Give for Good Half Hour Hero Payroll Deduction - Bon Secours Mercy Health Foundation

Payroll Deduction

Give Payroll Deduction - Half Hour Hero

Note: this form works best in Edge, Chrome, Firefox, and Safari.

This form allows you to make a gift via payroll deduction. 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

*

Question - Required - Yes! I want to Give for Good!

Power Hour (1 hour per pay period) *

Half Hour Hero (1/2 hour per pay period) *

Lead for Good = $1,000 ($38.47 per pay period) *

Lead for Good = $1,000 (one-time payroll deduction)

$_________ per pay period

$_________ one-time payroll deduction

None of the above

Question - Not Required - Amount per paycheck $

Question - Not Required - Amount of one-time payroll deduction $

*

Question - Required - So that we may enter your gift, please enter your hourly pay rate:

*If you don’t know your pay rate, you may find it by going to BSMH Central, Click on Workday, My Pay, Payslips. View your payslip and find your rate in the Earnings section.

*Would you like to make your gift recurring, meaning it will conveniently continue from year to year? You may stop or change your recurring gift at any time.

*

Question - Required - You may opt-out of recurring giving below. If you prefer to opt-out of recurring giving, so your per pay period gift will stop after 12/31/2023, select NO below.

Yes - Make my gift recurring

Please stop my gift after 26 pay periods

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

*

Question - Required - Associate Workday ID#

*

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

Question - Not Required - Half Hour Hero final value:

Question - Not Required - Half Hour Hero Ongoing Gift Calculation: