Thank you for taking the time to complete this form. Please answer all of the questions to the best of your ability. If you are applying for membership in HCPEA, someone will be in touch with you shortly.
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Firm name
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Primary Contact Person
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Title
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Street Address
Address Line 2
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City
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State
Alabama
Alaska
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Texas
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Washington DC
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Zip Code
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Phone Number
Fax
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Firm URL
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Year founded
About us
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Total AUM ($MM)
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Est. % AUM Invested in healthcare
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# of Investment Professionals at firm
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# of HC focused professionals at firm
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# of hc companies in portfolio
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Est. revenue ($MM) of hc portfolio
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Total # of people employed by hc portfolio companies
Healthcare Team Members
1. (main contact)
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Name
*
Title
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Email
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Phone
Bio
*
Boards
2.
Name
Title
Email
Phone
Bio
Boards
3.
Name
Title
Email
Phone
Bio
Boards
4.
Name
Title
Email
Phone
Bio
Boards
5.
Name
Title
Email
Phone
Bio
Boards
Fund Information
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Target Investment areas (check all that apply):
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
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Fund name
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Year
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Size $(MM)
Portfolio Companies
1.
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Company name
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Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
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# of employees
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Current Investment?
Yes
No
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Year acquired
Year exited
URL
2.
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Company name
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Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
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# of employees
*
Current Investment?
Yes
No
*
Year acquired
Year exited
URL
3.
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Company name
*
Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
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# of employees
*
Current Investment?
Yes
No
*
Year acquired
Year exited
URL
4.
Company name
Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
# of employees
Current Investment?
Yes
No
Year acquired
Year exited
URL
5.
Company name
Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
# of employees
Current Investment?
Yes
No
Year acquired
Year exited
URL
6.
Company name
Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
# of employees
Current Investment?
Yes
No
Year acquired
Year exited
URL
7.
Company name
Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
# of employees
Current Investment?
Yes
No
Year acquired
Year exited
URL
8.
Company name
Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
# of employees
Current Investment?
Yes
No
Year acquired
Year exited
URL
9.
Company name
Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
# of employees
Current Investment?
Yes
No
Year acquired
Year exited
URL
10.
Company name
Sector
Medical device/products
Healthcare services
Pharmaceuticals
Distribution
Other
# of employees
Current Investment?
Yes
No
Year acquired
Year exited
URL
*
Indicates Response Required