a Employee's social security number For Official Use Only 22322 Vold n OHB No. 1545-0008 b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld 3 Social security wages 4 Social security tax withheld c Employer's name, address, and ZIP code $ 5 Medicare wages and ops 5 Medicare tax withheld Quigley Corporation 1800 River Road Philadelphia, PA 19113-5548 7 Social security tips & Allocated tips 10 Dependent care benefits d Control number 9 Verification code e Employee's first name and initial Last name Suff. 11 Nonqualified plans 12a See Instructions for box 12 Randy A. Kellison Code DY 13 Retirement plan y 54 Gradison Place 12b Code Philadelphia, PA 19113-4054 14 Other 120 Code f Employee's address and ZIP code PA SUI 22.36 v 12d Code 15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tex 18 Local wages, lips, etc. 19 Local income tax 20 Locality name Phils. v