Attention:

You may file Forms W-2 and W-3 electronically on the SSA’s Employer
W-2 Filing Instructions and Information web page, which is also accessible
at www.socialsecurity.gov/employer. You can create fill-in versions of
Forms W-2 and W-3 for filing with SSA. You may also print out copies for
filing with state or local governments, distribution to your employees, and
for your records.
Note: Copy A of this form is provided for informational purposes only. Copy A appears in
red, similar to the official IRS form. The official printed version of this IRS form is scannable,
but the online version of it, printed from this website, is not. Do not print and file Copy A
downloaded from this website with the SSA; a penalty may be imposed for filing forms that
can’t be scanned. See the penalties section in the current General Instructions for Forms
W-2 and W-3, available at www.irs.gov/w2, for more information.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded, filled in, and printed and used to satisfy the requirement to provide the
information to the recipient.
To order official IRS information returns such as Forms W-2 and W-3, which include a
scannable Copy A for filing, go to IRS’ Online Ordering for Information Returns and
Employer Returns page, or visit www.irs.gov/orderforms and click on Employer and
Information returns. We’ll mail you the scannable forms and any other products you order.
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
 a Employee’s social security number For Official Use Only ▶
22222 VOID
OMB No. 1545-0008
560-43-7343
b Employer identification number (EIN) 59-3784671 1 Wages, tips, other compensation 2 Federal income tax withheld

26,400.00 2,016.00
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
26,400.00 1,632.00
CITY LITES NETWORK
5 Medicare wages and tips 6 Medicare tax withheld
26,400.00 384.00
520 N. LABREA AVE # 120
7 Social security tips 8 Allocated tips
INGLEWOOD, CA 9030
d Control number 1 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
See instructions for box 12
o

d
e

13 Statutory Retirement
party employee plan
Third-
sick pay
12b
C
o

HOPE M. FLOOD d
1201 N. LABREA AVENUE # 14 Other
e

12c
15 C
o

INGLEOOD, CA90302 d

12d
C
o

f Employee’s address and ZIP code

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc 19 Local income tax 20 Locality
26,400.00 336.00 26,400.00. 0.00 name
PA
CA

W-2 Wage and Tax Statement 2020 Department of the Treasury—Internal Revenue Service
Form For Privacy Act and Paperwork Reduction
Copy A—For Social Security Administration. Send this entire page with Act Notice, see the separate instructions.
Form W-3 to the Social Security Administration; photocopies are not acceptable. Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
 a Employee’s social security number
22222 560-43-7343 OMB No. 1545-0008
b Employer identification number (EIN) 59-3784671 1 Wages, tips, other compensation 2 Federal income tax withheld
26,400.00 2,016.00,
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
26,400 1,632.00
CITY LITES NETWORK
5 Medicare wages and tips 6 Medicare tax withheld
26,400.00 384.00
520 N. LABREA AVE # 120
7 Social security tips 8 Allocated tips
INGLEWOOD, CA 9030 26,400.00
d Control number 1 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
o

HOPE M. FLOOD d

1201 N. LABREA AVENUE # Statutory Retirement Third-party

e

12b
13
15 employee plan sick pay C
o

INGLEOOD, CA90302 d

14 Other 12c
C
o

12d
C
o

f Employee’s address and ZIP code e

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality
26,400.00 336.00 26,400.00 0.00 name
CA 132-0001
CA

Form W-2 Wage and Tax Statement

2020 Department of the Treasury—Internal Revenue Service

Copy 1—For State, City, or Local Tax Department

 a Employee’s social security number Safe, accurate, Visit the IRS website at
560-43-7343 OMB No. 1545-0008 FAST! Use www.irs.gov/efile

b Employer identification number (EIN) 59-3784671 1 Wages, tips, other compensation 2 Federal income tax withheld
26,400.00 2,016.00
C Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
26,400.00 1,632.00
CITY LITES NETWORK 5 Medicare wages and tips 6 Medicare tax withheld
26,400.00 384.00
520 N. LABREA AVE # 120
7 Social security tips 8 Allocated tips
INGLEWOOD, CA 9030
d Control number 1 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
See instructions for box 12
o

d
e

HOPE M. FLOOD 13 Statutory Third-

party sick
12b
C
pay o
1201 N. LABREA AVENUE # Retirement employee
plan d
15 e

14 Other 12c
C
INGLEOOD, CA90302 o

d
e

12d
C
o

d
e

f Employee’s address and ZIP code

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality
CA 132-0001 26,400.00 336.00 26,400.00 0.00 name
CA

Form W-2 Wage and Tax Statement

2020 Department of the Treasury—Internal Revenue Service

Copy B—To Be Filed With Employee’s FEDERAL Tax Return.

This information is being furnished to the Internal Revenue Service.

