Seton Foundations Attn: LyAnn Merritt Seton Cares Appeal ID: 2016cy SetonCares 1345 Philomena Street, Suite 400, Austin, Texas 78723 Donor Name: DONOR INFO Donor Address: City: State: ZIP: Work Location: Associate ID #: Home Phone: Cell Phone: Home Email: Work Email: Please refer to the accompanying pages for a list of Seton Cares giving options. FUND I would like to donate to the following fund(s): Fund #1 - Name & ID #: Fund #2 - Name & ID #: The MSC allows only one type of payroll deduction per associate. Please choose either one-time payroll deduction or recurring payroll deduction for all funds you choose to support. PAYMENT INFO One-Time Donation (Fill one) Cash Check* One-time Payroll Deduction (March 18, 2016 pay period) Credit Card Fund #1: $ one-time donation amount Fund #2: $ one-time donation amount Recurring Donation (Fill one) Bi-weekly Payroll Deduction (March 18 Dec. 9, 2016 pay periods) Fund #1: $ per pay period (minimum $2) Fund #2: $ per pay period (minimum $2) Recurring Monthly Credit Card (Fill one) Day 1 Day 15 Fund #1: $ per month (minimum $2) Fund #2: $ per month (minimum $2) Name on Credit Card: Card #: Card Security Code: Exp Date: / / Signature: Tribute Information - Optional: (Circle one) In Honor of In Memory of TRIBUTE INFO Name of Person You Are Honoring/Memorializing: Send acknowledgment to: Name: City: State: ZIP: Email: Signature: Donate today at SetonCares.org. For questions, please contact LyAnn Merritt at lpmerritt@seton.org or 512-324-5905. *Make checks payable to Seton Fund with Seton Cares 2016 in the memo line. *For United Way for Greater Austin donations, make your check payable directly to United Way. We will forward your check.
Page 1 of 4 Fund Descriptions Fund descriptions for the 2016 Seton Cares annual giving campaign are arranged in two groups: network-wide and site-specific funds. Network-wide Funds Emergency Relief Endowment (402006): Provides the primary source of funding for the Emergency Relief Fund. The Emergency Relief Fund, administered by the Patient Representatives, provides emergency financial assistance to patients or Seton associates in financial need. The annual associate giving campaign is the main source of donations to the endowment. Nursing Fund for Professional Development, Scholarly Activities and Recognition (113406): The Nursing Fund will provide financial support and advocacy for Seton s professional nurses who are pursuing professional development and are engaged in scholarly activities. The Nursing Fund can also provide for recognition of Seton s excellent nurses. Seton League House Special Projects, Programs & Supplies (181003): Supports special projects of Seton League House, such as renovations, repairs and furnishings. Seton League House provides a comfortable, safe and low-cost place to stay and serves as a home-awayfrom-home for families of hospitalized patients, as well as patients who have early morning procedures. Seton Cove Special Programs and Projects(193202): Seton Cove offers people of all faiths the opportunity to nourish and foster their journey toward wholeness. Donations to Seton Cove provide support for special programs and projects. Seton Clinical Professional Education Endowments: These five endowments provide support for education and training for Seton associates in these specialty areas: Cardio-Pulmonary/Neurodiagnostics (412702) Imaging (412701) Laboratory and Rehabilitation Services (412704) The general Seton Clinical Professional Education Endowment supports these four specialties and Pharmacy. (412700) The general Seton Clinical Professional Education Endowment (412603) supports these four specialties and Pharmacy. Dell Children s Medical Center Family Fund (503801): This fund will ensure direct and immediate funds to provide comfort items for families. The Family Fund will also provide emergency provisions for children and families hit with financial hardship due to life threatening illnesses or severe traumatic injuries. Charity Care at DCMC (509993): Helps pay for health care for children whose families can t afford it. Charity Care at DCMC helps Seton further its mission to care for and improve the health of those we serve, with a special concern for the poor and vulnerable. Endowment for Dell Children s - supports areas of greatest need (702000): This unrestricted endowment supports the areas of greatest need at Dell Children s, such as attracting and retaining top talent, maintaining and modernizing the facility when needed, and expanding and strengthening programs throughout the hospital. Endowment is the best source for