed by: Firm Worker; for services performed to (beginning date) . (ending date) 2 Explain your reason(s) for filing this form (for example, you received a bill from the IRS, you believe you erroneously received a Form 1099 or Form W-2, you are unable to get workers' compensation benefits, or you were audited or are being audited by the IRS). 3 4 Total number of workers who performed or are performing the same or similar services: Application Bid Employment Agency How did the worker obtain the job? 5 Attach copies of all supporting documentation (for example, contracts, invoices, memos, Forms W-2 or Forms 1099-MISC issued or received, IRS closing agreements or IRS rulings). In addition, please inform us of any current or past litigation concerning the worker’s status.

If no income reporting forms . (Form 1099-MISC or W-2) were furnished to the worker, enter the amount of income earned for the year(s) at issue $ . Other (specify) If both Form W-2 and Form 1099-MISC were issued or received, explain why. 6 Describe the firm’s business. For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 16106T Form SS-8 (Rev.

5-2014) . Page 2 Form SS-8 (Rev. 5-2014) Part I 7 General Information (continued) If the worker received pay from more than one entity because of an event such as the sale, merger, acquisition, or reorganization of the firm for whom the services are performed, provide the following: Name of the firm's previous owner: Previous owner's taxpayer identification number: Other (specify) Description of above change: Change was a: 8 Merger Acquisition Reorganization Date of change (MM/DD/YY): Describe the work done by the worker and provide the worker’s job title. 9 Sale Explain why you believe the worker is an employee or an independent contractor. 10 Did the worker perform services for the firm in any capacity before providing the services that are the subject of this determination request? Yes No N/A If “Yes,” what were the dates of the prior service? If “Yes,” explain the differences, if any, between the current and prior service. 11 If the work is done under a written agreement between the firm and the worker, attach a copy (preferably signed by both parties). Describe the terms and conditions of the work arrangement. Part II Click here to use the form. Behavioral Control (Provide names and titles of specific individuals, if applicable.) 1 What specific training and/or instruction is the worker given by the firm? 2 How does the worker receive work assignments? 3 Who determines the methods by which the assignments are performed? 4 Who is the worker required to contact if problems or complaints arise and who is responsible for their resolution? 5 What types of reports are required from the worker? Attach examples. 6 Describe the worker’s daily routine such as his or her schedule or hours. 7 At what location(s) does the worker perform services (for example, firm’s premises, own shop or office, home, customer’s location)? Indicate the appropriate percentage of time the worker spends in each location, if more than one. 8 Describe any meetings the worker is required to attend and any penalties for not attending (for example, sales meetings, monthly meetings, staff meetings). 9 10 11 Is the worker required to provide the services personally? . .

. If substitutes or helpers are needed, who hires them? If the worker hires the substitutes or helpers, is approval required? If “Yes,” by whom? . . . . . . . . . . . . . . . . Yes No . . . . . . . . . . . . . . . . Yes No 12 13 Who pays the substitutes or helpers? Is the worker reimbursed if the worker pays the substitutes or helpers? . If “Yes,” by whom? . . . . . . . . . . . . . . Yes No Form SS-8 (Rev. 5-2014) . Page 3 Form SS-8 (Rev. 5-2014) Part III 1 Financial Control (Provide names and titles of specific individuals, if applicable.) List the supplies, equipment, materials, and property provided by each party: The firm: The worker: 2 Other party: Does the worker lease equipment, space, or a facility? . . . . . . . . . . . . . . . . . . . . Yes No If “Yes,” what are the terms of the lease? (Attach a copy or explanatory statement.) 3 What expenses are incurred by the worker in the performance of services for the firm? 4 Specify which, if any, expenses are reimbursed by: The firm: Other party: 5 Type of pay the worker receives: Salary Commission Hourly Wage Lump Sum Other (specify) If type of pay is commission, and the firm guarantees a minimum amount of pay, specify amount. $ 6 Is the worker allowed a drawing account for advances? If “Yes,” how often? Specify any restrictions. . . . . . . . . 7 Whom does the customer pay? . .

. . .

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. If worker, does the worker pay the total amount to the firm? . . . . Yes . . Firm . .

. No If “No,” explain. 8 9 Does the firm carry workers' compensation insurance on the worker? . . .

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. . . Yes No What economic loss or financial risk, if any, can the worker incur beyond the normal loss of salary (for example, loss or damage of equipment, material)? 10 . . . . . . . . . Yes . No Worker Click here to use the form. Does the worker establish the level of payment for the services provided or the products sold? . If “No,” who does? Part IV 1 . Piece Work . . . . . . . Yes No Relationship of the Worker and Firm Please check the benefits available to the worker: Paid vacations Pensions Personal days Other (specify) Sick pay Paid holidays Bonuses Insurance benefits 2 Can the relationship be terminated by either party without incurring liability or penalty? If “No,” explain your answer. 3 Did the worker perform similar services for others during the time period entered in Part I, line 1? .

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. . . Yes No Yes No If “Yes,” is the worker required to get approval from the firm? .

. . .

. . .

. . .

. . .

. . .

. . Describe any agreements prohibiting competition between the worker and the firm while the worker is performing services or during any later period. Attach any available documentation. 4 . . . . . . . . . . Yes 5 6 Is the worker a member of a union? .

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. . . Yes What type of advertising, if any, does the worker do (for example, a business listing in a directory or business cards)? Provide copies, if applicable. 7 If the worker assembles or processes a product at home, who provides the materials and instructions or pattern? 8 What does the worker do with the finished product (for example, return it to the firm, provide it to another party, or sell it)? 9 No How does the firm represent the worker to its customers (for example, employee, partner, representative, or contractor), and under whose business name does the worker perform these services? 10 No If the worker no longer performs services for the firm, how did the relationship end (for example, worker quit or was fired, job completed, contract ended, firm or worker went out of business)? Form SS-8 (Rev.

5-2014) . Page 4 Form SS-8 (Rev. 5-2014) Part V For Service Providers or Salespersons. Complete this part if the worker provided a service directly to customers or is a salesperson. 1 What are the worker’s responsibilities in soliciting new customers? 2 3 Who provides the worker with leads to prospective customers? Describe any reporting requirements pertaining to the leads. 4 5 What terms and conditions of sale, if any, are required by the firm? Are orders submitted to and subject to approval by the firm? . . . . . . . . . . . . Yes No 6 Who determines the worker’s territory? 7 Did the worker pay for the privilege of serving customers on the route or in the territory? . . . . . . . . . . Yes No If “Yes,” whom did the worker pay? If “Yes,” how much did the worker pay? . . . . . .

$ . . . . . . . . . . . . . . . . . . . . . 8 Where does the worker sell the product (for example, in a home, retail establishment)? 9 List the product and/or services distributed by the worker (for example, meat, vegetables, fruit, bakery products, beverages, or laundry or dry cleaning services). If more than one type of product and/or service is distributed, specify the principal one. 10 11 Does the worker sell life insurance full time? . .

. . . Does the worker sell other types of insurance for the firm? . 12 If “Yes,” enter the percentage of the worker’s total working time spent in selling other types of insurance .

. . .

. If the worker solicits orders from wholesalers, retailers, contractors, or operators of hotels, restaurants, or other similar establishments, enter the percentage of the worker’s time spent in the solicitation . . .

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. . . 13 . . . . . . . . . . . . . . . . . . . . . . . . Is the merchandise purchased by the customers for resale or use in their business operations? .

. Describe the merchandise and state whether it is equipment installed on the customers’ premises. . . . . . . . . . . . . . . . . . . Yes No Yes No % Yes No % Click here to use the form. Sign Here Under penalties of perjury, I declare that I have examined this request, including accompanying documents, and to the best of my knowledge and belief, the facts presented are true, correct, and complete. Title Date Type or print name below signature. Form SS-8 (Rev. 5-2014) . II. 1099 INFORMATION RETURNS . FORM 1099 SERIES: GENERAL FILING REQUIREMENTS General Requirements Employers that make certain payments to nonemployees during a calendar year must furnish annual information returns both to the IRS and to the nonemployee recipient of the payment. The filing of these returns helps the IRS determine whether the nonemployee is reporting all income received during the year. In order to facilitate the reporting of these payments, IRS has developed the Form 1099 Series, which is a group of forms used to report ordinary kinds of payments made by an employer, such as dividends, interest, retirement distributions, and miscellaneous income payments. Although each Form 1099 has its own specific reporting requirements, there are several filing requirements that apply uniformly to each of these forms. Certain foreign financial institutions (FFI) or U.S. payors having a FATCA filing requirement under chapter 4 may satisfy their requirements by reporting on Forms 1099 under the election described in Regs 1.1471-4(d)(5)(i)(A) or (B).

Specific check boxes are included on the 1099 forms to identify an FFI filing this form to satisfy the chapter 4 requirement. Normal and Extended Due Dates Form 1099 must be furnished to recipients either in person or by first-class mail by January 31st of the year following the calendar year to which such forms relate. These forms also must be filed with the IRS on or before February 29th of the following year, or by March 31st if filing electronically. If the due date for filing a Form 1099 with a recipient or with the IRS falls on a Saturday, Sunday, or legal holiday, the form is deemed timely if it is filed the next succeeding business day. The due date for furnishing statements to recipients for Forms 1099-B, 1099-S, and 1099-MISC (if reporting amounts in boxes 8 or 14) has been extended to February 16. Employers can request an automatic 30-day extension of time for filing by completing Form 8809 "Application for Extension of Time to File Information Returns." The form may be submitted on paper, or through the FIRE system either as a fill-in form or an electronic file. No signature or explanation is required for the extension.

However, you must file Form 8809 by the due date of the returns in order to get the 30-day extension. Under certain hardship conditions you may apply for an additional 30-day extension. See the instructions for Form 8809 for more information. How to File Form 1099 with the IRS Forms 1099 filed by paper with the IRS must be accompanied by transmittal Form 1096, "Annual Summary and Transmittal of U.S.

Information Returns." Employers must use a separate Form 1096 for each type of return. Because paper forms are scanned, all Forms 1096 and Copies A must be prepared in accordance with IRS instructions and mailed to the applicable service center. To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or order online, and scannable forms will be mailed to you. State and Local Tax Departments Contact the applicable state and local tax department as necessary for reporting requirements and where to file Copy 1 (Forms 1099-MISC and 1099-R). Generally, the state or local tax department you need to contact will be located in the recipient’s state of legal residence. .

Substitute Statement to Recipients Substitute Forms 1099 (generally Copy B) can be used, provided they comply with format and content requirements as specified in Pub. 1179, which is revised annually. All substitute statements to recipients must contain the tax year, form number, and form name prominently displayed together in one area of the statement. Backup Withholding In some situations backup withholding may be required at a 28% rate for interest payments, dividends, rents, royalties, commissions, nonemployee compensation, and certain other payments. If the payment is one of these reportable payments, backup withholding will apply if: ï‚· ï‚· ï‚· ï‚· ï‚· The payee fails to furnish his or her taxpayer identification number. For interest, dividend, and broker and barter exchange accounts opened or instruments acquired after 1983, the payee fails to certify, under penalties of perjury, that the TIN provided is correct. The IRS notifies the payer to impose backup withholding because the payee furnished an incorrect TIN. For interest and dividend accounts or instruments, the payer is notified that the payee is subject to backup withholding (under section 3406(a)(1)(C), or For interest and dividend accounts opened or instruments acquired after 1983, the payee fails to certify to the payer, under penalties of perjury, that he or she is not subject to backup withholding. Examples of payments to which backup withholding does not apply include but are not limited to: ï‚· Wages. ï‚· Distributions from a pension, annuity, profit-sharing or stock bonus plan, any IRA, an owneremployee plan, or other deferred compensation plan. ï‚· Distributions from a medical or health savings account and long-term care benefits. ï‚· Certain surrenders of life insurance contracts. ï‚· Distribution from qualified tuition programs or Coverdell ESAs. ï‚· Gambling winnings if regular gambling winnings withholding is required under section 3402(q). However, if regular gambling winnings withholding is not required under section 3402(q), backup withholding applies if the payee fails to furnish a TIN. ï‚· Real estate transactions reportable under section 6045(e). ï‚· Cancelled debts reportable under section 6050P. ï‚· Fish purchases for cash reportable under section 6050R. Generally, the period for which the 28% should be withheld is as follows: ï‚· Withhold on payments made until the TIN is furnished in the manner required.

Special backup withholding rules may apply if the payee has applied for a TIN. The payee may certify this on Form W-9 by noting “Applied For” in the TIN block and by signing the form. This form then becomes an “awaiting-TIN” certificate, and the payee has 60 days to obtain a TIN and furnish it to you.

If no TIN is received from the payee within 60 days, begin backup withholding and continue until the TIN is provided. The 60-day exemption from backup withholding applies only to interest and dividend payments and certain payments made with respect to readily tradable instruments. Therefore, any other payment, such as nonemployee compensation, is subject to backup withholding even if the payee has applied for and is awaiting a TIN. .

ï‚· If a notice is received from the IRS that the payee’s TIN is incorrect, you may choose to withhold on any reportable payment made to the account(s) subject to backup withholding after receipt of the notice but you must begin backup withholding with any reportable payment made to the account more than 30 business days after the notice is received. Stop withholding within 30 days after you receive a certified Form W-9 (or other form that requires the payee to certify under penalty of perjury). The IRS will furnish a notice to the payer and the payer is required to promptly furnish a “B” notice or an acceptable substitute to the payee. ï‚· If an IRS notice is received that states that the payee is subject to backup withholding due to notified payee underreporting, you may choose to withhold on any reportable payment made to the account(s) subject to withholding after receipt of the notice, but you must withhold on any reportable payment made to the account more than 30 business days after you receive the notice. The payer must notify the payee when this procedure starts. The IRS will notify the payer in writing when the withholding can stop, or the payee may furnish a written certification from the IRS stating when the withholding will stop.

In most cases, the stop date will be January 1 of the year following the year of the notice. Report backup withholding on Form 945, Annual Return of Withheld Federal Income Tax. Also, report backup withholding and the amount of the payment on Forms W-2G, 1099-B, DIV, G, INT, MISC, OID, or PATR even if the amount of the payment is less than the amount for which an information return is normally required. Payments of withheld taxes must be deposited using EFTPS. Taxpayer Identification Number (TIN) Matching TIN Matching allows a payer to match TIN and name combinations with IRS records before submitting the forms to the IRS.

TIN Matching is one of the e-services products that is offered and is accessible through the IRS website. See Publication 2108-A, On-Line Taxpayer Identification (TIN) Matching Program, or go to the IRS.gov and enter keyword “TIN matching” in the upper right corner. Truncating Payee Identification Number Final regulations (REG-148873-09) permit filers of information returns in the Form 1098 series, Form 1099 series, and Form 5498 series to truncate an individual payee’s SSN, ITIN, or ATIN number on paper payee statements for the tax year 2015. Filers may truncate a payee’s identification number on the payee statement (including substitute and composite substitute statements) furnished to the payee in paper form or electronically.

Generally, the payee statement is that copy of an information return designated “Copy B” on the form. For some forms, the term “payee” will refer to beneficiary, borrower, debtor, insured, participant, payer, policyholder, recipient, shareholder, student, or transferor. If a filer truncates an identification number on Copy B, other copies of the form furnished to the payee may also include a truncated number. A filer may not truncate a payee’s identification number on any forms filed with the IRS or with state or local governments, on any payee statement furnished electronically, or on any payee statement not in the Form 1098, Form 1099, or Form 5498 series.

A filer’s identification number may not be truncated. A payee’s EIN may not be truncated. To truncate, replace the first 5 digits of the 9-digit number with asterisk (*) or Xs (for example, an SSN 123-45-6789 would appear on the paper payee statement as ***-**-6789 or XXX-XX-6789). . Electronic Filing If the payer files 250 or more returns of any individual Form 1099 type, it must file these returns electronically. The 250-or-more requirement applies separately to each type of form. For example, if you must file 500 Forms 1098 and 100 Forms 1099-A, you must file Forms 1098 electronically, but you are not required to file Forms 1099-A electronically. To receive a waiver from the required filing of information returns electronically, submit Form 8508, Request for Waiver From Filing Information Returns Electronically, at least 45 days before the due date of the returns.

You cannot apply for a waiver for more than 1 tax year at a time. If a waiver for original returns is approved, any corrections for the same types of returns will be covered under the waiver. 1099s may be filed electronically through the Filing Information Returns Electronically System (FIRE System); however you must have the software that can produce a file in the proper format according to Pub 1220.

The FIRE system does not provide a fill-in form option for information return reporting. You can access the FIRE system via the internet at http://FIRE.IRS.gov. Penalties for Noncompliance The penalties which can be imposed for failing to comply with the reporting and filing requirements associated with the Form 1099 Series, such as failing to file timely or electronically when required, failing to include all information required, or incorrect information included on the return has increased substantially. The amount of the penalty is based on when the correct information return is filed: ï‚· $30 per information return if correctly filed within 30 days; maximum penalty $250,000 per year ($75,000 for small businesses) ï‚· $60 per information return if correctly filed more than 30 days after the due date but by August 1st; maximum penalty $500,000 per year ($200,000 for small businesses) ï‚· $100 per information return if filed after August 1st or not filed at all; maximum penalty $1,500,000 per year ($500,000 for small businesses) A small business is defined as having average annual gross receipts for the three most recent tax years (or for the period of existence, if shorter) ending before the calendar year in which the information returns were due of $5 million or less. The following are exceptions to the failure to file penalty: ï‚· The penalty will not apply to any failure that was due to reasonable cause and not to willful neglect.

In general, one must be able to show that the failure was due to an event beyond control or due to significant mitigating factors. It must also be shown that the company acted in a responsible manner and steps were taken to avoid the failure. ï‚· An inconsequential error or omission is not considered a failure to include incorrect information. An inconsequential error or omission does not prevent or hinder the IRS from processing the return, from correlating the information required to be shown on the return with the information shown on the payee’s tax return, or from otherwise putting the return to its intended use. Errors and omissions that are never inconsequential are those related to (a) a TIN, (b) a payee’s surname, and (c) any money amount. .

ï‚· De minimus rule for corrections. If reasonable cause cannot be shown, the penalty for failure to file correct information returns will not apply to a certain number of returns if: a. The information returns were filed. b. Either all the information was not included or the incorrect information was included. c.

The corrections were filed by August 1st. If all of the conditions in a, b, and c above are met, the penalty for filing incorrect returns (but not for filing late) will not apply to the greater of 10 information returns or ½ of 1% of the total number of information returns that are required to file for the calendar year. Failure to provide correct payee/recipient statements by January 31 or February 16 (as required) without reasonable cause is subject to the same penalty provisions as those for late or failure to file noted earlier. Any failure to file or provide a correct information return that is due to intentional disregard of the filing or correct information requirements is penalized at a minimum of $250 per information return with no maximum penalty. Keeping Copies Generally, keep copies of information returns filed with the IRS or have the ability to reconstruct the data for at least 3 years, 4 years for Form 1099-C, from the due date of the returns. Keep copies of information returns 4 years if backup withholding was imposed. Special reporting requirements apply in many cases, the complete instructions for the proper completion and reporting of the following Forms 1099 can be found at www.irs.gov under the Forms and Publications tab. FORM 1096 - ANNUAL SUMMARY AND TRANSMITTAL Information return filers use Form 1096 to transmit paper Forms 1099, 1098, 3921, 3922, 5498, and W2G - to the IRS. Do not use the paper Form 1096 to transmit electronically.

For electronic submissions, see Pub. 1220, “Specifications for Filing Forms 1098, 1099, 3921, 3922, 5498, and W-2G Electronically”. When transmitting information returns to IRS, filers should use a separate Form 1096 for different groups of information returns - e.g., a separate 1096 for a group of Form 1099-MISC and another 1096 for a group of Form 1099-R. Form 1096 generally must be filed by the last day of February when used to transmit Forms 1098, 1099, 3921, 3922, and W-2G.

When used to transmit a Form 5498, 5498-ESA or 5498-SA the Form 1096 generally is due by May 31. . Do Not Staple Form 6969 1096 OMB No. 1545-0108 Annual Summary and Transmittal of U.S. Information Returns Department of the Treasury Internal Revenue Service 2013 FILER'S name Street address (including room or suite number) City or town, province or state, country, and ZIP or foreign postal code For Official Use Only Name of person to contact Telephone number Email address Fax number 1 Employer identification number 2 Social security number 3 Total number of forms 4 Federal income tax withheld 5 Total amount reported with this Form 1096 $ 6 Enter an “X” in only one box below to indicate the type of form being filed. W-2G 32 1097-BTC 50 1098 81 1098-C 78 1098-E 84 1098-T 83 1099-A 80 1099-B 79 1099PATR 97 1099-Q 31 1099-R 98 1099-S 75 1099-SA 94 3921 25 3922 26 5498 28 $ 7 If this is your final return, enter an “X” here 1099-C 1099-CAP 1099-DIV 85 73 91 1099-G 86 1099-H 71 1099-INT 92 . . 1099-K 1099-LTC 10 93 . . 1099MISC 95 . 1099-OID 96 5498-ESA 5498-SA 72 27 Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete. Signature Instructions Future developments.

For the latest information about developments related to Form 1096, such as legislation enacted after they were published, go to www.irs.gov/form1096. Reminder. The only acceptable method of filing information returns with Internal Revenue Service/Information Returns Branch is electronically through the FIRE system. See Pub.

1220, Specifications for Filing Forms 1097, 1098, 1099, 3921, 3922, 5498, 8935, and W-2G Electronically. Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the Internal Revenue Service. Do not use Form 1096 to transmit electronically. For electronic submissions, see Pub.

1220. Caution. If you are required to file 250 or more information returns of any one type, you must file electronically. If you are required to file electronically but fail to do so, and you do not have an approved waiver, you may be subject to a penalty.

For more information, see part F in the 2013 General Instructions for Certain Information Returns. Who must file. The name, address, and TIN of the filer on this form must be the same as those you enter in the upper left area of Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. A filer is any person or entity who files any of the forms shown in line 6 above. Enter the filer’s name, address (including room, suite, or other unit number), and TIN in the spaces provided on the form. Title Date When to file.

File Form 1096 as follows. • With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February 28, 2014. • With Forms 5498, file by June 2, 2014. Where To File Send all information returns filed on paper with Form 1096 to the following: If your principal business, office Use the following or agency, or legal residence in three-line address the case of an individual, is located in Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia, West Virginia For more information and the Privacy Act and Paperwork Reduction Act Notice, see the 2013 General Instructions for Certain Information Returns. Department of the Treasury Internal Revenue Service Center Austin, TX 73301 Cat. No. 14400O Form 1096 (2013) .

FORM 1099-MISC Form 1099-MISC, “Miscellaneous Income," must be filed by a business for certain payments made to nonemployees in the course of trade or business. Personal payments are not reportable. A trade or business is any entity that operates for gain or profit. However, non-profit organizations are also subject to these reporting requirements.

Organizations also subject to these reporting requirements include trusts of qualified pension or profit-sharing plans of employers, certain organizations exempt from tax under section 501(c) or (d), farmers’ cooperatives that are exempt from tax under section 521, and widely held fixed investment trusts. Payments made by federal, state, or local governments are also reportable. Form 1099-Misc is required for each person to whom payments have been made during the year: ï‚· $10 or more in royalties or broker payments in lieu of dividends or tax–exempt interest; ï‚· $600 or more in rents, services (including parts and materials), prizes and awards, other income payments, medical and health care payments, crop insurance proceeds, cash payments for fish you purchase from anyone engaged in the trade or business of catching fish, or generally, the cash paid from notional principal contract to an individual, partnership, or estate; ï‚· Any fish boat proceeds; ï‚· Gross proceeds to an attorney; ï‚· In addition, use Form 1099-Misc to report direct sales of at least $5000 of consumer products to a buyer for resale anywhere other than a permanent retail establishment; or ï‚· Any backup withholding regardless of the amount of payment. Examples of payments for which Forms 1099 are not required: ï‚· Generally payments to a corporation;* ï‚· Payments for merchandise, telegrams, telephone, freight, storage and similar items; ï‚· Payments of rent to real estate agents; ï‚· Wages paid to employees (report on Form W-2); ï‚· Military differential wage payments made to employees while they are on active duty in the Armed forces or other uniformed services (report on W-2); ï‚· Business travel allowances paid to employee (may be reportable on W-2); ï‚· Cost of current life insurance protection (report on Form W-2 or Form 1099-R, Distributions from Pensions, Annuities, Retirement, or Profit-Sharing plans, IRAs, Insurance Contracts, etc.); ï‚· Payments to a tax-exempt organization including tax-exempt trusts (IRAs, HSAs, Archer MSAs, and Coverdell ESAs), the United States, a state, the District of Columbia, a U.S. possession, or a foreign government; and ï‚· Payments made to or for homeowners from the HFA Hardest Hit Fund or the Emergency Homeowners’ Loan Program or similar state program. ï‚· Payments made with a credit card or payment card and certain other types of payments, including third party network transactions, must be reported on Form 1099-K by the payment settlement entity under section 6050W and are not subject to reporting on Form 1099-Misc. ï‚· A payment to an informer as an award, fee, or reward for information about criminal activity is not required to be reported if the payment is made by a federal, state, or local government agency, or by a nonprofit organization exempt from tax under section 501(c)(3) that makes the payment to further the charitable purpose of lessening the burdens of government. ï‚· Do not use Form 1099-MISC to report scholarship or fellowship grants.

Scholarship or fellowship grants that are taxable to the recipient because they are paid for teaching, research, or other services as a condition for receiving the grant are considered wages and must be reported on Form W-2. Other taxable scholarships or fellowship payments (to a degree or nondegree candidate) are not required to be reported to the IRS on any form. . ï‚· ï‚· Difficulty-of-care payments that are excludable from the recipient’s gross income are not required to be reported. Difficulty-of-care payments to foster care providers are not reportable if paid for not more than 11 children under age 19 and not more than six individuals age 19 or older. Amounts paid for more than 10 children or more than five other individuals are reportable on Form 1099-MISC. A canceled debt is not reportable on Form 1099-MISC. Canceled debts are required to be reported on Form 1099-C. *Reportable payments to corporations include medical and health payments reported in box 6, fish purchases for cash reported in box 7, attorneys’ fees reported in box 7, gross proceeds paid to an attorney reported in box 14, substitute payments in lieu of dividends or tax exempt interest reported in box 8, and payments by a federal executive agency for services reported in box 7. Rents-Box 1 Form 1099-MISC must be filed for each person to whom a taxpayer has paid at least $600 in rents. For these purposes, rents include real estate rentals paid for office space (unless paid to a real estate agent) and machine rentals (for example, renting a bulldozer to level your parking lot), and pasture rentals.

Note that if a rental fee for a machine is included in a contract that covers both the use of the machine and the operator, the contract fee rental should be prorated between the rent of the machine, reporting in box 1 and the operator's charge (reported as nonemployee compensation) in box 7. Public housing agencies must report in box 1 rental assistance payments made to owners of housing projects. See Rev. Rul.

88-53, 1988-1 C.B. 384. Coin-operated amusements: If an arrangement between an owner of coin-operated amusements and an owner of a business establishment where the amusements are placed is a lease of the amusements or the amusement space, the owner of the amusements or the owner of the space, whoever makes the payments, must report the lease payments in box 1 of Form 1099-MISC if the payments total at least $600. However, if the arrangement is a joint venture, the joint venture must file a Form 1065, U.S. Return or Partnership Income, and provide each partner with the information necessary to report the partner’s share of the taxable income.

Coin-operated amusements include video games, pinball machines, jukeboxes, pool tables, slot machines, and other machines and gaming devices operated by coins or tokens inserted into the machines by individual users. For more information, see Rev. Rul.

92-49, 1992-1 C.B. 433. Royalties-Box 2 If a taxpayer made royalty payments during the calendar year of at least $10 or more before reduction for severance and other taxes that may have been withheld and paid, it must file Form 1099-MISC. Royalty payments that must be reported include royalty payments for oil, gas, coal, timber, sand, gravel and other mineral interests.

Also include payments for intangible property such as patents, copyrights, trade names, trademarks, franchises, books and other literary compositions, musical compositions, artistic works, secret processes and formulas. Report gross royalties (before reduction for fees, commissions, or expenses) paid by a publisher directly to an author or literary agent in box 2 unless the agent is a corporation. The literary agent (whether or not a corporation) that received the royalty payment on behalf of the author must report the gross amount of royalty payments to the author on Form 1099-MISC whether or not the publisher reported the payment to the agent on its Form 1099-MISC. Payments for surface royalties should be reported in box 1. Oil or gas payments for a working interest should be reported in box 7.

Do not report timber royalties made under a pay-as-cut contract; report these timber royalties on Form 1099-S, Proceeds From Real Estate Transactions. . Other Income-Box 3 Enter other income of $600 or more to be reported on Form 1099-MISC that is not reportable in one of the other boxes on the form. Prizes and awards of $600 or more that are not for services rendered are reported on Form 1099-MISC box 3. Include the FMV (fair market value) of merchandise won on game shows. Also include amounts paid to a winner of a sweepstakes not involving a wager.

If a wager is made, report the winnings on Form W-2G, Certain Gambling Winnings. Prizes and awards granted in recognition of past accomplishments in religious, charitable, scientific, artistic, educational, literary, or civic fields are not reported on Form 1099-MISC if: (1) the winners are chosen without action on their part, and (2) the winners are not expected to perform future services, and (3) the payer transfers the prize or award to a charitable organization or governmental unit pursuant to a designation made by the recipient. Do not include prizes and awards paid to your employees. Report these on Form W-2.

Prizes and awards for services performed by nonemployees, such as an award for the top commission salesperson should be reported in box 7. Other items required to be reported in box 3 include the following: ï‚· Generally, all punitive damages, any damages for nonphysical injuries or sickness, and any other taxable damages. Report punitive damages even if they relate to physical injury or physical sickness. Generally, report all compensatory damages for nonphysical injuries or sickness, such as employment discrimination or defamation.

However, do not report damages (other than punitive damages): o Received on account of personal physical injuries or physical sickness; o That do not exceed the amount paid for medical care for emotional distress; o Received on account of nonphysical injuries (for example, emotional distress) under a written binding agreement, court decree, or mediation award in effect on or issued by September 13, 1995; or o That are for replacement of capital, such as damages paid to a buyer by a contractor who failed to complete construction of a building. Damages received on account of emotional distress, including physical symptoms such as insomnia, headaches, and stomach disorders, are not considered received for a physical injury or physical sickness and are reportable unless described above. However, damages received on account of emotional distress due to physical injuries or physical sickness are not reportable. ï‚· ï‚· Payments for deceased employee wages. (See W-2 section) Termination payments to former self-employed insurance salespeople.

These payments are not subject to self-employment tax and are reportable in box 3 (rather than box 7) if all the following apply: o The payments are received from an insurance company because of services performed as an insurance salesperson for the company. o The payments are received after termination of the salesperson’s agreement to perform services for the company. o The salesperson did not perform any services for the company after termination and before the end of the year. o The salesperson enters into a covenant not to compete against the company for at least 1 year after the date of termination. o The amount of the payments depends primarily on policies sold by the salesperson or credited to the salesperson’s account during the last year of the service agreement or to the extent those policies remain in force for some period after termination, or both. o The amount of the payments does not depend at all on length of service or overall earnings from the company (regardless of whether eligibility for payment depends on length of service). . ï‚· ï‚· If the termination payments do not meet all these requirements, report them in box 7. A payment or series of payments made to individuals for participating in a medical research study or studies. Payments for H-2A visa agricultural workers who did not give you a valid taxpayer identification number. You must also withhold federal income tax under the backup withholding rules Federal Income Tax-Box 4 Withholding for federal income taxes ordinarily is not required for payments to independent contractors. However, if at least $600 of "reportable payments" is made within a calendar year to an independent contractor or other nonemployee, and that individual fails to provide a correct taxpayer identification number before payment is made, the payer is required to withhold federal income taxes under the backup withholding rules. A flat 28 % of the payment must be withheld. Payers that withhold federal income taxes on miscellaneous income under the backup withholding rules must file Form 1099-MISC to report such amounts.

Backup withholding must be paid by EFTPS. Fishing Boat Proceeds- Box 5 Enter the individual’s share of all proceeds from the sale of catch or the FMV of a distribution in kind to each crew member of fishing boats with normally fewer than 10 crew members, or payments of up to $100 per trip that are contingent on a minimum catch and are paid solely for additional duties. Medical and Health Care Payments-Box 6 Enter payments of $600 or more made in the course of your trade or business to each physician or other supplier or provider of medical or health care services in box 6. Include payments made by medical or health care insurers under health, accident, and sickness insurance programs. If payment is made to a corporation, list the corporation as the recipient rather than the individual providing the services. Payments to persons providing health care services often include charges for injections, drugs, dentures, and similar items.

In these cases the entire payment is subject to information reporting. Payments to pharmacies for prescription drugs are not required to be reported. The exemption from issuing Form 1099-MISC to a corporation does not apply to payments for medical or health care services provided by corporations, including professional corporations. However, it is not required to report payments made to a tax-exempt hospital or extended care facility or to a United States (or its possessions), a state, the District of Columbia, or any of their political subdivisions, agencies, or instrumentalities. Generally, payments made under a flexible spending arrangement or a health reimbursement arrangement which is treated as employer-provided coverage under an accident or health plan for purposes of section 106 are exempt from the reporting requirements of section 6041. Nonemployee Compensation-Box 7 The types of nonemployee compensation that must be reported on Form 1099-MISC, box 7 include fees, commissions, prizes and awards for services performed by a nonemployee, other forms of compensation for services performed for a trade or business by an individual who is not an employee, and fish purchases for cash.

Include oil and gas payments for a working interest, whether or not services are performed. Also include expenses incurred for the use of an entertainment facility that you treat as compensation to a nonemployee. Federal executive agencies that make payments to vendors for services, including payments to corporations, must report the payments in this box. .

If the following four conditions are met, you must generally report a payment as nonemployee compensation: ï‚· ï‚· ï‚· ï‚· The payment is made to someone who is not your employee; The payment is for services in the course of your trade or business (including government agencies and nonprofit organizations). The payment is made to an individual, partnership, estate or, in some cases, a corporation; and The payment is at least $600 during the year. Generally, amounts reportable in box 7 are subject to self-employment tax. If payments to individuals are not subject to this tax and are not reportable elsewhere on Form 1099-MISC, report the payment in box 3. Examples of payments to be reported on Form 1099-MISC include: ï‚· Professional service fees, such as fees to attorneys (including corporations), accountants, contractors, engineers, architects, etc. ï‚· Fees paid by one professional to another, such as fee-splitting or referral fees. ï‚· Payments by attorneys to witnesses or experts in legal adjudication. ï‚· Payment for services, including payment for parts or materials used to perform the services if supplying the parts or materials was incidental to providing the service. ï‚· Commissions paid to nonemployee salespersons that are subject to repayment but not repaid during the calendar year. ï‚· A fee paid to a nonemployee, including an independent contractor, or travel reimbursement for which the nonemployee did not account to the payer, if the fee and reimbursement total at least $600. ï‚· Payments to nonemployee entertainers for services. ï‚· Exchanges of services between individuals in the course of their trade or businesses. ï‚· Taxable fringe benefits for nonemployees. ï‚· Gross oil and gas payments for a working interest. ï‚· Payments to an insurance salesperson who is not your common law or statutory employee. ï‚· Directors’ fees – see below. ï‚· Commissions paid to licensed lottery ticket sales agents. ï‚· Fish purchases for cash. ï‚· Nonqualified deferred compensation. (Section 409A) ï‚· Golden parachute payments. Excess payments are reported in box 13. .

Director’s Fees Directors of a corporation are defined by statute as nonemployees. If an organization pays its board members to attend board meetings or otherwise compensates them for performing their duties as directors, the organization should treat them as independent contractors. Directors’ fees and other remuneration, including payments made after retirement must be reported on Form 1099-MISC, box 7. An employer can provide certain benefits (insurance premiums, for example) to directors as taxable income which is also reported on Form 1099-MISC. Reimbursement of expenses without proper documentation paid to directors are also reportable to the IRS on Form 1099-MISC.

Per diem allowances may be used for directors without including them on Form 1099 provided the time, place, and business purpose of the travel are substantiated by adequate records and the director does not directly or indirectly own 10% of the entity paying the per diem. No reporting requirement Fee for attendance at meetings Reimbursement of actual expenses based on proper record-keeping and qualifying per diems: Public transportation Lodging, Mileage Meals Convention or conference Other Reimbursement of expenses without documentation or via non-qualifying per diem: Mileage Lodging Meals Convention or conference Medical insurance premiums Life insurance premiums: Payer is beneficiary Director names beneficiary Reportable X X X X X X X X X X X X X Substitute Payments in Lieu of Dividends or Interest-Box 8 Enter aggregate payments of at least $10 received by a broker for a customer in lieu of dividends or taxexempt interest as a result of a loan of a customer’s securities. For this purpose, a customer includes an individual, trust, estate, partnership, association, company, or corporation. It does not include a taxexempt organization, the United States, any state, the District of Columbia, a U.S.

possession, or a foreign government. Substitute payment means a payment in lieu of (a) a dividend or (b) tax-exempt interest to the extent that interest (including OID) has accrued while the securities were on loan. Payer Made Direct Sales-Box 9 For reporting direct sales of $5,000 or more of consumer products to a person on a buy-sell, depositcommission, or other commission basis for resale anywhere other than a permanent retail establishment. Enter an “X” in the checkbox for sales-box 9, not a dollar amount. . Crop Insurance Proceeds-Box 10 Crop insurance proceeds paid to farmers by insurance companies must be reported on Form 1099-MISC, box 10, unless the farmer has informed the insurance company that expenses have been capitalized under Internal Revenue Code Section 278, 263A, or 447. Foreign Tax-Box 11 Enter any foreign tax paid on Form 1099-MISC payments. Report the tax in U.S. dollars. Foreign County or Possession–Box 12 Enter the foreign country or U.S. possession for which the foreign tax was reported in Box 11. Excess Golden Parachute Payments–Box 13 A parachute payment is any payment that meets all of the following conditions: 1.

The payment is in the nature of compensation. 2. The payment is to, or for the benefit of, a disqualified individual*. 3. The payment is contingent on a change in the ownership of a corporation, the effective control of a corporation, or the ownership of a substantial portion of the assets of a corporation (a change in ownership or control). 4.

The payment has (together with other payments described in 1, 2, and 3, above, made to the same individual) an aggregate present value of at least three times the individual’s base amount. *A disqualified individual is one who at any time during the 12-month period prior to and ending on the date of the change in ownership or control of the corporation (the disqualified individual determination period) was an employee or independent contractor and was, in regard to that corporation, a shareholder, an officer, or a highly compensated individual. Enter any excess golden parachute payments. An excess parachute payment is the amount of the excess of any parachute payment over the base amount (the average annual compensation for services includible in the individual’s gross income over the most recent 5 tax years). Gross Proceeds Paid to Attorneys-Box 14 Attorneys’ fees of $600 or more paid in the course of your trade or business are reportable on Form 1099MISC, box 7. However, if you make a payment to an attorney in connection with a legal settlement and the attorney’s fee cannot be specifically determined, the total amount paid to the attorney (gross proceeds) must be reported in box 14.

If the attorney fees are part of a legal settlement and can be specifically determined, the amount of fees must be reported in box 7. For example, an insurance company pays to settle a claim directly to the attorney. These rules apply whether or not the legal services are provided to the payer and whether or not the attorney is the exclusive payee.

The exemption from filing for corporations does not apply to attorneys. Gross proceeds payments must be reported to the attorney even though some or all of the payment also must be reported to another party (e.g., the attorney’s client). Under the regulations, “payments to an attorney” include payments by check or other method such as cash, wire, or electronic transfer. A payment to an attorney, in the case of a payment by check, means a check on which the attorney is named as a sole, joint, or alternative payee. The attorney is the payee on a check written to the attorney’s client trust fund.

However, the attorney is not a payee when the attorney’s name is included on the payee line as “in care of”, such as a check written to “client c/o attorney,” or if the attorney’s name is included on the check in any other manner that does not give the attorney the right to negotiate the check. The regulations define a payer as a person who makes a payment if that person is an obligor on the payment, or the obligor’s insurer or guarantor. Under the regulations, the term “legal services” means all services related to, or supportive of, the practice of law performed by, or under the supervision of, an attorney. In addition, payments to an .

attorney that are unrelated to the practice of law are not subject to reporting. Joint or multiple payees: ï‚· Check delivered to one payee attorney – If more than one attorney is listed as payee on a check, the information return should be filed with respect to the attorney who received the check. ï‚· Check delivered to payee non-attorney – If at least one attorney is listed as a payee on a check and the check is delivered to a payee who is not an attorney, then an information return must be filed with respect to the first listed payee attorney on the check. ï‚· Check delivered to non-payee – If two or more attorneys are listed as payees on a check and the check is delivered to a non-payee, then an information return must be filed with respect to the first-listed payee attorney on the check. Exceptions- A 1099 information return is not required with respect to the following payments: ï‚· Payments of wages or other compensation paid to an attorney by the attorney’s employer. These payments must be reported on Form W-2. ï‚· Payments of compensation or profits paid or distributed to its partners by a partnership engaged in providing legal services. ï‚· Payments of dividends or corporate earnings and profits paid to its shareholders by a corporation engaged in providing legal services. ï‚· Payments of attorney fees only that are required to be reported as nonemployee compensation on Form 1099-MISC in box 7. Payments made to an attorney in the attorney’s capacity as the person responsible for closing a real estate sale or financing transaction. Note that this exception was expanded to include payments made to attorneys in connection with real estate financing.

The exception now covers, for example, payments made to attorneys in connection with refinancing and mortgages (not limited to purchase-money mortgages). ï‚· Payments made to an attorney in the attorney’s capacity as a bankruptcy trustee. Section 409A Deferrals-Box 15a You do not have to complete this box. If you do complete this box, enter the total amount deferred during the year of at least $600 for the nonemployee under all nonqualified plans. The deferrals during the year include earnings on the current year and prior year deferrals. For deferrals and earnings under nonqualified deferred compensation plans for employees, see the instructions for Forms W-2 and W-3. Section 409A Income-Box 15b Enter all amounts deferred (including earnings on amounts deferred) that are includible in income under Section 409A because the nonqualified deferred compensation plan fails to satisfy the requirements of Section 409A.

Do not include amounts properly reported on a Form 1099-MISC, corrected Form 1099MISC, Form W-2, or Form W-2c for a prior year. Also, do not include amounts that are considered to be subject to a substantial risk of forfeiture for purposes of section 409A. The amount included in box 15b is also includible in box 7 and generally is subject to self-employment tax. State Information-Boxes 16-18 These boxes, and Copies 1 and 2, are provided for your convenience only and need not be completed for the IRS. If you withheld state income tax on a payment, you may enter it in box 16.

In box 17 enter the state code and payer’s state identification number. In box 18 you may enter the amount of the state payment. Use Copy 1 to provide information to the state tax department.

Give Copy 2 to the recipient. . FORM 1099-DIV Form 1099-DIV, "Dividends and Distributions," must be filed for each person to or for whom a payer: ï‚· Paid dividends (including capital gains and exempt-interest dividends) and other distributions on stock of $10 or more; ï‚· Withheld and paid any foreign tax on dividends and other distributions on stock; ï‚· Withheld any federal income tax under the backup withholding rules; or ï‚· Paid $600 or more as part of a liquidation. A distinction is made for qualified dividends paid during the tax year from domestic corporations and qualified foreign corporations which receive preferred tax treatment. These payments should be reported in both boxes 1a and 1b. See the instructions for 1099-DIV for exceptions to this preferred tax treatment. If a payer receives a dividend payment of $10 or more as a trustee or middleman for another person and the payer pays such dividend to any other person, the payer must file Form 1099-DIV. Taxable dividend distributions from life insurance contracts and employee stock ownership plans are reported on Form 1099-R. Payments of section 404(k) dividends directly from the corporation to the plan participants must be reported on Form 1099-DIV. A payer does not report on Form 1099-DIV payments made to certain payees, including a corporation, a tax-exempt organization, any IRA, Archer MSA, or HSA, a U.S.

agency, a state, the District of Columbia, a U.S. possession, or a registered securities or commodities dealer. A payer also does not report on Form 1099-DIV certain distributions, commonly referred to as "dividends," that are actually interest.

Instead, these payments are reported on Form 1099-INT. Such payments include "dividends" on deposits or on share accounts in cooperative banks, credit unions, domestic building and loan associations, domestic and federal savings and loan associations, and mutual savings banks. If a payment is made that may be a dividend, but it is not possible to determine if any part of a payment may be a dividend by the time the Form 1099-DIV must be filed, the entire payment must be reported as a dividend. FORM 1099-INT Form 1099-INT, "Interest Income” interest payments are only reported when: ï‚· ï‚· ï‚· ï‚· ï‚· Interest of $10 or more paid or credited on earnings from savings and loan associations, credit unions, bank deposits, corporate bond holders of tax credit bonds, etc. Interest of $600 or more from other sources, in the course of your trade or business. Forfeited interest due to premature withdrawals of time deposits. Federal backup withholding and foreign tax withheld and paid on interest. Payments of any interest to bearers of certificates of deposit. Report only interest payments made in the course of your trade or business including federal, state and local government agencies and activities deemed nonprofit, or for which you were a nominee/middleman. Exempt-interest dividends from a mutual fund or other regulated investment company (RIC) are no longer reported on Form 1099-INT. Those amounts will now be reported on Form 1099-DIV. No form 1099-INT is required to be filed for payments made to exempt recipients or for interest excluded from reporting.

Do not report tax deferred interest, such as interest that is earned but not distributed from an IRA. . If a payer receives an interest payment of $10 or more as a trustee or middleman for another person and the payer pays such interest to any other person, the payer must file Form 1099-INT. Use box 10 to report the Committee on Uniformed Security Identification Procedures (CUSIP) number for each tax-exempt bond for which interest was reported in box 8. Box 13 has been added to report bond premium on tax-exempt bonds. FORM 1099-OID File Form 1099-OID, Original Issue Discount, if the original issue discount (OID) includible in gross income is at least $10 and you are any of the following: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· An issuer with any bond outstanding or other evidence of indebtedness in registered or bearer form issued with OID; An issuer of a certificate of deposit (CD) made, purchased, or renewed after 1970 if the CD has OID and a term of more than 1 year; A financial institution having other deposit arrangements such as time deposits or bonus-savings plans, if the arrangements have OID and a term of more than 1 year; A broker or other middleman holding an OID obligation, including CDs, as nominee for the actual owner; A trustee or middleman of a widely held fixed investment trust (WHFIT) or widely held mortgage trust (WHMT) or; A real estate mortgage investment conduit (REMIC), a holder of an ownership interest in a financial asset securitization investment trust (FASIT), or an issuer of a collateralized debt obligation (CDO). Also, a Form 1099-OID must be filed for any person for whom any foreign tax or federal income tax under the backup withholding rules was withheld and paid on OID even if the amount of the OID is less than $10. Use the Description box 5 to report the CUSIP number, abbreviation of the issuer, coupon rate or year of maturity when applicable. FORM 1099-R Form 1099-R, “Distributions from Pensions, Annuities, Retirement or Profit Sharing Plans, IRAs, Insurance Contracts, etc.” is used to report any distribution of $10 or more from pension sharing or retirement plans, any individual retirement arrangements, annuities, pensions, insurance contracts, survivor income benefit plans, permanent and total disability payments under life insurance contracts, charitable gift annuities, etc. This form is used when the payment is a total distribution, in which the recipient's entire account balance is paid out in a single taxable year, as well as for reporting periodic payments made from retirement income plans. Form 1099-R is also used to report death benefit payments made by employers that are not made as part of a pension, profit-sharing, or retirement plan. Reportable disability payments made from a retirement plan must also be reported on Form 1099-R. There are 9 numeric codes and 18 alpha codes to use when reporting amounts in box 7 of Form 1099-R. Enter the total amount of the distribution before income tax or other deductions were withheld in box 1, gross distribution.

Include direct rollovers, IRA rollovers to accepting employer plans, premiums paid by a trustee or custodian for the cost of current life or other insurance protection, including a recharacterization and a Roth IRA conversion. Also include in this box distributions to plan participants from governmental §457(b) plans. However, in the case of a distribution by a trust representing certificates of deposit redeemed early, report the net amount distributed. .

Include in box 1 the value of U.S. Savings Bonds distributed from a plan. Enter the appropriate taxable amount in Box 2a. Also include in box 1 amounts distributed from a qualified retirement plan for which the recipient elects to pay health insurance premiums under a cafeteria plan or that are paid to the recipient.

In addition to reporting distributions to beneficiaries of deceased employees, report here any death benefit payments made by employers that are not made as part of a pension, profit sharing, or retirement plan. Also enter these amounts in box 2a; enter Code 4 in box 7. Do not report accelerated death benefits on Form 1099-R.

Report them on Form 1099-LTC. For section 1035 exchanges that are reportable on Form 1099-R, enter the total value of the contract in box 1, 0 in box 2a, the total premiums paid in box 5, and Code 6 in box 7. If you are making a distribution from a designated Roth account, enter the gross distribution in box 1, the taxable portion in box 2a, the basis included in the distributed amount in box 5, any amount allocable to an IRR made within the previous 5 years in box 10, and the first year of the 5-taxable-year period for determining qualified distributions in box 11. If you distribute employer securities or other property, include in box 1 the FMV of the securities or other property on the date of distribution.

If cash or capital gain property is donated in exchange for a charitable gift annuity, report the total amount distributed during the year in box 1. When determining the taxable amount to be entered in box 2a, do not reduce the taxable amount by any portion of the $3,000 exclusion for which the participant may be eligible as a payment of qualified health and long-term care insurance premiums for retired public safety officers under §402(l). Generally, you must enter the taxable amount in box 2a. However, if you are unable to reasonably obtain the data needed to compute the taxable amount, leave this box blank and check box 2b – Taxable amount not determined. Do not enter excludable or tax-deferred amounts reportable in boxes 5, 6, and 8.

Enter 0 in box 2a for: ï‚· A direct rollover(other than a qualified rollover contribution under §408A(e) from a qualified plan (including a governmental § 457(b) plan) or section 403(b) plan or a rollover from a designated Roth account into a Roth IRA, ï‚· A traditional, SEP, or SIMPLE IRA directly transferred to an accepting employer plan, ï‚· An IRA recharacterization, or ï‚· A non-taxable section 1035 exchange of life insurance, annuity, or endowment or long-term care insurance contracts. ï‚· A nontaxable charge or payment, for the purchase of a qualified long-term care insurance contract, against the cash value of an annuity contract or the cash surrender value of a life insurance contract. Report payments to military retirees or payments of survivor benefit annuities on Form 1099-R. Report military retirement pay awarded as a property settlement to a former spouse under the name and taxpayer identification number of the recipient, not that of the military retiree. Report on Form 1099-R, not Form W-2, income tax withholding and distributions from a governmental section 457(b) plan maintained by a state or local government employer. Distributions from a governmental section 457(b) plan to a participant or beneficiary include all amounts that are paid from the plan. Report any reportable distributions from commercial annuities.

Also report distributions to employee plan participants from section 409A nonqualified deferred compensation plans including nongovernmental section 457(b) plans on Form W-2, not on Form 1099-R; for nonemployees, these payments are reportable on Form 1099-MISC. . . . FORM 1099-PATR Form 1099-PATR, “Taxable Distributions Received from Cooperatives”, must be filed by a cooperative if: ï‚· Paid $10 or more in patronage dividends (as defined below) and other distributions described in Internal Revenue Code Section 6044(b); or ï‚· Withheld federal income tax on patronage dividends and other distributions under the backup withholding rules regardless of the amount of payment. A patronage dividend is a distribution from cooperatives that is passed through to their patrons. Include in boxes 6 – 10 the patron’s share of unused credits and deductions, including the Domestic Production Activities Deduction. FORM 1099-LTC File Form 1099-LTC, “Long-Term Care and Accelerated Death Benefits”, if you pay any long-term care benefits, including accelerated death benefits. Payers include insurance companies, governmental units, and viatical settlement providers. Long-term care benefits means: ï‚· Any payments made under a product that is advertised, marketed, or offered as long-term care insurance (whether qualified or not); and ï‚· Accelerated death benefits (excludable in whole or in part from gross income under section 101(g)) paid under a life insurance contract or paid by a viatical settlement provider. Long-Term Care Benefits Paid: These benefits are all the amounts paid out on a per diem or other periodic basis or on a reimbursed basis. It includes amounts paid to the insured, to the policyholder, and to third parties. You are not required to determine whether any benefits are taxable or nontaxable. Accelerated Death Benefits: An accelerated death benefit is any amount paid under a life insurance contract to or on behalf of an insured that is terminally or chronically ill.

It also includes any amount paid by a viatical settlement provider for the sale or assignment of a death benefit under a life insurance contract. FORM 1099-SA File Form 1099-SA, “Distributions from an HSA, Archer MSA or Medicare Advantage MSA”, to report distributions made from a HSA, Archer MSA or Medicare Advantage MSA (MA MSA). The distribution may have been paid directly to a medical service provider or to the account holder. A separate return must be filed for each plan type. Excess employer contributions (and the earnings on them) withdrawn from employee HSA’s by the employer should not be reported as a distribution on form 1099-SA or as a contribution on Form 5498-A. Qualified health savings accounts (HSA) distributions from flexible spending arrangements (FSA’s) may no longer be made. .

FORM 1042-S Form 1042-S, “Foreign Person’s U.S. Source Income Subject to Withholding” is filed to report income subject to withholding paid to nonresident aliens, foreign partnerships, foreign corporations, or nonresident alien or foreign fiduciaries of estates or trusts. You must file a 1042-S even if you did not withhold tax because the income was exempt due to a U.S. tax treaty or the Code.

This includes but not limited to certain interest, dividends, rents, compensation for services performed in the United States, premiums, annuities or other gains, profits, or income unless specifically exempted under the Internal Revenue Code or a tax treaty. IRS Publication 901 (U.S. Tax Treaties) is a useful tool in determining what withholding percentages or exemptions apply for particular countries. If Form 1042-S is required, Form 1042-T Annual Summary and Transmittal of Forms 1042-S and Form 1042, Annual Withholding Tax Return for U.S.

Source Income of Foreign Persons, must also be filed. FORM 1099-A File Form 1099-A, “Acquisition or Abandonment of Secured Property”, for each borrower if you lend money in connection with your trade or business and, in full or partial satisfaction of the debt, acquire an interest in the property that is security for the debt, or there is reason to know that the property has been abandoned. You need not be in the business of lending money to be subject to this reporting requirement. If, in the same calendar year, you cancel a debt in connection with a foreclosure or abandonment of secured property, it is not necessary to file both Form 1099-A and Form 1099-C for the same debtor. You may file Form 1099-C only.

You will meet the Form 1099-A filing requirement for the debtor by completing boxes 4, 5 and 7 on Form 1099-C. However, if you file both Forms 1099-A and 1099-C, do not complete boxes 4, 5 and 7 on Form 1099-C. Property means any real property (such as a personal residence), any tangible property, and tangible personal property except: ï‚· No reporting is required for tangible personal property (such as a car) held only for personal use. However you much file Form 1099-A, if the property is totally or partly held for use in a trade or business or for investment. ï‚· No reporting is required if the property securing the loan is located outside the United States and the borrower has furnished the lender a statement, under penalties of perjury, that the borrower is an exempt foreign person (unless the lender knows the statement is false). Truncating an individual’s identifying number is no longer available on Forms 1099-A or C. Complete nine digit numbers must now be reported. FORM 1099-C File Form 1099-C, “Cancellation of Debt”, for each debtor for whom debt was canceled of $600 or more only if: You are an entity described below and if an identifiable event has occurred.

It does not matter whether the actual cancellation is on or before the date of the identifiable event. The creditor’s phone number must be provided in the creditor’s information box. Form 1099-C is not filed when fraudulent debt is canceled due to identity theft. Codes for identifying the type of event or other actual discharge before an identifiable event that led to the issuance of Form 1099-C are required in Box 6. .

File Form 1099-C if you are: ï‚· A financial institution described in section 581 and 591(a) (such as a domestic bank, trust company, building and loan or savings and loan association). ï‚· A credit union. ï‚· Any of the following, its successor, or subunit of one of the following: Federal Deposit Insurance Corporation, Resolution Trust Corporation, National Credit Union Administration, any federal executive agency, including government corporations, any military department, U.S. Postal Service or Postal Rate Commission, ï‚· a corporation that is a subsidiary of a financial institution or credit union, ï‚· a federal government agency (including: department, agency, court or court administrative office, or an instrumentality in the judicial or legislative branch of the government), and ï‚· an organization whose significant trade or business is the lending of money. A debt is deemed canceled on the date an identifiable event occurs or, if earlier, the date of the actual discharge if you choose to file Form 1099-C for the year of cancellation. An identifiable event is: ï‚· A discharge in bankruptcy under Title 11 of the U.S. Code for business or investment debt. ï‚· A cancellation or extinguishment making the debt unenforceable in receivership or foreclosure. ï‚· A cancellation or extinguishment when the statute of limitations of collecting the debt expires. ï‚· A cancellation or extinguishment when the creditor elects foreclosure remedies that by law end or bar the creditor’s rights to collect the debt. ï‚· A cancellation or extinguishment due to probate or similar proceeding. ï‚· A discharge of indebtedness under an agreement between the creditor and the debtor. ï‚· A discharge of indebtedness because of a decision or a defined policy of the creditor to discontinue collection activity and cancel the debt. ï‚· And the expiration of nonpayment testing period. The titles of boxes 1, 2 and 6 on form 1099-C have changed.

Box 1 is now Date of Identifiable Event; box 2 is now Amount of Debt Discharged; and box 6 is now Identifiable Event Code, and required the entry of a code for the identifiable event. FORM 1099-B A broker or barter exchange must file Form 1099-B for each person for whom the broker: ï‚· ï‚· ï‚· Sold (including short sales) stocks, bonds commodities, regulated futures contracts, foreign currency contracts, forward contracts, debt instruments, etc. for cash, Received cash, stock or other property from a corporation that the broker knows or has reason to know has had stock acquired in an acquisition of control or had a substantial change in capital structure reportable on Form 8806, or Exchanged property or services through a barter exchange. A broker is any person who, in the ordinary course of a trade or business, stands ready to effect sales to be made by others, including an obligor that regularly issues and retires its own debt obligations, or a corporation that redeems its own stock. The reporting requirement for Form 1099-B has expanded greatly in recent years, including acquisition dates and cost basis reporting beginning in 2011.

The IRS instructions should be reviewed for detailed information. . FORM 1099-K A payment settlement entity (PSE) must file Form 1099-K, Payment Card and Third-Party Network Transactions, for payments made in settlement of reportable payment transactions for each calendar year. A PSE makes a payment in settlement of a reportable payment transaction if the PSE submits the instruction to transfer funds to the account of the participating payee to settle the reportable payment transaction. Every PSE, which in any calendar year makes one or more payments in settlement of reportable payment transactions, must file a Form 1099-K reporting monthly transaction totals with respect to each participating payee for that calendar year. . 9595 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Rents OMB No. 1545-0115 2016 $ 2 Royalties Miscellaneous Income $ 4 Federal income tax withheld $ PAYER’S federal identification number RECIPIENT’S identification number Form 1099-MISC 3 Other income $ 5 Fishing boat proceeds 6 Medical and health care payments $ $ RECIPIENT’S name 7 Nonemployee compensation 8 Substitute payments in lieu of dividends or interest Street address (including apt. no.) $ $ City or town, state or province, country, and ZIP or foreign postal code 9 Payer made direct sales of 10 Crop insurance proceeds $5,000 or more of consumer products to a buyer $ (recipient) for resale 11 Account number (see instructions) FATCA filing 2nd TIN not. 13 Excess golden parachute requirement payments $ 15a Section 409A deferrals $ Form 1099-MISC 15b Section 409A income $ Cat.

No. 14425J 16 State tax withheld $ $ www.irs.gov/form1099misc 12 Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. 14 Gross proceeds paid to an attorney $ 17 State/Payer’s state no. 18 State income $ $ Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page . 9191 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1a Total ordinary dividends OMB No. 1545-0110 2016 $ 1b Qualified dividends $ Form 1099-DIV 2a Total capital gain distr. $ 2c Section 1202 gain 2d Collectibles (28%) gain $ $ 3 Nondividend distributions RECIPIENT’S name 2b Unrecap. Sec. 1250 gain $ PAYER’S federal identification number RECIPIENT’S identification number Dividends and Distributions 4 Federal income tax withheld $ File with Form 1096. $ 5 Investment expenses $ Street address (including apt.

no.) 6 Foreign tax paid City or town, state or province, country, and ZIP or foreign postal code 7 Foreign country or U.S. possession $ 8 Cash liquidation distributions $ 9 Noncash liquidation distributions $ FATCA filing 10 Exempt-interest dividends requirement $ Account number (see instructions) Copy A For Internal Revenue Service Center For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. 11 Specified private activity bond interest dividends $ 2nd TIN not. 12 State 13 State identification no.

14 State tax withheld $ $ Form 1099-DIV Cat. No. 14415N Do Not Cut or Separate Forms on This Page www.irs.gov/form1099div — Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page .

9292 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. OMB No. 1545-0112 Payer's RTN (optional) Interest Income 2016 1 Interest income Form 1099-INT $ 2 Early withdrawal penalty PAYER’S federal identification number RECIPIENT’S identification number Copy A $ 3 Interest on U.S. Savings Bonds and Treas. obligations For Internal Revenue Service Center $ RECIPIENT’S name 4 Federal income tax withheld 5 Investment expenses $ 6 Foreign tax paid 7 Foreign country or U.S.

possession $ Street address (including apt. no.) 8 Tax-exempt interest 9 Specified private activity bond interest FATCA filing requirement $ $ 10 Market discount City or town, state or province, country, and ZIP or foreign postal code 11 Bond premium $ $ 12 Bond premium on Treasury obligations 13 Bond premium on tax–exempt bond $ Account number (see instructions) Form 1099-INT 2nd TIN not. 14 Tax-exempt and tax credit bond CUSIP no. Cat.

No. 14410K www.irs.gov/form1099int File with Form 1096. $ For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. $ 15 State 16 State identification no. 17 State tax withheld $ $ Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page .

9696 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Original issue discount for 2016 OMB No. 1545-0117 $ 2016 2 Other periodic interest 1099-OID $ Form 3 Early withdrawal penalty 4 Federal income tax withheld $ $ 5 Market discount 6 Acquisition premium $ $ PAYER’S federal identification number RECIPIENT’S identification number RECIPIENT’S name Original Issue Discount Copy A For Internal Revenue Service Center 7 Description File with Form 1096. Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on U.S. Treasury obligations $ FATCA filing 9 Investment expenses requirement $ Account number (see instructions) 10 Bond premium $ 2nd TIN not.

11 State 12 State identification no. 13 State tax withheld For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. $ $ Form 1099-OID Cat. No.

14421R www.irs.gov/form1099oid Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page . 9898 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code OMB No. 1545-0119 1 Gross distribution 2a Taxable amount 2015 $ Form $ 2b Taxable amount not determined PAYER’S federal identification number RECIPIENT’S identification number Total distribution 3 Capital gain (included in box 2a) $ RECIPIENT’S name 4 Federal income tax withheld /Designated Roth contributions or insurance premiums $ Copy A For Internal Revenue Service Center File with Form 1096. $ 5 Employee contributions Street address (including apt. no.) 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 6 Net unrealized appreciation in employer’s securities For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. $ 7 Distribution code(s) IRA/ SEP/ SIMPLE 8 Other $ City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total distribution 10 Amount allocable to IRR 11 1st year of desig. Roth contrib.

12 State tax withheld within 5 years Account number (see instructions) Cat. No. 14436Q 13 State/Payer’s state no.

14 State distribution $ $ 15 Local tax withheld $ $ 1099-R $ $ $ $ Form % % 9b Total employee contributions 17 Local distribution $ $ www.irs.gov/form1099r Do Not Cut or Separate Forms on This Page 16 Name of locality — Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page . 9797 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. OMB No. 1545-0118 1 Patronage dividends $ 2015 2 Nonpatronage distributions $ 3 Per-unit retain allocations $ PAYER’S federal identification number RECIPIENT’S identification number Form 1099-PATR Copy A 4 Federal income tax withheld $ RECIPIENT’S name 5 Redemption of nonqualified notices and retain allocations $ 6 Domestic production activities deduction $ Street address (including apt. no.) 7 Investment credit $ City or town, state or province, country, and ZIP or foreign postal code 8 Work opportunity credit $ Account number (see instructions) 9 Patron’s AMT adjustment $ 2nd TIN not. 10 Other credits and deductions $ Form 1099-PATR Cat.

No. 14435F www.irs.gov/form1099patr Taxable Distributions Received From Cooperatives For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page . 9393 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Gross long-term care benefits paid $ 2 Accelerated death benefits paid PAYER’S federal identification number POLICYHOLDER'S identification number $ OMB No. 1545-1519 2015 Long-Term Care and Accelerated Death Benefits Form 1099-LTC INSURED'S taxpayer identification no. POLICYHOLDER'S name File with Form 1096. Street address (including apt. no.) Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) 5 Check, if applicable: (optional) 4 Qualified contract (optional) Copy A For Internal Revenue Service Center 3 Check one: Per Reimbursed diem amount INSURED'S name Chronically ill Terminally ill Date certified For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. 1099-LTC Cat.

No. 23021Z www.irs.gov/form1099ltc Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form . 9494 VOID CORRECTED TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number OMB No. 1545-1517 2015 Form 1099-SA RECIPIENT'S name 1 Gross distribution 2 Earnings on excess cont. $ PAYER'S federal identification number RECIPIENT'S identification number Distributions From an HSA, Archer MSA, or Medicare Advantage MSA $ 3 Distribution code 4 FMV on date of death $ Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) 5 HSA Archer MSA MA MSA Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. 1099-SA Cat. No.

38471D www.irs.gov/form1099sa Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form . 8080 VOID CORRECTED LENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. OMB No. 1545-0877 2015 Acquisition or Abandonment of Secured Property Form 1099-A LENDER’S federal identification number BORROWER’S identification number 1 Date of lender's acquisition or knowledge of abandonment 2 Balance of principal outstanding $ BORROWER’S name 3 4 Fair market value of property Copy A For Internal Revenue Service Center File with Form 1096. $ Street address (including apt. no.) 5 If checked, the borrower was personally liable for repayment of the debt . .

. . .

. . .

. . . City or town, state or province, country, and ZIP or foreign postal code 6 Description of property Account number (see instructions) For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. 1099-A Cat.

No. 14412G www.irs.gov/form1099a Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form . 7979 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Applicable check box on Form 8949 OMB No. 1545-0715 2015 Form 1099-B Proceeds From Broker and Barter Exchange Transactions 1a Description of property (Example 100 sh. XYZ Co.) 1b Date acquired PAYER'S federal identification number RECIPIENT'S identification number 1d Proceeds $ 1c Date sold or disposed 1e Cost or other basis 1f Code, if any 1g Adjustments $ RECIPIENT'S name Copy A $ 2 Type of gain or loss: Short-term 3 Check if basis reported to IRS For Internal Revenue Service Center File with Form 1096. Long-term Street address (including apt. no.) 4 Federal income tax withheld 5 Check if noncovered security $ 6 Reported to IRS: City or town, state or province, country, and ZIP or foreign postal code Gross proceeds 7 Check if loss is not allowed based on amount in 1d Net proceeds Account number (see instructions) 2nd TIN not. 8 Profit or (loss) realized in 2015 on closed contracts $ CUSIP number 14 State name $ 10 Unrealized profit or (loss) on 11 Aggregate profit or (loss) open contracts—12/31/2015 on contracts 15 State identification no.

16 State tax withheld $ $ Form 1099-B 9 Unrealized profit or (loss) on open contracts—12/31/2014 Cat. No. 14411V $ $ 12 For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. 13 Bartering $ www.irs.gov/form1099b Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page .

8585 VOID CORRECTED CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Date of identifiable event 2 Amount of debt discharged $ 3 Interest if included in box 2 $ CREDITOR'S federal identification number DEBTOR'S identification number OMB No. 1545-1424 2015 Form 1099-C Copy A 4 Debt description For Internal Revenue Service Center DEBTOR'S name Street address (including apt. no.) File with Form 1096. For Privacy Act and . Paperwork Reduction Act Notice, see the 2015 General Instructions for 7 Fair market value of property Certain Information Returns. $ 5 Check here if the debtor was personally liable for repayment of the debt . .

. . .

. . City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) Cancellation of Debt 6 Identifiable event code 1099-C Cat. No.

26280W www.irs.gov/form1099c Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form . 1010 VOID CORRECTED FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. FILER’S federal identification no. OMB No. 1545-2205 PAYEE’S taxpayer identification no. 2015 1a Gross amount of payment card/third party network transactions $ Form 1b Card Not Present transactions Payment settlement entity (PSE) Check to indicate transactions reported are: Payment card Electronic Payment Facilitator (EPF)/Other third party Third party network Check to indicate if FILER is a (an): 1099-K 2 Merchant category code $ 3 Number of payment transactions 4 Federal income tax withheld 5a January 5b February Copy A For Internal Revenue Service Center $ PAYEE’S name $ $ 5c March 5d April $ $ 5e May Street address (including apt. no.) 5f June $ $ 5g July 5h August $ $ 5i September City or town, state or province, country, and ZIP or foreign postal code File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. 5j October $ $ 5k November PSE'S name and telephone number 5l December $ Account number (see instructions) Payment Card and Third Party Network Transactions $ 2nd TIN not.

6 State 7 State identification no. 8 State income tax withheld $ $ Form 1099-K Cat. No. 54118B Do Not Cut or Separate Forms on This Page www.irs.gov/form1099k — Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page .

7575 VOID CORRECTED FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number 1 Date of closing OMB No. 1545-0997 2 Gross proceeds $ FILER'S federal identification number TRANSFEROR'S identification number 2015 Proceeds From Real Estate Transactions Form 1099-S 3 Address or legal description (including city, state, and ZIP code) Copy A For Internal Revenue Service Center TRANSFEROR'S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code 4 Check here if the transferor received or will receive property or services as part of the consideration Account or escrow number (see instructions) 5 Buyer's part of real estate tax $ File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. 1099-S Cat. No.

64292E www.irs.gov/form1099s Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form . 7373 VOID CORRECTED CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Date of sale or exchange 2 Aggregate amount rec'd* $ OMB No. 1545-1814 2015 Form 1099-CAP 3 No. of shares exchanged Changes in Corporate Control and Capital Structure 4 Classes of stock exchanged Copy A CORPORATION’S federal identification no. SHAREHOLDER’S identification no. For Internal Revenue Service Center SHAREHOLDER’S name Street address (including apt. no.) 5 City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) * The shareholder cannot claim a loss based on the amount in box 2. File with Form 1096. For Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns. 1099-CAP Cat.

No. 35115M www.irs.gov/form1099cap Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form . Form 1042-S Foreign Person’s U.S. Source Income Subject to Withholding Department of the Treasury Internal Revenue Service 1 Income 2 Gross income code Information about Form 1042-S and its separate instructions is at www.irs.gov/form1042s. AMENDED 4 Chap. 4: 3a Exemption code 4a Exemption code . Copy A for Internal Revenue Service 4b Tax rate 5 Withholding allowance 6 Net income . 8 Tax withheld by other agents 10 Total withholding credit 12a Withholding agent’s EIN OMB No. 1545-0096 PRO-RATA BASIS REPORTING 3 Chap.

3: 3b Tax rate 2015 Check if tax not deposited with IRS pursuant to escrow procedure 7 Federal tax withheld 9 Tax paid by withholding agent 11 Amount repaid to recipient 12b Ch. 3 status code 12c Ch. 4 status code 14a Primary Withholding Agent's Name (if applicable) 14b Primary Withholding Agent's EIN 15a Intermediary or flow-through entity's EIN, if any 12d Withholding agent's name 15b Ch.

3 status code 15c Ch. 4 status code 12e Withholding agent's Global Intermediary Identification Number (GIIN) 15d Intermediary or flow-through entity's name 12f Country code 12g Foreign taxpayer identification number, if any 15e Intermediary or flow-through entity's GIIN 15f Country code 15g Foreign tax identification number, if any 12h Address (number and street) 15h Address (number and street) 12i City or town, state or province, country, ZIP or foreign postal code 15i City or town, state or province, country, ZIP or foreign postal code 13a Recipient's U.S. TIN, if any 13h Recipient's GIIN 13b Ch.

3 status code 13d Recipient's name 13i Recipient's foreign tax identification number, if any 13c Ch. 4 status code 13e Recipient's country code 16 Recipient's account number 18 Payer's name 13f Address (number and street) 19 Payer's TIN Click here to use the form. 13g City or town, state or province, country, ZIP or foreign postal code 21 State income tax withheld For Privacy Act and Paperwork Reduction Act Notice, see instructions. 17 Recipient's date of birth 22 Payer’s state tax no. Cat. No.

11386R 20 Payer's GIIN 23 Name of state Form 1042-S (2015) . Form 1042-S Foreign Person’s U.S. Source Income Subject to Withholding Department of the Treasury Internal Revenue Service 1 Income 2 Gross income code Information about Form 1042-S and its separate instructions is at www.irs.gov/form1042s. AMENDED 4 Chap. 4: 3a Exemption code 4a Exemption code . Copy B 4b Tax rate for Recipient 5 Withholding allowance 6 Net income . 8 Tax withheld by other agents 10 Total withholding credit 12a Withholding agent’s EIN OMB No. 1545-0096 PRO-RATA BASIS REPORTING 3 Chap.

