Appointment Percentage Time or Salary Change NCC Appointment Percentage Time or Salary Change Form This form is to be used for changes to pastor's appointment percentage time or a mid-year change in salary. In all areas that require $$ amounts, please remember that you must type in 0.00 if you have nothing to fill in that spot. Is this a revision to a previously submitted Appointment Change Form?*YesNoWhat was the date of the original form submitted?*This will be on the email that you received. What is the reason for the revision?*Effective Date*When is the appointment percentage time or salary change? Pastor's name* First Middle Last Charge*What is the name of the charge affected?District*What District is this charge in?-- Select A District --Beacon DistrictCapital DistrictCorridor DistrictFairway DistrictGateway DistrictHarbor DistrictHeritage DistrictSound DistrictMulti-Point Charge/Dual Appointment*Does this person serve more than one church?-- Select An Option --NoYes - 2Yes - 3Yes - 4Change(s)*This form is being completed for the following change(s).-- Select An Option --Percentage Time OnlySalary Change OnlyBoth - Percentage Time and Salary ChangeInformation for Church 1Please answer the following questions for this church only.Name of Church 1*Appointment Percentage Time*What are the compensation package details for this person?100%75%50%25%Total Annual Salary (Line item 1.)*Other Cash Allowances (w/out receipts) - Health Insurance (Line item 2a1)*Coverage outside the NC Conference Group BCBS Insurance Plan. For pastors who are not enrolled in the NC Conference group health insurance plan through Blue Cross Blue Shield but who do receive an allowance from their church for health insurance through another policy. Enter the amount from the church’s budget for this allowance.Other Cash Allowances (w/out receipts) - Continuing Education (Line item 2a2.)*Not part of an accountable reimbursement plan. If the church provides a lump sum allowance to the pastor without requiring documentation of the expense, then enter the amount from the church’s budget for this allowance.Miscellaneous Cash Allowances (w/out receipts) (Line item 2a3)*Allowances that fall in this category include, but are not limited to, money not under an accountable reimbursement plan given for subscriptions, office supplies, love offerings, and Christmas cash gifts, etc.Total Other Cash Allowances (w/out receipts) (Line item 2a.)This will add line items 2a1, 2a2, 2a3 and input the total here.Vouchered Travel & Cash Allowances (Line item 2b1.)*Vouchered Continuing Education Allowance (Line item 2b2.)*Line item 2b2.Vouchered Miscellaneous Cash Allowance (Line item 2b3.)*Total Vouchered Other Cash Allowances (Line item 2b.)*This will add line items 2b1, 2b2, 2b3 and input the total here.Vouchered Utilities Allowance (Line item 3.)*Cash Housing Allowance (Line item 4a.)*Paid to Pastor.Utilities Allowance (Line item 4b.)*For Pastors who receive a Housing Allowance.Subtotal (Line item 5.)This will add line items 1, 2a, 4a, 4b and input the total here.Parsonage (line item 6)*Is a parsonage provided?YesNoParsonage Calculation - YES (Line item 6.)This will multiply Subtotal (line item 5) by 25% and the total will be entered here.Parsonage Calculation -NO - (Line Item 6)Plan Compensation - If Yes Parsonage (Line item 7.)This will add line items 5 & 6 and input the total here.Plan Compensation - If NO Parsonage (Line item 7.)This will add line items 5 & 6 and input the total here.Additional Information*Any other circumstances surrounding this appointment change that conference offices should know about? (ie: benefits, payroll, other salary-paying appointments, etc.) If there is nothing additional to add, please type N/A.Information for Church 2Please answer the following questions for this church only. Name of Church 2*Appointment Percentage Time*What are the compensation package details for this person?75%50%25%Total Annual Salary (Line item 1.)*Other Cash Allowances (w/out receipts) - Health Insurance (Line item 2a1)*Coverage outside the NC Conference Group BCBS Insurance Plan. For pastors who are not enrolled in the NC Conference group health insurance plan through Blue Cross Blue Shield but who do receive an allowance from their church for health insurance through another policy. Enter the amount from the church’s budget for this allowance.Other Cash Allowances (w/out receipts) - Continuing Education (Line item 2a2.)*Not part of an accountable reimbursement plan. If the church provides a lump sum allowance to the pastor without requiring documentation of the expense, then enter the amount from the church’s budget for this allowance.Miscellaneous Cash Allowances (w/out receipts) (Line item 2a3)*Allowances that fall in this category include, but are not limited to, money not under an accountable reimbursement plan given for subscriptions, office supplies, love offerings, and Christmas cash gifts, etc.Total Other Cash Allowances (w/out receipts) (Line item 2a.)This will add line items 2a1, 2a2, 2a3 and input the total here.Vouchered Travel & Cash Allowances (Line item 2b1.)*Vouchered Continuing Education Allowance (Line item 2b2.)*Vouchered Miscellaneous Cash Allowance (Line item 2b3.)*Total Vouchered Other Cash Allowances (Line item 2b.)This will add line items 2b1, 2b2, 2b3 and input the total here.Vouchered Utilities Allowance (Line item 3.)*Cash Housing Allowance (Line item 4a.)*Paid to Pastor.Utilities Allowance (Line item 4b.)