Organization Membership

Membership Terms and Conditions

All beds, units, services must be included in membership. IHCA, ICAL, ICHC bylaws state “it shall be expected that any member who owns and operates more than one of the above services shall have 100% of those facilities/services in membership of the IHCA, ICAL, and ICHC.”

Payment Information

Organization members will receive an invoice for their membership dues. A member may voluntarily withdraw from membership in the association with 30-day written notice to info@iowahealthcare.org. Upon voluntary termination, dues shall not be refunded. Termination does not reduce or forgive any debt owed at the time of termination.

Organization Name *

Organization Contact Name

First Last

Email

Phone

Address

Street Address Address Line 2 City State ZIP Code

Billing Contact Name *

First Last

Billing Contact Title *

First Last

Billing Contact Email *

Billing Address (if different from above)

Street Address Address Line 2 City State ZIP Code

Billing Preference *

Annual
Quarterly
Semi-Annual

Website

Ownership Type: *

Proprietary
Non-Proprietary

Facility Type: *

Single Facility (owns/manages 1-4 facilities in Iowa)
Multi (owns/manages 5+ facilities in Iowa)

Does any owner have financial interest in any other health care facilities/agencies in Iowa?

Yes
No

If yes, please list:

Facility Type

For each applicable facility type, please enter the number of beds/apartments.

Are you a CCRC?

Yes
No

Number of Assisted Living Apartments

Number of Home Health / Home Care Agencies

Home Health Certified Agency

Yes
No

If you selected yes to being a Home Health Certified Agency, please identify your 2019 Medicare revenue range. If you are not a Home Health Certified Agency, please select: "Not Applicable". *

Number of Nursing Facility Beds

Number of Residential Care Facility Beds

Number of Independent Living/Senior Housing Apartments

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Name, Title, Email

Organization Member Application Form

Membership Terms and Conditions

Payment Information

Facility Type

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