Please fill all required fields
    Employee name:
    Hospital name:
    Full-time employment date:
    Calendar
    Part-time employment date:
    Calendar
    This is a summary of an employee's total compensation, including benefits. Fill in shaded cells.  
    		Monthly value
    to employee     		Hospital's
    monthly cost     		Hospital's
    annual cost
    Wages
    Monthly salary
    Retirement plan
    The hospital contributes to a retirement plan for full-time employees after an employment duration of this many months:
    		 
    Medical insurance
    For employee and dependents (if family option selected)
    Dental and vision insurance
    For employee only
    Life insurance and accidental death and dismemberment insurance
    Bonus/profit-sharing plan (estimated average)
    The hospital's bonus plan is based on employee performance, attendance, and dedication, along with hospital performance each quarter.
    Continuing education
    Employees are eligible for continuing education every year.
    Other fringe benefits (estimated average)
    > Discount on veterinary services per employee manual
    > Uniforms furnished or reimbursed
    > Dues/membership fees
    > Other (please specify)
    ESTIMATED TOTAL COMPENSATION
    An employee's annual compensation includes vacation, holiday, and personal time during which the hospital continues to pay the employee's wages. These benefits total:  
    Paid vacations (estimated)
    In their first and second year, employees are paid for the equivalent of this number of vacation days per year.
    		 
    In their third year and beyond, employees are paid for the equivalent of this number of vacation days per year.
    Note: Vacation days are not cumulative.
    		 
    Paid holidays (estimated)
    Employees are paid for the equivalent of this number of holidays per year.
    		 
    Paid personal leave (estimated)
    Employees are paid for the equivalent of this number of personal hours per month.
    		 
    Total number of hours per year.
    Note: Personal days are not cumulative.
    		 
    ESTIMATED TOTAL PAID LEAVE (included above)
    The hospital also pays the following expenses based on an employee's wages:  
    Social Security
    The hospital and employee each contribute 7.65% of the employee's income, up to the federal maximum, for retirement, disability, and Medicare.
    Workers' Compensation (estimated)
    Disability income and medical care for work-related injuries.
    State unemployment insurance (estimated)
    Obtain this information from your bookkeeper or payroll company.
    Federal unemployment insurance (estimated)
    Obtain this information from your bookkeeper or payroll company.
    ESTIMATED ADDITIONAL COSTS
         
    ESTIMATED EMPLOYMENT COSTS: GRAND TOTAL