Pay Statement

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Company Code

R5 / OT3 23626163 01/


Loc/Dept Number Page
2737196 1 of 1
Earnings Statement
MOBILE VASCULAR SOLUTIONS LLC
11333 N Scottsdale Rd STE 115 Period Starting: 12/08/2019
Scottsdale, AZ 85254 Period Ending: 12/21/2019
Pay Date: 12/27/2019

Taxable Marital Status: Single


Exemptions/Allowances: Tax Override: Gilbert Guerrero
Federal: 4 Federal: 0.00 Addnl
State: 0 State: 6612 W Mercer Ln
Local: 0 Local: Glendale, AZ 85304
Social Security Number: XXX-XX-XXXX

Earnings rate hours/units this period year to date Other Benefits and
Information this period year to date
Regular 0.00 17143.20
Misc pay 0.00 1531.20 Sick
- Carry Over 2.60
Gross Pay $18,674.40 - Accrued Hours 0.00 10.43
- Taken Hours 0.00 0.00
- Balance 10.43

Net Pay Adjustments this period year to date Deposits


account number transit/ABA amount
*Misc reimbursement 252.88 252.88
XXXXXX8063 XXXXXXXXX 252.88
Net Pay $252.88

Your federal taxable wages this period are $0.00


* Excluded from Federal taxable wages
The accrued hours on your Sick Plan may not be available until your
90th day of employment

MOBILE VASCULAR SOLUTIONS LLC


11333 N Scottsdale Rd STE 115
Scottsdale, AZ 85254
Pay Date: 12/27/2019

Deposited to the account account number transit/ABA amount


Checking DirectDeposit XXXXXX8063 XXXXXXXXX 252.88

Gilbert Guerrero
6612 W Mercer Ln
Glendale, AZ 85304

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