Sponsorship and Contribution Requests

Wellmont Health System annually provides more than $90 million in community benefit to our region. Each year, our hospitals provide more than $70 million in uncompensated charity care for those who need medical attention but are unable to pay.

As our communities’ premier not-for-profit healthcare system, this is exactly why we’re here – to provide superior, compassionate health care when you’re sick and to help keep you healthy through community partnerships and wellness initiatives.

We know we can’t improve the health of our communities alone, and we welcome and encourage sponsorship and contribution requests that align with our mission and provide opportunities for meaningful partnerships.

All sponsorship and contribution requests must be submitted using the form below. Due to the number of requests we receive, please allow a minimum of six weeks for a response. And please recognize that we, too, are a charitable organization providing a community service, and we will be unable to fulfill every donation request.

Statement of Policy

It is the policy of Wellmont Health System to grant sponsorships and contributions to organizations that further our mission and improve the health status of the communities we serve.

Guiding Principles

The following guidelines determine how contributions are to be made by Wellmont Health System. Sponsorships and contributions are:

• Reserved for instances in which partnership with another organization is a more effective or efficient way to fulfill our own mission and vision.
• Generally restricted to organizations which have been granted 501(c)(3) tax-exempt status.
• Granted for one year unless otherwise specified, and recipients are responsible for requesting renewed support. Each request will be considered anew and compared with other requests received for that year.

Application

All information requested below has to be provided before submitting the form.

Name of Requesting Organization:

Address (Number and Street):

Address 1

Address 2

Address 3

City:

State: (Select) Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Title:  Mr. Mrs.  

First Name:

Last Name:

Phone:

Fax:  

E-mail:  

Web Site Address:  

Tax ID Number:  

Please briefly describe the specific sponsorship request, including details about the initiative or event.

 
Please briefly describe how this sponsorship advances Wellmont Health System’s mission and/or improves the health status of the communities we serve.

 What is the requested amount?

Are there additional partnership opportunities to help achieve our shared goals beyond financial support? If so, please elaborate.

Has Wellmont contributed to your organization in the past?

What promotional consideration will Wellmont receive for this sponsorship?