Notice to Employee W-2c, Corrected Wage and Tax Statement, with the Social
Do you have to file? Refer to the Instructions for Forms 1040 Security Administration (SSA) to correct any name, SSN, or
and 1040-SR to determine if you are required to file a tax return. money amount error reported to the SSA on Form W-2. Be sure
Even if you don’t have to file a tax return, you may be eligible for to get your copies of Form W-2c from your employer for all
a refund if box 2 shows an amount or if you are eligible for any corrections made so you may file them with your tax return. If
credit. your name and SSN are correct but aren’t the same as shown on
your social security card, you should ask for a new card that
Earned income credit (EIC). You may be able to take the EIC displays your correct name at any SSA office or by calling 800-
for 2020 if your adjusted gross income (AGI) is less than a 772-1213. You may also visit the SSA website at www.SSA.gov.
certain amount. The amount of the credit is based on income
and family size. Workers without children could qualify for a Cost of employer-sponsored health coverage (if such cost is
smaller credit. You and any qualifying children must have valid provided by the employer). The reporting in box 12, using
social security numbers (SSNs). You can’t take the EIC if your code DD, of the cost of employer-sponsored health coverage is
investment income is more than the specified amount for 2020 for your information only. The amount reported with code DD
or if income is earned for services provided while you were an is not taxable.
inmate at a penal institution. For 2020 income limits and more Credit for excess taxes. If you had more than one employer in
information, visit www.irs.gov/EITC. See also Pub. 596, Earned 2020 and more than $8,537.40 in social security and/or Tier 1
Income Credit. Any EIC that is more than your tax liability is railroad retirement (RRTA) taxes were withheld, you may be
refunded to you, but only if you file a tax return. able to claim a credit for the excess against your federal income
Clergy and religious workers. If you aren’t subject to social tax. If you had more than one railroad employer and more than
security and Medicare taxes, see Pub. 517, Social Security and $5,012.70 in Tier 2 RRTA tax was withheld, you may also be
Other Information for Members of the Clergy and Religious able to claim a credit. See the Instructions for Forms 1040 and
Workers. 1040-SR and Pub. 505, Tax Withholding and Estimated Tax.
Corrections. If your name, SSN, or address is incorrect, correct (See also Instructions for Employee on the back of Copy C.)
Copies B, C, and 2 and ask your employer to correct your
employment record. Be sure to ask the employer to file Form
 a Employee’s social security number This information is being furnished to the Internal Revenue Service. If
you are required to file a tax return, a negligence penalty or other
560-43-7343 OMB No. 1545-0008
sanction
may be imposed on you if this income is taxable and you fail to report
it.
b Employer identification number (EIN) 59-3784671 1 Wages, tips, other compensation 2 Federal income tax withheld
26,400.00 2,016.00
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
26,400 1,632.00
CITY LITES NETWORK
5 Medicare wages and tips 6 Medicare tax withheld
26,400.00 384.00
520 N. LABREA AVE # 120
7 Social security tips 8 Allocated tips
INGLEWOOD, CA 9030
d Control number 1 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
See instructions for box 12
o

HOPE M. FLOOD e
Statutory Retirement Third-party 12b
1201 N. LABREA AVENUE # 13 employee plan sick pay C
o

15 d

INGLEOOD, CA90302 e

14 Other 12c
C
o

12d
C
o

f Employee’s address and ZIP code e

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality
26,400.00 336.00 26,400.00 0.00 name
CA
CA

