Billing Specialist Accounts Receivable

LONE STAR URGENT CARE MANAGERS LLC

***** *** ***** ****** ***

SAN ANTONIO TX 78232

FEIN: 20-5428685

Pay Period 10/16/2023 - 10/29/2023

Pay Date 11/03/2023

JUANITA CONTRERAS

EMPLOYEE ID: 1413

DEPARTMENT: 30010

FITWH Filing Status: S Exemptions: 1

TX

DD RECEIPT: 128*******

THIS IS NOT A CHECK. THIS DOCUMENT IS TO BE USED FOR INFORMATIONAL PURPOSES ONLY. LONE STAR URGENT CARE MANAGERS LLC

14100 SAN PEDRO AVENUE 608

SAN ANTONIO TX 78232 Direct Deposit # 128*******

Date 11/03/2023

Pay this Amount

** N O N - N E G O T I A B L E ** D I R E C T D E P O S I T R E C E I P T ** VOID ** VOID ** Pay to the

Order of

30010 DD

JUANITA CONTRERAS

9081 S LOOP 1604 E LOT 1

LOT 1

ELMENDORF TX 78112-5648

DIRECT DEPOSIT $1,246.64

TO ACCOUNT # XXXXXX2022

BANK # XXXXXX6110

N O N - N E G O T I A B L E

Earnings RATE HOUR/UNIT CURRENT YTD HOUR/UNIT YTD

Hourly 18.90 68.25 1,289.93 1,680.80 31,767.13

OT 28.35 6.0667 171.99 247.9168 7,028.44

Hol 40.00 756.00

PTO 18.90 12.00 226.80 67.5667 1,277.01

Bon 250.00

Total 86.3167 $1,688.72 2,036.2835 $41,078.58

Total Hours Worked 74.3167 1,928.7168

Deductions CURRENT YTD

401k 50.66 1,232.35

401kLoan 337.79

401kLoan3 56.15 673.80

Dent125 15.23 317.66

EEVolAD&D -11.73 -4.14

H125 72.70 1,529.35

V125 3.89 63.38

VolLifeEE 81.50

Total $186.90 $4,231.69

Time Off (hours) ACCRUED TAKEN AVAILABLE

NonClinPTO 55.7672

Taxes CURRENT YTD

FITWH 133.01 3,413.85

MED 23.16 567.92

SOC 99.01 2,428.44

Total $255.18 $6,410.21

Net Pay XXXXXX2022 $1,246.64

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