Forms & Instructions

Attachment C-11
2012 Economic Census

Information; Professional, Scientific, and Technical Services; Management of
Companies and Enterprises; Administrative and Support and Waste Management
and Remediation Services; Educational Services; Health Care and Social
Assistance; Arts, Entertainment, and Recreation; and Other Services (Except Public
Administration) Sectors

Variable Content for Item 26 – Special Inquiries

VARIABLE CONTENT FOR ITEM 26. - SPECIAL INQUIRIES

The “Special Inquiries” item contains 24 separate inquiries. Those inquiries appear in this
attachment in the following order:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

Media
Franchise
New Construction, Including Renovation
Maintenance and Repair
Personnel by Occupation
Source of Research and Development Funds
Research and Development Acquisition
Proprietors and Partners of Unincorporated Businesses
Expenses of Legal Aid Societies
Single and Multiple Services
Computer System Integration
Gross Billings
Employment by Function
Merchandise Sales
Professional Employer Organizations
Placement Services
Patient Services
Government Ownership and Control
Grants, Similar Payments, and Transferred Contributions of TaxExempt Establishments
Social Assistance
Repair Receipts
Laundry Work
Dry cleaning
Repayments of Cash Advances
Dental Care
Purchase of Contract Manufacturer
Tavel Agency Classification
Type of Payer by Funding Source

Some inquiries have more than one variation. Each variation will show in this attachment with
the form numbers that the variation appears on noted.

IN-51101, IN-51102, IN-51103, IN-51105
#L MEDIA
Estimate the percent of receipts from subscriptions, sales, and advertising reported in
and 2, by type of dissemination media.

?

2012
Percent

, lines 1

1. Print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3791

2. Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3792

3. Other media, including CD-ROM/DVD-ROM, diskette or cassette, and microform

3793

4. TOTAL

. . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
%
1 0 0 %

IN-51103, IN-51801, PS-54101, PS-54102, PS-54107, PS-54110,
PS-54113, PS-54115, PS-54116, PS-54120, PS-54121, PS-54122,
AS-56101, AS-56102, AS-56103, AS-56104, AS-56105, AS-56106,
AS-56202, AS-56203, ED-61101, HC-62106, HC-62402, HC-62405,
HC-62406, AE-71302, AE-71303, AE-71304, OS-81101, OS-81103,
OS-81104, OS-81201, OS-81203, OS-81204, OS-81206, OS-81207

IN-51501, IN-51701, IN-51702
#L NEW CONSTRUCTION, INCLUDING RENOVATION
1. Was this establishment involved in new construction or renovation of buildings, structures, or communication
lines during 2012?
0991

Yes - Go to line 2

0992

No - Go to B
2012

2. Capital expenditures for new construction, including renovation (Include
labor and materials. Exclude land and the value of production machinery
and equipment not an integral part of a structure.) . . . . . . . . . . . . .

$ Bil.

Mil.

Thou.

Dol.

0900

Mark "X"
if None

3. Percentage of the capital expenditures reported in line 2 that represented work done by
your own employees as opposed to work done by contractors or other hired labor . . . . 0901

2012
Percent

%

IN-51750, IN-51751
#L NEW CONSTRUCTION, INCLUDING RENOVATION
1. Was this consolidated reporting unit involved in new construction or renovation of buildings, structures, or
communication lines during 2012?
0991

Yes - Go to line 2

0992

No - Go to B
2012

2. Capital expenditures for new construction, including renovation (Include
labor and materials. Exclude land and the value of production machinery
and equipment not an integral part of a structure.) . . . . . . . . . . . .

$ Bil.

Mil.

Thou.

Dol.

0900

Mark "X"
if None

3. Percentage of the capital expenditures reported in line 2 that represented work done by
your own employees as opposed to work done by contractors or other hired labor . . . 0901

2012
Percent

%

IN-51750, IN-51751
#L MAINTENANCE AND REPAIR
1. Was this consolidated reporting unit involved in maintenance and repair of buildings, structures, or
communication lines owned by your enterprise during 2012?
(Report "No" if expenses were limited to activities, such as janitorial services, cleaning, lawn maintenance, etc.)
0916

Yes - Go to line 2

0917

No - Go to

?

2012
$ Bil.

2. Expenses for maintenance and repairs (Exclude expenses for such activities
as janitorial services, cleaning, lawn maintenance, etc.) . . . . . . . . . . .

Mil.

Thou.

Dol.

0918

3. Percentage of the expenses for maintenance and repairs reported in line 2 that
represented work done by your own employees as opposed to work done by
contractors or other hired labor . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None
0919

2012
Percent

%

IN-51501, IN-51701, IN-51702
#L MAINTENANCE AND REPAIR
1. Was this establishment involved in maintenance and repair of buildings, structures, or communication lines
owned by your enterprise during 2012?
(Report "No" if expenses were limited to activities, such as janitorial services, cleaning, lawn maintenance, etc.)
0916

Yes - Go to line 2

0917

No - Go to

30

2012
$ Bil.

