St Vincent's

St. Vincent's Bruno Cancer Center Questionnaire
Required Required Question(s)

This survey is designed to gather your thoughts about the St. Vincent’s Bruno Cancer Center.  Additionally, this document will help us determine the potential for St. Vincent’s Foundation (the Foundation) to raise funds to complete the new Bruno Cancer Center, adding new equipment, technology and patient-care amenities for that space.

 

 
1.

Please provide your name and contact information for follow-up and/or additional clarification to your survey responses.

 

 

First Name:
Last Name:
Work Phone:
Email Address:
emailaddress@xyz.com

2.

What has been your association with the Bruno Cancer Center? Check all that apply.

 

 

Patient
Family of patient(s)
Friend of patient(s)
Staff
Hospital board member
Foundation Board
Other  
3.

How long have you had the above association?

 

1-5 years
6-10 years
11-15 years
16-25 years
More than 25 years
Other  
  • Comment:

  • 500 characters left.
Required 4.

Please select the one (1) response listed below that best characterizes your reason to visit the Bruno Cancer Center for treatment/that a family member or friend chose the Bruno Cancer Center.

 

Good reputation in the community
Recommended by family or friends
Referred by my doctor
It has a more personal and "homey" feeling
The staff is caring and knowledgeable
Faith-based organization/ministry
Other  
  • Comment:

  • 500 characters left.
Required 5.

 Please evaluate your overall experience with the Bruno Cancer Center.

 

5 Very positive 4 Positive 3 Neutral 2 Negative 1 Unsatisfactory       
      
  • Comment:

  • 500 characters left.
Required 6.

Please evaluate your experience with nursing staff of the Bruno Cancer Center.

 

5 Very Positive 4 Positive 3 Neutral 2 Negative 1 Unsatisfactory       
      
  • Comment:

  • 500 characters left.
Required 7.

Please evaluate your experience with the medical staff of the Bruno Cancer Center.

 

 

5 Very Positive 4 Positive 3 Neutral 2 Negative 1 Unsatisfactory       
      
  • Comment:

  • 500 characters left.
Required 8.

Please evaluate your experience with the physical facilities of the Bruno Cancer Center.

 

 

 

5 Very Positive 4 Positive 3 Neutral 2 Negative 1 Unsatisfactory       
      
  • Comment:

  • 500 characters left.
Required 9.

Please assess the image and reputation of the Bruno Cancer Center in Birmingham and the surrounding service area.

 

Excellent Good Fair Poor        
       
  • Comment:

  • 500 characters left.
Required 10.

Please rate the importance of quality care or high-touch care in your selection of a treatment facility.

 

5 Very Important 4 Important 3 Neutral 2 Unimportant 1 Very Unimportant       
      
  • Comment:

  • 500 characters left.
Required 11.

Please identify your top one (1) priority for future programs for Bruno Cancer Center to consider.

 

Patient Navigator
Additional support groups
Research library or online capability
Chapel/healing garden/labyrinth
Refreshment and family waiting area
  • Comment:

  • 500 characters left.
Required 12.

Please rate the readiness of the St. Vincent’s Foundation Board and Staff to launch a 2012 campaign to build and equip a new Bruno Cancer Center.

 

Excellent Good Fair Poor        
       
  • Comment:

  • 500 characters left.
13.

Suggest one action to enhance the visibility and fundraising capacity of the Bruno Cancer Center.

 

 

  • 1000 characters left.
Required 14.

The Foundation is considering a campaign to add facilities/equipment and enhance services at the Bruno Cancer Center. What is the greatest amount you believe the Foundation can raise?

 

More than $10M
$7M - $10M
$4M - $6.9M
$1M - $3.9M
Less than $1M
  • Comment:

  • 500 characters left.
Required 15.

On a scale of one to ten (ten being Very Achievable, and one being Not Achievable), please rank the potential for meeting the campaign dollar potential you have indicated above, paid over a three (3) year period.  Please select one.

 

10 (Very achievable) 1 (Not achievable)  
 
  • Comment:

  • 500 characters left.
Required 16.

