<p> PAYROLL DEDUCTION</p><p>POLICY:</p><p>It is the policy of Morrison Community Hospital to allow employees the option of utilizing payroll deduction for purchased items and/or services. </p><p>PURPOSE:</p><p>To outline the parameters for employees’ utilization of payroll deduction. </p><p>CONSIDERATIONS & RELATED ISSUES: Caring Fund Policy Attachment: Payroll Deduction Authorization Form PROCEDURE: 1. All employees are eligible to participate in the Morrison Community Hospital District Federal Credit Union. 2. Employees who meet the position status requirements are eligible to enroll in the MCH Self-funded Health Insurance Plan; the 457 tax Deferred Savings Plan; Voluntary Life Insurance, Cancer Insurance, and Disability Insurance; and Dental Insurance. Employees wishing any of the aforementioned should contact the Human Resources Office. 3. Payroll deduction is also available for uniform purchases, auxiliary fundraiser and account receivable items. These deduction requests will be submitted by the respective departments. REGULATIONS AFFECTING POLICY: None EFFECTIVE: 04/01/1991 REVIEWED: REVISED: 05/16/1993, 01/10/2001, 09/06/2006, 09/03/2010, 02/14/2011, 02/16/2012 APPROVALS:</p><p>______Chief Executive Officer Director of Human Resources Payroll Deduction Authorization Form</p><p>I authorize Morrison Community Hospital to deduct the amount of $______from my paycheck for services/items that have been purchased by MCH on my behalf.</p><p>For uniform/auxiliary deductions, the amount will be deducted from my paycheck according the following schedule:</p><p>Payment Schedule $30.00 - $50.00 1 Deduction $51.00 - $100.00 2 Deductions $101.00 - $150.00 3 Deductions $151.00 - $300.00 4 Deductions</p><p>(Max. Deduction total $300.00)</p><p>OR</p><p>The amount to be deducted from my paycheck will be $______for the next ______pay periods. </p><p>I understand that if my employment with Morrison Community Hospital is terminated or I change to PRN status, and I have an outstanding balance on this deduction agreement, I am authorizing Morrison Community Hospital to deduct the balance in full from my final scheduled paycheck.</p><p>Employee Signature: ______Date: ______</p><p>Witness: ______Date:______</p>