3: 3b Tax rate 2015 Check if tax not deposited with IRS pursuant to escrow procedure 7 Federal tax withheld 9 Tax paid by withholding agent 11 Amount repaid to recipient 12b Ch. 3 status code 12c Ch. 4 status code 14a Primary Withholding Agent's Name (if applicable) 14b Primary Withholding Agent's EIN 15a Intermediary or flow-through entity's EIN, if any 12d Withholding agent's name 15b Ch.

3 status code 15c Ch. 4 status code 12e Withholding agent's Global Intermediary Identification Number (GIIN) 15d Intermediary or flow-through entity's name 12f Country code 12g Foreign taxpayer identification number, if any 15e Intermediary or flow-through entity's GIIN 15f Country code 15g Foreign tax identification number, if any 12h Address (number and street) 15h Address (number and street) 12i City or town, state or province, country, ZIP or foreign postal code 15i City or town, state or province, country, ZIP or foreign postal code 13a Recipient's U.S. TIN, if any 13h Recipient's GIIN 13b Ch.

3 status code 13d Recipient's name 13i Recipient's foreign tax identification number, if any 13c Ch. 4 status code 13e Recipient's country code 16 Recipient's account number 18 Payer's name 13f Address (number and street) 19 Payer's TIN Click here to use the form. 13g City or town, state or province, country, ZIP or foreign postal code 21 State income tax withheld For Privacy Act and Paperwork Reduction Act Notice, see instructions. 17 Recipient's date of birth 22 Payer’s state tax no. Cat. No.

11386R 20 Payer's GIIN 23 Name of state Form 1042-S (2015) . U.S. Income Tax Filing Requirements Generally, every nonresident alien individual, nonresident alien fiduciary, and foreign corporation with United States income, including income that is effectively connected with the conduct of a trade or business in the United States, must file a United States income tax return. However, no return is required to be filed by a nonresident alien individual, nonresident alien fiduciary, or foreign corporation if such person was not engaged in a trade or business in the United States at any time during the tax year and if the tax liability of such person was fully satisfied by the withholding of United States tax at the source. Corporations file Form 1120-F; all others file Form 1040NR (or Form 1040NR-EZ if eligible).

You may get the return forms and instructions at any United States Embassy or consulate or by writing to: Internal Revenue Service, 1201 N. Mitsubishi Motorway, Bloomington, IL 61705-6613. En règle générale, tout étranger non-résident, tout organisme fidéicommissaire étranger non-résident et toute société étrangère percevant un revenu aux Etats-Unis, y compris tout revenu dérivé, en fait, du fonctionnement d’un commerce ou d’une affaire aux Etats-Unis, doit produire une déclaration d’impôt sur le revenu auprès des services fiscaux des Etats-Unis. Cependant aucune déclaration d’impôt sur le revenu n’est exigée d’un étranger non-résident, d’un organisme fidéicommissaire étranger non-résident, ou d’une société étrangère s’ils n’ont pris part à aucun commerce ou affaire aux Etats-Unis à aucun moment pendant l’année fiscale et si les impôts dont ils sont redevables, ont été entièrement acquittés par une retenue à la source sur leur salaire. Les sociétés doivent faire leur déclaration d’impôt en remplissant le formulaire 1120-F; tous les autres redevables doivent remplir le formulaire 1040NR (ou 1040NR-EZ s'ils en remplissent les conditions).

On peut se procurer les formulaires de déclarations d’impôts et les instructions y afférentes dans toutes les Ambassades et tous les Consulats des Etats-Unis. L’on peut également s’adresser pour tout renseignement à: Internal Revenue Service, 1201 N. Mitsubishi Motorway, Bloomington, IL 61705-6613. Por regla general, todo extranjero no residente, todo organismo fideicomisario extranjero no residente y toda sociedad anónima extranjera que reciba ingresos en los Estados Unidos, incluyendo ingresos relacionados con la conducción de un negocio o comercio dentro de los Estados Unidos, deberá presentar una declaración estadounidense de impuestos sobre el ingreso.

Sin embargo, no se requiere declaración alguna a un individuo extranjero, una sociedad anónima extranjera u organismo fideicomisario extranjero no residente, si tal persona no ha efectuado comercio o negocio en los Estados Unidos durante el año fiscal y si la responsabilidad con los impuestos de tal persona ha sido satisfecha plenamente mediante retención del impuesto de los Estados Unidos en la fuente. Las sociedades anónimas envían el Formulario 1120-F; todos los demás contribuyentes envían el Formulario 1040NR (o el Formulario 1040NR-EZ si les corresponde). Se podrá obtener formularios e instrucciones en cualquier Embajada o Consulado de los Estados Unidos o escribiendo directamente a: Internal Revenue Service, 1201 N.

Mitsubishi Motorway, Bloomington, IL 61705-6613. Im allgemeinen muss jede ausländische Einzelperson, jeder ausländische Bevollmächtigte und jede ausländische Gesellschaft mit Einkommen in den Vereinigten Staaten, einschliesslich des Einkommens, welches direkt mit der Ausübung von Handel oder Gewerbe innerhalb der Staaten verbunden ist, eine Einkommensteuererklärung der Vereinigten Staaten abgeben. Eine Erklärung, muss jedoch nicht von Ausländern, ausländischen Bevollmächtigten oder ausländischen Gesellschaften in den Vereinigten Staaten eingereicht werden, falls eine solche Person während des Steuerjahres kein Gewerbe oder Handel in den Vereinigten Staaten ausgeübt hat und die Steuerschuld durch Einbehaltung der Steuern der Vereinigten Staaten durch die Einkommensquelle abgegolten ist. Gesellschaften reichen den Vordruck 1120-F ein; alle anderen reichen das Formblatt 1040NR (oder wenn passend das Formblatt 1040NR-EZ) ein.

Einkommensteuererklärungen und Instruktionen können bei den Botschaften und Konsulaten der Vereiningten Staaten eingeholt werden. Um weitere Informationen wende man sich bitte an: Internal Revenue Service, 1201 N. Mitsubishi Motorway, Bloomington, IL 61705-6613. 01 02 03 04 05 22 29 30 31 33 51 Types of Income Interest paid by U.S.

obligors—general Interest paid on real property mortgages Interest paid to controlling foreign corporations Interest paid by foreign corporations Interest on tax-free covenant bonds Interest paid on deposit with a foreign branch of a domestic corporation or partnership Deposit Interest Original issue discount (OID) Short-term OID Substitute payment—interest Interest paid on certain actively traded or publicly offered securities1 Dividend Interest Box 1. Income code. Code 06 07 08 21 34 40 52 53 Other Explanation of Codes 09 10 11 12 13 14 Dividends paid by U.S. corporations—general Dividends qualifying for direct dividend rate Dividends paid by foreign corporations Gross income—Capital gain dividend Substitute payment—dividends Other dividend equivalents under IRC section 871(m) (formerly 871(l)) Dividends paid on certain actively traded or publicly offered securities1 Substitute payments-dividends from certain actively traded or publicly offered securities1 Capital gains Industrial royalties Motion picture or television copyright royalties Other royalties (for example, copyright, recording, publishing) Royalties paid on certain publicly offered securities1 Real property income and natural resources royalties Click here to use the form. See back of Copy C for additional codes code should only be used if the income paid is described in Regulations section 1.1441-6(c)(2) and withholding agent has reduced the rate of withholding under an income tax treaty without the recipient providing a U.S.

or foreign TIN. 1 This . Form 1042-S Foreign Person’s U.S. Source Income Subject to Withholding Department of the Treasury Internal Revenue Service 1 Income 2 Gross income code Information about Form 1042-S and its separate instructions is at www.irs.gov/form1042s. AMENDED 4 Chap. 4: 3a Exemption code 4a Exemption code . Copy C for Recipient 4b Tax rate Attach to any Federal tax return you file 5 Withholding allowance 6 Net income . 8 Tax withheld by other agents 10 Total withholding credit 12a Withholding agent’s EIN OMB No. 1545-0096 PRO-RATA BASIS REPORTING 3 Chap.

3: 3b Tax rate 2015 Check if tax not deposited with IRS pursuant to escrow procedure 7 Federal tax withheld 9 Tax paid by withholding agent 11 Amount repaid to recipient 12b Ch. 3 status code 12c Ch. 4 status code 14a Primary Withholding Agent's Name (if applicable) 14b Primary Withholding Agent's EIN 15a Intermediary or flow-through entity's EIN, if any 12d Withholding agent's name 15b Ch.

3 status code 15c Ch. 4 status code 12e Withholding agent's Global Intermediary Identification Number (GIIN) 15d Intermediary or flow-through entity's name 12f Country code 12g Foreign taxpayer identification number, if any 15e Intermediary or flow-through entity's GIIN 15f Country code 15g Foreign tax identification number, if any 12h Address (number and street) 15h Address (number and street) 12i City or town, state or province, country, ZIP or foreign postal code 15i City or town, state or province, country, ZIP or foreign postal code 13a Recipient's U.S. TIN, if any 13h Recipient's GIIN 13b Ch.

3 status code 13d Recipient's name 13i Recipient's foreign tax identification number, if any 13c Ch. 4 status code 13e Recipient's country code 16 Recipient's account number 18 Payer's name 13f Address (number and street) 19 Payer's TIN Click here to use the form. 13g City or town, state or province, country, ZIP or foreign postal code 21 State income tax withheld For Privacy Act and Paperwork Reduction Act Notice, see instructions. 17 Recipient's date of birth 22 Payer’s state tax no. Cat. No.

11386R 20 Payer's GIIN 23 Name of state Form 1042-S (2015) . Explanation of Codes (continued) Pensions, annuities, alimony, and/or insurance premiums Scholarship or fellowship grants Compensation for independent personal services2 Compensation for dependent personal services2 Compensation for teaching2 Compensation during studying and training2 Gross income—Other Real estate investment trust (REIT) distributions of capital gains Trust distributions subject to IRC section 1445 Unsevered growing crops and timber distributions by a trust subject to IRC section 1445 27 Publicly traded partnership distributions subject to IRC section 1446 28 Gambling winnings3 32 Notional principal contract income4 35 Substitute payment—other 36 Capital gains distributions 37 Return of capital Eligible deferred compensation items subject to IRC section 877A(d)(1) 38 39 Distributions from a nongrantor trust subject to IRC section 877A(f)(1) Guarantee of indebtedness 41 42 Earnings as an artist or athlete—no central withholding agreement5 43 Earnings as an artist or athlete—central withholding agreement5 44 Specified Federal procurement payments 50 Income previously reported under escrow procedure6 54 Other income Boxes 3a and 4a. Exemption code (applies if the tax rate entered in boxes 3b and 4b is 00.00). Code Authority for Exemption Chapter 3 Effectively connected income 01 02 Exempt under IRC (other than portfolio interest) 03 Income is not from U.S. sources Other 15 16 17 18 19 20 23 24 25 26 2 If See back of Copy D for additional codes compensation that otherwise would be covered under Income Codes 17 through 20 is directly attributable to the recipient’s occupation as an artist or athlete, use Income Code 42 or 43 instead. 3 Subject 4 Use 5 If 04 Exempt under tax treaty 05 Portfolio interest exempt under IRC 06 QI that assumes primary withholding responsibility 07 WFP or WFT 08 U.S. branch treated as U.S.

Person 09 Territory FI treated as U.S. Person 10 QI represents that income is exempt 11 QSL that assumes primary withholding responsibility 12 Payee subjected to chapter 4 withholding Chapter 4 13 Grandfathered payment 14 Effectively connected income 15 Payee not subject to chapter 4 withholding 16 Excluded nonfinancial payment 17 Foreign Entity that assumes primary withholding responsibility U.S. Payees—of participating FFI or registered deemed-compliant FFI 18 19 Exempt from withholding under IGA7 20 Dormant account8 Excluded payment on offshore obligation 21 22 Excluded payments on Collateral9 Code Type of Recipient, Withholding Agent, or Intermediary Chapter 3 Status Codes 01 U.S.

Withholding Agent—FI 02 U.S. Withholding Agent—Other 03 Territory FI—treated as U.S. Person 04 Territory FI—not treated as U.S.

Person 05 U.S. branch—treated as U.S. Person 06 U.S.

branch—not treated as U.S. Person 07 U.S. branch—ECI presumption applied 08 Partnership other than Withholding Foreign Partnership 09 Withholding Foreign Partnership to 30% withholding rate unless the recipient is from one of the treaty countries listed under Gambling winnings (Income Code 28) in Pub.

515. appropriate Interest Income Code for embedded interest in a notional principal contract. Income Code 42 or 43 is used, Recipient Code 22 (artist or athlete) should be used instead of Recipient Code 16 (individual), 15 (corporation), or 08 (partnership other than withholding foreign partnership). 6 Use only to report gross income the tax for which is being deposited in the current year because such tax was previously escrowed for chapters 3 and 4 and the withholding agent previously reported the gross income in a prior year and checked the box to report the tax as not deposited under the escrow procedure. See the instructions to this form for further explanation. 7 Use only to report a U.S. reportable account or non-consenting U.S.

account that is receiving a payment subject to chapter 3 withholding. Click here to use the form. 8 Use only if applying the escrow procedure for dormant accounts under Regulations section 1.1471-4(b)(6). If tax was withheld and deposited under chapter 3, do not check the “tax not deposited with IRS pursuant to escrow procedure” box. You must instead check box 3 and complete box 3b. 9 This code should only be used if the income paid is not subject to withholding under chapter 4 pursuant to Regulations section 1.1473-1(a)(4)(vii). .

Form 1042-S Foreign Person’s U.S. Source Income Subject to Withholding Department of the Treasury Internal Revenue Service 1 Income 2 Gross income code Information about Form 1042-S and its separate instructions is at www.irs.gov/form1042s. AMENDED 4 Chap. 4: 3a Exemption code 4a Exemption code . Copy D for Recipient 4b Tax rate Attach to any state tax return you file 5 Withholding allowance 6 Net income . 8 Tax withheld by other agents 10 Total withholding credit 12a Withholding agent’s EIN OMB No. 1545-0096 PRO-RATA BASIS REPORTING 3 Chap.

3: 3b Tax rate 2015 Check if tax not deposited with IRS pursuant to escrow procedure 7 Federal tax withheld 9 Tax paid by withholding agent 11 Amount repaid to recipient 12b Ch. 3 status code 12c Ch. 4 status code 14a Primary Withholding Agent's Name (if applicable) 14b Primary Withholding Agent's EIN 15a Intermediary or flow-through entity's EIN, if any 12d Withholding agent's name 15b Ch.

3 status code 15c Ch. 4 status code 12e Withholding agent's Global Intermediary Identification Number (GIIN) 15d Intermediary or flow-through entity's name 12f Country code 12g Foreign taxpayer identification number, if any 15e Intermediary or flow-through entity's GIIN 15f Country code 15g Foreign tax identification number, if any 12h Address (number and street) 15h Address (number and street) 12i City or town, state or province, country, ZIP or foreign postal code 15i City or town, state or province, country, ZIP or foreign postal code 13a Recipient's U.S. TIN, if any 13h Recipient's GIIN 13b Ch.

3 status code 13d Recipient's name 13i Recipient's foreign tax identification number, if any 13c Ch. 4 status code 13e Recipient's country code 16 Recipient's account number 18 Payer's name 13f Address (number and street) 19 Payer's TIN Click here to use the form. 13g City or town, state or province, country, ZIP or foreign postal code 21 State income tax withheld For Privacy Act and Paperwork Reduction Act Notice, see instructions. 17 Recipient's date of birth 22 Payer’s state tax no. Cat. No.

11386R 20 Payer's GIIN 23 Name of state Form 1042-S (2015) . Explanation of Codes (continued) 12 Certified Deemed-Compliant FFI—Non-Registering Local Bank 13 Certified Deemed-Compliant FFI—Sponsored Entity 10 Trust other than Withholding Foreign Trust 14 Certified Deemed-Compliant FFI—Investment Advisor or Investment Manager 11 Withholding Foreign Trust 15 Nonparticipating FFI 12 Qualified Intermediary 16 Owner-Documented FFI Qualified Securities Lender—Qualified Intermediary 13 17 Limited Branch treated as Nonparticipating FFI 14 Qualified Securities Lender—Other 18 Limited FFI treated as Nonparticipating FFI 15 Corporation 19 Passive NFFE identifying Substantial U.S. Owners 16 Individual 20 Passive NFFE with no Substantial U.S. Owners 17 Estate 21 Publicly Traded NFFE or Affiliate of Publicly Traded NFFE 18 Private Foundation 22 Active NFFE 19 Government or International Organization 23 Individual 20 Tax Exempt Organization (Section 501(c) entities) Section 501(c) Entities 24 21 Unknown Recipient Excepted Territory NFFE 22 Artist or Athlete 25 23 Pension Excepted NFFE — Other 26 Exempt Beneficial Owner 24 Foreign Central Bank of Issue 27 25 Nonqualified Intermediary Entity Wholly Owned by Exempt Beneficial Owners 28 Unknown Recipient 26 Hybrid entity making Treaty Claim 29 Recalcitrant Account Holder 30 Pooled Reporting Codes10 Nonreporting IGA FFI 31 27 Withholding Rate Pool—General Direct reporting NFFE 32 28 Withholding Rate Pool—Exempt Organization U.S. reportable account 33 29 PAI Withholding Rate Pool—General Non-consenting U.S.

account 34 30 PAI Withholding Rate Pool—Exempt Organization Sponsored direct reporting NFFE 35 31 Agency Withholding Rate Pool—General Excepted Inter-affiliate FFI 36 32 Agency Withholding Rate Pool—Exempt Organization Undocumented Preexisting Obligation 37 33 Joint account withholding rate pool U.S. Branch—ECI presumption applied 38 Chapter 4 Status Codes Account Holder of Excluded Financial Account11 39 01 U.S. Withholding Agent—FI 40 Passive NFFE reported by FFI12 02 U.S.

Withholding Agent—Other 41 NFFE subject to 1472 withholding 03 Territory FI—not treated as U.S. Person Pooled Reporting Codes 04 Territory FI—treated as U.S. Person 42 Recalcitrant Pool—No U.S.

Indicia 05 Participating FFI—Other 43 Recalcitrant Pool—U.S. Indicia 06 Participating FFI—Reporting Model 2 FFI 44 Recalcitrant Pool—Dormant Account 07 Registered Deemed-Compliant FFI—Reporting Model 1 FFI 45 Recalcitrant Pool—U.S. Persons 08 Registered Deemed-Compliant FFI—Sponsored Entity 46 Recalcitrant Pool—Passive NFFEs 09 Registered Deemed-Compliant FFI—Other 47 Nonparticipating FFI Pool 10 Certified Deemed-Compliant FFI—Other 48 U.S.

Payees Pool 11 49 Certified Deemed-Compliant FFI—FFI with Low Value Accounts QI-Recalcitrant Pool—GeneraI13 10 These codes should only be used by a QI, QSL, WP, or WT. 11 This code should only be used if income is paid to an account that is excluded from the definition of financial account under Regulations section 1.1471-5(b)(2) or under Annex II of the applicable Model 1 IGA or Model 2 IGA. 12 This Click here to use the form. code should only be used when the withholding agent has received a certification on the FFI withholding statement of a participating FFI or registered deemed-compliant FFI that maintains the account that the FFI has reported the account held by the passive NFFE as a U.S. account (or U.S. reportable account) under it's FATCA requirements.

The withholding agent must report the name and GIIN of such FFA in box 15d and 15e. 13 This code should only be used by a withholding agent that is reporting a payment (or portion of a payment) made to a QI with respect to the QI's recalcitrant account holders. . Form 1042-S Foreign Person’s U.S. Source Income Subject to Withholding Department of the Treasury Internal Revenue Service 1 Income 2 Gross income code Information about Form 1042-S and its separate instructions is at www.irs.gov/form1042s. AMENDED 2015 OMB No. 1545-0096 Copy E PRO-RATA BASIS REPORTING 3 Chap. 3: 4 Chap.

4: 5 Withholding allowance 3a Exemption code 4a Exemption code for Withholding Agent 6 Net income Check if tax not deposited with IRS pursuant to escrow procedure 3b Tax rate . 4b Tax rate . 8 Tax withheld by other agents 10 Total withholding credit 12a Withholding agent’s EIN 7 Federal tax withheld 9 Tax paid by withholding agent 11 Amount repaid to recipient 12b Ch. 3 status code 12c Ch. 4 status code 14a Primary Withholding Agent's Name (if applicable) 14b Primary Withholding Agent's EIN 15a Intermediary or flow-through entity's EIN, if any 12d Withholding agent's name 15b Ch.

3 status code 15c Ch. 4 status code 12e Withholding agent's Global Intermediary Identification Number (GIIN) 15d Intermediary or flow-through entity's name 12f Country code 12g Foreign taxpayer identification number, if any 15e Intermediary or flow-through entity's GIIN 15f Country code 15g Foreign tax identification number, if any 12h Address (number and street) 15h Address (number and street) 12i City or town, state or province, country, ZIP or foreign postal code 15i City or town, state or province, country, ZIP or foreign postal code 13a Recipient's U.S. TIN, if any 13h Recipient's GIIN 13b Ch.

3 status code 13d Recipient's name 13i Recipient's foreign tax identification number, if any 13c Ch. 4 status code 13e Recipient's country code 16 Recipient's account number 18 Payer's name 13f Address (number and street) 19 Payer's TIN Click here to use the form. 13g City or town, state or province, country, ZIP or foreign postal code 21 State income tax withheld For Privacy Act and Paperwork Reduction Act Notice, see instructions. 17 Recipient's date of birth 22 Payer’s state tax no. Cat. No.

11386R 20 Payer's GIIN 23 Name of state Form 1042-S (2015) . DO NOT STAPLE Form 1042-T OMB No. 1545-0096 Annual Summary and Transmittal of Forms 1042-S Department of the Treasury Internal Revenue Service 2015 Employer identification number 1) Ch. 4 Status Code 2) Ch. 3 Status Code Name of withholding agent Number, street, and room or suite no. City or town, state or province, country, and ZIP or foreign postal code 1a Type of paper Forms 1042-S attached (check only one box): Also check here if pro-rata (see instructions) b Number of paper Forms 1042-S attached 2 Original Total gross income reported on all paper Forms 1042-S (box 2) attached . 3 Total federal tax withheld on all paper Forms 1042-S attached: a Total federal tax withheld under chapter 4 .

. . .

. . .

. b Total federal tax withheld under chapter 3 . . .

. . .

. . . . . . . . Amended . . . . . . . . $ $ $ Caution: If you have already filed a Form 1042 and an attached Form 1042-S causes the gross income or tax withheld information shown on your previously filed Form 1042 to change, you must file an amended Form 1042. See the instructions below. If this is your FINAL return, enter an “X” here (see instructions) Click here to use the form. Please return this entire page to the Internal Revenue Service. Sign Here Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete. Your signature Title Instructions Purpose of form.

Use this form to transmit paper Forms 1042-S, Foreign Person’s U.S. Source Income Subject to Withholding, to the Internal Revenue Service. Use a separate Form 1042-T to transmit each type of Form 1042-S (see the instructions for line 1a). Electronic filing requirement.

If you file 250 or more Forms 1042S, you are required to submit them electronically. If you submit less than 250 Forms 1042-S, you are encouraged to file them electronically. If you are a financial institution you are required to submit Form 1042-S electronically irrespective of the number of Forms 1042-S you submit.

If you submit Forms 1042-S electronically, do not use Form 1042-T. See the instructions for Form 1042 for the definition of financial institution. Filing Forms 1042 and 1042-S. Use of this form to transmit paper Forms 1042-S does not affect your obligation to file Form 1042, Annual Withholding Tax Return for U.S.

Source Income of Foreign Persons. If you have not yet filed a Form 1042 for 2015, you may send in more than one Form 1042-T to submit paper Forms 1042-S prior to filing your Form 1042. You may submit amended Forms 1042-S even though changes reflect differences in gross income and tax withheld information of Forms 1042-S previously submitted with a Form 1042-T. If you have already filed a Form 1042 for 2015 and an attached Form 1042-S caused the gross income or tax withheld information previously reported on line 62c or 63e of your Form 1042 to change, you must file an amended Form 1042. Where and when to file. File Form 1042-T (and Copy A of the paper Forms 1042-S being transmitted) with the Ogden Service Center; P.O.

Box 409101; Ogden, UT 84409; by March 15, 2016. Send the forms in a flat mailing (not folded). Date Daytime phone number Identifying information at top of form. The name, address, EIN, and chapter 4 and 3 status codes of the withholding agent named on this form must be the same as those you enter on Forms 1042 and 1042-S. See the instructions for Form 1042 for definitions of withholding agent.

See the instructions for Form 1042-S for the withholding agent codes for the chapter 3 and 4 status codes. See instructions for Form 1042-S for the definition of withholdable payment to determine when a chapter 4 status code is required. Line 1a. You must file a separate Form 1042-T for each type of paper Form 1042-S you are transmitting.

Check only the Original or Amended box. If you are filing pro-rata Forms 1042-S (see Form 1042-S instructions), also check the pro-rata box. As a result, there are four possible types of Form 1042-S that may be transmitted: • Original non pro-rata • Original pro-rata • Amended non pro-rata • Amended pro-rata Each type must be transmitted with a separate Form 1042-T.

For example, you must transmit only original non pro-rata Forms 1042S with one Form 1042-T. Line 2. Enter the total of the gross income amounts shown on the Forms 1042-S (box 2) being transmitted with this Form 1042-T. Line 3. Enter the total of the federal tax withheld amounts shown on all Forms 1042-S (total of amounts in boxes 7, 8, and 9, reduced by any amount in box 11) being transmitted with this Form 1042-T. Allocate withheld amounts between chapter 4 and chapter 3 on lines 3a and 3b. Final return.

If you will not be required to file additional Forms 1042-S, including amended Forms 1042-S for the 2015 year (on paper or electronically), enter an “X” in the “FINAL return” box. Paperwork Reduction Act Notice. The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is 12 minutes. For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S. Cat. No.

28848W Form 1042-T (2015) . Form 8809 (Rev. September 2015) Application for Extension of Time To File Information Returns OMB No. 1545-1081 (For Forms W-2, W-2G, 1042-S, 1094-C, 1095, 1097, 1098, 1099, 3921, 3922, 5498, and 8027) Department of the Treasury Internal Revenue Service This form may be filled out online. See How to file below. Do not use this form to request an extension of time to (1) file Form 1040 (use Form 4868), (2) file Form 1042 (use Form 7004), or (3) furnish statements to recipients (see Extensions under part M in the General Instructions for Certain Information Returns). 2 Taxpayer identification number (TIN) (Enter the payer/filer nine-digit number. Do not enter hyphens.) 1 Payer's/filer's information.

Type or print clearly in black ink. Payer's/filer's name Address City State Contact name ZIP Code Telephone number Email address 3 Check your method of filing information returns (check only one box). Use a separate Form 8809 for each method. electronic 5 6 paper 4 If you are requesting an extension for more than one payer/filer, enter the total number of payers/ filers and attach a list of names and taxpayer identification numbers. See How to file below for details. Check this box only if you already requested the automatic extension and you now need an additional extension.

See instructions. Check only the box(es) that apply. Do not enter the number of returns. Form(s) W-2 Form(s) here here 5498 Click here to use the form. Form(s) here 8027 1097, 1098, 1099, 3921, 3922, W-2G 5498-ESA 1094-C, 1095-C 1042-S 5498-SA 1095-B If you checked the box on line 5, state in detail why you need an additional extension of time. You must provide sufficient cause as to why you were not able to file by the date granted by the first extension request.

If you need more space, attach additional sheets. Include the payer/filer name and taxpayer identification number on each additional page. 7 Under penalties of perjury, I declare that I have examined this form, including any accompanying statements, and, to the best of my knowledge and belief, it is true, correct, and complete. Signature Date Title General Instructions Purpose of form. Use Form 8809 to request an initial or additional extension of time to file only the forms shown in line 6 for the current tax year. Who should file.

Payers/filers who need more time to file information returns with the IRS should file this form before the filing due date. See When to file, later. How to file. Extensions may be requested. • Online by completing a fill-in Form 8809 through the FIRE system at http://fire.irs.gov for an automatic 30-day extension. Acknowledgements are automatically displayed online if the request is made by the due date of the return. • Electronically through the FIRE system in a file formatted according to the specifications in Pub.

1220. Extension requests for Form 5498-QA can only be filed on paper. Write “5498-QA” in the large gray box below box 2. ! CAUTION For Privacy Act and Paperwork Reduction Act Notice, see page 2. • On paper Form 8809. Mail the form to the address shown in Where to file, later, or fax it to 1-877-477-0572 (toll free).

You are encouraged to submit your request via the online fill-in form. Where to file. Send Form 8809 to: Internal Revenue Service Attn: Extension of Time Coordinator 240 Murall Drive, Mail Stop 4360 Kearneysville, WV 25430 Need help? If you have questions about Form 8809, call the IRS toll free at 1-866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not toll free). Also, see Pub.

1220 and Pub. 1187. For additional information, see Topic 803, Waivers and Extensions, at www.irs.gov/taxtopics. Note: Specifications for filing Forms W-2, Wage and Tax Statement, electronically are only available from the Social Security Administration (SSA).

Call 1-800-772-6270 for more information or visit the SSA's Employer W-2 Filing Instructions & Information page at www.socialsecurity.gov/employer. Cat. No. 10322N www.irs.gov/form8809 Form 8809 (Rev.

9-2015) . Page 2 Form 8809 (Rev. 9-2015) When to file. File Form 8809 as soon as you know an extension of time to file is necessary, but not before January 1 of the filing year. Form 8809 must be filed by the due date of the returns. See the chart below that shows the due dates for filing this form on paper or electronically.

Payers/filers of Form W-2 whose business has terminated should see Terminating a business in the Special Reporting Situations for Form W-2 section of the General Instructions for Forms W-2 and W-3 to request an extension. If you are requesting an extension of time to file several types of forms, you may use one Form 8809, but you must file Form 8809 by the earliest due date. For example, if you are requesting an extension of time to file both Forms 1099 and 5498, you must file Form 8809 by February 28 (March 31 if you file electronically). You may complete more than one Form 8809 to avoid this problem.

An extension cannot be granted if a request is filed after the filing due date of the information returns. The due dates for filing Form 8809 are shown below. IF you file Form(s) . . . ELECTRONICALLY, ON PAPER, then the due then the due date is .

. . date is . .

. W-2 Last day of February March 31 W-2G February 28 March 31 1042-S March 15 February 28 March 31 1095 February 28 March 31 1097 February 28 March 31 1098 February 28 March 31 1099 February 28 March 31 3921 February 28 3922 February 28 5498 May 31 May 31 8027 Last day of February March 31 ! March 15 1094-C The legal name and TIN on your extension request must be exactly the same as the name you provided when you applied for your EIN using Form SS-4, Application CAUTION for Identification Number, the Online Internet EIN Application, or the EIN Toll-Free Telephone Service. If a name change has been submitted to the IRS, supply the current legal name and TIN. Do not use abbreviations. Enter the name of someone who is familiar with this request whom the IRS can contact if additional information is required. Please provide your telephone number and email address. Line 2.

Enter the payer's/filer's nine-digit employer identification number (EIN) or qualified intermediary employer identification number (QI-EIN). If you are not required to have an EIN or QI-EIN, enter your social security number. Do not enter hyphens. Line 5.

Check this box only if you have already received the automatic 30-day extension, and you need an additional extension for the same year for the same forms. Do not check this box unless you requested an original extension. If you check this box, be sure to complete line 7. Signature. No signature is required for the automatic 30-day extension.

For an additional extension, Form 8809 must be signed by the payer/filer or a person who is duly authorized to sign a return. Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. We use this information to determine if you qualify for an extension of time to file information returns.

You are not required to request an extension of time to file; however, if you request an extension, sections 6081 and 6109 and their regulations require you to provide this information, including your identification number. Failure to provide this information may delay or prevent processing your request; providing false or fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws.

We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103. The time needed to complete and file this form will vary depending on individual circumstances.

The estimated average time is: Recordkeeping . . .

. . .

. . .

. . .

4 hr., 4 min. Learning about the law or the form . . .

. . .

. 18 min. Preparing and sending the form to the IRS . .

. . .

. . .

. . .

. . 22 min. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you.

You can send us comments from www.irs.gov/formspubs. Click on More Information and then click on Give us feedback. Or you can send your comments to the Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave.

NW, IR-6526, Washington, DC 20224. Do not send the form to this address. Instead, see Where to file, earlier. Click here to use the form. March 31 March 31 If any due date falls on a Saturday, Sunday, or legal holiday, file by the next business day. Note: File your information returns as soon as they are ready and do not send a copy of Form 8809 or any letters with the returns you file (see exception below). Exception.

When filing Form 8027 on paper only, attach a copy of your timely filed Form 8809. Extension period. The automatic extension is 30 days from the original due date. You may request one additional extension of not more than 30 days by submitting a second Form 8809 before the end of the first extension period (see Line 5, later).

Requests for an additional extension of time to file information returns are not automatically granted. Generally, requests for additional time are granted only where it is shown that extenuating circumstances prevented filing by the date granted by the first request. Note: The automatic extension of time to file and any approved requests for additional time will only extend the due date for filing the information returns with the IRS. It does not extend the due date for furnishing statements to recipients. Penalty.

Payers/filers may be subject to a late filing penalty if required information returns are filed late and you have not applied for and received an approved extension of time to file. The amount of the penalty is based on when you file the correct information return. For more information on penalties, see part O in the General Instructions for Certain Information Returns, and Penalties in the Instructions for Form 1042-S, the Instructions for Form 8027, and the General Instructions for Forms W-2 and W-3. Specific Instructions Line 1.

Enter the payer's/filer's name and complete mailing address, including room or suite number of the filer requesting the extension of time. Use the name and address where you want correspondence sent. For example, if you are a preparer and want to receive correspondence, enter your client’s complete name, care of (c/o) your firm, and your complete mailing address. .

W-9 Form (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: C Corporation S Corporation Partnership Trust/estate Individual/sole proprietor or single-member LLC Limited liability company.

Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner. 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.) Other (see instructions) 5 Address (number, street, and apt. or suite no.) Requester’s name and address (optional) 6 City, state, and ZIP code 7 List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box.

The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3.

For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. Social security number – or Employer identification number Click here to use the form. Part II – – Certification Under penalties of perjury, I certify that: 1.

The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S.

citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions.

You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN.

See the instructions on page 3. Sign Here Signature of U.S. person Date General Instructions • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted. • Form 1099-C (canceled debt) Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9. • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S.

person (including a resident alien), to provide your correct TIN. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following: If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. • Form 1099-INT (interest earned or paid) 3.

Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S.

person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2.

Certify that you are not subject to backup withholding, or 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. • Form 1099-K (merchant card and third party network transactions) Cat.

No. 10231X Form W-9 (Rev. 12-2014) .

Page 2 Form W-9 (Rev. 12-2014) Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9. Definition of a U.S.

person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S.

resident alien; • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; • An estate (other than a foreign estate); or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax.

Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income. In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S.

status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States: • In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity; • In the case of a grantor trust with a U.S.

grantor or other U.S. owner, generally, the U.S. grantor or other U.S.

owner of the grantor trust and not the trust; and • In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person.

If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9.

Instead, use the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income.

However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. 3. The IRS tells the requester that you furnished an incorrect TIN, 4.

The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See Exempt payee code on page 3 and the separate Instructions for the Requester of Form W-9 for more information. Also see Special rules for partnerships above. What is FATCA reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons.

Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W-9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt.

In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Click here to use the form. If you are a U.S.

resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country.

Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4.

The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States.

Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233. Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments.

This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2.

You do not certify your TIN when required (see the Part II instructions on page 3 for details), Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank.

The name should match the name on your tax return. If this Form W-9 is for a joint account, list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. a. Individual. Generally, enter the name shown on your tax return.

If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note. ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application. b.

Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2. c.

Partnership, LLC that is not a single-member LLC, C Corporation, or S Corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2. d. Other entities.

Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity.

You may enter any business, trade, or DBA name on line 2. e. Disregarded entity. For U.S.

federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity.

The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S.

person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes.

Enter the disregarded entity's name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN. .

Page 3 Form W-9 (Rev. 12-2014) Line 2 2 If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2. Line 3 Check the appropriate box in line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box in line 3. Limited Liability Company (LLC).

If the name on line 1 is an LLC treated as a partnership for U.S. federal tax purposes, check the “Limited Liability Company” box and enter “P” in the space provided. If the LLC has filed Form 8832 or 2553 to be taxed as a corporation, check the “Limited Liability Company” box and in the space provided enter “C” for C corporation or “S” for S corporation.

If it is a single-member LLC that is a disregarded entity, do not check the “Limited Liability Company” box; instead check the first box in line 3 “Individual/sole proprietor or single-member LLC.” However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions.

Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code. A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37) B—The United States or any of its agencies or instrumentalities Line 4, Exemptions If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space in line 4 any code(s) that may apply to you. Exempt payee code. • Generally, individuals (including sole proprietors) are not exempt from backup withholding. • Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. • Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. • Corporations are not exempt from backup withholding with respect to attorneys' fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC. The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2) C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i) E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i) F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state G—A real estate investment trust H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940 I—A common trust fund as defined in section 584(a) J—A bank as defined in section 581 K—A broker Click here to use the form. 2—The United States or any of its agencies or instrumentalities 3—A state, the District of Columbia, a U.S.

commonwealth or possession, or any of their political subdivisions or instrumentalities 4—A foreign government or any of its political subdivisions, agencies, or instrumentalities 5—A corporation 6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession 7—A futures commission merchant registered with the Commodity Futures Trading Commission 8—A real estate investment trust 9—An entity registered at all times during the tax year under the Investment Company Act of 1940 10—A common trust fund operated by a bank under section 584(a) 11—A financial institution 12—A middleman known in the investment community as a nominee or custodian 13—A trust exempt from tax under section 664 or described in section 4947 The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13. L—A trust exempt from tax under section 664 or described in section 4947(a)(1) M—A tax exempt trust under a section 403(b) plan or section 457(g) plan Note.

You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. Line 6 Enter your city, state, and ZIP code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box.

If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN.

However, the IRS prefers that you use your SSN. If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on this page), enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN. IF the payment is for .

. . THEN the payment is exempt for . .

. Note. See the chart on page 4 for further clarification of name and TIN combinations. Interest and dividend payments All exempt payees except for 7 Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. How to get a TIN.

If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213.

Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676). Barter exchange transactions and patronage dividends Exempt payees 1 through 4 Payments over $600 required to be 1 reported and direct sales over $5,000 Generally, exempt payees 2 1 through 5 Payments made in settlement of payment card or third party network transactions Exempt payees 1 through 4 1 See Form 1099-MISC, Miscellaneous Income, and its instructions. If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester.

For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note.

Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8. . Page 4 Form W-9 (Rev. 12-2014) Part II. Certification 3 To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9.

You may be requested to sign by the withholding agent even if items 1, 4, or 5 below indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code earlier. Signature requirements.

Complete the certification as indicated in items 1 through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2.

Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3.

Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4.

Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5.

Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester Give name and SSN of: The individual The actual owner of the account or, if combined funds, the first 1 individual on the account 3. Custodian account of a minor (Uniform Gift to Minors Act) The minor 4.

a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law 5.

Sole proprietorship or disregarded entity owned by an individual 6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i) (A)) The grantor-trustee 2 1 1 The actual owner The grantor* Give name and EIN of: The owner 4 Legal entity 9. Corporation or LLC electing corporate status on Form 8832 or Form 2553 10.

Association, club, religious, charitable, educational, or other taxexempt organization The corporation 11. Partnership or multi-member LLC 12. A broker or registered nominee The partnership The broker or nominee 13.

Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments The public entity 14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i) (B)) The trust 2 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 2. *Note.

Grantor also must provide a Form W-9 to trustee of trust. Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance.

You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The organization List first and circle the name of the person whose number you furnish.

If only one person on a joint account has an SSN, that person’s number must be furnished. Circle the minor’s name and furnish the minor’s SSN. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484.

You can forward suspicious emails to the Federal Trade Commission at: spam@uce.gov or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT (1-877-438-4338). Visit IRS.gov to learn more about identity theft and how to reduce your risk. 3 The owner For this type of account: 1 4 Click here to use the form. For this type of account: 1. Individual 2. Two or more individuals (joint account) 7.

Disregarded entity not owned by an individual 8. A valid trust, estate, or pension trust You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA.

The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. .

POINTS TO REMEMBER 1. Furnish (postmark) statements to recipients by January 31, 2016 (February 16 for Forms 1099-B, 1099-S and 1099-MISC if amounts are reported in Boxes 8 or 14), including the Fair Market Value of an IRA or contributions to an education IRA. 2. File (postmark) Forms 1098, 1099, 3921, 3922, W-2G with the IRS by February 29, 2016 or electronically by March 31, 2016. 3. File (postmark) Form 5498, 5498-ESA, or 5498-SA with the IRS and furnish (postmark) IRA contribution information to participants by May 31, 2016. 4.

Government approved forms must be used for Copy A paper filed with the Internal Revenue Service. Submit a separate Form 1096 for each type of information return that you file. 5. You may submit originals and corrections together with one Form 1096. 6. Be sure that the filer information on Form 1096 is the same as the filer information on Forms 1099, 1098, 3921, 3922 and 5498.

Filer information includes name, address, and tax identification number of the person or company filing the 1096. 7. If you are required to submit an information return, you must provide that person's TIN on the return. A penalty will be charged to those who cannot demonstrate that they made a proper attempt to obtain correct numbers. Use Form W-9 to request a TIN from a payee.

Proper matching of a TIN and name is important. When using a SSN the individual’s name must be reported as the recipient’s name, when reporting to a TIN the entities name must be used as the recipient’s name to prevent future correspondence from the IRS. 8. Electronic Filing a.

If you file more than 250 information returns, you must file electronically. b. All information returns are looked at separately to determine whether you need to file electronically. c. To get approval to file electronically, fill out Form 4419 "Application for Filing Information Returns Electronically (FIRE)", at least 30 days before the due date of the returns.

The form only needs to be filed one time for all information returns. d. If filing by electronically would cause an undue hardship, it is possible to get a waiver. Submit Form 8508 "Request for Waiver from Filing Information Returns Electronically" at least 45 days before the due date of the returns.

If approved, it would allow you to file your information returns on paper. You cannot apply for a waiver for more than one year at a time. 9. 1099s required recipients are for the following different types of entities: A.

Sole Proprietors – Yes B. Partnerships – Yes C. Corporations – No (except for, but not limited to attorneys’ fees and medical and health care payments) D.

LLP – Yes E. LLC – Depends on if the company is filing taxes as a corporation or as a partnership. This information can be obtained from Form W-9. F.

Tax Exempt Entities – No . Guide to Information Returns (If any date shown falls on a Saturday, Sunday, or legal holiday, the due date is the next business day.) Due Date 1042-S 1097-BTC Amounts To Report Title What To Report Foreign Person's U.S. Source Income Subject to Withholding Income such as interest, dividends, royalties, pensions and annuities, etc., and amounts withheld under Chapter 3. Also, distributions of effectively connected income by publicly traded partnerships or nominees. Bond Tax Credit To IRS To Recipient (unless indicated otherwise) See form instructions March 15 March 15 All amounts Form February 28* On or before the 15th day of the 2nd calendar month after the close of the calendar month in which the credit is allowed $600 or more February 28* (To Payer/Borrower) January 31 Gross proceeds of more than $500 February 28* (To Donor) 30 days from date of sale or contribution $600 or more February 28* January 31 Tax credit bond credits to shareholders. 1098 Mortgage Interest Statement Mortgage interest (including points) and certain mortgage insurance premiums you received in the course of your trade or business from individuals and reimbursements of overpaid interest. 1098-C Contributions of Information regarding a donated motor vehicle, boat, or airplane. Motor Vehicles, Boats, and Airplanes 1098-E Student Loan Interest Statement Student loan interest received in the course of your trade or business. 1098-MA Mortgage Assistance Payments Assistance payments paid to homeowners from funds allocated from the Housing Finance Agency Innovation Fund for the Hardest Hit Housing Markets (HFA Hardest Hit Fund) or the Emergency Homeowners' Loan Program All amounts February 28* January 31 Qualifying Longevity Annuity Contract Information Status of a contract that is intended to be a qualifying longevity annuity contract (QLAC), defined in section A-17 of 1.401(a)(9)-6, that is purchased or held under any plan, annuity, or account described in section 401(a), 403(a), 403(b), or 408 (other than a Roth IRA) or eligible governmental plan under section 457(b). All amounts February 28 January 31 1098-T Tuition Statement Qualified tuition and related expenses, reimbursements or refunds, and scholarships or grants (optional). See instructions February 28* January 31 1099-A Acquisition or Abandonment of Secured Property Information about the acquisition or abandonment of property that is security for a debt for which you are the lender. All amounts February 28* (To Borrower) January 31 1099-B Proceeds From Broker and Barter Exchange Transactions Sales or redemptions of securities, futures transactions, commodities, and barter exchange transactions. All amounts February 28* February 15** Cancellation of Debt Cancellation of a debt owed to a financial institution, the Federal Government, a credit union, RTC, FDIC, NCUA, a military department, the U.S. Postal Service, the Postal Rate Commission, or any organization having a significant trade or business of lending money. $600 or more February 28* January 31 Over $1,000 February 28* (To Shareholders) January 31 $10 or more, except $600 or more for liquidations February 28* January 31** $10 or more for refunds and unemployment February 28* January 31 $10 or more ($600 or more in some cases) February 28* January 31** February 28* January 31 1098-Q 1099-C 1099-CAP Changes in Information about cash, stock, or other property from an acquisition of Corporate Control control or the substantial change in capital structure of a corporation. and Capital Structure 1099-DIV Dividends and Distributions Distributions, such as dividends, capital gain distributions, or nontaxable distributions, that were paid on stock and liquidation distributions (including distributions reported pursuant to an election described in Regulations section 1.1471-4(d)(5)(i)(A) or reported as described in Regulations section 1.1471-4(d)(2)(iii)(A)). 1099-G Certain Government Payments Unemployment compensation, state and local income tax refunds, agricultural payments, and taxable grants. 1099-INT Interest Income Interest income (including payments reported pursuant to an election described in Regulations section 1.1471-4(d)(5)(i)(A) or reported as described in Regulations section 1.1471-4(d)(2)(iii)(A)). 1099-K Payment Card and Third Party Network Transactions Payment card transactions. All amounts $20,000 or more and 200 or more transactions Third party network transactions. *The due date is March 31 if filed electronically. **The due date is March 15 for reporting by trustees and middlemen of WHFITs. ­24­ Gen.

Instr. for Certain Info. Returns (2015) .

Guide to Information Returns (Continued) Due Date Form 1099-LTC 1099-MISC Title Long-Term Care and Accelerated Death Benefits Amounts To Report What To Report Payments under a long-term care insurance contract and accelerated death benefits paid under a life insurance contract or by a viatical settlement provider. To IRS To Recipient (unless indicated otherwise) All amounts February 28* January 31 Miscellaneous Income Rent or royalty payments; prizes and awards that are not for services, such as winnings on TV or radio shows (including payments reported $600 or more, except pursuant to an election described in Regulations section 1.1471-4(d)(5)(i) $10 or more for royalties (A) or reported as described in Regulations section 1.1471-4(d)(2)(iii)(A)). (Also, use to report direct sales of $5,000 or more of consumer goods for resale.) Payments to crew members by owners or operators of fishing boats including payments of proceeds from sale of catch. All amounts Section 409A income from nonqualified deferred compensation plans (NQDCs). All amounts Payments to a physician, physicians' corporation, or other supplier of health and medical services. Issued mainly by medical assistance programs or health and accident insurance plans. $600 or more Payments for services performed for a trade or business by people not treated as its employees (including payments reported pursuant to an election described in Regulations section 1.1471-4(d)(5)(i)(A) or reported as described in Regulations section 1.1471-4(d)(2)(iii)(A)). Examples: fees to subcontractors or directors and golden parachute payments. $600 or more Fish purchases paid in cash for resale. $600 or more Crop insurance proceeds. $600 or more January 31** February 28* Substitute dividends and tax-exempt interest payments reportable by brokers. $10 or more February 15** Gross Proceeds paid to attorneys $600 or more February 15** A U.S. account for chapter 4 purposes to which you made no payments during the year that are reportable on any applicable Form 1099 (or a U.S.

account to which you made payments during the year that do not reach the applicable reporting threshold for any applicable Form 1099) reported pursuant to an election described in Regulations section 1.1471-4(d)(5)(i)(A). All amounts (including $0) January 31** 1099-OID Original Issue Discount Original issue discount (including amounts reported pursuant to an election described in Regulations section 1.1471-4(d)(5)(i)(A) or reported as described in Regulations section 1.1471-4(d)(2)(iii)(A)). $10 or more February 28* January 31** 1099-PATR Taxable Distributions Received From Cooperatives $10 or more February 28* January 31 1099-Q Payments From Earnings from qualified tuition programs and Coverdell ESAs. Qualified Education Programs (Under Sections 529 and 530) All amounts February 28* January 31 Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Distributions from retirement or profit-sharing plans, any IRA, insurance contracts, and IRA recharacterizations (including payments reported pursuant to an election described in Regulations section 1.1471-4(d)(5)(i) (B) or reported as described in Regulations section 1.1471-4(d)(2)(iii)(A)). $10 or more February 28* January 31 1099-S Proceeds From Real Estate Transactions Gross proceeds from the sale or exchange of real estate and certain royalty payments. Generally, $600 or more February 28* February 15 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA Distributions from an HSA, Archer MSA, or Medicare Advantage MSA. All amounts February 28* January 31 1099-R Distributions from cooperatives passed through to their patrons including any domestic production activities deduction and certain pass-through credits. *The due date is March 31 if filed electronically. **The due date is March 15 for reporting by trustees and middlemen of WHFITs. ­25­ . Guide to Information Returns (Continued) Due Date Form Title Amounts To Report What To Report To IRS To Recipient (unless indicated otherwise) 3921 Exercise of an Transfer of stock pursuant to the exercise of an incentive stock option Incentive Stock Option under section 422(b). Under Section 422(b) All amounts February 28* January 31 3922 Transfer of Stock Acquired Through an Employee Stock Purchase Plan Under Section 423(c) Transfer of stock acquired through an employee stock purchase plan under section 423(c). All amounts February 28* January 31 IRA Contribution Information Contributions (including rollover contributions) to any individual retirement arrangement (IRA), including a SEP, SIMPLE, and Roth IRA; Roth conversions; IRA recharacterizations; and the fair market value (FMV) of the account. All amounts May 31 (To Participant) For FMV/RMD, Jan 31; For contributions, May 31 5498-ESA Coverdell ESA Contribution Information Contributions (including rollover contributions) to a Coverdell ESA. All amounts May 31 April 30 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information Contributions to an HSA (including transfers and rollovers) or Archer MSA and the FMV of an HSA, Archer MSA, or Medicare Advantage MSA. All amounts May 31 (To Participant) May 31 W-2G Certain Gambling Winnings Gambling winnings from horse racing, dog racing, jai alai, lotteries, keno, bingo, slot machines, sweepstakes, wagering pools, poker tournaments, etc. February 28* January 31 Wage and Tax Statement Wages, tips, other compensation; social security, Medicare, and withheld income taxes. Include bonuses, vacation allowances, severance pay, certain moving expense payments, some kinds of travel allowances, and third-party payments of sick pay. To SSA To Recipient Last day of February* January 31 5498 W-2 *The due date is March 31 if filed electronically. ­26­ Generally, $600 or more; $1,200 or more from bingo or slot machines; $1,500 or more from keno See separate instructions . Types of Payments Below is an alphabetic list of some payments and the forms to file and report them. However, it is not a complete list of all payments, and the absence of a payment from the list does not indicate that the payment is not reportable. For instructions on a specific type of payment, see the separate instructions in the form(s) listed. Type of Payment Report on Form Abandonment . . . .

. . .

. . .

. Accelerated death benefits . . .

. . Acquisition of control . .

. . .

. . . Agriculture payments .

. . .

. . .

. Allocated tips . . .

. . .

. . .

. . . Alternate TAA payments .

. . .

. . Annuities . .

. . .

. . .

. . .

. . . Archer MSAs: Contributions .

. . .

. . .

. . .

. . Distributions . .

. . .

. . .

. . .

. Attorney, fees and gross proceeds . . .

. . .

. . .

. . .

. . Auto reimbursements, employee . . Auto reimbursements, nonemployee .

. . .

. . .

. . .

. . Awards, employee . .

. . .

. . .

. Awards, nonemployee . . .

. . .

. Barter exchange income . . .

. . . Bond tax credit .

. . .

. . .

. . .

. Bonuses, employee . . .

. . .

. . Bonuses, nonemployee . .

. . .

. Broker transactions . . .

. . .

. . . Cancellation of debt .

. . .

. . .

. Capital gain distributions . . .

. . . Car expense, employee .

. . .

. . Car expense, nonemployee . .

. . Changes in capital structure . .

. . Charitable gift annuities . .

. . .

. . Commissions, employee . .

. . .

. Commissions, nonemployee . . .

. Commodities transactions . . .

. . Compensation, employee . .

. . . Compensation, nonemployee .

. . Contributions of motor vehicles, boats, and airplanes . .

. . .

. . .

. . . Cost of current life insurance protection .

. . .

. . .

. . .

. . .

. Coverdell ESA contributions . . .

. Coverdell ESA distributions . . .

. . Crop insurance proceeds . .

. . .

. Damages . . .

. . .

. . .

. . .

. . Death benefits . .

. . .

. . .

. . . 1099-A 1099-LTC 1099-CAP 1099-G W-2 1099-G 1099-R 5498-SA 1099-SA 1099-MISC W-2 1099-MISC W-2 1099-MISC 1099-B 1097-BTC W-2 1099-MISC 1099-B 1099-C 1099-DIV W-2 1099-MISC 1099-CAP 1099-R W-2 1099-MISC 1099-B W-2 1099-MISC 1098-C 1099-R 5498-ESA 1099-Q 1099-MISC 1099-MISC 1099-R Type of Payment Report on Form Accelerated .

. . .

. . .

. Debt cancellation . . .

. . Dependent care payments Direct rollovers . .

. . .

. . . .

. . . .

. . . .

. . .

. . . .

. . Direct sales of consumer products for resale . .

. . .

. . .

. . .

. . .

. . Directors' fees . .

. . .

. . .

. . . Discharge of indebtedness .

. . .

. Dividends . . .

. . .

. . .

. . .

. . Donation of motor vehicle . .

. . .

. Education loan interest . . .

. . .

. Employee business expense reimbursement . . .

. . .

. . .

. . Employee compensation . .

. . .

. Excess deferrals, excess contributions, distributions of . . .

. . .

. . .

. Exercise of incentive stock option under section 422(b) . . .

. . .

. . .

. Fees, employee . . .

. . .

. . .

. Fees, nonemployee . . .

. . .

. . Fishing boat crew members proceeds . .

. . .

. . .

. . .

. . . Fish purchases for cash .

. . .

. . Foreclosures . .

. . .

. . .

. . .

. Foreign persons' income . . .

. . . 401(k) contributions .

. . .

. . .

. 404(k) dividend . . .

. . .

. . .

. . Gambling winnings . .

. . .

. . .

. Golden parachute, employee . . .

. Golden parachute, nonemployee . . .

. . .

. . .

. . . Grants, taxable .

. . .

. . .

. . .

. Health care services . . .

. . .

. . Health savings accounts: Contributions . .

. . .

. . .

. . .

. Distributions . . .

. . .

. . .

. . . Income attributable to domestic production activities, deduction for .

. . .

. . .

. . .

. . .

. . . Income tax refunds, state and local .

. . .

. . .

. . .

. . .

. . . Indian gaming profits paid to tribal members .

. . .

. . .

. . .

. . .

. Interest income . . .

. . .

. . .

. . Tax-exempt . .

. . .

. . .

. . .

. . Interest, mortgage . .

. . .

. . .

. IRA contributions . . .

. . .

. . .

. IRA distributions . . .

. . .

. . .

. Life insurance contract distributions . . .

. . .

. . .

. . . Liquidation, distributions in .

. . .

. Loans, distribution from pension plan . . .

. . .

. . .

. . .

. . .

. . Long-term care benefits . .

. . .

. Medicare Advantage MSAs: Contribution . . .

. . .

. . .

. . . Distributions .

. . .

. . .

. . .

. . Medical services . .

. . .

. . .

. . Mileage, employee . .

. . .

. . .

. Mileage, nonemployee . . .

. . .

. Military retirement . . .

. . .

. . . Mortgage assistance payments .

. . ­27­ Type of Payment Report on Form 1099-LTC 1099-C W-2 1099-Q, 1099-R, 5498 1099-MISC 1099-MISC 1099-C 1099-DIV 1098-C 1098-E W-2 W-2 1099-R 3921 W-2 1099-MISC 1099-MISC 1099-MISC 1099-A 1042-S W-2 1099-DIV W-2G W-2 1099-MISC 1099-G 1099-MISC 5498-SA 1099-SA 1099-PATR 1099-G 1099-MISC 1099-INT 1099-INT 1098 5498 1099-R 1099-R, 1099-LTC 1099-DIV 1099-R 1099-LTC 5498-SA 1099-SA 1099-MISC W-2 1099-MISC 1099-R 1098-MA Mortgage interest . .

. . .

. . .

. . Moving expense . .

. . .

. . .

. . Nonemployee compensation . .

. . Nonqualified deferred compensation: Beneficiary . .

. . .

. . .

. . .

. . Employee . .

. . .

. . .

. . .

. . . Nonemployee .

. . .

. . .

. . .

. Original issue discount (OID) . . .

. Patronage dividends . . .

. . .

. . Payment card transactions . .

. . . Pensions .

. . .

. . .

. . .

. . .

. Points . . .

. . .

. . .

. . .

. . .

. Prizes, employee . . .

. . .

. . .

. Prizes, nonemployee . . .

. . .

. . Profit-sharing plan . .

. . .

. . .

. Punitive damages . . .

. . .

. . . Qualified longevity annuity contract information .

. . .

. . .

. . .

. . . Qualified plan distributions .

. . .

. Qualified tuition program payments . . .

. . .

. . .

. . .

. . Real estate transactions . .

. . .

. Recharacterized IRA contributions . . .

. . .

. . .

. . . Refund, state and local tax .

. . .

. Rents . . .

. . .

. . .

. . .

. . .

. Retirement . . .

. . .

. . .

. . .

. Roth conversion IRA contributions . . .

. . .

. . .

. . . Roth conversion IRA distributions .

. . .

. . .

. . .

. . Roth IRA contributions . .

. . .

. . Roth IRA distributions . .

. . .

. . Royalties . .

. . .

. . .

. . .

. . . Timber, pay-as-cut contract .

. . . Sales: Real estate .

. . .

. . .

. . .

. . . Securities .

. . .

. . .

. . .

. . . Section 1035 exchange .

. . .

. . . SEP contributions .

. . .

. . .

. . SEP distributions . .

. . .

. . .

. . Severance pay . .

. . .

. . .

. . . Sick pay .

. . .

. . .

. . .

. . .

. SIMPLE contributions . . .

. . .

. . SIMPLE distributions . .

. . .

. . . Student loan interest .

. . .

. . .

. Substitute payments in lieu of dividends or tax-exempt interest . . .

. . . Supplemental unemployment .

. . . Tax refunds, state and local .

. . . Third party network transactions .

. Tips . . .

. . .

. . .

. . .

. . .

. . Transfer of stock acquired through an employee stock purchase plan under section 423(c) . .

. . .

. . .

. . Tuition . .

. . .

. . .

. . .

. . .

. Unemployment benefits . . .

. . . Vacation allowance, employee .

. . Vacation allowance, nonemployee . .

. . .

. . .

. . .

. Wages . . .

. . .

. . .

. . .

. . . 1098 W-2 1099-MISC 1099-R W-2 1099-MISC 1099-OID 1099-PATR 1099-K 1099-R 1098 W-2 1099-MISC 1099-R 1099-MISC 1098-Q 1099-R 1099-Q 1099-S 1099-R, 5498 1099-G 1099-MISC 1099-R 5498 1099-R 5498 1099-R 1099-MISC 1099-S 1099-S 1099-B 1099-R W-2, 5498 1099-R W-2 W-2 W-2, 5498 1099-R 1098-E 1099-MISC W-2 1099-G 1099-K W-2 3922 1098-T 1099-G W-2 1099-MISC W-2 .

Where to File: Use the following address: If the principal business, office, or agency, or legal residence in the case of an individual, is located in: Department of the Treasury Internal Revenue Service Center Austin, TX 73301 Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia, West Virginia Department of the Treasury Internal Revenue Service Center Kansas City, MO 64999 Alaska, California, Colorado, District of Columbia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Utah, Washington, Wisconsin, Wyoming RETURNS, PAYMENTS, RECORDS; Combined Federal/State Filing Program for Information Returns Combined Federal/State Filing Program. Through the Combined Federal/State Filing Program (CF/SF), the IRS electronically forwards certain information returns (original or corrected) to participating states' taxing authorities once you are approved. Separate reporting to the states is not required unless amounts were withheld (IRS Publication 1220, 10.). To request approval to participate, an electronic test file coded for this program must be submitted to the IRS between November 12, 2015 and February 29, 2016. If the test file is acceptable, an approval letter will be sent.

There is no charge to use CF/SF for approved participants. A test file is only required for the first year a filer participates in the program; however, the IRS recommends a test file be submitted every year. Records in the test and actual file must conform to current procedures. Within two business days, the result of the electronic transmission will be sent to the email address that was provided on the “Verify Your Filing Information: screen. If using email-filtering software, configure the software to accept email from fire@irs.gov and irs.e-helpmail@irs.gov If the file is bad, the filer must return to https://fire.test.irs.gov and determine what errors are in the file.

If the test file was unacceptable, a new test file can be transmitted no later than February 28, 2015. Some participating states require separate notification that the payer is filing in this manner. The IRS acts as a forwarding agent only. It is the payer’s responsibility to contact the appropriate state for further information. .

State chart. The following quick reference chart lists participating states and valid state codes. For notification purposes, some states require employers and payers to submit a copy of the IRS approval letter. The approval no longer includes Form 6847, as it is obsolete (Rev Proc 2010-26, 2010-30 IRB). Details of the program.

Information regarding the program and its specifications can be found in IRS Publication 1220. States Participating in Combined Program Code States Participating in Combined Program Code Alabama Arizona Arkansas California Colorado Connecticut Delaware Georgia Hawaii Idaho Indiana Kansas Louisiana Maine Maryland Massachusetts 01 04 05 06 07 08 10 13 15 16 18 20 22 23 24 25 Michigan Minnesota Mississippi Missouri Montana Nebraska New Jersey New Mexico North Carolina North Dakota Ohio South Carolina Vermont Virginia Wisconsin 26 27 28 29 30 31 34 35 37 38 39 45 50 51 55 . CORRECTING INFORMATION RETURNS Voiding Incorrect Paper Returns If an error is made while preparing a return or an error is discovered before the return has been submitted to the IRS or the payee, you can cancel the return by checking the "VOID" box at the top of the form and redoing the return. Do not cut or separate the voided form from others on the same page. The entire page, including the voided form, must be submitted to the IRS. Corrected Returns on Paper Forms If you filed a return with the IRS and later discover you made an error on it, you must correct it as soon as possible and file Copy A and Form 1096 with the IRS. Also furnish statements to recipients showing the correction. Enter an “X” in the corrected checkbox only when correcting a form previously filed with the IRS or furnished to the recipient.

You may enter a date next to the “Corrected” checkbox. This will help the recipient in the case of multiple corrections. Certain errors may require two returns to make the corrections.

The General Instructions for Forms 1099, page 8 include detailed correction steps. Reporting Incorrect Payer Name and/or TIN If a payer discovers an error in reporting the payer name and/or TIN, write a letter to IRS/ECC-MTB (see below) containing the following information: 1. 2. 3. 4. 5. 6. 7. 8. 9. Name and address of the payer, Type of error (including the incorrect payer name/TIN that was reported), Tax year, Payer TIN, Transmitter Control Code (TCC), if applicable, Type of return, Number of payees, and Filing method (paper or electronic) Was federal income tax withheld? Send letter to: Internal Revenue Service Information Returns Branch 230 Murall Drive, Mail Stop 4360 Kearneysville, WV 25430 If the payer realizes duplicate reporting or a large percentage of incorrect information has been filed, contact the information reporting customer service site at 1-866-455-7438 for further instructions. Filing Corrections Electronically If you have 250 or more corrected returns of a single type to file, you must file them electronically. Electronic filing is required only for that individual type of form for which there are at least 250 corrections. For example, if you must file 250 (or more) corrected Forms 1099-MISC plus 150 corrected Forms 1099-DIV, only the 1099-MISC must be filed electronically. If you have 175 Forms 1098, 200 Forms 1099-MISC, and 150 Forms 1099-INT to correct, you are not required to file any of the corrections electronically.

Similarly the 250 threshold applies separately to corrections and originals; even if 250 or more originals of a single type of return were filed, electronic filing of corrections is not required unless there are 250 or more corrected forms to be sent. . Filing Corrected Returns on Paper Forms Identify the correction needed based on Error Type 1 or 2; then follow the steps to make the corrections and file the form(s). Also see Part H, earlier. Error Type 1 Correction Incorrect money amount(s), code, or checkbox A. Form 1097, 1098, 1099, 3921, 3922, 5498, or W­2G 1. Prepare a new information return. 2. Enter an “X” in the “CORRECTED” box (and date (optional)) at the top of the form. 3.

Correct any recipient information such as money amounts. Report other information as per the original return. A return was filed when one should not have been filed. B. Form 1096 1. Prepare a new transmittal Form 1096. 2.

Provide all requested information on the form as it applies to Part A, 1 and 2. 3. File Form 1096 and Copy A of the return with the appropriate service center. 4. Do not include a copy of the original return that was filed incorrectly. These errors require only one return to make the correction. Caution: If you must correct a TIN or a payee name, follow the instructions under Error Type 2. Error Type 2 Correction No payee TIN (SSN, EIN, QI­EIN, or ITIN), or Incorrect payee TIN, or Incorrect payee name, or Step 1.

Identify incorrect return submitted. 1. Prepare a new information return. 2. Enter an “X” in the “CORRECTED” box (and date (optional)) at the top of the form. 3.

Enter the payer, recipient, and account number information exactly as it appeared on the original incorrect return; however, enter 0 (zero) for all money amounts. Original return filed using wrong type of return (for example, a Form 1099-DIV was filed when a Form 1099-INT should have been filed). Step 2. Report correct information. A. Form 1097, 1098, 1099, 3921, 3922, 5498, or W­2G 1.

Prepare a new information return. 2. Do not enter an “X” in the “CORRECTED” box at the top of the form. Prepare the new return as though it is an original. 3.

Include all the correct information on the form including the correct TIN and name. Two separate returns are required to make the correction properly. Follow all instructions for both Steps 1 and 2. B. Form 1096 1.

Prepare a new transmittal Form 1096. 2. Enter one of the following phrases in the bottom margin of the form. Filed To Correct TIN. Filed To Correct Name. Filed To Correct Return. 3. Provide all requested information on the form as it applies to the returns prepared in Steps 1 and 2. 4.

File Form 1096 and Copy A of the return with the appropriate service center. 5. Do not include a copy of the original return that was filed incorrectly. Gen. Instr.

for Certain Info. Returns (2015) ­11­ . III. NEW HIRE REPORTING . NEW HIRE REPORTING REQUIREMENTS General Federal Requirements: The New Hire Reporting Program was mandated by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. It requires employers to report newly hired and rehired employees to designated state agencies. This information is then used to facilitate the collection of child support, medical support and/or to uncover fraud and abuse in unemployment compensation, workers’ compensation, and public assistance (welfare) benefit programs. Reporting requirements: Federal law requires seven data elements to be reported. The following six elements are found on federal Form W-4: employee’s name, address, and social security number; and employer’s name, address, and federal Employer Identification Number (EIN).

A more recent federal law requires all employers to report the employee’s date of hire. The date of hire is the date an employee first performed services for pay. This requirement was enacted in Section 802 of the Claims Resolution Act of 2010 (CRA; Pub.

L. No. 111-291) signed into law by President Obama on December 8, 2010.

States have the option of requiring additional information. Format and method: Employers can report new hires on the employee’s Form W-4 or an equivalent form containing the required information, and can transmit the report by first class mail, magnetically, or electronically. Many states now have secure web sites that allow employers with access to the Internet to file their reports online. Some states allow employers to report by phone, fax or to e-mail reports, either in the message itself or as a file attachment. Multi-state employers: While employers with employees in only one state must report newly hired employees to that state, multi-state employers may designate one state where they have employees as the state to which they report all their new hires.

In addition, multi-state employers do not have to report the required elements for every state in which they have employees – only those required by the state the employer has selected for new hire reporting purposes. Multi-state employers who choose to report to one state must submit new hire reports electronically or magnetically. The multi-state employer should contact the state agency to which it will be reporting to obtain its current electronic data specifications. Additionally, multi-state employers who report all their new hires to a single state must notify the Secretary of the U.S. Department of Health and Human Services as to which state they have designated to receive all their new hire information.

Multistate employers may notify the Secretary by form, letter, fax or internet. The form is available in Adobe .pdf format at: http://www.acf.hhs.gov/programs/css/resource/multistate-employer-registration-form-instructions To register online at the federal office of Child Support Enforcement’s Web site go to: http://www.acf.hhs.gov/programs/cse/newhire/employer/private/newhire.htm. The Claims Resolution Act of 2010 amended prior law to require an employer to report to the state Directory of New Hires, in addition to other information, “the date services for remuneration were first performed” by a newly hired employee. In other words, for each newly hired employee, as of June 8, 2011, the employer must provide the following information to the state directory: ï‚· ï‚· ï‚· The employee’s name, address, and social security number; The employer’s name, address, and federal identification number (EIN); and The date the employee first performed services for pay. .

Due dates for new hire reports: According to federal law, employers must report newly hired employees within 20 calendar days of the date of hire. However, states are given the option of establishing reporting time frames that may be shorter than 20 days. You must adhere to the reporting time frame of the state to which you report. Be sure to check with your state New Hire contact to learn your state's requirements. “Date of hire” is defined as the first day that an individual performs services for wages.

If an employer elects to report new hires magnetically or electronically, it must send two transmissions per calendar month which are 12 to 16 days apart. States can establish their own time frames for reporting new hires, but they can be no longer than the federal requirements. Multi-state employers that submit reports twice monthly must submit information for a newly hired employee as soon as possible after the date of hire, but no later than the next semimonthly pay period. Penalties for noncompliance: States have the option to impose civil penalties for failure to report new hires.

The fine may not exceed $25 per newly hired employee, with a $500 maximum if the failure to comply is the result of a conspiracy between the employer and the employee. States may also impose nonmonetary civil penalties under state law for noncompliance. The Trade Adjustment Assistance Extension Act of 2011 clarifies that for purposes of reporting rehired employees to the Directory of New Hires, the definition of “newly hired” employee means an employee who (i) has not previously been employed by the employer; or (ii) was previously employed by the employer “but was separated from such prior employment for at least 60 consecutive days.” This provision was effective April 21, 2012 (six months after the date of enactment), although states that have to pass legislation to put the new provision into effect may have more time depending on when their legislatures are in session. A potential benefit to employers of new hire reporting is the reduction and prevention of fraudulent unemployment and workers’ compensation payments. Timely receipt of new hire data allows each state to cross-match data against its active workers’ compensation and unemployment insurance claimant files – either stopping payments or recovering erroneous payments. EMPLOYMENT VERIFICATION RULES Employer's General Verification Obligations: I-9 Procedures: The purpose of the I-9 Form is to document verification of the identity and employment authorization of each new employee (both citizen and non-citizen) hired after November 6, 1986 is authorized to work in the United States. Employers are responsible for completing and retaining Form I-9.

The Form I-9 is only required for new employees. They do not need to complete new forms for current employees. However, employers must use the Form I-9 when employees require reverification. Form I-9 general instructions: Form I-9 is made of three sections.

Employers may be fined if the form is not complete. All employers, regardless of size, must verify the legal employment status of all newlyhired employees, including American citizens. However, requirements do not apply to casual domestic workers who provide sporadic or irregular services in a private home. To fulfill this requirement, employers must complete DHS (Department of Homeland Security) Form I-9, which contains three sections. .

Section one - Employee Information and Attestation, must be completed and signed by the newly-hired employees at the time of hiring. Employee must be provided both the front and the back of the I-9 when requested to complete it along with the Lists of Acceptable Documents. Section two - Employer or Authorized Representative Review and Verification, must be completed and signed by the employer within three business days of hiring. Before completing Section 2, employers must ensure that Section 1 is completed properly and on time. To complete Section two of the I-9 form, employers must examine one or more original document(s) establishing both the identity and employment eligibility of the newly-hired employee (eligible documents are listed below). Only unexpired, original documentation is acceptable.

The employer cannot specify which documents will be accepted for employment eligibility verification or require more or different documents than specified in the law. An employer's refusal to accept the legally-designated documents provided by a newly-hired employee as proof of identity or work authorization when the documents appear to be genuine, will subject the employer to civil fines. An employer must record on the I-9 form the types of documents examined, issuing authority, document number and expiration dates, and then sign the I-9 form.

