TAMIKO N SIMON

Friendly and compassionate individual with strong interpersonal skills and passion for patient care. Knowledge of basic medical terminology and proficiency in vital sign monitoring and patient assistance. Committed to providing high-quality care to improve patient well-being.

• This blue section is your Earnings Summary which provides more detailed information on the generation of your W-2 statement. The reverse side includes instructions and other general information.
• 1. Your Gross Pay was adjusted as follows to produce your W-2 Statement.
• Wages, Tips, other Compensation Box 1 of W-2
• Social Security Wages Box 3 of W-2
• Medicare Wages Box 5 of W-2
• Gross Pay 47,358.29 47,358.29 47,358.29
• Plus GTL (C-Box 12) 5.60 5.60 5.60
• Less Other Cafe 125 2,258.88 2,258.88 2,258.88
• Reported W-2 Wages 45,105.01 45,105.01 45,105.01
• 2. Employee Name and Address.
• TAMIKO N SIMON
• 6212 GLENVIEW DR., #216
• #216
• N RICHLAND HILLS TX 76180
• 2025 ADP, Inc.
• Wages, tips, other comp. 45,105.01
• Federal income tax withheld 3562.12
• Social security wages 45,105.01
• Social security tax withheld 2796.51
• Medicare wages and tips 45,105.01
• Medicare tax withheld 654.02
• Control number 007098 NCN2/FBY/000043
• Corp. Employee use only
• Employer's name, address, and ZIP code
• US RENAL CARE INC
• 5851 LEGACY CIR STE 900
• PLANO TX 75024
• Batch #03219
• Employer's FED ID number 62-1826478
• Employee's SSA number XXX-XX-0589
• Social security tips
• Allocated tips
• Dependent care benefits
• Nonqualified plans
• 12a See instructions for box 12
• 12b C 5.60
• 12c D
• 14 Other 7648.60
• 13 Statutory emp. Ret. plan 3rd party sick pay
• State Employer's state ID no TX
• 16 State wages, tips, etc. 45,105.01
• 17 State income tax 3562.12
• 18 Local wages, tips, etc.
• 19 Local income tax
• Instructions for Employee
• Box 1. Enter this amount on the wages line of your tax return.
• Box 2. Enter this amount on the federal income tax withheld line of your tax return.
• Box 5. You may be required to report this amount on Form 8959. See the 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 Medicare wages and tips above $200,000.
• Box 8. This amount is not included in boxes 1, 3, or 5. For information on how to report tips on your tax return, see the Form 1040 instructions. You must file Form 4137 with your income tax return to report all tips allocated to you and shown on your W-2. If you have records that show the actual amount of tips you received, report that amount even if it is more or less than the allocated tips. Use Form 4137 to figure the social security and Medicare tax owed on tips you didn't report to your employer. Enter this amount on the wages line of your tax return. By filing Form 4137, your social security tips will be credited to your social security record (used to figure your benefits).
• Box 10. This amount includes the total dependent care benefits that your employer paid to your incurred on your behalf under a dependent care assistance plan (section 125 cafeteria plan). Any amount over your employer's plan limit is also included in box 1. See Form 2441.
• Box 11. This amount is reported in box 11 if it is a distribution made to you from a nonqualified deferred compensation or nongovernmental section 457(b) plan. If you participated in both a 3rd party sick pay plan and a prior year deferral under a nongovernmental 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 shouldn't be used if you had a deferral and a distribution in the same calendar year. If you had a deferral and received a distribution in the same calendar year, and you are or will be age 72 by the end of the calendar year, your employer should file Form SSA-131, Employer Report of Special Wage Payments, 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, G, and S) and designated Roth contributions (codes AA, BB, and EE) under all plans are generally limited to a total of $23,500. (Generally, $16,500 for SIMPLE plans; $26,500 for section 403(b) plans if you qualify for the 15-year rule explained in Pub. 571.) Deferrals under code G are limited to $23,500. Deferrals under code H are limited to $7,000. However, if you are at least age 50 in 2025, your employer may have allowed an additional elective deferral or designated Roth contribution (catch-up contribution) to your plan. For information about the limits on catch-up contributions, including the higher limit if you are age 60 through 63 as of December 31, 2025, see Pub. 571. Contact your plan administrator if you need information. Amounts in excess of the elective deferral limit must be included in income. See the Form 1040 instructions.
