PAROCHIAL REPORT 2011 PACKAGE

Embed Size (px)

Citation preview

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    1/44

    THE 2010REPORT OF EPISCOPAL CONGREGATIONS AND MISSIONSACCORDING TO CANONS I.6,I.7, AND I.17

    (OTHERWISE KNOWN AS THEPAROCHIAL REPORT)

    Name of Congregation Diocese

    Street Address1 City State

    Street Address2 Zip + 4 County

    Mailing Address1 Mailing City State

    Mailing Address2 Zip + 4 Phone #

    Federal Tax ID# Email Address Congregation's Web Address

    http://

    Report PreparationPage 2. Prepared by: Daytime Phone

    Page 3. Prepared by: Daytime Phone

    Certified by the Clerk of the VestryCertified by (Print or type name)

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    2/44

    Certified by (Print or type name)

    Congregation City Diocese Page 2

    Membership, Attendance and Services of the Reporting Congregation

    Using Last Year's Report: Using the 2009 Parochial Report, record theNumber of Baptized MembersActive Baptized Members of Reported as of December 31, 2009. (See your 2009 Parochial Report, Box M09.)the Reporting Congregation

    Reported Last Year Members Reported Last Year = M09.

    Using the Register of Church Membership and Rites:

    During the Report Year 1. Increases during year: All members added to the baptized members section of thecongregation'sMembership Registerduring 2010 by: baptism, confirmation/reception, or transfer; andthose persons restored from inactive status, or not counted in last year's membership count.

    Increases in Membership Total Increases = 1.

    2. Decreases during year:All active baptized members lost by death, transferred to anothercongregation, removed to inactive status in theRegister of Church Membership and Rites, removedfor other reasons, or not removed from last year's membership count.

    Decreases in Membership Total Decreases = 2.

    Active Baptized Members of M10. Add the increases entered in box 1 toBoxM09. Then subtract the decreasesthe Reporting Congregation entered in box 2 for the total active membership as of December 31,2010.At Year-End

    Total Active Baptized Members (end of report year) = M10

    Communicantsin Good 3. All communicants in good standing: Allbaptized membersof the reportingStanding of the Reporting congregation, who have received Holy Communionat least three timesduring the

    Congregation preceding year and are faithful "in corporate worship, unless for good cause prevented,"and "in working, praying, and giving for the spread of the Kingdom of God."

    All communicants (adults and youth) in good standing = 3.

    Youth in Good Standing 4.Those communicants in good standing (counted on line 3) who are under 16.

    Communicants in good standing who are under 16 = 4. _______

    Others Active 5. Others who are active whose baptisms arenotrecorded in theMembership Register, or in another Episcopal congregation. Others = 5. _______

    Using the Service Register:Average Sunday Attendance 6. Sunday (&Saturday Evening)Attendance:Divide total

    for 2010 attendance by number of Sundays. Avg. Sunday Attendance = 6.

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    3/44

    Congregation City Diocese Page 3

    Stewardship and Financial Information of the Reporting Congregation

    Giving Information for 2010:Number of Pledges 1. Number of signed pledge cards for 2010-report year (1)

    Total $ Pledged 2. Total dollar amount pledged for 2010-report year (2)$Report of Revenues and Expenses for 2010:

    Operating Revenues 3. Plate offerings, pledge payments & regular support (3)

    4. Money from investments used for operations in 2010 (4)

    5. Other operating income, including unrestricted gifts& restricted gifts used for operations & contributionsfrom congregation's organizations (5)

    6. Unrestricted bequests used for operations (6)

    Subtotal Normal Operating Income (3+4+5+6) =A

    7. Assistance from diocese for operating budget (7)

    Total Operating Revenues (A+7) = B

    Non-Operating Revenues 8. Capital funds, gifts & additions (8)

    9. Additions to endowment & other investment funds (9)10. Contributions & grants for congregation-based

    outreach & mission programs (10)