Provide the name and the title of the person completing Section 2 as well as the employer’s name and address. Sometimes the newly-hired employee has lost or does not have a document required for proof of identity or work authorization. In those cases, the employer must obtain an acceptable receipt for the worker's application to secure the necessary document within three days from the date of hire. Within 90 days of hiring, the employer must also examine the necessary document and complete the I-9 form. Section three - Reverification and Rehires, must be completed by the employer when an employee’s employment authorization indicated in Section 1 or evidence of employment authorization recorded in Section 2 has expired.

An employer may also reverify employment authorization, in lieu of completing a new Form I-9, when an employee is rehired within three years of the date that the Form I-9 was originally completed and the employee’s work authorization or evidence of work authorization has expired. Reverification of Authorization and Eligibility: Reverification applies if evidence of employment authorization presented in Section 2 expires, unless the employee is a US citizen, a noncitizen national, or have presented a Permanent Resident Card. Employers may either complete Section 3 of a new Form 1-9 or Section 3 of the previously completed Form 1-9. Any new pages of Form 1-9 must be attached to the employee’s original Form 1-9 Employers must retain I-9 forms for as long as the individual works for the employer.

Once the individual’s employment ends, the employer must retain this form for 3 years after the date of hire or 1 year after date employment ends, whichever is later. Copies of identification and work authorization documents may be made by employers. If photocopies are made, they should be made for ALL new hires or reverifications.

If copies are made, they must be retained with the appropriate I-9 form. The Form I-9 may be signed and retained electronically. Verification Obligation of Other Parties: Independent contractors, and not the employers that engage the contractors' services, are responsible for verifying the legal employment status of their work force. Recruiters and referrers for a fee are required to verify the job eligibility of those persons who are actually hired as a result of their recruitment and referral. The recruiters are permitted to designate an agent or an employer that hired a referred individual to complete the employment verification form.

The agent or employer is required to provide the recruiter a photocopy of the completed I-9 form. Union hiring halls are excluded from the requirement to verify the employment status of referred persons. . Employment Identity Only Documents: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Driver's license or identification card issued by a state or an outlying possession of the U.S. Must contain the bearer's photograph or specify such identifying information as the bearer's name, date of birth, gender, height, color of eyes, and address. School identification card with photograph. U.S. military card or draft record. Identification card issued by a federal, state, or local government agency provided that it contains a photograph or information such as name, date of birth, gender, height, eye color, and address. Native American tribal documents. U.S. Coast Guard Merchant Mariner card. Driver's license issued by a Canadian Government authority. Voter’s registration card. Military dependent’s ID card. Employment Eligibility Only Documents: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Social Security number card, except a card marked 1) not valid for employment purposes 2) valid for work only with INS authorization, or 3) valid for work only with DHS authorization. Certificate of birth abroad issued by Department of State (Form FS-545). Original or certified copy of a birth certificate issued by a state, county, or municipal authority bearing the authority's seal. Native American tribal document. U.S.

citizen identification card (Form I-197). Identification card for use of resident citizen in the U.S. (Form I-179). Employment authorization document issued by the Department of Homeland Security. Certificate of report of birth issued by the Department of State (Form DS-1350). Employment Identity and Eligibility Documents: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· US Passport or US Passport Card Permanent Resident Card or Alien Resident Card (Form I-551) Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa Employment Authorization Document that contains a photograph (I-766) For a nonimmigrant alien authorized to work for a specific employer because of his or her status: a. Foreign passport, and b.

Form I-94 or Form I-94A that has 1) the same name as the passport and 2) an endorsement of the alien’s nonimmigrant status as long as that period of endorsement has not expired. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association between the US and the FSM or RMI. Parents or legal guardians assisting minors under the age of 18 or certain employees with disabilities should review the guidelines in the Handbook for Employers: Instructions for completing Form I-9 on www.uscis.gov/I-9Central before completing Section 1. . Document Inspection: Officials from the Department of Homeland Security, employees from the Office of Special Counsel for Immigration-Related Unfair Employment Practices at the Department of Justice (DOJ), and employees from the Department of Labor (DOL) may inspect an employer’s Forms I-9. Employers will generally receive a written Notice of Inspection at least three days before the inspection. These officials will inform the owner, designee, senior management official or registered agent of the business entity of an inspection in person or by certified U.S. mail, return receipt requested. Officials may also use subpoenas and warrants to obtain the forms without providing three days notice. SSA Social Security Number Verification Service (SSNVS) An employee’s SSN and name can be verified by the Social Security Administration for any employee who will have a Form W-2 prepared at year end – current or former employees and new employees after a commitment to hire has been made. SSA will not verify SSNs for those who will receive Form 1099.

The IRS’s TIN Matching System allows 1099 filers to check names and TINs for those receiving a form from the 1099/1098 series. Payers reporting on Forms 1099/1098 can verify up to 25 TINs online through IRS’s Interactive TIN matching System, and up to 100,000 TINs through the Bulk TIN Matching System. To register for this and IRS e-services, go the website located at https://la.www4.irs.gov/e-services/Registration/index.htm. Why Employers Should Verify Employee’s Names and SSNs Online: Employers are encouraged to verify names and social security numbers online for the following reasons: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Correct names and social security numbers on W-2 wage reports are key to the successful processing of an employee’s annual wage report submission. It is faster and easier to use the online system than submitting employer requests on paper lists or using SSA’s automated telephone verification option. It results in more accurate wage reports. SSNVS will match employee names and social security numbers with SSA’s records before you prepare and submit Forms W-2. It saves the employer additional processing costs and reduces the number of W-2c Forms. It allows SSA to properly credit employee’s earnings records, which will be important information in determining their social security benefits, as uncredited earnings can affect future eligibility for and amounts paid under SSA’s retirement, disability and survivor programs. Two SSNVS Options: There are two internet verification options that allow employers to verify their employee’s names and social security numbers against SSA’s records. Employers can: ï‚· ï‚· Verify up to 10 names and SSNs (per screen) online and receive immediate results.

There is no limit to the number of times the SSN Verification Web page may be used within a session. This option is ideal for verifying new hires. Upload a file with up to 250,000 names and SSNs. In most cases, the SSA will provide the results by the next government business day.

This option is ideal for employers who want to verify an entire payroll data base or who hire a large number of workers at a time. . The SSA can verify up to 250,000 names/social security numbers if the user submits a spreadsheet SSNVS file, “as long as the file is put in the correct format.” SSA offers the following formatting tips: ï‚· ï‚· ï‚· ï‚· If you are using Excel, to ensure that your electronic file submission is processed successfully, the file must not be in the “.xls” format. You must save the file in the appropriate format. To properly save an Excel file for processing: o Select Save As on the File Menu; o In the Save As dialog box, select the drop down box Save As type; o Select Formatted Text (space delimited) (*.prn); and o Type the filename and click Save. To create the file, you will need one column that is at least 130 characters long. This column will hold all data for each record. To download the specifications for the record layout, go to www.ssa.gov/employer/ssnvs_handbk.htm and click on “Submission File Format” under the Table of Contents.

Once you have saved your file, check it against the Submission File Format to ensure that the record length is 130 characters and that all fields are properly placed in their respective positions. The Multiple Request Indicator field in positions 128-130 must be populated with “000” and may not be left blank. Zip your file if you have over 500 name and SSN verification requests or if you have a slow connection. Other features of SSNVS are being able to download and/or view submission results, and view and print the SSNVS Handbook. The SSNVS information can be accessed at http://www.socialsecurity.gov/employer/ssnv.htm. To use the SSNVS, each individual who is going to use the system on behalf of an employer must first register with SSA’s Business Services Online (BSO).

To register and for additional information, visit: www.socialsecurity.gov/bso/bsowelcome.htm. In addition to SSNVS, SSA allows employee verification options by Telephone Number Employer Verification (TNEV) and by paper list. For more information, visit www.socialsecurity.gov/bso/bsowelcome.htm. US Citizenship & Immigration Services E-Verify: E-Verify enables employers to quickly verify employment eligibility of all their newly hired employees, regardless of citizenship. E-Verify is an internet based system that compares information from an employee’s Form I-9 and involves verification checks of the SSA and Department of Homeland Security databases by using an automated system to verify an employee’s SSN and employment authorization.

The system uses SSNs, alien registration numbers, and I-94 numbers (Arrival/Departure Numbers) to perform these verification checks. Effective September 8, 2009, certain contractors and subcontractors are required to use the E-Verify system administered by the Department of Homeland Security (DHS), U.S. Citizenship and Immigration Services, to verify that new hires and current employees working on federal contracts are eligible to work in the U.S. . State or Territory Is E-Verify Required for Private Employers? Is E-Verify Required for Public Employers? Is E-Verify Required for State Contractors? Alabama Alaska Arizona Arkansas Yes No Yes No No. Per the “Employment Acceleration Act of 2011,” the state of California and any of its cities, counties, or special districts are prohibited from requiring an employer (other than a government entity) to use E-Verify as a condition of receiving a government contract, applying for or maintaining a business license, or as a penalty for violating licensing or other similar laws. No Yes No Yes No Yes No Yes No No No No No No No No No No Yes, or alternative state verification program. No No No Yes Yes No Yes Yes Yes No Yes No No Yes No No No Yes No No No Yes Yes Maine Maryland Massachusetts Michigan No Yes No No No. Previous law had prohibited employers from participating; now they may do so voluntarily No No No No Employers must either use EVerify or check multiple forms of ID. Employers who use EVerify are acting in “good faith” and are protected from prosecution. No No No No – legislation pending No No No No – legislation pending Minnesota No No Mississippi Yes No – however, penalties for hiring unauthorized workers without using the system No No, although using e-verify will allow private employers to qualify for tax and other Yes No No No No – legislation pending Yes, for services in excess of $50,000. Yes Yes California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Missouri Montana Nebraska Yes No No Yes Yes .

economic incentives. State or Territory Is E-Verify Required for Private Employers? Is E-Verify Required for Public Employers? Is E-Verify Required for State Contractors? Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio No No No No No Yes No No Oklahoma No Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming No Yes No No Yes No Yes No Yes No Yes No No No No No No No No No Yes No No Yes, with alternative verification also listed in the statute. No Yes No No Yes No Yes No Yes No Yes No No No No No No No No No Yes No No Yes, with alternative verification also listed in the statute. No Yes No No Yes No Yes No Yes No Yes No No No No Penalties for Violation ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Knowingly recruiting, referring for a fee, hiring, or continuing to employ an individual who is not authorized to work in the U.S. is punishable with a civil fine. Penalties range from $375 to $3,200 per unauthorized alien for the first offense; from $3,200 to $6,500 per alien for a second offense; and $4,300 to $16,000 per alien for each subsequent offense. Failure to comply with verification requirement and completion of the I-9 form or committing document abuse is punishable with a civil fine of not less than $110 and not more than $1,100. Fines depend on company size, the employer's good faith and history of previous violations, the seriousness of the violation, and whether the worker was an unauthorized alien. Regular repeated and intentional violations of the Act are subject to a criminal fine of not more than $3,000 per unauthorized alien, imprisonment for not more than six months, or both. Unlawful discrimination is punishable with fines ranging from $375 to $3,200 for a first offense; from $3,200 to $6,500 for a second offense; and from $4,300 to $16,000 for each subsequent violation. Committing or participating in document fraud is punishable with a fine ranging from $375 to $3,200 for a first offense and $3,200 to $6,500 for each subsequent offense. Committing document abuse is punishable with a fine of not less than $110 and not more than $1,100. .

Deposit Requirements for Employment Taxes: Employment tax deposits are now required to be made electronically through the Electronic Federal Tax Payment System (EFPTS). To enroll in EFTPS, go to www.eftps.gov. It takes seven business days to receive a PIN and further instruction. If either (1) your employment tax deposit requirement for either the current quarter or the preceding quarter is less than $2,500 and you did not incur a $100,000 next-day deposit, or (2) you are a monthly schedule depositor and make a payment in accordance with the Accuracy of Deposit Rules you can still make the payment with the return.

All others will be required to deposit taxes electronically. This includes: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· FICA taxes and withheld income taxes, FUTA taxes, Non-payroll taxes, including backup withholding, Taxes withheld on nonresident aliens and foreign corps, Railroad retirement taxes, Corporate income taxes, Unrelated business income taxes of tax-exempt organizations, Private foundation excise taxes, Estimated taxes on certain trusts, and Excise taxes reported on Form 720, Quarterly Federal Excise Tax Return. For EFTPS deposits to be on time, you must initiate the transaction by 8 p.m. Eastern Time at least one calendar day before the date the deposit is due. Lookback Period: For quarterly return filers, an employer’s deposit schedule (monthly or semiweekly) is based on the total taxes reported on Form 941, in a four-quarter look-back period.

An employers’ deposit schedule for 2015 is based on the look-back period beginning July 1, 2013 and ending June 30, 2014. If an employer reported $50,000 or less of Form 941 taxes for the look-back period, it is a monthly depositor. If it reported more than $50,000, it is a semiweekly depositor. For annual return filers (Forms 943, 944, 945, and CT-1), the look-back period is the calendar year preceding the previous year.

The look-back period for 2015 is calendar year 2013. If an employer reported $50,000 or less of taxes for the look-back period, it is a monthly depositor. If it reported more than $50,000, it is a semiweekly depositor. The IRS considers a new employer’s tax liability to be zero, which makes new employers monthly depositors for their first year of business. Exceptions to monthly and semiweekly rule: If employers accumulate a tax liability of less than $2,500 during a quarter for Form 941 (during a calendar year for Forms 943, 944, 945, and CT-1), no deposits are required if they pay their tax in full with a timely filed return.

If employers accumulate a tax liability (reduced by any advance EIC payments) of $100,000 or more on any day during a deposit period, they must deposit the tax by the next banking day, regardless of whether they are a monthly or semiweekly depositor, and you will become a semiweekly depositor for the remainder of the calendar year and for the following year. Under the monthly deposit schedule, deposit accumulated taxes on payments made during a calendar month by the 15th day of the following month. For instance, for payments made to employees during the month of November, the tax liability is due by the 15th of December. . Under the semiweekly deposit schedule, deposit accumulated taxes on payments based on the following table: Deposit Period (Payment Deposit By Days) Wednesday, Thursday, and/or On or before the following Wednesday Friday Saturday, Sunday, Monday, and/or On or before the following Friday Tuesday SSN “Randomization” The Social Security Administration changed the way social security numbers are issued in 2011. The new method, called “randomization”, will keep the SSA from running out of SSNs in certain states and help protect against identity theft. SSN Randomization affected the SSN assignment as follows: ï‚· It eliminated the geographical significance of the first three digits of the SSN, referred to as the area number, by no longer allocating the area numbers for assignment to individuals in specific states. ï‚· It eliminated the significance of the highest group number and, as a result, the High Group List is frozen in time and can only be used to see the area and group numbers SSA issued prior to the randomization implementation date. ï‚· Previously unassigned area numbers were introduced for assignment excluding area numbers 000, 66, and 900-999. Some Things Won’t Change: Even with randomization, some aspects of SSN assignment will not change. The SSA will not issue: ï‚· ï‚· ï‚· ï‚· SSNs beginning with the number “9”; SSNs with the number “666” or “000” in positions 1-3; SSNs with the number “00” in positions 4-5; or SSNs with the number “0000” in positions 6-9. Employers, payroll service providers, state and local tax agencies, retirement plan administrators, and workers’ compensation agencies will need to adjust their systems and software to accept SSNs beginning with an “8”. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Alabama Phone: 334-206-6020 Fax: 334-206-6020 Email: NewHire@labor.alabama.gov Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? Within 7 days of hiring or reemployment. May be subject to administrative penalty up to $25 for each violation. New Hire Elements; Employee: Was the employee newly hired or recalled to work. Fax or mail if the employer has four or less employees; otherwise, file electronically via the internet. No 20 days New Hire Elements; Employer's EIN. Employee's date of birth and state of hire. Online (portal), mail, or fax, No Website: http://labor.alabama.gov/nh/ Alaska Phone: 907-269-6900 Phone: 877-269-6685 Fax: 907-787-3220 Email: dor.cssd.customerservice.anchorage@alaska.gov Website: www.childsupport.alaska.gov/employers/employer_information .asp Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 1 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Arizona Reporting Timeframe (non-magnetic media only) Online (portal), phone, fax, or payroll services Yes 20 days New Hire Elements; Employee's state of hire (only if reporting as a Multistate employer) Optional: Employee's date of birth and state of hire. Employer's phone number, fax number, and e-mail address. Online (portal), mail, or fax No E-mail: Fill and send Customer Service/Technical Support form at https://az-newhire.com/contact Website: www.az-newhire.com Public Fax : (800) 259-3562 E-mail: Fill and send Customer Service/Technical Support form at http://newhire-reporting.com/AR-Newhire/contact.aspx Reporting Independent Contractors? New Hire Elements; Employee's state of hire (only if reporting as a Multistate employer) Optional: Employee's date of birth and state of hire. Employer's phone number, contact name, e-mail address, and is medical insurance an employee benefit? Public Phone: (888) 282-2064 Ext. 250 Phone: 501-376-2125 Phone: 800-259-2095 Fax: 501-376-2682 Method of Transmission 20 days Phone: 888-282-2064 Fax: 888-262-0502 Arkansas Data Elements Website: www.ar-newhire.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 2 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information California Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission 20 days New Hire Elements; Employers: contact person name, phone number, and California employer account number. Online (portal), phone, or fax Yes, the independent contractor information must be reported within twenty (20) calendar days of either making payments totaling $600 or more, or entering into a contract for $600 or more with an independent contractor in any calendar year, whichever is earlier. 20 days New Hire Elements Optional: Employee's date of birth. Online (portal), mail (magnetic tape, cartridge tape, diskette), or fax No 20 days New Hire Elements Online (portal, FTP), mail, or fax As of Oct 1, 2003, report ICs if over $5000/year payment is anticipated. Phone: 916-657-0529 Fax: 916-319-4400 E-mail: Submit form at http://www.edd.ca.gov/About_EDD/Contact_EDD.htm Website: www.edd.ca.gov/payroll_taxes/new_hire_reporting.htm Colorado Reporting Independent Contractors? Phone: 303-297-2849 Phone: 800-696-1468 Fax: 303-297-2595 Email: CDHS_FSREmployerServices@state.co.us Website: www.newhire.state.co.us Connecticut Phone: 860-263-6310 Fax: 800-816-1108 Email: dol.ctnewhires@po.state.ct.us Website: www.ctnewhires.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 3 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Delaware Reporting Timeframe (non-magnetic media only) 20 days Phone: 855-481-0018 Fax: 855-481-0047 E-mail: Fill and send Customer Service/Technical Support Form at http://newhire.dhss.delaware.gov/deNewhire/contact.aspx New Hire Elements; Employer's state of hire (only if reporting as a multistate employer). Method of Transmission Reporting Independent Contractors? Online (portal, FTP), mail, fax, or payroll services Yes Online (portal, FTP), mail (diskette), fax, or payroll services No Optional: Employers: contact name at the company responsible for new hires, phone, fax, and e -mail address. Employees: date of birth, gender, and whether if employee left during reporting period. Website: newhire.dhss.delaware.gov District of Columbia Data Elements 20 days New Hire Elements Phone: 877-846-9523 Fax: 877-892-6388 Public Phone: (877)-846-9523 Ext. 300 E-mail: Fill and send Customer Service/Technical Support Form at https://dc-newhire.com/contact Website: www.dc-newhire.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 4 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Florida Phone: 850-656-3343 Phone: 888-854-4791 Fax: 888-854-4762 Email: newhiresupport@dor.state.fl.us Fax Direct: (850) 656-0528 Website: https://newhire.state.fl.us/Help%20Content/Reporting%20New %20Hires%20(Employers).aspx Office of Child Support Enforcement Employer Services Team 10/31/2015 Reporting Timeframe (non-magnetic media only) 20 days Data Elements New Hire Elements; Employee's state of hire (only if reporting as a multistate employer). Employers: Reemployment assistance identification number (if applicable). Method of Transmission Online (portal), phone, or fax Reporting Independent Contractors? No Optional: employee's date of birth and state of hire; employer's phone number, fax number, e-mail address, contact (individual's name), and medical insurance availability Page 5 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Georgia Phone: 404-525-2985 Phone: 888-541-0469 Fax: 404-525-2983 Public Fax: (888) 541-0521 E-mail: Fill and send Customer Service/Technical Support Form at https://newhire-reporting.com/GANewhire/Contact.aspx Website: www.ga-newhire.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Reporting Timeframe (non-magnetic media only) 10 days Data Elements New Hire Elements; Employee's date of birth, medical insurance availability, and state of hire. Optional: Employee's monthly salary. Does Employer provide multiple medical insurances? If multiple medical insurances are available, were they offered? Page 6 of 28 Method of Transmission Online (portal, FTP, encrypted e-mail), mail (diskette), or fax Reporting Independent Contractors? No To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Guam Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements; Employee's date of birth, occupation, start wage, wage frequency, and medical insurance availability. Employer's email address, phone, fax, and contact person. E-mail, mail, or fax Yes, for Guam government contractees 20 days New Hire Elements Optional: State of hire, State EIN, and employee's date of birth Fax, mail, or FTP upon request No Linda Uson Phone: 671-475-3360 Phone: 671-475-3324 Fax: 671-475-3203 Email: Linda.Uson@guamcse.net Direct Phone: (671) 475‐3360 ext. 1610 Direct E-mail: Linda.Uson@guamcse.net Public E-mail: child.support@guamcse.net Public Fax: (671) 477-2159 Website: www.guamcse.net Hawaii Phone: 808-692-7029 Fax: 808-692-7001 Phone: 808-692-7029 Fax: 808-692-7001 Website: http://hawaii.gov/ag/csea/main/info_for_employers/ Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 7 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Idaho Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements; Employers: Idaho Unemployment Insurance Number (SUTA), contact name, and contact number. Online (portal), mail (CD, diskette), or fax No 20 days New Hire Elements Optional: alternate address for income withholding orders Online (portal), e-mail, mail (magnetic cartridge, diskette), or fax No 20 days New Hire Elements; Employee's State of Hire (only if reporting as a Multistate employer) Online (Portal, FTP), e-mail, mail (diskette, CD-R) or fax No Phone: 208-332-8941 Phone: 800-627-3880 Fax: 208-332-7411 Email: newhire@labor.idaho.gov Website: https://labor.idaho.gov/newhire Illinois Phone: 800-327-4473 Fax: 217-557-1947 Email: DES.NHire@illinois.gov Website: http://www.ides.illinois.gov/Pages/New_Hire_Reporting.aspx Indiana Phone: 317-612-3028 Phone: 866-879-0198 Fax: 800-408-1388 Direct Fax: (317) 612-3036 E-mail: Fill and send General Comments and Feedback Form at https://newhire-reporting.com/IN-Newhire/contact.aspx Website: www.in-newhire.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 8 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Iowa Phone: 877-274-2580 Fax: 800-759-5881 Email: csrue@dhs.state.ia.us Website: www.iowachildsupport.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Reporting Timeframe (non-magnetic media only) 15 days Data Elements New Hire Elements; Is dependent health care coverage available?, approximate date this employee qualifies for coverage, and address where income withholding and garnishment orders should be sent, if different than above address. Employee's date of hire. Page 9 of 28 Method of Transmission Online (portal), mail, or fax Reporting Independent Contractors? Yes* * Definition of a "contractor" in Iowa: Who is 18 years of age or older; Who performs labor in IA and to whom a payor of income makes payments which are not subject to income withholding for child support; For whom the payor of income is required by the IRS to file a 1099 MISC form; and Who is a natural, individual person, NOT a corporation, government, business trust, estate, partnership, or other legal entity, however organized. To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Kansas Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements; Employee's state of hire (only if a Multistate employer) Optional: Employee's date of birth, state of hire, and dependent health insurance availability. Employer's phone name, fax number, and e-mail address. Online (portal), mail, or fax No 20 days New Hire Elements; Employer's State of Kentucky Employer Identification Number (KEIN) Optional: Employee's date of birth and availability of medical benefits. Employer's phone #, fax #, e-mail address, and contact name. Online (portal, FTP), mail (diskette), fax, or payroll services No Phone: 785-296-5000 Phone: 888-219-7801 Fax: 888-219-7798 Email: newhires@dol.ks.gov Direct Phone: (785) 296-5000, ext. 7700 Topeka Area Employers Fax: (785) 291-3423 or (785) 2913424 Website: http://www.dol.ks.gov/KansasEmployer.aspx Kentucky Phone: 800-817-2262 Fax: 800-817-0099 E-mail: Fill and send Customer Service/Technical Support Form at https://ky-newhire.com/contact Website: https://ky-newhire.com/ Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 10 of 28 To update contact information, email employerservices@acf.hhs.gov. .

State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Louisiana Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements; Employee's occupation. Employer's State Identification Number (SIN). Online (portal, FTP), mail (diskette), or fax No 7 days New Hire Elements; Employee's date of birth. Employer's phone number and Maine Department of Labor Number Online (portal, FTP), mail, or fax Yes, for the state when acting as a contracting agency and any contractor who contracts with the state, or subcontractor thereof (per ME LD 629). Phone: 888-223-1461 Fax: 888-223-1462 E-mail: Fill and send Customer Service/Technical Support Form at https://newhire-reporting.com/LANewhire/Contact.aspx Website: www.la-newhire.com Maine Phone: 207-624-7880 Phone: 800-845-5808 Fax: 207-287-6882 Email: maine.newhire@maine.gov Public Fax: (207) 287-6882 Website: https://portal.maine.gov/newhire/ Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 11 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Maryland Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements; Employee's medical benefits availability and salary and pay frequency. Employer's State of Maryland Unemployment Insurance Number (SUI). Optional: Employee's date of birth and gender. Online (portal, FTP), mail, or fax No 14 days New Hire Elements; Employee's work status Online (portal,) mail, or fax Yes Phone: 410-281-6000 Phone: 888-634-4737 Fax: 410-281-6004 Public Fax: (888) 657-3534 E-mail: Must fill in the "Feedback and Technical" box and submit at https://newhire-reporting.com/MDNewhire/comments.aspx Website: https://newhire-reporting.com/MDNewhire/default.aspx Massachusetts Phone: 617-887-7607 Fax: 617-376-3262 Email: pdustaff@dor.state.ma.us Website: http://www.mass.gov/dor/childsupport/employers/new-hire-reporting/ Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 12 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Michigan Reporting Timeframe (non-magnetic media only) Online (portal, FTP), mail (diskette, reel tape, cartridges), fax, or payroll services No 20 days New Hire Elements; Employee's state of hire (only if reporting as a Multistate employer) Optional: Employee's date of birth and state of hire. Employer's phone #, fax #, and e-mail address Online (portal, FTP), mail (diskette, reel tape, cartridges), fax, or payroll services Governmental agencies must report independent contractors they hire and all other employers may provide the same information on their independent contractors if they choose Website: www.mi-newhire.com E-mail: Fill and send Customer Service/Technical Support Form at https://newhire-reporting.com/MNNewhire/Contact.aspx Website: www.mn-newhire.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Reporting Independent Contractors? New Hire Elements; Employee's state of hire (only if reporting as a Multistate employer). Optional: Employee's date of birth, state of hire and driver's license. Employer phone #, fax #, e-mail address, contact name, and State Identification Number (SEIN). E-mail: Fill and send Customer Service/Technical Support Form at http://mi-newhire.com/mi-newhire/contact.aspx Phone: 800-672-4473 Fax: 800-692-4473 Method of Transmission 20 days Phone: 800-524-9846 Fax: 877-318-1659 Minnesota Data Elements Page 13 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Mississippi Reporting Timeframe (non-magnetic media only) Online (portal, FTP), mail, or fax No 20 days New Hire Elements Optional: Employee's state of hire (required if reporting as a Multistate employer), date of birth, employment type (full, part time, temporary), and health insurance eligibility. Employer's payroll address. Online (portal, FTP), mail, or fax No Website: www.ms-newhire.com E-mail: Must fill out general information form and submit at https://www.missouriemployer.dss.mo.gov/RequestHelpUnAut h.aspx Website: https://www.missouriemployer.dss.mo.gov/ Office of Child Support Enforcement Employer Services Team 10/31/2015 Reporting Independent Contractors? New Hire Elements; Employee's date of birth, gender, salary, payment frequency, and medical insurance availability. Optional: Employee's middle initial. Employer's phone number, contact name, e-mail address, and payroll country code E-mail: Fill and send Customer Service/Technical Support Form at https://ms-newhire.com/contact Phone: 888-663-6751 Fax: 573-526-8079 Method of Transmission 15 days Phone: 800-241-1330 Fax: 800-937-8668 Missouri Data Elements Page 14 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Montana Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements Optional: Employee's home phone number and date of birth. Employer's work phone number, fax number, state of hire, and health insurance availability Online (portal), mail, or fax No 20 days New Hire Elements Optional: Employee's date of birth, state of hire, and dependent health insurance availability. Employee's phone #, fax #, and e-mail address. Online (portal, FTP), mail (diskette, CD-R, reel tape, cartridges), fax, or payroll services Yes 20 days New Hire Elements Optional: Employee's date of birth and state of hire. Online (portal, FTP), mail, or fax No Phone: 406-444-9290 Phone: 888-866-0327 Fax: 406-444-0745 Email: NewHireReporting@mt.gov Public Fax: (888) 272-1990 Website: http://dphhs.mt.gov/CSED/employerinfo.aspx Nebraska Phone: 888-256-0293 Fax: 866-808-2007 E-mail: Fill and send Customer Service/Technical Support Form at https://newhire-reporting.com/NENewhire/contact.aspx Website: www.ne-newhire.com Nevada Phone: 775-684-6370 Phone: 888-639-7241 Fax: 775-684-6379 Email: cakoch@nvdetr.org Website: https://uitax.nvdetr.org/crphtml/new_hire_info.htm Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 15 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information New Hampshire Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements; NHES Employer Account Number, work state, and type of hire. Online (portal), mail (CD-R, diskette), or fax No 20 days New Hire Elements, Employee's date of birth Online (portal, FTP), mail (CD-R, cartridge), fax, or payroll services Yes Phone: 603-229-4371 Phone: 800-803-4485 Fax: 603-224-0825 Email: linda.m.nalette@nhes.nh.gov Public Fax: 855-253-9072 Website: www.nhes.state.nh.us New Jersey Phone: 877-654-4737 Fax: 800-304-4901 E-mail: Fill and send Customer Service/Technical Support Form at https://newhire-reporting.com/NJNewhire/contact.aspx Website: www.nj-newhire.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 16 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information New Mexico Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements Optional: Employee's date of birth, state of hire, and medical insurance availability. Employer's phone #, fax #, and e-mail address. Online (portal, FTP, encrypted e-mail), mail (CDR), fax, or payroll services No 20 days New Hire Elements Optional: If dependent health insurance benefits are available to the employee and if so, the date the employee qualifies for the benefits. Online (portal), mail, or fax Yes Phone: 888-878-1607 Fax: 888-878-1614 E-mail: Fill and send Customer Service/Technical Support Form at https://newhire-reporting.com/NMNewhire/contact.aspx Website: www.nm-newhire.com New York Phone: 800-972-1233 Fax: 518-320-1080 Email: childsupport.fc-ny@xerox.com Website: http://www.tax.ny.gov/bus/wt/newhire.htm Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 17 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information North Carolina Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements Optional: Employee's date of birth Online (portal, FTP), mail (CD-R, diskette), fax, or payroll services No 20 days New Hire Elements; report whether or not the employer offers Health Insurance to the new hire Online (portal), mail, or fax No Phone: 888-514-4568 Fax: 866-257-7005 Email: Fill and send Customer Service/Technical Support Form at https://newhire-reporting.com/NCNewhire/Contact.aspx Website: www.ncnewhires.com North Dakota Phone: 701-328-3582 Phone: 800-755-8530 Fax: 701-328-5497 Email: sohire@nd.gov Website: https://www.nd.gov/dhs/services/childsupport/empinfo/newhire/ Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 18 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Ohio Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements; Employee's state of hire Optional: Employee's gender, work status, and date of birth. Employer's income tax credit status and second address Online (portal, FTP), mail (CD-R), or fax Yes, if paid over $2,500 or more per year. Please Include dates payment will begin and length of contract service. 20 days New Hire Elements; Employee's state of hire Optional: Employees: occupation, salary, date of birth, dependent health insurance availability, and recall (rehire) date. Employers: Oklahoma Employer Account Number (Assigned by OESC) Online (portal), mail (diskette, magnetic tape), or fax No Phone: 614-221-5330 Phone: 888-872-1490 Fax: 888-872-1611 Direct Fax: (614) 221-7088 E-mail: Fill and send General Comments and Feedback Form at https://newhire-reporting.com/OH-Newhire/Contact.aspx Website: www.oh-newhire.com Oklahoma Phone: 405-325-9190 Phone: 866-553-2368 Fax: 800-317-3786 Email: ocss.contact.esc@okdhs.org Direct Fax: (405) 557-5350 Website: https://www.ok.gov/oesc/index.php?c=8&sc=2 Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 19 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Oregon Reporting Timeframe (non-magnetic media only) 20 days Phone: 503-378-2868 Phone: 866-907-2857 Fax: 877-877-7416 Website: www.Oregonchildsupport.gov/employers/Pages/index.aspx Reporting Independent Contractors? Online (portal, FTP), mail (CD-R, diskette, cartridge tape), or fax No 20 business days New Hire Elements; Employer: contact person name and their phone number. Employees: date of birth and state of hire. Online (portal, FTP), mail, fax, or payroll services No 20 days New Hire Elements Mail or fax No Phone: 888-724-4737 Fax: 866-748-4473 Email: RA-LI-CWDS-NewHire@pa.gov Website: www.cwds.state.pa.us Puerto Rico New Hire Elements; Employers: contact name, phone number Method of Transmission Optional: Employers: State Identification Number (SIN) and contact e-mail address. Employees: date of birth, email address, home phone, and cell phone. E-mail: emplnewhire.help@doj.state.or.us Pennsylvania Data Elements Phone: 787-754-5353 Fax: 787-765-1313 Website: https://patronos.dtrh.gobierno.pr/patronos/acercade.aspx (For English, select language from topic menu) Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 20 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Rhode Island Reporting Timeframe (non-magnetic media only) Method of Transmission Reporting Independent Contractors? 14 days New Hire Elements Optional: Employee's date of birth, state of hire, does employee have medical insurance? If so, provide date medical insurance started. Employer's phone number, contact number, and e-mail address. Online (portal, FTP), mail (diskette), fax, or payroll services No 20 days New Hire Elements; Employee's date of birth Optional: Employer's phone number Online (Portal) or fax No 20 days New Hire Elements Online (portal, FTP), mail, or fax No Phone: 888-870-6461 Fax: 888-430-6907 Public Phone: (888) 870-6461 Ext. 200 E-mail: Fill and send Customer Service/Technical Support Form at https://ri-newhire.com/contact Website: www.ri-newhire.com South Carolina Data Elements Phone: 803-898-9235 Fax: 803-898-9100 E-mail. Fill out form and send at https://newhire.sc.gov/Help/ContactUs Website: https://newhire.sc.gov/ South Dakota Phone: 605-626-2942 Phone: 888-827-6078 Fax: 605-626-2842 Public Fax: (888) 835-8659 Website: http://dlr.sd.gov/ui/newhirereporting.aspx Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 21 of 28 To update contact information, email employerservices@acf.hhs.gov. .

State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Tennessee Reporting Timeframe (non-magnetic media only) Online (portal, FTP), mail (diskette), fax, or payroll services No 20 days New Hire Elements Optional: Employee's date of birth, salary/wages, pay frequency, and state of hire. Employer's phone number, fax number, State Employer Identification Number (SEIN), and Doing Business As (DBA). Online (portal, FTP), mail, or fax No Website: www.tnnewhire.com Website: www.employer.texasattorneygeneral.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Reporting Independent Contractors? New Hire Elements: Employee's state of hire Optional: Employee's date of birth, gender, earned income tax credit available, employee left employment, availability of health insurance, payroll address (if different than physical address), the name of the person (or team) at the company responsible for reporting new hires and the company's phone, fax, and e -mail address. E-mail: Fill and send General Comments and Feedback Form at https://newhire-reporting.com/TN-Newhire/contact.aspx Phone: 800-850-6442 Fax: 800-732-5015 Email: employeroutreach.fc-sls@acs-inc.com Method of Transmission 20 days Phone: 615-884-2828 Phone: 888-715-2280 Fax: 877-505-4761 Texas Data Elements Page 22 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Utah Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission 20 days New Hire Elements Optional: Date of birth Online (portal), mail (diskette), fax, or telephone (up to 3) No 10 days New Hire Elements Online (portal), mail (CD), or fax No 20 days New Hire Elements; Employee's place of hire (only if reporting as a Multiisland employer) Online or fax No Phone: 801-526-9235 Phone: 800-222-2857 Fax: 801-526-4391 Email: dws-ui-contrib@utah.gov Reporting Independent Contractors? Direct Phone: (801) 526-9235 option 9 Public Phone: (800) 222-2857 (toll free) option 9 Website: jobs.utah.gov/UI/Employer/Login.aspx Vermont Phone: 802-828-4344 Fax: 802-828-4286 Email: Labor-UIandWagesDivision@state.vt.us Website: http://labor.vermont.gov/unemploymentinsurance/employers/new-hire-reporting/ Virgin Islands Phone: 340-776-3700 Fax: 340-777-4803 Email: newhire@usvi.org Website: http://www.vidol.gov/Units/BLS/New_Hire_I.htm Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 23 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Virginia Reporting Timeframe (non-magnetic media only) Data Elements Method of Transmission Reporting Independent Contractors? 20 days New Hire Elements Optional: Employee's date of birth and availability of medical benefits. Employer's phone #, fax #, e-mail address, and contact name Online (portal, FTP), mail. fax, or payroll services No 20 days 20 days New Hire Elements Optional: Employee's date of birth and availability of medical benefits. Employer's phone #, fax #, e-mail address, and contact name. W-4 elements; Employee's date of birth Phone: 800-979-9014 Fax: 800-688-2680 E-mail. Fill and send Customer Service/Technical Support Form at https://va-newhire.com/contact Website: https://va-newhire.com/ Washington Phone: 800-979-9014 Fax: 800-688-2680 E-mail: Fill and send General Comments and Feedback Form at https://va-newhire.com/contact Website: www.va-newhire.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 24 of 28 To update contact information, email employerservices@acf.hhs.gov. .

State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Online (portal), mail, fax, or phone Reporting Timeframe (non-magnetic media only) Online (portal, FTP, mail, fax, or payroll services Data Elements No Method of Transmission No Reporting Independent Contractors? Washington Phone: 800-562-0479 Fax: 800-782-0624 Email: dcshire@dshs.wa.gov Public Phone: (800) 5620479 (select option 3) Website: www.childsupportonline.wa .gov 20 days Office of Child Support Enforcement Employer Services Team 10/31/2015 20 days New Hire Elements Optional: Employee's date of birth and availability of medical benefits. Employer's phone #, fax #, e-mail address, and contact name. Page 25 of 28 W-4 elements; Employee's date of birth Online (portal), mail, fax, or phone To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Online (portal, FTP, mail, fax, or payroll services Reporting Timeframe (non-magnetic media only) No Data Elements No Method of Transmission West Virginia Reporting Independent Contractors? 14 days Phone: 877-625-4669 Fax: 877-625-4675 E-mail: Fill and send General Comments and Feedback Form at https://newhirereporting.com/WVNewhire/Contact.aspx Website: www.wvnewhire.com Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 26 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information New Hire Elements; Employee's state of hire (only if reporting as a Multistate employer) Office of Child Support Enforcement Employer Services Team 10/31/2015 Reporting Timeframe (non-magnetic media only) Data Elements Online (portal, FTP), mail (CD, Diskette), fax, or payroll services Employers must also report the hiring or rehiring of all independent contractors who receive compensation or execute a contract for services performed when payment for services equals or exceeds $2500.00 in any year. Reporting for independent contractors must occur at the time the contract is executed or the first payment, whichever is earlier. Page 27 of 28 Method of Transmission Wisconsin Reporting Independent Contractors? 20 days Phone: 888-300-4473 Fax: 800-277-8075 E-mail: Fill and send Customer Service/Technical Support Form at https://winewhire.com/contact Website: www.winewhire.com To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State New Hire Reporting This document provides state-specific information about new hire reporting contact information, reporting time frame, data elements (mandatory and optional), method of transmission, and whether the state requires or requests/allows the reporting of independent contractors. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information New Hire Elements; Employee's date of birth Optional: Employee's state of hire. Employer's phone number, fax number, e-mail address, and contact name. Reporting Timeframe (non-magnetic media only) Online (portal, FTP), mail, fax, or payroll services Data Elements No Method of Transmission Wyoming Reporting Independent Contractors? 20 days Phone: 800-970-9258 Fax: 800-921-9651 E-mail: Fill and send Customer Service/Technical Support Form at https://newhirereporting.com/WYNewhire/contact.aspx Website: www.wynewhire.com New Hire Elements; Employee's state of hire (only if reporting as a Multistate employer) Optional: Employee's date of birth. Employer's phone number and contact name. Office of Child Support Enforcement Employer Services Team 10/31/2015 Online (portal, FTP), encrypted e-mail, mail (CD, diskette, reel tape, cartridge), fax, or payroll services No Page 28 of 28 To update contact information, email employerservices@acf.hhs.gov. . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Alabama State Contact Information Address Melanie Duncan, Contract Manager Phone: 334-242-9300 Email: cslienunit@dhr.alabama.gov Fax: 334-242-0606 Other Information When to Start Withholding The employer has 14 days to answer whether or not they will be able to withhold. Withholding commences on the first pay period following the 14-day answer period. When to send payment (within a certain number of days stated, after payday) Once money is withheld, it must be remitted within 7 working days. Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support, medical support, arrears Withholding limit(s) applied to payments to employees Amounts allowed by the Federal Consumer Credit Protection Act (15 USC Section 1673(b)) Withholding limit(s) applied to payments to nonemployees AL has no additional withholding limits other than those prescribed by federal law Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $2 per month Legislative cite Code of Ala.§§30-3-61, 30-3-66, 30-3-67, 30-3-71, 38-10-8 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 1 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Alaska State Contact Information Address Rick Romero, Client Service Manager Phone: 907-269-6803 Ava Corbitt, Office Assistant II Employer Assistance Phone: 907-269-6089 Linda Ferreria, Supervisor Employer Assistance Phone: 907-269-6986 Website: www.childsupport.alaska.gov/Employers/Employer_In formation.asp Other Information When to Start Withholding 1st payday after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, mandatory retirement plans Priority for withholding Current support, health insurance premiums, arrears, interest Withholding limit(s) applied to payments to employees 40% of disposable income; may go up to 65% when good cause is determined by agency as outlined in Alaska Admin. Code Withholding limit(s) applied to payments to nonemployees 100% Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination 3 years after termination Maximum administrative fee allowed to be taken by employer (optional) $5 per payment Legislative cite Alaska Employer's Guide to Wage Withholding for Child Support; Ak. Stat. §§25.27.062, 25.27.255; 15 Ak. Adm.

Code §125.540 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 2 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Arizona State Contact Information Phone: 602-771-8000 Phone: 602-771-8127 Fax: 602-771-8130 E-mail: dcse-policyquestions@azdes.gov Address Arizona Department of Economic Security Division of Child Support Enforcement (DCSE) Policy Unit PO Box 40458 Attention: Site Code 776A Phoenix, Arizona 85067 Other Information When to Start Withholding 1st pay period occurring 14 days after date of notice When to send payment (within a certain number of days stated, after payday) 2 business days Mandatory deductions Federal, state, local income taxes, FICA, Medicare taxes Priority for withholding Current support, health insurance premiums, arrears, interest Withholding limit(s) applied to payments to employees 50% of disposable income Withholding limit(s) applied to payments to nonemployees 50% of the payment Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination At least 90 days Maximum administrative fee allowed to be taken by employer (optional) $1 per payment or $4 per month, whichever is greater Legislative cite A.R.S. §§25-504, 33-1131; A.R.S. § 25-505.01 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 3 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Arkansas State Contact Information Address Paula Phillips Phone: 501-682-6169 E-mail: Paula.Phillips@ocse.arkansas.gov Toni Erwin Phone: 800-216-0224 E-mail: employer.relations@ocse.arkansas.gov Other Information When to Start Withholding 1st pay period occurring 14 days after date notice was mailed When to send payment (within a certain number of days stated, after payday) Payday Mandatory deductions Federal, state, local income taxes, FICA, Medicare, Railroad Retirement Priority for withholding Current support, health insurance premiums, arrears, interest Withholding limit(s) applied to payments to employees Amounts allowed pursuant to the federal Consumer Credit Protection Act Withholding limit(s) applied to payments to nonemployees None. However, amounts withheld from lump sum payments, as defined under state law, are limited to the full amount of the past due support but not to exceed 50% of the lump sum payment. Contact AR OCSE to verify arrears. Allocation of orders Prorate When to send termination notice (for employees with orders only) Immediately How long to retain order after employee's termination Keep on file until notified Maximum administrative fee allowed to be taken by employer (optional) $2.50 per payment Legislative cite A.C.A. §§9-12-312, 9-14-224, 9-14-227, 9-14-228 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 4 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. California State Contact Information Address Program and Policy Branch Phone: 916-464-5883 Fax: 916-464-7032 E-mail: policy.branch@dcss.ca.gov Other Information When to Start Withholding Within 10 days after receipt When to send payment (within a certain number of days stated, after payday) No longer than 7 business days after the payment is withheld. Mandatory deductions Federal, state, and local taxes; FICA; Medicare; and disability insurance; union dues; deductions for disability insurance and payments to public employees' retirement systems, provided that the deductions are required as a condition of employment. Priority for withholding At this time, California allows for the non-aided individual to choose between medical support and current support. For aided individuals, it is always current support that is prioritized. Withholding limit(s) applied to payments to employees Except as provided by the court, the maximum withholding is 50% of the net disposable earnings; or 25% (may be lower by written agreement) of state disability, temporary worker's compensation benefits, or unemployment benefit payments. A court ordered IWO is limited to the limit under Section 1673 of Title 15 of the US Code. If the lump sum does not involve "earnings," then the lump sum would be subject to a 100% attachment depending on arrears amount owed. For example, a lump sum involving a civil judgment award not involving earnings would be subject to the maximum 100% attachment. Withholding limit(s) applied to payments to nonemployees Any moneys payable to the individual based upon compensation of personal service whether it is wages, salaries, commission, bonus, pay, allowances, or otherwise can be withheld to pay child support.

With the exception provided by the court, the maximum withholding is 50% of the net disposable earnings. Withholding from independent contractors is allowed by California law. Allocation of orders Prorate - If the NCP has more than one garnishment for support, total the amounts due for all assignments. If 50% of the NCP's net disposable earnings cannot satisfy all of the garnishments, prorate first among all the current obligations. Any remainder is applied to arrears in the same manner. When to send termination notice (for employees with orders only) Within 10 days Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 5 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. California Other Information How long to retain order after employee's termination Generally, the employer must retain the IWO until such time that the employer has been notified that the IWO has been terminated. By operation of law a withholding order for support shall automatically terminate one year after the employment of the employee by the employer terminates. Maximum administrative fee allowed to be taken by employer (optional) $1.50 per payment Legislative cite Cal. Civ. Proc.

Code §§706.022, §§706.030, 706.052; Cal. Fam. Code §§5235, 5231, 5238, 5246; 5282; 22 California Code of Regulations §§ 116100, 110280 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 6 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Colorado State Contact Information Address Janine Archuletta Phone: 303-866-4548 Email: cdhs_fsremployerservices@state.co.us Employer Services Unit Phone: 1-800-696-1468 Website: www.childsupport.state.co.us Other Information When to Start Withholding First pay period that begins within 14 business days from the date of the withholding notice When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA and health insurance premiums Priority for withholding Current support and current support when combined with alimony, medical support, arrears (child support, alimony and medical support), alimony only Withholding limit(s) applied to payments to employees Colorado law (C.R.S.§13-54-104) exactly matches federal law (15 USC 1673); 50% to 65% of disposable income depending upon age of arrears and whether the employee is supporting other dependents. Withholding limit(s) applied to payments to nonemployees 50% - 65% of the payment Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination Keep on file until notified by child support agency Maximum administrative fee allowed to be taken by employer (optional) $5 per month (from remainder of employee's income after deductions and withholding) Legislative cite C.R.S.§§ 13-54-104, 14-10-115, 14-14-102 and 14-14-111.5 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 7 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Connecticut State Contact Information Address Phone: 888-233-7223 Website: www.ctchildsupport.com Other Information When to Start Withholding 1st pay period after 14 days from service When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state city taxes, FICA, normal retirement contributions, union dues, group life and health insurance premiums*. * Cash child support has priority over med insurance premium. Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees If weekly disposable income is: Less than $145, then maximum amount to withhold is 15% (e.g., withhold $15 if weekly disposable is $100). * Greater than $145, then maximum amount to withhold is weekly disposable minus $123.25* *unless lower amount ordered Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No retention unless employee may return at a later date Maximum administrative fee allowed to be taken by employer (optional) No provision Legislative cite CT General Statutes Sec. 52-362(e). Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 8 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Delaware State Contact Information Address Leslie Woods, Social Services Administrator Phone: 302-395-6523 Email: leslie.woods@state.de.us Other Information When to Start Withholding No later than the first pay period occurring 7 days after receipt of IWO When to send payment (within a certain number of days stated, after payday) On or before payday Mandatory deductions Federal, state, city taxes, FICA, mandatory retirement, union dues Priority for withholding Current support, arrears, health insurance premiums Withholding limit(s) applied to payments to employees Federal CCPA limits of 50 to 65% Withholding limit(s) applied to payments to nonemployees 50 to 65% of the payment Allocation of orders Prorate When to send termination notice (for employees with orders only) Upon termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) No provision Legislative cite 13 DE. Code §513 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 9 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. District of Columbia State Contact Information Address Aggie Rhodes, Wage Withholding Manager Phone: 202-442-7089 Email: aggie.rhodes@dc.gov Other Information When to Start Withholding No later than the first pay period occurring 10 days after the date the notice or order to withhold was issued. When to send payment (within a certain number of days stated, after payday) No later than seven (7) business days after the date the income would have been paid to the obligor. Mandatory deductions Federal, state, local taxes, FICA Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees Follow the CCPA Withholding limit(s) applied to payments to nonemployees None Allocation of orders Withhold-ings are prorated among the obligor's orders up to the limits of the CCPA. When to send termination notice (for employees with orders only) Within 10 days after the obligor's termination or within 10 days after the employer receives notice of the termination from the obligor. How long to retain order after employee's termination The District has no law or policy on this issue. Maximum administrative fee allowed to be taken by employer (optional) $2.00 per deduction per pay period. Legislative cite D.C. Official Code §§46-208, 46-212, 46-216, 46-217 (2008). Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 10 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Florida State Contact Information Address Florida Child Support Employer Line Phone: 866-435-2763 Other Information When to Start Withholding No later than the first payment date which occurs more than 14 days after the date the income deduction notice was served on the payor. When to send payment (within a certain number of days stated, after payday) 2 days Mandatory deductions Federal, city taxes, FICA Priority for withholding Current support, health insurance premiums, arrears, then other medical coverage Withholding limit(s) applied to payments to employees CCPA Withholding limit(s) applied to payments to nonemployees CCPA Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $5 for 1st payment, $2 per payment thereafter Legislative cite Fla. Stat. §61.1301 Website: http://flsenate.gov/Laws/Statutes/2011/61.1301 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 11 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Georgia State Contact Information Erica D. Thornton Policy and Paternity Unit Phone: 404-657-3866 Email: DCSSPOLICY-PATERNITY@dhr.state.ga.us Address Division of Child Support Services 2 Peachtree St., N.W. 20th Floor Atlanta, GA 30303 Other Information When to Start Withholding No later than the first pay period that occurs after 14 days following the date the notice was mailed When to send payment (within a certain number of days stated, after payday) Within two business days after each payment date Mandatory deductions Federal, state, local taxes, FICA, Medicare Priority for withholding Current support, medical insurance if ordered in a specific dollar amount, arrears. Withholding limit(s) applied to payments to employees Federal CCPA limits of 50% - 65%; 50% for Orders to Withhold and Deliver Withholding limit(s) applied to payments to nonemployees 50% - 65%; 50% for Orders to Withhold and Deliver Allocation of orders Prorate When to send termination notice (for employees with orders only) Immediately How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) Up to $25.00 against the obligor's income to reimburse the payor for administrative costs for the first income deduction pursuant to an income deduction order and up to $3.00 for each deduction thereafter. Legislative cite O.C.G.A. §19-6-33 http://www.lexisnexis.com/hottopics/gacode/Default.asp Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 12 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Guam State Contact Information Address Yolanda Salalila, SDU Supervisor Phone: 671-475-3324, ext. 669 Fax: 671-475-3203 E-mail: yolanda.salalila@guamcse.net Other Information When to Start Withholding First pay period after receipt of the Order When to send payment (within a certain number of days stated, after payday) Within 5 days of the day an employee's pay is due Mandatory deductions Local tax, FICA Priority for withholding Current support, current medical support, child support arrears, medical support arrears, genetic test fees Withholding limit(s) applied to payments to employees 60% of disposable income, but only 50% if NCP supporting either a spouse or child not subject of an Order Withholding limit(s) applied to payments to nonemployees Allocation of orders Divide equally When to send termination notice (for employees with orders only) Immediately How long to retain order after employee's termination Notify agency if employee is terminated Maximum administrative fee allowed to be taken by employer (optional) No fee allowed Legislative cite 5 GCA Section 34132, 34133.1, 34134, 34135, 34137, 34138 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 13 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Hawaii State Contact Information Address Kaleialoha Vierra, CSE Specialist Phone: 808-692-7147 Fax: 808-692-7134 E-mail: kalei.a.vierra@hawaii.gov Other Information When to Start Withholding 1st pay period within 7 days from mailing When to send payment (within a certain number of days stated, after payday) 5 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding No policy with respect to medical support priority at this time Withholding limit(s) applied to payments to employees Federal Consumer Credit Protection Act limits Withholding limit(s) applied to payments to nonemployees None Allocation of orders Prorate When to send termination notice (for employees with orders only) Immediately How long to retain order after employee's termination Keep order until notified by IV-D Maximum administrative fee allowed to be taken by employer (optional) $2 per payment Legislative cite H.R.S. §576E-16 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 14 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Idaho State Contact Information Address Kristy White Phone: 208-334-4975 Email: whitek@dhw.idaho.gov Other Information When to Start Withholding 1st pay period after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal and state taxes Priority for withholding Current support, medical support, arrears Withholding limit(s) applied to payments to employees 50% of disposable income Withholding limit(s) applied to payments to nonemployees 50% of the payment Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination Keep until notified Maximum administrative fee allowed to be taken by employer (optional) $5 per payment Legislative cite Id. Code §32-1210 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 15 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Illinois State Contact Information Address Maximus Collection and Asset Recovery Phone: 888-245-1938 Email: iwoteam@maximus.com Other Information When to Start Withholding 1st payday after receipt When to send payment (within a certain number of days stated, after payday) 7 business days; if remitting for 10 or more employees OR if have 250 employees or more (do not all have to be in IL) and remitting for 1 or more, must send payments ELECTRONICALLY Mandatory deductions Federal, state, and local taxes and other retirement and disability contributions required to be withheld by law, FICA, union dues and amounts exempted by the federal Consumer Credit Protection Act Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees None Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 7 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $5 per month Legislative cite 750 ILCS 28/35 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 16 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Indiana State Contact Information Dorothy R Webb, Supervisor Employer Maintenance Unit Child Support Bureau Phone: 317-234-4870 Fax: 317-234-4767 E-mail: Dorothy.Webb@dcs.IN.gov Address 402 W Washington St MS 11 Indianapolis IN 46204 Other Information When to Start Withholding 14 business days after order is received When to send payment (within a certain number of days stated, after payday) If the employer has more than 50 employ-ees on staff and is remitting more than one child support payment, they are required to do it electronically. Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support, arrears, health insurance premiums Withholding limit(s) applied to payments to employees Amounts allowed by the Federal Consumer Credit Protection Act (15 USC 1673(b)) Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $2 per payment Legislative cite Ind. Code Ann. §§31-16-15-15, 31-16-15-17, 31-16-15-18 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 17 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Iowa State Contact Information Address Amy Wedemeier, Management Analyst II Phone: 319-226-7052 Phone: 877-274-2580 Fax: 515-564-4103 E-mail: csrue@dhs.state.ia.us Website: http://iowachildsupport.gov Andrea Bell, Management Analyst II Phone: 319-226-7041 Phone: 877-274-2580 Fax: 515-564-4103 Other Information When to Start Withholding 10 days after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding No policy with respect to medical support priority at this time Withholding limit(s) applied to payments to employees 50% of net disposable income Withholding limit(s) applied to payments to nonemployees 50% of the payment Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $2 per payment Legislative cite Iowa Code §§252D.17, 252D.18A Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 18 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Kansas State Contact Information Address Tonya Brunson Phone: 785-296-6974 Email: tonya.brunson@dcf.ks.gov Website: http://www.dcf.ks.gov/services/CSS/Pages/IncomeWithholding-Order-general-information.aspx Other Information When to Start Withholding 1st pay period after 14 days from receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA and other retirement and disability contributions Priority for withholding Current support, arrears, health insurance premiums Withholding limit(s) applied to payments to employees Kansas limits withholdings to 50% of disposable income as that term is defined in the CCPA for all withholdings occurring after July 1, 2013. Withholding limit(s) applied to payments to nonemployees Allocation of orders Divide equally When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) Lesser of $5 per pay period or $10 per month for income withheld from periodic payments (e.g. regular compensation). An additional $10 may be withheld for any lump sum withholdings. Legislative cite K.S.A. 23-3101 et seq.; Kansas House Bill 2015 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 19 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Kentucky State Contact Information Address Mary W. Sparrow Phone: 502-564-2285 ext. 4832 E-mail: mary.sparrow@ky.gov Other Information When to Start Withholding The first pay period that occurs 14 days after the date of the notice When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees Federal Consumer Credit Protection Act limits of 50-65% Withholding limit(s) applied to payments to nonemployees Kentucky can withhold up to 100% of the payment amount or the obligation due, whichever is less, depending on whether the income is determined to be derived from earnings. Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $1 per payment Legislative cite Kentucky Revised Statutes 405.465 and 405.467 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 20 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Louisiana State Contact Information Address Gloria Garner, Program Manager Phone: 225-342-2148 Email: gloria.garner@la.gov Other Information When to Start Withholding 1st pay period after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, retirement, medical, life insurance Priority for withholding Health insurance premiums, current support, arrears Withholding limit(s) applied to payments to employees 50% of disposable income Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $5 per pay period Legislative cite La. R.S. 13:3881, 46:236.3 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 21 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Maine State Contact Information Address Mike Hughes Phone: 207-624-6981 Email: mike.hughes@maine.gov Other Information When to Start Withholding 1st payday after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, state employee's retirement, required union dues Priority for withholding Current child support, arrears, health insurance premiums Withholding limit(s) applied to payments to employees None Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 15 days after termination How long to retain order after employee's termination Order stands until released by the child support agency Maximum administrative fee allowed to be taken by employer (optional) $2 per payment Legislative cite 14 M.R.S.A. §3126-A; 19-A M.R.S.A. §§2306, 2652, 2663; Code Me. R.

10-144351 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 22 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Maryland State Contact Information Address Donna Mooshegian Phone: 410-767-7054 Email: dmooshe2@dhr.state.md.us Other Information When to Start Withholding 1st pay period after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current child support, arrears, health insurance premiums, and cash medical support Withholding limit(s) applied to payments to employees Amounts allowed by the Federal Consumer Credit Protection Act (15 USC Section 1673(b)) Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination Not required Maximum administrative fee allowed to be taken by employer (optional) $2 per payment Legislative cite Md. Code Ann., Family Law §§10-128, 10-129, 10-130 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 23 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Massachusetts State Contact Information DOR/Child Support Enforcement Division Address P.O. Box 7057 Boston, MA 02114 Kathlyn Cox-Breen Phone: 617-887-7562 Email: cox@dor.state.ma.us Jackie Linnell Phone: 617-887-7689 Email: linnellj@dor.state.ma.us Michael Hood Phone: 617-887-7592 Email: hoodm@dor.state.ma.us Other Information When to Start Withholding 1st payday more than 3 days after notice When to send payment (within a certain number of days stated, after payday) 3 days; if remitting for 5 or more employees, must send payments electronically Mandatory deductions Federal, state, city taxes, FICA and mandatory public employee deductions Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees Federal Consumer Credit Protection Act limits Withholding limit(s) applied to payments to nonemployees Federal Consumer Credit Protection Act limits Allocation of orders Prorate When to send termination notice (for employees with orders only) Before next payday following termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $1 per payment Legislative cite Massachusetts General Laws Chapter 119A, section 12 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 24 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Michigan State Contact Information Address Chris Townsend Phone: 517-241-5053 Email: townsendc2@michigan.gov Other Information When to Start Withholding 7 days after service When to send payment (within a certain number of days stated, after payday) 3 days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support, arrears, health insurance premiums Withholding limit(s) applied to payments to employees 50% of disposable earnings as that term is defined in the Consumer Credit Protection Act (CCPA) at 15 USC 1672 Ref: MCL 552.608, MCL 552.611a, and MCL 552.626b Withholding limit(s) applied to payments to nonemployees No limit on payments or income that is not earnings or disposable earnings as those terms are defined in the Consumer Credit Protection Act (CCPA) at 15 USC 1672. Ref: MCL 552.608, MCL 552.611a, and MCL 552.626b. Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination Until notified by agency; IWN stays in effect even upon return to employment Maximum administrative fee allowed to be taken by employer (optional) Income submitted by electronic means:$1 each payment, but not to exceed $2 per month Income submitted by other means:$2 each payment, but not to exceed $4 per month Legislative cite M.C.L. §§ 552.608, 552.609, 552.611, 552.611a, 552.614, 552.623 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 25 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Minnesota State Contact Information Address Policy Help Desk Phone: 800-657-3890 Other Information When to Start Withholding 1st pay period occurring 14 days after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding No policy with respect to medical support priority at this time Withholding limit(s) applied to payments to employees None Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $1 per payment Legislative cite Minn. Stat. § §518A.53 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 26 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Mississippi State Contact Information Address Dana Kidd, Program Support Unit Phone: 601-359-4814 Fax: 601-359-4435 Email: Dana.Kidd@mdhs.ms.gov Other Information When to Start Withholding 1st pay period within 14 days after service When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, other retirement and disability contributions Priority for withholding No policy with respect to medical support priority at this time Withholding limit(s) applied to payments to employees 50-65% as promulgated by the Federal Credit Consumer Protection Act (15 USC Section 1673(b)) Withholding limit(s) applied to payments to nonemployees Mississippi has no withholding limit except those prescribed by federal law. Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination Do not retain; return copy of order to agency after termination Maximum administrative fee allowed to be taken by employer (optional) $2 per payment plus $5 to be withheld each month for DHS (the monthly $5 may be sent in with the withheld obligation). Legislative cite Miss. Code Ann. §93-11-111 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 27 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Missouri State Contact Information Address Matthew Williams Phone: 800-585-9234 Email: FSD.EmployerTeam@dss.mo.gov Other Information When to Start Withholding 2 weeks after mailing or electronic issuance of notice When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support (would include a dollar-specific medical support obligation), health insurance premiums, current spousal support, arrears, interest Withholding limit(s) applied to payments to employees State withholding statutes invoke the CCPA. However, withholding orders issued by the Missouri IV-D agency limit the withholding to 50% of the disposable earnings. Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) Within 10 days after termination How long to retain order after employee's termination Until notified by enforcing authority Maximum administrative fee allowed to be taken by employer (optional) $6 per month Legislative cite Section 454.505, RSMo Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 28 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Montana State Contact Information Address Monique Prevel Phone: 406-444-6893 Email: mprevel@mt.gov Other Information When to Start Withholding 1st pay period after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, employment taxes, mandatory retirement and mandatory union dues Priority for withholding Current support, arrears, health insurance premiums* Withholding limit(s) applied to payments to employees 50% of disposable income; if income is not wages, earnings or remuneration for personal services, up to 100% of net income (100% of contract proceeds) Withholding limit(s) applied to payments to nonemployees None Allocation of orders State orders take priority over income withholding orders issued by Montana court or court agency of another state. When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination Keep order until notified by IV-D that order is terminated or modified Maximum administrative fee allowed to be taken by employer (optional) $5 per month Legislative cite Mont. Code Ann. §§40-5-423 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 29 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Nebraska State Contact Information Address Nebraska Child Support Customer Service Call Center Phone: 1-877-631-9973, Option 2 http://dhhs.ne.gov/children_family_services/CSE/Pag es/CSEHome.aspx Other Information When to Start Withholding 1st pay period after date of notice When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, mandatory retirement Priority for withholding Current child support, spousal support, medical support payments including health insurance premiums; then arrears- child support, spousal support, then medical support; then interest on those arrears Withholding limit(s) applied to payments to employees Federal CCPA limits Withholding limit(s) applied to payments to nonemployees 50 - 65% of the payment Allocation of orders Prorate When to send termination notice (for employees with orders only) 30 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $2.50 per month Legislative cite Neb. Rev. Stat. §§42-364.01, 42-364.12, 43-1722, 43-1723, 43-1718.02 (2)(i) Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 30 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Nevada State Contact Information Address Debbie Fazzino Phone: 775-684-0701 Email: dfazzino@dwss.nv.gov Other Information When to Start Withholding 1st pay period occurring 14 days after date notice is mailed When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal taxes, FICA, Medicare Priority for withholding The employer shall allocate the funds available in accordance with the following priority, unless a court or administrative order directs otherwise: Current child and spousal support Health insurance premiums or current cash medical support; Arrearages Other child support obligations Withholding limit(s) applied to payments to employees Federal CCPA limits of 50 - 65% Withholding limit(s) applied to payments to nonemployees 50% - 65% of the payment Allocation of orders Prorate When to send termination notice (for employees with orders only) Timely How long to retain order after employee's termination No law or policy Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 31 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Nevada Other Information Maximum administrative fee allowed to be taken by employer (optional) $3 Employer's Cost Recovery fee: Allows employers to deduct up to $3.00 for each withholding from the amount paid the employee as reimbursement for the costs associated with carrying out the withholding. $2 Income Withholding Fee Payable to State Treasurer: Employers are required to collect $2 per payment (max. $4 per month) to be sent to State Treasurer no less than quarterly per NRS 31A.080(3). Send the $2 fee to: Nevada State Treasurer's Office PO Box 844500 Los Angeles, CA 90074-9549 For information on Electronic Funds Transfer (EFT) of Treasurer's Fee, contact SCaDU at E-mail: scadu.eft@dwss.nv.gov Legislative cite Office of Child Support Enforcement Employer Services Team 10/30/2015 Nev. Rev. Stat.

Ann. §§31.295, 31A.030, 31A.075, 31A.080, 31A.090 Page 32 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. New Hampshire State Contact Information Address Annette Harney Phone: 603-223-4803 Email: aharney@dhhs.state.nh.us Other Information When to Start Withholding 1st pay period occurring 14 days after date of notice When to send payment (within a certain number of days stated, after payday) Payday Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support (child and spousal), health insurance premiums, arrearages Withholding limit(s) applied to payments to employees Withholding cannot exceed maximum amount permitted under federal CCPA limits, as specified in 15 U.S.C. 1673(b). Withholding limit(s) applied to payments to nonemployees Payments to non-employees not subject to withholding but subject to lien. No payment limits except first $1000 of payment is not subject to lien. Allocation of orders Prorate When to send termination notice (for employees with orders only) 15 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $1 per payment Legislative cite NH Rev. Stat.

Ann. §§458-B:4, 458-B:6, & 461-A:14 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 33 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. New Jersey State Contact Information Address Judy Fornier Phone: 609-631-2798 Email: Judy.Fornier@dhs.state.nj.us Other Information When to Start Withholding 1st pay period ending after postmark date When to send payment (within a certain number of days stated, after payday) Payday Mandatory deductions Federal, state, city taxes, FICA Priority for withholding New Jersey guidelines have a line item for work related medical coverage; however, if the coverage is out-of-pocket, the priority is current support, health insurance premiums, arrears. Withholding limit(s) applied to payments to employees Shall not exceed the maximum amount permitted under section 303 (b) of the federal Consumer Credit Protection Act (15 U.S.C. s. 1673 (b)). Withholding limit(s) applied to payments to nonemployees If in response to an Income Withholding Order (IWO), you must apply the CCPA limit. If in response to a Writ of Execution, you must withhold the full amount specified in the Writ. Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No law; if employee leaves, notify IV-D Maximum administrative fee allowed to be taken by employer (optional) $1 per payment Legislative cite N.J.

Stat. §§2A:17-56.8, 2A:17-56.11 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 34 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. New Mexico State Contact Information Address Jeremy Toulouse Phone: 505-827-1333 Email: Jeremy.toulouse@state.nm.us Other Information When to Start Withholding Next payday after service When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, union dues Priority for withholding Current support (child and spousal), health insurance premiums, arrears Withholding limit(s) applied to payments to employees 50% of disposable income Withholding limit(s) applied to payments to nonemployees No limit Allocation of orders Prorate When to send termination notice (for employees with orders only) No specific provision; governed by federal requirements to send termination notice"promptly" How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $1 per payment Legislative cite N.M. Stat. Ann. §§40-4A-6, 40-4A-8 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 35 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. New York State Contact Information Address New York State Child Support Customer Service Helpline Phone: 888-208-4485 Email: nysdcse@otda.ny.gov Other Information When to Start Withholding 1st pay period after 14 days after service When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, and FICA Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees federal CCPA limits of 50 - 65% Withholding limit(s) applied to payments to nonemployees None Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination Return order to issuer if employee terminates Maximum administrative fee allowed to be taken by employer (optional) No provision Legislative cite N.Y. Civil Practice Law & Rules §5241 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 36 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. North Carolina State Contact Information Address North Carolina Child Support Phone: 800-992-9457 North Carolina Website http://www.ncchildsupport.com/ Other Information When to Start Withholding 1st pay period occurring 14 days after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, and involuntary retirement contributions Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees 40% of disposable income if one order only; 45% if multiple orders and NCP directly supports other dependents; 50% if multiple orders and no other dependents. Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $2 per payment Legislative cite N.C. Gen. Stat. §§110-136.6, 110-136.8 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 37 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. North Dakota State Contact Information Address Suzanne Witkowski Phone: 701-328-7528 Email: sewitkowski@nd.gov Other Information When to Start Withholding Next payday after receipt of notice When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding State income withholding law provides that child support payments must be satisfied before any payment is made to the health insurance provider. Withholding limit(s) applied to payments to employees Not to exceed 50% of the obligor's disposable income . . . N.D.C.C.

