Your Financial Subsidy
Proposal Request

For Community Hospitals

Preparing Your Financial Subsidy Proposal

Welcome:  Here's a few things you need to know.  We respect your privacy.  We won't ask you for your name or contact information to give you a proposal.  Also, your responses will be confidential and will not be disclosed to anyone outside CHC.

Directions:  Click the Step 1 Blue Banner and that section will open.  Answer a few questions and move to the next Step.  The more information you can provide will help us prepare your proposal.  When Completed, Click the HUG to send us your Proposal Request information. 

Thanks for your interest and participation.
Click Step 1 to begin

 

2020: Financial Information

$
$
$
$
Number of Patients

How Were You Paid?

Insurance:
$
No Insurance:
$
Medicaire:
$
Medicaide:
$
Other:
$
 
2019: Financial Information

$
$
$
$
Number of Patients

How Were You Paid?

Insurance:
$
No Insurance:
$
Medicaire:
$
Medicaide:
$
Other:
$
 
2018: Financial Information

$
$
$
$
Number of Patients

How Were You Paid?

Insurance:
$
No Insurance:
$
Medicaire:
$
Medicaide:
$
Other:
$
 

* Don't forget to fill out each year for this section.

You're almost done!

Once you've completed all the relevant fields, Click the "Send Us Your Subsidy Request" HUG.  We'll be back to you shortly.

What Would You Like To Do Next?