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INSTRUCTIONS FOR RECIPIENT

BOX 1. Shows the total unemployment compensation paid to you This year. Combine the box 1 taxable amounts from all Forms 1099-G, and report it as income on the unemployment compensation line of your income tax return. If you e'pect to receive these benefits in the future, you can ask the payer to withhold Federal Income Tax from each payment. Or, you can make estimated tax payments using Form 1040~ES. Estimated Tax for Individuals. BOX 4. Shows the amount of Federal Income Tax you requested to be withheld from all unemployment compensation programs during the calendar year. You may be eligible for a refund of all or part of this amount when you file your Federal Income Ta* return. Include this amount on your income tax return as tax withheld. DO NOT ADD TO BOX 1. BOX 5. Shows Alternative Trade Adjustment Assistance (ATAA) payments you received. Include on Form 1040 on the "Other Income" line. See the Form 1040 instructions. DO NOT ADD TO BOX 1. If you have a question about the amount you were paid, call (501) 682-3206. If you have a question about any amount you may have repaid, call (501) 682-3241.

THIS 1099 G FORM IS FOR YOUR RECORDS IT IS NQT NECESSARY TO SEND A COPY TO THE IRS. FOR MORE INFORMATION, SEE THE INSTRUCTIONS FOR YOUR FEDERAL INCOME TAX RETURN.

THIS IS NOT A BILL

---------

- -

; ~ 1099G - STATEMENT FOR RECIPIENTS OF UNEMPLOYMENT INSURANCE


1 . Unemployment Compensation CORRECTED IF MARKED PROCESSED ON 01/13/2012

Payers Name

Arkansas Department of Workforce Services P.O. Bo* 2981 Little Rock AR 722032981 Phone: 50 1 -682~320b Fprlpral If) 7 1 finnfifiQn

Address Ztr Code & Telephone Number

$4,044.00
4. Federal Income Tax Withheld

2011
Box 1 includes: TRA: DUA:

Recipients N.ime S Address

Form 1099-G OMB No 15450120

Certain Governmen t Payments 5.00


5.00

Copy B
for Recipient
This is important tax information and is be ing furnished to the Interne Revenue Service. If you are required to f i l e a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.

WILLIAM E GATES 103 SOUTH MAIN ST VV4Q3 LITTLE ROCK AR 72201

$383.00

Recipient s Identification Number

509-92-2790
-~~" """" ^ ,_, " Department of the

5. ATAA Payments

CHILD SUPPORT:
_ Treasury

s.oo

$.00

This iniofmaSan is b&m fesrmshed to the Sternal Revenue Service, tf you are required to {Be a tax return, a OS-B No. 1545-0008 negggaise pga&y or sCto sanction may be imposed on ^xj if this inc6me is taxable aid you fail to repdt it.

a. Control Number

i FormW-2

Pf

i Wage & Tax Statement L_ LJ Ju JJ


c. Employer's name, address, and ZIP code PEABODY LITTLE ROCK PEABODY MANAGEMENT INC 5118 PARK AVE SU ITE 245 TN 3 811 7 SuB. MEMPHIS

7. Social security fps 23.12 8. Allocated tips

1. Wages. t|3S, of her compensation 19785.70 3. Social secunty wages 20437.58 5. Medicare wages and tps 20460.70 11. Nonqualified plans 14. Other

2. Federal income tax withheld 1946.63 4. Social security tax withheld 859.35 6. Medicare tax withheld 296.68 12a Code See inst. for box 12 D 675.00 12bCode 12eCode 12dCode

10. Dependent care benefits 13. Statutory BeSrarnent TNstffarty employee Ipbn fStckpay i X >, b. Employer ident^icatton number 62-1084679 d. Employee's soctsi security number 509-92-2790

e. Employee's name, address, and ZIP code WILLIAM E GATES 103 S MAIN APT W403 LITTLE ROCK AR 72201

JR

15. State AR

Employer's state ID no.

16. State wages, tips. etc. 19785.70

17. State income tax 617.14 i

18. Local wages, tps. etc. 19. Local income tax

120. Name of locality

Copy C For EMPLOYEE'S RECORDS (See NoBce to Employee on back of Copy B.}
OMB No. 154S-OOOB

!
1. Wages, t^is, other compensation 1 9 7 8 5 . 7 0 3. Social security wages 20437. 58 5. Medicare wages and tips 20460.70 11. Nonqualified plans D 675.00 M. Other

X
Dept. of the Treasury-IRS 2. Federal income tax withheld 1946.63 4. Social security tax withheld 859.35 6. Medicare tax withheld 296.68 |12aCode See inst. for box 12 12bCode 12cCode 12dCode 120. Name of locality

a. Control Number

[ ? o rm W-2

1011

c Employer's name, address, and ZIP code PEABODY LITTLE ROCK PEABODY MANAGEMENT INC 5118 PARK AVE SUITE 245 MEMPHIS TN 3 8 11 7

1 Wage & Tax Statement C U JJ JJ

7. Social security tips 2 3 . 1 2 8. Allocated tips

10. Dependent care benefits Suff. JR b. Employer kierstrficaf ion number 62-1084679 d, bmpk^es's sods! security nunfeer 509-92-2790 17. State income fax 617.14 ] i 13. StaMore Retirement Tfsd-jjarty i X fi I

e. Employee's name, address, and ZIP code WILLIAM E GATES 103 S MAIN APT W403 LITTLE ROCK AR 72201

15. State AR

Employer's slate ID no.

16. State wages, tips, etc. 19785.70

J18. Local wages, tips, etc. 119. Local income tax

Copy 2 To Be Filed With Employee's Stele, City or Local Income Tax Return
OMB No, iS4MOS8

Bept. of the Treasury-IRS

a. Control Number

Form W

_2

D fl 1

! Wage & Tax Statement C U -U JU


c. Employer's name, address, and ZIP code PEABODY LITTLE ROCK PEABODY MANAGEMENT INC 5118 PARK AVE SUITE 245 MEMPHIS TN 3 8117 JR

7. Social security t^ss 23.12 8. Allocated tfjs 20437. 58 9. 10. Dependent care benefits
1 ! 1 i
v X

1. Wages, tips, other compensation 19785.70 3, Soctai security wages 5. Medicare wages and tips 20460.70 H.Nonqualif led plans 675.00

2. Federal income tax withheld 1946.63 4. Social security tax withheld 859.35 j 6. Medicare tax withheld 12aCode 296.68 See inst. for box 12 D

e. Employee's name, address, and ZIP code WILLIAM E GATES 103 AR 72201 S MAIN APT W403 LITTLE ROCK

12bCode 12cCode 12dCode i 20. Name of locality

I b, Empk>yer identification number 62-1084679 d. Enijioyee's social seorty number 509-92-2790 17. State income tax 18. Locai wages, tips. etc. 1 19. Local income tax 617.14
1 1

15, State no. A R

Employer's state ID

116. State wages, tips. etc. 19785.70


i 1

Copy 2 To Be Filed With Employee's State. City or Local Income Tax Return

w24*i)n

Dept. of the Treasury-IRS

Payer Code:

CTU C T U O nli ne , In c. C T U O nli ne 44 35 N or th C he st nu t St re et Su ite E C ol or ad o S pr in gs , C O 80 90 7 If you have questions contact: 1098T Contact Phone: 8668131836 Ext: 1
ra& TEP145914_2565_51291of2 Ik**

William Gates 103 South Main Street W403 Little Rock, AR 72201

I n s

t r u

c t i o n s f o r S t u d e n t
A n e li g i b l e e d u c a ti o n a l i n s ti t u ti o n , s u c h a s a c o ll e g e o r u n i v e r s it y i n w h i c h y o u a r e e n r o ll e d , a n d a n i n s u r e r w h o m a

k e s r e i m b u r s e m e n t s o r r e f u n d s o f q u a li fi e d t u it i o n a n d r e l a t e d e x p e n s e s t o y o u m u s t f u r n i s h t h i s s t a t e m e n t t o y o u . Y o u , o r t h e p e r s o n w h o c a n c l a i m y

o u a s a d e p e n d e n t , m a y b e a b l e t o c l a i m a n e d u c a t i o n c r e d i t o n F o r m 1 0 4 0 o r 1 0 4 0 A f o r t h e q u a l i f i e d t u i t i o n a n d r e l a t e d e x

p e n s e s t h a t w e r e a c t u a l l y p a i d i n 2 0 1 1 . T o s e e i f y o u q u a l i f y f o r t h e c r e d i t , s e e P u b . 9 7 0 , T a x B e n e f i t s f o r E d u c a t i o n ; F o

r m 8 8 6 3 , E d u c a ti o n C r e d it s ; a n d t h e F o r m 1 0 4 0 o r 1 0 4 0 A i n s t r u c ti o n s . I n s ti t u ti o n s m a y r e p o r t e it h e r p a y m e n t s r e c e i v e d i n b o x 1 o r a m o u n t s b il l e d i n b o

x 2 . T h e a m o u n t s h o w n i n b o x 1 o r 2 m a y r e p r e s e n t a n a m o u n t o t h e r t h a n t h e a m o u n t a c t u a ll y p a i d i n 2 0 1 1 . Y o u r i n s ti t u ti o n m u s t i n c l u d e it s n a m e , a d d r e s s , a

n d i n f o r m a t i o n c o n t a c t t e l e p h o n e n u m b e r o n t h i s s t a t e m e n t . I t m a y a l s o i n c l u d e c o n t a c t i n f o r m a t i o n f o r a s e r v i c e p r o v i d e r .

