Payroll Details
Hours and Earnings Taxes Deductions Employer
Description Hours Rate Amount Tax Amount Deduction Amount Net Pay Liability Amount
Pay Frequency: Biweekly
Employee: Biden, Robert H SSN: xxx-xx
Regular 40.00 10,000.00 FED FIT 2,459.31 6,620.80 FED MEDCARE-ER 145.00
40.00 10,000.00 FED 145.00 145.00
MEDCARE
DC SIT 774.89
3,379.20
Check Date: 11/16/2018 / Direct Deposit / Checking / Account No: XXXXX $6,620.80
Employee: Dodge, Catherine SSN: xxx-xx
Regular 20.00 1,500.00 FED FIT 512.04 803.50 FED SOCSEC-ER 93.00
20.00 1,500.00 FED SOCSEC 93.00 FED MEDCARE-ER 21.75
FED 21.75 114.75
MEDCARE
VA SIT 69.71
696.50
Check Date: 11/16/2018 / Direct Deposit / Checking / Account No: XXX $803.50
Employee: Roberts, Lunden A SSN: xxx-xx
Regular 40.00 1,500.00 FED FIT 136.44 1,176.08 FED SOCSEC-ER 93.00
40.00 1,500.00 FED SOCSEC 93.00 FED MEDCARE-ER 21.75
FED 21.75 114.75
MEDCARE
DC SIT 72.73
323.92
Check Date: 11/16/2018 / Direct Deposit / Checking / Account No: XXXX $1,176.08
Employee: Straughter, Erin SSN: xxx-xx
Regular 40.00 1,000.00 FED FIT 76.44 837.06 FED SOCSEC-ER 62.00
40.00 1,000.00 FED SOCSEC 62.00 FED MEDCARE-ER 14.50
FED 14.50 76.50
MEDCARE
CA SDI 10.00
162.94
Check Date: 11/16/2018 / Direct Deposit / Checking / Account No: XXXXX $837.06
Pay Frequency Totals: Biweekly
Regular 140.00 $14,000.00 FED FIT $3,184.23 $9,437.44 FED SOCSEC-ER $248.00
140.00 $14,000.00 FED SOCSEC $248.00 FED MEDCARE-ER $203.00
FED $203.00 $451.00
MEDCARE
DC SIT $847.62
VA SIT $69.71
CA SDI $10.00
$4,562.56
Total Employees - Biweekly: 4
Company Totals:
Company: Owasco PC 1 of 2 Date Printed: 11/16/2018 11:23
Check date: 11/16/2018 - Payroll 1 Run Number: 0017
Pay Period: 11/03/2018 to: 11/16/2018
Payroll Details
Hours and Earnings Taxes Deductions Employer
Description Hours Rate Amount Tax Amount Deduction Amount Net Pay Liability Amount
Regular 140.00 $14,000.00 FED FIT $3,184.23 $9,437.44 FED SOCSEC-ER $248.00
140.00 $14,000.00 FED SOCSEC $248.00 FED MEDCARE-ER $203.00
FED $203.00 $451.00
MEDCARE
DC SIT $847.62
VA SIT $69.71
CA SDI $10.00
$4,562.56
Total Employees - Company: 4
Company: Owasco PC 2 of 2 Date Printed: 11/16/2018 11:23
Check date: 11/16/2018 - Payroll 1 Run Number: 0017
Pay Period: 11/03/2018 to: 11/16/2018
Billing & Enrollment Services Provided By:
Owasco PC Account ID:
Coverage Month: December 2018
Bill Date: 11/05/2018
Due Date: 12/01/2018
Washington, DC 20007-3708 Broker: Jack Abel/The Meltzer Group
Account Activity Since Last Billing
Date Covg. Mth Transaction Type Description Memo Line of Coverage Class Amount Balance
10/25/18 11/01/18 Payment Auto Debit Auto Debit ($180.00) 0.00
11/05/18 12/01/18 Vision Billing $39.00 $39.00
11/05/18 12/01/18 Dental Billing $141.00 $180.00
Current Coverage Month Detail
Subscriber Health Carrier Health Dental Vision Total
BIDEN, ROBERT PC2 PC2
XXX-XX 77.00 19.00 96.00
ROBERTS, LUNDEN IND IND
XXX-XX 32.00 10.00 42.00
STRAUGHTER, ERIN IND IND
XXX-XX 32.00 10.00 42.00
Total Subscriber Count 0 3 3
Coverage Month Totals 0.00 141.00 39.00 180.00
KELLY | Customer Service hours Monday through Friday 8:30 A.M. to 5:30 P.M. Page 1/2
1 Kelly Way, Sparks, MD 21152 | | FAX: | Customer Service Email: kellyway.com
kellyway.com
Billing & Enrollment Services Provided By:
Owasco PC Account ID:
Coverage Month: 12/01/2018
