Covenant Health is an innovative, Catholic regional delivery network and a leader in values based, not-for-profit health and elder care. We sponsor hospitals, nursing homes, assisted living residences and other health and elder care organizations throughout New England.
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Making an Impact with Care & Compassion

Capital Campaign Pledge Form

Click here to download a PDF file of the Capital Campaign Pledge Form.

Personal Information

Name of Donor(s)  *Address  *City  *State  *Zip  *Home Phone  *Work Phone Email Address  *Please note that it is our practice to list donor names and gift ranges in appropriate publications. Name(s) as you wish to be listed, if different than above: If your gift qualifies for a naming opportunity, please state your preference here. You will be contacted to confirm. 

Gift/Pledge Information

I/We wish to make a one time gift of $ Pledge of $ Should the campaign exceed its fundraising goal of $6 million for the building project, those funds will be placed in a board-designated restricted account and used for additional capital expenses as needed. 

Pledge Payment Options

Contributions may be spread over time. Please indicate your choice below. I/We will give $ a year Every year for 

Pledge payments will begin (month/year) 

Payment Method

Preferred Payment Method Credit Card # Expiration Date CVC Code (3 digit code on back of card) Preferred Payment Method Please make check payable to “St. Mary’s” with “Capital Campaign” in the memo line and mail to Audrey Thomson, Executive Director of Philanthropy, St. Mary’s Health System,
PO Box 7291, Lewiston, ME 04243 

Legacy (Planned) Gift

Planned gifts have a tremendous impact on the future of St. Mary's. please contact Audrey Thomson at 207-777-8828 to share your planned gift intentions. 
St. Mary's Health System • 93 Campus Avenue • Lewiston, ME 04240