Court filing

Motion to Vacate, Set Aside, Or Correct Sentence Pursuant to 28 U.S.C. — USA v. Lattany (Dkt. 46, D. Colo.)

Filed November 13, 2023 in USA v. Lattany; one of 77 filings from this case.

Record facts

Court	U.S. District Court for the District of Colorado
Filed	2023-11-13

U.S. District Court for the District of Colorado · No. 1:23-cr-00074-NYW · Doc. 46 · 2023-11-13 · Docket on CourtListener

Full text

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLORADO

Civil Action No.
23-cr-00074-NYW-1

UNITED STATES OF AMERICA,

DEJANE REANIECE LATTANY, Movant/Defendant.

MOTION TO VACATE, SET ASIDE, OR CORRECT SENTENCE
PURSUANT TO 28 U.S.C. § 2255

A.
MOVANT/DEFENDANT INFORMATION
You must notify the court of any changes to your address where case-related papers may be
served by filing a notice of change of address. Failure to keep a current address on file with the
court may result in dismissal of your case.

DEJANE REANIECE LATTANY, 11125 Quintero Court Commerce City Colorado 80022
(Movant/Defendant’s name, prisoner identification number, and complete mailing address)

Indicate whether you are a prisoner or other confined person as follows: (check one)

Convicted and sentenced federal prisoner

Other: (Please explain)

NOTICE
Federal Rule of Civil Procedure 5.2 addresses the privacy and security concerns resulting from
public access to electronic court files. Under this rule, papers filed with the court should not
contain: an individual’s full social security number or full birth date; the full name of a person
known to be a minor; or a complete financial account number. A filing may include only: the
last four digits of a social security number; the year of an individual’s birth; a minor’s initials;
and the last four digits of a financial account number.
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 1
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FILED
UNITED STATES DISTRICT COURT
DENVER, COLORADO

JEFFREY P. COLWELL, CLERK
11/13/2023

B.
CONVICTION UNDER ATTACK
Name of the court that entered the
judgment of conviction:
UNITED STATES DISTRICT COURT

Date the conviction was entered:
August 15, 2023

Case number:
1:23-cr-00074-NYW-1

Length and type of sentence:
48 Months in Federal Prison

Are you serving any other sentence?

Yes X No (check one)

Offense(s) you were convicted of
committing:
Wire Fraud

What was your plea?
Guilty

Kind of trial:
N/A
Jury Judge only (check one)

C.
DIRECT APPEAL
Did you file a direct appeal?

Yes X No (check one)

Date and result of direct appeal:

Did you seek review in the United States
Supreme Court?

Yes X No (check one)

Date and result of review in the United
States Supreme Court:

If you did not file a direct appeal, explain
why:

List the claims raised:

Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 2
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D.
POSTCONVICTION PROCEEDINGS
Have you initiated any other postconviction proceedings with respect to the judgment under
attack in this motion?
Yes X ___ No (check one)

If the instant motion to vacate is a second or successive motion, have you obtained authorization
from the United States Court of Appeals for the Tenth Circuit for this court to consider the
motion?
Yes N / A
No (check one)

Complete this section of the form if you have filed prior postconviction proceedings with respect
to the judgment under attack in this motion. If you have initiated more than one prior
proceeding, use additional paper to provide the requested information for each prior
proceeding. Please indicate that additional paper is attached and label the additional pages
regarding prior proceedings as “D. POSTCONVICTION PROCEEDINGS.”

Name and location of court:

Type of proceeding:

Date filed:

Date and result:

Did you appeal?

Yes
No (check one)

Date and result on appeal:

E.
STATEMENT OF CLAIMS
State clearly and concisely every claim you are asserting in this action. For each claim, specify
the right that allegedly has been violated and all facts that support your claim. If additional
space is needed to describe any claim or to assert additional claims, use extra paper to continue
that claim or to assert the additional claims. Please indicate that additional paper is attached
and label the additional pages regarding the statement of claims as “E. STATEMENT OF
CLAIMS.”

WARNING: If you fail to assert all of your claims in this motion, you may be barred from
presenting additional claims at a later date.

I ask that the Honorable Court take note that I am aware that this motion is for the
Federal case only. The emphasis on the State Case is only to provide details that
explain my former Attorney’s ineffectiveness that led to the outcome in the Federal
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 3
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case sentencing. My former attorney Jason Flores Williams made promises and
advised me on the law. Jason Flores William’s promises and advisement of the law
turned out to be untrue and resulted in me having a higher criminal history score and
now being safety valve ineligible. In addition, my emphasis on the state case is to
inform the Federal court that I will be filing the proper appeal (2254) on the State case
that is currently wrapped up in this Federal case. By no means am I trying to over-
highlight the state case in this motion.

1. ViolaƟon of Brady v. Maryland: The prosecuƟon failed to disclose exculpatory evidence in violaƟon of
Brady v. Maryland, 373 U.S. 83 (1963), parƟcularly an email from the state accountant indicaƟng that
funds were owed to PeƟƟoner, which is material to her defense and could have changed the outcome
of the proceedings. In addiƟon, line by line analysis of records was requested and not provided aŌer
being requested by the former atorney.
2. The protecƟon of my rights was violated as I was made to understand by my former counsel, Jason
Flores Williams, that my state and federal cases would be treated as one and the same, not as
separate oﬀenses leading to enhanced sentencing. The former atorney has given me bad advice
which led me to a state court convicƟon and a higher criminal history score.
3. IneﬀecƟve Assistance of Counsel: My Sixth Amendment right to eﬀecƟve assistance of counsel was
violated by Jason Flores Williams’ acƟons and omissions, which include but are not limited to: a.
Coercing me to accept a plea deal against my wishes and best interest. b. Failing to adequately
communicate, prepare, and represent me during criƟcal junctures of my case before the change of
plea in my Federal case. My former atorney was not present during my presentencing report
Interview, nor did he prepare me for the presentencing report interview. The former atorney did not
inform me nor prepare me for the change of plea. c. Misinforming the me about legal concepts and
potenƟal outcomes, leading to uninformed and detrimental decisions. d. NeglecƟng to challenge
prosecutorial mischaracterizaƟons and errors during proceedings, leading to enhanced sentencing.
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 4
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Ineffective assistance of counsel
1.That counsel's performance was deficient, which means that the representation fell below an
objective standard of reasonableness; and
2.That the deficient performance prejudiced the defense, meaning there is a reasonable
probability that, but for counsel's unprofessional errors, the result of the proceeding would have
been different.

- Jason Flores Williams (former attorney) failed to inform me of the correct information about all
plea agreements and made decisions and filed paperwork without consulting me. Filed
sentencing memorandum and other documents without consulting me.

-Jason Flores Williams (Former attorney) did not Protect my right to appeal.

-Jason Flores Williams (Former attorney) failed to Object to inadmissible and prejudicial
evidence.

-Jason Flores Williams (Former attorney) did not Assert appropriate defenses before and during
the change of plea and on sentence date of August 15th, 2023

Supporting facts:

1. Brady v. Maryland (Evidence favorable to the accused was
suppressed by the government):
•
The email from the state accountant indicating they owe me funds.
•
The evidence from the SBA (Small Business Administration) showing the origin of the funds
that were claimed to have been stolen.
•
The Accountant and Medicaid's email showing the state owed the accused money for services
provided, contrary to the claim of Medicaid fraud.
•
The Attorney General’s office has conflicting statements from employees and clients.
•
Proof from the payroll provider that demonstrates NOT ALL Federal loans taken were
fraudulent.

Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 5
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2. Ineffective Assistance of Counsel
•
The attorney, Jason Flores Williams, promised that signing the plea agreement for the state of
Colorado would mean the federal judge would take "complete Jurisdiction" of the state case,
making it as if the state case didn't exist.
•
The attorney stated that if the cases were viewed separately, it would be "double jeopardy."
•
After providing the state with the business account information (instructed to do so by Former
attorney), the state Attorney General incorrectly used that balance to claim theft from
Medicaid. The money is from the SBA paycheck protection program, not Medicaid funds.
•
Former Attorney Jason Flores Williams gave me bad advice that led to having a State
Conviction and a higher criminal history score.

3. Ineffective Assistance of Counsel (Deficient performance by
the counsel and prejudice resulted from it):
•
Jason Flores Williams strongly suggested me not read the plea agreement, He only
summarized it, and assured me of the outcomes.
•
I was made to believe that by signing the plea, the federal judge would not see my history as
that of a criminal.
•
Despite promises, I ended up in a higher criminal category during sentencing.
•
Jason Flores Williams did not defend or explain discrepancies during or before the change of
plea or at the time sentencing.
•
I was not properly prepared for the presentencing report interview with the probation officer
Sara Johnson, and the attorney did not attend this with me.
•
Jason Flores Williams did not prepare me for the change of plea and told me just “to be strong
and agree with everything the judge asked”. He told me if I had questions to ask him after but
never answered my questions.
•
Lack of communication as evidence by Exhibit A showing the gaps in communication.
•
I was made to sign that I was satisfied with services before discovering the misrepresentation
and ineffective counsel on the date of sentencing.
•
I was not provided with essential documents before the change of plea or sentencing, such as
the Pre-Sentence Report, Sentencing Memorandum, and others.
•
I was convinced to give up information on an unrelated business account, which was then
wrongly used against me.
•
Exhibit B shows the attorney's awareness of potential errors being used against the accused
and still allowing them.
•
After receiving crucial evidence (email) that could prove the accused's innocence, the attorney
did not care to look at the email.
•
Jason Flores Williams did not provide me with me presentence report or any other case
paperwork filed until after sentencing took place.

Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 6
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In conclusion, the information provided show of the former attorney Jason Flores Williams
not only failed to provide effective counsel but may have actively misled and misadvised
me. The points raised touch upon significant potential violations of my rights, from
suppression of exculpatory evidence to instances of being charged and responsible for
restitution of the same money twice and highly ineffective legal representation.

Defendant’s Statement: In the aŌernoon of April 26th 2023, I called Jason ﬂores Williams (Former atorney) to
discuss the case and the plea-bargain for the State Medicaid case. I told him I did not want to take the plea-
agreement because they are making me responsible for over 300,000 dollars resƟtuƟon and a crime that I did
not do. I told him that I did not do that and the reason I did not have the paperwork to prove it was because
of covid 19. I was willing to subpoena all of the employees and clients that I could to atest the truth. I told
him that I wanted to ﬁght this state case because he had already told me the statute was if I fraudulently took
over 100,000 dollars. I know I wasn't taking anything fraudulently. I struggled to be paid by Medicaid and I had
to take out so many cash advance loans and use my own money to make the bi weekly payrolls. This is what
led to me seeking covid assistance. Judge Torrington did not accept the state’s plea agreement paperwork that
I was told to sign because it was missing paperwork, which is why it took them 3 diﬀerent plea agreements to
get it set in stone. I knew I could win but my former atorney Jason Flores Williams scared me out of ﬁghƟng
while I was mentally exhausted. (See Exhibit B) showing some evidence that Atorney Jason Flores Williams
understood that I knew I was not guilty of the state charges and that taking a plea agreement was not the best
opƟon for me). If I did not sign the plea agreement based oﬀ the promises of my atorney, for the state case,
the points and criminal category of my enƟre sentence would have yielded a diﬀerent result).

I had Jason on speaker phone with my grandmother and my children's father present. I told him I wanted to
ﬁght the case because I didn't do it and the federal judge would look at it as if I have history of being a
criminal. He said if I don't sign the plea agreement that I "would risk going to state prison even if I overbilled
by 2 dollars, they could get me for cybercrime". I said I wanted them to prove I stole that money line by line
and I can prove that I didn't by the ﬁnancial statements from Medicaid and my bank statements that showed I
was upside down every month unƟl I got help from the SBA and cash advances (selling of future proﬁts). He
said I need to sign the plea agreement or else I would go to a state prison that I didn't belong to. The day I
went to sign the plea agreement as I was instructed, I didn't read it as he strongly suggested, Jason Flores
Williams summarized it and told me that the Federal Judge wouldn't look at it as a separate crime and I would
serve them concurrently and it would be looked at as the same crime done at the same Ɵme. Jason Flores
Williams said if they looked at them separately, it would be considered a "double Jeopardy". He said that the
federal judge would take "complete JurisdicƟon" of the state case and "it would be like the state case is not
there anymore". Jason Flores Williams convinced me that this would be the easiest way and later I would be
able to go in and later see the that the Federal Government would show that the money belonged to the SBA.
(THIS IS THE ONLY REASON I SIGNED THE PLEA AGREEMENT)

My grandmother and my children's father were both hearing this conversaƟon and chimed in. They didn't
agree with him that I should be responsible for something that big that I didn't do. He told me " I hear people
in the background, and I need you to take me oﬀ of speaker phone, I know what I am talking about".
(statements and aﬃdavits can be submited upon request of the court)
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 7
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Several Ɵmes, my previous atorney taught me how to reply to the judge that I agree with everything and
even if I didn't understand to stand ﬁrm and say that I understand and agree, or I could jeopardize being out
on bond. As a result, I was afraid to say if I didn't understand something.

May 18th, 2023, I went and signed the 3rd revised plea agreement and at that Ɵme he went through and
summarized quickly and iniƟaled for me on each page. On the last page, I signed my signature. This happened
each Ɵme I signed the plea agreements.

May 18th, 2023, was the last Ɵme I spoke to him about my case. He didn't even prepare me for the
presentencing report with the probaƟon oﬃcer (I believe was on June 2nd, 2023), nor did he show up with me.
He didn't even help me or discuss. with the leters or for speaking to the judge or due dates or when things
were ﬁled against me or when he ﬁled on my behalf.

