Crouse Monthly Miles Club!

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Dwain Conley
8 years ago
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Increase your chances of living longer Feel better about yourself Sleep well at night Move around more easily Have stronger muscles and bones Stay at or get to a healthy weight Be with friends or

1 Crouse Monthly Miles Club! As we strive to provide the best in patient care, it is important to take care of ourselves as well. Physical activity has so many benefits and plays an important role in long term quality of life. It can help you. Increase your chances of living longer Feel better about yourself Sleep well at night Move around more easily Have stronger muscles and bones Stay at or get to a healthy weight Be with friends or meet new people Enjoy yourself and have fun Join the movement! Become a member of the Crouse Monthly Miles Club for just $5 per participant per year (spouses are also welcome). Here's how the club works... To get started, submit your registration form and payment (see last page). By the 5th of each month, send your total miles from the previous month to simplywell@crouse.org. Participants will then be entered into the raffle drawings below: Level # of Monthly Miles Raffle Drawings 90 to 120 miles 1 winner per month ($25 value) (equals 6,000-8,000 avg. steps per day) > 120 to 150 miles (equals 8,000-10,000 avg. steps per day) 1 winner per month ($50 value) > 150 miles (equals more than avg. 10,000 steps per day) 3 winners per month ($50 value) Winners announced by the 15 th of the month; winners will be asked to show tracking method and/or tracker to redeem prize. Bonus! Earn a $5 voucher to Clocktower Café & Jazzman s for every 500 miles you complete! Maximum of 4 vouchers per participant, per year. All kinds of activity counts! Here are ways to track your activity: Explore the app store! Smartphone apps have features that track miles, steps, and movement Use the chart on Page 2 to convert activity to miles or visit Pedometers available to club members (while supplies last) for those who do not have an activity tracker (ex: Fitbit) or Smartphone and wish to count miles using steps Your Care. In Our Hands. Give yourself a hand and focus on you!

2 Source:

3 Crouse Monthly Miles Club Registration Form and Payroll Deduction Authorization Participant Name (print) Affiliation with Crouse Crouse Employee # (if applicable) Mobile number (text updates) Preferred address (for club updates) a scan or photo of this registration/payroll form to simplywell@crouse.org or deliver this form and payment to Chrissy Lanigan on 8 Memorial (across from HR Conference Room). Select preferred payment option: Crouse Hospital Employee Payroll Deduction; paid in a single paycheck One check, made payable to Crouse Hospital Cash Indicate the total amount paid via cash, check or payroll deduction ($5 per club member): _$ List additional participant names (ex: spouse, adult children) included in your payment and contact information: Payroll Deduction Authorization (if applicable): I authorize Crouse Hospital Payroll Department to deduct the above payments from my paycheck as indicated in my payment option selection above. I agree that in the event of separation from employment I am legally obligated to satisfy the balance immediately through payroll deduction or direct payment to Crouse Hospital. Employee Name Employee Signature Date

org or deliver this form and payment to Chrissy Lanigan on 8 Memorial (across from HR Conference Room).

4 Crouse Monthly Miles Club! As we strive to provide the best in patient care, it is important to take care of ourselves as well. Physical activity has so many benefits and plays an important role in long term quality of life. It can help you. Increase your chances of living longer Feel better about yourself Sleep well at night Move around more easily Have stronger muscles and bones Stay at or get to a healthy weight Be with friends or meet new people Enjoy yourself and have fun Join the movement! Become a member of the Crouse Monthly Miles Club for just $5 per participant per year (spouses are also welcome). Here's how the club works... To get started, submit your registration form and payment (see last page). By the 5th of each month, send your total miles from the previous month to simplywell@crouse.org. Participants will then be entered into the raffle drawings below: Level # of Monthly Miles Raffle Drawings 90 to 120 miles 1 winner per month ($25 value) (equals 6,000-8,000 avg. steps per day) > 120 to 150 miles (equals 8,000-10,000 avg. steps per day) 1 winner per month ($50 value) > 150 miles (equals more than avg. 10,000 steps per day) 3 winners per month ($50 value) Winners announced by the 15 th of the month; winners will be asked to show tracking method and/or tracker to redeem prize. Bonus! Earn a $5 voucher to Clocktower Café & Jazzman s for every 500 miles you complete! Maximum of 4 vouchers per participant, per year. All kinds of activity counts! Here are ways to track your activity: Explore the app store! Smartphone apps have features that track miles, steps, and movement Use the chart on Page 2 to convert activity to miles or visit Pedometers available to club members (while supplies last) for those who do not have an activity tracker (ex: Fitbit) or Smartphone and wish to count miles using steps Your Care. In Our Hands. Give yourself a hand and focus on you!

5 Source:

6 Crouse Monthly Miles Club Registration Form and Payroll Deduction Authorization Participant Name (print) Affiliation with Crouse Crouse Employee # (if applicable) Mobile number (text updates) Preferred address (for club updates) a scan or photo of this registration/payroll form to simplywell@crouse.org or deliver this form and payment to Chrissy Lanigan on 8 Memorial (across from HR Conference Room). Select preferred payment option: Crouse Hospital Employee Payroll Deduction; paid in a single paycheck One check, made payable to Crouse Hospital Cash Indicate the total amount paid via cash, check or payroll deduction ($5 per club member): _$ List additional participant names (ex: spouse, adult children) included in your payment and contact information: Payroll Deduction Authorization (if applicable): I authorize Crouse Hospital Payroll Department to deduct the above payments from my paycheck as indicated in my payment option selection above. I agree that in the event of separation from employment I am legally obligated to satisfy the balance immediately through payroll deduction or direct payment to Crouse Hospital. Employee Name Employee Signature Date

7 Crouse Monthly Miles Club! As we strive to provide the best in patient care, it is important to take care of ourselves as well. Physical activity has so many benefits and plays an important role in long term quality of life. It can help you. Increase your chances of living longer Feel better about yourself Sleep well at night Move around more easily Have stronger muscles and bones Stay at or get to a healthy weight Be with friends or meet new people Enjoy yourself and have fun Join the movement! Become a member of the Crouse Monthly Miles Club for just $5 per participant per year (spouses are also welcome). Here's how the club works... To get started, submit your registration form and payment (see last page). By the 5th of each month, send your total miles from the previous month to simplywell@crouse.org. Participants will then be entered into the raffle drawings below: Level # of Monthly Miles Raffle Drawings 90 to 120 miles 1 winner per month ($25 value) (equals 6,000-8,000 avg. steps per day) > 120 to 150 miles (equals 8,000-10,000 avg. steps per day) 1 winner per month ($50 value) > 150 miles (equals more than avg. 10,000 steps per day) 3 winners per month ($50 value) Winners announced by the 15 th of the month; winners will be asked to show tracking method and/or tracker to redeem prize. Bonus! Earn a $5 voucher to Clocktower Café & Jazzman s for every 500 miles you complete! Maximum of 4 vouchers per participant, per year. All kinds of activity counts! Here are ways to track your activity: Explore the app store! Smartphone apps have features that track miles, steps, and movement Use the chart on Page 2 to convert activity to miles or visit Pedometers available to club members (while supplies last) for those who do not have an activity tracker (ex: Fitbit) or Smartphone and wish to count miles using steps Your Care. In Our Hands. Give yourself a hand and focus on you!

8 Source:

Crouse Monthly Miles Club Registration Form and Payroll Deduction Authorization Participant Name (print) Affiliation with Crouse Crouse Employee # (if applicable) Mobile number (text updates)

9 Crouse Monthly Miles Club Registration Form and Payroll Deduction Authorization Participant Name (print) Affiliation with Crouse Crouse Employee # (if applicable) Mobile number (text updates) Preferred address (for club updates) a scan or photo of this registration/payroll form to simplywell@crouse.org or deliver this form and payment to Chrissy Lanigan on 8 Memorial (across from HR Conference Room). Select preferred payment option: Crouse Hospital Employee Payroll Deduction; paid in a single paycheck One check, made payable to Crouse Hospital Cash Indicate the total amount paid via cash, check or payroll deduction ($5 per club member): _$ List additional participant names (ex: spouse, adult children) included in your payment and contact information: Payroll Deduction Authorization (if applicable): I authorize Crouse Hospital Payroll Department to deduct the above payments from my paycheck as indicated in my payment option selection above. I agree that in the event of separation from employment I am legally obligated to satisfy the balance immediately through payroll deduction or direct payment to Crouse Hospital. Employee Name Employee Signature Date

Health Savings Account (HSA) Administrator Switch from Bancorp to Bank of America Frequently Asked Questions

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