Office of Human Resources   TO:    New Salaried Employees in the Following Classifications:  

Administrative/Confidential Staff Full‐time, Temporary, Grant‐Funded Faculty on an Academic Year Contract Probationary and Regular Classified Staff Salaried Professional Employees Tenure‐Track/Tenured Faculty  

 FROM:    Charo Albarrán, Executive Director, Human Resources   DATE:    July 19, 2018   SUBJECT:  Notice of New Health Insurance Coverage Options and Your Health Coverage   Welcome to Napa Valley College!  The District is providing the attached Notice as required by the Affordable Care Act (ACA) and Fair Labor Standards Act (FLSA).  Please see information at the end of this email from the Department of Labor website and read the attached notice carefully as it provides important information regarding a new way to buy health insurance through the Health Insurance Marketplace, Covered California, as well as the possible tax implications for purchasing insurance through Covered California.   Salaried employees may wish to explore benefits offered through Covered California and should consider the tax implications cited on the attached Notice.  Employees must obtain any additional information regarding the Covered California plans and tax implications related to these plans directly from Covered California by calling 888‐975‐1142 or visiting coveredca.com.    The Office of Human Resources can provide information regarding the district‐sponsored CalPERS medical benefits and tax implications for benefits provided through Napa Valley College to help employees compare benefit levels, etc.  Questions regarding these district‐sponsored medical benefits should be directed to Isabel Isabel.mostafanejad@napavalley.edu or Extension 7106.  Please be advised that Human Resources staff members cannot advise employees regarding the Covered California options.       

Notice of New Health Insurance Coverage Options and Your Health Coverage July 19, 2018 Page 2   PLEASE READ THE FOLLOWING INFORMATION FROM THE DEPARTMENT OF LABOR WEBSITE: Per the United States Department of Labor, many provisions of the Patient Protection and Affordable Care Act (Affordable Care Act) that become effective beginning in 2014 are designed to expand access to affordable health coverage.  These include provisions for coverage to be offered through a Health Insurance Marketplace, premium tax credits to assist individuals in purchasing such coverage, employer notice to employees of coverage options available through the Marketplace, and other related provisions.  Beginning January 1, 2014, individuals will have access to affordable coverage through a new competitive private health insurance market – the Health Insurance Marketplace.  The Health Insurance Marketplace in California is Covered California.  This marketplace offers “one‐stop shopping” to find and compare private health insurance options.  Open enrollment for health insurance coverage through Covered California begins October 1, 2013.  The Affordable Care Act creates a new Fair Labor Standards Act (FLSA) section requiring a notice to employees of coverage options available through the Marketplace.  Attachment 

mailto:egomez@napavalley.edu

mailto:egomez@napavalley.edu

Note: To be Retained by New Employee

Dear Napa Valley College Employee:

This is to notify you that all employees of Napa Valley College are eligible to make anelective deferral from their salary to the Napa Valley College 403(b) Plan (the "Plan"). The Planalso permits elective deferrals to a 457 account and after-tax Roth contributions.

Per IRS regulations employers are required to provide compliance oversight andmanagement of all of their employees' 403(b) and 457 accounts. Napa Valley College haschosen MidAmerica Administrative & Retirement Solutions, Inc. as our third party administratorfor these plans.

All Plan related transactions (other than investment decisions) must be validated byMidAmerica prior to being processed by payroll or your investment provider. This includes all'distributions, transfers, rollovers, hardships, loans, and salary reduction agreements. To make anelective contribution to the Plan, you must complete a Salary Reduction Agreement and return itto MidAmerica. You may make, change or stop such an election to contribute as often as youwish, and it will be effective when indicated on the Salary Reduction Agreement or the nextapplicable payroll date after it is approved by MidAmerica. For a list of approved investmentproviders and complete instructions on how to enroll in the Plan, please see the attachedAdministrative Procedures for Plan Participants.

MidAmerica's fee for administrative services is $20.00 per year per actively contributingparticipant. All of the approved investment providers on the plan have been requested to pay theadministration fee. Some investment providers will agree to pay the fee but then will deduct theamount from your account. If you have questions regarding this practice please contact yourinvestment representative directly. The list of approved investment providers and whether theywill pay the fee is available on the MidAmerica website.

Such elective contributions are subject to applicable Internal Revenue Code limits and theterms of the Plan. They may also be suspended for 6 months following a distribution to you fromthe Plan on account of hardship. For a copy of the Salary Reduction Agreement or a summary ofthe Plan, or if you have any other questions, please contact MidAmerica Administrative &Retirement Solutions, Inc. at (866) 873-4240.

