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Thank you for giving through payroll deducation. Please fill out the online donation form below to set up your deductions. Payroll deductions will begin January 2022 with your first paycheck. If you would prefer to donate via credit card or other giving option, click the links below:
Credit card contribution | Check or other giving option
This donation form is intended for associates from: Carmel | Clay | Dunn | Fishers | Heart Center | Indianapolis Jennings | Kokomo | Randolph | Salem | Williamsport
Please click below if you're looking for forms for: Anderson | Evansville & Warrick | Mercy
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2022 Payroll Deduction Donation Form
Please complete the payroll deduction form below.
Payroll deduction gifts automatically recur bi-weekly with each pay period unless the Foundation is notified otherwise.
• Your Department ID is listed on your pay documents.
• Deductions will begin in January 2022 with the first paycheck.
• Your Associate ID is the first 8 digits of the 10-digit number on the back of your badge.