DEADLINE: JUNE 12

CONFIDENTIALITY AGREEMENT: All information supplied is kept completely confidential and will only be used by the judges in making their finalists selection. Get a signed copy of our non-disclosure agreement here.
 
THE WINNER WILL RECEIVE:
- Free one-hour consultation with the judge of your choice: Jonathan Sadock, Miriam Lieber or Lisa Wells ($300 - $500 value)
- A free one-year subscription to the HME Databank ($995 value)
- Full news coverage in HME News in print, online and in the HME Newswire (Hello, free marketing!)
- Prestigious "Glass House" Award (worth its weight in gold)
- Industry bragging rights (priceless)

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* 1. Contact Information

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* 2. Company URL:

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* 3. What year was your company founded?

BUSINESS

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* 4. Please tell us about your product mix. Check all that apply.

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* 5. Please tell us about your payer mix. Assign a percentage to each payer. (List whole numbers without % sign or decimals. Must total 100.)

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* 6. If you selected other in the question above, please specify here:

STAFFING

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* 7. Please List

COMMUNITY INVOLVEMENT

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* 8. List membership, dates and leadership positions in trade groups. (i.e. AAHomecare, NYMEP, MED, VGM)

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* 9. List membership, dates and leadership positions in clinical associations. (i.e. NRRTS, AARC)

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* 10. List your three most significant community outreach activities in past year. Activity must be non-profit.

FINANCIALS

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* 11. What was your average annual rate of sales growth for the last two years?

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* 12. What was your average pre-tax profit margin over the last three years?

LAST, BUT NOT LEAST

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* 13. In 100 words or less, tell us what differentiates you from your competition.

T