This Notice is to provide general information regarding availability of the Plan. You should consult withyour own financial, tax, or legal advisor as to whether you should contribute to the Plan. Should there beany difference between the information in this Notice and the Plan, the terms of the Plan will control. Theinformation in this Notice is not intended or written to be used, and cannot be used, for the purpose ofavoiding penalties under the Internal Revenue Code or promoting, marketing or recommending to anytransaction or matter addressed herein.

403(b) and 457 Third Party Administration Services

© MidAmerica Administrative & Retirement Solutions, Inc. Administrative Procedures for Plan Participants

Administrative Procedures for Plan Participants

To Enroll in the 403(b) or 457 Plan – 1. Go to the webpage for your plan (instructions below). 2. Choose an Investment Provider from the approved list for your plan. 3. Contact the Investment Provider directly to establish your 403(b) or 457 account. 4. Once you have established your account, complete and sign the Salary Reduction Agreement

provided on your plan’s webpage. 5. Fax the Salary Reduction Agreement to MidAmerica for processing (Fax: 863-688-4466).

All participant transaction requests and Salary Reduction Agreements (SRA) must be submitted to

MidAmerica for validation prior to being processed by your payroll department or your

Investment Provider. This includes all distributions, rollovers, transfers/exchanges, loans, hardships, or Salary Reduction Agreements. Contact your Investment Provider for all transaction forms such as distribution requests, loan requests, hardship distributions, transfers and exchanges. After completing the transaction request form, submit the paperwork to MidAmerica for compliance review and authorization. Go to www.MidAmerica.biz to access plan information and obtain forms such as Salary Reduction Agreements and Plan Highlights.

Click on Participants 403(b) TPA Services from the right menu Click Here To Go To Your Plan Start typing in your Employer Name until the link appears for your Plan Click on your Plan link to go to your Employer’s customized web page

If you only need to download forms, they are available on this page. Or you can click on your Plan’s customized Spokeskids link for additional information such as:

A complete list of the Investment Providers approved on your plan Videos and FAQs with general information about 403(b) and 457 Plans Retirement Calculator Forms for your plan

Customer Service: 866-873-4240 MidAmerica’s Customer Service Representatives for English and Spanish speaking participants are available: Monday – Thursday 8:30 a.m. – 8:00 p.m. EST Friday 8:30 a.m. – 6:00 p.m. EST

TPA Fax: 863-688-4466

Transactions secure upload website link:

https://www.midamerica.biz/forms/file-upload-pages/403b-transactions/?ssl SRA secure upload website link:

https://www.midamerica.biz/forms/file-upload-pages/403b-sra/?ssl

*All of Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, western portion of

Solano County (including Fairfield and points west) and the southern portion of Sonoma County (including

Windsor and points south).

Office of Human Resources

Dear Employee,

The Bay Area Commuter Benefits Program is a new regulation requiring employers with 50 or more full-time employees within the nine bay area counties* to offer commuter benefits to their employees. This program will help improve air quality and reduce traffic congestion by decreasing single-occupant commute trips, while providing tax saving for employees. Napa Valley College is implementing a tax-free commuter benefit program for all eligible employees who commute to work by public transit. Eligible employees are those who work twenty (20) hours or more per week. This benefit allows employees to pay their fare with pre-tax dollars by excluding up to $130 per month ($1,560 per year) from their taxable income. The transportation benefit goes into effect September 30, 2014. Below is a sample schedule of how the benefit will work:

Orders must be entered by the 10th of the month two months prior to the benefit period. For example, to receive an order for use in January, you must place your order before November 10th. In this example, payroll deductions would begin in November and benefits would be distributed on December 22 for use beginning January 1.

Please read the enclosed notification from My Commuter Check (MyCC), which includes information on how the program works and step-by-step instructions on how to register. If you have questions regarding how to place an order, how to register, and/or other concerns, MyCC Customer Support is available Monday-Friday from 5:00 a.m. to 5:00 p.m. (Pacific Time). You can reach them at 888-235-9223 or mycommutercheck@edenredusa.com.

Announcing Premium Commuter Benefits for Napa Valley Community College!

About My Commuter Check:

My Commuter Check is brought to you by Edenred - a top global provider of social and employee benefits worldwide. We manage programs that serve 30 million individuals in 40 countries in Europe, Latin America, Asia/Pacific, and North America.

Commuter Benefit Program Overview:

Commuting to work each day can be expensive. The commuter benefit program will help you save money on your commuting costs along with the convenience of automated electronic fulfillment. My Commuter Check provides Vouchers, Debit Cards and electronic loading of select Smart Cards for a number of transit authorities through an easy on-line enrollment and benefit management program. We are also committed to preserving the environment and reducing its carbon footprint and want to encourage employees to contribute to these efforts by taking public transportation. Together we can save money and the environment at the same time.

