Payroll Deduction Authorization Giving Form

Give a Special Gift Today!

St. Mary’s Medical Center will payroll deduct for gifts to the St. Mary’s Medical Center Foundation by Medical Center employees, based on the following criteria:

  1. Payroll deductions will be available only to regular full-time and regular part-time employees.
  2. The minimum payroll deduction will be $25.00.
  3. Any questions regarding the donation will be directed to the Vice President in charge of the Foundation. Please call Bradley Burck at 304.526.2658.
  4. In case of termination or change from regular full-time or regular part-time status to on-call/PRN, the total balance remaining will be deducted from the last payroll check.
  5. If it is not possible to make a deduction during any given pay period, due to insufficient gross wages, the next deduction will be increased by the amount of the missed deduction.

My Gift Using My Employee ID Number for Payroll Deduction

  • Please note how you would like your gift used. Example: Pallotti Fund