# Mary Rutan Hospital

Hospital in Bellefontaine, OH. From the hospital's IRS filing, tax year 2024.

Mary Rutan Hospital likely gives free care to households with a yearly income up to $19,950 for 1 person, $27,050 for 2, $34,150 for 3, $41,250 for 4, $48,350 for 5 or $55,450 for 6. It likely gives a discount to households with a yearly income up to $47,880 for 1 person, $64,920 for 2, $81,960 for 3, $99,000 for 4, $116,040 for 5 or $133,080 for 6.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $19,950 | $47,880 |
| 2 | $27,050 | $64,920 |
| 3 | $34,150 | $81,960 |
| 4 | $41,250 | $99,000 |
| 5 | $48,350 | $116,040 |
| 6 | $55,450 | $133,080 |

Dollar amounts use the 2026 federal poverty guidelines.

## How to apply

- Call (937) 651-3257 and ask for financial assistance.
- [Financial assistance policy named in the IRS filing](HTTPS://WWW.MARYRUTAN.ORG/PATIENTS-AND-VISITORS/BILLING-INFORMATION/FINANCI)
- We do not have the deadline yet. Apply as soon as you get a bill, and ask the billing office to pause collections while you apply.

## If you have insurance

If you have insurance, ask whether this policy helps with deductibles and copays.
Keep your insurance. Financial assistance covers bills from this one place only.

## State program in Ohio

### Hospital Care Assurance Program (Ohio Revised Code 5168.14 and Ohio Administrative Code 5160-2-17)

Ohio law says hospitals that get state Hospital Care Assurance Program (HCAP) funds must give basic, medically necessary hospital care free of charge to some patients. You may qualify if you live in Ohio, are not on Medicaid, and your household income is at or below the federal poverty level (100%). The law covers general medical and surgical hospitals and children's hospitals. It does not cover transplants. You must fill out and sign an application with proof of income and family size. Many people at this income can also get Medicaid, so the hospital may ask you to apply for it. HCAP covers only the hospital's own bill. Doctors who bill separately are not covered. Many hospitals offer more help than this under their own policy, so ask about both.

Income levels in the program are free up to 100% of poverty level.

Applies to nonfederal Ohio hospitals registered as general medical and surgical or pediatric general hospitals (and Medicare-recognized cancer hospitals) that receive HCAP funds; Ohio residents who are not Medicaid recipients.

How to apply. Ask the hospital's billing or financial assistance office for an HCAP application. Fill it out, sign it, and include proof of your income and family size. Hospitals must post signs about HCAP in admissions, the business office, and the emergency room.

> shall provide, without charge to the individual, basic, medically necessary hospital-level services

Source https://codes.ohio.gov/ohio-revised-code/section-5168.14, checked 2026-11-11

## Sources

- IRS Form 990 Schedule H, tax year 2024 https://apps.irs.gov/pub/epostcard/990/xml/2025/2025_TEOS_XML_11B.zip#202543089349302464_public.xml
- Policy link listed in the filing HTTPS://WWW.MARYRUTAN.ORG/PATIENTS-AND-VISITORS/BILLING-INFORMATION/FINANCI

Last checked IRS filing for tax year 2024.

HTML page https://hospitalaid.org/hospitals/mary-rutan-hospital-bellefontaine-oh/
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