{"hospital":{"ccn":"140177","name":"JACKSON PARK HOSPITAL","city":"CHICAGO","state":"IL","zip":"60649","phone":"773-947-7500","ownership":"Voluntary non-profit - Private","website_domain":"jacksonparkhospital.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Full financial assistance, Charity, at a 100% discount of Gross Charges, will be given to patients who have a gross family income equal to or below 200% of the Federal Poverty Levels (FPL), adjusted for family size, provided such patients are not eligible for other private or public health coverage and do not exceed the assets protection threshold.","source_id":"fap-538349a2f7466872","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"Payment Plans. This assists patients with financial needs through payment arrangements. This program is available to both insured and uninsured patients.","source_id":"fap-538349a2f7466872","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":null,"state_programs":null},"apply":{"form_url":{"value":"https://www.jacksonparkhospital.org/assets/1/7/Financial%20Assistance%20Application.pdf","layer":"documented","quote":"Complete our **[Financial Assistance Form with Instructions](/assets/1/7/Financial_Assistance_Guidelines_Packet.pdf)**","source_id":"fap-9a467b95213d19fd","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"form_version":null,"documents_required":{"value":["photo_id","proof_of_income","social_security_letter","tax_return","pay_stubs","bank_statements"],"layer":"documented","quote":"PROOF OF INCOME: In order to establish your Annual Net Income, the following documents are required.  Last four (4) pay stubs, yearly ledger to date if self-employed and/or proof of child support  Three most recent bank statements  Copy of last year’s W2 forms  Copy of last year’s complete tax form  Room and Board Letter if applicable or Rent Receipt  Drivers License (Photo I.D.)  Social Security Card","source_id":"fap-4a91561c56fe1bfc","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":null,"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"773-947-7500 x7996","layer":"documented","quote":"You can call 773-947-7500 x7996 to ask that a copy of any of the above be sent to you free of charge by mail or email.","source_id":"fap-538349a2f7466872","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"hours":{"value":"Sunday - Saturday 8:00am - 11:00pm","layer":"documented","quote":"QUESTIONS? Please feel free to call our office Sunday - Saturday 8:00am - 11:00pm at (773) 947-7500 ext. 7996 or 7997","source_id":"fap-4a91561c56fe1bfc","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"languages":{"value":["English","Spanish"],"layer":"documented","quote":"This policy and our Financial Assistance Application are available in other languages in accordance with the applicable \"Standards for Culturally and Linguistically Appropriate Services in Health Care\" (Standards 4 & 7, based on Title VI of the Civil Rights Act of 1964).","source_id":"fap-538349a2f7466872","checked_on":"2026-10-13","confidence":1.0,"support_count":0}},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-538349a2f7466872","kind":"hospital_web","url":"https://www.jacksonparkhospital.org/assets/1/7/Financial%20Assistance%20Policy%202021%20docx.pdf","title":"Financial Assistance Policy","fetched_on":"2026-10-13","sha256":"538349a2f7466872eafd3e5be1e08003dcf39b05c2f1b39e089874f9f30917e3","effective_date":null},{"id":"summary-74c93c9d7149c4e4","kind":"hospital_web","url":"https://www.jacksonparkhospital.org/assets/1/7/FAP%20Plain%20Language%20Summary.pdf","title":"FAP Plain Language Summary.pdf","fetched_on":"2026-10-13","sha256":"74c93c9d7149c4e496ee36125b905dffa6164da3b62736b3a5eb695979bc5bc3","effective_date":null},{"id":"fap-9a467b95213d19fd","kind":"hospital_web","url":"https://www.jacksonparkhospital.org/patients_and_visitors/financial-assistance-program","title":"Financial Assistance Program | jacksonparkhospital","fetched_on":"2026-10-13","sha256":"9a467b95213d19fdc05c4363245210f5dbe0f959c5fb8bc1a394fff9175026cd","effective_date":null},{"id":"fap-4a91561c56fe1bfc","kind":"hospital_web","url":"https://www.jacksonparkhospital.org/assets/1/7/Financial_Assistance_Guidelines_Packet.pdf","title":"FINANCIAL ASSISTANCE ELIGIBILITY GUIDELINES Dear ...","fetched_on":"2026-10-13","sha256":"4a91561c56fe1bfc154409727c56b9fb50753aa1ed3169534f0734f93aa8c65d","effective_date":null}],"accuracy":null}