Sample Compensation & Benefits Survey   This is a sample survey preview. No entries on this page can be submitted or saved. Participant Demographic Data Before participating in the survey, please provide your organization's demographic data in the fields below.  When finished click "Submit" below.   Contact Name: Organization: Email: City: State: Select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code: Type of Ownership: Select For Profit, Publicly Held For Profit, Privately Held Not for Profit Public Sector Industry: Select Education Financial Services Government Healthcare Hospitality Insurance Manufacturing Real Estate Research / Development Retail Other Service (For Profit) Other Service (Not for Profit) Please provide data, if available, for one of these three categories. 2018 Annual Revenues: 2018 Annual Operating Budget: 2018 Asset Size:   Employee Base Number of full-time employees: Number of part-time employees:   Wage and Budget Information 2018 Actual General Salary Budget Increase: 2018 Actual Pay Range Adjustment Budget:   Turnover Rates 2017 Overall Turnover Rate: 2018 Overall Turnover Rate:  2019 Year to Date Overall Turnover Rate:    Workweek Average workweek (in hours):   Ratio of HR staff to total employees:: (For example, 10:1732)   Payroll Department Location Payroll Department reports to: Select Accounting Human Resources Other

Sample Compensation & Benefits Survey This survey section is repeated for all surveyed job positions. Click here to view sample job titles covered in this survey. Compensation Data Please provide the compensation data for this position.  Please provide pay data as of January 1, 2019.  When finished click "Submit" below for your data to be accepted.   My organization does not have this position.   Degree of Match:   Select - = + Number of Employees:     Range Minimum: Maximum Hire: Range Maximum: Actual Average Base Pay: Actual Lowest Paid: Actual Highest Paid: Union Position:   Yes   No Incentive Paid in 2018:   Yes   No Shift Differential Paid:   Yes   No FLSA Status:   Exempt   Non-Exempt   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   1. What is the current split of healthcare costs between employer and employee?   Employer: Employee:   How long must employees be employed to be eligible for coverage? 0 months 1 month 2 months 3 months More than 3 months   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   2. Does your company offer a high deductible healthplan? Yes   No a. How do you contribute to the HSA? What portion of the premium do you pay?:       Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   3. Do you have a surcharge for smokers for healthcare benefits? Yes   No   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   4. Does your company offer supplemental disability benefits? Yes   No If so, please provide details in the comments.   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   5. Is there a defined contribution plan, such as a 401[k], 403[b], or Simple IRA at your organization? Yes   No    What is the maximum employees may contribute?    OR What is the maximum against which the organization will make a matching contribution?    OR What is the matching contribution in cents on the dollar provided by the organization? Which of the following is true? The organization plans to implement an employer contribution. The organization plans to keep the employer contribution at the same level. The organization plans to increase an employer contribution. The organization plans to decrease the employer contribution. The organization plans to eliminate the employer contribution. The organization does not provide an employer contribution and does not plan on adding an employer contribution in the near future. The organization suspended contributions in 2017. Yes No   The organization suspended contributions in 2018. Yes No   Does the plan allow for loans to employees? Yes No If yes, how many loans are permitted?   Does the plan allow for hardship withdrawals to employees? Yes No   Do you have an auto enrollment feature? Yes No   Do you have an auto increase feature? Yes No   If so at what percentage and cap?      Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   6. Do you have a Paid Time Off, or PTO, bank? Yes   No   How many days in total do you offer?:   Do you provide options to cash out unused time?: Yes   No Do you provide options for unused time to roll over into the next year?: Yes   No Do you provide options to roll unused time into a 401(k) or other defined contribution plan?: Yes   No   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   7. Do you offer a retiree benefits plan? Yes   No   a. Do you offer retiree healthcare coverage? Yes   No   What percentage does the retiree pay?   Have you limited eligibility for retiree healthcare coverage within the last two years? Yes No Are you considering whether to limit coverage in the next two years? Yes No Are you considering whether to discontinue coverage in the next two years? Yes No   Are you planning to add coverage within the next two years? Yes No   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   8. Do you have a plan in place for Medicare eligible employees who are still working? Yes   No   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   9. Does your organization offer a tuition assistance plan? Yes   No   a. In order to receive payment, do courses need to be job related? Yes No   b. Does the program cover graduate level courses? Yes No   c. Must the employee successfully complete the course? Yes  No    d. Do you provide assistance for fees? Yes No   e. Do you provide assistance for books? Yes No   f. What percent of tuition is reimbursed? Less than 50% At least 50%, but less than 100% 100%   g. What is the maximum tuition reimbursed per year? Less than $3,000 At least $3,000 but not unlimited No limit on reimbursement received   h. If reimbursement is based on the grade received, what amount is provided for the following grades? A B C D F i. Length of time employee is required to pay back reimbursement if employee leaves the organization? No length Less than a year 3 or more years If so, how long must an employee stay to avoid payback requirement:   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   10. Do you provide reimbursement for professional association memberships? Yes   No   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   11. Do you provide reimbursement for the cost of attending professional conferences or seminars? Yes   No   Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   12. Does your organization offer wellness programs? Yes   No   a. Who provides the wellness program? Paid by employer Provided by medical carrier at no cost to the employer Provided by other benefits carrier at no cost to the employer   b. What types of wellness programs are offered? Check all that apply. Reduced Insurance Premiums Gym/Fitness Reimbursement or Subsidies Nutrition Smoking cessation Exercise programs On-site fitness center Healthy cafeteria and vending machine choices Weight loss programs Health risk assessments Biometric screening Flu shots EAP Gym membership If other, please explain     c. Is the program a formal one that includes incentives? Yes No   d. If yes, what incentives are offered? Prizes Premium reductions Other         Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   13. Do you offer any of the following voluntary benefits? Accident insurance: Yes   No   Life insurance: Yes   No   Long term disability insurance: Yes   No   Short term disability insurance: Yes   No   Pet insurance: Yes   No   Long term care: Yes   No   Critical Care insurance: Yes   No   Spousal life insurance: Yes   No   Child life insurance: Yes   No   Identity Theft: Yes   No   Auto/Home Insurance: Yes   No   Other (please list below in comments):     Comments:

Sample Compensation & Benefits Survey Benefits Data Please provide your organization's benefits data in the provided fields. When finished click "Submit" below.   14. Which of the following does your organization offer as non-traditional or work/life balance benefits: Flexible schedules Telecommuting Adoption Dry-cleaning service Cafeteria/restaurant Bank/ATM Summer hours Lunch-n-learn On-site daycare Paid volunteer time Homeowners Insurance Adoption Insurance Estate/Funeral Planning Elder Care Other (Specify in comment box below)     Comments: