Kevin Test Census 20231227_201812

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Company Name: Kevin Test Census
Address: 810 Maxwell Ave
Greenwood State: OK
Zip Code: 29646
Point of Contact: Brad Setzler Email Census to:
Safe Harbor Rep: Josh Hyman
Payroll Frequency: Bi-Weekly * Please note any changes to Employee census info will result in changes to estimated savings
First Name Last Name Employee = P
Spouse = S Child = C
Date of Birth Home State Tax Filing:
Married Filling Jointly=M
Married Filling Separately=MS
Head of Household= HH
Approx. Annual Income
(Emp. Only)
Date of Hire Child Dependents Claimed Other Dependents Claimed Health Insurance Premiums PRE-TAX 401(K) Additional Pre-Tax Witholdings (Only Pre-Tax)
Ron Amerson P 10/12/64 OK M $31,200.00 4/6/21 1 0 $0.00 $0.00 $0.00 1
Milton Beckham P 08/29/1963 OK M $$31,200.00 03/18/2019 1 0 $0.00 $0.00 $0.00 1

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