Exhibit B Form W-3c — Internal Revenue Bulletin 2026-41

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55555	a Tax year/Form corrected / W-			For Official Use Only: ▲ OMB No. 1545-0029
bEmployer’s name, address, and ZIP code ▲ 3.18 in ▼ ▲ ▼ 1.00 in	bEmployer’s name, address, and ZIP code ▲ 3.18 in ▼ ▲ ▼ 1.00 in	bEmployer’s name, address, and ZIP code ▲ 3.18 in ▼ ▲ ▼ 1.00 in	c Kind of Payer(Check one) 941/941-SS Military 943 944 CT-1 Hshld. emp. Medicare govt. emp.	c Kind of Payer(Check one) 941/941-SS Military 943 944 CT-1 Hshld. emp. Medicare govt. emp.	c Kind of Payer(Check one) 941/941-SS Military 943 944 CT-1 Hshld. emp. Medicare govt. emp.	c Kind of Payer(Check one) 941/941-SS Military 943 944 CT-1 Hshld. emp. Medicare govt. emp.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	e) al	Third-party sick pay (Check if applicable)	Third-party sick pay (Check if applicable)
bEmployer’s name, address, and ZIP code ▲ 3.18 in ▼ ▲ ▼ 1.00 in	bEmployer’s name, address, and ZIP code ▲ 3.18 in ▼ ▲ ▼ 1.00 in	bEmployer’s name, address, and ZIP code ▲ 3.18 in ▼ ▲ ▼ 1.00 in	c Kind of Payer(Check one) 941/941-SS Military 943 944 CT-1 Hshld. emp. Medicare govt. emp.	c Kind of Payer(Check one) 941/941-SS Military 943 944 CT-1 Hshld. emp. Medicare govt. emp.	c Kind of Payer(Check one) 941/941-SS Military 943 944 CT-1 Hshld. emp. Medicare govt. emp.	c Kind of Payer(Check one) 941/941-SS Military 943 944 CT-1 Hshld. emp. Medicare govt. emp.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.	Kind of Employer(Check on None apply 501c non-govt. State/local non-501c State/local 501c Feder govt.
dTotal number of Forms W-2c	dTotal number of Forms W-2c	eEmployer identifcation number (EIN)	eEmployer identifcation number (EIN)	eEmployer identifcation number (EIN)	eEmployer identifcation number (EIN)	fEstablishment number 0.14 in	fEstablishment number 0.14 in	gEmployer’s state I	gEmployer’s state I	gEmployer’s state I	gEmployer’s state I	gEmployer’s state I	gEmployer’s state I	D number	D number	D number
Complete boxes h, i, or j only if incorrect on last form ﬁled.	Complete boxes h, i, or j only if incorrect on last form ﬁled.	hEmployer’soriginally reportedEIN	hEmployer’soriginally reportedEIN	hEmployer’soriginally reportedEIN	hEmployer’soriginally reportedEIN	i Incorrectestablishment number	i Incorrectestablishment number	jEmployer’sincorrec	jEmployer’sincorrec	jEmployer’sincorrec	jEmployer’sincorrec	jEmployer’sincorrec	jEmployer’sincorrec	tstate ID number	tstate ID number	tstate ID number
Total of amounts previously reported as shown on enclosed Forms W-2c.	Total of amounts previously reported as shown on enclosed Forms W-2c.	Total of corrected amounts as shown on enclosed Forms W-2c.	Total of corrected amounts as shown on enclosed Forms W-2c.	Total of corrected amounts as shown on enclosed Forms W-2c.	Total of corrected amounts as shown on enclosed Forms W-2c.	Total of amounts previously reported as shown on enclosed Forms W-2c.	Total of amounts previously reported as shown on enclosed Forms W-2c.	Total of corrected a shown on enclosed	Total of corrected a shown on enclosed	Total of corrected a shown on enclosed	Total of corrected a shown on enclosed	Total of corrected a shown on enclosed	Total of corrected a shown on enclosed	mounts as Forms W-2c.	mounts as Forms W-2c.	mounts as Forms W-2c.
