Revised 01/12/2012
Page 1 of 2
Liquidated Damages: Reports received over 30 days after the
Studio Code #
PAYROLL PERIOD ENDING date will be assessed 10% of the
Signatory contributions due. Reports received over 60 days after the
Employer
PAYROLL PERIOD ENDING date will be assessed 20% of the
contributions due.
Street Address
Effective January 1, 1989: Failure to supply project titles and
City & State Zip social security numbers of all performers for which contributions
are being remitted will result in the assessment of liquidated
Telephone ( ) damages in the amount of 10% of the Pension and Health
contributions due. If the Producer's failure to supply the data
requested continues for 60 or more days, then liquidated damages
of 20% of the contributions due will be assessed.
Check No.________________________________
Amount $_________________________________
Date Received_____________________________
List only the Performers employed during the above indicated week WHO WORKED UNDER S.A.G. JURISDICTION and for whom
contributions are due the Pension and Health Plans. Picture ID __________________________ Picture Type ____________
Last First Initial
Total Gross Compensation Subject to Contributions
$
Employer's Contribution @ % of Gross Compensation
$
Special Rate Code
(please see page 2 for codes)
Liquidated Damages @ % (See above) $
Make check payable to: SCREEN ACTORS GUILD-PRODUCERS PENSION AND HEALTH PLANS Check No.
P.O. Box 54867, Los Angeles CA 90054-0867
Phone (818) 973-4472
Only Producers who are signatory* to an applicable collective bargaining agreement of the Screen Actors Guild are eligible to make contributions to the Screen Actors
Guild-Producers Pension and Health Plans on behalf of the eligible Performers employed by such Producers. Any contributions submitted by a non-signatory* Producer
will not be accepted.
I certify that the above-named Employer is signatory* to such a collective bargaining agreement with the Screen Actors Guild. By signing this agreement, Producer
acknowledges that it has accepted and agreed to be bound by the Pension & Health Provisions established by the collective bargaining agreement to which Producer
is signatory. I further certify that the information contained herein is correct, and that all compensation subject to contributions earned by performers in our employ
during the period covered and only for work within the jurisdiction of such collective bargaining agreement has been reported herein.
Signature Name Title Date
*A Producer will be considered to be "signatory" if the producer is a party to a collective bargaining agreement with the Screen Actors Guild, or, if the collective
bargaining has expired, the producer is obligated by federal law to continue to make such contributions.
CATEGORY
PERFORMER/BACKGROUND ACTOR NAME Performer
Sessions-S
Residual-R
Deferred-D
Background
Actor (E)
Choreographers
(CHR)
SOCIAL
SECURITY
NUMBER COMPENSATION
REPORTABLE
GROSS
SCREEN ACTORS GUILD- PRODUCERS PENSION AND HEALTH PLANS
THEATRICAL WEEKLY REPORT OF CONTRIBUTIONS
ALL INFORMATION ON THE FORM MUST BE COMPLETED FOR PROCESSING
FOR OFFICE USE ONLY
Report Performers and Background Actors Separately
Name of Picture
________________________________________________
Payroll Period End Date__________________________________________
Start Date of Principal Photography
________________________________
1 of 2
0
10
Page 2 of 2
1. Use this form to report the payment of compensation to performers and background actors for services rendered on theatrical motion pictures or for use of
those pictures in markets or media that require a residual payment.
2. Report each theatrical motion picture on a separate theatrical contribution report.
3. Each contribution report must include the start date of principal photography, as well as the picture's complete cast list.
4. Mail a copy of the P&H report to the SAG office nearest the city in which the picture was made. Refer to SAG branch addresses at www.sag.org\branches
16.80% rate for new employment on pictures the principal photography of which commenced on or after July 1, 2011.
(16.50% for Free TV, Basic Cable, New Media and Supplemental Market Pay TV use; 13.50% for Supplemental Market Home Video use)
15.30% rate for new employment on pictures the principal photography of which commenced on or after June 10, 2009.
(15.00% for Free TV, Basic Cable, New Media and Supplemental Market Pay TV use; 13.50% for Supplemental Market Home Video use)
14.80% rate for new employment on pictures the principal photography of which commenced on or after July 1, 2005.
(14.50% for Free TV, Basic Cable, New Media and Supplemental Market Pay TV use; 13.50% for Supplemental Market Home Video use)
13.50% rate for use payments on pictures the principal photography of which commenced on or after July 1, 2004.
13.00% rate for use payments on pictures the principal photography of which commenced on or after July 1, 2003.
13.50% rate for use payments on pictures the principal photography of which commenced on or after July 1, 2001.
13.00% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1998.
13.00% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1995.
12.50% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1993.
12.50% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1992.
12.50% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1989.
11.50% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1988.
11.00% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1983.
10.00% rate for use payments on pictures the principal photography of which commenced on or after February 7, 1982.
9.00% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1977.
8.50% rate for use payments on pictures the principal photography of which commenced on or after July 1, 1974.
6.50% rate for use payments on pictures the principal photography of which commenced on or after February 1, 1966.
16.50% rate for theatrical pictures the principal photography of which commenced on or after July 1, 2011.
15.00% rate for theatrical pictures the principal photography of which commenced on or after June 10, 2009.
14.50% rate for theatrical pictures the principal photography of which commenced on or after July 1, 2005.
13.00% rate for theatrical pictures the principal photography of which commenced on or after July 1, 2003.
13.50% rate for theatrical pictures the principal photography of which commenced on or after July 1, 2001.
13.00% rate for theatrical pictures the principal photography of which commenced on or after July 1, 1995.
12.50% rate for theatrical pictures the principal photography of which commenced on or after July 1, 1992.
Please refer to www.sagph.org\employer for the choreographer form and reporting instructions; or contact the Plans at choreographer@sagph.org.
$232,000 for services rendered on or after July 1, 2005.
$200,000 for services rendered between July 1, 1983 and June 30, 2005.
$165,000 for services rendered between October 6, 1980 and June 30, 1983.
$150,000 for services rendered between July 1, 1977 and October 5, 1980.
$100,000 for services rendered prior to July 1, 1977.
S = Supplemental Market Pay TV use N = New Media use
H = Supplemental Market Home Video use O = Other
Theatrical Reporting Form
SCREEN ACTORS GUILD- PRODUCERS PENSION AND HEALTH PLANS
SPECIAL RATE CODES
CONTRIBUTION LIMITS-PERFORMERS/THEATRICAL MOTION PICTURES
CHOREOGRAPHERS
BACKGROUND ACTORS/THEATRICAL MOTION PICTURES
PERFORMERS/THEATRICAL MOTION PICTURES
2 of 2