    11. Funds for transmittal to other organizations (11)

    Subtotal Non-Operating Revenues (8+9+10+11) =C

    Total All Revenues (B+C) = D

    Operating Expenses 12. To diocese for assessment, apportionment, orfair share (12)

    13. Outreach from operating budget (13)

    14 All th ti (14)

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    4/44

    Congregation City Diocese Page 4

    Priest(s) Serving this CongregationLast name of Rector, Vicar, Dean, Priest-in-charge or interim First name Middle name

    Title of position Year ordained Diocese of canonical residence

    Employment status at this congregation:

    Full time Part time Non-stipendiary

    Year called to thiscongregation:

    Church pension status:

    Active Retiree Non-active

    Name of other congregation(s) currently served by this priest (if any)

    Last name of associate priest, assisting priest or curate First name Middle name

    Title of position Year ordained Diocese of canonical residence

    Employment status at this congregation:

    Full time Part time Non-stipendiary

    Year called to thiscongregation:

    Church pension status:

    Active Retiree Non-active

    Last name of associate, assisting or other priest First name Middle name

    Title of position Year ordained Diocese of canonical residence

    Employment status at this congregation:

    Full time Part time Non-stipendiary

    Year called to thiscongregation:

    Church pension status:

    Active Retiree Non-active

    Last name of associate, assisting or other priest First name Middle name

    Title of position Year ordained Diocese of canonical residence

    Employment status at this congregation:

    Full time Part time Non-stipendiary

    Year called to thiscongregation:

    Church pension status:

    Active Retiree Non-active

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    5/44

    GENERAL INSTRUCTIONSFOR COMPLETING THE 2010PAROCHIAL REPORT

    FILING AND PAGE 1

    File your Parochial Report online at http://pr.dfms.org using the UEID and PIN that are printed on the cardthat was included along with this instruction sheet in your Parochial Report packet. Do not forget to includethe dash in the middle of your UEID when you log on. If you are unable to file online, mail your completedParochial Report to your diocese. Please do not send your form to New York.

    Review your pre-printed addresses on Page 1 and correct them if there are errors or if information is blank.On your street address, do not give an intersection as your address. Give an actual street address and zipcode of where you hold worship services. This address is not used for mailing purposes, but to identify thephysical location of your place of worship.

    PAGE 2:MEMBERSHIP,ATTENDANCE, AND SERVICES

    Active Baptized Members of the Reporting Congregation Reported Last Year . This number willappear automatically on the electronic data entry form and may also appear pre-printed in Box M09 of the

    hard copy Parochial Report form. Do not change this number unless it is blank, zero, or if it is incorrectbecause your congregation failed to file a 2009 Parochial Report.

    Active Baptized Members of the Reporting Congregation. For statistical purposes the Episcopal

    Church counts only active baptized members. Inactive members should be noted as inactive in the Register

    of Church Membership and Ritesand should not be counted in the Parochial Report. By canon law they

    should remain on the membership rolls, however, until removed by reason of transfer or death.

    Enter all active baptized members added during 2010 to the Total Increases line (1.). Enter all of theactive baptized members removed by death, transfer or to your inactive roll during the year in line 2. Addthe increases to your membership total from last year and subtract your decreases to get your currentactive, baptized membership total (M10).

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    6/44

    congregation does not hold services on Sunday, it is appropriate to count attendance at services onanother day as Sunday services (unless most of your participants attend Sunday services elsewhere).

    Sacraments and Services. This section refers to services held, not the people who attended them.

    Refer to the Workbook for Page 2 for additional information about recording services (available athttp://generalconvention.org under Parochial Reports).

    PAGE 3:STEWARDSHIP AND FINANCIAL INFORMATION

    Pledge cards. On line 1, enter all persons, adults and children, who signed a pledge card (number ofsigned pledge cards) or some other pledge of record (signed note or letter of pledge) for the Report Year.

    Amount pledged. On line 2, enter the total amount pledged. This number does not refer to the amountof pledge income that was actually received.

