Appointment Change - District Office

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?*
- Yes
- No
What was the date of the original form submitted?*
This will be on the email that you received.
MM slash DD slash YYYY
What is the reason for the revision?*
Effective Date - Outgoing Pastor*
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 none
Exiting Charge District*
Please select the district of the Exiting Charge.

PLEASE list what district this affects - EVEN if the outgoing is TBS or none
Entering Charge*
The Outgoing Pastor is entering what Charge?
Entering Charge District*
Please select the district of the Entering Charge.
Entering Conference Status*
What will be the Outgoing Pastor's conference status in the charge that he/she is entering?
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?
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 Address
What is the address of the Outgoing Pastor?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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?
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?
N/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?
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.
What best describes this appointment?*
- This is ONLY one appointment
- Multi-Point Charge
- Dual Appointment
- Multi-Point AND Dual Appointment
Is this person part of the New Faith Communities project?*
- Yes
- No
Information for Appointment 1
Please 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, 2a2, 2a3, 4a, 4b and input the total here.
Parsonage (line item 6)*
Is a parsonage provided?
- Yes
- No
Hidden
Parsonage Calculation (Line item 6.)
This will multiply Subtotal (line item 5) by 25% and the total will be entered here.
Hidden
Plan Compensation - If Yes Parsonage (Line item 7.)
This will add line items 5 & 6 and input the total here.
Hidden
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.
Hidden
Information for Appointment 2
Please 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, 2a2, 2a3, 4a, 4b and input the total here.
Parsonage (line item 6)*
Is a parsonage provided?
- Yes
- No
Hidden
Parsonage Calculation (Line item 6.)
This will multiply Subtotal (line item 5) by 25% and the total will be entered here.
Hidden
Plan Compensation - If Yes Parsonage (Line item 7.)
This will add line items 5 & 6 and input the total here.
Hidden
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.
Hidden
Information for Appointment 3
Please 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, 2a2, 2a3, 4a, 4b and input the total here.
Parsonage (line item 6)*
Is a parsonage provided?
- Yes
- No
Hidden
Parsonage 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.
Hidden
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.
Hidden
Information for Appointment 4
Please 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, 2a2, 2a3, 4a, 4b and input the total here.
Parsonage (line item 6)*
Is a parsonage provided?
- Yes
- No
Hidden
Parsonage Calculation (Line item 6.)
This will multiply Subtotal (line item 5) by 25% and the total will be entered here.
Hidden
Plan Compensation - If Yes Parsonage (Line item 7.)
This will add line items 5 & 6 and input the total here.
Hidden
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 Section
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
Name
This field is for validation purposes and should be left unchanged.

NCC Appointment Change Form

Information for Appointment 1

Information for Appointment 2

Information for Appointment 3

Information for Appointment 4

Final Section