Gedmin v. North American Safety Products, Inc.

Filing 93

MOTION by Plaintiff Janelle Gedmin for judgment damages (Attachments: # 1 Exhibit A through G, # 2 Exhibit H and I, # 3 Exhibit J to M)(Doran, Karen)

EMPLOYEE HISTORY
,';\f '

tl~C.(i(ctt){VH/A(i'\/' ) '.J

'Ii j . .J
;J I; ,.\ ;

.,

i~ T? ' (.'
..
'

j · ·'

{""\:,1"
l)
bl

;' i
,,(

"

Ex A

EMPLOYEE HISTORY

f.:'

,.j ;.;). {,

1<.

Janelle

Wozniak

- E0007 - 2005 Sales

and Commission Earned

Report Date Paid Amount Paid

I
For the Period From Dec 1, 2004 to Dec 31, 2004

EOO07 Marketing Incentive

200,144.63

0.50%

1,000.72

2/15/2005

1,OOO~QQ.

For the Period From Jan 1,2005 to Jan 30,2005

ED007

Marketing Incentive

164,804.65

0.50%

824.02

For the Period From Feb 1,2005 to Feb 29, 2005

EOO07 Marketing Incentive

167,586.65

0.50%

837.93

3/18/2005

1,000.00

For the Period From Mar 1, 2005 to Mar 31, 2005

Eoo07

Marketing Incentive

108,363.49

0.50%

541.82

4/29/2005

2,662.68

For the Period From Apr 1,2005 to Apr 30, 2005

Eo007
Forthe

MarketinQ Incentive

140,384.97

0.50%

701.92

5/13/2005 5/27/2005 6/10/2005 6/24/2005 7/22/2005 8/5/2005 8/19/2005

541.82 500.00 500.00 500.00 500.00 500.00 500.00

Period From May 1, 2005 to May 31, 2005

EOO07 Marketing Incentive

165,922.34

0.50%

829.61

For the Period From J un 1, 2005 to J un 30, 2005

EOO07 Marketing Incentive

224,801.06

0.50%

1,124.01

For the Period From Ju11, 2005 to Ju131, 2005

EOO07 Marketing Incentive

171,031.73

0.50%

855.16

For the Period From AUQ 1, 2005 to AUQ 31, 2005

EOO07 Marketing Incentive

157,357.93

0.50%

786.79

9/16/2005

500.00

For the Period From Sep 1, 2005 to Sep 30, 2005

EOO07 Marketing Incentive

158,367.17

0.50%

791.84

10/14/2005

500.00

For the Period From Oct 1, 2005 to Oct 31, 2005

EOo07

Marketing Incentive

121,352.48

0.50%

606.76

11/22/2005

500.00

For the Period From Nov 1, 2005 to Nov 30, 2005

EOO07 Marketing Incentive
For the Period From December

297,271.02

0.50%

1,486.36

12/9/2005

700.00

1, 2005 to Dcember

31, 2005

EDDD?

Marketing Incentive

166,876.13

0.50%

834.38

1/20/2006

816.82

For the Period From Jan 1,2006 to Jan 30, 2006

EOO07 Marketing Incentive

160,391.16

0.50%

801.96

2/17/2006

700.00 -----

For the Period From Feb 1, 2006 to Feb 28, 2006

EOO07 Marketing Incentive
TOTALS

132,923.18 2,537,578.59

0.50%

664.62 12,687.89

3/17/2006

766.57 12,687.89

Department

State Of Illinois Of Emplovment

Security

Work Search Record
SOc:i_1 Security No. . .

Client !iignm.,e ~!ftb

Instructions. Please print this form and use the following tables to keep a record of all the employers
and labor unions you contact while filing for Unemployment Insurance benefits. You are responsible for maintaining your work search information on the form proVided by IDES on a weekly basis, for up to 26 weeks. YOu will be required to produce your work search upon request. Failure to do so may result in denial of benefits. Be sure to bring your work search record with you if you come into the local office. If you need additional pages, contact your local office or duplicate thiS fonn.

Important Notice: Keep Your Work search Records
A determination that you were actively seeking work during a week being claimed is subject to reconsideration (the determination may be reconsidered despite the fact that you have been paId benefits or returned to work). In order to preserve evidence that you were actively seeking work, do not discard your wrftten work search record for any week being daimed until 53 weeks have passed from the end of that week. Further, if there Is an appeal pending regarding your active work search for a week, keep your written work search record until there has been a final resolution of the matter.

Week Ending

2:2-

"-I -

oto
Type Of W~rk',

A(R.~,

II

ht :,',:, , . :Results

,"u ft'3
~p

Week Ending

~

-

II ·.

a.e
.' ., '

.~~~.: .._ ~Il~~e'~1j4Add'!!5s'0f Contacz ,: ..

c~~~

.,'..

Ex A2

Contact I-----~ate :.: """"And .

_..

..

AddFess OfCoRtae:t .

Co'":'':''oi

:··Me1IIodGf COIlt!~_

Type.Of Work ~.':"Saught

.R·····t5 l

-:'>.';.,:1G. ", n

fC'i'c. A~

~ Admin 4;;-;,,1. C>Cc 4rlOlJn.

~ec·IAd~

E:xec.-4s~+.
(.f:3~-

n1ons+er &t.ec.
{Y/ons+er

Ei. ~.

ot+iLe.

CrerJ..

AUG-12-201012:15 Week Ending ~_-

...·

CLe

17083014295

_

Method Of-"

C~Jlbe:t_

, Method,Of

, : t';onta~

Week Ending

(\

c.,t:W. . ,Results': "

lhe. ·.it'd' ·l.t..~ <' I.l' .. . i.(.t" ,.

re,,\c "1

e- mn

~-:;\._.ne

,n l~'.

, '" SO.,

Typ. ,Of'work'" , ,
lit' '

Results,

Adyn;'" '

Th (\il {~ c..(~'t,Q..J.

, niL.(jh~J'h I

.,~

e.- '1'l6.j'"

,-'f

mei:. ,I I

f.k!,fMf (")

fi ; Ad))), i'l

STATE OF ILLINOIS DEPARTMENT OF EMPLOYMENT SECtJR.JTY wOJU( SEARCD RltCOIU) ~llB<DfrYNO.

,

CUPl<l'SSlGNATIJIdlren.etae ~

Use the bible below to bep a record Df all the employers and labor unioos you c:oatac:t while 81in Unemployment InsulanCfl benefits. You Ullift malDtala yoar .··ork seareb i.formatloJII OD the form provided by IDES 0 ·· a weekly basis. Yon will be requ.incl tG plI'Oduce . your work seareh UpODrequest. Failure to do so may result EDdellial ofbenents. Be sure to bring your work seardl Tecord with you if you are c:alled to report into the local office. If you need adcijtional pages to iecont your work search. contact your local office or duplicate this fonJ IMPORTANT NOnCE: KEEPING YOUR WORK SEAaCR RECORDS A determination that you were actively seeking work during a week beiDs claim is subject to RlCOnSidenrtion. (The detennination may be reconsidered despite the filet thlt you have been paid benefits or returned to work since thai.) In order to preserve evidence 1h1l1 you were actively seeking work, do not WSCIII'd your written work search record fur any week beitlg-claimed until S3 weeks bave passed ft'om the l'lIld oithat week. Further, if there is an appeal pcn.din.8 regarding your active work seafCh for a week, keep-your written work searcb record until there bas t>een a final resolution of the matter.
WEEKENDINC~
CONTACT PERSON CONTACTED

DATE

NAME AND I\DDRESS OF CONTACT

METHOOOF CONTACt-

F'A)( ~1'S)t#iD3~1'113

FA~ r"}08Jlc81-5~"<a

r:cod 5en,l.

:WEEKENDING
CONTACT DATE CONTACTED

PERSON

\-2v

H~

i --)tp [
( - (ilo
WEEK ENDING
OATE

Ht2..
N'llKe..
\

H~

-~

a ..1- 0'\ .
CONTACTED

CONTACT

PERSON

SOCIAL SECURITY NO. __ WEEK ENDING
COt/T"er

a· I .., Q'I -

"__

"__

WENT'S SIGNATIJU&»

q M e ~.yru.

171383014295

P. El6

n
""K«.'(.
RESULTS

OATE

ktfe.··..~

AUG-12-2010

12:18 " _

17083014295

SOCIAL SECURITY NO. __

CUENT'S SIGNATURE ~CIJ

e Lft

P.01

\c}j.lljluvu/'f\

CONTACr

METHOD OF

TYPE OF WORK

SOUGHT

RESULTS

fV10tl5fer

"PersOl"k:\ I

WEEK ENDING_~~_
DATE
CONTACT

~~
~Ct1e.
WEEKENDlNG~
CONTACT DATE PERSON CONTACTED METHODOF CONTAeT-

bf{'(le

Dt'{ice

e-rvta' )

SOCIAL SECURITY NO. WEEK ENDING COf'lT.'CT OATE

L..l ~

II - a1-

_

CLIENT'S SIGNATURE

'::rj2/'Il £. tV e y, ·JLCfLl11 (.Y\ . 1 ...

17083014295

P.02

PERSON CONTACTED

CONT'ACT"

WTHOO OF

~

E-Mli~ I
. · M'~'

.

~

WEEKE1\l>ING ~
CONTACT

C'Te

lYPEOFWORK SOUGHT

4\ili
e..t , t (Q

DV\·e.vt.l.

off

i <.. e...

f

E~ LviIu

, . etar

WEEK ElmlNG ~:
CONTACT DATe

aez ".cB...

WEEKEDJNG
DATE
CONTACT

AUG-12-2010

12:18 - __

17083014295

SOCIAL SECURITY NO. __

CLIENT'S SIGNATURB

Ba:'Yl e 0

WEEK ENDING
CONTACT

5- q - 09_
c.c'mp.;ft'r
..ctl';,.
METHOD OF CONTAeT-

e, ..~.(., .

P.03

'Y, .

DATE

WEEK Er.'DlNG ~
CONTACT

DATE

WEEK ENDING

5" d

e,..cfL .

WEEK ENDING

5 -:"D :-r:a.. a

fhQl1t,.
APPly
O~liVJ·e
l!t'~'M.~4\f

~.

k

'BiC.
c:

I-klM;n,
.'.

