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                                               PA W-2 RECONCILIATION WORKSHEET
START PA-40 W-2 RW (EX) 07-19(FI)
HERE  Name                                                                                                                                                             Social Security Number 
Ü      
      Employer’s identification number from Box bFEDERAL WAGES            FEDERAL WAGES          MEDICARE WAGES
                                                                                                 (Box 1)                               (Box 1)                              (Box 5)                 
                                                                                                                                     
      SECTION I Starting Point               
      SECTION II Additions                                                                     COLUMN A                   COLUMN B                  COLUMN C                                  
          1.    Company contribution to deferred compensation plan. 
          2.    Elective deferrals to IRC Section 401(k) - Code “D” 
                  in Box 12. 
          3.    Elective deferrals under IRC Section 403(b) salary reduction 
                  agreement - Code “E” in Box 12. 
          4.    Elective deferrals under IRC Section 408(k)(6) salary reduction 
                  agreement (SEP) - Code “F” in Box 12. 
          5.    Elective and non-elective deferrals under IRC Section 457(b) 
                  deferred compensation plan - Code “G” in Box 12. 
          6.    Elective deferrals to a Section 501 (C)(18)(D) tax-exempt 
                  organization plan - Code “H” in Box 12. 
          7.    Income from a nonqualified deferred compensation (NQDC) 
                   plan - Code “Z” in Box 12. 
          8.    Deferrals to a NQDC plan qualifying under IRC Section 409A -  
                  Code “Y” in Box 12. 
          9.    Other Additions (provide full descriptions) 
                             Fields 9a. through 9e.
        9a. 
        9b. 
        9c. 
        9d. 
        9e. 

        10.   TOTAL (add Lines 1 through 9e.) 
      SECTION III Subtractions                                                              COLUMN A                   COLUMN B                  COLUMN C                                     
         11.    Company contribution to deferred compensation plan. 
        12.    Cost of group-term life - Code “C” in Box 12. 
        13.    Income from a NQDC plan - Code “Z” in Box 12. 
        14.    Deferrals to a NQDC plan qualifying under IRC Section 409A -  
                  Code “Y” in Box 12. 
        15.    Personal use of company vehicle. 
        16.    Distributions from a NQDC plan. 
        17.    Distributions from a NQDC plan previously taxed for 
                  Pennsylvania purposes. 
        18.    Other Subtractions (provide full descriptions) 
                             Fields 18a. through 18e.
      18a. 
      18b. 
      18c. 
      18d. 
      18e. 

        19.   TOTAL (add Lines 11 through 18e.) 

      SECTION IV Finishing Point              
      [Add Section I and Section II, Line 10 then subtract Section III, Line 19]       MEDICARE WAGES                 PA WAGES                        PA WAGES 
                                                                                                                                     (Box 5)                              (Box 16)                            (Box 16)
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                                                              Pennsylvania Department of Revenue 

                                                              Instructions for PA W-2 RW 
PA-40 W-2 RW IN (EX) 07-19                                                                        Interest Income  

