Fringe Benefit Breakout
Sample
Fringe Benefit Breakout Report
ABC Construction Company
5 Anywhere Lane
Anytown, NH 03301
Email: ABC@
* Benefits are based on 2080 hours (40-hour workweek, year-round employment)
John Doe (Laborer)
Holiday: $0.29 (5 days @ 8 hrs per day x $15.00 divided by 2080)
Vacation: $0.58 (10 days @ 8 hrs per day x $15.00 divided by 2080)
Life Insurance: $0.03 ($4.50 x 12 divided by 2080)
Health Insurance: $2.88 ($500.00 x 12 divided by 2080)
Total Fringes: $3.78
Jane Smith (Excavator Operator)
Holiday: $0.36 (5 days @ 8 hrs per day x $18.50 divided by 2080)
Vacation: $0.71 (10 days @ 8 hrs per day x $18.50 divided by 2080)
Life Insurance: $0.03 ($4.75 x 12 divided by 2080)
Health Insurance: $2.74 ($475.00 x 12 divided by 2080)
Total Fringes: $3.84
Randy Noname (Ironworker)
Holiday: $0.36 (5 days @ 8 hrs per day x $18.50 divided by 2080)
Vacation: $0.71 (10 days @ 8 hrs per day x $18.50 divided by 2080)
Life Insurance: $0.03 ($4.75 x 12 divided by 2080)
Health Insurance: $2.74 ($475.00 x 12 divided by 2080)
Total Fringes: $3.84
Compliance Notes:
- Hours may vary, but must be based on all hours worked, or the number of hours of work that can be reasonably anticipated (all hours include any overtime hours).
- Ineligible employer costs include, but are not limited to, workers’ compensation insurance premiums, company vehicle assignments, mileage, travel payments, Social Security contributions, Medicare, production bonuses, or any benefit paid as an obligation under law.
- Refer to 29 CFR 4.171 for fringe benefits guidelines
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