COVID Recovery Fund Application

Made possible by The MolinaCares Accord, Amerigroup Foundation and Care Initiatives.

Important Application Information: Any member in good standing of the Iowa Health Care Association or its affiliates, Iowa Center for Assisted Living or Iowa Center for Home Care can apply for this fund by completing the application form below.

The purpose of this fund is to help member providers prevent, mitigate and recover from COVID-19 based on their organization’s specific needs. Requests of up to a maximum of $1,000 per member organization will be accepted as long as funds are available, with requests for PPE limited to $250. Eligible applications will be granted on a first come, first serve basis.

Applications will be reviewed and approved each week, as long as funding remains available. Applications received by the end of the day Tuesday each week will be notified by the following Friday on the status of their application.

Note: Past expenses, cash payments and gift cards are not eligible items for the COVID Recovery Fund. Tangible gifts for employee recognition (such as tote bags, shirts, water bottles, etc.) are eligible for the COVID Recovery Fund.

For questions, contact IHCA Foundation Executive Director Lori Ristau.

COVID Recovery Fund Application

Today's Date * Required
MM slash DD slash YYYY
Contact Name * Required
First Last
Job Title * Required
Organization Name * Required
Organization Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone * Required
Email * Required
Is your organization a member of the Iowa Health Care Association? * Required
- Yes
- No
Is your request related to the COVID-19? * Required
- Yes
- No
PURPOSE OF THE REQUEST * Required
Briefly describe the situation/problem the request is intended to address.
HOW WILL FUNDS BE USED * Required
Briefly describe how the requested funds will be used to address the above situation/problem.
AMOUNT REQUESTED * Required
Please note requests are limited up to a maximum of $1,000.
Have you explored any additional, alternative funding sources related to this request? * Required
- Yes
- No
If yes, describe the source, date and amount of the alternative funding request.
Review Process
All COVID Recovery Fund request forms received by the end of the day each Tuesday will be reviewed by the IHCA Foundation COVID Recovery Fund Review Committee each Thursday. Applicants will be notified the following Friday by the IHCA Foundation whether their application was approved. Those approved to receive funding will be expected to submit a receipt to the IHCA Foundation for approved items. Payment for approved expenditures will be issued within 7 days after receipts are received by the IHCA Foundation. For questions, contact Lori Ristau at lori@iowahealthcare.org.
Review Process Confirmation * Required
By checking below, I confirm that I have read the Review Process for the the IHCA Foundation COVID Recovery Fund.
- Yes, I have read the Review Process.