Questionnaire - Euricse

Questionnaire
This questionnaire that can be completed online at www.monitor.coop. If you prefer to fill the questionnaire out
in paper form, please fill this document and return it to:
Alex Rigotti (Email: alex.rigotti@euricse.eu – Skype: alex.rigotti – Telephone: +390461283753)
Section 1. General data
1. Contact person who is compiling the questionnaire:
Name Surname
Phone Email
2. Data you are about to enter refer to a:
Co-­‐operative
An autonomous association composed mainly of persons united voluntarily to meet their common economic, social, and cultural
needs and aspirations through a jointly-­‐owned and democratically-­‐controlled enterprise. Members usually receive limited
compensation, if any, on capital subscribed as a condition of membership.
Co-­‐operative of co-­‐operatives/mutuals
Co-­‐operatives composed mainly of co-­‐operatives/mutuals that carry out an economic activity for the production of goods or the
provision of services of common interest for their members.
It publishes periodically its own financial statements.
Co-­‐operative group
A co-­‐operative group: 1) is composed of organizations that operate as a single economic entity; 2) regularly publishes a
consolidated financial statement; 3) includes mainly co-­‐operatives; 4) acts according co-­‐operative principles and values; and 5) is
controlled by co-­‐operatives.
Co-­‐operative network (including Federations and Unions with an economic activity for the production of goods or the
provision of services)
A co-­‐operative network: 1) is composed of organizations that operate as a single economic entity; 2) does not publish a
consolidated financial statement; 3) includes mainly co-­‐operatives; 4) acts according co-­‐operative principles and values; and 5) is
controlled by co-­‐operatives.
Mutual
Private co-­‐operative type organization providing insurance or other welfare related services. Consider also micro-­‐insurance and
mutuals with both voluntary and compulsory membership.
Non co-­‐operative enterprise in which co-­‐operatives have a controlling interest
3. Please enter a brief description of your co-­‐operative group/co-­‐operative network:
Only if question 02 = “Co-­‐operative group” or “Co-­‐operative network”
4. Country:
5. Organization details:
Organization name
Year of registration
Address
City Zip Code
Website

6. President:
Name Surname
Phone Email
7. Chief Executive Officer:
Name Surname
Phone Email
8. Co-­‐operative type
Only if question 02 = “Co-­‐operative”
worker co-­‐operative
producer co-­‐operative
retailer-­‐owned co-­‐operative
consumer co-­‐operative
purchasing co-­‐operative
financial co-­‐operative (co-­‐operative bank, credit union and insurance and other financial service co-­‐operative)
housing co-­‐operative
social co-­‐operative
other, please explain: _________________________________________________________
9. Is your co-­‐operative/mutual part of a group of companies?
Only if question 02 = “Co-­‐operative” or “Mutual”
Yes, a co-­‐operative group
Yes, a co-­‐operative network
Yes, other type of group of companies
No – skip to question 13
10. Group of companies details:
Group name
Website
11. Is your co-­‐operative the parent company of the group?
Yes
No
12. Parent company details:
Only if question 11 = “No”
Name website

13. Sector of activity:
Select all sectors of activity in which the organization operates, and indicate the main one.
all sectors main sector
ACCOMMODATION AND FOOD SERVICE ACTIVITIES
ADMINISTRATIVE AND SUPPORT SERVICE ACTIVITIES
AGRICULTURE, FORESTRY AND FISHING
ARTS, ENTERTAINMENT AND RECREATION
CONSTRUCTION
EDUCATION
ELECTRICITY, GAS, STEAM AND AIR CONDITIONING SUPPLY
FINANCIAL ACTIVITIES
HUMAN HEALTH AND SOCIAL WORK ACTIVITIES
INFORMATION AND COMMUNICATION
INSURANCE ACTIVITIES
MANUFACTURING
MINING AND QUARRYING
PROFESSIONAL, SCIENTIFIC AND TECHNICAL ACTIVITIES
REAL ESTATE ACTIVITIES
TRANSPORTATION AND STORAGE
WATER SUPPLY; SEWERAGE, WASTE MANAGEMENT, REMEDIATION ACTIVITIES
WHOLESALE AND RETAIL TRADE
OTHER SERVICE ACTIVITIES
14. Your organization produces goods and/or services that are distributed at (even through middlemen):
local level
national level
international level
15. Does your mutual organization provide only micro-­‐insurance policies (e.g.: travel insurance, mobile phone
insurance, etc.)?
Required only for mutual organizations
Yes
No
16. Is membership in your organization voluntary?
Yes
No
17. Do members have equal voting rights (one member, one vote)?
Yes – skip to question 19
No
18. Since the members of your organization do not have equal voting rights, how does your organization
exercise democracy?

Section 2. Economic data
19. Currency:
20. Turnover (revenues from sales of goods or services for the fiscal year ending in 2011):
Not required for financial co-­‐operatives (see question 21), co-­‐operative groups and networks (see question 22)
Turnover
21. Income (fiscal year ending in 2011):
Required only for financial co-­‐operative (co-­‐operative bank, credit union and insurance and other financial service co-­‐ops)
a. Net interest income
b. Non-­‐interest income
c. Premium income
22. Co-­‐operative groups and networks revenues (fiscal year ending in 2011):
Required only for co-­‐operative groups and co-­‐operative networks
If your co-­‐operative group (or co-­‐operative network) provides banking and/or insurance service please enter:
a. Net interest income
b. Non-­‐interest income
c. Premium income
If your co-­‐operative group (or network) provides services other than banking and insurance please enter:
Turnover
23. Other economic data (fiscal year ending in 2011):
Total assets
Total fixed assets
Total debts
Total operating costs
Costs of goods
Profit (loss) for period
Staff costs
Equity
Sponsorships
Donations
Bursaries

24. Does your organization remunerate members?
No Total value for the fiscal year ending in 2011 (if available):
Yes with patronage refunds ______________________
Yes, with profit sharing ______________________
Yes, with discounts on products/services ______________________
Yes, with other remuneration ______________________
25. Market share (fiscal year ending in 2011):
In the event that a cooperative operates in several sectors, enter the market share at the national level in each sector of
activity.
26. Does your organization have an audited annual report (fiscal year ending in 2011)?
Yes (if so please send us the PDF file)
No
27. Does your group of companies have an audited consolidated report (fiscal year ending in 2011)?
Required only for co-­‐operative groups or question 09 = “Yes”
Yes (if so please send us the PDF file)
No
Section 3. Social data
28. Number of members (year 2011):
of which active members (if applicable)
29. Referring to members (year 2011) please enter:
Individuals
Organizations
Number of
30. Referring to individual members (year 2011) please enter the percentage of:
Allowed numbers from 0 to 100, with 1 decimal optional
% female members
% youth members (persons aged between 15 and 24)

31. Referring to organization members (year 2011) please enter:
Allowed numbers from 0 to 100, with 1 decimal optional
Co-­‐operatives
Mutuals
Other companies
Number of
32. Average number of employees (year 2011):
Of which full time employees*
* Please note that there is no internationally accepted standard for the minimum number of hours worked per week
that would constitute full-­‐time work. The distinction between “full-­‐time” and “part-­‐time” employment is therefore
established on a country-­‐by-­‐country basis or in special regional compilations.
33. Referring to employees (year 2011) please enter the percentage of:
Allowed numbers from 0 to 100, with 1 decimal optional
% female employees
% youth employees (employees aged between 15 and 24)
% graduates (employees who have attained tertiary education)
34. Number of elected officers (year 2011):
35. Number of volunteers (year 2011):
volunteer work = activities or work that some people willingly do without pay to promote a cause or help someone outside of
their household or immediate family (International Labour Organization, Manual on the Measurement of Volunteer Work).

Section 4. Measuring social impact
36. Many researchers are trying to understand how to measure the impact of cooperatives going beyond
traditional balance-­‐sheet indicators.
We kindly ask you to reflect on data and indicators that your organization collects for measuring the impact
of your organization’s activity on the stakeholders (members, employees, the community, etc...) and the
society at large.
For example: do you collect data on the number of subjects who benefited from services or product of your
organization?
37. Does your organization have also non-­‐financial reports (social report, environmental report, sustainability
report, integrated report, etc.)?
Yes (if so please send us the PDF file)
No
_______________________________________________________________________
The data on this questionnaire is collected by the European Research Institute on Cooperative and Social Enterprises (Euricse) on behalf
and based on the needs of the International Co-­‐operative Alliance (ICA).
Data will be used exclusively for the purpose of managing the World Co-­‐operative Monitor project by ICA and Euricse and for research
purposes by Euricse. Data will be treated in line with relevant European legislation (D95/46/CE). The co-­‐operative organization gives its
consent to the use of the data collected in this questionnaire for the above-­‐mentioned purposes.
Yes
No
The co-­‐operative organization gives its consent to the publication of the data collected in this questionnaire (name, address, social and
economic data) to promote your organization all around the world.
Yes
No