捐赠给“一的力量” "*表示必填字段 Use this form to pledge a 100% tax-deductible donation.员工类型:* 医生 Advanced Practice Nurse / 医生 Assistant 领袖 其他所有人 我宣誓:* A Sustaining 工资扣除 持续的每月礼物 A 工资扣除 (through December 2024) 一次性供款 隐藏的(医生)我保证:* A Sustaining 工资扣除 持续的每月礼物 一次性扣除工资 一次性供款 Sustaining payroll deduction will begin July 2023 and recur until further notice. Future adjustments to sustaining gifts can be made by contacting the 圣弗朗西斯基金会 at 573-331-5133 or foundation@sfmc.网Future adjustments to sustaining gifts can be made by contacting the 圣弗朗西斯基金会 at 573-331-5133 or foundation@sfmc.网Payroll deductions will begin July 2023 and end December 2024.Sorry, physicians are ineligible to donate ETO. Please choose another pledge type.工资扣除金额:* 每个工资期200美元 – Qualifies for 1875 Founders Society recognition. Benefits include: Donor Wall recognition and invitation to Major Donor Dinner. 每个支付周期10美元 – Entered to win $2,400 worth of gas 每个工资期5美元或以上 -免费粉底杯. Fill it up anytime at the Tuscan Sun for just 50 cents! 每个工资期200美元 每个工资期150美元 每个支付期100美元 每个工资期75美元 每个工资期50美元 每个工资期40美元 每个工资期30美元 每个工资期20美元 每个支付周期15美元 每个工资期10美元 每个支付周期5美元 每个工资期的其他金额 Amount to Deduct Per Pay Period:*One-Time Contribution Payment Method:*Minimum One-Time Contribution is $5 检查 现金 Credit Card / Debit Card / e检查 工资扣除 One-Time 检查 / 现金 Donation Amount:*Please forward your donation via mail or a Foundation drop box in the Medical Center.One-Time Credit Card / Debit Card / e检查 Donation Amount:*Credit Card donations will be processed on the next page after you’ve submitted this form.Please enter a number greater than or equal to 5.One-Time 工资扣除金额:*承诺的经济贸易服务时数:* ETO will be eligible for donation beginning January 2024 through June 2024. 最少8小时. Applicable sales tax will be withheld from Earned Time Off donations. Earned Time Off will be paid out at 100%. Current ETO Sell-Back policy applies. 医生s are ineligible to donate ETO.Sustaining Gift Monthly Contribution Amount:*Credit card / debit card / e检查 only. Your payment will be processed on the next page after you’ve submitted this form.捐款总额:I Wish to Support (Up to Four):* 最需要的地区 CancerCare CardiacCare 关爱基金 教堂 临终关怀 有希望的父母 以斯帖修女基金 以人为本基金 指定基金名称:*Please list a 圣弗朗西斯基金会 Fund 名称:* 第一个 最后的 工作邮箱:* 地址:* 街道地址 城市 状态 阿拉巴马州阿拉斯加美属萨摩亚亚利桑那州阿肯色州加州科罗拉多州康涅狄格特拉华州哥伦比亚特区佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰麻萨诸塞州密歇根明尼苏达州密西西比州密苏里州蒙大拿内布拉斯加州内华达新汉普郡新泽西新墨西哥纽约北卡罗莱纳北达科他北马里亚纳群岛俄亥俄州俄克拉何马州俄勒冈州宾西法尼亚波多黎各罗德岛州南卡罗来纳南达科塔州田纳西州德州犹他州U.S. 属维尔京群岛佛蒙特州维吉尼亚州华盛顿西维吉尼亚州威斯康辛州怀俄明美洲武装部队欧洲武装力量太平洋武装部队 邮政编码 电话号码:*员工部门:*选择部门:3楼ACC - 6500会计- 8170Aco - 7299行政- 8250Advanced Orthopedic Specialists – 7851救护车- 7080麻醉- 6700麻醉学- 6710审计- 8168AWL Family 健康care System – 7836生物医学服务部,8060Black River Management – 8255黄铜- 6506业务发展- 8135呼叫中心- 6845Cancer Services Administration – 7310Cap Labor EMR Pre-Implementation – 6640Cape Cardiology Group - 6680Cape Care for Women - 7415角脑血管 & Endovascular Neurosurgery – 6690糖尿病的角 & 内分泌科- 6820开普ENT集团- 7417Cape Gastroenterology Specialists – 6865Cape Gynecologic Oncology – 6790开普医疗集团- 7837开普医学肿瘤科- 6670Cape Neurology Specialists – 6695Cape Neurosurgical Associates – 7855海角疼痛管理- 7815开普儿科组- 7846Cape Perinatology Services – 6590Cape 医生 Associates – 7825开普初级保健- 7835角肺学 & 睡眠医学- 7020Cape Radiation Oncology – 7300Cape Spine and Neurosurgery – 6685开普胸 & 心血管外科- 7040Cardiac Intensive Care Unit – 6540心脏康复服务- 7240心血管实验室- 7030案例管理- 6521Cat扫描器- 7070Center for Digestive Diseases – 6860集中供电- 6800集中调度- 