Constituent Organization Survey
* Constituent organization's name
* Name of principal respondent
* Position of principal respondent
(should be board officer)
* E-mail address:
Directions: Many of the following questions can have multiple answers, so please mark all that apply.  
FINANCIAL AND ORGANIZATIONAL INFORMATION
* 1. What year was the constituent organization established?
* 2. Is the constituent organization incorporated?
a. If yes, what date was the constituent organization incorporated?
b. If yes, in which state is the constituent organization incorporated?
* 3. Does the constituent organization have a tax ID number?
a. If yes, what is the constituent organization’s tax ID number?
* 4. What is the tax status of the constituent organization?
* 5. When were your constituent organization's bylaws last reviewed and amended?




* 6. Does the constituent organization have an official policy and procedures manual?
* 7. What is the constituent organization’s annual budget?
* 8. What does the constituent organization have in reserve funds?
* 9. After income and expenses are considered, what is the constituent organization’s bottom line?
* 10. What is the last year a tax form (e.g., 990) was filed for the constituent organization?
* 11. Does your constituent organization undergo a formal annual audit done by an outside organization?

 
OFFICER AND MEMBERSHIP INFORMATION
* 12. Who are the constituent organization’s current officers?
 Officer's Name
President
President Elect
Past President
Secretary
Treasurer

* 13. What is the constituent organization’s term of office?
* 14. Do any of the constituent organization’s officers or committee chairs hold multiple positions?
* 15. Does the constituent organization have vacant board and/or committee chair positions?
* 16. What is the constituent organization’s membership year?
* 17. What are the number of members and amount of membership dues by membership category for the constituent organization?
 Fellow Affiliate Student Associate Other
Number
Dues


18. Identify which membership benefits and services your constituent organization provides to its members, and who is assigned to implement the service?
(Mark all that apply)
 Provided Volunteer Management staff COMS
  YesNoa.b.c.
A. Central address
B. Toll-free phone line
C. E-mail address
D. Web site
E. Newsletter
F. Membership directory
G. Membership in another health care organization
H. Membership campaign
I. Job opportunities/listing
J. Medical journal subscription
K. Annual CME/conference
L. Dinner CME
M. Physician - PA team practice presentation
N. Representation to physician society
O. Director/Officer insurance
P. General liability insurance
Q. Legislative/regulatory advocacy
R. Other


 
* 19. When was the last time your constituent organization conducted a joint membership campaign with AAPA?




* 20. Does your constituent organization sell or rent its membership list?
* 21. Is your constituent organization's membership regionalized?
* 22. How does your constituent organization monitor state legislation?
(Mark all that apply)






 
GENERAL INFORMATION

23. The constituent organization has accessed or used which AAPA programs?
(Mark all that apply)
 Used 2004 2003 2002
  YesNoYear usedYear usedYear used
A. Planning for PA Association Progress (PPAP) site visit
B. Constituent Organization Award of Excellence
C. PA Leadership Summit attendance
D. PA Leadership Summit funding assistance recipient
E. Regional meeting attendance
F. Regional meeting funding assistance recipient
G. HOD attendance
H. HOD delegate representation
I. General liability insurance
J. Director and officer insurance
K. The PA Job Link
L. CapitolWiz
M. Legislative grant recipient
N. Chapter lecture series
O. Constituent Organization Management Services (COMS)
Q. Other


24. Please indicate visits by AAPA leaders and staff to the constituent organization.
  2004200320022001
A. AAPA President
B. AAPA President elect
C. AAPA Speaker of the House
D. AAPA Board Member
E. CRC Representative
F. CEO/EVP (Steve Crane)
G. State Govenment Affairs staff(Ann Davis, Bari Lavant)
H. Reimbursement staff(Michael Powe, Fauzea Hussain)
I. Constituent Organization Services (COS) staff (Susan Palmer/Sue Curtis)
J. CME
K. Communications
L. Marketing (Ken Brady)
M. Other

* 25. Does your constituent organization employ a lobbyist, if so how?





* 26. Does your constituent organization retain or have some sort of formal arrangement with an attorney who is familiar with PA practice and PA law and can advise your constituent organization on legal issues?
* 27. What does your constituent organization charge for exhibit booths?







* 28. Does your constituent organization have a charitable nonprofit foundation?
* 29. Does your constituent organization or foundation provide scholarships?
* 30. What are your constituent organization's top three challenges/problems?
























How can AAPA assist in the advancement and organizational development of your constituent organization?

 
Thank you very much for your time and input.

Completing this survey will help provide us with the necessary information needed to better serve you and your constituent organization.

Completed surveys will be e-mailed directly to Sue Curtis. If you print out the survey, please mail or fax to: Constituent Organization Survey, Attention: Sue Curtis, AAPA, 950 North Washington Street, Alexandria, VA 22314-1552; fax, 703/684-1924.

 
* Indicates Response Required