Delta Memorial Hospital (DMH) Renovation Vision Survey
RequiredRequired Question(s)

 


This survey is designed to test the potential for Delta Memorial Hospital (DMH) to gain community support for the Delta Memorial sales tax renewal and then to raise $1,200,000 in 2019 to renovate the 1978 Delta Health Services Clinic.  Renovation of the Delta Health Services clinic would provide a modern, comfortable facility enhancing healthcare support for the 21,251 annual patient visits from the 13 counties it serves.
 

 
1.
What has been your primary association with Delta Memorial Hospital (DMH) and Delta Health Services Clinic?
Patient
Family member-patient
Donor
Current or past Delta Memorial Board member
Community leader
Other  
2.
How long have you been associated with the Delta Health Services Clinic?

None
5 years or less
6-10 years
11-15 years
16-25 years
More than 25 years
3.
In your experience, what word or phrase best describes Delta Health Services Clinic'simportance to Dumas and the 13 counties we serve? 
 

1000 characters left.
Required 4.

Please evaluate your overall personal experience with Delta Health Services Clinic. In the comments section, please explain why you selected this rating.

5. Very positive 4. Positive 3. Neutral 2. Fair 1. Poor       
      
  • Comment:

  • 500 characters left.
Required 5.

Please assess your perception of the Delta Health Services Clinic's image and reputation. In the comments section, please explain why you selected this rating.

5. Excellent 4. Good 3. Neutral 2. Fair 1. Poor       
      
  • Comment:

  • 500 characters left.
Required 6.
Please assess the performance of the Delta Health Services staff. In the comments section, please explain why you selected this rating.
5. Excellent 4. Good 3. Neutral 2. Fair 1. Poor       
      
  • Comment:

  • 500 characters left.
Required 7.

How likely do you believe that Dumas City voters will be to vote YES in January 2019 for the continuation of the 2009 Delta Memorial sales tax?


In the comments section, please explain why you selected this rating.

5. Very Likely 4. Likely 3. Neutral 2. Unlikely 1. Very Unlikely       
      
  • Comment:

  • 500 characters left.
Required 8.
How likely will you be to actively support a YES campaign for the continuation of the 2009 Delta Memorial sales tax that funds the equipment and maintenance expenses of the Delta Memorial Hospital and Delta Health Services Clinic?

In the comment section, please explain why you selected this rating.
5. Very Likely 4. Likely 3. Neutral 2. Unlikely 1. Very Unlikely       
      
  • Comment:

  • 500 characters left.
Required 9.
How would you prefer to be involved in the Delta Memorial Hospital sales tax renewal? Select all that apply.
I will vote for renewal.
I will donate to support the campaign.
I will volunteer to help in the campaign.
Use my name as an endorser of the sales tax renewal.
Other  
10.
What one thing would you recommend that the Delta Memorial Hospital board do to gain voter support for the sales tax election?

 

1000 characters left.
Required 11.
How would you prefer to learn about upcoming Delta Memorial Hospital and Delta Health Services Clinic growth and changes?

Mark your priority way to hear.  

Quarterly print and mailed newsletter
Quarterly enewsletter
Articles in the Dumas Clarion newspaper
Visit the Delta Memorial website
Follow Delta Memorial and Delta Health Services Clinic on Facebook
Other  
  • Comment:

  • 500 characters left.
Required 12.

In your opinion, how likely will the community and prospective donors be to give to a    $1,200,000 capital campaign to renovate and endow the 1978 Delta Health Services building to accommodate a growing patient census?

5. Very Likely 4. Likely 3. Neutral 2. Unlikely 1. Very unlikely       
      
  • Comment:

  • 500 characters left.
Required 13.
After reading the Delta Health Services renovation case summary, how does the proposed clinic renovation relate to your personal interests?
5. High interest 4. Moderate interest 3. Low interest 2. No interest 1. The renovation is not needed.       
      
  • Comment:

  • 500 characters left.
Required 14.
Please rank order the following five (5) renovation elements in your personal priority.
          Note: Rank 1 as top priority and 5 as the lowest priority.

(1 = Least)
 
Replace the roof and HVAC system.
Increase accessibility by redoing parking lots, entrances and installing automatic doors.
Install new flooring, paint the facility and remodel restrooms for cleanliness.
Realign the rooms to provide improved flow and space for an additional physician in 2019.
Enhance the electrical, phone, Wi-Fi and computer system.
Delta Memorial Hospital and Delta Health Services Clinic have never had a community campaign to support improvements in the facility. This study is testing the level of support
for a comprehensive campaign to renovate the clinic.
 
Required 15.
How would you rate Delta Memorial Hospital's current overall fundraising strength?

In the comments section, please explain the reason for your selection.
5. Excellent 4. Good 3. Neutral 2. Fair 1. Poor       
      
  • Comment:

  • 500 characters left.
Required 16.
Suggest one (1) action the Delta Memorial Hospital Board might take to enhance its visibility and/or fundraising capacity.

 

1000 characters left.
Required 17.
Above and beyond any current financial support you may already give to DMH, would you consider making a gift or pledge to the proposed renovation campaign?
Yes
No
Required 18.

What pledge payout period would you prefer?

5-year
3-year
One-time gift
Other  
19.
If you answered Yes to Question 17, what would be your estimated range of financial support over the pledge period for the renovation campaign? (Terrapin Consulting will keep your response confidential.)

Less than $1,000
$1,000 - $9,999
$10,000 - $24,999
$25,000 - $49,999
$50,000 - $99,999
$100,000 - $249,999
$250,000 or more
  • Comment:

  • 500 characters left.
Required 20.
On a scale of 1-4, how interested do you believe residents would be in giving a small monthly gift over the next three years to renovate the Delta Health Services building?

1. Very interested 2. Somewhat interested 3. Neutral 4. Not interested        
       
21.
Would you or one of your combined families consider purchasing a room in the clinic to honor or as a memorial to a loved one?

Yes
No
  • Comment:

  • 500 characters left.
22.
How likely would it be that any donor makes a gift to name a room in the clinic?
5. Very Likely 4. Likely 3. Neutral 2. Unlikely 1. Very Unlikely       
      
  • Comment:

  • 500 characters left.
Required 23.
Do you have a name and contact information for an individual, company or foundation that DMH should consider a prospect for a large gift? (Your recommendation(s) will be kept confidential.)

 

1000 characters left.
24.
Do you have any recommendations for persons who you would like to see work on this campaign?
 

1000 characters left.
Required 25.

 

In order to raise $1,200,000, Terrapin estimates that major gifts totaling $840,000 (70% of goal) paid over the pledge period will be needed.  Do you think such gifts are available to DMH for the proposed clinic renovation project?
 


Yes
No
  • Comment:

  • 500 characters left.
Required 26.
Do you currently have Delta Memorial Hospital in your will or estate plan?

Yes
No
27.
If you answered No to Question 26, would you consider a planned giving gift through your will or estate plan?  
Yes
No
28.
What advice would you share with the Delta Memorial Hospital board as they prepare for a renovation campaign?
 

1000 characters left.
Required 29.
Please enter the information indicated below.

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

30.

Date of interview/study:

 

350 characters left.