long-term security for DCMC. Child Neurology Fellowship Program Education & Research (502070): Supports education, conferences and/or research in this Pediatric Emergency Medicine Residency Program Education & Research (502071): Supports education, conferences and/or research in this Medical Residents Social Medicine Education and Research (114116): Supports the collaborative practice of social medicine, within residency programs and among education programs at Seton and local community resources. This fund supports education, conferences and/or research related to social medicine. Residency programs including but not limited to OB/ GYN, Family Medicine, Internal Medicine and Pediatrics are eligible. Resident Association Fund Special Projects and Programs (114130): Provides financial support for special programs and projects of the UTSW-Seton Austin Residents Association. Adult Psychiatry Residency Program Education & Research (114201): Supports education, conferences and/or research in this Child/Adolescent Psychiatry Residency Program Education & Research (114206): Supports education, conferences and/or research in this Child Neurology Fellowship Program Education & Research (502070): Supports education, conferences and/or research in this Craniofacial Surgery Fellowship Program Education & Research (114217): Supports education, conferences and/or research in this
Page 2 of 4 Dermatology Residency Program Education & Research (114118): Supports education, conferences and/or research in this ESP Emergency Residency Program (113500): Provides support of residency positions and programs for the Emergency Medicine Residency Family Medicine Residency Program Education & Research (114202): Supports education, conferences and/or research in this Internal Medicine Residency Program Education & Research (114204): Supports education, conferences and/or research in this Neurology Residency Program Education & Research (114203): Supports education, conferences and/or research in this Ob/Gyn Residency Program Education & Research (114205): Supports education, conferences and/or research in this Pediatrics Residency Program Education & Research (114107): Supports education, conferences and/or research in this Pediatric Emergency Medicine Residency Program Education & Research (502071): Supports education, conferences and/or research in this Physical Medicine and Rehabilitation Residency Program Education & Research (114108): Supports education, conferences and/or research in this Psychosomatic Medicine Fellowship Program Education & Research (114212): Supports education, conferences and/or research in this Surgery Residency Program Education & Research (114214): Supports education, conferences and/or research in this Transitional Residency Program Education & Research (114113): Supports education, conferences and/or research in this Seton Administrative Offices (SAO), Clinics & Non-Clinical Sites Seton Community Health Centers: When you give to Seton Kozmetsky, Seton McCarthy or Seton Topfer Community Health Centers, your donation helps provide operational support for these Seton facilities that provide a continuum of care for the uninsured and underinsured. Kozmetsky (23100) McCarthy (22100) Topfer (24100) Charity Care Network (113016): Helps pay for health care for people who can t afford it. Charity Care helps Seton further its mission to care for and improve the health of those we serve, with a special concern for the poor and vulnerable. Seton Edgar B. Davis Hospital SEBD Children s Care-a-Van (Operational Support) (292000): The Care-a-Van provides health care to children who are underserved and uninsured in our community. Building and Equipment Needs at SEBD (292001): Funds raised help support construction and equipment needs at SEBD. Charity Care at SEBD (292005): Your donation helps pay healthcare costs at SEBD for people who cannot afford it and helps Seton further our mission to care for and improve the health of those we serve, with a special concern for the poor and vulnerable. Seton Highland Lakes Hospital Building and Equipment Needs at SHL (284007): Your donation helps support construction and equipment needs at Seton Highland Lakes Hospital. Seton Kids Care-a-Van (Operational Support) (284001): The Care-A-Van provides health care to children who are under-served and uninsured throughout the Highland Lakes community. Lena Faye Ballenger Seton Nurse Scholarship Endowment (810008): Provides scholarships for Seton associates who are residents of Burnet and Llano Counties, and who are pursuing or advancing a career in nursing.