Today, I have an email from the state accountant staƟng that they need to send me funds that I am owed. I
asked for that to be inserted into evidence along with a statement considering re-opening the state case. I was
promised by my previous atorney Jason Flores Williams that the state of Colorado would not be able to claim
the resƟtuƟon of money that belonged to the federal government. There is clear evidence that the money
that the state of Colorado Medicaid is claiming was wired in by the SBA and did not belong to the state of
Colorado. This was another reason why I was against signing the plea agreement for the state of Colorado.
However, my former atorney Jason Flores Williams made promises and stated that I would not need to worry
about it and the state would need to ﬁght the Federal Government for the funds and that it would be out of
my hands. However, because I listened to my former atorney Jason Flores Williams, I am now responsible for
double funds that I did not take. In addiƟon, I am being sentenced as a former criminal in category 2. My
Former atorney Jason Flores Williams was ineﬀecƟve with having me plead guilty to the State case. In his
ineﬀecƟveness he caused me to Plead guilty for the state charges before pleading guilty to the Federal charges
causing me to be in a higher criminal history category 2 instead of 1. With his advice, I did not go to trial with
the state as I desired. Because of this, I am now also Safety Valve ineligible. With the proper guidance and
eﬀorts of my previous atorney, I would sƟll be a ﬁrst-Ɵme oﬀender according to the Federal Guidelines and
not responsible for a crime that I did not commit.

Also, up unƟl September 27th, 2022, We were going to challenge porƟons the federal case. (All of the loans I
took out were NOT fraud. 6 of them were truthful with real numbers from my payroll provider (see payroll
provider records, EXHIBIT D That proves against the State Medicaid charges). Because I broke down aŌer he
said the Federal Government would never give me a chance at home incarceraƟon, he said for me just take
the plea deal because I was not “emoƟonally able to ﬁght”. I agreed because I just had my baby and lost my
grandfather who raised me on top of Jason Flores Williams promising me outcomes that did not happen.

I spoke with Jason Flores Williams (Former atorney) June 20th, 2023, to get a refund, I wired Jason Flores
Williams for the expert that Jason Flores Williams advised me would be helpful when we were going forward
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 8
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to ﬁght the state Medicaid case. The expert was needed because I was being accused based of oﬀ limited
knowledge of the Atorney General’s oﬃce. The Atorney General’s oﬃce did not have a full understanding of
how the class B licensed home care businesses operate, nor did the Atorney General’s oﬃce understand the
Medicaid billing system. Jason Flores Williams was aware of these facts. AŌer his advice heavily swaying me
NOT to go to trial with the state of Colorado Medicaid because it would be easier just to roll the state case
into the Federal case, Jason Flores Williams told me I could get a refund since we were not going to trial
because of his advice. He made me sign that we were done aŌer August 15th, and he was no longer
represenƟng me. This form I was made to sign stated that I was saƟsﬁed with services before the
misrepresentaƟon and ineﬀecƟve counsel that occurred before the change of plea and on the date of
sentencing.

Monday, August 14th, he called that morning just to remind me that I had Federal court the next day. That
was it. I was not provided anything prior to sentencing from my Atorney such as my Pre-Sentence Report, my
Sentencing Memorandum, the ProsecuƟon’s late moƟons and order nor was any of what my former atorney
Jason Flores Williams ﬁled discussed or agreed upon with me (for example the Sentencing Memorandum). I
want to say thank you again to the Honorable Judge Wang for having the missing documents sent to me and
ordering an atorney be appointed to me for the appeal process. (SEE EXHIBIT A THAT SHOW GAPS IN
COMMUNICATION DURING THE TIMES OF HIME FILING WITH THE COURTS ON MY BEHALF WITHOUT
DISCUSSING WITH ME).

On the day of sentencing August 15th, 2023, the prosecuƟng Atorney made statements about prior criminal
history. In reply to the statement, the honorable Judge Wang was correct at considering criminal history by
acknowledging the statement of my prosecutors. However, I signed the appellate waiver and plea
arrangements only oﬀ the strength my previous atorney Jason Flores Williams staƟng that judge Wang would
not view it as prior criminal history and it would be looked at as the same crime at the same Ɵme. Towards the
end of sentencing when the Honorable Judge Wang stated that I would be in category 2 instead of what my
atorney Jason Flores Williams promised, I look at him and nudged him in confusion because What I was
sentenced to in regard to my criminal history points does not align with at all with what Jason Flores Williams
promised me. Jason never explained any of the court documents to me and at the change of plea, Jason told
me to agree with everything the Judge would state. Jason Flores Williams made assurances about the state
case which turned out to be untrue.
During sentencing on August 15th, 2023, Jason Flores Williams said nothing, and he did nothing to explain or
defend me or what he stated would happen at sentencing. He packed his belongings and didn’t provide me
with any help or comments to the Honorable Judge Wang about the agreement. Jason Flores William’s
assurances made to me as my counsel caused me to now be in a criminal history category that has made me
safety valve ineligible.

The reason I would not be able to successfully appeal is because I was advised by my atorney to sign the
appellate waivers and plea agreements based only on his promises of being charged in federal court as a ﬁrst
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 9
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Ɵme oﬀender and that when the state of Colorado peƟƟons the Federal government for the paycheck
protecƟon money the state of Colorado is claiming, through the government, it would be revealed that it
wasn’t the State of Colorado Medicaid’s money.

At court, my atorney advised me to give up informaƟon on a business account that was not associated with
any business done with Medicaid. The account was even located at canvas credit Union whereas my business
account doing business with Medicaid was located at citywide banks. The atorney General for the state of
Colorado used the wrong account and the wrong balance and the wrong money to prove his case. AŌer giving
up the account informaƟon, the atorney general used the Frozen balance to say that was what was taken
from Medicaid. Clearly, the money is traced back to a wire deposit from the SBA paycheck protecƟon
program. I conƟnued to advise my atorney that I wanted to ﬁght the state case because I didn’t do the fraud.
My former atorney Jason Flores Williams was well aware of this being used against me and conƟnued to
allow it (PLEASE SEE EXHIBIT B).
Medicaid not paying stressed me every payroll on top of COVID-19 causing a mulƟtude of physical and
administraƟve issues is the reason I was seeking out the Federal loans in the ﬁrst place. (This can be seen in
ALL business bank statements from Citywide banks up unƟl I started geƫng the loans. They can be submited
for proof).

AŌer being accused of the crime Medicaid stopped paying me in March of 2021 and I conƟnued to pay my
employees unƟl July 2021 from federal funds and cash advance loans. I told my former atorney that I did not
owe Medicaid and instead they owe me. At a later date aŌer pleading guilty to both the 3-point oﬀense with
the state and the Federal oﬀense, I received an email from the Accountant and Medicaid staƟng that they owe
me as I have previously stated. This email is proof of what I have been saying that I am innocent, and that
Medicaid owes me a balance for the services my company provided. At the Ɵme of business, home care
agencies could not bill for client’s that they do not have a prior authorizaƟon for. This fact contradicts what I
was accused for. (PLEASE SEE EXHIBIT C as it represents my claims of me telling my former atorney
Mr. Jason Flores Williams that I am innocent of the state charges. If I were guilty of fraudulently billing over
300,000 from Colorado Medicaid, the state accountant would surely not calculate any payment is owed to
me. However, there are payments owed to me because I didn’t commit Medicaid Fraud and Waste). I asked
My former atorney Jason Flores Williams to submit this as a basis for acknowledgement of the courts. He
did not care to look at the email. The State of Colorado Medicaid case was able to conƟnue based on my
being deemed incompliant because of all the missing paperwork to prove the hours billed. Paperwork was
missing because my oﬃce was unorganized due to Covid and my staﬀ members and clients passing away
during that Ɵme. I ran the business successfully passing all state audits and relicensing up unƟl COVID 19
causing discord and death in the oﬃce. Pleading guilty to the state charges landed me in a bad predicament
because the outcome was FALSE JUSTICE; In which was encouraged to take the blame by my former atorney
with the understanding that my agreeing and cooperaƟon with both government enƟƟes would be brought
concurrent making me a ﬁrst-Ɵme oﬀender. I relied on my former atorney to navigate me through the jusƟce
system and legal jargon in the plea agreements signed. A lot of the Ɵme, Jason Flores Williams said not to
worry about it. (The transcripts of the Medicaid case court dates and paperwork, ﬁled along with the 3
diﬀerent court dates, to sign modiﬁed plea agreements, can be submited).
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 10
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AŌer August 15, 2023, I was very upset aŌer being greeted with an email from Jason Flores Williams
conﬁrming his feelings toward me, lisƟng out the crimes I was charged with. While staƟng I should be grateful
for the sentence I am receiving from the courts aŌer several weeks of reaching out and asking for my
presentencing report and all of my case paperwork ﬁled. He stated that he wasn’t obligated to provide me
with the report due to the date of his response being aŌer August 15th, 2023. However, he did provide me
with the presentencing report in that same email. (This email can be provided if requested).
My former atorney Jason Flores Williams, during his speech at sentencing, when describing porƟons of my
character that he thought was correct, he stated to the court that I was not the type of person to go for
ineﬀecƟve assistance of counsel. (This should be in the transcripts). At this Ɵme, I did not even know what
ineﬀecƟve assistance of counsel was. He had previously menƟoned to me twice before sentencing, in a joking
manner not to go ﬁling ineﬀecƟve assistance of counsel on him. I didn’t really understand why he was bringing
ineﬀecƟve assistance of counsel up to me. I never menƟoned it to him because I trusted him as my counsel. I
trusted his advice and knowledge of the Law. However, I looked up the terminology he used aŌer his promises
and advisement of the law turned out to be nothing of what he stated.

I would like to say that I do NOT wish to move to take negaƟve acƟon against Jason Flores Williams. However, I
am staƟng the supporƟng facts because they are truth. I simply move to ask the court to apply and uncover
the proper JusƟce to me aside from the unprofessional mistakes that my former atorney Jason Flores
Williams made while represenƟng me.

F.
PROCEDURAL DEFAULT
Did you raise on direct appeal any of the
claims you are asserting in this motion?

Yes X No (check one)

If you answered “Yes,” state which claims were raised on direct appeal and explain why those
claims are being raised again:

If you answered “No,” explain why you did not raise your claims on direct appeal:

To the Honorable Court,

The defendant wishes to provide a clear explanation regarding their decision not to appeal their
sentence or judgment. We humbly submit the following factors that weighed heavily on the
defendant's decision-making:

1. Appellate Waiver: After being granted an extension for time to appeal and upon the
appointment of a Public Defender, the defendant was duly informed about the appellate waiver
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 11
of 422

they had previously signed. This waiver effectively precluded the possibility of an appeal,
based on the clear stipulations contained therein.
2. Reliance on Prior Legal Counsel: At the heart of the defendant's decision to sign the
appellate waiver and plea agreements was the reliance on the representations made by their
former attorney, Mr. Jason Flores Williams. Mr. Williams advised the defendant that the state
crime would not be viewed in conjunction with the Federal case as a prior criminal history.
Furthermore, he asserted that the state-level crime would be regarded as concurrent with the
plea agreements – essentially indicating that they would be treated as a single event. This
representation was not made in passing; it was a pivotal piece of advice that influenced the
defendant's entire approach to the legal process. Moreover, there were witnesses present when
these statements were made, emphasizing the weight the defendant placed on this advice.
3. Good Faith in the Justice System: The defendant, trusting in the justice system and the
advice of their legal counsel, proceeded in good faith. The decision to sign the appellate
waiver, under the assumptions provided by Mr. Williams, was done with the belief that the
court would view the crimes in the manner as represented by their former attorney.

Given these circumstances, the defendant's decision not to appeal is not a reflection of acquiescence
or satisfaction with the judgment. Instead, it stems from the pragmatic understanding that the
appellate waiver, which was signed based on potentially flawed advice, would render any appeal
fruitless.

The Defendant urges the Court to take into consideration these factors as a testament to the
defendant's good faith, reliance on legal counsel, and belief in our justice system.

G.
TIMELINESS OF MOTION
If the judgment of conviction or the sentence under attack became final more than one year prior
to the filing of this motion, explain why the motion is not barred by the one-year limitation period
in 28 U.S.C. § 2255(f). If additional space is needed, use extra paper to explain your answer.
Please indicate that additional paper is attached and label the additional pages regarding
timeliness as “G. TIMELINESS OF MOTION.”

H.
REQUEST FOR RELIEF
State the relief you are requesting or what you want the court to do. If additional space is needed
to identify the relief you are requesting, use extra paper to request relief. Please indicate that
additional paper is attached and label the additional pages regarding relief as “H. REQUEST
FOR RELIEF.”

PRAYER FOR RELIEF
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 12
of 422

Wherefore, in light of the aforementioned grounds and supporting facts, Petitioner DEJANE
REANIECE LATTANY, respectfully requests this honorable Court:

1. Grant an evidentiary hearing to determine the merits of the claims presented herein.
2. Take a further look into the ineffective assistance of counsel that landed me a 3 point
conviction on the criminal history scale. This offense disqualified me from being Safety
Valve eligible.
3. Vacate or set aside the Petitioner's sentence.
4. Allow home confinement until I am granted counsel and able to file for both 2255 and 2254.
5. Correct the sentence as the Court deems just and proper.
6. Grant such other and further relief as the Court deems equitable and just.
7. Above all, I Request for Habeas Corpus Relief:

I must express concern about the quality of legal representaƟon provided to me before and at the Ɵme of the
change of plea (and at the Ɵme of sentencing). There is a reasonable basis to believe that ineﬀecƟve
assistance of counsel may have deprived me of a fair outcome and, consequently, the right to due process
under the law.
The potenƟal grounds for ineﬀecƟve assistance of counsel include:
1. Failure to InvesƟgate: It appears that my defense counsel failed to conduct a proper invesƟgaƟon into
the case, including failure to interview crucial witnesses and gather essenƟal evidence that could have
been used in my defense resulƟng in a guilty plea on a 3-point state convicƟon rolled over into my
Federal sentencing. This leŌ me in category 2 instead of category 1. This has leŌ me Safety Valve
ineligible and a higher convicƟon raƟng.
2. Inadequate Trial PreparaƟon: My defense counsel seemed unprepared for trial, thus convincing me
through my trust in him to take a plea agreement, at the state level, leading to missed opportuniƟes
to challenge the prosecuƟon's case and present a more robust defense.
3. Lack of Zealous Advocacy: I did not receive the zealous advocacy that is required under the Sixth
Amendment. Key arguments and potenƟal legal defenses were not pursued.
4. Errors in Legal Advice: It appears that counsel provided erroneous legal advice or failed to adequately
explain legal opƟons to me, potenƟally leading to a plea agreement that may not have been in my
best interest.
Based on these concerns, I am seeking habeas corpus relief in order to address the potenƟal violaƟon of my
consƟtuƟonal rights. I believe that there are signiﬁcant issues related to ineﬀecƟve assistance of counsel that
need to be thoroughly examined by this Court.
In light of the gravity of the potenƟal issues raised, I respecƞully request that the Court grant an evidenƟary
hearing to further explore these maters. I am enƟtled to a full and fair review of these claims to ensure that
jusƟce is served.
I understand the importance of due process, and I am commited to assisƟng the Court in any way necessary
to ensure a just resoluƟon of this mater.
to vacate the conviction due to ineffective assistance of counsel along with conditional relaease
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 13
of 422

Thank you for your consideraƟon, and I look forward to addressing these issues with this honorable court.