How Does the Program Work?

Using the My Commuter Check website (see Registration is Easy below), you will create an account and place orders for transit products. My Commuter Check will send your employer information about your selections and instruct them to deduct the proper amounts from your paycheck.

Ordering Vouchers, Smart Cards or Debit Cards:

My Commuter Check is a national service. Our long-standing relationships with transit authorities across the nation enable us to provide electronic loading of smart cards in selected cities. Once you have created your new account, just select the Transit Order button on the left. Select your Greater Metropolitan Area and choose from the following Transit Smart Cards available:

Community Transit METRO (HOUSTON) Pierce Transit

COMPASS Card Metro North Railroad Monthly SFRTA Tri-Rail

CTA - Chicago Card Plus Metro SmarTrip® Card Sound

Foothill Transit (West Covina) Metro (Seattle) TAP Card

Kitsap Transit MTS-SANDAG Clipper (TransLink)

Long Island Rail Road Monthly NCTD-The Coaster Ventura County Transportation Commission

MBTA - CharlieCard ORCA Washington State Ferries

MDTA PATCO

Commuter Check Card for Transit: A re-loadable commuter benefit card that is accepted at Transit Agencies or designated transit retail centers where only transit and vanpool passes, tickets, and fare cards are sold*. The Commuter Check Card can be also used at Fare Vending Machines, which saves you time waiting in line and time locating a customer service desk or staffed sales area.

*For compliance reasons the Commuter Check Card can only be accepted at designated outlets that sell transit products exclusively, such as Transit Stations and Kiosks. Stores that sell other products, such as gift shops and pharmacies, will not accept the Commuter Check Card.

Commuter Check for Transit Vouchers: If you cannot find a transit product on the website, you can order a Commuter Check Voucher to purchase the pass you want. Just select Commuter Check Voucher from the product menu and specify the quantity and denomination(s) you desire. My Commuter Check will send the vouchers to you, and you can use them to purchase transit passes at designated transit retail outlets.

Your Commuter Benefit has some features you need to know about in order to take full advantage of the program:

The program is a monthly program; log in and place an order to be fulfilled on a monthly basis. Orders must be entered by the 10

th of the month two months prior to the benefit period. For example, to receive an order for

use in January, you must place your order before November 10th

Changes must be made online before the cut-off date of the 10

th of the month for the upcoming month.

Use the convenient recurring settings option to request funds to automatically be loaded to your smart card each month. Don’t worry; we’ll email you a reminder so remember to give us a valid email address when you register.

Pre-tax deductions are allowed up to the limit of $130 per month for transit.

No retroactive changes may be made.

Registration is Easy:

Registering and placing orders is easy. Follow these simple steps to get started. Go to: https://www.mycommutercheck.com * * My Commuter Check is designed to work with Microsoft Explorer Version 6.0 and above

From the main landing page, select First time user? from the menu on the left of the page. To register, you will need the following information: Company ID: 109569 First Name: Last Name: Zip Code: 94558

All information must match your employer’s records at the time of eligibility*; this information is used to authenticate you as a user in the system. So, if your employer’s records list you as James instead of Jim, you will want to enter James in the first name field. If you have any trouble with the process, please contact Customer Support at 888.235.9223.

Once you have entered this data, you will advance to another page where you are asked to enter your personal demographic information, set your password, and set your user name. Note that this is the information we will use to contact you about your orders. The system will send email reminders about your orders as well, so make sure to enter a valid email address.

*IMPORTANT: The current mailing address listed under your profile is the employer address (2277 Napa Vallejo Highway, Napa, CA 94558). Be sure to update this information under your account settings to reflect your mailing address; this way information regarding your orders can be mailed directly to your home address.

Important Registration Tips:

Username: Must consist of at least 6 characters (symbols are okay, spaces are not)

Password: Must consist of at least 6 characters

Contacting Customer Support:

Customer Support is available to assist you with registration, placing an order or any other questions or concerns you may have. Our skilled representatives are available Monday through Friday from 5:00 AM to 5:00 PM Pacific Time. You can reach Customer Support as follows:

By Phone: 888.235.9223

By Email: mycommutercheck@edenredusa.com

Office of Human Resources

PERSONNEL INFORMATION

Administrator Classified Confidential Salaried Professional Full-Time Instructor Temporary, Hourly Part-Time Faculty/Substitute

PLEASE PRINT SOCIAL SECURITY NUMBER:

Ms. Mrs. NAME: Mr. Dr. Last Name First Name Middle Initial ADDRESS:

Street Number and Name Apt. # City State Zip Code TELEPHONE: Primary: Home Cell Phone Business Secondary: Home Cell Phone Business E-MAIL ADDRESS: BIRTH DATE:

Position Start Date:

Position:

Supervisor:

Department:

VERIFIED DISABILITY: Yes No (see reverse for definition)

Gender: Male Female

U.S. Citizen/Resident Alien (holder of form I-551)

Non-resident Alien

EMERGENCY CONTACT INFORMATION RACE/ETHNICITY: Optional. Check all that apply (indicate primary ethnicity). See reverse for definitions.

