Facility (SNF/AL)

caregiver smiling and talking with senior male

IHCA/INCAL’s facility membership is dedicated to Indiana’s skilled nursing facilities and assisted living communities. Member benefits are for ALL employees affiliated with the community.

2026 Membership and Dues Information

Step 1 of 7

14%

Your Name(Required)

First Last

Your Email(Required)

Facility Information

Facility Name

Address

Street Address Address Line 2 City State ZIP / Postal Code

Fax number

Phone

Website

Bed Type

# of Licensed Residential Care/Assisted Living Beds

# of Licensed Comprehensive Care Bed Type

(includes – SNF/NF, SNF, NF, NCC)

# of Unlicensed Residential Care/Assisted Living Beds

# of Unlicensed Independent Living Beds

Total Bed Capacity

Billing Contact Information

Use the “plus sign” on each field to add a row to input additional contacts.

First and Last Name of Billing Contact

Position

Phone Number

Email Address

Please describe your accounts payable process, and include whether invoices are to be sent to the corporate office or to the facility.

Key Facility Staff Information

IHCA/INCAL offers a wealth of resources that are exclusively developed for our members. To maximize your membership benefits, it is important that you provide us with the contact information of key staff members of your facility who should receive access to IHCA/INCAL’s suite of digital communications resources including a self-serve member portal, e-newsletters, toolkits, on-demand education offerings, and more.

Administrator Name

First Last

Administrator Email

Medical Director Name

First Last

Medical Director Email

Director of Nursing Name

First Last

Director of Nursing Email

Social Services Name

First Last

Social Services Email

HR Director Name

First Last

HR Director Email

Dietary Manager Name

First Last

Dietary Manager Email

Maintenance Director Name

First Last

Maintenance Director Email

Other Facility Contacts

Please click on the “plus” sign to add a row next to each field and input contact information of other key staff members who should receive access to IHCA/INCAL’s suite of digital communications and resources.

First Name

Last Name

Title

Email Address

Corporate Information

Name of Operating Entity

Does your organization classify as a not-for-profit organization?

Yes

Address

Street Address Address Line 2 City State ZIP / Postal Code

Phone

Fax number

Website

Corporate Leadership Contact Information

President/CEO Name

First Last

President/CEO Email

Other Key Corporate Leadership Contact Information

Please click on the “plus” sign to add a row to input contact information of each key corporate staff member who should receive access to IHCA/INCAL’s suite of digital communications and resources.

First Name

Last Name

Title/Designation

Email Address

Agreement and Payment

I attest to the accuracy of the information on this application and understand that submission of this application is not a guarantee of IHCA membership and that this application must be approved by the IHCA Board of Directors. I understand that membership benefits are only to be used by the applicant and its employees and that any misuse of membership rights and benefits may result in membership termination. I agree to abide by all policies of the IHCA, including, but not limited to, the IHCA Dues Collection Policy. If this application is approved, I permit IHCA to use the information contained in this application in IHCA membership directories (both electronic and printed), and I consent to receive communications via regular mail, email, telephone, and/or fax sent by or on behalf of IHCA. IHCA dues are not deductible as charitable contributions for tax purposes, but may continue to be deductible as a business expense. In compliance with Section 6033(e) of the Internal Revenue Code (IRC), the Indiana Health Care Association reasonably estimates that 3% of 2024 IHCA dues will be spent on lobbying and other expenditures subject to Section 162(e)(1) of the IRC. In addition, the American Health Care Association reasonably estimates that 30% of 2024 AHCA dues will be spent on lobbying and other expenditures subject to Section 162(e)(1) of the IRC. Therefore, these portions of 2024 IHCA and AHCA dues, respectively, are not deductible for Federal income tax purposes.

CAPTCHA

Educate

Indiana’s premier host of long-term care events, conferences, courses, workshops and continuing education. Read More »

Advocate

Indiana’s leading voice in long-term care. Read More »

Elevate

Indiana’s strongest partner in improving the quality and image of long-term care. Read More »

Celebrate

Indiana’s largest association championing the wins and successes of the long-term care profession. Read More »

Your Questions Matter

Email Us