2. Expenses for maintenance and repairs (Exclude expenses for such activities
as janitorial services, cleaning, lawn maintenance, etc.) . . . . . . . . . . .

Mil.

Thou.

Dol.

0918

3. Percentage of the expenses for maintenance and repairs reported in line 2 that
represented work done by your own employees as opposed to work done by
contractors or other hired labor . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None
0919

2012
Percent

%

PS-54101
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupation. The
total should equal the number reported in ? , line A.
Enter personnel who perform a variety of functions (secretaries, etc.) on the one line which best describes the
primary nature of their work.
Line 1 - Lawyers who are members of a professional service corporation should be included here. The
proprietor or partners not considered employees of the firm for federal tax purposes should be included in B,
PROPRIETORS AND PARTNERS OF UNINCORPORATED BUSINESSES.
Census
use

1. Associate lawyers (employees of firm)

. . . . . . . . . . . . . . . . . . . . . . . .

3231

2. Paraprofessionals (law clerks, legal assistants, investigators, etc.) . . . . . . . . . . . .

3232

3. Managers and other non-legal professional staff . . . . . . . . . . . . . . . . . . . .

3233

4. All other (stenographers, bookkeepers, etc.) . . . . . . . . . . . . . . . . . . . . . .

3234

5. TOTAL (Add lines 1 through 4. Total should equal

3200

?

, line A.) . . . . . . . . . . . . .

Number of
employees for pay
period including
March 12, 2012

PS-54059
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupation. The total
should equal the number reported in ? , line A.
Enter personnel who perform a variety of functions (e.g., those with multiple job duties, licenses, or registrations)
on the one line which best describes the primary nature of their work. Scientific research and development
establishments should report scientists, engineers, and technicians/technologists on lines 4a and 4b.

1.

2.

Census
use

Accounting personnel
a. Certified public accountants (employees of the firm) . . . . . . . . . . . . . .

3251

b. Public accountants not certified (employees of the firm) . . . . . . . . . . . .

3252

Legal personnel
a. Associate lawyers (employees of the firm)

3.

. . . . . . . . . . . . . . . . . .

3231

b. Legal paraprofessionals (Include law clerks, legal assistants, investigators, etc.) .

3232

Computer personnel
a. Computer programmers . . . . . . . . . . . . . . . . . . . . . . . . . . .

3201

b. Systems engineers

3202

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. Other computer-related personnel
4.

5.

. . . . . . . . . . . . . . . . . . . . . .

3203

a. Scientists and engineers . . . . . . . . . . . . . . . . . . . . . . . . . . .

3224

b. Technicians/technologists

3225

Research and development personnel

. . . . . . . . . . . . . . . . . . . . . . . . . .

Other personnel and technology
a. Licensed or registered architects . . . . . . . . . . . . . . . . . . . . . . .

3241

b. Licensed or registered engineers . . . . . . . . . . . . . . . . . . . . . . .

3242

c. Licensed or registered surveyors . . . . . . . . . . . . . . . . . . . . . . .

3243

d. Certified engineering technicians . . . . . . . . . . . . . . . . . . . . . . .

3244

e. Other technically-trained personnel . . . . . . . . . . . . . . . . . . . . . .

3362

Number of employees
for pay period including
March 12, 2012

PS-54059
Census
use

6.

Sales personnel

7.

Managers, management consultants, and all other professionals

. . . . . . . . .

3269

8.

Manufacturing/production workers . . . . . . . . . . . . . . . . . . . . . . . .

0325

9.

All other personnel (Include personnel, such as secretarial, maintenance, security,
and other support staff.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3270

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. TOTAL (Add lines 1 through 9. Total should equal

?

, line A.) . . . . . . . . . . .

3206

3200

Number of employees
for pay period including
March 12, 2012

PS-54107
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the number reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated businesses operating
at more than one location should report the proprietor or partners at the one location at which they spend most of
their working time.
Number of active
Census
use

1. Computer programmers

Number of
employees for pay
period including
March 12, 2012

Census
use

. . . . . . . . . . . . . . . . . . .

3201

3261

2. Systems engineers . . . . . . . . . . . . . . . . . . . . . .

3202

3262

3. Other computer-related personnel . . . . . . . . . . . . . . .

3203

3263

4. Engineers, except systems . . . . . . . . . . . . . . . . . .

3204

3264

5. Other technical personnel, except computer . . . . . . . . . .

3205

3265

6. Sales personnel . . . . . . . . . . . . . . . . . . . . . . .

3206

3266

7. Manufacturing/production workers

. . . . . . . . . . . . . .

