Community Support Request

Thank you for contacting Passavant Area Hospital. Passavant demonstrates its support for health, wellness and fitness through sponsorship of local not-for profit events and programming. Passavant Area Hospital (PAH) receives numerous requests from community organizations for donations, sponsorships and participation in special events. As a nonprofit organization, PAH must give careful consideration to whether and to what extent these requests support our hospital’s mission.

We also strive to address our identified community priorities of obesity, mental health, and access to care. Preference will be given to supporting community programs that are improving the health status and quality of life for underserved, low income or vulnerable members of our communities.

Nonprofit 501(c)(3) organizations, tax-exempt entities and other organizations may submit a request for support a minimum of 6 weeks in advance. Completion of this application does not guarantee funding of your request. Please be prepared to submit your organization’s IRS W-9 form, you can find information regarding a W-9 form on the IRS website.

Organizations interested in support for programs consistent with this mission should submit their request using the form below. Questions can be referred to communitysupportrequest@passavanthospital.com. Forms are also available in the Marketing and Communications Office. For more information, call 217-245-9541, ext. 3129.






Contact Information

Name of Organization:
Contact Person:
Contact Phone (Work):
Contact Phone (Mobile):
Contact Email Address:
Organization Address:
City:
State:
Zip Code:

Organizational Information

1. Is your organization a 501 (c)(3) non profit or other tax-exempt organization?
 Yes No

2. Organization’s Website Address (if applicable)

3. What is your organization’s mission?

4. What cities or counties are served by your organization?

Request Information

Event/Program Name

Date

Location

Date Sponsorship Funds Needed

What type of support is requested? Check all that apply.
 Sponsorship Exhibitor Monetary Donation Giveaways Health Presentation Health Screening

What level of sponsorship are you requesting? Please include dollar amount.

Community Support Information

1. Briefly describe how your request can improve the health of our community. Include your target audience, the number of people to be served, and how you will use this donation.

2. Does your initiative specifically address or support one of Passavant’s identified community health needs? (obesity, access to healthcare, and mental health)
 Yes No

If you marked “Yes” to the previous question, how?

Passavant Area Hospital Information

1. Is anyone at Passavant on your organization’s board or involved with this initiative?
 Yes No

2. Will Passavant receive any publicity or recognition for this donation?
 Yes No

If “Yes,” please elaborate.

3. Has Passavant provided support for your organization in the past?
 Yes No

If “Yes,” please elaborate.

4. If a Passavant sponsorship/contribution is provided, the use of those dollars is to be restricted to the purpose as stated in this application. Do you accept this restriction of funding?
 Yes No

Cassie Houf-Seagraves is Employee of the Month

Posted on: December 7, 2017

Passavant Area Hospital’s Employee of the Month is Cassie Houf-Seagraves, a licensed clinical social worker. She works in the Social Services department and has been a Passavant employee four years. A grateful co-worker nominated Cassie for the honor. “We recently had a patient who was defiant and confused and had mental and physical complications. The patient was no longer able to care for herself and had to be sent to a nursing home. Cassie found a nursing home quickly and could have been satisfied with the task being completed. Instead, Cassie continued to work with Case Management to look for nursing homes to make sure all of the patient’s physical, mental health and communication needs were met. Cassie helped make arrangements for the patient’s belongings to get to the nursing home, and even made sure the patient’s cat would receive care. When it was time to go to the nursing home, the patient was upset and confused, refusing to go. Cassie went to the patient for a heart-to-heart conversation. Cassie was able to relieve the patient of her fears and make her feel important and supported.” As a social worker, Cassie’s responsibilities include identifying, addressing and resolving socially complex situations with patients, coordinating care with patient families, providing resources, advocating for patients and community members and providing crisis intervention and supportive counseling. “Passavant works endlessly to continue to improve and offer top notch services in a rural community,” said Cassie. “Employees, patients and community members are beyond fortunate that Passavant is part of a health system that opens leading doors to this area and never ceases to work to improve the health of the people and communities it serves.” Cassie and her husband, Michael, reside in Jacksonville with their son, Landon. The Employee of the Month at Passavant receives eight hours off with pay, an Employee of the Month plaque, a close parking space for one month, gift cards for the Cafeteria and Gift Shop, a movie gift card, pen and pencil set, picnic blanket, flashlight/tool kit, Mason jar cup, umbrella, small cooler, lunch sack, drawstring tote, water bottle, notepad, flashlight key ring, coffee mug, and cup.

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