Step 1 of 5 20% Insight Group Key Indicators ReportingPlease fill out all the questions to the best of your ability. If you need to save your work and come back to it at another time please click the "Save & Continue Later" Button" to get a link emailed to you.Member InformationMember ID Region(Required)What region of the country do you practice in? Northeast (ME, NH, VT, MA, CT, NY, PA, NJ, MA, RI) Midwest (MI, OH, IN, IL, WI, MN, ND, SD, NE, KS, MO, IA) South (TX, OK, AR, LA, MS, AL, TN, KY, WV, DC, VA,, MD, DE, NC, SC, GA, FL) West (MT, WY, CO, NM, UT, AZ, NM, NV, ID, WA, OR, CA, NV) Pacific (AK, HI) Period Ending(Required)What is the period you are reporting these results? 04/30/2021 06/30/2021 08/31/2021 10/31/2021 12/31/2021 Practice DemographicsLocations(Required)How many locations does your Group Practice currently have?Dentists(Required)How many Dentists does your Practice currently have? Include W-2 AND 1099 independent contractors.Dentist Hrs.(Required)For the period, what where the total number of hour worked by Dentists?Hygienists(Required)How many Hygienists does your Practice currently have? Include W-2 AND 1099 independent contractors.Hygienists Hrs.(Required)For the period, what where the total number of hour worked by Hygienists?Employees(Required)How many Employees does your Group Practice currently have? Include W-2 AND 1099 independent contractors.Days OpenDuring this last two month period, how many days was the Practice open?Hours OpenDuring this last two month period, how many hours was the Practice open?Production (Revenue)TTL Gross ProductionWhat was the total production for this last two month period?TTL Adjusted ProductionWhat was the Adjusted Production (Gross Production minus fee adjustments and write-offs)TTL Dentist ProductionWhat was the total Dentists production for this last period?TTL Hygienist ProductionWhat was the total Hygienist production for this last period? Balance Sheet InformationCurrent AssetsWhat was the total Current Assets listed on your Balance Sheet at Period end?ARWhat was the total Accounts Receivable listed on your Balance Sheet at Period end?APWhat was the total Accounts Payable listed on your Balance Sheet at Period end?Current LiabilitiesWhat was the total Current Liabilities listed on your Balance Sheet at Period end?Long Term DebtWhat was the total Long Term Debt listed on your Balance Sheet at Period end?Net IncomeWhat was the Net Income listed on your Balance Sheet at Period end?A/R & CollectionTTL CollectionWhat was the total amount of billing collected during the period?31-60 DaysWhat was the 31-60 Days Balance listed on your AR Aging Report for the period?61-90 DaysWhat was the 61-90 Days Balance listed on your AR Aging Report for the period?Over 90 DaysWhat was the Over 90 Days Balance listed on your AR Aging Report for the period? Practice ExpendituresStaffing/WagesWhat was the total amount spent on all staffing during the period? (does not include owner compensation)Lab FeesWhat was the total amount spent on lab fees during the period?Business OfficeHow much was spent on the business office (office supplies, utilities, etc.) during the period?Marketing ExpendituresWhat was the total amount spent on Marketing or New Patient Generation during the period?Rent/MortgageHow much was spent on your rent or mortgage during the period?Total ExpensesWhat were the total expenses for the Period? (less owner compensation)CompensationOwner CompWhat was the amount spent on Owner Compensation during the period?Dentist CompWhat was the amount spent on Dentist Compensation during the period?Hygienist CompWhat was the amount spent on Hygienist Compensation during the period?Admin CompWhat was the amount spent on Administration Compensation during the period? Patient ActivityPatients ScheduledWhat was the total number of SCHEDULED Patients visits during this two month period?Patients CompletedWhat was the total number of COMPLETED Patients visits during this two month period?Follow Up ScheduledWhat was the total number of Patients who had a follow-up appointment scheduled during the period?New PatientsHow many new Patients visited your Practice during this period?Referral SourcesBy Other PatientsHow many of those new patients were referred from existing Patients?From Your WebsiteHow many of those new patients were referred from your website?Digital MarketingHow many of those new patients were referred from Facebook/Google AdvertisingFrom NetworkingHow many of those new patients were referred from your networking? (Associations, Networking Events, Chamber of Commerce)Insurance TypePrivate InsuranceHow many Patients who visited the Practice during this period had a private insurance policy?Public AssistanceHow many Patients who visited the Practice during this period had a public assistance policy?No CoverageHow many Patients who visited the Practice during this period had a no Insurance policy?Case AcceptanceTreatment PresentedHow many treatment plans were PRESENTED to Patients during this period?Treatment AcceptedHow many treatment plans were ACCEPTED by Patients during this period?PhoneThis field is for validation purposes and should be left unchanged.
