2018

a Employee's social security number

OMB No. 1545-0008

2018
W2 & EARNINGS 359-62-0010
c Employer's name, address, and ZIP code 1 Wages,tips,other compensation 2 Federal income tax
SUMMARY DOMINICAN UNIVERSITY 38922.43 1102.62
3 Social security wages 4 Social security tax
7900 W DIVISION 2493.81
40222.43
RIVER FOREST, IL 60305

Wage and Tax Statement

5 Medicare wages and tips 6 Medicare tax withheld

Copy B to be filed with Employee's Federal Income Tax Return.

b Employer's identification number d Control Number
40222.43 583.24

Federal Filing Copy

DOMINICAN UNIVERSITY
7 Social security tips 8 Allocated tips
7900 W DIVISION 36-2167855 78481-558524
e Employee's name and address 9 Verification code 10 Dependent care benefits
RIVER FOREST, IL 60305
e021-655d-26ad-dffc
EMMA MIMS 11 Nonqualified plans 12 See instrs. for box 12
4421 W. ADAMS C 25.22
CHICAGO, IL 60624 13 Stat emp. Ret. Plan 3 Party Sick
E 1300.00
X
14 Other BB 390.00
EMMA MIMS DD 22144.68

W2
15 State & Employer's state ID 16 State wages,tips,etc 17 State income tax 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
Filing Status Exemptions IL 3621678550000 38922.43 1517.34
FITWH M 4
IL M 4
a Employee's social security number

OMB No. 1545-0008

2018
OTHER 359-62-0010
c Employer's name, address, and ZIP code 1 Wages,tips,other compensation 2 Federal income tax
Description Amount Box
DOMINICAN UNIVERSITY 38922.43 1102.62
GTLN401K 25.22 12 7900 W DIVISION 3 Social security wages 4 Social security tax
40222.43 2493.81
403B 1300.00 12 RIVER FOREST, IL 60305

Wage and Tax Statement

5 Medicare wages and tips 6 Medicare tax withheld
b Employer's identification number d Control Number
WAGES 40222.43 583.24

Copy 2 to be filed with Employee's State Income Tax Return.

State Filing Copy
7 Social security tips 8 Allocated tips
36-2167855 78481-558524
e Employee's name and address 9 Verification code 10 Dependent care benefits
EMMA MIMS
11 Nonqualified plans 12 See instrs. for box 12
4421 W. ADAMS C 25.22
CHICAGO, IL 60624 13 Stat emp. Ret. Plan 3 Party Sick
X E 1300.00
14 Other BB 390.00
DD 22144.68

W2
15 State & Employer's state ID 16 State wages,tips,etc 17 State income tax 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
TOTAL GROSS WAGES 44169.59 IL 3621678550000 38922.43 1517.34
Description Amount Box
Soc. Security Wages 40222.43 3
Medicare Wages 40222.43 5
a Employee's social security number

OMB No. 1545-0008

2018
Fed. Taxable Wages 38922.43 1 359-62-0010
c Employer's name, address, and ZIP code 1 Wages,tips,other compensation 2 Federal income tax
IL Taxable Wages 38922.43 16
DOMINICAN UNIVERSITY 38922.43 1102.62
WITHHOLDINGS 3 Social security wages 4 Social security tax
7900 W DIVISION
Description Amount Box 40222.43 2493.81
RIVER FOREST, IL 60305

Wage and Tax Statement

Fed. Income Tax
Soc. Security Tax
City or Local Filing Copy
5 Medicare wages and tips 6 Medicare tax withheld
1102.62 2 b Employer's identification number d Control Number
40222.43 583.24
7 Social security tips 8 Allocated tips
2493.81 4 36-2167855 78481-558524

Copy 2 for Employee's City/Local Income Tax Return.

Medicare Tax 583.24 6 e Employee's name and address 9 Verification code 10 Dependent care benefits
IL Income Tax 1517.34 17 EMMA MIMS
11 Nonqualified plans 12 See instrs. for box 12
DEDUCTIONS 4421 W. ADAMS C 25.22
Description Amount Box CHICAGO, IL 60624 13 Stat emp. Ret. Plan 3 Party Sick
X E 1300.00
403(b) Annuity 1300.00 12 14 Other BB 390.00
Roth 403B Plan 390.00 12 DD 22144.68
Health ER Premium 18528.12 12

W2
Health 125 Deduction 3616.56 12
15 State & Employer's state ID 16 State wages,tips,etc 17 State income tax 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
Section 125 Benefit Plan 3947.16 IL 3621678550000 38922.43 1517.34

a Employee's social security number

OMB No. 1545-0008
2018

359-62-0010
c Employer's name, address, and ZIP code 1 Wages,tips,other compensation 2 Federal income tax
DOMINICAN UNIVERSITY 38922.43 1102.62
3 Social security wages 4 Social security tax
7900 W DIVISION
40222.43 2493.81
Employee Reference Copy

RIVER FOREST, IL 60305

Wage and Tax Statement

5 Medicare wages and tips 6 Medicare tax withheld

b Employer's identification number d Control Number
40222.43 583.24
7 Social security tips 8 Allocated tips
36-2167855 78481-558524
e Employee's name and address 9 Verification code 10 Dependent care benefits

EMMA MIMS e021-655d-26ad-dffc

11 Nonqualified plans 12 See instrs. for box 12
4421 W. ADAMS C 25.22
CHICAGO, IL 60624 13 Stat emp. Ret. Plan 3 Party Sick
E 1300.00
Copy C for Employee's records.

X
14 Other BB 390.00
DD 22144.68
W2

15 State & Employer's state ID 16 State wages,tips,etc 17 State income tax 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
IL 3621678550000 38922.43 1517.34