Name:

Relationship:

Phone Number:

Alternate Phone Number:

Additional Name:

Relationship:

Phone Number :

Are you Hispanic or Latino? Yes No White Black or African American American Indian / Alaskan Native Mexican, Mexican-American, Chicano Central American South American Hispanic Other Filipino Chinese Japanese

Korean Laotian Cambodian Vietnamese Asian Indian Asian Other Guamanian Hawaiian Samoan Pacific Islander, Other

1) Are you currently contributing to, or have your ever been a member of a California Public Retirement system? Yes No Full-time Part-time California Public Employees’ Retirement System (PERS) California State Teachers’ Retirement System (STRS)

2) Have you retired from California Public Employees’ Retirement System (PERS)? Yes No If you answered yes to the above question, you must complete and submit the Retired Annuitant Certification

form on the following page.

3) Have you retired from California State Teachers’ Retirement System (STRS)? Yes No

4) Have you requested a refund of contributions from California Public Employees’ Retirement System (PERS)? Yes No

5) Have you requested a refund of contributions from California State Teachers’ Retirement System (STRS)? Yes No

PERSONNEL INFORMATION Page 2

6) Can you communicate effectively in a language other than English, please indicate: 7) Are you currently employed as a teacher in a California public school district (K-14)? Yes No

If yes, what district? What percentage of time?

I WISH TO HAVE MY CHECK DISBURSED AS FOLLOWS:

Pick up check at Business Office (will be mailed if not picked up within 60 days)

Mail check to: Address on previous page Other:

Electronic money transfer:

You must attach the Automatic Payroll Deposit Authorization form and a voided blank check.

Until the electronic money transfer goes into effect:

I wish to pick up my check(s) at Business Office.

I wish to have my check(s) mailed.

Signature: Date:

HR/Payroll Use Only:

Pay rate: Range Step $_________ per month OR $_______ per hour.

Number of hours per day ________________ / number of hours per week __________________.

ETHNIC GROUP DEFINITIONS

American Indian or Alaska Native A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.

Asian A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, The Philippine Islands, Thailand, and Vietnam. Black or African American A person having origins in any of the Black racial groups of Africa. Hispanic/Latino All persons of Chicano, Mexican, Puerto Rican, Cuban, Central or South American origin, or other Spanish cultures or origins, regardless of race. Native Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

DEFINITION OF PERSON WITH A DISABILITY One who (1) has a physical or mental impairment which substantially limits one or more of such person’s major life activities, (2) has a record of impairment, or (3) is regarded as having such impairment. (Title V, 53001j) Rev. 6/2009;2/2013; 3/2017; 1/2018

2277 Napa-Vallejo Highway, Napa, CA 94558 (707) 256-7100 www.napavalley.edu

Office of Human Resources

RETIRED ANNUITANT CERTIFICATION

California law prohibits the appointment of a retired annuitant by a CalPERS employer if, during the 12 month period prior to appointment, the retiree received unemployment insurance compensation for prior retired annuitant employment with any public employer. If you are working as a retired annuitant and it is discovered that during the previous 12 months you were paid unemployment insurance compensation based on prior retired annuitant employment with any CalPERS employer, your employment must be terminated on the last day of the current pay period. You will not be eligible for appointment as a retired annuitant with any CalPERS employer for 12 months following the termination date of the current employment. Violation of this unemployment insurance compensation restriction does not result in mandatory reinstatement from retirement. I certify that as a retired annuitant, I am in compliance with this requirement. Employee Name: Signature: Date:

