SA-7115 Service Annual Survey

OMB No. 0607-0422: Approval Expires XX/XX/2012

2009 Annual Services Report
Service Annual Survey

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

FORM

SA-7115

REPORT DUE

Any questions call 1–800–772–7851
M–F, 8:30 a.m. to 5:00 p.m. EST.

or

Please correct any error in the name, address, or ZIP Code.

Visit our web site:
www.census.gov/econhelp/sas
Internet Reporting
To complete this report online go to: www.census.gov/econhelp/sas
Click on "Census Taker" and use your username and password to login.

Username:
Password:

YOUR RESPONSE IS REQUIRED BY LAW
Title 13, U.S. Code, requires businesses and other organizations that receive this questionnaire to answer the
questions and return the report to the Census Bureau.

YOUR RESPONSE IS CONFIDENTIAL BY LAW
Title 13, U.S. Code, requires that your response may be seen only by persons sworn to uphold the confidentiality of Census
Bureau information and may be used only for statistical purposes. The law also provides that copies retained in your files are
immune from legal process.

YOUR RESPONSE IS IMPORTANT
The services industries account for nearly 70 percent of all economic activity. We conduct this survey to obtain timely,
comprehensive and consistent measures needed by policy-makers, businesses, and the public to accurately assess domestic
economic performance.

FORM asr_a_09 (4-9-2009)

USCENSUSBUREAU

Annual Services Report
•
•

This report should be completed and returned on or before the due date in the preaddressed envelope provided.
If filing within the required time frame will cause an undue burden and you would like an extension, or if you have any questions, please write to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
or call a Census Bureau Representative at 1–800–772–7851, weekdays from 8:30 a.m. to 5:00 p.m., Eastern Standard Time.

1 Report Coverage

Does the above coverage describe this firm’s business activity?
0001

1
2

Yes – Go to 2
No – Specify the firm’s business activity and complete the report where applicable beginning with 2 .
0002

2 Report Periods
What periods of time will this data represent?
• Report data for the 2009 calendar year if possible.
• For locations that were sold or acquired during the year, only report for the periods that this firm operated the locations.
2009
Month
0007
0006

1

2009 calendar year – Go to 3

2

Other than calendar year – Enter the periods this report will cover. . . . . . . . . . . . . . . . . .
0008
(e.g., fiscal years, periods with less than a full calendar
year).
To

FORM asr_b_09 (4-8-2009)

From

Day

Year

3 Operating Revenue
Report the total operating revenue for this firm’s locations defined in 1 for the following categories.
• Enter "0" where applicable.
• Estimates are acceptable.
Exclude:
• Transfers made within the company.

2009 Operating Revenue
Bil.
Mil.
Thou.
Dol.

1. TOTAL OPERATING REVENUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1800 $

4 Not Applicable

FORM asr_c_09 (4-8-2009)

5 Operating Expenses
Report operating expenses for this firm’s locations as defined in 1 for the following categories.
• Enter "0" where applicable.
• Estimates are acceptable.
Exclude:
• Transfers made within the company
• Capitalized expenses
• Interest
• Bad debt
• Impairment
• Income tax

Personnel Costs
1. Gross annual payroll – Total annual Medicare salaries and wages for all
employees as reported on your firm’s IRS Form 941, Employer’s Quarterly
Federal Tax Return, line 5(c) for the four quarters that correspond to the survey
period or IRS Form 944 Employer’s Annual Federal Tax Return line 4(c). . . . . . . . .
2. Employer’s cost for fringe benefits – Employer’s cost for legally required programs
and programs not required by law. Include insurance premiums for hospital plans,
medical plans, and single service plans (e.g., dental, vision, prescription drugs);
premium equivalents for self-insured plans and fees paid to third-party administrators
(TPAs); defined benefit pension plans; defined contribution plans (e.g., profit sharing,
401K and stock option plans); and other fringe benefits (e.g., Social Security, workers’
compensation insurance, unemployment tax, state disability insurance programs, life
insurance benefits, Medicare). Exclude employee contributions. . . . . . . . . . . . . . .

3. Temporary staff and leased employee expense – Total costs paid to Professional
Employer Organizations (PEOs) and staffing agencies for personnel. Include all
charges for payroll, benefits, and services. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2009 Operating Expenses
Bil.
Mil.
Thou.
Dol.

Mark "X"
if None
1821

$

Mark "X"
if None
1822

$

Mark "X"
if None
1823

$

Expensed Materials, Parts and Supplies (not for resale)
4. Expensed equipment – Expensed computer hardware and other equipment
(e.g., copiers, fax machines, telephones, shop and lab equipment, CPUs and
monitors). Report packaged software in line 6. Report leased and rented equipment
in line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Expensed purchases of other materials, parts, and supplies – Materials and
supplies used in providing services to others; materials and parts used in repairs;
office and janitorial supplies; small tools; containers and other packaging materials;
and motor fuels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None
1824

$

Mark "X"
if None
1825

$

Expensed Purchased Services
6. Expensed purchases of software – Purchases of prepackaged, custom coded, or
vendor customized software. Include software developed or customized by others,
web-design services and purchases, licensing agreements, upgrades of software,
and maintenance fees related to software upgrades and alterations. . . . . . . . . . . .

