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Form 103 Salary Worksheet - FCMM Benefits & Retirement 2026

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4.8 out of 5

125 votes

The document is an enrollment form for Group Long Term Disability Insurance and Term Life/AD&D provided by the Evangelical Free Church of America, administered by FCMM Benefits & Retirement. It includes instructions for completing the salary worksheet necessary for employee enrollments and updates, detailing how to calculate total annual salary and premium payments. The form also outlines employer responsibilities and submission guidelines.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name and email address in the designated fields. This ensures that your information is accurately recorded.
Next, fill in your employer's name and address, along with the contact person's details. This section is crucial for proper communication regarding your benefits.
In the salary section, input your gross annual base salary on Line 1. Remember to include any applicable amounts as specified, but exclude housing allowances and employer contributions.
If you receive a housing allowance, enter that amount on Line 2. Ensure that this figure reflects any designated allowances or fair rental values provided by your church.
Calculate your total annual salary by adding the amounts from Lines 1 and 2. This total will be used for premium calculations.
Complete the employer information section if this is an initial enrollment. Ensure all required fields are filled out accurately.
Finally, review all entries for accuracy before submitting the form through our platform’s secure file exchange or via mail.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (125 Votes)

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