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we GALENCARE, INC 75193594

LITY: HCA FLORIDA BRANDON HOSP

*** ******** *****, *******, ** 33511 LILLIAN PULIDO

ois ean ssst 01/28/2022

VEL: 01384

E ID: 069071407

STATEMENT OF EARNINGS AND DEDUCTIONS

YEAR- YEAR-

YN] HOURS] RATE EARNINGS TO- DESCRIPTION] TAXES/DEDUCT] TO-

DATE DATE

69.75 [17.4100 1,214.35 2,241.54 SS EE 76.01 159.74

0.00 Jo.o000 25.00 } 50.00 Medicare 1778 3736

23.25 1.0000 23.25 47.00 FIT WH 74.90 164.29

0.00 Joaoooo 250} 5.00 Medicat 26.00 5200

0.00 Jo.0000 0.00 208.92 Dentat 476 952

0.00 Jo.0000 0.00 102.28 tro 37 1674

401K % 37.88 7949

Hospital 498 9.96

>>> 1,265.10 2,654.74

YEAR-TO-

DESC EARNINGS DATE Total 250.68 529.10

Deductions

NET PAY Lo14a2

>>>

PAY 01/09/2022 -

PERIOD, 01/22/2022

“AR-TO-DATE TAXABLE WAGES +): [__ACCRUAL PLAN ACCRUAL BALANCE

349695] PTO 536 22.38

2576.48

2,576.48 TAX ADD'U

statusicope EXEMPTIONS “amr

FED s 0 0.00

YOUR ESPP BALANCE

ll FOR THIS PURCHASE PERIOD $0.00

BER __DIRECT DEPOSIT _ AMOUNT _ s;

98 1,014.42

nRonncit

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