This is a Duplicate Form This is a Duplicate Form
Copy B-To Be Filed With Employee's FEDERAL Tax Year 2022 Copy 2-To Be Filed With Employee's State, City, Tax Year 2022
Tax Return. OMB No. 1545-0008 or Local Income Tax Return. OMB No. 1545-0008
a. Employee's social security 1 Wages, tips, other comp. 2 Federal income tax withheld a. Employee's social security 1 Wages, tips, other comp. 2 Federal income tax withheld
number ***-**-7869 $19,557.34 $1,955.72 number ***-**-7869 $19,557.34 $1,955.72
b. Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld b. Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld
13-3689044 13-3689044
d. Control number 5 Medicare wages and tips 6 Medicare tax withheld d. Control number 5 Medicare wages and tips 6 Medicare tax withheld
TE09745500001 TE09745500001
7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9
c. EMPLOYER'S name, address, and ZIP code c. EMPLOYER'S name, address, and ZIP code
TRANSAMERICA RETIREMENT SOLUTIONS TRANSAMERICA RETIREMENT SOLUTIONS
6400 C STREET SW 6400 C STREET SW
CEDAR RAPIDS, IA 52499 CEDAR RAPIDS, IA 52499
FOR QUESTIONS CALL 800-755-5801 FOR QUESTIONS CALL 800-755-5801
e. EMPLOYEE'S name, address, and ZIP code e. EMPLOYEE'S name, address, and ZIP code
SWIERAT RICHARD P 450DTB SWIERAT RICHARD P 450DTB
1 MARCELLA BLVD 1 MARCELLA BLVD
HOPEWELL JUNCTION, NY 12533 HOPEWELL JUNCTION, NY 12533
TE09745500001 TE09745500001
10 Dependent care benefits 11 Nonqualified plans See instructions for box 12 10 Dependent care benefits 11 Nonqualified plans
$19,557.34 $19,557.34
12a 12a
13 14 Other 13 14 Other
Statutory employee 12b Statutory employee 12b
12c 12c
Retirement plan 12d Retirement plan 12d
Third-party sick pay 12e Third-party sick pay 12e
15 State/Employer's state ID 16 State wages, tips, etc. 17 State income tax 15 State/Employer's state ID 16 State wages, tips, etc. 17 State income tax
NY/1336890445 $19,557.34 $1,881.40 NY/1336890445 $19,557.34 $1,881.40
18 Local wages, tips, etc. 19 Local income tax 20 Locality name 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement Department of the Treasury - Internal Revenue Service Form W-2 Wage and Tax Statement Department of the Treasury - Internal Revenue Service
This information is being furnished to the Internal Revenue Service.
This is a Duplicate Form This is a Duplicate Form
Copy C-For EMPLOYEE'S RECORDS (See Notice Tax Year 2022 Copy 2-To Be Filed With Employee's State, City, Tax Year 2022
to Employee on the back of Copy B.) OMB No. 1545-0008 or Local Income Tax Return. OMB No. 1545-0008
a. Employee's social security 1 Wages, tips, other comp. 2 Federal income tax withheld a. Employee's social security 1 Wages, tips, other comp. 2 Federal income tax withheld
number ***-**-7869 $19,557.34 $1,955.72 number ***-**-7869 $19,557.34 $1,955.72
b. Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld b. Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld
13-3689044 13-3689044
d. Control number 5 Medicare wages and tips 6 Medicare tax withheld d. Control number 5 Medicare wages and tips 6 Medicare tax withheld
TE09745500001 TE09745500001
7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9
c. EMPLOYER'S name, address, and ZIP code c. EMPLOYER'S name, address, and ZIP code
TRANSAMERICA RETIREMENT SOLUTIONS TRANSAMERICA RETIREMENT SOLUTIONS
6400 C STREET SW 6400 C STREET SW
CEDAR RAPIDS, IA 52499 CEDAR RAPIDS, IA 52499
FOR QUESTIONS CALL 800-755-5801 FOR QUESTIONS CALL 800-755-5801
e. EMPLOYEE'S name, address, and ZIP code e. EMPLOYEE'S name, address, and ZIP code
SWIERAT RICHARD P 450DTB SWIERAT RICHARD P 450DTB
1 MARCELLA BLVD 1 MARCELLA BLVD
HOPEWELL JUNCTION, NY 12533 HOPEWELL JUNCTION, NY 12533
TE09745500001 TE09745500001
10 Dependent care benefits 11 Nonqualified plans See instructions for box 12 10 Dependent care benefits 11 Nonqualified plans
$19,557.34 12a $19,557.34 12a
13 Statutory employee 14 Other 12b 13 Statutory employee 14 Other 12b
12c 12c
Retirement plan 12d Retirement plan 12d
Third-party sick pay 12e Third-party sick pay 12e
15 State/Employer's state ID 16 State wages, tips, etc. 17 State income tax 15 State/Employer's state ID 16 State wages, tips, etc. 17 State income tax
NY/1336890445 $19,557.34 $1,881.40 NY/1336890445 $19,557.34 $1,881.40
18 Local wages, tips, etc. 19 Local income tax 20 Locality name 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement Department of the Treasury - Internal Revenue Service Form W-2 Wage and Tax Statement Department of the Treasury - Internal Revenue Service
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. Page 1 of 2
450DTB
TRANSAMERICA RETIREMENT SOLUTIONS
6400 C STREET SW
CEDAR RAPIDS, IA 52499
SWIERAT RICHARD P
1 MARCELLA BLVD
HOPEWELL JUNCTION, NY 12533
Notice to Employee
Do you have to file? Refer to the Form 1040 instructions to determine if you are required to file up to $6,500 ($3,000 for section 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is
a tax return. Even if you don't have to file a tax return, you may be eligible for a refund if not subject to the overall limit on elective deferrals. For code G, the limit on elective deferrals may be higher
box 2 shows an amount or if you are eligible for any credit. for the last 3 years before you reach retirement age.