Mif6t-er

i-{ f( .

SOCIAL SECURITY NO. __

WEEI( ENDING
CONTACT OATE

Jo- (" - 09-

-_-

__

PERSON CONTACTS)
Oll'"

M(:.~'l
. I,

AWl:'

PERSON OONl'ACTED

ME1MOP F O OON'I"ACr

Oa.t"\
·

(.1

, e.tter'

e/~

WEEK ENDING..1" CONTACT ~TE

ao -oCL

WEiK ENnING
DATE
(X)NTACT

Jp ..a ~ - 0 q

17083014295
SOCIAL SECURITY NO. .......-- CLlEN1"S SIGNATURE ~

C ('

Of)

,l:J-e cel'WL.(;/'(,

P.05

WEEKENDlNG~
CONTACT
DATE

PERSON CONTACTED

METHOD F O coNTACT"

:rt'ltAt.<:ltl.
C!

WEEK E~1)(NG
CON'I'ACT
DATE P!:RSON
CONTACTED

MeTHOOOF CONTACT*

. SOUGHT

lYPEOFWORK

· C '·c"O AilI-

i ~c:cpm

"J:f)

?eiSOO

Admio .

mOt'\5fer
l\(.

CATE

<XlNTACT
NAUEANDADORESS OF CONTACT

CONTACTED

PERSON

OONTACr

ME1HOOOF

SOUGHT

TVPeOFWORK

RESULTS

WEEK ENDING.-J OATE
CONTACT

d

t') -

0

9CONTACTED
PERSON

NAME AND AODRI5SS OF CONTACT

MElHODOF CON'IACr

SOUGtn'

TYPE OF WORK

RESULTS

r UIU

AUG-12-2010 2:19 1
,IUU:>:
.)t;:a.l'vll

1111l1lUU:S VI JVLJ::I UUW

17083014295
I

IVIVU::IL~Lt,,;V1U

Don't lose trllck Of the jobs you've ~ppliea ror. You can reView the status of your submitted resume, tr"ck your progress, Mil compare with other CIlIl/lj(fate~ I/ho applied tor the same lob, I

see

how you

AlISJlied with Rc5l1mC itle: r~~dicill S;St~lIl: fJ4~l"tr.o T M Cliver Letter: N/A o.te Applied: 6/J9/2010 Applv stBtIIs: Received Davs Pll.!ltedl a/9/2010 QUl!!ItiD,",aire: N/ A

Applied with
R.eSUIIM! Tiue: Me(llr.a: Mr.,stall! (J12UO Cover Letter: N/A Date Applied: 6/19/2010 Apply Status: Received

Notes

r~'\te-u--vetuecQ i

Days Pasted: 7/18/2010
Questionnaire: N/A

(\00

~~er

Appliod with Rc5"me Titfe; Mt::dlC31 A~~i~tan:: !'i42:l.10 Cover ~~r: Vir,,, ,~wt\,ie~t,ll'

Notes

Date Applied: 4/21/2010 Apply Status: Received Days Posted: 5/27/2010 Questlonnillre: N/A

'I(\1-er U\e~ d-' ALCf.p+eoR \)Ob

500 cha ·.·· ter~ remaining C

Applied with Resume "title: Cover Lefter: Oilte Applied: Apply Stl'M: DayS po.sled, Questionnaire:

R~ceiv~d 4/26/2010
N/A

."4~·1:c,,1 SSI~~~n~04;'.~,\l) A liieo: ,ov~r I(~t~<" 4/2114010

RUG-12-2810

12: 19

CBJobs
Job Title

~

\fC:a~
Location

17883814295

17883814295

P.89
.A.

"1:>"'"

·.

VA

·.

Posted

Expires

Saved

Floater. Phlebotomy Service @ Quest Diagnostics

Expired

6/1912010

Application History
Job Title
Certified Medical Assistant Medical Assistant Rap. Phlebotorny Services

Location

Posted

Expires Expired Expired

Appli9d
6/19/2010

6/23/2010 6119/2010

US-IL-Plainfield

3 Weeks Ago

In 3 Days

666 Dundee Rd., #501 Northbrook, IL 60062-2733 [phone]

~@06
$
3 Other income

Miscellaneous Income
Copy B
For Recipient

Form

1099-MISC

4 Feder.ll incvme laX wi1hheld

$
5 Fishing boat proceeds

$ 6 Medicaland hallh care paymerts

$
9

$
Payer made direct sales of 10 $5,000 or more 01 consumer Crop insurance proceeds

This is Important tax information and is befng furnished to the Internal Revenue

Service. If you are
required to file a

7618 W. Saint
City, slate, and ZIP code

Francis

Road

products to 8 buyer (ltlClpient) for resale ~

0

$
12

Frankfort,

IL
$
16 State t2lC withheld
"n. _.

Account number (see instroetions)

penalty or other sanction may be imposed on you If this income is taxable and tt1e IRS determines that it has not been

reltJrn, a negligence

reported.

17

$
Form

$ 1099-MISC
MV1099M·B

JL __ .___. ,.___. ., . . .

_.!!

StatefPayer's

state no.

_n ·····

_.P..

