FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`NYSCEF DOC. NO. 43
`
`INDEX NO. 614305/2016
`
`RECEIVED NYSCEF: 01/04/2019
`
`Exhibit I
`
`Plaintiff Shapiro’s Payroll Records (Bates stamped
`JTMMH000107-127, 131-151, 461, 463-472)
`
`

`

`
`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`__'INDI'3"X_' NO. 614305/2016
`
`FI-LEDv:--—SUFE9LK--~C—0ImT—Y—GLERK—O—1 £92!
`0199-.--‘-~05.-:-~1.-
`
`
`
`
`
`
`
`NYSCEF DOC. NO. 43
`RECEIVED NYSCEF: 01/04/2019
`NYSCEF DOC; NO. 43,
`‘
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`R«C«Iqu UYSCEF: 01/04/2019
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`John T. Mather Memorial. HpsPitaI
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`01/26/2006
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`Check Number
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`71.7945
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`421 01/26/06 717946
`3700
`Perry Shapiro
`4.l Eaton Kane
`West Islip,NY 1179s
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`01/08/06
`. Net Pay
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`3,051.72
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`SSN
`Hire Date
`06/18/96
`' PeriodlEnd
`01/21/06
`.
`Clock
`A
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`Status
`. '1‘
`Check Type
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`Net Check
`3,051.72
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`
`Total Gross Pay
`Hours
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`Current Amt
`thl Amt
`'
`'
`Tom! Gross Pay
`43063“.
`MEETING '_
`0.00
`0.00
`0.00
`.' Federal Taxes
`~910.14
`REGULAR
`0.00
`. 0.00
`12,652.88
`‘
`NEW YEAR DAY
`0.00
`0.00
`869.40
`Stat? and L°°al Taxes
`'245'08
`PRESIDENTS DAY
`0.00
`0.00
`0.00
`Other Deductions
`0.00
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`MEMORIAL DAY
`0.00
`0.00
`0.00
`Net Pay
`.
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`.
`'
`_
`JULY 4TH
`0.00
`0.00 _
`0.00
`_
`LABOR DAY
`0.00
`0.00
`0.00
`Du-ect Deposus
`0.00
`
`COLUMBUS DAY
`0.00.
`0.00
`0.00
`. Net Check ,4
`'
`. THANKSGIVING
`0.00
`0.00
`0.00
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`0.00
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`0.00
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`0.00
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`0.00’
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`4,206.94
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`Currant Amt
`Benefits
`72.60
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`PENSION HOURS
`0.00
`0.00 0
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`352.53
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`72.60.
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`Status~
`Taxable Current Amt‘ ma Amt '
`Federal Income Tax
`. M-4
`4,206.94
`588.31
`- 3,405.14
`OASD; '
`4,206.94
`260.83
`1,202.07
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`4,206.94
`.
`61.00
`281.13
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`M-4
`4,206.94 .
`245.08
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`-1.155.22
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`6,103.94.
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`Other Deducfi'ons from Pay
`HANYS4033
`
`JTM INSURANCE Premier
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`-
`
`'
`
`Current Amt.
`0.00
`
`YtdAmt
`. 600,00 9
`
`o.00_
`
`~ 152.36 a
`
`*
`
`JTMMH000107
`
`

`

`
`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`_
`INDEX No. 51g305/2016
`
`FI—LED—z-«SU—FFQLKmC—QUNT—Y—G- -
`,
`-
`{3204940544542
`
`
`
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`
`
`NYSCEF DOC. NO. 43
`RnCnIVnD‘fiYSCEF: 01/04/2019
`NYSCEF DOC. NO. 43
`RECEIVED NYSCEF: 01/04/2019
`
`0.00
`752.36
`
`I
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`
`‘ 0 This code' is shown for information only. It has no effect on your net pay.
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`

`

`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`l_.II.}I_l_D_Ij3‘§§___N_O. 614305/2016
`
`NYSCEF DOC. NO. 43
`NYSCEF DOC. NO: 43
`'
`'
`_'
`
`INDEX NO. 614305/2016
`
`
`
`
`RECEIVED NYSCEF: 01/04/2019
`R4c41v4D NYSCEEz'01/04/2019
`
`‘IJ/b- III/IIvnII/II<I7I¢II!(II[J 7hikis‘l1’ll!!£/?C’:kl'?.’l).)~7/lnl\HOIUPI'N'II/f‘0”? l/thIlv/tltllu/lU/L’ IIInnIIu/c/LIIII/IIII/II [Ilia/144010004114
`l<.I
`E.’
`John}T.vMather Memorial Hospital
`.
`.
`'
`'
`CheckDate
`'
`,
`Check Number
`1'-
`75106101”(loamy Road
`.
`.
`01/25/2007
`_
`.
`733812
`Port Jefferson, NY 11777
`‘
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`(631) 4734320
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`
`‘
`
`'3700 .421 01/25/07 755312
`Perry‘Shapiro
`41 Eaton Lane
`West Islip, NY 1 1795
`
`' VOID 7 This is not a check
`
`Payroll Check
`.
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`
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`ayt ls
`, #4444244: 3329.12
`Amount Thlee Thousand Th1ee Hundled Twenty-~Nine Dollars And Twelve Cents *********"‘******‘****‘
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`mun/Imam: 02111-”I! WA!
`
`Emp [cl
`-
`421-
`L‘oc
`.
`, 765-00
`Period Begin
`01/07/07
`Ne; Pay
`3,329.12
`SSN
`- 1_ Hire Date
`06/18/96
`Period End
`01/20/07
`Clock
`,
`- 421
`Status
`T
`Check Type
`2ndClleck
`
`Net Check
`
`3,329.12
`
`.
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`Total Gross Pay
`Hours
`Rate
`Current Amt
`Ygd Amt
`MEETING
`0.00
`0.00
`4,452.00
`REGULAR
`0.00
`0.00
`12,955.00
`.NEW YEAR DAY
`0.00
`0.00
`890.40 .
`PRESIDENTS DAY
`0.00
`0.00 ,
`0.00
`MEMORIAL DAY
`0.00
`0.00 .
`0.00
`JULY 4TH
`0.00
`0.00
`0.00
`LABORDAY
`0.00
`0.00.
`0.00
`‘ COLUMBUS DAY
`0.00
`0.00
`0.00
`THANKSGIVING
`0.00
`.000
`0.00
`CHRISTMAS
`0.00
`0.00
`890.40
`PERSONAL DAY 1
`0.00
`0.00
`890.40
`PERSONAL DAY2
`0.00
`0.00
`0.00
`PERSONAL DAY 3
`0.00
`0,00
`0.00
`PERSONAL DAY 4
`0.00
`0.00
`. 0.00
`MISCELLANEOUS
`0.00
`0.00
`0,00
`RETRO PAY
`0.00
`0.00
`. 0.00.
`-
`Sick Dollars
`0.00
`4,649.52
`4,649.52
`' CURYEARVAC
`0.00
`0.00
`0.00-
`
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`0.00
`‘
`0.00
`. 0.00 ~
`0.00.
`4,649.52
`24,757.72
`
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`
`Total GrbsS Pay
`Federal Taxes
`
`.
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`.
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`.
`
`State and Local Taxes
`Other Deductions
`Net Pa
`.y
`. 4
`DlreotDeposIlts
`
`.
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`.
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`
`4
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`4,649.52
`. 4,039.70
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`.
`. 0.00
`77.16
`PENSION HOURS
`0.00
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`Sick Dollars
`464.50
`1.22479 0
`‘
`. 0.00
`77.16
`
`.
`
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`
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`
`'
`Taxes
`Federal Income Tax
`OASDI
`Medicare
`New York SITW
`NY Disabllity - EE
`
`Status
`M-4
`
`M-4
`
`.
`
`Taxable Current Amt
`4,649.52
`684.01
`4,649.52
`288.27
`4,649.52
`”67.42
`4,649.52
`280.70
`0.00
`0.00
`1,320.40
`
`.
`
`Ytd Amt
`5,005.3 l
`‘ 1,529.09
`357.61
`1,604.63
`2.40
`8,499.04
`
`Other Deductions frqm Pax '
`HANY5403B
`JTM INSURANCE Premier
`
`>
`
`.
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`Current Amt
`0.00
`0.00
`
`Ytd Amt
`600.00 a
`172.20' 8
`
`.
`
`'
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`..
`
`,
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`_
`
`I
`
`JTMMH000109
`
`