A l t h o u g h t h e s e r v i c e p r o v i d e r m a y b e a b l e t o a n s w e r c e r t a i n q u e s t i o n s a b o u t t h e s t a t e m e n t , d o n o t c o n t a c t t h e m o r t h e f i l

e r f o r e x p l a n a ti o n s o f t h e r e q u ir e m e n t s f o r ( a n d h o w t o fi g u r e ) a n y e d u c a ti o n c r e d it t h a t y o u m a y c l a i m . S t u d e n t ' s i d e n t i f i c a t i o n n u m b e r . F o r y o u

r p r o t e c ti o n , t h i s f o r m m a y s h o w o n l y t h e l a s t f o u r d i g i t s o f y o u r S S N . I T I N , o r A T I N . H o w e v e r , t h e i s s u e r h a s r e p o r t e d y o u r c o m p l e t

e i d e n t i f i c a t i o n n u m b e r t o t h e I R S a n d , w h e r e a p p l i c a b l e , t o s t a t e a n d / o r l o c a l g o v e r n m e n t s . A c c o u n t n u m b e r . M a y s h o w a n

a c c o u n t o r o t h e r u n i q u e n u m b e r t h e f i l e r a s s i g n e d t o d i s t i n g u i s h y o u r a c c o u n t . B o x 1 . S h o w s t h e t o t a l p a y m e n t s r e c

e i v e d f r o m a n y s o u r c e f o r q u a li f i e d t u i t i o n a n d r e l a t e d e x p e n s e s l e s s a n y r e l a t e d r e i m b u r s e m e n t s o r r e f u n d s . B o x 2 .

S h o w s t h e t o t a l a m o u n t s b il l e d f o r q u a li fi e d t u it i o n a n d r e l a t e d e x p e n s e s l e s s a n y r e l a t e d r e d u c ti o n s i n c h a r g e s . B o x

3 . S h o w s w h e t h e r y o u r i n s t i t u t i o n c h a n g e d i t s m e t h o d o f r e p o r t i n g f o r 2 0 1 1 . I t h a s c h a n g e d i t s m e t h o d o f r e p o r t i n g i f t h e m e t h o d

( p a y m e n t s r e c e i v e d o r a m o u n t s b i l l e d ) u s e d f o r 2 0 1 1 i s d i f f e r e n t t h a n t h e r e p o r t i n g m e t h o d u s e d f o r 2 0 1 0 . Y o u s h o u l d b e a w a

r e o f t h i s c h a n g e i n f i g u r i n g y o u r e d u c a t i o n c r e d i t s . T h e c r e d i t s a r e a ll o w a b l e o n l y f o r a m o u n t s a c t u a ll y p a i d d u r i n g t h e y e a r a n

d n o t a m o u n t s r e p o r t e d a s b il l e d , b u t n o t p a i d , d u r i n g t h e y e a r .

B o x 4 . S h o w s a n y a d j u s t m e n t m a d e f o r a p r i o r y e a r f o r q u a l i f i e d t u i t i o n a n d r e l a t e d e x p e n s e s t h a t w e r e r e p o r t e d o n a p r

i o r y e a r F o r m 1 0 9 8 T . T h i s a m o u n t m a y r e d u c e a n y a l l o w a b l e e d u c a t i o n c r e d i t t h a t y o u c l a i m e d f o r t h e p r i o r y e a r . S e e " r e

c a p t u r e " i n t h e i n d e x t o P u b . 9 7 0 t o r e p o rt a r e d u c ti o n i n y o u r e d u c a ti o n c r e d it o r t u it i o n a n d f e e s d e d u c ti o n . B o x 5 . S h o w s t h e t o t a l o f a ll s c h o l a r s h i

p s o r g r a n t s a d m i n i s t e r e d a n d p r o c e s s e d b y t h e e li g i b l e e d u c a ti o n a l i n s ti t u ti o n . T h e a m o u n t o f s c h o l a r s h i p s o r g r a n t s f o r t h e c a l e n d a r y e a r (i n c l

u d i n g t h o s e n o t r e p o r t e d b y t h e i n s t i t u t i o n ) m a y r e d u c e t h e a m o u n t o f t h e e d u c a t i o n c r e d i t y o u c l a i m f o r t h e y e a r . B o x 6 . S h

o w s a d j u s t m e n t s t o s c h o l a r s h i p s o r g r a n t s f o r a p r i o r y e a r . T h i s a m o u n t m a y a f f e c t t h e a m o u n t o f a n y a l l o w a b l e t u i t i o n a

n d f e e s d e d u c ti o n o r e d u c a ti o n c r e d it t h a t y o u c l a i m e d f o r t h e p r i o r y e a r . Y o u m a y h a v e t o fi l e a n a m e n d e d i n c o m e t a x r e t u r n ( F o r m 1 0

