2024 Employee Giving Campaign Form

Y UR PASSION OUR PURPOSE

2024 Employee Giving Campaign Pledge Form UnityPoint Health – Des Moines

Employee #: ______________________________________________________ Name: ___________________________________________________________ Address: _________________________________________________________

Work Phone: __________________________________ Signature: _____________________________________ (required)

_________________________________________________________________

Choose where you want your donation to go: PASSION CATEGORIES

Ways to Give (please round to nearest dollar or hour): One-Time Payroll Payroll Deduction Deduction (Jan. 5, 2024) (Per Pay)

PTO Donation (Nov. 2023)

Sub Total

$

$

$

Grand Total

$

$

$

PTO Donation (Feb. 2024)

PTO Cash/ Donation Check (Per Pay) (Enclosed)

Passion Category: Staff Support Nursing Education & Technology Employee Crisis Fund: UnityPoint Health – Des Moines Employee Crisis Fund: UnityPoint Clinic Employee Crisis Fund: UnityPoint at Home Diversity, Equity & Inclusion Education Fund Passion Category: Blank Children’s Child Life STAR Center Pediatric Therapy Passion Category: Mental Health Mental Health - ILH Inpatient/Outpatient Eyerly Ball Passion Category: Cancer Care Oncology Navigators Charlie Cutler Healing & Wellness Program Adolescent & Young Adult (AYA) Cancer Program Passion Category: Hospice Care Patient Assistance Fund Taylor House Passion Category: Patient Support Younker Rehabilitation - Equipment & Technology LGBTQ Fund Compassion Fund: Blank Children’s Hospital Compassion Fund: Methodist, Lutheran & Methodist West Compassion Fund: John Stoddard Cancer Center Compassion Fund: Eyerly Ball Other Giving Options Other UPH–DM Foundation Fund: I’d like my donation designated to the following: ________________________________________________ United Way of Central Iowa Variety – the Children’s Charity Passion Category: Events 2025 Rally Against Cancer ($225/person)

#________ Tickets | $___________ Underwriting

2025 A Night of Blue & White ($175/person) #________ Tickets | $___________ Underwriting

2024 Hops for Hospice ($125/person)

#________ Tickets | $___________ Underwriting

2024 Festival of Trees & Lights ($250/person) #________ Tickets | $___________ Underwriting

Frequently Asked Questions How do payroll deductions work?

Is this form online?

Yes! You can complete this form using QR code or online at https://bit.ly/2024YPOP

Your gift per paycheck can add up to a lot each year. Payroll deductions are made over 26 pay periods starting in 2024.

Let’s do some number crunching. The chart to the right can assist you in determining annual gift totals.

To whom do I make my check?

Make checks payable to UnityPoint Health – Des Moines Foundation. Support for United Way and Variety should be made payable to them.

Amount Per Pay Period

Annual Pay Periods

= Total Gift

$2

x 26

= $52

$3

x 26

= $78

$4

x 26

= $104

$5

x 26

= $130

$6

x 26

= $156

Where can I find a list of UPH-DM Foundation Funds?

A full list of funds and descriptions can be found on our website at: https://bit. ly/2024YPOP.

$7

x 26

= $182

$8

x 26

= $208

$9

x 26

= $234

Who do I contact if I have a question about the Employee Giving Campaign?

Contact the UnityPoint Health – Des Moines Foundation at 515-241-6304 or e-mail unitypointfoundation@unitypoint.org.

$10

x 26

= $260

$20

x 26

= $520

$25

x 26

= $650

$40

x 26

= $1,040

$50

x 26

= $1,300

When is a one-time payroll deduction taken out of my paycheck?

One-time payroll deduction will be deducted January 5, 2024.

How are PTO (Paid Time Off) hours deducted?

PTO hours will be deducted November 10, 2023 and February 2, 2024. NOTE: PTO is taxed at 30% and will be deducted from your donation; please contact the Foundation with any questions.

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Wear your passion on your sleeve: GIVE 5 CHALLENGESunday & Monday............PARTICIPATE with All Team Signing Day

Make a gift of $5/per pay period, join the 1-Hour Club or make a one-time gift of $130+ and receive a campaign t-shirt.

Imagine if every UnityPoint Health - Des Moines employee joined the GiveTuesday...................................EDUCATE 5 Challenge - together we can raise more than Wednesday...........................MOTIVATE $1,000,000 to impact the lives of our patients and employees. Go ahead. Wear your passion on your sleeve. To receive Thursday............................APPRECIATE your t-shirt, the deadline to submit paper or online forms is September 27.

Friday...................................CELEBRATE If you qualify, list your size here:_________

Passion Categories and Their Impact Passion Category: Staff Support

Passion Category: Cancer Care

• Nursing Education & Technology: To provide advanced education and technology for nurses to remain at the forefront of care. Impact: 2,000 nurses each year.

• Oncology Navigators: Specially trained nurses and social workers help connect patients and families with resources within the Cancer Center and in the community. Impact: Added a financial navigator to navigate patients through financial barriers of care.

• Employee Crisis Fund: Helps meet the immediate emergency needs of employees who have been impacted by personal crisis such as prolonged illness, death, or weather event. Impact: Hundreds of UnityPoint Health employees.

• Diversity, Equity & Inclusion Education Fund: Provide qualified, underrepresented employee applicants the opportunity to further their leadership education, knowledge and skills to advance within UnityPoint Health.

Impact: 12 scholarships given to team members last year.

• Charlie Cutler Healing & Wellness Program: Provides evidence-based complementary therapies that support mind, body and spirit. Impact: 378 hours of massage therapy, 6,200 Meals that Matter provided, 56 music therapy hours.

• Adolescent & Young Adult (AYA) Cancer Program: Provides programs and services to cancer patients, ages 15-39.

Impact: 435 patients served since 2013.

Passion Category: Blank Children’s

Passion Category: Hospice Care

• Child Life: Help children find positive ways to cope with the fear and anxiety that often accompany a trip to the doctor, a medical procedure or a hospital stay. Impact: 34,000 interactions per year.

• Patient Assistance Fund: Provides comfort, dignity and compassion to all patients and families ensuring no patient is turned away. Impact: 85 patients are provided assistance per year.

• STAR Center: A special center that is child and adolescent friendly and trauma sensitive to help children thrive regardless of circumstance. Impact: 3,440 services to 1,657 patients.

• Taylor House: Provides care and comfort to terminally ill patients and their families in home-like setting. Impact: 422 patients served.

• Pediatric Therapy: Provides full range of therapy services for inpatient and outpatient care for infants, children and teens.

Impact: 4,300 patients served per year.

Passion Category: Mental Health • Mental Health - ILH Inpatient/Outpatient: Offers an extensive spectrum of care covering all age groups and types of programs to meet the needs of our community. Impact: 100,000 patients served through inpatient and outpatient visits.

• Eyerly Ball: Committed to providing comprehensive community mental health services. Impact: 5,000 individuals served every year.

Passion Category: Patient Support • Compassion Funds: Provides additional support to patients and families based on financial need.

• Methodist, Lutheran & Methodist West – Impact: Help more than 250 patients each year with medication and transportation.

• John Stoddard Cancer Center – Impact: 350 gas cards given to patients per year.

• Blank Children’s Hospital – Impact: 1,050 patients with a variety of needs per year.

• LGBTQ Fund: Supports education and training for staff as well as special needs for patients. Impact: 200+ appointments per year.

• Younker Rehabilitation: To provide state-of-the-art rehabilition equipment and technology to help patients achieve their goals. Impact: 800+ patients served per year.