18

State Income

;$ ·. __

_.. _""""

Ex B

&.176900000

SLM Financial Corporatlon Educatlonal Loan ProgrlUl1 Re a ment Schedule aOl;l Truth-Jn-Lendln Disclosure V.Ui».,:';~~UillV.il,;'~!p,miili',iBc1i'g~er~W!NWIli'il.::",,~IJljl!"U!U' i;; if ! iiii:'''! dli " li,,~iI!~ iii;Jllo~f ",'!:r.'''!~1l!1i !l!iii,,;''''!~ I I

Date

08/29/2006

iI1li~!,,;:

JANELLE

GEDMlN

In this disclosure thc words 'you' and 'your' refer to Borrower and any Cosigner. Lender refers to SALLIE MAE BANK , located in the state of UT School refers to COMPUTERTRAINING.COM - IL The Lender has approved a Loan for $ 25.265.00 . The estimated funding date for this Joan is 08f3lf06 The interest rate you will pay on the loan is the Prime Rate as pUblished in The WalJ Streer Journal plus 3.000 % (the Margin), Your current variable interest rate is 1 1.250 % . In no way will the interest rate, exceed the maximum rote allowed by law The Prime Rate used to calculate your variable interest rate was 8.250 % The supplemenlal fee for tbis loan is 3.1224 % ruth-Inending Isclosure TIle amount of credit provided 10 you or on your behalf. The amount you Will have paid when you have made all scheduled payments.

)~:;I~\\j\.l\!iNNu]\l!!i\2~~NjjI~)(:~I~.,m~.¢El'lrIf~'&wtl~;'.:I.I , ;! ~ l ~I :
The cost of your credit as a yearly rate.

; Mr:!~i;~.~~ilA~lifiWrmlcifl:\ll! illlU.r,\,'::iralllil\~&~~r.~~m:~I\UiilT.t11\lln~I~J1
s

11.743 %
Late Charge: Prepayment: Variable Rate:

The dollar amount the credit' will cost you.

Security: Addltlunal

Terms:

57,682.85 S 33,182.85 $ 24500.00 Ifany part ofa principal or interest payment is more than~ days lale, you will have to pay a late charge of.J.Q..QQ!!..'/o, of !he monthly paymenl or .$ 2000 , whichever is greater. rfyou pay off the loan early, you will not have to pay a penalty, if you prepay your loan, you arc not entitled 10 11 refund of any finance charge. The interest rate will change monthly on the lirst day of each month. The rate is equal to the sum of !he highest Prime Ralc as published in The Wall Street JOllrnul 2 business days before the end of the prior month, plus the Margin disclosed above per annum, rounded to Ihe nearest one· fourth of one percent (0.25%). For example, the interest rate for January will bc de1ermincd by the Prime Rate published the preceding December 29th (iflhere is no intervening weekend). Your interest rate will increase if the Prime Rate increases. An increase on lbe anniversary dale of this loan will take the fonn of big her payments. For example assume tbat your Joan is for Slo,OOO at 10.00% interest for 120 months. If the interest rate increases 1010.25%, your monthly p.1yment amount will increase on the next anniversary of your first disbursement from $132.15 to S 133.54 An increase in the Prime Rate may result in payments insufficient to cOver the interest due. Any difference not made up durinllthe year will be added to your loun amount on the next anniversary date. You have given a security interest in any refund that may be due 10 the student from tbe School. Please see your Promissory Note for information about nonpayment, default, the right 10 accelerate the maturity of the obligation, and prepayment rebates and penalties.
e means an eslimate average.

:V:;;~P~~~\Jj~~i'~'ffi'l~yt~:"i'l;Wr,~ii~~;PJ!'h~;~(;~'~l"o!'Jta~~~iif?~~~tJii!''diliJ!~';lil:li!l~l.lill:l~iIlllH:l·lIl!nl!m.M'i'l'l'~W·!ma\ililiI:1~.~lr!i1I!1l!l1lf1Uc~1W;rti!i.i!nl'1"Ii~:1iIl\iI~edr;I,:r'~Jrdlili,"mrilllmi;'"IT!lllIni . !l ll "'; " i l; ' i\,' : ll ~ il le 'i i l l Q", if ~; \ i nm
Number of PaymenL, 12 179 ! S S Amount of Pavments· 10.00
319.68 340.13

'These payment amounts are an eshmated

S
$ $

When Payments Are Due (MonthlY Beginning) 1l9J28/l}{j 1l9J21l1lJ7 08128122

$ $ $

24,500,00
765.00

Amount Financed Supplemental Loan Amount Fee (Prepaid Finance Charge)

25.265.00

S S
S

SLM Financial Corporation (as servleer fur Lender)

