DEADLINE: JUNE 2
Sorry, incomplete applications won’t be considered.

BUSINESS TYPE

1. What is your primary business type?

2. For Home Respiratory Provider Only

3. For Rehab Technology Provider Only

FINANCIALS

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

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

COMMUNITY INVOLVEMENT

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

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

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

STAFFING

9. Please List

QUALITY CONTROL

10. Note the number of years accredited with the following accrediting organizations:

11. Do you have a dedicated compliance officer? If no, leave blank.

LAST, BUT NOT LEAST

12. In 100 words or less, tell us one thing that makes your company extraordinary.

13. Contact Information

*PLEASE NOTE: All information is for judging purposes only and will be kept confidential.


BONUS: Winners will receive a free registration to the 2017 HME News Business Summit in Cleveland, OH - hmesummit.com

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