File 102
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José i rivereraFile 102
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José i rivereraCONTROL NUMBER:
CHECK DATE: 12/05/2025 JOSE I RIVERA RUIZ 109975139
PERIOD END: 11/22/2025 3126 BLAKELEY AVE #6
TEAM MEMBER#: 2158493 EAU CLAIRE, WI 54701-0000
(715) 876-2000
BANK NAME: US BANK
PAYMENT METHOD: DIRECT DEPOSIT HEALTH INSURANCE: Enrolled, Part Time, Single
PAY FREQUENCY: WEEKLY DENTAL INSURANCE: Regular
SOC. SEC#: XXX-XX-7493 WORK UNIT: 3039 - 327 - EAU CLAIRE DISTRIBUTION CENTER
TOTAL PTO DAYS AVAILABLE: 0 TOTAL YTD PROFIT SHARING HOURS: 1,633.57
0 DAYS AVAILABLE FROM 01/01/25 THROUGH 02/07/26
TAX TYPE TAX ID FILING STATUS EXEMPTIONS ADDL WITHHELD FED W4 PARAMETERS
FEDERAL S 0 0 MULTI JOB?: NO
STATE WI S 0 0 OTHER INCOME: 0.00
CALC DEPENDS: 0.00
CALC DEDUC: 0.00
EARNINGS TAXES
DESCRIPTION RATE HOURS CURRENT YEAR-TO-DATE DESCRIPTION CURRENT YEAR-TO-DATE
REGULAR 20.25 35.89 726.77 32,193.70 FED W/H -36.32 -2,556.17
OVERTIME 265.72 F.I.C.A. -39.02 -2,143.57
PREMIUM PAY 102.39 MEDICARE -9.13 -501.32
SHIFT 2 1,569.66 WISCONSIN W/H -22.44 -1,339.92
HOLIDAY 344.80 TOTAL -106.91 -6,540.98
PROFIT SHARING 2,531.15
PTO 1,551.60 DEDUCTIONS and REIMBURSEMENTS
TOTAL 726.77 38,559.02 DESCRIPTION CURRENT YEAR-TO-DATE
INSUR/POP -93.93 -3,862.09
DENTAL INS POP -3.52 -123.20
PURCHASES -44.93
TOTAL -97.45 -4,030.22
SUMMARY GROSS TAXABLE TAXES DEDUCTIONS NET
CURRENT PERIOD: 726.77 629.32 -106.91 -97.45 522.41
YEAR-TO-DATE: 38,559.02 34,573.73 -6,540.98 -4,030.22 27,987.82
DEDUCTION DETAIL
INVOICE# AMOUNT DATE SELLING UNIT INVOICE# AMOUNT DATE SELLING UNIT
WEEKLY INS -93.93 12/05/2025 DENTAL INS -3.52 12/05/2025
NON NEGOTIABLE THIS IS NOT A CHECK
Your overtime rate will be equal to 1/2 of your regular hourly rate, unless you have earned Premium Pay. If Premium pay is earned, your
overtime rate will be calculated as follows, and will be greater than 1/2 of your regular rate. This is complicated, but this is to comply with the
Federal Labor Standards Act (29 USC). This is not something we just dreamed up.
OVERTIME RATE CALCULATION:
Total non-overtime earnings from hours worked x .5 = Adjusted Overtime Rate
Total Hours Worked
Example: A Team Member worked 56 total hours for the week. This included 16 hours of overtime and 8 hours of Sunday premium time.
Team Member regular pay rate = $8.00 Hour 56 total hours worked x $8.00 = $448.00
Premium hourly rate = $3.00 Hour 8 Sunday hours x $3.00 = $24.00
Total non-overtime earnings from hours worked
Team Member overtime rate = $4.00 Hour
16 Overtime hours x 4.2143** = $67.43
$472.00 non-overtime earnings x .5 = $4.2143** Total Gross Earnings = $539.43
56 Total hours worked Adjusted Overtime Rate
