W-2VI U.S. Virgin Islands Wage and Tax Statement

Version A, Cycle 3

22222

a Employee’s social security number

Void

For Official Use Only

▶

OMB No. 1545-0008

b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI income tax withheld

c Employer’s name, address, and ZIP code

3 Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6 Medicare tax withheld

Internal Use Only
DRAFT AS OF
March 8, 2013
7 Social security tips

d Control number

8

9

e Employee’s first name and initial

Last name

10

Suff. 11 Nonqualified plans
13

Statutory
employee

Retirement
plan

12a See instructions for box 12
C
o
d
e

Third-party
sick pay

14 Other

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
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e

f Employee’s address and ZIP code

Form

W-2VI

U.S. Virgin Islands
Wage and Tax Statement

2014

Copy A For Social Security Administration — Send this entire page with Copy A of
Form W-3SS to the Social Security Administration; photocopies are not acceptable.

Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction Act
Notice, see the separate instructions.

Do Not Cut, Fold, or Staple Forms on This Page

Cat. No. 49977C

Version A, Cycle 3

22222

a Employee’s social security number

Void

OMB No. 1545-0008

b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI income tax withheld

c Employer’s name, address, and ZIP code

3 Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6 Medicare tax withheld

Internal Use Only
DRAFT AS OF
March 8, 2013
7 Social security tips

d Control number

8

9

e Employee’s first name and initial

Last name

Suff.

10

11 Nonqualified plans
13

Statutory
employee

14 Other

Retirement
plan

12a
C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2VI

U.S. Virgin Islands
Wage and Tax Statement

Copy 1—For VI Bureau of Internal Revenue

2014

Department of the Treasury—Internal Revenue Service

Version A, Cycle 3
a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI income tax withheld

c Employer’s name, address, and ZIP code

3 Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6 Medicare tax withheld

Internal Use Only
DRAFT AS OF
March 8, 2013
7 Social security tips

d Control number

8

10

9

e Employee’s first name and initial

Last name

Suff.

11 Nonqualified plans
13

Statutory
employee

14 Other

Retirement
plan

12a See instructions for box 12
C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2VI

U.S. Virgin Islands
Wage and Tax Statement

Copy B—To Be Filed With Employee’s VI Tax Return

2014

Department of the Treasury—Internal Revenue Service
This information is being furnished to the
VI Bureau of Internal Revenue.

Version A, Cycle 3

Notice to Employee
Do you have to file? Refer to the Form 1040 Instructions to determine if you
are required to file a tax return. Even if you do not have to file a tax return,
you may be eligible for a refund if box 2 shows an amount or if you are
eligible for any credit.
Copies B and C; corrections. File Copy B of this form with your 2014 U.S.
Virgin Islands income tax return. Keep Copy C for your records. If your name,
social security number (SSN), or address is incorrect, correct Copies B and C
and ask your employer to correct your employment record. Be sure to ask
your employer to file Form W-2c, Corrected Wage and Tax Statement, with
the Social Security Administration (SSA) to correct any name, amount, or
SSN error reported to the SSA.

the allocated tips. Use Form 4137 to figure the social security and Medicare
tax owed on tips you did not report to your employer. Enter this amount on
the wages line of your tax return. (Form 1040-SS filers, see the instructions
for Form 1040-SS, Part I, line 5.) By filing this form, your social security tips
will be credited to your social security record (used to figure your benefits).
(Also see the Instructions for Employee on this page and the back of Copy C.)

Instructions for Employee

Internal Use Only
DRAFT AS OF
March 8, 2013

Estimated tax. If you expect to owe $1,000 or more in tax (including selfemployment tax) for 2015, you may have to make estimated tax payments to
the U.S. Internal Revenue Service. Use Form 1040-ES, Estimated Tax for
Individuals.
Clergy and religious workers. If you are not subject to social security and
Medicare taxes, see Pub. 517, Social Security and Other Information for
Members of the Clergy and Religious Workers.
Cost of employer-sponsored health coverage (if such cost is provided
by the employer). The reporting in box 12, using code DD, of the cost of
employer-sponsored health coverage is for your information only. The
amount reported with code DD is not taxable.

Credit for excess social security tax. If one employer paid you wages
during 2014 and more than $X,XXX.XX in social security tax was withheld,
you can claim a refund of the excess by filing Form 1040 with the V.I. Bureau
of Internal Revenue, 6115 Estate Smith Bay, Suite 225, St. Thomas, VI 00802.
If you had more than one employer in 2014 and more than $X,XXX.XX in
social security tax was withheld, you can have the excess refunded by filing
Form 843, Claim for Refund and Request for Abatement, with the
Department of the Treasury, Internal Revenue Service Center, Austin, TX
73301-0215, USA. However, if you are required to file Form 1040 with the
United States, you must claim the excess tax as a credit on Form 1040.

