First Name

Last Name

Email Address

Name of Hospital, Clinic, Integrated Health Care Delivery (IDN) System or Group Purchasing Organization (GPO)

Select the nominee’s core business and areas of service. Medical/ Surgical ManufacturerSupplierLogisticsIT/Technology or SoftwareService ProviderOther

If you selected "Other" please list the type of diverse business (i.e. IDN, GPO, acute care hospital, non-acute facility such as surgery centers, nursing homes, outpatient clinics, community resource, etc.)

Describe an example of how this organization demonstrates its commitment to diversity and inclusion within its executive leadership team, specifically?

Within the last 12-18 months, how has this organization demonstrated commitment to diversity & inclusion in its workforce & communities it serves? Has it impacted patient satisfaction?

How has this organization demonstrated its commitment to diversity in its sourcing and procurement practices and procedures?

Provide amount of dollars spent with diverse suppliers in the previous year's spend? Provide Tier I & Tier II dollars spent as direct (Medical-Surgical) or indirect (Operational Expenses).

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