Project Access San DiegoKP Super Saturday Needs You!Garfield Outpatient, October 20, 2012Volunteer to Help Change LivesSign up at www.sdcmsf.org/surgery day Your time improves the health of San Diego County residents without insuranceThank You Kaiser Permanente Staff!

P R O J E C T A C C E S S

5575 Ruffin Road, Suite 250 San Diego, California 92123phn: 858.595.8161 fax: 858.569.1334 www.sdcmsf.org

San Diego CountyMedical Society Foundation

 

August 7, 2012 

Saturday Surgery Day 

WHAT IS SATURDAY SURGERY DAY? 

Saturday Surgery Day is a partnership between San Diego County Medical Society Foundation’s Project 

Access San Diego (PASD) and Kaiser Permanente San Diego Medical Center aimed at providing uninsured 

patients donated surgical procedures that will significantly improve their health, ability to work and 

quality of life. 

WHERE IS MY CONTRIBUTION GOING? 

For the October 20, 2012 Surgery Day, represented employees whose unions have entered into 

Saturday Surgery Day agreements will participate as community service workers. This means that in 

addition to providing your services on the day of the event, you will be able to make an impact through 

a financial contribution.  Your participation as a community service worker will support the general 

operations of San Diego County Medical Society Foundation and Project Access San Diego.  

 

By electing to participate in a Saturday Surgery Day as a community service worker, you will be asked to 

sign a Payroll Deduction Authorization Form, which will authorize KP to deduct an amount equivalent to 

sixty percent (60%) of the gross base earnings that are earned for working the Saturday Surgery Day.   

After being calculated, this amount will be deducted from a subsequent paycheck and will be forwarded 

to San Diego County Medical Society Foundation and Project Access San Diego.  The remaining forty 

percent (40%) will be withheld to cover estimated taxes.  You will see the deduction in the subsequent 

pay period.  PASD will send you confirmation of receipt, in addition to a description of the donation, to 

be used for your tax reporting purpose. Additional information will be provided once your participation 

in Surgery Day has been confirmed.  Union agreements do not pertain to unrepresented or salaried 

staff, unrepresented or salaried staff interested in participating in Saturday Surgery Day will do so as 

volunteers. 

WHAT DO I NEED TO DO TO PARTICIPATE? 

To participate in a Saturday Surgery Day, please be sure to complete the following steps, leading toward 

your great work: 

 

1. Contact your local department administrator (DA) or PASD expressing your interest. 

 

2. Fill out a Saturday Surgery Day Interest Form on the back of this page and return it to: 

Francesca Mueller 

Director, Project Access 

Francesca.mueller@sdcmsf.org 

Fax (858) 560‐0179 

 

Francesca Mueller will contact you confirming eligibility to participate on Saturday Surgery Day and 

provide additional information.  

August 2012

Community Surgery Day Interest Form

Yes, I am interested in participating in Community Surgery Day with San Diego County Medical Society Foundation’s Project Access San Diego on October 20, 2012 at Garfield Specialty Care Center.

NAME ___________________________ _________________________________

First Last

HOME ADDRESS _________________________________________________________________

Street City State Zip

PHONE (___) _______________ (___) ______________ (___) ____________________

Home Work Cell

EMAIL _________________________________________________________________

T-shirt Size S M L XL

I AM EMPLOYED BY KAISER PERMANENTE AS A ___________________________________________ (Job Title)

Department: ________________________________

KP Location: _________________________________________________________________________

Department Administrator (Name): ________________________________________________________

I AM A MEMBER OF THE FOLLOWING UNION: UNAC/UHCP UFCW USW KPNAA

Local 30 UHW Teamsters _____________

I AM BILINGUAL IN: Spanish/English Other (please specify): _________________________________

I PREFER TO RECEIVE FOLLOW UP INFORMATION VIA:

EMAILED ATTACHMENTS INTEROFFICE MAIL FAX, LIST FAX NUMBER: ___________________