Form
W-2
Wage and Tax
Statement
Copy C for Employee’s Records. (See Notice to
Employee on back of Copy B)
2013
OMB No. 1545-0008
University of Pittsburgh
4200 Fifth Avenue
Pittsburgh, PA
15260
e Employee’s name, address and zip code
Darling, Elizabeth
2001 Campus Drive
Pittsburgh, PA
15213
2 Federal income tax withheld
46,379.35
7 Social security tips
8 Allocated tips
c Employer’s name, address and zip code
1 Wages, tips, other compensation
9 Advance EIC payment
0.00
3 Social security wages
0.00
5 Medicare wages and tips
0.00
12b
12d
13 Statutory
12c
4,107.00
Retirement
emp
Plan
sick pay
14 Other
14E
14G
14H
14A
14D
123-45-6789
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.
PA
15 State
25-0965591
50,908.35
Employer’s state ID number 16 State wages, tips, etc 17 State income tax
18 Local wages, tips, etc.
Box 1
Social Security Wages (FICA)
Benefit Credit
+
50.00
Imputed WR
+
+
160.00
Taxable Football Ticket
+
260.00
Taxable Moving Expense
+
1600.00
Taxable Scholarship
-
4,107.00
-
92.00
-
2,425.00
-
250.00
-
1,000.00
=
$46,379.35
Medicare Wages
$51,333.35 Salary
$51,333.35
600.00
250.00
20 Locality name
Box 5
Salary
+
+
19 Local income tax
260.00
250.00
600.00
104.00
50.00
70
1527.24
Box 3
Wages, Tips & Other Compensation
$51,333.35
50,908.35
1,562.88
4,217.27
Third-party
x
25-0965591
.00
P
d Employee’s social security number
b Employer identification number
732.05
11 Nonqualified plans
1,000.00
E
2,120.43
6 Medicare tax withheld
50,486.35
10 Dependent care benefits
12a See instructions for box 12
4 Social security tax withheld
50,486.35
7,874.00
Salary
600.00
+
600.00 Benefit Credit
+
50.00
+
160.00
Taxable Football Ticket
280.00
Taxable Moving Expense
Benefit Credit
+
50.00
+
160.00
Taxable Football Ticket
+
260.00
Taxable Moving Expense
+
Imputed WR
Imputed WR
+
1600.00
Taxable Scholarship
+
1 600.00 Taxable Scholarship
+
250.00
University Provided Car
+
-
92.00
Parking
-
92.00
HlthCare Spending Fund
-
2,425.00
Med/Dent/Vision
-
250.00
Med/Dent/Vision
Dependent Care
-
1,000.00
Dependent Care
Amount subject to FICA
(Social Security + Medicare)
=
University Provided Car
250.00
University Provided Car
Tax Deferred Retirement
Parking
Parking
-
2,425.00
-
250.00
HlthCare Spending Fund
HlthCare Spending Fund
Med/Dent/Vision
-
1,000.00
=
$50,486.35
Dependent Care
Amount subject to Federal
Income Tax
Box 2
Federal Income Tax Withheld FIT
Total Federal Income tax withheld for the tax year.
$50,486.35 Amount subject to Federal Income Tax
Note: Total FICA Wage Base Not to
Exceed $113,700
Box 4
Social Security Tax Withheld (FICA)
Amount in Box 3 X FICA rate of 6.2%.
Box e
Employee’s Name & Address
Employee’s name and address as it appears in the Payroll Master File.
Box 6
Medicare Tax Withheld
Amount in Box 5 X rate of 1.45%
*Additional .9% for compensation
exceeding $200,000
Box 9
Box 17
Box 13
Advance EIC Payment
State Income Tax
Retirement Plan
An “X” indicates that employee
participated in retirement plan.
Amount paid to the employee as
Earned Income Credit advance
payment (Form W-5).
Total state income tax withheld for the tax year.
Box 14
Box 10
Local Wages, Tips, Etc.
Dependent Care Benefits
Code
14A
Amount paid for dependent care benefit.
Description
Basketball Tickets
Football Tickets
Scholar Med
Scholar Med Refund
Executive Misc
Imp Fed OAD
Imp State OAD
Imputed General Income
Imputed Medical
WR Imputed Income
WR Imputed Income 2
NonQualified Moving Expense
Pers Clubs
Pers Company Car
Scholarship
Scholarship Dependent
Scholarship1 Dependent
Scholar ADD
Scholar ADD Refund
Scholar Life
Scholar Life Refund
Scholar Bus Pass
Scholar Bus Pass Refund
Local Service Tax (LST)
14B
14C
14D
Box 11
Nonqualified plans
Taxable amount from a
nonqualified deferred
compensation plan.
14E
14F
14G
14H
Box 12
Examples of Other Taxable
&
Non-Taxable Items
Code
(c)
(e)
(BB)
(DD)
(P)
Box 18
Other: Taxable Fringe Benefits
14I
14J
Description
Imputed Life
Retirement (TIAA/
Vanguard)
Roth IRA
Health Coverage
Qualified Relocation
14X
Box 16
$51,133.35
Salary
+
600.00
Benefit Credit
+
50.00
Imputed WR
+
1,600.00
Taxable Scholarship
-
2,425.00
HlthCare Spending Fund
-
250.00
Med/Dent/Vision
=
$50,908.35
Amount subject to Local
Income Tax
Box 19
Local Income Tax
Total local income tax withheld for the tax year.
Box 20
Locality Name
Box 16
State Wages, Tips, Etc.
$51,333.35
Salary
+
600.00
+
50.00
Benefit Credit
Imputed WR
+
1600.00
Taxable
Scholarship
-
2,425.00
-
250.00
=
$50, 908.35
HlthCare Spending Fund
Med/Dent/Vision
Amount subject to
State Income Tax
Please note: The above example is for PA only.
TCD for Jordan (70)