This appendix has Form and Report Examples
This is an example of the graphical check form:
Date 06/09/2014 Time 13:52:37 XYZ Company Report-#0000000 Page 0009
4 0 1 ( K ) C O N T R I B U T I O N S R E P O R T
Starting pay period date: 11/01/2014 Ending pay period date: "Latest" T after Check# = ACH transaction
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Emp-# Name Emp-amount Empr-amount Roth-401(k) Emp-soc-sec-no 401k Ded flag
------------------------------------------------------------------------------------------------------------------------------------
10 Prieskorn, Jeff-DD 1 check .00 10.00 50.00 ***-**-8332 Y
12 Schultz, Kenneth J.-DD 1 check .00 10.00 .00 ***-**-7701 Y
Report totals: 2 employees .00 20.00 50.00
-- End of report --
Date 03/04/2011 Time 11:31:17 XYZ Company Report #000000 Page 0002
P A Y R O L L R E G I S T E R H I S T O R Y
Starting date: 01/01/2014 Ending date: "Latest"
Starting employee: 1001 Ending employee: 1002
Entry types: P = payroll check V = advance vacation check A = adjustment B = bonus/separate suppl earning C = commission
Cash account #: "All" T by Check# = ACH transaction * by Check# = split transaction (check/DDP)
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Emp# Name Typ Check# Chk-date Prd-date Gross Tot-taxes Deductions Net pay Tips+meals
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1001 Palmer, Edward W. P 2525 1/02/14 1/14/14 50,000.00 27,033.74 170.00 22,796.26
Employee 1001 Totals: 1 trans 50,000.00 27,033.74 170.00 22,796.26
1002 Levine, Susan M. P 2592 1/30/14 4/01/14 9,166.67 3,999.21 65.00 5,102.46
P 2534 2/01/14 3/13/14 9,166.67 4,043.62 65.00 5,058.05
P 2560T 2/01/14 3/13/14 9,166.67 4,043.62 65.00 5,058.05
P 497T 10/31/14 10/31/14 9,166.67 3,999.21 65.00 5,102.46
Employee 1002 Totals: 4 trans 36,666.68 16,085.66 260.00 20,321.02
Grand totals: 2 employees 5 trans 86,666.68 43,119.40 430.00 43,117.28
-- End of report --
Date 06/09/2014 Time 10:11:27 XYZ Company Report-#0000000 Page 0003
P A Y R O L L D I S T R I B U T I O N T O G E N E R A L L E D G E R R E P O R T
Starting account #: 1000-000 Ending account #: "Last" PR = Payroll checks
Starting date: 03/01/2014 Ending date: 03/31/2014 PM = Manual payroll
T after Chk-# = ACH transaction
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Acct-# Description Chk-date Jrnl-# Cash-account Chk-# Emp-# Distrib-amt
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1000-000 Cash account #13557-000 03/01/14 PR0100131 1000-000 2528 550 714.00CR
03/17/14 PR1000147 1000-000 2562 10 2,407.05CR
Account total: 3,121.05CR
2100-000 Federal W/H tax payable 03/01/14 PR0100131 1000-000 2528 550 159.50CR
03/17/14 PR1000147 1000-000 2562 10 416.38CR
Account total: 575.88CR
2120-000 FICA taxes payable 03/01/14 PR0100131 1000-000 2528 550 153.00CR
03/17/14 PR1000147 1000-000 2562 10 542.34CR
Account total: 695.34CR
2130-000 FUI taxes payable 03/01/14 PR0100131 1000-000 2528 550 6.00CR
Account total: 6.00CR
2130-100 FUI taxes payable 03/17/14 PR1000147 1000-000 2562 10 20.73CR
Account total: 20.73CR