7. Purchased electricity and fuels (except motor fuels) – If the cost of electricity and
heating fuels (e.g., natural gas, propane, oil, coal) are included in lease or rental
payments, report in line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Lease and rental payments – For land, buildings, offices, structures, machinery,
equipment, and other tangible items. Include lease and rental of transportation
equipment without operators; and penalties incurred for broken leases. Exclude
capital and financing lease agreements and licensing/leasing of software. . . . . . . .

FORM asr_g1_09 (5-20-2009)

Mark "X"
if None
1826

$

Mark "X"
if None
1827

$

Mark "X"
if None
1828

$

5 Operating Expenses – (Continued)
Report operating expenses for this firm’s locations as defined in 1 for the following categories.
• Enter "0" where applicable.
• Estimates are acceptable.
Exclude:
• Transfers made within the company
• Capitalized expenses
• Interest
• Bad debt
• Impairment
• Income tax

Expensed Purchased Services – (Continued)
9. Purchased repair and maintenance – Include expensed repair and maintenance to
2009 Operating Expenses
buildings and integral building components (e.g., elevators, heating and cooling
Mark "X"
Bil.
Mil.
Thou.
Dol.
systems), structures, offices, machinery, vehicles, equipment, and computer hardware. if None
Exclude materials, parts, and supplies used for repair and maintenance performed by
this firm’s employees. Report janitorial and grounds maintenance services in
$
line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1829
Mark "X"
if None

10. Purchased advertising and promotional services – Include marketing and public
relations services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1830

$

Other Operating Expenses
11. Depreciation and amortization charges – Include depreciation charges taken
against tangible assets owned and used by your firm, tangible assets and
improvements owned by your firm within leaseholds, tangible assets obtained
through capital lease agreements, and amortization charges against intangible
assets (e.g., patents, copyrights). Exclude impairment. . . . . . . . . . . . . . . . . . . . .

12. Governmental taxes and license fees – Payments to government agencies for
taxes and licenses. Include business and property taxes. Exclude income taxes,
and sales and excise taxes collected from customers. . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None
1831

$

Mark "X"
if None
1832

$

Mark "X"

13. All other operating expenses – All other operating expenses not reported above,
if None
unless specifically excluded in the general instructions at the top of the page. Include
office postage and package delivery. Exclude purchases of merchandise for resale and
non-operating expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1899

$

14. TOTAL OPERATING EXPENSES – Sum of lines 1–13. . . . . . . . . . . . . . . . . . . . . . . . . . 1900 $

6 Not Applicable

FORM asr_g2_09 (5-4-2009)

7 Not Applicable

8 E-Commerce Revenue
E-commerce includes sales, receipts, and contributions from any transaction completed over an Internet, extranet, EDI
network, electronic mail or other online system. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods and services may or may not be made
online.
2009 E-Commerce Revenue
Bil.
Mil.
Thou.
Dol.

Did the revenue reported in 3 include any
e-commerce revenue?
1
0011

2

Yes – What was this firm’s e-commerce revenue? . . . . . . . . . . . . . . . . . . . . . . . 2000 $
No – Go to 9

9 Export Revenue
An exported service is a service performed for a customer or client (individual, government, business establishment, etc.) located
outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
• Services performed for unaffiliated and affiliated foreign firms (i.e., foreign parent firms, subsidiaries, branches, etc.).
Exclude:
• Services provided to domestic subsidiaries of foreign firms.

Did the revenue reported in 3 include any revenue
from exports?
1
0009

2

Yes – What was this firm’s revenue from exports?
No – Go to 11

10 Not Applicable

FORM asr_ef_09 (4-9-2009)

Bil.

. . . . . . . . . . . . . . . . . . . . . . 2100 $

2009 Export Revenue
Mil.
Thou.
Dol.

11 Change in Structure
Did you have an Employer Identification Number (EIN) change in 2009?
0015
0013

Yes – Enter the new EIN. . . . . . . . . . . . . .
No – Continue

1
2

EIN

–

Month

Was there a change in ownership or control?
1

Yes – Provide the date of the change and the firm’s information. . . . . . . . . . . . . . . . . . . . .
(for multiple mergers, provide each firm’s information as an attachment to this report)

2

No – Go to 12

0016

0017

Year

0018

Name of company acquired or merged with

Street address

City, State, ZIP Code

0019
EIN

–

Specify the nature of this change here
0035

12 Remarks –

Please provide an explanation for any inconsistent or incomplete data that would aid in understanding this report.
For any separate correspondence pertaining to this report, please include the identification number shown in the
address label area at the top of the first page.

0027

13 Certification – This report is substantially accurate and has been prepared in accordance with the instructions.
0020 Name of person completing this report – Please print

0024 Title

0025 Date

0021 Address (Street address, City, State, ZIP Code)

0022 Telephone number
Area code

Number

Return Completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
or fax to: 1–800–447–4613

0023 Fax number
Extension

Area code

0026 E-mail address

Number

Public reporting burden for this collection of information is estimated to average
per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: Paperwork Project 0607-0422, U.S. Census Bureau, 4600
Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to [email protected]; use
"Paperwork Project 0607-0422" as the subject. Please include form name and number in all correspondence. Respondents
are not required to respond to any information collection unless it displays a valid approval number from the Office of
Management and Budget. This 8-digit number appears in the top right corner on the front of this form.

To see aggregate industry results of previous Service Annual Surveys, go to the following website: www.census.gov/services/index.html
FORM asr_z_09 (5-20-2009)