0325

3267

8. All other personnel . . . . . . . . . . . . . . . . . . . . . .

3208

3268

9. TOTAL (Add lines 1 through 8. Total should equal ? , line A for
column 1.) . . . . . . . . . . . . . . . . . . . . . . . . . .

3200

3260

proprietors or
partners for pay
period including
March 12, 2012

PS-54112
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the number reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated businesses operating
at more than one location should report the proprietor or partners at the one location at which they spend most of
their working time.
Enter each employee, proprietor, or partner on one line only. Include personnel with multiple licenses or registrations
on the line which best describes the primary nature of their work.
Census
use

Number of
employees for pay
period including
March 12, 2012

Census
use

1.

Licensed or registered architects . . . . . . . . . . . . . . .

3241

3291

2.

Licensed or registered engineers . . . . . . . . . . . . . . .

3242

3292

3.

Licensed or registered surveyors . . . . . . . . . . . . . . .

3243

3293

4.

Certified engineering technicians

. . . . . . . . . . . . . .

3244

3294

5.

Computer programmers . . . . . . . . . . . . . . . . . . .

3201

3261

6.

Systems engineers . . . . . . . . . . . . . . . . . . . . .

3202

3262

7.

Other computer-related personnel . . . . . . . . . . . . . .

3203

3263

8.

Other technically-trained personnel

. . . . . . . . . . . . .

3245

3295

9.

All other personnel . . . . . . . . . . . . . . . . . . . . .

3246

3296

10. TOTAL (Add lines 1 through 9. Total should equal ? , line A
for column 1.) . . . . . . . . . . . . . . . . . . . . . . .

3200

3260

Number of active
proprietors or
partners for pay
period including
March 12, 2012

PS-54102
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category.
The total should equal the number reported in ? , line A.
Enter personnel who perform a variety of functions on the one line which best describes the primary nature of
their work.
Lines 1a and 1b - Accountants who are members of a professional service corporation should be included here.
The proprietor or partners not considered employees of the firm for federal tax purposes should be included in B,
PROPRIETORS AND PARTNERS OF UNINCORPORATED BUSINESSES.
Line 1b - Licensed, registered, and public accountants, and accounting practitioners who are not certified by the
state should be included here.
Census
use

1. Type of employee working for this establishment
a. Certified public accountants (employees of firm) . . . . . . . . . . . . . . . . . .

3251

b. Public accountants not certified (employees of firm)

. . . . . . . . . . . . . . . .

3252

c. Management consultants and other non-accounting professional staff . . . . . . . .

3253

d. All others, including clerical and other support staff

. . . . . . . . . . . . . . . .

3254

2. Employees whose payroll is processed by this establishment, but who are not
management and administrative employees of this establishment (i.e., employees or
individuals serviced by payroll or talent payment services) . . . . . . . . . . . . . . .

3255

3. TOTAL (Add lines 1a through 2. Total should equal

3200

?

, line A.)

. . . . . . . . . . . .

Number of
employees for pay
period including
March 12, 2012

PS-54119
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupation. The total
should equal the number reported in ? , line A.
Enter personnel who perform a variety of functions (e.g., those with mutiple job duties, licenses, or registrations) on
the one line which best describes the primary nature of their work.
Census
use

1. Research and development personnel:
a. Scientists and engineers

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3224

b. Technicians/technologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3225

2. Administrative and professional mangement staff (e.g., executives, accounting,
personnel/human relations, legal) . . . . . . . . . . . . . . . . . . . . . . . . . . .

3227

3. All other personnel (Include personnel, such as secretarial, maintenance, security, and
other support staff.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3229

4. TOTAL (Add lines 1a through 3. Total should equal

3200

?

, line A.)

. . . . . . . . . . . .

Number of
employees for pay
period including
March 12, 2012

HC-62104, HC-62109
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the number reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated practices operating
at more than one location should report the proprietor or partners at the one location at which they spend most of
their working time.
Census
use

1.

Allopathic physicians - licensed practitioners having M.D.
degree . . . . . . . . . . . . . . . . . . . . . . . . . . .
Osteopathic physicians - licensed practitioners having D.O.
degree . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of
employees for pay
period including
March 12, 2012

Census
use

3211

3271

3212

3272

3214

3274

3215

3275

3216

3276

Dentists - licensed practitioners having D.M.D., D.D.S., or
D.D.Sc. degree . . . . . . . . . . . . . . . . . . . . . .

3213

3273

Other dental practitioners (Include hygienists, assistants, and
others performing or assisting with dental procedures.) . . .

3223

3283

Mental health practitioners, excluding practitioners with M.D.
or D.O. degree (Include psychologists, licensed clinical social
workers, etc.) . . . . . . . . . . . . . . . . . . . . . . .