8180集中遥测- 7840基于CGO证明- 9020Charleston Family Care – 7833胸部疼痛 & 中风中心- 7025Clinical Neurophysiology – 7000基于CMO证明- 9010通讯- 8160Continuing Care Clinic – 7412Copper Top Pharmacy PB – 7857COVID - 19 Unit - 6515COVID输液中心- 6516基于ctv的证明- 9040客服- 7390射波刀- 7330Deli Plus - 8017Dexter Fitness Plus - 7366糖尿病教育 & 管理- 7210灾难管理- 6817Durable Medical Equipment – 7165电诊断- 6950急诊室- 6850雇员健康- 6840血管内实验室- 6990Entrance 2 Convenient Care – 6856入口管理- 6813环境服务- 8110史诗- 7890Erc - 8301ERC东北- 8303ERC西南- 8302评估单元- 6780设施管理- 8050家庭出生地- 6600Farmington 医生 Associates – 7844弗格森医疗集团- 7861Ferguson Medical Group CH – 7863Ferguson Medical Group EP – 7864Ferguson Medical Group Lab – 7867Ferguson Medical Group SC – 7862Ferguson Medical Group SI – 7865财务规划- 8163财政服务- 8165健身中心- 7290健身Plus - 7295浮动秩序- 8200餐饮服务部- 8010基础- 8220朋友咖啡馆- 8015通用医疗- 6502Healing Arts Infusion Center – 7790治疗艺术实验室- 6920Healing Arts Urgent Care – 6859健康 & 健康Cat扫描- 6960健康之家- 7301健康 Information Management – 7900家庭输液疗法- 7130临终关怀- 7420医院账单- 8190住院医生——6830人人力资源杂项预算$ 8155HRSA 93.110 – 8248HRSA 93.912 – 8247HRSA外展补助金- 6975人力资源部- 8150Immediate Convenient Care – 6857Immediate Convenient Care – Jackson – 7839Immediate Convenient Care Perryville – 6858感染预防- 7880信息系统- 8210输液中心- 7860输液中心Dexter - 7355住院透析- 6770Inpatient Occupational Therapy – 7180Inpatient Physical Therapy – 7200Inpatient Rehabilitation – 6620Inpatient Respiratory Therapy – 7150灵感精品店- 8225重症监护员- 6831静脉治疗- 7120杰克逊家庭护理中心- 7832Kids Plus - 7297Knee, Hip and Shoulder Clinic – 6985Kneibert诊所- 7848Kneibert实验室- 6912Kneibert药房- 7849实验室- 6900洗衣和亚麻- 8120Learning and Development – 8140法律服务- 8169III级NICU - 6610连接件- 7500Mag网ic Resonance Imaging – 7060市场营销- 8130医疗事务部- 8245医疗主任- 7410医疗重症监护- 6550医学图书馆- 7800Medical Office Building – 7400任务综合- 8240新生儿科- 6580神经科学- 6512核医学- 7250苗圃- 6660营养服务- 7370NWM行为健康- 7853NWM药房- 7854职业医学- 6855OP儿童中心- 6520MRI - 6970手术室- 6650骨科-外科- 6630Outpatient Occupational Therapy – 7190Outpatient Physical Therapy – 7260Outpatient Rehab Services – 7170Outpatient Speech Therapy – 7280疼痛中心- 7810姑息治疗- 7425Patient Care Administration – 6400Patient Financial Services – 8175病人运输- 8235PB Condo - 6705Performance Improvement – 8020性能加- 7292宠物扫描仪- 7010药房- 7100Physical Therapy Dexter – 7155医生招聘- 8246医师联盟- 6505医生s Park General Surgery – 7780医生s Park Primary Care – 7842Piedmont 医生 Associates – 7845工厂操作- 8040Poplar Bluff Neurology Specialists – 7847Poplar Bluff Occupational Therapy – 7856Poplar Bluff Pediatrics – 7852麻醉后单元- 6750PPPC - Lab - 7843PPPC听力- 7834打印店- 8100专业计费- 7340渐进护理病房- 6560心理服务- 7270采购 & 收货- 8230质量改进- 7411放射治疗- 7320放射学- 7050注册中心- 7360Rehab Administration Services – 7220康复医疗- 7838已发还薪金- 8030零售药房- 7140Saint Francis Breast Care Center – 7850Saint Francis Clinic Jackson – 7841Saint Francis Outpatient Center – 7365Saint Francis Outpatient Center – Imaging – 7363Saint Francis Outpatient Center PB – 7364同日手术- 6980安全- 7910SFC PB 2 - 7858Sikeston Imaging Center – 7866Sikeston Radiation Oncology – 7350睡眠障碍中心- 7160社会服务- 8090SPD Reprocess - 7930专科诊所- 7830语言和听力- 7230斯塔尔培训- 8300无菌处理- 7920STF区域实验室- 6910外科- 6510Surgical Trauma Intensive Care – 6530健康的体重- 7298戒烟- 7872转接中心- 6812创伤- 6810Trauma Surgery 医生s – 6815超声波- 7090Utilization Review - 6835静脉中心- 6760志愿者- 8080减肥方案- 6720健康- 7870工地烟草- 7873伤口护理- 7820Saint Francis Colleague Badge Number:*承诺协议:* I agree to fulfill my pledge in its entirety 验证码电子邮件This field is for validation purposes and should be left unchanged.