1. Enter your access code:                  

 
This is a 6 character long text or number that you select to link your data together.  If you have forgotten this code, you need to start from the beginning and re-enter your data. 

2. What is the full name of your organization?  You can enter an alias if you want to keep the information confidential. 

3. How many square foots of space is used by the organization to see patients, house clinical or non-clinical staff or carry out the business of the organization. 

  square foots

4. Enter the market value of clinical office space in the nearest zip code area.   This data can be obtained online or through calling a local real estate agent.

$  per month per square foot

5.  What was the total expenditure on personnel (salary plus fringe benefits) within the organization in the most recent fiscal year?

$  per fiscal year

6.  How much did the organization spend on material and supplies during most recent fiscal period?

$  per fiscal year

7.  How much did the organization spend on occupancy costs (utilities, office supplies, etc.)?

$  per fiscal year

8.  What is the average hourly cost of volunteer/free services provided to the organization?

$  per hour

9.  What was the total number of full time equivalent personnel working within the organization in the most recent fiscal year? 

$  Full Time Equivalent persons