`

` 65125102029 7‘ ea fcgzwiae u" out aomrnuntfy
`
`-='
`
`-
`
`
`
`
`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`INDEX NO .
`6 1 4 3 0 5 / 2 0 1 6
`FI_]':.EP__: “SUFFOLK
`C_I:‘ERK__ 01m 2 Q 1 9 ‘ 0 5 : 1 5 P
`
`
`
`
`
`
`
`NYSCEF BO‘C '_ NO ' 4? .
`______________,_._n_.=..=~. Ri-CjE—{ITD uYSEEF ;
`0 1 /E)4'/210 1 9
`RECEIVED NYSCEF: 01/04/2019
`NYSCEF DOC. NO. 43
`
`I OUNTRY ROAD ' PORT JEFFERSON ' NEW YORK 11777-2190 ' 631-473-1320.
`
`www.muiherhospilal.org
`
`September 16, 2004
`
`AAPS
`Board of Certification in Emergency Medicine
`2296 Henderson Mill Rd.
`Atlanta, GA 30345
`'
`
`Re: Perry Shapiro
`
`Dear Sirs:
`
`Please let this letter serve as verification that Dr. Perry Shapiro has been employed as an
`Emergency Room Physician at John T. Mather Memorial Hospital from calendar years
`1996 —- present. Itemizations of his years (1996-2003) and hours worked are as follows:
`
`\
`
`YEAR
`
`1996 -
`1997
`1998
`1999
`2000
`2001
`2002
`2003
`
`r
`
`HOURS
`
`STATUS
`
`951
`2,080
`1,955
`2,015
`2,023
`1,935
`1,975
`2,005
`
`Full Time
`Full Time
`Full Time
`Full Time
`Full Time
`Full Time
`Full Time
`Full Time
`
`Sincerely,
`
`0mg,W
`
`Diane Marotta
`V.P. for Human Resources
`
`:kw
`
`MEMBER or me Mather as St. Charles HEALTH ALLIANCE . CARING FOR you AND YOUR FAMILYITMMH000098
`
`

`

`
`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`__'INDI'3"X_' NO. 614305/2016
`
`FI-LEDv:--—SUFE9LK--~C—0ImT—Y—GLERK—O—1 £92!
`0199-.--‘-~05.-:-~1.-
`
`
`
`
`
`
`
`NYSCEF DOC. NO. 43
`RECEIVED NYSCEF: 01/04/2019
`NYSCEF DOC; NO. 43,
`‘
`"
`~.
`-
`R«C«Iqu UYSCEF: 01/04/2019
`
`,
`
`.
`
`I'D/I) - 7723/3 nm a aha-ck VOID -' 7m: Is no! a check I’OID - This is um a chunk VOID - TIn'x Ix no! a check VOID - Til/0‘ Lv IIOI a check VOID ~ This is no! r/ char/r.
`f
`.
`7,5.
`John T. Mather Memorial. HpsPitaI
`if
`.3.
`3 75 Norgh Country Road
`- E
`E Poft Jefferson, NY 11777
`g
`.,,
`3::
`5
`(631) 473-1320
`[,3
`‘
`IS-
`l
`.
`R Pay 01'
`Payroll Check F5
`
`
`g Amount: Three Thousand Fifty-One Doliars And Seventy-Two Cents ****f*********************
`'
`- *****.* 3,051.72 g
`
`
`n
`n
`'
`‘
`-
`U
`
`'
`
`'
`
`\
`
`'
`
`.
`
`,
`
`'
`
`‘
`
`.
`
`'
`
`Check Date
`01/26/2006
`
`-
`
`.
`
`Check Number
`-
`71.7945
`
`.
`
`>3
`:
`
`'
`
`E
`3 Payto
`T3
`the order 0“-
`A,
`4
`
`421 01/26/06 717946
`3700
`Perry Shapiro
`4.l Eaton Kane
`West Islip,NY 1179s
`
`VOID — Tins IS not a check
`“
`J
`
`‘
`
`3:-
`:
`
`§
`A?
`g:
`.
`
`"0!I) 1- Thls is m» a check VOID ~ This 115' not :7 clmrk VOID - This is no! u chew/r VOID r This is m»! ('1 check VOID - This is m)! u thee/r I’OID - This is mu (1 chug/t
`'
`'
`'
`I
`wuzomm/mu mot-m:um
`
`
`Emp Id
`fl Loc
`' 765-08
`.
`Period Begin
`01/08/06
`. Net Pay
`'|
`.
`3,051.72
`1
`SSN
`Hire Date
`06/18/96
`' PeriodlEnd
`01/21/06
`.
`Clock
`A
`421
`Status
`. '1‘
`Check Type
`anCheck
`Net Check
`3,051.72
`
`
`Total Gross Pay
`Hours
`Rate
`Current Amt
`thl Amt
`'
`'
`Tom! Gross Pay
`43063“.
`MEETING '_
`0.00
`0.00
`0.00
`.' Federal Taxes
`~910.14
`REGULAR
`0.00
`. 0.00
`12,652.88
`‘
`NEW YEAR DAY
`0.00
`0.00
`869.40
`Stat? and L°°al Taxes
`'245'08
`PRESIDENTS DAY
`0.00
`0.00
`0.00
`Other Deductions
`0.00
`
`MEMORIAL DAY
`0.00
`0.00
`0.00
`Net Pay
`.
`.3.
`.
`'
`_
`JULY 4TH
`0.00
`0.00 _
`0.00
`_
`LABOR DAY
`0.00
`0.00
`0.00
`Du-ect Deposus
`0.00
`
`COLUMBUS DAY
`0.00.
`0.00
`0.00
`. Net Check ,4
`'
`. THANKSGIVING
`0.00
`0.00
`0.00
`.
`CHRISTMAS
`0.00
`0.00
`869.40
`PERSONAL DAY 1
`0.00
`0.00
`869.40
`PERSONAL DAY2
`0.00
`' 0.00 _
`0.00
`PERSONAL DAY 3
`0.00
`0.00
`0.00
`PERSONAL DAY4 .
`0.00’
`0.00
`1 0.00
`MISCELLANEOUS
`0.00
`4,206.94
`4,206.94 -
`RETRO PAY 4
`-'
`0.00
`0.00
`.
`0.00 .
`CURYEARVAC
`0.00
`0.00
`0.00
`'PRIORYEARV'AC
`0.00
`0.00
`0.00
`
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`
`19,468.02
`4,206.94
`‘
`'Ytd Amt
`Currant Amt
`Benefits
`72.60
`a 0.00
`GTL
`PENSION HOURS
`0.00
`0.00 0
`
`Sick Dollars
`352.53
`‘
`901,23 0
`0.00
`72.60.
`
`‘
`
`a
`
`.-
`
`‘
`
`
`Taxes
`Status~
`Taxable Current Amt‘ ma Amt '
`Federal Income Tax
`. M-4
`4,206.94
`588.31
`- 3,405.14
`OASD; '
`4,206.94
`260.83
`1,202.07
`‘ Medicare
`4,206.94
`.
`61.00
`281.13
`NewYmk srrw
`M-4
`4,206.94 .
`245.08
`1,214.20
`
`NY Disability . EE
`-
`0.00
`'
`0.00
`2.40
`
`_
`
`'
`
`'
`
`'-
`
`-1.155.22
`
`6,103.94.
`
`,
`
`Other Deducfi'ons from Pay
`HANYS4033
`
`JTM INSURANCE Premier
`
`-
`
`'
`
`Current Amt.
`0.00
`
`YtdAmt
`. 600,00 9
`
`o.00_
`
`~ 152.36 a
`
`*
`
`JTMMH000107
`
`