S
S $ $ S S $ $

S
$ $

S
Addltlonll1 Fees: Payment Return Fee: If you make a payment by check or otherwise and !hat payment is returned or refused by your bank for Bny reason, you agree to pay a cbarge up to 520,00 for each payment so returned. Such Payment Return Fee may be added to your prmcipal balance hercunder and accrue interest at the rate provided in this Disclosure, without notice. You may request and thc Lender. at the Lender's sole discretion, may grant you a Forbearance under which Forbearance Fee: you may defer regularly scheduled payments for up to six months. If you request such a Forbearance and the Lender grants it. you agree to pay up to a $50.00 Forbearance Fee. Such fee may be added to Your Principal Balance By signing you acknowledge receipt of a compleled copy oftnis two page disclosure

of

x Borrower's sraturc x Cosigner's

JANELL

GEDMIN

Date Date

x Cosigner's x Cosigner's

Sign Sign

Date Date

Signature

Sign and return to: SLM Financial Corporation· SLM Financial Corporation·

PO Box 470. Marlton, NJ 08053-0470 or 6000 Commerce Parkway. Suite A · MI. Laurel,

NJ 08054

SLMF0506

1111111 1111111111111111111 IIIIj ' '11

Iml Jllif ifill

11111I

J11II1IJ1I1J11IfIIIIII

r IlJllI/IJIIII'" IIIIIIIJIII

fill 11II1 11111 11111 111111 11I11 1111 1111I 1111111111111111111111111111

I JIIIIII

1111 1111111111 1II1111111111111111J 11I111111111111111

Ex C

x.

~

_

x Cosigner's Signature
_

_

Borrower's Signature

Date

JANELLE
x

GEDMIN x.
Cosigner's Signature

_

Cosih'ller's Signature

Date

Sign and return to: SLM Flnanehd Corporation' PO Box 470 · Marlton, NJ 08053·0470 or SLM Financial Cor oration' 6000 Commerce Parkwa , Suite A · Mt. Laurel, NJ 08054

[---~----l Cn:_~._~J L .__ _
+~.~:

__

.J
2
4 6
ederallncome tal< w1l11lleld

--~-~ .._
988.11
Sodlll 5eQllily lax V/ilhheld

Jr::J:.

De iIf1meni of the Treasu - - InlemuT Revenua Service Control roo 1 Wages. lips. ather CC/TP.

8439.46

3 Socialsecuritywages 5

Me1Ilcare wages and tips

849

=
58
~$

C

~_

··· __

t
l

trol no.

This Infomallon

843946
EmpIO)'flI'll name. adcIn::o$, and ZIP code

~e~e/nlu"e::S:1r.vfic'ee.d Rv e
name. addnlss, lIlId ZIP code

Wi.

ChIcago Bath.s.yslems LLC 7748 W. 99Th Street Hickory Hills. IL 60457

Chicago Bath Systems LLC 7748 W. 99Th Street Hickory Hills. IL 60457 9 0.00
Advance EIC payment

7

Sodil security tips

0.00

8

Allocated tips

10Dependl!fll ClUe benefits

11 NonquaUfiedp1D1lS

12aSee Ins!.

0.00
fill" boJ< 12

7

Sadal securilyUp$

10Depenclenl QI1e benefits

0.00

8

Allocaledtlps
p/DIls

11 NonquaIified

Employee's name. addless, and ZIP code

Janelle L Gedmin 7618 W St Francis Road Frankfort. It 60423

Employee's narre. address, and ZIP code

Janelle L Gedmln 7618 W St Francis Road Frankfort. It 60423

38-2099803

2007

1~~:~D~::_ ~6_~~=-~0!0~ 1~~:..~~_ 27 .38-2OS9B03 17StaI ·· lncome~_

~6~~~~~J~~~6
18Localwages.llps.

._".. .-wF~2- W~@JI!l.d_ Tax ._ Statement
Copy.2 - To Be Filed

------------

253:18-

18Loca1wages.lips,elc.

-----------

-"---'-

···W--2-Starement-· --'---'_.'-_.'-""-253;18-".-'--"'---'
Copy

Form Wage and Tax 17slaleinc:omelax

2- To

Be Flied

------------

-----------

.. .--

ele.

With Employee's State, City, or Local IncomaTaxRelum.

19Local Income lax ------------

20 Locality name -----------

With Employee's State, City, or Local Income Tax Relum.

19LClall income lax ------------

20 LOCSrily ame n -----------

Ex 0

FllER'S name. slreet address,clly,lltale. ZIP code, and telephone number

o

C RRECTED $ $

1 PaymenLs rec:elved far
qualified tultion and
relatedllllpl!llSes

Joliet Junior College J.215 Soubolt Rd Joliet, __L &0431-8938 I Tel~phone:
FILER'S Fedelal identllicallon no.

-'

897.00
related expenses
qualIfied lullion and

2 AmountsbBIedfor

~@07

Tuition Statement
CopyB
For Student

3 If this ball is clled<ed.your educationalinsUlulfon
lias changedits nlPDfllngmalhod lor 2007

4 Acf)USlrnenlsmade lor a
prior year

Janelle

Gedm.i.n IL 60423-6931

$

$
AdjuSlmenls to

7618 W SAINT FRANCIS RD
Frankfort,

6

7

Checked il lhe IIIIlOIlllt

This is important

sdlolllnlhlps or gl1InIs

In box 1 or 2 includes
amout1l!1 for en aCllllemlc pedod begiming JanumyMardi 2008

1ax information
and is being

for a prior year

Service Provider/Acel

No. (see instr.)

8

$
Checked 1/atlellel hafr.ume sluden!

