Payment and Dues Calculation

Calculation of Dues: Determine the Net Operating Revenue for the ALL programs and sites you listed. “Net Operating Revenue” includes the most recent fiscal full year’s revenues, excluding disallowances, contractual adjustments and non-operating revenues such as gifts, bequests, and donations.

Table comparing net operating revenue charges based on provider category. Columns display revenue brackets: $0-1M, $1-3M, $3-5M, and $5+M. Rows display charges for one site and multiple sites for one program: $450-$1350.

Payment Information: Determine your dues amount using the chart above.

Company Name:

Net Operating Revenue for All Sites listed is:

Sites:

Programs:

Pay By:

Less 2% if payment is paid by check

Voluntary Round Up/Increase:

Yes

No

If yes, please tell us the total:

Amount Due:

Please refer to the table for your total. It is based on Site(s) and Program(s)

Digital Signature:

I certify that all information provided in the Provider Membership Application is accurate.

Title:

Date

MM

DD

YYYY

Important Information: MAHC is exempt from income tax under Internal Revenue Code 501(c)(6) as a trade association and, as such, dues and/or contributions to MAHC do not qualify as deductible charitable contributions.

Please Note: Due to congressional action which eliminates the deductibility of lobbying expenses, MAHC reasonably estimates that only 90% of MAHC membership dues may be deductible as an “ordinary and necessary business expense” for federal income tax purposes. Consult an attorney or tax advisor if you require further information on this law.