EFTA00176026



DG-NOT STAPLE OR FOLD


<table><thead><tr><th colspan="2">a Control number</th><th>33333</th><th colspan="2">For Official Use Only<br>OMB No. 1545-0008</th></tr></thead><tbody><tr><td rowspan="2">b Kind of Payer</td><td rowspan="2">941-8B Military 94B Helid, emp. Medicare gov. emp. Third-party sick pay</td><td>1 Wages, tips, other compensation</td><td>2 Income tax withheld</td></tr><tr><td>732788.09</td><td>113360.00</td></tr><tr><td rowspan="2">c Total number of Forms W-2 12</td><td rowspan="2">d Establishment number</td><td>3 Social security wages</td><td>4 Social security tax withhold</td></tr><tr><td>600413.96</td><td>37225.68</td></tr><tr><td colspan="2">e Employer identification number</td><td>5 Medicare wages and tips</td><td>6 Medicare tax withhold</td></tr><tr><td colspan="2">66-0567418</td><td>7 Social security tips</td><td>8</td></tr><tr><td rowspan="4">f Employer&#x27;s name FINANCIAL TRUST COMPANY, INC. 6100 RED HOOK QUARTER B-3 ST. THOMAS, USVI 00802</td><td rowspan="4"></td><td>9 Advance ID payments</td><td>10</td></tr><tr><td>11 Nonqualified plans</td><td>12 Deferred compensation</td></tr><tr><td colspan="2">13 For third-party sick pay use only</td><td>35019.95</td></tr><tr><td colspan="2">14 Income tax withhold by payer of third-party sick pay</td><td></td></tr><tr><td colspan="2">h Other EIN used this year</td><td colspan="2">16 Check the appropriate box<br>Type of Form W-2AG W-2OM W-2GU W-2VI</td></tr><tr><td colspan="2">i Employer&#x27;s territorial ID number</td><td colspan="2"></td></tr><tr><td colspan="2">Contact person Jeanne Brennan<br>E-mail address</td><td>Telephone number<br>(340) 775-2525<br>Fax number<br>(340) 775-2528</td><td>For Official Use Only</td></tr></tbody></table>

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, correct, and complete.



Title ▶ Controller





Date ▶ x / 15 / 0₅



2004

Department of the Treasury

Internal Revenue Service



end this entire page with the entire Copy A page of Forms W-2AS, W-2GU, W-2CM, or W-2VI

> the Social Security Administration (SSA). Photocopies are not acceptable.

> not send any remittance (cash, checks, money orders, etc.) with Forms W-2AS, W-2GU, W-2CM, W-2VI, and W-3SS.



Instructions for Forms W-2AS, W-2GU, W-2VK and W-3SS

Notice references are to the Internal Revenue Code unless otherwise noted.

ems To Note

new size for 2004 Forms W-2AS, W-2GU, W-2VI, and W-3SS were reformatted to conform with the guidelines used in the substitute black and white laser Forms W-2 and W-3HDMIS shown in Exhibits E and F of the May 2008 revision of Pub. 1141, General Rules and Specifications for Substitute Forms W-2 and W-3. This change allows programmers to write universal code for data entry on both the official and the laser-printed versions of the forms. Make certain that Copy A of your paper forms W-2AS, W-GU, W-2VI, and W-3SS reflects these changes.

amoval of dollar signs and shading. The dollar sign and shading have been moved from Copy A of Forms W-2AS, W-2GU, W-2VI, and W-39S to provide pro space. Do not show dollar signs ("$") when reporting money amounts.

e Copy.A of Form W-3SS with Copy A of Form W-2AS, W-2GU, W-2CM, or 2VI (including reports filed on magnetic media) by February 28, 2005.

However, if you file electronically, you may file by March 31, 2005. See the SSA webalto at www.socialsecurity.gov/employer/ for electronic filing options.

sw reporting code for box 12. A new code (Code W—Employer’s contribution on employee’s Health Savings Account) has been added for use in box 12 of arms W-2AS, W-2GU, and W-2VI. See page 5 for details.



'hen To File


Extension to file. You may request an extension of time to file Form W-2AS, W-2GU, W-2CM, or W-2VI by sending Form 8609, Application for Extension of Time To File Information Returns, to the address shown on that form. You must request the extension by the due date of the forms for your request to be considered. You will have an additional 30 days to file. See Form 8609 for details.

Caution: Even if you receive an extension of time to file Forms W-2AS, W-2GU, W-2CM, or W-2VI, you must still furnish the forms to your employees by January 31, 2005. But see Extension to furnish Forms W-2 to employees on page 3.

## Where To File Copy A

Send the entire first page of this form (Copy A) with the entire Copy A page of Form W-2AS, W-2GU, W-2CM, or W-2VI to:

## Social Security Administration
Data Operations Center
Wilkes-Barre, PA 18769-0001

Note: If you use "Certified Mail" to file, change the ZIP code to "18769-0002." If you use an IRS-approved private delivery service, add "ATTN: W-2 Process, 1150 E. Mountain Dr." to the address and change the ZIP code to "18702-7997."

See Circular E (Pub. 15), Employer’s Tax Guide, for a list of IRS-approved private delivery services.

Also see Where to file Copy 1 and Shipping and mailing on page 2.

FTCO016

Cnt. No. 101178