CO. FILE DEPT. CLOCK VCHR. NO.

WGD 133375 0000025635 1

Earnings Statement
ESKENAZI HEALTH Period Beginning: 12/24/2023
720 ESKENAZI AVE. Period Ending: 01/06/2024
INDIANAPOLIS, IN 46202 Pay Date: 01/12/2024

ANGELA K GORDON
Filing Status: Head of household 8037 EGRET LN
Exemptions/Allowances:
Federal: Standard Withholding Table
INDIANAPOLIS IN 46260

rate hours this period year to date this period year to date
Regular 24 5400 68 50 1 680 99 1 680 99 Checking 1 -2 692 46
OT Premium 14 1106 11 75 165 80 346 90
Net Check $0 00
OT Premium 16 4636 11 00 181 10
Cigna Std Er 6 80 6 80
Holiday Worked 24 5400 11 50 282 21 282 21 Excluded from federal taxable wages
Hwrkd Premium 24 5400 11 50 282 21 282 21
Overtime Base 24 5400 22 75 558 29 558 29 Your federal taxable wages this period are
Sfdf Holevet3 24 5400 4 00 48 00 48 00 $3 383 99
Sftdif Eve T3 24 5400 33 00 198 00 198 00
Other Benefits and
Sftdif Wkd T3 24 5400 11 25 90 00 90 00
this period total to date
Gross Pay $3 493 40 3 493 40
G T L 0 11 0 11
401A 104 60
Statutory
Pto Balance 156 16
Federal Income Tax -246 06 246 06
Social Security Tax -209 81 209 81
Medicare Tax -49 07 49 07 YOUR COMPANY PHONE NUMBER IS :- 317-880-3788
IN State Income Tax -98 52 98 52
Marion R Income Tax -65 25 65 25
Exemptions/Allowances:
IN: 4

CritIllEmployee -10 29 10 29
Dental C -21 01* 21 01
EYEMED VISION -2 33* 2 33
Health Ins Ns -86 18* 86 18
Opad&D -0 60 0 60
Opt Life -5 02 5 02
STD ER -6 80 6 80

Net Pay $2 692 46

2000 ADP, Inc.

ESKENAZI HEALTH Advice number: 00000025635

720 ESKENAZI AVE Pay date: 01/12/2024
INDIANAPOLIS IN 46202

Deposited to the account of account number transit ABA amount

ANGELA K GORDON xxxxxx3309 xxxx xxxx $2 692 46

NON-NEGOTIABLE