A) request for relief of the current federal sentence due to ineffective counsel

B) In making the decision to grant any relief, I ask that the courts honor the fact that
I have had zero prior criminal history or history of fraud up until the federal
investigation. I also ask that the court consider viewing exhibit d as proof that I
have ran successful business from 2015 until covid 19 and have never had any
prior unsuccessful audits or accusations of fraud.

C) request that the government grant proper relief and apply justice were my rights
were unprotected; due to former counsel Jason flores Williams making
assurances about the state case, that has been rolled into the federal case, that has
turned out to by untrue and, caused me to be in a criminal history category 2 that
has caused me to be safety valve intelligible, due to ineffective counsel.

D) The defendant be placed on home confinement until corrections are made and/or
proper counsel can assist in addressing the state of Colorado case where proper
justice will be applied and corrections can be made to the federal sentence
according to the correct criminal history points, according to the terms that i was
promised by my former attorney before the change of plea and the plea
agreements and appellate waivers were signed.

What I was sentenced to regarding my criminal history points does not align with the terms
agreed upon from what my attorney advised me would be in my plea agreement and court
documents, nor does it reflect the arguments that my attorney was to argue/present during my
sentencing as he promised and advised me of the Law.

I.
MOVANT/DEFENDANT’S SIGNATURE

I declare under penalty of perjury that I am the movant/defendant in this action, that I have read
this motion, and that the information in this motion is true and correct. See 28 U.S.C. § 1746; 18
U.S.C. § 1621.

Under Federal Rule of Civil Procedure 11, by signing below, I also certify to the best of my
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 14
of 422

knowledge, information, and belief that this motion: (1) is not being presented for an improper
purpose, such as to harass, cause unnecessary delay, or needlessly increase the cost of litigation.
(2) is supported by existing law or by a nonfrivolous argument for extending or modifying
existing law; (3) the factual contentions have evidentiary support or, if specifically, so identified,
will likely have evidentiary support after a reasonable opportunity for further investigation or
discovery; and (4) the application otherwise complies with the requirements of Rule 11.

(Movant/Defendant’s signature)

(Date)

11/11/2023
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 15
of 422

EXHIBIT B IN THIS
EXHIBIT, I AM
REFFERRING TO THE
STATE OF COLORADO
ATTORNEY GENERAL
CLAIMING FEDERAL
FUNDS WITH NO LINE
BY LINE PROOF THAT
THIS MONEY OR
AMOUNT WAS TAKEN
FROM MEDICAID.
ME (DEFENDANT)-BLUE
WITH WHITE WRITING

FORMER ATTORNEY
(JASON FLORES
WILLIAMS)- BLACK
WITH WHITE WRITING
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 16
of 422

EXHIBIT A SHOWING GAPS
IN COMMUNICATION AFTER MAY
2023 along with my full
cooperaƟon.
In addition, during the gaps in
communication, my former attorney
Jason Flores Williams filed
documents without speaking to me
or obtaining my consent/agreement
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 17
of 422

Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 18
of 422

Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 19
of 422

Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 20
of 422

Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 21
of 422

EXHIBIT C
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 22
of 422

Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 23
of 422

R
R
R
Signature Title Date
REFERENCE COPY PREPARED BY PAYCHEX. DO NOT FILE.
correct, and complete.
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true,
1 2 3 4 5
Total number of forms
( )
E-mail address
Fax Number
( )
Telephone number
Name of person to contact
For Official Use Only
<;18
Internal Revenue Service
Department of the Treasury
1096
Form
U.S. Information Returns
Annual Summary and Transmittal of
OMB No. 1545-0108
DO NOT STAPLE
R
Enter an "X" in only one box below to indicate the type of form being filed. Form 1099-MISC with NEC in box 7, check ...
$ $
Employer identification number
Social security number
Federal income tax withheld
Total amount reported with this Form 1096
6
7
97
31
98
75
94
72
2A
1099-
1099-Q
1099-R
1099-S
1099-SA
5498
5498-ESA
5498-QA
32
50
78
84
83
80
79
85
73
91
86
92
W-2G
1097-BTC
1098-C
1098-E
1098-T
1099-A
1099-B
1099-C
1099-CAP
1099-DIV
1099-G
1099-INT
25
3921
81
1098
1098-Q
74
95
96
1099-
1099-OID
93
1099-LTC
1099-LS
1A
1099-QA
27
5498-SA
28
16
1099-K
10
PATR
43
1099-SB
MISC
3922
26
IS FILED ELECTRONICALLY
YOUR FEDERAL 1099 & 1096 DATA
DO NOT FILE
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
LATTANY DEJANE 720 318-0173
80-0438877 5 25977.00
X
X
0095-13058390 TAXPAY^ 19010
EXHIBIT D
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 24
of 422

R
R
R
Signature Title Date
REFERENCE COPY PREPARED BY PAYCHEX. DO NOT FILE.
correct, and complete.
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true,
1 2 3 4 5
Total number of forms
( )
E-mail address
Fax Number
( )
Telephone number
Name of person to contact
For Official Use Only
<;18
Internal Revenue Service
Department of the Treasury
1096
Form
U.S. Information Returns
Annual Summary and Transmittal of
OMB No. 1545-0108
DO NOT STAPLE
R
Enter an "X" in only one box below to indicate the type of form being filed. Form 1099-MISC with NEC in box 7, check ...
$ $
Employer identification number
Social security number
Federal income tax withheld
Total amount reported with this Form 1096
6
7
97
31
98
75
94
72
2A
1099-
1099-Q
1099-R
1099-S
1099-SA
5498
5498-ESA
5498-QA
32
50
78
84
83
80
79
85
73
91
86
92
W-2G
1097-BTC
1098-C
1098-E
1098-T
1099-A
1099-B
1099-C
1099-CAP
1099-DIV
1099-G
1099-INT
25
3921
81
1098
1098-Q
74
95
96
1099-
1099-OID
93
1099-LTC
1099-LS
1A
1099-QA
27
5498-SA
28
16
1099-K
10
PATR
43
1099-SB
MISC
3922
26
IS FILED ELECTRONICALLY
YOUR FEDERAL 1099 & 1096 DATA
DO NOT FILE
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
LATTANY DEJANE 720 318-0173
80-0438877 5 25977.00
X
X
0095-13058390 TAXPAY^ 18363
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 25
of 422

$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
deferrals
income
15a Section 409A
15b Section 409A
16 State tax withheld
17 State/Payer's state no.
18 State income
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
16 State tax withheld
17 State/Payer's state no.
18 State income
deferrals
15a Section 409A
15b Section 409A
income
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
16 State tax withheld
17 State/Payer's state no.
18 State income
income
15a Section 409A
15b Section 409A
deferrals
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$
$
$
$
deferrals
16 State tax withheld
17 State/Payer's state no.
18 State income
income
15a Section 409A
15b Section 409A
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
11
11
11
11
12
12
12
12
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
FATCA filing
requirement
FATCA filing
requirement
FATCA filing
requirement
FATCA filing
requirement
2018 80-0438877 522-87-9194 0095-13058390 - 15 19010
AGGIES ANGELS CARE PROVIDERS ZIPPORAH ARRINGTON
14475 ROBINS DR
DENVER CO 80239
0.00 0.00 0.00
14125.00
CO/0941838 14125.00
2018 80-0438877 - - 0095-13058390 - 48 19010
AGGIES ANGELS CARE PROVIDERS RAMONA J COOPER
14475 ROBINS DR 13795 E 25TH PL
DENVER CO 80239
AURORA CO 80011
0.00 0.00 0.00
696.00
CO/0941838 696.00
2018 80-0438877 522-95-1873 0095-13058390 - 26 19010
AGGIES ANGELS CARE PROVIDERS TENEA T LATTANY
14475 ROBINS DR 4699 KITTRIDGE
DENVER CO 80239
DENVER CO 80239
0.00 0.00 0.00
1704.00
CO/0941838 1704.00
2018 80-0438877 521-83-7462 0095-13058390 - 18 19010
AGGIES ANGELS CARE PROVIDERS DEVIN MOORE
14475 ROBINS DR
DENVER CO 80239
0.00 0.00 0.00
3902.00
CO/30941838 3902.00
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 26
of 422

$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
deferrals
income
15a Section 409A
15b Section 409A
16 State tax withheld
17 State/Payer's state no.
18 State income
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
16 State tax withheld
17 State/Payer's state no.
18 State income
deferrals
15a Section 409A
15b Section 409A
income
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
16 State tax withheld
17 State/Payer's state no.
18 State income
income
15a Section 409A
15b Section 409A
deferrals
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$
$
$
$
deferrals
16 State tax withheld
17 State/Payer's state no.
18 State income
income
15a Section 409A
15b Section 409A
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
11
11
11
11
12
12
12
12
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
FATCA filing
requirement
FATCA filing
requirement
FATCA filing
requirement
FATCA filing
requirement
2018 80-0438877 449-25-6930 0095-13058390 - 25 19010
AGGIES ANGELS CARE PROVIDERS DEMETRIA D SKIPPER
14475 ROBINS DR 4155 E IOWA # 103
DENVER CO 80239
DENVER CO 80222
0.00 0.00 0.00
5550.00
CO/0941838 5550.00
X
X
X
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 27
of 422

$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
deferrals
income
15a Section 409A
15b Section 409A
16 State tax withheld
17 State/Payer's state no.
18 State income
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
16 State tax withheld
17 State/Payer's state no.
18 State income
deferrals
15a Section 409A
15b Section 409A
income
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
16 State tax withheld
17 State/Payer's state no.
18 State income
income
15a Section 409A
15b Section 409A
deferrals
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$
$
$
$
deferrals
16 State tax withheld
17 State/Payer's state no.
18 State income
income
15a Section 409A
15b Section 409A
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
11
11
11
11
12
12
12
12
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
FATCA filing
requirement
FATCA filing
requirement
FATCA filing
requirement
FATCA filing
requirement
2018 80-0438877 522-87-9194 0095-13058390 - 15 18363
AGGIES ANGELS CARE PROVIDERS ZIPPORAH ARRINGTON
14475 ROBINS DR
DENVER CO 80239
0.00 0.00 0.00
14125.00
CO/0941838 14125.00
2018 80-0438877 - - 0095-13058390 - 48 18363
AGGIES ANGELS CARE PROVIDERS RAMONA J COOPER
14475 ROBINS DR 13795 E 25TH PL
DENVER CO 80239
AURORA CO 80011
0.00 0.00 0.00
696.00
CO/0941838 696.00
2018 80-0438877 522-95-1873 0095-13058390 - 26 18363
AGGIES ANGELS CARE PROVIDERS TENEA T LATTANY
14475 ROBINS DR 4699 KITTRIDGE
DENVER CO 80239
DENVER CO 80239
0.00 0.00 0.00
1704.00
CO/0941838 1704.00
2018 80-0438877 521-83-7462 0095-13058390 - 18 18363
AGGIES ANGELS CARE PROVIDERS DEVIN MOORE
14475 ROBINS DR
DENVER CO 80239
0.00 0.00 0.00
3902.00
CO/30941838 3902.00
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 28
of 422

$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
deferrals
income
15a Section 409A
15b Section 409A
16 State tax withheld
17 State/Payer's state no.
18 State income
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
16 State tax withheld
17 State/Payer's state no.
18 State income
deferrals
15a Section 409A
15b Section 409A
income
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$5,000 or more of consumer
14 Gross proceeds paid to
10 Crop insurance proceeds
13 Excess golden parachute
9 Payer made direct sales of
$
$
$
$
5 Fishing boat proceeds
6 Medical and health care payments
7 Nonemployee compensation
8 Substitute payments in lieu of dividends or interest
$
$
$
$
2 Royalties
4 Federal income tax withheld
1 Rents
3 Other Income
CALENDAR YEAR
PAYER'S TIN
RECIPIENT'S TIN
2nd TIN Not.
Account number (see instructions)
16-033 1690
VOID
CORRECTED
Form
MISCELLANEOUS INCOME
1099-MISC
$
$
$
$
16 State tax withheld
17 State/Payer's state no.
18 State income
income
15a Section 409A
15b Section 409A
deferrals
R
(recipient) for resale
$
$
$
products to a buyer
payments
an attorney
$
$
$
$
deferrals
16 State tax withheld
17 State/Payer's state no.
18 State income
income
15a Section 409A
15b Section 409A
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
Certain Information Returns.
General Instructions for
Paperwork Reduction Act Notice, see the
For Privacy Act and
NOT FILE.
COPY C, FOR PAYER - DO
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
RECIPIENT'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code.
11
11
11
11
12
12
12
12
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
www.irs.gov/form1099misc
Department of the Treasury - Internal Revenue Service
FATCA filing
requirement
FATCA filing
requirement
FATCA filing
requirement
FATCA filing
requirement
2018 80-0438877 449-25-6930 0095-13058390 - 25 18363
AGGIES ANGELS CARE PROVIDERS DEMETRIA D SKIPPER
14475 ROBINS DR 4155 E IOWA # 103
DENVER CO 80239
DENVER CO 80222
0.00 0.00 0.00
5550.00
CO/0941838 5550.00
X
X
X
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 29
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-87-9194
0095-13058390 - 15
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

ZIPPORAH ARRINGTON

14125.00
19010
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-87-9194
0095-13058390 - 15
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

