Trinity Health



1571625-25336500PTO Cash-out Election FormService and Support Union2019Your Paid Time Off (PTO) Cash-out election for 2019 must be faxed to HR Service Center by Thursday, November 15th. This timeframe restriction is necessary to avoid taxation on the value of your PTO bank, including the hours that you do not intend to cash-out. Your election is irrevocable and cannot be changed.You may only cash-out hours that you will accrue during the calendar year in which you plan to receive payment. Please keep in mind, you must maintain a minimum of 40 hours in your PTO bank at the time of the cash-out in 2019. Consequently, you may not cash-out PTO hours carried over from previous years. (For example: Jane has a PTO balance of 100 hours as of December 31, 2018. During Open Enrollment, she elects to cash-out 40 hours in 2019. Jane cannot cash-out any of the 100 hours earned prior to January 1, 2019. She must plan her 2019 cash-out amount on only the hours she will accrue in 2018.) I elect to cash-out as indicated below. In addition, I understand that this election is irrevocable and cannot be changed. Furthermore, if I do not have enough available PTO accrued in 2019 at the point I am to receive this cash-out, my election will be decreased accordingly. Please complete the election below.Payroll Date to Receive PayoutNumber of Hours to be Paid out (may elect up to 80 hours in one-hour increments)2nd pay in June1st pay in DecemberName ________________________________Workday ID ___________ SS No. (Last Four)_______Employee Signature________________________________Date __________-78105323215SUBMIT COMPLETED FOR TO HR Service CenterFax 312-957-2567Email: HR4U@trinity-DEADLINE TO SUBMIT IS NOVEMBER 15, 2018DEADLINE TO SUBMIT IS NOVEMBER 15, 2017Zk0SUBMIT COMPLETED FOR TO HR Service CenterFax 312-957-2567Email: HR4U@trinity-DEADLINE TO SUBMIT IS NOVEMBER 15, 2018DEADLINE TO SUBMIT IS NOVEMBER 15, 2017Zk ................
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