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The following information is required to make a determination for charity assistance on your bills. This information must be returned within 30 days. If it is not returned, your request may be denied.
- Complete and sign the enclosed Charity Application
- A complete, signed copy of your Federal Income Tax Return from the previous year. (If you are self-employed, include all schedules.) Call the IRS at 1-800-829-1040 if you do not file a tax return or do not have a copy, and ask for letter number 1722.
- Proof of income for the last three (3) months. (If unemployed, proof from the unemployment office stating whether or not you are receiving benefits.)
- Proof of house payment or rent.
- Legal proof of receiving Social Security, Disability, Alimony, Welfare, and/or Child Support.
- Legal proof of receiving Food Stamps.
- Copy of your state Property Tax receipt from the previous year for home, automobiles, campers, motorcycles, etc.
Please do not send original receipts/proof of items listed above.
If you have any questions, please call our Customer Service Department at 314-576-8100 or toll free at 888-924-9200, Monday-Friday, 8:30 a.m. to 5 p.m. Please send the infomation to:
232 S. Woods Mill Rd
Chesterfield, MO 63017
Attn: Patient Financial Committee
For the application, click here (PDF).
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