2019 CT Workers' Compensation Insurance Data Collection

Workers' Compensation coverage is mandatory under State law for all employers of full- and/or part-time personnel. Coverage is provided to all member churches/charges and church-controlled schools/nurseries and camps of the New York Annual Conference through a master policy with Church Mutual Insurance Company. 

To ensure that we have appropriate coverage and that our billing is correct, please provide the 2019 actual payroll data specified below no later than Friday, February 28th. This data pertains only to employees, not to those providing services to the church as independent contractors (those who receive IRS Form 1099, such as independent contractors supplying repair or other services to the church). As a reminder, all clergy are considered to be “employees” (must be issued a W-2) and should be included in the data you submit.

Charges - only the entity that disburses the payroll directly to the employee should be reporting payroll.  If a church pays an amount to another church in the Charge for “salaries,” they should not report payroll for Worker’s Compensation purposes. Instead, the charge or paying church reports such payroll since they are the “payroll agent.” If you are submitting for a multi-church charge (two or more churches sharing a pastor) and the other church/churches' payroll is included in this submission and they do not pay any additional payroll, please click the box "Only the Charge disburses payroll." That way, we won't need to reach out to the other church/churches to remind them that their submission is due.

If you have technical issues while completing the form, please contact Barbara Eastman at website@nyac.com; if you have questions about what data to enter, please contact Ross Williams at rwilliams@nyac.com.

Please click here for a document containing instructions and frequently asked questions about this form.

Please don't submit twice - you can click the link in your confirmation email to make changes.

With over 430 churches, we need to ensure that we have submissions from every church, even if the payroll was zero.  This will avoid questions that can arise in the future regarding coverage. If your payroll is zero (and your church payroll isn't submitted by the multi-church charge), it should take less than one-minute to complete the form. If you are reporting zero payroll, simply provide your Contact information, check "A" under "Entities covered," choose your church from the drop-down menu, and click "Submit Form" at the bottom of the page.

Contact Person
*First Name
*Last Name
*Entities Covered by Workers' Comp (choose one)

Churches with church-controlled schools that want separate invoices for the school and the church must complete separate submissions.

A. I am submitting data for my church only and want a separate bill
B. I am submitting data for my church-controlled school/nursery or camp only and want a separate bill
C. I am submitting data for BOTH my church and church-controlled school/nursery or camp and want a combined bill
Your Charge

NEW: If you are filing for a charge (two or more churches sharing a pastor), and only one of the churches in the charge directly disburses all payroll for all churches, please select your charge in the next drop-down list and click the button "Only the Charge disburses payroll." We will not expect submissions from the churches that do not disburse payroll. 

Only the Charge disburses payroll

 If you check this box, we won't need to reach out to the other church/churches to remind them that their submission is due. Thank you!

Charge Federal Tax ID#

Use format 12-3456789

- OR -

Your Church

Please choose your church from the drop-down list - these are sorted by church "short name." If you are filing for a church-controlled school/nursery or camp, please choose the church to which that entity is associated and enter the name in the name field below.

Church Federal Tax ID #

Use format 12-3456789

Name of church-controlled school/nursery/day camp

This is required if you are filing for a church-controlled school/nursery/day camp or an overnight camp. If you have both, please list both names here.

Church-controlled school/nursery/day camp Federal Tax ID#

If you chose either option B or C, please list the federal tax ID# for the church-controlled school/nursery/day camp or an overnight camp here. Use format 12-3456789.

2019 Actual Payroll

Please insert the combined total of gross payroll for each of the categories below from your payroll reports.

1. Church: Clergy, Choir Director, Organist, Church Secretary, other professional staff (e.g. Treasurer)

1a. 2019 Gross Payroll (excluding Cash Housing Allowances Paid)
1b. Cash Housing Allowances Paid
1c. Number of Parsonages/Residences Provided

2. Schools: Teachers, Aids, Administrators, Nurses, Secretaries (this is for church-controlled school/nursery/day camp only)

2a. 2019 Gross Payroll (excluding Cash Housing Allowances Paid)
2b. Cash Housing Allowances Paid
2c. Number of Parsonages/Residences Provided

3. Non-professional: Janitors, Sextons, Groundskeepers, Maintenance workers, Cafeteria employees

3a. 2019 Gross Payroll (excluding Cash Housing Allowances Paid)
3b. Cash Housing Allowances Paid
3c. Number of Parsonages/Residences Provided

4. Overnight Camps: Directors, Counselors, Caretakers, Lifeguards

4a. 2019 Gross Payroll (excluding Cash Housing Allowances Paid)
4b. Cash Housing Allowances Paid
4c. Number of Parsonages/Residences Provided
Your browser is not supported or has JavaScript turned off. To register use a different browser or turn on JavaScript.