2015 Member Data Form

October 21, 2015

    Organizational Information

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    Management

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    Sponsorship

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    Service Type

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    Housing

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    Home and Community Based Services (HCBS)

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    Program Service Revenue

    Program service revenue is defined as the revenue an organization receives from aging services. It EXCLUDES unrelated items such as interest, realized and unrealized gains or losses, special events/activities, charitable contributions and any other services unrelated to the LeadingAge mission. Program revenue activities are “primarily those that form the basis for an organization’s exemption from tax,” according to the IRS and how your membership dues are calculated. Program service revenue is reported on Part I, Line 9 of the 990 form filed with the IRS, or may be identified in an organization’s Medicaid cost report or year-end financial statement. The program service revenue should come from IRS Form 990, Part I, line 9 of the most recently completed fiscal year.
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    Contacts

    Please submit the names and email addresses of key individuals within your organization.
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