State Farm Insurance Companies One State Farm Plaza Bloomington, IL 61710-0001

Rickey Davis 6190 Glacier Run Norcross, GA 30093

Name Company Employee ID Pay Period Begin Pay Period End Check Date Check Number
Rickey Davis State Farm Mutual Auto Ins Co 346108 02/18/2023 03/03/2023 03/10/2023

Hours Worked Gross Pay Pre Tax Deductions Employee Taxes Post Tax Deductions Net Pay
Current 77.50 1,630.58 210.26 117.05 3.36 1,299.91
YTD 333.25 7,969.30 1,039.49 938.37 16.28 5,975.16

Earnings Employee Taxes

Description Dates Hours Rate Amount YTD Hours YTD Amount Description Amount YTD
Regular Hours 02/18/2023 - 02/24/2023 38.75 21.039752 815.29 OASDI 94.86 462.65
Regular Hours 02/25/2023 - 03/03/2023 38.75 21.039752 815.29 333.25 6,858.48 Medicare 22.19 108.20
Life Taxable-Benefit 02/18/2023 - 03/03/2023 0 0 11.88 0 54.12 Federal Withholding 0.00 235.73
Life Leave 0 7.75 156.94 State Tax - GA 0.00 131.79
Non-PTO Paid Absence 0 31 627.76
PTO 0 15.5 326.12
Earnings 1,642.46 8,023.42 Employee Taxes 117.05 938.37

Pre Tax Deductions Post Tax Deductions

Description Amount YTD Description Amount YTD
401(k) Savings Plan 97.83 478.14 Long-Term Disability After-Tax 3.36 16.28
Dental/PPO Before-Tax 8.61 43.05
Life Before-Tax 4.30 20.70
Medical/PPO Before-Tax 101.29 506.45
Vision Before-Tax 5.73 28.65
Wellness Incentive PPO BT -7.50 -37.50
Pre Tax Deductions 210.26 1,039.49 Post Tax Deductions 3.36 16.28

Employer Paid Benefits Taxable Wages

Description Amount YTD Description Amount YTD
Dental/PPO Non-Taxable 13.42 67.10 OASDI - Taxable Wages 1,530.03 7,462.07
Life Non-Taxable 22.32 107.44 Medicare - Taxable Wages 1,530.03 7,462.07
Medical/PPO Non-Taxable 318.03 1,590.15 Federal Withholding - Taxable Wages 1,432.20 6,983.93
Employer Paid Benefits 353.77 1,764.69 State Tax Taxable Wages - GA 1,432.20 6,983.93

Federal State Absence Plans

Marital Status Head of Household
Description Used Balance
Allowances 0 0
Additional Withholding 0 0 PTO 0.00 60.25
Life Leave 0.00 32.25
Crisis Leave 0.00 80.00

Payment Information
Bank Account Name Account Number Amount
n/a n/a ******4452 ******4452 1,299.91