| |
|
Employer:
| |
| Employer Identification Number (EIN):134147118 |
| DELOITTE SERVICES LP | |
| 4022 SELLS DRIVE | |
| HERMITAGE, TN 37076-2903 | |
| |
|
Employee:
| |
| Employee's Social Security Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIRCLE | |
| FRANKLIN, TN 37067-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $50,134.00 |
| Federal Income Tax Withheld: | $4,611.00 |
| Social Security Wages: | $61,628.00 |
| Social Security Tax Withheld: | $3,820.00 |
| Medicare Wages and Tips: | $61,628.00 |
| Medicare Tax Withheld: | $893.00 |
| Social Security Tips: | $0.00 |
| Allocated Tips: | $0.00 |
| Dependent Care Benefits: | $0.00 |
| Deferred Compensation: | $11,494.00 |
| 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: | $5,323.00 |
| 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 |
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|
Employer:
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| Employer Identification Number (EIN):630956857 |
| QUANTUM RESEARCH INTERNAT | |
| 991 DISCOVERY DRIVE | |
| HUNTSVILLE, AL 35806-0000 | |
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|
Employee:
| |
| Employee's Social Security Number:
607-17-0964 |
| RAJU PUSAPATI | |
| 1506 BRADEN CIRCLE | |
| FRANKLIN, TN 37067-0000 | |
| |
| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $7,726.00 |
| Federal Income Tax Withheld: | $652.00 |
| Social Security Wages: | $8,890.00 |
| Social Security Tax Withheld: | $551.00 |
| Medicare Wages and Tips: | $8,890.00 |
| Medicare Tax Withheld: | $128.00 |
| Social Security Tips: | $0.00 |
| Allocated Tips: | $0.00 |
| Dependent Care Benefits: | $0.00 |
| Deferred Compensation: | $1,163.00 |
| 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: | $313.00 |
| 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 |
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|
Trustee:
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| Trustee/Issuer's Federal Identification Number (FIN):941737782 |
| CHARLES SCHWAB & CO., INC. | |
| 9800 SCHWAB WAY | |
| LONE TREE, CO 80124-0000 | |
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|
Participant:
| |
| Participant's Identification Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIRCLE | |
| FRANKLIN, TN 37067-0000 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 62720304 |
| IRA Contributions: | $0.00 |
| Rollover Contributions: | $292,872.00 |
| Roth Conversion Amount: | $0.00 |
| Recharacterized Contributions: | $0.00 |
| Fair Market Value of Account: | $117,660.00 |
| Life Insurance Cost Included in Box 1: | $0.00 |
| SEP Code: | Not Checked |
| IRA Code: | Checked |
| Simple Code: | Not Checked |
| Roth IRA Code: | Not Checked |
| RMD For Subsequent Year: | RMD box not checked |
| RMD Date: | 00-00-0000 |
| Year: | |
| Postponed Contribution Code: | |
| Repayments Code: | |
| Fair Market Value of certain specified assets: | N/A |
| SEP Contributions: | $0.00 |
| SIMPLE Contributions: | $0.00 |
| Roth IRA Contributions: | $0.00 |
| Required Minimum Distribution Amount: | $0.00 |
| Postponed Contributions: | $0.00 |
| Repayment of a qualified reservist distribution or federally designated disaster withdrawal repayment: | $0.00 |
| Fair Market Value of Certain Specified Assets: | $0.00 |
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|
Trustee:
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| Trustee/Issuer's Federal Identification Number (FIN):941737782 |
| CHARLES SCHWAB & CO., INC. | |
| 9800 SCHWAB WAY | |
| LONE TREE, CO 80124-0000 | |
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|
Participant:
| |
| Participant's Identification Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIRCLE | |
| FRANKLIN, TN 37067-0000 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 95483118 |
| IRA Contributions: | $0.00 |
| Rollover Contributions: | $0.00 |
| Roth Conversion Amount: | $0.00 |
| Recharacterized Contributions: | $0.00 |
| Fair Market Value of Account: | $219,775.00 |
| Life Insurance Cost Included in Box 1: | $0.00 |
| SEP Code: | Not Checked |
| IRA Code: | Checked |
| Simple Code: | Not Checked |
| Roth IRA Code: | Not Checked |
| RMD For Subsequent Year: | RMD box not checked |
| RMD Date: | 00-00-0000 |
| Year: | |
| Postponed Contribution Code: | |
| Repayments Code: | |
| Fair Market Value of certain specified assets: | N/A |
| SEP Contributions: | $0.00 |
| SIMPLE Contributions: | $0.00 |
| Roth IRA Contributions: | $0.00 |
| Required Minimum Distribution Amount: | $0.00 |
| Postponed Contributions: | $0.00 |
| Repayment of a qualified reservist distribution or federally designated disaster withdrawal repayment: | $0.00 |
| Fair Market Value of Certain Specified Assets: | $0.00 |
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Payer/Trustee:
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| Payer's/Trustee's Federal ID No.:626001445 |
| STATE OF TENNESSEE, TREASURY DEPARTMENT | |
| TNSTARS COLLEGE SAVINGS 529 PROGRAM | |
| 15TH FLOOR ANDREW JACKSON BUILDING | |
| NASHVILLE, TN 37243-0000 | |
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|
Recipient:
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| Recipient's SSN:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIRCLE | |
| FRANKLIN, TN 37067-0000 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 839133656-01 |
| Gross Distribution: | $8,906.00 |
| Earnings: | $2,355.00 |
| Basis: | $6,551.00 |
| Trustee-to-Trustee Transfer Indicator: | Box Not Checked |