3217

3277

Physical and occupational therapists, speech-language
pathologists, and audiologists . . . . . . . . . . . . . . .

3218

3278

. . . . . . . . . . . . . . . . . . . . .

3219

3279

11. Licensed practical nurses . . . . . . . . . . . . . . . . . .

3220

3280

12. All other health practitioners . . . . . . . . . . . . . . . .

3221

3281

13. All other employees (Include management and administrative
staff.) . . . . . . . . . . . . . . . . . . . . . . . . . . .

3222

3282

14. TOTAL (Add lines 1 through 13. Total should equal ? , line A
for column 1.) . . . . . . . . . . . . . . . . . . . . . . .

3200

3260

2.
3.
4.
5.
6.
7.
8.

9.

Chiropractic physicians - licensed practitioners having D.C.
degree . . . . . . . . . . . . . . . . . . . . . . . . . . .
Podiatric physicians - licensed practitioners having D.P.M.
degree . . . . . . . . . . . . . . . . . . . . . . . . . . .
Optometrists - licensed practitioners having O.D. degree . . .

10. Registered nurses

Number of active
proprietors or
partners for pay
period including
March 12, 2012

HC-62105
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category
in column 1. The total of column 1 should equal the number reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated practices operating
at more than one location should report the proprietor or partners at the one location at which they spend most of
their working time.
Census
use

Number of
employees for pay
period including
March 12, 2012

Census
use

1. Dentists - licensed practitioners having D.M.D., D.D.S., or
D.D.Sc. degree . . . . . . . . . . . . . . . . . . . . . . .

3213

3273

2. Other dental practitioners (Include hygienists, technicians, and
assistants.) . . . . . . . . . . . . . . . . . . . . . . . . .

3223

3283

3. Registered nurses . . . . . . . . . . . . . . . . . . . . . .

3219

3279

4. Licensed practical nurses

. . . . . . . . . . . . . . . . . .

3220

3280

5. All other health practitioners . . . . . . . . . . . . . . . . .

3221

3281

6. All other employees (Include management and administrative
staff.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3222

3282

7. TOTAL (Add lines 1 through 6. Total should equal ? , line A
for column 1.) . . . . . . . . . . . . . . . . . . . . . . . .

3200

3260

Number of active
proprietors or
partners for pay
period including
March 12, 2012

PS-54103
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the number reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated businesses operating
at more than one location should report the proprietor or partners at the one location at which they spend most of
their working time.
Enter each employee, proprietor, or partner on one line only. Include personnel with multiple licenses or registrations
on the line which best describes the primary nature of their work.
Census
use

Number of
employees for pay
period including
March 12, 2012

Census
use

1.

Licensed or registered architects . . . . . . . . . . . . . . .

3241

3291

2.

Licensed or registered engineers . . . . . . . . . . . . . . .

3242

3292

3.

Licensed or registered surveyors . . . . . . . . . . . . . . .

3243

3293

4.

Certified engineering technicians

. . . . . . . . . . . . . .

3244

3294

5.

Computer programmers . . . . . . . . . . . . . . . . . . .

3201

3261

6.

Systems engineers . . . . . . . . . . . . . . . . . . . . .

3202

3262

7.

Other computer-related personnel . . . . . . . . . . . . . .

3203

3263

8.

Other technically-trained personnel

. . . . . . . . . . . . .

3245

3295

9.

All other personnel . . . . . . . . . . . . . . . . . . . . .

3246

3296

10. TOTAL (Add lines 1 through 9. Total should equal ? , line A
for column 1.) . . . . . . . . . . . . . . . . . . . . . . .

3200

3260

Number of active
proprietors or
partners for pay
period including
March 12, 2012

PS-54105
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the number reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated businesses operating
at more than one location should report the proprietor or partners at the one location at which they spend most of
their working time.
Enter each employee, proprietor, or partner on one line only. Include personnel with multiple licenses or registrations
on the line which best describes the primary nature of their work.
Census
use

Number of
employees for pay
period including
March 12, 2012

Census
use

1.

Licensed or registered architects . . . . . . . . . . . . . . .

3241

3291

2.

Licensed or registered engineers . . . . . . . . . . . . . . .

3242

3292

3.

Licensed or registered surveyors . . . . . . . . . . . . . . .

3243

3293

4.

Certified engineering technicians

. . . . . . . . . . . . . .

3244

3294

5.

Computer programmers . . . . . . . . . . . . . . . . . . .

3201

3261

6.

Systems engineers . . . . . . . . . . . . . . . . . . . . .

3202

3262

7.

Other computer-related personnel . . . . . . . . . . . . . .

3203

3263

8.

Other technically-trained personnel

. . . . . . . . . . . . .

3245

3295

9.

All other personnel . . . . . . . . . . . . . . . . . . . . .

