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North Carolina Hospital Association

Serving North Carolina Hospitals & Health Systems

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Request Assistance

Note: Hospital employees must submit forms through your Human Resources Department. Please do not submit a form directly to the Assistance Fund.

The North Carolina Hospital Employee Assistance Fund, administered by the North Carolina Hospital Foundation (NCHF), a 501(c)(3) organization, has been established to provide assistance to hospital employees who suffered significant property loss to their homes/residences during the August 2016 flooding disaster.

Employees may download an Employee Request for Assistance form (FORM A) from this website or request a form from their Human Resources department. Forms must be submitted to the hospital at which the individual is employed. Applicants must meet the following criteria:

  • Must be a full or part-time employee of an NCHA member hospital who lives in one of the FEMA-designated disaster counties in North Carolina; and
  • Must have suffered significant property loss to their home/residence during the August 2016 flooding disaster.

Chief Executive Officers, Human Resource Directors, or other designated leaders of NCHA member hospitals and health systems may submit names of employees to the NC Hospital Foundation based on applications received or information gathered by the hospital. Each hospital must complete a form (Form B) documenting the name and address for every employee that requests assistance from the North Carolina Hospital Employee Assistance Fund.This is necessary to comply with 501-C3 tax-exempt requirements. Multiple forms may be submitted.

All requests must be submitted by member hospitals and health systems by December 31, 2016.

Payments by check from the North Carolina Hospital Foundation will be made to hospital/health system employees based on the total number of requests. Each hospital will be responsible for distributing the checks to their identified employees. Hospitals will be asked to confirm the distribution of funds.

The North Carolina Hospital Foundation will send a check payable to qualifying hospitals based on the number of eligible employees submitted. The hospitals will then distribute the funds to employees who meet the criteria using these forms:
 

  • FORM A: Employee Request for Assistance (to be submitted to your hospital HR department)
  • FORM B: Hospital Request For Funds for Employees Who Meet Criteria (deadline is December 31, 2016) 

For information about the North Carolina Hospital Employee Assistance Fund or if you have questions about these forms, email AssistanceFund@ncha.org or call 919-677-4200.
 

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