CO. FILE DEPT. CLOCK VCHR. NO.

Q6W 007624 000520 MNTSF 0000270882 1

Earnings Statement
418-0001
CREEKSTONE FARMS PREMIUM BEEF LLC Period Beginning: 06/28/2021
604 GOFF INDUSTRIAL PARK ROAD Period Ending: 07/04/2021
ARKANSAS CITY, KS 67005 Pay Date: 07/09/2021

JAMES FITCH III

Filing Status: Married filing jointly 409 NORTH 4TH STREET
Exemptions/Allowances:
Federal: Standard Withholding Table
ARKANSAS CITY KS 67005

rate hours this period year to date

Regular 19 0000 8 12 154 28 16 711 88
Your federal taxable wages this period are $530 66
Vacation 19 0000 24 00 456 00 1 292 00
Overtime 2 249 63 Other Benefits and
Bonus 1 000 00 this period total to date
Holiday 288 00 Vacation 12 00
Sat Premium 250 00
Totl Hrs Worked 8 12
Sick 724 00
Gross Pay $610 28 22 515 51
YOUR COMPANY’S PHONE NUMBER IS 620-741-3100

Statutory
BASIS OF PAY: HOURLY
Federal Income Tax -4 80 508 82
Social Security Tax -35 17 1 328 34
Medicare Tax -8 22 310 66
KS State Income Tax -21 98 535 86 Taxable Marital Status:
KS: Married

Adp Roth$ -36 62 96 98 Exemptions/Allowances:

KS: 0,Joint,Spouse Does Not Work,$10
Adp 401K $ -36 62* 1 242 17
Additional Tax
Dental -5 69* 153 63
Hdhp -34 62* 866 16
Meals -3 30 402 10
Vision -2 69* 70 83

Net Pay $420 57

Checking Acct -420 57

Net Check $0 00

Excluded from federal taxable wages

2000 A DP, LLC

CREEKSTONE FARMS PREMIUM BEEF LLC Advice number: 00000270882

604 GOFF INDUSTRIAL PARK ROAD Pay date: 07/09/2021
ARKANSAS CITY KS 67005

Deposited to the account of account number transit ABA amount

JAMES FITCH III xxxxxx0070 xxxx xxxx $420 57

NON-NEGOTIABLE