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The form instructs that each contribution form be completed in full and included with every check, with submissions required weekly and forwarded within five days of receipt to comply with state law. It records the total number of checks and total contribution amount and requires that the check signature matches the contributor, then directs mailing to the Missouri Hospital Association.",{"@graph":63,"@context":122},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/healthpac-contributions-transmittal-form-return-completed-forms-within-five-days/276225/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/healthpac-contributions-transmittal-form-return-completed-forms-within-five-days/276225.png","ImageObject",442,249,{"name":88,"@type":89},"Mack Lee","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":8},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114,118],{"name":105,"@type":106,"acceptedAnswer":107},"How quickly must HEALTHPAC contributions be forwarded after receipt?","Question",{"text":108,"@type":109},"HEALTHPAC contributions must be forwarded within five days of receipt to comply with state law.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What must accompany each HEALTHPAC check?",{"text":113,"@type":109},"Each contribution form must be completed in its entirety and accompany each contribution/check.",{"name":115,"@type":106,"acceptedAnswer":116},"How should contributions be submitted over time?",{"text":117,"@type":109},"Contributions should be submitted on a weekly basis.",{"name":119,"@type":106,"acceptedAnswer":120},"What is required regarding the signature on the checks?",{"text":121,"@type":109},"The signature on the check must be that of the contributor.","https://schema.org",{"og:url":78,"og:type":124,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":126,"canonical":78},"index,follow",{"doc_id":128,"site_id":56},276225,1790464895,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":88,"user_avatar":133,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":139,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":61,"update_tm":143,"read_time":4},1236954509970,"https://us-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","HEALTHPAC CONTRIBUTIONS – TRANSMITTAL FORM  \nPlease complete and return this form with each set of contribution forms and checks you return. Feel free to copy this form as needed.  \nHEALTHPAC contributions must be forwarded within five days of receipt to comply with state law. A contribution form must be completed in its entirety and accompany each contribution. Please submit contributions on a weekly basis.  \nName of Hospital/Health System:   Contact Person:   Title:   Email Address:   Phone Number:    \nTotal number of HEALTHPAC checks submitted:    \n(The signature on the check must be that of the contributor.)  \nTotal amount of HEALTHPAC contributions submitted: $   \nMail to:  \nMissouri Hospital Association  \n4712 Country Club Dr.  \nJefferson City, MO 65109-4541","cbCaidLrDwvbItKI","https://ap.wps.com/l/cbCaidLrDwvbItKI","pdf",149964,"English","# HEALTHPAC Contributions - Transmittal Form\n## Submission timing and compliance requirements\n## Hospital and contact information\n## Totals for checks and contribution amount\n## Mailing address","[{\"question\":\"How quickly must HEALTHPAC contributions be forwarded after receipt?\",\"answer\":\"HEALTHPAC contributions must be forwarded within five days of receipt to comply with state law.\"},{\"question\":\"What must accompany each HEALTHPAC check?\",\"answer\":\"Each contribution form must be completed in its entirety and accompany each contribution/check.\"},{\"question\":\"How should contributions be submitted over time?\",\"answer\":\"Contributions should be submitted on a weekly basis.\"},{\"question\":\"What is required regarding the signature on the checks?\",\"answer\":\"The signature on the check must be that of the contributor.\"}]","HEALTHPAC Contributions - Transmittal Form - Return Completed Forms Within Five Days | PDF",1789492021]