ILLINI COMMUNITY HOSPITAL

"Patient has reported income below 275% of the Federal Poverty Income Guidelines at any Blessing location."

documented · checked 2026-10-13 · Financial Assistance - blessinghealth.org

"Copy of your most recent filed Federal 1040 Income Tax Return including all schedules, W-2 Statements, and 1099 forms. If you did not file a Return for the most recent filing period, your application must include an explanation of the reason why no Return was filed. • Forms advising status of unemployment, worker's compensation, or Medicaid • Copy of most recent paycheck stubs from all jobs held in the current year showing year to date earnings in the absence of income, a letter of support and/or a declaration of no income from the patient and/or responsible party detailing how the individual's current living needs are being met • Proof of all income such as Social Security, unemployment, disability, pensions, child support, alimony or foster care. • Other information that Blessing may deem relevant in assisting Blessing entities in making the most appropriate financial determination"

documented · checked 2026-10-13 · Financial Assistance - blessinghealth.org

"Please complete this application and submit with the requested documentation to the hospital in person, by mail, or by fax to apply for free or discounted care."

documented · checked 2026-10-13 · Blessing Health Center Financial Assistance Application

"Questions or Concerns If you have questions or concerns, you may contact Blessing Health System Patient Financial Services by calling (855) 354-5896 or (217) 277-3512."

documented · checked 2026-10-13 · Blessing Health Center Financial Assistance Application

"Illini Community Hospital 640 West Washington Street | Pittsfield, IL"

documented · checked 2026-10-13 · Blessing Health Center Financial Assistance Application