2150-000 SUI taxes payable 03/01/14 PR0100131 1000-000 2528 550 .72CR
Account total: .72CR
2170-000 401(k) Elective deferrals 03/17/14 PR1000147 1000-000 2562 10 50.00CR
Account total: 50.00CR
2200-400 State sales taxes payable 03/01/14 PR0100131 1000-000 2528 550 50.00CR
03/17/14 PR1000147 1000-000 2562 10 400.00CR
Account total: 450.00CR
2355-100 Employer matching 401k 03/17/14 PR1000147 1000-000 2562 10 10.00CR
Account total: 10.00CR
5120-100 401k Expense accounts 03/17/14 PR1000147 1000-000 2562 10 10.00
Account total: 10.00
6000-000 Administrative salaries 03/01/14 PR0100131 1000-000 2528 550 1,000.00
Account total: 1,000.00
6000-100 Salaries and wages expense 03/17/14 PR1000147 1000-000 2562 10 3,544.60
Account total: 3,544.60
6100-000 FICA tax expense 03/01/14 PR0100131 1000-000 2528 550 76.50
03/17/14 PR1000147 1000-000 2562 10 271.17
Account total: 347.67
6110-000 FUI tax expense 03/01/14 PR0100131 1000-000 2528 550 6.00
Account total: 6.00
6110-100 FUI tax expense 03/17/14 PR1000147 1000-000 2562 10 20.73
Account total: 20.73
6120-000 SUI tax expense 03/01/14 PR0100131 1000-000 2528 550 .72
Account total: .72
Grand total: .00
-- End of report --
Employee Gross Hours and Wages with Check Details
Date 06/09/2014 Time 11:10:03 XYZ Company Report-#0000000 Page 0001
E M P L O Y E E G R O S S H O U R S A N D W A G E S R E P O R T
Starting date: "Earliest" Ending date: "Latest" (By pay period date)
Starting employee: 1002 Ending employee: 1002
Entry types: P = payroll check A = adjustment V = advanced vacation T after Check# = ACH transaction
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Emp-# Name Typ Check# Chk-date Prd-date RegPay OvrPay VacPay HolPay SickPay SpecPay
Hrs Hrs Hrs Hrs Hrs Hrs
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1002 Levine, Susan M. P 482T 9/26/13 11/08/13 9,166.67 .00 .00 .00 .00 .00
86.67 .00 .00 .00 .00 .00
P 2534 2/01/14 3/13/14 9,166.67 .00 .00 .00 .00 .00
86.67 .00 .00 .00 .00 .00
P 2560T 2/01/14 9,166.67 .00 .00 .00 .00 .00
86.67 .00 .00 .00 .00 .00
P 2592 1/30/14 4/01/14 9,166.67 .00 .00 .00 .00 .00
86.67 .00 .00 .00 .00 .00
P 497T 10/31/14 10/31/14 9,166.67 .00 .00 .00 .00 .00
86.67 .00 .00 .00 .00 .00
Employee 1002 Totals: 5 trans 45,833.35 .00 .00 .00 .00 .00
433.35 .00 .00 .00 .00 .00
Grand totals: 1 employees 5 trans 45,833.35 .00 .00 .00 .00 .00
433.35 .00 .00 .00 .00 .00
-- End of report --
Date 06/20/2014 Time 16:44:17 XYZ Company Report-#0000000 Page 0001
E M P L O Y E E S B Y E M P L O Y E E N A M E
Starting employee: Prieskorn, Jeff
Ending employee: Prieskorn, Jeff
Employee types: H = hourly S = salary N = non-employee
Pay frequencies: D = daily W = weekly B = bi-weekly S = semi-monthly M = monthly Q = quarterly
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Emp-# Name Street City St Zip Soc-sec-# Emp Pay
type freq
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10 Prieskorn, Jeff 710 Delaware Street Detroit MI 48123 ***-**-8332 H M
Emp. notes: Date 1/16/09 Time 10:44
Received a Regular rate raise today of $2.00 an hour.