ZIPPORAH ARRINGTON

19010
COPY B, FOR RECIPIENT
$14,125.00
CO/30941838
14125.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-87-9194
0095-13058390 - 15
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

ZIPPORAH ARRINGTON

14125.00
19010
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 30
of 422

ZIPPORAH ARRINGTON

19010
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$14,125.00
CO/30941838
14125.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 31
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
- -
0095-13058390 - 48
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

RAMONA J COOPER
13795 E 25TH PL

AURORA CO 80011
696.00
19010
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
- -
0095-13058390 - 48
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

RAMONA J COOPER
13795 E 25TH PL

AURORA CO 80011
19010
COPY B, FOR RECIPIENT
$696.00
CO/30941838
696.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
- -
0095-13058390 - 48
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

RAMONA J COOPER
13795 E 25TH PL

AURORA CO 80011
696.00
19010
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 32
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
- -
0095-13058390 - 48
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

RAMONA J COOPER
13795 E 25TH PL

AURORA CO 80011
19010
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$696.00
CO/30941838
696.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 33
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-95-1873
0095-13058390 - 26
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

TENEA T LATTANY
4699 KITTRIDGE

DENVER CO 80239
1704.00
19010
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-95-1873
0095-13058390 - 26
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

TENEA T LATTANY
4699 KITTRIDGE

DENVER CO 80239
19010
COPY B, FOR RECIPIENT
$1,704.00
CO/30941838
1704.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-95-1873
0095-13058390 - 26
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

TENEA T LATTANY
4699 KITTRIDGE

DENVER CO 80239
1704.00
19010
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 34
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-95-1873
0095-13058390 - 26
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

TENEA T LATTANY
4699 KITTRIDGE

DENVER CO 80239
19010
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$1,704.00
CO/30941838
1704.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 35
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
521-83-7462
0095-13058390 - 18
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEVIN MOORE

3902.00
19010
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
521-83-7462
0095-13058390 - 18
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEVIN MOORE

19010
COPY B, FOR RECIPIENT
$3,902.00
CO/30941838
3902.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
521-83-7462
0095-13058390 - 18
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEVIN MOORE

3902.00
19010
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 36
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
521-83-7462
0095-13058390 - 18
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEVIN MOORE

19010
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$3,902.00
CO/30941838
3902.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 37
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
449-25-6930
0095-13058390 - 25
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEMETRIA D SKIPPER
4155 E IOWA # 103

DENVER CO 80222
5550.00
19010
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
449-25-6930
0095-13058390 - 25
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEMETRIA D SKIPPER
4155 E IOWA # 103

DENVER CO 80222
19010
COPY B, FOR RECIPIENT
$5,550.00
CO/30941838
5550.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
449-25-6930
0095-13058390 - 25
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEMETRIA D SKIPPER
4155 E IOWA # 103

DENVER CO 80222
5550.00
19010
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 38
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
449-25-6930
0095-13058390 - 25
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEMETRIA D SKIPPER
4155 E IOWA # 103

DENVER CO 80222
19010
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$5,550.00
CO/30941838
5550.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 39
of 422

ZIPPORAH ARRINGTON

14125.00
18363
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-87-9194
0095-13058390 - 15
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

ZIPPORAH ARRINGTON

18363
COPY B, FOR RECIPIENT
$14,125.00
CO/30941838
14125.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-87-9194
0095-13058390 - 15
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

ZIPPORAH ARRINGTON

14125.00
18363
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 40
of 422

ZIPPORAH ARRINGTON

18363
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$14,125.00
CO/30941838
14125.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 41
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
- -
0095-13058390 - 48
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

RAMONA J COOPER
13795 E 25TH PL

AURORA CO 80011
696.00
18363
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
- -
0095-13058390 - 48
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

RAMONA J COOPER
13795 E 25TH PL

AURORA CO 80011
18363
COPY B, FOR RECIPIENT
$696.00
CO/30941838
696.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
- -
0095-13058390 - 48
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

RAMONA J COOPER
13795 E 25TH PL

AURORA CO 80011
696.00
18363
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 42
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
- -
0095-13058390 - 48
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

RAMONA J COOPER
13795 E 25TH PL

AURORA CO 80011
18363
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$696.00
CO/30941838
696.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 43
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-95-1873
0095-13058390 - 26
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

TENEA T LATTANY
4699 KITTRIDGE

DENVER CO 80239
1704.00
18363
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-95-1873
0095-13058390 - 26
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

TENEA T LATTANY
4699 KITTRIDGE

DENVER CO 80239
18363
COPY B, FOR RECIPIENT
$1,704.00
CO/30941838
1704.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-95-1873
0095-13058390 - 26
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

TENEA T LATTANY
4699 KITTRIDGE

DENVER CO 80239
1704.00
18363
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 44
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
522-95-1873
0095-13058390 - 26
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

TENEA T LATTANY
4699 KITTRIDGE

DENVER CO 80239
18363
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$1,704.00
CO/30941838
1704.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 45
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
521-83-7462
0095-13058390 - 18
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEVIN MOORE

3902.00
18363
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
521-83-7462
0095-13058390 - 18
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEVIN MOORE

18363
COPY B, FOR RECIPIENT
$3,902.00
CO/30941838
3902.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
521-83-7462
0095-13058390 - 18
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEVIN MOORE

3902.00
18363
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 46
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
521-83-7462
0095-13058390 - 18
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEVIN MOORE

18363
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$3,902.00
CO/30941838
3902.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 47
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
449-25-6930
0095-13058390 - 25
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEMETRIA D SKIPPER
4155 E IOWA # 103

DENVER CO 80222
5550.00
18363
COPY B, FOR RECIPIENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
449-25-6930
0095-13058390 - 25
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEMETRIA D SKIPPER
4155 E IOWA # 103

DENVER CO 80222
18363
COPY B, FOR RECIPIENT
$5,550.00
CO/30941838
5550.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
449-25-6930
0095-13058390 - 25
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEMETRIA D SKIPPER
4155 E IOWA # 103

DENVER CO 80222
5550.00
18363
TO BE FILED WITH FEDERAL INCOME TAX RETURN IF NECESSARY
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 48
of 422

Instructions for Recipient
Recipient's taxpayer Identification Number(TIN). For your
protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is
checked, the payer is reporting on this Form 1099 to satisfy its chapter
4 account reporting requirement. You also may have a filing
requirement. See the Instructions to Form 8938.
Amounts shown may be subject to self-employment (SE) tax. If
your net income from self-employment is $400 or more, you must file a
return and compute your SE tax on Schedule SE (Form 1040). See Pub.
334 for more information. If no income or social security and Medicare
taxes were withheld and you are still receiving these payments, see
Form 1040-ES (or Form 1040-ES(NR)). Individuals must report these
amounts as explained in the box 7 instructions on this page.
Corporations, fiduciaries, or partnerships must report the amounts on
the proper line of their tax returns.
Form 1099-MISC incorrect? If this form is incorrect or has been
issued in error, contact the payer. If you cannot get this formcorrected,
attach an explanation to your tax return and report your income
correctly.
Box 1. Report rents from real estate on Schedule E (Form1040).
However, report rents on Schedule C (Form1040) if you provided
significant services to the tenant, sold real estate as a business, or
rented personal property as a business. See Pub. 527.
Box 2. Report royalties fromoil, gas, or mineral properties,
copyrights, and patents on Schedule E (Form1040). However, report
payments for a working interest as explained in the box 7 instructions.
For royalties on timber, coal, and iron ore, see Pub. 544.
Box 3. Generally, report this amount on the “Other income” line of
Form 1040 (or Form 1040NR) and identify the payment. The amount
shown may be payments received as the beneficiary of a deceased
employee, prizes, awards, taxable damages, Indian gaming profits, or
other taxable income. See Pub. 525. If it is trade or business income,
report this amount on Schedule C or F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian gaming
profits. Generally, a payer must backup withhold if you did not furnish
your TIN. See Form W-9 and Pub. 505 for more information. Report
this amount on your income tax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040).
See Pub. 334.
Box 6. For individuals, report on Schedule C (Form 1040).
Box 7. Shows nonemployee compensation. If you are in the trade or
business of catching fish, box 7 may show cash you received for the
sale of fish. If the amount in this box are SE income, report it on
Schedule C or F (Form 1040), and complete Schedule SE (Form
1040). You received this form instead of FormW-2 because the payer
did not consider you an employee and did not withhold income tax or
social security and Medicare tax. If you believe you are an employee
and cannot get the payer to correct this form, report this amount on the
line for "Wages, salaries, tips, etc." of Form 1040 (or Form 1040NR).
You must also complete Form8919 and attach it to your return. If you
are not an employee but the amount in this box is not SE income (for
example, it is income from a sporadic activity or a hobby), report this
amount on the "Other income" line of Form 1040 (or Form 1040NR).
Box 8. Shows substitute payments in lieu of dividends or tax-exempt
interest received by your broker on your behalf as a result of a loan of
your securities. Report on the “Other income” line of Form1040 (or
Form 1040NR).
Box 9. If checked, $5,000 or more of sales of consumer products was
paid to you on a buy-sell, deposit-commission, or other basis. A dollar
amount does not have to be shown. Generally, report any income from
your sale of these products on Schedule C (Form1040).
Box 10. Report this amount on Schedule F (Form 1040).
Box 13. Shows your total compensation of excess golden parachute
payments subject to a 20% excise tax. See the Form 1040 (or Form
1040NR) instructions for where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount included
in box 15a that is currently taxable is also included in this box. This
income is also subject to a substantial additional tax to be reported on
Form 1040 (or Form 1040NR) . See the Form 1040 (or Form
1040NR) instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.
Future developments. For the latest information about developments
related to Form 1099-MISC and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099misc.
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
2018
80-0438877
449-25-6930
0095-13058390 - 25
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239

DEMETRIA D SKIPPER
4155 E IOWA # 103

DENVER CO 80222
18363
TO BE FILED WITH STATE INCOME TAX RETURN IF NECESSARY
$5,550.00
CO/30941838
5550.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Form 1099 - MISC
VOID
CORRECTED
MISCELLANEOUS
INCOME
16-033 1690
CALENDAR YEAR
PAYER'S TIN
Account number (see
instructions)
RECIPIENT'S TIN
FATCA filing
requirement
This is important tax information and
is being furnished to the Internal
Revenue Service. If you are required
to file 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.
PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.
RECIPIENT'S name, street address, city or town, state or province, country
and ZIP or foreign postal code
1 Rents
5 Fishing boat proceeds
9 Payer made direct sales of $5000 or more of consumer
products to a buyer
(recipient) for resale
15a Section 409A
deferrals
15b Section 409A
income
2 Royalities
3 Other Income
6 Medical and health care payments
10 Crop insurance proceeds
16 State tax withheld
7 Nonemployee compensation
17 State/Payer's state no.
4 Federal income tax withheld
8 Substitute payments in lieu of dividends or interest
13 Excess golden parachute
payments
14 Gross proceeds paid to
an attorney
18 State income
X
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11
12
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 49
of 422

Employer identification number
(EIN)
Name (not your trade name)
Trade name (if any)
Address
Number
Street
Suite or room number
City
State
ZIP code
Foreign country name
Foreign province/county
Foreign postal code
850113
OMB No. 1545-0028
Read the separate instructions before you complete this form. Please type or print within the boxes.
Part 1:
Tell us about your return. If any line does NOT apply, leave it blank. See instructions before completing Part 1.
Employer's Annual Federal Unemployment (FUTA) Tax Return
Department of the Treasury - Internal Revenue Service
1a
If you had to pay state unemployment tax in one state only, enter the state abbreviation .
1a
1b
If you had to pay state unemployment tax in more than one state, you are a multi-state
employer .
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1b
Complete Schedule A
(Form 940).
2
If you paid wages in a state that is subject to CREDIT REDUCTION .
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.
.
2
Check here. Complete
Schedule A (Form 940).
3
Total payments to all employees .
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3
n
4
Payments exempt from FUTA tax .
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4
n
Check all that apply
4a
Fringe benefits
4c
Retirement/Pension
4e
Other
4b
Group-term life insurance
4d
Dependent care
5
Total of payments made to each employee in excess of
$7,000 .
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5
n
6
Subtotal (line 4 + line 5 = line 6) .
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6
n
7
Total taxable FUTA wages (line 3 - line 6 = line 7) (see instructions) .
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7
n
8
FUTA tax before adjustments (line 7 x 0.006 = line 8) .
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8
n
9
If ALL of the taxable FUTA wages you paid were excluded from state unemployment tax,
multiply line 7 by 0.054 (line 7 x 0.054 = line 9). Go to line 12 .
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9
n
10
If SOME of the taxable FUTA wages you paid were excluded from state unemployment tax,
OR you paid ANY state unemployment tax late (after the due date for filing Form 940),
complete the worksheet in the instructions. Enter the amount from line 7 of the worksheet .
.
.
10
n
11
If credit reduction applies, enter the total from Schedule A (Form 940) .
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11
n
12
Total FUTA tax after adjustments (line 8 + 9 + 10 + 11 = line 12) .
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12
n
13
FUTA tax deposited for the year, including any overpayment applied from a prior year .
.
13
n
14
Balance due If line 12 is more than line 13, enter the excess on line 14.
n If line 14 is more than $500, you must deposit your tax.
n If line 14 is $500 or less, you may pay with this return. See instructions
.
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.
14
n
15
Overpayment If line 13 is more than line 12, enter the excess on line 15 and check a box
below
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. 15
n
You MUST complete both pages of this form and SIGN it.
Check one:
Apply to next return.
Send a refund.
0095-13058390
TAXPAY®
19010
Type of Return
(Check all that apply.)
a. Amended
b. Successor employer
c. No payments to employees
in 2018
d. Final: Business closed or
stopped paying wages
Go to www.irs.gov/form940 for
instructions and the latest information.
Form 940 for 2018:
Part 2:
Determine your FUTA tax before adjustments. If any line does NOT apply, leave it blank.
Part 3:
Determine your adjustments. If any line does NOT apply, leave it blank.
Part 4:
Determine your FUTA tax and balance due or overpayment. If any line does NOT apply, leave it blank.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Cat. No. 11234O
Form 940 (2018)
Next
C
O

