Employee Wage and Benefits Statement – 2004
|
Employee:_________________________
|
SSN:_____________________________
|
|
| Base Wage or Salary | $ _______________ | |
| Vacation Pay | $ _______________ | |
| Bonus or Incentive Pay | $ _______________ | |
| Other | $ _______________ | |
| Total Direct Cash Compensation | $ ____________ | |
| Commodities or Produce | $ _______________ | |
| Personal Use of Farm Equip. (including vehicles) | $ _______________ | |
| House | $ _______________ | |
| Utilities | $ _______________ | |
| Meals | $ _______________ | |
| Life Insurance | $ _______________ | |
| Health Insurance | $ _______________ | |
| Retirement Plan | $ _______________ | |
| Employer’s Share of Social Security Taxes | $ _______________ | |
| Other: _________________________ | $ _______________ | |
|
Other: _________________________ |
$ _______________ | |
|
Total Fringe & Non-cash Benefits
|
$ ____________
|
|
| Total Compensation – 2004 | $ ____________ | |