CO. FILE DEPT. CLOCK VCHR. NO.

070
IGI 000559 000500 GA 1800380773 12 Earnings Statement
WESLEY WOODS SENIOR LIVING Period Beginning: 05/28/2023
2280 US-29 06/10/2023
Period Ending:
NEWMAN GA 30265
Pay Date: 06/21/2023

TREENA FORDHAM
Filing Status: Single/Married filing separately
2340 DAWN DRIVE
Exemptions/Allowances:
DECATUR GA 30032
Federal: Standard Withholding Table

Social Security Number: XXX-XX-5214

Earnings rate hours this period year to date Other Benefits and
Regular 28.8500 80.00 2,308.00 27,696.00 Information this period total to date

Tips 0.00 Sick Availa 0.00

Overtime 73.80
Totl Hrs Worked 80
Gratuity 200.00
Holiday 136.80
Important Notes
Holiday 1.5 257.18 COMPANY PH 8587770069
Sick 600.00
Gross Pay $2,308.00 28,963.78 BASIS OF PAY: HOURLY

IF NO GA Spsl Used IS LISTED YOU HAVE USED ZERO H

Deductions Statutory
Federal Income Tax 338.73 4,064.76 Additional Tax Withholding Information
Social Security Tax 143.00 1,716.00 Taxable Marital Status
Medicare Tax 33.00 396.00 GA: Single
State Income 108.00 1,296.00 Exemptions/Allowance
- 0.00 0.00 GA: 1
- 0.00 0.00

Net Pay $1,685.27

CHECKING -1,685.27

Net Check $0.00

Your federal taxable wages this period are

$2,308.00

© 2023 ADP, Inc

WESLEY WOODS SENIOR LIVING Advice number: 1800380773

2280 US-29
NEWMAN GA 30265 Pay date: 06/21/2023

Deposited to the account of account number transit ABA amount

TREENA FORDHAM xxxxx2358 xxxx xxxx $1,685.27

NON-NEGOTIABLE
 CO. FILE DEPT. CLOCK VCHR. NO. 070
IGI 000559 000500 CA 1800380774 15 Earnings Statement
IHSS PUBLIC AUTHORITY Period Beginning: 07/09/2023
401 MILE OF CARS WAY #200 07/22/2023
Period Ending:
NATIONAL CITY, CA 91950
Pay Date: 07/28/2023

BETTY TINYEE HOM

Filing Status: Single/Married filing separately
5669 SNELL AVE PMB 403
Exemptions/Allowances:
SAN JOSE, CA 95123
Federal: Standard Withholding Table

Social Security Number: XXX-XX-5860

Earnings rate hours this period year to date Other Benefits and
Regular 52.4000 80.00 4,192.00 62,880.00 Information this period total to date

Tips 0.00 Sick Availa 0.00

Overtime 73.80
Totl Hrs Worked 80
Gratuity 200.00
Holiday 136.80
Important Notes
Holiday 1.5 257.18 COMPANY PH 8587770069
Sick 600.00
Gross Pay $4,192.00 64,147.78 BASIS OF PAY: HOURLY

IF NO CA Spsl Used IS LISTED YOU HAVE USED ZERO H

Deductions Statutory
Federal Income Tax 585.00 8,775.00 Additional Tax Withholding Information
Social Security Tax 260.00 3,900.00 Taxable Marital Status
Medicare Tax 61.00 915.00 CA: Single
State Disability Insurance 42.00 630.00 Exemptions/Allowance
State Income 132.00 1,980.00 CA: 1
- 0.00 0.00

Net Pay $3,112.00

CHECKING -3,112.00

Net Check $0.00

Your federal taxable wages this period are

$4,192.00

© 2023 ADP, Inc

IHSS PUBLIC AUTHORITY Advice number: 1800380774

401 MILE OF CARS WAY #200
NATIONAL CITY, CA 91950 Pay date: 07/28/2023

Deposited to the account of account number transit ABA amount

BETTY TINYEE HOM xxxxx2358 xxxx xxxx $3,112.00

NON-NEGOTIABLE
 CO. FILE DEPT. CLOCK VCHR. NO. 070
IGI 000352 000721 NY 2361700050 23 Earnings Statement
GREAT OAKS FOUNDATION, INC. FELLOWS Period Beginning: 10/29/2023
38 DELANCY STREET 11/11/2023
Period Ending:
NEW YORK, NY 10002
Pay Date: 11/17/2023

MWESA C MULONDA
Filing Status: Single/Married filing separately
17 WILLIAM STREET
Exemptions/Allowances:
NEWARK, NJ 07102
Federal: Standard Withholding Table

Social Security Number: XXX-XX-4567

Earnings rate hours this period year to date Other Benefits and
Regular 43.2750 80.00 3,462.00 79,626.00 Information this period total to date

Tips 0.00 Sick Availa 0.00

Overtime 73.80
Totl Hrs Worked 80
Gratuity 200.00
Holiday 136.80
Important Notes
Holiday 1.5 257.18 COMPANY PH 8587771597
Sick 600.00
Gross Pay $3,462.00 80,893.78 BASIS OF PAY: HOURLY

IF NO NY Spsl Used IS LISTED YOU HAVE USED ZERO H

Deductions Statutory
Federal Income Tax 594.00 13,662.00 Additional Tax Withholding Information
Social Security Tax 215.00 4,945.00 Taxable Marital Status
Medicare Tax 50.00 1,150.00 NY: Single
Paid Family And Medical 1.00 23.00 Exemptions/Allowance
State Income 136.00 3,128.00 NY: 1
SDI 2.00 46.00

Net Pay $2,464.00

CHECKING -2,464.00

Net Check $0.00

Your federal taxable wages this period are

$3,462.00

© 2023 ADP, Inc

GREAT OAKS FOUNDATION, INC. FELLOWS Advice number: 2361700050

38 DELANCY STREET
NEW YORK, NY 10002 Pay date: 11/17/2023

Deposited to the account of account number transit ABA amount

MWESA C MULONDA xxxxx2222 xxxx xxxx $2,464.00

NON-NEGOTIABLE
 CO. FILE DEPT. CLOCK VCHR. NO. 070
IGI 000352 000721 IL 2361700050 6 Earnings Statement
QUICKSTAFF NURSING Period Beginning: 03/10/2024
1901 N ROSELLE RD STE 200 03/23/2024
Period Ending:
SCHAUMBURG, IL 60195
Pay Date: 03/29/2024

JALYN BELLAR
Filing Status: Single/Married filing separately
13927 MAXIMOS DR
Exemptions/Allowances:
HOUSTON, TX 77083
Federal: Standard Withholding Table

Social Security Number: XXX-XX-8111

Earnings rate hours this period year to date Other Benefits and
Regular 73.5578 80.00 5,884.62 35,307.74 Information this period total to date

Tips 0.00 Sick Availa 0.00

Overtime 26.00
Total Hrs Worked 80
Gratuity 0.00
Holiday 119.00
Important Notes
Holiday 1.5 0.00 COMPANY PH 8587771597
Sick 0.00
Gross Pay $5,884.62 35,452.74 BASIS OF PAY: HOURLY

IF NO IL Spsl Used IS LISTED YOU HAVE USED ZERO HR

Deductions Statutory
Federal Income Tax 1,030.62 6,183.72 Additional Tax Withholding Information
Social Security Tax 364.00 2,184.00 Taxable Marital Status
Medicare Tax 85.33 511.98 IL: Single
Health 88.76 532.56 Exemptions/Allowance
State Income 286.21 1,717.26 IL: 1
Dental and Vision 24.63 147.78

Net Pay $4,004.22

CHECKING -4,004.22

Net Check $0.00

Your federal taxable wages this period are

$5,884.62

© 2024 ADP, Inc

QUICKSTAFF NURSING Advice number: 2361700050

1901 N ROSELLE RD STE 200
SCHAUMBURG, IL 60195 Pay date: 03/29/2024

Deposited to the account of account number transit ABA amount

JALYN BELLAR xxxxx8122 xxxx xxxx $4,004.22

NON-NEGOTIABLE