0

furnished to the Internal Revenue
Setvice.

0222063
- ·-'---Form-1098--T

IE

9

Checked

If a gmduale

Illudant

····

0

10

Ins. ""nlred

relmbJrelimcl

$
-------------Ot:piltllT'olnl'Dft/WTIlIllsorr--mmrllal"ReYli'llue~ietl-·_-

(l'leep-foryourrecords)--" -- ---

An eligible educational institution, such as a college or university, in wtrich you are enrolled and an insurer who makes reimbursements 01 refunds of qIJiIMtled tlllllon and related expensas to yOll, must fumlsh thls statement to you. YOll. or Ihe person who may claim you as a dependenl, may be able 10 take either the tuition and fees deduction or claim an education credit on Form 1040 or 1Q40A for the qualified tll/llon and related expenses that were aclualty paid In 2007.lnstnullons may report alther paymenls ruceived In box 1 or amounts billed In box 2. The amount shown In box 1 or 2 may represent an amolint other than the amount actually paid In 2007. Your Institution must Include iI$ name, address, and Information contact telephone number on this statement. it may also InclUde contact Information for a selllice provider. AI/hough lhe service provIder may be sble to 'snswer certain QUeslions alloutthe stalement, do nol c:on/a(;Ithem or the filer for$lplanalions of the requirements for (and how to figure) any allowable tuition and fees deduction or edUcallon credit that you may claim. For more Information about the deduction or credit. see Pub. 970, Tax Beneflls for EducalJon, Form 8863. Educallon Cte<lits. and the Fonn 1040 or 1040A Instructions. Account number. May show an account orolJler unique number the fiIe,asslgned to distingulsh your 8Q:OUnt 80x 1. Shows the Iotal payments recelYed rrom any sowce for quallfied lullIon and related expenses Ie" any relaled refmbul8emenls or refunds. Box 2. Shows the lolal amounts billed for qualified tufUon and related expenses less any related reduellons In cherges. Sox 3. Shows whether your Instltullon changed /Is method of reporting for 2007. II has changed lis melhod of reporting If the method (payments received or amounts bUled) used for 2007 Is dltrerentlhan the raporUng'method used for 2006. You should be aware 01 this change In fl!Juring your allowable tullioR and fees deduction or educatIon credits. The deduction and the credits are allowable only for amounls actually paid during the year and not amounts _ eported as billed, but not paid. during Ihe year. r

Ball 4. Shows any adjustment made for a prior year for qualltled tuition and related expensesthet wern reported 011 a prior year Fann 1098-T. This amallnl may reduce any allowable educalion Cll!ldit you may claim for the prior year. See Form 8863 01 Pub. 970 for mare InformaUon. BOil 5. ShoWs the total of ell scholarships or grants administered and processed by the eligible educationallnstilutian. The amount of scholarships or grants for the calendar year (including those not reported by the lnstituflOfl) may reduce the emount of any allowable tulllon and fees deducllon or the educellon credit you may claim for the yeer. · Box 6. Shows adjustments to schofalShlps or grants for a prior year. This amount may affect the amount of any allowable tultlon and fees deduction or educallon credlt you may claim for the prior year. See Pub. 970 for how to report·these amounts. Box 7. Shows whelher the amount In box 1 or 2 Includes amounts for an academic period beginning January-Mardl 2008. See Pub. 970 lor how 10 report lhesa amounts. ~ Box 8. Shows whether you are considered 10 be canylng et least one-half the normal tun·time WOIk load for your I';OUlSl! of study at the reparting Inslilution. If you are at least a half·llme student for at least one academic period II1at begins during the year. you meet one of the Rlquirements for the Hope credit You do not have to meet the wor1<Ioadrequirement to qualify for the Iuitlon and fees deduclIon or the Rfellme learning credit. Box 9. Shows whether YOlIare considered to be enrolled in a program leading 10 a graduate degree, graduate·level certificate. or other recognfud graduate.Jevel educational credential. If you are enrolled In a graduate program. you are not eligible for the Hope credll, but you may qualify for the tulUon and fees deducllon or the Ilfallmaleamlng credIt Box 10. Shows the tala I amount of reimbursements or refundS of qualified tulUon ll1Id related expenses made by an Insurer. The amount of reimbursements or refunds for the calendar year may reduca the amount of any allowable tuition and fees deduction or education credit you may claim lor the year.

f\o.·wr"\

vy, lau
Student Class Schedule

~t )i..Pki/}V).R/)..... .

JZ~lC.~C~"(\

(~to

--{)Ler r"lt)

(0 l

'O./~.Y..1Q.t

()c»vu.Q.Qc

__C_l_c__t_ print Schedul_.'_, 0e ik o

.

_. __

.-.-------_
~
1--

..

..--------- --~\r------- .

~-r

CI:".J ~.

----'----------~------_.---------------------~------ ..----i-----' ,-.,
FORM

Copy 8· To Be fIIod With Empl"V""'s FEDEJIALT ····1IatJ.m.
ThIlt Inlormallon Is bIIslg f\lmiShIId 10 1he In""naI Rev ······ Semce.

W2
-

Wage and Tax Statement

2007

L_~_.·_. .