3246

3296

10. TOTAL (Add lines 1 through 9. Total should equal ? , line A
for column 1.) . . . . . . . . . . . . . . . . . . . . . . .

3200

3260

Number of active
proprietors or
partners for pay
period including
March 12, 2012

PS-54059
#L SOURCE OF RESEARCH AND DEVELOPMENT FUNDS
Report receipts and revenues of this establishment during 2012 to support research and development activities (i.e.,
wages and salaries, direct materials costs, services and supporting costs, and an appropriate share of depreciation
and overhead). If this establishment performed research and development for the federal government or for other
enterprises on contract during 2012, include the total amount charged for such work performed.
1. Did this establishment receive funds for research and development during 2012?
3571

Yes - Go to line 2

3572

No - Go to C
2012
$ Bil.

a. Federal government contracts and subcontracts . . . . . . . .

3581

b. Non-federal sources outside your enterprise (Include receipts
from other enterprises, state and local governments, and other
organizations.) . . . . . . . . . . . . . . . . . . . . . . . .

3582

c. Transfers or other payments from other establishments of your
enterprise . . . . . . . . . . . . . . . . . . . . . . . . . .

3583

d. TOTAL (Add lines a through c - Note that the sum of lines a
and b should equal ? , sum of lines 15 through 20.) . . . . . .

3580

Mil.

Thou.

Dol.

MN-55102
#L SOURCE OF RESEARCH AND DEVELOPMENT FUNDS
Report receipts and revenues of this establishment during 2012 to support research and development activities (i.e.,
wages and salaries, direct materials costs, services and supporting costs, and an appropriate share of depreciation
and overhead). If this establishment performed research and development for the federal government or for other
enterprises on contract during 2012, include the total amount charged for such work performed.
1. Did this establishment receive funds for research and development during 2012?
3571

Yes - Go to line 2

3572

No - Go to C
2012

2. Source of funds for research and development
a. Federal government contracts and subcontracts

$ Bil.

. . . . . . . . . . . .

3581

b. Non-federal sources outside your enterprise (Include receipts from other
enterprises, state and local governments, and other organizations.) . . .

3582

c.

Transfers or other payments from other establishments of your
enterprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. TOTAL (Add lines a through c - Note that the sum of lines a and b
should equal ? , line 5.) . . . . . . . . . . . . . . . . . . . . . . . .

3583

3580

Mil.

Thou.

Dol.

PS-54059
#L RESEARCH AND DEVELOPMENT ACQUISITION
(To be completed by establishments engaged in research and development.)
The United States includes all 50 states, District of Columbia, U.S. Commonwealth
Territories, and U.S. possessions.
Yes

During 2012 did this establishment:

No

Do not
know

1. Acquire research and development performed by another establishment of your
enterprise in the United States? . . . . . . . . . . . . . . . . . . . . . . . .

3811

3812

3813

2. Acquire research and development performed by another establishment of your
enterprise outside of the United States? . . . . . . . . . . . . . . . . . . . .

3821

3822

3823

3. Acquire research and development performed by another company in the
United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3831

3832

3833

4. Acquire research and development performed by another company outside of
the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3841

3842

3843

5. Acquire rights to use patents, inventions, licenses, trademarks, software, or
other types of intellectual property from others for use in this establishment's
products or processes? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3851

3852

3853

MN-55102
#L RESEARCH AND DEVELOPMENT ACQUISITION
The United States includes all 50 states, District of Columbia, U.S. Commonwealth
Territories, and U.S. possessions.
Yes

During 2012 did this establishment:
1. Perform research and development?

No

Do not
know

. . . . . . . . . . . . . . . . . . . . .

3801

3802

3803

2. Acquire research and development performed by another establishment of your
enterprise in the United States? . . . . . . . . . . . . . . . . . . . . . . . .

3811

3812

3813

3. Acquire research and development performed by another establishment of your
enterprise outside of the United States? . . . . . . . . . . . . . . . . . . . .

3821

3822

3823

4. Acquire research and development performed by another company in the
United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3831

3832

3833

5. Acquire research and development performed by another company outside of
the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3841

3842

3843

6. Acquire rights to use patents, inventions, licenses, trademarks, software, or
other types of intellectual property from others for use in this establishment's
products or processes? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3851

3852

3853

PS-54119
#L RESEARCH AND DEVELOPMENT ACQUISITION
The United States includes all 50 states, District of Columbia, U.S. Commonwealth
Territories, and U.S. possessions.
During 2012 did this establishment:

Yes

No

Do not
know

1. Acquire research and development performed by another establishment of your
enterprise in the United States? . . . . . . . . . . . . . . . . . . . . . . . .

3811

3812

3813

2. Acquire research and development performed by another establishment of your
enterprise outside of the United States? . . . . . . . . . . . . . . . . . . . .