    General Description of Operating Revenues and Expenses: All funds, from whatever source, that areused for the general operation of the congregation are operating revenues. The general operation of thecongregation includesbut is not limited tocompensation of clergy & lay staff, all expenses related tooperating and insuring the building(s), expenses of the music program, church school, adult educationprograms, flowers and supplies for the altar, diocesan quota or assessment, utilities, and office expenses.

    Because operating revenues are defined as the funds that are used to pay operating expenses, TotalOperating Revenue will typically equal or nearly equal Total Operating Expenses.

    Money received from investments used for operations in 2010. Line 4 does not refer to gains orlosses in your congregations investments, but rather to funds transferred from your investments to youroperating budget. A negative number cannot be reported here because it is incorrect.

    Non-operating revenue. Funds included here are not part of a congregations operating budget. All

    funds received that were used for a non-operating purpose (expense) must also be non-operatingrevenue. Thus, funds received via plate or pledge but that were transferred to your investments shouldnot be counted in line 3. They should be counted in line 9. If they are spent at some later date for anoperating purpose, the amount transferred from investments into the operating budget is recorded in line

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    7/44

    GENERAL INSTRUCTIONSFOR COMPLETING THE 2010PAROCHIAL REPORT

    FILING AND PAGE 1

    File your Parochial Report online at http://pr.dfms.org using the UEID and PIN that are printed on the cardthat was included along with this instruction sheet in your Parochial Report packet. Do not forget to includethe dash in the middle of your UEID when you log on. If you are unable to file online, mail your completedParochial Report to your diocese. Please do not send your form to New York.

    Review your pre-printed addresses on Page 1 and correct them if there are errors or if information is blank.On your street address, do not give an intersection as your address. Give an actual street address and zipcode of where you hold worship services. This address is not used for mailing purposes, but to identify thephysical location of your place of worship.

    PAGE 2:MEMBERSHIP,ATTENDANCE, AND SERVICES

    Active Baptized Members of the Reporting Congregation Reported Last Year . This number willappear automatically on the electronic data entry form and may also appear pre-printed in Box M09 of the

    hard copy Parochial Report form. Do not change this number unless it is blank, zero, or if it is incorrectbecause your congregation failed to file a 2009 Parochial Report.

    Active Baptized Members of the Reporting Congregation. For statistical purposes the Episcopal

    Church counts only active baptized members. Inactive members should be noted as inactive in the Register

    of Church Membership and Ritesand should not be counted in the Parochial Report. By canon law they

    should remain on the membership rolls, however, until removed by reason of transfer or death.

    Enter all active baptized members added during 2010 to the Total Increases line (1.). Enter all of theactive baptized members removed by death, transfer or to your inactive roll during the year in line 2. Addthe increases to your membership total from last year and subtract your decreases to get your currentactive, baptized membership total (M10).

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    8/44

    congregation does not hold services on Sunday, it is appropriate to count attendance at services onanother day as Sunday services (unless most of your participants attend Sunday services elsewhere).

    Sacraments and Services. This section refers to services held, not the people who attended them.

    Refer to the Workbook for Page 2 for additional information about recording services (available athttp://generalconvention.org under Parochial Reports).

    PAGE 3:STEWARDSHIP AND FINANCIAL INFORMATION

    Pledge cards. On line 1, enter all persons, adults and children, who signed a pledge card (number ofsigned pledge cards) or some other pledge of record (signed note or letter of pledge) for the Report Year.

    Amount pledged. On line 2, enter the total amount pledged. This number does not refer to the amountof pledge income that was actually received.

    General Description of Operating Revenues and Expenses: All funds, from whatever source, that areused for the general operation of the congregation are operating revenues. The general operation of thecongregation includesbut is not limited tocompensation of clergy & lay staff, all expenses related tooperating and insuring the building(s), expenses of the music program, church school, adult educationprograms, flowers and supplies for the altar, diocesan quota or assessment, utilities, and office expenses.