Payroll Department

Page 1 of 4

Dear Napa Valley College Employee, You are being provided with the background, explanation, and instructions for the CalPERS Reciprocal Self-Certification Form (PERS-CASD 901). With the implementation of The Public Employees’ Pension Reform Act of 2013 (PEPRA) on January 1, 2013, CalPERS requires that employers determine the applicable retirement benefit formula for new employees who may qualify for enrollment in the CalPERS Retirement system. If your position qualifies for membership in the CalPERS Retirement system, the Reciprocal Self-Certification form allows you to provide essential information to Napa Valley College and will be used to enroll you into CalPERS membership, if applicable. This information will assist in identifying your retirement benefit level. Reciprocity among public retirement systems is to allow members to separate from one public employer and enter into employment with another public employer within a specific time limit without losing valuable retirement and related benefit rights. Within 10 business days of employment you must complete, sign, date, and submit to Human Resources the Reciprocal Self-Certification form. When completing the form, reference the attached list of qualifying Public Retirement Systems in California. If applicable, list your previous membership date(s) in the qualifying Public Retirement System and your permanent separation date(s); OR indicate that you are not a current or past member of a qualifying Public Retirement System. The completion of the Reciprocal Self-Certification From does not establish reciprocity and is not a request to establish reciprocity. In order to request that reciprocity be established, visit the CalPERS website, www.calpers.ca.gov and download the publication When You Change Retirement Systems. It is the responsibility of the employee to complete and send the form, Confirmation of Intent to Establish Reciprocity When Changing Retirement Systems to CalPERS.

Active Duty Military Service Credit CalPERS members have the right to purchase their past military service credit through CalPERS. Please see the CalPERS publication 15 titled A Guide to Your CalPERS Military Service Credit Options which is available online through the CalPERS website. This publication provides valuable information for members who are requesting to purchase active duty military service credit prior to CalPERS membership, and/or military leave of absence service credit. This publication also provides the necessary form to request service credit information.

http://www.calpers.ca.gov/

NAPA VALLEY COMMUNITY COLLEGE DISTRICT

LOYALTY OATH

I, _________________________________________, do solemnly affirm that I (Please Print)

will support and defend the Constitution of the United States and the Constitution of

the State of California against all enemies, foreign and domestic; that I will bear true

faith and allegiance to the Constitution of the United States and the Constitution of

the State of California; that I take this obligation freely, without any mental reservation

or purpose of evasion; and that I will well and faithfully discharge the duties upon

which I am about to enter.

_________________________________________ Signature

_________________________________________

Date

Execution of this oath is a condition of employment by a public agency pursuant to Article 20, Section 3, of the Constitution of the State of California.

Form W-4 (2018)Future developments. For the latest information about any future developments related to Form W-4, such as legislation enacted after it was published, go to www.irs.gov/FormW4.Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.Exemption from withholding. You may claim exemption from withholding for 2018 if both of the following apply.• For 2017 you had a right to a refund of all federal income tax withheld because you had no tax liability, and

• For 2018 you expect a refund of all federal income tax withheld because you expect to have no tax liability.If you’re exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2018 expires February 15, 2019. See Pub. 505, Tax Withholding and Estimated Tax, to learn more about whether you qualify for exemption from withholding.

General InstructionsIf you aren’t exempt, follow the rest of these instructions to determine the number of withholding allowances you should claim for withholding for 2018 and any additional amount of tax to have withheld. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

You can also use the calculator at www.irs.gov/W4App to determine your tax withholding more accurately. Consider

using this calculator if you have a more complicated tax situation, such as if you have a working spouse, more than one job, or a large amount of nonwage income outside of your job. After your Form W-4 takes effect, you can also use this calculator to see how the amount of tax you’re having withheld compares to your projected total tax for 2018. If you use the calculator, you don’t need to complete any of the worksheets for Form W-4.

Note that if you have too much tax withheld, you will receive a refund when you file your tax return. If you have too little tax withheld, you will owe tax when you file your tax return, and you might owe a penalty.Filers with multiple jobs or working

spouses. If you have more than one job at a time, or if you’re married and your spouse is also working, read all of the instructions including the instructions for the Two-Earners/Multiple Jobs Worksheet before beginning. Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you might owe additional tax. Or, you can use the Deductions, Adjustments, and Other Income Worksheet on page 3 or the calculator at www.irs.gov/W4App to make sure you have enough tax withheld from your paycheck. If you have pension or annuity income, see Pub. 505 or use the calculator at www.irs.gov/W4App to find out if you should adjust your withholding on Form W-4 or W-4P. Nonresident alien. If you’re a nonresident alien, see Notice 1392, Supplemental Form

W-4 Instructions for Nonresident Aliens, before completing this form.

Specific Instructions

Personal Allowances Worksheet

Complete this worksheet on page 3 first to determine the number of withholding allowances to claim.Line C. Head of household please note: Generally, you can claim head of household filing status on your tax return only if you’re unmarried and pay more than 50% of the costs of keeping up a home for yourself and a qualifying individual. See Pub. 501 for more information about filing status.Line E. Child tax credit. When you file your tax return, you might be eligible to claim a credit for each of your qualifying children. To qualify, the child must be under age 17 as of December 31 and must be your dependent who lives with you for more than half the year. To learn more about this credit, see Pub. 972, Child Tax Credit. To reduce the tax withheld from your pay by taking this credit into account, follow the instructions on line E of the worksheet. On the worksheet you will be asked about your total income. For this purpose, total income includes all of your wages and other income, including income earned by a spouse, during the year.Line F. Credit for other dependents.

