2018 Hhssaduespolicy,Scheduleapplication

2018 HHSSADUESPOLICY,SCHEDULEAPPLICATION

P.O. Box 5028 ▪ Parsippany, New Jersey ▪ 07054

Phone: 732-864-7111 ▪

The Home Health Services Association of New Jersey (HHSANJ) has adopted a dues structure that balances the size and focus of its current and prospective members. The dues year begins on January 1st . The year ends December 31st. This membership is not transferable. Current members may take advantage of the dues payment options and incentives outlined below. The Board of Directors reserves the right to cancel any membership that is 60 or more days delinquent. HHSANJ dues are used to improve service delivery and training standards, influence state policy and regulation and address critical issues affecting either the home care provider or the recipient of home care services. Importantly, we have representation by an influential and successful lobbyist firm, 1868.

Dues Structure – Full Member Independent Businesses Four or Fewer Offices-

For Independent Businesses, the annual dues will be predicated upon the average number of persons (all part time and full-time staff) paid in a payroll cycle. If more than one location exists the total is based on all locations even if a separate payroll is run for the different locations:

A. Average number of employees per payroll is less than 15: $400 (This option is only for startup businesses in their first year of operation - must provide supporting documentation)

B. Average number of employees per payroll is less than 50: $800

C. Average number of employees per payroll is 50 to 100: $1,625

D. Average number of employees per payroll is 101 to 200: $3,375

E. Average number of employees per payroll is 201 to 400: $5,075

F. Average number of employees per payroll is greater than $401 = $9,500

Each member shall be entitled to one vote regardless of the number of locations.

Payment Incentives- All Privately Owned

•HHSSA offers the following incentives to its current members:

A.5% discount if full payment of 2017 is made by December 31, 2017.

B.Recruitment of a new full member: $100 credit toward a meeting in 2018

C.Recruitment of a new associate member: $25 credit toward a meeting in 2018

•HHSSA offers new Members a 10% discount for their first-year dues. Franchises and Corporations with five locations or more are already deeply discounted and cannot take advantage of this discount.

DEFINITION OF AN EMPLOYEE: All employees who can work under a Home Health Service Firm license including, Companions, Certified Home Health Aides, Skilled Nursing, Physical Therapists, Occupational

Therapists, Speech Therapists, Medical Social Workers, Private Duty Nursing, Primary Care, Geriatric Care Management, DME, Pediatric Care, Infusion Therapy, Maternal Child Health, whether your employees are under your Home Health Service Firm license, Temporary Help License, Employment Agency, Consulting Firm. ALL EMPLOYEES

Dues Structure –FRANCHISED SYSTEMS AND CORPORATIONS WITH FIVE OR MORE LOCATIONS: For franchise systems or corporations with five or more locations the annual dues will be predicated upon the total number of locations. It will be up to the corporation or franchise owners to allocate shares of the total dues to its respective locations or franchises.

One representative will be designated for the group and will be responsible for making sure everything is filled out correctly, copies of individual licenses for each business, and correct amount to be paid for each business. Franchise systems and corporations must pay in full to receive this discount or they will pay the Independent Business Structure.

Franchises Enrolled / Business Locations / Total for All Locations / Average Cost Per Location
5 / $3,200 / $640
6 / $3,600 / $600
7+ / $4,000 + $400 for each additional location / -

Each member shall be entitled to one vote regardless of the number of locations.

Payment Incentives- Franchised and Corporation Locations

•HHSSA offers the following incentives to its current members:

A.5% discount if full payment of 2017 is made by December 31, 2017.

B.Recruitment of a new full member: $100 credit toward a meeting in 2018

C.Recruitment of a new associate member: $25 credit toward a meeting in 2018

Bi-annual (twice a year) Payments. Members may execute a binding agreement stipulating that they will pay their current dues on a bi-annual basis. A credit card must be used for these payments. Two equal payments are due, the first when renewing or joining HHSANJ, the second on June 1, 2018. No early payment discount is allowed with this option. The Board of Directors reserve the right to cancel any membership that is 60 or more days delinquent and/or initiate action to enforce the terms of the payment agreement.

Payment by Credit Card. Members may elect to pay their dues via credit card--we accept Visa, MasterCard, Discover and American Express.