Unreported tip income. You must file Form 4137, Social Security and
Medicare Tax on Unreported Tip Income, with your income tax return to
report at least the allocated tip amount unless you can prove a smaller
amount with adequate records. If you have records that show the actual
amount of tips you received, report that amount even if it is more or less than

(Also see Notice to Employee on this page.)

Box 5. This amount may be required to be entered on Form 8959. See Form
1040 instructions to determine if you are required to complete Form 8959.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all
Medicare wages and tips shown in Box 5, as well as the 0.9% Additional
Medicare Tax on any of those Medicare wages and tips above $200,000.
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you
from a nonqualified deferred compensation or nongovernmental section
457(b) plan or (b) included in box 3 and/or 5 if it is a prior year deferral under
a nonqualified or section 457(b) plan that became taxable for social security
and Medicare taxes this year because there is no longer a substantial risk of
forfeiture of your right to the deferred amount. This box should not be used if
you had a deferral and a distribution in the same calendar year. If this
happens and you are or will be age 62 by the end of the calendar year, your
employer should file Form SSA-131 with the Social Security Administration
and give you a copy.
Box 12. The following list explains the codes shown in box 12. You may
need this information to complete your tax return. Elective deferrals (codes
D, E, F, and S) and designated Roth contributions (codes AA, BB, and EE)
under all plans are generally limited to a total of $XX,XXX ($XX,XXX if you
have only SIMPLE plans; $XX,XXX for section 403(b) plans if you qualify for
the 15-year rule explained in Pub. 571). Deferrals under code G are limited to
$XX,XXX. Deferrals under code H are limited to $X,XXX.
(continued on back of Copy C)

Version A, Cycle 3
a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI income tax withheld

c Employer’s name, address, and ZIP code

3 Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6 Medicare tax withheld

Internal Use Only
DRAFT AS OF
March 8, 2013
7 Social security tips

d Control number

8

9

e Employee’s first name and initial

Last name

Suff.

10

11 Nonqualified plans
13

Statutory
employee

14 Other

Retirement
plan

12a See instructions for box 12
C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2VI

U.S. Virgin Islands
Wage and Tax Statement

Copy C—For EMPLOYEE'S RECORDS (See Notice to Employee
on the back of Copy B.)

2014

Department of the Treasury—Internal Revenue Service
This information is being furnished to the
VI Bureau of Internal Revenue.

Version A, Cycle 3

Instructions for Employee (continued from
back of Copy B)

N—Uncollected Medicare tax on taxable cost of group-term life insurance
over $50,000 (former employees only). Report on U.S. Form 1040, or on
Form 1040-SS if not required to file Form 1040.

Box 12 (continued)

P—Excludable moving expense reimbursements paid directly to employee
(not included in boxes 1, 3, or 5)

However, if you were at least age 50 in 2014, your employer may have
allowed an additional deferral of up to $X,XXX ($X,XXX for section 401(k)(11)
and 408(p) SIMPLE plans). This additional deferral amount is not subject to
the overall limit on elective deferrals. For code G, the limit on elective
deferrals may be higher for the last 3 years before you reach retirement age.
Contact your plan administrator for more information. Amounts in excess of
the overall elective deferral limit must be included in income. See the
“Wages, Salaries, Tips, etc.” line instructions for your tax return.

Q—Nontaxable combat pay. See your tax return instructions for details on
reporting this amount.
R—Employer contributions to your Archer MSA. Report on Form 8853,
Archer MSAs and Long-Term Care Insurance Contracts.
S—Employee salary reduction contributions under a section 408(p) SIMPLE
plan (not included in box 1)

Internal Use Only
DRAFT AS OF
March 8, 2013

Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a
make-up pension contribution for a prior year(s) when you were in military
service. To figure whether you made excess deferrals, consider these
amounts for the year shown, not the current year. If no year is shown, the
contributions are for the current year.

T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified
Adoption Expenses, to figure taxable and nontaxable amounts.

A—Uncollected social security tax on tips. Report on U.S. Form 1040, or on
Form 1040-SS if not required to file Form 1040.

W—Employer contributions (including amounts the employee elected to
contribute using a section 125 (cafeteria) plan) to your health savings
account (HSA). Report on Form 8889, Health Savings Accounts (HSAs).