`

`
`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`_
`INDEX No. 51g305/2016
`
`FI—LED—z-«SU—FFQLKmC—QUNT—Y—G- -
`,
`-
`{3204940544542
`
`
`
`
`
`
`
`NYSCEF DOC. NO. 43
`RnCnIVnD‘fiYSCEF: 01/04/2019
`NYSCEF DOC. NO. 43
`RECEIVED NYSCEF: 01/04/2019
`
`0.00
`752.36
`
`I
`
`"
`
`‘ 0 This code' is shown for information only. It has no effect on your net pay.
`8 This code is not included in your Federal taxable wages.
`'
`
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`
`‘
`
`I.
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`,~
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`
`' _JTMMH000108
`
`

`

`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`.
`,
`, 6.1.4 395.129 1 6
` FI—LEBJ. —-sUFF0L-K—eeUN—T—Y—GLERK- 0:1 {IV-209435 :-
`
`
`
`NYSCI
`
`R«CRIV«D NYSCEFz'Ol/D4/2019
`NYSCEF DOC. NO. 43
`RECEIVED NYSCEF: 01/04/2019
`3F Doc. NO. 43
`
`0100
`772.20
`
`0 This cod; is shown for information only. It has no‘ effect on .your net pay.
`6 This code iwot included in your Fademl taxable wages.
`
`.
`
`. JTMMH000110
`
`

`

`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`
`
`FILED. SUFFOLK COUNTY CLEBKm012019 05:15 P INDEX NO “4305/2016
`
`
`
`
`
`
`NYSCEF DOC. NO. 43 _
`,
`R3c31v3D N15023F.01/04/2019
`NYSCEF DOC. NO. 43
`RECEIVED NYSCEF: 01/04/2019
`
`r-
`
`*
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`L
`
`.
`
`.
`
`1
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`'11“I-Iil) 'Iim 151740 0 47742151131“. 'I'hi' ix MI I: chmk I'CIIIJ- Zl‘hix 'iSIwI (I cliurrl: I'D/LI; This: i1.- Im/ «film-I." VOID « 'I‘Iu’x 1‘1: 00/ 17 aim-l. Will)- '/'!n'0' 1': ual (.1 1:111:01:
`4
`.
`.‘C
`John T. Mather Memorial Hospital
`.
`'
`.
`'
`Check Date
`Check Number
`55
`‘75-North Country Road
`'
`01/24/2008
`749285 '
`3'
`PortJefferson,NYll7.'/7
`(631)473-1320
`r h.
`
`-
`
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`
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`
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`NN.
`3‘:.-
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`Payro!kCheck I:
`Pa th'
`
`413100;; Three Thousand Nm‘e HundredNinety-one Dollars And Thuty Cents 14144444**3“**.**********'
`_
`
`..
`,
`"~
`421 01/24/01 749275
`
`‘
`
`’.
`
`-
`
`3701
`
`Pay to
`the order of-
`
`Perry Shapiro-
`41EatonLane
`West Islip, NY 11795
`
`.
`
`L
`
`I VOID-This is notacheck
`
`I'CII'D—Thisisno!0died:
`
`‘(Wlb Tim [1770! «that i'OlD— J‘IIIS IS [Jul (1 6/1804 F'l'J/D. ThisisnIIIac‘hulcl’CIID- This» 770/ (IL/ml! VOID- Tmsn nol (Him/I VOID 7711.111 not (I I‘lm‘t
`wuzmuwflmm U fill-1m: WAY
`
`
`_ Bmp Id
`421
`Loc
`765-08
`- Period Begin
`01/06/08
`Net Pay
`3,991.30
`SSN
`1- Hire Date
`06/13/96 “
`Period End
`01/19/08
`Clock
`421
`Status
`,
`T
`Check Type
`2nd Check
`Net Check
`3,991.30
`-
`
`,
`
`.
`
`
`
`'
`
`‘
`
`Rate
`
`._
`
`-.
`
`~
`
`.
`
`. Total Gross Pay
`Federal Taxes
`
`5,751.30
`’ 4,389.62
`
`-370.38 '
`0 00
`
`~
`
`-
`
`.
`
`~
`
`.
`
`Ytd Amt
`Current Amt
`Hours
`Total Gross Pay
`0.00
`0.00
`0.00
`MEETING
`15,333.00
`0.00
`0.00
`REGULAR
`$57.60
`0.00
`0.00
`NEW YEAR DAY
`0.00 -
`0.00
`0.00
`PRESIDENTS DAY
`0.00
`0.00 .
`0.00 .
`MEMORIAL DAY
`0.00
`0.00
`0.00
`JULY 4TH
`0.00
`0.00
`0.00
`LABORDAY
`0.00
`0.00
`0.00
`COLUMBUS DAY
`0.00
`0.00
`0.00
`THANKSGIVING
`957.60
`0.00
`0.00
`CHRISTMAS
`957.60
`0.00
`0.00
`. PERSONAL DAY '1
`0.00
`0.00‘
`0.00
`PERSONAL DAY 2
`0.00
`0.00
`0.00
`PERSONAL DAYS
`0.00
`0.00
`0.00
`PERSONAL DAY 4'
`0.00
`0.00
`_ 0.00
`MISCELLANEOUS
`5,751.30
`5,751.30
`0.00 .
`Sink Dollais
`CUR YEARVAC
`'
`0.00
`'
`0.00,
`0.00
`
`PRIOR YEAR VAC '
`0.00
`.
`0.00
`1957.60
`'
`0.00
`5,751.30
`24,914.70
`
`Benefits
`Current AFnt _
`Ytd Amt
`GIL
`- 0.00
`53.73
`PENSION HOURS
`‘
`~
`0.00
`0.00 0
`Sick Dollars
`'
`442.67
`1,114.97 0
`
`
`.
`
`'
`
`State and Local Taxes
`- Other Deductions
`-
`
`.
`
`13101- Pf”
`_
`DII‘CCt Dep051ts
`at
`N Check
`
`.
`
`_
`
`
`
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`
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`
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`»
`
`'
`
`-
`
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`
`'
`
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`
`.
`
`,
`
`'
`
`'
`
`0.00
`
`83.78 ‘
`
`
`Taxes
`.
`-
`Status
`‘ Taxable Current Amt
`Ytd Amt
`Federal Income Tax
`.M-4
`_ 5,751.30
`. 949.65 -
`4,834.55
`OASDI
`,
`5,751.30
`356.58
`1,538.34
`‘
`Medicare
`5,751.30
`83.39 -
`359.77
`New York srrw
`M-4
`. 5,751.30
`370,33.
`.
`1,623.81
`
`NY Disability - E15
`0.00
`0.00
`2.40
`
`.
`
`.
`
`‘
`
`Other Deducfioné fiom Pa!
`’HANYS403B
`JTM INSURANCE Premier
`
`.
`
`.
`
`'
`
`1,760.00
`
`8,358.87
`
`Current Amt
`0.00
`0.00
`
`Ytd Amt
`600.00 9
`186.54 9
`
`’
`
`-.
`
`.
`
`:4
`
`.
`
`.'
`
`.
`
`y
`
`_
`
`.
`
`JTMMH000111
`
`

