One Team, Exceptional Care:
2017 Employee Giving Campaign
Dimensions Healthcare System
Bowie Health Center │ Laurel Regional Hospital │ Prince George’s Hospital Center
Family Health & Wellness Center │ Dimensions Surgery Center
Dimensions Healthcare System │ One Team, Exceptional Care: 2017 Employee Giving Campaign | Thank You for Your Support!
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2017 EMPLOYEE GIVING CAMPAIGN
Name: ________________________________________________
*Employee ID#: _____________________________________
Home Address: __________________________________________
DHS Department: ___________________________________
C/S: _____________________________
Zip: _____________
Email: _________________________________________________
Phone Number: _________________________________________
DHSHF
Internal
Use
Only
RECEIVED:
PROCESSED:
DHSHF ID:
*Required for payroll deduction(s)
STEP 1
Define Gift & Frequency
 Sign me up for the Employee Campaign: 13-Payroll Week Campaign (or Ending June 30, 2017)
 Sign me up for the Employee Campaign: Dates to Start: _________________ and End: ______________
 I would like to discontinue my payroll deductions.
Gift Designation
STEP 2
I would like to designate my gift to the following DHS Hospital Foundation: (Please select designation)
 Bowie Health Center Foundation
 Laurel Regional Hospital Foundation
 Prince George’s Hospital Center Foundation
I would like to contribute to the following philanthropic funding priorities: (Optional)
 Areas of Greatest Need
or  Philanthropic Funding Priorities Below (See Page 4 for Details)
________________________________________________________________________
Giving Options and Deduction Authorization
 Payroll deduction (One-Time) and Amount: $ _____________________________
STEP 3
 Payroll deductions (On-Going) and amount per pay period: $_________________ (Donation Guide on Page 3)
 Credit Card Amount: $ _______________  Mastercard
 Visa
 American Express
 Discover
Card #: _____________________________ Expiration Date: _______ CVV#: ______
 One-Time
or
th
 Re-Occurring (Deducted on the 24 of each month)
Signature: ____________________________________________________ Date: _________________________
To donate online, visit ‘Ways to Give/Employee Giving’ at www.dhshospitalfoundations,org.
Dimensions Healthcare System │ One Team, Exceptional Care: 2017 Employee Giving Campaign | Thank You for Your Support!
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We understand that individual circumstances vary and hope you will consider a gift that is right for you. All gifts, of any
amount, are greatly needed and genuinely appreciated. Together, all gifts will make a difference.
DONATION GUIDE
Here is an example of what our ONE TEAM can achieve!
Make a gift pledge or one-time contribution or determine your own gift level
and sign up or give your gift today!
November 4, 2016
January 1, 2017
First Pay Period in January 2017
Pledge Period Starts
Campaign Starts
First Payroll Deduction
YOUR $ PER PAY PERIOD:
YOUR 13 PAYROLL
WEEKS DONATION
TOTAL:
IF THIS
NUMBER OF
EMPLOYEES
DONATE:
TOGETHER WE WILL RAISE!
$5
$10
$20
$40
$60
$80
$100
$65
$130
$260
$520
$780
$1,040
$1,300
500
500
200
75
50
50
50
$32,500
$65,000
$52,000
$39,000
$39,000
$52,000
$65,000
Important considerations for all contributions:

Payroll deductions will begin with the first payroll in January 2017.
If you sign-up after January 1, your first payroll deduction is the
next available payroll, within two weeks.

On-going contributions will continue until discontinuance is
requested in writing by checking the box in Step 1, “I would like to
end my payroll deductions.” Sign and submit the form.

Contributions to the DHS Hospital Foundation you selected are
tax deductible to the fullest extent allowed by law. The DHS
Hospital Foundation you selected does not provide goods or services
in consideration for contributions to the 2017 Employee Giving Campaign.

Employees who make contributions to the 2017 Employee Giving Campaign through Dimensions Healthcare
System payroll will have their total contribution reported on their IRS W-2 in the calendar year in which the
contributions are donated. All donations will be acknowledged through US Postal Service to the address provided
on this form at the end of the campaign period.
Dimensions Healthcare System │ One Team, Exceptional Care: 2017 Employee Giving Campaign | Thank You for Your Support!
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2017 Philanthropic Funding Priorities:
Dimensions Healthcare Systems’ vision is to be the healthcare system of choice recognized for clinical,
academic and service excellence, through compassionate and innovative health care." With support from the
community, Prince George’s Hospital Center, Laurel Regional Hospital and Bowie Health Center will continue
to deliver outstanding, individualized and clinically-excellent care in partnership with, patients, families,
caregivers and physician groups.
To build upon our reputation for trusted and quality health services, it
is essential that we continue to attract the best and brightest medical
talent from across the region to care for our patients and to ensure
we serve as the first choice for our patients seeking care for their
medical needs. Aligned with this goal is to ensure our hospitals and
medical facilities are state-of-the-art institutions, integrate leadingedge technology in our medical service lines, expand programs that
meet population goal objectives and ensure transformation giving
spanning the hospital’s key service lines will impact our full
continuum of care now and into the future.
To make good on our promise of support, our current philanthropic
funding priorities are:
 Service Lines and Programs
 Behavioral Health
 Cardiac Rehabilitation
 Cardiac Surgery Program
 Diabetes and Metabolic Syndrome Services
 Domestic Violence and Sexual Assault Center
 Emergency Medical Service
 Level III Neonatal Intensive Care Unit Expansion
 Maternal and Child Health
 Population Health and Community Programs
 Trauma Services
 Essential equipment to put advanced technology in the hands of our healthcare providers
 Renovations to existing buildings and capital support for the new Regional Medical Center
Your donations serve the greater good toward improving health outcomes for our patients and their families. As
Dimensions Healthcare System evolves into an affiliate of the University of Maryland Medical System, our
hospitals and medical facilities are strategically positioned to transform healthcare delivery in Prince George’s
County, Maryland.
Visit www.dimensionshealth.org for more information about the service lines and programs within our hospitals
and medical facilities.
For information about the DHS Hospital Foundations and Gateways to Giving, please visit the foundations’ new
website at www.dhshospitalfoundations.org.
THANK YOU!
Dimensions Healthcare System │ One Team, Exceptional Care: 2017 Employee Giving Campaign | Thank You for Your Support!
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DHS Hospital Foundations
7300 Van Dusen Road
Laurel, MD 20707
(240) 456-2934
[email protected]
www.dhshospitalfoundations.org
Dimensions Healthcare System │ One Team, Exceptional Care: 2017 Employee Giving Campaign | Thank You for Your Support!
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