PAYROLL DEDUCTIONS

A GUIDE FOR GIVING with Payroll Deduction

It's easy! You can donate thru payroll deduction by completing the form below. Following is a guide to help you decide your level of giving and a brief description of the 2022 Funds. You can select up to two funds for your payroll deduction.

Obstetrics Fund is our FEATURED FUND FOR 2022
The purpose of the Obstetrics Fund is to provide necessary resources for equipment and safety upgrades to the Obstetrics Department at Mosaic Center-Maryville, in an effort to create a healing environment for our patients and caregivers.

Obstetrics Fund

donate

Cancer Care Fund

donate

Unrestricted/Greatest Need Fund

donate

Technology/Equipment Fund

donate

Mental Health Fund

donate

Women's Health

donate

PAYROLL DEDUCTION

Complete the form to participate in the CareGIVER Campaign thru payroll deduction. 100% of your tax deductible donation will be applied towards the fund(s) of your choice.

* Indicates required field

Name *

First

Last

Address *

City *

State *

Zip *

Phone/Ext. *

employee id *

Payroll deduction for 12 months/26 pay periods starting January 10, 2020. Indicate below the amount you want deducted per pay period.

Donation Amount *

Please apply my gift to the following fund.

Choose no more than two funds *

Caregiver Assistance Fund Unrestricted/Greatest Need Fund Mental Health Fund Other

write in your choice for other *

signature (type name) *

Submit