Previous Balance December 2018 Coverage Adjustments to Account Payment(s) Received Balance Due By
(Billing Date 11/05/2018 ) After Last Month's Billing --Thank You-- 12/01/2018
$180.00 $180.00 $0.00 ($180.00) $180.00
Enrollment: Guidelines -- Timeliness-Forms
All enrollment additions, terminations and/or changes must be submitted through KTBSonline (www.ktbsonline.com) or an approved Election Form or
Termination/Change Form and received prior to the requested date as per the carrier guidelines. Subscriber and dependent additions or changes for
previous months require carrier approval and will not appear on your statement unless approved and confirmed.
Employer and Employee signatures are required on paper forms requesting additions and changes; only Employer signatures are needed for terminations.
Terminations for dependents who are over the maximum age for dent coverage must be forward Pa be obtained at
www.ktbsonline.com or by contacting the KELLY Call Center at Kellyway.com or by phone at or
It is important that you review your invoice to ensure discrepancies are identified and resolved timely. KELLY will not assume liability for any discrepancy
reported to us beyond 30 days.
y proce rollment updates through www.ktbsonline.com. Paper f e sent to KELLY’s Enrollment Team via fax
, email Kellyway.com) or mail, to KELLY, Attn: Enrollment, Sparks, MD 21152.
Change of Address
To change a group address, please contact the KELLY Call Center at Kellyway.com and note if the change is for your mailing address only or for
your physical and mailing address.
Monthly Statements: Available online!
An electronic version of your KELLY statement is available to you through KTBSOnline (www.ktbsonline.com). To view your bill online, you will need
to visit www.ktbsonline.com and enter your Username and Password to log on to your company benefits page. If you do not have a Username and
Password, you may obta em by visiting www.Kellyway. ng r & Client Login. You may also contact the KELLY Call
Center for assistance, at Kellyway.com or by phone at or SAVE TIME: We offer auto debit and online payment
options. Visit www.ktbsonline.com to enroll today.
.................................................................................................................................................................
Please remove this portion of the statement and return with your check or money order made payable to KELLY
Please be sure to include your Account Number (CO ID shown below) in the memo field of your check or money order.
The Balance Due on your bill is expected to be paid in full by the Due Date.
Previous Balance December 2018 Coverage Adjustments to Account Payment(s) Received Balance Due By
(Billing Date 11/05/2018 ) After Last Month's Billing --Thank You-- 12/01/2018
$180.00 $180.00 $0.00 ($180.00) $180.00
Payment address:
KELLY SAVE TIME Payment Enclosed $_______________________________
We offer auto debit and
BOSTON, MA 02241-8926 online payment options!
KELLY
Visit www.ktbsonline.com
(Contact KELLY for overnight courier address) to enroll today!
KELLY Co ID:
KELLY | Customer Service hours Monday through Friday 8:30 A.M. to 5:30 P.M. Page 2/2
1 Kelly Way, Sparks, MD 21152 | / | FAX: | Customer Service Email: kellyway.com
kellyway.com
