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Donation Form
Donation Information
St. Mary’s Health Care System Foundation is a 501(c)(3) non-profit organization serving the communities of St. Mary’s Hospital-Athens, Good Samaritan Hospital-Greensboro, and Sacred Heart Hospital-Lavonia. Your gift is tax deductible to the full extent of the law. Donations may be given to a specific hospital’s service lines or to their area of greatest need. Thank you for your support!
Amount:
$
*
Designation:
SM Area of Greatest Need
SM Community Health & Wellness
SM Mission Services
SM Professional Growth & Development
SM Women & Family Services
GS Area of Greatest Need
GS Community Health & Wellness
GS Mission Services
GS Professional Growth & Development
GS Women & Family Services
SH Area of Greatest Need
SH Community Health & Wellness
SH Mission Services
SH Orthopedic Services
SH Professional Growth & Development
SH Women & Family Services
Additional Information
Frequency:
Weekly
Monthly
Quarterly
Annually
Every 4 weeks
On:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Starting:
Ending:
Ending:
Details / Notes about this gift:
Employee ID:
*
Billing Information
Title:
Mr.
Mrs.
Miss
Ms.
Dr.
Drs.
Professor
Hon.
Pastor
Sister
Brother
Ambassador
The Reverend Dr.
Chief
Chaplain
Bishop
Congresswoman
Reverend
Congressman
Colonel
Major General
Father
Major
Lt. Governor
Cmdr.
Mayor
The Reverend
Judge
Rabbi
Deacon
Lt. Col.
The Honorable
Chaplain Col.
Captain
Governor
Senator
Sergeant
Mx.
First name:
*
Last name:
*
Country:
Afghanistan
American Samoa
Angola
Argentina
Australia
Austria
Bahamas
Belgium
Belize
Bermuda
Bolivia
Bosnia and Herzegovina
Brazil
Bulgaria
Canada
China
China (PRC)
Colombia
Costa Rica
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
England
Finland
France
Germany
Ghana
Greece
Guam
Guatemala
Guyana
Honduras
Hong Kong
Hungary
India
Indonesia
Iran, Islamic Republic of
Ireland
Israel
Italy
Jamaica
Japan
Japan 141
Jordan
Kenya
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Lebanon
Liberia
Liechtenstein
Macedonia,The former Yugoslav Republic
Malaysia
Malta
Mexico
Monaco
Mongolia
Monte Carlo
Myanmar
N. Ireland
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Nigeria
North Ireland
Norway
NP Bahamas
Pakistan
Panama
Papua New Guinea
Peru
Philippines
Poland
Portugal
Puerto Rico
Romania
Russian Federation
Rwanda
Saint Lucia
Santo Domingo
Saudi Arabia
Scotland
Scotland, UK
Singapore
Slovenia
South Africa
Spain
Swaziland
Sweden
Switzerland
Taiwan, Republic of China
Tanzania, United Republic of
Thailand
Trinidad and Tobago
Turkey
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA
Viet Nam
Virgin Islands, U.S.
West Africa
*
Address:
*
City:
*
State:
<Please Select>
Armed Forces Americas
Armed Forces Europe/Canada/Middle East/Africa
Alaska
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Armed Forces Pacific
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District of Columbia
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Email:
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