`

`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`
`wMAagilé-f? __
`
`NYSCEF DOC. NO. 43
`NYSCEF DOC. NO. 43'
`‘”
`7
`J
`-
`_
`.
`i
`.g
`"
`‘
`
`
`INDEX NO. 614305/2016
`. w_w._,__6..1_4.30_/LZ_016
`
`
`
`
`
`RECEIVED NYSCEF: 01/04/2019
`RfiCfiIVyD fiyscaF; 01/04/2019
`
`,
`
`186.54
`0.00
`q. 0 This c0de is shown for information only. It has no effect on your net pay.
`' 0 This €ode is not inqluded in your Federal taxable wages.
`|
`
`'
`
`~
`
`I‘
`
`.
`
`-
`
`-
`
`' J_TMMH00()112'_
`
`

`

` INDEX NO.
`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`
`614305/2016
`FILED. SUFFOLK COUNTY CLERK 01M2019 05:15 P ___________,«II/«D
`
`
` I‘D-:1]
`
`R4-C
`NYSC.
`01/04/2019
`RECEIVED NYSCEF: 01/04/2019
`NYSCEF DOC. NO. 43
`3F DOC. NO. 43
`‘
`.
`I
`
` NYSCIF
`
`'1
`
`“DI/.1-IhIIIsmIIo-‘I‘IuiIH’IJ 'lhitiaI1!!ItIt"hII¢/Ii(.IID- 71H”?Iia/tluluii‘ifni) mnnnulm/m-i14)!!! [17'1“176,d(/ll1(/ 1'01!)-/'III'.I‘I'i'ImII'Ic/IuI
`Check Number
`763963
`
`
`
`
`
`1'01)?)-Thisixmuachar]:VOID-ThisisumI;that]:*
`
`John T. Mather Memorial Hospital
`75North.CountryRoad
`Port Jefferson, NY 11777
`(631) 473-1320 -
`
`'Check Date .
`01/22/2009
`
`Pay this
`A",aunt Three Thousand Eight Hundred Nineteen DollarsAnd Twenty
`
`«Payroll Check
`
` ****** 3,819.22
`-Two Cents *flI-HHMHHHHH
`
`V012)": This is not a check
`
`3703
`
`421 ill/27109 763963
`
`Pay to
`th" 0rd“ 0f'
`
`Perry Shapiro
`41 Eaton Lane
`West lslip, NY 11795
`
`L.
`
`
`
`T1'1)!0-Thisisno!aglut]:IUI'D-77mIsno!udie-alt.
`
`’U/D- f/‘lIlH/SHUHJC/‘flT/I‘ i"()/D- ”IMHHIIIUIIIGKII i'.-i7/D
`
`/'IIII'I5 nor a duck VCII'D- ThisI.\ mil (1 check 1010- 771i:IA‘ nor a thee/I I'OID' Thisix no! (I check
`vanmwmm OMMIZ50"!
`
`
`
`Emp Id
`ssu
`Clock
`
`421
`10-
`421
`
`Loc
`Hire Date
`Status
`
`.
`
`765,418
`06/18/96 _
`. ' ”I
`
`Period Begin
`Period End
`Cheek Type
`
`.
`
`(11/04/09
`01l17/09
`2ndChecit
`
`~i Net Pay-
`.
`.
`Net Check
`
`3.81922
`I
`
`3.819.22
`
`
`
`Ytd Amt
`Current Amt
`Total Gross Pay ' Hours
`0.00
`0.00
`MEETING
`0.00
`17,955.00 '
`0.00
`REGULAR.
`0.00
`957.60
`0.00
`NEW YEAR DAY
`0.00
`0.00
`0.00
`PRESIDENTS DAY
`0:00
`0.00
`0.00
`MEMORIAL DAY
`0.00
`0.00
`0.00
`JULY 4TH
`0.00
`0.00
`0.00
`LABOR DAY
`0.00
`0.00
`0.00
`COLUMBUS DAY
`0.00
`0.00
`0.00
`THANKSGIVING
`0.00
`957.60
`0.00
`CHRISTMAS
`- 0.00
`0.00 .
`0.00
`PERSONAL DAY 1
`. 0.00
`0.00
`0.00
`PERSONAL DAY 2
`0.00
`0.00
`0.00
`PERSONAL DAY 3
`0.00
`0.00
`0.00
`PERSONAL DAY 4
`0.00
`0.00
`0.00
`SICK
`0.00
`0.00
`0.00
`MISCELLANEOUS
`0.00
`0.00
`0.00
`Performance Comp
`0.00 .
`0.00
`0.00
`,RE‘I‘RO PAY
`0.00
`5,426.91
`5,426.91
`Sick Dollars
`0.00
`0.00
`0.00
`-
`CUR YEAR VAC
`0.00
`
`. PRIOR YEAR VAC
`0.00
`0.00
`0.00
`
`z
`
`'
`
`Rate
`
`'
`
`.
`
`,
`
`.
`
`»
`
`'
`
`'
`
`‘
`
`‘
`
`Total Gross Pay
`
`' Federal Taxes
`State and Local Taxes
`Other Deductions
`
`Net Pay
`
`Direct Deposits
`Net Check
`
`e42e91
`-1,263.71_
`-34198
`
`ooo
`
`
`
`
`
`25,297.11
`5,426.91
`.
`0.00
`‘
`
`Benefits
`Current Amt
`Ytd Amt
`GTL
`‘
`0.00
`83.78 '
`'
`PENSION. HOURS
`0.0:;
`0.0.0 0
`
`Sick Dollars
`245.04
`949.08 0 _
`000
`83.78
`
`'
`
`
`Taxes
`Status.-
`Taxable . Current Amt
`Ytd Amt
`Federal Income Tax
`M-4
`5,426.91 -
`' 848.55
`4,865.98
`OASDI
`5,426.91
`336.47
`1,560.44
`Medicare
`5,426.91
`.7869
`364.94
`M—4
`New York' SITW
`5,426.91
`343.98
`1,647.46
`
`NY Disability - 1313
`0.00
`0.00
`2.40
`1,607.69
`8,441.22
`
`‘ Other Deductions from Fe
`HANYS4OSB
`
`~
`
`.
`
`I
`
`Current Amt
`0.00
`
`Ytd Amt
`
`600.00. 8
`
`JTMMH000113
`
`