Denied Payments. Returned checks and denied credit card transactions will be subject to a $50.00 reprocessing fee.

Additional Membership information – Please note your information will be shared with associate members unless you opt out. You may opt out by checking here. ______

E-mail address for communications: ______

E-mail address for invoices: ______

*****It is up to you to keep HHSANJ updated on your email. Please add to your safe list and check your Junk Mail, Clutter and other mail folders for messages from the association. *****

If you have any questions e-mail The HHSANJ Board at: or visit our website at:

We look forward to hearing from you.

We appreciate and encourage member participation

The HHSANJ board would like to concentrate on the following committees. Please indicate below if you would be interested in Chairing or Serving on them.

LEGISLATIVE:Chairing: ______Serving: ______

EVENTS/MEETING:Chairing: ______Serving: ______

MEMBERSHIP:Chairing: ______Serving: ______

MEDICAID:Chairing: ______Serving: ______

DIRECTORY:Chairing: ______Serving: ______

Computer / Website: Chairing: ______Serving: ______

COMPLETE PAGES 3, 4, 5, 6 – PAGE 7 IS ONLY REQUIRED IF USING A CREDIT CARD. INCLUDE A COPY OF YOUR CURRENT STATE LICENSE.

FAX COMPLETED FORMS TO 973-845-6127 OR MAIL TO

Home Health Services Association of New Jersey, P.O. Box 5028, Parsippany, NJ 07054

PLEASE PRINT as you complete this form Date ______

Agency Name: ______

Health Care Service Firm License #: ______

PLEASE SUBMIT COPY OF CURRENT LICENSE

Contact Person: ______Title: ______

Address: ______

City: ______State: _ Zip Code: _ _ _

Phone #: _ _ _ _ _ Cell Phone #: ______

E-Mail Address: ______

Counties Served – this will be listed on our website:

______

Website – this will be listed on our website: ______

E-mail invoice to: Contact person ______Other_____ provide contact information below:

______

You must notify the Association if you change your email address

Type of Business (please check one): Franchise______Independent Business ______

Services you offer:

Skilled Nursing Private Duty Nursing Home Health Aides

Physical Therapy Companions Primary Care

Speech Therapy Maternal Child Health Pediatric Care

Occupational Therapy Infusion Therapy DME

Medical Social Worker Geriatric Care Management

What licenses do you currently hold in the State of NJ for placing people in client’s homes?

______

Are you Accredited? No ____ Yes ____ By WHOM: ______

If you are in the process of Accreditation, which body are you applying for?

______

When do you anticipate becoming Fully Accredited? _ _ _ _ _

This membership is NOT transferable. You are responsible for full membership dues regardless if you drop out. If you pay by check, you must pay in full or guarantee payment with a credit card on file to be used on June 1, 2018.

DEFINITION OF AN EMPLOYEE: All employees who can work under a Home Health Service Firm license including, Companions, Certified Home Health Aides, Skilled Nursing, Physical Therapists, Occupational

If you have more than one location, on a separate sheet of paper, list each of them with the contact person, full address, phone, fax, email address, number of employees, client census and a copy of each license. This is requiredor your application will be returned to you.

Number of NJ offices: for each office we need the following information:

Number of Employees: ______Client Census: ______

Employee and Client Census are also used for counts on how many people our Association represents as voters to Politicians. These numbers are very important!

I hereby certify to the best of my knowledge and belief, the information contained in this Membership Application, including but not limited to number of employees, number of offices and payment information is true and accurate. In addition, I hereby understand the information provided herein. You may be required to provide a consolidated financial statement if requested by The Board.

Print Name: ______Date:______

Signature: ______Title: ______

FAX COMPLETED FORMS TO 973-845-6127 OR MAIL TO

Home Health Services Association of New Jersey, P.O. Box 5028, Parsippany, NJ 07054

If you have any questions e-mail The HHSANJ Board at: or visit our website at:

HOME HEALTH SERVICES & STAFFING ASSOCIATION CREDIT CARD AUTHORIZATION FORM

Company Name: ______

Last Name: ______First Name: ______

Address: ______

City: ______State: ______

Email: ______

Contact Name: ______