CARING FUND

POLICY:

It is the policy of Morrison Community Hospital to establish and maintain a Caring Fund and outline parameters for fundraising activities; for use on a discretionary basis, based on established guidelines.

PURPOSE:

The Caring Fund will be utilized by Morrison Community Hospital as a means to recognize and/or offer condolences to our employees. In addition, departments may decide to assist employees with life changing events through individualized fundraisers approved by Administration.

CONSIDERATIONS & RELATED ISSUES:

Employee Life Event will be defined as an employee celebrating the birth of a child, undergoing hospitalization, or mourning the loss of a loved one. This includes; spouse son, daughter, son/daughter in-law, mother, father, sister, brother, father/mother in-law, step child, grandparent or grandchild (as outlined by the bereavement leave policy).

An employee Catastrophic Life Event examples include (this is not an all-inclusive list);

□Catastrophic loss (house fire, accident)

□An employee who is hospitalized, missing 3 or more days of work.

□Death of a family member as defined by the Bereavement and Death of a Family Member policy.

In order for the employee to qualify for Catastrophic Life Event assistance, he/she must be on an approved Leave of Absence and/or FMLA as defined by MCH policies.

PROCEDURE:

Employee Life Event

  1. Administration will be notified that an employee event has occurred. This is the responsibility of the Department Director/Supervisor of the affected employee. The Department Director/Supervisor will provide the name of the employee, event, and hospital/funeral arrangements if known.
  2. Administration will order a plant/floral arrangement. The Administrative Assistant to the CEO will be responsible for the ordering of the plant/flowers.
  3. For the birth of a child, ababy blanket will be given as a gift.
  4. For an expression of sympathy, a plant/floral arrangement, will be sent to the employee.

Catastrophic Life Event

  1. If the employee has suffered a catastrophic life event (such as a house fire, major illness as defined by meeting Leave of Absence/Family Medical Leave Act criteria, etc.) Administration/Employees in the department/a group of employees may decide to host a fundraising event, such as a bake sale. All fundraising events must be approved by administration. All handling of money for the event will be the responsibility of one person in the department as well as the Accounting department for keeping the monies and auditing purposes.
  2. In addition, an employee may choose to payroll deduct from his/her bi-weekly payroll check to assist the affected employee.
  3. The employee completes a payroll deduction form designating their bi-weekly payroll deduction. (location of form)
  4. The voluntary deduction amount will be for a minimum of $2.00 per pay-period, not to exceed six pay periods.
  5. The employee can elect to cancel or change contribution amount at any time.
  6. An employee may also choose to donate the cash value equivalent of vacation time to the affected employee. Vacation time must be donated in 4 hour increments.

REGULATIONS AFFECTING POLICY:None

EFFECTIVE: 04/01/2012, 10/29/2014

REVIEWED:

REVISED:

APPROVALS:

______

Chief Executive Officer

______

Director of Human Resources

Date: ______Donation Event:______

I agree to utilize payroll deduct for the specific Caring Fund drive as indicated above. I further agree to have $______deducted from my pay check for a total of $ ______. (This deduction is not to exceed six pay periods.)

Employee Name (print): ______

Employee Number: ______

Signature:______

Date: ______Donation Event:______

I am choosing to donate ______hours of vacation time (4 hour increments) for the specific Caring Fund drive as indicated above.

Employee Name (print): ______

Employee Number: ______

Signature:______

Morrison Community Hospital

Hospital Stay Request Form

(Use this form in the event of hospitalization of a MCH employee)

Employee Name:
Department:
REASONS FOR HOSPITALIZATION
Illness Childbirth (Baby Girl) Childbirth (Baby Boy)
Name of Hospital:
Address:
Child’s Full Name:
Child’s Date of Birth:
Supervisors Signature:
Date of Request:

ARRANGEMNT OPTIONS (Not to exceed $35.00)

Flowers Plant Other
Baby Blankets (with Childs Name & DOB)

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Administration Use Only

Florist:
Date Called:
Payment: Billed Credit Card

Morrison Community Hospital

Floral Request Form

(Use this form in the event of the death of a MCH employee or the immediate family member where there was no funeral service or there was late notification about the service.)

DECEDENT INFORMATION

Decedent Name:
Decedent Relationship to Employee
Spouse (life partner) Son Daughter Spouse of a Son or Daughter Mother Father Sister Brother Parent of Spouse
Step Child Grandparent Grandchild (as outline by the bereavement policy)
Name of MCH Employee:
Address:
City: / State: / Zip Code:
Phone:
Supervisors Signature:
Date of Request:

ARRANGEMNT OPTIONS (Not to exceed $35.00)

Flowers Plant Other

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Administration Use Only

Florist:
Date Called:
Payment: Billed Credit Card

Morrison Community Hospital

Funeral Request Form

(Use this form in the event of the death of a MCH employee or the immediate family member)

DECEDENT INFORMATION

Decedent Name:
Decedent Relationship to Employee
Spouse (life partner) Son Daughter Spouse of a Son or Daughter Mother Father Sister Brother Parent of Spouse
Step Child Grandparent Grandchild (as outline by the bereavement policy)
Name of MCH Employee:
FUNERAL HOME INFORMATION
Funeral Home Name:
Address:
City: / State: / Zip Code:
Phone:
Date of Visitation: / Time of Visitation:
Supervisors Signature:
Date of Request:

ARRANGEMNT OPTIONS (Not to exceed $35.00)

Flowers Plant Other

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Administration Use Only

Florist:
Date Called:
Payment: Billed Credit Card