210 ILCS 55/5

(a) Each application for a provisional license for a home health agency, home services agency, home nursing agency, home services placement agency, or home nursing placement agency as provided in Section 4 shall contain the following information: (1) name, address and location of the agency; (2) organization and governing structure of agency; (3) number and qualification of staff; (4) sources of financing of services and agency; (5) service area; (6) patient load; (7) agency utilization; (8) service charges; (9) affiliation agreements with other health care providers; and (10) such other information as the Department may require. (b) Applications for licenses shall be in accordance with departmental regulations.