When you file your tax return, you might be eligible to claim a credit for each of your dependents that don’t qualify for the child tax credit, such as any dependent children age 17 and older. To learn more about this credit, see Pub. 505. To reduce the tax withheld from your pay by taking this credit into account, follow the instructions on line F of the worksheet. On the worksheet, you will be asked about your total income. For this purpose, total income includes all of

Separate here and give Form W-4 to your employer. Keep the worksheet(s) for your records.

Form W-4Department of the Treasury Internal Revenue Service

Employee’s Withholding Allowance Certificate Whether you’re entitled to claim a certain number of allowances or exemption from withholding is

subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.

OMB No. 1545-0074

20181 Your first name and middle initial Last name

Home address (number and street or rural route)

City or town, state, and ZIP code

2 Your social security number

3 Single Married Married, but withhold at higher Single rate.

Note: If married filing separately, check “Married, but withhold at higher Single rate.”

4 If your last name differs from that shown on your social security card,

check here. You must call 800-772-1213 for a replacement card.

5 Total number of allowances you’re claiming (from the applicable worksheet on the following pages) . . . 5

6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6 $7 I claim exemption from withholding for 2018, and I certify that I meet both of the following conditions for exemption.

• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and

• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . 7

Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.

Employee’s signature

(This form is not valid unless you sign it.) Date

8 Employer’s name and address (Employer: Complete boxes 8 and 10 if sending to IRS and complete boxes 8, 9, and 10 if sending to State Directory of New Hires.)

9 First date of employment

10 Employer identification number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 4. Cat. No. 10220Q Form W-4 (2018)

Form W-4 (2018) Page 2

your wages and other income, including income earned by a spouse, during the year.Line G. Other credits. You might be able to reduce the tax withheld from your paycheck if you expect to claim other tax credits, such as the earned income tax credit and tax credits for education and child care expenses. If you do so, your paycheck will be larger but the amount of any refund that you receive when you file your tax return will be smaller. Follow the instructions for Worksheet 1-6 in Pub. 505 if you want to reduce your withholding to take these credits into account.

Deductions, Adjustments, and Additional Income Worksheet

Complete this worksheet to determine if you’re able to reduce the tax withheld from your paycheck to account for your itemized deductions and other adjustments to income such as IRA contributions. If you do so, your refund at the end of the year will be smaller, but your paycheck will be larger. You’re not required to complete this worksheet or reduce your withholding if you don’t wish to do so.

You can also use this worksheet to figure out how much to increase the tax withheld from your paycheck if you have a large amount of nonwage income, such as interest or dividends.

Another option is to take these items into account and make your withholding more accurate by using the calculator at www.irs.gov/W4App. If you use the calculator, you don’t need to complete any of the worksheets for Form W-4.

Two-Earners/Multiple Jobs Worksheet

Complete this worksheet if you have more

than one job at a time or are married filing jointly and have a working spouse. If you don’t complete this worksheet, you might have too little tax withheld. If so, you will owe tax when you file your tax return and might be subject to a penalty.

Figure the total number of allowances you’re entitled to claim and any additional amount of tax to withhold on all jobs using worksheets from only one Form W-4. Claim all allowances on the W-4 that you or your spouse file for the highest paying job in your family and claim zero allowances on Forms W-4 filed for all other jobs. For example, if you earn $60,000 per year and your spouse earns $20,000, you should complete the worksheets to determine what to enter on lines 5 and 6 of your Form W-4, and your spouse should enter zero (“-0-”) on lines 5 and 6 of his or her Form W-4. See Pub. 505 for details.

Another option is to use the calculator at www.irs.gov/W4App to make your withholding more accurate.Tip: If you have a working spouse and your incomes are similar, you can check the “Married, but withhold at higher Single rate” box instead of using this worksheet. If you choose this option, then each spouse should fill out the Personal Allowances Worksheet and check the “Married, but withhold at higher Single rate” box on Form W-4, but only one spouse should claim any allowances for credits or fill out the Deductions, Adjustments, and Additional Income Worksheet.

Instructions for EmployerEmployees, do not complete box 8, 9, or

10. Your employer will complete these

boxes if necessary.

New hire reporting. Employers are

required by law to report new employees to a designated State Directory of New Hires. Employers may use Form W-4, boxes 8, 9, and 10 to comply with the new hire reporting requirement for a newly hired employee. A newly hired employee is an employee who hasn’t previously been employed by the employer, or who was previously employed by the employer but has been separated from such prior employment for at least 60 consecutive days. Employers should contact the appropriate State Directory of New Hires to find out how to submit a copy of the completed Form W-4. For information and links to each designated State Directory of New Hires (including for U.S. territories), go to www.acf.hhs.gov/programs/css/employers.

