CHURCH BENEFITS ASSOCIATION
REPORTING FORM FOR 2003 STATISTICAL REPORT

1. GENERAL INFO

2. PENSION PLANS

3. HEALTH PLANS

4. INVESTMENT PERFORMANCE

Instructions: - All information should be reported for the year ending 12/31/2003 (or as of that date); if another 12-month period is used, please indicate. - If information is not available, please estimate or leave blank; however, note that for each section only complete information can be included in the summary report.

CBA Organization:
Reporting Calendar Year:
Your Name:
Your Telephone:
Your E-mail:

A. Member Organization Information
(As reported by the member organization or church body)

Enter data as requested OR NA/UN if applicable (DO NOT USE COMMAS)			NA - Not Applicable UN - Unavailable
Church membership:
Number of congregations:
Number of ministers	Active	Retired
	Total
Net assets, end of year - In Thousands A1

B. Plans reported 
(please complete a separate input form for each plan)

Number of pension plans	Defined benefit	Defined contribution
Number of health plans	Insured	Self-Funded

Footnotes:

A1	At market value for all benefit plans; this should exclude any endowment or other non-benefit assets; for members of the Church Alliance this amount will be used to determine the supporting contribution to be billed.