._~

"·..."331eJr--. ~

j

i

I
·.···. ··.. ·~McI tu r xw held
2 4 6

--_! o.1.imifti" Dfifiilfiln.v-k.,nit mpensatian Federal income

c

plolet · Mme, address. and ZIP code

Medicar. tax withheld

f

tv tPo

whhhekl

773.05 386,95

BIG SHOULDERS DIGITAL VIDEO PR 303 E WACKER DRIVE CHICAGO, IL 60601

.-

··

Lastname

JANELLE L. GEDMIN 7618 W SAINT FRANCIS RD FRANKFORT, IL 60423
I Emplo-ye.'. ocIdmss and ZIP code

_f~_

FORM Statement Cop, 2 · To Be filed wlth Employee's

W2
Tilt

Wage and Tax

2007
Slole, CIty, or Loc81 ·

Ol1-20205 DMIlNo.11_
7 cIII_trlills

3 SoclalAaJll1Y_
5 Mod1caIe W"ll"8 _

6241.13
4 8

SaclolllDCUri1'("" Withheld MedlcIre 11111 II_ w

773.05. 386.95

m-ne

Return.

c

Employe", name, address, end ZIP code

624l.13
lip.

BIG SHOULDERS DIGITAL VIDEO PR 303 E WACKER DRIVE CHICAGO, IL 60601
·· Employee's 1St nameandinltla Last name

JANELLE L. GEDMIN 7618 W SAINT FRANCIS RD ___ -l[~KFO..E%, It. 60423
I Employee's address and ZIP code

.X!>. _

,_.~ 1

~._
.

..

!

---<.!!;".;.."

.

Ex F

I

I
I

Em 0 r idenlif ·····ion number (EII\ EmplQyl>l"S name. alIcfress. and Z1PCCllle

'20 SQIIInsIIIldIDllS for Box 12 , Wages, tips. lllher oompensallon

2 RKI81ll1 1I1C0l1llIIax WlIMl!1C

;
Ub

27657.41
.SocIaIseculily VIlIgeS
4 Social seculily

3506.36
lel< llrilhheld

ALLSTATE INSURANCE COMPANY HUMAN RESOURCE SUPPORT TEAM Sl WEST HIGGINS ROAD Sl'E VGA SOUTH BARRINGTON, IL 60010

1~
12.

i2c

!

