Questionnaire. Section 1. General data

Transcription

1 Questionnaire This questionnaire that can be completed online at If you prefer to fill the questionnaire out in paper form, please fill this document and return it to: Alex Rigotti ( Skype: alex.rigotti Telephone: ) Section 1. General data 1. Contact person who is compiling the questionnaire: Name Phone Surname 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 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. n 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. Area: Asia Africa America Europe Oceania 5. Country:

2 6. Organization details: Organization name Year of registration Address City Website Zip Code 7. Chief Executive Officer: Name Phone Surname 8. Co-operative type Only if question 02 = Co-operative worker co-operative producer co-operative retail 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, a co-operative group, a co-operative network, other type of group of companies skip to question Group of companies details: Group name Website 11. Is your co-operative the parent company of the group? 12. Parent company details: Only if question 11 = No Name website

3 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 16. Is the membership of your organization voluntary? 17. Do members have equal voting rights (one member, one vote)? skip to question Since the members of your organization do not have equal voting rights, how does your organization exercise democracy?

4 Section 2. Social data 19. Number of members (year 2011): 20. Referring to members (year 2011) please enter: Individuals Organizations Number of % of total share capital 21. 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) % graduates (members who have attained tertiary education) 22. 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 % of total share capital 23. Average number of employees (year 2011): 24. 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) 25. Number of elected officers (year 2011): 26. 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).

5 Section 3. Economic data 27. Currency: 28. Turnover (revenues from sales of goods or services from the year 2011) : Not required for financial co-operatives (please see question 29), co-operative groups and networks (please see question 30) Turnover 29. Income (year 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 30. Co-operative groups and networks revenues (year 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 31. Other economic data (year 2011): Total assets Total fixed assets Total payables Total operating costs Profit (loss) for period Staff costs Equity Sponsorships, donations and bursaries 32. Does your organization remunerate members? with patronage refunds Total value for the year 2011:, with profit sharing Total value for the year 2011:, with discounts on products/services Total value for the year 2011:, with other remuneration Total value for the year 2011:

6 33. Does your organization have an audited annual report? (if so please send us the PDF file) 34. Does your group of companies have an audited consolidated report? Required only for co-operative groups or question 09 = Yes (if so please send us the PDF file) Section 4. Measuring social impact 35. 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 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? or do you have data about your market share? 36. Does your organization have also non-financial reports (social report, environmental report, sustainability report, integrated report, etc.)? (if so please send us the PDF file) 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. 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.