| |
|
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 | |
| 2217 N POWER RD | |
| MESA, AZ 85215-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $42,225.00 |
| Federal Income Tax Withheld: | $110.00 |
| Social Security Wages: | $42,764.00 |
| Social Security Tax Withheld: | $2,651.00 |
| Medicare Wages and Tips: | $42,764.00 |
| Medicare Tax Withheld: | $620.00 |
| Social Security Tips: | $0.00 |
| Allocated Tips: | $0.00 |
| Dependent Care Benefits: | $0.00 |
| Deferred Compensation: | $538.00 |
| 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: | $20.00 |
| 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):464389868 |
| DESERT MOUNTAIN CO OF PHOENIX LLC | |
| 190 S MCQUEEN RD SU | |
| GILBERT, AZ 85233-0000 | |
| |
|
Employee:
| |
| Employee's Social Security Number:
647-40-0297 |
| CHANDLER S KINSEY | |
| 37363 N GARY ROAD 1006 | |
| QUEEN CREEK, AZ 85142-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $14,924.00 |
| Federal Income Tax Withheld: | $454.00 |
| Social Security Wages: | $15,164.00 |
| Social Security Tax Withheld: | $940.00 |
| Medicare Wages and Tips: | $15,164.00 |
| Medicare Tax Withheld: | $219.00 |
| Social Security Tips: | $0.00 |
| Allocated Tips: | $0.00 |
| Dependent Care Benefits: | $0.00 |
| Deferred Compensation: | $240.00 |
| 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):860950231 |
| BULWARK EXTERMINATING LLC | |
| 5810 S SOSSAMAN ROAD | |
| MESA, AZ 85212-0000 | |
| |
|
Employee:
| |
| Employee's Social Security Number:
647-40-0297 |
| CHANDLER SCOTT KINSEY | |
| 37363 N GARY ROAD | |
| QUEEN CREEK, AZ 85142-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $1,277.00 |
| Federal Income Tax Withheld: | $74.00 |
| Social Security Wages: | $1,277.00 |
| Social Security Tax Withheld: | $79.00 |
| Medicare Wages and Tips: | $1,277.00 |
| Medicare Tax Withheld: | $18.00 |
| 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 |
