Questionnaire

This questionnaire that can be completed online at www.euricse.eu/en/WorldCooperativeMonitor.

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
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. Area:
¡ Asia
¡ Africa
¡ America
¡ Europe
¡ Oceania

5. Country:
6. Organization details:

Organization name
Year of registration
Address
City Zip Code
Website

7. Chief Executive Officer:

Name Surname
Phone Email

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
¡ 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 the membership of 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. Social data

19. Number of members (year 2011):

20. Referring to members (year 2011) please enter:

Number of % of total share capital

Individuals
Organizations

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

Number of % of total share capital

Co-operatives
Mutuals
Other companies

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).
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?

¡ No
¡ Yes with patronage refunds
¡ Yes, with profit sharing
¡ Yes, with discounts on products/services
¡ Yes, with other remuneration
Total value for the year 2011: ______________________
Total value for the year 2011: ______________________
Total value for the year 2011: ______________________
Total value for the year 2011: ______________________
33. Does your organization have an audited annual report?
¡ Yes (if so please send us the PDF file)
¡ No
34. Does your group of companies have an audited consolidated report?
Required only for co-operative groups or question 09 = “Yes”

¡ Yes (if so please send us the PDF file)

¡ No

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.)?
¡ 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