3821

3822

3823

3. Acquire research and development performed by another company in the
United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3831

3832

3833

4. Acquire research and development performed by another company outside of
the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3841

3842

3843

5. Acquire rights to use patents, inventions, licenses, trademarks, software, or
other types of intellectual property from others for use in this establishment's
products or processes? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3851

3852

3853

PS-54101, PS-54102
#L PROPRIETORS AND PARTNERS OF UNINCORPORATED BUSINESSES
Unincorporated businesses should report each proprietor or partner not considered employees for federal
tax purposes at this location. For businesses operating at more than one location, report the proprietor or
partners at the location where they spend most of their working time.
2012
Mark "X" Number for the pay
if None
period including
March 12

Active proprietor or partners at this location . . . . . . . . . . . . . . . . . . . .

3260

PS-54101
#L EXPENSES OF LEGAL AID SOCIETIES
Total operating expenses, including payroll and fringe benefits, rent,
depreciation, business and property taxes, and other overhead.
(Exclude capital expenditures, funds invested, losses from the sale of assets,
interest paid, and bad debt.) . . . . . . . . . . . . . . . . . . . . . . . . .

2012
$ Bil.
3520

Mil.

Thou.

Dol.

PS-54102
#L SINGLE AND MULTIPLE SERVICES
(To be completed by offices of Certified Public Accountants.)
Of the accounting services reported in ? , lines 1 through 9, what percent were transacted as:
1. A single service

2012
Percent

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3761

2. Part of a multiple service package (such as financial auditing and tax planning offered together
in a single transaction) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3762

3. TOTAL

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
1 0 0 %

PS-54107
#L COMPUTER SYSTEM INTEGRATION
Estimate the percentage of the value of the integrated systems reported in
following categories:

?

2012
Percent

, line 1.c.(3), for the

1. Resale of purchased computer hardware . . . . . . . . . . . . . . . . . . . . . . . . . . .

0644

2. Resale of purchased computer software

0645

. . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Sale of custom software produced by this establishment
4. Other, including consulting, training, engineering, etc.

. . . . . . . . . . . . . . . . . . .

0646

. . . . . . . . . . . . . . . . . . . .

0647

5. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
%
%
1 0 0 %

PS-54110
#L GROSS BILLINGS
(To be completed only by advertising agencies.)
Gross billings and costs associated with receipts reported in

?

Mark "X"
if None $ Bil.

, line 1.

1. Sales of (billings for) advertising media . . . . . . . . . . . . . . .

3030

2.

Billings for advertising materials and other outside production
services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Cost of advertising media in line 1 above . . . . . . . . . . . . . .

3031

4. Purchases of advertising materials and services in line 2 above

3033

. . .

3032

2012
Mil.

Thou.

Dol.

MN-55102
#L EMPLOYMENT BY FUNCTION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by function. The total should
equal the number reported in ? , line A (number of employees at this location).
Enter each employee on the one line which best describes his/her position. Where records do not provide actual
employee counts in terms of the function listed, estimates of the approximate number in each are acceptable.

1.

Census
use

Administrative and management:
a. Executive and general management (e.g., corporate officers and staff) . . . . . . .

3321

b. Accounting, billing, tax preparation, and bookkeeping . . . . . . . . . . . . . . .

3322

c. Personnel/human relations . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3323

d. Advertising and marketing/market research, excluding direct sales staff . . . . . . .

3320

e. Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3326

f. Computer systems design, custom computer programming, and electronic data
processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3338

g. Other - Specify
3329

0829

2.

Sales employees (and support staff) selling directly to customers from this location

. .

3206

3.

Procurement/purchasing staff . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3331

4.

Research and development:
a. Scientists and engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3224

b. Technicians/technologists

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

3225

Security, including security patrol, locksmith, monitoring, and investigation; and
building services, including janitorial, carpet cleaning, pest control, and landscaping . .

3350

6.

Repair and maintenance (for vehicles and equipment) . . . . . . . . . . . . . . . . .

3335

7.

Trucking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3336

8.

Warehousing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3337

9.

Manufacturing/production workers . . . . . . . . . . . . . . . . . . . . . . . . . .

0325

5.

10. All other - Specify
3339

0839

11. TOTAL (Add lines 1a through 10. Total should equal

?

, line A.)

. . . . . . . . . . .

3200

Number of
employees for pay
period including
March 12, 2012

PS-54193, AS-56191, AS-56192, IA-form

#L MERCHANDISE SALES
Did the sale of merchandise account for more than half of the total receipts of this establishment in 2012?
3531

Yes - Specify merchandise sold
0831

3532

No

MN-55102, PS-54059
#L MERCHANDISE SALES
Estimate the percent of merchandise sales reported in

?