§ 14-09-09.16(6) Withholding limit(s) applied to payments to nonemployees The amount withheld may not exceed 50% of the payment. Allocation of orders Prorate When to send termination notice (for employees with orders only) Within 7 business days of termination How long to retain order after employee's termination Until notified by child support agency that order has terminated Maximum administrative fee allowed to be taken by employer (optional) $3 per month Legislative cite N.D. Cent. Code §14-09-09.16, 14-09-09.10 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 38 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Ohio State Contact Information First Choice: Contact the local child support agency Website for county listing: http://jfs.ohio.gov/County/County_Directory.pdf Address Contact the local child support agency listed on the income withholding. Second Choice: JACK SALIBA Phone: 614-752-2586 Jack.Saliba@JFS.Ohio.Gov Other Information When to Start Withholding Begin the withholding no later than: (a) Fourteen business days from the date the notice is mailed to the payor; or (b) The first pay period that occurs after fourteen business days from the date the notice is mailed to the payor. When to send payment (within a certain number of days stated, after payday) Send the amount withheld to the Ohio Child Support Payment Central (CSPC) immediately but no later than seven business days after the obligor is paid. Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Ohio gives priority to all forms of cash child support first (e.g., current support, periodic arrears, fees, reimbursements) and the medical insurance premium second. This priority is dictated by Ohio Revised Code section 3119.36(B) which requires an employer to return the NMSN without action if the combined total of the support payment and the medical insurance premium exceeds CCPA. Withholding limit(s) applied to payments to employees 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks Withholding limit(s) applied to payments to nonemployees Ohio has no additional withholding limits other than those prescribed by federal law Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 business days after termination How long to retain order after employee's termination Order to be kept on file until notified by IV-D to terminate or to reduce withholding Maximum administrative fee allowed to be taken by employer (optional) $2 or up to 1% of payment, whichever is greater Legislative cite Ohio Rev. Code §§3121.03, 3121.033, 3121.034, 3121.037, 3121.18, 3121.19, 3121.20 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 39 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Oklahoma State Contact Information Employer Services Center Phone: 866-553-2368 E-mail: OCSS.Contact.ESC@okdhs.org Address DHS/CSS PO Box 248805 Oklahoma City , OK 73124 Other Information When to Start Withholding Next payday after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Effective 10-01-07, employers receiving an income assignment and NMSN are to allocate withholdings to (1) current child and spousal support, then (2) health insurance premiums, then (3) arrearages, then (4) other child support obligations. Withholding limit(s) applied to payments to employees Oklahoma follows the CCPA limits of 50-65% Withholding limit(s) applied to payments to nonemployees The payer should withhold 100% of the amount due each month. Do not exceed the total monthly amount to withhold each month. Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination Orders to be kept on file indefinitely Maximum administrative fee allowed to be taken by employer (optional) $5 per payment; up to $10 per month Legislative cite 12 Okla. Stat. §§1171.2, 1171.3 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 40 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Oregon State Contact Information Employer Services Central Unit Phone: 866-907-2857 E-mail: ead.staff@doj.state.or.us Address Department of Justice 4600 25th Ave NE, Suite 180 Salem, OR 97301 Other Information When to Start Withholding 1st payday within 5 business days after date of notice When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, worker's compensation, statutory pension contributions Priority for withholding Current cash child/medical/spousal support, then arrears for child/medical/spousal support and last health care coverage premium. Withholding limit(s) applied to payments to employees Yes, 50% limit of net disposable income. If withholding is for arrears only support and is issued for attachment of Veterans or Black Lung or Social Security Disability benefits the claimant must retain an amount equal to 160 hours multiplied by the federal minimum wage rate before withholding can occur. Withholding limit(s) applied to payments to nonemployees Payments to non-employees for compensation, personal services, salary, commission, bonus, pension, retirement, cash dividends, interest payments, substitute wages and amounts owed to independent contractors qualify for withholding child support when more than $4.99 is owed to an obligor. A withholder is considered any person who pays an obligor income (ORS 25.010). The maximum withholding amount for non-employees is 50% of the gross income. Allocation of orders Prorate current or current and arrears support cases only before withholding arrears/ past due "only" orders. If withholding for arrears/ past due only support, split amount withheld evenly, not to exceed ordered amount When to send termination notice (for employees with orders only) Immediately or no later than the next pay day How long to retain order after employee's termination Until further notice from court or entity issuing notice Maximum administrative fee allowed to be taken by employer (optional) $5 per order per month Legislative cite O.R.S 25.372 - 25.424 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 41 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Pennsylvania State Contact Information Address Robert Cherry Phone: 717-783-7777 Email: rocherry@pa.gov Other Information When to Start Withholding No later than 14 days from the issuance of the notice to the employer. When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support, current medical support including health insurance premiums, child support arrears, medical support arrears Withholding limit(s) applied to payments to employees Amounts allowed by the Federal Consumer Credit Protection Act (15 USC Section1673(b)) Withholding limit(s) applied to payments to nonemployees Non-employees (such as self-employed independent contractors) would not have wages attached by a Pennsylvania Domestic Relations Section. No limits would be applied by the income withholder because the non-employee would not have a garnishment. Allocation of orders Prorate When to send termination notice (for employees with orders only) No specific provision; governed by federal requirements to send termination notice "promptly" How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) 2% of payment Legislative cite 23 Pa. C.S. §4348 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 42 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Puerto Rico State Contact Information Address Silvia Bula-Bula, Auxiliary Administrator Phone: 787-767-1500, ext 2837 E-mail: sbula@asume.pr.gov Other Information When to Start Withholding 7 business days after 1st payday When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding No information available at this time Withholding limit(s) applied to payments to employees None Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 30 days after termination How long to retain order after employee's termination Orders to be kept on file until 30 days after termination Maximum administrative fee allowed to be taken by employer (optional) Will be stated on order (up to $1 per payment) Legislative cite 8 L.P.R.A. §523 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 43 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Rhode Island State Contact Information Address Kathleen McCusker, Chief Human Services Policy and Systems Specialist Phone: 401-458-4427 Email: Kathleen.McCusker@dhs.ri.gov Other Information When to Start Withholding 1 week from date received When to send payment (within a certain number of days stated, after payday) 7 days Mandatory deductions Federal, state, city taxes, FICA and Medicare taxes Priority for withholding Current support, current medical support (cash order), current spousal support and then arrears Withholding limit(s) applied to payments to employees None Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination Order remains in effect until modified or terminated by court Maximum administrative fee allowed to be taken by employer (optional) $2 per payment Legislative cite R.I. Gen. Laws §§15-5-24, 15-16-5.1, 15-16-9, 15-16-10, 15-16-12 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 44 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. South Carolina State Contact Information Address Tim Mose, Assistant Director South Carolina Department of Social Services Phone: 803-898-9304 Email: timothy.mose@dss.sc.gov Other Information When to Start Withholding Next pay period after service When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, other retirement deductions, disability contributions Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees None Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 20 days after termination How long to retain order after employee's termination If employee leaves, employer's responsibility ends Maximum administrative fee allowed to be taken by employer (optional) $3 per payment Legislative cite S.C. Code Ann. §20-7-1315 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 45 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. South Dakota State Contact Information Address Carmin Sommer Phone: 605-367-5444 ext. 405 E-mail: carmin.sommer@state.sd.us Other Information When to Start Withholding 1st payday after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, Medicare. Priority for withholding Current support, arrears, health insurance premiums Withholding limit(s) applied to payments to employees 50% of disposable income; total amount of arrearage may be withheld from property, money and credits or other income not listed Withholding limit(s) applied to payments to nonemployees 50% of the payment Allocation of orders Prorate When to send termination notice (for employees with orders only) 5 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) Effective 7-1-2004: up to $3.00 per month Legislative cite S.D. Cod. L.

§§25-7A-32, 25-7A-34, 25-7A-35, 25-7A-36 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 46 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Tennessee State Contact Information Elsie Rhodes, Coordinator Phone: 615-313-5761 Email: elsie.rhodes@state.tn.us Fax: 615-532-2791 Address TN Child Support Services 400 Deaderick Street, 14th Fl Nashville, TN 37243 Other Information When to Start Withholding 14 days after date of the order When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA and health insurance premiums for dependent listed on the child support order Priority for withholding The current support obligations are paid first in the following order: child support, medical support including health insurance premiums, spousal support. Arrears obligations are paid next in the same order. Withholding limit(s) applied to payments to employees 50% of disposable income Reference TCA 36-5-501(j)(2)(A) Withholding limit(s) applied to payments to nonemployees 50%. Reference TCA 36-5-501(j)(2)(A) Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) Up to 5% of payment, not to exceed $5 per month Legislative cite Tenn. Code Ann. §36-5-501 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 47 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Texas State Contact Information Address Christa Arocha-DeLeon Phone: 512-460-6229 Email: christa.arochadeleon@texasattorneygeneral.gov Other Information When to Start Withholding 1st pay period after receipt When to send payment (within a certain number of days stated, after payday) Payday; for EFT/EDI payments, no later than 2nd business day after payday Mandatory deductions To arrive at "Texas Family Code disposable earnings," calculate CCPA disposable earnings and then subtract union dues and medical, hospital and disability insurance for employee and dependents. Priority for withholding The cost of medical support for coverage provided through the employer is considered a deduction from income before reaching the disposable income available for support under the garnishment limits and therefore are not subject to maximum available income limits; any other medical support order is considered additional child support and no distinction made for the purpose of withholding priority. That priority is current support, interest, arrears, costs and fees. Withholding limit(s) applied to payments to employees Texas Family Code garnishment cap is 50% of Texas Family Code disposable earnings, plus the garnishment amount for health insurance; if the CCPA garnishment limit is lower, the CCPA limit applies. Withholding limit(s) applied to payments to nonemployees Allocation of orders Divide equally When to send termination notice (for employees with orders only) 7 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $10 per month Legislative cite Tex. Fam. Code §§158.009, 158.202, 158.203, 158.204 158.207, 158.211 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 48 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Utah State Contact Information Kenneth Ransom Phone: 801-741-7522 E-mail: kransom@utah.gov. Address Office of Recovery Services PO Box 45033 Salt Lake City, UT 84145-0033 Linda Long Phone: 801-741-7526 E-mail: llong@utah.gov Other Information When to Start Withholding 1st pay period occurring 5 business days after receipt When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA, and Medicare Priority for withholding If withholding is required for employee contributions to one or more plans under this notice and for a support obligation under a separate notice and available funds are insufficient for withholding for both cash and medical support contributions, the employer must withhold amounts for purposes of cash support and medical support contributions in accordance with the law, if any, of the State of the employee's principal place of employment requiring prioritization between cash and medical support, as described here: If the employee's principal place of employment is in Utah, deduct current child support before deducting amounts for health insurance coverage. As required under section 2.b.2. of the Employer Responsibilities, complete item 5 of the Employer Response to notify the Issuing Agency that enrollment cannot be completed because of prioritization or limitations on withholding. Withholding limit(s) applied to payments to employees Utah Code Annotated 62A-11-406 limits the total amount of an employee's income withheld for child support to the maximum permitted under Section 303(b) of the Consumer Credit Protection Act as cited in 15 U.S.C. Section 1673(b).

In general, income withholding will be limited to withholding 50% of the employee's disposable income. If 50% of the employee's income does not result in withholding sufficient to cover the employee's current support and medical support obligations, the employee's circumstances may be reviewed to determine whether a higher percentage is permitted under the provisions of the Consumer Credit Protection Act . Withholding limit(s) applied to payments to nonemployees Utah Code defines those who are subject to income withholding for child support and medical support as an individual who receives a payment from a "payor" regardless of whether the income is "earnings, compensation, or other payment due..." such as a "contract payment" (62A-11-103(8). As a result, Utah Code applies the same withholding amounts for employees as non-employees, which is generally 50% of the non-employee/contractor's payment. Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 49 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Utah Other Information Allocation of orders Prorate When to send termination notice (for employees with orders only) 5 days after termination How long to retain order after employee's termination Keep withholding order in place until notified Maximum administrative fee allowed to be taken by employer (optional) One-time fee of $25 (may be charged all at once, or over several pay periods) Legislative cite Utah Code Ann. §§62A-11-406, 62A-11-407, 62A-11-413, 62A-11-506, 62A-11507, 78-7-44; Rule 64D of the Utah Rules of Civil Procedure; Utah Adm. Code R527-302-1 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 50 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Vermont State Contact Information Address Vermont Customer Service Unit Phone: 800-786-3214 Fax: 802-769-8382 E-mail: ocscsu@state.vt.us Other Information When to Start Withholding 10 days after receipt or next payday When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current child support, medical support, child support arrears, medical support arrears, surcharge Withholding limit(s) applied to payments to employees Follow CCPA limits Withholding limit(s) applied to payments to nonemployees None Allocation of orders Prorate When to send termination notice (for employees with orders only) Within 10 days of the date employment is terminated How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $5 per month Legislative cite 15 V.S.A. §§787, 789 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 51 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Virgin Islands State Contact Information Address Terrence Joseph, Acting Director Paternity and Child Support Division US Virgin Islands Department of Justice Phone: 340-778-5958, ext. 4073 E-mail: tjoseph@pcsd.gov.vi Other Information When to Start Withholding When to send payment (within a certain number of days stated, after payday) Mandatory deductions Federal, state, city taxes, FICA Priority for withholding No statutory policy; preference for current support, medical support including health insurance premiums, arrears Withholding limit(s) applied to payments to employees None Withholding limit(s) applied to payments to nonemployees Allocation of orders Divide equally When to send termination notice (for employees with orders only) How long to retain order after employee's termination Order to be kept until date of termination or modification Maximum administrative fee allowed to be taken by employer (optional) Up to $1 Legislative cite Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 52 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Virginia State Contact Information Pat Watson Phone: 800-257-9986 Email: pat.watson@dss.virginia.gov Address Virginia Division of Child Support Enforcement 801 East Main Street, 12th floor Richmond, VA 23219-2901 Other Information When to Start Withholding Next payday after service When to send payment (within a certain number of days stated, after payday) Payday if by mail; 4 days after payday if via EFT Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support, arrears (including interest), health insurance premium Withholding limit(s) applied to payments to employees 50-65% of disposable earnings consistent with the Federal CCPA limits, Code of Virginia §34-29 closely follows the federal CCPA.. All IWOs issued by the Virginia child support agency provide the withholding limit information on the Income Withholding Order. Withholding limit(s) applied to payments to nonemployees 50-65% of the payment. All IWOs issued by the Virginia child support agency provide the withholding limit information on the Income Withholding Order. Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination No specific retention period Maximum administrative fee allowed to be taken by employer (optional) $5 per payment Legislative cite Va. Code Ann.

§§20-79.3, 34-29, 63.2-1923 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 53 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Washington State Contact Information Address Doug Cheney Phone: 360-664-5200 Email: dcs-cru@dshs.wa.gov Other Information When to Start Withholding 1st payday after receipt When to send payment (within a certain number of days stated, after payday) 7 days Mandatory deductions Federal, state, city taxes, FICA, Medicare, statutory pension contributions, mandatory union dues Priority for withholding Current support, health insurance premiums, arrears, interest Withholding limit(s) applied to payments to employees 50% of disposable income Withholding limit(s) applied to payments to nonemployees 50% of payments Allocation of orders Divide equally When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination Discard upon termination Maximum administrative fee allowed to be taken by employer (optional) $10 for 1st payment; $1 for all others Legislative cite Wash. Rev. Code §§26.18.090, 26.18.110, 26.23.060 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 54 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. West Virginia State Contact Information Nancy Light, Supervisor Phone: 304-356-4714 E-Mail: nancy.l.light@wv.gov Address 350 Capitol Street, Room 147 Charleston , WV 25301 Phone: 800-835-4683 Other Information When to Start Withholding 1st pay period occurring 14 days from date of order is mailed to employer When to send payment (within a certain number of days stated, after payday) Payday Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees W. Va. Code §48-14-408 reduces the CCPA limits by 10% each. Also, in a case with current support, the arrearage collection cannot be more than 25% of the current support amount.

The 25% limit can be increased by up to $200 per month if the obligor owes a substantial arrearage. (W. Va.

Code §48-14-801) Withholding limit(s) applied to payments to nonemployees Same as for employees, unless the withholding notice specifies to take the entire amount Allocation of orders Prorate When to send termination notice (for employees with orders only) Promptly How long to retain order after employee's termination There is no specific requirement for retention of paper document. Maximum administrative fee allowed to be taken by employer (optional) $1 per payment Legislative cite W. Va. Code §§48-14-406, 48-14-407, 48-14-408, 48-14-409, 48-14-410, 48-14412 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 55 of 57 .

State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Wisconsin State Contact Information Address Patti Reuter Phone: 608-267-4873 Email: patriciax.reuter@wisconsin.gov Other Information When to Start Withholding 1st pay period after receipt When to send payment (within a certain number of days stated, after payday) 5 days Mandatory deductions Federal, state, city taxes, FICA Priority for withholding Current child and spousal support, health insurance premiums. Withholding limit(s) applied to payments to employees None Withholding limit(s) applied to payments to nonemployees Allocation of orders Prorate When to send termination notice (for employees with orders only) 10 days after termination How long to retain order after employee's termination Retain until notified by child support agency Maximum administrative fee allowed to be taken by employer (optional) Actual costs up to $3 per payment Legislative cite Wis. Stat. §§767.75 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 56 of 57 . State/Employer Contact and Program Information State Income Withholding This document provides the state-specific contact, address and information about income withholding. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Wyoming State Contact Information Address Denise Dunn, Program Manager Phone: 307-777-5653 Email: denise.dunn@wyo.gov Fax: 307-777-5588 Other Information When to Start Withholding 1st pay period after service When to send payment (within a certain number of days stated, after payday) 7 business days Mandatory deductions Personal income taxes, social security and Medicare deductions, cost of dependent health care coverage for all dependent children and mandatory pension deductions Priority for withholding Current support, health insurance premiums, arrears Withholding limit(s) applied to payments to employees Not less than 35% nor more than 65% of gross income after deducting federal taxes. Wyoming follows 15 U.S.C. 1673. Withholding limit(s) applied to payments to nonemployees Not less than 35% nor more than 65% of gross income after deducting federal taxes. Wyoming follows 15 U.S.C.

1673. Allocation of orders Prorate When to send termination notice (for employees with orders only) 30 days after termination How long to retain order after employee's termination No law or policy Maximum administrative fee allowed to be taken by employer (optional) $5 per payment Legislative cite Wyo. Stat. §20-2-201-222 Office of Child Support Enforcement Employer Services Team 10/30/2015 Page 57 of 57 .

State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Alabama Code of Alabama 1975, Section 27-21B-10 Clifford Smith Phone: 334-501-7550 ext. 228 Fax: 334-821-4297 E-mail: clifford.smith@dhr.alabama.gov Website: http://www.legislature.state.al.us/CodeofAlabama/1975/coat oc.htm Alaska Lisa Taylor Phone: 907-269-6803 Fax: 907-787-3159 fax E-mail: lisa.taylor@alaska.gov Friederike Cook Phone: 907-269-6838 Fax: 907-787-3262 E-mail: friederike.cook@alaska.gov Ronda Hausser Phone: 907-269-6837 Fax: 907-787-3149 E-mail: ronda.hausser@alaska.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 1 of 20 Reasonable Cost Definition Rule 32(B)(7)(c)(3) Alabama Rules of Judicial Administration states that cash medical support or the cost of private health insurance is considered reasonable if the cost to the parent responsible for providing medical support does not exceed 10% of his/her gross income. . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Arizona Arizona Dept of Economic Security Division of Child Support Enforcement (DCSE) Policy Unit PO Box 40458 Attention: Site Code 776A Phoenix, Arizona 85067 State Statute on Medical Support Arizona Revised Statute 25-320(R)(4) link: A.R.S. 25-320(R)(4) states: Website: http://www.azleg.state.az.us/FormatDocument.asp "Reasonable cost" means an amount that does not exceed the higher of five per cent of the gross income of the obligated parent or an income-based numeric standard that is prescribed in the child support guidelines. Phone: 602-771-8000 Phone: 602-771-8127 Fax: 602-771-8130 E-mail: dcse-policyquestions@azdes.gov Arkansas Paula Phillips Phone: 501-682-3483 Fax: 501-682-6002 Email: paula.phillips@ocse.arkansas.gov California Program and Policy Branch Phone: 916-464-5883 Fax: 916-464-5893 E-mail: policy.branch@dcss.ca.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Reasonable Cost Definition Page 2 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Colorado State Statute on Medical Support Reasonable Cost Definition C.R.S. Section 14-10-115(10)(g) "Where the application of the premium payment on the guidelines results in a child support order of $50 or less or the premium payment is 20% or more of the parent's gross income, ..." (20% reasonable cost standard) D.C. Law 17-128, "Child Support Compliance Amendment Act of 2007" Reasonable Health Insurance Coverage Defined: Health insurance coverage shall be considered reasonable in cost if the cost to the parent obligated to provide coverage for the children subject to the support order does not exceed 5 percent of the parent's gross income. Kathleen Edwards Phone: 303-866-4582 Fax: 303-866-4359 E-mail: Kathleen.edwards@state.co.us Connecticut Edgar Young Phone: 860-424-5292 Fax: 860-951-2996 E-mail: edgar.young@ct.gov Delaware Ana DePaul Phone: 302-395-6587 Fax: 302-395-6734 E-mail: ana.depaul@state.de.us District of Columbia Artish Jacobs Phone: 202-724-2316 Fax: 202-724-3713 E-mail: artish.jacobs@dc.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 3 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Florida Reasonable Cost Definition Florida statutes section 61.13 (1) (b) states: "Health insurance is presumed to be reasonable in cost if the incremental cost of adding health insurance for the child or children does not exceed 5 percent of the gross income, as defined in s. 61.30, of the parent responsible for providing health insurance." Employer Line Phone: 866-435-2763 E-mail: dorcse@dor.state.fl.us Georgia Lamaya Paschal Phone: 404-463-1733 Fax: 770-344-3323 E-mail: lrking1@dhr.state.ga.us Guam No guidance on definition of "reasonable cost", but the Referee uses 5% of gross income. Pauline R. Chaco Phone: 671-475-3360, ext. 1210 Fax: 671-475-3203 E-mail: pauline.chaco@guamcse.net Hawaii Hawaii Revised Statutes Section 576E-17 Kaleialoha Vierra Phone: 808-692-7147 Fax: 808-692-7134 http://www.courts.state.hi.us/selfhelp/courts/forms/oahu/child_support.html Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 4 of 20 May be found in the Hawaii Child Support Guidelines: set "10% of net income" as a reasonableness standard for private insurance costs. .

State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Idaho State Statute on Medical Support Idaho Code 32-1214B(11) "Reasonable cost" means the cost to the obligor does not exceed five percent (5%) of his or her gross income. 750 ILCS Section 28/22 750 ILCS Section 28/50(a) 750 ILCS Section 5/505.2 Legislation not changed yet so no guidance with respect to reasonable cost at this time IC 31-16-6-4 The cost of private health insurance for child(ren) is considered reasonable, if it does not exceed five percent (5%) of the Weekly Gross Income of the parent obligated to provide medical support. Iowa Code Chapter 252E Website: http://coolice.legis.state.ia.us/Cool-ICE/default.asp Generally, 5% to 1% of gross income, but there are exceptions Kristy White Phone: 208-334-4975 E-mail: whitek@dhw.idaho.gov Illinois Barb McDermott Phone: 217-782-2359 E-mail: barb.mcdermott@illinois.gov Indiana Reasonable Cost Definition Jill King Phone: 317-232-4936 E-mail: jill.king@dcs.in.gov Employer Maintenance Unit Phone: 800-292-0403 Iowa Phone: 877-274-2580 Fax: 319-226-7150 Website: https://secureapp.dhs.state.ia.us/epay/ Office of Child Support Enforcement Employer Services Team 10/31/2015 Iowa Court Rules Chapter 9 Website: http://www.legis.state.ia.us/DOCS/ACO/CR/LINC/08-022010.chapter.9.pdf Page 5 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Kansas Health insurance is considered reasonable in cost if the cost to the parent responsible for providing coverage does not exceed twelve percent of that parent's gross income. Amy Burgoon Phone: (785) 296-1584 E-mail: Amy.Burgoon@dcf.ks.gov Kentucky Reasonable cost is defined in KRS 403.211(8)(a), as, For purposes of this section, "reasonable in cost" means that the cost of coverage to the responsible parent does not exceed five percent (5%) of his or her gross income. The five percent (5%) standard shall apply to the cost of adding the child to an existing policy, the difference in cost between a single and a family policy, or the cost of acquiring a separate policy to cover the child. If the parties agree or the court finds good cause exists, the court may order medical coverage in excess of five percent (5%) of the parent's gross income. Mary W. Sparrow Phone: 502-564-2285, ext.

4428 Fax: 502-564-0255 E-mail: mary.sparrow@ky.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Reasonable Cost Definition Page 6 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Reasonable Cost Definition Louisiana Gloria Garner, Program Manager Phone: 225-342-2148 Fax: 225-342-8822 E-mail: gloria.garner@la.gov Brenda Washington, Program Coordinator Phone: 225-342-4791 Fax: 225-342-8822 E-mail: brenda.f.washington@la.gov Maine Link not available at this time Reasonable cost is defined as 6% of gross income or, if gross income does not exceed 150% of the federal poverty level for one person, 0% of gross income. Family Law Article, §§12-102--12-102.3, Annotated Code of Maryland The cost of providing health insurance for a child is considered reasonable if it does not exceed five percent of the gross income of the parent who is providing the insurance. Jeffery P. Young Phone: 207-624-6987 Fax: 207-287-6883 E-mail: jeffery.p.young@maine.gov Maryland Judith Angell Phone: 410-767-7403 Fax: 410-333-0952 E-mail: jangell@dhr.state.md.us Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 7 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Massachusetts State Statute on Medical Support Massachusetts General Laws, Chapter 119A, sec. 12. Karen E. Melkonian Phone: 617-626-4204 Fax: 617-660-0163 E-mail: melkonian@dor.state.ma.us Joanne McNally Phone: 617-626-4135 Fax: 617-660-1064 E-mail: mcnallyj@dor.state.ma.us Michigan Vanessa Washington Phone: 517-241-8328 Fax: 517-373-4980 E-mail:Vanessa.washington@michigan.gov Minnesota MN Child Support Partners Phone: 651-431-4344 or 800-657-3890 Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 8 of 20 Reasonable Cost Definition Health care coverage shall be deemed available to the obligor at reasonable cost if it is available through his/her employer. . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Mississippi Dana Kidd Phone: 601-359-4814 Fax: 601-359-4435 E-mail: Dana.Kidd@mdhs.ms.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 State Statute on Medical Support 43-19-101(6): All orders involving support of minor children, as a matter of law, shall include reasonable medical support. Notice to the obligated parent's employer that medical support has been ordered shall be on a form as prescribed by the Department of Human Services. In any case in which the support of any child is involved, the court shall make the following findings either on the record or in the judgment: The availability to all parties of health insurance coverage for the child(ren); The cost of health insurance coverage to all parties. The court shall then make appropriate provisions in the judgment for the provision of health insurance coverage for the child(ren) in the manner that is in the best interests of the child(ren). If the court requires the custodial parent to obtain the coverage then its cost shall be taken into account in establishing the child support award.

If the court determines that health insurance coverage is not available to any party or that it is not available to either party at a cost that is reasonable as compared to the income of the parties, then the court shall make specific findings as to such either on the record or in the judgment. In that event, the court shall make appropriate provisions in the judgment for the payment of medical expenses of the child(ren) in the absence of health insurance coverage. Page 9 of 20 Reasonable Cost Definition 45 CFR 303.31 (a)(1) states that health insurance, for the purpose of child support enforcement, is considered reasonable in cost if the cost to the parent responsible for providing medical support or ordered to pay cash medical support does not exceed five percent (5%) of his or her gross income. In applying the 5% for the cost of private health insurance, the cost is for adding the child(ren) to the existing coverage or the difference between self-only and family coverage. .

State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Missouri Website: http://www.moga.mo.gov/statutes/c454.htm John Mier, Establishment of Medical Support Phone: 573-751-7079 Fax: 573-522-4011 E-mail: john.r.mier@dss.mo.gov Reasonable Cost Definition The medical support statutes can be found at 454.600 through 454.645. No guidance with respect to reasonable cost at this time Angela Terry, Enforcement of Medical Support Phone: 573-751-6529 Fax: 573-522-4011 E-mail: angela.terry@dss.mo.gov Nancy Crocker, Public Inquiries Phone: 573-526-5356 Fax: 573-522-4011 E-mail: nancy.j.crocker@dss.mo.gov Montana Out-of-Pocket Premium < (Gross Income) x 0.05- *If the parent's monthly out-of-pocket premium cost for coverage of the child(ren) is less than or equal to 5% of the parent's gross income, or- If there is no additional cost to add a child(ren) to an already existing plan. Chad Dexter Phone: 406-444-1846 E-mail: cdexter@mt.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 10 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Nebraska Cash medical support or the cost of private health insurance is considered reasonable in cost if the cost to the party responsible for providing medical support does not exceed three percent of his/her gross income. In applying the three percent standard the cost is the cost of adding the child(ren) to existing health care coverage or the difference between self-only and family health care coverage. Margaret Ewing Phone: 402-471-7317 Fax: 402-471-7311 fax E-mail: margaret.ewing@nebraska.gov Nevada Debbie Fazzino Phone: 775-684-0701 Fax: 775-684-0702 E-mail: dfazzino@dwss.nv.gov Website: http://www.leg.state.nv.us/NRS/NRS031A.html#NRS031ASec350 Website: http://www.leg.state.nv.us/NRS/NRS125B.html#NRS125BSec085 New Hampshire Sarah Kourian Phone: 603-223-4823 Fax: 603-271-7336 E-mail: sarah.kourian@dhhs.state.nh.us New Jersey Alisha Griffin Phone: 609-584-5093 Fax: 609-588-2064 E-mail: alisha.griffin@dhs.state.nj.us Office of Child Support Enforcement Employer Services Team 10/31/2015 Reasonable Cost Definition Page 11 of 20 Cash medical support or the cost of private health insurance is considered reasonable in cost if the cost to the parent responsible for providing health insurance does not exceed five percent (5%) of the parent's gross monthly income (GMI). In applying the five percent standard, the cost is the cost of adding the child(ren) to existing health coverage or the difference between self-only and family coverage. . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information New Mexico State Statute on Medical Support See NMSA 1978 §40-4C-1 et seq. Theresa M. Griego Phone: 505-476-7037 Email: theresam.griego@state.nm.us Fax: 505-476-7045 Rhonda T. Rodriguez Phone: 505-827-1320 Email: rhondat.rodriguez@state.nm.us Fax: 505-476-7045 New York New York State Child Support Customer Service Helpline Phone: 888-208-4485 Email: nysdcse@otda.ny.gov North Carolina Donna Buchanan Phone: 919-855-4433 Fax: 919-733-2783 E-mail: donna.buchanan@dhhs.nc.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 12 of 20 Reasonable Cost Definition . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Reasonable Cost Definition North Dakota Paulette Oberst Phone: 701-328-3582 Fax: 701-328-6575 E-mail: poberst@nd.gov Ohio Al Marcinonis Phone: 614-752-2680 E-mail: al.marcinonis@jfs.ohio.gov Oklahoma Dorinda Morris Phone: 580-227-2516 E-mail: dorinda.morris@okdhs.org Oregon Employer Services Central Unit Phone: 866-907-2857 Fax: 503-986-6011 E-mail: ead.staff@doj.state.or.us Office of Child Support Enforcement Employer Services Team 10/31/2015 ORS 25.321 to ORS 25.343 Website: http://landru.leg.state.or.us/ors/025.html Page 13 of 20 OAR 137-050-0750 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Pennsylvania Pennsylvania Rules of Civil Procedure 1910.16-6(b)(3)(i)) Robert Cherry, Human Services Program Specialist Dept. of Public Welfare Phone: 717-783-7777 Fax: 717-772-4936 Email: rocherry@pa.gov http://www.pacode.com/secure/data/231/chapter1910/s1910 .16-6.html 23 Pennsylvania Consolidated Statutes §4324) http://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/23/00.043. 024.000..HTM 23 Pennsylvania Consolidated Statues §4326 Reasonable Cost Definition 23 Pennsylvania Consolidated Statues §4324(l) "Reasonable cost." Cost of health care coverage that does not exceed 5% of the party's net monthly income and, if the obligor is to provide health care coverage, the cost of the premium when coupled with a cash child support obligation and other child support-related obligations does not exceed the amounts allowed by the Federal threshold set forth in the Consumer Credit Protection Act (Public Law 90-321, 15 U.S.C. §1601 et seq.). http://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/23/00.043. 026.000..HTM Puerto Rico Addo Perez-Valentin Phone: 787-767-1500, ext. 2700 Fax: 787-772-9352 E-mail: aperez@asume.gobierno.pr Rhode Island Reasonable Cost is equal to five percent (5%) or less of the gross of the parent.

However, when the obligor has multiple orders, then "Reasonable Cost" is defined as being equal to no more than 5% (of the gross income of the parent) for the first order; 2.5% for the second order; (and) 0% for all subsequent orders. Frank DiBiase Phone: 401-458-4412 Fax: 401-222-3835 E-mail: fdibiase@dhs.ri.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 14 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Reasonable Cost Definition South Carolina Russ Collins Phone: 803-898-9450 Fax: 803-898-9227 Email: jruss.collins@dss.sc.gov South Dakota SDCL 25-7-6.16; 25-7A-58, 59, 61 and 62 8% of net income Texas Family Code154.181-.193 Texas Family Code154.181(e) In this section, "reasonable cost" means the cost of health insurance coverage for a child that does not exceed nine percent of the responsible parent's annual resources, as described by Section 154.062(b) Website: http://www.statutes.legis.state.tx.us/SOTWDocs/FA/htm/FA. 154.htm#154.181 Josh Mason Phone: 605-773-3492 Fax: 605-773-6569 E-mail: josh.mason@state.sd.us Tennessee Elsie Rhodes, Coordinator Phone: 615-313-5761 Fax: 615-532-2791 E-mail: elsie.rhodes@state.tn.us Texas Ted White Phone: 512-460-6515 E-mail: ted.white@texasattorneygeneral.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Website: http://www.statutes.legis.state.tx.us/SOTWDocs/FA/htm/FA. 154.htm#D Page 15 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Utah State Statute on Medical Support Utah Code Annotated 62A-11-326. Scott Weight Phone: 801-741-7435 Email: sweigh2@utah.gov Denise Fairbourn Phone: (801) 741-7527 Fax: (801) 536-8509 Email: dfairbourn@utah.gov Website (state statute): http://le.utah.gov/code/TITLE62A/htm/62A11_032600.htm. Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 16 of 20 Reasonable Cost Definition Pursuant to R527-201-7. Reasonable Cost of Insurance Premiums, "Employment-related or other group coverage that does not exceed 5% of the obligated parent's monthly gross income is generally considered reasonable in cost. . ." .

State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Vermont The court shall order either or both parents owing a duty of support to provide a cash contribution or medical coverage for a child, provided that medical coverage is available to the parent at a reasonable cost. Medical coverage is presumed to be available to a parent at a reasonable cost only if the amount payable for the individual's contribution to the insurance or health benefit plan premium is five percent or less of the parent's gross income. The court, in its discretion, retains the right to order a parent to obtain medical coverage even if the cost exceeds five percent of the parent's gross income if the cost is deemed reasonable under all the circumstances after considering the factors pursuant to section 659 of this title. If private health insurance or an employer-sponsored health benefit plan is not available at a reasonable cost, the court may order one or both parents owing a duty of support to contribute a cash contribution of up to five percent of gross income toward the cost of health care coverage of a child under public or private health insurance or a health benefit plan. A cash contribution under this section shall be considered child support for tax purposes.

When calculating the contribution of a parent whose child receives coverage under Medicaid, a Medicaid waiver program, or Dr. Dynasaur, the court shall not order a contribution greater than the premium amount charged by the agency of human services for the child's coverage. Jennifer Lyford Phone: 802-871-6522 Fax: 802-769-8382 Email: jennifer.lyford@state.vt.us Office of Child Support Enforcement Employer Services Team 10/31/2015 Reasonable Cost Definition Page 17 of 20 . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Virgin Islands Dean Barnes Phone: 340-775-3070, ext. 3009 Phone: 340-775-3808 E-mail: ginad_13@hotmail.com Virginia Michelle Knowles Phone: (804) 726-7448 Fax: (804) 726-7481 E-mail: michelle.knowles@dss.virginia.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Page 18 of 20 Reasonable Cost Definition . State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information State Statute on Medical Support Washington Reasonable cost is calculated as 25% of the obligated parent's Basic Child Support Obligation (BCSO). The BCSO is calculated from Line 7 of the Washington State Child Support Schedule Worksheet with revision date prior to 10/2009. The BCSO is shown on Line 19 of the Washington State Child Support Schedule Worksheet with revision date 10/2009 and later. If no figure is shown on Line 19, the BCSO is calculated from Line 9. The court shall have discretion to order health insurance coverage that exceeds 25% of the BCSO when it is in the best interest of the child. This is considered "no limit to cost", except that current child support, plus the children's insurance premium, plus arrears cannot exceed 50% of the parent's disposable earnings. Gaye L. McQueen Phone: 360-664-5068 Fax: 360-586-3274 E-mail: gmcqueen@dshs.wa.gov West Virginia WV Code §48-12-101 et seq. Karen Yahr Phone: 304-356-4750 Fax: 304-558-4092 E-mail: karen.m.yahr@wv.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Reasonable Cost Definition Page 19 of 20 The child's portion of the medical insurance premiums not exceeding 5% of the gross income of the parent who provides the coverage. .

State/Employer Contact and Program Information State Medical Support This document provides state-specific information about medical support contact information, state statute on medical support, and the state's definition of reasonable cost for medical support. To locate a state, from the menu bar, select Edit tab, select Find (or Ctrl+F for Window users or Option+F for Mac OS users), then enter the state name in the search field. Contact Information Wisconsin Phyllis Fuller Department of Children and Families Wisconsin Bureau of Child Support Phone: 608-264-6065 Fax: 608-267-2824 E-mail: phyllis.fuller@wi.gov State Statute on Medical Support 767.127 (1m) Wis. Stat. Disclosure of health insurance availability to the parties 767.513 Wis. Stat.

Child health care expenses 767.75 Wis. Stat. Income Withholding for payment obligations Wisconsin Administrative Rule Chapter DCF 150.05 Medical Support Wyoming Administrative Rule DCF Chapter 150.05 (1)(b) 2 The court may consider a private health insurance plan to be available at a reasonable cost if the cost to enroll the child or children does not exceed 5% of the insuring parent's monthly income available for child support and would cover hospitalization and other medical costs without large out-ofpocket deductibles or co-payments.

In applying this 5% standard, the cost to enroll the child or children in a private health insurance plan is the cost to add the child or children to existing coverage or the difference between the cost of self-only coverage and the cost to that parent after adding the child or children. A parent whose income is below 150% of the federal poverty level is not required to provide medical support unless it can be provided at no cost. The cost to provide health care coverage or to provide cash medical support for children at no more than five percent (5%) of the providing party's income, as defined in W.S. 202-303(a)(ii). Jay Mullendore Phone: 307-777-5653 Fax: 307-777-5588 E-mail: jay.mullendore@wyo.gov Office of Child Support Enforcement Employer Services Team 10/31/2015 Reasonable Cost Definition Page 20 of 20 . IV. FORMS W-3 AND W-2 . FORM W-2 Who Must File Form W-2: Every employer engaged in a trade or business that pays remuneration for services performed by an employee, including noncash payments of $600 or more (all amounts if any income, social security, or Medicare tax was withheld), must furnish a Form W-2 to each employee even if the employee is related to the employer. Employers must file Form W-2 for wages paid to each employee from whom: ï‚· ï‚· Income, social security, or Medicare taxes were withheld or Income tax would have been withheld if the employee had claimed no more than one withholding allowance or had not claimed exemption from withholding on Form W-4, Employee’s Withholding Allowance Certificate. When to file: If you file using paper forms, you must file Copy A of Form W-2 with From W-3 by February 29, 2016. However, if you e-file, the due date is March 31, 2016. You may owe a penalty for each Form W-2 that you file late. Extension to file: You may request an automatic extension of time to file From W-2 with the SSA by sending Form 8809, Application for Extension of Time to File Information Returns, to the address shown on Form 8809. You must request the extension before the due date of Forms W-2.

You will have an additional 30 days to file. See Form 8809 for details. Where to file paper Forms W-2 and W-3: File Copy A of Form W-2 with Form W-3 at the following address. Social Security Administration Data Operations Center Wilkes-Barre, PA 18769-0001 How to complete Form W-2: Form W-2 is a multi-part form. Ensure all copies are legible.

Send Copy A to the SSA; Copy 1, if required, to your state, city, or local tax department; and Copies B, C, and 2 to your employee. Keep Copy D, and a copy of Form W-3, with your records for 4 years. Enter the information on Form W-2 using black ink in 12-point Courier font. Copy A is read by machine and must be typed clearly with no corrections made to the entries and with no entries exceeding the size of the boxes. Entries completed by hand, in script or italic fonts, or in colors other than black cannot be read by the machines.

Make all dollar entries on Copy A without the dollar sign and comma but with the decimal point (00000.00). Show the cents portion of the money amounts. If a box does not apply, leave it blank. Send the whole Copy A page of Form W-2 with Form W-3 to the SSA even if one of the Forms W-2 on the page is blank or void.

Do not staple Forms W-2 together or to Form W-3. File Forms W-2 either alphabetically by employees' last names or numerically by employees' SSNs. Calendar year basis: The entries on Form W-2 must be based on wages paid during the calendar year. Use Form W-2 for the correct tax year.

For example, if an employee worked from December 22, 2015, through January 9, 2016, and the wages were paid on January 10, 2016, include those wages on the 2016 Form W-2. . Filing Instructions for Preparing W-2 Forms: Box A – Employee’s social security number: Enter the number shown on the employee’s social security card. If the employee does not have a card, he or she should apply for one by completing Form SS-5. If the employee has applied but does not have a number in time for filing, enter “Applied For” in box A on paper Forms W-2 with the SSA. If e-filing, enter zero (000-00-0000 if creating forms online or 000000000 if uploading a file. Ask the employee to inform you of the number and name as they are shown on the social security card when it is received. Then correct your previous report by filing Form W-2c showing the employee's SSN. ITINs for aliens.

Do not accept an ITIN in place of an SSN for employee identification or for work. An ITIN is only available to resident and nonresident aliens who are not eligible for U.S. employment and need identification for other tax purposes.

You can identify an ITIN because it is a 9-digit number, beginning with the number “9” with either a “7” or “8” as the fourth digit, and is formatted like an SSN (for example, 9NN-7N-NNNN). An individual with an ITIN who later becomes eligible to work in the United States must obtain an SSN. Do not auto-populate in ITIN into box A Box B – Employer Identification Number (EIN): Show the employer identification number EIN assigned by the IRS. (00-0000000).

This should be the same number that is used on the Federal employment tax returns (941, 941-SS 940, 943, 944, CT-1 or Schedule H (Form 1040)). Do not use a prior owner’s EIN. If you do not have an EIN when filing Forms W-2, enter “Applied For” in box B, not your social security number. Box C – Employer’s name, address, and ZIP code: This entry should be the same as shown on the Form 941, 941-SS, 943, 944, 940, CT-1 or Schedule H (Form 1040). The U.S.

Postal Service recommends that no commas or periods be used in return addresses. Box D – Control number: This box is used to identify individual Forms W-2. It does not have to be used. Boxes E and F – Employee’s name and address: Enter the name as shown on the employee’s social security card (first name, middle initial, last name). If the name does not fit in the space allowed on the form, you may show the first and middle initials and the full last name.

Generally, do not enter “Jr.,” “Sr.,” etc in the “Suff.” Box on Copy A unless the suffix appears on the card. However, SSA still prefers that you do not enter the suffix on Copy A. If the employee’s name does not fit in the space provided, enter the first initial, middle initial, and last name only.

Separate parts of a compound name with either a hyphen or a blank. Do not join them into a single word. If the employee’s name has changed during the year but the employee has not yet obtained a new social security card, use the name on the original card. The employee must get a new card from the SSA office with their correct name on it. Include in the address and number, street, and apartment or suite number (or P.O.

box number if mail is not delivered to a street address). Box 1 - Wages, tips, other compensation: Show the total wages, tips, and other compensation, before any payroll deductions that were paid during the calendar year. Do not include any elective deferrals or pretax deductions. a. Total wages, bonuses (including signing bonuses), prizes, and awards paid to employees during the year; b.

Total noncash payments, including certain fringe benefits; c. Total tips reported by the employee to the employer (does not include allocated tips); d. Certain employee business expense reimbursements; e.

The cost of accident and health insurance premiums for 2% or more shareholderemployees paid by an S corporation; f. Taxable benefits from a section 125 (cafeteria) plan. (i.e., the employee chooses cash); .

g. Employee contributions to a Archer medical savings account; h. Employer contributions to a Archer medical savings account if includible in the income of the employee; i. Employer contributions for long-term care services to the extent the coverage is provided through a flexible spending arrangement; j.

Group-term life insurance in excess of $50,000; k. Payments for non-job-related education expenses or for payments under a nonaccountable plan, unless excludable under Educational Assistance Programs; l. The employee’s share of taxes paid by the employer; m.

Distributions to an employee or former employee from a nonqualified deferred compensation plan or a 457 plan of a tax-exempt organization; n. Amounts includible in income under section 457(f) because the amounts are no longer subject to a substantial risk of forfeiture; o. Payments to statutory employees that are subject to social security and Medicare taxes but not subject to Federal income tax withholding must be shown in box 1 as other compensation; p.

Cost of current insurance protection under a compensatory split-dollar life insurance arrangement; q. Employee contributions to a Health Savings Account; r. Employer contributions to a Health Savings Account if includible in the income of the employee; s.

Amounts includible in income under a nonqualified deferred compensation plan because of section 409A; t. Designated Roth contributions made under a section 401(k) plan or under a section 403(b) salary reduction agreement or a government section 457(b) plan; u. Payments made to former employees while they are on active duty in the Armed Forces or other uniformed services; v.

All other compensation, including certain scholarship and fellowship grants. Other compensation are amounts paid to the employee that Federal income tax is not withheld. You may show other compensation on a separate Form W-2. Wages include all cash or non-cash payments for services an employee performed for his employer, unless specifically exempted.

This includes wages, salary, fees, vacation allowance, commissions, draws or bonuses, and all wage types that are included in federal taxable wages. The employee share of Social Security tax and Medicare tax paid by the employer must also be included. Non-cash payments (including taxable fringe benefits): a) The value of non-cash items such as personal use of company vehicle and most awards b) Cost of group term life insurance that exceeds $50,000 of coverage. Also, this amount is reported in Boxes 1, 3, and 5. c) Tips reported by employee.

Do not include the amount calculated in Box 8 for allocated tips. d) Reporting employee business expense. The amounts paid to employees under a nonaccountable plan must be reported. Also, an advance to an employee where the employee does not return the advance and does not account for the expenses is includible in income.

If you provide a per diem, mileage or other allowance amount, you must include amounts that exceed the IRS specified rates. Box 2 - Federal income tax withheld: Report the total Federal income tax withheld from the employee’s wages for the calendar year. Also include the 20% excise tax withheld on excess golden parachute payments. Box 3 - Social Security wages: Total wages paid subject to employee social security tax, but not . including tips and allocated tips, are reported here. Includes: a) Business expense reimbursements reported in box 1; b) Elective deferrals to certain qualified cash or deferred compensation arrangements and to retirement plans described in box 12, Codes D, E, F, G, and S (even though not included in box 1); c) Designated Roth contributions made to a section 401(k) plan or under a section 403(b) salary reduction agreement described in box 12, Codes AA, BB and EE; d) The value of group-term life insurance in excess of $50,000 included in box 1; e) Company paid employee’s share of social security and Medicare taxes; f) Employee contributions to a SIMPLE retirement account. g) Amounts deferred under a nonqualified or section 457(b) plan must be included in boxes 3 and/or 5 as social security and/or Medicare wages as of the later of when the services giving rise to the deferral are performed or when there is no substantial risk of forfeiture of the rights to the deferred amount. Include elective and non-elective deferrals for purposes of section 457(b) plans; h) Signing bonuses an employer pays for signing or ratifying an employment contract; i) Cost of accident and health insurance premiums for 2% or more shareholder-employees paid by an S corporation, but only if not excludable under section 3121(a)(2)(B); j) Employee and non-excludable employer contributions to a MSA or HSA. However, do not include employee contributions to an HSA that were made through a cafeteria plan. k) Adoption Benefits The total of boxes 3 and 7 should not exceed $118,500 for 2015.

(maximum social security wage base). Box 4 – Social security tax withheld: The total employee social security tax withheld or paid by the employer for the employee is reported here. For 2015 the amount should not exceed $7,347 ($118,500 x 6.2%). The amount entered in Box 4 should equal the total of Box 3 and Box 7 multiplied by 6.2% less any amounts entered in Box 12 with codes A and M. Box 5 – Medicare wages and tips: The wages and tips subject to Medicare tax are the same as those subject to social security tax except that there is no wage base limit for Medicare tax.

You may be required to report this amount on Form 8959. Box 6 – Medicare tax withheld: The total employee Medicare tax withheld (including any additional Medicare tax) or paid by the employer for the employee is reported here. If the employer is a government (public sector) employer with employees paying only the Medicare tax and not social security, enter the Medicare tax in this box. This amount includes the 1.45% Medicare Tax withheld on all Medicare wages and tips in Box 5, as well as the 0.9% Additional Medicare Tax on any of those Medicare Tax on any of those Medicare wages and tips above $200,000. Box 7 – Social security tips: Enter here the amount of tips reported by the employee to the employer during the year even if employee funds were insufficient to collect social security tax on the tips.

The total of Boxes 3 and 7 should not exceed $118,500 for 2015. Box 8 - Allocated tips: Tips must be allocated for any large food and beverage establishment where there are more than ten employees on a typical business day during the preceding calendar year. Form 8027 should be filed in relation to tip allocation. The amount is not included in Boxes 1, 3, 5, or 7. Box 9 - Do not enter an amount in Box 9. Box 10 – Dependent care benefits: The total amount of dependent care benefits paid by the employer including, the fair market value of employer-provided or sponsored day care facilities, amounts paid directly to a day care facility on behalf of the employee or reimbursed to the employee, or benefits from the pre-tax contributions made by the employee to a section 125 dependent care flexible spending .

account. Include any amounts over $5,000 in Boxes 1, 3, and 5. If an employee participates in a Section 125 Dependent care flexible spending account, forfeitures need not be considered when completing Box 10. (i.e.

An employee contributes $5,000 to their pretax dependent care flexible spending account during the plan year but only has $4,000 reimbursed will have $5,000 reported in Box 10 of their Form W-2.) Box 11 – Nonqualified plans: Report the amount of deferrals, including any accumulated interest, that became taxable for social security and Medicare taxes during the year (but were for prior year services) because the deferred amounts were no longer subject to a substantial risk of forfeiture. Do not include in box 11 deferrals that are included in boxes 3 and/or 5 and that are for current year services. Show distributions to an employee from a nonqualified plan or a nongovernmental section 457(b) plan. Also report these distributions in box 1. Make only one entry in this box.

Distributions from governmental section 457(b) plans must be reported on Form 1099-R, not in box 1 of Form W-2. Box 12 – Codes: Complete and code this box for all items described below. Report in box 12 any items that are listed as codes A – EE. Do not report in box 12 section 414(h)(2) contributions-relating to certain state or local government plans.

Instead use box 14 for these items and any other information you wish to give your employees. For example, union dues and uniform payments may be reported in box 14. Code A B C D E F G H J K L M N P Q R S T V W Y Description Uncollected Social Security tax on employee tips Uncollected Medicare tax on employee tips Cost of group-term life insurance in excess of $50,000 Employee contribution to Section 401(k) plan including “catch-up” contributions made by employees 50 years of age and older during the plan year Employee contribution to Section 403(b) plan Employee contribution to Section 408(k)(6) plan SEP Deferrals Elective deferrals and employer contributions to Section 457(b) plan Employee contribution to Section 501(c)(18)(D) plan including “catch-up” contributions made by employees 50 years of age and older during the plan year Nontaxable sick pay 20% excise tax on excess golden parachute payments Report amount of employee business expenses when using a per diem or mileage allowance that exceeds the amount treated as substantiated by the IRS. Report in Box 12 the amount nontaxable.

The unsubstantiated or excess IRS allowed per diem is reported in Boxes 1, 3, and 5. If reimbursements do not exceed IRS allowed rates, nothing needs to be reported. Uncollected Social Security tax on group-term life insurance in excess of $50,000 coverage provided for former employees and retirees. Uncollected Medicare tax on group-term life insurance in excess of $50,000 coverage provided for former employees and retirees. Excludable moving expense reimbursement to an employee Nontaxable combat pay Employer contributions to an Archer medical savings account (MSA) Employee salary reduction contributions to a section 408(p) SIMPLE plan including “catch-up” contributions made by employees 50 years of age or older during the plan year Employer-provided Adoption benefits including the pre-tax contributions made by the employee to a §125 adoption plan account. Report all amounts including those in excess of the $ 13,400 exclusion. Income from the exercise of non-statutory stock option(s) Employer’s contribution to an employee’s Health Savings Account Deferrals under a section 409A nonqualified deferred compensation plan .

Z AA BB DD EE Income under section 409A on a nonqualified deferred compensation plan Designated Roth contributions to a section 401(k) plan Designated Roth contributions under a section 403(b) salary reduction agreement Cost of employer-sponsored health coverage Designated Roth contributions under a governmental section 457(b) plan Box 13 - Statutory employee: Check this box for employees whose earnings are subject to Social Security and Medicare tax, but not subject to federal income tax withholding (such as life insurance agents). Box 13 - Retirement Plan: Check this box if the employee was an active participant in a retirement plan or participated in a collectively bargained plan. Do Not check this box if you are reporting contributions made to a non-qualified pension plan or Section 457(b) plan. (Section 457 plans are certain plans of governmental units and tax exempt organizations). This includes any of the following plans: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· A qualified pension, profit sharing, or stock-bonus plan described in section 401(a) (including a 401(k) plan). An annuity plan described in section 403(a). An annuity contract or custodial account described in section 403(b). A simplified employee pension (SEP) plan described in section 408(k). A SIMPLE retirement account described in section 408(p). A trust described in section 501(c)(18). A plan for federal, state, or local government employees or by an agency or instrumentality thereof (other than a section 457(b) plan). (An employee is an active participant if covered by (a) a defined benefit plan for any tax year that he or she is eligible to participate or (b) a defined contribution plan for any tax year that employer or employee contributions (or forfeitures) are added to his or her account.) Type of Plan Conditions Defined Benefit Plan (i.e., a traditional pension plan) Employee qualifies for employer funding into the plan, due to age/years of service – even though the employee may not be vested or ever collect benefits. Employee is eligible to contribute but does not elect to contribute any money in this tax year. Employee is eligible to contribute and elects to contribute money in this tax year. Defined Contribution Plan (i.e., 401(k) or 403(b), but not a 457 plan) Defined Contribution Plan (i.e.,401(k), 403(b), Roth 401(k), or Roth 403(b), but not a 457 plan) Defined Contribution Plan (i.e.,401(k), 403(b), Roth 401(k), or Roth 403(b), but not a 457 plan) Defined Contribution Plan (i.e.,401(k), 403(b), Roth 401(k), or Roth 403(b), but not a 457 plan) Profit Sharing Plan Employee is eligible to contribute but does not elect to contribute any money in this tax year, but the employer does contribute funds. Employee contributed in past years but not during the current tax year under report Plan includes a grace period after the close of the plan year when profit sharing can be added to the participant’s account Retirement Box Checked? Yes No Yes Yes No (even if the account value grows due to gains in the investments) Yes Box 13 - Third-Party Sick Pay: Check this box if you are a third party sick pay payer filing a Form W2 for an insured’s employee or an employer reporting sick pay payments made by a third party to an employee. .

Box 14 – Other: The lease value of a vehicle provided to your employee and included in Box 1 must be reported here. Use to report other information that you want to give the employee. For example, contributions to an employee pension plan, union dues, deductions for health insurance premiums, payroll savings, life insurance, etc. You may use this box for information needed for state reporting, but not required by IRS.

Each item should be labeled. Boxes 15 through 20: Information for state and local wages and withholding. Reminders: 1. Type in all data - no handwriting is allowed. 2. Do not cut or separate top form (Copy A). 3.

No photocopies of any forms should be mailed to the Social Security Administration. 4. Do not staple, tear, or tape any of the forms. 5. Do not change the title of any box on the form. 6.

Do not insert data in the untitled shaded areas. 7. Do not submit any copy other than Copy A to the Social Security Administration. 8. Print money amounts without dollar signs or commas.

Use decimal points to indicate cents. If a box does not apply, leave it blank. 9. File electronically if 250 or more W-2s are to be filed. a.

Due dates: W-2 is due to the employee February 1, 2016, and W-3 is due February 29, 2016, or March 31, 2016 if filed electronically. 10. Void-make sure this box is marked on any W-2 with an error and is not included in W-3 amounts. 11. Do not use titles such as Mr., Ms., Dr., etc. 12.

Do not use a period after the middle initial. 13. Any employee (recipient) copies of Form W-2 that were attempted to be delivered but could not, should be kept for a period of 4 years. 14. If an employee does not have a social security number at the time the W-2 forms are being prepared, enter “applied for” in Box A if filing paper forms or “000-00-0000” if filing electronically. .

22222 Void a Employee’s social security number For Official Use Only OMB No. 1545-0008 b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld c Employer’s name, address, and ZIP code 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 d Control number 9 e Employee’s first name and initial Last name 10 Dependent care benefits Suff. 11 Nonqualified plans 12a See instructions for box 12 C o d e 13 Statutory employee Retirement plan Third-party sick pay 14 Other 12b C o d e 12c C o d e 12d C o d e f Employee’s address and ZIP code 15 State Form Employer’s state ID number W-2 16 State wages, tips, etc. Wage and Tax Statement 17 State income tax 2015 Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable. 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Do Not Cut, Fold, or Staple Forms on This Page Cat. No.

10134D . Common W-2 Reporting Errors General Errors: ï‚· Incorrect or missing employer identification number ï‚· Incorrect employee names and SSNs ï‚· Do not omit the decimal point and cents from entries ï‚· Using ink that is too light – use only black ink ï‚· Entries made that are too small or too large (Use 12-point Courier font, if possible) ï‚· Dollar signs added to the money amount boxes ï‚· Inappropriately checking the “Retirement plan” checkbox in box 13 ï‚· Misformatting the employee’s name in box e. Enter the employee’s first name and middle initial in the first box, his or her surname in the second box, and his or her suffix (such as “Jr.”) in the third box. ï‚· Cut, fold, or staple Copy A paper forms mailed to Social Security Administration. Errors resulting in out-of-balance reports: ï‚· Use of maximum social security or Medicare wage amounts for a prior year - instead of for the tax year being reported. ï‚· Use of social security maximum yearly wage amount for Medicare wages. ï‚· Decimal mistakes in money fields; i.e. "4800" which is treated by SSA as $48.00 - instead of $4800.00. ï‚· Tips included in the social security wage field as well as in the social security tip field. ï‚· Omitted wage or tax fields on wage reports. Errors common to paper Form W-2 reports: ï‚· Prior tax year form used. ï‚· Unscannable reports ï‚· Failure to file Copy A of Form W-2 with SSA ï‚· "Void" indicator on Form W-2 checked in error ï‚· Failure to complete the pension plan block in Box 15 of Form W-2 Charging Fees for Duplicate Copies According to the IRS, employers may not collect a fee for supplying original and corrected W-2 and 1099 forms, but that a fee may be charged for supplying duplicate copies. Duplicate W-2 and 1099 forms are often issued to employees and other payers who have lost or destroyed their copy of the form. The IRS stated that a fee may be charged for furnishing additional copies of the forms because once an employer has timely furnished correct W-2 and 1099 forms it has met its statutory obligations.

Moreover, there are no penalties under the Internal Revenue Code for refusing to satisfy a request for another copy of an information return. Consider using the following W-2 Request Form to authorize such a payroll deduction. . Mail to: Company Name Company Address Attn: __________________________ Date of Request Department with Forms W-2 Fax No: Request for Duplicate IRS Form W-2 (Please Print) Please issue a WAGE AND TAX STATEMENT (Form W-2) for the following employee, for the tax year ending ___________ Employee Name:_______________________________________________________________________ Social Security No:_____________________________________________________________________ Employee Current Mailing Address: Street Address:________________________________________________________________________ City:______________________________________State:____________Zip Code:__________________ Click here to use the form. Work Location & No:___________________________________________________________________ Location Address:______________________________________________________________________ City:______________________________________State:____________Zip Code:__________________ The Form W-2 is requested for the following reason: ______________ Never Received ______________ Misplaced or Destroyed ______________ Social Security Number or Name Incorrect ______________ Other (Explain):__________________________________________________ I authorize that $________ be deducted from my next pay to receive this payroll department service. ____________________________________ Signature of Employee FOR PAYROLL DEPT. USE ONLY: Date request received:______________________________Original W-2 resent:__________________ Processed by:______________________________________ Duplicate W-2 reissued:________________ _____________________________________________________________________________________ . Form W-3 Who must file Form W-3 Anyone required to file Form W-2 must file Form W-3 to transmit Copy A of Forms W-2. Make a copy of Form W-3; keep it and Copy D (For Employer) of Forms W-2 with your records for 4 years. Be sure to use Form W-3 for the correct year. Household employers with only one employee must file Form W-3 to transmit Copy A of Form W-2. On Form W-3, check the “Hshld emp” checkbox in box b. Filing Instructions for Preparing Form W-3 ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Box A - control number (optional). Box B - kind of payer.

Check one box. If more than one type of W-2, send each type with a separate Form W-3. Box C - total number of statements. The number of completed statements does not include voided or subtotal statements. Box D - establishment number (optional) Box E - federal ID number.

If you do not have an EIN number when filing, enter “Applied For”. Do not use a social security number. Box F - employer's name Box G - employer's address and zip code Box H - other EIN used this year Boxes 1 through 8 - enter the totals reported in boxes 1 through 8 on Forms W-2 being transmitted. Box 9 – do not enter an amount Box 10 – dependent care benefits reported in box 10 on W-2 Box 11 - nonqualified plans. Report the total amount of distributions from nonqualified and Section 457 plans as reported in Box 11 of Forms W-2. Box 12a - deferred compensation. Enter the total of the amounts with codes D-H, S, Y, AA, BB and EE reported in box 12 of Forms W-2.

Do not enter a code. Box 13 – for third party sick pay use only Box 14 - income tax withheld by third-party payer Box 15 – State/Employer’s state ID number Box 16 – 19 – State/local wages and income tax from W-2 Who may sign Form W-3 A transmitter or sender (including a service bureau, reporting agent, paying agent, or disbursing agent) may sign form W-3 (or use its PIN to e-file) for the employer or payer only if the sender is authorized to sign under state law, and writes “For (name of taxpayer) next to the signature (paper Form of W-3 only). When to file: If using paper forms, you must file Copy A of form W-2 with Form W-3 by February 29th, 2016. If you use the e-file method, the due date is March 31st, 2016. If you need an extension to file form W-2, you must send Form 8809, Application for Extension of Time to File Information Returns, to the address shown on the 8809 form. The extension must be requested before the due date of the W-2 form.

After the 8809 form has been submitted and approved, you will have an additional 30 days to file. Please keep in mind that you still need to furnish a W-2 to your employees by February 1st, 2016. . Electronic Filing: Filing of Forms W-2 can now be done over the internet. The Business Services Online program (BSO) lets you upload wage-data files over the Internet. Uploaded data files must conform to the SSA’s specifications. Except for Internet service and long-distance charges, the BSO is free. In addition to uploading wage-data files, you can also use the BSO to: ï‚· ï‚· ï‚· ï‚· ï‚· Check the status of wage-data submissions after a pre-processing period of one to six weeks. Send e-mail to SSA. Browse the online handbook. Verify social security numbers. View file errors. SSA’s “Create Forms W-2 Online” option allows you to create “fill-in” versions of Forms W-2 for filing with the SSA and to print out copies of the forms for filing with state or local governments, distribute to employees, and for your files.

Form W-3 will be automatically created based on your Forms W-2. Visit SSA’s website at www.socialsecurity.gov/employer and select “Business Services Online” (BSO). Paper Filing: If the paper filing method is preferred, please File Copy A of Form W-2 with W-3 to: Social Security Administration Data Operations Center Wilkes-Barre, PA 18769-0001 Reminders:  ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Use blank ink on all forms Do not staple or tape any forms to each other Be sure that the amounts on Form W-3 are the total amounts from Forms W-2 Be sure to look over each amount in each box carefully Reconcile W-3 with your four quarterly forms (941, or 943, etc) by comparing the amounts reported for income tax withholding, Social security wages, Medicare wages/tips and social security wages/tips. Social security and Medicare taxes (the amounts shown on the 941, 943, etc) including current year adjustments, should be approximately twice the amounts shown on W-3. If amounts do not match due to valid reasons, you should determine that the reasons are valid. Retain your reconciliation information in case you receive inquiries from the IRS or SSA. . DO NOT STAPLE a Control number 33333 For Official Use Only OMB No. 1545-0008 b 941 Kind of Payer Military Hshld. emp. CT-1 943 944 Medicare govt. emp. (Check one) None apply 501c non-govt. State/local non-501c Kind of Employer State/local 501c Third-party sick pay Federal govt. (Check if applicable) (Check one) d Establishment number 1 Wages, tips, other compensation 2 Federal income tax withheld e Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld f Employer’s name 5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tips c Total number of Forms W-2 10 Dependent care benefits 9 11 Nonqualified plans 12a Deferred compensation 13 For third-party sick pay use only 12b g Employer’s address and ZIP code h Other EIN used this year 15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 14 Income tax withheld by payer of third-party sick pay 18 Local wages, tips, etc. 19 Local income tax Employer's contact person Employer's telephone number Employer's fax number Employer's email address For Official Use Only Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete. Signature Form W-3 Date Title Transmittal of Wage and Tax Statements 2016 Department of the Treasury Internal Revenue Service Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA). Photocopies are not acceptable. Do not send Form W-3 if you filed electronically with the SSA. Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3. Reminder Separate instructions.

See the 2016 General Instructions for Forms W-2 and W-3 for information on completing this form. Do not file Form W-3 for Form(s) W-2 that were submitted electronically to the SSA. Purpose of Form A Form W-3 Transmittal is completed only when paper Copy A of Form(s) W-2, Wage and Tax Statement, is being filed. Do not file Form W-3 alone.

All paper forms must comply with IRS standards and be machine readable. Photocopies are not acceptable. Use a Form W-3 even if only one paper Form W-2 is being filed.

Make sure both the Form W-3 and Form(s) W-2 show the correct tax year and Employer Identification Number (EIN). Make a copy of this form and keep it with Copy D (For Employer) of Form(s) W-2 for your records. The IRS recommends retaining copies of these forms for four years. When To File E-Filing Mail Form W-3 with Copy A of Form(s) W-2 by February 28, 2017. The SSA strongly suggests employers report Form W-3 and Forms W-2 Copy A electronically instead of on paper.

The SSA provides two free e-filing options on its Business Services Online (BSO) website: • W-2 Online. Use fill-in forms to create, save, print, and submit up to 50 Forms W-2 at a time to the SSA. • File Upload. Upload wage files to the SSA you have created using payroll or tax software that formats the files according to the SSA’s Specifications for Filing Forms W-2 Electronically (EFW2). W-2 Online fill-in forms or file uploads will be on time if submitted by March 31, 2017.

For more information, go to www.socialsecurity.gov/ employer. First time filers, select “Go to Register”; returning filers select “Go To Log In.” Where To File Paper Forms Send this entire page with the entire Copy A page of Form(s) W-2 to: Social Security Administration Data Operations Center Wilkes-Barre, PA 18769-0001 Note: If you use “Certified Mail” to file, change the ZIP code to “18769-0002.” If you use an IRS-approved private delivery service, add “ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change the ZIP code to “18702-7997.” See Publication 15 (Circular E), Employer’s Tax Guide, for a list of IRS-approved private delivery services. For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat.

No. 10159Y . Correcting Forms W-2/W-3 File Form W-3c, Transmittal of Corrected Wage and Tax Statements, whenever you file a Form W-2c with the Social Security Administration, even if the only thing being corrected is an employee’s name or social security number. Correcting an error after issuing employee’s copy but before transmitting to SSA: If an error is discovered on Form W-2 after issuing it to the employee but before it is sent to the Social Security Administration, check the “Void” box at the top of the incorrect W-2 form on Copy A. Prepare a new Form W-2 with correct information and send Copy A to the SSA. Write “Corrected” on the employee’s new copies (B, C, and 2), and furnish them to the employee. If the “Void” Form W-2 is on a page with a correct Form W-2, send the entire page to the SSA. The “Void” form will not be processed. Correcting an employee’s name and/or SSN only: If an employee’s name and or/SSN needs to be corrected, complete Form W-2c, boxes d through i.

Do not complete boxes 1 through 20. Employee should be advised to correct the SSN and/or name on his or her original W-2 form. If employee’s name and SSN was reported as blanks or zeros, you must contact the SSA at 1-800-7726270 for instructions. Do not use form W-2c. Making an adjustment in 2015 to correct a prior year: To correct an incorrect tax year and/or EIN on a previously submitted Form W-2 or W-3, file one Form W-3c along with form W-2c for each employee affected.

Enter the tax year and EIN originally reported, and enter in the “previously reported” boxes the monetary amounts that were on the original W-2. In the “correct information” boxes, enter zeros. A second W-3c and W-2c must also be prepared for each affected employee. Enter zeros in the “previously reported” boxes, and enter the correct monetary amounts in the “Correct information” boxes.

Enter the correct tax year and EIN. If an error on a previously filed Form 941 (or 941, 941-SS, 943, 944, 944-SS, or CT-1) is found, the error must be corrected by using the “x” forms (941-X, 943-X, 944-X, or CT-1X). For each Form 941 that is being corrected, a separate Form 941-X should be filed. The 941-X should not be attached to Form 941.

Social security and Medicare wages and taxes are the only items that may be corrected for prior years. Income tax withheld can only be corrected for a prior year if it was “an administrative error”. Copy A of both Forms W-2c and W-3c should also be filed with SSA to correct social security records.

The employee must receive a Form W-2c also. Form 941-X has three types of errors: 1. Under reported amounts only; 2. Over reported amounts only; and 3.

Both under reported and over reported amounts. See the Form 941-X instructions for specific help. Incorrect address on employee’s Form W-2: If Form W-2 was filed with an incorrect employee address but all other information was correct, do not file a Form W-2c with SSA merely to correct the address. However, if the address was incorrect on Form W-2 furnished to the employee, either: 1. Issue a new, corrected Form W-2 to the employee, including the new address. Indicate .

“REISSUED STATEMENT” on the new copies. Do not send Copy A to the SSA, or 2. Issue a Form W-2c to the employee showing the correct address in box i and all other correct information. Do not send Copy A to the SSA, or 3.

Mail the Form W-2, with the incorrect address to the employee in an envelope showing the correct address or otherwise deliver it to the employee. Penalties: The following are the amounts of penalties that may be imposed if a person either fails to file a correct Form W-2 by the due date and cannot show reasonable cause: ï‚· ï‚· ï‚· $ 30 per Form W-2 if you correctly file within 30 days (by March 30); maximum penalty $250,000 per year ($75,000 for small businesses). – (see note below) $60 per Form W-2 if you correctly file more than 30 days after the due date but by August 1, ; maximum penalty $500,000 per year ($200,000 for small businesses). – (see note below) $100 per Form W-2 if you file after August 1, or you do not file required Forms W-2; maximum penalty $1,500,000 per year ($500,000 for small businesses).

– (see note below) If any person willfully files a fraudulent Form W-2 for payments purported to be made to another person, the other person may bring a civil action for damages against the person filing the Form W-2. You are a small business if your average annual gross receipts for the 3 most recent tax years ending before the calendar year in which the Forms W-2 were due are $5 million or less. If an employer must file electronically, but fails to do so, it is treated as having failed to file a return even if it timely files paper returns that contain the correct information and a penalty may be imposed. A waiver to file electronically may be requested on Form 8508. Exceptions to the penalty: 1. The penalty will not apply to any failure that you can show was due to reasonable cause and not willful neglect.

In general, you must be able to show that your failure to file was due to an event beyond your control or due to significant mitigating factors. You must also be able to show that you acted in a responsible manner and took steps to avoid the failure. 2. An inconsequential error or omission is not considered a failure to include correct information. An inconsequential error or omission does not prevent or hinder the SSA/IRS from processing the Form W-2, from correlating the information required to be shown on the form with the information shown on the payee’s tax return, or from otherwise putting the form to its intended use.

Errors and omissions that are never inconsequential include a TIN, a payee’s surname, and any money amounts. 3. De minimis rule for corrections. Even though you cannot show reasonable cause, the penalty for failure to file correct Forms W-2 will not apply to a certain number of returns if you: a) filed those Forms W-2 on or before the required filing date.

b) either failed to include all the information required on the form or included incorrect information and c) filed corrections of these forms by August 1, 2015. If any failure to file a correct Form W-2 or furnish a correct payee statement to the employee is due to intentional disregard of the filing requirements, the penalty is at least $250 per Form W-2 with no maximum penalty. . DO NOT CUT, FOLD, OR STAPLE 55555 a Tax year/Form corrected For Official Use Only / W- OMB No. 1545-0008 c Kind of Payer (Check one) 941/941-SS Military 943 944 b Employer’s name, address, and ZIP code Hshld. emp. CT-1 Kind of Employer (Check one) Third-party sick pay None apply 501c non-govt. Medicare govt. emp. State/local State/local non-501c 501c Federal govt. (Check if applicable) d Number of Forms W-2c e Employer’s Federal EIN f Establishment number g Employer’s state ID number Complete boxes h, i, or j only if incorrect on last form filed. h Employer’s originally reported Federal EIN i Incorrect establishment number j Total of amounts previously reported as shown on enclosed Forms W-2c. Employer's incorrect state ID number Total of amounts previously reported as shown on enclosed Forms W-2c. Total of corrected amounts as shown on enclosed Forms W-2c. Total of corrected amounts as shown on enclosed Forms W-2c. 1 Wages, tips, other compensation 1 Wages, tips, other compensation 2 Federal income tax withheld 2 Federal income tax withheld 3 Social security wages 3 Social security wages 4 Social security tax withheld 4 Social security tax withheld 5 Medicare wages and tips 5 Medicare wages and tips 6 Medicare tax withheld 6 Medicare tax withheld 7 Social security tips 7 Social security tips 8 Allocated tips 8 Allocated tips 9 9 10 Dependent care benefits 10 Dependent care benefits 11 Nonqualified plans 11 Nonqualified plans 12a Deferred compensation 12a Deferred compensation 14 Inc. tax w/h by third-party sick pay payer 14 Inc.

tax w/h by third-party sick pay payer 12b 12b 16 State wages, tips, etc. 16 State wages, tips, etc. 17 State income tax 17 State income tax 18 Local wages, tips, etc. 18 Local wages, tips, etc. 19 Local income tax 19 Local income tax Explain decreases here: Has an adjustment been made on an employment tax return filed with the Internal Revenue Service? If “Yes,” give date the return was filed Yes No Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it is true, correct, and complete. Signature Title Date Employer's contact person Employer's fax number For Official Use Only Employer's telephone number Employer's email address Form W-3c (Rev. 11-2015) Transmittal of Corrected Wage and Tax Statements Department of the Treasury Internal Revenue Service Purpose of Form When To File Use this form to transmit Copy A of the most recent version of Form(s) W-2c, Corrected Wage and Tax Statement. Make a copy of Form W-3c and keep it with Copy D (For Employer) of Forms W-2c for your records.

File Form W-3c even if only one Form W-2c is being filed or if those Forms W-2c are being filed only to correct an employee’s name and social security number (SSN) or the employer identification number (EIN). See the General Instructions for Forms W-2 and W-3 for information on completing this form. File this form and Copy A of Form(s) W-2c with the Social Security Administration as soon as possible after you discover an error on Forms W-2, W-2AS, W-2GU, W-2CM, W-2VI, or W-2c. Provide Copies B, C, and 2 of Form W-2c to your employees as soon as possible. E-Filing The SSA strongly suggests employers report Form W-3c and Forms W-2c Copy A electronically instead of on paper.