Page 3 of 4 Seton Medical Center Austin Building and Equipment Needs for NICU and Mother/Baby Services at SMCA (123051): Donations to this fund will benefit the Marialice Shivers Regional Neonatal Intensive Care Unit at Seton Medical Center Austin and mother/baby services for expansion, renovation and upgrades at SMCA. Patient Clothing Closet at Seton Shoal Creek (271008): Donations to the Patient Clothing Closet at Seton Shoal Creek help stock the clothing closet, providing items of clothing for patients who need them. Seton Medical Center Hays Building and Equipment Needs at SMCH (291000): Funds raised help support construction and equipment needs at SMCH. SMCH Volunteers Golf Cart and Hospitality Services (295107): Donations to this fund help support maintenance and operations for a golf cart that transports visitors from the parking lot to the hospital as well as other hospitality services. Seton Nurse Scholarship Endowment SMCH (861002): Provides scholarships to Seton associates who work at SMCH to advance or pursue a career in nursing. Charity Care at SMCH (295110): Your donation helps pay healthcare costs at SMCH for people who cannot afford it and helps Seton further our mission to care for and improve the health of those we serve, with a special concern for the poor and vulnerable. Seton Medical Center Williamson Building and Equipment Needs at SMCW (281000): Your donation helps support construction and equipment needs at Seton Medical Center Williamson. SMCW Seton Circle Annual Membership (109101): Your donation is pooled with donations from other members to fund grant requests from SMCW departments. Members vote on grants annually. Giving levels: $5,000 Platinum Plus, $2,500 Platinum, $1,000 Gold, $500 Silver, $250 Bronze. All levels receive an invitation to the annual Seton Williamson Foundation celebration and recognition in the foundation s newsletter, on the SWF website and the SMCW lobby television screen. Seton Nurse Scholarship Endowment for SMCW (810003): Provides scholarships to Seton associates who work at SMCW to advance or pursue a career in nursing. Seton Northwest Hospital Building and Equipment Needs at SNW (285001): Your donation helps support construction and equipment costs at Seton Northwest Hospital. SNW Courtyard Renovation - $250 Brick Sponsor (285014): When a Seton associate donates $250 or more to this fund during the 2016 calendar year, recognition will be given on an individual brick that will be placed in the courtyard of Seton Northwest Hospital. Donations to this fund will benefit renovations to the SNW courtyard. Gifts and pledges must be paid by Dec. 9, 2016. Seton Shoal Creek Hospital Building and Equipment Needs for NICU and Mother/Baby Services at SMCA (123051): Donations to this fund will benefit the Marialice Shivers Regional Neonatal Intensive Care Unit at Seton Medical Center Austin and mother/baby services for expansion, renovation and upgrades at SMCA. Patient Clothing Closet at Seton Shoal Creek (271008): Donations to the Patient Clothing Closet at Seton Shoal Creek help stock the clothing closet, providing items of clothing for patients who need them. Seton Smithville Regional Hospital Building and Equipment Needs at SSRH (297302): Funds raised help support construction and equipment needs at Seton Smithville Regional Hospital. Charity Care at SSRH (297301): Your donation helps pay healthcare costs at Seton Smithville Regional Hospital for people who cannot afford it and helps Seton further our mission to care for and improve the health of those we serve, with a special concern for the poor and vulnerable.
Page 4 of 4 Seton Southwest Hospital Special Projects Building & Equipment Needs at SSW (296502): Funds raised help support special projects, building and equipment needs at Seton Southwest Hospital. Sister Jean Ann Wesselman, D.C., Nursing and Allied Health Scholarship Endowment (885000): Helps nurses and clinical staff at Seton Southwest Hospital with their education and provides associates an opportunity to go to school to become nurses. Charity Care at SSW (296201): Your donation helps pay healthcare costs at Seton Southwest Hospital for people who cannot afford it and helps Seton further our mission to care for and improve the health of those we serve, with a special concern for the poor and vulnerable. University Medical Center Brackenridge & Clinical Education Center Other Seton Community Health Centers: When you give to Seton Kozmetsky, Seton McCarthy or Seton Topfer Community Health Centers, your donation helps provide operational support for these Seton facilities that provide a continuum of care for the uninsured and underinsured. Charity Care Network (113016): Helps pay for health care for people who can t afford it. Charity Care helps Seton further its mission to care for and improve the health of those we serve, with a special concern for the poor and vulnerable. Social Medicine Education and Research (114116): Supports the collaborative practice of social medicine, within residency programs and among education programs at Seton and local community resources. This fund supports education, conferences and/or research related to social medicine. Residency programs including but not limited to OB/ GYN, Family Medicine, Internal Medicine and Pediatrics are eligible. Caring for the Caregivers Fund: This fund will provide support for education, travel, conferences, research, supplies and related expenses for Mary Graves Taylor Outstanding Caregiver Award recipients. Award recipients must work at UMCB or Dell Seton Medical Center at the University of Texas.