501(c)(3) Non-Profit Organization. Donations may be tax deductible as approved by the IRS. Please consult your tax advisor for details. The Procurement Committee reserves the right to combine, split, or hold items at its discretion. Please fill out the form completely.

This form does not serve as a tax receipt for this contribution and is intended for our internal record keeping purposes only. A receipt describing the items or merchandise donated will be mailed to the address provided by the donor. Samaritan Health Services affiliated foundations, listed above, are unable to include the estimated value on the donor receipt. For all gift-in-kind donations, it is the donor’s responsibility to describe and assign value to donated items. For items with a fair market value of $500 or more you will need to complete IRS Form 8283 in order to claim a deduction. All gifts valued at $5,000 or more must also include an independent appraisal. Please consult your tax advisor, IRS Publications 526 and 561 and IRS Form 8283 regarding all non-cash contributions, gift date and deductibility to you. Thank you for your support!