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From the beginning, American Presbyterians have recognized the need to care for those who serve the Church. At the inaugural meeting of their first synod, in Philadelphia in 1717, they established the Fund for Pious Uses. The first award from the fund to an individual was to the widow of the Reverend John Wilson of New Castle, Delaware.

Throughout the 18th century, presbyteries formed and established funds of their own to care for the families of pastors. In the 19th century, funding of this particular benevolence remained largely a synod function. Faithful church leaders recognized additional needs of disabled pastors who could not earn sufficient income to care for their families. Numerous societies for the support of these pastors were formed in the synods and many continued into the early part of the 20th century.

Presbyterians ran through a series of ministerial relief plans in the 20th century. Generally, however, strides were made. By 1983, when the northern and southern branches of the Church reunited as the Presbyterian Church (U.S.A.), the concept of care had moved from simple relief to retirement support, including pension plans for pastors and other employees. Medical benefits were also provided.

Today, the Benefits Plan of the Presbyterian Church (U.S.A.) represents the incorporation and expansion of benefits provided by the Presbyterian Church in the United States (PCUS) and United Presbyterian Church in the United States of America (UPCUSA) at the time of reunion. Designers of the plan, which took effect January 1, 1987, rooted it in the belief that burdens are to be shared, that Scripture guides us to love and care for one another.

In fall 2014, as the Church continued to reform, the Board began a transformational process to serve more, serve better, and serve the Church. A series of listening sessions, held over a year throughout the Church, led the Board to redesign the Benefits Plan. The redesigned plan was effective January 1, 2017.

While the commitment to provide comprehensive benefits to installed pastors remains strong, there has been a need for flexibility and, with it, affordability so that congregations and other
PC(USA)-affiliated employers might care for their employees based on their resources. The redesigned Benefits Plan enables employers to provide choice and coverage to more of their workers.