The SSA provides two free e-filing options on its Business Services Online (BSO) website: • W-2c Online. Use fill-in forms to create, save, print, and submit up to 25 Forms W-2c at a time to the SSA. • File Upload. Upload wage files to the SSA you have created using payroll or tax software that formats the files according to the SSA’s Specifications for Filing Forms W-2c Electronically (EFW2C). For more information, go to www.socialsecurity.gov/employer.

First time filers, select "Go to Register"; returning filers select "Go To Log In." For Paperwork Reduction Act Notice, see separate instructions. Where To File If you use the U.S. Postal Service, send Forms W-2c and W-3c to the following address: Social Security Administration Data Operations Center P.O. Box 3333 Wilkes-Barre, PA 18767-3333 If you use a carrier other than the U.S.

Postal Service, send Forms W-2c and W-3c to the following address: Social Security Administration Data Operations Center Attn: W-2c Process 1150 E. Mountain Drive Wilkes-Barre, PA 18702-7997 Cat. No.

10164R . DO NOT CUT, FOLD, OR STAPLE THIS FORM For Official Use Only 44444 OMB No. 1545-0008 a Employer’s name, address, and ZIP code c Tax year/Form corrected d Employee’s correct SSN / W-2 e Corrected SSN and/or name (Check this box and complete boxes f and/or g if incorrect on form previously filed.) Complete boxes f and/or g only if incorrect on form previously filed f Employee’s previously reported SSN b Employer's Federal EIN g Employee’s previously reported name h Employee’s first name and initial Note. Only complete money fields that are being corrected (exception: for corrections involving MQGE, see the General Instructions for Forms W-2 and W-3, under Specific Instructions for Form W-2c, boxes 5 and 6). Last name Suff. i Employee’s address and ZIP code Previously reported Correct information 1 Wages, tips, other compensation 1 Wages, tips, other compensation 2 Federal income tax withheld Previously reported 2 Federal income tax withheld 3 Social security wages 3 Social security wages 4 Social security tax withheld 4 Social security tax withheld 5 Medicare wages and tips 5 Medicare wages and tips 6 Medicare tax withheld 6 Medicare tax withheld 7 Social security tips 7 Social security tips 8 Allocated tips 8 Allocated tips 9 9 Correct information Retirement plan Third-party sick pay 14 Other (see instructions) 13 Statutory employee Retirement plan Third-party sick pay 14 Other (see instructions) C o d e 12b 12b C o d e C o d e 12c 12c C o d e 12d C o d e Statutory employee 12a See instructions for box 12 C o d e 12d 13 12a See instructions for box 12 11 Nonqualified plans 10 Dependent care benefits C o d e 11 Nonqualified plans 10 Dependent care benefits C o d e State Correction Information Previously reported 15 State Correct information 15 State Employer’s state ID number Previously reported 15 State Employer’s state ID number Correct information 15 State Employer’s state ID number Employer’s state ID number 16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc. 17 State income tax 17 State income tax 17 State income tax 17 State income tax Locality Correction Information Previously reported Correct information Previously reported Correct information 18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc. 19 Local income tax 19 Local income tax 19 Local income tax 19 Local income tax 20 Locality name 20 Locality name 20 Locality name 20 Locality name For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Form W-2c (Rev. 8-2014) Corrected Wage and Tax Statement Copy A—For Social Security Administration Cat.

No. 61437D Department of the Treasury Internal Revenue Service . Fringe Benefits and Special Reporting Issues The IRS defines gross income as “all income from whatever source derived, including (but not limited to) compensation for services, including fees, commissions, fringe benefits, and similar items” under IRC section 61. IRS Regulation section 1.61-1 further explains that “gross income means all income from whatever source derived, unless excluded by law. Gross income includes income realized in any form, whether in money, property, or services. Income may be realized, therefore, in the form of services, meals, accommodations, stock, or other property, as well as cash.” These definitions mean that all employee compensation, provided in whatever form, is taxable unless another section of the IRC states the compensation in not taxable. Taxable Fringe Benefits: In general, the amount you must include in the employee’s gross income is the amount by which the fair market value of the benefit exceeds the amount the employee paid after taxes for the benefit, less any amount the law excludes. The employer must determine the value of fringe benefits provided to the employee no later than January 31 of the following year in order to report the taxable value on the employee’s Form W-2. However, waiting until January to value the benefits may require the employer to pay the employee’s taxes and may subject the employer to a deposit penalty if the taxes are not deposited timely based on the benefits being deemed paid on December 31. When Fringe Benefits are Considered Paid: Employer provided non-cash taxable fringe benefits are subject to federal income, social security, Medicare, and unemployment tax rules.

To determine the amount to be withheld and when to deposit taxes withheld for non-cash fringe benefits, the fringe benefits may be reported as paid by the pay period, monthly, quarterly, or on any other basis, so long as the benefits are reported as being paid at least annually. This choice can be varied among employees and benefits. The employer is not required to notify the employee or IRS of the date selected.

Employers may change methods at any time, as long as all benefits provided in a calendar year are treated as paid by December 31 of the calendar year. The employer has the option to consider a single fringe benefit to be paid on one or more dates in the same calendar year, even if the employee acquires the entire benefit at one time. When employers select the payment dates, they must report the taxes on their return in the same tax period in which they treated them as paid. This election does not apply to a fringe benefit where real property or investment personal property is transferred. Any fringe benefit paid in cash must be included in income subject to withholding, depositing, and reporting when paid. Nonqualified moving expense reimbursements are not “non-cash fringe benefits” and must be included in income and taxed when constructively received. Special Accounting Rule: The employer may elect to treat the value of taxable noncash fringe benefits provided in November and December, or any other shorter period during that time, as paid in the subsequent year.

This applies only to the benefits actually provided during November and December, not to benefits that were provided earlier in the year but are treated as being paid during those months. The special accounting rule is limited to noncash fringe benefits. . When using the special accounting rule, employers are required to notify the affected employees of the period for which they used it. Notify the employees of the applicable benefits between the last payday of the calendar year and at or near the time the employer provides the employees with their Form W-2. If the rule is used for a benefit, it must be used for all employees for receive the benefit. This rule cannot be used for a fringe benefit where the employer transfers real property or investment personal property to the employee. The value of group-term life insurance and nonqualified moving expense reimbursements are not considered noncash fringe benefits by the IRS and cannot be reported under the special accounting rule. Depositing Taxes on Fringe Benefits: Federal taxes must be deposited for the same semiweekly or monthly deposit period that the employer deems the fringe benefit paid.

Deposit the taxes using the deposit rules for that tax period. If the employer underestimates the fringe benefit amount when calculating taxes, or for some other reason does not withhold and deposit enough taxes, it must pay the employee’s share of social security and Medicare taxes. It can collect the tax from the employee at a future date by deducting it from the employee’s after-tax wages, but it must recover the income taxes before April 1 of the following year. Withholding on Fringe Benefits: The employer has two options in determining how to withhold federal income taxes from fringe benefits: 1. Imputing – add the value of the benefit to the employee’s regular wages for a payroll period and calculate the taxes to be withheld on the total wages, or 2.

Withhold federal income tax on the value of the benefit at the optional flat tax rate. If the annual supplemental wages for an employee are less than $1 million, the optional flat tax rate is only available if federal income tax was withheld from the employee’s payment of regular wages during the current or preceding calendar year. Supplemental Wage Payments: Supplemental wages include any wages paid by an employer that are not regular wages. The IRS defines regular wages as amounts paid by an employer for a payroll period either at a regular hourly rate or in a predetermined fixed amount.

Wages that vary from payroll period to payroll period based on factors other than the amount of time worked are supplemental wages, if they are paid in addition to regular wages. Payments that satisfy the basic definition of supplemental wages (i.e., all wage payments other than regular wage payments) are supplemental wages regardless of whether the employee has received any regular wages in his or her working career with the employer. Examples of supplemental wage payments include but are not limited to: ï‚· Reported tips; ï‚· Overtime pay; ï‚· Bonuses; ï‚· Awards and prizes; ï‚· Back pay; ï‚· Severance pay; ï‚· Accumulated sick leave; ï‚· Commissions; ï‚· Expense allowances paid under a nonaccountable plan; ï‚· Distributions of nonqualified deferred compensation; ï‚· Taxable noncash fringe benefits; ï‚· Sick pay paid by a third party as an agent of the employer; . ï‚· ï‚· ï‚· ï‚· Amounts includible in gross income under IRC §409A and reported in Box 12, code Z; Income recognized on the exercise of a non-statutory stock option; Imputed income for health coverage for a non-dependent; and Income recognized on the lapse of a restriction on restricted property transferred from an employer to an employee. How you withhold on supplemental wages depends on whether the supplemental payment is identified as a separate payment from regular wages and if an employee receives more than $1 million of supplemental wages during the calendar year. Withholding on supplemental wages when an employee receives more than $1,000,000 of supplemental wages during the calendar year: If a supplemental wage payment, together with other supplemental wage payments made to the employee during the calendar year exceed $1,000,000, the excess is subject to withholding at 39.6% (or the highest rate of income tax for the year). Withhold using the 39.6% rate without regard to the employee’s Form W-4. Withholding on supplemental wage payments to an employee who does not receive $1,000,000 of supplemental wages during the calendar year: If the supplemental wages paid to the employee during the calendar year are less than or equal to $1,000,000, the following rules apply in determining the amount of income tax to be withheld. ï‚· ï‚· Supplemental wages combined with regular wages: If the supplemental wages are combined with regular wages but do not specify the amount of each, withhold federal income tax as if the total were a single payment for a regular payroll period. Supplemental wages identified separately from regular wages: If the supplemental wages are paid separately (or combined in a single payment with each amount specified), the federal income tax withholding method depends partly on whether income tax was withheld from the employee’s regular wages. 1. If income tax was withheld from an employee’s regular wages in the current or immediately preceding calendar year, one of the following methods can be used: a. Withhold a flat 25% (no other percentage is allowed). b. If the supplemental wages are paid concurrently with regular wages, add the supplemental wages to the regular wages and calculate the tax on the total based on the employee’s Form W-4.

If there are no concurrently paid regular wages, add the supplemental wages to either the regular wages paid or to be paid for the current payroll period or the regular wages paid for the preceding payroll period. Calculate the income tax withholding as if the total of the regular wages and the supplemental wages is a single payment. Subtract the tax withheld from the regular.

Withhold the remaining tax from the supplemental wages. 2. If income tax was not withheld from the employee’s regular wages in the current or immediately preceding calendar year, use method 1-b above. Tips treated as supplemental wages: Withhold income tax on tips from wages earned by the employee or from other funds the employee makes available. If an employee receives regular wages and reports tips, figure income tax withholding as if the tips were supplemental wages. If income tax has not been withheld from regular wages, the tips should be added to the regular wages and income tax withholding calculated on the total.

If income tax has been withheld from the regular wages, income tax withholding on the tips can be calculated by method 1-a or 1-b above. See chart in appendix for a list of state supplemental rates. . Example 1: John is paid a base salary on the 1st of each month. He is single and claims one withholding allowance. In January of 2015, he is paid $1,000. Using the wage bracket tables, $50 is withheld for federal income taxes.

In February 2015, he receives salary of $1,000 plus a commission of $2,000, which is included with regular wages. The withholding is based on the total of $3,000. Using the withholding tables, the federal income taxes withheld are $336. Example 2: Sharon is paid a base salary on the 1st of each month.

She is single and claims one withholding allowance. On May 1, 2015, she is paid $2,000. Using the wage bracket tables, $186 is withheld from her check for federal income taxes.

On May 14, 2014, she receives a bonus of $1,000. Under the aggregate method, her withholding would be calculated as follows: 1. Add the bonus amount to the amount of wages from the most recent pay date ($2,000 + $1,000 = $3,000). 2. Determine the amount of withholding on the combined $3,000 using the wage bracket tables ($336). 3.

Subtract the amount withheld from wages on the most recent pay date from the combined withholding amount ($336 - $186 = $150). 4. Withhold $150 from the bonus payment. Example 3: The facts are the same as in Example 2, except the flat rate withholding method is elected for the bonus payment. $250 ($1,000 x 25%) will be withheld from Sharon’s bonus payment. Special rules apply to the extent that supplemental wages paid to any one employee during the calendar year exceed $1 million.

Once a supplemental wage payment to an employee brings the total of all supplemental wage payments to that employee during the calendar year to more than $1 million, the amount of supplemental wages above $1 million is subject to withholding at 39.6% (or the highest income tax rate). In applying this mandatory flat tax rate, the employer must ignore the employee’s Form W-4, even where the employee claims to be exempt from withholding. This rule applies only for purposes of income tax withholding from wages; other types of withholding, such as pension withholding and backup withholding, are not affected. NOTE: The employer may treat the entire amount of the payment that results in the employee receiving total supplemental wages in excess of $1 million as subject to the mandatory 39.6% flat tax rate. In addition, this treatment can apply on an employee-by-employee basis. Example: Kelly has previously received $925,000 in supplemental wages from her employer this year.

In December, she receives a bonus of $100,000. Her employer has the choice of either withholding $39,600 ($100,000 x 39.6%) or $28,650 ($75,000 x 25% plus $25,000 x 39.6%). . Employer-Paid Taxes: Frequently an employer will pay the applicable income and employment taxes on behalf of the employee on the taxable value of a noncash fringe benefit. This also applies if they under withheld taxes, such as federal income, Social Security, and Medicare taxes and pays them on the employee’s behalf. The amount paid by the employer is to be treated as taxable income, subject to federal income tax and employment taxes in the year paid. If in 2015, you paid an employee’s taxes due in April 2015 for the employee’s 2014 tax liability, the amount paid in 2015 is part of the employee’s 2015 wages and is subject to 2015 income, social security, and Medicare taxes. The employer may request reimbursement from the employee for the taxes paid, either through an authorized payroll deduction or by a personal check.

Any amount of federal income tax not reimbursed to the employer by April 1 of the following year becomes taxable income to the employee for the prior year. The employer issues a Form W-2c to report this additional income and would deposit any applicable taxes associated with the gross-up. Taxable employer-paid taxes are reported in boxes 1, 3, and 5 of Form W-2 as well as state wages, if applicable. They are also reported as federal and state unemployment wages. When an employer pays taxes on behalf of the employee, this is referred to as “gross-up” and the taxes paid become wages. To determine an employee’s gross-up, use the following formula: Amount of Payment 100% - % of employee tax due = Taxable income Example: An employee has nonqualified moving expenses during the year equal to $2,500.

The employee does not have any state tax and the YTD earnings are $15,000. 25.00% Federal Income Tax (Supplemental rate) 6.20% Social Security 1.45% Medicare 32.65% 100% - 32.65% = 67.35% $2,500.00 ÷ 0.6735 = $3,711.95 Taxable Income Wages reported: (Form W-2, Boxes 1, 3, & 5) FIT (W-2, Box 2) Soc.Sec. (W-2, Box 4) Medicare (W-2, Box 6) $3,711.95 x 25.00% $3,711.95 x 6.20% $3,711.95 x 1.45% $3,711.95 = = = $ 927.99 $ 230.14 $ 53.82 Total tax = $1,211.95 Net amount = $2,500.00 State taxes should be included in the calculation as well, if applicable. See state supplemental tax rate chart in appendix. .

The following formula should be used if the employee’s wages are near the social security wage base: Social Security Tax Balance + Amount of Payment 100% - % of employee tax due (less social security tax rate) = Taxable income Example: An employee receives a bonus payment of $10,000.00, and no taxes are withheld. The employee’s year- to-date taxable social security wages are $113,100.00. The employee does not have any state tax. $118,500.00 - $113,100.00 = $5,400 (remaining taxable social security wages) $5,400.00 x 6.2% = $334.80 $334.80 + $10,000.00 100% - (25% + 1.45%) = $14,051.40 Taxable income Wages reported: (Form W-2, Boxes 1 & 5) ($5,400.00 Form W-2, Box 3) FIT (W-2, Box 2) Soc.Sec. (W-2, Box 4) Medicare (W-2, Box 6) $14,051.40 x 25.00% $ 5,400.00 x 6.20% $14,051.39 x 1.45% $14,051.40 = = = $ 3,512.85 $ 334.80 $ 203.75 Total tax = $ 4,051.40 Net amount = $10,000.00 Also watch if the employee has to pay the additional Medicare tax on wages over $200,000. Cafeteria Plans and Flexible Benefit Plans: The terms “cafeteria plans” and “flexible benefit plans” or “flex plans” are used interchangeably today to refer to an approach used to provide employees with a “menu” from which they may select various benefit options.

In August 2007, the IRS issued comprehensive new proposed regulations on cafeteria plans that replace proposed regulations issued in 1984, 1989, 1997, and 2000. In addition, temporary regulations issued in 1986 are removed. Qualified and Nonqualified Benefits: The new proposed regulations clarify that when employees may elect between taxable and nontaxable benefits, this ability to elect results in gross income to the employees unless a specific Internal Revenue Code section (e.g., §125 or §132(f)(4)) provides an exception. In addition, the regulations provide that unless a plan satisfies the requirements of IRC §125 and the regulations, the plan is not a cafeteria plan.

Reasons that a plan would fail to satisfy the §125 requirements include: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Offering nonqualified benefits; Not offering an election between at least one permitted taxable benefit and at least one qualified benefit; Deferring compensation; Failing to comply with the uniform coverage rule or use-or-lose rule; Allowing employees to revoke elections or make new elections during a plan year, except as provided in the regulations; Failing to comply with substantiation requirements; . ï‚· Paying or reimbursing expenses incurred for qualified benefits before the effective date of the cafeteria plan or before a period of coverage; ï‚· Allocating experience gains (forfeitures) other than as expressly allowed in the regulations; and ï‚· Failing to comply with grace period rules. Definition of a Cafeteria Plan: The new proposed regulations provide that a cafeteria plan is a separate written plan that complies with the requirements of §125 and the regulations, that is maintained by an employer for employees, and that is operated in compliance with the requirements of §125 and the regulations. Participants in cafeteria plans must be permitted to choose among at least one permitted taxable benefit (e.g., cash, including salary reduction) and at least one qualified (nontaxable) benefit. Finally, a cafeteria plan must not provide for deferral of compensation, except as specifically permitted under the regulations. Written Plan: A cafeteria plan must be in writing, and must be operated in accordance with the written plan terms. The new proposed regulations require that the written plan: ï‚· ï‚· ï‚· ï‚· Specifically describe all benefits, Set forth the rules for eligibility to participate and the procedure for making elections, Provide that all elections are irrevocable (except that a plan may include certain optional changein-status rules), and State how employer contributions may be made under the plan (e.g., salary reductions or nonelective employer contributions), the maximum amount of elective contributions, and the plan year. If the plan includes a flexible spending arrangement (FSA), the written plan must include provisions complying with the uniform coverage rule and the use-or-lose rule. The new proposed regulations require that the written cafeteria plan specify that only employees may participate in the plan, and that all provisions of the written plan apply uniformly to all participants. Who May Participate in a Cafeteria Plan: All participants in a cafeteria plan must be employees. The new proposed regulations provide that employees include common law employees, leased employees, and fulltime insurance salesmen.

Former employees (including laid-off employees and retired employees) may also participate in a plan, but a plan may not be maintained predominantly for former employees. Note that all employees who are treated as employed by a single employer under IRC §414 are treated as employed by a single employer for purposes of §125. A participant’s spouse or dependents may receive benefits through a cafeteria plan, although they cannot participate in the plan. Self-employed individuals are not treated as employees for purposes of §125. Accordingly, sole proprietors, partners, and directors of corporations may not participate in a cafeteria plan because they are not employees.

A self-employed individual may, however, sponsor a cafeteria plan for his or her employees. The new proposed regulations clarify that 2% shareholders of an S corporation are not employees for purposes of §125. Finally, the new proposed regulations provide rules for dual status individuals moving between employee and non-employee status. . Qualified Benefits: In general, in order for a benefit to be a qualified benefit for purposes of §125, the benefit must be excludable from employees’ gross income under a specific provision of the IRC and must not defer compensation, except as specifically allowed. Examples of qualified benefits include: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Group-term life insurance on the life of an employee; Employer-provided accident and health plans, including health flexible spending arrangements and accidental death and dismemberment policies; A dependent care assistance program; An adoption assistance program; Contributions to a §401(k) plan; Contributions to certain plans maintained by educational organizations; Contributions to Health Savings Accounts; and Long-term and short-term disability coverage. No Deferral of Compensation: Qualified benefits must be current benefits. In general, a cafeteria plan may not offer benefits that defer compensation or operate to defer compensation. This means that plan benefits may not be carried over to a later plan year or used in one plan year to purchase benefits to be provided in a later plan year.

For example, life insurance with a cash value build-up or group-term life insurance with a permanent benefit defers the receipt of compensation and thus is not a qualified benefit. The new proposed regulations clarify whether certain benefits and plan administration practices defer compensation. For example, the regulations permit an accident and health insurance policy to provide certain benefit features that apply for more than one plan year, such as reasonable lifetime limits on benefits, level premiums, premium waiver during disability, guaranteed renewability of coverage for specified accidental injury or specific diseases, and the payment of a fixed amount per day for hospitalization. But these insurance policies must not provide an investment fund or cash value to pay premiums, and no part of the premium may be held in a separate account for any beneficiary. The new proposed regulations also provide that the following benefits and practices do not defer compensation: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· A long-term disability policy paying benefits over more than one plan year; Reasonable premium rebates or policy dividends; Certain two-year lock-in vision and dental policies; Certain advance payments for orthodontia; Salary reduction contributions in the last month of a plan year used to pay accident and health insurance premiums for the first month of the following plan year; Reimbursement of §213(d) expenses for durable medical equipment; and Allocation of experience gains (forfeitures) among participants. Grace Periods: The new proposed regulations allow a written cafeteria plan to provide an optional grace period immediately following the end of each plan year, extending the period for incurring expenses for qualified benefits.

A grace period may apply to one or more qualified benefits (e.g., health FSA or dependent care assistance program) but in no event does it apply to paid time off or contributions to §401(k) plans. Unused benefits or contributions for one qualified benefit may only be used to reimburse expenses incurred during the grace period for that same qualified benefit. The amount of unused benefits and contributions available during the grace period may be limited by the employer. A grace period may extend to the fifteenth day of the third month after the end of the plan year (but may be for a shorter period).

Benefits or contributions not used as of the end of the grace period are forfeited under the use-or-lose rule. . Nonqualified Benefits: A cafeteria plan must not offer any of the following benefits: ï‚· Archer MSAs ï‚· Athletic facilities ï‚· De minimis benefits ï‚· Educational assistance ï‚· Employee discounts ï‚· Lodging on the business premises ï‚· Meals ï‚· Moving expense reimbursements ï‚· No-additional-cost services ï‚· Transportation benefits ï‚· Tuition reduction ï‚· Working condition benefits After-tax Employee Contributions: The new proposed regulations allow a cafeteria plan to offer after-tax employee contributions for qualified benefits or paid time off. A cafeteria plan may only offer the taxable benefits specifically permitted. Nonqualified benefits may not be offered through a cafeteria plan, even if paid with after-tax employee contributions. Employer Contributions through Salary Reduction: Employees electing a qualified benefit through salary reduction are electing to forego salary and instead to receive a benefit which is excludible from gross income because it is provided by employer contributions. The employee is treated as receiving the qualified benefit from the employer in lieu of the taxable benefit. A cafeteria plan may also impose reasonable plan administration fees that may be paid through salary reduction.

A cafeteria plan is not required to allow employees to pay for any qualified benefit with aftertax employee contributions. Making, Revoking, and Changing Elections: Generally, a cafeteria plan must require employees to elect annually between taxable benefits and qualified benefits. Elections must be made before the earlier of the first day of the period of coverage or when benefits are first currently available. Note that the determination of whether a taxable benefit is currently available does not depend on whether it has been constructively received by the employee. Annual elections generally must be irrevocable and may not be changed during the plan year.

However, a cafeteria plan may allow for changes in elections based on certain changes in status. If Health Savings Account contributions are made through salary reduction under a cafeteria plan, employees may prospectively elect, revoke, or change salary reduction elections for HSA contributions at any time during the plan year with respect to salary that has not become currently available at the time of the election. A cafeteria plan is permitted to include an automatic election for new employees or current employees. A new rule also permits a cafeteria plan to provide an optional election for new employees between cash and qualified benefits. New employees avoid gross income inclusion if they make an election within 30 days after the date of hire even if benefits provided pursuant to the election relate back to the date of hire. However, salary reduction amounts used to pay for such an election must be from compensation not yet currently available on the date of the election.

Also, this special election rule for new employees does not apply to any employee who terminates employment and is rehired within 30 days after terminating employment (or who returns to employment following an unpaid leave of absence of less than 30 days). . New elections and permissible revocations or changes in elections can be made electronically. Only an employee can make an election or revoke or change his or her election. An employee’s spouse or dependent may not make an election under a cafeteria plan and may not revoke or change an employee’s election. Nondiscrimination Rules: Discriminatory benefits provided to highly compensated cafeteria plan participants are included in these employees’ gross income. The new proposed regulations provide guidance on the cafeteria plan nondiscrimination rules, including definitions of key terms (e.g., highly compensated individual or participant, officer, 5% shareholder, key employee, compensation). The regulations also provide an objective test to determine when the actual election of benefits is discriminatory. Specifically, the regulations provide that a cafeteria plan must give each similarly situated participant a uniform opportunity to elect qualified benefits, and that highly compensated participants must not actually disproportionately elect qualified benefits. Finally, the new rules provided guidance on the safe harbor for cafeteria plans providing health benefits and create a safe harbor for premium-only plans that satisfy certain requirements. Additional Information on Cafeteria Plans: Social Security and Medicare Tax: The definition of wages for social security and Medicare exclude any payment to, or on behalf of, an employee or beneficiary under a cafeteria plan.

This exclusion does not apply to 401(k) deferrals. Federal Unemployment Tax (FUTA): Payments under a cafeteria plan are excluded from federal unemployment tax. This exclusion does not apply to 401(k) deferrals. Reporting Requirements in Connection with Cafeteria Plan Grace Period: IRS guidance clarifies the Form W-2 reporting requirements when an employer has amended a cafeteria plan document to provide a grace period for qualified dependent care assistance immediately following the end of a cafeteria plan year. Under existing reporting rules for dependent care assistance, the amount reported on Form W-2 is the total amount of cash reimbursement furnished to the employee during the calendar year. However, if the employer does not know the actual total amount of cash reimbursement at the time the Form W-2 is prepared, then the employer may report a reasonable estimate of the total amount.

The amount an employee elects to contribute for the year (plus any employer matching contributions) will be considered a reasonable estimate. The IRS has clarified that an employer that amends its cafeteria plan to provide a grace period for dependent care assistance may continue to rely on these rules by reporting in Box 10 of Form W-2 the salary reduction amount elected by the employee for the year for dependent care assistance (plus employer matching contributions). EXAMPLE: An employer amends its calendar year cafeteria plan to permit a grace period for dependent care assistance until March 15 of the subsequent year. An employee elects salary reduction of $5,000 for dependent care assistance for the 2015 calendar year and $5,000 for the 2016 calendar year. The employee has $500 of dependent care contributions remaining at the end of the 2015 plan year, which is available for reimbursement of dependent care expenses during the grace period. For the 2015 calendar year, the employer should report in Box 10 of Form W-2 the $5,000 of salary reduction amount elected by the employee for 2015.

Similarly, for the 2016 calendar year, the employer should report in Box 10 of Form W-2 the $5,000 salary reduction amount elected by the employee for 2016. . Effect of the Family and Medical Leave Act: Responsibilities for Premium Payments: An employee making premium payments under a cafeteria plan that chooses to continue group health plan coverage (including a medical FSA) while on FMLA leave is responsible for the share of group health premiums that the employee was paying while working, such as amounts pursuant to a salary reduction agreement. The employer must continue to contribute the share of the cost of the employee’s coverage that the employer was paying before the employee commenced FMLA leave. Payment Options: A cafeteria plan may, on a nondiscriminatory basis, offer one or more of the following three payment options to an employee who continues group health plan coverage (including medical FSA) while on unpaid FMLA leave. ï‚· Pre-pay option: A cafeteria plan may permit an employee to pay, prior to commencement of the FMLA leave period, the amounts due for the FMLA leave period even though the amount may be a prepayment to a future plan year. The employer may not mandate the pre-pay option. Contributions may be made on a pretax salary reduction basis from any taxable compensation (including the cashing out of unused sick or vacation days), or on an after-tax basis. However, a payment for coverage in a future plan year cannot be a pretax salary reduction; it must be an after-tax deduction. ï‚· Pay-as-you-go option: Employees may pay their share of the premium payments on the same schedule as payment would be made if the employee were not on leave or under any other payment schedule permitted by the Labor Department regulations.

Contributions under this option are generally made by the employee on an after-tax basis. However, they may be made on a pretax basis to the extent that the contributions are made from taxable compensation (e.g., cashing out of unused sick or vacation days) that is due the employee during the leave period, and provided that all cafeteria plan requirements are satisfied. An employer is not required to continue the health coverage of an employee who fails to make required premium payments while on FMLA leave. However, if the employer chooses to continue the health coverage of an employee who fails to make required premium payments while on FMLA leave the employer is entitled to recoup those payments as noted below. ï‚· Catch-up option: the employer and the employee must agree in advance of the coverage period that: the employee elects to continue health coverage while on unpaid FMLA leave; the employer will assume responsibility for advancing payments of the premiums on the employee’s behalf during the FMLA leave; and these advance amounts must be paid by the employee when the employee returns from FMLA leave.

Contributions may be made on a pretax salary reduction basis when the employee returns from FMLA leave from any available taxable compensation (including the cashing out of unused sick and vacation days), or on an after-tax basis. However, a payment for coverage in a previous plan year cannot be a pretax salary reduction; it must be an after-tax deduction. Exceptions: ï‚· The pre-pay option cannot be the sole option offered to employees on FMLA leave. However, this option may be offered, even if the option is not offered to employees on non-FMLA leavewithout-pay. ï‚· The catch-up option can be the sole option offered to employees on FMLA leave only if the catch-up option is the sole option offered to employees on non-FMLA leave-without-pay. .

ï‚· A cafeteria plan cannot offer employees on FMLA leave a choice of either the pre-pay option or the catch-up option without also offering the pay-as-you-go option, if the pay-as-you-go option is offered to employees on non-FMLA leave-without pay. Flexible Spending Accounts (FSAs): In general, an FSA is a benefit designed to reimburse employees for expenses incurred for certain qualified benefits, up to a maximum amount not substantially in excess of the salary reduction and employer flex-credits allocated to the benefit. The maximum amount of reimbursement reasonably available must be less than five times the value of the coverage. Employer flex-credits are non-elective employer contributions that an employer makes available for every employee eligible to participate in the cafeteria plan, to be used at the employee’s election only for one or more qualified benefits (but not as cash or other taxable benefits). The three types of FSAs are dependent care assistance, adoption assistance, and medical care reimbursements (health FSA). Uniform coverage rule: The new proposed regulations retain the rule that the maximum amount of reimbursement from a health FSA must be available at all times during the period of coverage (properly reduced as of any particular time for prior reimbursements). The uniform coverage rule does not apply to FSAs for dependent care assistance or adoption assistance. Use-or-lose rule: An FSA must satisfy all the requirements of §125, including the prohibition against deferring compensation.

In general, this means that all benefits and contributions must be used by the end of the plan year (or grace period, if applicable), or they are forfeited. The new proposed regulations continue the use-or-lose rule. As of October 31, 2013, the U.S. Department of Treasury and IRS issued an updated guidance which permits employers to allow plan participants to carry over up to $500 of their unused health FSA balances remaining at the end of a plan year.

In addition, the existing option for plan sponsors to allow employees a grace period after the end of the plan year remains in place. However, a health FSA cannot have both a carryover and a grace period. It can have one or the other or neither. Period of coverage: The required period of coverage for all FSAs continues to be 12 months, with an exception for short plan years that satisfy certain conditions.

Note that the period of coverage and the plan year need not be the same. The new proposed regulations clarify that FSAs for different qualified benefits need not have the same coverage period. The regulations also continue to provide that expenses are incurred when services are provided. In addition, expenses incurred before or after the period of coverage may not be reimbursed. Health FSA: A health FSA may only reimburse certain substantiated §213(d) medical care expenses incurred by the employee or the employee’s spouse or dependents.

It may be limited to a subset of permitted §213(d) expenses (e.g., it may exclude reimbursement of certain over-the-counter drugs). Under the Patient Protection and Affordable Care Act of 2010, beginning in 2011, only the cost of medicine prescribed by a doctor and insulin can be reimbursed through a health FSA. Similarly, a health FSA may be an HSA-compatible limited-purpose health FSA or post-deductible health FSA. However, a health FSA may not reimburse premiums for accident and health insurance or long-term care insurance. A cafeteria plan may limit enrollment in a health FSA to those employees who participate in the employer’s accident and health plan. .

Dependent care assistance after termination: A new optional rule permits an employer to reimburse a terminated employee’s qualified dependent care expenses incurred after termination through a dependent care FSA if all §129 requirements are otherwise satisfied. Experience gains: If an employee fails to use all contributions and benefits for a plan year before the end of the plan year (and the grace period, if applicable), those unused contributions and benefits are forfeited under the use-or-lose rule. Unused amounts are also known as experience gains. The new proposed regulations clarify that the employer sponsoring the cafeteria plan may retain forfeitures, use forfeitures to defray expenses of administering the plan, or allocate forfeitures among employees contributing through salary reduction on a reasonable and uniform basis. Also, any amounts reimbursed over and above what the employee had funded at the time the valid claim was submitted and not subsequently recovered from the employee is non-taxable to the employee and is not recoverable by the employer. Substantiation of Expenses: Incurring and reimbursing expenses – The new proposed regulations provide that only expenses for qualified benefits incurred after the later of the effective date or the adoption date of the cafeteria plan are permitted to be reimbursed under the cafeteria plan. If a plan amendment adds a new qualified benefit, only expenses incurred after the later of the effective date or the adoption date are eligible for reimbursement. This rule applies to all qualified benefits. A cafeteria plan may pay or reimburse only expenses for qualified benefits incurred during a participant’s period of coverage. Substantiation and reimbursement – After an employee incurs an expense for a qualified benefit during the coverage period, the expense must first be substantiated before the expense may be paid or reimbursed.

All expenses must be substantiated. Substantiating only a limited number of total claims, or not substantiating claims below a certain dollar amount, does not satisfy the requirements in the new proposed regulations. Note that FSAs for dependent care assistance and adoption assistance must follow the substantiation procedures applicable to health FSAs. Debit Cards – The new proposed regulations incorporate previously issued guidance on substantiating, paying, and reimbursing §213(d) medical care expenses using debit cards. Among the permissible substantiation methods are copayment matches, recurring expenses, and real-time substantiation. The new proposed regulations also allow point-of-sale substantiation through matching inventory information with a list of medical expenses.

The employer is responsible for ensuring that the inventory information approval system complies with the new regulations and with recordkeeping requirements. The new proposed regulations also provide rules under which an FSA may pay or reimburse dependent care expenses using debit cards. After June 30, 2009, health FSA debit cards may not be used at stores with the Drug Stores and Pharmacies merchant category code unless (1) the store participates in the inventory information approval system, or (2) on a store-location-by-store-location basis, 90% of the store’s gross receipts during the prior taxable year consisted of items that qualify as expenses for medical care under §213(d), including certain nonprescription medications. . Note: Under the new Health Care legislation, reimbursements for non-prescription medicines will NOT be permitted. The IRS has provided guidance on the effective date and implications of the new restriction on health plan reimbursement of non-prescription medicines (IRS Notes 2010-59). An individual may be reimbursed for over-the-counter drugs if the individual has a prescription. A prescription is a written or electronic order that meets the legal requirements of a prescription in the state in which the expense is incurred. The prescription must be issued by an individual legally authorized to do so in that state.

Items that are not medicine or drugs, such as crutches, diagnostic devices such as blood sugar test kits, and bandages, may qualify as reimbursable medical expenses. The changes are effective for purchases of over-the-counter medicine and drugs without a prescription after December 31, 2011. This effective date applies regardless of whether the plan year for the employer arrangement is a fiscal or calendar year. However, reimbursements from an employer HRA or health FSA may be made after December 31, 2011, if the reimbursement relates to the purchase of an over-thecounter medicine or drug during 2011. Debit cards may no longer be used for health FSA and HRA purchases of non-prescription medicines. Dependent Care Benefits: Employers can provide dependent care assistance to their employees that may be excluded, within limits, from their income, if, at the time of the payment or service, it is reasonable to believe that the employee will be able to exclude the payment under IRC §129.

The annual exclusion for dependent care assistance on the employee’s income tax return is limited to the lesser of: ï‚· ï‚· $5,000 or $2,500 if married, filing a married-separate return, or the exclusion cannot exceed the employee’s earned income or the earned income of the employee’s spouse, whichever is less. As employers do not know if the employee is filing married-separate or the spouse’s earned income, employer-provided plans limit the amount excluded from income to the lesser of $5,000 or the employee’s earned income. Employers are only required to monitor the $5,000 and employee earned income exclusions. Dependent care assistance can: ï‚· be provided in-kind (i.e., on-site facility); ï‚· be employer-paid or subsidized; or ï‚· take the form of a Section 125 flexible spending account. Unlike other fringe benefits, dependent care assistance is treated as received during the year in which the services were provided, rather than when the employee was reimbursed. Individuals for whom dependent care assistance can be provided include the following: ï‚· a dependent child under the age of 13; or ï‚· a spouse or dependents of the employee who are physically unable to care for themselves. The care provider used by the employee may not be the employee’s child who will be under the age of 19 at the end of the calendar year, or any individual claimed as a dependent by the employee. . To provide a qualified dependent care assistance program the employer is required to have a separate written plan designed for the exclusive benefit of its employees. The plan does not need to be funded by the employer but the following requirements must be met: ï‚· The plan must benefit employees who qualify under a classification set up by the employer, and the plan must not discriminate in favor of the officers, owners, or highly compensated employees (or their dependents). Exception: Employees may be excluded from the plan if they are covered by a collectivebargaining agreement and the plan was subject to good faith bargaining between the employees’ representative and the employer. ï‚· The employer must provide reasonable notification of the availability and terms of the plan to eligible employees. ï‚· The plan must provide a written statement to each employee, on or before January 31 of each year, indicating the amount of dependent care assistance provided by the employer during the previous calendar year. This reporting requirement is satisfied by reporting 100% of the cash paid or, if other than cash, the fair market value, or pretax amount in Box 10 of Form W-2. NOTE: If the employer has an onsite dependent care facility, more than $5,000 may be reported in Box 10. The first $5,000 is excluded in income and any amounts in excess of that must also be reported in Boxes 1, 3, and 5. ï‚· The employer must report the fair market value (not the cost to the employer) of the benefit received if the employer is directly providing the benefit or use the IRS-approved formula: o (125% of direct costs ÷ number of days available ÷ maximum capacity) x days used by the employee ï‚· When reporting values for “flexible spending account” plans report either: 1.

The amount reimbursed for benefits received during the calendar year, or 2. The amount set aside on a pretax basis by the employee in the calendar year. Adoption Assistance: IRC §23 allows individuals to take an income tax credit for qualified adoption expenses. IRC §137 excludes from an employee’s income employer-provided adoption assistance that is furnished under an adoption assistance program in connection with the employee’s adoption of an eligible child. The maximum exclusion on an individual’s personal income tax return for qualified adoption expenses in 2015 in $13,400 per eligible child. Qualifying Expenses: Qualifying adoption expenses are: ï‚· Reasonable and necessary adoption fees ï‚· Court costs ï‚· Attorney fees ï‚· Travel expenses (including amounts spent for meals and lodging) while away from home ï‚· Other expenses directly related to, and whose principal purpose is for, the legal adoption of an eligible child .

Non-qualifying Expenses: Non-qualifying adoption expenses are: ï‚· Expenses that violate state or federal law ï‚· For carrying out any surrogate parenting arrangement ï‚· For the adoption of a spouse’s child ï‚· Paid using funds received from any federal, state or local program ï‚· Allowed as a credit or deduction under any other federal income tax rule ï‚· Paid or reimbursed by the employer or otherwise (except that amounts paid or reimbursed under an adoption assistance program may be qualifying expenses for the exclusion) Adoption Assistance Program Requirements: There are several requirements that an adoption assistance program must meet before employer-provided adoption assistance can be excluded from an employee’s income. ï‚· The adoption assistance program must be a separate written plan established for the exclusive benefit of the employer’s employees, although it may be a part of an employer’s comprehensive employee benefit plan. ï‚· The program may not discriminate in favor of highly compensated employees or their dependents. For 2015, a highly compensated employee is defined as (1) an employee who was a 5% owner at any time during the current or preceding year OR (2) an employee who received more than $115,000 in pay for the preceding year. Test 2 may be ignored if the employee was not also in the top 20% of employees when ranked by pay for the preceding year. ï‚· No more than 5% of the adoption assistance provided in any year may go to shareholders or owners owning more than 5% of the stock, capital, or profits interest of the employer on any day during the year. ï‚· The program is not required to be funded. ï‚· Employers must provide reasonable notification of the availability and terms of the program to eligible employees. An adoption assistance program that meets the requirements of IRC §137 may be offered as a qualified benefit through an employer’s IRC §125 cafeteria plan. Withholding and Reporting Obligations: The dollar limit on adoption assistance does not apply to the exclusion from federal income tax withholding. The exclusion applies to all of the employerprovided adoption assistance, regardless of the number of children adopted or whether the adoptions are successful, as long as the assistance is for substantiated and qualified expenses for qualified children.

However, all of the payments are subject to social security, Medicare, and FUTA taxes. If the assistance is provided through employee contributions to a cafeteria plan or FSA: ï‚· Decrease federal, social security, Medicare, and FUTA wages ï‚· Withdrawals from the set aside funds increase social security, Medicare, and FUTA wages (i.e., reimbursements) ï‚· Amounts deducted from pay must be used for adoption expenses incurred and claimed during the program’s fiscal year, or the funds will be forfeited. In either situation, qualified adoption assistance must be reported on Form W-2 in Box 12 using Code T, unless the assistance consists of employee deductions that are forfeited under “use or lose.” The assistance is not reported in Box 1, regardless of the amount reimbursed. This includes amounts in excess of the maximum exclusion amount, as well as adoption benefits paid or reimbursed from an employee’s pretax contributions to a cafeteria plan. The dollar limit does apply, however, on a per child basis, when it comes to the Form 1040 personal income tax return, and the exclusion is phased out based on how much an individual’s modified adjusted gross income exceeds the maximum exclusion. Refer to IRS Publication 15-B for additional information. .

Health Savings Accounts: A Health Savings Account (HSA) is an account owned by a qualified individual who is generally an employee or former employee. Any contributions made to an HSA by the employer become the employee’s property and cannot be withdrawn by the employer. Contributions to the account are used to pay current or future medical expenses of the account owner, his or her spouse, and any qualified dependent. The medical expenses must not be reimbursable by insurance or other sources and their payment from HSA funds (distribution) will not give rise to a medical expense deduction on the individual’s federal income tax return. A qualified individual must be covered by a High Deductible Health Plan (HDHP) and not be covered by other health insurance except for permitted insurance listed under section 223(c)(3) or insurance for accidents, disability, dental care, vision care, or long-term care.

For calendar year 2015, a qualifying HDHP must have a deductible of at least $1,300 for self-only coverage or $2,600 for family coverage and must limit annual out-of-pocket expenses of the beneficiary to $6,450 for self-only coverage and $12,900 for family coverage. There are no income limits that restrict an individual’s eligibility to contribute to an HSA nor is there a requirement that the account owner have earned income to make a contribution. Exceptions: An individual is not a qualified individual if he or she can be claimed as a dependent on another person’s tax return. Also, an employee’s participation in a health flexible spending arrangement (FSA) or health reimbursement arrangement (HRA) generally disqualifies the individual (and employer) from making contributions to his or her HSA. However, an individual may qualify to participate in an HSA if he or she is participating in only a limited-purpose FSA or HRA or a post-deductible FSA. Employer contributions: Up to specified dollar limits, cash contributions to the HSA of a qualified individual (determined monthly) are exempt from federal income tax withholding, social security tax, Medicare tax, and FUTA tax.

For 2015, you can contribute up to $3,350 for self-only coverage or $6,650 for family coverage to a qualified individual’s HSA. The contribution amounts listed above are increased by $1,000 for a qualified individual who is age 55 or older at any time during the year. For two qualified individuals who are married to each other and who each are age 55 or older at any time during the year, each spouse’s contribution limit is increased by $1,000 provided each spouse has a separate HSA. No contributions can be made to an individual’s HSA after he or she becomes enrolled in Medicare Part A or Part B. Nondiscrimination rules: The employer’s contribution to an employee’s HSA must be comparable for all employees who have comparable coverage during the same period.

Otherwise, there will be an excise tax equal to 35% of the amount contributed to all employees’ HSAs. For guidance on employer comparable contributions to HSAs under section 4980G in instances where an employee has not established an HSA by December 31 and in instances where an employer accelerates contributions for the calendar year for employees who have incurred qualified medical expenses, see Treasury Decision 9393, 2008-20 I.R.B. 975, available at www.irs.gov/irb/2008-20_IRB/ar08.html. Exception: The Tax Relief and Health Care Act of 2006 allows employers to make larger HSA contributions for a non-highly compensated employee than for a highly compensated employee. A highly compensated employee for 2015 is an employee who meets either of the following tests: ï‚· ï‚· The employee was a 5% owner at any time during the year or the preceding year. The employee received more than $115,000 in pay for the preceding year. .

Test 2 can be ignored if the employee was not also in the top 20% of employees when ranked by pay for the preceding year. Partnerships and S Corporations: Partners and 2% shareholders of an S corporation are not eligible for salary reduction (pre-tax) contributions to an HSA. Employer contributions to the HSA of a bona fide partner or 2% shareholder are treated as distributions or guaranteed payments as determined by the facts and circumstances. Cafeteria plans: An employer may contribute to an employee’s HSA using a cafeteria plan and the employer’s contributions are not subject to the statutory comparability rules. However, cafeteria plan nondiscrimination rules still apply. For example, contributions under a cafeteria plan to employee HSAs cannot be greater for higher-paid employees than they are for lower-paid employees.

Contributions that favor lower-paid employees are not prohibited. Reporting requirements: Employer contributions to an employee’s HSA must be reported on Form W-2 in box 12 using code “W”. Employee contributions made through a cafeteria plan are considered to be made by the employer so they are included in box 12 as well. The trustee or custodian of the HSA, generally a bank or insurance company, reports distributions from the HSA using Form 1099-SA, Distributions from the HSA, Archer MSA, or Medicare Advantage MSA. Note: Effective for distributions made after December 31, 2010 under the new Health Care legislation, the penalty for an individual withdrawing HSA funds that are not used to pay for qualified medical expenses is increased from 10% to 20%. Health Savings Accounts High Deductible Health Plan Individual Annual Deductible High Deductible Health Plan Family Annual Deductible High Deductible Health Plan Individual out of pocket expenses limit High Deductible Health Plan Family out of pocket expenses limit Maximum Annual Contribution – Individual Maximum Annual Contribution – Family Maximum Annual Catch-up Contribution 2015 $1,300 $2,600 $6,450 2016 $1,300 $2,600 $6,550 $12,900 $12,900 $3,350 $6,650 $1,000 $3,350 $6,750 $1,000 Employer-Provided Accident and Health Plan: Coverage under an employer-provided accident and health plan that satisfies certain requirements may be provided as a qualified benefit through a cafeteria plan and is excludible from employees’ gross income. The new proposed regulations specifically permit a cafeteria plan (but not a health FSA) to pay or reimburse substantiated individual accident and health insurance premiums.

In addition, a cafeteria plan may provide for payment of COBRA premiums for an employee. Domestic Partner Health Insurance Coverage: The IRS has announced that same-sex couples, legally married in jurisdictions that recognize their marriages, will be treated as married for federal tax purposes. This applies regardless of whether the couple lives in a jurisdiction that recognizes same-sex marriage or a jurisdiction that does not recognize same-sex marriages (Rev. Rul 2013-17, 2013-38 IRB 201).

The new ruling applies to all federal tax provisions where marriage is a factor, including filing status, claiming personal and dependency exemptions, taking the standard deduction, employee benefits, contributing to an IRA, and claiming the earned income tax credit or child tax credit. . The ruling does not apply to registered domestic partnerships, civil unions, or similar formal relationships recognized under state law. For federal tax purposes, the term “marriage” does not include registered domestic partnerships, civil unions, or other similar formal relationships recognized under state law that are not denominated as a marriage under state’s law. What About the States?: Some states have enacted laws allowing same-sex couples to get married or to enter into a “civil union” that provides all the same state benefits that are provided to a married couple. Health insurance premiums paid by an employer to cover an employee’s same-sex spouse or civil union partner may not be taxable to the employee for state purposes, but remains subject to federal income, social security, and Medicare taxes. Health Insurance Premiums on 2% Shareholders: Health insurance premiums paid to cover employees normally are not considered taxable wages. However, in the case of health insurance premiums paid to cover employees who are 2% or greater shareholders of an S corporation, the amount of the premiums must be considered wages subject to federal income tax withholding. This amount would be included in box 1 of Form W-2.

These premiums are not subject to social security, Medicare, or FUTA taxes. However, health insurance provided solely to 2% or more shareholder-employees of S corporations, not to other employees, does not qualify for the FICA exemption and is subject to social security, Medicare, and FUTA taxes. New W-2 Reporting Requirement: The Patient Protection and Affordable Care Act of 2010 requires employers to report the total cost of employer-provided health coverage on employees’ Forms W-2. The reporting requirement applied for the first time to Forms W-2 for 2012 that employers filed in 2013. The IRS issued interim guidance on Form W-2 reporting of the cost of employer-sponsored group health plan coverage in 2012 (Notice 2012-9, 2012-4 IRB 315).

The guidance emphasizes that the reporting requirement is for informational purposes only, to inform employees of the cost of their health care coverage. It does not cause excludable employer-sponsored health care coverage to become taxable. All employers that provide applicable employer-sponsored coverage during a calendar year are subject to the reporting requirements. This includes federal, state and local government entities, churches and other religious organizations, and employers that are not subject to the COBRA continuation coverage requirements, to the extent such employers provide applicable employer-sponsored coverage under a group health plan, but does not include federally recognized Indian tribal governments.

Until further guidance is issued, tribally chartered corporations wholly-owned by a federally recognized Indian tribal government are not subject to the reporting requirements. In the case of 2015 Forms W-2, however, until further guidance is issued, an employer is not subject to the reporting requirement for any calendar year if the employer was required to file fewer than 250 Forms W-2 for the preceding calendar year. Therefore, if an employer filed fewer than 250 2014 Forms W-2, the employer is not subject to the reporting requirement for 2015 Forms W-2. Preparation Tip: The 2014 Form W-2 indicates that the cost of employer-sponsored health coverage, if optionally entered, is to be placed in Box 12, and designated with Code DD. The instructions for the employee state that “the amount reported with Code DD is not taxable.” Do not report a zero amount in Box 12 if no employer-sponsored health coverage. .

Note: An employer is not required to issue a Form W-2 with the aggregate reportable cost of health insurance to an individual to whom the employer is not otherwise required to issue a Form W-2, such as a retiree or other former employee receiving no compensation. Therefore, an employer that must issue a Form W-2 to a retiree to report payments under a nonqualified deferred compensation plan or uncollected FICA taxes on group-term life insurance would have to report the reportable cost of coverage on that Form W-2. . Form W-2 Reporting of Employer-Sponsored Health Coverage Coverage Type Form W-2, Box 12, Code DD Report Do Not Optional Report Major medical X Dental or vision plan not integrated into another medical or health plan X Dental or vision plan which gives the choice of declining or electing and X paying an additional premium Health Flexible Spending Arrangement (FSA) funded solely by salaryX reduction amounts Health FSA value for the plan year in excess of employee’s cafeteria plan X salary reductions for all qualified benefits Health Reimbursement Arrangement (HRA) contributions X Health Savings Arrangement (HSA) contributions (employer or employee) X Archer Medical Savings Account (Archer MSA) contributions (employer or X employee) Hospital indemnity or specified illness (insured or self-funded), paid on afterX tax basis Hospital indemnity or specified illness (insured or self-funded), paid through X salary reduction (pre-tax) or by employer Employee Assistance Plan (EAP) providing applicable employer-sponsored Required if employer Optional if employer does healthcare coverage charges a COBRA not charge a COBRA premium premium On-site medical clinics providing applicable employer-sponsored healthcare Required if employer Optional if employer does coverage charges a COBRA not charge a COBRA premium premium Wellness programs providing applicable employer-sponsored healthcare Required if employer Optional if employer does coverage charges a COBRA not charge a COBRA premium premium Multi-employer plans X Domestic partner coverage included in gross income X Governmental plans providing coverage primarily for members of the military X and their families Federally recognized Indian tribal government plans and plans of tribally X charted corporations wholly owned by a federally recognized Indian tribal government Self-funded plans not subject to Federal COBRA X Accident or disability income X Long-term care X Liability insurance X Supplemental liability insurance X Workers' compensation X Automobile medical payment insurance X Credit-only insurance X Excess reimbursement to highly compensated individual, included in gross X income Payment/reimbursement of health insurance premiums for 2% shareholderX employee, included in gross income Other Situations Report Do Not Optional Report Employers required to file fewer than 250 Forms W-2 for the preceding X calendar year (determined without application of any entity aggregation rules for related employers) Forms W-2 furnished to employees who terminate before the end of a X calendar year and request, in writing, a Form W-2 before the end of that year Forms W-2 provided by third-party sick-pay provider to employees of other employers X . The Patient Protection and Affordable Care Act of 2010 requires an employer to report on an employee’s Form W-2 the aggregate cost of “applicable employer-sponsored coverage,” excluding: (1) the amount contributed to an Archer MSA of the employee or the employee’s spouse, (2) the amount contributed to a health savings account of the employee or the employee’s spouse, and (3) the amount of any salary reduction contributions to a flexible spending arrangement. Prior to the IRS’ issuance of interim relief, this requirement was scheduled to become effective for taxable years beginning after Dec. 31, 2010. “Applicable employer-sponsored coverage” is generally defined as coverage under any group health plan made available to an employee by an employer that is excludable from the employee’s gross income under the Code. Applicable employer-sponsored coverage includes the entire cost of the coverage, without regard to whether the employer or the employee pays for the coverage.

The aggregate cost of coverage is determined under rules similar to those for determining premiums under the Consolidated Omnibus Budget Reconciliation Act (COBRA) – excluding the 2 percent administrative charge that may be applied to COBRA coverage. Applicable employer-sponsored coverage excludes: ï‚· Coverage for long-term care. ï‚· Coverage only for accident, or disability income insurance, or any combination thereof. ï‚· Coverage issued as a supplement to liability insurance. ï‚· Liability insurance, including general liability insurance and automobile liability insurance. ï‚· Workers’ compensation insurance or similar insurance. ï‚· Automobile medical payment insurance. ï‚· Credit-only insurance. ï‚· Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits. ï‚· Coverage for a specified disease or illness, hospital indemnity, or other fixed indemnity insurance, if the coverage is offered as an independent, non-coordinated benefit the payment of which is not excludable from income, and no deduction is allowed. ï‚· Coverage under a separate policy, certificate, or contract of insurance that provides dental or vision benefits. Methods of Calculating the Cost of Coverage: The reportable cost for an employee receiving coverage under a plan is the sum of the reportable costs for each period (such as a month) during the year as determined under the method used by the employer. An employer is not required to use the same method for every plan, but must use the same method with respect to a plan for every employee receiving coverage under that plan. ï‚· COBRA applicable premium method: Under the COBRA applicable premium method, the reportable cost for a period equals the COBRA applicable premium for that coverage for that period. If the employer applies this method, the employer must calculate the COBRA applicable premium in a manner that satisfies the requirements under IRC §4980B(f)(4).

The COBRA applicable premium does not include the 2% administrative fee that an employer can charge an employee in addition to the premium. ï‚· Premium charged method: The premium charged method may be used to determine the reportable cost only for an employee covered by an employer’s insured group health plan. In such a case, if the employer applies this method, the employer must use the premium charged by the insurer for that employee’s coverage (for example, for single-only coverage or for family coverage, as applicable to the employee) for each period as the reportable cost for that period. . ï‚· Modified COBRA premium method: An employer may use the modified COBRA premium method with respect to a plan only where it subsidizes the cost of COBRA (so that the premium charged to COBRA qualified beneficiaries is less than the COBRA applicable premium) or where the actual premium charged by the employer to COBRA qualified beneficiaries for each period in the current year is equal to the COBRA applicable premium for each period in a prior year. If the employer subsidizes the cost of COBRA, the employer may determine the reportable cost for a period based on a reasonable good faith estimate of the COBRA applicable premium for that period, if such reasonable good faith estimate is used as the basis for determining the subsidized COBRA premium. If the actual premium charged by the employer to COBRA qualified beneficiaries for each period in the current year is equal to the COBRA applicable premium for each period in a prior year, the employer may use the COBRA applicable premium for each period in the prior year as the reportable cost for each period in the current year. Example 1: For calendar year 2015, Jeff’s Auto subsidizes 50% of a reasonable good faith estimate of the COBRA applicable premium. Jeff’s reasonable good faith estimate of the COBRA applicable premium for self-only coverage for each month in 2015 is $300. Accordingly, the actual COBRA premium Jeff’s charges individuals eligible for COBRA continuation coverage electing self-only coverage is $150 per month.

Solely for purposes of §6051(a)(14) reporting, if Jeff’s uses the modified COBRA premium method, it must treat $300 per month (the reasonable good faith estimate of the COBRA applicable premium) as the monthly reportable cost for self-only coverage for calendar year 2015. Example 2: Get it Right Payroll Services determined that the COBRA applicable premium for each month in calendar year 2015 for individuals eligible for COBRA continuation coverage electing self-only coverage would be $350 per month, and charged an actual COBRA premium for such coverage of $357 per month ($350 x 102%). Get it Right knows that the cost of coverage for 2015 is not less than the COBRA applicable premium for 2014 and decides not to make a new determination of the COBRA applicable premium for the calendar year 2015 but rather to continue to charge an actual COBRA premium for selfonly coverage of $357 per month ($350 x 102%). Solely for purposes of §6051(a)(14) reporting, if Get it Right uses the modified COBRA premium method, it must treat $350 per month ($357 charged - $7 increase permissible under COBRA) as the monthly reportable cost for self-only coverage for the calendar year 2015. Example 3: The Rib Rack makes a good faith estimate of the COBRA applicable premium for calendar year 2015 for individuals eligible for COBRA continuation coverage electing self-only coverage of $500 per month.

To ensure compliance with the COBRA requirements despite not calculating a precise COBRA applicable premium, The Rib Rack charges an actual COBRA premium of $350 per month for individuals eligible for COBRA coverage electing self-only coverage. Solely for purposes of §6051(a)(14) reporting, if The Rib Rack uses the modified COBRA premium method, it must treat $500 per month as the monthly reportable cost for self-only coverage for calendar year 2015. Group - Term Life Insurance Coverage: Group term life insurance coverage with a value of $50,000 or less is excludable from income if: ï‚· it provides a general death benefit that is not included in income; ï‚· it is provided to a group of employees of more than 10; ï‚· it provides an amount of insurance to each employee based on a formula that prevents individual selection (this formula must use factors such as the employee’s age, years of service, pay, or position); and . ï‚· it is provided under a policy that the employer either directly or indirectly carries. Even if the employer does not pay any of the policy’s cost, the employer is considered to carry it if they arrange for payment of its cost by its employees and charge at least one employee less than, and at least one other employee more than, the cost of his or her insurance. Group-term life insurance does not include insurance that does not provide general death benefits, such as travel insurance or a policy providing only accidental death benefits, life insurance on the life of the employee’s spouse or dependent, or insurance provided under a policy that provides a permanent benefit, unless certain requirements are met. The value in excess of $50,000, reduced by any employee after-tax payroll deductions, is taxable income. The employer is not required to withhold federal income tax on the taxable group-term life insurance, but the value is subject to federal taxation and must be reported on the employee’s Form W-2 as “other compensation” (Box 1 and Box 12 – Code C). Taxable group-term life insurance is subject to social security and Medicare tax withholding and must be reported on Form W-2 in boxes 3 and 5. Although the value in excess of $50,000 is not taxable for FUTA purposes, it is reportable as total wages on line 1 and as excludable wages on line 2 of Part I of Form 940 (FUTA). Generally, if the group-term life insurance plan favors key employees as to participation or benefits, the entire cost of the insurance must be included in the key employees’ wages. If the policy provides coverage in excess of $50,000, the value of the insurance benefit to be included in the employee’s income is calculated using the IRS “Uniform Premium Table I”. Uniform Premiums – Table 1 IRC Section 79 Fair Market Value of Group-term Life Insurance Per $1,000 of Excess Benefit per Month______ Age Monthly Cost Per $1,000 Under 25 $ .05 25 to 29 .06 30 to 34 .08 35 to 39 .09 40 to 44 .10 45 to 49 .15 50 to 54 .23 55 to 59 .43 60 to 64 .66 65 to 69 1.27 70 and above 2.06 The employee’s age on the last day of the calendar year is used when determining the group-term life cost factor before the following formula can be used to calculate the value in excess of $50,000.

You must prorate the cost from the table if less than a full month of coverage is involved. [(Group-term life coverage - $50,000) x .001 x cost factor] – employee after-tax deduction for group-term life insurance = taxable monthly premium value . Example: Bill will be 58 on 12/31/15. His group-term life insurance benefit amount will be $100,000 and he pays after-tax premiums of $10.50 per month. Bill retired in July. Calculated Imputed income through July: 1) $100,000 - $50,000 = $50,000 2) $50,000 x .001 = $50.00 3) $50.00 x $0.43 = $21.50 4) $21.50 - $10.50 = $11.00 5) Bill’s taxable imputed income for 2015 will be $77.00. ($11.00 x 7 months) Report in Boxes 1, 3, 5 and 12 with Code C on Form W-2. If the employee pays for any part of the cost of the insurance, this payment reduces the amount otherwise included in income.

However the employer cannot reduce the amount to include in the employee’s income by: ï‚· Payments for coverage in a different tax year, or ï‚· Payments for coverage through a cafeteria plan, unless the payments are after-tax contributions Group-term life insurance coverage is not taxable to the employee when: ï‚· The beneficiary of the policy is with the company for the entire calendar year, ï‚· The beneficiary of the policy is a charitable organization for the entire calendar year, or ï‚· The employee terminates during the year due to a permanent disability. Dependent Group-Term Life Coverage: Under the de minimis fringe benefit rules, an employer may provide tax-free dependent group-term life insurance coverage for the spouse or eligible dependents of an employee with no more than $2,000 of face value coverage. When the coverage exceeds $2,000, the de minimis value no longer exists and the value of the dependents’ entire group-term life insurance coverage is calculated using the rates in Table I in the same manner as when calculating for the employee. For the employee’s children, either use the rate associated with the dependent’s actual age or use the “under age 25” rate if your policy does not permit dependent coverage for any dependent age 25 or older.

For the employee’s spouse, use the spouse’s actual age or the employee’s age. Unlike group-term life insurance on the life of an employee, the value of dependent group-term life insurance included in the employee’s income is subject to federal income tax withholding, as well as social security and Medicare taxes. The amount included in the employee’s income is not subject to FUTA tax, however. Group-term Life Insurance Coverage for Former Employees: Employers report on the Form W-2 (Box 12) uncollected social security (Code M) and Medicare (Code N) taxes on group-term life insurance coverage over $50,000 for former employees who have continuing group-term life coverage after their termination. This includes any payment for group-term life to the extent “such payment is for coverage for periods during which an employment relationship no longer exists between the employee and the employer.” It only applies to situations where the employer continues to provide group-term life insurance coverage for an individual who is no longer on the employer’s payroll, such as a retiree. This provision does NOT apply in situations where the employer failed to withhold social security and Medicare taxes, for group-term life insurance coverage, because the employee terminated before the calculation was made.

In these instances, the employer must pay the applicable taxes on behalf of the employees and report them as wages subject to employment and withholding taxes, or request reimbursement from the employees for the social security and Medicare taxes due on the imputed income. Additionally, IRS Publication 15-B states: “Do not use withheld federal income tax to pay the social security and Medicare taxes due.” . Whole-Life Insurance: An employer may purchase individual whole-life or straight-life insurance policies for its employees or pay premiums on policies already owned by its employees. A straight-life policy provides two types of benefits: 1. Death benefit – A benefit payable at the death of the insured employee in an amount equal to the face amount of the policy. 2. Savings – A portion of every premium goes toward the savings segment of the policy.

Referred to as the “cash surrender value,” as premiums are paid, this value of the policy increases. Another option of the policy may allow the employee to borrow against the cash surrender value or surrender the policy and withdraw it. In addition, the employee usually earns a return from the insurance company, which is reflected as additional increases in the cash surrender value, additional insurance coverage or a payout of cash dividends. The employer must generally include in the employee’s gross income the cost of the straight-life insurance the amount the employer pays in premiums each year if the proceeds of the policy are payable to the employee’s designated beneficiaries. The employer must withhold federal income tax, but if the insurance coverage is part of a plan intended to benefit employees or their dependents, social security, Medicare and FUTA taxes do not apply.

If the employer is the sole beneficiary of the policy or the employee pays the premiums with after-tax dollars, the value of the policy is not included in income. If the insurance is being purchased for the employee as part of a qualified retirement plan or if the proceeds of the policy are payable to the employee’s beneficiary, the amount to include as income on Form 1099-R is the sum of: 1. the increase in the policy’s cash surrender value for the year (provided the employee’s right to the cash surrender value is substantially vested), and 2. the “reasonable net premium cost” of the current life insurance protection (equal to the death benefit payable under the policy minus the cash surrender value of the policy at the end of the year). When purchased as part of a qualified retirement plan, the income is not reported on Form W-2 but is reported in boxes 1 and 2 on Form 1099-R as a distribution from a qualified plan to purchase the insurance and requires code 9 in box 7, to prevent the employee from being subject to early distribution penalties.

Since the cash surrender value increases each year, the current insurance component decreases and must be calculated for tax purposes each year. The following interim IRS table gives the reasonable net premium cost for one year for $1,000 of current straight-life insurance protection, based on the employee’s age. Multiply the appropriate factor times the number of thousands of dollars of current protection and add the increase in the cash surrender value for the year to determine the imputed income. . Interim Table of One-Year Term Premiums for $1,000 of Life Insurance Protection Attained Age Section 79 Extended & Interpolated Annual rates Attained Age Section 79 Extended & Interpolated Annual rates Attained Age Section 79 Extended & Interpolated Annual rates 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 $0.70 $0.41 $0.27 $0.19 $0.13 $0.13 $0.14 $0.15 $0.16 $0.16 $0.16 $0.19 $0.24 $0.28 $0.33 $0.38 $0.52 $0.57 $0.59 $0.61 $0.62 $0.62 $0.64 $0.66 $0.68 $0.71 $0.73 $0.76 $0.80 $0.83 $0.87 $0.90 $0.93 $0.96 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 $0.98 $0.99 $1.01 $1.04 $1.06 $1.07 $1.10 $1.13 $1.20 $1.29 $1.40 $1.53 $1.67 $1.83 $1.98 $2.13 $2.30 $2.52 $2.81 $3.20 $3.65 $4.15 $4.68 $5.20 $5.66 $6.06 $6.51 $7.11 $7.96 $9.08 $10.41 $11.90 $13.51 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 $15.20 $16.92 $18.70 $20.62 $22.72 $25.07 $27.57 $30.18 $33.05 $36.33 $40.17 $44.33 $49.23 $54.56 $60.51 $66.74 $73.07 $80.35 $88.76 $99.16 $110.40 $121.85 $133.40 $144.30 $155.80 $168.75 $186.44 $206.70 $228.35 $250.01 $265.09 $270.11 $281.05 . Deferred Compensation Plans: Qualified Plans: Employer contributions to qualified compensation plans (under IRC Section 401(a)) are excluded from federal wages and are not subject to social security, Medicare and FUTA taxes except when the contributions are made under a salary reduction arrangement. ï‚· Section 401(k) Plans: A 401(k) plan is usually made available to employees in the form of a salary reduction agreement. Under this agreement, a participating employee elects to reduce his or her salary or defer future salary increases or bonuses by authorizing the employer to contribute this amount to the plan (subject to percentage requirements). Under these plans eligible employees may elect to have the employer contribute a portion of their pay to a plan in lieu of receiving that pay in cash. By deferring compensation, the employee decreases taxable income subject to federal income tax withholding and creates a tax savings. The employee is not required to pay federal or, in most cases, state income tax on the money contributed to the plan until the money is withdrawn.

In essence, the participant takes taxable compensation and converts it into a before-tax employer contribution. However, amounts deferred by the employee are subject to social security, Medicare, and FUTA taxes. The participant is subject to federal income tax withholding on the deferral when the amount deferred is distributed to the participant. The employee’s salary reduction amount contributed to the plan is fully tax deductible to the company even though it reduces the taxable income of the employee for federal and most state taxes. Designated Roth Contributions: Designated Roth contributions to 401(k), 403(b), and 457(b) plans are allowed under IRC §402A, if the employer’s plan provides for contributions to a Roth plan.

Under §402A, a plan may permit an employee who makes elective contributions under a §401(k) plan to designate some or all of those contributions as contributions to a Roth IRA (individual retirement account). NOTE: Roth IRAs are different from traditional IRAs in that contributions to a Roth IRA are not deductible from income and are includable in boxes 1, 3, and 5 on Form W-2. Distributions are not included in gross income if they meet certain qualifications. Individuals may put up to the maximum deductible amount for a traditional IRA in a Roth IRA in a year, but that amount is reduced by any contributions by the individual or other IRAs for that year. Designated Roth Contributions Defined: Designated Roth contributions are defined as elective contributions under qualified cash or deferred arrangement that is: ï‚· ï‚· Included by the employer in the employee’s income at the time the employee would have received the contribution amounts in cash if the employee had not made the cash or deferred election (i.e., by treating the contributions as wages subject to applicable withholding requirements) Reported as income on Form W-2 in Boxes 1, 3, and 5 and in Box 12 with Code AA (401(k) plans), Code BB (403(b) plans), or Code EE (457(b) plans). .

Designated Roth Contribution Rules: Some aspects of designated Roth contributions must be reflected in plan terms. For instance, contributions may be treated as designated Roth contributions only to the extent permitted under a plan. In addition while a plan is permitted to allow an employee to elect the character of a distribution, the extent to which this is permitted must be set forth in the plan. And the plan must provide that designated Roth contributions may be rolled over only to another plan maintaining a designated Roth contribution account or to a Roth IRA. ï‚· Separate Accounting: The regulations provide that contributions and withdrawals of designated Roth contributions must be credited and debited to a designated Roth contribution account maintained for the employee who made the designation, and the plan must maintain a record of the employee’s investment with respect to the employee’s designated Roth contribution account.

In addition, gains, losses, and other credits or charges must be separately allocated on a reasonable and consistent basis to the designated Roth contribution account and other accounts under the plan. The separate accounting requirement applies at the time the designated Roth contribution is contributed to the plan and continues to apply until the designated Roth contribution account is completely distributed. ï‚· Elections: The rules regarding the frequency of elections to make pre-tax elective contributions apply to elections to make designated Roth contributions. Under the final regulations, a plan that provides for a cash or deferred election under which contributions are made in the absence of an affirmative election and that has both pre-tax elective contributions and designated Roth contributions must set forth the extent to which those default contributions are pre-tax elective contributions or designated Roth contributions. If the default contributions are designated Roth contributions, then an employee who has not made an affirmative election is deemed to have irrevocably designated the contributions as designated Roth contributions. A direct rollover from a designated Roth account under a qualified cash or deferred arrangement may only be made to another designated Roth account or to a Roth IRA and only to the extent the direct rollover is permitted under §402(c).

In addition, a plan is permitted to treat the balance of a participant’s designated Roth account and the participant’s other accounts under the plan as account held under two separate plans for purposes of applying the special rule. Therefore, if a participant’s balance in the designated Roth account is less than $200, then the plan is not required to offer a direct rollover election with respect to that account or to apply the automatic rollover provisions of §401(a)(31)(B) with respect to that account. ï‚· Excess Contributions: Designated Roth contributions are taken into account under the ADP (actual deferral percentage) test applicable to §401(k) plans in the same manner as pre-tax elective contributions. The regulations permit a highly compensated employee with elective contributions for a year that include both pre-tax elective contributions and designated Roth contributions to elect whether excess contributions are to be attributed to pre-tax elective contributions or designated Roth contributions. A distribution of excess contributions is not includible in gross income to the extent it represents a distribution of designated Roth contributions.

However, the income allocable to a corrective distribution in excess contributions that are designated Roth contributions is includible in gross income in the same manner as income allocable to a corrective distribution of excess contributions that are pre-tax elective contributions. ï‚· Reporting in Box 12: o 401(k) o 403(b) o 457(b) Code AA Code BB Code EE . Automatic 401(k) Enrollment: (can be used for 403(b) and 457(b) plans as well) ï‚· Basic automatic enrollment 401(k) plan: A written plan document must be adopted to establish a basic automatic enrollment 401(k) plan. It must state that employees will be automatically enrolled in the plan unless they elect otherwise and must specify the percentage of an employee’s wages that will be automatically deducted from each paycheck for contribution to the plan. The document must also explain that employees have the right to elect not to have salary deferrals withheld or to elect a different percentage to be withheld. ï‚· Eligible automatic contribution arrangement (EACA): An eligible automatic contribution arrangement (EACA) is similar to the basic automatic enrollment plan but has specific notice requirements. In addition, when the participant does not provide direction, the employee salary deferrals must be invested in certain default investments.