123858 18
a
26310 90a
26310 90
97547 28
585 28
585 28
585 28

Check Here
a.
b.
c.
d.
8 0 0 4 3 8 8 7 7

AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER
CO
80239
0095-13058390
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 50
of 422

850212
104 94
129 08
172 14
179 12
585 28
/
/
(
)
-

Part 6:
May we speak with your third-party designee?
Part 5:
Report your FUTA tax liability by quarter only if line 12 is more than $500. If not, go to Part 6.
Name (not your trade name)
Employer identification number (EIN)
AGGIES ANGELS CARE PROVIDERS
80-0438877
Part 7:
Sign here. You MUST complete both pages of this form and SIGN it.
0095-13058390
TAXPAY®
19010
REFERENCE COPY PREPARED
BY PAYCHEX. DO NOT FILE
Page 2
Form 940 (2018)
X
16 Report the amount of your FUTA tax liability for each quarter; do NOT enter the amount you deposited. If you had no liability for
a quarter, leave the line blank.
16a 1st quarter (January 1 - March 31)
.
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.
16a
n
16b 2nd quarter (April 1 - June 30) .
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16b
n
16c 3rd quarter (July 1 - September 30) .
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16c
n
16d 4th quarter (October 1 - December 31) .
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16d
n
17 Total tax liability for the year (line 16a + 16b + 16c + 16d = line 17) 17
n
Total must equal line 12.
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions
for details.
Yes.
Designee's name and phone number
Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS
No.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to
the best of my knowledge and belief, it is true, correct, and complete, and that no part of any payment made to a state
unemployment fund claimed as a credit was, or is to be, deducted from the payments made to employees. Declaration of
preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign your
name here
Print your
name here
Print your
title here
Date
Best daytime phone
Paid preparer use only
Check if you are self-employed
Preparer's name
PTIN
Preparer's
signature
Date
Firm's name (or yours
if self-employed)
EIN
Address
Phone
City
State
ZIP code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 51
of 422

Employer identification number
(EIN)
Name (not your trade name)
Trade name (if any)
Address
Number
Street
Suite or room number
City
State
ZIP code
Foreign country name
Foreign province/county
Foreign postal code
850113
OMB No. 1545-0028
Read the separate instructions before you complete this form. Please type or print within the boxes.
Part 1:
Tell us about your return. If any line does NOT apply, leave it blank. See instructions before completing Part 1.
Employer's Annual Federal Unemployment (FUTA) Tax Return
Department of the Treasury - Internal Revenue Service
1a
If you had to pay state unemployment tax in one state only, enter the state abbreviation .
1a
1b
If you had to pay state unemployment tax in more than one state, you are a multi-state
employer .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1b
Complete Schedule A
(Form 940).
2
If you paid wages in a state that is subject to CREDIT REDUCTION .
.
.
.
.
.
.
.
2
Check here. Complete
Schedule A (Form 940).
3
Total payments to all employees .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
n
4
Payments exempt from FUTA tax .
.
.
.
.
.
.
.
.
4
n
Check all that apply
4a
Fringe benefits
4c
Retirement/Pension
4e
Other
4b
Group-term life insurance
4d
Dependent care
5
Total of payments made to each employee in excess of
$7,000 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5
n
6
Subtotal (line 4 + line 5 = line 6) .
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.
.
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.
6
n
7
Total taxable FUTA wages (line 3 - line 6 = line 7) (see instructions) .
.
.
.
.
.
.
.
.
.
.
7
n
8
FUTA tax before adjustments (line 7 x 0.006 = line 8) .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
8
n
9
If ALL of the taxable FUTA wages you paid were excluded from state unemployment tax,
multiply line 7 by 0.054 (line 7 x 0.054 = line 9). Go to line 12 .
.
.
.
.
.
.
.
.
.
.
.
.
9
n
10
If SOME of the taxable FUTA wages you paid were excluded from state unemployment tax,
OR you paid ANY state unemployment tax late (after the due date for filing Form 940),
complete the worksheet in the instructions. Enter the amount from line 7 of the worksheet .
.
.
10
n
11
If credit reduction applies, enter the total from Schedule A (Form 940) .
.
.
.
.
.
.
.
.
.
11
n
12
Total FUTA tax after adjustments (line 8 + 9 + 10 + 11 = line 12) .
.
.
.
.
.
.
.
.
.
.
.
12
n
13
FUTA tax deposited for the year, including any overpayment applied from a prior year .
.
13
n
14
Balance due If line 12 is more than line 13, enter the excess on line 14.
n If line 14 is more than $500, you must deposit your tax.
n If line 14 is $500 or less, you may pay with this return. See instructions
.
.
.
.
.
.
.
.
.
14
n
15
Overpayment If line 13 is more than line 12, enter the excess on line 15 and check a box
below
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. 15
n
You MUST complete both pages of this form and SIGN it.
Check one:
Apply to next return.
Send a refund.
0095-13058390
TAXPAY®
18363
Type of Return
(Check all that apply.)
a. Amended
b. Successor employer
c. No payments to employees
in 2018
d. Final: Business closed or
stopped paying wages
Go to www.irs.gov/form940 for
instructions and the latest information.
Form 940 for 2018:
Part 2:
Determine your FUTA tax before adjustments. If any line does NOT apply, leave it blank.
Part 3:
Determine your adjustments. If any line does NOT apply, leave it blank.
Part 4:
Determine your FUTA tax and balance due or overpayment. If any line does NOT apply, leave it blank.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Cat. No. 11234O
Form 940 (2018)
Next
C
O

123858 18
a
26310 90a
26310 90
97547 28
585 28
585 28
585 28

Check Here
a.
b.
c.
d.
8 0 0 4 3 8 8 7 7

AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER
CO
80239
0095-13058390
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 52
of 422

850212
104 94
129 08
172 14
179 12
585 28
/
/
(
)
-

Part 6:
May we speak with your third-party designee?
Part 5:
Report your FUTA tax liability by quarter only if line 12 is more than $500. If not, go to Part 6.
Name (not your trade name)
Employer identification number (EIN)
AGGIES ANGELS CARE PROVIDERS
80-0438877
Part 7:
Sign here. You MUST complete both pages of this form and SIGN it.
0095-13058390
TAXPAY®
18363
REFERENCE COPY PREPARED
BY PAYCHEX. DO NOT FILE
Page 2
Form 940 (2018)
X
16 Report the amount of your FUTA tax liability for each quarter; do NOT enter the amount you deposited. If you had no liability for
a quarter, leave the line blank.
16a 1st quarter (January 1 - March 31)
.
.
.
.
.
.
.
.
.
.
16a
n
16b 2nd quarter (April 1 - June 30) .
.
.
.
.
.
.
.
.
.
.
.
16b
n
16c 3rd quarter (July 1 - September 30) .
.
.
.
.
.
.
.
.
.
16c
n
16d 4th quarter (October 1 - December 31) .
.
.
.
.
.
.
.
.
16d
n
17 Total tax liability for the year (line 16a + 16b + 16c + 16d = line 17) 17
n
Total must equal line 12.
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions
for details.
Yes.
Designee's name and phone number
Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS
No.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to
the best of my knowledge and belief, it is true, correct, and complete, and that no part of any payment made to a state
unemployment fund claimed as a credit was, or is to be, deducted from the payments made to employees. Declaration of
preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign your
name here
Print your
name here
Print your
title here
Date
Best daytime phone
Paid preparer use only
Check if you are self-employed
Preparer's name
PTIN
Preparer's
signature
Date
Firm's name (or yours
if self-employed)
EIN
Address
Phone
City
State
ZIP code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 53
of 422

Phone Number
Signature
Number of W-2s Attached
1000-130
DR 1093 (06/28/16)
Account Number
Period
Due Date
Colorado Department of Revenue
Annual Transmittal of State W-2 Forms
COLORADO DEPARTMENT OF REVENUE
www.TaxColorado.com
SSN 1
SSN 2
FEIN
Denver CO 80261-0009
First Name
Middle Initial
Last Name or Business Name
(MM/YY - MM/YY)
(MM/DD/YY)
Mark here if this is an Amended Return
Paid by
EFT
1.
2.
3.
4.
5.
6.
Signed under penalty of perjury in the second degree.
(MM/DD/YY)
Date
Mail reconciliation with W-2 forms and any payment due on line 6 to:
Colorado Department of Revenue,
Denver, CO 80261-0009
The State may convert your check to a one-time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will
not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.
Additional Balance Paid
Add lines 3A, 4, and 5
Interest
(see instructions)
Penalty
(see instructions)
A. Balance Due
If line 1 is more than line 2, enter difference and (see instructions)
B. Overpayment
If line 2 is more than line 1, enter the difference and (see instructions)
Total Colorado income taxes remitted for the period indicated above.
Total Colorado income taxes withheld per W-2 forms attached.
(890)
(100)
(415)
(200)
(300)
(355) $
( )
Departmental Use Only
Address
City
State
ZIP
161093 11124
.
80-0438877 30941838
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
01/18 12/18 01/31/19
35
2794 00
2794 00
0 00
0 00
0.00
REFERENCE COPY PREPARED BY PAYCHEX DO NOT FILE
0095-13058390 19010 TAXPAY^
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 54
of 422

*****************************************
* CLIENT 13058390 *
* *
* THESE ARE YOUR W2 REFERENCE COPIES. *
* KEEP THESE COPIES FOR 4 YEARS. *
* DO NOT DISTRIBUTE TO YOUR EMPLOYEES. *
*****************************************
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 55
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000010-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 522-87-9194 DENVER CO 80239
1430.00 18.51
1430.00 88.66
ZIPPORAH ARRINGTON 1430.00 20.74
CO 30941838 1430.00 12.00 1430.00 4.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000005-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 506-70-6071 DENVER CO 80239
3814.80
3814.80 236.52
MICHELLE A BOAKYE-LEALI 3814.80 55.31
15070 ROBINS DR
DENVER CO 80239
CO 30941838 3814.80 103.00 3814.80 12.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000035-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 522-99-1928 DENVER CO 80239
1183.00 36.00
1183.00 73.35
DECHELLE BROWN 1183.00 17.15
200 RAMPART WAY #204
DENVER CO 80230
CO 30941838 1183.00 29.00 1183.00 4.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000041-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 521-11-6922 DENVER CO 80239
2224.00 25.38
2224.00 137.89
ANNETTE CARLISLE 2224.00 32.25
4055 ALBION ST
DENVER CO 80216
CO 30941838 2224.00 14.00 2224.00 6.00 CO AUROR
PAGE 1
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 56
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000044-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 521-95-9514 DENVER CO 80239
130.00
130.00 8.06
PRECIOUS CARTER 130.00 1.89
15460 E 13TH AVE # 302
AURORA CO 80011
CO 30941838 130.00 2.00 130.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000024-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-86-3393 DENVER CO 80239
4341.60
4341.60 269.18
CALVIN COLEY 4341.60 62.95
1769 HANOVER ST
AURORA CO 80010
CO 30941838 4341.60 4341.60 16.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000004-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-08-1995 DENVER CO 80239
6926.50 16.03
6926.50 429.44
SHAONDALYN L COLEY 6926.50 100.43
5095 EAGLE STREET
DENVER CO 80239
CO 30941838 6926.50 233.00 6926.50 18.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000045-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 425-45-2124 DENVER CO 80239
621.00 15.84
621.00 38.50
APRIL D DRIVER 621.00 9.00
2257 W BYERS DR
DENVER CO 80223
CO 30941838 621.00 15.00 621.00 2.00 CO AUROR
PAGE 2
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 57
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000047-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-31-9402 DENVER CO 80239
1104.00 79.60
1104.00 68.45
CHANTEL ELLISON 1104.00 16.01
1925 S VAUGHN WAY #308
AURORA CO 80014
CO 30941838 1104.00 42.00 1104.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000006-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-87-3130 DENVER CO 80239
6609.60 33.30
6609.60 409.80
MIRNA FLORES 6609.60 95.84
CO 30941838 6609.60 62.00 6609.60 22.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000036-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 562-33-6426 DENVER CO 80239
2419.20 103.14
2419.20 149.99
JOHN GIVENS 2419.20 35.08
1155 S HAVANA ST # 396
AURORA CO 80012
CO 30941838 2419.20 72.00 2419.20 10.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000019-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-13-8337 DENVER CO 80239
3774.00 200.88
3774.00 233.99
DEWANDA GRAHAM 3774.00 54.72
4617 FREEPORT WAY
DENVER CO 80239
CO 30941838 3774.00 117.00 3774.00 16.00 CO AUROR
PAGE 3
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 58
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000032-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 651-20-6502 DENVER CO 80239
360.00 20.58
360.00 22.32
SAGUAYA JOHNSON 360.00 5.22
2975 IVANHOE STREET
DENVER CO 80207
CO 30941838 360.00 12.00 360.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000007-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-77-9492 DENVER CO 80239
25811.80 2307.77
25811.80 1600.33
DEJANE LATTANY 25811.80 374.27
14475 ROBINS DR
DENVER CO 80239
CO 30941838 25811.80 904.00 25811.80 12.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000014-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 522-95-1873 DENVER CO 80239
3744.00 211.64
3744.00 232.13
TENEA T LATTANY 3744.00 54.29
4699 KITTRIDGE
DENVER CO 80239
CO 30941838 3744.00 106.00 3744.00 4.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000028-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 DENVER CO 80239
1142.40
1142.40 70.83
JUSTINA LAWRENCE 1142.40 16.56
CO 30941838 1142.40 1142.40 6.00 CO AUROR
PAGE 4
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 59
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000027-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-27-0712 DENVER CO 80239
14499.10 944.29
14499.10 898.94
MICHAEL LEE 14499.10 210.24
146 S EAGLE CIRCLE
AURORA CO 80012
CO 30941838 14499.10 467.00 14499.10 20.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000031-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-12-2152 DENVER CO 80239
3912.00 209.48
3912.00 242.54
PHATEEMA LOPEZ 3912.00 56.72
13204 E PARKVIEW DR
DENVER CO 80202
CO 30941838 3912.00 106.00 3912.00 8.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000021-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-88-9226 DENVER CO 80239
4351.20 265.50
4351.20 269.77
THERESA LOVATO 4351.20 63.09
3051 S GOLDEN WAY
DENVER CO 80226
CO 30941838 4351.20 152.00 4351.20 18.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000046-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-14-0029 DENVER CO 80239
480.00 17.16
480.00 29.76
ALYSSIA MARTINEZ 480.00 6.96
3051 S GOLDEN WAY
DENVER CO 80227
CO 30941838 480.00 14.00 480.00 2.00 CO AUROR
PAGE 5
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 60
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000037-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-14-0088 DENVER CO 80239
560.00 13.96
560.00 34.72
LEYDI MARTINEZ 560.00 8.12
372 SCRANTON ST
AURORA CO 80011
CO 30941838 560.00 13.00 560.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000043-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-85-0263 DENVER CO 80239
792.00 35.16
792.00 49.10
KEIAJEAU MCGILL 792.00 11.48
CO 30941838 792.00 24.00 792.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000029-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 647-50-9003 DENVER CO 80239
409.00 19.98
409.00 25.36
CAMERON HOLLIS MONTOUR 409.00 5.93
CO 30941838 409.00 12.00 409.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000030-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-07-0995 DENVER CO 80239
3089.00
3089.00 191.52
MADISEN MONTOUR 3089.00 44.79
2215 S OAKLAND WAY
AURORA CO 80014
CO 30941838 3089.00 2.00 3089.00 8.00 CO AUROR
PAGE 6
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 61
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000040-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 422-96-3729 DENVER CO 80239
560.00
560.00 34.72
BETTY MOORE 560.00 8.12
4463 STEEL STREET
DENVER CO 80230
CO 30941838 560.00 560.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000011-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 521-83-7462 DENVER CO 80239
774.00
774.00 47.99
DEVIN MOORE 774.00 11.22
CO 30941838 774.00 27.00 774.00 4.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000042-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-93-4275 DENVER CO 80239
2093.00 133.84
2093.00 129.77
WENDY MORALES 2093.00 30.35
CO 30941838 2093.00 74.00 2093.00 6.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000033-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 521-12-9049 DENVER CO 80239
403.20 24.90
403.20 25.00
BENESE THOMAS 403.20 5.85
11817 E CANAL DR
AURORA CO 80011
CO 30941838 403.20 14.00 403.20 2.00 CO AUROR
PAGE 7
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 62
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000034-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-14-8141 DENVER CO 80239
492.80 7.24
492.80 30.55
NYOMI ISIS TURPIN 492.80 7.15
11815 EAST CANAL DR
AURORA CO 80011
CO 30941838 492.80 10.00 492.80 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000022-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-93-4047 DENVER CO 80239
4151.40
4151.40 257.39
JASMINE VALDEZ 4151.40 60.20
2342 MOLINE STREET
AURORA CO 80010
CO 30941838 4151.40 4151.40 18.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000020-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 572-91-2194 DENVER CO 80239
4731.60
4731.60 293.36
ANGEL VIGIL 4731.60 68.61
5165 W COLGATE PLACE
DENVER CO 80236
CO 30941838 4731.60 4731.60 16.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000038-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 DENVER CO 80239
4209.00 282.12
4209.00 260.96
DEREK WASHINGTON 4209.00 61.03
CO 30941838 4209.00 156.00 4209.00 10.00 CO AUROR
PAGE 8
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 63
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 19010
0095-13058390
0000000001-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 465-79-8669 DENVER CO 80239
4661.00
4661.00 288.98
NATALIE M WILLIAMS 4661.00 67.58
2102 M L K BLVD
DENVER CO 80205
CO 30941838 4661.00 4661.00 16.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000009-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 510-76-6414 DENVER CO 80239
4179.18
4179.18 259.11
STEPHANIE WILRICH 4179.18 60.60
2102 MARTIN LUTHER KING BLVD
DENVER CO 80205
CO 30941838 4179.18 4179.18 16.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000003-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 522-04-1936 DENVER CO 80239
3874.80
3874.80 240.24
CHERYL R WOODSON 3874.80 56.18
1775 W MOSIER PLACE #1209
DENVER CO 80223
CO 30941838 3874.80
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 DENVER CO 80239
123858.18 5022.30
X 123858.18 7679.22
123858.18 1795.93
CO 30941838 123858.18 2794.00 119983.38 286.00 CO AUROR
PAGE 9
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 64
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000010-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 522-87-9194 DENVER CO 80239
1430.00 18.51
1430.00 88.66
ZIPPORAH ARRINGTON 1430.00 20.74
CO 30941838 1430.00 12.00 1430.00 4.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000005-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 506-70-6071 DENVER CO 80239
3814.80
3814.80 236.52
MICHELLE A BOAKYE-LEALI 3814.80 55.31
15070 ROBINS DR
DENVER CO 80239
CO 30941838 3814.80 103.00 3814.80 12.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000035-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 522-99-1928 DENVER CO 80239
1183.00 36.00
1183.00 73.35
DECHELLE BROWN 1183.00 17.15
200 RAMPART WAY #204
DENVER CO 80230
CO 30941838 1183.00 29.00 1183.00 4.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000041-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 521-11-6922 DENVER CO 80239
2224.00 25.38
2224.00 137.89
ANNETTE CARLISLE 2224.00 32.25
4055 ALBION ST
DENVER CO 80216
CO 30941838 2224.00 14.00 2224.00 6.00 CO AUROR
PAGE 1
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 66
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000044-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 521-95-9514 DENVER CO 80239
130.00
130.00 8.06
PRECIOUS CARTER 130.00 1.89
15460 E 13TH AVE # 302
AURORA CO 80011
CO 30941838 130.00 2.00 130.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000024-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-86-3393 DENVER CO 80239
4341.60
4341.60 269.18
CALVIN COLEY 4341.60 62.95
1769 HANOVER ST
AURORA CO 80010
CO 30941838 4341.60 4341.60 16.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000004-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-08-1995 DENVER CO 80239
6926.50 16.03
6926.50 429.44
SHAONDALYN L COLEY 6926.50 100.43
5095 EAGLE STREET
DENVER CO 80239
CO 30941838 6926.50 233.00 6926.50 18.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000045-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 425-45-2124 DENVER CO 80239
621.00 15.84
621.00 38.50
APRIL D DRIVER 621.00 9.00
2257 W BYERS DR
DENVER CO 80223
CO 30941838 621.00 15.00 621.00 2.00 CO AUROR
PAGE 2
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 67
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000047-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-31-9402 DENVER CO 80239
1104.00 79.60
1104.00 68.45
CHANTEL ELLISON 1104.00 16.01
1925 S VAUGHN WAY #308
AURORA CO 80014
CO 30941838 1104.00 42.00 1104.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000006-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-87-3130 DENVER CO 80239
6609.60 33.30
6609.60 409.80
MIRNA FLORES 6609.60 95.84
CO 30941838 6609.60 62.00 6609.60 22.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000036-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 562-33-6426 DENVER CO 80239
2419.20 103.14
2419.20 149.99
JOHN GIVENS 2419.20 35.08
1155 S HAVANA ST # 396
AURORA CO 80012
CO 30941838 2419.20 72.00 2419.20 10.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000019-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-13-8337 DENVER CO 80239
3774.00 200.88
3774.00 233.99
DEWANDA GRAHAM 3774.00 54.72
4617 FREEPORT WAY
DENVER CO 80239
CO 30941838 3774.00 117.00 3774.00 16.00 CO AUROR
PAGE 3
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 68
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000032-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 651-20-6502 DENVER CO 80239
360.00 20.58
360.00 22.32
SAGUAYA JOHNSON 360.00 5.22
2975 IVANHOE STREET
DENVER CO 80207
CO 30941838 360.00 12.00 360.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000007-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-77-9492 DENVER CO 80239
25811.80 2307.77
25811.80 1600.33
DEJANE LATTANY 25811.80 374.27
14475 ROBINS DR
DENVER CO 80239
CO 30941838 25811.80 904.00 25811.80 12.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000014-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 522-95-1873 DENVER CO 80239
3744.00 211.64
3744.00 232.13
TENEA T LATTANY 3744.00 54.29
4699 KITTRIDGE
DENVER CO 80239
CO 30941838 3744.00 106.00 3744.00 4.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000028-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 DENVER CO 80239
1142.40
1142.40 70.83
JUSTINA LAWRENCE 1142.40 16.56
CO 30941838 1142.40 1142.40 6.00 CO AUROR
PAGE 4
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 69
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000027-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-27-0712 DENVER CO 80239
14499.10 944.29
14499.10 898.94
MICHAEL LEE 14499.10 210.24
146 S EAGLE CIRCLE
AURORA CO 80012
CO 30941838 14499.10 467.00 14499.10 20.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000031-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-12-2152 DENVER CO 80239
3912.00 209.48
3912.00 242.54
PHATEEMA LOPEZ 3912.00 56.72
13204 E PARKVIEW DR
DENVER CO 80202
CO 30941838 3912.00 106.00 3912.00 8.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000021-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 524-88-9226 DENVER CO 80239
4351.20 265.50
4351.20 269.77
THERESA LOVATO 4351.20 63.09
3051 S GOLDEN WAY
DENVER CO 80226
CO 30941838 4351.20 152.00 4351.20 18.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000046-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-14-0029 DENVER CO 80239
480.00 17.16
480.00 29.76
ALYSSIA MARTINEZ 480.00 6.96
3051 S GOLDEN WAY
DENVER CO 80227
CO 30941838 480.00 14.00 480.00 2.00 CO AUROR
PAGE 5
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 70
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000037-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-14-0088 DENVER CO 80239
560.00 13.96
560.00 34.72
LEYDI MARTINEZ 560.00 8.12
372 SCRANTON ST
AURORA CO 80011
CO 30941838 560.00 13.00 560.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000043-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-85-0263 DENVER CO 80239
792.00 35.16
792.00 49.10
KEIAJEAU MCGILL 792.00 11.48
CO 30941838 792.00 24.00 792.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000029-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 647-50-9003 DENVER CO 80239
409.00 19.98
409.00 25.36
CAMERON HOLLIS MONTOUR 409.00 5.93
CO 30941838 409.00 12.00 409.00 2.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000030-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-07-0995 DENVER CO 80239
3089.00
3089.00 191.52
MADISEN MONTOUR 3089.00 44.79
2215 S OAKLAND WAY
AURORA CO 80014
CO 30941838 3089.00 2.00 3089.00 8.00 CO AUROR
PAGE 6
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 71
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000040-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 422-96-3729 DENVER CO 80239
560.00
560.00 34.72
BETTY MOORE 560.00 8.12
4463 STEEL STREET
DENVER CO 80230
CO 30941838 560.00 560.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000011-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 521-83-7462 DENVER CO 80239
774.00
774.00 47.99
DEVIN MOORE 774.00 11.22
CO 30941838 774.00 27.00 774.00 4.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000042-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-93-4275 DENVER CO 80239
2093.00 133.84
2093.00 129.77
WENDY MORALES 2093.00 30.35
CO 30941838 2093.00 74.00 2093.00 6.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000033-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 521-12-9049 DENVER CO 80239
403.20 24.90
403.20 25.00
BENESE THOMAS 403.20 5.85
11817 E CANAL DR
AURORA CO 80011
CO 30941838 403.20 14.00 403.20 2.00 CO AUROR
PAGE 7
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 72
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000034-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 653-14-8141 DENVER CO 80239
492.80 7.24
492.80 30.55
NYOMI ISIS TURPIN 492.80 7.15
11815 EAST CANAL DR
AURORA CO 80011
CO 30941838 492.80 10.00 492.80 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000022-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 523-93-4047 DENVER CO 80239
4151.40
4151.40 257.39
JASMINE VALDEZ 4151.40 60.20
2342 MOLINE STREET
AURORA CO 80010
CO 30941838 4151.40 4151.40 18.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000020-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 572-91-2194 DENVER CO 80239
4731.60
4731.60 293.36
ANGEL VIGIL 4731.60 68.61
5165 W COLGATE PLACE
DENVER CO 80236
CO 30941838 4731.60 4731.60 16.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000038-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 DENVER CO 80239
4209.00 282.12
4209.00 260.96
DEREK WASHINGTON 4209.00 61.03
CO 30941838 4209.00 156.00 4209.00 10.00 CO AUROR
PAGE 8
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 73
of 422

