Document Date
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Effective Date
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Church Name
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Charge Name
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| Multipoint Charge?
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| Clergy Name
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Name of Payroll Processing Church
(leave blank if church processes own payroll to pastor)
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Pension & Benefits Payment Option?
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| Click to view/download ACH form |
Waivers (Requires appropriate documentation and approval through Benefits) |
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For all values below, enter numbers only, no commas or $
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| Base Compensation |
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| Taxable Cash Allowance |
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| Equitable Compensation |
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Health Ins Allowance
(Your portion up to $15,850. Required for 3/4 and full-time)
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Housing Allowance
(paid in lieu of parsonage)
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View/Download Housing Resolution Document
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| Total Salary Value |
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| Parsonage Available? |
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| Parsonage Lived In? |
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View/Download Housing Resolution Document
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Parsonage Fair Rental Value (Enter Annual Amt) |
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| Parsonage Pension Value |
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| (If parsonage available then 35% * (Total Salary - Health Ins) |
Accountable Reimb Professional Development |
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Accountable Reimb Travel & Other |
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View/Download Accountable Reimb Document
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Health Insurance Paid By Church Sponsored Plan |
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