This title has been used in Lutheranism since 1527 for pastors leading a denomination at the regional level.
[1] The office was similar to that of bishop, but instead of being ordained by the archbishop, the superintendent was appointed by the Crown.
[4] In the American sense, specifically within the United Methodist Church, the title is used not to refer to a minister who is equivalent to a bishop but to the supervisor of a district, which is a regional subdivision below an episcopal area (equivalent to a diocese).
Bishops are elected and district superintendents are appointed from the group of elders who are ordained to be ministers of Word, Sacrament, and Order and thereby participate in the ministry of Christ, in sharing a royal priesthood which has apostolic roots (I Peter 2:9; John 21:15-17; Acts 20:28; I Peter 5:2-3; I Timothy 3:1-7).
[6] In some Pentecostal denominations, the title is used, such as Assemblies of God since 1914, regionally and nationally.