B—Uncollected Medicare tax on tips. Report on U.S. Form 1040, or on Form
1040-SS if not required to file Form 1040.
C—Taxable cost of group-term life insurance over $50,000 (included in
boxes 1, 3 (up to social security wage base), and 5)

D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also
includes deferrals under a SIMPLE retirement account that is part of a
section 401(k) arrangement.
E—Elective deferrals under a section 403(b) salary reduction agreement
F—Elective deferrals under a section 408(k)(6) salary reduction SEP

G—Elective deferrals and employer contributions (including nonelective
deferrals) to a section 457(b) deferred compensation plan
H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan.
(You may be able to deduct.)
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
M—Uncollected social security tax on taxable cost of group-term life
insurance over $50,000 (former employees only). Report on U.S. Form 1040,
or on Form 1040-SS if not required to file Form 1040.

V—Income from exercise of nonstatutory stock option(s) (included in boxes
1, 3 (up to social security wage base), and 5). See Pub. 525 and instructions
for Schedule D (Form 1040) for reporting requirements.

Y—Deferrals under a section 409A nonqualified deferred compensation plan
Z—Income under section 409A on a nonqualified deferred compensation
plan. This amount is also included in box 1. It is subject to an additional 20%
tax plus interest. See “Other Taxes” in the instructions for your tax return.
AA—Designated Roth contributions under a section 401(k) plan
BB—Designated Roth contributions under a section 403(b) plan
DD—Cost of employer-sponsored health coverage. The amount reported
with code DD is not taxable.
EE—Designated Roth contributions under a governmental section 457(b)
plan. This amount does not apply to contributions under a tax-exempt
organization section 457(b) plan.
Box 13. If the “Retirement plan” box is checked, special limits may apply to
the amount of traditional IRA contributions that you may deduct.
Note. Keep Copy C of Form W-2VI for at least 3 years after the due date for filing
your income tax return. However, to help protect your social security benefits, keep
Copy C until you begin receiving social security benefits just in case there is a
question about your work record and/or earnings in a particular year.

Version A, Cycle 3
a Employee’s social security number

Void

OMB No. 1545-0008

b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI income tax withheld

c Employer’s name, address, and ZIP code

3 Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6 Medicare tax withheld

Internal Use Only
DRAFT AS OF
March 8, 2013
7 Social security tips

d Control number

8

9

e Employee’s first name and initial

Last name

Suff.

10

11 Nonqualified plans
13

Statutory
employee

14 Other

Retirement
plan

12a See instructions for box 12
C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2VI

Copy D—For Employer

U.S. Virgin Islands
Wage and Tax Statement

2014

Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction Act
Notice, see the separate instructions.

Version A, Cycle 3

Employers, Please Note—
Specific information needed to complete Form W-2VI is
available in a separate booklet titled the 2014 General
Instructions for Forms W-2 and W-3. You can order these
instructions and additional forms by calling toll free 1-800TAX-FORM (1-800-829-3676). You also can get forms and
instructions at IRS.gov.
Caution. Do not send the SSA Forms W-2VI and W-3SS that
you have printed from IRS.gov. The SSA is unable to process
these forms. Instead, you can create and submit them online.
See E-filing, later.
Due dates. By January 31, 2015, furnish Copies B and C to
each person who was your employee during 2014. By March
2, 2015, send Copy A of Form(s) W-2VI and W-3SS to the
SSA. However, if you file electronically, the due date is
March 31, 2015. See the separate instructions.
Need help? If you have questions about reporting on Form
W-2VI, call the information reporting customer service site
toll free at 1-866-455-7438 or 304-263-8700 (not toll free).

For TTY/TDD equipment for persons who are deaf, hard of
hearing, or have a speech disability, call 304-579-4827 (not
toll free). The hours of operation are 8:30 a.m. to 4:30 p.m.
Eastern time.
E-filing. If you file 250 or more Form(s) W-2VI, you must file
electronically. E-filing can save you time and effort, even if
you are not required to do so. Employers may now use the
SSA's W-2 Online service to create, save, print, and submit
up to 50 Form(s) W-2VI at a time over the Internet. For
information, visit the SSA’s Employer W-2 Filing Instructions
& Information website at www.socialsecurity.gov/employer or
contact your Employer Services Liaison Officer (ESLO) at
1-212-264-1117 (not toll free).

Internal Use Only
DRAFT AS OF
March 8, 2013

Future developments. Information about any future
developments affecting Form W-2VI and its instructions
(such as legislation enacted after we release them) will be
posted at www.irs.gov/w2.