    Because operating revenues are defined as the funds that are used to pay operating expenses, TotalOperating Revenue will typically equal or nearly equal Total Operating Expenses.

    Money received from investments used for operations in 2010. Line 4 does not refer to gains orlosses in your congregations investments, but rather to funds transferred from your investments to youroperating budget. A negative number cannot be reported here because it is incorrect.

    Non-operating revenue. Funds included here are not part of a congregations operating budget. All

    funds received that were used for a non-operating purpose (expense) must also be non-operatingrevenue. Thus, funds received via plate or pledge but that were transferred to your investments shouldnot be counted in line 3. They should be counted in line 9. If they are spent at some later date for anoperating purpose, the amount transferred from investments into the operating budget is recorded in line

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    9/44

    INSTRUCTIONS FOR 2010 PAROCHIAL REPORT

    TO: Those who fill out parochial reports

    FROM: Barbara Baugh

    DATE: December 28, 2010

    Enclosed in this packet are several very important items regarding the 2010 Parochial Report which isdue in the office of the Diocese of West Texas by February 1, 2011. They are:

    Diocesan supplemental information pages

    Letter from General Convention

    Card with UIED and PIN numbers Keep this card The numbers will not change

    The 2010 Report of Episcopal Congregations and Missions (Parochial Report)

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    10/44

    MEMORANDUMDecember 28, 2010

    street number and zip code rather than the intersection of streets . You will need the UIEDnumber and PIN number for your church. There is a card included in your packet containing this

    information. Save this card because these numbers remain the same from year to year. If you needassistance in putting your report online, please call me.

    Here are a few quick tips to assist you:

    Do not forget to obtain the appropriate signatures on the first page of the report.

    Federal Tax I.D. No. Your congregation should have this number which is issued to

    churches as well as to businesses for identification of employers. If you do not haveone, you need to apply for one.

    Do NOT report in dollarsand cents. ROUND OFF TO THE NEAREST DOLLAR.When you file online, this is done for you automatically.

    Please note that there are 9 additional items enclosed in this mailing. The brief, but importantDiocesan reports, must be completed and mailed with your parochial report:

    1. Instructions for filing online2. Salaries for 2011 (report has some small changes from last year)3. Diocesan Stewardship Statistics for 2011 (report has some small changes from last

    year)4. Church Officials for 20115. Vestry or Bishops Committee for 2011

    6. Certification of Insurance7. Instructions for Audit Committee Team Members8. Necrology form9. Workers Compensation Payroll Audit

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    11/44

    INSTRUCTIONS FOR FILING ON-LINE

    1. Access the Episcopal Church Web page athttp://www.episcopalchurch.org/gc/ or go directly to http://pr.dfms.org

    2. Select Parochial Reports and left click File Report to become linkedto a menu that will ask for your Universal Episcopal Identifier number(UEID) followed by your password. (If you need these numbers,

    please contact Barbara Baugh, 888/210-824-5387, ext. 111)

    3. Go to Update Name and Address to check this information. Makeany changes, then Save or click Cancel if nothing has changed sincelast year.

    4. Select Update File Information. Make any changes, then save

    before returning to the system menu.

    5. Choose Vital Statistics and Financial Statistics successively toenter the needed data. Now go to Mark Report Complete. ClickConfirm to submit Parochial Report, then exit at the bottom of thescreen to exit the program.

    6. Go to View/Print Parochial Report to obtain a hard copy to review.Select the correct year and left click the Submit button for the reportto download. You can re-enter at will to make changes or updates.

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    12/44

    SALARIES FOR 2011

    Church _______________________________________ City _______________________

    Instructions: List the Title: Rector, Vicar, Assistant, etc., followed by the Annual Cash Salary for the year 2011. Indicate whether Housing, Utilities, or Auto are provided and amounts. (Indicate amounts if provided by the congregation, e.g., if clergyperson is provided a church-owned rectory or if

    utilities are paid by the Church.) Please answer the question concerning Equity Allowances.

    CLERGY POSITION CASH SALARYINCL. SECA

    HOUSINGALLOWANCE

    UTILITIESALLOWANCE

    AUTO/TRAVELALLOWANCE

    CONTINUINGEDUCATION

    ALLOWANCE

    MEDICALINS.

    PENSION

    $ $ $ $ $ $ $ $

    $ $ $ $ $ $ $ $

    $ $ $ $ $ $ $ $

    Is clergyperson who lives in a church-owned rectory provided with an Equity Allowance? Yes ___ No ___

    OTHER SALARIES FOR 2011

    Please enter actual amounts, not a check mark. Additional spaces provided on the reverse side

    LAY POSITION ANNUALSALARY

    YEARS OFSERVICE

    PARTTIME

    # OF HOURS

    FULLTIME

    # OF HOURS

    VOLUNTEER DISABILITYINSURANCE

    L/T S/T

    MEDICALINS. $

    PENSION$ AND %

    Christian Ed Director $ $ $ %

    Lay Minister $ $ $ %

    Music Director $ $ $ %

    Organist $ $ $ %

    ParishAdministrator

    $ $ $ %

    Secretary $ $ $ %

    Sexton $ $ $ %

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    13/44

    LAY POSITION ANNUALSALARY

    YEARS OFSERVICE

    PARTTIME

    # OF HOURS

    FULLTIME

    # OF HOURS

    VOLUNTEER DISABILITYINSURANCE

    L/T S/T

    MEDICALINS. $

    PENSION$ AND %

    Youth Minister $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    $ $ $ %

    Organists, nursery workers, etc. should be considered paid employees. An independent contractor must provide their own supplies, come on their own schedule, and have proof ofworkers compensation and liability insurance (a copy should be kept on file at the church).

    (Revised - 01/20/11)

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    14/44

    STEWARDSHIP STATISTICS 2010 Actual & 2011 Estimate

    The Department of Stewardship consists of three primary divisions. Volunteer consultants are nowavailable to assist congregations in the following areas:

    Annual Giving To assist with developing a commitment program tailored to your church

    Capital Giving To assist with assessing the degree of readiness and planning theeducation process that produces readiness in a congregationLegacy Giving To assist with the development and implementation of congregationalWills Clinics, Final Affairs Fairs, and to teach the ABCs of estate planning

    Church ____________________________________________ City ___________________

    2011 Stewardship/EMC/Planned Giving Contact Persons with E-mail __________________

    ___________________________________________________________________________________________________________________________________________

    __________________________________________________________________

    S t e w a r d s h i p 2 0 1 0 / 1 1Did you use the Herb Miller New Consecration Sunday StewardshipProgram in 2010?

    YES NO

    If not, what annual stewardship campaign did you use?(Letter Campaign, Cottage Meetings, Festive Meal, Home Visitation,other)

    Did you see an increase in total dollars pledged for 2011? YES NO

    If so, what was the percentage (%) increase in dollars pledged? %

    Did you see an increase in number of pledging units for 2011? YES NO

    If so, what was the percentage (%) increase in # of pledge units? %How many pledge units increased their giving for 2011? #

    * # of actual pledging units for 2011 year #

    Pleasere

    turnthisformwithyourpa

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    15/44

    CHURCH OFFICIALS FOR THE YEAR 2011(Please print or type)

    Church ___________________________________________ Street Address ___________________________________________

    Mailing Address (if different than above) ________________________________________________________________________

    Church Phone Number _________________ Fax Number ____________________E-mail Address_________________________

    TITLE NAME MAILINGADDRESS

    PHONENUMBER

    E-MAIL ADDRESS

    Senior Warden(if Parish)

    Bishops Warden(if Mission)

    Treasurer

    Christian EdDirector

    ParishAdministrator

    Secretary

    Secretary

    Secretary

    FinancialSecretary

    Communications

    Music

    Youth

    Lay Ministry

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    16/44

    PLEASE LIST ALL CLERGY (SALARIED ONLY):

    TITLE NAME1.

