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Compassus Cares Financial Grant

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Call Us: 833.380.9583

Financial Grant Application

The Compassus Colleague Assistance and Relief in Emergency Situations – CARES – is an emergency assistance program funded through colleague contributions. Colleagues of Compassus experiencing financial hardship due to an urgent and unexpected situation may apply to receive a financial grant from the fund.

Eligible colleagues include:

• All Regular (non-PRN) colleagues, employed for a minimum of 6 months
• Colleague is not on decision-making leave
Need to know information:
If the vendor you are seeking payment to refuses or is unable to complete a W9 form, CARES will not be able to submit payment, even if approved by the committee.
Funds are not paid to teammates, but directly to the vendor/company that payment is being requested for.

You must also include copies of:

• Supporting documents of the unexpected circumstance (such as police reports, doctors’ notes, etc.)
• Financial documents for which you are requesting assistance (copy of bills, invoices, quotes/estimates. These documents must have the account number, creditor’s name, and address)
• Last 2 paycheck stubs for all income earners
• Most recent bank statement for all accounts (checking, savings, etc.)
• To expedite payment for approved requests, please have the creditors complete the attached W9 form. Payment cannot be issued without a completed W9 for each entity requiring payment.

Confidentiality Notice

Compassus CARES will make every effort to keep your information confidential. The Compassus CARES Administrator and your supervisor will be the only two people who are advised of your situation. The Compassus CARES Administrator will make copies of your application and supporting documents but removing your name from each of these and replacing it with a case identification number. Thus, the Compassus CARES Committee will only know your case by number.

Process

  • Applicants will be notified of the receipt of their application through the CARES email.
  • Applicants will be notified of the status of their application within 2 weeks of its submission, after the Compassus CARES Committee has reviewed the case. If the situation is extremely urgent, this should be indicated in the application and the committee will do its best to expedite the
  • The decision on an application may be delayed if the required documentation is not included or if the application is not completed in its
  • If the application is approved, funds will be provided in the form of a check written to the vendor or checks may be sent directly to the colleague’s creditor(s) on behalf of the

All colleagues who are awarded funds from the CARES program agree to complete a budget training course and attest to remain with the company for the next 6 months.  Leaving the company prior to 6 months may result in garnishment up to the amount of the funds received through CARES.

 Please fill out this application and send the application and required accompanying documents to:  Compassus.Cares@compassus.com

Compassus Cares

Basic Information

Do not leave any section blank
Name(Required)
Phone(Required)
Personal
Work
 
Marital Status(Required)
Child Support(Required)

Dependents(Required)
Name
Age
Relationship
 
Other Members in the Household (spouse, extended family, roommate)(Required)
Name
Age
Relationship
 

Employment Information

Status(Required)
MM slash DD slash YYYY
Second Job(Required)
Employer
Hours Worked Each Week
Pay Rate
Pay Frequency
 
Max. file size: 768 MB.
Situation:(Required)

MM slash DD slash YYYY
Have you applied for assistance before?(Required)

How will the funds be used?(Required)
Bill
Amount
Late
 
(Amount of bills, what is the bill for) Please provide a copy of the bill/invoice verifying the amount
*This must be completed; CARES assistance should be used as a last resort.

Please read and sign(Required)
Colleague Name(Required)
MM slash DD slash YYYY
Please read and sign(Required)
Colleague Name(Required)
MM slash DD slash YYYY

Monthly Total Household Income:

The following information is to be completed entirely and accurately for ANY and ALL persons living in the household. This includes and is not limited to: spouse, significant other, roommate, parent(s), working child(ren), temporary tenants, etc. If there is no amount, place a 0/zero in the amount column.
(State assistance, child support)
amount received each month

Monthly Expenses

Do not list insurances taken from paycheck
clothing, hair care, etc.
not taken from paycheck
Hulu, Amazon,etc.
not taken from paycheck
Other Expenses
List Above

Personal Assests

401k
ATV, camper, boat, planes
significant land, buildings, equipment, etc.

Personal Liabilities:

ATV, camper, boat, planes
payday loans, loans from friends/family:
Signature of teammate
MM slash DD slash YYYY

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