`

`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`
`
`;_SUEEOLK_.COUN.TI_ CLERK—01mm
`
`NYSCEF DOC. NO. 43
`NYSCEF pQC. NO. 43
`'*
`3
`i
`
`
`
`INDEX NO. 614305/2016
`INDEX_NQ:_§14305/2016
`
`
`
`
`
`R«C«IV«D VYSCEF: 01/04/2019
`RECEIVED NYSCEF: 01/04/2019
`
`
`
`,
`1
`
`D‘EN'FAL INSURANCE .
`JTM lNSURANCEPrgnier
`
`-
`
`.
`
`4
`
`A
`
`0.00
`0.00
`0.00
`
`14.00 a
`193.43 a
`' 812.48
`
`‘ (“This code isshown for information only. It has no effept'on your'net pay.
`9 This code is horincluded in your Federal taxable wages.
`
`JTMMH000114
`
`

`

`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`FILED. SUFFOLK COUNTY CLERK 012019 05:15_P
`
`NYSC.
`EF DOC. NO. 43
`3.
`NYSCEF DOC. NO. 43
`1
`
`INDEX NO.
`
`614305/2016
`INDEX NO. 614305/2016
`
`
` :IVED \IYSCEE:
`01/04/2019
`RECEIVED NYSCEF: 01/04/2019
`:REc:
`
`7
`
`r
`
`IIII:I: um 11 clmc‘.r
`
`
`
`
`
`VOID—This'111'I70:d:chchcVOID-7'71“;12711;}!achm-l:
`
`‘ lVII-I) flue-01774.71 r: (Inc/1 HJIIJJ- 7hIIII'1noIrII.I'.LI:.I'l III/l.)- I'JIE.1'I'.1'II¢II II qlmm’r I’Oil.) - 'I’."II‘11 I'.1' HUI l'lh'llGil'I l(JILP- 'lIIix71' MI filial/117 l(JIF-
`.4.I4‘’4"C.1-.
`Ch‘eck Dhte
`Check Number
`John '1‘. Mather Memorial Hospital
`’01/21/2010
`777971
`75 Noflh County Road
`'02
`Port Jefferson, NY 11777
`.8:V...
`(631) 473-1320
`IE1
`
`,.
`
`'
`
`421 01721710 777971 '
`3701
`Perry Shapiro
`Pay to
`them!” Of-, 41134110113111:
`'
`West [slip',NY 11795 .
`
`.VOID - IThIs £9..qu a‘ check
`I
`.
`
`;5
`
`Q 31
`
`'
`
`‘.
`~5<LI
`3\'4
`eNr.
`5 .
`K"
`. 14'
`Eis.1
`C:
`R,u
`
`Payroll Cheek
`.
`'.
`Pay thié
`411114-401 331024
` '
`Amo'umI Three Thousand Seven Hundred Ten Dollars Angl Twenty-F901 Cents*****************f"-”‘****'
`
`
`
`
`
`
`Tm:Io nom thee/I I’OID- Thu 11 nu! ucIm/IIfC’IID- '.TIII'H'.1' mIl admir-
`IDID - Tlmix I‘wI-u :‘IIE'L'II VOID - TIIIS 711' 770/ 17 whack .I'IC'IIDZ Til/4' I: no! u check VOID-
`uvua'ammanla 620010011 mi
`
`
`
`
`Bmp‘ld
`~ SSN
`Clock
`
`-
`
`.
`
`~421
`10—.
`421 .‘
`
`.L00-
`1-10.: Date
`810qu
`
`7550:;
`06/18/96
`T
`
`.
`
`Period Begin
`Beriod End
`Check Type I
`
`01/03/10
`01/16/10 I.
`2ndCl1eclc
`
`. :17:th
`.
`'_ NetCheck
`
`' 3.710.24
`
`3,710.24
`
`
`5,293.04
`T_oItaI Gross Pay _
`-1,205.84
`Federal Taxes
`State and Local Taxes
`cher Dedfictions
`Net Pay
`
`Rate
`
`-
`
`_
`
`.
`
`Ytd Amt
`Cunent Amt
`Hours
`. Total Gross Pay
`0.00
`0.00
`0.00
`MEETING
`-
`19,825.00
`0.00
`0.00
`,
`REGULAR
`1,092.00
`0.00
`. 0.00
`NEW YEARDAY
`0.00
`0.00
`. 0.00
`PRESIDENTS DAY
`0.00
`0.00
`0.00
`MEMORIALIDAY
`0.00
`0.00
`‘ 0.00
`JULY 4TH
`0,00
`0.00
`0.00
`.LADOR'DAY _
`0.00
`0.00
`0.00
`COLUMBUSIDAY
`0.00
`0.00
`0.00
`THANKSGIVING
`1,092.00
`0.00
`0.00
`CHRISTMAS
`000
`0.00
`0.00
`- PERSONAL DAY I
`- 0.00
`0.00
`0.00
`PERSONAL DAY 2
`0.00
`0.00
`PERSONAL mm 000
`0.00
`-
`0.00
`PERSONAL DAY 4 .
`0.00
`5,245.27
`5,245.27
`Sick Dollars
`0.00
`CUR YEAR VAC.
`0.00
`.
`0.00
`.
`0.00
`
`PRIOR YEAR VAC
`7 . 0.00
`,
`0.00
`-
`-
`0.00
`
`;
`
`.
`
`.
`
`.
`
`-
`
`.
`
`‘
`
`
`
`DilectDepositsI .
`' Net Check ..
`
`
`
`‘
`
`0.00
`
`1
`
`5,245.27 ,
`
`21,254.27
`
`-
`
`YId Amt
`Cu'rrent Amt
`Benefits
`143.31
`, 47.77
`GTL
`PENSION HOURS
`.
`'
`~
`.
`-
`0.00.
`o00 0
`
`Sick Dolla'Is
`.
`'
`.
`'
`508.41
`1 276.73 o
`'
`47.77
`143.31
`
`'
`
`'
`
`
`. Taxes
`'
`Status
`Taxable Current Amt Ytd Amy '
`Federal Income Tax
`114-4
`5.293,04
`800;92
`5,520.32
`OAISDII
`‘
`5293,04
`328.17
`1,685.48.
`.
`Medicare
`5,293.04
`76.75
`394.13
`New York srrw
`M—4
`3.293104
`329.19 ,
`1,789.72
`
`.NY Di'sabilit'y ~EE
`-
`.
`0.00
`0.00
`_.2.40
`I
`'. 1,535.03 -
`9,392.60 '
`
`.
`
`I
`
`.
`
`.
`
`'
`
`Other Deductions from Pa
`H4NYS40313
`DENTAL‘ INSURANCE
`
`' Current Amt
`‘
`0.00
`0.00
`
`JTMINSURANCE Premier
`
`"
`
`'
`
`.~
`
`0.00
`
`'
`
`- Ytd Amt
`. 600.00 a
`14.00 a
`198.48 a ‘
`
`'
`
`"
`
`. " JITMMH000115
`
`

