(515) 332-4200 Pay My Bill SERVICES PROVIDERS & CLINICS PATIENTS & VISITORS SENIOR LIVING CAREERS & VOLUNTEERS MORE Online Donation Form Donor Information Designation -Select Designation- HCMH Auxiliary HCMH Foundation Humboldt County Hospice Foundation Humboldt County Hospice Foundation Light Up a Life Amount -Select Amount- $10 $50 Other Amount Occurrence -Select Frequency- Monthly Quarterly Yearly One-Time Donation I would like to make this gift anonymously I would like to dedicate this donation Donor Information First Name Middle Initial Last Name Organization Address City State -Select State- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Phone Email Confirm Email Credit Card Information Name on Credit Card Credit Card Number Expiration Date / CCID Total $0 Donate CONTACT US (515) 332-4200 Find a Provider or Clinic Number AREAS OF EXCELLENCE Corporate Health & Wellness Surgery Senior Living Hospice RESOURCES Administration Humboldt County Public Health UnityPoint - Humboldt Patient Billing & Accounts Community Resources PRIVACY POLICY COMPLIANCE ACCESSABILITY NON-DISCRIMINATION ACCESSIBILITY NOTICE © 2021 UnityPoint Health, All Rights Reserved, ® SM tradesmarks of UnityPoint Health | Web Development byBlue Compass

(515) 332-4200 Pay My Bill SERVICES PROVIDERS & CLINICS PATIENTS & VISITORS SENIOR LIVING CAREERS & VOLUNTEERS MORE 19th Annual Founder's Event PURCHASE YOUR TICKETS ONLINE HERE Download Registration/Business Sponsorship Form Here Questions? Call Mardi Ratzlaff, Foundation Director at 515-332-7626 or email mardir@humboldthospital.org CONTACT US (515) 332-4200 Find a Provider or Clinic Number AREAS OF EXCELLENCE Corporate Health & Wellness Surgery Senior Living Hospice RESOURCES Administration Humboldt County Public Health UnityPoint - Humboldt Patient Billing & Accounts Community Resources PRIVACY POLICY COMPLIANCE ACCESSABILITY NON-DISCRIMINATION ACCESSIBILITY NOTICE © 2021 UnityPoint Health, All Rights Reserved, ® SM tradesmarks of UnityPoint Health | Web Development byBlue Compass