          GENERAL INFORMATIONGENERAL                         INSTRUCTIONS                                             
PURPOSE OF SCHEDULE                                           Column A reconciles the amount of federal wages in Box 1 
Use the PA W-2 RW to provide supplemental information         of the W-2 to the amount of Medicare wages reported in 
regarding amounts reported on federal Form W-2, Wage          Box 5 of W-2. Include those items of compensation, such 
and Tax Statement, so that the department may reconcile       as various types of retirement plan deferrals and any other 
the wages to determine if the proper amount of gross com-     items of compensation that are not included in federal 
pensation income is reported for Pennsylvania personal        wages but are included Medicare wages in Section II of the 
income tax purposes. The W-2 RW may also be used to           W-2 RW. Include those items of compensation included in 
provide additional information regarding nonqualified         federal wages that are not included in Medicare wages in 
deferred compensation distributions previously taxed.         Section III of the W-2 RW. 
                                                              Column B reconciles federal wages in Box 1 of the W-2 to 
      RECORDING DOLLAR AMOUNTS                                Pennsylvania wages in Box 16 or to what Pennsylvania 
Show money amounts in whole-dollars only. Eliminate any       wages should be (for wages earned by a Pennsylvania res-
amount less than $0.50 and increase any amount that is        ident outside the state or by nonresidents). Include those 
$0.50 or more to the next highest dollar.                     items of compensation, such as various types of retirement 
                                                              plan deferrals and any other items of compensation that 
          WHO MUST COMPLETEare not included in federal wages but are included 
                                                              Pennsylvania wages in Section II of the W-2 RW. Include 
The W-2 RW must be completed by taxpayers when the            those items of compensation included in federal wages that 
amount shown as Medicare wages in Box 5 of the W-2 are        are not included in Pennsylvania wages in Section III of the 
greater than Pennsylvania wages shown in Box 16 and           W-2 RW. 
there is insufficient information included on the W-2 to rec-
                                                              Column C reconciles Medicare wages in Box 5 of the W-2 
oncile the wages without the additional information repre-
                                                              to Pennsylvania wages in Box 16 or to what Pennsylvania 
sented on the W-2 RW. The W-2 RW must also be complet-
                                                              wages should be (for wages earned by a Pennsylvania res-
ed when a PA resident taxpayer works in another state and 
                                                              ident outside the state or by nonresidents). Include those 
Pennsylvania tax is not withheld from the wages when 
                                                              items of compensation, that are not included in Medicare 
insufficient information is included on the W-2 to adjust the 
                                                              wages but are included Pennsylvania wages in Section II of 
wages to the amount of world-wide wages a Pennsylvania 
                                                              the W-2 RW. Include those items of compensation included 
resident would be subject to using Pennsylvania personal 
                                                              in Medicare wages that are not included in Pennsylvania 
income tax rules. The W-2 RW may also be used to provide 
                                                              wages in Section III of the W-2 RW. 
additional information regarding when wages reported on 
PA-40 Schedule W-2S, Wage Statement Summary, are not          NOTE: The most common differences between fed-
subject to tax for Pennsylvania personal income tax pur-      eral, Medicare and Pennsylvania wages are included 
poses.                                                        on Lines 1 thru 8 and Lines 10 thru 17. Other additions and 
                                                              subtractions not listed may be reported on Lines 9 and 17, 
                                                              respectively. 
          SCHEDULE INSTRUCTIONS                            
IDENTIFICATION INFORMATION                                    IMPORTANT: If including the W-2 RW with a PA-40, 
NAME OF TAXPAYER ON W-2                                       Personal Income Tax Return, all three columns of the 
                                                              W-2 RW must be completed. 
Enter the name of the taxpayer shown on the W-2. 
SOCIAL SECURITY NUMBER                                                                                                
                                                                       LINE INSTRUCTIONS
Enter the Social Security number (SSN) of the taxpayer 
shown on the W-2.                                                                                                     
                                                                                  SECTION I
EMPLOYER’S IDENTIFICATION NUMBER 
Enter the federal employer identification number from Box     STARTING POINT 
b of the W-2 for the employer whose wages are being rec-      Enter the amount of federal wages from Box 1 of the W-2 
onciled.                                                      in the space above the headings for Columns A and B. 

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Enter the amount of Medicare wages from Box 5 of the W-Box 12 of the W-2, enter the amount from the last pay 
2 in the space above the heading for Column C.              statement of the year from the employer. 

                                                                               LINE 7
              SECTION II                                                                                     
                                                            COLUMN A 
ADDITIONS 
                                                            Enter the amount of earnings on amounts deferred that are 
                LINE 1                                      included in Box 1 when a nonqualified deferred compensa-
                                                            tion (NQDC) plan fails to satisfy the requirements under 
COLUMN A                                                    IRC Section 409A plan shown as Code Z in Box 12 of the 
Enter the amount of any company contributions to a          W-2. 
deferred compensation plan not included in federal wages 
that are included in Medicare wages.                                           LINE 8
                                                                                                             
                LINE 2                                      COLUMNS A AND B 
                                                            Enter the amount of any deferrals the taxpayer/employee 
COLUMNS A AND B                                             made to a nonqualified deferred compensation (NQDC) 
Enter the amount of any elective deferrals the              plan that are not required to be included in compensation 
taxpayer/employee made to an IRC Section 401(k) cash or     under IRC Section 409A shown as Code Y in Box 12 of the 
deferred arrangement plan shown as Code D in Box 12 of      W-2. If contributions were made but are not shown in Box 
the W-2. If contributions were made but are not shown in    12 of the W-2, enter the amount from the last pay statement 
Box 12 of the W-2, enter the amount from the last pay       of the year from the employer. 
statement of the year from the employer. 
                                                                     LINES 9a THROUGH 9e                     
                LINE 3                          
                                                            COLUMNS A AND B 
COLUMNS A AND B 
                                                            Enter the amount of any items of compensation not shown 
Enter the amount of any elective deferrals the              on Lines 1 thru 8 that are not included in federal wages that 
taxpayer/employee made to an IRC Section 403(b) salary 
                                                            are included in Medicare or Pennsylvania wages. 
reduction agreement shown as Code E in Box 12 of the W-
2. If contributions were made but are not shown in Box 12   COLUMN C 
of the W-2, enter the amount from the last pay statement of Enter the amount of any items of compensation not shown 
the year from the employer.                                 on Lines 1 thru 8 that are not included in Medicare wages 
                                                            that are included in Pennsylvania wages. 
                LINE 4                          
COLUMNS A AND B                                                                LINE 10                       
Enter the amount of any elective deferrals the              COLUMNS A AND B 
taxpayer/employee made to an IRC Section 408(k)(6)          Add the amounts on Lines 1 thru 9e and enter the total for 
salary reduction agreement shown as Code F in Box 12 of     each column. 
the W-2. If contributions were made but are not shown in 
Box 12 of the W-2, enter the amount from the last pay                                                        
statement of the year from the employer.                                       SECTION III

