So Cal 9th District Sound & Comm Agreement
Monthly Payroll Report For Hours Worked Within
IBEW Local Union #441
This report may also include Health Only contributions for hours worked
within the IBEW Local #40, 413, 428, 440, 477, 639, and 952 jurisdictions.
Employer Name: Federal Registration Number:
Street Address: Are you a NECA Member?
□ YES □ NO
City, State, Zip: Is this your First or Last Report?
□ FIRST □ LAST □ NO
Phone Number: Working Month & Year Reported:
This transmittal covers all payroll weeks ending in the month shown above.
Grand Totals From ALL #441 Employee Pages
Box 1
441 Hours
Box 2
441 Earnings
Box 3
441 Health
Box 4
441 Pension
Box 5
441 Training
Box 6
441 LMCC
Box 7
441 AMF
Box 8
441 Dues
TOTAL PAYMENT DUE
Total Electrical Industry Accounts
(Sum of Boxes 3 – 8)
Total Health Only Contributions
(For hours worked outside of #441, if applicable)
National Electrical Benefit Fund (NEBF)
(Box 2 x 3.00%)
NEIF – NECA Members Only
(Box 2 x 1.00%)
Please include with Payment:
1 Copy of this #441 Cover Page
1 Copy of the #441 Employee Page(s)
Make One Check Payable to:
Orange County Electrical Industry
Employees Benefit Board #119
P.O. Box 5210, Orange, CA 92863
Total Due:
Signature & Title: ___________________________________________________________________________ Date: _________________
Report Prepared By: _________________________________________________________________________________________________
(Please Print Name Clearly)
So Cal 9th District Sound & Comm Agreement
Monthly Payroll Report For Hours Worked Within
IBEW Local Union #441
Employer Name: Working Month & Year Reported:
This transmittal covers all payroll weeks ending in the month shown above.
#441 Employees Hours and Earnings Details
Installers - INST Technicians - TECH Foreman - FM Unindentured - UNID Indentured Prior to 11/29/2004 - APR* Indentured On or After 11/29/2004 - Use Appropriate % Rate
Social Security
Number
Employee Name
Class
Level
Total Hours
Total Gross
Earnings
Total Health
Total
Pension
Total LMCC Total AMF Total Dues
#441 Grand Totals:
Page ____ of ____
So Cal 9th District Sound & Comm Agreement
IBEW Local Union #441
This report contains Health Only contributions for hours worked
within the IBEW Local #40, 413, 428, 440, 477, 639, and 952 jurisdictions.
Employer Name: Working Month & Year Reported:
This transmittal covers all payroll weeks ending in the month shown above.
#441 Health Only Contributions
Installers - INST Technicians - TECH Foreman - FM Unindentured - UNID Indentured Prior to 11/29/2004 - APR* Indentured On or After 11/29/2004 - Use Appropriate % Rate
Social Security Number Employee Name Class Level Local Union # Total Hours Health Rate Total Health
Total Health Only Contributions:
Page ____ of ____
Report Cover Page Instructions
REPORT COVER PAGE - The Report Cover Page summarizes the entire report. This Page must be filled out after all Employee Transmittal Pages have been
completed. Benefit values from all subsequent sections, for all classifications, shall be included in the Grand Totals on this page.
EMPLOYER NAME AND ADDRESS, Clearly print your firm's name, office address, city, state, complete post office zip code, and phone number.
FEDERAL ID NUMBER, Clearly print your Employer Federal Tax Identification Number.
NECA MEMBERSHIP STATUS, If you are a NECA Member in any jurisdiction, check the YES box. Otherwise, check the NO box.
FIRST/LAST REPORT, Indicate if this is your First or Last report in the jurisdiction by checking the appropriate box.
REPORTING MONTH & YEAR, Enter the proper month and year in which the employees' hours are worked.
GRAND TOTALS FROM ALL #441 EMPLOYEE PAGES, Combine all of the hours, earnings, and fund contribution totals from all employee pages and enter
the result in the appropriate Grand Totals box.
TOTAL ELECTRICAL INDUSTRY ACCOUNTS (EIA), Add Grand Total boxes 3 through 8 and enter the result here.
TOTAL HEALTH ONLY CONTRIBUTIONS, If applicable, enter the sum of all Health Only contributions here.
NATIONAL ELECTRICAL BENEFIT FUND (NEBF), Multiply the Total Gross Earnings (Grand Total boxes 2) by 3.00% and enter the results here.