b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
OMB No. 1545-0008
Department of the Treasury - Internal Revenue Service
Void
c Employer's name, address, and ZIP code
d Control number
15 State Employer's state I.D. No.
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
15 State Employer's state I.D. No.
11 Nonqualified plans
10 Dependent care benefits
7 Social security tips
8 Allocated tips
12
See Instrs. for Box 12
14
Other
e Employee's name, address, and ZIP code
5 Medicare wages and tips
6 Medicare tax withheld
4 Social security tax withheld
3 Social security wages
plan
employee
sick pay
13
Retirement
Statutory
Third-party
Subtotal
2 Federal income tax withheld
1 Wages, tips, other compensation
b
a
Employee's social security number
Employer's identification number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
11 Nonqualified plans
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE 18363
0095-13058390
0000000001-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 465-79-8669 DENVER CO 80239
4661.00
4661.00 288.98
NATALIE M WILLIAMS 4661.00 67.58
2102 M L K BLVD
DENVER CO 80205
CO 30941838 4661.00 4661.00 16.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000009-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 510-76-6414 DENVER CO 80239
4179.18
4179.18 259.11
STEPHANIE WILRICH 4179.18 60.60
2102 MARTIN LUTHER KING BLVD
DENVER CO 80205
CO 30941838 4179.18 4179.18 16.00 CO AUROR
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
0000000003-0000W2 AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 522-04-1936 DENVER CO 80239
3874.80
3874.80 240.24
CHERYL R WOODSON 3874.80 56.18
1775 W MOSIER PLACE #1209
DENVER CO 80223
CO 30941838 3874.80
Form W-2 Wage and Tax Statement 2018 EMPLOYER REFERENCE COPY - DO NOT FILE
0095-13058390
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
80-0438877 DENVER CO 80239
123858.18 5022.30
X 123858.18 7679.22
123858.18 1795.93
CO 30941838 123858.18 2794.00 119983.38 286.00 CO AUROR
PAGE 9
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 74
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000010-0000W2
80-0438877
522-87-9194
1430.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ZIPPORAH ARRINGTON
18.51
1430.00
88.66
1430.00
2018
Copy C,
20.74
CO
30941838
1430.00
12.00
1430.00
4.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
3f94-3fb5-4b3f-e68c
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000010-0000W2
80-0438877
522-87-9194
1430.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ZIPPORAH ARRINGTON
18.51
1430.00
88.66
1430.00
2018
Copy B,
20.74
CO
30941838
1430.00
12.00
1430.00
4.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
3f94-3fb5-4b3f-e68c
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000010-0000W2
80-0438877
522-87-9194
1430.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ZIPPORAH ARRINGTON
18.51
1430.00
88.66
1430.00
2018
Copy 2,
20.74
CO
30941838
1430.00
12.00
1430.00
4.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 75
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000010-0000W2
80-0438877
522-87-9194
1430.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ZIPPORAH ARRINGTON
18.51
1430.00
88.66
1430.00
2018
Copy 2,
20.74
CO
30941838
1430.00
12.00
1430.00
4.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 76
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000005-0000W2
80-0438877
506-70-6071
3814.80
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MICHELLE A BOAKYE-LEALI
15070 ROBINS DR
DENVER CO 80239
3814.80
236.52
3814.80
2018
Copy C,
55.31
CO
30941838
3814.80
103.00
3814.80
12.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
9ee8-802a-2058-8555
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000005-0000W2
80-0438877
506-70-6071
3814.80
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MICHELLE A BOAKYE-LEALI
15070 ROBINS DR
DENVER CO 80239
3814.80
236.52
3814.80
2018
Copy B,
55.31
CO
30941838
3814.80
103.00
3814.80
12.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
9ee8-802a-2058-8555
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000005-0000W2
80-0438877
506-70-6071
3814.80
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MICHELLE A BOAKYE-LEALI
15070 ROBINS DR
DENVER CO 80239
3814.80
236.52
3814.80
2018
Copy 2,
55.31
CO
30941838
3814.80
103.00
3814.80
12.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 77
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000005-0000W2
80-0438877
506-70-6071
3814.80
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MICHELLE A BOAKYE-LEALI
15070 ROBINS DR
DENVER CO 80239
3814.80
236.52
3814.80
2018
Copy 2,
55.31
CO
30941838
3814.80
103.00
3814.80
12.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 78
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000035-0000W2
80-0438877
522-99-1928
1183.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DECHELLE BROWN
200 RAMPART WAY #204
DENVER CO 80230
36.00
1183.00
73.35
1183.00
2018
Copy C,
17.15
CO
30941838
1183.00
29.00
1183.00
4.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
de28-7dc2-5c06-343a
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000035-0000W2
80-0438877
522-99-1928
1183.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DECHELLE BROWN
200 RAMPART WAY #204
DENVER CO 80230
36.00
1183.00
73.35
1183.00
2018
Copy B,
17.15
CO
30941838
1183.00
29.00
1183.00
4.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
de28-7dc2-5c06-343a
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000035-0000W2
80-0438877
522-99-1928
1183.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DECHELLE BROWN
200 RAMPART WAY #204
DENVER CO 80230
36.00
1183.00
73.35
1183.00
2018
Copy 2,
17.15
CO
30941838
1183.00
29.00
1183.00
4.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 79
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000035-0000W2
80-0438877
522-99-1928
1183.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DECHELLE BROWN
200 RAMPART WAY #204
DENVER CO 80230
36.00
1183.00
73.35
1183.00
2018
Copy 2,
17.15
CO
30941838
1183.00
29.00
1183.00
4.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 80
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000041-0000W2
80-0438877
521-11-6922
2224.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ANNETTE CARLISLE
4055 ALBION ST
DENVER CO 80216
25.38
2224.00
137.89
2224.00
2018
Copy C,
32.25
CO
30941838
2224.00
14.00
2224.00
6.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
e6f9-faac-eb6e-2070
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000041-0000W2
80-0438877
521-11-6922
2224.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ANNETTE CARLISLE
4055 ALBION ST
DENVER CO 80216
25.38
2224.00
137.89
2224.00
2018
Copy B,
32.25
CO
30941838
2224.00
14.00
2224.00
6.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
e6f9-faac-eb6e-2070
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000041-0000W2
80-0438877
521-11-6922
2224.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ANNETTE CARLISLE
4055 ALBION ST
DENVER CO 80216
25.38
2224.00
137.89
2224.00
2018
Copy 2,
32.25
CO
30941838
2224.00
14.00
2224.00
6.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 81
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000041-0000W2
80-0438877
521-11-6922
2224.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ANNETTE CARLISLE
4055 ALBION ST
DENVER CO 80216
25.38
2224.00
137.89
2224.00
2018
Copy 2,
32.25
CO
30941838
2224.00
14.00
2224.00
6.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 82
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000044-0000W2
80-0438877
521-95-9514
130.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
PRECIOUS CARTER
15460 E 13TH AVE # 302
AURORA CO 80011
130.00
8.06
130.00
2018
Copy C,
1.89
CO
30941838
130.00
2.00
130.00
0.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
0088-1387-639a-21ba
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000044-0000W2
80-0438877
521-95-9514
130.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
PRECIOUS CARTER
15460 E 13TH AVE # 302
AURORA CO 80011
130.00
8.06
130.00
2018
Copy B,
1.89
CO
30941838
130.00
2.00
130.00
0.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
0088-1387-639a-21ba
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000044-0000W2
80-0438877
521-95-9514
130.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
PRECIOUS CARTER
15460 E 13TH AVE # 302
AURORA CO 80011
130.00
8.06
130.00
2018
Copy 2,
1.89
CO
30941838
130.00
2.00
130.00
0.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 83
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000044-0000W2
80-0438877
521-95-9514
130.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
PRECIOUS CARTER
15460 E 13TH AVE # 302
AURORA CO 80011
130.00
8.06
130.00
2018
Copy 2,
1.89
CO
30941838
130.00
2.00
130.00
0.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 84
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000024-0000W2
80-0438877
523-86-3393
4341.60
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
CALVIN COLEY
1769 HANOVER ST
AURORA CO 80010
4341.60
269.18
4341.60
2018
Copy C,
62.95
CO
30941838
4341.60
4341.60
16.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
39a9-03c6-810c-10cc
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000024-0000W2
80-0438877
523-86-3393
4341.60
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
CALVIN COLEY
1769 HANOVER ST
AURORA CO 80010
4341.60
269.18
4341.60
2018
Copy B,
62.95
CO
30941838
4341.60
4341.60
16.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
39a9-03c6-810c-10cc
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000024-0000W2
80-0438877
523-86-3393
4341.60
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
CALVIN COLEY
1769 HANOVER ST
AURORA CO 80010
4341.60
269.18
4341.60
2018
Copy 2,
62.95
CO
30941838
4341.60
4341.60
16.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 85
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000024-0000W2
80-0438877
523-86-3393
4341.60
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
CALVIN COLEY
1769 HANOVER ST
AURORA CO 80010
4341.60
269.18
4341.60
2018
Copy 2,
62.95
CO
30941838
4341.60
4341.60
16.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 86
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000004-0000W2
80-0438877
524-08-1995
6926.50
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
SHAONDALYN L COLEY
5095 EAGLE STREET
DENVER CO 80239
16.03
6926.50
429.44
6926.50
2018
Copy C,
100.43
CO
30941838
6926.50
233.00
6926.50
18.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
903f-84d6-0113-3200
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000004-0000W2
80-0438877
524-08-1995
6926.50
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
SHAONDALYN L COLEY
5095 EAGLE STREET
DENVER CO 80239
16.03
6926.50
429.44
6926.50
2018
Copy B,
100.43
CO
30941838
6926.50
233.00
6926.50
18.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
903f-84d6-0113-3200
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000004-0000W2
80-0438877
524-08-1995
6926.50
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
SHAONDALYN L COLEY
5095 EAGLE STREET
DENVER CO 80239
16.03
6926.50
429.44
6926.50
2018
Copy 2,
100.43
CO
30941838
6926.50
233.00
6926.50
18.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 87
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000004-0000W2
80-0438877
524-08-1995
6926.50
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
SHAONDALYN L COLEY
5095 EAGLE STREET
DENVER CO 80239
16.03
6926.50
429.44
6926.50
2018
Copy 2,
100.43
CO
30941838
6926.50
233.00
6926.50
18.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 88
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000045-0000W2
80-0438877
425-45-2124
621.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
APRIL D DRIVER
2257 W BYERS DR
DENVER CO 80223
15.84
621.00
38.50
621.00
2018
Copy C,
9.00
CO
30941838
621.00
15.00
621.00
2.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
e6e8-d5d3-b208-d13e
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000045-0000W2
80-0438877
425-45-2124
621.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
APRIL D DRIVER
2257 W BYERS DR
DENVER CO 80223
15.84
621.00
38.50
621.00
2018
Copy B,
9.00
CO
30941838
621.00
15.00
621.00
2.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
e6e8-d5d3-b208-d13e
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000045-0000W2
80-0438877
425-45-2124
621.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
APRIL D DRIVER
2257 W BYERS DR
DENVER CO 80223
15.84
621.00
38.50
621.00
2018
Copy 2,
9.00
CO
30941838
621.00
15.00
621.00
2.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 89
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000045-0000W2
80-0438877
425-45-2124
621.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
APRIL D DRIVER
2257 W BYERS DR
DENVER CO 80223
15.84
621.00
38.50
621.00
2018
Copy 2,
9.00
CO
30941838
621.00
15.00
621.00
2.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 90
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000047-0000W2
80-0438877
524-31-9402
1104.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
CHANTEL ELLISON
1925 S VAUGHN WAY #308
AURORA CO 80014
79.60
1104.00
68.45
1104.00
2018
Copy C,
16.01
CO
30941838
1104.00
42.00
1104.00
2.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
7123-c591-8c6c-6c33
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000047-0000W2
80-0438877
524-31-9402
1104.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
CHANTEL ELLISON
1925 S VAUGHN WAY #308
AURORA CO 80014
79.60
1104.00
68.45
1104.00
2018
Copy B,
16.01
CO
30941838
1104.00
42.00
1104.00
2.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
7123-c591-8c6c-6c33
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000047-0000W2
80-0438877
524-31-9402
1104.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
CHANTEL ELLISON
1925 S VAUGHN WAY #308
AURORA CO 80014
79.60
1104.00
68.45
1104.00
2018
Copy 2,
16.01
CO
30941838
1104.00
42.00
1104.00
2.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 91
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000047-0000W2
80-0438877
524-31-9402
1104.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
CHANTEL ELLISON
1925 S VAUGHN WAY #308
AURORA CO 80014
79.60
1104.00
68.45
1104.00
2018
Copy 2,
16.01
CO
30941838
1104.00
42.00
1104.00
2.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 92
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000006-0000W2
80-0438877
524-87-3130
6609.60
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MIRNA FLORES
33.30
6609.60
409.80
6609.60
2018
Copy C,
95.84
CO
30941838
6609.60
62.00
6609.60
22.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
06e9-6552-a195-cf13
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000006-0000W2
80-0438877
524-87-3130
6609.60
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MIRNA FLORES
33.30
6609.60
409.80
6609.60
2018
Copy B,
95.84
CO
30941838
6609.60
62.00
6609.60
22.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
06e9-6552-a195-cf13
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000006-0000W2
80-0438877
524-87-3130
6609.60
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MIRNA FLORES
33.30
6609.60
409.80
6609.60
2018
Copy 2,
95.84
CO
30941838
6609.60
62.00
6609.60
22.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 93
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000006-0000W2
80-0438877
524-87-3130
6609.60
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MIRNA FLORES
33.30
6609.60
409.80
6609.60
2018
Copy 2,
95.84
CO
30941838
6609.60
62.00
6609.60
22.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 94
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000036-0000W2
80-0438877
562-33-6426
2419.20
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
JOHN GIVENS
1155 S HAVANA ST # 396
AURORA CO 80012
103.14
2419.20
149.99
2419.20
2018
Copy C,
35.08
CO
30941838
2419.20
72.00
2419.20
10.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
1c91-cad1-5ca1-0d20
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000036-0000W2
80-0438877
562-33-6426
2419.20
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
JOHN GIVENS
1155 S HAVANA ST # 396
AURORA CO 80012
103.14
2419.20
149.99
2419.20
2018
Copy B,
35.08
CO
30941838
2419.20
72.00
2419.20
10.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
1c91-cad1-5ca1-0d20
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000036-0000W2
80-0438877
562-33-6426
2419.20
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
JOHN GIVENS
1155 S HAVANA ST # 396
AURORA CO 80012
103.14
2419.20
149.99
2419.20
2018
Copy 2,
35.08
CO
30941838
2419.20
72.00
2419.20
10.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 95
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000036-0000W2
80-0438877
562-33-6426
2419.20
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
JOHN GIVENS
1155 S HAVANA ST # 396
AURORA CO 80012
103.14
2419.20
149.99
2419.20
2018
Copy 2,
35.08
CO
30941838
2419.20
72.00
2419.20
10.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 96
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000019-0000W2
80-0438877
524-13-8337
3774.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DEWANDA GRAHAM
4617 FREEPORT WAY
DENVER CO 80239
200.88
3774.00
233.99
3774.00
2018
Copy C,
54.72
CO
30941838
3774.00
117.00
3774.00
16.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
d6d5-5576-836b-a9a3
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000019-0000W2
80-0438877
524-13-8337
3774.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DEWANDA GRAHAM
4617 FREEPORT WAY
DENVER CO 80239
200.88
3774.00
233.99
3774.00
2018
Copy B,
54.72
CO
30941838
3774.00
117.00
3774.00
16.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
d6d5-5576-836b-a9a3
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000019-0000W2
80-0438877
524-13-8337
3774.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DEWANDA GRAHAM
4617 FREEPORT WAY
DENVER CO 80239
200.88
3774.00
233.99
3774.00
2018
Copy 2,
54.72
CO
30941838
3774.00
117.00
3774.00
16.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 97
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000019-0000W2
80-0438877
524-13-8337
3774.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DEWANDA GRAHAM
4617 FREEPORT WAY
DENVER CO 80239
200.88
3774.00
233.99
3774.00
2018
Copy 2,
54.72
CO
30941838
3774.00
117.00
3774.00
16.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 98
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000032-0000W2
80-0438877
651-20-6502
360.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
SAGUAYA JOHNSON
2975 IVANHOE STREET
DENVER CO 80207
20.58
360.00
22.32
360.00
2018
Copy C,
5.22
CO
30941838
360.00
12.00
360.00
2.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
d624-3e34-02ce-265d
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000032-0000W2
80-0438877
651-20-6502
360.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
SAGUAYA JOHNSON
2975 IVANHOE STREET
DENVER CO 80207
20.58
360.00
22.32
360.00
2018
Copy B,
5.22
CO
30941838
360.00
12.00
360.00
2.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
d624-3e34-02ce-265d
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000032-0000W2
80-0438877
651-20-6502
360.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
SAGUAYA JOHNSON
2975 IVANHOE STREET
DENVER CO 80207
20.58
360.00
22.32
360.00
2018
Copy 2,
5.22
CO
30941838
360.00
12.00
360.00
2.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg 99
of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000032-0000W2
80-0438877
651-20-6502
360.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
SAGUAYA JOHNSON
2975 IVANHOE STREET
DENVER CO 80207
20.58
360.00
22.32
360.00
2018
Copy 2,
5.22
CO
30941838
360.00
12.00
360.00
2.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
100 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000007-0000W2
80-0438877
523-77-9492
25811.80
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DEJANE LATTANY
14475 ROBINS DR
DENVER CO 80239
2307.77
25811.80
1600.33
25811.80
2018
Copy C,
374.27
CO
30941838
25811.80
904.00
25811.80
12.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
338f-b7d2-1c99-ab08
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000007-0000W2
80-0438877
523-77-9492
25811.80
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DEJANE LATTANY
14475 ROBINS DR
DENVER CO 80239
2307.77
25811.80
1600.33
25811.80
2018
Copy B,
374.27
CO
30941838
25811.80
904.00
25811.80
12.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
338f-b7d2-1c99-ab08
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000007-0000W2
80-0438877
523-77-9492
25811.80
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DEJANE LATTANY
14475 ROBINS DR
DENVER CO 80239
2307.77
25811.80
1600.33
25811.80
2018
Copy 2,
374.27
CO
30941838
25811.80
904.00
25811.80
12.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
101 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000007-0000W2
80-0438877
523-77-9492
25811.80
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
DEJANE LATTANY
14475 ROBINS DR
DENVER CO 80239
2307.77
25811.80
1600.33
25811.80
2018
Copy 2,
374.27
CO
30941838
25811.80
904.00
25811.80
12.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
102 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000014-0000W2
80-0438877
522-95-1873
3744.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
TENEA T LATTANY
4699 KITTRIDGE
DENVER CO 80239
211.64
3744.00
232.13
3744.00
2018
Copy C,
54.29
CO
30941838
3744.00
106.00
3744.00
4.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
c92f-b846-6c6a-970a
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000014-0000W2
80-0438877
522-95-1873
3744.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
TENEA T LATTANY
4699 KITTRIDGE
DENVER CO 80239
211.64
3744.00
232.13
3744.00
2018
Copy B,
54.29
CO
30941838
3744.00
106.00
3744.00
4.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
c92f-b846-6c6a-970a
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000014-0000W2
80-0438877
522-95-1873
3744.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
TENEA T LATTANY
4699 KITTRIDGE
DENVER CO 80239
211.64
3744.00
232.13
3744.00
2018
Copy 2,
54.29
CO
30941838
3744.00
106.00
3744.00
4.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
103 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000014-0000W2
80-0438877
522-95-1873
3744.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
TENEA T LATTANY
4699 KITTRIDGE
DENVER CO 80239
211.64
3744.00
232.13
3744.00
2018
Copy 2,
54.29
CO
30941838
3744.00
106.00
3744.00
4.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
104 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000028-0000W2
80-0438877
1142.40
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
JUSTINA LAWRENCE
1142.40
70.83
1142.40
2018
Copy C,
16.56
CO
30941838
1142.40
1142.40
6.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
63df-b96d-7893-fdce
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000028-0000W2
80-0438877
1142.40
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
JUSTINA LAWRENCE
1142.40
70.83
1142.40
2018
Copy B,
16.56
CO
30941838
1142.40
1142.40
6.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
63df-b96d-7893-fdce
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000028-0000W2
80-0438877
1142.40
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
JUSTINA LAWRENCE
1142.40
70.83
1142.40
2018
Copy 2,
16.56
CO
30941838
1142.40
1142.40
6.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
105 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000028-0000W2
80-0438877
1142.40
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
JUSTINA LAWRENCE
1142.40
70.83
1142.40
2018
Copy 2,
16.56
CO
30941838
1142.40
1142.40
6.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
106 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000027-0000W2
80-0438877
524-27-0712
14499.10
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MICHAEL LEE
146 S EAGLE CIRCLE
AURORA CO 80012
944.29
14499.10
898.94
14499.10
2018
Copy C,
210.24
CO
30941838
14499.10
467.00
14499.10
20.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
5ddc-c309-c85b-74fe
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000027-0000W2
80-0438877
524-27-0712
14499.10
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MICHAEL LEE
146 S EAGLE CIRCLE
AURORA CO 80012
944.29
14499.10
898.94
14499.10
2018
Copy B,
210.24
CO
30941838
14499.10
467.00
14499.10
20.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
5ddc-c309-c85b-74fe
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000027-0000W2
80-0438877
524-27-0712
14499.10
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MICHAEL LEE
146 S EAGLE CIRCLE
AURORA CO 80012
944.29
14499.10
898.94
14499.10
2018
Copy 2,
210.24
CO
30941838
14499.10
467.00
14499.10
20.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
107 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000027-0000W2
80-0438877
524-27-0712
14499.10
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
MICHAEL LEE
146 S EAGLE CIRCLE
AURORA CO 80012
944.29
14499.10
898.94
14499.10
2018
Copy 2,
210.24
CO
30941838
14499.10
467.00
14499.10
20.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
108 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000031-0000W2
80-0438877
653-12-2152
3912.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
PHATEEMA LOPEZ
13204 E PARKVIEW DR
DENVER CO 80202
209.48
3912.00
242.54
3912.00
2018
Copy C,
56.72
CO
30941838
3912.00
106.00
3912.00
8.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
ff08-58a2-8770-4ac7
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000031-0000W2
80-0438877
653-12-2152
3912.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
PHATEEMA LOPEZ
13204 E PARKVIEW DR
DENVER CO 80202
209.48
3912.00
242.54
3912.00
2018
Copy B,
56.72
CO
30941838
3912.00
106.00
3912.00
8.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
ff08-58a2-8770-4ac7
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000031-0000W2
80-0438877
653-12-2152
3912.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
PHATEEMA LOPEZ
13204 E PARKVIEW DR
DENVER CO 80202
209.48
3912.00
242.54
3912.00
2018
Copy 2,
56.72
CO
30941838
3912.00
106.00
3912.00
8.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
109 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000031-0000W2
80-0438877
653-12-2152
3912.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
PHATEEMA LOPEZ
13204 E PARKVIEW DR
DENVER CO 80202
209.48
3912.00
242.54
3912.00
2018
Copy 2,
56.72
CO
30941838
3912.00
106.00
3912.00
8.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
110 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000021-0000W2
80-0438877
524-88-9226
4351.20
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
THERESA LOVATO
3051 S GOLDEN WAY
DENVER CO 80226
265.50
4351.20
269.77
4351.20
2018
Copy C,
63.09
CO
30941838
4351.20
152.00
4351.20
18.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
42fe-9081-845f-a2bc
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000021-0000W2
80-0438877
524-88-9226
4351.20
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
THERESA LOVATO
3051 S GOLDEN WAY
DENVER CO 80226
265.50
4351.20
269.77
4351.20
2018
Copy B,
63.09
CO
30941838
4351.20
152.00
4351.20
18.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
42fe-9081-845f-a2bc
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000021-0000W2
80-0438877
524-88-9226
4351.20
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
THERESA LOVATO
3051 S GOLDEN WAY
DENVER CO 80226
265.50
4351.20
269.77
4351.20
2018
Copy 2,
63.09
CO
30941838
4351.20
152.00
4351.20
18.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
111 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000021-0000W2
80-0438877
524-88-9226
4351.20
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
THERESA LOVATO
3051 S GOLDEN WAY
DENVER CO 80226
265.50
4351.20
269.77
4351.20
2018
Copy 2,
63.09
CO
30941838
4351.20
152.00
4351.20
18.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
112 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000046-0000W2
80-0438877
653-14-0029
480.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ALYSSIA MARTINEZ
3051 S GOLDEN WAY
DENVER CO 80227
17.16
480.00
29.76
480.00
2018
Copy C,
6.96
CO
30941838
480.00
14.00
480.00
2.00 CO AUROR
for employee's records
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
Verification Code
69d9-48cf-4916-6862
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000046-0000W2
80-0438877
653-14-0029
480.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ALYSSIA MARTINEZ
3051 S GOLDEN WAY
DENVER CO 80227
17.16
480.00
29.76
480.00
2018
Copy B,
6.96
CO
30941838
480.00
14.00
480.00
2.00 CO AUROR
to be filed with employee's FEDERAL tax return
Verification Code
69d9-48cf-4916-6862
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000046-0000W2
80-0438877
653-14-0029
480.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ALYSSIA MARTINEZ
3051 S GOLDEN WAY
DENVER CO 80227
17.16
480.00
29.76
480.00
2018
Copy 2,
6.96
CO
30941838
480.00
14.00
480.00
2.00 CO AUROR
CO
to be filed with employee's tax return for
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
113 of 422

