Eligibility Quiz Please enable JavaScript in your browser to complete this form.Is the colleague facing a hardship due to an extended illness or injury for yourself or a dependent family member? YesNoWas the colleague employed by HCA Healthcare at the time of the event?YesNoIs the colleague requesting assistance with past due rent/mortgage/utilities, etc. or outstanding medical bills due to an extended illness or injury?YesNoCan you provide physician documentation for any time out of work or medical bills after insurance/adjustments to document your event?YesNoIs the financial need due to the death of a colleague or dependent family member?YesNoIs the colleague requesting assistance with funeral and burial bills?YesNoIs the colleague requesting assistance due to travel for funeral services?YesNoCan you provide itemized bills from the funeral home which includes the deceased's name, city and state of funeral home and amount to be paid by applicant to document your event?YesNoIs the financial need related to a domestic violence event for the colleague or dependent family member?YesNoIs the colleague requesting assistance with past due rent/mortgage/utilities, etc. or new housing due to the event?YesNoCan you provide a restraining order, order of protection or letter from a counselor to document your event?YesNoIs the colleague facing a financial need due to a fire or natural disaster (hurricane, tornado, earthquake, wildfire, etc.)?YesNoIs the colleague requesting assistance with unexpected insurance deductibles, property repair, or displacement from your home?YesNoCan you provide documentation of the damage or displacement from your property to document your event?YesNoHas the colleague or spouse experienced a loss of employment in the past 12 months resulting in a financial hardship?YesNoWas the colleague employed by HCA Healthcare at the time of the job loss?YesNoIs the colleague requesting assistance with past due rent/mortgage/utilities, etc. due to the job loss?YesNoCan you provide documentation of the job loss to document your event?YesNoWas the colleague or dependent family member the victim of a violent crime?YesNoWas the colleague employed by HCA Healthcare at the time of the event?YesNoIs the colleague requesting assistance with past due rent/mortgage/utilities, etc. due to the event?YesNoCan you provide documentation of the crime to document your event?YesNoIs the colleague facing a financial need due to an unexpected sale/foreclosure of a home rented by the colleague?YesNoWas the colleague employed by HCA Healthcare at the time of the event?YesNoIs the colleague requesting assistance with past due rent/mortgage/utilities, etc. due to the event?YesNoCan you provide documentation of the unexpected sale or foreclosure to document your event?YesNoIs the colleague facing a financial need due to major car repairs, outside of routine maintenance?YesNoWas the colleague employed by HCA Healthcare at the time of the event?YesNoIs the colleague requesting assistance with repairs or deductible due to the event?YesNoCan you provide a quote for repairs from a licensed mechanic or repair shop completing the repairs?YesNoCheck Eligibility
