1
Church Info
2
Salaries
3
Premium
4
Submit
Church & Contact Information
Step 1 of 4Church Name
Senior Pastor
Church ID
Employer ID Number (EIN)
Number of Parsonages Occupied
Annual 2026 Salaries
Step 2 of 4
Enter the full year anticipated salary — NOT prorated amounts.
| Category | Annual Salary |
|---|---|
1Church Clerical Staff Administrative staff, secretaries, office personnel |
— |
2Senior & Associate Pastors All clergy salaries |
— |
3Other Church Lay Staff Diaconal ministers, youth directors, camp employees, other staff leaders |
— |
4School Professional Staff Teachers, principals, licensed educators |
— |
5Other School Staff Non-professional school employees |
— |
6Child Care Staff Daycare, preschool, and nursery employees |
— |
7Building Operations Staff Custodians, facilities managers, maintenance |
— |
Premium Rate Calculation — 2026
Step 3 of 4| Category | Salary | Rate | Premium |
|---|---|---|---|
| A — Clerical Staff Box 1 | $0.00 | 0.00116% | $0.00 |
| B — Senior & Associate Pastors Box 2 | $0.00 | 0.00447% | $0.00 |
| C — Other Church Lay Staff Box 3 | $0.00 | 0.02554% | $0.00 |
| D — School Professional Staff Box 4 | $0.00 | 0.00447% | $0.00 |
| E — Other School Staff Box 5 | $0.00 | 0.02544% | $0.00 |
| F — Child Care Staff Box 6 | $0.00 | 0.00916% | $0.00 |
| G — Building Operations Staff Box 7 | $0.00 | 0.02193% | $0.00 |
| Box 9 — Subtotal Premium (A+B+C+D+E+F+G) | $0.00 | ||
| Box 10 — Discounted Premium (Box 9 × 0.9585) | × 0.9585 | $0.00 | |
| Short Term Incapacity Fund (STIF) Assessment — mandatory | fixed | $35.00 | |
| Total Payment Due (Box 10 + $35.00) | $35.00 | ||
Summary & Submission
Step 4 of 4Church Name
—
Senior Pastor
—
Church ID
—
EIN
—
Total Salaries (Box 8) $0.00
Subtotal Premium (Box 9) $0.00
Discounted Premium — Box 10 (after 4.15% discount)$0.00
STIF Assessment (mandatory) $35.00
Total Payment Due $35.00
ACH Payment Notice
Starting in 2026, a one-time ACH will be made for the annual estimated premium amount.
Enrollment deadline: March 30, 2026.
ACH withdrawal date: April 30, 2026.
Please keep a copy of this form for your records.
Preparer Information
How to Submit This Form
Click Export to PDF below to download a copy to your computer, then click Submit Via Email to send your completed form to benefits@inumc.org.
Click Export to PDF below to download a copy to your computer, then click Submit Via Email to send your completed form to benefits@inumc.org.