2/8/2018 Print Preview

Dennis D Gieselman - 10497571 - TRH - BILLINGS, MT

W-2
Form W-2 Wage & Tax Statement 2017
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.

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

a Employee's social security number 1 Wages, tips, other compensation 2 Federal income tax withheld
532-92-4009 9826.70 371.67
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
9826.70 609.26
TRH - MANAGEMENT CORP 5 Medicare wages and tips 6 Medicare tax withheld
6040 Dutchmans Lane
9826.70 142.49
Louisville, KY 40205 7 Social security tips 8 Allocated tips
USA
0.00 0.00
b Employer identification number (EIN) 9 Verification code 10 Dependent care benefits
61-1316260 0.00
e Employee's name, address, and ZIP code 11 Nonqualified plans 13 Statutory Retirement Third-party
employee plan sick pay
Dennis D Gieselman 0.00
104 N. 31st Street
12 See instructions for box 12 14 Other
Billings, MT 59101 ANDYOUTREACH 21.50
15 State Employer's state ID No. 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
MT 805467 9826.70 259.00

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Form W-2 Wage & Tax Statement 2017

Copy 2 - To Be Filed With Employee's State, City, or Local Income Tax Return.
Department of the Treasury - Internal Revenue Service OMB No. 1545-0008
a Employee's social security number 1 Wages, tips, other compensation 2 Federal income tax withheld
532-92-4009 9826.70 371.67
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
9826.70 609.26
TRH - MANAGEMENT CORP 5 Medicare wages and tips 6 Medicare tax withheld
6040 Dutchmans Lane
9826.70 142.49
Louisville, KY 40205 7 Social security tips 8 Allocated tips
USA
0.00 0.00
b Employer identification number (EIN) 9 Verification code 10 Dependent care benefits
61-1316260 0.00
e Employee's name, address, and ZIP code 11 Nonqualified plans 13 Statutory Retirement Third-party
employee plan sick pay
Dennis D Gieselman 0.00
104 N. 31st Street
12 See instructions for box 12 14 Other
Billings, MT 59101 ANDYOUTREACH 21.50
15 State Employer's state ID No. 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
MT 805467 9826.70 259.00

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Form W-2 Wage & Tax Statement 2017

Copy C-For EMPLOYEE'S RECORDS.
This information is being furnished to the Internal Revenue Service. If you are required to file a tax return, a negligence penalty or other
sanction may be imposed on you if this income is taxable and you fail to report it.

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

a Employee's social security number 1 Wages, tips, other compensation 2 Federal income tax withheld
532-92-4009 9826.70 371.67
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
9826.70 609.26
TRH - MANAGEMENT CORP 5 Medicare wages and tips 6 Medicare tax withheld
6040 Dutchmans Lane
9826.70 142.49
Louisville, KY 40205 7 Social security tips 8 Allocated tips
USA
0.00 0.00
b Employer identification number (EIN) 9 Verification code 10 Dependent care benefits
61-1316260 0.00
e Employee's name, address, and ZIP code 11 Nonqualified plans 13 Statutory Retirement Third-party
employee plan sick pay
Dennis D Gieselman 0.00
104 N. 31st Street
12 See instructions for box 12 14 Other
Billings, MT 59101 ANDYOUTREACH 21.50
15 State Employer's state ID No. 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
MT 805467 9826.70 259.00

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1. The following information reflects your final pay statement plus employer adjustments that
comprise your W-2 statement.
Earnings Description Wages, Tips, Other Comp. Social Security Wages Medicare Wages
Gross Wages 9826.70 9826.70 9826.70
Less Exempt Wages - 0.00 - 0.00 - 0.00
Less Deferred Comp - 0.00
Less Housing/Transportation - 0.00 - 0.00 - 0.00
Less Dependent Care - 0.00 - 0.00 - 0.00
Less Sec 125 - 0.00 - 0.00 - 0.00
Less Excess Wages - 0.00
Taxable Wages 9826.70 9826.70 9826.70
(Reported on Form W2) Box 1 of W-2 Box 3 of W-2 Box 5 of W-2

2. Employee W-4 profile to change your Employee W-4 profile information, file a new W-4 with the
payroll department
FIT: S 3 SIT Res: MTSIT S 3 SIT Work: MTSIT S 3