Earned income credit (EIC). You may be able to take the EIC for 2022 if your adjusted gross income (AGI) is Contact your plan administrator for more information. Amounts in excess of the overall elective deferral limit
less than a certain amount. The amount of the credit is based on income and family size. Workers without must be included in income. See the Form 1040 instructions.
children could qualify for a smaller credit. You and any qualifying children must have valid social security Note: If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pension contribution for
numbers (SSNs). a prior year(s) when you were in military service. To figure whether you made excess deferrals, consider
You can't take the EIC if your investment income is more than the specified amount for 2022 or if income is these amounts for the year shown, not the current year. If no year is shown, the contributions are for the
earned for services provided while you were an inmate at a penal institution. For 2022 income limits and current year.
more information, visit www.irs.gov/EITC. See also Pub. 596, Earned Income Credit. Any EIC that is more A- Uncollected social security or RRTA tax on tips. Include this tax on Form 1040 or 1040-SR.
than your tax liability is refunded to you, but only if you file a tax return. See the Form 1040 instructions.
Employee's social security number (SSN). For your protection, this form may show only the last four digits of B- Uncollected Medicare tax on tips. Include this tax on Form 1040 or 1040-SR. See the Form 1040
your SSN. However, your employer has reported your complete SSN to the IRS and the Social Security Administration (SSA). instructions.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub. 517, C- Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up to the social
Social Security and Other Information for Members of the Clergy and Religious Workers. security wage base), and 5)
Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and ask your employer to D- Elective deferrals to a section 401(k) cash or deferred arrangement. Also includes deferrals under a
correct your employment record. Be sure to ask the employer to file Form W-2c, Corrected Wage and Tax SIMPLE retirement account that is part of a section 401(k) arrangement.
Statement, with the SSA to correct any name, SSN, or money amount error reported to the SSA E- Elective deferrals under a section 403(b) salary reduction agreement
on Form W-2. Be sure to get your copies of Form W-2c from your employer for all F- Elective deferrals under a section 408(k)(6) salary reduction SEP
corrections made so you may file them with your tax return. If your name and SSN are correct but aren't the G- Elective deferrals and employer contributions (including nonelective deferrals) to a section 457(b) deferred
same as shown on your social security card, you should ask for a new card that displays your correct name compensation plan
at any SSA office or by calling 800-772-1213. You may also visit the SSA website at www.SSA.gov. H- Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See the
Cost of employer-sponsored health coverage (if such cost is provided by the employer). The reporting Form 1040 instructions for how to deduct.
in box 12, using code DD, of the cost of employer-sponsored health coverage is for your information only. J- Nontaxable sick pay (information only, not included in box 1, 3, or 5)
The amount reported with code DD is not taxable. K- 20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
Credit for excess taxes. If you had more than one employer in 2022 and more than $9,114 in social L- Substantiated employee business expense reimbursements (nontaxable)
security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to claim a credit for M- Uncollected social security or RRTA tax on taxable cost of groupterm life insurance over $50,000
the excess against your federal income tax. See the Form 1040 instructions. If you had more than one railroad employer and (former employees only). See the Form 1040 instructions.
more than $5,350.80 in Tier 2 RRTA tax was withheld, you may be able to claim a refund on Form 843. See the N- Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (former employees
Instructions for Form 843. only). See the Form 1040 instructions.
