{"hospital":{"ccn":"141302","name":"MIDWEST MEDICAL CENTER","city":"GALENA","state":"IL","zip":"61036","phone":"815-777-1340","ownership":"Voluntary non-profit - Private","website_domain":"midwestmedicalcenter.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"150","layer":"documented","quote":"Patients with an adjusted gross income at or below 150% of the Federal Poverty Guidelines for the Family Size will be eligible for 100% Financial Assistance.","source_id":"application-49297fa665523bce","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":{"value":["IL"],"layer":"documented","quote":"Illinois Resident means a Patient who lives in Illinois and intends to continue living in Illinois indefinitely. A Patient who relocates to Illinois for the sole purpose of receiving health care is not an Illinois Resident.","source_id":"application-49297fa665523bce","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"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":["photo_id","proof_of_income","tax_return","pay_stubs","proof_of_residency"],"layer":"documented","quote":"Required Documents: For the Hospital Uninsured Patient Discount, only one of the following Income Verification and Residency Verification documents is needed. Income Verification  Most recently filed federal income tax return and corresponding Schedules and W-2 and 1099 Forms;  Most recent W-2 and 1099 forms;  Copies of the 2 most recent pay stubs;  Written income verification from an employer if paid in cash; or  1 other reasonable form of income verification deemed acceptable to MMC. Residency Verification  Any one of the above Income Verification documents;  Valid state-issued ID Card;  Recent residential utility bill;  Lease Agreement;  Vehicle registration card;  Voter registration card;  Mail addressed to the patient at an IL address from a credible source;  Statement from family member residing at same address who presents verification of residency; or  A letter from a homeless shelter or similar facility verifying residency.","source_id":"application-49297fa665523bce","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"Patients must complete the Application within 240 days following the date MMC provides the first billing statement to the Patient","source_id":"application-49297fa665523bce","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"decision_days":{"value":30,"layer":"documented","quote":"MMC will send written notification of approval or denial of financial assistance to the Patient within 30 working days following receipt of a completed and signed Application submitted with all requested documents.","source_id":"application-49297fa665523bce","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":{"value":120,"layer":"documented","quote":"MMC shall not engage in any ECA during the first 120 days following the first billing statement to the patient","source_id":"billing-deefd0149451e373","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"collection_agencies":null},"contacts":{"phone":{"value":"877-632-2129","layer":"documented","quote":"If you have questions or need assistance in submitting an Application, please call 877-632-2129 or visit a Registration Representative.","source_id":"application-49297fa665523bce","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":{"value":["One Medical Center Drive, Galena, IL 61036"],"layer":"documented","quote":"Paper copies of these Policies and the Application form financial assistance will be available at our facility located at One Medical Center Drive, Galena, IL 61036 at the Main Registration and Emergency Registration areas.","source_id":"billing-deefd0149451e373","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"application-49297fa665523bce","kind":"hospital_web","url":"https://www.midwestmedicalcenter.org/content/pdfs/Charity-Care-Application.pdf","title":"Financial Assistance Policy and Application","fetched_on":"2026-10-14","sha256":"49297fa665523bceffba8ea77869cd3bc8e529221f77656c8600b2d13891ab62","effective_date":null},{"id":"billing-deefd0149451e373","kind":"hospital_web","url":"https://www.midwestmedicalcenter.org/content/pdfs/Fair-Billing-and-Collection-Policy-501r-Final-Regs-2-4-7-16.pdf","title":"[PDF] BILLING AND COLLECTION POLICY - Midwest Medical Center","fetched_on":"2026-10-14","sha256":"deefd0149451e3738856b28b1763c80e04fd550414667786058a0ddf23578b52","effective_date":null},{"id":"application-cd6094a55fe5cf91","kind":"hospital_web","url":"https://www.midwestmedicalcenter.org/content/pdfs/Financial_Assistance_Application_Final_Updated_9.24.24.pdf","title":"[PDF] Financial Assistance Application - Midwest Medical Center","fetched_on":"2026-10-14","sha256":"cd6094a55fe5cf911c6dfa7e182ed729ef3d6d21fd2f4db1014eded9ac8fa808","effective_date":null}],"accuracy":null}