An EACA can allow automatically enrolled participants to withdraw their contributions during the first 90 days. ï‚· Qualified automatic contribution arrangement (QACA): A qualified automatic contribution arrangement (QACA) is a type of automatic enrollment 401(k) plan that automatically passes certain kinds of annual IRS testing. The plan must include certain required features, such as automatic employee contributions (including annual increases), employer contributions, a special vesting schedule, and specific notice requirements. Notification must be provided to employees who are eligible to participate in the plan about certain benefits, rights, and features under the plan. Employees must receive an initial notice prior to automatic enrollment in the plan and receive a similar notice each year.

The notice should include information about the automatic contribution process, including the opportunity to elect out of the plan. In addition, the notice must describe the default investment the plan is using, the participants’ right to change investments, and where to obtain information about other investments offered by the plan. The participant generally must receive the initial notice at least 30 days, but not more than 90 days, before eligibility to participate in the plan or the first investment. Subject to certain conditions, the notice may be provided, and an employee may be enrolled in the plan, on the first day of work. An annual notice must be provided to participants and all eligible employees at least 30 days, but not more than 90 days, prior to the beginning of each subsequent plan year. If the participant, after receiving the initial or annual notice, does not provide investment direction, the participant is considered to have decided to remain in a default investment. In addition, a summary plan description (SPD) must be provided to all participants.

The SPD is a more comprehensive document that informs participants and beneficiaries about the plan and how it operates. The SPD typically is created with the plan document and must include information about: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· When and how employees become eligible to participate in the 401(k) plan; The contributions to the plan; How long it takes to become vested; When employees are eligible to receive their benefits; How to file a claim for those benefits; and Basic rights and responsibilities participants have under the Federal retirement law, the Employee Retirement Income Security Act (ERISA). The SPD must be given to participants when they join the plan and to beneficiaries when they first receive benefits. SPDs must also be redistributed periodically during the life of the plan. . Other notifications that must be given to employees who are eligible to participate in the plan include a summary of material modification, individual benefit statement, and a summary annual report. ï‚· ï‚· Participation: Employees are automatically enrolled in the plan and a specific percentage will be deducted from each participant’s salary unless the participant opts out or chooses a different percentage. However, as with any 401(k) plan, some employees may be excluded if they: o Have not attained age 21; o Have not completed a year of service; or o Are covered by a collective bargaining agreement that does not provide for participation in the plan, if retirement benefits were the subject of good faith bargaining. Contributions: o Basic and Eligible Automatic Enrollment 401(k) Plans: Employer matching can be elected by matching the amount of the employee’s contribution (within the limits of the law) or by contributing a percentage of each employee’s compensation (called a nonelective contribution) or by doing both. The amount of matching and non-elective contributions can be changed each year. o Qualified Automatic Contribution Arrangements (QACAs): If a plan is set up as a QACA with certain minimum levels of employee and employer contributions, it is exempt from the annual IRS testing requirement that a traditional 401(k) plan must perform. The initial automatic employee contribution must be a least 3 percent of compensation. Contributions may have to automatically increase so that, by the fifth year, the automatic employee contribution is a least 6 percent of compensation. The automatic employee contributions cannot exceed 10 percent of compensation in any year.

The employee is permitted to change the amount of his or her employee contributions or choose not to contribute but must do so by making an affirmative election. The employer must make at least either: o A matching contribution of 100 percent for salary deferrals up to 1 percent of compensation and a 50 percent match for all salary deferrals above 1 percent but no more than 6 percent of compensation; or o A non-elective contribution of 3 percent of compensation to all participants. In a QACA, the employer may make an additional contribution to each employee’s account and have the flexibility to change the amount of these additional contributions each year. ï‚· Contribution Limits: Employer and employee contributions to an automatic enrollment 401(k) plan are subject to an overall annual limitation for each employee. Employer and employee contributions and forfeitures (non-vested employer contributions of terminated participants) may not exceed the lesser of: o 100 percent of the employee’s compensation; or o $53,000 (for 2015 and 2016) Employees can make salary deferrals of up to $18,000 for 2015. This includes both pre-tax employee salary deferrals and after-tax designated Roth contributions (if permitted under the plan).

An automatic enrollment 401(k) plan can allow catch-up contributions of $6,000 for 2015 and 2016 for employees aged 50 and over. ï‚· Transferring or Withdrawing Investments from a Default Investment: Employees may not want to participate in the company retirement plan, or they may decide to direct their plan investments themselves rather than have their contributions invested on their behalf. The plan document must provide for withdrawal of contributions and be set up as an EACA. If participants elect to withdraw their contributions, they must do so within 90 days.

Participants whose contributions . are automatically deposited in the default investment must be allowed to change their investments to other available plan options as frequently as participants who actively chose the default investment, and at least once every quarter. If an employee decides to withdraw investments within 90 days of the first contribution or to change investments, a plan cannot impose restrictions, fees, or expenses beyond standard fees for services such as investment management and account maintenance. Further, participants should not be subject to penalties such as surrender charges, liquidation fees, or market value adjustments. All participants in the plan must be offered an opportunity to diversify their portfolios with a broad range of other options in addition to the default investments. ï‚· Permissible Withdrawals of Automatic Contributions: If an eligible automatic enrollment 401(k) plan (EACA) has opted to allow employees to withdraw their automatic contributions within 90 days of their first contribution, then those amounts, distributed with earnings, are treated as taxable income in the year distributed. They are reported on Form 1099-R and are not subject to the 10 percent additional early withdrawal tax. This is merely an overview of automatic enrollment 401(k) plans. For more information, expanded information is available on the IRS and U.S.

Department of Labor’s (DOL’s) Employee Benefits Security Administration websites, www.irs.gov/ep and www.dol.gov/ebsa. For the IRS, go to “Types of Retirement Plans” in the left pane. For DOL, go to “Publications” and scroll down to “Compliance Assistance Publications – Retirement.” Nonqualified Deferred Compensation Plans: Income Tax Reporting and Withholding – Before January 1, 2005: For plans in effect before October 3, 2004, that has not had significant changes to the plan or contributions made after October 3, 2004, withhold income tax on nonqualified plans as follows: ï‚· Funded plan: Withhold when the employees’ rights to amounts are not subject to substantial risk of forfeiture or are transferable free of such risk.

A funded plan is one in which an employer irrevocably contributes the deferred compensation to a separate fund, such as an irrevocable trust. ï‚· Unfunded plan: Withhold when you make payments to the employee. Employment taxes and withheld income tax on these plans must be reported on Forms W-2 and 941. Income Tax Reporting and Withholding – After January 1, 2005: Effective for amounts deferred in taxable years beginning after December 31, 2004, amounts deferred under a nonqualified deferred compensation plan are currently includible in gross income if they are not subject to a substantial risk of forfeiture and have not previously been included in income, unless certain requirements regarding distributions and the timing of deferral elections are satisfied as defined by IRC §409A. A nonqualified deferred compensation plan is defined as any plan that provides for the deferral of compensation other than a qualified retirement plan, or any bona fide vacation leave, sick leave, compensatory time, disability pay, or death benefit plan. Guidance on Reporting and Withholding Requirements for Nonqualified Deferred Compensation: The IRS has issued a notice providing interim guidance to employers and payers on their reporting and wage withholding requirements with respect to deferrals of compensation and amounts includible in gross income under IRC §409A. In addition, the notice provides guidance to service providers on their income tax reporting and tax payment requirements with respect to amounts includible in gross income under §409A [Notice 2008-115, 2008-52 IRB 1367].

The notice generally extends guidance provided in Notice 2006-100 and Notice 2007-89 applicable to calendar years 2005, 2006, and 2007. The interim guidance provided in Notice 2008-115 is effective for calendar year 2008 and will remain in . effect for subsequent calendar years until the IRS issues further guidance. The IRS does not anticipate that further guidance will be issued until the recently proposed regulations addressing the calculation of the amount includible in income under §409A(a) and the calculation of additional taxes are finalized. Further, the IRS anticipates that with respect to annual deferral reporting (Form W-2, Box 12, Code Y; Form 1099-MISC, Box 15a), such guidance will not be made effective before the calendar year beginning after such regulations are finalized. Annual Deferrals – Amounts Reportable on Form W-2 or Form 1099-MISC: Until the IRS issues further guidance, employers are not required to report amounts deferred during the year under a nonqualified deferred compensation (NQDC) plan subject to §409A on Form W-2 in Box 12 with Code Y (employees) or on Form 1099-MISC in Box 15a (independent contractors). However, an employer must treat amounts includible in gross income under §409A as wages for income tax withholding purposes and must be reported as wages paid on Line 2 of Form 941 and in Box 1 of Form W-2. An employer must also report such amounts as §409A income in Box 12 of Form W-2 using Code Z. Amounts includible in gross income under §409A are supplemental wages for purposes of determining how much income tax to withhold regardless of whether the employer has paid the employee any regular wages during the calendar year of the payment. The amount required to be withheld is not increased on account of the additional income taxes imposed under §409A.

Employees should thus be aware that estimated tax payments or increased withholding from regular wages may be required to avoid penalties. Calculating amounts includible in income: For purposes of IRS Notice 2008-115, the amount includible in gross income because of a plan failure under §409(a) and required to be reported by the employer or payer equals the portion of the total amount deferred under the plan that, as of December 31 of the applicable calendar year, is not subject to a substantial risk of forfeiture and has not been included in income in the previous year, plus any amounts of deferred compensation paid or made available to the employee or payee under the plan during the applicable calendar year. An employer or payer may treat an amount as previously included in income if it was properly reported by the employer or payer on a Form W-2, Form 1099-MISC, or Form W-2c or corrected Form 1099-MISC. Amounts previously reported and included in income should not be reported again. Amounts includible in gross income under §409(a) include only amounts deferred that are subject to §409A and not, for example, amounts deferred that were earned and vested prior to January 1, 2005, and that are not otherwise subject to §409A due to the application of the effective date provisions. Wage payment date of includible amounts: Amounts includible in gross income under §409A(a) that are either actually or constructively received by an employee during calendar year are considered wages paid when received by the employee for purposes of withholding, depositing, and reporting income tax. Amounts includible in gross income under §409A(a) that are neither actually nor constructively received by the employee during the applicable calendar year are treated as a payment of wages on December 31 of that calendar year, for purposes of withholding, depositing, and reporting income tax. If, as of December 31 of the applicable calendar year, the employer does not withhold income tax from the employee on such wages, or withholds less than the amount of income tax required to be withheld, the employee will receive credit for that calendar year on his or her personal income tax return if the employer: ï‚· withholds or gets from the employee the amount of the under collection before February 1 of the subsequent year, and reports the wages for the quarter ending December 31 of the applicable calendar year, on Form 941 and in Box 1 of the employee’s Form W-2; or ï‚· pays the income tax withholding liability on behalf of the employee and reports the gross amount of wages and the employer-paid taxes for the quarter ending December 31 of the applicable .

calendar year, on Form 941 and in Box 1 of the employee’s Form W-2. For purposes of the employment tax deposit rules, if the income tax withholding liability for wages treated as paid to the IRS by the due date of the Form 941 for the quarter ending on December 31 of the applicable calendar year, on which the wages are reported, then failure-to-deposit penalties will not be imposed. Calculating deferrals: The rules for determining the total deferred under a NQDC plan for purposes of calculating the amount required to be included in income under §409A(a) are similar to the rules for calculating the amount to include in income under a nonqualified deferred compensation plan for purposes of social security and Medicare taxation under IRC §3121(v)(2). ï‚· Account balance plans – For account balance plans, the amount deferred as of December 31 of a calendar year equals the amount that would be treated as an amount deferred on that date if the entire account balance (including all principal amounts, adjusted for income, gain, or loss credited to the employee’s account) as of December 31 of the calendar year were treated as a principal amount credited to the employee’s account on that date. Note that these same rules apply for purposes of determining the amount reported on Form 1099-MISC with respect to a nonemployee. ï‚· Non-account balance plans – For non-account balance plans, where the amount deferred is reasonably ascertainable, the amount deferred as of December 31 of the calendar year equals the present value of all future payments to which the employee has obtained a legally binding right as of that date, calculated as if the employee had obtained all of such rights on December 31 of that calendar year. An amount deferred is considered reasonably ascertainable on the first date on which the amount, form, and commencement date of the benefit payments attributable to the amount deferred are known, and the only actuarial assumptions needed to determine the amount are interest and mortality. Note that these same rules apply for purposes of determining the amount reported on Form 1099-MISC with respect to a nonemployee. ï‚· Stock rights – For a plan that is a stock right under Proposed Reg.

§1.409A-1(1), the amount deferred as of December 31 of a calendar year equals the amount that the service provider would be required to include in income of the stock right were immediately exercisable and exercised on December 31 of that calendar year. In general, this will mean with respect to a stock right outstanding as of December 31 of a calendar year that the amount deferred as of December 31 of that calendar year equals the fair market value of the underlying stock less the sum of the exercise price and any amount paid by the service provider for the stock right. ï‚· Other deferred amounts – For all deferred amounts not addressed by the account balance, nonaccount balance, and stock right plan rules, the amount deferred as of December 31 of a calendar year must be determined under a reasonable, good faith application of a reasonable, good faith method. This method must reflect reasonable, good faith assumptions with respect to any contingencies as to the timing or amount of any payment.

Assumptions that result in the amount deferred being the lowest potential value of the future payment will be presumed not to be reasonable, good faith assumptions unless clear and convincing evidence demonstrates otherwise. Protection from future reporting or withholding: An employer or payer that complies with Notice 2008115 regarding computing amounts includible in gross income under §409A and withholding and reporting those amounts for a calendar year will not be liable for additional income tax withholding or penalties, or be required to file any subsequent forms for those amounts as a result of future published guidance with respect to the computation of amounts includible in gross income under §409A. If it is subsequently determined that the employer did not apply Notice 2008-115 in determining amounts includible in gross income or wages for a calendar year, any recalculation of these amounts may result in . additional liability for income tax withholding for these years, plus any applicable penalties. In addition, the employer or payer will be required to file an original or corrected information return and furnish an original or corrected payee statement. For purposes of determining any amount includible in income under §409A in a subsequent year, an amount will not be treated as previously included in income unless the amount has been reported appropriately on an information return and payee statement, or has been included by the service provider in a previous year. Social Security and Medicare Tax Withholding Rules: For purposes of withholding and depositing social security, Medicare, and FUTA taxes, an amount deferred is treated as wages paid by the employer and received by the employee at the time it is taken into account. If the employer is unable to calculate the amount deferred for a year by December 31, the employer has two alternative methods it can use, either the estimated or lag method. ï‚· Estimated method – under the estimated method, an employer may treat a reasonably estimated amount as wages paid on the last day of the calendar year (the “first year”). If the employer underestimates the amount deferred that should be taken into account and under deposits social security, Medicare, or FUTA taxes, it can choose to treat the shortfall as wages either in the first year or the first quarter of the next year.

The short-fall does not include income credited to the amount deferred after the first year. If the shortfall is treated as wages in the first year but was not included on the employee’s Form W-2, the employer must issue a Form W-2c. Also, the employer must correct the information on the Form 941 for the last quarter of the first year.

In such a case, the shortfall will not be treated as a late deposit subject to penalty if it is deposited by the employer’s first regular deposit date following the first quarter of the next year. Conversely, if the amount deferred is overestimated, the employer can claim a refund or credit. ï‚· Lag method – under the lag method, an employer may calculate the end of the year amount deferred on any date in the first quarter of the next calendar year. The amount deferred will be treated as wages on that date, and the amount deferred that would otherwise have been taken into account on the last day of the first year must be increased by income earned through the date on which the amount is taken into account. .

Nonqualified Deferred Compensation Reporting Example Chart Example How to report on Form W-2 Example 1—Deferral, immediately vested (no risk of forfeiture). Regular wages: $200 Defer, vested: $20 Employer match, vested: $10 Box 1 = $180 ($200 – $20) Boxes 3 and 5 = $210 ($200 + $10) Box 11 = $0 Example 2—Deferral, delayed vesting (risk of forfeiture) of employee and employer portions. Regular wages: $200 Defer, not vested: $20 Employer match, not vested: $10 Box 1 = $180 ($200 – $20) Boxes 3 and 5 = $180 ($200 – $20) Box 11 = $0 Example 3—Deferral, immediately vested. Prior year deferrals and employer matches are now vesting. Regular wages: $200 Defer, vested: $20 Vesting of prior-year deferrals and employer matches: $100 + $15 (earnings on $100) Box 1 = $180 ($200 – $20) Boxes 3 and 5 = $315 ($200 + $100 + $15) Box 11 = $115 ($100 + $15) Example 4—No deferrals, but there are distributions. No vesting of prior year deferrals. Regular wages: $100 Distribution: $50 Box 1 = $150 ($100 + $50) Boxes 3 and 5 = $100 Box 11 = $50 Special Rule for W-2 Box 11: Distributions and Deferrals in the Same Year – Form SSA-131 If, in the same year, there are NQDC distributions and deferrals that are reportable in boxes 3 and/or 5 (current or prior year deferrals), do not complete box 11. Instead, report on Form SSA-131 the total amount the employee earned during the year. Generally, Box 1 will report distributions and current year deferrals that are vested (employee and employer portions).

Do not consider prior-year deferrals that are vesting in the current year. If there was a plan failure, the box 1 amount in this calculation should be as if there was no plan failure. Submit the SSA-131 to the nearest SSA office or give it to the employee. Example 5—Deferral, immediately vested, and distributions.

No vesting of prior year deferrals. Regular wages: $200 Defer, vested: $20 Employer match, vested: $10 Distribution: $50 Box 1 = $230 ($200 – $20 + $50) Boxes 3 and 5 = $210 ($200 + $10) Box 11 = $0 Example 6—Deferral, delayed vesting, and distributions. No vesting of prior year deferrals. Regular wages: $200 Defer, not vested: $20 Distribution: $50 Box 1 = $230 ($200 – $20 + $50) Boxes 3 and 5 = $180 ($200 – $20) Box 11 = $50 Example 7—Deferral, immediately vested, and distributions. Prior-year deferrals and employer matches are now vesting. Regular wages: $200 Defer, vested: $20 Distribution: $50 Vesting of prior-year deferrals and employer matches: $100 + $15 (earnings on the $100) Box 1 = $230 ($200 – $20 + $50) Boxes 3 and 5 = $315 ($200 + $100 + $15) Box 11 = $0 Example 8—Deferral, delayed vesting, and distributions.

Prior-year deferrals and employer matches are now vesting. Regular wages: $200 Defer, not vested: $20 Distribution: $50 Vesting of prior-year deferrals and employer matches: $100 + $15 (earnings on the $100) Box 1 = $230 ($200 – $20 + $50) Boxes 3 and 5 = $295 ($200 – $20 + $100 + $15) Box 11 = $0 Form SSA-131 = $210 ($230 (Box 1) – $50 (distribution) + $30 (vested employee and employer deferrals)) Form SSA-131 = $200 ($230 (Box 1) – $50 (distribution) + $20 (vested deferral)) Form SSA-131 = $180 ($230 (Box 1) – $50 (distribution)) See Nonqualified deferred compensation plans. General Instructions for Forms W-2 and W-3 (2015) -29- . Nonqualified Deferred Compensation Reporting Example Chart—(Continued) Example How to report on Form W-2 Special Rule for Payment of Social Security, Medicare, and Unemployment Taxes Estimated Method Under the estimated method, an employer may treat a reasonably estimated amount as wages paid on the last day of the calendar year (the “first year”). If the employer underestimates the amount deferred and, thereby, underdeposits social security, Medicare, or FUTA taxes, it can choose to treat the shortfall as wages either in the first year or the first quarter of the next year. The shortfall does not include income credited to the amount deferred after the first year. Conversely, if the amount deferred is overestimated, the employer can claim a refund or credit.

If the employer chooses to treat the shortfall as wages in the first year, the employer must issue a Form W-2c. Also, the employer must correct the information on the Form 941 for the last quarter of the first year. In such a case, the shortfall will not be treated as a late deposit subject to penalty if it is deposited by the employer’s first regular deposit date following the first quarter of the next year. If the amount cannot be reasonably ascertained (the employer is unable to calculate an amount for a year by December 31), the employer has two methods it can use.

For example, immediately-vested employer contributions to NQDC made late in the year would have no effect on W-2 box 1, but they would affect FICA and FUTA taxes. Lag Method Under the lag method, an employer may calculate the end-of-the-year amount on any date in the first quarter of the next calendar year. The amount deferred will be treated as wages on that date, and the amount deferred that would otherwise have been taken into account on the last day of the first year must be increased by income earned on that amount through the date on which the amount is taken into account. Section 409A NQDC Plan Failure Example 9—Deferral, immediately vested. No distributions.

Plan failure. Plan balance on January 1, 2010: $325, vested. Regular wages: $100 Defer, vested: $50 Employer match, vested: $25 Plan failure in 2010. Box 12, Code Z = $400 Amount in the plan account on December 31, 2010, not subject to risk of forfeiture and not included in prior-year income: $400 ($325 + $50 + $25) Current-year distributions: $0 $400 ($0 + $400) Box 1 = $450 ($100 – $50 + $400) Boxes 3 and 5 = $125 ($100 + $25) Box 11 = $0 SSA-131 = not required Section 409A NQDC Plan Failure Example 10—Deferral, some delayed vesting, and distributions. Plan failure. Plan balance on January 1, 2010: $250 vested; $75 not vested. Regular wages: $100 Defer, vested: $50 Employer match, not vested: $25 Distribution: $200 Plan failure in 2010. Box 12, Code Z = $300 Amount in the plan account on December 31, 2010, not subject to risk of forfeiture and not included in prior-year income: $100 ($250 + $50 – $200) Current-year distributions: $200 $100 + $200 = $300 Box 1 = $350 ($100 – $50 + $300 (code Z amount, which already includes the distribution)) Boxes 3 and 5 = $100 Box 11 = $0 SSA-131 = $100 ($250 (what box 1 would have been without plan failure) – $200 (distributions) + $50 (vested deferral)) See Nonqualified deferred compensation plans. -30- General Instructions for Forms W-2 and W-3 (2015) . Personal Use of Company Vehicle: Although the business use of a company-owned vehicle is excludable (based on the employee’s documentation of the business use) from taxable income, the personal use of the vehicle is taxable compensation. The employer may elect not to withhold federal income tax on the personal use of the vehicle, but federal wages must be reported and social security and Medicare taxes must be withheld on the value of personal use. The personal use of a company vehicle is also subject to FUTA tax. The value of personal use of a company vehicle is required to be reported as income at least once a year. Either the general valuation method or one of three safe-harbor methods may be used to determine the cash value of the personal use of a company vehicle. Under the general valuation method, the personal use of a company car is determined by the cost an individual would incur to lease the same vehicle under the same terms in the same geographic area. A cents-per-mile lease rate cannot be used unless it can be shown such a lease was available for that type of car at that time and in that area.

Because an employee’s use of the vehicle is generally mixed between business and personal use, it is most likely more advantageous to use one of the safe-harbor valuation methods. 1) Annual lease value method 2) Cents-per-mile method 3) Commuting value method General rules that enable the use of the special valuation methods: ï‚· If either the vehicle cents-per-mile or annual lease valuation method is used by the employer, it must be used for all subsequent years that the vehicle is provided to any employee, although the employer may switch to the commuting valuation method in any year it applies. ï‚· Neither the employer nor the employee may use a special valuation method unless at least one of the following conditions is met: o the employer reports the value of the benefit as wages by January 31 of the next year: o the employee includes the value of the benefit in income within the prescribed time: o the employee is not a control employee; or o the employer demonstrates a good faith effort to treat the benefit correctly for reporting purposes. ï‚· The same special valuation method need not be used for all company-provided vehicles or all employees. ï‚· If an employer uses a special valuation method, the employee must use the same rule or general valuation method on his or her personal income tax return. ï‚· If a single company-provided vehicle is used by more than one employee, the employer must use the same valuation method for all the employees using that vehicle and must allocate the vehicle’s use based on the facts of the situation. . Annual Lease Value Method: Under this method, the fair market value (FMV) of an employee’s personal use of a company-provided car is determined by multiplying the annual lease value of the car (as found in the IRS Annual Lease Value Table) by the percentage of personal miles driven. Here are the steps the employer must take: 1. The employer must determine the FMV of the car on the first day it was made available to the employee for personal use. For employer-owned vehicles, this is the total cost of the car to an individual in an arm’s length transaction (including sales tax and title fees).

For employer-leased vehicles, the value can be determined by using a nationally recognized pricing source, such as the “Blue Book” (www.kbb.com) and it is recalculated after the car has been used for four full calendar years. If the vehicle is transferred to another employee, the annual lease value may be recalculated based on the car’s fair market value on January 1 of the calendar year of the transfer. 2. Find the car’s FMV in the Annual Lease Value Table.

The car’s annual lease value can be found directly to the right of the FMV. 3. Calculate the percentage of personal miles driven during the year (personal miles driven divided by total miles driven). 4. Calculate the FMV of the employee’s personal use of the car that must be included in the employee’s income (annual lease value x percentage of personal miles driven). The amount determined from the table (or the calculation for more expensive cars) includes the value of maintenance and insurance; it does not include the value of fuel provided by the employer, which must be valued separately.

Fuel may be valued at the employer’s actual cost or at 5.5 cents ($0.055) per mile for 2015 for each mile driven by the employee in the U.S., its possessions and territories, Canada, Mexico, only if the employer provides fuel in kind. If the employee has the car for less than a year but it is available for use for at least 30 consecutive days, the annual lease value must be prorated for that period by using the following formula: Annual lease value x (number of days available divided by 365) If the car is available to the employee for periods of less than 30 consecutive days during the year, the employer should treat the car as being available for 30 days to avoid harsher valuation rules (unless the availability is 7 or fewer days per year). You do not have to include the value of a telephone or any specialized equipment added to, or carried in, the automobile if the equipment is necessary for your business. However, include the value of specialized equipment if the employee to whom the automobile is available uses the specialized equipment in a trade or business other than yours. . Annual Lease Value Table Automobile Fair Market Value $0 – 999 1,000 – 1,999 2,000 – 2,999 3,000 – 3,999 4,000 – 4,999 5,000 – 5,999 6,000 – 6,999 7,000 – 7,999 8,000 – 8,999 9,000 – 9,999 10,000 – 10,999 11,000 – 11,999 12,000 – 12,999 13,000 – 13,999 14,000 – 14,999 15,000 – 15,999 16,000 – 16,999 17,000 – 17,999 18,000 – 18,999 19,000 – 19,999 20,000 – 20,999 21,000 – 21,999 22,000 – 22,999 23,000 – 23,999 24,000 – 24,999 25,000 – 25,999 26,000 – 27,999 28,000 – 29,999 30,000 – 31,999 32,000 – 33,999 34,000 – 35,999 36,000 – 37,999 38,000 – 39,999 40,000 – 41,999 42,000 – 43,999 44,000 – 45,999 46,000 – 47,999 48,000 – 49,999 50,000 – 51,999 52,000 – 53,999 54,000 – 55,999 56,000 – 57,999 58,000 – 59,999 Above 59,999 Annual Lease $600 850 1,100 1,350 1,600 1,850 2,100 2,350 2,600 2,850 3,100 3,350 3,600 3,850 4,100 4,350 4,600 4,850 5,100 5,350 5,600 5,850 6,100 6,350 6,600 6,850 7,250 7,750 8,250 8,750 9,250 9,750 10,250 10,750 11,250 11,750 12,250 12,750 13,250 13,750 14,250 14,750 15,250 25% of FMV + $500 . T-240 1/2004 PERSONAL USE OF COMPANY VEHICLE ANNUAL LEASE VALUE Employee: Vehicle: GENERAL INFORMATION: 1. Date: Available: Transferred: 2. Odometer: Available: Transferred: 3. Fair market value on date available: 4. Annual lease value on date available: 5. Current year total miles: 6. Current year personal miles: COMPUTATION OF TOTAL VALUE: Click here to use the form. 7. Annual lease value, Line 4 (if available 365 days or less, otherwise go to line 11) 0.00 8. Days in tax year (usually 365) 365 9. Daily value rate (line 7 divided by line 8) 0.00 10. Days available for use (use line 8 for full year, actual days for less than full year, 30 days of available for more than 7 days but less than 30, or four times days available if 7 days or less) 0 11. Annual lease value (table* or line 9 times line 10) 0.00 12. Fuel factor (5.5 cents time line 5, or fair market value of fuel provided) 0.00 13.

Fair market value of other services 14. Total value (add lines 11, 12, and 13) 0.00 15. Personal use factor: A.

Personal miles (line 6) 0 B. Total miles (line 5) 0 C. Divide 15A by 15B 16.

Gross income of employee (line 14 times line 15C) *Table from Reg 1.61-2T(d)(2)(B)(iii) (on previous page) 0.00% $0.00 . Cents-Per-Mile Method: The fair market value of an employee’s personal use of a company-provided vehicle is determined by multiplying the IRS standard business mileage rate of $0.0575 per mile through 12/31/15 the number of personal miles driven. The following conditions must be met to use this method: 1. The employer must expect the employee to regularly use the vehicle while conducting the employer’s business, or the vehicle must actually be driven at least 10,000 miles annually (including personal use) and be used primarily by employees. 2. The fair market value of the vehicle cannot exceed the luxury value for the year the vehicle was first put into use. In 2015, $16,000 for a passenger car or $17,500 for a truck or van. 3.

If the employee pays for fuel, the mileage rate is reduced by 5.5 cents ($0.055) per mile for 2015. Commuting Value Method: The commuting valuation rule may be used only when the following conditions are met. The value is calculated by multiplying the number of trips by either $1.50 each way or $3.00 round trip. ï‚· ï‚· The vehicle is owned or leased by the employer and is provided to the employee for use in connection with the employer’s trade or business. The employer, for non-compensatory business reasons, requires the employee to commute to and/or from work in the vehicle. NOTE: Employer-provided vehicles used to transport at least three employees to and from work in an employer-sponsored carpool or vanpool arrangement satisfy the first two requirements. ï‚· The employer has a written policy prohibiting the employee (and the employee’s spouse and dependents) from using the vehicle for personal use other than commuting or de minimis personal errands, and the policy is enforced. ï‚· The employee is not a control employee. A control employee is an employee who: o Is a corporate officer earning at least $105,000 in 2015 o Is a director o Earns at least $215,000 in 2015 o Owns 1% or more equity, capital, or profits interest in the business Exclusion: The IRS provides certain exclusions for qualified non-personal use vehicles.

Employees can exclude 100% of the value of the use of a qualified non-personal use vehicle from gross income as a working condition fringe benefit. A qualified non-personal use vehicle is any vehicle that, by its nature, an employee is unlikely to use more than a minimum amount for personal purposes. Cement mixers, moving vans, and forklifts are examples of the types of vehicles that are exempt from taxation. Passenger automobiles, such as sedans, are generally not exempt from taxation because, by design, they can easily be used for personal purposes. However, federal regulations allow clearly marked police and fire vehicles, and unmarked law enforcement vehicles used by law enforcement officers, to be treated as qualified non-personal use vehicles. Reporting: The personal use of a company vehicle is reported on Form W-2 in boxes 1, 3, 5, and 14 and on Form 941 on line 2, 5a, and 5c.

On Form 940, it is reported on line 3 of Part 2. . Qualified Transportation Fringe Benefits: An employer may provide certain transportation fringe benefits to its employees without including the fair market value of the benefits in their income. They include: ï‚· Transportation between the workplace and employee’s home in a commuter highway vehicle (van pool) provided by the employer, if: o The vehicle seats at least 6 adults including the driver; o At least 80% of the vehicle’s mileage can be expected to be for commuting; and o At least one-half of the vehicle’s seating capacity (excluding the driver) is used by employees. ï‚· Transit pass – A transit pass is any pass, token, farecard, voucher, or similar item entitling a person to ride, free of charge or at a reduced rate, on mass transit or in a vehicle that seats at least 6 adults (not including the driver) if a person in the business of transporting persons for pay or hire operates it. Mass transit may include bus, rail, or ferry. ï‚· Parking provided on or near the employer’s premises or at a “park and ride” facility from which the employee uses mass transportation, a vanpool, or a carpool or any other means to get to work. Parking “on or near the employer’s premises” includes parking on or near a work location where the employee works for the employer, but not if the value of parking provided by the employer or reimbursement for the employee’s parking cost is otherwise excluded from income as a working condition fringe benefit or an employee’s business expense reimbursed under an accountable plan. Exclusion limits - Up to $250 in 2015, is excluded from income for qualified parking provided by the employer and $130 for transit passes. Transportation Fringe Benefits Extended to Bicycle Commuters: Beginning in 2009, under the Emergency Economic Stabilization Act of 2008 (Pub.

L. No. 110-343), an employer may reimburse employees for certain expenses related to commuting to work by bicycle without including the reimbursement in the employee’s income subject to federal income, social security, Medicare, or FUTA tax.

The maximum amount of the benefit for an employee is determined on an annual basis and is equal to $20 multiplied by the number of the employee’s qualified bicycle commuting months during a calendar year. The maximum amount of the benefit is not adjusted annually based on inflation. A “qualified bicycle commuting month” is any month when an employee regularly uses a bicycle for a substantial portion of the employee’s commute to work, so long as the employee is not receiving any other qualified transportation fringe benefit from the employer. Therefore, the employee can’t add the bicycle commuting benefit to a transit pass, vanpool, or parking benefit for any month. Expenses that qualify for reimbursement include the purchase of a bicycle and bicycle improvements, repair, and storage if the bicycle is regularly used by the employee to commute from home to work.

For expenses incurred during a calendar year, the reimbursements can be made by the employer during the calendar year and up to 3 months afterward. Qualified bicycle commuting reimbursements may not be provided under a “compensation reduction arrangement” that offers an employee a choice between cash compensation and the bicycle commuting benefit. If this is done, the amount of the compensation reduction is taxable income to the employee. . Employee Relocation Expense Reimbursements: Qualified Moving Expense Reimbursements: Qualified moving expenses that an employer paid to a third party on behalf of the employee and services that an employer furnished in kind to an employee are not reported on Form W-2. Employer reimbursements for an employee’s moving expenses are treated as excludable from the employee’s gross income and wages if: 1) The expenses would be deductible by the employee if he or she had directly paid or incurred the expenses, and 2) The employee did not deduct the expenses in a prior year. In addition, the reimbursements should be made under rules similar to those relating to an accountable plan. If the plan does not meet the accountable plan rules for business travel expenses (see previous section), then all reimbursements must be included in the employee’s income. To qualify for these deductions, the distance between the employee’s new workplace and his or her old residence must be at least 50 miles farther than the distance between the employee’s old work place and his or her old residence. Employees must also work full time in the general location of their new place of work for at least 39 weeks during the 12 months immediately following the move. The only expenses that are deductible (with no dollar limit on the deduction) are: ï‚· Expenses incurred in moving household goods and personal effects from the employee’s old residence to the new residence (including storage for up to 30 days), and ï‚· Traveling (including lodging but NOT meals, mileage in excess of $0.23 per mile from January 1 through December 31, 2015) from the old residence to the new residence. The Form W-2 reporting requirements for moving expense reimbursements made in 2015 are as follows: Nonqualified Subject to FITW, FICA, and FUTA Reported on 941, Lines 2, 5a, & 5c Reported on 940, Line 3 4 Reported on W-2, Boxes 1, 3, & 5 Qualified–Paid to a Third Party No Withholding No 941 Reporting 940, Line 3, subtracted on Line 4 No W-2 Reporting Qualified–Paid to Employee No Withholding No 941 Reporting 940, Line 3, subtracted on Line W-2, Box 12, Code P If an employer reimburses an employee for moving expenses that meet the criteria for qualified relocation deductibility, the amount of the reimbursement is excluded from the employee’s income as a nontaxable fringe benefit (so long as the employee has not deducted the expenses in a prior year).

Employers are no longer required to provide employees with Form 4782, Moving Expense Information. Although qualified moving expenses are not taxable for FUTA purposes, they are reportable as total wages on Part 2, line 3 and excludable wages on Part 2, line 4 of Form 940 (FUTA). Also, check box 4a (Fringe Benefits) of Part 2, line 4 for qualified moving expenses. Non-qualified Moving Expense Reimbursements: Exclusions from income for moving expenses are not allowed for the cost of: ï‚· ï‚· ï‚· ï‚· ï‚· ï‚· Pre-move house hunting trips Temporary living expenses in the general area of the new workplace Selling (or settling an unexpired lease on) the old residence and buying (or acquiring a lease on) the new residence Real estate transactions Any meals connected with the relocation Mileage in excess of $0.23 per mile from 1/1/15 – 12/31/15. . ï‚· More than one trip from the old residence to the new residence Since these amounts are not deductible, reimbursements for these expenses are income and are subject to full taxation (FIT, FICA, FUTA) when paid by the employer. A review of your company’s relocation policy might be necessary, especially if your company reimburses house-hunting trips and temporary living expenses for its employees. Reimbursements for expenses which are generally not deductible by individuals on their tax return may have additional funds added (gross-up) to cover the taxes due. Special note: Employer-reimbursed relocation expenses not qualifying as excludable fringe benefits under IRC Section 132 must be reported as income immediately, with the applicable taxes withheld. When reimbursed, taxable relocation expenses are treated like an employee bonus. The wages must be reported immediately and the taxes withheld at the time of payment.

If the expenses are reimbursed through accounts payable, you must report the taxable amount in payroll and deposit the applicable taxes withheld as a manual payment on the date paid by accounts payable. You cannot wait to report the reimbursements at year-end, just as you would not wait to report an employee’s bonus at year-end. The special accounting rule cannot be used for these reimbursements.

See IRS Publication 521 for more information on moving expenses. De Minimis Fringe Benefits: The value of a de minimis benefit provided to employees can be excluded from wages. A de minimis benefit is any property or service provided to an employee that has so little value (taking into account how frequently you provide similar benefits to your employees) that accounting for it would be unreasonable or administratively impracticable. Cash and cash equivalents (gift card, charge card, or credit card) no matter how little, is never excludable as a de minimis benefit, except for the occasional meal money or transportation fare.

Such "perks" are tax-free only if they meet the definition and requirements that apply to "de minimis" fringe benefits. Specifically, a gift/award is de minimis if: ï‚· ï‚· ï‚· ï‚· The value is nominal; Accounting for the item would be administratively impracticable; It is provided infrequently; and It is furnished for the purpose of promoting health, good will, contentment, or the efficiency of employees. What is nominal? Many employers maintain written policies that specify a dollar limit for tax-free gifts/awards, generally $25. Recognized as the threshold for tax-free gifts and awards for so long, it is assumed by many to be a rule established by the IRS.

The fact is that neither the $25 rule nor the more recent transition by some to the $75 rule can be found in any IRS guidance. According to the IRS, it purposely does not specify a dollar amount at which a gift/award is de minimis because to do so would undermine the very reason that de minimis gifts are tax-free - that is, they are so small that accounting for them would be unreasonable or administratively impracticable. Administratively impracticable to account for: The primary characteristic of a de minimis fringe benefit is the administrative impracticality of determining its value and/or the amount allocable to individual employees. For instance, a holiday party, the total cost of which is easily determinable, generally is a good example of this concept.

Although it may be easy to ascertain which employees attended the function, it would be administratively difficult to determine how much food or drink was consumed by each guest. Employer-sponsored raffles are another example. Although the employer likely knows how much it spent on raffle prizes, keeping track of who won the raffled items could be burdensome, particularly if employees made contributions toward the purchase of raffle tickets.

This is not to say that all items won in a raffle are tax-free. For example, a television won in a raffle is not tax-free to the employee winning it because its value exceeds what would be nominal. Additionally, it is not difficult to keep an account of the employees winning the most valuable items. .

Frequency: A fringe benefit is de minimis only if it is provided infrequently to employees. The regulations explain that generally, the frequency with which similar fringes are provided by the employer to its employees is determined by reference to the frequency with which the employer provided the fringes to each individual employee. Where it would be administratively difficult to determine frequency with respect to individual employees, the frequency with which similar fringes are provided by the employer to its employees is determined by reference to the frequency with which the employer provides the fringes to the work force as a whole. Therefore, under this rule, the frequency with which any individual employee receives such a fringe benefit is not relevant and, in some circumstances, the de minimis fringe exclusion may apply with respect to a benefit even though a particular employee receives the benefit frequently.

For example, if an employer exercises sufficient control and imposes significant restrictions on the personal use of a company copying machine so that at least 85% of the use of the machine is for business purposes, any personal use of the copying machine by particular employees is considered to be a de minimis fringe. Promoting health, good will, contentment, or the efficiency of employees: The IRS has clarified that to be de minimis, the benefit must be provided for the purpose of creating an atmosphere that encourages productivity. The tax-free status of fringe benefits is jeopardized if they are provided to reward or compensate for productivity (however, such gifts are considered tax-free if provided infrequently for outstanding performance). For instance, flowers given to employees for an illness are expressly identified as an example of a de minimis fringe benefit.

On the other hand, the routine and expected distribution of free theater tickets each time employees meet certain sales quotas would be considered a bonus and must be treated a taxable compensation. The IRS states: "Amounts paid to employees for outstanding work, such as bonuses or awards, are income and should be shown on Form W-2. These include prizes such as vacation trips for meeting sales goals.

If a prize or award is provided in the form of goods or services, the employer must include the fair market value of the goods or services in the employee's income." Exceptions apply to length-of-service and safety achievement awards: Awards of a specified amount given to certain employees for length-of-service or safety achievement are tax-free as long as they meet the following limits: ï‚· ï‚· Nonqualified: Total deductible awards (both safety and length of service awards) for any one person cannot exceed a noncash value of $400 in a calendar year. Qualified Plan: Total deductible awards (both safety and length of service awards) for any one person (including nonqualified) cannot exceed a noncash value of $1,600 in a calendar year. The average cost or fair market value of all individual achievement awards cannot exceed a noncash value of $400 each. A plan is qualified if it does not discriminate in favor of highly compensated employees and it is a written plan that has been put in place by the employer on a regular basis. If a qualified plan award exceeds $1,600, the amount includable in the employee’s income and subject to federal income and employment taxes is the difference between the cost of the item and the employer’s deductible amount of $1,600. ï‚· ï‚· To be excluded, the award must be tangible property (does not include cash, cash equivalents, gift certificates (unless for a specific tangible property item), stocks, bonds, other securities, tickets for sporting events or the theater, vacations, meals, lodging, etc.) The award must be presented in a meaningful ceremonious presentation. In most cases, the cost of the award is used in the determination of the $400 or $1,600 limit.

However, where the cost of an employee achievement award to the employer is so disproportionate to the award’s fair market value that there is a significant likelihood that the award was given as disguised compensation, no portion of the award will qualify as an employee achievement award excludable under section 274(j) (Proposed Reg. §1.74-2). . Employee: For purposes of determining the taxability of an achievement award, treat the following individuals as employees: ï‚· A current employee. ï‚· A former common-law employee you maintain coverage for in consideration of or based on an agreement relating to prior service as an employee. ï‚· A leased employee who has provided services to you on a substantially full-time bases for at least a year if the services are performed under your primary direction or control. Safety Awards: To qualify as a safety award, the following criteria must be met: ï‚· Excluding de minimis fringe awards, not more than 10% of all employees may be entitled to this safety award. ï‚· Managers, professional, administrative, and clerical employees are not eligible for safety awards. ï‚· The employee must work full-time with at least one year of service. Length-of-Service Awards: To qualify for exclusion from income the award must not have been: ï‚· Received during the employee’s first five years of employment for the employer making the award, or ï‚· Provided to an employee who received a previous award during that year or any of the preceding four years, excluding awards categorized under de minimis benefits. Gift Cards or Coupons: Because cash and cash equivalent fringe benefits like gift certificates have a readily ascertainable value, they do not constitute de minimis fringe benefits because these items are not unreasonable or administratively impracticable to account for. In fact, accounting for cash or cash equivalent fringe benefits such as gift cards is never considered administratively impracticable under IRC §132. According to an IRS technical advice memorandum, an employer-provided holiday gift coupon with a face value of $35 that was redeemable at several local grocery stores was not excludable from gross income and wages as a de minimis fringe benefit under IRC §132(a)(4) [TAM 200437030, 4-30-04]. Under an earlier program, an employer provided its employees with a ham, turkey, or gift basket as an annual holiday gift. Then the employer changed its program and instead provided its employees with a gift coupon with a face value of $35. The employer intended that the gift coupons would be approximately equal in value to the annual holiday gifts previously provided.

The employer did not withhold or pay any employment taxes on any portion of the $35 gift coupons provided to employees. Coupons were shaped like bank checks and included the words “endorse here” next to a signature line in the bottom right corner. Printed on the front of each coupon were the employer’s name and address, the $35 face value, and the words “gift coupon.” Printed on the back of each coupon were the employee’s name and address and a number that identified the employee’s department. In the first year, the gift coupon listed four food stores where it was redeemable (some with multiple locations). The next year, the coupon listed 23 food stores where it was redeemable (some with multiple locations) but was otherwise unchanged.

The coupons included the following restrictions: ï‚· ï‚· ï‚· ï‚· Good toward the purchase of any grocery product excluding tobacco, alcohol, or pharmacy goods; Store may reserve the right not to accept it; Can only be used once and any unused portion is forfeited; and Redeemable between November 15 and January 31 of the following year. Here, the IRS said that the employer-provided “gift coupon” operated in essentially the same way as a cash equivalent fringe benefit such as a gift certificate. As with gift certificates, it was not administratively impracticable to account for the coupons; they had a face value of $35. . The IRS rejected the employer’s argument that because the gift coupons were not redeemable for cash they should not be included in the employees’ gross income or subject to employment taxes. Neither the statute nor the regulations pertaining to de minimis fringe benefits define a cash equivalent fringe benefit as one that can be readily converted to cash. Instead, the question (Under IRC §132(e)) is whether it was administratively impracticable to account for the gift coupons in this case. The IRS also rejected the employer’s attempt to apply the substantiation threshold used in connection with deductible length of service and achievement awards (IRS Regulation §1.274-3(b)(iv)) or substantiated business expenses (IRS Regulation §1.274-5(c)(2)(iii)(A)(2)) to de minimis fringe benefits. The argument that “it would seem that items of less than $75 in value would be considered de minimis” is inconsistent with IRC §132(e), which requires “a determination of value relative to the frequency with which a particular benefit is provided.” IRS examples of de minimis fringe benefits: ï‚· Occasional personal use of an employer's copying machine, provided that the employer exercises sufficient control and imposes significant restrictions on the personal use of the machine so that 85% of the use of the machine is for business purposes. ï‚· Occasional cocktail parties, group meals, or picnics for employees and their guests. ï‚· Traditional birthday or holiday gifts of property (not cash) with a low fair market value. ï‚· Occasional theater or sporting event tickets. ï‚· Coffee, doughnuts, and soft drinks. ï‚· Local telephone calls. ï‚· Flowers, fruit, books, or similar property provided to employees under special circumstances (e.g., on account of illness, outstanding performance, or family crisis). Employer-Provided Cell Phones: The value of an employer-proved cell phone, provided primarily for noncompensatory business reasons, is excludable from an employee’s income as a working condition fringe benefit. Employee’s personal use of an employer-provided cell phone, provided primarily for noncompensatory business reasons, is excludable from an employee’s income as a de minimis fringe benefit. An employer will be considered to have provided an employee with a cell phone primarily for noncompensatory business purposes if there are substantial reasons relating to the employer’s business, other than providing compensation to the employee, for providing the employee with a cell phone. Examples of substantial noncompensatory business reasons are: ï‚· ï‚· ï‚· The employer needs to contact the employee at all times for work-related emergencies The employer requires the employee to be available to speak with clients at times when the employee is away from the office The employee needs to speak with clients located in other time zones at times outside the employee’s normal work day. A cell phone provided to promote the morale or good will of an employee, to attract a prospective employee or as a means of furnishing additional compensation to an employee is not provided primarily for noncompensatory business purposes. Educational Assistance: One of the most popular benefits provided by employers is employer-paid educational assistance, where the employer pays for or reimburses the cost of educational courses attended by an employee.

Different taxation rules apply depending on whether or not the courses are job-related. Job-Related : Educational assistance can be excluded from the employee’s income, with no dollar limit, . as a working condition fringe benefit under §132, if the education could be deducted on the employee’s individual income tax return using the definition found in IRS Regulation 1.162-5 if the employee paid for the education. If the employer pays for the educational assistance and the employee meets the requirements to deduct the education, the exclusion applies if the education can be defined as job-related. In order for the educational assistance to qualify as job-related, three conditions must be met: 1. The course must not be necessary to meet the minimum education requirements of the job. 2. The course must not be taken to qualify the employee for a promotion or transfer to a different type of work. 3.

The course must be related to the employee’s current job and must help maintain or improve the knowledge or skills required for that job. If the job requirements change while the employee is working, employer-provided education designed to meet the changing requirements is considered job-related. Non-job-Related: §127 of the IRC allows the exclusion from income of up to $5,250 per year of employer-provided non-job-related educational assistance if the employer sponsored program meets the following requirements: 1. The Educational Assistance Program is found in a separate written plan of an employer for the exclusive benefit of its employees. 2.

The program shall benefit employees who qualify under a classification set up by the employer. The program is not discriminatory in favor of employees who are highly compensated employees or their dependents. For purposes of nondiscrimination testing of pension plans and other benefits, the definition of a highly compensated employee includes: ï‚· Any employee who was a 5% owner of the employer during the current or preceding year: or ï‚· Any employee who received more than $115,000 in compensation from the employer during the preceding year. If the employer wishes, it can limit the employees fitting under the second definition to those in the top-paid 20% of employees. 3. Not more than 5% of the amounts paid or incurred by the employer for educational assistance during the year may be provided for the class of individuals who are shareholders or owners (or their spouses or dependents), each of whom (on any day of the year) owns more than 5% of the stock or of the capital or profits interest in the employer. 4.

A program must not provide eligible employees with a choice between educational assistance and other remuneration includible in gross income. 5. The program is not required to be funded. 6. Reasonable notification of the availability and terms of the program must be provided to eligible employees. The IRS has generally taken the position that courses leading to a graduate-level degree such as an MBA are non job-related. Definitions and Special Rules: The term “educational assistance” means: ï‚· The payment, by an employer, of expenses incurred by or on behalf of an employee for education of the employee (including, but not limited to, tuition, fees, and similar payments, books, supplies, and equipment), and ï‚· The provision, by an employer, of courses of instruction for such employee (including books, supplies, and equipment). However, “educational assistance” does not include payment for, or the provision of, tools or supplies which may be retained by the employee after completion of a course of instruction, or meals, lodging, or transportation.

The term “educational assistance” also does not include any payment for, or the provision of any benefits with respect to, any course or other education involving sports, games, or hobbies. . For purposes of this exclusion, the term “employee” includes: ï‚· A current employee. ï‚· A former employee who retired, left on disability, or was laid off. ï‚· A leased employee who has provided services to you on a substantially full-time basis for at least a year if the services are performed under your primary direction or control. ï‚· Yourself (if you are a sole proprietor). ï‚· A partner who performs services for a partnership. The term “employer” includes any individual who owns the entire interest in an unincorporated trade or business. A partnership shall be treated as the employer of each partner who is an employee. In summary, employer-paid education that is related to an employee’s current job is excluded from income as a working condition fringe benefit under the conditions given above, with no dollar limit. On the other hand, employer-paid education that is non job-related is excluded from income under §127 of the IRC only up to $5,250 a year, if the above requirements are met. §127, which originally was set to expire at the end of 2010, was extended for an additional two years under the Tax Relief Unemployment Insurance Reauthorization and Job Creation Act of 2010.

The income exclusion under IRC §127 has become permanent and will no longer be subject to expiration as it has been since 1978. Differential Military Pay: Many employers are faced with decisions on how to tax and report any pay they provide to reservists who are called to military service. Compensation paid to an employee while on military duty that represents the difference between the employee’s regular pay and the pay provided by the state or federal government is referred to as differential military pay. The tax treatment of differential military pay is governed by the circumstances of the employee’s military service. If such payments are made to employees who are called to military service for 30 days or less, they are treated as wages subject to federal income tax withholding and social security, Medicare, and FUTA taxes. In 2009, the IRS issued guidance on the tax treatment of differential wage payments made by employers to their employees on active duty in the uniformed services for more than 30 days [Rev.

Rul. 2009-11, 416-09]. The guidance is based on a scenario where an employer has employees who are called or voluntarily enlist for active military service in the U.S.

armed forces for periods exceeding 30 days. The employer continues making payments to the individuals in an amount equal to the difference between the compensation they receive for their military service and the wages they would have received from the employer if they were performing services for the employer. IRC §3401(h) Heroes Earnings Assistance and Relief Tax (HEART) Act added new IRC section 3401(h), which provides that, for purposes of income tax withholding, any differential wage payment is to be treated as a payment of wages by the employer to the employee. The term “differential wage payment” is defined as any payment that: 1.

Is made by an employer to an individual with respect to any period during which the individual is performing service in the uniformed services while on active duty for more than 30 days, and 2. Represents all or a portion of the wages that the individual would have received from the employer if the individual were performing services for the employer. IRC §3401(h) applies to differential wage payments paid after December 31, 2008. It also requires that an individual receiving a differential wage payment be treated as an employee of the employer making the payment, and differential wage payments be treated as compensation for retirement plan purposes. For example, for purposes of the limitation on contributions to an IRA, the term .

“compensation” would be amended to include differential wage payments. Tax Treatment of Differential Wage Payments to Employees on Active Military Duty: Here, the payments made by the employer meet the definition of “differential wage payments” under §3401(h). These payments are therefore treated as wages for income tax withholding purposes, and the employer must withhold income taxes on the differential wage payments. However, because the individuals are scheduled to be on active military duty for an extended period of time, rather than being temporarily absent, the differential wage payments are not wages for purposes of FICA and FUTA taxes. Section 3401(h) does not address the FICA and FUTA treatment of differential wage payments and therefore does not affect existing guidance that differential wage payments do not constitute wages subject to FICA or FUTA taxes. That guidance, which dated from the late 1960s, provided that IRS considers the employment relationship to be severed during the extended period of military service. Differential wage payments are supplemental wages because they are not a payment for services for the non-military employer in the current payroll period.

Therefore, if the amount of the differential pay, when added to all other supplemental wages paid by the same employer to the employee during the calendar year does not exceed $1 million, the employer may use either the aggregate method or optional flat rate withholding (if federal income tax has been withheld from regular wages paid to the employee in the current or preceding calendar year) to calculate the amount of income taxes to be withheld from the differential wage payments. Because differential payments are treated as wages subject to income tax withholding, the employer must report the payments on each employee’s Form W-2 in Box 1, with the amount withheld reported in Box 2. The amounts are not reported in Boxes 3 and 5 because they are not subject to social security or Medicare tax. Deferrals from Differential Military Pay to Qualified Retirement Plans: IRS regulations under IRC §415 on the limitations on benefits and contributions under qualified plans affect administrators of, participants in, and beneficiaries of qualified employer plans and other retirement plans. The regulations provide that amounts received following severance from employment are generally not considered compensation for §415 purposes. Corresponding changes took affect for the regulations under §401(k), §403(b), or §457(b), so that amounts receivable following severance from employment can only be deferred if those amounts meet the conditions in the regulations. However, the rule pursuant to which compensation received after severance from employment is not considered compensation for §415 purposes generally does not apply to payments to an individual in qualified military service up to the amount the individual would have received if he or she was still working for the employer. In other words, employees may continue to contribute to their employer’s retirement plans while performing qualified military service. Loans to Employees: Loans made to employees by their employers at interest rates below the applicable federal interest rate are below-market, compensation-related loans.

The amount representing the difference between the interest charged to the employee and the applicable federal interest rate must be included in the income of the employee on any day in which the combined amount of all outstanding loans between the employer and the employee is more than $10,000. The taxable amount is not subject to federal income tax withholding, but must be reported in box 1 on the employee’s Form W-2. The taxable amount is subject to social security, Medicare, and FUTA taxes. . EXAMPLE: If an employer provides an employee with a $20,000 loan with an interest rate of 2% when the applicable federal interest rate is 6%, the employee will have the following reported on Form W-2: ï‚· Box 1: $800.00 ($20,000 x (6% - 2%) ï‚· Box 3: $800.00 ($20,000 x (6% - 2%) ï‚· Box 4: $49.60 ($800 x 6.2%) ï‚· Box 5: $800.00 ($20,000 x (6% - 2%) ï‚· Box 6: $11.60 ($800 x 1.45%) If the employer forgives the debt, or for any other reason the employee is not expected to repay the loan, the entire balance of the loan becomes income subject to federal income tax withholding and social security, Medicare and FUTA taxes in the year the debt is forgiven. Loans made to employees in connection with a job-related relocation to facilitate the purchase of a new residence (i.e., mortgage or bridge loans) may be tax exempt if the relocation qualifies for the moving expense deduction. Draws Against Commissions: Salespeople often receive compensation in the form of advances that are later subtracted from (or drawn against) earned compensation. Such amounts are not loans and are supplemental wages subject to federal income tax withholding and employment taxes at the time of payment if the employee is not legally obligated to repay them under an agreement with the employer. If, however, the employee signs an agreement acknowledging the indebtedness and the loan otherwise qualifies under the rules for compensation-related loans to employees, the advance is not wages and is not subject to federal income tax withholding or social security, Medicare, or FUTA taxes. Questions to Ask: ï‚· Did the principal on all loans provided to an employee exceed $10,000 at any time during the year? ï‚· What interest rate is the employee paying with the loan repayment? ï‚· Have any employee loans been forgiven? Employee Discounts: This exclusion applies to a price reduction given to an employee on property or services offered to customers in the ordinary course of the line of business in which the employee performs substantial services. However, it does not apply to discounts on real property or discounts on personal property of a kind commonly held for investment, such as stocks or bonds. The value of an employee discount can generally be excluded from the employee’s wages up to the following limits: ï‚· ï‚· For a discount on services, 20% of the price charged to non-employee customers for the service. For a discount on merchandise or other property, the gross profit percentage times the price charged to non-employee customers for the property. This exclusion does not apply to highly compensated employees if the same discount is not available to one of the following groups: ï‚· All of your employees. ï‚· A group of employees defined under a reasonable classification you set up that does not favor highly compensated employees. . Third-Party Sick Pay: Third Party sick pay is paid to an employee by a third party under an insurance arrangement. These payments are wage replacement income for an employee who is absent from work for more than a few days due to illness or injury but are expected to return to work at some point. These payments are through the employer’s sick pay plan in the form of short-term or long-term disability payments and may be made by the employer, an agent of the employer, or a third party insurance company (requiring special treatment at year-end because the IRS reconciles an entity’s social security and Medicare wages reported quarterly on Forms 941 with the same wages reported annually on Forms W-2 and W-3). Taxability of the payments is determined by how the plan benefits are funded. Benefits attributable to employee post-tax contributions from wages are not taxable income.

However, benefits that are attributable to employer contributions or to employee pre-tax contributions through a cafeteria plan are taxable income to the employee and may be subject to federal income tax withholding and social security, Medicare and FUTA taxes. If both the employer and the employee contribute to the premiums for the plan, the taxable portion of benefits received is the amount attributable to the employer-funded portions of the premiums. Special rules apply for determining the amount of benefits included in the employee’s income where the employer and employee both contribute to a group insurance policy.

If the employer knows the net premiums paid for at least 3 policy years, the formula for calculating the employee’s taxable amount is as follows: Employee’s sick pay x employer-paid premiums for last 3 years Total premiums for last 3 years Example: Bill, an employee of XYZ, Inc., was injured in a non-job related accident on February 28, 2015 and was out of work until January 1, 2016. Bill received payments of $3,000 per month while out of work from his employer’s insurance company. During the 3 policy years before 2015, Bill’s employer contributed $36,000 in net premiums to insure its employees, while the employees paid $18,000 in aftertax dollars.

The amount of Bill’s monthly sick pay that is included in income is: Taxable sick pay = $3,000 x [$36,000 ÷ ($36,000 + $18,000)] Taxable sick pay = $3,000 x ($36,000 ÷ $54,000) Taxable sick pay = $3,000 x .67 Taxable sick pay = $2,010 Once it is determined that payments under a sick pay or disability plan are taxable income in whole or in part to an employee, the next step is to determine the federal income tax withholding and social security, Medicare, and FUTA tax responsibilities related to the taxable portion of the payments. Sick payments made to an employee after the employee has been absent from work for six calendar months are excluded from wages subject to social security, Medicare, and FUTA tax. Example Continued: Assume same facts as above. The amount of Bill’s total sick pay that is included in income is: Taxable sick pay = $3,000 x [$36,000 ÷ ($36,000 + $18,000)] Taxable sick pay = $3,000 x ($36,000 ÷ $54,000) Taxable sick pay = $3,000 x .67 Taxable sick pay = $2,010 per month Sick pay subject to federal income tax = $2,010 x 10 months = $20,100 (W-2, Box 1) Sick pay subject to social security and Medicare taxes = $2,010 x 6 months = $12,060 (W-2, Boxes 3 and 5) . Payments Made by a Third Party who is Not an Agent: The third-party insurer assumes more tax responsibility when it bears the risk of insuring the employees through premium payments either by the employer and/or the employees. The third party must withhold federal income taxes (if requested by the employee) and the employee’s share of social security and Medicare taxes for each payment made and pay over the taxes within 6 months after the end of the last month the employee worked for the employer. The third party is also responsible for the employer’s share of social security and Medicare, as well as FUTA, unless it transfers the liability for these taxes back to the employer. This liability is transferred if the third party takes the following steps: 1.

Withholds the employee social security and Medicare taxes from the sick pay payments, 2. Makes timely deposits of the employee social security and Medicare taxes, and 3. Notifies the employer for whom the employee normally works of the payments on which employee taxes were withheld and deposited.

The third party must notify the employer within the time required for the third party's deposit of the employee part of the social security and Medicare taxes. For instance, if the third party is a monthly schedule depositor, it must notify the employer by the 15th day of the month following the month in which the sick pay payment is made because that is the day by which the deposit is required to be made. The third party should notify the employer as soon as information on payments is available so that an employer required to make electronic deposits can make them timely. When the third-party insurer makes the payments and transfers the employer’s share of social security, Medicare, and FUTA taxes back to the employer, the employer is liable for the employment taxes when it is notified by the third party as to the amount of the payments made and employee taxes withheld and deposited. The third party is not required to withhold federal income tax from payments made to a disabled employee unless the employee requests a certain amount be withheld by furnishing the third party with Form W-4S.

If the employee provides Form W-4S, the third party must begin withholding with the first payment made at least 8 days after the form is provided. The third party may, at its option, withhold federal income tax before 8 days have passed. Through Form W-4S, the employee may request that a minimum of $4 per day, $20 per week, or $88 per month is withheld from each paycheck.

No matter which withholding method is used, if the amount requested to be withheld reduces the net sick payment to below $10, no federal income tax should be withheld from that payment. If the third party does not transfer social security and Medicare tax liability to the employer, it becomes liable for depositing those taxes (along with the employee’s share of social security and Medicare and any withheld federal income taxes) when payment is made to the employee. The third party should make the deposit using its own name and employer identification number, not the employer’s. If the third party properly transfers the responsibility for the employer’s share of social security, Medicare, and FUTA taxes to the employer, it must deposit only the employee’s share of social security, Medicare, and withheld income taxes, using its own name and EIN. Reporting Process: Reporting for third-party payments is unique because both the third-party administrator and the employer report an employee’s social security and Medicare wages on their respective Forms 941; ï‚· ï‚· The third-party administrator reports the employee social security and Medicare wages subject to employee taxes, and The employer reports the employee social security and Medicare wages subject to the employer taxes. In addition, both are required to report the equivalent wages on their respective Forms W-2 and W-3 in order to reconcile to their 941 Forms. Therefore, the IRS has provided specific instructions to assist in the .

reporting requirements for employers and third-party administrators. ï‚· ï‚· If the third-party administrator does not provide to the employer information about the sick pay payments made during the year by January 15th or if individual payments are not reported in order for the employer to make timely deposits of the employer taxes, the third-party administrator prepares Forms W-2 and W-3 for the employee. If the third-party administrator timely notifies the employer about the sick pay payments, then the following instructions apply: o Employers: If an employee receives sick pay in the current calendar year from an insurance company or other third-party administrator in an insurance arrangement, report the following on the employee’s W-2 Form if the third party administrator provides the information by January 15th:  Box 1 – Amount of sick pay the employee must include in income; also report on line 2 of Form 941  Box 2 – Income tax withheld from the sick pay by the third party administrator; do NOT include on line 3 of Form 941  Box 3 – Amount of sick pay that is subject to employee social security tax  Box 4 – Employee social security tax withheld by the third party administrator  Box 5 – Sick pay subject to employee Medicare tax  Box 6 – Employee Medicare tax withheld by the third party administrator  Box 12 – Amount of any sick pay not included in income reported in box 1 because the employee contributed to the sick pay plan. Use Code J.  Box 13 – Check the Third-Party Sick Pay box as an employer reporting sick pay payments made by a third-party. Either include these amounts on the Form W-2 you issue to the employee showing wages, or give the employee a separate Form W-2 stating that the amounts are for third-party sick pay. In either case, place in box 14 of Form W-3 the total amount of income tax withheld by the third-party administrator, even though the amounts are included in box 2. In addition, on Form W-3 you will check the ThirdParty Sick Pay check box when reporting sick pay payments made by a third party. o o Third Party Administrator: Because the third party administrator withheld social security and Medicare tax (and perhaps federal income tax) from persons for whom they do not file Forms W-2, the third party administrator must file a separate “Third-Party Sick Pay Recap” Form 8922.

Form 8922 must be filed with the IRS by March 2, 2015.  Filer’s name - If employer box is checked, enter the employer EIN. If Insurer/Agent box is checked, enter insurer or agent EIN  Filer’s EIN – same as above  Other party’s name and EIN – If the employer box is checked, employer will provide this information. A separate form 8922 must be filed for each separate insurer or agent.

If the Insurer/Agent box is checked, the insurer or agency may, but is not required to, provide the name and EIN of the employer.  Box 1 – Total taxable sick pay subject to federal income tax.  Box 2 – Total income tax withheld, if any, from the sick pay.  Box 3 – Total sick pay subject to employee social security tax.  Box 4 – Total amount of social security tax withheld from the sick pay.  Box 5 – Total sick pay subject to Medicare tax.  Box 6 – Total amount of the Medicare tax withheld from sick pay.  Box 13 – Third party checks the “Third Party sick pay” box.  Box b – Third party’s EIN.  Box c – Third party’s name and address.  Box e – The words “Third Party sick pay recap” in place of the employee’s name. . Preparing Form 941: Line 2 – Include taxable sick pay if you get timely notice from your insurance carrier concerning the amount of third-party sick pay it paid your employee. Line 3 – DO NOT include here any federal income tax withheld from sick pay by a third party as doing so will cause an out of balance between Forms 941 and Forms W-2. Federal income tax withheld from sick pay by a third party is reported on the third-party administrator’s Form 941. The IRS will reconcile this amount with the “Third Party Sick Pay Recap” filed by the third-party administrator. Line 5a – Include any taxable sick pay paid by a third party administrator to your employees. Line 5c – Include any taxable sick pay paid by a third party administrator to your employees. Line 8 – Enter here as a negative number the total of the employee’s share of social security and Medicare tax withheld and paid by the third party administrator. Schedule B – Enter in the appropriate box, the total liability of the employer’s share of any social security and Medicare taxes paid on third party sick pay. Preparing Form 940: Line 3 – Include total amount of any sick pay paid to your employees by a third party administrator. Line 4 – Include any non-taxable amounts of any sick pay paid to your employees by a third party administrator. THIRD PARTY SICK PAY – NOT AS AN AGENT AND LIABILITY TRANSFERRED TO EMPLOYER Employer Responsibilities Third Party Responsibilities Withhold Employee Taxes Income No Yes if W-4S is filed Social Security No Yes Medicare No Yes Deposit Employee Taxes Income No Yes — using Third Party EIN Social Security No Yes — using Third Party EIN Medicare No Yes — using Third Party EIN Deposit Employer Taxes Social Security Yes — using employer EIN No Medicare Yes — using employer EIN No FUTA Yes — using employer EIN No Report Employee Wage and Taxes on Form 941 Income Report Taxable Wages Report Tax Withheld Social Security *Report Taxable Wages *Report Taxable Wages Medicare *Report Taxable Wages *Report Taxable Wages *Adjustment on Line 8 for employee taxes deposited by *Adjustment on Line 8 for employer taxes deposited by third party. employer. Report Employee Wage and Taxes on Form W-2* Income Yes No — File Form 8922 Social Security Yes No — File Form 8922 Medicare Yes No — File Form 8922 *See the instructions earlier if operating under the Optional rule for Form W-2 . . Employee Business Expense Reimbursement: Reimbursement for business travel expenses for temporary travel is excluded from the employee’s income and is not subject to federal income tax withholding or social security, Medicare or FUTA taxes if made under an accountable plan. If the reimbursement is made for indefinite travel under a nonaccountable plan or exceeds the amount substantiated by the employee, the reimbursement or the excess amount is included in income and is subject to federal income tax withholding and social security, Medicare and FUTA taxes, when paid. Employer reimbursements of employee travel expenses can be excluded from income only if the expenses are incurred while the employee is temporarily away from home on the employer’s business. To qualify as “away from home”, the employee must be away from the general area of their tax home substantially longer than an ordinary day’s work, and they need to sleep or rest to meet the demands of work while away from home. To qualify as temporary travel away from home, the employee must realistically be expected to be away from home for no more than one year, and must in fact only be gone for one year or less. An indefinite assignment is an assignment or job in a single location that is realistically expected to last for more than one year, whether or not is actually lasts for more than one year.

The IRS has adopted a realistic expectation test that focuses on whether employment in a single location is realistically expected to last for more or less than one year, rather than on the actual length of employment at a temporary location: ï‚· ï‚· ï‚· If employment away from home in a single location is realistically expected to last (and does in fact last) for one year or less, the employment will be treated as temporary in the absence of facts and circumstances indicating otherwise; If employment away from home is expected to last for more than one year or there is no realistic expectation that the employment will last for one year or less, the employment will be treated as indefinite, regardless of whether it actually exceeds one year; and If employment away from home is realistically expected not to exceed one year, the employment will be treated as temporary (in absence of facts and circumstances indicating otherwise) until the date the taxpayer’s realistic expectation changes. Accountable Plans: Reimbursements or other expense allowances made under an accountable plan are not required to be reported on Form W-2, and they are generally tax-free to the employee. An accountable plan must meet the following three requirements: 1. Business Connection: Expenses must be business-related and have been paid or incurred while performing services as an employee of your employer. 2.

Substantiation: The employee must substantiate, “within a reasonable period of time,” the expenses with a detailed record of the expense including a statement of expense, an account book or similar record in which each expense is entered at or near the time it occurred, along with documentary evidence (such as receipts) of the travel, mileage, and other business expenses. One can substantiate expenses either through documenting actual expenses or a per diem arrangement. 3. Return of Unsubstantiated Amounts: The employee must return, within a “reasonable period of time,” any advances that exceed the employee’s substantiated expenses.

If the employee does not return or substantiate the expenses, the unproved amount will be considered paid under a nonaccountable plan. Reasonable period of time: Actions that take place within the times specified below will be treated as taking place within a reasonable period of time: ï‚· An advance is received within 30 days of the time you have an expense. ï‚· Expenses are adequately accounted for within 60 days after they were paid or incurred. ï‚· Excess reimbursements are returned within 120 days after the expense was paid or . ï‚· incurred. A periodic statement is provided at least quarterly that asks you to either return or adequately account for outstanding advances and you comply within 120 days of the receiving the statement. Non-Accountable Plans: Any business expense reimbursement plan, advance or specific reimbursement which does not meet the three qualifications of an accountable plan is considered a non-accountable plan. These reimbursements must be treated as taxable wages either when paid or, if they fail one of the safe harbors, in the first pay period after the failure. They are subject to federal income tax, social security tax, Medicare tax, and FUTA employer tax. They must also be reported on the employee’s Form W-2. Reimbursing an employee at a higher amount than the standard IRS mileage rate would result in the excess of $0.57 in 2015 being classified as provided under a non-accountable plan.

Reimbursing employees at a rate greater than allowed without including the excess in wages or withholding on the excess may cause the entire plan to be classified as non-accountable. Amounts which are reimbursed as nontaxable (i.e. up to the IRS limit) are reported in Box 12, code L. Per Diems and Mileage Allowances: Reimbursing an employee at the standard IRS mileage rates of $0.57 in 2015, or less, allows a mileage reimbursement plan to be classified as an accountable plan. Meals and incidental expense per diems or mileage allowances paid to employees which are less than or equal to the applicable rates set for federal employees are “deemed substantiated" without the employee having to provide a detailed record of expenses.

The employees need only account for the time, place, and business purpose of their expenses. If the per diem or mileage rates paid to an employee under an accountable plan exceeds the expenses that are deemed substantiated, the amount exceeding the substantiated expenses must be treated as paid under a non-accountable plan. Likewise, the excess portion is subject to withholding and employment taxes. Employers have a choice of reimbursing actual expenses of business travel away from home, or reimbursing employees at a per diem rate to cover lodging, meals, and incidental expenses. If a per diem rate is paid, any additional payment with respect to these expenses is treated as paid under a nonaccountable plan, resulting in compensation to the employee. All payments through a business expense reimbursement plan are treated as paid under a non-accountable plan if the arrangement shows a “pattern of abuse” of the expense reimbursement rules. Other Rules and Provisions: Under the following conditions a reimbursement arrangement which is in part accountable and part non-accountable must be treated as both an accountable and a non-accountable plan: ï‚· The plan must provide payments for “deductible” employee business expenses as well as payments for other “bona fide” expenses related to the employer’s business which are nondeductible. ï‚· Reimbursements do not satisfy the “business connection” requirement if they are nondeductible (i.e., overnight travel expenses are deductible but expenses for business travel completed without an overnight stay are not deductible, even though they may be “bona fide” expenses related to the employer’s business). ï‚· The portion of a reimbursement arrangement which pays the nondeductible expenses is treated as a non-accountable plan, while the part paying the deductible expenses is treated as an accountable .

plan, providing that it also satisfies the “substantiation” and “return of excess” requirements. Wages Paid After Death: If an employee dies during the year, accrued wages, vacation pay, and other compensation paid after the date of death must be reported. Following is an explanation of the tax and reporting requirements that currently apply to wages paid after death. ï‚· ï‚· Wages paid after death but in the same calendar year as the employee's death: Wages paid after death but in the year of death are considered wages for FICA, Medicare, and federal unemployment tax purposes but not federal income tax withholding for reporting purposes. Under IRS regulations, employers are required to report wages received after death on Form W-2 (Boxes 3 and 5), with corresponding FICA and Medicare taxes withheld in boxes 4 & 6. The federal taxable amount is reported on Form 1099-MISC, Box 3 (in the name of beneficiary).

The federal taxable amount is not reported on Form W-2, Box 1. Wages paid after death and in the calendar year after the employee's death: Wages paid after death and in the calendar year after death are exempt from FITW, FICA, Medicare, and FUTA. Form W-2 is not completed. Instead, the entire payment is reported on a Form 1099-MISC (Box 3) to the estate or beneficiary of the employee. .

Special Rules for Various Types of Fringe Benefits Treatment Under Employment Taxes Type of Fringe Benefit Income Tax Withholding Social Security and Medicare (including Additional Medicare Tax when wages are paid in excess of $200,000) Exempt, except for certain payments to S corporation employees who are 2% shareholders. Federal Unemployment (FUTA) Accident and health benefits Exempt1,2, except for long-term care benefits provided through a flexible spending or similar arrangement. Achievement awards Exempt1 up to $1,600 for qualified plan awards ($400 for nonqualified awards). Adoption assistance Exempt1,3 Athletic facilities Exempt if substantially all use during the calendar year is by employees, their spouses, and their dependent children and the facility is operated by the employer on premises owned or leased by the employer. De minimis (minimal) benefits Exempt Taxable Exempt Exempt Taxable Exempt 3 Dependent care assistance Exempt up to certain limits, $5,000 ($2,500 for married employee filing separate return). Educational assistance Exempt up to $5,250 of benefits each year. Employee discounts Exempt3 up to certain limits. Employee stock options Employer-provided cell phones Exempt if provided primarily for noncompensatory business purposes. Exempt1,4, 7 up to cost of $50,000 of coverage. (Special rules apply to former employees.) Exempt Group-term life insurance coverage Health savings accounts (HSAs) Exempt for qualified individuals up to the HSA contribution limits. Lodging on your business premises Exempt Exempt1 if furnished for your convenience as a condition of employment. Meals Exempt if furnished on your business premises for your convenience. Exempt if de minimis. Moving expense reimbursements Exempt1 if expenses would be deductible if the employee had paid them. No-additional-cost services Exempt3 Exempt3 Exempt3 5 5 Exempt5 Retirement planning services Transportation (commuting) benefits Exempt Exempt Exempt1 up to certain limits if for rides in a commuter highway vehicle and/or transit passes ($130), qualified parking ($250), or qualified bicycle commuting reimbursement6 ($20). Exempt if de minimis. Tuition reduction Exempt3 if for undergraduate education (or graduate education if the employee performs teaching or research activities). Working condition benefits Exempt 1 Exempt Exempt Exemption does not apply to S corporation employees who are 2% shareholders. 2 Exemption does not apply to certain highly compensated employees under a self-insured plan that favors those employees. 3 Exemption does not apply to certain highly compensated employees under a program that favors those employees. 4 Exemption does not apply to certain key employees under a plan that favors those employees. 5 Exemption does not apply to services for tax preparation, accounting, legal, or brokerage services. 6 If the employee receives a qualified bicycle commuting reimbursement in a qualified bicycle commuting month, the employee cannot receive commuter highway vehicle, transit pass, or qualified parking benefits in that same month. 7 You must include in your employee's wages the cost of group-term life insurance beyond $50,000 worth of coverage, reduced by the amount the employee paid toward the insurance. Report it as wages in boxes 1, 3, and 5 of the employee's Form W-2. Also, show it in box 12 with code “C.” The amount is subject to social security and Medicare taxes, and you may, at your option, withhold federal income tax. . State Taxation of Salary Deferrals to Cafeteria Plans and §401(k) Plans State Alabama Cafeteria Plans (§125) Deferrals Income Taxable U.I. Taxable No Yes CODA (§401(k) Plan) Deferrals Income Taxable U.I. Taxable No Yes (elective contributions only) N/A No Alaska N/A Arizona Arkansas California Colorado No No No No No if used to purchase medical or life insurance or retirement benefits No No No No Connecticut No No No Delaware District of Columbia Florida Georgia Hawaii Idaho No No N/A No No No Yes Yes No No Yes No No No N/A No No No Illinois No No Indiana Iowa No No No if used to purchase medical or life insurance No Yes Kansas No No No Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana No No No No No No No No No No Yes No No No Yes Yes Yes No No Yes No No No No No No No No No No Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina No N/A N/A Yes No No No No Yes Yes Yes No Yes No No N/A N/A No No No No No No No No No No Yes Yes Yes Yes (elective contributions only) Yes (elective contributions only) Yes Yes Yes Yes Yes Yes (elective contributions only) Yes Yes Yes (elective contributions only) Yes (elective contributions only) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes (elective contributions only) Yes Yes Yes Yes Yes Yes Yes . State Taxation of Salary Deferrals to Cafeteria Plans and §401(k) Plans State North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina Cafeteria Plans (§125) Deferrals Income Taxable U.I. Taxable No Yes No No No No No No if used to purchase medical or life insurance No if used to purchase Yes health or life insurance, disability insurance, supplemental unemployment benefits, or strike benefits Yes, except Yes qualified pension No No No No CODA (§401(k) Plan) Deferrals Income Taxable U.I. Taxable No Yes No Yes No Yes (elective contributions only) No Yes Yes Yes No Yes No No No Yes (elective contributions only) Yes Yes Yes (elective contributions only) Yes Yes Yes Yes Yes Yes Yes South Dakota Tennessee Texas N/A N/A N/A Yes Yes Yes N/A N/A N/A Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming No No No N/A No No N/A No Yes No Yes Yes No No No No No N/A No No N/A . 2015 - 2016 Changes Returned Wage Reports Effective January 1, 2015, the SSA will be returning W-2 electronic and paper wage reports to filers without processing the reports if the report contains the following errors: ï‚· ï‚· ï‚· Medicare wages and tips are less than the sum of Social Security wages and Social Security tips Social Security tax is greater than zero; Social Security wages and Social Security tips are equal to zero; and Medicare tax is greater than zero; Medicare wages and tips are equal to zero The preferred method of informing filers that is has rejected a W-2 submission is by e-mail. It will only send a reject notice in the mail if it doesn’t have the filer’s e-mail address. Reject notices no longer include specific error information; the filer will need to go Business Services Online to find out what is causing the error. FUTA Credit Reductions Because of State Loans: Under the joint federal/state unemployment insurance system, states with a high rate of unemployment and difficulty meeting their benefit obligations can borrow money from the Federal Unemployment Account (FUA) to pay benefits. If loans taken out during one year are not repaid by the end of the following calendar year, the FUTA credits for employers in those states are reduced, with the extra FUTA taxes paid being applied against each state’s loan balance. A state with an outstanding loan can avoid a credit reduction for its employers by repaying the loan by November 10 of the year the reduction is scheduled to take effect.

If the loan is not repaid by that date, a credit reduction of 0.3% goes into effect. Each year a loan remains unpaid, the credit reduction increases by 0.3% although there are limits for states that have made an effort to keep their balances in check. Even if a state has outstanding loans on November 10, it can avoid a credit reduction by meeting certain criteria regarding the amount it has paid back, whether it can meet upcoming payments without needing any further advances from the federal government, and the size of the net increase in the solvency of the state unemployment compensation system. Sometime after November 10 of each year, the credit reductions for that year are announced by the IRS and are included on Form 940 so employers in the affected states can figure the amount of their credit reduction. Credit Reduction States: Updated information on state loans can be accessed at the following web site: http://workforcesecurity.doleta.gov/unemploy/tax.asp. Click on the link “Trust Fund Loans” to get access to FUA state loan balances.

The following link, updated monthly, provides the actual date when states began borrowing funds: http://www.ncsl.org/?tabid=13294. . State AR AZ CA CT DE GA IN KY MO NY NC OH RI SC VI WI Year State Loan Orig. 2009 2014 2009 2009 2010 2009 2008 2009 2009 2009 2009 2009 2009 2008 2009 2009 FUTA Credit Reduction Rates Loan Balance as 2012 of 12/3/2015 $0 0.6% $0 0.0% $6,027.441,529.85 0.6% $101,312,479.76 0.6% $0 0.3% $0 0.6% $0 0.9% $0 0.6% $0 0.6% $0 0.6% $0 0.3% $774,834,855.39 0.6% $0 0.6% $0 0.0% $72,154,621.84 0.6% $0 0.6% 2013 2014 2015 0.9% 0.0% 0.9% 0.9% 0.6% 0.9% 1.2% 0.9% 0.9% 0.9% 0.6% 0.9% 0.9% 0.0% 1.2% 0.9% 0.0% 0.0% 1.2% 1.7% 0.0% 0.0% 1.5% 1.2% 0.0% 1.2% 1.2% 1.2% 0.0% 0.0%* 1.2% 0.0% 0.0% 0.0% 1.5**% 2.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1.5% 0.0% 0.0% 1.5% 0.0% **After five years, states are also subject to a benefit cost ratio add on (BCR add on), which reduces the FUTA credit further by an additional 1.5%. California, Ohio, and the Virgin Islands applied for, and received, waivers from the BCR add-on credit reduction. These states had Title XII advance balances on January 1 of at least two consecutive years and on November 10, 2015, and did not qualify for credit reduction avoidance. Patient Protection & Affordable Care Act & Health Care & Education Reconciliation Act: Many more changes are coming from these acts, automatic health insurance enrollment, penalties to large employers for not offering essential coverage, and excise tax on high-cost health coverage. Please be aware of these upcoming changes and look for more information on them as they become effective. Reporting Health Care Coverage Offered to Employees The reporting requirement goes into effect beginning with the 2015 tax year (forms filed in early 2016). The following forms are used to report the health insurance coverage: 1095-B, Health Coverage; 1094B, Transmittal of Health Coverage Information Returns; 1095-C, Employer-Provided Health Insurance Offer and Coverage; and 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns. Publication 1542 – Per Diem Rate Tables – No Longer Be Updated Effective for 2012 and later, the IRS will no longer be updated Publication 1542. Instead, current per diem rates may be found on the U.S.

General Services Administration (GSA) website. http://www.gsa.gov/portal/category/21287 Other information regarding per diem rates, such as substantiation methods and transition rules, may be found in Publication 463, Travel, Entertainment, Gift, and Car Expenses. Auto and Truck Fair Market Value Limitation are Calculated for 2016 Cents-per-mile method – Based on the October 2015 CPI, it has been determined that for employerprovided vehicles first made available to employees for personal use in 2016, the cents-per-mile method cannot be used if the value of a passenger automobile exceeds $15,900 (down from $16,000 in 2015) and the value of a truck or van exceeds $17,700 (up from $17,500 in 2015). The IRS usually does not announce these limitations until after the New Year. . Revisions to Overtime Regulations In July 2015, the Department of Labor issued a proposed rule that included the following changes: 1) the standard salary under which employees would be eligible to receive overtime would increase from $455 per week to $970 per week in 2016; 2) the annual salary threshold for highly compensated employees (HCE) would increase from $100,000 to $122,148; 3) the standard salary level and HCE thresholds would be adjusted annually for inflation. The DOL accepted comments on the proposed rule until September 4, 2015. The DOL received approximately 270,000 comments. The overtime regulations aren’t likely to be finalized until late 2016 due to the large volume of comments and the complex nature of the changes. Several States Moving Up W-2 Filing Deadlines Alabama, Connecticut, Indiana, North Carolina, and Utah have all moved up their W-2 filing deadlines from February 28 to January 31. 2016 Pension Plan Limits The pension plan limitations will not change for 2016 because the increase in the cost-of-living index did not meet the statutory thresholds that trigger their adjustment. . V. APPENDIXMISC CONTACT INFORMATION, FORMS, & CHARTS . SSA Regional Employer Services Liaison Officers Calls from Telephone Location E-mail Address Alabama (404) 562-1315 (334) 875-8682 Atlanta, GA Montgomery, AL kirk.jockell@ssa.gov frances.tatum@ssa.gov Alaska (206) 615-2125 Seattle, WA SEA.RO.CPS.ESLO@ssa.gov American Samoa (510) 970-8247 San Francisco, CA SF.CA.RO.CPS.ESLO@ssa.gov Arizona (510) 970-8247 San Francisco, CA SF.CA.RO.CPS.ESLO@ssa.gov Arkansas (816) 936-5657 Kansas City, MO California (510) 970-8247 San Francisco, CA SF.CA.RO.CPS.ESLO@ssa.gov Colorado (303) 844-0759 Denver, CO DEN.ESLO@ssa.gov Connecticut (617) 565-2895 Boston, MA BOS.RO.CPS.ESLO@ssa.gov Delaware (215) 597-2354 Philadelphia, PA bernard.a.daniels@ssa.gov Dist. Columbia (215) 597-2354 Philadelphia, PA bernard.a.daniels@ssa.gov Florida (404) 562-1315 Atlanta, GA kirk.jockell@ssa.gov Georgia (404) 562-1315 Atlanta, GA kirk.jockell@ssa.gov Guam (510) 970-8247 San Francisco, CA SF.CA.RO.CPS.ESLO@ssa.gov Hawaii (510) 970-8247 San Francisco, CA SF.CA.RO.CPS.ESLO@ssa.gov Idaho (206) 615-2125 Seattle, WA SEA.RO.CPS.ESLO@ssa.gov Illinois (312) 575-4244 Chicago, IL paul.dieterle@ssa.gov Indiana (312) 575-4244 Chicago, IL paul.dieterle@ssa.gov Iowa (816) 936-5657 Kansas City, MO kelli.chappelow@ssa.gov Kansas (816) 936-5657 Kansas City, MO kelli.chappelow@ssa.gov Kentucky (404) 562-1315 Atlanta, GA kirk.jockell@ssa.gov Louisiana (816) 936-5657 Kansas City, MO kelli.chappelow@ssa.gov Maine (617) 565-2895 Boston, MA BOS.RO.CPS.ESLO@ssa.gov Maryland (215) 597-2354 Philadelphia, PA bernard.a.daniels@ssa.gov Massachusetts (617) 565-2895 Boston, MA BOS.RO.CPS.ESLO@ssa.gov Michigan (312) 575-4244 Chicago, IL paul.dieterle@ssa.gov Minnesota (312) 575-4244 Chicago, IL paul.dieterle@ssa.gov Mississippi (404) 562-1315 (866) 403-8014 x26239 (888) 436-2621 x16578 Atlanta, GA Meridian, MS kirk.jockell@ssa.gov sue.d.clark@ssa.gov Jackson, MS janice.m.buckley@ssa.gov kelli.chappelow@ssa.gov Missouri (816) 936-5657 Kansas City, MO kelli.chappelow@ssa.gov Montana (303) 844-0759 Denver, CO DEN.ESLO@ssa.gov Nebraska (816) 936-5657 Kansas City, MO kelli.chappelow@ssa.gov Nevada (510) 970-8247 San Francisco, CA SF.CA.RO.CPS.ESLO@ssa.gov New Hampshire (617) 565-2895 Boston, MA BOS.RO.CPS.ESLO@ssa.gov New Jersey (212) 264-1462 New York, NY elizabeth.roback@ssa.gov New Mexico (816) 936-5657 Kansas City, MO kelli.chappelow@ssa.gov New York (212) 264-1462 New York, NY elizabeth.roback@ssa.gov . Calls from North Carolina Telephone (404) 562-1315 (888) 383-1598 x21824 (866) 366-9556 x15104 Location E-mail Address Atlanta, GA Charlotte, NC kirk.jockell@ssa.gov john.h.heath@ssa.gov Goldsboro, NC ethel.barnes@ssa.gov DEN.ESLO@ssa.gov North Dakota (303) 844-0759 Denver, CO Northern Mariana Islands (510) 970-8247 San Francisco, CA SF.CA.RO.CPS.ESLO@ssa.gov Ohio (312) 575-4244 Chicago, IL paul.dieterle@ssa.gov Oklahoma (816) 936-5657 Kansas City, MO kelli.chappelow@ssa.gov Oregon (206) 615-2125 Seattle, WA SEA.RO.CPS.ESLO@ssa.gov Pennsylvania (215) 597-2354 Philadelphia, PA bernard.a.daniels@ssa.gov Puerto Rico (212) 264-1462 New York, NY elizabeth.roback@ssa.gov Rhode Island (617) 565-2895 Boston, MA BOS.RO.CPS.ESLO@ssa.gov South Carolina (404) 562-1315 Atlanta, GA kirk.jockell@ssa.gov South Dakota (303) 844-0759 Denver, CO DEN.ESLO@ssa.gov Tennessee (404) 562-1315 (866) 365-3040 x11051 Atlanta, GA Chattanooga, TN kirk.jockell@ssa.gov connie.kennedy@ssa.gov Texas (816) 936-5657 Kansas City, MO kelli.chappelow@ssa.gov Utah (303) 844-0759 Denver, CO DEN.ESLO@ssa.gov Vermont (617) 565-2895 Boston, MA BOS.RO.CPS.ESLO@ssa.gov Virgin Islands (212) 264-1462 New York, NY elizabeth.roback@ssa.gov Virginia (215) 597-2354 Philadelphia, PA bernard.a.daniels@ssa.gov Washington (206) 615-2125 Seattle, WA SEA.RO.CPS.ESLO@ssa.gov West Virginia (215) 597-2354 Philadelphia, PA bernard.a.daniels@ssa.gov Wisconsin (312) 575-4244 Chicago, IL paul.dieterle@ssa.gov Wyoming (303) 844-0759 Denver, CO DEN.ESLO@ssa.gov CPAs, Accountants, Enrolled Agents, and other third parties, may contact the Internal Revenue Service's Martinsburg Computing Center toll-free at 1-866-455-7438 (1-304-263-8700). . Employer Reporting Service Center Social Security’s toll free line for employers – 800-772-6270 For help with wage reporting questions or problems Monday thru Friday 7am to 7pm Eastern time Email – employerinfo@ssa.gov SSA National 800 Number General SSA and Wage information number – 800-772-1213 Internet General – www.socialsecurity.gov Employer – National – www.ssa.gov/employer Denver Region – www.ssa.gov/denver/ Social Security Business Services Online (File W-2s electronically, view report status, errors, and error notices, view name and social security number errors, and verify social security numbers online) www.ssa.gov/bso/bsowelcome.htm Internal Revenue Service Phone Numbers and Website eFile Help Line – 866-255-0654 General Information for individuals – 800-829-1040 General Information for businesses – 800-829-4933 Taxpayer Advocate – 877-275-8271 Website – www.irs.gov Other Useful Websites: Access to most federal forms: Department of Labor: Office of Child Support Enforcement Department of Health & Human Services U.S. Citizenship and Immigration Services Other Sites:           http://search.usa.gov/forms www.dol.gov www.acf.hhs.gov/programs/cse www.dhhs.gov http://uscis.gov www.americanpayroll.org www.paycheckcity.com www.payroll-taxes.com www.taxsites.com   IRS Web Page for Payroll Professionals The IRS hosts a page on its website for payroll professionals, consolidating a variety of payroll tax information for this target audience. The Payroll Professionals Tax Center is accessible at http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Payroll-Professionals-Tax-CenterInformation-for-Payroll-Professionals-and-Their-Clients Find links to: ï‚· Information on employment taxes for businesses including employment tax forms; ï‚· Affordable Care Act Provisions; ï‚· Worker Classification Issues (Independent Contractor vs. Employee); ï‚· Tax pro Events: Classes, phone forums, and seminars covering employment tax topics; ï‚· And much, much more! .

Social Security and Medicare Social Security Wage Base Maximum Employer Social Security Tax Maximum Employee Social Security Tax Employer Social Security Tax Rate Employee Social Security Tax Rate Medicare Wage Base Maximum Medicare Tax Medicare Tax Rate Additional Medicare Tax on wages > $200,000 Social Security Earnings Limit (under full retirement age) Social Security Earnings Limit (reach full retirement age in current year) – for earnings before the month they reach full retirement age Threshold for Election Worker Coverage Threshold for Domestic Employee Coverage Pension Plan Adjustments Maximum Limitation for annual benefit under §415(b)(1)(A) for defined benefit plans Maximum Contribution Limitation for defined contribution plans under §415(c)(1)(A) Limitations on exclusions for elective deferrals under: §402(g)(1) (applies to §401(k), and §408(k)(6) salary reduction SEPS) §403(b); non-profit employers; tax-sheltered annuities §457; state & local governments; tax exempts §408(p); SIMPLE IRA plans Catch-Up Contributions §401(k), §403(b), §457, SEP SIMPLE Limitation used in the definition of highly compensated employee under §414(q) Annual compensation limit under §401(a)(17) and §404(1); and under §408(k)(3)(C) pertaining to SEP plans Minimum annual compensation amount under §408(k)(2)(C); SEP plans Annual compensation limitation under §401(a)(17) for eligible participants in certain governmental plans that, under the plan as in effect on July 1, 1993, allowed cost-of-living adjustments to the compensation limitation under the plan under §401(a)(17) to be taken into account Compensation amounts under reg. §1.61 – 21(f)(5)(i) concerning the definition of “control employee” for fringe benefit valuation purposes (board member or officer) Compensation amounts under reg. §1.61 – 21(f)(5)(iii) concerning the definition of “control employee” for fringe benefit valuation purposes (compensation-based) High/Low Per Diem Rates High Cost Combined Rate Low Cost Combined Rate Standard Deduction – Personal Exemption Values Married, filing jointly; qualified widow(er) Married, filing separately Head of Household 2015 $118,500 $7,347.00 $7,347.00 6.2% 6.2% None None 1.45% 0.9% $15,720 $41,880 2016 $118,500 $7,347.00 $7,347.00 6.2% 6.2% None None 1.45% 0.9% $15,720 $41,880 $1,600 $1,900 $1,700 $2,000 2015 2016 $210,000 $210,000 $53,000 $53,000 $18,000 $18,000 $18,000 $12,500 $18,000 $18,000 $18,000 $12,500 $6,000 $3,000 $120,000 $6,000 $3,000 $120,000 $265,000 $265,000 $600 $395,000 $600 $395,000 $105,000 $105,000 $215,000 $215,000 Effective 10/1/2014 $259 $172 2015 $12,600 $6,300 $9,250 Effective 10/1/2015 $275 $185 2016 $12,600 $6,300 $9,300 . Single Annual Personal Exemptions $6,300 $4,000 Mileage Rates Business Charitable Activities Relocation Related Medical Related Qualified Transportation Rates Combined Commuter Highway Vehicle and Transit Passes Qualified Parking Bicycle Personal Use of Company Vehicle Cents-Per-Mile Cents-Per-Mile Maximum Values Luxury Car Value SUV Value Fleet Value – Luxury Car Fleet Value – SUV Value Commuting Value Employer-Provided Adoption Assistance Dollar Limitation Income Limitation phase-out begins Income Exclusion for U.S. Citizens Living Abroad Maximum amount of the foreign earned income exclusion Maximum amount of the foreign housing cost exclusion Housing Cost Exclusion Limitation Base Housing Amount $6,300 $4,050 2015 $0.575/mi $0.14/mile $0.23/mi $0.23/mi 2015 $130/month $250/month $20/month 2015 $0.575/mi 2016 Not yet Released By IRS $16,000 $17,500 $21,300 $22,900 $1.50 each trip 2015 $13,400 $201,010 2015 $100,800 $14,112 $30,240 $16,128 2016 $130/month $255/month $20/month Not yet Released By IRS $13,460 $241,920 Not yet Released By IRS . Selected State Contact Information State Withholding Tax Unemployment Arizona Department of Revenue Income Withholding Division PO Box 29009 Phoenix, AZ 85038-9009 602.255.3381 www.azdor.gov Department of Economic Security PO Box 6028 Phoenix, AZ 85005-6028 602.771.6601 www.azdes.gov/esa/uitax/uithome.asp Colorado Department of Revenue Taxpayer Services Division 1375 Sherman St Denver, CO 80261-0009 303.238.7378 www.colorado.gov/tax Department of Labor and Employment Unemployment Insurance Tax Operations 633 17th Street Suite 201 Denver, CO 80202-3660 303.318.8000 www.coworkforce.com/UIT Idaho State Tax Commission PO Box 36 Boise, ID 83722-0410 208.334.7660 www.tax.idaho.gov/index.cfm Department of Labor Unemployment Insurance Division 317 West Main St. Boise, ID 83735 208.332.3570 http://labor.idaho.gov Illinois Department of Revenue Willard Ice Building 101 W Jefferson St Springfield, IL 62702 217.782.3336 800.732.8866 www.revenue.state.il.us Department of Employment Security 527 South Wells St Chicago, IL 60607 800.247.4984 www.ides.state.il.us Indiana Department of Revenue Taxpayer Services Division 100 North Senate Ave Indianapolis, IN 46204 317.233.4016 www.in.gov/dor Department of Workforce Development Indiana Government Center South 10 North Senate Ave Indianapolis, IN 46204 800.437.9136 www.in.gov/dwd Iowa Department of Revenue PO Box 10465 Des Moines, IA 50306-0465 515.281.3114 www.state.ia.us/tax Workforce Development Department 1000 East Grand Ave Des Moines, IA 50319-0209 800.562.4692 www.iowaworkforce.org/ui/uiemployers.htm Minnesota Department of Revenue Mail Station 6501 St Paul, MN 55146-6501 651.282.9999 800.657.3777 www.taxes.state.mn.us Unemployment Insurance Program 1st National Bank Building 332 Minnesota St Suite E200 St Paul, MN 55101-1351 651.296.6141 www.uimn.org Montana Department of Revenue Withholding Taxes PO Box 5835 Helena, MT 59604-5835 866.859.2254 www.revenue.mt.gov Department of Labor and Economic Growth Unemployment Insurance Agency PO Box 6339 Helena, MT 59604-6339 406.444.3834 http://uid.dli.mt.gov/ . State Withholding Tax Unemployment Nebraska Department of Revenue PO Box 98915 Lincoln, NE 68509-8915 402.471.5729 www.revenue.state.ne.us Office of Unemployment Insurance 550 South 16th St PO Box 94600 Lincoln, NE 68509-4600 402.471.9898 www.dol.nebraska.gov North Dakota Office of State Tax Commissioner 600 East Boulevard Ave Dept 127 Bismarck, ND 58505-0599 701.328.3125 www.nd.gov/tax/ Job Service of North Dakota PO Box 5507 Bismarck, ND 58506-5507 800.366.6888 www.jobsnd.com/unemployment-business Oklahoma Oklahoma Tax Commission 2501 North Lincoln Boulevard Oklahoma City, OK 73194 405.521.3160 www.tax.ok.gov Department of Job and Family Services PO Box 52003 Oklahoma City, OK 73152-2003 405.525.1500 https://unemployment.state.ok.us/ South Dakota No Income Tax Department of Labor Unemployment PO Box 4730 Aberdeen, SD 57402-4730 605.626.2312 http://dlr.sd.gov/ui/ Utah State Tax Commission 210 North 1950 West Salt Lake City, UT 84134 801.297.2200 www.tax.utah.gov Division of Unemployment Insurance PO Box 45249 Salt Lake City, UT 84145-0249 801.526.9235 https://jobs.utah.gov/employer/index.html Wisconsin Department of Revenue PO Box 8902 Madison, WI 53708 608.261.6261 www.dor.state.wi.us Department of Workforce Development Unemployment Insurance Division PO Box 79051 Madison, WI 53707-7905 608.232.0633 www.dwd.wisconsin.gov . 2015 State Annual Reconciliation Returns State Alabama Arizona Arkansas California Due Date 2/1/16 Form Notes A-3 25 or more W-2 Forms and A-3 form must be filed electronically; forms filed on paper should include an adding machine tape or computer totals if a computer listing is submitted A1-R AR3MAR DE 9 Colorado 2/29/16 2/29/16 2/1/16 (for 4th Qtr return) 2/29/16 Connecticut 2/1/16 CT-W3 Delaware 2/29/16 W-3 District of Columbia Georgia 2/1/16 FR-900B 2/29/16 G-1003 Hawaii Idaho Illinois 2/29/16 2/29/16 HW-3 967 N/A Indiana Iowa 2/29/16 2/29/16 WH-3 VSP Kansas Kentucky Louisiana Maine Maryland Massachusetts 2/29/16 2/1/16 2/29/16 2/29/16 2/29/16 2/29/16 3/31/16 2/29/16 KW-3 K-3 or K-3E L-3 W-3ME MW508 M-3 or M-3M N/A 165 Missouri Montana Nebraska New Jersey New Mexico New York 2/29/16 2/29/16 3/31/16 2/29/16 2/29/16 2/1/16 2/29/16 2/29/16 2/1/16 N/A 89-140 89-140 MO W-3 MW-3 W-3N NJ-W-3M RPD-41072 NYS-45-MN North Carolina 2/1/16 NC-3 or NC3M Michigan Minnesota Mississippi DR 1093 Can be filed electronically Employers are not required to submit copies of Forms W-2; Employers will report withholding taxes, unemployment insurance, employer training tax, and state disability insurance quarterly on Form DE 9 Required for paper filed W-2 forms. Only required for electronically filed W-2s if amounts appear on lines 3A or 3B of Form DR 1093. Due date extended to 3/31/16 for Forms W-2 filed electronically via the Revenue Online System A paper form CT-W3 can be filed for employers who issue 24 or fewer W-2s W-3 automatically generate if Forms W-2 are filed electronically; due date is 3/31/16 File Form G-1003 Income Statement Transmittal Form with W-2s (Form G-1003 can be filed online) Electronic W-2 reporting by 3/31/16 for employers with > 250 employees and payroll providers Electronic required for employers with more than 25 W-2 Forms VSP form is filed through eFile & Pay or by touch-tone telephone; paper forms are not mailed and W-2 Forms are not required Do not mail W-2 forms with annual reconciliation return Paper copies; submit adding machine tape or other W-2 listing Electronic required Form MW508 needed only for paper filers, enclose W-2 forms also Paper W-2 forms with reconciliation form Machine-readable W-2 forms; reconciliation form not needed If using magnetic media, submit Form 165 separately from W-2 forms Annual reconciliation is part of e-File Minnesota transmission Due date if paper Forms W-2 are filed If Forms W-2 are filed electronically If paper copies, submit adding machine tape or computer printout If paper copies, submit an employee summary list with totals Annual report should be completed, but filing not required Deadline for 4th quarter reports; Employers are not required to submit copies of Forms W-2 Reconciliation form only needed for paper W-2 forms. If paper copies, submit adding machine tape or other W-2 listing . State Due Date 2/29/16 Form Notes 307 Ohio Oklahoma Oregon 2/29/16 3/31/16 IT-3 N/A WR Pennsylvania Rhode Island South Carolina Utah Vermont Virginia West Virginia Wisconsin 2/1/16 2/29/16 2/29/16 2/29/16 2/29/16 2/1/16 2/29/16 2/1/16 REV-1667 RI-W3 WH-1606 TC-941R WH-434 VA-6 WV/IT-103 WT-7 Reconciliation form only needed for paper W-2 forms. If paper copies, submit adding machine tape or other W-2 listing If paper copies, submit adding machine tape or other W-2 listing Employers are not required to submit copies of Form W-2 Employers do not submit copies of Forms W-2 with Form WR If paper copies, submit adding machine tape or other W-2 listing If paper copies, submit adding machine tape or other W-2 listing North Dakota Due date extended to 3/31/16 if Forms W-2 filed electronically All employers must file electronically at www.tax.virginia.gov File form electronically if 50 or more employees Due date for W-2s that do not report Wisconsin withholding are due 2/29/16. Employers and payroll transmitters filing 50 or more W-2 forms must file electronically . 2015 State Supplemental Tax Rates State Alabama Arkansas California Colorado Georgia Idaho Illinois Indiana Iowa Kansas Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska New Mexico New York NYC Resident Yonkers Resident Yonkers NonResident North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Vermont Virginia West Virginia Regular Supplemental payments Stock options and bonuses* Annual wages: under $8,000 $8,000 to $10,000 $10,001 to $12,000 $12,001 to $15,000 Over $15,000 Withhold as for federal; Use 6% if federal flat rate is used Withhold as for federal; Use 4.25% if federal flat rate is used Withhold as for federal; Use 5% if federal flat rate is used Withhold as for federal; Use 4.9% if federal flat rate is used Tax Rate 5.0% 6.9% 6.6% 10.23% 4.63% 2.0% 3.0% 4.0% 5.0% 6.0% 7.4% 3.75% 3.3% 6.0% 4.5% 5.0% 5.75% plus county w/h rate 5.15% 4.25% 6.25% 6.0% 6.0% 5.0% 4.9% 9.62% 4.25% 1.61135% 0.5% Withhold at 9% or use daily or miscellaneous withholding table 5.75% 2.05% 3.5% 5.25% 9.0% 3.07% 5.99% 7.0% Withhold at 24% of federal withholding amount Annual wages: under $10,000 $10,000 to $25,000 $25,000 to $40,000 $40,000 to $60,000 Over $60,000 5.75% 3.0% 4.0% 4.5% 6.0% 6.5% . State Wisconsin Annual wages: under $10,910 $10,910 to $21,820 $21,820 to $240,190 $240,190 and over Tax Rate 4.0% 5.84% 6.27% 7.65% *Stock appreciation rights and restricted stock grants are viewed by the California EDD as bonus payments. Arizona, Connecticut, Delaware, District of Columbia, Hawaii, Kentucky, Louisiana, Mississippi, New Jersey, and Utah do not use a different rate for state tax withholding on supplemental wages. Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington, and Wyoming do not have a state income tax. 2015 State Reciprocity Agreements State District of Columbia Illinois Indiana Iowa Kentucky Maryland Michigan Minnesota Montana New Jersey North Dakota Ohio Pennsylvania Virginia West Virginia Wisconsin States with Reciprocal Agreements Maryland and Virginia. All non-residents who work in DC can claim exemption from withholding for the DC income tax. Iowa, Kentucky, Michigan, Wisconsin Kentucky, Michigan, Ohio, Pennsylvania, Wisconsin Illinois Illinois, Indiana, Michigan, Ohio, West Virginia, Wisconsin, Virginia. Residents of Virginia are exempt from Kentucky withholding only if they commute daily to their places of work in Kentucky.

Ohio residents are not exempt if they are a shareholder employee who is a 20% or greater direct or indirect equity investor in a S corporation. District of Columbia, Pennsylvania, Virginia, West Virginia Illinois, Indiana, Kentucky, Minnesota, Ohio, Wisconsin – Employers may create their own exemption form or use the line on MI-W4 for claiming exemption from withholding. Employee should write “Reciprocal Agreement” and the state name on that line. Michigan, North Dakota North Dakota Pennsylvania Minnesota, Montana Indiana, Kentucky, Michigan, Pennsylvania, West Virginia Indiana, Maryland, New Jersey, Ohio, Virginia, West Virginia Kentucky, Maryland, District of Columbia, Pennsylvania, West Virginia* Kentucky, Maryland, Ohio, Pennsylvania, Virginia Illinois, Indiana, Kentucky, Michigan Exemption Form D-4A IL-W-5-NR WH-47 44-016 42A809 MW-507 MI-W4 MWR MT-R NJ-165 NDW-R IT-4NR REV-420 VA-4 WV/IT-104 W-220 *The agreement with DC and Kentucky cover those employees who commute daily to their places of employment in Virginia. The agreements with Pennsylvania and West Virginia cover only those employees whose sole income from Virginia is from salaries and wages which are subject o taxation by their home state. . Government of the District of Columbia Your first name Form D-4A Certificate of Nonresidence in the District of Columbia Year M.I. Last name Click here to use the form. Temporary DC address (number and street) Social security number Permanent address (number and street) City State Apartment number Zip code + 4 Country or U.S. commonwealth Signature Signature Under penalties of law, I certify that my permanent residence is not in DC and that I will not be residing in DC for 183 days or more in the tax year. Date Revised 11/06 . Instructions Who must file a Form D-4A? You must file a Form D-4A with your employer to establish that you are not a resident of DC and, therefore, not subject to DC income tax withholding. You qualify as a nonresident if: What if your resident status changes? If you become a DC resident any time after you have filed a Form D-4A with your employer, you must file a Form D-4, Employee Withholding Allowance Certificate, promptly so that the proper amount of DC income tax can be withheld from your wages. Click here to use the form. • Your permanent residence is outside DC during all of the tax year and • You do not reside in DC for 183 days or more in the tax year. Employees who are residents of DC should file a Form D-4, Employee Withholding Allowance Certificate. How do you file the Form D-4? After completing this form, give it to your employer to keep on file. . Illinois Department of Revenue IL-W-5-NR Employee’s Statement of Nonresidence in Illinois Must I complete this form? To employers: You must complete Part 1 of this form if • you are a resident of Iowa, Kentucky, Michigan, or Wisconsin, or • your spouse is in the military, you and your spouse are both residents of the same state (other than Illinois) and you are in Illinois only because your spouse is stationed here by the military, and your wages are exempt from withholding of Illinois Income Tax under the reciprocal withholding agreements between Illinois and these states or under the Military Spouses Residency Relief Act. You must file your completed Form IL-W-5-NR with your Illinois employer. If you change your state of residence, you must notify your employer within ten days. You are required to have a copy of this form on file for each employee who • is a resident of Iowa, Kentucky, Michigan, or Wisconsin; receives compensation paid in Illinois; and elects to claim exemption from withholding of Illinois Income Tax under the reciprocal withholding agreements between Illinois and these states, OR • is exempt from Illinois Income Tax on compensation under the Military Spouses Residency Relief Act. Part 1: Employee information Part 2: Employer information _____ ______ _____ - _____ _____ - _____ _____ _____ _____ _____ _____ - _____ _____ _____ _____ _____ _____ _____ Social Security number Federal employer identification number ______________________________________________________________________ Name ______________________________________________________________________ Name ______________________________________________________________________ Mailing address ______________________________________________________________________ Mailing address ______________________________________________________________________ City State ZIP ______________________________________________________________________ City State ZIP I declare under penalties of perjury that I am a resident of the state of: Iowa Kentucky Michigan Wisconsin, OR My spouse and I are residents of (write the 2-letter abbreviation for your state of residency) ____ and I am in Illinois only because my spouse is a member of the US military who is stationed in Illinois. Click here to use the form. ______________________________________________________________________ Employee’s signature IL-W-5-NR (R-12/10) Date This form is authorized under the Illinois Income Tax Act. Disclosure of this information is required. Failure to provide information may result in this form not being processed and may result in a penalty. .

Certificate of Residence Form WH-47 SF# 9686 (R/12-97) This form is to be used only by residents of States with a reciprocal tax agreement.* Indiana Employer's Name Employer TID Number Employee Name Street and City Address Social Security Number The employee swears to be a legal resident of the State of , does not own personal property in Indiana, and understands that income from salaries, wages, tips and commissions received from Indiana sources are taxable in their state of residence and not subject to Indiana Adjusted Gross Income Tax as a result of the reciprocal tax agreement with the State of . Employee further states the Indiana employer will be advised of any change in legal residence. Note: The employee understands that the employer remains responsible for withholding any applicable Indiana County taxes. Date , Employee Signature Subscribed and sworn to before me, a Notary Public in and for said County and State, this , My Commission Expires . day of Notary Public Signature My County of Residence is to be filed with and Click here to use itthe form. held by the employer. Do not send this form to the Indiana Department of Revenue *States that have reciprocal agreements with Indiana are: Kentucky, Michigan, Ohio, Pennsylvania and Wisconsin. .

Iowa Department of Revenue www.iowa.gov/tax Employee’s Full Name Employee’s Statement of Nonresidence in Iowa Social Security Number Address, City, State, ZIP Employer’s Name Employer’s Address Employer: You are required to have a copy of this form on file for each employee who is a resident of Illinois receiving compensation paid in Iowa and who claims exemption from withholding of Iowa income tax under the reciprocal agreement between Iowa and Illinois. Employee: If you are a resident of Illinois, you may claim exemption from withholding of Iowa income tax by completing this form and filing it with your employer, under the reciprocal agreement between Iowa and Illinois. Note: If you change your state of residence, you must notify your employer within 10 days. Iowa Department of Revenue www.iowa.gov/tax Employee’s Full Name Address, City, State, ZIP Employer’s Name Click here to use the form. Employer’s Address Employer: You are required to have a copy of this form on file for each employee who is a resident of Illinois receiving compensation paid in Iowa and who claims exemption from withholding of Iowa income tax under the reciprocal agreement between Iowa and Illinois. Employee: If you are a resident of Illinois, you may claim exemption from withholding of Iowa income tax by completing this form and filing it with your employer, under the reciprocal agreement between Iowa and Illinois. Note: If you change your state of residence, you must notify your employer within 10 days. Employee’s Full Name ___________________________ Date: _____/_____/_____ 44-016 (08/31/12) I hereby declare, under penalty of perjury, that I am a resident of the state of Illinois and that, pursuant to an agreement existing between that state and the state of Iowa, I claim exemption from withholding of Iowa income tax on compensation paid to me in the state of Iowa. Employee Signature: ___________________________ Date:_____/_____/_____ 44-016 (08/31/12) Employee’s Statement of Nonresidence in Iowa Social Security Number Address, City, State, ZIP Employer’s Name Employee Signature: Employee’s Statement of Nonresidence in Iowa Social Security Number Iowa Department of Revenue www.iowa.gov/tax I hereby declare, under penalty of perjury, that I am a resident of the state of Illinois and that, pursuant to an agreement existing between that state and the state of Iowa, I claim exemption from withholding of Iowa income tax on compensation paid to me in the state of Iowa. Employer’s Address Employer: You are required to have a copy of this form on file for each employee who is a resident of Illinois receiving compensation paid in Iowa and who claims exemption from withholding of Iowa income tax under the reciprocal agreement between Iowa and Illinois. Employee: If you are a resident of Illinois, you may claim exemption from withholding of Iowa income tax by completing this form and filing it with your employer, under the reciprocal agreement between Iowa and Illinois. Note: If you change your state of residence, you must notify your employer within 10 days. I hereby declare, under penalty of perjury, that I am a resident of the state of Illinois and that, pursuant to an agreement existing between that state and the state of Iowa, I claim exemption from withholding of Iowa income tax on compensation paid to me in the state of Iowa. Employee Signature: ___________________________ Date:_____/_____/_____ 44-016 (08/31/12) . COMMONWEALTH OF KENTUCKY, DEPARTMENT OF REVENUE FRANKFORT, KENTUCKY 40620 42A809 3-07 See Instructions on Reverse CERTIFICATE OF NONRESIDENCE (Please Type or Print) Name of employee ____________________________________________________ Home address____________________________________________ Number and street or rural route Social Security No. _____________________________ _________________________ City, town, or post office ________________ State __________ ZIP Code I have not been a resident of Kentucky during the year. (Check block in front of applicable statement.) I work in Kentucky and reside in: Illinois, Indiana, Michigan, West Virginia, Wisconsin Virginia and commute daily to my place of employment in Kentucky. (Must commute daily to apply.) Ohio and I am not a shareholder-employee who is a “twenty (20) percent or greater” direct or indirect equity investor in a S corporation. I hereby certify that the above information is true and complete.

I further certify that at any time I change my status as a resident of_________________________________ , I will notify my employer of such fact within ten days from date of change. Name of current state of residence _______________________________________________ _________________________________________ Signature of employee Date Click here to use the form. . MARYLAND FORM MW507 Purpose. Complete Form MW507 so that your employer can withhold the correct Maryland income tax from your pay. Consider completing a new Form MW507 each Basic Instructions. Enter on line 1 below, the number of personal exemptions you will claim on your tax return.

However, if you wish to claim more exemptions, hold), you must complete the Personal Exemption Worksheet on page 2. Complete the Personal Exemption Worksheet on page 2 to further adjust your Maryland withholding based on itemized deductions, and certain other expenses that exceed your standard deduction and are not being claimed at another job or by your spouse. However, you may claim fewer (or zero) exemptions. Additional withholding per pay period under agreement with employer.

If you are not having enough tax withheld, you may ask your employer to withhold more by entering an additional amount on line 2. Exemption from withholding. You may be entitled to claim an exemption from the withholding of Maryland income tax if: a. Last year you did not owe any Maryland Income tax and had a right to a full b.

This year you do not expect to owe any Maryland income tax and expect to have a right to a full refund of all income tax withheld. If you are eligible to claim this exemption, complete Line 3 and your employer will not withhold Maryland income tax from your wages. Students and Seasonal Employees whose annual income will be below the mini income tax return. Complete Line 4. This line is to be completed by residents of the District of Columbia, Virginia or West Virginia who are employed in Maryland and who do not maintain a place of abode in Maryland for 183 days or more. Residents of Pennsylvania who are employed in Maryland and who do not maintain a place of abode in Maryland for 183 days or more, should complete line 5 to ex empt themselves from the state portion of the withholding tax. These employees are still liable for withholding tax at the rate in effect for the Maryland county in If you are domiciled in the District of Columbia, Pennsylvania or Virginia and main tain a place of abode in Maryland for 183 days or more, you become a statutory reporting your total income.

You must apply to your domicile state for any tax credit to which you may be entitled under the reciprocal provisions of the law. If tax on wage or salary income, regardless of the length of time you may have spent in Maryland. Under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act, you may be exempt from Maryland income tax on your wages if (i) your spouse is a member of the armed forces present in Maryland in compliance with military orders; (ii) you are present in Maryland solely to be with your spouse; and (iii) you maintain your domicile in another state. If you claim exemption under the SCRA enter your state of domicile (legal residence) on Line 8; enter “EXEMPT” in the box to the right on Line 8; and attach a copy of your In addition, you must also complete and attach Form MW507M. Duties and responsibilities of employer. attachments to the Compliance Division, Compliance Programs Section, 301 West 2.

The employee claims more than 10 exemptions; 3. The employee claims an exemption from withholding because he/she had no tax liability for the preceding tax year, expects to incur no tax liability this year and the wages are expected to exceed $200 a week; 4. The employee claims an exemption from withholding on the basis of nonresi dence; or 5.

The employee claims an exemption from withholding under the Military Spouses Residency Relief Act. Click here to use the form. line 7. Pennsylvania residents of York and Adams counties may claim an exemp tion from the local withholding tax by completing line 6. Pennsylvania residents living in other local jurisdictions which do not impose an earnings or income tax on Maryland residents may claim an exemption by completing line 7.

Employees Line 4 is NOT to be used by residents of other states who are working in Maryland, because such persons are liable for Maryland income tax and withholding from Duties and responsibilities of employee. If, on any day during the calendar year, the number of withholding exemptions that the employee is entitled to claim is less than the number of exemptions claimed on the withholding exemption with the employer within 10 days after the change occurs. FORM MW507 Print full name Street Address, City, State, ZIP Single County of residence Married (surviving spouse or unmarried Head of Household) Rate Married, but withhold at Single rate 1. Total number of exemptions you are claiming not to exceed line f in Personal Exemption Worksheet on page 2.

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1. _________________ 2. Additional withholding per pay period under agreement with employer.

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_________________ 3. I claim exemption from withholding because I do not expect to owe Maryland tax. See instructions above and check boxes that apply. a.

Last year I did not owe any Maryland income tax and had a right to a full refund of all income tax withheld and b. This year I do not expect to owe any Maryland income tax and expect to have the right to a full refund of all income tax withheld. If both a and b apply, enter year applicable _____________ (year effective) Enter “EXEMPT” here . .

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I claim exemption from withholding because I am domiciled in one of the following states. Check state that applies. District of Columbia Virginia West Virginia I further certify that I do not maintain a place of abode in Maryland as described in the instructions above. Enter “EXEMPT” here.

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_________________ 5. I claim exemption from Maryland state withholding because I am domiciled in the Commonwealth of Pennsylvania and I do not maintain a place of abode in Maryland as described in the instructions on Form MW507. Enter “EXEMPT” here.

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I claim exemption from Maryland local tax because I live in a local Pennysylvania jurisdiction within York or Adams counties. Enter “EXEMPT” here and on line 4 of Form MW507. . .

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_________________ 7. I claim exemption from Maryland local tax because I live in a local Pennsylvania jurisdiction that does not impose an earnings or income tax on Maryland residents. Enter “EXEMPT” here and on line 4 of Form MW507.

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_________________ ments set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act. Enter “EXEMPT” here. .

8. _________________ Under the penalty of perjury, I further certify that I am entitled to the number of withholding allowances claimed on line 1 above, or if claiming exemption from withholding, that I am entitled to claim the exempt status on whichever line(s) I completed. Employee’s signature COM/RAD-036 14-49 Date . page 2 MARYLAND FORM MW507 Personal Exemptions Worksheet Line 1 a. Multiply the number of your personal exemptions by the value of each exemption from the table below. (Generally the value of your exemption will be $3,200; however, if your federal adjusted gross income is expected to be over $100,000, the value of your exemption may be reduced. Do not claim any personal exemptions you currently claim at another job, or any exemptions being claimed by your spouse. income tax return for the corresponding tax year. NOTE: Dependent taxpayers may not claim themselves as an exemption.

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a. _____________ b. Multiply the number of additional exemptions you are claiming for dependents 65 years old or older by the value of each exemption from the table below.

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Enter the estimated amount of your itemized deductions (excluding state and local income taxes) that retirement contributions, business losses and employee business expenses for the year. Do not claim any additional amounts you currently claim at another job or any amounts being claimed by your spouse. NOTE: Standard deduction allowance is 15% of Maryland adjusted gross income with a minimum of $1,500 and a maximum of $2,000. .

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_____________ d. Enter $1,000 for additional exemptions for taxpayer and/or spouse at least 65 years old and/or blind. .

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Divide the amount on line e by $3,200. Drop any fraction. Do not round up.

This is the maximum number of exemptions you may claim for withholding tax purposes. . .

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_____________ Click here to use the form. If Your federal AGI is Single or Married Filing Separately Your Exemption is $3,200 $100,000 or less Joint, Head of Household or Qualifying Widow(er) Your Exemption is $3,200 Over But not over $100,000 $125,000 $1,600 $3,200 $125,000 $150,000 $800 $3,200 $150,000 $175,000 $0 $1,600 $175,000 $200,000 $0 $800 $0 $0 In excess of $200,000 FEDERAL PRIVACY ACT INFORMATION numbers are used primarily to administer and enforce the individual income tax laws and to exchange Information furnished to other agencies or persons shall be used solely for the purpose of administering tax COM/RAD-036 14-49 . MI-W4 (Rev. 8-08) EMPLOYEE'S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE STATE OF MICHIGAN - DEPARTMENT OF TREASURY This certificate is for Michigan income tax withholding purposes only. You must file a revised form within 10 days if your exemptions decrease or your residency status changes from nonresident to resident. Read instructions below before completing this form. 1.

Social Security Number 2. Date of Birth Issued under P.A. 281 of 1967. 3.

Type or Print Your First Name, Middle Initial and Last Name 4. Driver License Number Home Address (No., Street, P.O. Box or Rural Route) 5.

Are you a new employee? Yes City or Town State If Yes, enter date of hire . . .

. ZIP Code No 6. Enter the number of personal and dependent exemptions you are claiming 6. 7. Additional amount you want deducted from each pay .00 (if employer agrees) 7.

$ 8. I claim exemption from withholding because (does not apply to nonresident members of flow-through entities - see instructions): a. A Michigan income tax liability is not expected this year. b. Wages are exempt from withholding. Explain: _______________________________________________________ c. Permanent home (domicile) is located in the following Renaissance Zone: _________________________________ EMPLOYEE: If you fail or refuse to file this form, your employer must withhold Michigan income tax from your wages without allowance for any exemptions.

Keep a copy of this form for your records. Under penalty of perjury, I certify that the number of withholding exemptions claimed on this certificate does not exceed the number to which I am entitled. If claiming exemption from withholding, I certify that I anticipate that I will not incur a Michigan income tax liability for this year. 9. Employee's Signature Date Employer: Complete lines 10 and 11 before sending to the Michigan Department of Treasury. INSTRUCTIONS TO EMPLOYER: Employers must report all new hires to the State 10.

Employer's Name, Address, Phone No. and Name of Contact Person of Michigan. Keep a copy of this certificate with your records.

If the employee claims 10 or more personal and dependent exemptions or claims a status exempting the employee from withholding, you must file their original MI-W4 11. Federal Employer Identification Number form with the Michigan Department of Treasury. Mail to: New Hire Operations Center, P.O. Box 85010; Lansing, MI 48908-5010. Click here to use the form. INSTRUCTIONS TO EMPLOYEE You must submit a Michigan withholding exemption certificate (form MI-W4) to your employer on or before the date that employment begins.

If you fail or refuse to submit this certificate, your employer must withhold tax from your compensation without allowance for any exemptions. Your employer is required to notify the Michigan Department of Treasury if you have claimed 10 or more personal and dependent exemptions or claimed a status which exempts you from withholding. If you hold more than one job, you may not claim the same exemptions with more than one employer. If you claim the same exemptions at more than one job, your tax will be under withheld. Line 7: You may designate additional withholding if you expect to owe more than the amount withheld. Line 6: Personal and dependent exemptions.

The total number of exemptions you claim on the MI-W4 may not exceed the number of exemptions you are entitled to claim when you file your Michigan individual income tax return. Line 8: You may claim exemption from Michigan income tax withholding ONLY if you do not anticipate a Michigan income tax liability for the current year because all of the following exist: a) your employment is less than full time, b) your personal and dependent exemption allowance exceeds your annual compensation, c) you claimed exemption from federal withholding, d) you did not incur a Michigan income tax liability for the previous year. You may also claim exemption if your permanent home (domicile) is located in a Renaissance Zone. Members of flow-through entities may not claim exemption from nonresident flow-through withholding. For more information on Renaissance Zones call the Michigan Tele-Help System, 1-800-827-4000.

Full-time students that do not satisfy all of the above requirements cannot claim exempt status. If you are married and you and your spouse are both employed, you both may not claim the same exemptions with each of your employers. Web Site Visit the Treasury Web site at: www.michigan.gov/businesstax You MUST file a new MI-W4 within 10 days if your residency status changes or if your exemptions decrease because: a) your spouse, for whom you have been claiming an exemption, is divorced or legally separated from you or claims his/her own exemption(s) on a separate certificate, or b) a dependent must be dropped for federal purposes. Line 5: If you check "Yes," enter your date of hire (mo/day/year). . MWR Reciprocity Exemption/Af davit of Residency for Tax Year 2015 For Michigan and North Dakota Residents who Work in Minnesota Read instructions on back. Please print. Employees: Complete this form and give it to your employer. Employee’s last name First name and initial Employee’s Social Security number State (check one) Zip code Permanent address Employee Information City Michigan 1 If you earned wages in Minnesota during the previous year, enter the wages you earned. $ (nearest dollar) 2 I have lived at the above residence since (month and year) Current employer’s name Employer Information . 3 Do you return to the above residence at least once a month? . .

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. . . * If your answer is NO, you do not qualify for the reciprocity exemption. 4 Were you ever a resident of Minnesota? .

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. . . Employee’s Signature North Dakota YES, from (month/year) Click here to use the form. Employer’s mailing address City to YES (month/year) NO* . Employer’s federal tax ID Employer‘s phone State Zip code I declare that the above information is correct and complete to the best of my knowledge and belief. I understand there is a $500 penalty for making false statements. Employee’s signature Date Employee’s phone Employers: Mail this form to Minnesota Revenue, Mail Station 6501, St.

Paul, MN 55146-6501. Keep a copy for your records. Note: If this form is not lled out completely, you must withhold Minnesota income tax from wages earned in Minnesota. (Rev. 11/14) NO . MONTANA MT-R New 08 13 Reciprocity Exemption from Withholding For North Dakota residents who work in Montana Employee Information First Name and Initial Last Name Social Security Number - - Permanent Address City State Zip Code Mailing Address (if different than permanent address) City State Zip Code Employee Residency Information 2. YYY Y ............................................................ 1. Was North Dakota your state of legal residence during the entire taxable year for ........................................................................................ No ............................................................................................. 3 Yes Yes No Click here to use the form. YYY Y If yes, enter the last year you were a Montana resident .......................................................................... 4. Enter the wages you earned in Montana from the employer listed below during the ........................................................................................................................... $ ___________________ Employer Information Employer Name Employer FEIN Employer’s Mailing Address Employer Phone Number ( City ) State - Zip Code Employee’s Signature _________________________________________ Signature M M D D Y Y Y Y Date Employee Employer earned in Montana. *13BS0101* *13BS0101* ( ) - Daytime Phone . NJ-165 STATE OF NEW JERSEY Department of the Treasury Division of Taxation PO Box 269 Trenton, NJ 08695-0269 12-09, R-5 EMPLOYEE’S CERTIFICATE OF NONRESIDENCE IN NEW JERSEY Please Print or Type First Name MI Last Name Social Security No. Street Address City State Zip Code PENNSYLVANIA RESIDENTS I hereby declare, under penalties of perjury, that I am a resident of the State of Pennsylvania and that, pursuant to a reciprocal agreement existing between that State and the State of New Jersey, I claim exemption from withholding of New Jersey Gross Income Tax on compensation paid to me in the State of New Jersey and authorize my employer to withhold Pennsylvania Personal Income Taxes on my behalf. Click here to use the form. Note: If you change your residence from Pennsylvania to any other state, you must notify your employer within 10 days. __________________________ (Date) _____________________________________________________________________ (Signature) MILITARY SPOUSES Under the Servicemember Civil Relief Act (SCRA), as amended by the Military Spouses Residency Relief Act, you may be exempt from New Jersey income tax on your wages if (i) your spouse is a member of the armed forces present in New Jersey in compliance with military orders; (ii) you are present in New Jersey solely to be with your spouse; and (iii) you maintain your domicile in another state. If you claim exemption under the SCRA, attach a copy of your spousal military identification card to Form NJ-165. I certify that I am not subject to New Jersey withholding. I meet the conditions set forth under the Servicemember Civil Relief Act, as amended by the Military Spouses Residency Relief Act. __________________________ (Date) _____________________________________________________________________ (Signature) NEW JERSEY EMPLOYER: You are required to have a copy of this form on file for each employee receiving compensation paid in New Jersey and who is a resident of Pennsylvania and claims exemption from withholding of New Jersey Gross Income Tax under the reciprocal agreement entered into between New Jersey and Pennsylvania or who claims exemption from withholding of New Jersey Gross Income Tax under the Servicemember Civil Relief Act, as amended by the Military Spouses Residence Relief Act. Do not forward this Form to the Division of Taxation. MAY BE REPRODUCED DO NOT FORWARD THIS FORM TO THE DIVISION OF TAXATION .

Form North Dakota Office of State Tax Commissioner NDW-R Reciprocity exemption from withholding for qualifying Minnesota and Montana residents working in North Dakota Please type or print in black or blue ink. Fill in circles completely. See instructions on back before completing For calendar year: 20 Employee information Employee's name (last, first, middle initial) Employee's social security number Employee's permanent address State (fill in applicable circle) Minnesota Montana City Zip code Employee residency information 1. I have lived at the above address since (month/day/year): Month/Day/Year 2. Will you return to the above address at least once a month? Yes No If you are a resident of Minnesota and answer "No" to this question, you do not qualify for this exemption. Click here to use the form. 3.

Were you ever a resident of North Dakota in the past three years? Yes No If yes, fill in the dates you were a North Dakota resident (month/day/year): to Month/Day/Year Month/Day/Year 4. Fill in the wages you earned in North Dakota during the previous calendar year: Employer information Current employer's name Employer's federal ID Employer's mailing address Phone number City State Zip code Employee's signature I declare under the penalties of North Dakota Century Code §12.1-11-02, which provides for a Class A misdemeanor for making a false statement in a governmental matter, that this form has been examined by me and to the best of my knowledge and belief is true, correct, and complete. Employee's signature Date signed Employee's daytime phone number Employee - Make a copy for your records. Give this completed form to your employer. Employer - Verify that the Employer's Federal ID is correct.

Make a copy for your records. Mail this form to: Office of State Tax Commissioner, 600 E Boulevard Ave., Dept. 127, Bismarck, ND 58505-0599. www.nd.gov/tax . Ohio Form IT 4NR Statement of Residency Click here to use the form. ✁ please detach here Employee’s Statement of Residency in a Reciprocity State Print full name IT 4NR Rev. 5/07 Social Security number Home address and ZIP code Ohio employers: You are required to have a copy of this form on file for each employee who is a resident of Indiana, Kentucky, West Virginia, Michigan or Pennsylvania receiving compensation paid in Ohio and who claims exemption from withholding of Ohio income tax under the reciprocal agreements between Ohio and these other states. Employees residing outside Ohio and in a state with whom Ohio has reciprocity: If you are a resident of a state with whom Ohio has reciprocity, you may claim exemption from withholding of Ohio income tax by completing this form and filing it with your employer under the reciprocal withholding agreements between Ohio and these states. Note: If you change your residence from the state specified herein to any other state, you must notify your employer within 10 days. I hereby declare, under penalties of perjury, that I am a resident of the state of and that, pursuant to an agreement existing between that state and the state of Ohio, I claim exemption from withholding of Ohio income tax on compensation paid to me in the state of Ohio. Signature Date . REV-420 AS (06-07) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF BUSINESS TRUST FUND TAXES PO BOX 280904 HARRISBURG, PA 17128-0904 EMPLOYEE'S STATEMENT OF NONRESIDENCE IN PENNSYLVANIA AND AUTHORIZATION TO WITHHOLD OTHER STATE’S INCOME TAX PLEASE PRINT OR TYPE Employer Instructions: You must keep a copy of this form on file for each employee who claims exemption from withholding of Pennsylvania Personal Income Tax on compensation received in Pennsylvania and who authorizes withholding of income tax for another state for remittance to that state. Send the bottom portion of this form to the PA Department of Revenue, Bureau of Business Trust Fund Taxes, PO BOX 280904, Harrisburg, PA 17128-0904. Photocopies of this form are acceptable. Unless the state of residence changes, it is not necessary to refile this statement each year. Employee Instructions: You must complete both portions of this form to claim an exemption from withholding of Pennsylvania Personal Income Tax and to authorize withholding of your state’s income tax.

Only residents of the states listed on this form are eligible for exemption of withholding from Pennsylvania since they are the only states with which there is a reciprocal agreement. If you change your residence from the state specified on this form, you must notify your employer and complete a new form within 10 days of that change of residence. £ CUT HERE EMPLOYER COPY (EMPLOYEE COMPLETES INFORMATION BELOW AND SIGNS) Employee name: First, Middle Initial, Last Social Security Number Home Address City State Zip Code I hereby declare that, under penalties of perjury, I am a resident of the state checked below: INDIANA MARYLAND OHIO NEW JERSEY VIRGINIA WEST VIRGINIA and that pursuant to the reciprocal agreement between those states, I claim an exemption from withholding of Pennsylvania Personal Income Tax and authorize my employer to withhold income tax for my resident state on compensation paid to me in the Commonwealth of Pennsylvania. Click here to use the form. Employee’s Signature Date (EMPLOYER COMPLETES INFORMATION BELOW) Employer Name: Federal Employer Identification Number (EIN) Business Address Telephone Number ( City £CUT HERE ) State Zip Code COPY TO BE SENT TO THE COMMONWEALTH OF PENNSYLVANIA (EMPLOYEE COMPLETES INFORMATION BELOW AND SIGNS) Employee name: First, Middle Initial, Last Social Security Number Home Address City State Zip Code I hereby declare that, under penalties of perjury, I am a resident of the state checked below: INDIANA MARYLAND OHIO NEW JERSEY VIRGINIA WEST VIRGINIA and that pursuant to the reciprocal agreement between those states, I claim an exemption from withholding of Pennsylvania Personal Income Tax and authorize my employer to withhold income tax for my resident state on compensation paid to me in the Commonwealth of Pennsylvania. Employee’s Signature Date (EMPLOYER COMPLETES INFORMATION BELOW) Employer Name: Business Address Federal Employer Identification Number (EIN) Telephone Number ( City State ) Zip Code . FORM VA-4 COMMONWEALTH OF VIRGINIA DEPARTMENT OF TAXATION PERSONAL EXEMPTION WORKSHEET (See back for instructions) 1. If you wish to claim yourself, write “1” .............................................................. _______________ 2. If you are married and your spouse is not claimed on his or her own certi cate, write “1” ...............................................................

_______________ 3. Write the number of dependents you will be allowed to claim on your income tax return (do not include your spouse) ................................... _______________ 4.

Subtotal Personal Exemptions (add lines 1 through 3) ..................................... _______________ 5. Exemptions for age (a) If you will be 65 or older on January 1, write “1” ..................................

_______________ (b) If you claimed an exemption on line 2 and your spouse will be 65 or older on January 1, write “1” ............................................ _______________ 6. Exemptions for blindness (a) If you are legally blind, write “1” ...........................................................

_______________ (b) If you claimed an exemption on line 2 and your spouse is legally blind, write “1” ........................................................... _______________ 7. Subtotal exemptions for age and blindness (add lines 5 through 6) ...................................................

______________ 8. Total of Exemptions - add line 4 and line 7 ......................................................................................... ______________ Click here to use the form. D FORM VA-4 K EMPLOYEE’S VIRGINIA INCOME TAX WITHHOLDING EXEMPTION CERTIFICATE Your Social Security Number Name Street Address City State Zip Code COMPLETE THE APPLICABLE LINES BELOW 1.

If subject to withholding, enter the number of exemptions claimed on: (a) Subtotal of Personal Exemptions - line 4 of the Personal Exemption Worksheet ........................................................................................... (b) Subtotal of Exemptions for Age and Blindness line 7 of the Personal Exemption Worksheet ....................................................................... (c) Total Exemptions - line 8 of the Personal Exemption Worksheet......................................... 2. Enter the amount of additional withholding requested (see instructions).......................................... 2601064 Rev. 08/11 3.

I certify that I am not subject to Virginia withholding. l meet the conditions set forth in the instructions ................................................................................. (check here) 4.

I certify that I am not subject to Virginia withholding. l meet the conditions set forth Under the Service member Civil Relief Act, as amended by the Military Spouses Residency Relief Act .......................................................................................... (check here) Signature Date EMPLO ER: eep exemption certi cates with your records.

If you believe the employee has claimed too many exemptions, notify the Department of Taxation, P.O. Box 1115, Richmond, Virginia 23218-1115, telephone (804) 367-8037. Note: Employers may establish a system to electronically receive orms VA-4 from employees, provided the system meets Internal Revenue Service requirements as speci ed in 31.3402(f)(5)-1(c) of the Treasury Regulations (26 CFR). .

WEST VIRGINIA EMPLOYEE’S WITHHOLDING EXEMPTION CERTIFICATE FORM WV/IT-104 Complete this form and present it to your employer to avoid any delay in adjusting the amount of state income tax to be withheld from your wages. If you do not complete this form, the amount of tax that is now being withheld from your pay may not be sufficient to cover the total amount of tax due the state when filing your personal income tax return after the close of the year. You may be subject to a penalty on tax owed the state. Individuals are permitted a maximum of one exemption for themselves, plus an additional exemption for their spouse and any dependent other than their spouse that they expect to claim on their tax return. If you are married and both you and your spouse work and you file a joint income tax return, or if you are working two or more jobs, the revised withholding tables should result in a more accurate amount of tax being withheld. If you are Single, Head of Household, or Married and your spouse does not work, and you are receiving wages from only one job, and you wish to have your tax withheld at a lower rate, you must check the box on line 5. Click here to use the form. When requesting withholding from pension and annuity payments you must present this completed form to the payor. Enter the amount you want withheld on line 6. If you determine the amount of tax being withheld is insufficient, you may reduce the number of exemptions you are claiming or request additional taxes be withheld from each payroll period. Enter the additional amount you want to have withheld on line 6. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - cut here- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - WV/IT-104 Rev.

12/09 WEST VIRGINIA EMPLOYEEE’S WITHHOLDING EXEMPTION CERTIFICATE Name________________________________________ Social Security Number ____________________________________ Address________________________________________________________________________________________________________ City________________________________________ State_____________________ Zip Code ____________________ 1. If SINGLE, and you claim an exemption, enter “1”, if you do not, enter “0 .......................................... 2. If MARRIED, one exemption each for husband and wife if not claimed on another certificate. (a) If you claim both of these exemptions, enter “2” (b) If you claim one of these exemptions, enter “1” ........................................ (c) If you claim neither of these exemptions, enter “0” 3. If you claim exemptions for one or more dependents, enter the number of such exemptions. ........... 4. Add the number of exemptions which you have claimed above and enter the total ............................ 5. If you are Single, Head of Household, or Married and your spouse does not work, and you are receiving wages from only one job, and you wish to have your tax withheld at a lower rate, check here ........... 6. Additional withholding per pay period under agreement with employer, enter amount here .............. $ Note that special withholding allowances provided on Federal Form W-4 may not be claimed on your West Virginia Form WV/IT-104 I CERTIFY, under penalties provided by law, that the number of exemptions claimed in this certificate is not in excess of those to which I am entitled. Date__________________________ Signature____________________________________________ NONRESIDENTS-SEE REVERSE SIDE .

Click here to use the form. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - cut here- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - WV/IT-104 Rev. 12/09 WEST VIRGINIA CERTIFICATE OF NONRESIDENCE This form is to be completed by employees who reside in Kentucky, Maryland, Ohio, Pennsylvania, Virginia or by an employee who is a Military Spouse exempt from income tax on wages. If you are a resident of Kentucky, Maryland, Ohio, Pennsylvania or Virginia and your only source of income from West Virginia is wages or salaries, you are exempt from West Virginia Personal Income Tax Withholding. Upon receipt of this form, properly completed, your employer is authorized to discontinue the withholding of West Virginia Income Tax from your wages or salaries earned in West Virginia. If you are a military spouse and (a) your spouse is a member of the armed forces present in West Virginia in compliance with military orders; (b) you are present in West Virginia solely to be with your spouse; and (c) you maintain your domicile in another State and you are claiming exemption under the Servicemember Civil Relief Act, enter your state of domicile (legal residence) on the following statement and attach a copy of your spousal military identification card. I certify that I am a legal resident of the state of ____________ and am not subject to West Virginia withholding because l meet the requirements set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act. Name________________________________________ Social Security Number ____________________________________ Address_______________________________________________________________________________________________ City________________________________________ State_____________________ Zip Code ____________________ I hereby certify, under penalties provided by law, that I am not a resident of West Virginia, that I reside in the State of________________and live at the address shown on this certificate, and request is hereby made to my employer to NOT withhold West Virginia income tax from wages paid to me. If at any time hereafter I become a resident of West Virginia, or otherwise lose my status of being exempt from West Virginia withholding taxes, I will properly notify my employer of such fact within ten (10) days from the date of change so that my employer may then withhold West Virginia income tax from my wages. I certify that the above statements are true, correct, and complete. Date__________________________ Signature____________________________________________ .