If an employer is sending a copy of Form W-4 to a designated State Directory of New Hires to comply with the new hire reporting requirement for a newly hired employee, complete boxes 8, 9, and 10 as follows. Box 8. Enter the employer’s name and address. If the employer is sending a copy of this form to a State Directory of New Hires, enter the address where child support agencies should send income withholding orders. Box 9. If the employer is sending a copy of this form to a State Directory of New Hires, enter the employee’s first date of employment, which is the date services for payment were first performed by the employee. If the employer rehired the employee after the employee had been separated from the employer’s service for at least 60 days, enter the rehire date.Box 10. Enter the employer’s employer identification number (EIN).

Form W-4 (2018) Page 3

Personal Allowances Worksheet (Keep for your records.)A Enter “1” for yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A

B Enter “1” if you will file as married filing jointly . . . . . . . . . . . . . . . . . . . . . . . B

C Enter “1” if you will file as head of household . . . . . . . . . . . . . . . . . . . . . . . C

D Enter “1” if: { • You’re single, or married filing separately, and have only one job; or• You’re married filing jointly, have only one job, and your spouse doesn’t work; or• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.

} D

E Child tax credit. See Pub. 972, Child Tax Credit, for more information.• If your total income will be less than $69,801 ($101,401 if married filing jointly), enter “4” for each eligible child. • If your total income will be from $69,801 to $175,550 ($101,401 to $339,000 if married filing jointly), enter “2” for each eligible child.

• If your total income will be from $175,551 to $200,000 ($339,001 to $400,000 if married filing jointly), enter “1” for each eligible child.

• If your total income will be higher than $200,000 ($400,000 if married filing jointly), enter “-0-” . . . . . . . E

F Credit for other dependents.

• If your total income will be less than $69,801 ($101,401 if married filing jointly), enter “1” for each eligible dependent. • If your total income will be from $69,801 to $175,550 ($101,401 to $339,000 if married filing jointly), enter “1” for every two dependents (for example, “-0-” for one dependent, “1” if you have two or three dependents, and “2” if you have four dependents).

• If your total income will be higher than $175,550 ($339,000 if married filing jointly), enter “-0-” . . . . . . . F

G Other credits. If you have other credits, see Worksheet 1-6 of Pub. 505 and enter the amount from that worksheet here . . G

H Add lines A through G and enter the total here . . . . . . . . . . . . . . . . . . . . . . H

For accuracy, complete all worksheets that apply. {

• If you plan to itemize or claim adjustments to income and want to reduce your withholding, or if you have a large amount of nonwage income and want to increase your withholding, see the Deductions, Adjustments, and Additional Income Worksheet below.

• If you have more than one job at a time or are married filing jointly and you and your spouse both work, and the combined earnings from all jobs exceed $52,000 ($24,000 if married filing jointly), see the Two-Earners/Multiple Jobs Worksheet on page 4 to avoid having too little tax withheld.

• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 above.

Deductions, Adjustments, and Additional Income Worksheet

Note: Use this worksheet only if you plan to itemize deductions, claim certain adjustments to income, or have a large amount of nonwage income.

1

Enter an estimate of your 2018 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 7.5% of your income. See Pub. 505 for details . . . . . . . . . . . . . . . . . . . . . . 1 $

2 Enter: { $24,000 if you’re married filing jointly or qualifying widow(er)$18,000 if you’re head of household$12,000 if you’re single or married filing separately

} . . . . . . . . . . . 2 $

3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . . 3 $4 Enter an estimate of your 2018 adjustments to income and any additional standard deduction for age or

blindness (see Pub. 505 for information about these items) . . . . . . . . . . . . . . . . 4 $5 Add lines 3 and 4 and enter the total . . . . . . . . . . . . . . . . . . . . . . 5 $6 Enter an estimate of your 2018 nonwage income (such as dividends or interest) . . . . . . . . . 6 $7 Subtract line 6 from line 5. If zero, enter “-0-”. If less than zero, enter the amount in parentheses . . . 7 $8 Divide the amount on line 7 by $4,150 and enter the result here. If a negative amount, enter in parentheses.

Drop any fraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Enter the number from the Personal Allowances Worksheet, line H above . . . . . . . . . . 9

10

Add lines 8 and 9 and enter the total here. If zero or less, enter “-0-”. If you plan to use the Two-Earners/

Multiple Jobs Worksheet, also enter this total on line 1, page 4. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 . . . . . . . . . . . . . . . . . . . . . . . . . 10

Form W-4 (2018) Page 4

Two-Earners/Multiple Jobs Worksheet

Note: Use this worksheet only if the instructions under line H from the Personal Allowances Worksheet direct you here.

