Mercy Medical Center, Trinity Health

Colleague Giving Donation Form

The Office of Philanthropy is proud to provide support to our Hospitals and our community and we’re inspired by the impact that we can have – together. Thank you for your support of Mercy Medical Center and Johnson Memorial Hospital and your consideration of a gift to this Campaign.


Step 1: Colleague Information

Name *
Address *
Address 2
City *
State *
Zip *
Phone *
Email *
Colleague ID # *
Department

Step 2: Designation





 
Employer *
Name
Department

Step 3: Contribution

1. Payroll Deduction


         

         

2. Check Donation

Check Donation of ($)

Make checks payable to Mercy Medical Center and send to:
Mercy Medical Center Office of Philanthropy, Gift Processing Center, PO Box 320635, Hartford, CT 06132-9900

3. Cash Donation

Cash Donation of ($)

For cash donations, please email funddevelopment@sphs.com for information.

Step 4: Appreciation Gift

Gifts of $100 or more receive a hospital-specific "Be Inspired" long-sleeve men or ladies t-shirt.

T-Shirt Size