<p> Kentucky Annual Conference 2016 Clergy Compensation Report</p><p>A – Clergy Information</p><p>1. Name: ______5. District: ______</p><p>2. Address: ______6. Charge: ______</p><p>3. City/State/Zip: ______7. GCFA #: ______</p><p>4. Conference relationship status: ______8. Church: ______</p><p>9. Appointment percentage: ☐Full ☐¾ ☐½ ☐¼</p><p>B – Compensation</p><p>1. Cash Salary $ ______</p><p>2. Equitable Compensation $ ______3. Health Insurance (only include any amount paid other than the Employee Only premium for the Conference health plan. $ ______Do not include Employee Only premium.) 4. Self-Employment Tax (if paid by local church) $ ______</p><p>5. Other Income $ ______</p><p>6. Total Cash Compensation (total of lines 1-5) $ ______</p><p>C-1 – Housing: Parsonage 1. Is the minister provided a parsonage? ☐ Yes ☐ No 2. If yes, does the minister live in the parsonage provided? ☐ Yes ☐ No</p><p>3. If the minister lives in the parsonage, calculate: x 0.25 = Line B-6 (above) Parsonage Equivalent C-2 – Housing: Housing Allowance 1. Is the minister provided a cash housing allowance in lieu of a parsonage? ☐ Yes ☐ No If yes, enter amount: $ ______D – Calculate Total Pensionable Compensation + = 1. Total Cash Compensation (Line B-6) 2. Parsonage Equivalent or Housing Allowance 3. Total Pensionable Compensation</p><p>E – Housing Exclusion (required by the General Board of Pension and Health Benefits) 1. IRC Section 107 Housing Exclusion: *Amount that has been designated by the charge conference for housing expenses and expected to be excluded from federal income taxation. $ ______F – Signatures Staff Parish Relations Chairperson ______Date ______</p><p>Scan and email the completed form to [email protected] or mail to the Conference office ATTN: Benefits Clergy ______Date ______</p><p>District Superintendent ______Date ______</p>