Appointment Change NCC Appointment Change Form This form is to be used for changes in appointments between sessions of Annual Conference. This form is to be completed by the District Superintendent or Assistant to the District Superintendent overseeing the appointment at the Exiting Charge. Please be aware that appointment changes may have a dramatic impact on pension and insurance benefits. For complete details of how a particular appointment scenario will affect these benefits and the pastor's overall compensation package, please contact JoAnna Ezuka or Sandy Lee at 1-800-849-4433. 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. Date Format: MM slash DD slash YYYY What is the reason for the revision?*Effective Date - Outgoing Pastor* Date Format: MM slash DD slash YYYY Outgoing Pastor*Enter "TBS" if To Be Supplied or "None" if this is an addition of an associate or co-pastor OR if this is a Dual Appointment situation. First Middle Last Exiting Charge*The Outgoing Pastor is exiting what Charge? PLEASE list what church/ churches this affects - EVEN if the outgoing is TBS or noneExiting Charge District*Please select the district of the Exiting Charge. PLEASE list what district this affects - EVEN if the outgoing is TBS or none-- Select A District --BeaconCapitalCorridorFairwayGatewayHarborHeritageSoundEntering Charge*The Outgoing Pastor is entering what Charge?Entering Charge District*Please select the district of the Entering Charge.-- Select A District --N/ABeaconCapitalCorridorFairwayGatewayHarborHeritageSoundEntering Conference Status*What will be the Outgoing Pastor's conference status in the charge that he/she is entering?-- Select A Status --N/AAffiliate Member (AF)Associate Member (AM)Associate Member of Other Conference (OA)Certified Lay Minister (LM)Deacon in Full Connection (FD)Deacon Member of Other Conference (OD)Diaconal Minister (DM)Elder in Full Connection (FE)Elder Member of Other Conference (OE)Full Member of Other Denomination (OF)Full-time Local Pastor (FL)Part-time Local Pastor (PL)Part-time Local Pastor (PL)(SP) - Student Pastor of Other ConferencePart-time Local Pastor/Deacon (PL/D)Provisional Deacon (PD)Provisional Elder (PE)Provisional Member of Other Conference (OP)Retired Associate Member (RA)Retired Deacon in Full Connection (RD)Retired Diaconal Minister (DR)Retired Full Elder (RE)Retired Local Pastor (RL)Retired Local Pastor/Deacon (RL/D)Retired Member of Other Annual Conference (OR)(Elder)Retired Member of Other Denomination (OR)(Other)Retired Provisional Deacon (RP)(Deacon)Retired Provisional Member (RP)Supplied/Hired/Assigned (SY)N/A Status (Outgoing)Please explain if the answer above was N/A.Appointment Status (Outgoing)*If the Outgoing Pastor is not going to another appointment, then what is their status at the effective date?-- Select A Status --N/AAppointed to attend school (BOD para. 416.6)Continuing Candidate (BOD 313)Discontinued Candidate (DOB 314)Discontinued Local Pastor AND Discontinued Candidate (BOD 314 / 320.1)Discontinued Local Pastor (BOD 320.1)Dual Appointment (serving current charge & taking on another BUT not merging with current)Extension Ministry (BOD 331)Extension Ministry (BOD 344.1.a.c)Extension Ministry (BOD 344.1.b)Extension Ministry (BOD 344.1.d)Extension Ministry (BOD 345)Family Leave (BOD 354.2.b)Honorable Location (BOD 359)Medical Leave (BOD 357)Military LeaveNo record of appointment (BOD para. 320)On loan to another conference (BOD para.346.1)Personal Leave (BOD para. 354.2.a)Retired (BOD para. 358)Returned to home conferenceSabbatical leave (BOD para. 352)Surrendered credentials (BOD para. 360)Surrendered credentials - Voluntary Transition Program (BOD para. 360)Transferred membership out of NC Conference (BOD para. 347.1)Transitional leave - paid through NC Conference (BOD para. 354.c)Transitional leave - unpaid (BOD para. 354.2.c)Transitioning out of ministryWithdawn / complaints (BOD para. 361.3)Withdrawn / to united with another denomination (BOD para. 361.1)CC Membership (OP)*What is the charge conference membership for the OP?Outgoing Pastor Phone*What is the phone number for the Outgoing Pastor?Outgoing Pastor AddressWhat is the address of the Outgoing Pastor? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Incoming Pastor*Please enter the name of the Incoming Pastor appointed as successor to the Outgoing Pastor. Otherwise, enter "TBS" if this is a To Be Supplied. First Middle Last Effective Date - Incoming Pastor*What is the date of this appointment change? Date Format: MM slash DD slash YYYY Entering Conference Status (Incoming)*What will be the Incoming Pastor's conference status in the charge that they are entering?