`

`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`.
`,
`, 6.1.4 395.129 1 6
` FI—LEBJ. —-sUFF0L-K—eeUN—T—Y—GLERK- 0:1 {IV-209435 :-
`
`
`
`NYSCI
`
`R«CRIV«D NYSCEFz'Ol/D4/2019
`NYSCEF DOC. NO. 43
`RECEIVED NYSCEF: 01/04/2019
`3F Doc. NO. 43
`
`0100
`772.20
`
`0 This cod; is shown for information only. It has no‘ effect on .your net pay.
`6 This code iwot included in your Fademl taxable wages.
`
`.
`
`. JTMMH000110
`
`

`

`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`
`
`FILED. SUFFOLK COUNTY CLEBKm012019 05:15 P INDEX NO “4305/2016
`
`
`
`
`
`
`NYSCEF DOC. NO. 43 _
`,
`R3c31v3D N15023F.01/04/2019
`NYSCEF DOC. NO. 43
`RECEIVED NYSCEF: 01/04/2019
`
`r-
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`*
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`1
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`4
`.
`.‘C
`John T. Mather Memorial Hospital
`.
`'
`.
`'
`Check Date
`Check Number
`55
`‘75-North Country Road
`'
`01/24/2008
`749285 '
`3'
`PortJefferson,NYll7.'/7
`(631)473-1320
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`
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`3‘:.-
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`Payro!kCheck I:
`Pa th'
`
`413100;; Three Thousand Nm‘e HundredNinety-one Dollars And Thuty Cents 14144444**3“**.**********'
`_
`
`..
`,
`"~
`421 01/24/01 749275
`
`‘
`
`’.
`
`-
`
`3701
`
`Pay to
`the order of-
`
`Perry Shapiro-
`41EatonLane
`West Islip, NY 11795
`
`.
`
`L
`
`I VOID-This is notacheck
`
`I'CII'D—Thisisno!0died:
`
`‘(Wlb Tim [1770! «that i'OlD— J‘IIIS IS [Jul (1 6/1804 F'l'J/D. ThisisnIIIac‘hulcl’CIID- This» 770/ (IL/ml! VOID- Tmsn nol (Him/I VOID 7711.111 not (I I‘lm‘t
`wuzmuwflmm U fill-1m: WAY
`
`
`_ Bmp Id
`421
`Loc
`765-08
`- Period Begin
`01/06/08
`Net Pay
`3,991.30
`SSN
`1- Hire Date
`06/13/96 “
`Period End
`01/19/08
`Clock
`421
`Status
`,
`T
`Check Type
`2nd Check
`Net Check
`3,991.30
`-
`
`,
`
`.
`
`
`
`'
`
`‘
`
`Rate
`
`._
`
`-.
`
`~
`
`.
`
`. Total Gross Pay
`Federal Taxes
`
`5,751.30
`’ 4,389.62
`
`-370.38 '
`0 00
`
`~
`
`-
`
`.
`
`~
`
`.
`
`Ytd Amt
`Current Amt
`Hours
`Total Gross Pay
`0.00
`0.00
`0.00
`MEETING
`15,333.00
`0.00
`0.00
`REGULAR
`$57.60
`0.00
`0.00
`NEW YEAR DAY
`0.00 -
`0.00
`0.00
`PRESIDENTS DAY
`0.00
`0.00 .
`0.00 .
`MEMORIAL DAY
`0.00
`0.00
`0.00
`JULY 4TH
`0.00
`0.00
`0.00
`LABORDAY
`0.00
`0.00
`0.00
`COLUMBUS DAY
`0.00
`0.00
`0.00
`THANKSGIVING
`957.60
`0.00
`0.00
`CHRISTMAS
`957.60
`0.00
`0.00
`. PERSONAL DAY '1
`0.00
`0.00‘
`0.00
`PERSONAL DAY 2
`0.00
`0.00
`0.00
`PERSONAL DAYS
`0.00
`0.00
`0.00
`PERSONAL DAY 4'
`0.00
`0.00
`_ 0.00
`MISCELLANEOUS
`5,751.30
`5,751.30
`0.00 .
`Sink Dollais
`CUR YEARVAC
`'
`0.00
`'
`0.00,
`0.00
`
`PRIOR YEAR VAC '
`0.00
`.
`0.00
`1957.60
`'
`0.00
`5,751.30
`24,914.70
`
`Benefits
`Current AFnt _
`Ytd Amt
`GIL
`- 0.00
`53.73
`PENSION HOURS
`‘
`~
`0.00
`0.00 0
`Sick Dollars
`'
`442.67
`1,114.97 0
`
`
`.
`
`'
`
`State and Local Taxes
`- Other Deductions
`-
`
`.
`
`13101- Pf”
`_
`DII‘CCt Dep051ts
`at
`N Check
`
`.
`
`_
`
`
`
`
`
`'
`
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`
`,
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`»
`
`'
`
`-
`
`,
`
`'
`
`.
`
`.
`
`,
`
`'
`
`'
`
`0.00
`
`83.78 ‘
`
`
`Taxes
`.
`-
`Status
`‘ Taxable Current Amt
`Ytd Amt
`Federal Income Tax
`.M-4
`_ 5,751.30
`. 949.65 -
`4,834.55
`OASDI
`,
`5,751.30
`356.58
`1,538.34
`‘
`Medicare
`5,751.30
`83.39 -
`359.77
`New York srrw
`M-4
`. 5,751.30
`370,33.
`.
`1,623.81
`
`NY Disability - E15
`0.00
`0.00
`2.40
`
`.
`
`.
`
`‘
`
`Other Deducfioné fiom Pa!
`’HANYS403B
`JTM INSURANCE Premier
`
`.
`
`.
`
`'
`
`1,760.00
`
`8,358.87
`
`Current Amt
`0.00
`0.00
`
`Ytd Amt
`600.00 9
`186.54 9
`
`’
`
`-.
`
`.
`
`:4
`
`.
`
`.'
`
`.
`
`y
`
`_
`
`.
`
`JTMMH000111
`
`