NONRESIDENT EMPLOYEE’S WITHHOLDING RECIPROCITY DECLARATION (To be filed with your Wisconsin employer) Employee’s Name (first name, middle initial & last name) Social Security Number I declare that while working in Wisconsin I am a legal resident of: Illinois City or Post Office State Zip Code Kentucky Indiana Employee’s Home Address (number and street) Michigan Employee’s Signature Date NOTE: THIS DECLARATION MAY ONLY BE USED BY A NONRESIDENT WORKING IN WISCONSIN WHO IS A LEGAL RESIDENT OF ILLINOIS, INDIANA, KENTUCKY, OR MICHIGAN. Reciprocal agreements Wisconsin has with Illinois, Indiana, Kentucky, and Michigan exempt legal residents of those states from Wisconsin income taxes on compensation (e.g., wages, fees, commissions) earned for personal services performed in Wisconsin. A nonresident employee qualifying for this exemption must complete and file this declaration with his or her employer as authorization for the employer to stop the withholding of Wisconsin income taxes. If the employer has withheld Wisconsin income taxes while the employee qualifies for the exemption, the employee must file a Wisconsin income tax return (Form 1NPR), during the regular filing season, requesting a refund of those income taxes. W-220 (R. 11-09) Click here to use the form. Wisconsin Department of Revenue . State Unemployment Insurance Taxable Wage Bases – 2015/2016 State/Territory 2015 2016 State/Territory 2015 2016 Alabama $8,000 $8,000 Nevada $27,800 $28,200 Alaska $38,700 $39,700 New Hampshire $14,000 $14,000 Arizona $7,000 $7,000 New Jersey $32,000 $32,600 Arkansas $12,000 $12,000 New Mexico $23,400 $24,100 California $7,000 $7,000 New York $10,500 $10,700 Colorado $11,800 $12,200 North Carolina $21,700 $22,300 Connecticut $15,000 $15,000 North Dakota $35,600 $37,200 Delaware $18,500 $18,500 Ohio $9,000 $9,000 District of Columbia $,9000 $9,000 Oklahoma $17,000 $17,500 Florida $7,000 $7,000 Oregon $35,700 $36,900 Georgia $9,500 $9,500 Pennsylvania $9,000 $9,500 Hawaii $40,900 $42,200 Puerto Rico $7,000 $7,000 Idaho $36,000 Rhode Island** $21,200/22,700 $22,000 Illinois $12,960 South Carolina $14,000 $14,000 Indiana $9,500 $9,500 South Dakota $15,000 $15,000 Iowa $27,300 $28,300 Tennessee $9,000 Kansas $12,000 $14,000 Texas $9,000 $9,000 Kentucky $9,900 $10,200 Utah $31,300 $32,200 Louisiana $7,700 $7,700 Vermont $16,400 $16,800 Maine $12,000 $12,000 Virginia $8,000 $8,000 Maryland $8,500 $8,500 Washington $42,100 $44,000 Massachusetts $15,000 $15,000 West Virginia $12,000 $12,000 Michigan* $9,000 $9,500 Wisconsin $14,000 $14,000 Minnesota $30,000 $31,000 Wyoming $24,700 $25,000 Mississippi $14,000 $14,000 Missouri $13,000 $13,000 Montana $29,500 $30,500 Nebraska $9,000 $9,000 *Michigan – Effective third quarter 2015, the taxable wage base decreases to $9,000 for contributing employers that are not delinquent on UI payments (i.e., most employers). **Rhode Island – For employers that pay at the highest UI tax rate of 9.79%, the wage base is the higher of the two. State Disability Insurance Wage Bases and Tax Rates State Hawaii Wage Base 2015 2016 $104,378 $____ (annual) (annual) $951.23(weekly) $ _____(weekly) New Jersey $32,000(annual) $32,600 (annual) New York $______ (weekly) Puerto Rico $120.00 (weekly) $9,000 (annual) Rhode Island $64,200(annual) $_____ (annual) California $_____ (annual) Contribution Rate 2015 2016 0.9% of annual wages up to ___% of annual wages up to wage base wage base Maximum of 0.5% of weekly Maximum of ___% of weekly wages up to wage base wages up to wage base 0.5% of annual wages up to ___% of annual wages up to wage base wage base 0.5% of weekly wages up to ___% of weekly wages up to maximum of $0.60 maximum of $___ 0.3% of annual wages up to ___% of annual wages up to wage base wage base 1.2% of annual wages up to ___% of annual wages up to wage base wage base . Table of State Payday Requirements State Semi-monthly Monthly Alaska X X Arizona X3 Arkansas X California Weekly X9 Bi-weekly X9 X Colorado Connecticut X X4 Delaware X District of Columbia X Georgia X Hawaii X Idaho X Illinois X Indiana Iowa X5 X X X X6 X X2 Kansas X X Kentucky X Louisiana X X7 X8 Maine Maryland X Massachusetts X X Michigan 9 X X X Mississippi Missouri Montana12 X11 X X10 Minnesota X X10 X11 X . Nebraska 13 State Weekly Bi-weekly Semi-monthly Monthly X X2 New Jersey X X21 New Mexico X X2 Nevada New Hampshire New York X X14 X14 North Carolina 15 North Dakota X Ohio X Oklahoma X Oregon X Pennsylvania 13 Rhode Island X 16 X 16 X 16 South Dakota X Tennessee X Texas X X17 Utah X18 X18 Vermont Virginia X X19 X19 X 20 X20 X2 Washington West Virginia X X Wisconsin Wyoming X X 1 Alabama and South Carolina. No regulations or not specified. 2 Illinois, Nevada, New Mexico and Virginia. Monthly payday requirements for Executive, Administrative, and Professional personnel. 3 Arizona. Payday two or more days in a month, not more than 16 days apart. 4 Connecticut.

Longer interval (up to monthly) permitted if approved by labor commissioner. . 5 Hawaii. Employees may choose to be paid on a monthly basis under special election procedure. Director of labor and industrial relations also may grant exceptions to the general semi-monthly payday requirement. Payday requirement applies only to private sector employment. 6 Iowa. Any predictable and reliable pay schedule is permitted as long as employees get paid at least monthly and no later than 12 days (excluding Sundays and legal holidays) from the end of the period when the wages were earned.

This can be waived by written agreement; employees on commission have different requirements. 7 Louisiana. Applicable to entities employing 10 or more employees that are engaged in manufacturing, mining, or boring for oil, and to every public service corporation. Payment is required no less than twice during each calendar month. 8 Maine.

Payment due at regular intervals not to exceed 16 days. 9 California and Michigan. Frequency of payday depends on the occupation. 10 Minnesota. Employees engaged in transitory employment, i.e.

migrant workers, must be paid at intervals of not more than 15 days. Employees of “public service corporations doing business within this state” are required to be paid at least semimonthly the wages earned by them to within 15 days of the date of such payment, unless prevented by inevitable casualty. 11 Mississippi. Applicable to every entity engaged in manufacturing of any kind in the State employing 50 or more employees and employing public labor, and to every public service corporation doing business in the State.

Payment is required once every two weeks or twice during each calendar month. 12 Montana. If there is not an established time period or time when wages are due and payable, the pay period is presumed to be semimonthly in length. 13 Nebraska and Pennsylvania. Payday designated by employer. 14 New York.

Weekly payday for manual workers. Semi-monthly payday upon approval for manual workers and for clerical and other workers. 15 North Carolina. None specified, pay periods may be daily, weekly, bi-weekly, semi-monthly or monthly. 16 Rhode Island.

Childcare providers shall have the option to be paid every two weeks. Effective January 1, 2014, employers that meet certain requirements outlined in Rhode Island General Law Section 28-14-2.2 may petition the Rhode Island Department of Labor and Training for permission to pay employees less frequently than weekly, but must pay wages at least twice a month. 17 Texas. Monthly payday for employees exempt from overtime provisions of the Fair Labor Standards Act. 18 Utah. Employees on a yearly salary can be paid on a monthly basis. 19 Vermont.

Employers may implement bi-weekly and semi-monthly payday with written notice. 20 Virginia. Employees whose weekly wages total more than 150 percent of the average weekly wage of the Commonwealth may be paid monthly, upon agreement of each affected employee. 21 New Jersey. Employer may pay bona fid executive, supervisory and other special classifications of employees once per month. Note: South Carolina.

Employers with 5 or more employees are required to give written notice at the time of hiring to all employees advising them of their wages agreed upon, and the time and place of payment along with their expected hours of work. The employer must pay on the normal time and at the place of payment established by the employer. Prepared By: Division of Communications Wage and Hour Division U.S. Department of Labor .

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada Final Paycheck Deadline No statute If employee is fired: within three working days. If employee quits: next regular payday at least three days after employee gives notice. (Alaska Stat. § 23.05.140.) If employee is fired: within seven working days or next payday, whichever is sooner. If employee quits: next payday. (Ariz. Rev.

Stat. Ann. § 23-353.) If employee is fired: within seven days from discharge.

(Arkansas Code § 11-4-405.) If employee is fired: immediately. If employee quits: within 72 hours, or immediately if employee has given at least 72 hours' notice. (Cal. Lab.

Code §§ 201, 202, and 227.3.) If employee is fired: immediately. (Within six hours of start of next workday, if payroll unit is closed; 24 hours if unit is offsite.) Employer decides check delivery. If employee quits: next scheduled payday. (Colo.

Rev. Stat. Ann.

§ 8-4-109.) If employee is fired: next business day after discharge. If employee quits: next scheduled payday. (Conn. Gen.

Stat. Ann. § 31-71c.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday.

(Del. Code Ann. tit.

19, § 1103.) If employee is fired: next business day. If employee quits: next scheduled payday or within seven days, whichever is sooner. (D.C. Code § 32-1303.) No statute No statute If employee is fired: immediately or next business day, if conditions prevent immediate payment. If employee quits: next scheduled payday or immediately, if employee gives one pay period's notice. (Haw.

Rev. Stat. § 388-3.) If employee is fired: next payday or within 10 days (excluding weekends & holidays) whichever is sooner.

If employee makes a written request for earlier payment, within 48 hours of receiving request (excluding weekends & holidays). If employee quits: next payday or within 10 days (excluding weekends & holidays), whichever is sooner. If employee makes a written request for earlier payment, within 48 hours of receiving request (excluding weekends & holidays). (Idaho Code §§ 45-606, 45-617.) If employee is fired: at time of separation if possible, but no later than next payday. If employee quits: at time of separation if possible, but no later than next payday. (820 Ill. Comp.

Stat. 115/5.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday. If employee has not provided a forwarding address, employer may wait until 10 days after employee demands wages or until employee provides an address where the check may be mailed.

(Ind. Code §§ 22-2-9-1 and 22-2-5-1.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday. (Iowa Code Ann.

§ 91A.4.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday. (Kan. Stat.

Ann. § 44-315.) If employee is fired: next scheduled payday or within 14 days, whichever is later. If employee quits: next scheduled payday or within 14 days, whichever is later. (Ky. Rev.

Stat. Ann. § 337.055.) If employee is fired: next payday or within 15 days, whichever is earlier. If employee quits: next payday or within 15 days, whichever is earlier. (La.

Rev. Stat. Ann.

§ 23:631.) If employee is fired: next scheduled payday or within two weeks after demand, whichever is earlier. If employee quits: next scheduled payday or within two weeks after demand, whichever is earlier. (Me. Rev. Stat.

Ann. tit. 26, § 626.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday.

(Md. Lab. & Emp.

Code Ann. § 3-505.) If employee is fired: day of discharge. If employee quits: next payday. If no scheduled payday, then following Saturday. (Mass.

Ann. Laws ch. 149 § 148.) If employee is fired: next payday. If employee quits: next payday.

(Mich. Comp. Laws §§ 408.474 and 408.475.) If employee is fired: immediately. If employee quits: next payday.

If payday is less than five days after last day of work, employer may pay on the following payday or 20 days after last day of work, whichever is earlier. (Minn. Stat. §§ 181.13 and 181.14.) No statute If employee is fired: day of discharge.

(Mo. Ann. Stat.

§ 290.110.) If employee is laid off or fired for cause: immediately. Employer may have a written policy earlier. extending this time to the next payday or within 15 days, whichever is earlier. If employee quits: next payday or within 15 days, whichever is earlier. (Mont. Code Ann.

§ 39-3-205.) If employee is fired: next scheduled payday or within two weeks, whichever is If employee quits: next payday or within two weeks, whichever is earlier. (Neb. Rev. Stat.

§ 48-1230.) If employee is fired: immediately. If employee quits: next scheduled payday or within seven days, whichever is earlier. (Nev. Rev. Stat.

§§ 608.020 and 608.030.) . State New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Final Paycheck Deadline If employee is fired: within 72 hours. If employee is laid off, employer may wait until the next payday. If employee quits: next scheduled payday or within 72 hours, if employee gives one pay period's notice. (N.H. Rev.

Stat. Ann. § 275:44.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday.

(N.J. Stat. Ann.

§ 34:11-4.3.) If employee is fired: within five days. If employee quits: next payday. (N.M. Stat.

Ann. §§ 50-4-4, 50-4-5.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday. (N.Y.

Labor Laws § 191.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday. (N.C. Gen.

Stat. § 95.25.7.) If employee is fired: next payday or within 15 days, whichever is earlier. If employee quits: next payday. (N.D.

Cent. Code § 34-14-03.) If employee is fired or quits: next regularly scheduled pay date, or within fifteen (15) days, employee who quits his or her job is entitled to receive his or her final paycheck on or before the next regularly scheduled pay date.. (Ohio Rev.

Code Ann. § 4113.15.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday. (Okla.

Stat. Ann. tit.

40, § 165.3.) If employee is fired: end of first business day after termination (must be within five days if employee submits time records to determine wages due). If employee quits: immediately, if employee has given 48 hours' notice (excluding weekends & holidays). Without notice, within five days or the next payday, whichever occurs first. (must be within five days if employee submits time records to determine wages due). (Or.

Rev. Stat. § 652.140.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday.

(43 Pa. Cons. Stat.

Ann. § 260.5.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday. (R.I.

Gen. Laws § 28-14-4.) If employee is fired: within 48 hours or next scheduled payday, but not more than 30 days. (S.C. Codified Laws § 41-10-50.) If employee is fired: next payday or when employee returns employer's property. If employee quits: next payday or when employee returns employer's property. (S.D.

Codified Laws §§ 60-11-10 and 60-11-14.) If employee is fired: next scheduled payday or within 21 days, whichever is later. If employee quits: next scheduled payday or within 21 days, whichever is later. (Tenn. Code. Ann.

§ 50-2-103.) If employee is fired: within six days. If employee quits: next payday. (Texas Code Ann., Labor § 61.014) If employee is fired: within 24 hours. If employee quits: next scheduled payday. (Utah Code Ann.

§ 34-28-5.) If employee is fired: within 72 hours. If employee quits: next scheduled payday or, if no scheduled payday exists, the next Friday. (Vt. Stat. Ann.

tit. 21, § 342.) If employee is fired: next scheduled payday. If employee quits: next scheduled payday. (Va.

Code § 40.1-29.) If employee is fired: end of next pay period. If employee quits: end of next pay period. (Wash. Rev.

Code § 49.48.010.) If employee is fired: within 72 hours. If employee quits: Immediately, if employee has given one pay period's notice; otherwise, next scheduled payday. (W. Va.

Code § 21-5-4.) If employee is fired: next payday or within one month, whichever is earlier. If termination is due to merger, relocation, or liquidation of business, within 24 hours. If employee quits: next payday. (Wis.

Stat. Ann. § 109.03.) If employee is fired: five working days. If employee quits: five working days.

(Wyo. Stat. Ann.

§ 27-4-104.) . Form W-4 (2015) Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes. Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it.

Your exemption for 2015 expires February 16, 2016. See Pub. 505, Tax Withholding and Estimated Tax. Note.

If another person can claim you as a dependent on his or her tax return, you cannot claim exemption from withholding if your income exceeds $1,050 and includes more than $350 of unearned income (for example, interest and dividends). Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee: • Is age 65 or older, • Is blind, or • Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return. The exceptions do not apply to supplemental wages greater than $1,000,000. Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet below.

The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations. Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages. Head of household.

Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information. Tax credits.

You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances. Nonwage income.

If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you have pension or annuity income, see Pub.

505 to find out if you should adjust your withholding on Form W-4 or W-4P. Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others.

See Pub. 505 for details. Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form. Check your withholding.

After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for 2015. See Pub.

505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married). Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at www.irs.gov/w4. Personal Allowances Worksheet (Keep for your records.) A Enter “1” for yourself if no one else can claim you as a dependent . .

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. A • You are single and have only one job; or Enter “1” if: B • You are married, have only one job, and your spouse does not work; or . . . • Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less. Enter “1” for your spouse.

But, you may choose to enter “-0-” if you are married and have either a working spouse or more than one job. (Entering “-0-” may help you avoid having too little tax withheld.) . .

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. . . C Enter number of dependents (other than your spouse or yourself) you will claim on your tax return .

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. D Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . . E Enter “1” if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit . .

. F (Note. Do not include child support payments. See Pub.

503, Child and Dependent Care Expenses, for details.) Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. • If your total income will be less than $65,000 ($100,000 if married), enter “2” for each eligible child; then less “1” if you have two to four eligible children or less “2” if you have five or more eligible children. G • If your total income will be between $65,000 and $84,000 ($100,000 and $119,000 if married), enter “1” for each eligible child .

. . Add lines A through G and enter total here. (Note.

This may be different from the number of exemptions you claim on your tax return.) H { B C D E F } Click here to use the form. G H For accuracy, complete all worksheets that apply. { • If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2. • If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld. • If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below. Separate here and give Form W-4 to your employer. Keep the top part for your records. Form W-4 Department of the Treasury Internal Revenue Service 1 Employee's Withholding Allowance Certificate OMB No. 1545-0074 Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the IRS.

Your employer may be required to send a copy of this form to the IRS. Your first name and middle initial Last name Home address (number and street or rural route) 2 3 Single Married 2015 Your social security number Married, but withhold at higher Single rate. Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box. City or town, state, and ZIP code 4 If your last name differs from that shown on your social security card, check here. You must call 1-800-772-1213 for a replacement card. 5 6 7 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5 Additional amount, if any, you want withheld from each paycheck .

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. 6 $ I claim exemption from withholding for 2015, and I certify that I meet both of the following conditions for exemption. • Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and • This year I expect a refund of all federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write “Exempt” here . . .

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. . . 7 Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete. Employee’s signature (This form is not valid unless you sign it.) 8 Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) For Privacy Act and Paperwork Reduction Act Notice, see page 2. Date 9 Office code (optional) Cat.

No. 10220Q 10 Employer identification number (EIN) Form W-4 (2015) . Page 2 Form W-4 (2015) Deductions and Adjustments Worksheet Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income. Enter an estimate of your 2015 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state 1 and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1951) of your income, and miscellaneous deductions. For 2015, you may have to reduce your itemized deductions if your income is over $309,900 and you are married filing jointly or are a qualifying widow(er); $284,050 if you are head of household; $258,250 if you are single and not head of household or a qualifying widow(er); or $154,950 if you are married filing separately.

See Pub. 505 for details . .

. . $12,600 if married filing jointly or qualifying widow(er) 2 Enter: $9,250 if head of household . .

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. . . $6,300 if single or married filing separately 3 Subtract line 2 from line 1.

If zero or less, enter “-0-” . . .

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. 4 Enter an estimate of your 2015 adjustments to income and any additional standard deduction (see Pub. 505) Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to 5 Withholding Allowances for 2015 Form W-4 worksheet in Pub.

505.) . . .

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. . . { 6 7 8 9 10 } Enter an estimate of your 2015 nonwage income (such as dividends or interest) .

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. Subtract line 6 from line 5. If zero or less, enter “-0-” . .

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. . Divide the amount on line 7 by $4,000 and enter the result here. Drop any fraction .

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. . . Enter the number from the Personal Allowances Worksheet, line H, page 1 .

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. . Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below.

Otherwise, stop here and enter this total on Form W-4, line 5, page 1 1 $ 2 $ 3 4 $ $ 5 6 7 8 9 $ $ $ 10 Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.) Note. Use this worksheet only if the instructions under line H on page 1 direct you here. Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1 2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than “3” .

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. . 3 Click here to use the form. If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter “-0-”) and on Form W-4, line 5, page 1.

Do not use the rest of this worksheet . . .

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. . . 1 2 3 Note.

If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill. 4 5 6 7 8 9 Enter the number from line 2 of this worksheet . .

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. . 4 Enter the number from line 1 of this worksheet . .

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. . 5 Subtract line 5 from line 4 . .

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. . Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . .

. . Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed .

. Divide line 8 by the number of pay periods remaining in 2015. For example, divide by 25 if you are paid every two weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2015. Enter the result here and on Form W-4, line 6, page 1.

This is the additional amount to be withheld from each paycheck Table 1 Married Filing Jointly 6 7 8 $ $ 9 $ Table 2 Married Filing Jointly All Others If wages from LOWEST paying job are— Enter on line 2 above If wages from LOWEST paying job are— Enter on line 2 above $0 - $6,000 6,001 - 13,000 13,001 - 24,000 24,001 - 26,000 26,001 - 34,000 34,001 - 44,000 44,001 - 50,000 50,001 - 65,000 65,001 - 75,000 75,001 - 80,000 80,001 - 100,000 100,001 - 115,000 115,001 - 130,000 130,001 - 140,000 140,001 - 150,000 150,001 and over 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 $0 - $8,000 8,001 - 17,000 17,001 - 26,000 26,001 - 34,000 34,001 - 44,000 44,001 - 75,000 75,001 - 85,000 85,001 - 110,000 110,001 - 125,000 125,001 - 140,000 140,001 and over 0 1 2 3 4 5 6 7 8 9 10 Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding.

Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires.

We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. If wages from HIGHEST paying job are— $0 75,001 135,001 205,001 360,001 405,001 - $75,000 - 135,000 - 205,000 - 360,000 - 405,000 and over Enter on line 7 above $600 1,000 1,120 1,320 1,400 1,580 All Others If wages from HIGHEST paying job are— $0 - $38,000 38,001 - 83,000 83,001 - 180,000 180,001 - 395,000 395,001 and over Enter on line 7 above $600 1,000 1,120 1,320 1,580 You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103. The average time and expenses required to complete and file this form will vary depending on individual circumstances.

For estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return. . 941 for 2015: Form (Rev. January 2015) 950114 Employer’s QUARTERLY Federal Tax Return OMB No. 1545-0029 Department of the Treasury — Internal Revenue Service Report for this Quarter of 2015 — Employer identification number (EIN) (Check one.) 1: January, February, March Name (not your trade name) 2: April, May, June Trade name (if any) 3: July, August, September 4: October, November, December Address Number Street Suite or room number Instructions and prior year forms are available at www.irs.gov/form941. City State Foreign country name ZIP code Foreign postal code Foreign province/county Read the separate instructions before you complete Form 941. Type or print within the boxes. Part 1: 1 Answer these questions for this quarter. Number of employees who received wages, tips, or other compensation for the pay period including: Mar.

12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4) 1 2 Wages, tips, and other compensation . . . . . . 2 3 Federal income tax withheld from wages, tips, and other compensation . . . . . . 3 4 If no wages, tips, and other compensation are subject to social security or Medicare tax 5a Taxable social security wages . . 5b Taxable social security tips . . . 5c Taxable Medicare wages & tips. . 5d Taxable wages & tips subject to Additional Medicare Tax withholding . . . . . . . . . . . Click here1 to use the form. Column Column 2 . . . . . × .124 = × .029 = × .009 = Add Column 2 from lines 5a, 5b, 5c, and 5d 5f Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions) 6 Total taxes before adjustments.

Add lines 3, 5e, and 5f . . . . . . . . . 7 Current quarter’s adjustment for fractions of cents . . . . . . . . . 8 Current quarter’s adjustment for sick pay . . . . . . . . 9 Current quarter’s adjustments for tips and group-term life insurance . . . . . . . . . . . . . . Check and go to line 6. . . . . × .124 = 5e . . . . . . . . . . . . . 5f . . . 6 . . . . 7 . . . . . 8 . . . . . . 9 . . . . . . . . . . . . 5e 10 Total taxes after adjustments. Combine lines 6 through 9 . 10 11 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, 944-X (PR), or 944-X (SP) filed in the current quarter . .

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. . . 11 12 Balance due.

If line 10 is more than line 11, enter the difference and see instructions 12 13 Overpayment. If line 11 is more than line 10, enter the difference . . . . Check one: . . Apply to next return. Next You MUST complete both pages of Form 941 and SIGN it. For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Send a refund. Cat. No.

17001Z Form 941 (Rev. 1-2015) . 950214 Name (not your trade name) Part 2: Employer identification number (EIN) Tell us about your deposit schedule and tax liability for this quarter. If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see Pub. 15 (Circular E), section 11. 14 Check one: Line 10 on this return is less than $2,500 or line 10 on the return for the prior quarter was less than $2,500, and you did not incur a $100,000 next-day deposit obligation during the current quarter. If line 10 for the prior quarter was less than $2,500 but line 10 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule depositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941).

Go to Part 3. You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3. Tax liability: . . . . Month 1 Month 2 Month 3 Total liability for quarter Total must equal line 10. You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941), Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Part 3: Tell us about your business.

If a question does NOT apply to your business, leave it blank. 15 If your business has closed or you stopped paying wages . . . . Check here, and Click here to use the form. If you are a seasonal employer and you do not have to file a return for every quarter of the year . . Check here. enter the final date you paid wages 16 Part 4: / / . . . . . . . . . . . . May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Yes. Designee’s name and phone number Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS. No. Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.

Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Print your name here Sign your name here Date Print your title here / / Best daytime phone Paid Preparer Use Only Check if you are self-employed Preparer’s name Date Firm’s name (or yours if self-employed) . EIN Address . PTIN Preparer’s signature . Phone City Page 2 State / / ZIP code Form 941 (Rev. 1-2015) . Form 941-V, Payment Voucher Purpose of Form Specific Instructions Complete Form 941-V, Payment Voucher, if you are making a payment with Form 941, Employer’s QUARTERLY Federal Tax Return. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. Box 1—Employer identification number (EIN). If you do not have an EIN, you may apply for one online. Go to IRS.gov and type “EIN” in the search box.

You may also apply for an EIN by faxing or mailing Form SS-4, Application for Employer Identification Number, to the IRS. If you have not received your EIN by the due date of Form 941, write “Applied For” and the date you applied in this entry space. Box 2—Amount paid. Enter the amount paid with Form 941. Box 3—Tax period.

Darken the circle identifying the quarter for which the payment is made. Darken only one circle. Box 4—Name and address. Enter your name and address as shown on Form 941. • Enclose your check or money order made payable to the "United States Treasury." Be sure to enter your EIN, "Form 941," and the tax period on your check or money order.

Do not send cash. Do not staple Form 941-V or your payment to Form 941 (or to each other). • Detach Form 941-V and send it with your payment and Form 941 to the address in the Instructions for Form 941. Note. You must also complete the entity information above Part 1 on Form 941. Making Payments With Form 941 To avoid a penalty, make your payment with Form 941 only if: • Your total taxes after adjustments for either the current quarter or the preceding quarter (Form 941, line 10) are less than $2,500, you did not incur a $100,000 next-day deposit obligation during the current quarter, and you are paying in full with a timely filed return, or • You are a monthly schedule depositor making a payment in accordance with the Accuracy of Deposits Rule.

See section 11 of Pub. 15 (Circular E), Employer's Tax Guide, for details. In this case, the amount of your payment may be $2,500 or more. Otherwise, you must make deposits by electronic funds transfer.

See section 11 of Pub. 15 (Circular E) for deposit instructions. Do not use Form 941-V to make federal tax deposits. Caution.

Use Form 941-V when making any payment with Form 941. However, if you pay an amount with Form 941 that should have been deposited, you may be subject to a penalty. See Deposit Penalties in section 11 of Pub.

15 (Circular E). Click here to use the form. Form Detach Here and Mail With Your Payment and Form 941. 941-V Payment Voucher Department of the Treasury Internal Revenue Service 1 OMB No. 1545-0029 2015 Do not staple this voucher or your payment to Form 941. Enter your employer identification number (EIN). 2 Dollars Cents Enter the amount of your payment. Make your check or money order payable to “United States Treasury” 4 Enter your business name (individual name if sole proprietor). 3 Tax Period 1st Quarter 3rd Quarter 2nd Quarter 4th Quarter Enter your address. Enter your city, state, and ZIP code or your city, foreign country name, foreign province/county, and foreign postal code. . Schedule B (Form 941): 960311 Report of Tax Liability for Semiweekly Schedule Depositors (Rev. January 2014) OMB No. 1545-0029 Department of the Treasury — Internal Revenue Service Employer identification number (EIN) Report for this Quarter... (Check one.) — 1: January, February, March Name (not your trade name) 2: April, May, June Calendar year 3: July, August, September (Also check quarter) 4: October, November, December Use this schedule to show your TAX LIABILITY for the quarter; DO NOT use it to show your deposits. When you file this form with Form 941 or Form 941-SS, DO NOT change your tax liability by adjustments reported on any Forms 941-X or 944-X.

You must fill out this form and attach it to Form 941 or Form 941-SS if you are a semiweekly schedule depositor or became one because your accumulated tax liability on any day was $100,000 or more. Write your daily tax liability on the numbered space that corresponds to the date wages were paid. See Section 11 in Pub.

15 (Circular E), Employer’s Tax Guide, for details. Month 1 1 2 3 4 5 6 7 8 . . . . . . . . 9 10 11 12 13 14 15 16 . . . 17 25 . . . 18 26 . . . 19 27 . . . 20 28 . . . 21 29 . . . 22 30 Click here to use the form. . . . 23 31 . . 24 Tax liability for Month 1 . Month 2 1 2 3 4 5 6 7 8 . . . . . . . . 9 10 11 12 13 14 15 16 . . . . . . . . 17 18 19 20 21 22 23 24 . . . . . . . . 25 26 27 28 29 30 31 . . . . . . . Tax liability for Month 2 . . . . . . . Tax liability for Month 3 . Month 3 1 2 3 4 5 6 7 8 . . . . . . . . 9 10 11 12 13 14 15 16 . . . . . . . . 17 18 19 20 21 22 23 24 . . . . . . . . 25 26 27 28 29 30 31 . Total liability for the quarter Fill in your total liability for the quarter (Month 1 + Month 2 + Month 3) Total must equal line 10 on Form 941 or Form 941-SS. For Paperwork Reduction Act Notice, see separate instructions. IRS.gov/form941 Cat. No. 11967Q . Schedule B (Form 941) (Rev.

1-2014) . Form 940 for 2015: Employer's Annual Federal Unemployment (FUTA) Tax Return Department of the Treasury — Internal Revenue Service Employer identification number — 850113 OMB No. 1545-0028 Type of Return (EIN) (Check all that apply.) Name (not your trade name) a. Amended Trade name (if any) b. Successor employer Address c.

No payments to employees in 2015 d. Final: Business closed or stopped paying wages Number Street Suite or room number Instructions and prior-year forms are available at www.irs.gov/form940. City ZIP code State Foreign country name Foreign postal code Foreign province/county Read the separate instructions before you complete this form. Please type or print within the boxes. Part 1: Tell us about your return.

If any line does NOT apply, leave it blank. See instructions before completing Part 1. 1a 1b If you had to pay state unemployment tax in one state only, enter the state abbreviation . 1a If you had to pay state unemployment tax in more than one state, you are a multi-state employer . .

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. . Total payments to all employees . 4 Payments exempt from FUTA tax . . . . . . . 7 Total taxable FUTA wages (line 3 – line 6 = line 7) (see instructions) 8 FUTA tax before adjustments (line 7 x .006 = line 8) 11 . . . . . . . . . . 4e Other . Subtotal (line 4 + line 5 = line 6) . 10 . Retirement/Pension Dependent care 6 9 . . 3 . 4 Check all that apply: 4a Fringe benefits 4c 4b 4d Group-term life insurance Total of payments made to each employee in excess of $7,000 . .

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. . 5 Part 3: Check here. Complete Schedule A (Form 940). 2 Determine your FUTA tax before adjustments. If any line does NOT apply, leave it blank. 3 5 Check here. Complete Schedule A (Form 940). . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . 6 . . . 8 Determine your adjustments.

If any line does NOT apply, leave it blank. If ALL of the taxable FUTA wages you paid were excluded from state unemployment tax, multiply line 7 by .054 (line 7 × .054 = line 9). Go to line 12 . .

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. . . 9 If SOME of the taxable FUTA wages you paid were excluded from state unemployment tax, OR you paid ANY state unemployment tax late (after the due date for filing Form 940), complete the worksheet in the instructions.

Enter the amount from line 7 of the worksheet . . 10 If credit reduction applies, enter the total from Schedule A (Form 940) Part 4: . . . . . . . . . . 11 Determine your FUTA tax and balance due or overpayment. If any line does NOT apply, leave it blank. 12 Total FUTA tax after adjustments (lines 8 + 9 + 10 + 11 = line 12) . . . . . 13 FUTA tax deposited for the year, including any overpayment applied from a prior year . 13 14 Balance due (If line 12 is more than line 13, enter the excess on line 14.) • If line 14 is more than $500, you must deposit your tax. • If line 14 is $500 or less, you may pay with this return.

(see instructions) . . 14 . . . . . . . . 12 15 . . . Overpayment (If line 13 is more than line 12, enter the excess on line 15 and check a box below.) . . .

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. 15 You MUST complete both pages of this form and SIGN it. Check one: Apply to next return. . . Send a refund. Next For Privacy Act and Paperwork Reduction Act Notice, see the back of Form 940-V, Payment Voucher. Cat. No. 11234O Form 940 (2015) .

850212 Employer identification number (EIN) Name (not your trade name) Part 5: Report your FUTA tax liability by quarter only if line 12 is more than $500. If not, go to Part 6. 16 Report the amount of your FUTA tax liability for each quarter; do NOT enter the amount you deposited. If you had no liability for a quarter, leave the line blank. 16a 1st quarter (January 1 – March 31) . . . . . . . . . . . . . . . . . 16b 16c 3rd quarter (July 1 – September 30) . . . . . . . . 16c 16d 4th quarter (October 1 – December 31) . . . . . . . . . . . . 16a 16b 2nd quarter (April 1 – June 30) . 17 . 16d Total tax liability for the year (lines 16a + 16b + 16c + 16d = line 17) 17 Part 6: Total must equal line 12. May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Yes. Designee’s name and phone number Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS No. Part 7: Click here to use the form. Sign here. You MUST complete both pages of this form and SIGN it. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that no part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments made to employees.

Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Print your name here Sign your name here Date Print your title here / Best daytime phone / Paid Preparer Use Only Check if you are self-employed Preparer’s name PTIN Preparer’s signature Date Firm’s name (or yours if self-employed) EIN Address . Phone City Page 2 State / / ZIP code Form 940 (2015) . Form 940-V, Payment Voucher Purpose of Form Specific Instructions Complete Form 940-V if you are making a payment with Form 940. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. Box 1—Employer Identification Number (EIN). If you don't have an EIN, you may apply for one online. Go to IRS.gov and type “EIN” in the search box.

You may also apply for an EIN by faxing or mailing Form SS-4 to the IRS. If you haven't received your EIN by the due date of Form 940, write “Applied For” and the date you applied in this entry space. Box 2—Amount paid. Enter the amount paid with Form 940. Box 3—Name and address.

Enter your name and address as shown on Form 940. • Enclose your check or money order made payable to “United States Treasury.” Be sure to enter your EIN, “Form 940,” and “2015” on your check or money order. Don't send cash. Don't staple Form 940-V or your payment to Form 940 (or to each other). • Detach Form 940-V and send it with your payment and Form 940 to the address provided in the Instructions for Form 940. Note: You must also complete the entity information above Part 1 on Form 940. Making Payments With Form 940 To avoid a penalty, make your payment with your 2015 Form 940 only if your FUTA tax for the fourth quarter (plus any undeposited amounts from earlier quarters) is $500 or less. If your total FUTA tax after adjustments (Form 940, line 12) is more than $500, you must make deposits by electronic funds transfer.

See When Must You Deposit Your FUTA Tax? in the Instructions for Form 940. Also see sections 11 and 14 of Pub. 15 for more information about deposits. Use Form 940-V when making any payment with Form 940.

However, if you pay an amount with Form 940 that should have been deposited, you CAUTION may be subject to a penalty. See Deposit Penalties in section 11 of Pub. 15. ! Click here to use the form. Form Detach Here and Mail With Your Payment and Form 940. 940-V Department of the Treasury Internal Revenue Service 1 Enter your employer identification number (EIN). Payment Voucher OMB No.

1545-0028 2015 Don't staple or attach this voucher to your payment. Dollars 2 Cents Enter the amount of your payment. Make your check or money order payable to “United States Treasury” 3 Enter your business name (individual name if sole proprietor). Enter your address. Enter your city, state, and ZIP code or your city, foreign country name, foreign province/county, and foreign postal code. . Schedule A (Form 940) for 2015: 860312 Multi-State Employer and Credit Reduction Information OMB No. 1545-0028 Department of the Treasury — Internal Revenue Service See the instructions on page 2. File this schedule with Form 940. — Employer identification number (EIN) Name (not your trade name) Place an “X” in the box of EVERY state in which you had to pay state unemployment tax this year. For each state with a credit reduction rate greater than zero, enter the FUTA taxable wages, multiply by the reduction rate, and enter the credit reduction amount.

Don't include in the FUTA Taxable Wages box wages that were excluded from state unemployment tax (see the instructions for Step 2). If any states don't apply to you, leave them blank. Postal Abbreviation AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS FUTA Taxable Wages . . . . . . . . . . . . . . . . . . . . . . . . . . . Reduction Rate Credit Reduction Postal Abbreviation FUTA Taxable Wages . NC . ND × .000 . NE × .000 . NH × .000 . NJ × .015 . NM × .000 . NV × .021 Click here .to use the form. NY × .000 . OH × .000 . OK × .000 . OR × .000 . PA × .000 . RI × .000 . SC × .000 . SD × .000 . TN × .000 . TX × .000 . UT × .000 . VA × .000 . VT × .000 . WA × .000 . WI × .000 . WV × .000 . WY × .000 . PR × .000 . VI × .000 . × .000 × .000 Reduction Rate . . . . . . . . . . . . . . . . . . . . . . . . . . MT Total Credit Reduction. Add all amounts shown in the Credit Reduction boxes.

Enter the total here and on Form 940, line 11 . . .

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No. 16997C Credit Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .015 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .000 × .015 . Schedule A (Form 940) 2015 . Instructions for Schedule A (Form 940) for 2015: 860412 Multi-State Employer and Credit Reduction Information Specific Instructions: Completing Schedule A Step 1. Place an “X” in the box of every state (including the District of Columbia, Puerto Rico, and the U.S. Virgin Islands) in which you had to pay state unemployment taxes this year, even if the state's credit reduction rate is zero. Note: Don't enter your state unemployment wages in the FUTA Taxable Wages box. Note: Make sure that you have applied for a state reporting number for your business. If you do not have an unemployment account in a state in which you paid wages, contact the state unemployment agency to receive one.

For a list of state unemployment agencies, visit the U.S. Department of Labor's website at www.workforcesecurity.doleta.gov/unemploy/ agencies.asp. Enter your total in the Credit Reduction box at the end of the line. The table below provides the two-letter postal abbreviations used on Schedule A. State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Postal Abbreviation AL AK AZ AR CA CO CT DE DC Postal Abbreviation State Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota MT NE NV NH NJ NM NY NC ND FL GA HI ID IL IN IA KS KY Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas OH OK OR PA RI SC SD TN TX Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri LA ME MD MA MI MN MS MO Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico U.S. Virgin Islands UT VT VA WA WV WI WY PR VI Step 2.

You are subject to credit reduction if you paid FUTA taxable wages that were also subject to state unemployment taxes in any state listed that has a credit reduction rate greater than zero. If you paid FUTA taxable wages that were also subject to state unemployment taxes in any state that is subject to credit reduction, find the line for each state. In the FUTA Taxable Wages box, enter the total FUTA taxable wages that you paid in that state. (The FUTA wage base for all states is $7,000.) However, don't include in the FUTA Taxable Wages box wages that were excluded from state unemployment tax. For example, if you paid $5,000 in FUTA taxable wages in a credit reduction state but $1,000 of those wages were excluded from state unemployment tax, report $4,000 in the FUTA Taxable Wages box for that state. 2 Step 3.

Total credit reduction To calculate the total credit reduction, add up all of the Credit Reduction boxes and enter the amount in the Total Credit Reduction box. Then enter the total credit reduction on Form 940, line 11. Example 1 You paid $20,000 in wages to each of three employees in State A. State A is subject to credit reduction at a rate of .003 (.3%). Because you paid wages in a state that is subject to credit reduction, you must complete Schedule A and file it with Form 940. Total payments to all employees in State A . . . . . . $60,000 Payments exempt from FUTA tax (see the Instructions for Form 940) . . . . . . . . Total payments made to each employee in excess of $7,000 (3 x ($20,000 - $7,000)) . . . . . . .

$39,000 . Click here to use the form. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Page Then multiply the total FUTA taxable wages by the reduction rate. Total FUTA taxable wages you paid in State A entered in the FUTA Taxable Wages box ($60,000 - $0 - $39,000) . Credit reduction rate for State A . $0 . . $21,000 . . . . . . .003 Total credit reduction for State A ($21,000 x .003) . . . . . . . . . $63 Don't include in the FUTA Taxable Wages box wages in excess of the $7,000 wage base for each employee subject to state unemployment insurance in the credit CAUTION reduction state.

The credit reduction applies only to FUTA taxable wages that were also subject to state unemployment tax. ! In this case, you would write $63.00 in the Total Credit Reduction box and then enter that amount on Form 940, line 11. Example 2 You paid $48,000 ($4,000 a month) in wages to Employee A and no payments were exempt from FUTA tax. Employee A worked in State B (not subject to credit reduction) in January and then transferred to State C (subject to credit reduction) on February 1. Because you paid wages in more than one state, you must complete Schedule A and file it with Form 940. The total payments in State B that are not exempt from FUTA tax are $4,000.

Since this payment to Employee A does not exceed the $7,000 FUTA wage base, the total FUTA taxable wages paid in State B are $4,000. The total payments in State C that are not exempt from FUTA tax are $44,000. However, $4,000 of FUTA taxable wages was paid in State B with respect to Employee A. Therefore, the total FUTA taxable wages with respect to Employee A in State C are $3,000 ($7,000 (FUTA wage base) - $4,000 (total FUTA taxable wages paid in State B)).

Enter $3,000 in the FUTA Taxable Wages box, multiply it by the Reduction Rate, and then enter the result in the Credit Reduction box. Attach Schedule A to Form 940 when you file your return. . Form 943 OMB No. 1545-0035 Employer’s Annual Federal Tax Return for Agricultural Employees 2015 Information about Form 943 and its separate instructions is at www.irs.gov/form943. Department of the Treasury Internal Revenue Service Name (as distinguished from trade name) Type or Print Employer identification number (EIN) Trade name, if any If address is different from prior return, check here. Address (number and street) City or town, state or province, country, and ZIP or foreign postal code If you do not have to file returns in the future, check here 1 2 3 4 5 6 7 8 9 10 11 12 . . . . . . . . . . . . Number of agricultural employees employed in the pay period that includes March 12, 2015 Total wages subject to social security tax . . .

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. Total deposits for 2015, including overpayment applied from a prior year and Form 943-X Click here to use the form. 13a Reserved . b Reserved . 14 15 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13b . . . 1 . . . 3 . . . 5 . . . . . . . . . . . . . . . . . . 7 8 9 10 11 12 . . . 13a Reserved . .

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. 14 Balance due. If line 11 is more than line 12, enter the difference and see the instructions . 15 $ Overpayment. If line 12 is more than line 11, enter the difference Check one: Apply to next return. Send a refund. • All filers: If line 11 is less than $2,500, do not complete line 17 or Form 943-A. • Semiweekly schedule depositors: Complete Form 943-A and check here • Monthly schedule depositors: Complete line 17 and check here 17 Monthly Summary of Federal Tax Liability.

(Do not complete if you were a semiweekly schedule depositor.) Tax liability for month A B C D E January . February . March . April . . May . . ThirdParty Designee Sign Here Paid Preparer Use Only . . . . . . . . . . Tax liability for month F G H I J June .

. July . . August . September October . . . . . . . . . . . Tax liability for month K L November . December . . . M Total liability for year (add lines A through L) . . Do you want to allow another person to discuss this return with the IRS (see separate instructions)? Designee’s name . . Yes.

Complete the following. No. Personal identification number (PIN) Phone no. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Signature Print/Type preparer’s name Print Your Name and Title Preparer’s signature Firm’s name Firm’s address For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Date Check if self-employed Date PTIN Firm’s EIN Phone no. Cat. No.

11252K Form 943 (2015) . Form 943-V, Payment Voucher Purpose of Form Specific Instructions Complete Form 943-V if you are making a payment with Form 943. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. Box 1—Employer identification number (EIN). If you don't have an EIN, you may apply for one online. Go to IRS.gov and type “EIN” in the search box.

You may also apply for an EIN by faxing or mailing Form SS-4 to the IRS. If you haven't received your EIN by the due date of Form 943, write “Applied For” and the date you applied in this entry space. Box 2—Amount paid. Enter the amount paid with Form 943. Box 3—Name and address.

Enter your name and address as shown on Form 943. • Enclose your check or money order made payable to “United States Treasury.” Be sure to enter your EIN, “Form 943,” and “2015” on your check or money order. Don't send cash. Don't attach Form 943-V or your payment to Form 943 (or to each other). • Detach Form 943-V and send it with your payment and Form 943 to the address provided in the Instructions for Form 943. Note: You must also complete the entity information above line 1 on Form 943. Making Payment With Form 943 To avoid a penalty, make your payment with your 2015 Form 943 only if: • Your total taxes after adjustments for the year (Form 943, line 11) are less than $2,500 and you are paying in full with a timely filed return, or • You are a monthly schedule depositor making a payment in accordance with the Accuracy of Deposits Rule. See section 7 of Pub.

51 for details. In this case, the amount of your payment may be $2,500 or more. Otherwise, you must make deposits by electronic funds transfer. See section 7 of Pub.

51 for deposit instructions. Don't use Form 943-V to make federal tax deposits. ! Use Form 943-V when making any payment with Form 943. However, if you pay an amount with Form 943 that should have been deposited, you may be subject to a penalty. See Deposit Penalties in section 7 of Pub.

51. CAUTION Click here to use the form. Detach Here and Mail With Your Payment and Form 943. Form 943-V Payment Voucher 2015 Don't attach this voucher or your payment to Form 943. Department of the Treasury Internal Revenue Service 1 Enter your employer identification number (EIN). OMB No. 1545-0035 2 Enter the amount of your payment . .

. Make your check or money order payable to “United States Treasury” 3 Enter your business name (individual name if sole proprietor). Enter your address. Enter your city or town, state or province, country, and ZIP or foreign postal code. Dollars Cents . Form 943-A (Rev. February 2015) Department of the Treasury Internal Revenue Service Name (as shown on Form 943) Agricultural Employer's Record of Federal Tax Liability OMB No. 1545-0035 Information about Form 943-A and its instructions is at www.irs.gov/form943a. File with Form 943 or Form 943-X. Calendar Year Employer identification number (EIN) You must complete this form if you are required to deposit on a semiweekly schedule or if your tax liability during any month was $100,000 or more. Show tax liability here, not deposits.

(The IRS gets deposit data from electronic funds transfers.) DO NOT change your tax liability by adjustments reported on any Forms 943-X. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 January Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A Total liability for month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 April Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 D Total liability for month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 February Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 March Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 B Total liability for C Total Click here month use the form. liability for month to 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 May Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 E Total liability for month For Privacy Act and Paperwork Reduction Act Notice, see the separate Instructions for Form 943. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 June Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 F Total liability for month Cat. No.

17030C Form 943-A (Rev. 2-2015) . Form 943-A (Rev. 2-2015) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 July Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 G Total liability for month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 October Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 J Total liability for month Page August Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 H Total liability for month I Total liability for month November Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Click here to use the form. K Total liability for month M Total tax liability for year (add lines A through L) . . . . . . 2 September Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 December Tax Liability 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 L Total liability for month . . . . . . . . Form 943-A (Rev. 2-2015) . Form 944 for 2015: Employer’s ANNUAL Federal Tax Return Department of the Treasury — Internal Revenue Service OMB No. 1545-2007 Who Must File Form 944 — Employer identification number (EIN) You must file annual Form 944 instead of filing quarterly Forms 941 only if the IRS notified you in writing. Instructions and prior-year forms are available at www.irs.gov/form944. Name (not your trade name) Trade name (if any) Address Number Street Suite or room number City ZIP code State Foreign country name Foreign postal code Foreign province/county Read the separate instructions before you complete Form 944. Type or print within the boxes. Part 1: Answer these questions for this year. Employers in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the U.S.

Virgin Islands, and Puerto Rico can skip lines 1 and 2. 1 Wages, tips, and other compensation . . . . . . 1 . 2 Federal income tax withheld from wages, tips, and other compensation . . . . . . 2 . 3 If no wages, tips, and other compensation are subject to social security or Medicare tax 3 Check and go to line 5. 4 Taxable social security and Medicare wages and tips: Column 1 . . . . . . . . . . . Click here to use the form. Column 2 4a Taxable social security wages . × .124 = . 4b Taxable social security tips . × .124 = . 4c Taxable Medicare wages & tips . × .029 = . . × .009 = . 4d Taxable wages & tips subject to Additional withholding . Medicare Tax . . .

. . . . . . . . . . . . . . . . 4e . 5 Total taxes before adjustments. Add lines 2 and 4e . . . . . . . . . . . . . 5 . 6 Current year’s adjustments (see instructions) . . . . . . . . . . . . . 6 . 7 Total taxes after adjustments.

Combine lines 5 and 6 . . . . . . . . . . . . . 7 . 8 Total deposits for this year, including overpayment applied from a prior year and overpayments applied from Form 944-X, 944-X (PR), 944-X (SP), 941-X, or 941-X (PR) . . 8 . 11 . 4e Add Column 2 from lines 4a, 4b, 4c, and 4d 9a . Reserved 9b . Reserved 10 Reserved 11 Balance due. If line 7 is more than line 8, enter the difference and see instructions . 12 Overpayment.

If line 8 is more than line 7, enter the difference . . . . Check one: Apply to next return. You MUST complete both pages of Form 944 and SIGN it. For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Send a refund. Next Cat. No. 39316N Form 944 (2015) .

Name (not your trade name) Employer identification number (EIN) Part 2: Tell us about your deposit schedule and tax liability for this year. 13 Check one: Line 7 is less than $2,500. Go to Part 3. Line 7 is $2,500 or more. Enter your tax liability for each month. If you are a semiweekly depositor or you accumulate $100,000 or more of liability on any day during a deposit period, you must complete Form 945-A instead of the boxes below. Apr. Jan. . 13a 13c . 13f Nov. . 13h Jun. Dec. . 13i Total liability for year.

Add lines 13a through 13l. Total must equal line 7. . 13k Sep. . . 13j Aug. . 13e Mar. Oct. . 13g May . 13b . 13d Feb. Jul. . 13l . 13m Part 3: Tell us about your business. If question 14 does NOT apply to your business, leave it blank. 14 If your business has closed or you stopped paying wages... Check here and enter the final date you paid wages. Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Click here to use the form. Yes.

Designee’s name and phone number Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS. No. Part 5: Sign Here. You MUST complete both pages of Form 944 and SIGN it. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Print your name here Sign your name here Print your title here Date Best daytime phone Paid Preparer Use Only Check if you are self-employed Preparer’s name PTIN Preparer’s signature Date Firm’s name (or yours if self-employed) EIN Address Phone City Page 2 State ZIP code Form 944 (2015) .

Form 944-V, Payment Voucher Purpose of Form Complete Form 944-V if you are making a payment with Form 944. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. Use Form 944-V when making any payment with Form 944. However, if you pay an amount with Form 944 that should have been deposited, you CAUTION may be subject to a penalty. See Deposit Penalties in section 11 of Pub.

15. ! Making Payments With Form 944 Specific Instructions To avoid a penalty, make your payment with your 2015 Form 944 only if one of the following applies. • Your net taxes for the year (Form 944, line 7) are less than $2,500 and you are paying in full with a timely filed return. • You already deposited the taxes you owed for the first, second, and third quarters of 2015, and the tax you owe for the fourth quarter of 2015 is less than $2,500, and you are paying, in full, the tax you owe for the fourth quarter of 2015 with a timely filed return. • Your net taxes for the third quarter are $2,500 or more, net taxes for the fourth quarter are less than $2,500, and you didn't incur a $100,000 next-day deposit obligation during the fourth quarter. • You are a monthly schedule depositor making a payment in accordance with the Accuracy of Deposits Rule. See section 11 of Pub. 15 for details.

In this case, the amount of your payment may be $2,500 or more. Otherwise, you must make deposits by electronic funds transfer. See section 11 of Pub. 15 for deposit instructions.

Don't use Form 944-V to make federal tax deposits. Box 1—Employer identification number (EIN). If you don't have an EIN, you may apply for one online. Go to IRS.gov and type “EIN” in the search box.

You may also apply for an EIN by faxing or mailing Form SS-4 to the IRS. If you haven't received your EIN by the due date of Form 944, write “Applied For” and the date you applied in this entry space. Box 2—Amount paid. Enter the amount paid with Form 944. Box 3—Name and address.

Enter your name and address as shown on Form 944. • Enclose your check or money order made payable to “United States Treasury” and write your EIN, “Form 944,” and “2015” on your check or money order. Don't send cash. Don't staple Form 944-V or your payment to Form 944 (or to each other). • Detach Form 944-V and send it with your payment and Form 944 to the address provided in the Instructions for Form 944. Note: You must also complete the entity information above Part 1 on Form 944. Click here to use the form. Form Detach Here and Mail With Your Payment and Form 944. 944-V Department of the Treasury Internal Revenue Service 1 Enter your employer identification number (EIN). Payment Voucher OMB No.

1545-2007 2015 Don't staple this voucher or your payment to Form 944. 2 Dollars Cents Enter the amount of your payment. Make your check or money order payable to “United States Treasury” 3 Enter your business name (individual name if sole proprietor). Enter your address. Enter your city, state, and ZIP code or your city, foreign country name, foreign province/county, and foreign postal code. . Form 945 Annual Return of Withheld Federal Income Tax OMB No. 1545-1430 For withholding reported on Forms 1099 and W-2G. 2015 For more information on income tax withholding, see Pub. 15 and Pub. 15-A. Information about Form 945 and its separate instructions is at www.irs.gov/form945. Department of the Treasury Internal Revenue Service Name (as distinguished from trade name) Employer identification number (EIN) If address is different from prior return, check here. Trade name, if any Type or Print Address (number and street) City or town, state or province, country, and ZIP or foreign postal code A If you do not have to file returns in the future, check here 1 Federal income tax withheld from pensions, annuities, IRAs, gambling winnings, etc.

. . . . . 1 2 Backup withholding . . . . . 2 3 Total taxes. If $2,500 or more, this must equal line 7M below or Form 945-A, line M . . . . . 3 4 Total deposits for 2015, including overpayment applied from a prior year and overpayment applied from Form 945-X . .

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. 4 5 Balance due. If line 3 is more than line 4, enter the difference and see the separate instructions . 5 6 Overpayment. If line 4 is more than line 3, enter the difference . . . . . . . . . . . . and enter date final payments made. . . . . . . . . . Click here to use the form. $ Apply to next return. Check one: Send a refund. • All filers: If line 3 is less than $2,500, do not complete line 7 or Form 945-A. • Semiweekly schedule depositors: Complete Form 945-A and check here .

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. • Monthly schedule depositors: Complete line 7, entries A through M, and check here . . . . . . . . . . . . . . . . . . . . . . 7 Monthly Summary of Federal Tax Liability. (Do not complete if you were a semiweekly schedule depositor.) Tax liability for month A B C D E January . February March . April . . May .

. ThirdParty Designee Sign Here . . . . . . . . . . Tax liability for month F G H I J June . . July . . August . September October . . . . . . . . . . . . . . . . Tax liability for month K November L December Phone no. . . M Total liability for year (add lines A through L ) .

. Do you want to allow another person to discuss this return with the IRS (see the instructions)? Designee’s name . . Yes. Complete the following. No. Personal identification number (PIN) Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Signature Paid Preparer Use Only Print/Type preparer’s name Print Your Name and Title Preparer’s signature Date Date Firm’s name PTIN Firm’s EIN Firm’s address For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Check if self-employed Phone no. Cat.

No. 14584B Form 945 (2015) . Form 945-V, Payment Voucher Purpose of Form Specific Instructions Complete Form 945-V if you are making a payment with Form 945. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. Box 1—Employer identification number (EIN). If you don't have an EIN, you may apply for one online. Go to IRS.gov and type “EIN” in the search box.

You may also apply for an EIN by faxing or mailing Form SS-4 to the IRS. If you haven't received your EIN by the due date of Form 945, write “Applied For” and the date you applied in this entry space. Box 2—Amount paid. Enter the amount paid with Form 945. Box 3—Name and address.

Enter your name and address as shown on Form 945. • Enclose your check or money order made payable to “United States Treasury.” Be sure to enter your EIN, “Form 945,” and “2015” on your check or money order. Don't send cash. Don't staple Form 945-V or your payment to the return (or to each other). • Detach Form 945-V and send it with your payment and Form 945 to the address provided in the Instructions for Form 945. Note: You must also complete the entity information above line A on Form 945. Making Payments With Form 945 To avoid a penalty, make your payment with your 2015 Form 945 only if: • Your total taxes for the year (Form 945, line 3) are less than $2,500 and you are paying in full with a timely filed return, or • You are a monthly schedule depositor making a payment in accordance with the Accuracy of Deposits Rule. See section 11 of Pub.

15 for details. In this case, the amount of your payment may be $2,500 or more. Otherwise, you must make deposits by electronic funds transfer. See section 11 of Pub.

15 for deposit instructions. Don't use Form 945-V to make federal tax deposits. Use Form 945-V when making any payment with Form 945. However, if you pay an amount CAUTION with Form 945 that should have been deposited, you may be subject to a penalty.

See Deposit Penalties in section 11 of Pub. 15. ! Click here to use the form. Detach Here and Mail With Your Payment and Form 945. Form 945-V Department of the Treasury Internal Revenue Service 1 Enter your employer identification number (EIN). OMB No. 1545-1430 Payment Voucher 2015 Don't attach this voucher or your payment to Form 945. 2 Enter the amount of your payment .

. Dollars Make your check or money order payable to “United States Treasury” 3 Enter your business name (individual name if sole proprietor). Enter your address. Enter your city or town, state or province, country, and ZIP or foreign postal code. Cents . Form 945-A OMB No. 1545-1430 Annual Record of Federal Tax Liability (Rev. February 2015) Information about Form 945-A and its instructions is at www.irs.gov/form945a. File with Form 945, 945-X, CT-1, CT-1 X, 944, or 944-X. Calendar Year Name (as shown on Form 945, 945-X, CT-1, CT-1 X, 944, or 944-X) Employer identification number (EIN) Department of the Treasury Internal Revenue Service You must complete this form if you are required to deposit on a semiweekly schedule or if your tax liability during any month was $100,000 or more. Show tax liability here, not deposits. (The IRS gets deposit data from electronic funds transfers.) DO NOT change your tax liability by adjustments reported on any Form 945-X, 944-X, or CT-1 X. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 D January Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total for month April Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 February Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 March Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 B Total for month C Total Click here to Liability the form.

for month Tax Liability May Tax use June Total for month For Paperwork Reduction Act Notice, see page 4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 E Total for month 17 18 19 20 21 22 23 24 25 26 27 28 29 30 F Total for month Cat. No. 14733M Form 945-A (Rev.

2-2015) . Page 2 Form 945-A (Rev. 2-2015) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 G 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 J July Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total for month October Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total for month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 August Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 H Total for month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 November Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Total for month Click here to use the form. K Total for month December Tax Liability 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 L Total for month M Total tax liability for the year (add lines A through L). This should equal line 3 on Form 945 (line 15 on Form CT-1, line 7 on Form 944). .

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941-X: Form (Rev. April 2015) Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund Department of the Treasury — Internal Revenue Service Employer identification number (EIN) OMB No. 1545-0029 Return You Are Correcting ... — Check the type of return you are correcting: 941 Name (not your trade name) 941-SS Trade name (if any) Check the ONE quarter you are correcting: Address Number Street 1: January, February, March Suite or room number 2: April, May, June City ZIP code State 3: July, August, September 4: October, November, December Foreign country name Foreign province/county Foreign postal code Read the separate instructions before completing this form. Use this form to correct errors you made on Form 941 or 941-SS.

Use a separate Form 941-X for each quarter that needs correction. Type or print within the boxes. You MUST complete all three pages.

Do not attach this form to Form 941 or 941-SS. Part 1: Select ONLY one process. See page 4 for additional guidance. 1. 2. Enter the calendar year of the quarter you are correcting: (YYYY) Enter the date you discovered errors: Adjusted employment tax return. Check this box if you underreported amounts.

Also check this box if you overreported amounts and you would like to use the adjustment process to correct the errors. You must check this box if you are correcting both underreported and overreported amounts on this form. The amount shown on line 20, if less than zero, may only be applied as a credit to your Form 941, Form 941-SS, or Form 944 for the tax period in which you are filing this form. / / (MM / DD / YYYY) Claim.

Check this box if you overreported amounts only and you would like to use the claim process to ask for a refund or abatement of the amount shown on line 20. Do not check this box if you are correcting ANY underreported amounts on this form. Click here to use the form. Part 2: Complete the certifications. 3. I certify that I have filed or will file Forms W-2, Wage and Tax Statement, or Forms W-2c, Corrected Wage and Tax Statement, as required. Note. If you are correcting underreported amounts only, go to Part 3 on page 2 and skip lines 4 and 5.

If you are correcting overreported amounts, for purposes of the certifications on lines 4 and 5, Medicare tax does not include Additional Medicare Tax. Form 941-X cannot be used to correct overreported amounts of Additional Medicare Tax unless the amounts were not withheld from employee wages or an adjustment is being made for the current year. 4. If you checked line 1 because you are adjusting overreported amounts, check all that apply.

You must check at least one box. I certify that: a. I repaid or reimbursed each affected employee for the overcollected federal income tax or Additional Medicare Tax for the current year and the overcollected social security tax and Medicare tax for current and prior years. For adjustments of employee social security tax and Medicare tax overcollected in prior years, I have a written statement from each affected employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection. b. The adjustments of social security tax and Medicare tax are for the employer’s share only. I could not find the affected employees or each affected employee did not give me a written statement that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection. c. The adjustment is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I did not withhold from employee wages. 5.

If you checked line 2 because you are claiming a refund or abatement of overreported employment taxes, check all that apply. You must check at least one box. I certify that: a. I repaid or reimbursed each affected employee for the overcollected social security tax and Medicare tax. For claims of employee social security tax and Medicare tax overcollected in prior years, I have a written statement from each affected employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection. b. I have a written consent from each affected employee stating that I may file this claim for the employee’s share of social security tax and Medicare tax. For refunds of employee social security tax and Medicare tax overcollected in prior years, I also have a written statement from each affected employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection. c. The claim for social security tax and Medicare tax is for the employer’s share only.

I could not find the affected employees; or each affected employee did not give me a written consent to file a claim for the employee’s share of social security tax and Medicare tax; or each affected employee did not give me a written statement that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection. The claim is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I did not withhold from employee wages. Next d. For Paperwork Reduction Act Notice, see the instructions. IRS.gov/form941x Cat. No. 17025J Form 941-X (Rev.

4-2015) . Name (not your trade name) Employer identification number (EIN) Correcting quarter (1, 2, 3, 4) Correcting calendar year (YYYY) Part 3: Enter the corrections for this quarter. If any line does not apply, leave it blank. Column 2 Column 1 Total corrected amount (for ALL employees) — Column 3 Amount originally reported or as previously corrected (for ALL employees) Column 4 Difference (If this amount is a negative number, use a minus sign.) = Tax correction 6. Wages, tips and other compensation (Form 941, line 2) . — . = . Use the amount in Column 1 when you prepare your Forms W-2 or Forms W-2c. 7. Federal income tax withheld from wages, tips, and other compensation (Form 941, line 3) . — . = . Copy Column 3 here . . — . = . × .124* = . 8. 9. Taxable social security wages (Form 941 or 941-SS, line 5a, Column 1) *If you are correcting a 2011 or 2012 return, use .104. If you are correcting your employer share only, use .062. See instructions. Taxable social security tips (Form 941 or 941-SS, line 5b, Column 1) — . = . . . × .124* = *If you are correcting a 2011 or 2012 return, use .104.

If you are correcting your employer share only, use .062. See instructions. 10. Taxable Medicare wages and tips (Form 941 or 941-SS, line 5c, Column 1) — . = . . . × .029* = *If you are correcting your employer share only, use .0145. See instructions. 11. Taxable wages & tips subject to Additional Medicare Tax withholding (Form 941 or 941-SS, line 5d; only for quarters beginning after December 31, 2012) — . = . . . × .009* = *Certain wages and tips reported in Column 3 should not be multiplied by .009.

See instructions. 12. Section 3121(q) Notice and Demand — Tax due on unreported tips (Form 941 or 941-SS, line 5f (line 5e for quarters ending before January 1, 2013)) 13. Tax adjustments (Form 941 or 941-SS, lines 7–9) 14. Special addition to wages for federal income tax . — . 15. Special addition to wages for social security taxes . — 16. Special addition to wages for Medicare taxes . 17. Special addition to wages for Additional Medicare Tax . 18. Combine the amounts on lines 7–17 of Column 4 19a. COBRA premium assistance payments (see instructions) 19b. Number of individuals provided COBRA premium assistance (see instructions) 20. Total. Combine the amounts on lines 18 and 19a of Column 4 . . Copy Column 3 here . . Copy Column 3 here . = . See instructions . . = . See instructions . — . = . See instructions . — . = . See instructions . — . = . Click here to use .the= form. . — . . . . . . . . . — . . . . . . . . = . . . . . . . See instructions . . = — . . . . . . . . . . . . . . . . . . If line 20 is less than zero: • If you checked line 1, this is the amount you want applied as a credit to your Form 941 for the tax period in which you are filing this form. (If you are currently filing a Form 944, Employer’s ANNUAL Federal Tax Return, see the instructions.) • If you checked line 2, this is the amount you want refunded or abated. If line 20 is more than zero, this is the amount you owe.

Pay this amount by the time you file this return. For information on how to pay, see Amount You Owe in the instructions. Next Page 2 Form 941-X (Rev. 4-2015) .

Name (not your trade name) Employer identification number (EIN) Correcting quarter (1, 2, 3, 4) Correcting calendar year (YYYY) Part 4: Explain your corrections for this quarter. 21. Check here if any corrections you entered on a line include both underreported and overreported amounts. Explain both your underreported and overreported amounts on line 23. 22. Check here if any corrections involve reclassified workers. Explain on line 23. 23. You must give us a detailed explanation of how you determined your corrections. See the instructions. Click here to use the form. Part 5: Sign here.

You must complete all three pages of this form and sign it. Under penalties of perjury, I declare that I have filed an original Form 941 or Form 941-SS and that I have examined this adjusted return or claim, including accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. ✗ Print your name here Sign your name here Date Print your title here / / Best daytime phone Paid Preparer Use Only Check if you are self-employed Preparer’s name PTIN Preparer’s signature Date Firm’s name (or yours if self-employed) EIN Address Phone City Page 3 State / . . / ZIP code Form 941-X (Rev. 4-2015) .

Type of errors you are correcting Form 941-X: Which process should you use? Underreported amounts ONLY Use the adjustment process to correct underreported amounts. • Check the box on line 1. • Pay the amount you owe from line 20 by the time you file Form 941-X. Overreported amounts ONLY The process you use depends on when you file Form 941-X. If you are filing Form 941-X MORE THAN 90 days before the period of limitations on credit or refund for Form 941 or Form 941-SS expires... Choose either the adjustment process or the claim process to correct the overreported amounts. Choose the adjustment process if you want the amount shown on line 20 credited to your Form 941, Form 941-SS, or Form 944 for the period in which you file Form 941-X. Check the box on line 1. OR Choose the claim process if you want the amount shown on line 20 refunded to you or abated. Check the box on line 2. If you are filing Form 941-X WITHIN 90 days of the expiration of the period of limitations on credit or refund for Form 941 or Form 941-SS... BOTH underreported and overreported amounts The process you use depends on when you file Form 941-X. You must use the claim process to correct the overreported amounts. Check the box on line 2. If you are filing Form 941-X MORE THAN 90 days before the period of limitations on credit or refund for Form 941 or Form 941-SS expires... Choose either the adjustment process or both the adjustment process and the claim process when you correct both underreported and overreported amounts. Click here to use the form. Choose the adjustment process if combining your underreported amounts and overreported amounts results in a balance due or creates a credit that you want applied to Form 941, Form 941-SS, or Form 944. • File one Form 941-X, and • Check the box on line 1 and follow the instructions on line 20. OR Choose both the adjustment process and the claim process if you want the overreported amount refunded to you or abated. File two separate forms. 1.

For the adjustment process, file one Form 941-X to correct the underreported amounts. Check the box on line 1. Pay the amount you owe from line 20 by the time you file Form 941-X. 2.

For the claim process, file a second Form 941-X to correct the overreported amounts. Check the box on line 2. If you are filing Form 941-X WITHIN 90 days of the expiration of the period of limitations on credit or refund for Form 941 or Form 941-SS... You must use both the adjustment process and the claim process. File two separate forms. 1. For the adjustment process, file one Form 941-X to correct the underreported amounts.

Check the box on line 1. Pay the amount you owe from line 20 by the time you file Form 941-X. 2. For the claim process, file a second Form 941-X to correct the overreported amounts.

Check the box on line 2. Page 4 Form 941-X (Rev. 4-2015) . Deductions - Analysis by Quarter (* = Cafeteria Plans ** = Pension) NAME 1 2 3 4 TOTAL ** 401(k) 0.00 * FSA 0.00 * Dependent Care 0.00 * Pretax Health 0.00 * Pretax Dental 0.00 * Pretax Vision 0.00 After-tax Health 0.00 After-tax Dental 0.00 After-tax Vision 0.00 Advances 0.00 Child Support 0.00 Misc Deduction 0.00 0.00 0.00 TOTAL 0.00 State Withholding Taxes State 1 2 3 4 WAGES 0.00 State 0.00 WAGES 0.00 STATE W/H 1 2 3 4 Click here to use the form. 0.00 0.00 TOTAL TOTAL Quarter STATE W/H 0.00 GROSS FED W/H FICA MED STATE W/H 0.00 DEDNS 0.00 NET 1 0.00 2 0.00 3 0.00 4 0.00 TOTAL 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total Taxable Wages 0.00 Pretax Deductions Tips 0.00 Total Gross Wages (should equal total wages from all 4 quarters) Social Security & Medicare Wages 1 2 3 4 TOTAL Social Security Wages 0.00 Social Security Tips 0.00 Medicare Wages & Tips 0.00 . Federal Unemployment Taxes 1 2 3 4 TOTAL Taxable Wages 0.00 Tax 0.00 0.00 0.00 0.00 0.00 State Unemployment Taxes 1 2 3 4 TOTAL State____________Taxable Wages 0.00 Tax State____________Taxable Wages 0.00 0.00 Tax Total All states taxable wages Total All states tax 0.00 0.00 1 0.00 0.00 3 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL 0.00 Less Cafeteria Plans 0.00 0.00 0.00 0.00 0.00 Less Pension 0.00 0.00 0.00 0.00 0.00 Gross Pay on 941 0.00 0.00 0.00 0.00 0.00 Add Pension 0.00 0.00 0.00 0.00 0.00 Medicare Wages 0.00 0.00 0.00 0.00 0.00 Less Tips 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Gross Wages 2 0.00 0.00 0.00 0.00 4 Add Tips Social Security Wages 0.00 Click here to use the form. 0.00 0.00 0.00 . Retention Requirements of Payroll Records Internal Revenue Service – The following records must be kept for four years after the tax due date or the actual date paid, whichever is later. • • • • • • • • • • • • • • • • • • Name, address, occupation, and social security number of each employee Total compensation and date paid including tips and non-cash payments Compensation subject to withholding for federal income, social security and Medicare tax Pay period for each compensation period Explanation of difference in total compensation and taxable compensation Employee’s W-4 Form Dates of employment (beginning and ending) Employee tip reports Wage continuation made to an absent employee by employer or third party Details of fringe benefits provided to employee Copy of employee’s request to use the cumulative method of wage withholding Adjustments or settlement of taxes Amounts and dates of tax deposits Total compensation paid to employee during calendar year Compensation subject to FUTA State unemployment contributions made All information shown on Form 940 Copies of returns filed (941, 943, W-3, Copy A of Form W-2 and returned W-2 forms) Department of Labor – The following records must be kept for three years after date of last entry. • • • • • • • • • • • • • • • Employee’s name as it appears on social security card Complete home address and date of birth if under age of 19 Sex and occupation The beginning of the employee’s work week regular rate of pay for overtime weeks Hours worked each workday and workweek Straight-time earnings including the straight-time portion of overtime earnings Overtime premium earnings Total wages paid for each pay period including additions and deductions Date of payment and pay period covered Records showing total sales volume and goods purchased Following records must be kept for two years after the last date of entry Employment and earnings records, employee hours of work, basis for determining wages and wages paid Order, shipping, and billing records showing customers orders and delivery records Wage rate tables and piece rate schedules Work time schedules that establish hours and days of employment . Department of Labor – In addition to the general requirements of both the IRS and the DOL, record retentions are mandated by several federal acts. They are:  Family and Medical Leave Act ° Basic payroll and employee data · Dates FLMA leave is taken · Hours worked by employee in last 12 months · Hours of FLMA leave for exempt employee · Copies of employee notice to employer · Copies of general and specific notes given to employees · Copies of policy regarding taking of paid and unpaid leave by employee · Documents verifying premium payments of employee benefits · Records of FLMA leave disputes between employee and employer Title VII of the Civil Rights Act of 1964 and the Americans with Disability Act of 1990 have no general record requirement under the law, but to meet the requirements all records relating to hiring, promotion, demotion, transfer, layoff or termination, rates of pay, and selection for training or apprenticeship should be kept for one year from date of action.  The Age Discrimination in Employment Act of 1967 requires that you keep the following records for three years: ° Name ° Address ° Date of birth ° Occupation ° Pay rate ° Compensation earned - Also keep the following for one year from the date of action: ° Job applications ° Resumes ° Response to advertised job openings ° Records related to the failure to hire an individual - You must also keep all records related to: ° Layoff or discharge of an employee ° Job orders submitted to a placement agency ° Employee administrated by employee physical exams used to make personnel decisions ° Job advertisements  The Immigration Reform and Control Act requires that you must retain copies of the I-9 Form for three years after the date of hire. .