MONTH EMPLOYER SHARE EMPLOYEE SHARE ME-5 # DATE PAID
April 2016 P 162.50 162.50 311023859 5/11/2016
May 175.00 175.00 312227296 6/10/2016 June 175.00 175.00 312230366 7/11/2016 July 162.50 162.50 312230482 8/10/2016 August 137.50 137.50 312230631 9/9/2016 September 162.50 162.50 312321863 10/19/2016 October 150.00 150.00 312322001 11/17/2016 November 150.00 150.00 312322154 12/19/2016 December 125.00 125.00 314261341 1/17/2017 January 2017 P 150.00 150.00 314261470 2/17/2017
This is being issued in compliance with the hospital requirement.