2018 ANNUAL REPORT FORM




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In accordance with the executed affiliation agreement, the Chapter must continue to meet the criteria as outlined below in order to remain affiliated with ASHE. Please confirm at the filing of this report, that your Chapter is still in compliance with the following criteria.

Chapters which have a formal affiliation with a state hospital association are exempt from providing proof of EIN number, a bank account, and tax exempt status, provided that the state hospital association is in compliance and proof of compliance has been documented by the Chapter and previously provided to ASHE.





(Please attached a copy of the chapter's updated general or liability insurance certificate).


(Please attached a copy of the chapter's updated directors and officers's insurance certificate).


(Please attached a copy of your Chapter's latest filing with the IRS )


In addition to confirming your insurance documents, and providing your latest IRS filing, please attach your chapter's membership list. Chapters planning to participate in the 2018 Awards Program has the option to submit their membership roster during the awards application submittal process. Please check yes to indicate that your intent to participate in the awards program and submit your membership roster at that time or check no to indicate the chapter will not participate and is submitting the required roster now.

Rosters must be in an.xls Excel format and include the following fields: First Name, Title, Organization, Street Address, City, Sate, Zip Code, Phone, and Email
Please highlight those members in common with ASHE as part of maintaining the 15% in common membership.





(Please provide information regarding your 2018 major conferences and events. Please list the dates and location of each event. Provide all available links to the conferences or meeting information). This information will be included on the Chapter Calendar on the ASHE website.


(Please upload your up-to-date insurance certificates, your latest IRS filing, and your chapter's membership roster).






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