`

`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`
`wMAagilé-f? __
`
`NYSCEF DOC. NO. 43
`NYSCEF DOC. NO. 43'
`‘”
`7
`J
`-
`_
`.
`i
`.g
`"
`‘
`
`
`INDEX NO. 614305/2016
`. w_w._,__6..1_4.30_/LZ_016
`
`
`
`
`
`RECEIVED NYSCEF: 01/04/2019
`RfiCfiIVyD fiyscaF; 01/04/2019
`
`,
`
`186.54
`0.00
`q. 0 This c0de is shown for information only. It has no effect on your net pay.
`' 0 This €ode is not inqluded in your Federal taxable wages.
`|
`
`'
`
`~
`
`I‘
`
`.
`
`-
`
`-
`
`' J_TMMH00()112'_
`
`

`

` INDEX NO.
`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`
`614305/2016
`FILED. SUFFOLK COUNTY CLERK 01M2019 05:15 P ___________,«II/«D
`
`
` I‘D-:1]
`
`R4-C
`NYSC.
`01/04/2019
`RECEIVED NYSCEF: 01/04/2019
`NYSCEF DOC. NO. 43
`3F DOC. NO. 43
`‘
`.
`I
`
` NYSCIF
`
`'1
`
`“DI/.1-IhIIIsmIIo-‘I‘IuiIH’IJ 'lhitiaI1!!ItIt"hII¢/Ii(.IID- 71H”?Iia/tluluii‘ifni) mnnnulm/m-i14)!!! [17'1“176,d(/ll1(/ 1'01!)-/'III'.I‘I'i'ImII'Ic/IuI
`Check Number
`763963
`
`
`
`
`
`1'01)?)-Thisixmuachar]:VOID-ThisisumI;that]:*
`
`John T. Mather Memorial Hospital
`75North.CountryRoad
`Port Jefferson, NY 11777
`(631) 473-1320 -
`
`'Check Date .
`01/22/2009
`
`Pay this
`A",aunt Three Thousand Eight Hundred Nineteen DollarsAnd Twenty
`
`«Payroll Check
`
` ****** 3,819.22
`-Two Cents *flI-HHMHHHHH
`
`V012)": This is not a check
`
`3703
`
`421 ill/27109 763963
`
`Pay to
`th" 0rd“ 0f'
`
`Perry Shapiro
`41 Eaton Lane
`West lslip, NY 11795
`
`L.
`
`
`
`T1'1)!0-Thisisno!aglut]:IUI'D-77mIsno!udie-alt.
`
`’U/D- f/‘lIlH/SHUHJC/‘flT/I‘ i"()/D- ”IMHHIIIUIIIGKII i'.-i7/D
`
`/'IIII'I5 nor a duck VCII'D- ThisI.\ mil (1 check 1010- 771i:IA‘ nor a thee/I I'OID' Thisix no! (I check
`vanmwmm OMMIZ50"!
`
`
`
`Emp Id
`ssu
`Clock
`
`421
`10-
`421
`
`Loc
`Hire Date
`Status
`
`.
`
`765,418
`06/18/96 _
`. ' ”I
`
`Period Begin
`Period End
`Cheek Type
`
`.
`
`(11/04/09
`01l17/09
`2ndChecit
`
`~i Net Pay-
`.
`.
`Net Check
`
`3.81922
`I
`
`3.819.22
`
`
`
`Ytd Amt
`Current Amt
`Total Gross Pay ' Hours
`0.00
`0.00
`MEETING
`0.00
`17,955.00 '
`0.00
`REGULAR.
`0.00
`957.60
`0.00
`NEW YEAR DAY
`0.00
`0.00
`0.00
`PRESIDENTS DAY
`0:00
`0.00
`0.00
`MEMORIAL DAY
`0.00
`0.00
`0.00
`JULY 4TH
`0.00
`0.00
`0.00
`LABOR DAY
`0.00
`0.00
`0.00
`COLUMBUS DAY
`0.00
`0.00
`0.00
`THANKSGIVING
`0.00
`957.60
`0.00
`CHRISTMAS
`- 0.00
`0.00 .
`0.00
`PERSONAL DAY 1
`. 0.00
`0.00
`0.00
`PERSONAL DAY 2
`0.00
`0.00
`0.00
`PERSONAL DAY 3
`0.00
`0.00
`0.00
`PERSONAL DAY 4
`0.00
`0.00
`0.00
`SICK
`0.00
`0.00
`0.00
`MISCELLANEOUS
`0.00
`0.00
`0.00
`Performance Comp
`0.00 .
`0.00
`0.00
`,RE‘I‘RO PAY
`0.00
`5,426.91
`5,426.91
`Sick Dollars
`0.00
`0.00
`0.00
`-
`CUR YEAR VAC
`0.00
`
`. PRIOR YEAR VAC
`0.00
`0.00
`0.00
`
`z
`
`'
`
`Rate
`
`'
`
`.
`
`,
`
`.
`
`»
`
`'
`
`'
`
`‘
`
`‘
`
`Total Gross Pay
`
`' Federal Taxes
`State and Local Taxes
`Other Deductions
`
`Net Pay
`
`Direct Deposits
`Net Check
`
`e42e91
`-1,263.71_
`-34198
`
`ooo
`
`
`
`
`
`25,297.11
`5,426.91
`.
`0.00
`‘
`
`Benefits
`Current Amt
`Ytd Amt
`GTL
`‘
`0.00
`83.78 '
`'
`PENSION. HOURS
`0.0:;
`0.0.0 0
`
`Sick Dollars
`245.04
`949.08 0 _
`000
`83.78
`
`'
`
`
`Taxes
`Status.-
`Taxable . Current Amt
`Ytd Amt
`Federal Income Tax
`M-4
`5,426.91 -
`' 848.55
`4,865.98
`OASDI
`5,426.91
`336.47
`1,560.44
`Medicare
`5,426.91
`.7869
`364.94
`M—4
`New York' SITW
`5,426.91
`343.98
`1,647.46
`
`NY Disability - 1313
`0.00
`0.00
`2.40
`1,607.69
`8,441.22
`
`‘ Other Deductions from Fe
`HANYS4OSB
`
`~
`
`.
`
`I
`
`Current Amt
`0.00
`
`Ytd Amt
`
`600.00. 8
`
`JTMMH000113
`
`