NECA MEMBERS ONLY (NEIF), Multiply the Total Gross Earnings (Grand Total boxes 2) by 1.00% and enter the results here.
TOTAL PAYMENT DUE, Add the total EIA + Health Only + NEBF + NEIF and enter the result here.
SIGNATURE, This report must be signed by (1) the individual, if the employer is a sole proprietor; (2) the president, treasurer or other officer if the employer is
a corporation; or (3) a responsible and duly authorized member having knowledge of the firm's affairs if the employer is a partnership or other unincorporated
organization.
Employee Page Instructions for Hours Worked Within Local #441
#441 EMPLOYEES HOURS AND EARNINGS DETAILS PAGE(S) - The following information shall be set forth in separate columns for each of your employees. If
an employee has worked under multiple Classifications during the report period, then you must report each employee Classification on separate lines.
EMPLOYEE'S SOCIAL SECURITY NUMBER, Clearly print the employee's SSN: "xxx-xx-xxxx".
NAME OF EMPLOYEE, Clearly print the employee's Last, First name.
CLASS LEVEL, Enter one of the following Classification Levels for each employee line in Column #3:
INST For ALL Installers, including Stepped Installers.
TECH For ALL Technicians
FM For ALL Foreman
UNID For ALL Unindentured Apprentices
APR For ALL Apprentices Indentured Prior to 11/29/2004
xx% For ALL Apprentices Indentured On or After 11/29/2004, Use Appropriate % Rate (i.e. - 45%, 50%, ...90%)
CLOCK HOURS, Enter the total clock hours for the employee in column 4.
GROSS EARNINGS, Enter the actual Gross Earnings subject to withholding taxes for the employee in column 5.
TOTAL HEALTH, Multiply the Employee’s Clock Hours by the appropriate H&W rate as indicated on the current benefit rate sheet and enter the result in column 6.
Enter $0.00 for any employee who is not eligible to participate.
TOTAL PENSION Multiply the Employee’s Clock Hours by the appropriate Pension rate as indicated on the current benefit rate sheet and enter the result in
column 7. Enter $0.00 for any employee who is not eligible to participate.
TOTAL LMCC, Multiply the Employee’s Clock Hours by the appropriate LMCC rate as indicated on the current benefit rate sheet and enter the result in column 8.
TOTAL AMF, Multiply the Employee’s Clock Hours by the appropriate AMF rate as indicated on the current benefit rate sheet and enter the result in column 9.
UNION DUES, Enter the Employee’s total Union Dues withholding result in column 11. Enter $0.00 for those who do not participate.
GRAND TOTALS THIS PAGE, Total each benefit column on all pages. The Grand Totals for all pages will be included on the Report Cover Page.
Employee Page Instructions for Health Only Contributions
(For hours worked within the IBEW Local #40, 413, 428, 440, 477, 639, and 952 jurisdictions)
#441 HEALTH ONLY CONTRIBUTIONS PAGE(S) - The following information shall be set forth in separate columns for each of your employees. If an employee
has worked under multiple Classifications during the report period, then you must report each employee Classification on separate lines.
EMPLOYEE'S SOCIAL SECURITY NUMBER, Clearly print the employee's SSN: "xxx-xx-xxxx".
NAME OF EMPLOYEE, Clearly print the employee's Last, First name.
CLASS LEVEL, Enter one of the following Classification Levels for each employee line in Column #3:
INST For ALL Installers, including Stepped Installers.
TECH For ALL Technicians
FM For ALL Foreman
UNID For ALL Unindentured Apprentices
APR For ALL Apprentices Indentured Prior to 11/29/2004
xx% For ALL Apprentices Indentured On or After 11/29/2004, Use Appropriate % Rate (i.e. - 45%, 50%, ...90%)
LOCAL UNION, Enter the Local Union number where work was performed in column 4.
CLOCK HOURS, Enter the total clock hours for the employee in column 5.
HEALTH RATE, Enter the appropriate hourly Health Contribution Rate for the Employee as indicated on the current benefit rate sheet in column 6.
TOTAL HEALTH, Multiply the Employee’s Clock Hours by the appropriate hourly Health Contribution Rate and enter the result in column 7. Enter $0.00 for any
employee who is not eligible to participate.
GRAND TOTALS THIS PAGE, Total all Health Only Contributions from all pages. Provide the Total Health Only Contributions for all pages on the Report Cover
Page as directed in the Report Cover Page Instructions.
