{"hospital":{"ccn":"050782","name":"CASA COLINA HOSPITAL","city":"POMONA","state":"CA","zip":"91767","phone":"909-596-7733","ownership":"Voluntary non-profit - Private","website_domain":"casacolina.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"CHARITY CARE is defined as services customarily provided by Casa Colina, which are provided to patients who do not have available resources to pay and are at or below 200% of the federal poverty level.","source_id":"fap-247546d5010a89ed","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"discount_tiers":null,"assistance_ceiling_fpl":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"DISCOUNTED CARE is defined as services provided to patients who are either uninsured with higher income levels or are underinsured but whose income is at or below four hundred percent (400%) of the federal poverty level standard.","source_id":"fap-247546d5010a89ed","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":null,"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":{"value":["proof_of_income","social_security_letter","tax_return","pay_stubs","bank_statements"],"layer":"documented","quote":"> \nPay stubs (most recent available)\n\n> \nMost recent tax returns\n\n> \nCompleted and signed Financial Assistance Application\n\n> \nAward letters for Social Security, SSI, Disability, Unemployment, General Relief, Alimony, etc.\n\n> \nEmployment status, both current and future; or, if self‐employed, current year‐to‐date profit and loss statement to determine current income\n\n> \nFamily size\n\n> \nLast two months’ bank, brokerage and investment statements\n\n> \nCopies of prior year’s 1099 for interest income, dividends, capital gains, etc.\n\n> \nOther appropriate financial data if tax returns or pay stubs are not available. Certain assets—such as retirement plans, homes, and automobiles owned by the patient— are excluded.\n\n> \nRent verification\n\n> \nProperty/mortgage verification","source_id":"fap-247546d5010a89ed","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"in_person","detail":"Paper copies are also available in the Admitting and Registration Departments throughout the facility located at 255 E. Bonita Ave., Pomona, CA 91767."}],"layer":"documented","quote":"Paper copies are also available in the Admitting and Registration Departments throughout the facility located at 255 E.","source_id":"fap-247546d5010a89ed","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":{"value":14,"layer":"documented","quote":"All decisions will be communicated in writing to the requestor no later than 14 business days from final approval or denial date.","source_id":"fap-247546d5010a89ed","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"909/596-7733, ext. 5558","layer":"documented","quote":"If you have any questions, please contact our Patient Financial Services Department at 909/596‐7733, ext. 5558.","source_id":"fap-247546d5010a89ed","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"hours":null,"languages":{"value":["English","Spanish"],"layer":"documented","quote":"The application is available in English and Spanish.","source_id":"fap-247546d5010a89ed","checked_on":"2026-10-10","confidence":1.0,"support_count":0}},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-3ed3acb62803ee7e","kind":"hospital_web","url":"https://www.casacolina.org/documents/content/5-Financial-Assistance-Policy.rev-11.19)-Spanish.pdf","title":"Ayuda económica para los pacientes - Casa Colina Hospital","fetched_on":"2026-10-10","sha256":"3ed3acb62803ee7e953705fcdc188a63c7c2553399ada47a2598e37e42af31dd","effective_date":null},{"id":"fap-247546d5010a89ed","kind":"hospital_web","url":"https://www.casacolina.org/documents/Patient-Financial-Assistance-Discounted-Care-and-Charity-Care.Final-5.22.26).pdf","title":"CASA COLINA HOSPITAL AND CENTERS FOR HEALTHCARE ...","fetched_on":"2026-10-10","sha256":"247546d5010a89ed61af6dc947cc417f58e3e4b2b8710e160372a6d681da068d","effective_date":null},{"id":"fap-b5e2dca2b776ac90","kind":"hospital_web","url":"https://www.casacolina.org/patients-families/help-paying-your-bill","title":"Financial Assistance | Casa Colina Hospital and Centers for ...","fetched_on":"2026-10-10","sha256":"b5e2dca2b776ac90da3ecfe46ee5fe04e7723f3f02fcac848218ae49798ce722","effective_date":null}],"accuracy":null}