1 employees 0 daily 0 weekly 0 bi-weekly 0 semi-monthly 1 monthly 0 quarterly
-- End of report --
Date 06/09/2014 Time 10:46:15 XYZ Company PDF Generated Report Page 0001
E M P L O Y E E S B Y E M P L O Y E E #
Starting employee #: 1002 Ending employee #: 1002
Marital statuses: S = single M = married H = head of household
Employee types: H = hourly S = salary N = non-emp
Pay/Deduct freq: D = daily W = weekly B = bi-weekly S = semi-monthly M = monthly Q = quarterly
For deduction/earning codes see deduction/earning code list
Tax-pct-of-gross: 1 = FWT gross 4 = fed unemp gross 5 = state unemp gross 6 = work comp gross
7 = Emp soc sec gross 8 = Emp medicare gross 9 = Empr soc sec gross 10 = Empr medicare gross
SS = Social Security Mc = Medicare
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Emp-# Name Street City St Zip Phone-# Soc-sec-#
1002 Levine, Susan M. 5097 Windward Ave. Woodland Hills CA 91002 555-456-5522 ***-**-8795
Birth-dt Mar Hire-dt Lst-rais Revu-dt Term-dt Typ Frq W-Comp Dept Wage-account Grp Salary Reg-rate Ovt-rate
09/30/75 S 03/01/10 12/01/09 S S 0000 1010-000 9,166.67 105.765 158.648
Spec rate1 Spec W-Comp1 Spec desc1 Spec rate2 Spec W-Comp2 Spec desc2 Spec rate3 Spec W-Comp3 Spec desc3
211.530 SPEC .000 .000
Vac-due Vac-pd Sik-due Pen Dst Ins-prem Stax Ctax #/$-exm-FWT #/$-exm-SWT #/$-exm-OST-1 #/$-exm-OST-2
100.000 .000 11.000 N N CA-2 LA-A 0 .00 0 .00 0 .00 0 .00
$-exm-empr-OST #/$-exm-CWT State-crd Ad-FWT Ad-SWT Ad-CWT EIC SS? Mc? FUI? SUI? 401k Union /frq/account-#
.00 0 .00 .00 .00 .00 .00 N N N N Y .00 0000-000
Loan/frq/balance Garn /frq/balance
.00 .00 .00 .00
401K Frq Trad amt/rate/% Type Roth amt/rate/% Type Empr-401K Frq Amt/rate/% Type Max
4K1 W 65.00 amt C1 W 150.00 amt 2,500.00
D-E1/ amount /frq/balance-due D-E2/ amount /frq/balance-due D-E3/ amount /frq/balance-due D-E4/ amount /frq/balance-due
.00 (n/a) .00 (n/a) .00 (n/a) .00 (n/a)
D-E5/ amount /frq/balance-due D-E6/ amount /frq/balance-due D-E7/ amount /frq/balance-due D-E8/ amount /frq/balance-due
.00 (n/a) .00 (n/a) .00 (n/a) .00 (n/a)
D-E9/ amount /frq/balance-due Vac-date/Hrs-per-frq/Max-v-hrs/frq/Sick-date/Hrs-per-frq/Max-s-hrs/frq
.00 (n/a) 7/15/14 40.00000 100.000 Y 12/01/10 0.50000 100.000 M
YTD-gross YTD-FWT-gr YTD-emp-SoSc-gr YTD-emp-Mdcr-gr YTD-empr-SoSc-gr YTD-empr-Medc-gr YTD-FUI-gr YTD-W-Comp-gr
36,666.68 36,406.68 36,666.68 36,666.68 36,666.68 36,666.68 7,000.00 .00
YTD-supp-ben-gr YTD-SUI-gr YTD-FWT YTD-EIC YTD-emp-SoSc YTD-emp-Mdcr YTD-empr-SoSc YTD-empr-Mdcr YTD-SWT
.00 7,000.00 9,200.16 .00 2,273.32 531.68 2,273.32 531.68 2,988.30
YTD-OST-1 YTD-OST-2 YTD-Empr-OST YTD-CWT YTD-othr-tax YTD-401k YTD-Empr-401k Tot-hours YTD-tip-CR CR-elig
.00 .00 .00 1,092.20 .00 260.00 600.00 346.68 .00 N
Direct deposit account information:
ACH: Bank Name Account Typ Amount Meth Bank Name Account Typ Amount Meth
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DDP Last National Bank ***2163 Chk .00 Bal
-- End of report --
Date 06/09/2014 Time 11:19:48 XYZ Company Report-#0000000 Page 0001
E M P L O Y E E P A Y R O L L H I S T O R Y R E P O R T
Starting date: 10/01/2014 Ending date: "Latest" (By pay period date)
Starting employee: 1002 Ending employee: 1002
Entry types: P = payroll check V = advance vacation check A = adjustment B = bonus/separate suppl earning C = commission
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Emp# Name Typ Check-# Gross Soc-sec SWT Deductions Reg-hrs Wks-wrk State
Soc-sec-# Prd-date Chk-dat FWT-gross Medicare OST-1 Union Ovt-hrs Wrk-units /City
Csh-acct Chk-amt Net-pay FWT OST-2 Loan Spc-hrs Tips tax
DDP-Cash-acct Direct-dpst-acct Direct-dpst 401(k) CWT Garnishment EIC Meals codes
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1002 Levine, Susan M. P 497 9,166.67 568.33 724.87 .00 86.67 2.16 CA-2
