I look forward to talking with you about this gift intention. I understand that listing this gift may be an incentive for others to give, and I am willing to be publicly acknowledged.

I understand you would like to contact me and I would be happy to discuss this with you, but I prefer not to be listed or acknowledged publicly.

My Will/Trust was signed on:

My Will/Trust provides that percent shall be bequeathed to The Foundation of FirstHealth, Inc. through my estate. As of today's date, I estimate that the value of this provision in my estate plan would be approximately $ .

My Will/Trust provides that $ shall be bequeathed to The Foundation of FirstHealth, Inc. through my estate.

My Will/Trust provides that certain items of real or personal property shall be bequeathed to The Foundation of FirstHealth, Inc. through my estate. The items are as follows:

As of today's date, I estimate these items to be worth approximately $ .

My Will/Trust indicates that the bequest through my estate is unrestricted.
My Will/Trust directs The Foundation of FirstHealth, Inc. to use my bequest through my estate for a specific purpose.

The specific purpose is as follows:

I understand that I am not making a legal, or binding, commitment upon my estate by submitting this Estate Intention Form. Further, FirstHealth should understand that the size of my future gift might be significantly different from the amount estimated above for the purposes of valuation in any campaign. If for any reason in the future FirstHealth is no longer included in my estate plan, I will notify you so that you can update your records and remove me from the planned giving society.

Donor:
Phone Number:
Date: