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Supporting documentation

The HCA Healthcare Hope Fund is required to obtain supporting documentation for every grant given because the Hope Fund is a 501(c)3 nonprofit organization and not an HCA Healthcare employee benefit

The forms of supporting documentation required for each situation are listed below. You can attach all supporting documentation to your online application, or you can email the documentation to hopefund@hcahealthcare.com or fax it to 866-337-4354. Please be sure your name and 3-4 ID are on the cover page. Note that the Hope Fund staff may ask for additional forms of documentation to verify your event and need.

Illness or Injury

The Hope Fund can consider the financial needs related to an extended illness or injury for a colleague or their dependent spouse/children.

Illness or injury required documentation
  • Physician documentation stating the nature of the illness/injury and the dates the colleague or spouse is unable to work
  • If the spouse is out of work/unpaiddocumentation from spouse’s employer as to pay rate and unpaid status while out of work
  • Physician documentation stating need for treatment and amount that is due in advance of receiving treatment (if applicable)
  • Documentation for dates of treatment and expenses related to travelhotel fees, air/car travel, etc. (if applicable)
  • Outstanding/unpaid medical bills, after insurance payments and adjustments (if applicable)

Natural Disaster

The Hope Fund can consider the financial needs related to a natural disaster that affects the colleague's primary residence.

Natural disaster required documentation
  • Fire report/Police report
  • Signed lease or landlord statement for new rental stating all funds needed to move in (security deposit, first month's rent, etc.)
  • Proof of insurance payout or declination letter
  • Quote from a licensed contractor who will be making the repairs
  • Any other documentation relevant to this request (insurance report, etc.)
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Family Death

The Hope Fund can consider the financial needs due to an unexpected death of a dependent family member or if travel assistance is needed due to death in the immediate family.

Family death required documentation
  • Itemized bills from funeral home which includes the deceased's name, city and state of funeral home and amount to be paid by applicant
  • Receipt showing payment of funeral services
  • Proof of relationship (i.e. obituary, birth certificate, etc.)
  • Documentation of travel expenses incurred to attend services (flight, hotel, rental car, etc.)

Domestic Violence

The Hope Fund can consider the financial needs when a colleague or dependent family member is experiencing a domestic violence event.

Domestic violence required documentation
  • Copy of an active restraining order or an order of protection. In some situations, a letter from a professional (clergy, counselor, social worker, etc.) will be accepted in absence of a restraining order
  • Documentation of expenses such as rent, first/last security deposits for moving to a safe location or loss of income for mortgage/rent payments

Essential Needs

The Hope Fund considers assistance with unexpected, qualifying events hindering the applicant from meeting their basic household needs.

Essential needs documentation
  • Documentation of the event that has led to your financial need
  • Notice to vacate/foreclosure notice
  • Separation letter from previous employer that clearly states the reason and date for unemployment on company letterhead with contact information
  • Notice of condemnation/other documentation showing home uninhabitable
  • Signed lease and/or landlord statement for new rental property stating all finances needed to move in (security deposit, first month's rent, etc.)
  • Essential utilities deposit statements (electricity, gas, water)
  • Any other documentation relevant to this request (insurance report, etc.)

Major Car Repairs

Assistance for major car repairs can be considered when repairs are needed to the applicant’s sole source of transportation for a condition that is preventing the applicant from using the vehicle with no alternatives to travel to work.

Major car repairs required documentation
  • Proof of vehicle ownership (ex. loan statement, car registration, title, etc.)
  • Proof of vehicle insurance coverage (in the event of an accident)
  • Proof of insurance payout or declination email (in the event of an accident)
  • Quote for repairs from a licensed mechanic or repair shop completing the repairs