Give for Good PTO Donation - Bon Secours Mercy Health Foundation

Give for Good Campaign

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This form allows you to make a gift via personal time off (PTO) donation. If you would rather give by credit card, visit the credit card form »

If you would like to select another way to give, return to bsmhgiveforgood.com

PTO Donation

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Question - Required - I wish to make a PTO donation** (deducted from PTO balance in November 2022) of the following number of hours (8 hours minimum):

Due to policy changes, PTO donations can only be accepted from non-exempt (hourly) associates.

**PTO donations: I understand the final value of PTO I donate will be reduced by 10% per tax laws and Bon Secours Mercy Health policy, and the remainder will be reported as taxable compensation to which applicable taxes will be applied. The after-tax amount will be the value of my donation and can be reported on my personal tax return as a charitable contribution consistent with IRS guidelines.

** If your gift qualifies you for Half Hour Hero (13 hours) or Power Hour (26 hours) giving level, we will email you to select your reward.

Donor Information

Your information:


	Title:
*	First Name: Required
	Middle Name:
*	Last Name: Required
	Suffix:
	Professional Suffix:
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
*	Phone Number: Required
	If you respond and have not already registered, you will receive periodic updates and communications from Bon Secours Mercy Health Foundation.

Question - Not Required - Phone type

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Question - Required - Associate Workday ID#

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Question - Required - My Market:

Question - Not Required - AHPR

Choose a Special Purpose / Gift Designation

(Total of all selections must equal 100%)

Note: When selecting your market's corresponding fund you may need to scroll all the way down to find your market’s funds.

Question - Not Required - BSMH Ministry-wide Funds:

Question - Not Required - Amount (%)

Question - Not Required - Ministry-Wide Fund ID:

Question - Not Required - Choose a Market

Question - Not Required - Choose a Fund

Question - Not Required - Amount (%)

Question - Not Required - Market Choice #1 Fund ID:

Question - Not Required - Choose a Market:

Question - Not Required - Choose a Fund:

Question - Not Required - Amount (%)

Question - Not Required - Market Choice #2 Fund ID:

Question - Not Required - Choose a Market:

Question - Not Required - Choose a Fund:

Question - Not Required - Amount (%):

Question - Not Required - Market Choice #3 Fund ID:

Question - Not Required - Choose a Market:

Question - Not Required - Choose a Fund:

Question - Not Required - Amount (%):

Question - Not Required - Market Choice #4 Fund ID:

Question - Not Required - Choose a Market:

Question - Not Required - Choose a Fund:

Question - Not Required - Amount (%):

Question - Not Required - Market Choice #5 Fund ID:

Question - Not Required - Custom Fund

I would like to enter details about a fund or designation not already listed.

Question - Not Required - Market and Fund Name:

Question - Not Required - Amount (%):

Question - Not Required - Gift Calculation

Question - Not Required - For internal use only