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About Us
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News & Events

Donate

About Us
Our Projects
Ways to Give
News & Events

Associate Campaign: Raise the Roof!

HaysMed Associates donated over

$83,100

to support programs and projects that benefit HaysMed patients and one another.

Thank you!

Donations to the 2021 Associate Campaign can be given through the end of 2021: Complete the Online Pledge Card on this Page OR Click Here to Give Online Now

2021 Associate Campign Online Pledge Form

"*" indicates required fields

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

HaysMed Child Care Center

Patient Assistance Fund

Nurses' Lounge Fund

Drive-Thru Flu Vaccinations

Other

Use my gift for the immediate needs of:*

Where the Need is Greatest

Associate Care Team Fund

Cancer Fund

Cardiology Fund

Hospice Fund

Nursing Fund

Nurses' Lounge Fund

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 Email*

Preferred Phone is*

Home

Cell

Work

Other

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. 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.

Phone

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

Congratulations to Associate Campaign Prize Winners!

Maribel Alvarez – iRobot Roomba 692

Deloris Farthing & Lora Gottschalk – 32” Fire TV

Rose Ann Dreiling – Ring Doorbell Bundle

Fernando Guzman-Soto – Deep Tissue Massager

Drew Morley & Regina Borthwick – Wireless Earbuds/Charging Case

Sarah Dreiling & Debbie Linenberger – Fire HD 8 Tablet

Jerry Weber & Tashia Becker – Echo Show

Mark Pakkebier & Andrea Ottley – Fire Stick 4K

Judy Jordan & Veronica Hartman – Echo Dot

Tami Koenigsman & Alivia Inlow – Tactical Flashlight/Cervs Card

Weekly Winners

Anna Marie Johnson, Kristen Jones, Deb Linenberger, Andrea Ottley, Sarah Powers, Joyce Mattison, Ellen Call, Patti Lane, Debbie Gross-Pfannenstiel, Steph Staab, Sarah Dreiling, Megan Mawhirter, Deloris Farthing, Dr. Artem Ryazantsev, Jen Howard, Tammy Klaus, Suzie Bleumer, Veronica Hartman, Pam Mayers and Cindy Zadina.

Donors who have not received a Tool Pen are invited to stop by the Foundation office or email jayne.inlow@haysmed.com.

Thanks for all you do to provide exceptional care at HaysMed!

HaysMed Foundation
2220 Canterbury Drive
Hays, KS 67601
785-623-2350

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