| Qualified Tuition Program Indicator: | State Box Checked |
| Designated Beneficiary Indicator: | Recipient is Not Designated Beneficiary |
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Recipient/Lender:
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| Recipient's Federal Identification Number (FIN):941687665 |
| BANK OF AMERICA N.A. | |
| PO BOX 31785 | |
| TAMPA, FL 33631-3785 | |
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Payer/Borrower:
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| Payer's Social Security Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | MTG0272414629 |
| Mortgage Interest Received from Payer(s)/Borrower(s): | $7,047.00 |
| Points Paid on Purchase of Principal Residence: | $0.00 |
| Refund of Overpaid Interest: | $0.00 |
| Mortgage Insurance Premiums: | $0.00 |
| Outstanding Mortgage Principle: | $290,302.00 |
| Mortgage Origination Date: | 05-18-2017 |
| Property Address Verification: | |
| Address of property securing Mortgage: | 1506 BRADEN CIR |
| Other information from recipient: | FRANKLIN TN 37067-8595 |
| The number of mortgaged properties: | 00000000 |
| Mortgage Acquisition Date: | 00-00-0000 |
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Payer:
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| Payer's Federal Identification Number (FIN):541061178 |
| REGENT UNIVERSITY | |
| 1000 REGENT UNIVERSITY DRIVE | |
| VIRGINIA BEACH, VA 23464-0000 | |
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|
Recipient:
| |
| Recipient's Identification Number:
607-17-0964 |
| PUSAPATI RAJU | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 10980309137643283 |
| Qualified Tuition and Related Expense: | $3,210.00 |
| Scholarships or Grants: | $0.00 |
| Half Time Student Indicator: | Less Than Half Time Student |
| Graduate Student Indicator: | Graduate Student |
| Academic Period Code: | Academic Period Box Not Checked |
| TIN Checkbox: | box marked |
| Adjustments Made for Prior Year: | $0.00 |
| Adjustments to Scholarships or Grants for a Prior Year: | $0.00 |
| Reimbursements/Refunds from an Insurance Contract: | $0.00 |
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|
Payer:
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| Payer's Federal Identification Number (FIN):941737782 |
| CHARLES SCHWAB & CO., INC. | |
| 9800 SCHWAB WAY | |
| LONE TREE, CO 80124-0000 | |
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|
Recipient:
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| Recipient's Identification Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIRCLE | |
| FRANKLIN, TN 37067-0000 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 91216345 |
| Interest: | $0.00 |
| 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 |
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Payer:
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| Payer's Federal Identification Number (FIN):232186884 |
| VANGUARD FIDUCIARY TRUST COMPANY | |
| PO BOX 982902 | |
| EL PASO, TX 79998-2902 | |
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|
Recipient:
| |
| Recipient's Identification Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 09323820200000587441 |
| Distribution Code Value: | Qualified plan loan offsets |
| Distribution Code: | M |
| Distribution Code Value: | Early Distribution, exception applies (Under age 59 1/2) |
| Distribution Code: | 2 |
| Tax Amount Undetermined Code: | Not checked |
| Total Distribution Code: | Not checked |
| 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: | $0.00 |
| Total Employee Contributions: | $0.00 |
| Unrealized Appreciation: | $0.00 |
| Other Income: | $0.00 |
| Gross Distribution: | $22,107.00 |
| Taxable Amount: | $22,107.00 |
| Eligible Capital Gains: | $0.00 |
| Amount to IRR: | $0.00 |
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|
Payer:
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| Payer's Federal Identification Number (FIN):841455663 |
| GREAT-WEST TRUST COMPANY LLC | |
| PO BOX 5340 D999 | |
| DENVER, CO 80217-3764 | |
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|
Recipient:
| |
| Recipient's Identification Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 98986 |
| Distribution Code Value: | Direct rollover and rollover contribution |
| Distribution Code: | G |
| 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: | $0.00 |
| Total Employee Contributions: | $0.00 |
| Unrealized Appreciation: | $0.00 |
| Other Income: | $0.00 |
| Gross Distribution: | $292,872.00 |
| Taxable Amount: | $0.00 |
| Eligible Capital Gains: | $0.00 |
| Amount to IRR: | $0.00 |
| |
|
Payer:
| |
| Payer's Federal Identification Number (FIN):841455663 |
| GREAT-WEST TRUST COMPANY LLC | |
| PO BOX 5340 D999 | |
| DENVER, CO 80217-3764 | |
| |
|
Recipient:
| |
| Recipient's Identification Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 98986 |
| Distribution Code Value: | Early Distribution, exception applies (Under age 59 1/2) |
| Distribution Code: | 2 |
| Distribution Code Value: | Not significant |
| Distribution Code: | Blank |
| Tax Amount Undetermined Code: | Not checked |
| Total Distribution Code: | Not checked |
| 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: | $4,509.00 |
| Total Employee Contributions: | $0.00 |
| Unrealized Appreciation: | $0.00 |
| Other Income: | $0.00 |
| Gross Distribution: | $22,546.00 |
| Taxable Amount: | $22,546.00 |
| Eligible Capital Gains: | $0.00 |
| Amount to IRR: | $0.00 |