                                                            SUBTRACTIONS 
                LINE 5                          
COLUMNS A AND B                                                                LINE 11
                                                                                                             
Enter the amount of any elective and non-elective deferrals 
the taxpayer/ employee made to an IRC Section 457(b)        COLUMN C 
deferred compensation plan shown as Code G in Box 12 of     Enter the amount of any company contributions to a 
the W-2. If contributions were made but are not shown in    deferred compensation plan not included in federal wages 
Box 12 of the W-2, enter the amount from the last pay       that are included in Medicare wages. 
statement of the year from the employer. 
                                                                               LINE 12                       
                LINE 6
                                                            COLUMNS B AND C 
COLUMNS A AND B                                             Enter the amount of the cost of group-term life insurance 
Enter the amount of any elective deferrals the              payments shown as Code C in Box 12 of the W-2. If pay-
taxpayer/employee made to an IRC Section 501(C)(18)(D)      ments were made but are not shown in Box 12 of the W-2, 
tax-exempt organization plan shown as Code H in Box 12      enter the amount from the last pay statement of the year 
of the W-2. If contributions were made but are not shown in from the employer. 

2 PA-40 W-2 RW                                                                             www.revenue.pa.gov

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                                                             IMPORTANT: Proof that the amounts deferred for a 
                    LINE 13
                                                             NQDC plan were previously included in Pennsylvania 
COLUMN C                                                     wages is also required to be included with the return. 
Enter the amount of earnings on amounts deferred that are 
included in Box 1 when the NQDC plan fails to satisfy the              LINES 18a THROUGH 18e                         
requirements under IRC Section 409A plan shown as Code 
                                                             COLUMNS A AND B 
Z in Box 12 of the W-2. 
                                                             Enter the amount of any items of compensation not shown 
                    LINE 14                                  on Lines 11 thru 16 that are included in federal wages that 
                                                             are not included in Medicare or Pennsylvania wages. 
COLUMN C 
Enter the amount of any deferrals the taxpayer/employee      COLUMN C 
made to a NQDC plan that are not required to be included     Enter the amount of any items of compensation not shown 
in compensation under IRC Section 409A shown as Code         on Lines 11 thru 16 that are included in Medicare wages 
Y in Box 12 of the W-2. If contributions were made but are   that are not included in Pennsylvania wages. 
not shown in Box 12 of the W-2, enter the amount from the 
last pay statement of the year from the employer.                             LINE 19                                
                                                             COLUMNS A, B AND C 
                    LINE 15
                                                             Add the amounts on Lines 11 thru 18e and enter the total 
COLUMNS B AND C                                              for each column. 
Enter the amount of any personal use of company vehicle 
included in federal wages. This amount is sometimes                                                                  
                                                                              SECTION IV
included in Box 14 of the W-2. If not included as a separate 
amount in Box 14 of the W-2, enter the amount from the       FINISHING POINT 
last pay statement of the year from the employer.            COLUMNS A, B AND C 
                                                             Add the amount from Section I and Section II, Line 10 and 
                    LINE 16                                  subtract the amount from Section III, Line 19 and enter the 
COLUMN A                                                     result for each column.  
Enter the amount of any distributions from a NQDC plan       IMPORTANT: The Finishing Point amounts from 
that were not previously included in Pennsylvania wages.     Columns B and C should be the same and equal the 
                                                             amount of Pennsylvania wages reported on Form W-2 pro-
                                                             vided by an employer for a Pennsylvania resident working 
                    LINE 17                             
                                                             in Pennsylvania. When the amounts do not match, report 
COLUMN B                                                     the amount from Column C as the amount of taxable 
Enter the amount of any distributions from a NQDC plan       Pennsylvania wages in the “PA compensation from Box 16” 
that were previously included in Pennsylvania wages.         Column on PA-40 Schedule W-2S for the employer.

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