• Note: If your codes are through K, S, Y, AA, BB, or EE, you may make a pension contribution for a prior year only 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 amounts are for the current year.
• A—Uncollected social security or RRTA tax on tips. Include this on Form 1040 or 1040-SR. See the Form 1040 instructions.
• B—Uncollected Medicare tax on tips. Include this tax on Form 1040 or 1040-SR. See the Form 1040 instructions.
• C—Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3, or 5) (use the social security wage base, as of)
• 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 408(k) salary reduction agreement SEP (this includes elective deferrals made to a Roth SEP IRA)
• F—Elective deferrals under a section 403(b) salary reduction agreement (this includes elective deferrals made to a Roth 403(b) plan)
• 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. See the Form 1040 instructions for how to deduct.
• J—Non-taxable sick pay (information only, not included in box 1, 3 or 5)
• K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
• L—Substantiated employee business expense reimbursements (non-taxable)
• M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (former employees only). See the Form 1040 instructions.
• N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (former employees only). See the Form 1040 instructions.
• P—Excludable moving expense reimbursements paid directly to a member of the U.S. Armed Forces (not included in box 1, 3, or 5)
• Q—Non-taxable combat pay. See the Form 1040 instructions for details on reporting this amount.
• R—Employer contributions to your Archer MSA. Report on Form 8853.
• NOTE: THESE ARE SUBSTITUTE WAGE AND TAX STATEMENTS AND ARE ACCEPTABLE FOR FILING WITH YOUR FEDERAL, STATE AND LOCAL/CITY INCOME TAX RETURNS.
• Future developments. For the latest information about developments related to Form W-2, such as legislation enacted after it was published, go to www.irs.gov/FormW2.
• 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 don't 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.
• Earned income tax credit (EITC). You may be able to take the EITC for 2025 if your adjusted gross income (AGI) is less than a certain amount. The amount of the credit is based on income and family size. Workers without children could qualify for a smaller credit. You and any qualifying children must have valid social security numbers (SSNs). You can't take the EITC if your investment income is more than the specified amount for 2025 or if income is earned for services provided while you were an inmate at a penal institution. For 2025 income limits and more information, visit www.irs.gov/EITC. See also Pub. 596. Any EITC that is more than your tax liability is refunded to you, but only if you file a tax return.
• Employee's social security number (SSN). For your protection, this form may show only the last four digits of your SSN. However, your employer has reported your complete SSN to the IRS and the Social Security Administration (SSA).
• Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub. 517.
• Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and ask your employer to correct your employment record. Be sure to ask the employer to give you Form W-2c, Corrected Wage and Tax Statement, with the SSA to correct any name, SSN, or any other error reported to the SSA on Form W-2. Be sure to report all corrections made so you may file them with your tax return. If your name and SSN are correct but aren't the same as shown on your social security card, you should ask for a new card that displays your correct name at any SSA office or by calling 800-772-1213. You may also visit the SSA website at www.SSA.gov.
• Cost of employer-sponsored health coverage (if such cost is provided by the employer). Reporting in box 12, 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 taxes. If you had more than one employer in 2025 and more than $10,918.20 in social security tax or Tier 1 railroad retirement tax withheld, you may be able to claim a credit for the excess against your federal income tax. See the Form 1040 instructions. If you had more than one railroad employer and more than the $6,409.20 Tier 2 RRTA tax was withheld, you may be able to claim a refund on Form 843. See the instructions for Form 843.

Ccht