* 1. Does your business offer healthcare benefits?

* 2. If you don't currently offer healthcare benefits, how likely are you to offer it in the future?

* 3. If you are unsure, unlikely or not at all likely to offer healthcare benefits in the future, what are the contributing factors to this decision? Select all that apply.

* 4. If you indicated that you are likely or definitely likely to offer healthcare benefits, how soon are you looking to do so?

* 5. If you are likely or definitely likely to offer healthcare benefits, what level of healthcare coverage are you interested in offering to your employees?

* 6. If you are interested in learning more about healthcare coverage options, please complete the form below and indicate how many employees you have.

* 7. Number of employees:

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