TripleTree iAwards for Connected Health | 2014 Application

Thank you for your interest in the 2014 iAward program! To activate your application, a $195 fee is required and payable when this application is complete and ready to be submitted.

The iAward process is blinded, meaning we can only evaluate the information that is submitted in this application. For the best representation, we advise against incomplete or partial answers to the following questions.

All responses are confidential.

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1. iAWARD QUALIFICATION REQUIRES THIS APPLICATION TO BE COMPLETED IN FULL.

Primary Applicant (Company Name)

Secondary or Partner Applicant (Company Name)

Brand Name of Solution, Product or Service being nominated (either a stand alone or partnership driven solution)

Question Title

2. Primary Applicant - Key Contact (Individual)

Name:

Title:

Street Address (Line 1):

Street Address (Line 2):

City:

State:

Postal Code:

Country:

Email Address:

Phone Number:

Question Title

3. In 150 words or less, describe your solution and its target market. Explain the value proposition and how your solution improves quality and/or reduces cost. If possible, please also email a brief overview / investor presentation (10 slides or less) to jfarel@triple-tree.com.

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4. In 100 words or less, describe how your solution improves upon currently available or competitive solutions.

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5. Name your top competitors. (Note: Answering "we don't have any competition" is not valid).

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6. To help us better understand your solution, please rank its focus on improving...

Provider related workflow or operational efficiency

N/A

Provider related clinical decision-making

N/A

Provider related remote monitoring

N/A

Provider related quality, patient engagement and /or communication

N/A

Patient / consumer self management, compliance and adherence

N/A

Patient / consumer access to health information

N/A

Patient / consumer experience and/or satisfaction

N/A

Payer related workflow efficiency and/or care management

N/A

Payer related member engagement

N/A

Consumer knowledge of healthy lifestyle choices, healthcare costs, risks, and alternatives

N/A

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7. In the question above, if your Company's solution focus isn't represented, please describe it here.

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8. What was your Company's revenue in 2013, or its most recent fiscal year?

Less than $1M

$1M - $10M

$10M - $25M

$25M - $50M

Greater than $50M

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9. What percentage of your 2013 revenue (if any) was generated by customers outside of your home country?

<10%

10% - 25%

25% - 50%

50% - 75%

N/A

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10. For the target markets listed along the left column, please indicate your sales and marketing approach.

	Direct Sales	Channel / Partner Sales	Physician Referral	Retailer	App Store
Consumer	Consumer Direct Sales	Consumer Channel / Partner Sales	Consumer Physician Referral	Consumer Retailer	Consumer App Store
Employer	Employer Direct Sales	Employer Channel / Partner Sales	Employer Physician Referral	Employer Retailer	Employer App Store
Payer	Payer Direct Sales	Payer Channel / Partner Sales	Payer Physician Referral	Payer Retailer	Payer App Store
Pharma	Pharma Direct Sales	Pharma Channel / Partner Sales	Pharma Physician Referral	Pharma Retailer	Pharma App Store
Provider	Provider Direct Sales	Provider Channel / Partner Sales	Provider Physician Referral	Provider Retailer	Provider App Store
Alternate Site, Home Care, Etc.	Alternate Site, Home Care, Etc. Direct Sales	Alternate Site, Home Care, Etc. Channel / Partner Sales	Alternate Site, Home Care, Etc. Physician Referral	Alternate Site, Home Care, Etc. Retailer	Alternate Site, Home Care, Etc. App Store

Please clarify the answers above if needed

Question Title

11. As a percentage, please rank the target markets below in terms of annual revenue contribution for your company (or list n/a).

Consumer

Employer

Payer (Commercial / Government)

Pharma

Provider (Physician, Hospital)

Provider-Alternate Site (i.e. Home Care)

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12. In the question above, if a meaningful target market in terms of revenue contribution for your Company wasn't listed, please describe it here.

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13. How dependent is your revenue stream on reimbursement (commercial insurance, Medicare, Medicaid)?

100%

Partially

Minimally

Not at all

Please clarify the answers above if needed

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14. Select how your solution is deployed for users, or technically delivered to your target markets.

Software (subscription or license)

Device license

Product sale

Professional services / consulting

Online affiliate web site

Downloadable App

Ad Revenue

Other deployment model used (if not listed above)

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15. If the way your Company deploys its solution isn't represented above, please describe it here.

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16. What is needed for your solution to realize stronger growth?

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17. Please summarize your best client / customer case study, or indicate that you will submit a Powerpoint presentation describing it. Be sure to include:
-Your clients business objective
-How your solution addressed their business needs
-Summary of implementation
-Measurable results

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18. Do you anticipate needing growth capital or investment banking support in the next 12 months?

Likely

Likely in 18 months

Unlikely

Please add supporting commentary as needed

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19. Are you interested in learning more about membership with the Wireless-Life Sciences Alliance?

Yes, please contact me

No thanks

Please print this page for your records and proceed to the next page where you will complete your application submission.

Question Title

1. iAWARD QUALIFICATION REQUIRES THIS APPLICATION TO BE COMPLETED IN FULL.

Question Title

2. Primary Applicant - Key Contact (Individual)

Question Title

3. In 150 words or less, describe your solution and its target market. Explain the value proposition and how your solution improves quality and/or reduces cost. If possible, please also email a brief overview / investor presentation (10 slides or less) to jfarel@triple-tree.com.

Question Title

4. In 100 words or less, describe how your solution improves upon currently available or competitive solutions.

Question Title

5. Name your top competitors. (Note: Answering "we don't have any competition" is not valid).

Question Title

6. To help us better understand your solution, please rank its focus on improving...

Question Title

7. In the question above, if your Company's solution focus isn't represented, please describe it here.

Question Title

8. What was your Company's revenue in 2013, or its most recent fiscal year?

Question Title

9. What percentage of your 2013 revenue (if any) was generated by customers outside of your home country?

Question Title

10. For the target markets listed along the left column, please indicate your sales and marketing approach.

Question Title

11. As a percentage, please rank the target markets below in terms of annual revenue contribution for your company (or list n/a).

Question Title

12. In the question above, if a meaningful target market in terms of revenue contribution for your Company wasn't listed, please describe it here.

Question Title

13. How dependent is your revenue stream on reimbursement (commercial insurance, Medicare, Medicaid)?

Question Title

14. Select how your solution is deployed for users, or technically delivered to your target markets.

Question Title

15. If the way your Company deploys its solution isn't represented above, please describe it here.

Question Title

16. What is needed for your solution to realize stronger growth?

Question Title

17. Please summarize your best client / customer case study, or indicate that you will submit a Powerpoint presentation describing it. Be sure to include:-Your clients business objective-How your solution addressed their business needs-Summary of implementation-Measurable results

Question Title

18. Do you anticipate needing growth capital or investment banking support in the next 12 months?

Question Title

19. Are you interested in learning more about membership with the Wireless-Life Sciences Alliance?

17. Please summarize your best client / customer case study, or indicate that you will submit a Powerpoint presentation describing it. Be sure to include:
-Your clients business objective
-How your solution addressed their business needs
-Summary of implementation
-Measurable results