W-2 Wage and Tax Statement 2020

Department of the Treasury—Internal Revenue Service
Form Safe, accurate,
Copy C—For EMPLOYEE’S RECORDS FAST! Use
(See Notice to Employee on the back of Copy B.)
deferral under a nonqualified or section 457(b) plan that became taxable
Instructions for Employee for social security and Medicare taxes this year because there is no
(See also Notice to Employee on the back of Copy B.) longer a substantial risk of forfeiture of your right to the deferred amount.
Box 1. Enter this amount on the wages line of your tax return. This box shouldn’t be used if you had a deferral and a
Box 2. Enter this amount on the federal income tax withheld line of your
tax return.
Box 5. You may be required to report this amount on Form 8959,
Additional Medicare Tax. See the Instructions for Forms 1040 and
1040-SR to determine if you are required to complete Form 8959.
Box 6. This amount includes the 1.45% Medicare Tax withheld 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 and tips above $200,000.
Box 8. This amount is not included in box 1, 3, 5, or 7. For information
on how to report tips on your tax return, see the Instructions for Forms
1040 and 1040-SR.
You must file Form 4137, Social Security and Medicare Tax on
Unreported Tip Income, with your income tax return to report at least
the allocated tip amount unless you can prove with adequate records
that you received a smaller amount. If you have records that show the
actual amount of tips you received, report that amount even if it is more
or less than the allocated tips. Use Form 4137 to figure the social
security and Medicare tax owed on tips you didn’t report to your
employer. Enter this amount on the wages line of your tax return. By
filing Form 4137, your social security tips will be credited to your social
security record (used to figure your benefits).
Box 10. This amount includes the total dependent care benefits that
your employer paid to you or incurred on your behalf (including amounts
from a section 125 (cafeteria) plan). Any amount over $5,000 is also
included in box 1. Complete Form 2441, Child and Dependent Care
Expenses, to compute any taxable and nontaxable amounts.
Box 11. This amount is (a) reported in box 1 if it is a distribution made 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 year
 distribution in the same calendar year. If you made a deferral and
received a distribution in the same calendar year, and you are or will
be age 62 by the end of the calendar year, your employer should file
Form SSA-131, Employer Report of Special Wage Payments, with the
Social Security Administration and give you a copy.
Box 12. The following list explains the codes shown in box 12. You may
need this information to complete your tax return. Elective deferrals
(codes D, E, F, and S) and designated Roth contributions (codes AA,
BB, and EE) under all plans are generally limited to a total of $19,500
($13,500 if you only have SIMPLE plans; $22,500 for section 403(b)
plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals
under code G are limited to $19,500. Deferrals under code H are limited
to $7,000.
However, if you were at least age 50 in 2020, your employer may
have allowed an additional deferral of up to $6,500 ($3,000 for section
401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount
is not subject to the overall limit on elective deferrals. For code G, the
limit on elective deferrals may be higher for the last 3 years before you
reach retirement age. Contact your plan administrator for more
information.
Amounts in excess of the overall elective deferral limit must be included
in income. See the Instructions for Forms 1040 and 1040-SR.
Note: If a year follows code D through H, S, Y, AA, BB, or EE, you
made a make-up pension contribution for a prior year(s) when you
were in military service. To figure whether you made excess deferrals,
consider these amounts for the year shown, not the current year. If no
year is shown, the contributions are for the current year.
A—Uncollected social security or RRTA tax on tips. Include this tax on
Form 1040 or 1040-SR. See the Instructions for Forms 1040 and 1040-
SR.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040
or 1040-SR. See the Instructions for Forms 1040 and 1040-SR.
C—Taxable cost of group-term life insurance over $50,000 (included in
boxes 1, 3 (up to social security wage base), and 5)
D—Elective deferrals to a section 401(k) cash or deferred
arrangement. Also includes deferrals under a SIMPLE retirement
account that is part of a section 401(k) arrangement.
E—Elective deferrals under a section 403(b) salary reduction agreement
(continued on back of Copy 2)
 a Employee’s social security number
560-43-7343 OMB No. 1545-0008
b Employer identification number (EIN) 59-3784671 1 Wages, tips, other compensation 2 Federal income tax withheld
26,400.00 2,016.00
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
26,400 1,632.00
CITY LITES NETWORK
5 Medicare wages and tips 6 Medicare tax withheld
26,400.00 384.00
520 N. LABREA AVE # 120
7 Social security tips 8 Allocated tips
INGLEWOOD, CA 9030
d Control number 1 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
o

HOPE M. FLOOD e
Statutory Retirement Third-party 12b
1201 N. LABREA AVENUE # 13 employee plan sick pay C
o

15 d

INGLEOOD, CA90302 e

14 Other 12c
C
o

12d
C
o

f Employee’s address and ZIP code e

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality
26,400.00 336.00 26,400.00 0.00 name
CA
CA