-- Select A Status --N/AAffiliate Member (AF)Associate Member (AM)Associate Member of Other Conference (OA)Certified Lay Minister (LM)Deacon in Full Connection (FD)Deacon Member of Other Conference (OD)Diaconal Minister (DM)Elder in Full Connection (FE)Elder Member of Other Conference (OE)Full Member of Other Demonination (OF)Full-time Local Pastor (FL)Part-time Local Pastor (PL)Part-time Local Pastor (PL)(SP) - Student Pastor of Other ConferencePart-time Local Pastor/Deacon (PL/D)Provisional Deacon (PD)Provisional Elder (PE)Provisional Member of Other Conference (OP)Retired Associate Member (RA)Retired Deacon in Full Connection (RD)Retired Diaconal Minister (DR)Retired Full Elder (RE)Retired Local Pastor (RL)Retired Local Pastor/Deacon (RL/D)Retired Member of Other Annual Conference (OR)(Elder)Retired Member of Other Denomination (OR)(Other)Retired Provisional Deacon (RP)(Deacon)Retired Provisional Member (RP)Supplied/Hired/Assigned (SY)OtherN/A Status (Incoming)Please explain if the answer above was N/A.Appointment Status (Incoming)*If the Incoming Pastor is not coming from another appointment, what is their status before the effective date?-- Select A Status --N/AAppointed to attend school (BOD para. 416.6)Continuing Candidate (BOD 313)Discontinued Candidate (DOB 314)Discontinued Local Pastor AND Discontinued Candidate (BOD 314 / 320.1)Discontinued Local Pastor (BOD 320.1)Dual Appointment (serving current charge & taking on another BUT not merging with current)Extension Ministry (BOD 331)Extension Ministry (BOD 344.1.a.c)Extension Ministry (BOD 344.1.b)Extension Ministry (BOD 344.1.d)Extension Ministry (BOD 345)Family Leave (BOD 354.2.b)Honorable Location (BOD 359)Medical Leave (BOD 357)Involuntary Leave (BOD para. 355)Military LeaveNo record of appointment (BOD para. 320)On loan to another conference (BOD para.346.1)Personal Leave (BOD para. 354.2.a)Retired (BOD para. 358)Returned to home conferenceSabbatical leave (BOD para. 352)Surrendered credentials (BOD para. 360)Surrendered credentials - Voluntary Transition Program (BOD para. 360)Transferred membership out of NC Conference (BOD para. 347.1)Transitional leave - paid through NC Conference (BOD para. 354.c)Transitional leave - unpaid (BOD para. 354.2.c)Transitioning out of ministryWithdawn / complaints (BOD para. 361.3)Withdrawn / to united with another denomination (BOD para. 361.1)Multi-Point Charge/Dual Appointment*Will this person serve more than one appointment? A multi-point charge is a collection of appointments that are affiliated with each other. A dual appointment is when two or more appointments that are not affiliated with each other are served by the same pastor.-- Select An Option --No - serving one appointmentYes - 2Yes - 3Yes - 4What best describes this appointment?*This is ONLY one appointmentMulti-Point ChargeDual AppointmentMulti-Point AND Dual AppointmentIs this person part of the New Faith Communities project?*YesNoInformation for Appointment 1Please answer the following questions for this appointment only. Name of Appointment 1*Appointment Percentage Time (Incoming)*What are the compensation package details for the Incoming Pastor?100%75%50%25%Total Annual Salary for Appointment 1 (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 (Line item 2b1.)*Vouchered Continuing Education Allowances - with receipts (Line item 2b2.)*Vouchered Miscellaneous Cash Allowances (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 (Line item 6.)This will multiply Subtotal (line item 5) by 25% and the total will be entered here.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 Appointment 2Please answer the following questions for this appointment only. Name of Appointment 2*Appointment Percentage Time (Incoming)*What are the compensation package details for the Incoming Pastor?75%50%25%Total Annual Salary for Appointment 2 (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 (Line item 2b1.)*Vouchered Continuing Education Allowances - with receipts (Line item 2b2.)*Vouchered Miscellaneous Cash Allowances (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 (Line item 6.)This will multiply Subtotal (line item 5) by 25% and the total will be entered here.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 Appointment 3Please answer the following questions for this appointment only. Name of Appointment 3*Appointment Percentage Time (Incoming)*What are the compensation package details for the Incoming Pastor?75%50%25%Total Annual Salary for Appointment 3 (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 (Line item 2b1.)*Vouchered Continuing Education Allowances - with receipts (Line item 2b2.)*Vouchered Miscellaneous Cash Allowances (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 (Line item 6.)This will multiply Subtotal (line item 5) by 25% and the total will be entered here.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 Appointment 4Please answer the following questions for this appointment only. Name of Appointment 4*Appointment Percentage Time (Incoming)*What are the compensation package details for the Incoming Pastor?75%50%25%Total Annual Salary for Appointment 4 (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 (Line item 2b1.)*Vouchered Continuing Education Allowances - with receipts (Line item 2b2.)*Vouchered Miscellaneous Cash Allowances (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 (Line item 6.)This will multiply Subtotal (line item 5) by 25% and the total will be entered here.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 SectionName of Who is Completing this FormWho 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 NameThis field is for validation purposes and should be left unchanged.