Team Member Giving Payroll Deduction Form PHUF 2026 Team Member Giving Campaign – Payroll Deduction Personal Information Title Mr.Ms.Mrs.MissDr.Other Title Name * Name First First Last Last Address * Address Street Address Street Address Street Address 2 Street Address 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email Address * Phone Number * Work Information Employee Number * Department Name * Hospital/Dept Number If you are on the Prisma Health Network, find your Employee ID Number Here. If you are not on the network, your Employee ID Number can be found on Workday under your “Job Details” page. Donation Information We hope you will consider joining Elevate with a donation of $1,000, only $38.47 per pay period. Gift Designation * 2026 Team Member Giving Priority Projects Don’t see your cause? Please choose your designation from the options below: Team Member Giving Projects * Please make one selection:Catalyst FundHelp Greer GrowHelp Fountain Inn Grow Other Causes * Medical Experience AcademyUSC School of Medicine Greenville Scholarship FundPsychiatry & Behavioral Health FundBradshaw Institute Diaper Bank FundGreatest Current Need – Bradshaw InstituteSafe KidsCenter for Cancer Prevention & Wellness (CCPW)Center for Integrative Oncology & Survivorship (CIOS/Moving On)Greatest Current Need – Cancer InstituteInstitute for Translational Oncology Research (ITOR)McCrary Blood & Marrow Transplant Unit (BMT)Mobile Mammography UnitBK Bryan Neonatal Intensive Care Unit (NICU)Child Life ProgramFerlauto Institute for Complex Pediatric CareGreatest Current Need – Children's HospitalPediatric Intensive Care Unit (PICU)Cerebrovascular & Stroke Center FundHeart Institute FundALS ClinicNeuroscience Institute FundCenter for Nursing ExcellenceAaron Owens Memorial FundGreatest Current Need – Roger C. PeaceTraumatic Brain Injury FundUCAN (Upstate Community Abilities Network) ProgramGynecological Oncology Research FundGreatest Current Need – Women's HealthThe Canine F.E.T.C.H. Unit (Facility Dog Program)Community Health Initiatives (Accountable Communities)Transplant Center FundGreenville Memorial Medical Campus FundPrisma Health C.A.R.E. FundPrisma Health Transplant Center FundCare Management Patient Assistance Fund Donation amount per period * $ Use slider below to choose number of pay periods for deductions (26 pay periods is one full year) * 12626 Donation amount per pay period $ Total number of pay periods Total donation $ Signature Enter your full name to sign this form * Date * CAPTCHA Submit If you are human, leave this field blank.
