Greater Sioux Community Health Center

Effective 3-1-2011

Sliding Fee Scale - Based on 2011 Poverty Guidelines

Pt. Pays

Pay 0% of Chgs

Pay 25% of chgs

Pay 50% of chgs

Pay 75% of chgs

Pay 100% of chgs

SF Scale

100% SLIDE

75% SLIDE

50% SLIDE

25% SLIDE

0% SLIDE

FPL

< 100% FPL

101% - 133% FPL

134% - 166% FPL

167% - 199% FPL

> 200% FPL

MONTLY INCOME

# in Household

1

0-907

908 - 1210

1211 - 1514

1515 - 1814

> 1,815

2

0-1225

1226 - 1634

1635 - 2043

2044 - 2451

> 2,452

3

0-1543

1544 - 2058

2057 - 2571

2572 - 3087

> 3,088

4

0-1862

1863 - 2483

2484 - 3104

3105 - 3724

> 3,725

5

0-2180

2181 - 2907

2908 - 3634

3635 - 4361

> 4,362

6

0-2498

2499 - 3331

3332 - 4164

4165 - 4997

> 4,998

7

0-2817

2818 - 3756

3757 - 4695

4696 - 5634

> 5,635

8

0-3135

3136 - 4180

4181 - 5225

5226 - 6271

> 6,272

9

0-3453

3454 - 4604

4605 - 5755

5756 - 6908

> 6909

10

0-3771

3772 - 5028

5029 - 6285

6286 - 7545

> 7546

11

0-4089

4090 - 5452

5453 - 6815

6816 - 8182

> 8183

12

0-4407

4408 - 5876

5877 - 7345

7346 - 8819

> 8820

YEARLY INCOME

# in Household

1

0-10,889

10,890 - 14,519

14,520 - 18,149

18,150 - 21,779

21,780

2

0-14,709

14,710 - 19,613

19,614 - 24,517

24,518 - 29,419

29,420

3

0-18,529

18,530 - 24,706

24,707 - 30,883

30,884 - 37,059

37,060

4

0-22,349

22,350 - 29,799

29,800 - 37,249

37,250 - 44,699

44,700

5

0-26,169

26,170 - 34,893

34 894 -43,617

43,618 - 52,339

52,340

6

0-29,989

29,990 - 39,986

39,987 - 49,983

49,984 - 59,979

59,980

7

0-33,809

33,810 - 45,079

45,080 - 56,349

56,350 - 67,619

67,620

8

0-37,629

37,630 - 50,172

50,173 - 62,715

62,716 - 75,259

75,260

9

0-41,449

41,450 - 55,265

55,266 - 69,081

69,082 - 82,899

82,900

10

0-45,269

45,270 - 60,358

60,359 - 75,447

75,448 - 90,539

90,540

11

0-49,089

49,090 - 65,451

65,452 - 81,813

81,814 - 98,179

98,180

12

0-52,909

52,910 - 70,544

70,545 - 88,179

88,180 - 105,819

105,820