CO. FILE DEPT. CLOCK VCHR. NO.

T7D A1H89 11099 NYC 0000430079 1

Earnings Statement
632−0001
METRO PAIN SPECIALIST PC Period Beginning: 01/08/2021
9016 SUTPHIN BLVD Period Ending: 01/22/2021
JAMAICA, NY 11435 Pay Date: 01/28/2021

Taxable Marital Status: Single INDISMEL SANTANA

Exemptions/Allowances: 450 KENT AVENUE
Federal: 0
NY: 0
BROOKLYN NY 11249

rate hours this period year to date

Regular Pay 42 2191 80 00 3 377.53
Net Check $0 00
Pto/Sick 1 569 12
Vacation 261 52
Overtime Bonus 331 00 Excluded from federal taxable wages
Float Holiday 2 500 00
Holiday Holiday 523 04 Your federal taxable wages this period are
Worked 523 04 $3 377.53
2 175 86
Other Benefits and
Gross Pay $3 377 53 53 969 02
this period total to date
Gtl 0 50 11 00
Statutory Mta 8 36 193 73
Federal Income Tax −353 40 8 563 38 401K Elib Wgs 3 377.53 53 969 02
Social Security Tax −152 46 3 532 75
Medicare Tax −35 66 826 21
NY State Income Tax −125 59 3 027 55
NY SUI/SDI Tax 1 20 18 00
NY Paid Family Leave Ins 51 64

Dental −6 04* 114 40

Medical −67 58* 1 282 14
N Y P F L −Curr −3 19
Supp Life −1 38 9 84
Vision −2 93* 55 67

Net Pay $2 628 10

Checking −2,628 10 34 457 07

2000 A DP, LLC

METRO PAIN SPECIALIST PC Advice number: 00000430079

9016 SUTPHIN BLVD Pay date: 01/28/2021
JAMAICA NY 11435

Deposited to the account of account number transit ABA amount

INDISMEL SANTANA xxxxx5120 xxxx xxxx $2,628.10

NON−NEGOTIABLE