LOS ANGELES UNIFIED SCHOOL DISTRICT



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TITLE: 2015 Wage and Tax Statement (Form W-2 ) ROUTING All Schools and Offices Administrators NUMBER: MEM-4090.10 Time Reporters ISSUER: DATE: January 25, 2016 V. Luis Buendia, Controller PURPOSE: INSTRUCTIONS: The purpose of this Memorandum is to provide information to employees to assist in understanding the Wage and Tax Statement (Form W-2) for calendar year 2015. Administrators are requested to post this memorandum at their site or provide a copy to each employee. I. W-2 FORM DELIVERY PROCEDURES Wage and Tax Statements for calendar year 2015 are to be mailed January 27, 2016 via school mail to employees who receive their salary payments at their work location and via U.S. mail to employees who receive their salary payments at their home address. Employees who access their salary payment information on line will receive their W-2 via the delivery method used before they opted out of receiving a pay stub. Secretaries/School Administrative Assistants who receive a Form W-2 for employees no longer assigned at their location should return the Form W-2 immediately via school mail to Salary Delivery, Payroll Services, Beaudry Building 27 th Floor. Green border payroll envelopes must not be used to return Forms W-2. II. 403(b) AND 457(b) TAX SHELTERED ACCOUNTS The total amount of 403(b) and 457(b) reductions for calendar year 2015 will appear in box 12 identified as code E and code G respectively. These amounts are not included in box 1, Wages, tips, other compensation, or box 16, State wages, tips, etc. III. VEHICLE USE FRINGE BENEFIT The total Vehicle Use fringe benefit value for calendar year 2015 will appear in box 14 identified as VEH FR. The Vehicle Use fringe benefit value is included in box 1, Wages, tips, other compensation MEM-4090.10 Page 1 of 7 January 25, 2016

and box 16, State wages, tips, etc., of affected employees for Federal and State income tax reporting purposes. In addition and if applicable, this value is also included in box 3, Social security wages and box 5, Medicare wages and tips and the corresponding tax amount of the value is reflected in boxes 4 and 6, Social security tax withheld and Medicare tax withheld, respectively. IV. TRANSIT SUBSIDY FRINGE BENEFIT For Federal income tax reporting for calendar year 2015, the value of all employer provided transit subsidy payments such as mass transit, car pool, drop-off, bicycle, and walkers are not exempt from gross income and will be included in box 1, Wages, tips, and other compensation of affected employees. In addition and if applicable, this amount is also included in box 3, Social security wages and box 5, Medicare wages and tips, and the corresponding tax amount of the value is reflected in boxes 4 and 6, Social security tax withheld and Medicare tax withheld, respectively. For California income tax reporting for calendar year 2015, the value of all employer provided transit subsidy payments such as mass transit, car pool, drop-off, bicycle, and walkers are exempt from gross income and will not be included on Form W-2. V. WORKERS COMPENSATION PAYMENTS The total amount of temporary disability payments for Workers Compensation for calendar year 2015 will appear in box 14 identified as TD. These temporary disability payments are not included in box 1, Wages, tips, other compensation, or box 16, State wages, tips, etc. In addition and if applicable, this amount is not subject to Social Security and Medicare tax and is not reflected in box 3, Social security wages, box 5, Medicare wages and tips, box 4, Social security tax withheld, and box 6, Medicare tax withheld, respectively. VI. DEPENDENT CHILD CARE BENEFITS The total amount of pre-tax contributions made to Section 125, Dependent Care Flexible Spending account, will appear in box 10, Dependent care benefits. This amount is not included in box 1, Wages, tips, other compensation, or box 16, State wages, tips, etc. MEM-4090.10 Page 2 of 7 January 25, 2016