`

`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`
`
`;_SUEEOLK_.COUN.TI_ CLERK—01mm
`
`NYSCEF DOC. NO. 43
`NYSCEF pQC. NO. 43
`'*
`3
`i
`
`
`
`INDEX NO. 614305/2016
`INDEX_NQ:_§14305/2016
`
`
`
`
`
`R«C«IV«D VYSCEF: 01/04/2019
`RECEIVED NYSCEF: 01/04/2019
`
`
`
`,
`1
`
`D‘EN'FAL INSURANCE .
`JTM lNSURANCEPrgnier
`
`-
`
`.
`
`4
`
`A
`
`0.00
`0.00
`0.00
`
`14.00 a
`193.43 a
`' 812.48
`
`‘ (“This code isshown for information only. It has no effept'on your'net pay.
`9 This code is horincluded in your Federal taxable wages.
`
`JTMMH000114
`
`

`

`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`FILED. SUFFOLK COUNTY CLERK 012019 05:15_P
`
`NYSC.
`EF DOC. NO. 43
`3.
`NYSCEF DOC. NO. 43
`1
`
`INDEX NO.
`
`614305/2016
`INDEX NO. 614305/2016
`
`
` :IVED \IYSCEE:
`01/04/2019
`RECEIVED NYSCEF: 01/04/2019
`:REc:
`
`7
`
`r
`
`IIII:I: um 11 clmc‘.r
`
`
`
`
`
`VOID—This'111'I70:d:chchcVOID-7'71“;12711;}!achm-l:
`
`‘ lVII-I) flue-01774.71 r: (Inc/1 HJIIJJ- 7hIIII'1noIrII.I'.LI:.I'l III/l.)- I'JIE.1'I'.1'II¢II II qlmm’r I’Oil.) - 'I’."II‘11 I'.1' HUI l'lh'llGil'I l(JILP- 'lIIix71' MI filial/117 l(JIF-
`.4.I4‘’4"C.1-.
`Ch‘eck Dhte
`Check Number
`John '1‘. Mather Memorial Hospital
`’01/21/2010
`777971
`75 Noflh County Road
`'02
`Port Jefferson, NY 11777
`.8:V...
`(631) 473-1320
`IE1
`
`,.
`
`'
`
`421 01721710 777971 '
`3701
`Perry Shapiro
`Pay to
`them!” Of-, 41134110113111:
`'
`West [slip',NY 11795 .
`
`.VOID - IThIs £9..qu a‘ check
`I
`.
`
`;5
`
`Q 31
`
`'
`
`‘.
`~5<LI
`3\'4
`eNr.
`5 .
`K"
`. 14'
`Eis.1
`C:
`R,u
`
`Payroll Cheek
`.
`'.
`Pay thié
`411114-401 331024
` '
`Amo'umI Three Thousand Seven Hundred Ten Dollars Angl Twenty-F901 Cents*****************f"-”‘****'
`
`
`
`
`
`
`Tm:Io nom thee/I I’OID- Thu 11 nu! ucIm/IIfC’IID- '.TIII'H'.1' mIl admir-
`IDID - Tlmix I‘wI-u :‘IIE'L'II VOID - TIIIS 711' 770/ 17 whack .I'IC'IIDZ Til/4' I: no! u check VOID-
`uvua'ammanla 620010011 mi
`
`
`
`
`Bmp‘ld
`~ SSN
`Clock
`
`-
`
`.
`
`~421
`10—.
`421 .‘
`
`.L00-
`1-10.: Date
`810qu
`
`7550:;
`06/18/96
`T
`
`.
`
`Period Begin
`Beriod End
`Check Type I
`
`01/03/10
`01/16/10 I.
`2ndCl1eclc
`
`. :17:th
`.
`'_ NetCheck
`
`' 3.710.24
`
`3,710.24
`
`
`5,293.04
`T_oItaI Gross Pay _
`-1,205.84
`Federal Taxes
`State and Local Taxes
`cher Dedfictions
`Net Pay
`
`Rate
`
`-
`
`_
`
`.
`
`Ytd Amt
`Cunent Amt
`Hours
`. Total Gross Pay
`0.00
`0.00
`0.00
`MEETING
`-
`19,825.00
`0.00
`0.00
`,
`REGULAR
`1,092.00
`0.00
`. 0.00
`NEW YEARDAY
`0.00
`0.00
`. 0.00
`PRESIDENTS DAY
`0.00
`0.00
`0.00
`MEMORIALIDAY
`0.00
`0.00
`‘ 0.00
`JULY 4TH
`0,00
`0.00
`0.00
`.LADOR'DAY _
`0.00
`0.00
`0.00
`COLUMBUSIDAY
`0.00
`0.00
`0.00
`THANKSGIVING
`1,092.00
`0.00
`0.00
`CHRISTMAS
`000
`0.00
`0.00
`- PERSONAL DAY I
`- 0.00
`0.00
`0.00
`PERSONAL DAY 2
`0.00
`0.00
`PERSONAL mm 000
`0.00
`-
`0.00
`PERSONAL DAY 4 .
`0.00
`5,245.27
`5,245.27
`Sick Dollars
`0.00
`CUR YEAR VAC.
`0.00
`.
`0.00
`.
`0.00
`
`PRIOR YEAR VAC
`7 . 0.00
`,
`0.00
`-
`-
`0.00
`
`;
`
`.
`
`.
`
`.
`
`-
`
`.
`
`‘
`
`
`
`DilectDepositsI .
`' Net Check ..
`
`
`
`‘
`
`0.00
`
`1
`
`5,245.27 ,
`
`21,254.27
`
`-
`
`YId Amt
`Cu'rrent Amt
`Benefits
`143.31
`, 47.77
`GTL
`PENSION HOURS
`.
`'
`~
`.
`-
`0.00.
`o00 0
`
`Sick Dolla'Is
`.
`'
`.
`'
`508.41
`1 276.73 o
`'
`47.77
`143.31
`
`'
`
`'
`
`
`. Taxes
`'
`Status
`Taxable Current Amt Ytd Amy '
`Federal Income Tax
`114-4
`5.293,04
`800;92
`5,520.32
`OAISDII
`‘
`5293,04
`328.17
`1,685.48.
`.
`Medicare
`5,293.04
`76.75
`394.13
`New York srrw
`M—4
`3.293104
`329.19 ,
`1,789.72
`
`.NY Di'sabilit'y ~EE
`-
`.
`0.00
`0.00
`_.2.40
`I
`'. 1,535.03 -
`9,392.60 '
`
`.
`
`I
`
`.
`
`.
`
`'
`
`Other Deductions from Pa
`H4NYS40313
`DENTAL‘ INSURANCE
`
`' Current Amt
`‘
`0.00
`0.00
`
`JTMINSURANCE Premier
`
`"
`
`'
`
`.~
`
`0.00
`
`'
`
`- Ytd Amt
`. 600.00 a
`14.00 a
`198.48 a ‘
`
`'
`
`"
`
`. " JITMMH000115
`
`

`

`INDEX NO. 614305/2016
`FILED: SUFFOLK COUNTY CLERK 01/04/2019 05:15 PM
`IND_3X NO. 614305/2016
`
`
`
`
`
`
`NYSCEF DOC. NQ4‘43‘ u‘:'-"':.
`\-
`,'
`:'
`V ‘
`.
`,
`,.:
`I f
`;-
`'
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