Financial Assistance Request

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Overview

Before You Begin

Please take a moment to review these important details. We know asking for help can be difficult, and our goal is to make this process as simple, supportive, and transparent as possible.

Who Can Apply?

You may be eligible if:

  • You or a family member has a childhood-onset heart condition.
  • You are experiencing financial hardship related to the condition.
  •  You or your family member receives care, has received care, or has been referred for care by a St. Louis-area hospital, healthcare professional, or approved referral partner (such as a physician, nurse, social worker, case manager, or healthcare team member).
  • You are willing to complete an assessment with our team.

How Help Works

Ollie Hinkle Heart Foundation provides short-term financial assistance and resource support to help families during difficult times.Support may include:

  • Housing assistance
  • Utility assistance
  • Transportation assistance
  • Food assistance
  • Temporary lodging
  • Essential household needs
  • Bereavement support
  • Other approved hardship-related needs

Whole-Family Support

A childhood-onset heart condition can affect every part of a family's life—not just finances.


As part of Ollie Hinkle Heart Foundation's whole-family approach, Care Managers may talk with you about resources that support coping, resilience, caregiver well-being, and overall family support.These supports may include:

  • Ollie's Branch services
  • Support you already receive
  • Other approved family well-being resources

Our goal is to help families build stability, strengthen resilience, and feel supported throughout their journey.


Important Things to Know

Every application is reviewed individually.

  • Financial assistance is not guaranteed.
  • Ollie Hinkle Heart Foundation is a short-term safety net designed to help families during periods of hardship.
  • A Care Manager will work with you to better understand your needs, identify available resources, and create a plan to help stabilize your situation.
  • You will be asked to provide documents to support your application.
  • Community resources will be explored before financial assistance is approved.
  • Financial assistance is intended to address immediate hardship while helping families connect to longer-term support whenever possible.

What Is Not Covered

Ollie Hinkle Heart Foundation is a short-term safety net designed to help families during periods of hardship.
  • Medical bills
  • Insurance premiums
  • Insurance deductibles or co-pays
  • Credit card debt
  • Legal expenses
  • Court costs
  • Tuition or student loans
  • Vacation or entertainment expenses
  • Luxury or non-essential purchases
  • Expenses not related to a childhood-onset heart condition hardship 

Have You Received Financial Assistance Before?

If you've received Financial Assistance before, we'll ask a few more questions to learn about your current situation and see if you may qualify for support again.

Privacy

Your information is kept confidential and is only used to review your request, provide services, and connect you with resources.

OHHF does not sell your personal information or share it with third parties without your permission, except as needed to provide services or as required by law.

Please review our Privacy Policy to learn more about how we collect, use, and protect your information

Before Continuing

☐ I understand that financial assistance is not guaranteed and that eligibility will be determined through Ollie Hinkle Heart Foundation's review process.


☐ I understand that I will be asked to provide documentation and participate in an assessment.


☐ I understand that Ollie Hinkle Heart Foundation will discuss family well-being and support resources as part of my assessment and stabilization plan.


☐ I have reviewed the Privacy Policy.










Contact Information

























  • Start typing in your address below--spell out street names ("Street" instead of "St" or "Avenue" instead of "Ave").
  • Click your full address when it pops up in the search. Confirm that it's correct and add any apartment or unit info in the "Street 2" box.
  • If your address does not come up in search, select each box individually to manually type it in.






Tell Us More About Your Heart Condition











If yes, please submit here.

Wonderful! Your Care Manager will make a formal referral for you so you can be connected to a peer mentor.
Please choose the category or categories that fit you. You can pick more than one.

After you choose, you can opt in to see more specific conditions. If you're not sure about a category, you can check the box to see the choices on the next page then uncheck on this page if it doesn't fit.

Your information is private and safe.


Tell Us About Your Child
























If yes, please submit here
Please choose the category or categories that fit your family. You can pick more than one. After you choose, we'll show you more specific diagnoses. If you're not sure about a category, you can check the box it to see the choices on the next page then uncheck it if it doesn't fit. Your answers help us connect you with the right care and support. Your information is private and safe.


Heart Conditions










NICU-Related Conditions

Genetic Conditions

Neurodevelopmental & Neurodivergent Conditions





Mental Health Conditions


















Tell Us About Your Healthcare Coverage





Tell Us About Your Household









Help Us Understand Your Needs

All assistance payments will be issued directly to the vendor. After OHHF approval, allow 7-14 days for payment processing and mailing.

Any bill submitted below must be a complete statement and include the following:
- company name
- your name
- account number
- amount owed
- how to pay the balance

Review may be delayed if all information is not submitted with the initial request.






































Tell us if you are facing any of these Barriers

Please answer the following questions as honestly as possible.









Tell us about your financial health

The information provided on this page will help us determine the amount of financial assistance OHHF can provide toward your request. Please answer the following questions honestly by selecting the statement that best represents your needs. 


Our team will reach out after we review your intake form to talk about options.


Definitions:
* Basic needs include food, housing, and transportation.
** Expendable income might mean you can regularly buy coffee at a shop, buy new clothes, go to the movies, etc.











Share References

Please provide two references. These can include your social worker, nurse, physician, or other healthcare provider.










Consent to Participate in Community Outreach Program

By completing and submitting this form, I understand and agree to the following:

1. Collection of Information
  • Ollie Hinkle Heart Foundation (OHHF) is collecting the personal information I provide for the purpose of offering services, resources, and communications related to its mission.
2. Use of Information
  • My information may be used by OHHF staff to assess needs, connect me with programs, provide updates, and improve services.
  • De-identified and aggregated data may be used for reporting, evaluation, and advocacy purposes.
3. Sharing of Information
  • OHHF will not sell or share my personal information with third parties for marketing purposes.
  • OHHF may share my information with trusted partners or providers only when necessary to deliver requested services or as required by law.
4. Confidentiality & Security
  • OHHF will take reasonable steps to protect my information and maintain confidentiality.
  • Despite these safeguards, I understand that no system of transmitting or storing data can be guaranteed 100% secure.
5. Voluntary Consent
  • Providing my information is voluntary. I may choose not to share certain information, but this may limit the services or resources available to me.
  • I may request to update or withdraw my information at any time by contacting OHHF at publicrelations@theohhf.org. 
6. Digital Media Consent
  • I understand Ollie Hinkle Heart Foundation may use any photograph, video or other digital media (“Photos”) taken during this event, in any and all of its publications, including print or web-based publications
7. Consent Statement
  • By submitting this form, I confirm that I have read, understood, and voluntarily consent to the collection, use, and sharing of my information as described above.
By typing your name and initials, you are acknowledging and agreeing to the above regarding your request.
  • I have reviewed OHHF’s website privacy policy and agree with all terms.
  • I have reviewed OHHF’s client rights and responsibility policy and agree with all terms.
  • I understand that OHHF has not and will not provide me with medical, legal, or tax advice.
  • I will complete a client satisfaction survey if approved for financial aid services.





I hereby authorize the name/s listed below to discuss and participate in coordinating my services through the Community Outreach Program. I understand that if a name is not listed below, Ollie Hinkle Heart Foundation cannot release any information.




Based on your responses, you do not currently meet eligibility requirements for Financial Assistance re-engagement.

Families who have previously received financial assistance may be eligible to apply again if:
- Twelve (12) or more months have passed since their previous financial assistance episode was completed; or
- A significant new medical hardship related
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Contact Information