CO. FILE DEPT. CLOCK VCHR. NO.

WGD 133375 0000501664 1

Earnings Statement
ESKENAZI HEALTH Period Beginning: 11/26/2023
720 ESKENAZI AVE. Period Ending: 12/09/2023
INDIANAPOLIS, IN 46202 Pay Date: 12/15/2023

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 80 00 1 963 20 43 672 67 Garnishment -619 24 9 505 95
OT Premium 14 1534 13 75 194 61 6 147 24 Health Ins Ns -80 03* 2 000 75
OT Premium 14 4982 23 50 340 71 Opad&D -0 60 7 80
Cigna Std Er 6 80 167 00 Opt Life -5 02 65 26
Overtime Base 24 5400 37 25 914 12 10 876 73 STD ER -6 80 167 00
Sftdif Eve T3 24 5400 34 25 205 50 2 104 50
Net Pay $2 266 71
Sftdif Wkd T3 24 5400 35 00 280 00 1 700 00
Checking 1 -2 266 71
Holiday Worked 535 79
Hwrkd Premium 535 79 Net Check $0 00
Pto 1 447 86
Pto Notsched 605 50
Excluded from federal taxable wages
Sfdf Holevet3 48 00
Shft Reg Ct7 2 278 38
Your federal taxable wages this period are
Shft Wk Ct7 169 06
$3 712 38
Gross Pay $3 904 94 70 288 52
Other Benefits and
this period total to date
Statutory
G T L 0 11 1 39
Federal Income Tax -340 77 3 986 90
401A 116 94
Social Security Tax -230 17 4 059 34
Medicare Tax -53 83 949 36 Pto Balance 141 38
IN State Income Tax -112 09 1 941 24
Marion R Income Tax -71 88 1 244 86
YOUR COMPANY PHONE NUMBER IS :- 317-880-3788

CritIllEmployee -5 16 129 00
Exemptions/Allowances:
Dental C -18 00* 450 00 IN: 4
EYEMED VISION -2 33* 58 25
Fsa Med -92 31* 2 307 75

2000 ADP, Inc.

ESKENAZI HEALTH Advice number: 00000501664

720 ESKENAZI AVE Pay date: 12/15/2023
INDIANAPOLIS IN 46202

Deposited to the account of account number transit ABA amount

ANGELA K GORDON xxxxxx3309 xxxx xxxx $2 266 71

NON-NEGOTIABLE