Gross Monthly Pay
Base Monthly Salary     $
Hourly equivalent (calculated 173.3 hours / month) $    
Premium Pays
Average overtime:    hours per month times 1.5 $    
Other  $    
Other  $    
     Total premium pay per month: $    
   Total monthly salary (base + premium pays)   $
Additional Employer Paid Amounts
Health Plan
Contribution to health premium  $  
Dental Plan
Contribution to dental premium  $  
Health Savings Account Yes  No
Purchase of life insurance & AD&D $  
Purchase of short term disability insurance $  
Contribution to Medicare Part B $  
Contribution to PERA $  
     Total of employer's contributions $
Leave Benefits
Number of hours of Annual Leave earned per month  $  
Number of hours of Extended Sick Leave earned per month.  (4) $  
Ten days (80 hours) Holiday Leave: average of 6.667 hours per month. $  
hours of Administrative Leave used per month for past 12 month. $  
hours of Funeral Leave used per month for past 12 months. $  
hours of Military Training Leave used per month for past 12 months. (maximum of 15) $  
     Total value of Leave benefit amounts $
Other Incentives Received
Pay for Performance One-time Non-base Building Awards recieved in the last year: $ $    
Other $  
Work-Life Benefits
Participate in Flexible work arrangement options (Flexplace or Flextime). Assign your own monthly value based on personal costs avoided (parking, transportation, dry cleaning, child care, etc.) $  
Employee discounts used: assign monthly value you saved by using discount $  
Employee Wellness Program Yes  No
     Total value of other incentives and work-life benefits $
   Total monthly value of pay, employer contributions, and other incentives work life $
Other fringe benefits unique to certain districts. Check those that apply and assign a value if known or you are able to estimate a value.
  Estimated Value
Value of state provided training courses for career development purposes, per month. $
Value of reduced fees for use of recreation or health club facilities, per month. $
Value of counseling or other CSEAP services used, per month. $
Value of reduced cost of parking or bus pass, per month. $
Value of Ecopass, per month. $
Value of  , per month. $
Value of  , per month. $
Value of  , per month. $
Total for other fringe estimates, per month.      $
 Total yearly value of pay, employer contributions, leaves, incentives, work-life programs, and other  fringe benefits:

Salary (pay and premium pays)  

Leaves, benefit contributions & other fringes 


Employees should also consider enrolling in your employer's pre-tax deduction program to save on taxes because these programs can offer you savings and more money in your monthly paycheck.  Employees within four years of retirement should carefully consider these pre-tax programs as they affect your highest average salary (HAS) for PERA retirement.