In addition and if applicable, this amount is not subject to Social Security and Medicare tax and is not reflected in box 3, Social security wages, box 5, Medicare wages and tips, box 4, Social security tax withheld, and box 6, Medicare tax withheld, respectively. VII DOMESTIC PARTNER HEALTH BENEFIT The total value of Domestic Partner coverage for calendar year 2015 will appear in box 14 identified as DP GR. This amount is included in box 1, Wages, tips, other compensation and box 16, State wages, tips, etc. of affected employees for Federal and State income tax reporting purposes. Domestic Partners who are registered with the State of California are exempt from State income tax and the amount of the coverage shown in box 14 will not appear in box 16 State wages, tips, etc. In addition and if applicable, this value is also included in box 3, Social security wages and box 5, Medicare wages and tips and the corresponding tax amount of the value is reflected in boxes 4, 6, and 14, Social security tax withheld, Medicare tax withheld and SDI TX (State Disability Insurance Tax), respectively. For inquiries pertaining to Domestic Partner Imputed Income, please call Benefits Administration customer service at 213-241-4262. VIII. HEALTH INSURANCE The total cost of District paid health coverage will appear in box 12 identified as code DD. The amount is displayed on the Form W-2 for information only and is not subject to any type of payroll tax. IX. IMPACT OF OVERPAYMENTS ON W-2 DATA If you were overpaid in 2015 and repaid the overpayment in 2015, your 2015 W-2 will not reflect the wages overpaid in the calendar year. If you repaid a prior year overpayment during the 2015 calendar year there is no impact to your 2015 W-2 wages or taxes. Instead, you will receive a statement noting the amount you repaid in 2014 which you may use when filing your 2015 tax forms. MEM-4090.10 Page 3 of 7 January 25, 2016

X. NON-RECEIPT OF FORM W-2 Employees who have not received a 2015 Form W-2 by February 8, 2016 must submit a request for a duplicate using the Request for Duplicate Form W-2, Attachment A, provided in this memorandum. This form is also available online and can be accessed through the LAUSD website using this web address: http://payroll.lausd.net/page/440. Employees should send the completed form via fax to 866-761-7413. District confirmation of receipt of your request will be provided via email to the email address provided on your form. Requests for duplicate W-2s will be processed weekly beginning the week of February 8, 2016. All requests submitted prior to noon each Thursday will be available for pick-up in the Payroll Support Services office on Friday of the following week. All W-2 s not picked up from Payroll Support Services will be mailed the following Monday. W-2 copies will also be available through the Employee Self Service (ESS) site after February 16, 2016. Employees may log online at https://selfservice.lausd.net with Single Sign On and password and select W-2 reprint for 2015. XI. W-2 DATA INQUIRIES Every attempt has been made to ensure the accuracy of the information. However, any employee who feels the information is inaccurate may complete the W-2 Inquiry Form, Attachment B, provided in this memorandum. This form is also available online and can be accessed through the LAUSD website using this web address: http://achieve.lausd.net/page/440. Employees should submit the completed form via fax to 866-761-7413. Employees are asked to provide detailed information as to their specific issues and concerns with the W-2 received. Based on the information provided, Payroll Administration will perform research to determine whether an additional interview with employee and/or issuance of a corrected W-2 (W-2c) is necessary. If an additional interview is necessary, the employee will be contacted by a member of the payroll team. Employees will be notified of the outcome of District research via the contact information provided on your inquiry form. MEM-4090.10 Page 4 of 7 January 25, 2016

RELATED RESOURCES: ASSISTANCE: None. Employees who require further information regarding a duplicate W-2 or a W-2 Inquiry should contact Payroll Support Services at 213-241-2570. MEM-4090.10 Page 5 of 7 January 25, 2016

ATTACHMENT A Request for Duplicate Form W-2 Employee Name Employee Number Document(s) Requested 2015 W-2 Prior Year W-2 Year(s): Requests received before noon on Thursday will be available for pick-up on Friday, the following week. W-2s not picked-up will be put in the U.S. Mail on the following Monday. Note: Generation of W-2 s will only go back to 2005 and will require an additional 10-14 days for processing and distribution. Mailing Instruction All duplicate requests for W-2 s not picked-up will be mailed to the home address on file. Please complete below for address changes. Home Address City, ST ZIP Address Change (your address on record will be updated) Telephone Number Email Address Signature Date Please fax completed form to 866-761-7413 MEM-4090.10 Page 6 of 7 January 25, 2016

ATTACHMENT B W-2 Inquiry Form Employee Name Employee Number Box number box 1 Wages, tips, other compensation in question box 2 Federal income tax withheld (please check) box 5 Medicare wages and tips box 6 Medicare tax withheld box 16 State wages, tips, etc. box 17 State income tax Reason for inquiry Mailing Instruction All W-2c s, if applicable, will be mailed to the home address or the updated address if provided below. Home Address City, ST ZIP Address Change (your address on record will be updated) Telephone Number Email Address Signature Date Please fax completed form to 866-761-7413 MEM-4090.10 Page 7 of 7 January 25, 2016