Pay Statement

Period Start Date 10/08/2022

1851 Telfair Street Period End Date 10/21/2022
P.O.Box 1140 Pay Date 10/28/2022
Dublin, GA 31021-3118 Document 512357
478-275-3150
Net Pay $1,051.89

Pay Details

Debra A Nelson Employee Number 007660 Pay Group Regular

853 Gausetown Rd SSN XXX-XX-XXXX Location Sumter
kingstree, SC 29556
Job Store Manager B Entity STORE - Stores
USA
Pay Rate $18.7500 Group GRP17 - Group 17

Pay Frequency Biweekly Department 000 - All Stores

Earnings

Pay Type Hours Pay Rate Current YTD

Bonus 0.0000 $0.0000 $0.00 $10,197.43

Group Term Life $0.90 $19.20

Holiday 0.0000 $0.0000 $0.00 $590.08

Regular Pay 80.0000 $0.0000 $1,500.00 $29,116.08

Sick Pay 0.0000 $0.0000 $0.00 $1,050.00

Vacation 0.0000 $0.0000 $0.00 $2,095.04

Total Hours Worked 0.0000 Total Hours 80.0000

Deductions

Deduction Pre-Tax Employee Current Employee YTD Employer Current Employer YTD

Accidental Yes $12.56 $383.96 $0.00 $0.00

Cancer Yes $23.75 $529.52 $0.00 $0.00

FHF Foundation No $5.00 $110.00 $0.00 $0.00

Group Term Life No $0.90 $19.20 $0.00 $0.00

Medical Yes $95.00 $2,350.00 $368.71 $7,851.62

Short Term Disa No $0.00 $341.82 $0.00 $0.00

Specified Dis Yes $9.19 $202.18 $0.00 $0.00

Sup Life Child No $0.00 $11.96 $0.00 $0.00

Sup Life Emp No $20.77 $346.18 $0.00 $0.00

Sup Life Spouse No $6.23 $103.82 $0.00 $0.00

AD&D No $0.00 $0.00 $0.53 $11.63

ER Paid LTD No $0.00 $0.00 $6.30 $137.97

GTL - Life No $0.00 $0.00 $5.13 $112.35

Taxes

Tax Current YTD

Federal Income Tax $95.58 $1,225.98

Employee Medicare $19.72 $574.23

Social Security Employee Tax $84.34 $2,455.33

SC State Income Tax $75.97 $1,681.30

Paid Time Off Net Pay Distribution

Plan Current Balance Account Number Account Type Amount

Sick pay 0.0000 160.0000 xxxxxxxx0491 Checking $1,051.89

Vacation 0.0000 96.0000 Total $1,051.89

Pay Summary

Gross FIT Taxable Wages Taxes Deductions Net Pay

Current $1,500.90 $1,360.40 $275.61 $173.40 $1,051.89

YTD $43,067.83 $39,602.17 $5,936.84 $4,398.64 $32,732.35