Associate Campaign: Chip In

Associate Grand Prize Drawing!

Congratulations to this year's CAMPAIGN PRIZE and WEEKLY DRAWING WINNERS!

This year’s Chip In theme celebrates the everyday acts of generosity that make HaysMed shine.

Whether it’s a heartfelt thank-you, a moment of encouragement, a helping hand, or a smile—each gesture adds to our collective treasure chest.

In addition, each year HaysMed Associates generously choose to financially support the Foundation Associate Campaign to be an even bigger part of this uplifting movement!

2026 Associate Campaign contributions can be made until December 31.

Complete the form below or stop in the HaysMed Foundation office!

Associate Campaign Online Pledge Form

"*" indicates required fields

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This field is for validation purposes and should be left unchanged.

Please choose the statement that most accurately describes your associate status at HaysMed

I am a physician

I am a non-physician full or part-time associate

I am a non-physician PRN associate

How would you like to make your gift?*

Associates may choose to pledge a gift of PTO or through regular payroll deduction. PTO gifts are processed once per year, usually in June or July. Pledges made now via payroll deduction will begin with the first pay period after Jan. 1. If you'd like to make a gift now, you will be directed to our online giving portal where you may make an immediate gift on your credit or debit card.

I would like to pledge a future gift using PTO

I would like to pledge a future gift using payroll deduction

I would like to make a gift now using my credit or debit card

Click HERE to give securely online with your credit or debit card.

If you prefer to write a check, please make it out to:
HaysMed Foundation
2220 Canterbury
Hays, KS 67601

You may also stop in our office located in Corridor B.

At this time, PRN Associates are not eligible for PTO gifts or payroll deduction.

Click HERE to give securely online with your credit or debit card.

If you prefer to write a check, please make it out to:
HaysMed Foundation
2220 Canterbury
Hays, KS 67601

You may also stop in our office located in Corridor B.

Gift Information

I would like to donate _______ hours of PTO.*

Foundation staff will contact you with details

Please enter a number from 1 to 200.

I have an existing payroll gift that I'd like to continue*

Yes

No or I'm not sure

Use my gift for the immediate needs of:*

Where the Need is Greatest

Patient Assistance Fund

Nurses' Lounge Fund

Lifelong Vitality Initiative

Other

Use my gift for the immediate needs of:*

Where the Need is Greatest

Associate Care Team Fund

Cancer Fund

Cardiology Fund

Hospice Fund

Lifelong Vitality Initiative

Patient Assistance Fund

Scholarship Fund

Stroke/Rehabilitation Fund

Women/Children Fund

Other

Pledge Renewal*

Payroll Deduction*

Payroll deduction begins Jan. 1. If choosing "other" below, please note this amount is per pay period.

$10 per pay period ($260 annually)

$25 per pay period ($650 annually)

$50 per pay period ($1,300 annually)

Other

Payroll Deduction*

Payroll deduction begins Jan. 1. If choosing "other" below, please note this amount is per pay period.

$2 per pay period ($52 annually)

$5 per pay period ($130 annually)

$10 per pay period ($260 annually)

Other

Personal Information

Name*

First Last

I wish my gift to be anonymous

Preferred Phone*

Preferred Phone is*

Home

Cell

Work

Other

Preferred Email*

Preferred Email is*

Home

Work

Other

Upon successful form submission, you will be redirected to a page with a thank you message.
If you do not see the thank you page after clicking "submit," please scroll down and verify the form has no errors.
If you have questions about your associate campaign pledge, please contact the Foundation.

Consent (Must check in order to submit)*

By checking the consent box and submitting this form I verify that I am the individual named above in the "Personal Information" section.

Payroll deduction elections will begin with the first pay period after January 1. Elected PTO payouts occur one time per year, generally in May, June, or July.

The HaysMed Foundation may use the information submitted on this form to update constituent contact and donor records. The HaysMed Foundation uses personal information collected from donors for the purposes of processing payments and communicating with donors about, as well as conducting fundraising and other operations.

Personally identifiable information is strictly confidential and will not be shared with any other organization outside of HaysMed or the HaysMed Foundation.

I agree to the terms and conditions.

Thank you from the 2026 Associate Campaign Committee

THANK YOU HAYSMED ASSOCIATES!

The reason HaysMed is such a treasure chest is simple — our Associates! The HaysMed Associate Campaign is a great example of how Associates Chip In to make HaysMed shine.

Why It Matters

Associates contribute nearly $80,000 annually through the HaysMed Associate Campaign
Associate gifts support patients, programs, and projects throughout HaysMed and the region
Every dollar- 100% of every gift - goes directly to the program, project, or department you choose

Ways to Give - Complete your pledge online on this page

Payroll Deduction – Easy and automatic
Gifts of PTO – Share your time for a cause
Check or Credit Card – One-time or recurring gifts

Weekly Drawings for gift cards totaling $500 from our favorite local restaurants.

Plus, all Associates donating $52 or more receive a Power Clip!

Weekly Winners

Week 1 Prize Winners:

Wanda Ball

Brenda Dechant

Martha Lambert

Connie Mermis

Carey Lewis

Week 2 Prize Winners:

Melissa Dewey

Myrna Jordan

Kelly Miller

Kaitlin Robben

Dr. Shanon Custer

Week 3 Prize Winners:

Kim Foster

Kelli Delimont

Bryan Noone

Sonya Reade

Leonard Zetko

Week 4 Prize Winners:

Diana Budke

Kelly Myers

Jana Zeller

Betty Brungardt

Jensen Breit

<img decoding="async" class="size-full wp-image-6753 aligncenter" src="https://haysmedfoundation.org/wp-content/uploads/2025/08/icon4.jpg" alt="" width="59" height="58" />Associate Grand Prize Drawing!

Associate Campaign Online Pledge Form

Gift Information

Personal Information

Thank you from the 2026 Associate Campaign Committee

THANK YOU HAYSMED ASSOCIATES!

Why It Matters

Ways to Give - Complete your pledge online on this page

Weekly Drawings for gift cards totaling $500 from our favorite local restaurants.

Plus, all Associates donating $52 or more receive a Power Clip!

Weekly Winners

Week 1 Prize Winners:

Week 2 Prize Winners:

Week 3 Prize Winners:

Week 4 Prize Winners:

Associate Grand Prize Drawing!