***-**-8795 10/31/14 10/31/14 9,101.67 132.92 .00 .00 .00 .00 LA-A
1010-000 .00 5,102.46 2,300.04 .00 .00 .00 .00
1010-000 ***2163 DDP 5,102.46 65.00 273.05 .00 .00 .00
ACH: Bank Name Account Typ Amount Meth Bank Name Account Typ Amount Meth
DDP Last National Bank ***°°°° Chk 5,102.46 Bal
Employee 1002 totals: 1 trans 9,166.67 568.33 724.87 .00 86.67 2.16
9,101.67 132.92 .00 .00 .00 .00
5,102.46 2,300.04 .00 .00 .00 .00
5,102.46 65.00 273.05 .00 .00 .00
Grand totals:
1 employees 1 trans 9,166.67 568.33 724.87 .00 86.67 2.16
9,101.67 132.92 .00 .00 .00 .00
5,102.46 2,300.04 .00 .00 .00 .00
5,102.46 65.00 273.05 .00 .00 .00
Worker's comp grand totals: Class Subj-wages Rptd-units Total-prem
-- End of report --
Date 06/09/2014 Time 11:27:46 XYZ Company Report-#0000000 Page 0009
E M P L O Y E R P A Y R O L L E X P E N S E R E P O R T
Starting date: 10/01/2014 Ending date: "Latest" (By pay period date)
Starting employee: 1002 Ending employee: 1002 T after Check-# = ACH transaction
Entry types: P = payroll check V = advance vacation check A = adjustment B = bonus/separate suppl earning C = commission
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Emp# Name Typ Check-# Gross Soc-sec SUI Reg-hrs Wks-wrk State
Soc-sec-# Prd-date Chk-dat FWT-gross Medicare Empr-OST Ovt-hrs Wrk-units /City
Pay-desc/W-comp-code Csh-acct Chk-amt Net-pay FUI Suppl-ben Spc-hrs W-comp-prem tax
Spec-rate DDP-Cash-acct Direct-dpst-acct Direct-dpst 401(k) State-tip-cr Fed-tip-cr W-comp-gross codes
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1002 Levine, Susan M. P 497T 9,166.67 568.33 .00 86.67 2.16 CA-2
***-**-8795 10/31/14 10/31/14 9,101.67 132.92 .00 .00 .00 LA-A
REG 1010-000 .00 5,102.46 .00 .00 .00
.000 1010-000 ***2163 DDP 5,102.46 150.00 .00 .00 .00
Employee 1002 totals: 1 trans 9,166.67 568.33 .00 86.67 2.16
9,101.67 132.92 .00 .00 .00
5,102.46 .00 .00
5,102.46 150.00 .00 .00 .00
Grand totals:
1 employees 1 trans 9,166.67 568.33 .00 86.67 2.16
9,101.67 132.92 .00 .00 .00
5,102.46 .00 .00
5,102.46 150.00 .00 .00 .00
-- End of report --
Date 06/09/2014 Time 11:59:18 XYZ Company Report-#0000000 Page 0001
L E A V E R E P O R T
Starting department: "First" Ending department: "Last"
Starting employee: 10 Ending employee: 10
Starting date: 10/01/2014 Ending date: "Latest" (By pay period date)
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Emp# Name
------------ Annual-hours -------------- -------------- Sick-hours ---------------
Prd-date Beg-due Accrued Used End-due Beg-due Accrued Used End-due
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Department: 1200
Employee: 10 Prieskorn, Jeff
10/31/14 45.000 5.000 .000 50.000 8.000 .000 .000 8.000
11/30/14 50.000 5.000 .000 55.000 8.000 .000 .000 8.000
Employee 10 Total 10.000 .000 .000 .000
Dept 1200 Total 10.000 .000 .000 .000
--------------------------------------------------------------------------------
Date 06/09/2014 Time 11:59:18 XYZ Company Report-#0000000 Page 0002
L E A V E R E P O R T
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Emp# Name
------------ Annual-hours -------------- -------------- Sick-hours ---------------
Prd-date Beg-due Accrued Used End-due Beg-due Accrued Used End-due
------------------------------------------------------------------------------------------------------------------------------------
Grand totals: 10.000 .000 .000 .000
-- End of report --
Date 06/09/2014 Time 13:40:00 XYZ Company Report-#0000000 Page 0004
Q U A R T E R L Y P A Y R O L L R E P O R T
Quarter # 3 ending: 9/30/14 Federal unemployment %: .60
Company: XYZ Company
Address: P.O. Box 400
Merrimack, NH 03227
Federal ID#: 77-XXXXXXX
Notes: Reported tips are included in gross amounts according to tip earning codes.
"Total hours" includes regular, overtime and special hours only.
"Wages over FUI max" for this quarter are obtained using the wages for this quarter AND all previous quarters.
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Emp-# Name Gross-pay Emp-soc-sec-wgs Emp-soc-sec-tips Emp-soc-sec FWT-grs FWT
Soc-sec-# Reported-tips Emp-medicare-wgs Emp-medicare-tips Emp-medicare Emp-401(k)-ded Empr-401(k)-amt
Earn-income-cr Empr-soc-sec-wgs Empr-soc-sec-tips Empr-soc-sec FUI-grs FUI
Tot-hrs Empr-medicare-wgs Empr-medicare-tips Empr-medicare Wgs-over-FUI-max Wks-wrk
------------------------------------------------------------------------------------------------------------------------------------
113131 Carlos, Juan 100.00 100.00 200.00 18.60 300.00 29.78
xxx-xx-9987 200.00 100.00 200.00 4.35 .00 .00
.00 100.00 200.00 18.60 300.00 1.80
40.00 100.00 200.00 4.35 .00 1.00
--------------------------------------------------------------------------------
Date 06/09/2014 Time 13:40:00 XYZ Company Report-#0000000 Page 0005
Q U A R T E R L Y P A Y R O L L R E P O R T
Quarter # 3 ending: 9/30/14 Federal unemployment %: .60
Company: XYZ Company
Address: P.O. Box 400
Merrimack, NH 03227
Federal ID#: 77-XXXXXXX
Notes: Reported tips are included in gross amounts according to tip earning codes.
"Total hours" includes regular, overtime and special hours only.
"Wages over FUI max" for this quarter are obtained using the wages for this quarter AND all previous quarters.
------------------------------------------------------------------------------------------------------------------------------------
Gross-pay Emp-soc-sec-wgs Emp-soc-sec-tips Emp-soc-sec FWT-grs FWT
Reported-tips Emp-medicare-wgs Emp-medicare-tips Emp-medicare Emp-401(k)-ded Empr-401(k)-amt
Earn-income-cr Empr-soc-sec-wgs Empr-soc-sec-tips Empr-soc-sec FUI-grs FUI
Tot-hrs Empr-medicare-wgs Empr-medicare-tips Empr-medicare Wgs-over-FUI-max Wks-wrk
------------------------------------------------------------------------------------------------------------------------------------
Federal totals: 100.00 100.00 200.00 18.60 300.00 29.78
200.00 100.00 200.00 4.35 .00 .00
.00 100.00 200.00 18.60 300.00 1.80
40.00 100.00 200.00 4.35 .00 1.00
* Federal Return Information *
Emp soc sec percent: 6.20 Empr soc sec percent: 6.20 FUI percent: .60
Emp soc sec max wages: 117,000.00 Empr soc sec max wages: 117,000.00 FUI max wages: 7,000.00
Emp medicare percent: 1.45 Empr medicare percent: 1.45
Emp medicare max wages: .00 Empr medicare max wages: .00
Calculated taxes:
FUI = FUI-gross x FUI-% = 300.00 x .60% = 1.80
Emp-soc-sec = Emp-soc-sec-grs x Emp-soc-sec-% = 300.00 x 6.20% = 18.60
Emp-medicare = Emp-medicare-grs x Emp-medicare-% = 300.00 x 1.45% = 4.35
Empr-soc-sec = Empr-soc-sec-grs x Empr-soc-sec-% = 300.00 x 6.20% = 18.60
Empr-medicare = Empr-medicare-grs x Empr-medicare-% = 300.00 x 1.45% = 4.35
-- End of report --