*For Pastors who receive a Housing Allowance.Subtotal (Line item 5.)This will add line items 1, 2a, 4a, 4b and input the total here.Parsonage (line item 6)*Is a parsonage provided?YesNoParsonage Calculation - YES (Line item 6.)This will multiply Subtotal (line item 5) by 25% and the total will be entered here.Parsonage Calculation -NO - (Line Item 6)Plan Compensation - If Yes Parsonage (Line item 7.)This will add line items 5 & 6 and input the total here.Plan Compensation - If NO Parsonage (Line item 7.)This will add line items 5 & 6 and input the total here.Additional Information*Any other circumstances surrounding this appointment change that conference offices should know about? (ie: benefits, payroll, other salary-paying appointments, etc.) If there is nothing additional to add, please type N/A.Information for Church 3Please answer the following questions for this church only.Name of Church 3*Appointment Percentage Time*What are the compensation package details for this person?75%50%25%Total Annual Salary (Line item 1.)*Other Cash Allowances (w/out receipts) - Health Insurance (Line item 2a1)*Coverage outside the NC Conference Group BCBS Insurance Plan. For pastors who are not enrolled in the NC Conference group health insurance plan through Blue Cross Blue Shield but who do receive an allowance from their church for health insurance through another policy. Enter the amount from the church’s budget for this allowance.Other Cash Allowances (w/out receipts) - Continuing Education (Line item 2a2.)*Not part of an accountable reimbursement plan. If the church provides a lump sum allowance to the pastor without requiring documentation of the expense, then enter the amount from the church’s budget for this allowance.Miscellaneous Cash Allowances (w/out receipts) (Line item 2a3)*Allowances that fall in this category include, but are not limited to, money not under an accountable reimbursement plan given for subscriptions, office supplies, love offerings, and Christmas cash gifts, etc.Total Other Cash Allowances (w/out receipts) (Line item 2a.)This will add line items 2a1, 2a2, 2a3 and input the total here.Vouchered Travel & Cash Allowances (Line item 2b1.)*Vouchered Continuing Education Allowance (Line item 2b2.)*Vouchered Miscellaneous Cash Allowance (Line item 2b3.)*Total Vouchered Other Cash Allowances (Line item 2b.)This will add line items 2b1, 2b2, 2b3 and input the total here.Vouchered Utilities Allowance (Line item 3.)*Cash Housing Allowance (Line item 4a.)*Paid to Pastor.Utilities Allowance (Line item 4b.)*For Pastors who receive a Housing Allowance.Subtotal (Line item 5.)This will add line items 1, 2a, 4a, 4b and input the total here.Parsonage (line item 6)*Is a parsonage provided?YesNoParsonage Calculation - if YES (Line item 6.)This will multiply Subtotal (line item 5) by 25% and the total will be entered here.Parsonage Calculation - if NO (Line item 6.)Plan Compensation - If Yes Parsonage (Line item 7.)This will add line items 5 & 6 and input the total here.Plan Compensation - If NO Parsonage (Line item 7.)This will add line items 5 & 6 and input the total here.Additional Information*Any other circumstances surrounding this appointment change that conference offices should know about? (ie: benefits, payroll, other salary-paying appointments, etc.) If there is nothing additional to add, please type N/A.Information for Church 4Please answer the following questions for this church only.Name of Church 4*Appointment Percentage Time*What are the compensation package details for this person?75%50%25%Total Annual Salary (Line item 1.)*Other Cash Allowances (w/out receipts) - Health Insurance (Line item 2a1)*Coverage outside the NC Conference Group BCBS Insurance Plan. For pastors who are not enrolled in the NC Conference group health insurance plan through Blue Cross Blue Shield but who do receive an allowance from their church for health insurance through another policy. Enter the amount from the church’s budget for this allowance.Other Cash Allowances (w/out receipts) - Continuing Education (Line item 2a2.)*Not part of an accountable reimbursement plan. If the church provides a lump sum allowance to the pastor without requiring documentation of the expense, then enter the amount from the church’s budget for this allowance.Miscellaneous Cash Allowances (w/out receipts) (Line item 2a3)*Allowances that fall in this category include, but are not limited to, money not under an accountable reimbursement plan given for subscriptions, office supplies, love offerings, and Christmas cash gifts, etc.Total Other Cash Allowances (w/out receipts) (Line item 2a.)This will add line items 2a1, 2a2, 2a3 and input the total here.Vouchered Travel & Cash Allowances (Line item 2b1.)*Vouchered Continuing Education Allowance (Line item 2b2.)*Vouchered Miscellaneous Cash Allowance (Line item 2b3.)*Total Vouchered Other Cash Allowances (Line item 2b.)This will add line items 2b1, 2b2, 2b3 and input the total here.Vouchered Utilities Allowance (Line item 3.)*Cash Housing Allowance (Line item 4a.)*Paid to Pastor.Utilities Allowance (Line item 4b.)*For Pastors who receive a Housing Allowance.Subtotal (Line item 5.)This will add line items 1, 2a, 4a, 4b and input the total here.Parsonage (line item 6)*Is a parsonage provided?YesNoParsonage Calculation - if YES (Line item 6.)This will multiply Subtotal (line item 5) by 25% and the total will be entered here.Parsonage Calculation - if NO (Line item 6.)Plan Compensation - If Yes Parsonage (Line item 7.)This will add line items 5 & 6 and input the total here.Plan Compensation - If NO Parsonage (Line item 7.)This will add line items 5 & 6 and input the total here.Additional Information*Any other circumstances surrounding this appointment change that conference offices should know about? (ie: benefits, payroll, other salary-paying appointments, etc.) If there is nothing additional to add, please type N/A.Final SectionCharge Conference Date*When was the Charge Conference held to approve salary change? Presiding Elder Name*Who was the presiding Elder over this Called Charge Conference? First Middle Last Name of Who is Completing this Form*Who is completing this form? First Last Email of Who is Completing this Form*Please enter a valid email address for the person completing this form. Enter Email Confirm Email EmailThis field is for validation purposes and should be left unchanged.