2012
Percent

, line 1, from:

1. Products manufactured or assembled at this establishment . . . . . . . . . . . . . . . . . .

3731

2. Products manufactured or assembled by other establishments of this enterprise and sold by
employees of this establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3732

3. Product resales (products purchased from others and sold by this establishment without further
manufacture, fabrication, processing or assembly) . . . . . . . . . . . . . . . . . . . . . .

3733

4. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
%
1 0 0 %

OS-81190, OS-81191
#L MERCHANDISE SALES
1. Did this establishment sell 'new' merchandise, excluding parts installed in repair work, in 2012?
3372

Yes - Go to line 2

3374

No - Go to

30

2. List below the principal lines of 'new' merchandise sold and indicate the approximate
percentage of each to the total dollar sales and receipts in 2012.

New merchandise sold

2012
CenPercent of
sus total sales and
use receipts of this
establishment

3377

a.

3380

3378

b.

3381

3379

c.

3382

d. TOTAL of 'new' merchandise sold (Add lines a through c) . . . . . . . . . . . . . .

3383

%
%
%
%

AS-56101
#L PROFESSIONAL EMPLOYER ORGANIZATIONS
(To be completed by Professional Employer Organizations (PEOs) only.)
2012

1.

$ Bil.

Net revenues (i.e., gross amounts billed to client firms LESS clients'
(worksite) payroll costs, such as salaries, benefits, and taxes paid to taxing
authorities) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0737

Mil.

Thou.

Dol.

AS-56101
A. PROFESSIONAL EMPLOYER ORGANIZATIONS - Continued
(To be completed by Professional Employer Organizations (PEOs) only.)
Annual payroll

2. Payroll and employment
a. Clients' (worksite) employees paid by this
establishment, by industry category of client

Census
use

Number of
employees for pay
period including
March 12, 2012

Census $ Bil.
use

1.

Agriculture, forestry, hunting . . . . . . . .

0738

0739

2.

Mining . . . . . . . . . . . . . . . . . .

0740

0741

3.

Utilities . . . . . . . . . . . . . . . . . .

0742

0743

4.

Construction

. . . . . . . . . . . . . . .

0744

0745

5.

Manufacturing . . . . . . . . . . . . . . .

0746

0747

6.

Wholesale . . . . . . . . . . . . . . . . .

0748

0749

7.

Retail . . . . . . . . . . . . . . . . . . .

0760

0761

8.

Transportation and warehousing . . . . . .

0762

0763

0764

0765

0766

0767

0768

0769

0770

0771

13. Administrative and support and waste
management and remediation services . . .

0772

0773

14. Educational services . . . . . . . . . . . .

0774

0775

15. Health care and social assistance . . . . . .

0776

0777

16. Arts, entertainment, and recreation . . . . .

0778

0779

17. Accommodation (e.g., hotels and motels)
and food services (e.g., restaurants) . . . .

0780

0781

18. Repair, personal care, and laundry services

0782

0783

0784

0785

b. Management and administrative employees of
this establishment . . . . . . . . . . . . . . .

3562

3567

c. TOTAL (Add lines a1 through b. Total should
equal ? , line A for column 1 and ? , line B1 for
column 2.) . . . . . . . . . . . . . . . . . .

3200

3300

9.

Information services (e.g., publishing,
motion picture, sound recording, and
communications) . . . . . . . . . . . . .
10. Finance and insurance . . . . . . . . . . .
11. Real estate and rental and leasing
12.

. . . . .

Professional, scientific, and technical
services . . . . . . . . . . . . . . . . . .

19. Other - Specify
0786

Mil.

Thou.

Dol.

AS-56101
#L PLACEMENT SERVICES

2012
Percent

Estimate the percentage of placement fees reported in ? , lines 1 through 3, from the following
sources:
1. Business clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3722

2. Individual clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3721

3. Other clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3723

4. TOTAL

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
%
1 0 0 %

HC-62104, HC-62109
#L PATIENT CARE
Estimate the percent of patient care reported in

?

2012
Percent

, line 1, from:

1. Visits and consultations - evaluation and management services . . . . . . . . . . . . . . . .

3701

2. Surgical interventions - treatment of disease, injury, or deformity by surgeons . . . . . . . . .

3702

3. Non-surgical interventions - treatment of disease, injury, or deformity except by surgery . . . .

3703

4. Anesthesia services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3704

5. Laboratory services and tests paid directly by individuals, insurers, or government payers, such
as Medicare and Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3706

6. Laboratory services and tests paid by other health care providers . . . . . . . . . . . . . . .

3705

7. Other, including health facility services, such as provisions of space and equipment, meals,
nursing care, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3707

8. TOTAL

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
%
%
%
%
%
1 0 0 %

HC-62201
#L PATIENT CARE
Estimate the percent of patient care reported in

?

