{"hospital":{"ccn":"141318","name":"OSF HOLY FAMILY MEDICAL CENTER","city":"MONMOUTH","state":"IL","zip":"61462","phone":"309-734-3141","ownership":"Voluntary non-profit - Church","website_domain":"holyfamilymedicalcenter.com","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"350","layer":"documented","quote":"Charity Care/Full Coverage (100% Discount):\n\nAvailable to individuals or families with income at or below 350% of the Federal Poverty Level (FPL). Eligible patients may receive a 100% write-off of the portion of charges they are responsible for.","source_id":"summary-9155d91a39ee6fd1","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"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","pay_stubs","bank_statements","social_security_letter"],"layer":"documented","quote":"Along with the application, please provide a copy of at least one of the following items as your proof of income: \n\n• Two (2) most recent paystubs from employer \n• Most recent yearly tax return (if self-employed, include all schedules) \n• Social Security and/or Pension Retirement Award Letter \n• Parent/Guardian’s most recent yearly tax return (if applicant is a dependent listed on their tax form and under the age 25) \n• Other income validation documents \n• Bank statements from last 3 months \n• Receipt of unemployment benefits","source_id":"application-1a18f5e6eafd1466","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Holy Family Medical Center c/o Patient Financial Services-HBRC 3628 E Imperial Hwy, Suite 104 Lynwood, CA 90262"},{"kind":"email","detail":"FinancialAssistance@primehealthcare.com"},{"kind":"fax","detail":"310-900-8857"}],"layer":"documented","quote":"Please complete this application and submit it to Holy Family Medical Center by mail, by electronic mail (email), or by fax to apply for free or discounted care as soon as possible after the date of service.","source_id":"application-1a18f5e6eafd1466","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"We will accept your application for up to 240 days following the first billing statement for your care.","source_id":"application-1a18f5e6eafd1466","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"773-990-3289","layer":"documented","quote":"call our Patient Financial Services at [773-990-3289](tel:773-990-3289).","source_id":"fap-eab384cc7230632a","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"hours":null,"languages":{"value":["English","Spanish"],"layer":"documented","quote":"Financial assistance documents, including the policy, this plain language summary and application, are available in multiple languages and can be found on our website at: https://holyfamilymedicalcenter.com/financial-assistance/.","source_id":"summary-9155d91a39ee6fd1","checked_on":"2026-10-14","confidence":1.0,"support_count":0}},"coverage":{"facilities":{"value":["Holy Family Medical Center"],"layer":"documented","quote":"River Road, Des Plaines, IL 60016","source_id":"summary-9155d91a39ee6fd1","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-eab384cc7230632a","kind":"hospital_web","url":"https://holyfamilymedicalcenter.com?p=15208","title":"Financial Assistance | Holy Family Medical Center","fetched_on":"2026-10-14","sha256":"eab384cc7230632a9738c8eec0a69005b2ce894528a9e62fef1c96c2d3965ec2","effective_date":null},{"id":"summary-9155d91a39ee6fd1","kind":"hospital_web","url":"https://holyfamilymedicalcenter.com/wp-content/uploads/2025/09/Holy-Family_FAP-Plain-Language-Summary-9-4-25.pdf","title":"[PDF] Financial Assistance & Charity Care Program","fetched_on":"2026-10-14","sha256":"9155d91a39ee6fd112da23238a584f6e6c7e4b6fc30ae7d671fc585ad9d99526","effective_date":null},{"id":"fap-ece8b9f22f66181b","kind":"hospital_web","url":"https://holyfamilymedicalcenter.com/financial-assistance","title":"Financial Assistance | Holy Family Medical Center","fetched_on":"2026-10-14","sha256":"ece8b9f22f66181be7f21cf7a7a11a630f5319926790d3d80d14af48345c5d75","effective_date":null},{"id":"fap-eab384cc7230632a","kind":"hospital_web","url":"https://holyfamilymedicalcenter.com/patients-visitors/financial-assistance","title":"Financial Assistance - Holy Family Medical Center","fetched_on":"2026-10-14","sha256":"eab384cc7230632a9738c8eec0a69005b2ce894528a9e62fef1c96c2d3965ec2","effective_date":null},{"id":"fap-f8f3359a16c89124","kind":"hospital_web","url":"https://www.holyfamilymedicalcenter.com/wp-content/uploads/2025/11/Holy-Family_FAP-Policy-10-29-25_ENGLISH.pdf","title":"Financial Assistance Program – Policy","fetched_on":"2026-10-14","sha256":"f8f3359a16c891240207549212d62ae2e4696f1f891a4dbb5e9b34f6d25ec93c","effective_date":null},{"id":"application-1a18f5e6eafd1466","kind":"hospital_web","url":"https://www.holyfamilymedicalcenter.com/wp-content/uploads/2025/10/Holy-Family_FAP-Application-10-15-25.pdf","title":"Financial Assistance Program – Application","fetched_on":"2026-10-14","sha256":"1a18f5e6eafd1466f68be5fd5cebe265e4d122c8842106a86876c9ceff3aa9d4","effective_date":null},{"id":"application-22ac4ef76fb70f7a","kind":"hospital_web","url":"https://www.holyfamilymedicalcenter.com/wp-content/uploads/2025/10/Holy-Family_FAP-Application-10-15-25_Spanish.pdf","title":"Programa de Asistencia Financiera – Aplicación","fetched_on":"2026-10-14","sha256":"22ac4ef76fb70f7aa9725af71252bfe9a5e4dff8732c1c684e5140953887fc15","effective_date":null}],"accuracy":null}