Become A Member
After submission, your application will be sent to the LIHNC Board of Directors for approval and you will receive an email regarding your application status. Membership dues are billed quarterly or annually. You will be invoiced the prorated amount for this year.
Organization Name
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Fax
*
Please enter a valid phone number.
Website
*
Year organized
*
Most recent fiscal year audited net operating revenue
*
LIHNC annual dues are determined by the member organization’s most recent fiscal year’s net operating expenses, as reported on their 990 form and/or other Internal Revenue Service reporting format, including expenditures for all programs and services, including programs supported by grant funds, and any additional companies that are under the management of the parent organization.
Network Logo
*
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Optional - logo will be added to your online profile at LIHNC.org if provided.
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Your organizational mission statement.
*
Why are you seeking to join LIHNC?
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Tell us about your organization.
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Total number of employees.
*
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Member Composition: What is the composition of organization (e.g. hospitals, clinics, mixed?) Enter the number of each type of member.
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Number of Each
Ambulance Providers
Behavioral Health Providers
Community-based Organizations
Community Health Centers
CAH's
Free Clinics
Hospice Agencies
Hospital-owned Provider Clinics
Large Hospitals (>200 beds)
Long-term Care Facilities
Medium Hospital (51-200 beds)
Oral Health Providers
Physician-owned Clinics
Post-secondary Education Institutions
Rural Health Clinics
Schools/School District Health Clinics
Surgical Center
Other
If you indicated "Other" above, please specify other types of entities
*
Enter types of members that are included in "Other" (e.g. Home Health, EMS providers, non-profits, etc.)
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Location of organization
*
What parish are you located in?
CEO/Responsible Party Information
*
First Name
Last Name
Title
*
Email
*
example@example.com
Director Photo
*
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Optional - Will be added to your profile at LIHNC.org if provided.
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Which of the following LIHNC benefits are you most interested in?
*
Opportunities for Payor Contracting
Improving my organizations Care Coordination
Executive partnerships and opportunities for cost savings via Contracting (GPO, IS, Consortiums, etc.)
Executive Roundtable Calls (monthly)
LIHNC General Information
Remaining and Independent Organization
Business Development
Opportunities to connect with other healthcare and hospital leaders for collaboration, patient care and quality improvement, collaborative policies and operational improvement.
Access to LIHNC Resources (Medical Staff Credentialing, Affinity Groups, Policies)
Other
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