Form W-2 Wage and Tax Statement

2020 Department of the Treasury—Internal Revenue Service

Copy 2—To Be Filed With Employee’s State, City, or Local

Income Tax Return

Instructions for Employee (continued from back of Taxable and Nontaxable Income, for reporting requirements.
Copy C) W—Employer contributions (including amounts the employee elected to
contribute using a section 125 (cafeteria) plan) to your health savings
Box 12 (continued) account. Report on Form 8889, Health Savings Accounts (HSAs).
F—Elective deferrals under a section 408(k)(6) salary reduction SEP
G—Elective deferrals and employer contributions (including nonelective
deferrals) to a section 457(b) deferred compensation plan
H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization
plan. See the Instructions for Forms 1040 and 1040-SR for how to deduct.
J—Nontaxable sick pay (information only, not included in box 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the
Instructions for Forms 1040 and 1040-SR.
L—Substantiated employee business expense reimbursements (nontaxable)
M—Uncollected social security or RRTA tax on taxable cost of group-
term life insurance over $50,000 (former employees only). See the
Instructions for Forms 1040 and 1040-SR.
N—Uncollected Medicare tax on taxable cost of group-term life
insurance over $50,000 (former employees only). See the Instructions for
Forms 1040 and 1040-SR.
P—Excludable moving expense reimbursements paid directly to a
member of the U.S. Armed Forces (not included in box 1, 3, or 5)
Q—Nontaxable combat pay. See the Instructions for Forms 1040 and
1040-SR for details on reporting this amount.
R—Employer contributions to your Archer MSA. Report on Form 8853,
Archer MSAs and Long-Term Care Insurance Contracts.
S—Employee salary reduction contributions under a section 408(p)
SIMPLE plan (not included in box 1)
T—Adoption benefits (not included in box 1). Complete Form 8839,
Qualified Adoption Expenses, to compute any taxable and nontaxable
amounts.
V—Income from exercise of nonstatutory stock option(s) (included in
boxes 1, 3 (up to social security wage base), and 5). See Pub. 525,
Y—Deferrals under a section 409A nonqualified deferred compensation
plan
Z—Income under a nonqualified deferred compensation plan that
fails to satisfy section 409A. This amount is also included in box 1. It
is subject to an additional 20% tax plus interest. See the Instructions
for Forms 1040 and 1040-SR.
AA—Designated Roth contributions under a section 401(k) plan
BB—Designated Roth contributions under a section 403(b) plan
DD—Cost of employer-sponsored health coverage. The amount
reported with code DD is not taxable.
EE—Designated Roth contributions under a governmental section
457(b) plan. This amount does not apply to contributions under a tax-
exempt organization section 457(b) plan.
FF—Permitted benefits under a qualified small employer health
reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of
the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may
apply to the amount of traditional IRA contributions you may deduct.
See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as
state disability insurance taxes withheld, union dues, uniform
payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s
parsonage allowance and utilities. Railroad employers use this box to
report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax,
Medicare tax, and Additional Medicare Tax. Include tips reported by
the employee to the employer in railroad retirement (RRTA)
compensation.
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 social
security benefits, keep Copy C until you begin receiving social
security benefits, just in case there is a question about your work record
and/or earnings in a particular year.
 a Employee’s social security number
VOID 560-43-7343 OMB No. 1545-0008
b Employer identification number (EIN) 59-3784671 1 Wages, tips, other compensation 2 Federal income tax withheld
26,400.00 2,016.00
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
1,632.00
CITY LITES NETWORK 5 Medicare wages and tips
26,400
6 Medicare tax withheld
520 N. LABREA AVE # 120 26,400.00 384.00
7 Social security tips 8 Allocated tips
INGLEWOOD, CA 9030 0.000
d Control number 1 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
See instructions for box 12
o

HOPE M. FLOOD d

1201 N. LABREA AVENUE # Statutory Retirement Third-party

e

12b
13
15 employee plan sick pay C
o

INGLEOOD, CA90302 d

14 Other 12c
C
o

12d
C
o

f Employee’s address and ZIP code e

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc 19 Local income tax 20 Locality
26,400.00 336.00 26,400.00. 0.00 name
CA
CA

W-2 2020
Department of the Treasury—Internal Revenue Service
Form Wage and Tax Statement For Privacy Act and Paperwork Reduction
Copy D—For Employer Act Notice, see separate instructions.

Employers, Please Note— equipment for persons who are deaf, hard of hearing, or have a
speech disability, call 304-579-4827 (not toll free).
Specific information needed to complete Form W-2 is available
in a separate booklet titled the 2020 General Instructions for E-filing. See the 2020 General Instructions for Forms W-2 and
Forms W-2 and W-3. You can order these instructions and W-3 for information on when you’re required to file
additional forms at www.irs.gov/OrderForms. electronically. Even if you aren’t required to file electronically,
doing so can save you time and effort. Employers may now use
Caution: Do not send the SSA Forms W-2 and W-3 that you
the SSA’s W-2 Online service to create, save, print, and submit
have printed from IRS.gov. The SSA is unable to process these
up to 50 Form(s) W-2 at a time over the Internet. When you e-file
forms. Instead, you can create and submit them online. See E-
with the SSA, no separate Form W-3 filing is required. An
filing, later.
electronic Form W-3 will be created for you by the W-2 Online
Due dates. By February 1, 2021, furnish Copies B, C, and 2 to service. For information, visit the SSA’s Employer W-2 Filing
each person who was your employee during 2020. Mail or Instructions & Information website at www.SSA.gov/employer.
electronically file Copy A of Form(s) W-2 and W-3 with the SSA
Future developments. Information about any future
by February 1, 2021. See the separate instructions.
developments affecting Form W-2 and its instructions (such as
Need help? If you have questions about reporting on Form W-2, legislation enacted after we release them) will be posted at
call the information reporting customer service site toll free at www.irs.gov/FormW2.
866-455-7438 or 304-263-8700 (not toll free). For TTY/TDD