27657.41
MelIlCa/.8·waues and lips' . B MedIcate

1714.76
Ialllllil!ll1el!l .

~~~~57.41

401. 03

!

".:'8
JANELLE

7618 W SAINT FRANCIS RD FRANKFORT, XL 60423-6931

L.

GEDMIN

= o

o
letu)'

~~'"':Jo.:J,-;1

5 Slale

~~-.. Em I
. idllirlific:atlail

: '6 ~,1I;!Igll$;.1pS..et;:.~:;< ',7S1l1e

_____ §~1~_tl ~1

.

laxL:::: ..... _.. ." . _

~~2~§1 __
;lgll$;.!IJI$o;Jllnef,cemperl1ia tax WI

ni.iiJiei' - '.' ..
. INSlJIUINCE COMPAID!
f2tJ

, Employer's name.:address.llIld ZIP coile ALLSTATE

SOUTH BARRINGTON,

!lOMAN RESOURCE SUPPORT TEAM 51 WEST BIGGINS ROAD STS VGA

IL 60010

12c
-- ..·.. .::.>:·l~ i
12·
I

!

~"'.s!!cUI!lY'wageS,..
:M~:waoes_~UPlF . ,.~Ilp!!'>':"'.:

- -··-2·'1-6-57.413506;36

.. 4Soc1.als":'"!lylaxwltNleld
;

27657.41
:.
i. '

&~~.tai<".ltlhekf· l! AIIoi:itIedtipS'

1714.76 401.03

27657.41

.. ::

1'L.~.L1o rSHH"lIro·'3-OXc;n

7618 W SAINT FRANCIS RD FRANKFORT, IL 60423-6931

JANELLE L.

GEOMIN

604

001615

:.'8=

o

1-'111111111I111111111111111111_11 1111111.11111.-111._111.111 III)

Em Ir idet1tmi:iation nUmber Bnployer's name, address, and ZIP code
ALLSnTE
HUMAN

an·' : ; ~.SodBI ~dly.lax 121:

lax·\IIiI!e. :l lJ

3506 .. 36
WltNleld TEAM

51 WEST BIGGI:NS ROAD STE VGA

RESOURCE

INSURANCE COMPANY
StlPPORT

1714.76
IJ-Medio:lirel\ll!' wi1llheld .

SOUTH BARRINGTON,

IL 60010

"..:.. :.~t;-:·:::'::-;::. ::.

r-

1

!

2d

401.03

JANEU.E

7618 W SAINT FRANCIS RD FRANKFORT, IL 60423-6931

L.

GEDMIN

.(Z~~!~i:~·:~
;.-.. :"'.!.':~:"':"' ·. ' _ ".
':l · '. _. · .'

ThIs In!cnnation Is being fUrnished 10 Ille Intemal ReYEnUeserviCe

'13

o

"-"=.,r. " '-. .

5 St8 e Employer's state I number.-,

~J;;__

;

22bl2

EmplOridenlitlCallOn hUmbel' El
emploY8~.'s·name. ~ acldr<l!o&,.lIM ZIP cocIe INSURANCE COMPANY RESOURCE SUPPORT TEAM

. ... 3506.36
. ;~at
......
S!l!'UIi1y

lnCame1llll

I

ALLSTATE

iex wi1l!h~

51 WEST BIGGINS ROAD STE VGA

SOUTH BARRINGTON,

IL 60010

li;~_I!I'.Il.1axWilltlllld

1714.76
401.03

'b Em

0 I!f

c enployer'sname,

ilenlillcaUon number IEtN addfess, and ZiP cccle

Y2e
elf BnlllOYws naml!, BddrBSs,llIld.ZIP.i:ode
', .. ' ".".' '.~
"

.. ::'.'.

!

:'.

7618 W SAINT FRANCIS RD FRANKFORT, IL 60423-6931
8
·,."8S1ll.Ie .·····.·. -

JANELLE ~DMIll

.. With Employeo's '

C~py 2";''(0 Be·Flled· . State. City, or Loc;al>

.

14 Olher

Income Tax Return'.; :,i
soi:Iolse<Uilyl1!'Jll!lir
1I ····

~'$

__~!~~ __

~····..·'.8te. ".:'~ ,1 · .

e.I.nco.· 8.. 111ll : ' -'-" . .m

/ 1' '· IC·'· .. 1]~a!_:~._~ a1~:::~~e:~· ~~~_l._~ncan&lalC~_:~~~~ '. ~s .,. IlCall ~

2O'~IY'Nf1\e

_
Taa Rd omelaK ····1I!IG '

------------------------~------------------------"-.----~
b Em iilenUIication number Et c ·Employer's namu, adc:tess, and 2IP'lIllde

.Form W-2 W··

and T.~ Stalement

llOOl

-Oepal1menI or· the Treasury-lnlemal. Revenue 5arviee

..---.-------_.--_._.----------------------------"-----------------------------_.----_
OMIU·' 545-0008 c.py.z - Te ····.··.·· . Wl!9SS;·/lpS;. .
EmpIDrloe'. _e, CU" .r.Le·· ,_

"II"

r campensalian. .. .. '

2.

.

ALLSXATE INSURANCE COMPANY HUMAN RESOURCE SUPPORT TEAM 51 WEST BIGGINS ROAD STE TGA SOUTH BARRINGTON, IL 60010
>:~";; :.;..

121>

2441.26
. SoC:laI. "":Wlly.Wll9eS·; MelIICiie:~ ~Ilps

lC

4 Social security tax "~llVleld . 6'Medicara tax y,ilhheld

308.04 151.36 35.40

12d 1 :
:

1

20

2441.26
1I~ l1}1ps.· .

2441.26

210

%LALL 7S*·"''''Auro**]-1lrG:rT

JANELLE L. GEDMIN 7618 K SAINT FRANCIS RD FRANKFORT, IL 60423-6931

6alli

'1 .....,.,

o

.....,..

I'll JIll II Mil '11I11I11t11'"111'1 "Ull"1I11"III'llu'II'1I11

/If,m . rJientlrlCaliOn number· EJN .~' C Bnploy~r'gname. actlraS'i, :8I1dZ1P..code

.; .. 8QI!l!,

ps,: .. erCllllllJlen&a

e

. 18K Wit

ALLSTATE

HUMAN RESOURCE

INSURANCE

51 WEST HIGGINS ROAD STE TGA SOUTH BARRINGTON, IL 60010

SUPPORT

COMPANY

:$Ql:l!l! $IlCUli!YlIlliIgBS '.'. c., ":'.' ,. ,. "~lII.!;BCUriIv

2441.26

18K\\ilhllelcl

308.04 151.36 35.40

TEAM

'M~'Wages

2441.26 2441.26
.'

1II1d!IllS:::': '; ·.

U~edlciu'e.tall y,ilhheltl· .. ' " II Anoca19Cf Ups ,

s!JCl!l1~' .J:lS,: '~':""

JANELLE L. GEDMIN 761B W SAINT FRANCIS RD FRANKFORT, IL 60423-6931

.~~JJir.
. oepanmenl

TIlls rnirmnaUon Is being furnlsl1ed 10 \he 'memlll Revenue Service

"""" o"

~"l'

.b

c 'Employer'$ name ·.·adclr~ ·.and ZJf>·C«Ie
HUMAN RESOURCE

em ...

ri~

iiumber eN'

---------------_._----:---_. __ .._----------_
of.lhe Trea:5U.'Y·.I.nlellllllRsvel1.u ··.~...vIc:" OMB' 1545-0008
Co.,

B-T.

. ..S~._With..;".,·-··-·~·. .:....-_----R.. ~ "" · ·· _~
Fu.el FEDERAL T··

ALLSTATE

INSURANCE

SOUTH BARRINGTON,

51 WEST HIGGINS

SUPPORT

COMPANY

ROAD STE TGA
IL 60010

TEAM

JAN&LLE L. GEDMIN FRANKFORT,
7618

o

. ··,,=',"..

W SAINT FRANCIS RD

IL 60423-6931