2018 NY 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 2018 actual payroll data specified below no later than Thursday, 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.

Cooperative Parishes and Charges - only the entity that disburses the payroll directly to the employee should be reporting payroll.  If a church pays an amount to a Cooperative Parish or another church in the Charge for “salaries,” they should not report payroll for Worker’s Compensation purposes.  Instead, the Cooperative Parish or paying church reports such payroll since they are the “payroll agent.”

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 440 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, 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)
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
D. I am submitting data for BOTH my church and church-controlled school/nursery or camp and want separate bills
*Your Church/Charge/Parish

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

Church Federal Tax ID #
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, C or D above, please list the federal tax ID# for the church-controlled school/nursery/day camp or an overnight camp here. If you have both, please list both numbers here.

2018 Actual Payroll

Please insert the combined total of payroll from your W-2 forms for each of the categories below. Use the total in Box 1 (wages, tips, other compensation) for each employee in each category.

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

1a. 2018 Gross Payroll (excluding Cash Housing Allowances Paid)
1b. Cash Housing Allowances Paid
1c. Number of Parsonages/Residences Provided

2. Church: Secretary, and other clerical workers (e.g. receptionists, bookkeepers)

2a. 2018 Gross Payroll (excluding Cash Housing Allowances Paid)
2b. Cash Housing Allowances Paid
2c. Number of Parsonages/Residences Provided

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

3a. 2018 Gross Payroll (excluding Cash Housing Allowances Paid)
3b. Cash Housing Allowances Paid
3c. Number of Parsonages/Residences Provided

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

4a. 2018 Gross Payroll (excluding Cash Housing Allowances Paid)
4b. Cash Housing Allowances Paid
4c. Number of Parsonages/Residences Provided

5. Overnight Camps: Directors, Counselors, Caretakers, Lifeguards, Maintenance workers, Cafeteria employees

5a. 2018 Gross Payroll (excluding Cash Housing Allowances Paid)
5b. Cash Housing Allowances Paid
5c. Number of Parsonages/Residences Provided
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