| |
Transferor:
| |
Transferor's Federal Identification Number (FIN):
00-9102603 |
SAMPLE PAYER 1 | |
5963 LAKE ST | |
DALLAS, TX 75089 | |
| |
Employee:
| |
Employee's Identification Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
Submission Type: | Original document |
Account Number (Optional): | 999999999 |
PSE-EPF Indicator: | Check box if FILER is Payment Settlement Entity (PSE) |
Merchant Category Code: | 8931 |
Transactions Reported: | Check box if TRANSACTIONS are Payment Card |
Number of Payment Transactions: | 10 |
Second TIN Notice Indicator: | |
Federal Income Tax Withheld: | $0.00 |
Gross Amount of Payment Card/Third Party Transactions: | $9,087.00 |
January Payments: | $2,585.00 |
February Payments: | $2,585.00 |
March Payments: | $3,917.00 |
April Payments: | $0.00 |
May Payments: | $0.00 |
June Payments: | $0.00 |
July Payments: | $0.00 |
August Payments: | $0.00 |
September Payments: | $0.00 |
October Payments: | $0.00 |
November Payments: | $0.00 |
December Payments: | $0.00 |
Card Not Present Transactions: | $9,087.00 |
| |
Employer:
| |
Employer Identification Number (EIN):
00-2126816 |
HILLSBOROUGH PUBLIC SCHOOLS | |
901 EAST KENNEDY BLVD | |
TAMPA, FL 33602 | |
| |
Employee:
| |
Employee's Social Security Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
Submission Type: | Original document |
Wages, Tips and Other Compensation: | $30,477.00 |
Federal Income Tax Withheld: | $5,662.00 |
Social Security Wages: | $30,477.00 |
Social Security Tax Withheld: | $1,888.00 |
Medicare Wages and Tips: | $30,477.00 |
Medicare Tax Withheld: | $441.00 |
Social Security Tips: | $0.00 |
Allocated Tips: | $0.00 |
Dependent Care Benefits: | $0.00 |
Deferred Compensation: | $0.00 |
Code "Q" Nontaxable Combat Pay: | $0.00 |
Code "W" Employer Contributions to a Health Savings Account: | $0.00 |
Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan: | $0.00 |
Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan: | $0.00 |
Code "R" Employer's Contribution to MSA: | $0.00 |
Code "S" Employer's Contribution to Simple Account: | $0.00 |
Code "T" Expenses Incurred for Qualified Adoptions: | $0.00 |
Code "V" Income from exercise of non-statutory stock options: | $0.00 |
Code "AA" Designated Roth Contributions under a Section 401(k) Plan: | $0.00 |
Code "BB" Designated Roth Contributions under a Section 403(b) Plan: | $0.00 |
Code "DD" Cost of Employer-Sponsored Health Coverage: | $0.00 |
Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan: | $0.00 |
Code "FF" Permitted benefits under a qualified small employer health reimbursement arrangement: | $0.00 |
Code "GG" Income from Qualified Equity Grants Under Section 83(i): | $0.00 |
Code "HH" Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year: | $0.00 |
Third Party Sick Pay Indicator: | Unanswered |
Retirement Plan Indicator: | Unanswered |
Statutory Employee: | Not Statutory Employee |
W2 Submission Type: | Original |
W2 WHC SSN Validation Code: | Correct SSN |
| |
Trustee:
| |
Trustee/Issuer's Federal Identification Number (FIN):
00-2345281 |
CHARLES SCHWAB | |
P.O. BOX 628291 | |
ORLANDO, FL 32862 | |
| |
Participant:
| |
Participant's Identification Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
| |
Submission Type: | Original document |
Account Number (Optional): |
271155002 |
IRA Contributions: | $0.00 |
Rollover Contributions: | $0.00 |
Roth Conversion Amount: | $0.00 |
Recharacterized Contributions: | $0.00 |
Fair Market Value of Account: | $103.00 |
Life Insurance Cost Included in Box 1: | $0.00 |
SEP Code: | Not Checked |
IRA Code: | Checked |
Simple Code: | Not Checked |
Roth IRA Code: | Not Checked |
RMD For Subsequent Year: | RMD box not checked |
RMD Date: | 00-00-0000 |
Year: | |
Postponed Contribution Code: | |
Repayments Code: | |
Fair Market Value of certain specified assets: | N/A |
SEP Contributions: | $0.00 |
SIMPLE Contributions: | $0.00 |
Roth IRA Contributions: | $0.00 |
Required Minimum Distribution Amount: | $0.00 |
Postponed Contributions: | $0.00 |
Repayment of a qualified reservist distribution or federally designated disaster withdrawal repayment: | $0.00 |
Fair Market Value of Certain Specified Assets: | $0.00 |