Liberty Hospital Foundation · Employee Giving Campaign Form 2020

Hearts can heal!

2020 Employee Giving Campaign

This year's campaign runs during the month of September. From programs like Hughes Family Assistance to the TreeHouse and other Patient Assistance efforts, to the Walking Trail, Kyleigh’s Gift and Professional Education – your gift will help us further our entire mission of improving the quality of health, wellness, and care for our community in and outside of the Hospital. We'll be celebrating and highlighting our donors, and all employees, during the month of September with a special meal in early October for those that give during our campaign. Thank you!

How I plan to give

Payroll Deduction

PTO Hours

One-time Gift

Payroll Deduction

I authorize Liberty Hospital to make the deductions selected here from my paycheck as a charitable contribution going forward (starting in Oct, 2020). And understand I can contact the Foundation at any time to make changes to my bi-weekly deduction.

$20

$15

$10

Other amount

One-Time Gift

Payroll Deduction

Credit Card

Check

Credit Card Amount

$250

$100

$50

$35

Donation Schedule

One-time Gift Amount

$250

$100

$50

$35

Other amount

Paid Time Off

Income taxes will be deducted from your PDO donation and will be reflected on your pay stub. Please enter a number from 8 to 500.

Notes about my gift

Your Information

Name

First Name

Last Name

Employee ID Number

Never underestimate how meaningful you are. We don't.

If giving a one-time gift, add 3% to my total amount to help cover the payment processing fees