Date 06/20/2014 Time 16:56:22 XYZ Company PDF Generated Report Page 0001
U N I O N D E D U C T I O N S R E P O R T
Starting pay period date: "Earliest" Ending pay period date: "Latest"
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Soc-sec-# Name -------------Hours------------ #-of Wks Subj-pay Calc Union
Regular Overtime Special trans method deduction
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For union account # 2050-000 Union dues deduct payable
***-**-8912 Lopez, Felicia J. 160.00 .00 20.00 5 4.00 4,400.00 per payprd 25.00
Union totals: 160.00 .00 20.00 5 4.00 4,400.00 25.00
-- End of report --
Date 06/09/2014 Time 13:29:57 XYZ Company Report-#0000000 Page 0003
Y E A R - E N D P A Y R O L L R E P O R T
Company: XYZ Company State: CA Single State ID:
Address: P.O. Box 400 City: LA All City ID:
Merrimack, NH 03227
Fed ID: 77-XXXXXXX
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Emp-# Soc-Sec-# ---1st-qtr--- ---2nd-qtr--- ---3rd-qtr--- ---4th-qtr--- Year-total
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1002 ***-**-8795 Grs-wages: 27,500.01 .00 .00 9,166.67 36,666.68
Name: Susan M. Levine Emp-401(k)-ded: 195.00 .00 .00 65.00 260.00
Addr: 5097 Windward Ave. FWT-gross: 27,305.01 .00 .00 9,101.67 36,406.68
Woodland Hills FWT-w/h: 6,900.12 .00 .00 2,300.04 9,200.16
CA 91002 Emp-soc-sec-wgs: 27,500.01 .00 .00 9,166.67 36,666.68
Emp-soc-sec-tips: .00 .00 .00 .00 .00
Emp-soc-sec-w/h: 1,704.99 .00 .00 568.33 2,273.32
Earning categories year tots: Emp-medicare-wgs: 27,500.01 .00 .00 9,166.67 36,666.68
Reg-pay: 36,666.68 Emp-medicare-tips: .00 .00 .00 .00 .00
Ovt-pay: .00 Emp-medicare-w/h: 398.76 .00 .00 132.92 531.68
Spec-pay: .00 SWT-gross: 27,305.01 .00 .00 9,101.67 36,406.68
Vac-pay: .00 SWT-w/h: 2,263.43 .00 .00 724.87 2,988.30
Hol-pay: .00 OST-1-gross: .00 .00 .00 .00 .00
Sick-pay: .00 OST-1-w/h: .00 .00 .00 .00 .00
OST-2-gross: .00 .00 .00 .00 .00
OST-2-w/h: .00 .00 .00 .00 .00
Deduction categories year tots: CWT-gross: 27,305.01 .00 .00 9,101.67 36,406.68
Garnish: .00 CWT-w/h: 819.15 .00 .00 273.05 1,092.20
Loan: .00 Empr-401(k)-amt: 450.00 .00 .00 150.00 600.00
Union: .00 Empr-soc-sec-wgs: 27,500.01 .00 .00 9,166.67 36,666.68
Empr-soc-sec-tips: .00 .00 .00 .00 .00
Empr-soc-sec-tax: 1,704.99 .00 .00 568.33 2,273.32
Empr-medicare-wgs: 27,500.01 .00 .00 9,166.67 36,666.68
Empr-medicare-tip: .00 .00 .00 .00 .00
Empr-medicare-tax: 398.76 .00 .00 132.92 531.68
W/Comp-gross: .00 .00 .00 .00 .00
Est-W-Comp-prem: .00 .00 .00 .00 .00
FUI-gross: 7,000.00 .00 .00 .00 7,000.00
FUI: 42.00 .00 .00 .00 42.00
SUI-gross: 7,000.00 .00 .00 .00 7,000.00
SUI: 238.00 .00 .00 .00 238.00
Empr-OST-gross: .00 .00 .00 .00 .00
Empr-OST: .00 .00 .00 .00 .00
Suppl-ben-grs: .00 .00 .00 .00 .00
Suppl-ben: .00 .00 .00 .00 .00
Reported-tips: .00 .00 .00 .00 .00
Fed-tip-cr: .00 .00 .00 .00 .00
State-tip-cr: .00 .00 .00 .00 .00
-- End of report --