(See also Instructions for Employee on the back of Copy C.) P- Excludable moving expense reimbursements paid directly to a member of the U.S. Armed Forces (not
included in box 1, 3, or 5)
Instructions for Employee Q- Nontaxable combat pay. See the Form 1040 instructions for details on reporting this amount.
(See also Notice to Employee on the back of Copy B.) R- Employer contributions to your Archer MSA. Report on Form 8853, Archer MSAs and Long-Term Care
Box 1. Enter this amount on the wages line of your tax return. Insurance Contracts.
Box 2. Enter this amount on the federal income tax withheld line of your tax return. S- Employee salary reduction contributions under a section 408(p) SIMPLE plan (not included in box 1)
Box 5. You may be required to report this amount on Form 8959, Additional Medicare Tax. See the T- Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
Form 1040 instructions to determine if you are required to complete Form 8959. figure any taxable and nontaxable amounts.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare wages and tips shown in V- Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up to the social security
box 5, as well as the 0.9% Additional Medicare Tax on any of those Medicare wages and tips above wage base), and 5). See Pub. 525, Taxable and Nontaxable Income, for reporting requirements.
$200,000. W- Employer contributions (including amounts the employee elected to contribute using a section 125
Box 8. This amount is not included in box 1, 3, 5, or 7. For information on how to report tips on your tax (cafeteria) plan) to your health savings account. Report on Form 8889, Health Savings Accounts (HSAs).
return, see the Form 1040 instructions. Y- Deferrals under a section 409A nonqualified deferred compensation plan
You must file Form 4137, Social Security and Medicare Tax on Unreported Tip Income, with your income Z- Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This amount
tax return to report at least the allocated tip amount unless you can prove with adequate records that you is also included in box 1. It is subject to an additional 20% tax plus interest.
received a smaller amount. If you have records that show the actual amount of tips you received, report that See the Form 1040 instructions.
amount even if it is more or less than the allocated tips. Use Form 4137 to figure the social AA- Designated Roth contributions under a section 401(k) plan
security and Medicare tax owed on tips you didn't report to your employer. Enter this amount on the wages BB- Designated Roth contributions under a section 403(b) plan
line of your tax return. By filing Form 4137, your social security tips will be credited to your social security DD- Cost of employer-sponsored health coverage. The amount reported with code DD is not taxable.
record (used to figure your benefits). EE- Designated Roth contributions under a governmental section 457(b) plan. This amount does not apply to
Box 10. This amount includes the total dependent care benefits that your employer paid to you or incurred contributions under a taxexempt organization section 457(b) plan.
on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over your employer's FF- Permitted benefits under a qualified small employer health reimbursement arrangement
plan limit is also included in box 1. See Form 2441. GG- Income from qualified equity grants under section 83(i)
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from a nonqualified deferred HH- Aggregate deferrals under section 83(i) elections as of the close of the calendar year
compensation or nongovernmental section 457(b) plan, or (b) included in box 3 and/or box 5 if it is a prior Box 13. If the "Retirement plan" box is checked, special limits may apply to the amount of traditional IRA
year deferral under a nonqualified or section 457(b) plan that became taxable for social security and contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement Arrangements (IRAs).
Medicare taxes this year because there is no longer a substantial risk of forfeiture of your right to the Box 14. Employers may use this box to report information such as state disability insurance taxes withheld,
deferred amount. This box shouldn't be used if you had a deferral and a distribution in the same calendar union dues, uniform payments, health insurance premiums deducted, nontaxable income, educational
year. If you made a deferral and received a distribution in the same calendar year, and you are or will be assistance payments, or a member of the clergy's parsonage allowance and utilities. Railroad employers use
age 62 by the end of the calendar year, your employer should file Form SSA-131, Employer Report of this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax, Medicare tax, and
Special Wage Payments, with the Social Security Administration and give you a copy. Additional Medicare Tax. Include tips reported by the employee to the employer in railroad retirement
Box 12. The following list explains the codes shown in box 12. You may need this information to complete (RRTA) compensation.
your tax return. Elective deferrals (codes D, E, F, and S) and designated Roth contributions (codes AA, BB, Note: Keep Copy C of Form W-2 for at least 3 years after the due date for filing your income tax return.
and EE) under all plans are generally limited to a total of $20,500 ($14,000 if you only have SIMPLE plans; However, to help protect your social security benefits, keep Copy C until you begin receiving social security
$23,500 for section 403(b) plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals under benefits, just in case there is a question about your work record and/or earnings in a particular year.
code G are limited to $20,500. Deferrals under code H are limited to $7,000.
However, if you were at least age 50 in 2022, your employer may have allowed an additional deferral of
Page 2 of 2
