I would like to make this gift in honor of...Please provide the name of the Care Team or individual(s) you wish to recognize.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Share a message...We will ensure this “thank you” is shared with the team or individual you are honoring.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Thank you for the privilege of allowing us to care for your loved oneand offering us the opportunity to make a difference in the community.

Please complete both sides of this form and return it to:

JourneyCare Foundtion - Grateful Family & Friends405 Lake Zurich Road, Barrington, Illinois 60010

Formerly Hospice Foundation of Northeastern Illinois

Making Every Moment CountMaking Every Moment Count

Yes, I would like to say “Thank You”____________________________________________________________________________________

Name

____________________________________________________________________________________

Address

____________________________________________________________________________________

City/State/Zip

____________________________________________________________________________________

Phone

____________________________________________________________________________________

E-Mail

Enclosed is my donation of: $1,000 $500 $250 $100

$50 $25 Other $_____________________________________

Please use my gift for...

Area of Greatest Need Patient Assistance Fund

Payment method:

Enclosed is a check (Please make checks payable to JourneyCare Foundation)

Please charge my credit card (fi ll out card information below)

____________________________________________________________________________________

Name on credit card

_____________________________________________________ __________________________

Credit Card # Exp. Date

____________________________________________________________________________________

Signature

Please send me information about how I can include JourneyCare in my estate planning.

I would like to receive communication from JourneyCare via: e-mail Regular mail

Please complete both sides of this form >

Maybe it was an encouraging smile...a blanket to make sure your loved one was warm and comfortable…sitting by the bedside listening

to your loved one tell stories...simple, compassionate gestures that helped make moments count.

For over 30 years, JourneyCare has had the privilege of serving thousands of patients and

families. Every day we hear about the many ways JourneyCare staff have touched their lives

and are asked how to say “thank you” for the exceptional care a loved one received.

JourneyCare Foundation created the Grateful Family and Friends Program as a thoughtful

way for you to express your gratitude to those who meant so much to you and your loved

one. Perhaps it is a supportive team, an extraordinary nurse or aide, a thoughtful volunteer, a

chaplain, physician or therapist.

Your gift of thanks honoring these caregivers

will help us remain committed to our mission

of making every moment count for those

touched by serious illness and loss, while

helping to ensure we never have to turn

anyone away because of inability to pay.

You can choose to designate your Grateful

Family & Friends gift to help either the Area of

Greatest Need or thed Patient Assistance Fund.dd

When making a gift*, please share your story

with us on the attached card. Those you

recognize for outstanding care will receive an acknowledgement letter and your personalized

note, if you choose to include one.

For more information, visit our website at

www.journeycare.org/grateful-family-and-friendsor call JourneyCare Foundation at 244-770-2413.

*Should you choose not to make a gift at this time, we would still deeply appreciate an acknowledgement of the

JourneyCare team that made moments count for you using the attached card or any format that is convenient for you.