What is the single largest gift that you think can be successfully solicited for a Bruno Cancer Center campaign?

 

Greater than $10M
$6 - $10M
$1M - $5,999,999
$500,000 - $999,999
$250,000 - $499,999
Less than $250,000
  • Comment:

  • 500 characters left.
Required 17.

In your opinion, how receptive will prospective donors be to a Bruno Cancer Center campaign?

 

Very receptive
Somewhat receptive
Not at all receptive
  • Comment:

  • 500 characters left.
Required 18.

For you personally, what priority is high tech with high touch cancer care?

 

High priority
Moderate priority
Low priority
  • Comment:

  • 500 characters left.
Required 19.

How does such a campaign relate to your own interests?

 

 

High interest
Moderate interest
Low interest
It is not needed
  • Comment:

  • 500 characters left.
Required 20.

Please place in rank order the following five reasons for updating the Bruno Cancer Center. Most important=1 and least important=5. Please rank all five reasons.

 


(1 = Most Important)
 
Expanded and more comfortable waiting area
Larger and private changing rooms
Enhanced technology/equipment
Larger exam rooms
Easier access (parking and easy to find)
  • Comment:

  • 500 characters left.
Required 21.

To which one of these priorities would you personally be most interested in giving? Select one.

 

Expanded and more comfortable waiting area
Larger and private changing rooms
Enhanced technology/equipment
Larger exam rooms
Easier access (parking and easy to find)
  • Comment:

  • 500 characters left.
Required 22.

Above and beyond support you may already give to St. Vincent’s Foundation, would you consider making a gift or pledge to the Bruno Cancer Center campaign?

 

Yes
No
  • Comment:

  • 500 characters left.
Required 23.

If you answered yes to the above question, what would be your estimated range of financial support over three years for the proposed campaign? (Gardner & Associates will keep your response confidential.)

 

More than $10M
$5M - $9,999,999
$3M - $4,999,999
$2M - $2,999,999
]$1M - $1,999,999
$500,000 - $999,999
$250,000 - $499,999
$100,000 - $249,999
$50,000 - $99,999
$25,000 - $49,999
Less than $25,000
  • Comment:

  • 500 characters left.
Required 24.

If a VIP/concierge program requiring a gift of at least $100,000 and/or a significant planned gift was offered, which benefits would you be interested in receiving?

 

Free valet parking
Refreshment area
Free technology use (laptop, ipod)
Free use of entertainment library (dvds, music)
Not interested in a VIP/concierge program
  • Comment:

  • 500 characters left.
Required 25.

Which pledge payout period would you most prefer?

 

3-year
2-year
One-time gift
Other  
  • Comment:

  • 500 characters left.
26.

Please identify the name and contact information for an individual, company or foundation that the Foundation should consider a prospect for a lead gift.  (Your recommendations will be kept confidential)

 

 

  • 1000 characters left.
27.

Please indicate the name of the person or persons you believe would be the best campaign chair for the Bruno Cancer Center.

 

 

  • 1000 characters left.
28.

If asked, would you serve as a volunteer for the proposed campaign?

 

Yes
No
  • Comment:

  • 500 characters left.
Required 29.

Please rate the impact that the following external factors might have on the Bruno Cancer Center campaign.

 

 5 High positive 4 Positive 3 Neutral 2 Negative 1 High Negative 
Alabama and national economy
Healthcare reform
Competing fundraising campaigns
National political environment
  • Comment:

  • 500 characters left.
Required 30.

In order to raise $10 million dollars, it is estimated that 8-10 lead gifts totaling $7M (70%+ of goal) paid over the pledge period will be needed.  Do you think such gifts are available to a Bruno Cancer Center campaign?

 

Yes
No
  • Comment:

  • 500 characters left.
31.

Do you know of any other factors that might hinder the success of the proposed campaign?

 

 

  • 1000 characters left.
32.

Are there any recommendations or comments you would like to share with the leadership of the Bruno Center or Foundation as they consider your responses and prepare for a campaign?

 

 

  • 1000 characters left.