1. (a) Hospitals subject to the medicaid enhancement tax shall complete and file Form DP-153-ES, “Medicaid Enhancement Tax Payment Non-binding Estimate”, on or before January 15th in the taxable period.
2. (b) An authorized representative of the hospital shall sign and date the Form DP-153-ES on the hospital’s behalf in ink as provided in Rev 2904.04 or by electronic signature as provided in Rev 2904.05, and include the representative’s name, title, and contact number.

3. (c) Form DP-153-ES shall be filed electronically or by mailing the completed form to:

   NH Department of Revenue Administration

   Administration Unit

   109 Pleasant Street

   P.O. Box 457

   Concord, NH 03302-0457

Source. #10755, eff 1-1-15; ss by #12823, eff 7-4-19; ss by #12907, eff 10-23-19