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The Benefit Underwriting Pledge Form

The Benefit for Harborview Medical Center Underwriting Pledge Form

1. Please provide your contact information:
Please check your preferred method of communication:
2. Yes, I/we will underwrite the event at the following level:
3. Payment Information:

THE TITLE SUPPORTER will also be recognized on the save-the-date, via logo, if a commitment is made by Monday, April 1, 2024. 

TAX-DEDUCTIBILITY. All of the event’s net proceeds — 100 percent — will benefit Harborview Medical Center. Your ticket or support, minus the fair market value, is tax-deductible as specified in IRS regulations. All tickets and underwriting packages take into account the cost of dinner, and, pursuant to IRS Rev. Rule 67-246, the fair market value of each $250 ticket is $150. The fair market values of underwriting packages are listed below. Pursuant to RCW 19.09, the University of Washington (tax I.D. 94-3079432) is registered as a charitable organization with the secretary of state, state of Washington. For information, call the Office of the Secretary of State, 1.800.332.4483. 

FAIR MARKET VALUES (FMV) OF UNDERWRITING PACKAGES AND TICKETS TITLE SUPPORTER: Gift $48,200, FMV $1,800; PRINCIPAL SUPPORTER: Gift $23,200, FMV $1,800; STRATEGIC SUPPORTER: Gift $9,280 FMV $720; SUPPORTER: Gift $4,640, FMV $360; NONPROFIT/COMMUNITY SUPPORTER: Gift $2,140, FMV $360; TABLE: Gift $1,000, FMV $1,500; TICKET: Gift $100, FMV $150. For office use: Harborview Benefit Fund/DSC-123989/APL20502.