W-2
Wage and Tax Statement Tax Year 2023
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
41-3921847 APX-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
Apex Marketing Solutions LLC
3500 West 76th Street, Suite 200, Edina, MN 55435 XXX-XX-8888
e Employee's first name and initial Last name Suf. f Employee's address and ZIP code
Sam Chen 3215 Lakeview Circle, Wayzata, MN 55391
1 Wages, tips, other compensation 2 Federal income tax withheld
$97,000.00 $18,400.00
3 Social security wages 4 Social security tax withheld
$107,500.00 $6,665.00
5 Medicare wages and tips 6 Medicare tax withheld
$107,500.00 $1,558.75
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 $10,500.00
12b 14 Other
15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax
MN MN-413921847 $97,000.00 $6,200.00
18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement 2023 | Employer: Apex Marketing Solutions LLC (EIN 41-3921847) | Employee SSN: XXX-XX-8888 | Synthetic demo data only — not for tax filing purposes
