Fundraiser Event Charitable Contribution Request Form
Fundraiser Event Charitable Contribution Criteria
Business Conduct Standards Brochure

Fundraiser Event Charitable Contribution Request Form
To download a Word version of the Fundraiser Event Charitable Contribution Request Form, click on the link at the bottom of this section.

MSD's charitable contribution request forms are formatted with MicroSoft's form tool. To complete the request form:

• Move to each field that needs to be completed by using the Tab button or a moving your curser to the next field.
• If the field is a box, then just click on the appropriate box to place an "x" in the box.
• If the field is a gray text area (it is empty white space in a printed version of the form), simply start typing in the requested information.
• If you need to unlock the form to add information that does not have a box or text field: (1) select "View" on the top menu bar, (2) select "Toolbars", (3) select the "Forms" toolbar. Once the toolbar is added, click on the icon that looks like a padlock so it is no longer highlighted. You can then type anywhere on this document. If you click on the padlock again, you may lose the information you entered in a box or text field - so avoid unlocking the document until you have completed all of the form fields and then do not re-lock it.

Submit the form according to the directions on the form. To avoid any delays in reviewing your request, please be sure to complete the request form and provide all of the requested information and documents.

If you have any questions about the request form or MSD's charitable contribution program and practices, send an email to MSD's Charitable Contributions Manager at MSDCharitableContributions@medtronic.com. The current Charitable Contributions Manager's name and phone number are available at the Charitable Contributions home page in the Charitable Contributions Manager section.

Please read the rest of this page before completing a request form to make sure you have all of the information that you need before you complete the form.

Download Fundraiser Event Charitable Contribution Request Form

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Fundraiser event Charitable Contribution Criteria
In addition to the criteria that apply to all Customer-Based Charitable Contributions, a fundraiser event for which as charitable contribution is requested must also satisfy the following additional criteria:

1. The recipient is soliciting a broad range of potential donors and not merely MSD and other vendors of products and services that are reimbursed, in whole or in part, by Medicare, Medicaid, and other federal health care programs.
2. The request is received at least six weeks before the fundraiser event.
3. The contribution does not to pay for a Customer to attend or participate in the fundraiser unless the sponsor selects the attendees or participants without MSD input into the selection process.
4. If the fundraiser event is a golf or tennis tournament, the contribution is typically no more than $2,500.
5. If the fundraiser event is a dinner, the contribution is typically no more than $5,000.
   

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Business Conduct Standard Brochure
MSD's Compliance office has a "Charitable Contributions Program" brochure that provides answers to common questions people have.

To order the brochure, you need access to MySpineTools.com. If you do not have access, you can ask your local MSD sales representative for the brochure or send an email to MSDCharitableContributions@medtronic.com and ask for the brochure

If you have access to MySpineTools.com, the brochure can be ordered on MySpineTools.com by selecting "Resources" from the top navigation bar and then, from the Overview page, select "Click here to order available literature and video for customer use." The brochures are under the Sales Division category. The Item # for the brochure is LITCCBR4.

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