<p>Approval Date:______CEO/President______</p><p>Date: ______Human Resources Director:______</p><p>Developed 7/04</p><p>Revised 8/04 3/07 12/12</p><p>Reviewed</p><p>Policy: Compassionate PTO Donation Program</p><p>Subject: Compassionate PTO Donation Program to assist employees at the Midwest Medical Center during financial hardship.</p><p>Objectives: The purpose of this policy is to provide a mechanism for employees to assist a fellow employee during a period of financial hardship due to a lack of income caused by lost work time due to personal or family illness or injury.</p><p>Policy:</p><p>Employees of the Midwest Medical Center may donate a portion of their earned PTO benefit to another employee who has exhausted their paid benefits and is unable to work due to their own illness or injury or due to the illness or injury to a family member as defined by FMLA. The recipient shall not accrue PTO on the donation.</p><p>Such assignment shall be totally voluntary on the part of the employee making the contributions.</p><p>Midwest Medical Center employees who are eligible to accrue and use PTO time, are eligible to participate in the Compassionate PTO Donation Program. Eligibility requirements are as followed: shall be employed at least 6 months and the donating employee shall ensure that their remaining PTO balance is at least twenty (20) or more hours once the donation is made. Procedure:</p><p>1. An employee in need of assistance or someone aware of an employee’s need should contact the Human Resources department. 2. An employee wishing to donate current PTO time to an employee shall obtain the Authorization to Donate Hours form from the time clock area or Human Resources. He/She shall complete the form and return it to Human Resources. 3. Staff members and/or their supervisors may not make donating PTO mandatory or in any way pressure others into donating PTO hours. Donations are on a voluntary basis only. 4. Each donation by an eligible donor must be a minimum of one (1) hours. The maximum that may be donated is twenty (20) hours in a twelve-month period. The donor must ensure that his/her bank has at least eighty (20) hours of PTO for their use. 5. The employee receiving a donation may acquire a maximum of one hundred sixty (160) hours of transferred PTO per fiscal year. 6. The Human Resources department shall process the contributions and adjust the PTO balances. 7. The recipient employee shall have appropriate income tax withheld. The donor may not claim these donated monies as a tax-deductible item. 8. The monies transferred shall be paid out at the recipient pay rate. 9. Monies transferred shall be automatically paid out to the recipient through payroll. 10. Premium pays, such as differentials, are not paid on Compassionate PTO hours. Compassionate PTO shall not be paid out at termination. 11. Once a donation has been processed, neither the donor nor the recipient may revoke the transaction, even if it has not yet been paid. 12. Exceptions to this policy may be made at the discretion the Midwest Regional Medical Center.</p><p>Misuse of donated PTO by the receiving employee shall be grounds for disciplinary action up to and including termination. AUTHORIZATION TO DONATE HOURS COMPASSIONATE TRANSFER OF LEAVE POLICY</p><p>To initiate the donation of PTO hours complete the information below. Please print.</p><p>Donor’s Last Name:______First Name:______</p><p>Date of Hire:______</p><p>1. I wish to donate______(a minimum of 1 hours) accrued PTO hours for the Compassionate PTO Donation Program for: </p><p>Employee’s Name:______</p><p>2. I understand the donation must be made in increment of whole hours.</p><p>3. I am donating these hours freely and have not been forced or coerced into doing so.</p><p>4. My donation is irrevocable.</p><p>5. I understand that I must keep at least twenty (20) hours in my PTO bank.</p><p>Employee Signature:______Date:______</p><p>Submit original signed and completed form to Human Resources Director. Contact number is extension 6391.</p>