| |
|
Employer:
| |
| Employer Identification Number (EIN):203754038 |
| VIVINT INC | |
| 4931 NORTH 300 WEST | |
| PROVO, UT 84604-0000 | |
| |
|
Employee:
| |
| Employee's Social Security Number:
647-40-0297 |
| CHANDLER S KINSEY | |
| 5135 E EVERGREEN ST UN | |
| MESA, AZ 85205-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $19,888.00 |
| Federal Income Tax Withheld: | $2,317.00 |
| Social Security Wages: | $19,888.00 |
| Social Security Tax Withheld: | $1,233.00 |
| Medicare Wages and Tips: | $19,888.00 |
| Medicare Tax Withheld: | $288.00 |
| 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: | |
| W2 WHC SSN Validation Code: | Correct SSN |
| |
|
Employer:
| |
| Employer Identification Number (EIN):273411457 |
| GREEN MANGO PEST CONTROL | |
| 2440 E GERMANN RD STE | |
| CHANDLER, AZ 85286-0000 | |
| |
|
Employee:
| |
| Employee's Social Security Number:
647-40-0297 |
| CHANDLER KINSEY | |
| 1361 S GREENFIELD RD A | |
| MESA, AZ 85206-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $1,640.00 |
| Federal Income Tax Withheld: | $109.00 |
| Social Security Wages: | $1,640.00 |
| Social Security Tax Withheld: | $101.00 |
| Medicare Wages and Tips: | $1,640.00 |
| Medicare Tax Withheld: | $23.00 |
| 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: | |
| W2 WHC SSN Validation Code: | Correct SSN |
| |
|
Employer:
| |
| Employer Identification Number (EIN):860850417 |
| GODADDY COM LLC | |
| 14455 N HAYDEN RD STE | |
| SCOTTSDALE, AZ 85260-0000 | |
| |
|
Employee:
| |
| Employee's Social Security Number:
647-40-0297 |
| CHANDLER S KINSEY | |
| 1361 S GREENFIELD RD # | |
| MESA, AZ 85206-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $9,824.00 |
| Federal Income Tax Withheld: | $0.00 |
| Social Security Wages: | $10,127.00 |
| Social Security Tax Withheld: | $627.00 |
| Medicare Wages and Tips: | $10,127.00 |
| Medicare Tax Withheld: | $146.00 |
| Social Security Tips: | $0.00 |
| Allocated Tips: | $0.00 |
| Dependent Care Benefits: | $0.00 |
| Deferred Compensation: | $302.00 |
| 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: | Yes - retirement plan |
| Statutory Employee: | Not Statutory Employee |
| W2 Submission Type: | |
| W2 WHC SSN Validation Code: | Correct SSN |
| |
|
Employer:
| |
| Employer Identification Number (EIN):943327894 |
| WEB COM GROUP INC | |
| 12808 GRAN BAY PKWY | |
| JACKSONVILLE, FL 32258-0000 | |
| |
|
Employee:
| |
| Employee's Social Security Number:
647-40-0297 |
| CHANDLER S KINSEY | |
| 5135 E EVERGREEN | |
| MESA, AZ 85206-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $12,287.00 |
| Federal Income Tax Withheld: | $562.00 |
| Social Security Wages: | $12,422.00 |
| Social Security Tax Withheld: | $770.00 |
| Medicare Wages and Tips: | $12,422.00 |
| Medicare Tax Withheld: | $180.00 |
| 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: | |
| W2 WHC SSN Validation Code: | Correct SSN |
| |
|
Employer:
| |
| Employer Identification Number (EIN):943327894 |
| WEB COM GROUP INC | |
| 12808 GRAN BAY PKWY | |
| JACKSONVILLE, FL 32258-0000 | |
| |
|
Employee:
| |
| Employee's Social Security Number:
647-40-0297 |
| CHANDLER S KINSEY | |
| 5135 E EVERGREEN | |
| MESA, AZ 85206-0000 | |
| |
| Submission Type: | Amended document |
| Wages, Tips and Other Compensation: | $12,422.00 |
| Federal Income Tax Withheld: | $0.00 |
| Social Security Wages: | $0.00 |
| Social Security Tax Withheld: | $0.00 |
| Medicare Wages and Tips: | $0.00 |
| Medicare Tax Withheld: | $0.00 |
| 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: | No Correction |
| Statutory Employee: | No Correction |
| W2 Submission Type: | |
| W2 WHC SSN Validation Code: | Correct SSN |
| |
|
Payer:
| |
| Payer's Federal Identification Number (FIN):134994650 |
| JPMORGAN CHASE BANK, N.A. | |
| P.O. BOX 182051 | |
| COLUMBUS, OH 43218-2051 | |
| |
|
Recipient:
| |
| Recipient's Identification Number:
647-40-0297 |
| CHANDLER SCOTT KINSEY | |
| 5135 E EVERGREEN ST UNIT 1250 | |
| MESA, AZ 85205-5313 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | AZ303397597 |
| Interest: | $300.00 |
| Tax Withheld: | $0.00 |
| Savings Bonds: | $0.00 |
| Investment Expense: | $0.00 |
| Interest Forfeiture: | $0.00 |
| Foreign Tax Paid: | $0.00 |
| Tax-Exempt Interest: | $0.00 |
| Specified Private Activity Bond Interest: | $0.00 |
| Market Discount: | $0.00 |
| Bond Premium: | $0.00 |
| Bond Premium on Tax Exempt Bond: | $0.00 |
| Bond Premium on Treasury Obligations: | $0.00 |
| Second Notice Indicator: | No Second Notice |
| Foreign Country or US Possession: | |
| CUSIP Number: | |
| FATCA Filing Requirement: | Box not checked no Filing Requirement |
| |
|
Payer:
| |
| Payer's Federal Identification Number (FIN):416257133 |
| RETIREMENT SERVICES | |
| 550 S. 4TH STREET, N9310-08J | |
| MINNEAPOLIS, MN 55415-1529 | |
| |
|
Recipient:
| |
| Recipient's Identification Number:
647-40-0297 |
| CHANDLER S KINSEY | |
| 1361 S GREENFIELD RD 2060 | |
| MESA, AZ 85206-0000 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 65000012932531T1 |
| Distribution Code Value: | Early Distribution, no known exception (in most cases, under age 59 1/2) |
| Distribution Code: | 1 |
| Distribution Code Value: | Not significant |
| Distribution Code: | Blank |
| Tax Amount Undetermined Code: | Not checked |
| Total Distribution Code: | Total Distribution |
| First Year Roth Contribution: | 0000 |
| SEP Indicator: | IRA/SEP/SIMP box not checked |
| FATCA Indicator: | not FATCA |
| Date of Payment for Reportable Death Benefits under Section 6050Y: | 00-00-0000 |
| Tax Withheld: | $541.00 |
| Total Employee Contributions: | $0.00 |
| Unrealized Appreciation: | $0.00 |
| Other Income: | $0.00 |
| Gross Distribution: | $2,706.00 |
| Taxable Amount: | $2,706.00 |
| Eligible Capital Gains: | $0.00 |
| Amount to IRR: | $0.00 |