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.
Earned income credit (EIC). You may be able to take the EIC for 2020 if your adjusted gross
income (AGI) is less than a certain amount. The amount of 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 EIC if your investment income is more
than the specified amount for 2020 or if income is earned for services provided while you were an
inmate at a penal institution. For 2020 income limits and more information, visit www.irs.gov/EITC.
Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to
you, but only if you file a tax return.
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see Pub.
517, Social Security and Other Information for Members of the Clergy and Religious Workers.
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 file Form W-2c,
Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of
Form W-2c from your employer for 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 at www.SSA.gov.
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 taxes. If you had more than one employer in 2020 and more than $7,960.80 in
social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. If you had more than one railroad
employer and more than $4,674.60 in Tier 2 RRTA tax was withheld, you also may be able to claim a
credit. See your Form 1040 Instructions and Pub. 505, Tax Withholding and Estimated 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, Additional Medicare Tax. 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 of those Medicare wages and tips above
$200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on
your tax return, see your Form 1040 instructions.
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 that you
received a smaller amount. 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. On Form 4137 you will calculate
the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you
must report as income and on other tips you did not report to your employer. By filing Form 4137,
your social security tips will be credited to your social security record (used to figure your benefits).
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by your software.
The only valid characters are the letters A-F and numerals 0-9. This code assists the IRS in validating
the W-2 data submitted with your return. The code is not entered on paper-filed returns.
Box 10. This amount includes the total dependent care benefits that your employer paid to you or
incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over
$5,000 also is included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to
compute any taxable and nontaxable amounts.
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 shouldn't be used if you had a deferral and a distribution in the
same calendar year. If you made a deferral and received a distribution in the same calendar year, and
you are or will be age 62 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, and S) and designated Roth contributions
(codes AA, BB, and EE) under all plans are generally limited to a total of $18,500 ($12,500 if you only
have SIMPLE plans; $21,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Pub. 571). Deferrals under code G are limited to $18,500. Deferrals under code H are limited to
$7,000.
However, if you were at least age 50 in 2020, your employer may have allowed an additional
deferral of up to $6,000 ($3,000 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 instructions for Form 1040.
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.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See the Form
1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See the Form 1040 instructions.
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. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
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 boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to
compute any taxable and nontaxable amounts.
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, Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts the employee elected to contribute using a section
125 (cafeteria) plan) to your Health Savings Account. Report on Form 8889, Health Savings Accounts
(HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form
1040 instructions.
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.
FF—Permitted benefits under a qualified small employer health reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional
IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement
Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state disability insurance taxes
withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income,
educational assistance payments, or a member of the clergy’s parsonage allowance and utilities.
Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2
tax, Medicare tax and Additional Medicare Tax. Include tips reported by the employee to the employer
in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 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.
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
0095-13058390
0000000046-0000W2
80-0438877
653-14-0029
480.00
AGGIES ANGELS CARE PROVIDERS
14475 ROBINS DR
DENVER CO 80239
ALYSSIA MARTINEZ
3051 S GOLDEN WAY
DENVER CO 80227
17.16
480.00
29.76
480.00
2018
Copy 2,
6.96
CO
30941838
480.00
14.00
480.00
2.00 CO AUROR
AUROR
to be filed with employee's tax return for
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
d Control number
Void
b Employer's identification number
a Employee's social security number
13
Statutory
Employee
Retirement
plan
Third-party
sick pay
12 See Instrs. for Box 12
14 Other
15 State
Employer's state I.D. No.
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0008
1 Wages, tips, other compensation
c Employer's name, address, and ZIP code
e Employee's name, address, and ZIP code
2 Federal Income tax withheld
3 Social Security wages
4 Social Security tax withheld
5 Medicare wages and tips
7 Social Security tips
11 Nonqualified plans
6 Medicare tax withheld
8 Allocated Tips
10 Dependent care benefits
Form W-2 Wage and Tax Statement
X
2018
Verification Code
Case No. 1:23-cr-00074-NYW Document 46 filed 11/13/23 USDC Colorado pg
114 of 422

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Motion to Vacate, Set Aside, Or Correct Sentence Pursuant to 28 U.S.C. — USA v. Lattany (Dkt. 46, D. Colo.)

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