W-2
Wage and Tax Statement Tax Year 2024
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
$170,000.00 $38,100.00
3 Social security wages 4 Social security tax withheld
$168,600.00 $10,453.20
5 Medicare wages and tips 6 Medicare tax withheld
$193,000.00 $2,798.50
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 $23,000.00
12b 14 Other
W $1,500.00
15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax
MN MN-412847501 $170,000.00 $11,900.00
18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement 2024 | Employer: Clearwater Tech, Inc. (EIN 41-2847501) | Employee SSN: XXX-XX-4444 | Synthetic demo data only — not for tax filing purposes
