Physician Giving Payroll Deduction - Northwest Community Healthcare

Choose Your Payroll Deduction Amount

$192.31 per pay period ($5,000 annual)

$96.16 per pay period ($2,500 annual)

$57.70 per pay period ($1,500 annual)

Commitments totaling $1,500+ qualify for the NCH Physician Society, with a range of benefits and special invitations throughout the year.

Designation (Please choose where your gift goes)*

Other Designation

Choose the Length of Your Commitment*

Ongoing (Never worry about signing up again. Contact the NCH Foundation to change your contribution level at any time.)

26 pay periods only (beginning with your January 12, 2023 paycheck and ending in December 2023)

Your Information

Employee ID*

Name*

First Name* Last Name*

Address*

Street Address* Address Line 2 City* State* ZIP Code*

Phone*

Email*

Additional Information

Recognition in materials (Dr. Jane Smith, Jane and Joe Smith etc.)

Comments

Consent*

Agree to Terms and Conditions*

I authorize payroll deduction in the amount indicated per pay period as my gift to the NCH Physician Giving Campaign. I understand that at any time I can raise, lower or cancel my contribution by notifying the foundation via email or in writing.

*Required Field

COVID-19 AND MPOX UPDATES

Payroll Deduction

Your Information

Additional Information

For questions on payroll deduction

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