Southern Mono Healthcare District Policy
POLICY: PTO Donation Policy
DEPARTMENT: Human Resources
Written by:
Jeff Byberg
Approved by: SMG
Reviewed by: SMG
DISTRIBUTION:
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Effective Date:
Revised Date:
X District-wide
 Accounting
 Administration
 Admitting
 Bio-Medicine
 Bishop Bus. Office
 Bridgeport
 Community Relations
 Data Support
 Data Quality
 Dental
 Dietary
 Education
 Emergency Dept
 Engineering
 HIMS
 Housekeeping
 Human Resource
 Information Systems
 Internal Med
 Interpreters
 Laboratory
 Maint/Engineer
 Medical Staff
 Med /Surg
 Nursing
 ORTHO
 Patient Accounts
March 1, 2007
March 14, 2007
 Pediatrics
 Perinatal
 Perioperative
 Pharmacy
 Physical Therapy
 Purchasing
 Radiology
 Senior Managers
 Urology
 Woman’s Health
Purpose
The Southern Mono Healthcare District (SMHD) recognizes that there are instances in which
an employee or immediate family member may suffer from a serious financial hardship,
resulting from a Catastrophic Illness or non-work related injury requiring extensive medical
treatment and rehabilitation. To alleviate hardship in these situations, SMHD shall establish a
PTO (paid time off) Leave Pool (hereinafter known as the Pool) to provide for the alleviation of
the hardship caused when a Personal Emergency forces the employee to exhaust all accrued
paid leave and major medical leave benefits. Employees of SMHD may donate their accrued
PTO to the Pool to assist eligible employees in need.
Definitions
Pool Donor – An employee whose voluntary written request transfers accrued PTO to the
Pool.
Eligible Employee – An active employee who maintains either full or part-time status with
SMHD with a minimum of six months of continuous employment with SMHD. Per Diem or
contracted employees are not eligible recipients for the Pool.
Pool Recipient – An eligible employee who has a personal or immediate family medical
emergency that is likely to require the employee’s absence from work for a prolonged period
of time (generally interpreted to be a minimum of 30 days), and has no available PTO or Major
Medical, and is approved to receive donated PTO from the Pool Committee.
Pool Committee – Comprised of members of the SMHD Senior Management team.
Personal Emergency – A personal or immediate family illness or medical emergency that is
likely to require an employee’s absence from work for a prolonged period of time, and will
result in a substantial loss of income to the employee because of the unavailability of accrued
leave.
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Immediate Family – For purposes of this policy, immediate family is defined as the
employee’s spouse, child, mother, father, and grandchild only if the employee is the primary
caretaker of the grandchild.
Scope / Applicability
This policy is applicable to all current SMHD employees. Per Diem or contracted employees
are not eligible recipients of the Pool.
Policy
The PTO Leave Pool shall be maintained as follows:
Making a Donation
SMHD employees may donate to the Pool at anytime during the year using the PTO Donation
Form. Donating to the Pool is voluntary. The employee may request that a specific number of
PTO hours be donated (minimum of two), or request that a recurring number of PTO hours be
donated at each payroll cycle. The value of the PTO donation is calculated by the Pool
Donor’s hourly wage. PTO Donation Forms shall be submitted to the Payroll Department. If
the Pool is depleted, the Payroll Department will notify the Human Resources Manager to
request additional donations from the staff.
SMHD employees have no input into the dissemination of the PTO Leave Pool, and all
donations to the Pool are irrevocable. The Pool Committee shall decide eligible Pool
Recipients.
Eligible Recipients
To be eligible to submit requests for the PTO Leave Pool, employees must:
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Have been continuously employed by SMHD for at least six (6) months in a full or parttime status.
Have exhausted their personal PTO balance.
Have exhausted their personal Major Medical balance (if applicable).
Use the donated leave while absent ONLY for sick leave and/or other serious family
medical purposes for which the donations were approved (i.e. due to personal illness
or disability of an Eligible Family member.
Requests for PTO Leave Pool
The Eligible Employee (or the employee’s designee if the employee is unable to submit the
request) may request donated PTO leave by submitting a written request to Human
Resources. The request must describe the reason for the requesting donating leave. If the
employee is eligible for State Disability Insurance (SDI), the employee must apply for SDI and
any donated PTO may be considered for the wage loss gap. Similar to SDI eligibility, the
request for donated PTO should be made only after an employee is unable to do his or her
regular or customary work for at least eight consecutive days. A medical statement (or other
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documentation) supporting the need must be submitted with the request. (Note: The medical
information contained in the statement must be considered confidential and is to be shared
with individuals only on a “need to know” basis. The statement is to be maintained in a
confidential file separate from the employee’s personnel file).
The completed request, along with the supporting medical statement, should be forwarded to
the the Human Resources Manager for review. If the request meets the requirements of the
PTO Donation Policy, the Human Resources Manager shall forward the request to the
Donation Committee for consideration.
The Donation Committee shall approve or disapprove the request based on the provisions of
this policy. At the discretion of the Donation Committee, an approved employee may receive
donated leave on an “as needed basis”, up to a maximum of 80 PTO hours per pay period.
The approved Pool Recipient shall be eligible for donated PTO for duration of no more than 16
weeks, or when the hardship terminates, whichever comes first. If the Personal Emergency
continues beyond 16 weeks, the Donation Committee may approve an extension of the
donated PTO. Calculation of the donated PTO hours for an approved employee shall be
based on the eligible employee’s hourly wage.
When the Personal Emergency Terminates
The Personal Emergency affecting a leave recipient ends when it is determined that the
illness or medical hardship no longer exists or the leave recipient’s employment terminates.
The department supervisor/manager should monitor the status of the leave recipient’s illness
or medical hardship to ensure that the leave recipient is not permitted to receive or use
donated PTO after the hardship ends. The Pool Recipient or the department
supervisor/manager shall inform the Human Resources Manager when the hardship ends.
The Human Resources Manager shall notify Payroll to discontinue the availability of Donated
PTO to the employee.
Responsible Department
Human Resources shall coordinate the Leave Pool program with all parties (Pool Recipient,
Pool Donor, Pool Committee, and Payroll). All forms associated with this policy shall be
available through the Human Resources Department.
Sanctions
Eligible Employees that receive donated PTO shall notify Human Resources when a Personal
Emergency ends. Failure to do so may lead to disciplinary action, up to and including
termination.
Renewal / Review
Senior Management may revise or revoke this policy at their discretion. If the policy is
revoked, donated PTO shall be returned to the Donor.
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