{"hospital":{"ccn":"140127","name":"CARLE BROMENN MEDICAL CENTER","city":"NORMAL","state":"IL","zip":"61761","phone":"309-454-1400","ownership":"Voluntary non-profit - Church","website_domain":"carle.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Federal Poverty Level ≤ 200%","source_id":"fap-cdf397d82c5a98cf","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":{"value":true,"layer":"documented","quote":"Patients covered by Medicare Part A or Part B must complete a Carle Financial Assistance application which includes a request that the patient provide a federal tax return and a defined list of assets.","source_id":"fap-cdf397d82c5a98cf","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"residency":null,"insured_patients_covered":null,"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","tax_return"],"layer":"documented","quote":"− Prior year’s Federal Tax Return showing all household members and their adjusted gross income.","source_id":"fap-cdf397d82c5a98cf","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":null,"decision_days":{"value":30,"layer":"documented","quote":"All efforts will be made to send written determination to the applicant within 30 working days of receipt of the completed application.","source_id":"fap-cdf397d82c5a98cf","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":"(888) 71-CARLE, (888) 712-2753","layer":"documented","quote":"Calling Patient Financial Services at (888) 71-CARLE, (888) 712-2753, or – Writing Carle Financial Assistance Program at PO Box 4024, Champaign, IL 61824-4024","source_id":"fap-4cbf7040e46e78f2","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"hours":null,"languages":{"value":["English","Spanish"],"layer":"documented","quote":"Translated copies of all Carle Financial Assistance Program materials are available in Spanish at Carle.org/FinancialAssistance or by request to Carle representatives at FinancialAssistance@Carle.com or by phone at (888) 71-CARLE.","source_id":"fap-cdf397d82c5a98cf","checked_on":"2026-10-10","confidence":1.0,"support_count":0}},"coverage":{"facilities":{"value":["Carle BroMenn Medical Center"],"layer":"documented","quote":"Carle BroMenn Medical Center and Clinic Locations:\n• Carle West Physician Group\n• Carle BroMenn Outpatient Center\n• Carle BroMenn Comfort and Care Suites","source_id":"fap-4cbf7040e46e78f2","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-4cbf7040e46e78f2","kind":"hospital_web","url":"https://dev.carle.org/X0873-eng","title":"Carle Financial Assistance Programs","fetched_on":"2026-10-10","sha256":"4cbf7040e46e78f2f2c649e3924596500277a247ce65e51202835a8da0eba52e","effective_date":null},{"id":"billing-e502db8b7f6fc3b3","kind":"hospital_web","url":"https://carle.org/patients-visitors/answers-to-billing-questions","title":"Answers to Frequently Asked Billing Questions - FAQs | Carle.org","fetched_on":"2026-10-10","sha256":"e502db8b7f6fc3b3981ed0b73f93e19b1a3eee57f49d25061f1867413d7d8070","effective_date":null},{"id":"fap-bfcbef51a9f3799b","kind":"hospital_web","url":"https://carle.org/patients-visitors/financial-assistance","title":"Financial Assistance - Apply Today | Carle Health","fetched_on":"2026-10-10","sha256":"bfcbef51a9f3799b93bdc0d2e0cfdf6cbc7c3acea23cb2a71fe80de2e8813f37","effective_date":null},{"id":"fap-cdf397d82c5a98cf","kind":"hospital_web","url":"https://carle.org/getmedia/39d776c5-008f-4aa2-abfe-df0c5e358c0b/AD300-new.pdf","title":"Carle Financial Assistance Program - AD300","fetched_on":"2026-10-10","sha256":"cdf397d82c5a98cf8b25409b253531da87519349dae3d7d942a38c7a304cfe2d","effective_date":null},{"id":"fap-719bd70136e7d63d","kind":"hospital_web","url":"https://carle.org/patients-visitors/asistencia-financiera","title":"Financial Assistance en Espanol","fetched_on":"2026-10-10","sha256":"719bd70136e7d63d054a1d457658fa6a5d9f43918e234db68d8fac0829dd0b6f","effective_date":null},{"id":"fap-88cc9b03d3916937","kind":"hospital_web","url":"https://www.carle.org/getmedia/c9fd9222-41c0-4dfb-ba91-bb8dddb85d67/Carle-Rural-Health-Financial-Assistance-Program92625.pdf","title":"Carle Rural Health Financial Assistance Program","fetched_on":"2026-10-10","sha256":"88cc9b03d391693737af0e4d7130473c137df261ac29118507da02311992fdc2","effective_date":null}],"accuracy":null}