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* 1. From the list provided, please select the top three topics of importance when it comes to the success of your business/centers. (check three)

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* 2. What one thing about your business keeps you up at night?

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* 3. Please rank the following financing needs by importance to your company. 

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* 4. Please rank the below resources in terms of how helpful they would be to you?

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* 5. Are you a member of the American Health Care Association/National Center for Assisted Living AHCA/NCAL?

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* 6. How many times have you attended the following AHCA/NCAL conferences in the last five years?

  Not Sure Have Never Attended (0) A Couple of Times (1-2) Many Times (3-4) Always (5+)
AHCA/NCAL Annual Convention and Expo
Independent Owners Conference
Quality Summit
Multifacility Conference for CEOs and Senior Executive Leaders
Congressional Briefing

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* 7. Do you attend the annual convention in your state?

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* 8. Please list the states where you own skilled nursing or assisted living centers. If you are not an owner, please answer in terms of the company where you work.

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* 9. Do you own skilled nursing facilities or assisted living centers?

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* 10. How many assisted living centers do you own?  If you are not an owner, please answer in terms of the company where you work.

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* 11. How many skilled nursing centers do you own?  If you are not an owner, please answer in terms of the company where you work.

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* 12. Is your company a family-owned business?

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* 13. What additional comments would you like to make?

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* 14. Would you be willing to participate in a focus group to provide more information and help us meet your needs?  

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