Community Care


CCH offers financial assistance to those who qualify through the Community Care program. 
Q: How do I qualify for Community Care?

A:The first step is to submit an application. It is available in a fill-able PDF format. You can click on Community Care Application and download the PDF. Fill out the document and save it. Once complete press the submit button or save the application and attach it to an email. Or you can also click on Community Care Application, print the application, complete it, and return it with supporting documentation to:

TO USE OUR FILLABLE PDF By Mail: By Email: By Fax:

The free Adobe Acrobat Reader allows you to view and print fillable PDF forms from the Web site. Adobe Acrobat Reader version 8 or higher allows you to save the completed PDF form on your computer for reference or to send as an attachment to an e-mail.

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Patient Financial Counselor
Columbus Community Hospital
1515 Park Avenue
Columbus, WI 53925-2402

pfs@cch-inc.com 920-623-1508

If you wish to receive an application in the mail, please call (920) 623-2200 or (800) 549-7511 and ask to speak to a Patient Financial Counselor.


Q: What supporting documentation do I need to include with my application?

A: Required documents include:

  • copies of the three (3) most recent paystubs for all adult family members
  • copy of most recent federal tax return
  • copy of unemployment or pension compensation
  • Patient Financial Counselors may require other verification of income or assets when deemed necessary.

Q: How long does it take to know if I qualify?

A: Applicants will be notified in writing of approval or denial within 14 days of receipt of a complete Community Care Application. An application is considered complete when all requested supporting documentation has been received.