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* 1. Please rank the importance of the following in your decision to evaluate a group discounted option using a scale from 1 (Most important) to 7 (least important).

  1. Enhance our HR resources and tools
  2. Select from a menu of Ancillary and Voluntary employee benefits
  3. Lower our Workers Compensation insurance costs 
  4. Improve our Compliance tools
  5. Have resources to deal with the new COVID rules & regs
  6. Lower our Health Insurance costs and improve benefits
  7. Have tools for applicant tracking, online enrollment and COBRA admin.

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* 2. Which of the following advantages need to be guaranteed for your organization to participate in this program? Check the box to indicate the advantage is required.

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* 3. I am willing to participate (meet/discuss/supply data) to determine whether savings to my organization and improved HR and compliance options are possible.

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* 4. We would be willing to provide all of the following information to a vendor in order to evaluate options for savings (check all that apply). ALL INFORMATION TO BE HELD SECURELY AND CONFIDENTIALLY.

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* 5. Organization Name

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* 6. Number of Full Time Equivalent Employees (FTE’s)

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* 7. Annual Operating Budget

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* 8. Your Name

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* 9. Your Title

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* 10. Your Email

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* 11. Your Phone Number

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