Horn Memorial Hospital offers financial assistance and charity care for qualified patients. Below is our policy and application forms.
Payment requirements as of 01/01/2016 will be:
$1.00 - $49.99
$50.00 - $100.00
$100.01 - $250.00
$250.01 - $750.00
$750.01 - $1200.00
$1200.01 - $2000.00
$2000.01 or greater
Minimum REGULAR Monthly Payment Required
Payment in full (100%)
33% of the monthly balance
25% of the monthly balance
10% of the monthly balance
8% of the monthly balance
7.5% of the month balance
5.5% of the monthly balance, to be paid in full within 18 months
Payments received that are below the minimum payment amount noted above will be returned to the patient with a letter of explanation.
Please ensure you have the following compiled and completed:
SIGNED and completed application
Copy of current Federal Tax Return
Copies of last 3 pay/social security stubs
Copies of last 3 bank statements
If you have questions regarding financial assistance please contact the HMH Business Office at 712.364.3311.