Notice to Employee
Do you have to file? Refer to the Form 1040 instructions to Corrections. If your name, SSN, or address is incorrect, correct
determine if you are required to file a tax return. Even if you Copies B, C, and 2 and ask your employer to correct your employment
don't have to file a tax return, you may be eligible for a refund if record. Be sure to ask the employer to file Form W-2c, Corrected Wage
box 2 shows an amount or if you are eligible for any credit. and Tax Statement, with the Social Security Administration (SSA) to
correct any name, SSN, or money amount error reported to the SSA on
Earned income credit (EIC). You may be able to take the EIC Form W-2. Be sure to get your copies of Form W-2c from your
for 2017 if your adjusted gross income (AGI) is less than a employer for all corrections made so you may file them with your tax
certain amount. The amount of the credit is based on income return. If your name and SSN are correct but aren't the same as shown
and family size. Workers without children could qualify for a on your social security card, you should ask for a new card that
smaller credit. You and any qualifying children must have valid displays your correct name at any SSA office or by calling 1-800-772-
social security numbers (SSNs). You can't take the EIC if your 1213. You also may visit the SSA at www.SSA.gov.
investment income is more than the specified amount for 2017
or if income is earned for services provided while you were an Cost of employer-sponsored health coverage (if such cost is
inmate at a penal institution. For 2017 income limits and more provided by the employer). The reporting in box 12, using code DD,
information, visit www.irs.gov/eitc. Also see Pub. 596, Earned of the cost of employer-sponsored health coverage is for your
Income Credit. Any EIC that is more than your tax liability information only. The amount reported with code DD is not
is refunded to you, but only if you file a tax return. taxable.

Clergy and religious workers. If you aren't subject to social Credit for excess taxes. If you had more than one employer in 2017
security and Medicare taxes, see Pub. 517, Social Security and and more than $7,886.40 in social security and/or Tier 1 railroad
Other Information for Members of the Clergy and Religious retirement (RRTA) taxes were withheld, you may be able to claim a
Workers. credit for the excess against your federal income tax. If you had more
than one railroad employer and more than $4,630.50 in Tier 2 RRTA
tax was withheld, you also may be able to claim a credit. See your
Form 1040 or Form 1040A instructions and Pub. 505, Tax Withholding
and Estimated Tax.

Instructions for Employee

Box 1. Enter this amount on the wages line of your tax return. Box 9. If you are e-filing and if there is a code in this box, enter it
when prompted by your software. This code assists the IRS in
Box 2. Enter this amount on the federal income tax withheld validating the W-2 data submitted with your return. The code is not
line of your tax return. entered on paper-filed returns.

Box 5. You may be required to report this amount on Form Box 10. This amount includes the total dependent care benefits that
8959, Additional Medicare Tax. See Form 1040 instructions to your employer paid to you or incurred on your behalf (including
determine if you are required to complete Form 8959. amounts from a section 125 (cafeteria) plan). Any amount over $5,000
is also included in box 1. Complete Form 2441, Child and Dependent
Box 6. This amount includes the 1.45% Medicare Tax withheld Care Expenses, to compute any taxable and nontaxable amounts.
on all Medicare wages and tips shown in box 5, as well as the
0.9% Additional Medicare Tax on any of those Medicare wages Box 11. This amount is (a) reported in box 1 if it is a distribution made
and tips above $200,000. to you from a nonqualified deferred compensation or nongovernmental
section 457(b) plan, or (b) included in box 3 and/or 5 if it is a prior
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For year deferral under a nonqualified or section 457(b) plan that became
information on how to report tips on your tax return, see your taxable for social security and Medicare taxes this year because there
Form 1040 instructions. is no longer a substantial risk of forfeiture of your right to the deferred
amount. This box shouldn't be used if you had a deferral and a
You must file Form 4137, Social Security and Medicare Tax on distribution in the same calendar year. If you made a deferral and
Unreported Tip Income, with your income tax return to report at received a distribution in the same calendar year, and you are or will
least the allocated tip amount unless you can prove that you be age 62 by the end of the calendar year, your employer should file
received a smaller amount. If you have records that show the Form SSA-131, Employer Report of Special Wage Payments, with the
actual amount of tips you received, report that amount even if it Social Security Administration and give you a copy.
is more or less than the allocated tips. On Form 4137 you will
calculate the social security and Medicare tax owed on the
allocated tips shown on your Form(s) W-2 that you must report
as income and on other tips you did not report to your
employer. By filing Form 4137, your social security tips will be
credited to your social security record (used to figure your
benefits).

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Box 12. The following list explains the codes shown in box 12. P—Excludable moving expense reimbursements paid directly to
You may need this information to complete your tax return. employee (not included in boxes 1, 3, or 5).
Elective deferrals (codes D, E, F, and S) and designated Roth
contributions (codes AA, BB, and EE) under all plans are Q—Nontaxable combat pay. See the instructions for Form 1040 or
generally limited to a total of $18,000 ($12,500 if you only have Form 1040A for details on reporting this amount.
SIMPLE plans; $21,000 for section 403(b) plans if you qualify for
the 15-year rule explained in Pub. 571). Deferrals under code G R—Employer contributions to your Archer MSA. Report on Form 8853,
are limited to $18,000. Deferrals under code H are limited to Archer MSAs and Long-Term Care Insurance Contracts.
$7,000.
S—Employee salary reduction contributions under a section 408(p)
However, if you were at least age 50 in 2017, your employer SIMPLE plan (not included in box 1).
may have allowed an additional deferral of up to $6,000 ($3,000
for section 401(k)(11) and 408(p) SIMPLE plans). This additional T—Adoption benefits (not included in box 1). Complete Form 8839,
deferral amount is not subject to the overall limit on elective Qualified Adoption Expenses, to compute any taxable and nontaxable
deferrals. For code G, the limit on elective deferrals may be amounts.
higher for the last 3 years before you reach retirement age.
Contact your plan administrator for more information. Amounts V—Income from exercise of nonstatutory stock option(s) (included in
in excess of the overall elective deferral limit must be included boxes 1, 3 (up to social security wage base), and 5). See Pub. 525,
in income. See the "Wages, Salaries, Tips, etc." line instructions Taxable and Nontaxable Income, for reporting requirements.
for Form 1040.
W—Employer contributions (including amounts the employee elected
Note: If a year follows code D through H, S, Y, AA, BB, or EE, to contribute using a section 125 (cafeteria) plan) to your health
you made a make-up pension contribution for a prior year(s) savings account. Report on Form 8889, Health Savings Accounts
when you were in military service. To figure whether you made (HSAs).
excess deferrals, consider these amounts for the year shown,
not the current year. If no year is shown, the contributions are Y—Deferrals under a section 409A nonqualified deferred compensation
for the current year. plan.

A—Uncollected social security or RRTA tax on tips. Include this Z—Income under a nonqualified deferred compensation plan that fails
tax on Form 1040. See "Other Taxes" in the Form 1040 to satisfy section 409A. This amount is also included in box 1. It is
instructions. subject to an additional 20% tax plus interest. See "Other Taxes" in
the Form 1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form
1040. See "Other Taxes" in the Form 1040 instructions. AA—Designated Roth contributions under a section 401(k) plan.

C—Taxable cost of group-term life insurance over $50,000 BB—Designated Roth contributions under a section 403(b) plan.
(included in boxes 1, 3 (up to social security wage base), and
5). DD—Cost of employer-sponsored health coverage. The amount
reported with Code DD is not taxable.
D—Elective deferrals to a section 401(k) cash or deferred
arrangement. Also includes deferrals under a SIMPLE retirement EE—Designated Roth contributions under a governmental section
account that is part of a section 401(k) arrangement. 457(b) plan. This amount does not apply to contributions under a tax-
exempt organization section 457(b) plan.
E—Elective deferrals under a section 403(b) salary reduction
agreement. FF—Permitted benefits under a qualified small employer health
reimbursement arrangement.
F—Elective deferrals under a section 408(k)(6) salary reduction
SEP. Box 13. If the "Retirement plan" box is checked, special limits may
apply to the amount of traditional IRA contributions you may deduct.
G—Elective deferrals and employer contributions (including See Pub. 590-A, Contributions to Individual Retirement Arrangements
nonelective deferrals) to a section 457(b) deferred (IRAs).
compensation plan.
Box 14. Employers may use this box to report information such as
H—Elective deferrals to a section 501(c)(18)(D) tax-exempt state disability insurance taxes withheld, union dues, uniform
organization plan. See "Adjusted Gross Income" in the Form payments, health insurance premiums deducted, nontaxable income,
1040 instructions for how to deduct. educational assistance payments, or a member of the clergy's
parsonage allowance and utilities. Railroad employers use this box to
J—Nontaxable sick pay (information only, not included in boxes report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax,
1, 3, or 5). Medicare tax and Additional Medicare Tax. Include tips reported by the
employee to the employer in railroad retirement (RRTA) compensation.
K—20% excise tax on excess golden parachute payments. See
"Other Taxes" in the Form 1040 instructions. Note: Keep Copy C of Form W-2 for at least 3 years after the due
date for filing your income tax return. However, to help protect your
L—Substantiated employee business expense reimbursements social security benefits, keep Copy C until you begin receiving social
(nontaxable). security benefits, just in case there is a question about your work
record and/or earnings in a particular year.
M—Uncollected social security or RRTA tax on taxable cost of
group-term life insurance over $50,000 (former employees
only). See "Other Taxes" in the Form 1040 instructions.

N—Uncollected Medicare tax on taxable cost of group-term life

insurance over $50,000 (former employees only). See "Other
Taxes" in the Form 1040 instructions.

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