2012
Percent

, line 1, from:

1. Inpatient hospital facility services - evaluation and management services, treatment of disease,
injury, or deformity by surgical procedures and non-surgical procedures, etc. . . . . . . . . .

3711

2. Outpatient visits and consultations - evaluation and management services . . . . . . . . . . .

3712

3. Outpatient surgical interventions - treatment of disease, injury, or deformity by surgeons

3713

. . .

4.

Outpatient non-surgical interventions - treatment of disease, injury, or deformity except by
surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Outpatient anesthesia services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3714

3715

6. Outpatient medical and diagnostic testing services . . . . . . . . . . . . . . . . . . . . . .

3716

7. Other, including outpatient health facility services

3717

8. TOTAL

. . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
%
%
%
%
%
1 0 0 %

HC-62201
#L GOVERNMENT OWNERSHIP AND CONTROL
1. Was this establishment operated by or under the control of a government entity or a board of directors either
appointed by such an entity or publicly elected?
3501

Yes - Go to line 2

3502

No - Go to B

2. Level of government operating or controlling this establishment (Mark "X" only ONE box.)
3506

Federal (Include all armed services, Veterans Administration, Indian Health Service, etc.)

3507

State

3508

Local (Include county, city, hospital district or authority, etc.)

HC-62402, HC-62403, HC-62404, HC-62405, HC-62406, OS-81301,
OS-81302

HC-62402, HC-62403, HC-62404, HC-62405, HC-62406
#L SOCIAL ASSISTANCE
Estimate the percent of receipts for social assistance services reported in
the following payers:

?

2012
Percent

, lines 1 through 8, from

1. Government payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3741

2. Private payers

3742

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
1 0 0 %

OS-81301
#L SOCIAL ASSISTANCE
Estimate the percent of receipts for social assistance services reported in
following payers:

?

2012
Percent

, line 5, from the

1. Government payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3741

2. Private payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3742

3. TOTAL

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
1 0 0 %

OS-81302
#L SOCIAL ASSISTANCE
Estimate the percent of receipts for social assistance services reported in
following payers:

?

2012
Percent

, line 13, from the

1. Government payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3741

2. Private payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3742

3. TOTAL

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
1 0 0 %

OS-81059
#L REPAIR RECEIPTS
Estimate the percentage of repair receipts reported in

?

, lines 1 through 6, by category:

2012
Percent

1. Labor charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3401

%

2. Parts installed in repair work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3402

%

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 0 0 %

OS-81103, OS-81104
#L REPAIR RECEIPTS
Estimate the percentage of repair receipts reported in

?

, lines 1 through 4, by category:

2012
Percent

1. Labor charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3401

2. Parts installed in repair work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3402

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
1 0 0 %

OS-81101
#L REPAIR RECEIPTS
Estimate the percentage of repair receipts reported in

?

, lines 1 through 5, by category:

2012
Percent

1. Labor charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3401

2. Parts installed in repair work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3402

3. TOTAL

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
1 0 0 %

OS-81203

#L LAUNDRY WORK
Was laundry work (other than finish work) done at this location?
3001

Yes

3002

No

OS-81203

#L DRYCLEANING
Was drycleaning work (other than finish work) done at this location?
3011

Yes

3012

No

OS-81204
#L REPAYMENTS OF CASH ADVANCES
1. Did the receipts or revenue (reported in ? ) include repayments of cash advances made by this establishment
for the convenience of those served to cover such items as cemetery expenses, transportation, flowers,
newspaper notices, clergy and musician honoraria, transcripts, and other items not in the services normally
included in the price of a funeral selected at this establishment?
3771

Yes - Go to line 2

3772

No - Go to B

2. Percent of receipts or revenue from repayments of cash advances . . . . . . . . . . . . . . . 3780

2012
Percent

%

HC-62105

MN-55102, PS-54059
#L PURCHASE OF CONTRACT MANUFACTURING
1. Did this establishment purchase contract manufacturing services from other companies or foreign plants of
your company in 2012?
Include:
• Products for which the manufacturing (i.e., transforming or otherwise processing materials or
components based on specifications provided by your company) was outsourced to other companies.
• Products for which the manufacturing was performed by your company's foreign plants.
Exclude:
• Services for packaging and assembling.
• Purchases of merchandise for resale (sale of products bought and sold without further processing or
transformation).
1011

Yes - Go to line 2

1012

No - Go to

2012

?

$ Bil.

2. Report the costs incurred by this establishment for contract
manufacturing purchased in 2012 . . . . . . . . . . . . . . . .

1013

3. Report the value of sales, shipments, receipts, or revenue
generated in 2012 from products whose purchases were reported
as contract manufacturing costs in line 2 . . . . . . . . . . . .

1015

Mil.

Thou.

Dol.

AS-56103

HC-62110