In Kind Gifts | Adventist Health in Kern County

Planning to donate an item, service, or experience?

Please complete the form below so that we may properly acknowledge your gift.

Thank you for supporting healthcare in our community!

In-Kind Gift Form

Gift Information

Gift Description(Required)

Please describe the gift in as much detail possible, indicating the quantity, serial number, model number, manufacturer, etc. and whether it needs space, additional support, material and/or service to operate.

Gift Valuation(Required)

Please provide the value of the gift. In accordance with IRS rules regarding in-kind contributions: 1) the donor is responsible for providing the gift valuation and 2) Adventist Health will not include the value of a gift in any donor acknowledgement letter.

Valuation Method(Required)

Please select valuation method. Attach any valuation documentation.

Gift Restrictions(Required)

Gift is to be used for VIPink purposes

Gift is to be retained and used for Adventist Health Bakersfield purposes

Gift made with other stipulations/limitations (please describe or attach details)

Gift is to be sold and used for:

Specify what gift will be sold and used for:

Optional Additional Information

Provide further information related to gift stipulations/limitations or valuation.

Optional Attachment(s)

Please upload any additional documentation related to gift stipulations/limitations or valuation.

Drop files here or

Max. file size: 4 MB, Max. files: 3.

Donor Information

Individual/Personal or Business(Required)

Business Name (as it should be acknowledged and credited)(Required)

Name of Primary Donor(Required)

Prefix First Last

Spouse/Partner Name (if joint gift)

Business Contact Name(Required)

Prefix First Last Title

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Enter Email Confirm Email

Business Contact Email(Required)

Enter Email Confirm Email

Phone(Required)

Business Contact Phone(Required)

Phone Type(Required)

Recognition Preference

Anonymous

I/we prefer this gift to be anonymous.

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Make a Gift In Kind

Planning to donate an item, service, or experience?

In-Kind Gift Form

Gift Information

Donor Information

Recognition Preference