4 0 X ) f o r t h e p ri o r y e a r. B o x 7 . S h o w s w h e t h e r t h e a m o u n t i n b o x 1 o r 2 i n c l u d e s a m o u n t s f o r a n a c a d e m i c p e r i o d b e g i n n i n g J a n u a r y M

a r c h 2 0 1 2 . S e e P u b . 9 7 0 f o r h o w t o r e p o r t t h e s e a m o u n t s . B o x 8 . S h o w s w h e t h e r y o u a r e c o n s i d e r e d t o b e c a r r y i n g a t l e a s t o n

e h a l f t h e n o r m a l f u l l t i m e w o r k l o a d f o r y o u r c o u r s e o f s t u d y a t t h e r e p o r t i n g i n s t i t u t i o n . I f y o u a r e a t l e a s t a h a l f t i m e s t

u d e n t f o r a t l e a s t o n e a c a d e m i c p e r i o d t h a t b e g i n s d u r i n g t h e y e a r , y o u m e e t o n e o f t h e r e q u i r e m e n t s f o r t h e A m e r i c a n o p p o r t u n it y c

r e d it . Y o u d o n o t h a v e t o m e e t t h e w o r k l o a d r e q u i r e m e n t t o q u a li f y f o r t h e li f e t i m e l e a r n i n g c r e d i t . B o x 9 . S h o w s w h e t h e r y o u a r e c

o n s i d e r e d t o b e e n r o l l e d i n a p r o g r a m l e a d i n g t o a g r a d u a t e d e g r e e , g r a d u a t e l e v e l c e r t i f i c a t e , o r o t h e r r e c o g n i z e d g r a d u a

t e l e v e l e d u c a t i o n a l c r e d e n t i a l . I f y o u a r e e n r o l l e d i n a g r a d u a t e p r o g r a m , y o u a r e n o t e l i g i b l e f o r t h e A m e r i c a n o p p o r t u n i t y

c r e d i t , b u t y o u m a y q u a li f y f o r t h e li f e t i m e l e a r n i n g c r e d i t . B o x 1 0 . S h o w s t h e t o t a l a m o u n t o f r e i m b u r s e m e n t s o r r e f u n d s o f q u a l i f i e

d t u i t i o n a n d r e l a t e d e x p e n s e s m a d e b y a n i n s u r e r . T h e a m o u n t o f r e i m b u r s e m e n t s o r r e f u n d s f o r t h e c a l e n d a r y e a r m a y r e d u c e t h e

a m o u n t o f a n y e d u c a t i o n c r e d i

t y o u c a n c l a i m f o r t h e y e a r .

Taxable State:

AR

] CORRECTED
P code, and telephone number 1 Payments received for qualified tuition and related expenses OMB No. 1545-1574

FILER'S name, street address, city, state, Zl

CTU Online, Inc. CTU - Online 4435 North Chestnut Street Suite E Colorado Springs, CO 80907

!11
Form 1098-T

Tuition Statement
Copy B For Student This is important tax information and is being furnished to the Internal Revenue Service.

2 Amounts billed for qualified tuition and related expenses

S 8.120.00
FILER'S federal identification no.

26-1763096
STUDENT'S name, street address (including apt.

STUDENT'Ssocial security number

509-92-2790

no.), city, state, and ZIP code

William Gates 103 South Main Street W403 Little Rock, AR 72201

3 If this box is checked, your educational institution has changed its reporting method for 201 1 i ---------1 4 Adjustments made for 5 Scholarships or grants a prioryear $ 4,105.50 $ 6 Adjustments to scholarships or grants fora prioryear $ 7 Checked if the amount in box 1 or 2 includes amounts for an academic period beginningjanuary- _________ March 2012 ^. 10 Ins. contract reimb. /refund $

Service Provider/Accl, No, 8 Checked if at least 9 Checked if a (see instr.) 6 1454433 , --------------------------------------------------------------------------------------------------graduate student , half-time student |X | Department of the Treasury- Internal Revenue Service (keep for your records) Form 1098-T

1H8018 3.000