W-2
Wage and Tax Statement Tax Year 2022
Department of the Treasury — Internal Revenue Service
b Employer identification number (EIN) d Control number Void Copy B — To Be Filed With
Employee's FEDERAL Tax Return
41-2847501 NLT-W2-AUTO
This information is being furnished to the Internal Revenue Service.
c Employer's name, address, and ZIP code a Employee's social security number
Clearwater Tech, Inc.
1800 Technology Parkway, Minneapolis, MN 55441 XXX-XX-4444
e Employee's first name and initial Last name Suf. f Employee's address and ZIP code
Alex Chen 3215 Lakeview Circle, Wayzata, MN 55391
1 Wages, tips, other compensation 2 Federal income tax withheld
$162,000.00 $35,600.00
3 Social security wages 4 Social security tax withheld
$147,000.00 $9,114.00
5 Medicare wages and tips 6 Medicare tax withheld
$182,500.00 $2,646.25
7 Social security tips 8 Allocated tips
9 (Blank) 10 Dependent care benefits
11 Nonqualified plans
12 See instructions for box 12 13 / 14 Checkboxes and Other
12a 13 Retirement plan
n
D $20,500.00
12b 14 Other
W $1,350.00
15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax
MN MN-412847501 $162,000.00 $11,100.00
18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement 2022 | Employer: Clearwater Tech, Inc. (EIN 41-2847501) | Employee SSN: XXX-XX-4444 | Synthetic demo data only — not for tax filing purposes
