Speare Memorial Hospital

How to Apply for Financial Assistance

Call financial counseling services at 1-866-557-2555. A financial counselor will advise you and investigate other sources that might provide financial assistance.


Complete a financial assistance application, you can click here to print the form, or pick it up at the financial counselor’s office at Speare Memorial Hospital, or call us at 1-866-557-2555 to request that one be mailed to you.

Submit the application with the following documents:

  • Complete copy of your most recent Federal Income Tax Return and all schedules. Include copies of last year’s W-2 forms.
  • Copies of the four most recent, paycheck stubs or a statement from the employer
  • Copies of three most recent bank statements (e.g., savings, checking, money market, IRA, 401K, etc.)
  • Copies of unemployment, disability compensation benefits statements
  • Copies of social security or pension benefits income
  • Copy of current property tax bill showing the assessed value of the property, and a copy of a mortgage statement showing the current mortgage or home equity balance.
  • Copies of government assistance notices, such as Social Security disability and Medicaid

Please submit the above documents through postal service mail or in person; do not email copies as we cannot guarantee the security of your personal information.