1 Enter the number from the Personal Allowances Worksheet, line H, page 3 (or, if you used the Deductions, Adjustments, and Additional Income Worksheet on page 3, the number from line 10 of that worksheet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you’re married filing jointly and wages from the highest paying job are $75,000 or less and the combined wages for you and your spouse are $107,000 or less, don’t enter more than “3” . . . . . . . . . . . . . 2

3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter “-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . . . . . 3

Note: If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill.

4 Enter the number from line 2 of this worksheet . . . . . . . . . . . 4

5 Enter the number from line 1 of this worksheet . . . . . . . . . . . 5

6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . . 7 $8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . . . 8 $

9

Divide line 8 by the number of pay periods remaining in 2018. For example, divide by 18 if you’re paid every 2 weeks and you complete this form on a date in late April when there are 18 pay periods remaining in 2018. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 $

Table 1

Married Filing Jointly

If wages from LOWEST paying job are—

Enter on line 2 above

$0 - $5,000 05,001 - 9,500 19,501 - 19,000 2

19,001 - 26,500 326,501 - 37,000 437,001 - 43,500 543,501 - 55,000 655,001 - 60,000 760,001 - 70,000 870,001 - 75,000 975,001 - 85,000 1085,001 - 95,000 1195,001 - 130,000 12

130,001 - 150,000 13150,001 - 160,000 14160,001 - 170,000 15170,001 - 180,000 16180,001 - 190,000 17190,001 - 200,000 18200,001 and over 19

All Others

If wages from LOWEST paying job are—

Enter on line 2 above

$0 - $7,000 07,001 - 12,500 1

12,501 - 24,500 224,501 - 31,500 331,501 - 39,000 439,001 - 55,000 555,001 - 70,000 670,001 - 85,000 785,001 - 90,000 890,001 - 100,000 9

100,001 - 105,000 10105,001 - 115,000 11115,001 - 120,000 12120,001 - 130,000 13130,001 - 145,000 14145,001 - 155,000 15155,001 - 185,000 16185,001 and over 17

Table 2

Married Filing Jointly

If wages from HIGHEST paying job are—

Enter on line 7 above

$0 - $24,375 $42024,376 - 82,725 50082,726 - 170,325 910

170,326 - 320,325 1,000320,326 - 405,325 1,330405,326 - 605,325 1,450605,326 and over 1,540

All Others

If wages from HIGHEST paying job are—

Enter on line 7 above

$0 - $7,000 $4207,001 - 36,175 500

36,176 - 79,975 91079,976 - 154,975 1,000

154,976 - 197,475 1,330197,476 - 497,475 1,450497,476 and over 1,540

Privacy Act and Paperwork Reduction

Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this

information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and

U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this

information to other countries under a tax treaty, to federal and state agencies to

enforce federal nontax criminal laws, or to federal law enforcement and intelligence

agencies to combat terrorism.You aren’t required to provide the

information requested on a form that’s subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be

retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

AUTOMATIC PAYROLL DEPOSIT AUTHORIZATION Please print! Name ___________________________ Action

ID or SSN #_____________________ Start

Department ______________________ Change Please fill out and sign the bottom of this form and return to the payroll office along with a VOIDED CHECK(S) from your account(s). The system requires that we test each new account as it is set up so you should expect that direct deposit will take effect no earlier than the second payday after our receipt of this form. You may split the direct deposit of your net pay to two different banks. You must specify a dollar amount for the first account and the remainder of your pay will be deposited to the second account. You may not split your net pay between two different accounts at the same bank, as most banks have a process for automatic transfers from one account to another. 1st Account: Bank Name Amount $________

Checking Savings 2nd Account: Bank Name _________________________________ Amount Remainder

Checking Savings EXAMPLE: 1st Account: Bank Name Bank of America Amount $500.00

Checking Savings 2nd Account: Bank Name Wells Fargo Amount Remainder

Checking Savings

Please indicate if you would like to pick up check or have check mailed until direct deposit goes into effect.

Once direct deposit is in effect I would like my pay stub mailed or put in NVC mailbox I hereby authorize Napa Valley College to provide for direct deposit of any wages due me, less the mandatory or authorized withholding(s), deductions and/or corrections to previous deposits, in the above designated account. If any action taken by me results in a rejection of a direct deposit, I understand that Napa Valley College assumes no responsibility for processing a supplemental salary or wage payment until the amount of the rejected deposit is returned to Napa Valley College by the financial institution. Employee Signature_____________________________ Date_____________________