{"hospital":{"ccn":"360218","name":"LICKING MEMORIAL HOSPITAL","city":"NEWARK","state":"OH","zip":"43055","phone":"740-348-4000","ownership":"Voluntary non-profit - Private","website_domain":"lmhealth.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"100","layer":"documented","quote":"Household income must be at or below one-hundred percent (100%) of the poverty income guidelines established by the Department of Health and Human Services.","source_id":"application-93c8f9b67817d904","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"discount_tiers":{"value":[{"min_fpl_exclusive":"100","max_fpl_inclusive":"150","discount_percent":80},{"min_fpl_exclusive":"150","max_fpl_inclusive":"200","discount_percent":50},{"min_fpl_exclusive":"200","max_fpl_inclusive":"250","discount_percent":45}],"layer":"documented","quote":"Annual Family Income  Amount of Discount\n\nLess than 100% FPG  100%\n\n100% - 150% FPG  80%\n\n150% - 200% FPG  50%\n\n200% - 250% FPG  45%","source_id":"application-93c8f9b67817d904","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"In accordance with the procedure outlined below, insured (including Medicare) and uninsured patients who do not have the means to pay for services provided at Licking Memorial Health Systems may request to be considered for financial assistance under this policy.","source_id":"application-93c8f9b67817d904","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":null,"form_version":null,"documents_required":{"value":["proof_of_income"],"layer":"documented","quote":"In addition to income documentation (i.e. pay stubs, pension), self-declaration of income may be used.","source_id":"application-93c8f9b67817d904","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":"(220) 564-1500","layer":"documented","quote":"The Financial Assistance Policy and Application are available online by logging into MyChart at MyChart.LMHealth.org, by visiting LMHealth.org and clicking on “Assistance & Financial Aid” under Quick Links, or by calling Patient Financial Services at (220) 564-1500.","source_id":"application-a0e6c3560963f92b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"application-93c8f9b67817d904","kind":"hospital_web","url":"https://www.lmhealth.org/PDF-Files/Forms/00001-04-23.aspx","title":"Financial Assistance, 00001 04 23","fetched_on":"2026-10-13","sha256":"93c8f9b67817d90433e08e8aff4e3142654eacbc4e890b19fbf052655a7a4be0","effective_date":null},{"id":"billing-47bc2c72b649d2ad","kind":"hospital_web","url":"https://www.lmhealth.org/Patients-Visitors/After-Your-Stay/Billing.aspx","title":"Licking Memorial Health Systems - Billing","fetched_on":"2026-10-13","sha256":"47bc2c72b649d2ad6cbcdb0b8d928c27b90fcdf1c976e94461c6ee7197ce9248","effective_date":null},{"id":"application-a0e6c3560963f92b","kind":"hospital_web","url":"https://www.lmhealth.org/PDF-Files/Forms/1900-5007-Financial-Assistance-Summary.aspx","title":"Financial Assistance Summary","fetched_on":"2026-10-13","sha256":"a0e6c3560963f92b96b19a424d3422ef07b0ff969ea35c2b2d883af2adbf5d59","effective_date":null}],"accuracy":null}