1Wages, tips, other compensation	1Wages, tips, other compensation	1Wages, tips, other compensation	1Wages, tips, other compensation	1Wages, tips, other compensation	1Wages, tips, other compensation	2Federal income tax withheld	2Federal income tax withheld	2Federal income ta	2Federal income ta	2Federal income ta	2Federal income ta	2Federal income ta	2Federal income ta	x withheld	x withheld	x withheld
3Social security wages	3Social security wages	3Social security wages	3Social security wages	3Social security wages	3Social security wages	4Social security tax withheld	4Social security tax withheld	4Social security tax	4Social security tax	4Social security tax	4Social security tax	4Social security tax	4Social security tax	withheld	withheld	withheld
5Medicare wages and tips	5Medicare wages and tips	5Medicare wages and tips	5Medicare wages and tips	5Medicare wages and tips	5Medicare wages and tips	6Medicare tax withheld	6Medicare tax withheld	6Medicare tax with	6Medicare tax with	6Medicare tax with	6Medicare tax with	6Medicare tax with	6Medicare tax with	held ▲ ▼	held ▲ ▼	0.33 in
7Social security tips	7Social security tips	7Social security tips	7Social security tips	7Social security tips	7Social security tips	8Allocated tips	8Allocated tips	8Allocated tips 7.19 in	8Allocated tips 7.19 in	8Allocated tips 7.19 in	8Allocated tips 7.19 in	8Allocated tips 7.19 in	8Allocated tips 7.19 in	8Allocated tips 7.19 in	8Allocated tips 7.19 in	8Allocated tips 7.19 in
9 ▶ ▶ 1.90 in	9 ▶ ▶ 1.90 in	9 ▶ ▶ 1.90 in	9 ▶ ▶ 1.90 in	9 ▶ ▶ 1.90 in	9 ▶ ▶ 1.90 in	10Dependent care benefts ▶ ▶ 1.90 in	10Dependent care benefts ▶ ▶ 1.90 in	10Dependent care b ▶ 1.80 in	10Dependent care b ▶ 1.80 in	10Dependent care b ▶ 1.80 in	10Dependent care b ▶ 1.80 in	10Dependent care b ▶ 1.80 in	10Dependent care b ▶ 1.80 in	enefts ▶	enefts ▶	enefts ▶
11Nonqualifed plans	11Nonqualifed plans	11Nonqualifed plans	11Nonqualifed plans	11Nonqualifed plans	11Nonqualifed plans	12aDeferred compensation	12aDeferred compensation	12aDeferred compen	12aDeferred compen	12aDeferred compen	12aDeferred compen	12aDeferred compen	12aDeferred compen	sation	sation	sation
14Inc. tax w/h by third-party sick pay payer	14Inc. tax w/h by third-party sick pay payer	14Inc. tax w/h by third-party sick pay payer	14Inc. tax w/h by third-party sick pay payer	14Inc. tax w/h by third-party sick pay payer	14Inc. tax w/h by third-party sick pay payer	12b	12b	12b	12b	12b	12b	12b	12b
16State wages, tips, etc.	16State wages, tips, etc.	16State wages, tips, etc.	16State wages, tips, etc.	16State wages, tips, etc.	16State wages, tips, etc.	17State income tax	17State income tax	17State income tax	17State income tax	17State income tax	17State income tax	17State income tax	17State income tax
18Local wages, tips, etc.	18Local wages, tips, etc.	18Local wages, tips, etc.	18Local wages, tips, etc.	18Local wages, tips, etc.	18Local wages, tips, etc.	19Local income tax	19Local income tax	19Local income tax	19Local income tax	19Local income tax	19Local income tax	19Local income tax	19Local income tax
Explain decreases here: ▲ ▼ 0.33 in
Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?	Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?	Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?	Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?	Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?	Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?	Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?	Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?	Has an adjustment been made on an employment tax return fled with the Internal Revenue Service?		Yes		No	No
If “Yes,” give date the return was fled:
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it correct, and complete. Signature: Title: Date: ▲ ▼ 0.50 in	is true,	is true,	is true,
Employer’s contact person	Employer’s contact person	Employer’s contact person	Employer’s contact person	Employer’s contact person	Employer’s telephone number	Employer’s telephone number	Employer’s telephone number	Employer’s telephone number	For Ofﬁcial	For Ofﬁcial	For Ofﬁcial	For Ofﬁcial	For Ofﬁcial	Use Only	Use Only	Use Only
Employer’s fax number	Employer’s fax number	Employer’s fax number	Employer’s fax number	Employer’s fax number	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼	Employer’s email address ▼