West Jefferson Hospital Foundation - Full Filing - News Apps 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the required information section. Enter your employment status by selecting either O WJMC, O NOPS, or O LCMC Health. Then, provide your name, last four digits of your SS#, department, home address, city, state, home phone, cell phone, zip code, and email.
3. Next, choose your payroll deduction donation options. You can select between annual giving, continued giving, or a one-time gift. For annual giving and continued giving, calculate the deduction per paycheck based on the total gift you wish to contribute.
4. If opting for other donation methods like check or credit/debit card, fill in the respective details including card number and expiration date. Ensure you sign where required for credit/debit transactions.
5. Indicate how you would like your gift to be used by selecting from the available options such as supporting the Friends of West Jeff Fund or Employee Assistance Fund.
6. Finally, review all entered information for accuracy before submitting. You can print the completed form or scan and email it to wjhfoundation@LCMChealth.org.

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