    2.

    3.

    4.

    5.

    NONSTIPENDIARY CLERGY

    1.

    2.

    3.

    OTHER PAID EMPLOYEES (NUMBER ONLY)

    PAROCHIAL SCHOOL INFORMATION OR MOTHERS DAY OUT INFORMATION(Circle the one that applies)

    Name of school ________________________________________________ Phone ________________________

    Address ______________________________________________________ Zip ___________________________

    Headmaster, Principal, or Director ______________________________________________________________

    Grade or age levels ____________________________________________ Capacity ______________________

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    17/44

    VESTRY OR BISHOPS COMMITTEE FOR THE YEAR 2011(Please print or type)

    Church ____________________________________________________________________________________________________

    NAME MAILING

    ADDRESS

    PHONE

    NUMBER

    E-MAIL ADDRESS

    1.

    2.

    3.

    4.

    5.

    6.

    7.

    8.

    9.

    10.

    11.

    12

    13.

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    18/44

    14

    15

    16.

    17.

    18.

    19.

    20.

    21.

    22.

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    19/44

    CERTIFICATION OF INSURANCE - 2011

    Church _______________________________________

    City __________________________________________

    INSURANCE

    INSURANCECATEGORY

    NAME OF PRIMARY INSURANCECANON I.6.1 (3)

    COVERAGE

    Building(s) $

    Contents of Building(s) $

    Bonding $

    Workers Compensation $

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    20/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    21/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    22/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    23/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    24/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    25/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    26/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    27/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    28/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    29/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    30/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    31/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    32/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    33/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    34/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    35/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    36/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    37/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    38/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    39/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    40/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    41/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    42/44

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    43/44

    NECROLOGYFebruary, 2010, through January, 2011

    CHURCH____________________________________CITY______________________

    The following deaths have occurred from February, 2010, through January, 2011,of those persons who served the diocese on Vestries, Bishops Committees,Council Delegates, officers of the diocese, Diocesan Altar Guild, or otherdiocesan committees:

    NAMES:

  • 8/8/2019 PAROCHIAL REPORT 2011 PACKAGE

    44/44

    NAME INSURED POLICY NUMBER 46 WE LO4627

    ADDRESS POLICY TERM 1/1/2010 - 1/1/2011

    CITY, STATE ZIP FEDERAL I.D. #

    INSTRUCTIONS - Please provide your 2010 ACTUAL NUMBER OF EMPLOYEES AND WAGES in the appropriate columns below.

    1. Indicate under the appropriate classification(s) the amount of employee(s) gross salary, including housing and utility allowances for clergy.2. Payroll for contractors performing Church related operations must be included, unless they have provided evidence of their own WC coverage.

    3. DO NOT include any salaries paid by the diocese.

    4. Return this form by mail, FAX (210) 824-2164 or email to the Bishop Jones Center to [email protected] on or before January 31, 2011.

    # of Empl.

    CHURCH PROFESSIONAL

    Clergy, Deacons, Supply Clergy & Interim Priests

    Clerical Employees

    Organist, Choir Member

    Sexton/Other, Maintenance Employees, CooksChild Care during Worship Service

    Other: (Provide Brief Job Description, i.e. Youth Minister)

    SCHOOL PROFESSIONAL

    Teachers

    Maintenance Employees, Cooks

    Clerical Employees

    Other: (Provide Brief Job Description)

    CHILD DAY CARE CENTER

    Professional EmployeesClerical Employees

    Maintenance Employees

    TOTAL PAYROLLS

    Contact Name: (Please Print) Phone

    The undersigned certifies that all salaries and wages earned by all persons employed are included in this report.

    By Date

    (Name/Title)

    WORKER'S COMPENSATION - PAYROLL AUDIT REPORT - 2010

    2010 ACTUAL WAGES

    CLASSIFICATION OF WORK Total Earnings