{"hospital":{"ccn":"361312","name":"MERCY HEALTH - URBANA HOSPITAL","city":"URBANA","state":"OH","zip":"43078","phone":"937-653-5231","ownership":"Voluntary non-profit - Private","website_domain":"mercy.com","system":null},"version":3,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Individuals with an income level at 200% FPG or below receive free care.","source_id":"fap-df3f019cf294baf8","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"discount_tiers":null,"assistance_ceiling_fpl":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"],"layer":"documented","quote":"Proof of income is required with exception of patients who qualify for presumptive eligibility detailed below. 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