SA-722E Annual Retail Trade Report

Attachment 2 Page 89 of 92

OMB No. 0607-0013: Approval Expires 10/31/2011
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

SA-722E

(DRAFT)

2011 ANNUAL FOOD SERVICES REPORT

RESTAURANTS, FOOD SERVICE CONTRACTORS AND DRINKING
PLACES

DUE DATE

Need help or have questions?
Call 1-800-327-4389, option "2"
(8:00 a.m. - 5:00 p.m. ET, M-F)
YOUR RESPONSE IS
REQUIRED BY LAW. Title
13, United States Code,
requires businesses and other
organizations that receive
this questionnaire to answer
the questions and return the
report to the U.S. Census
Bureau. By the same law,
YOUR CENSUS REPORT IS
CONFIDENTIAL. It may be seen
only by persons sworn to uphold
the confidentiality of Census
Bureau information and may be
used only for statistical purposes.
Further, copies retained in
respondents' files are immune
from legal process.
(Please correct any errors in name, address, and ZIP Code.)

Return via Internet:
census.gov/econhelp/arts

Return via Fax:
1-800-447-4613

To view Survey Results:
census.gov/retail

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GENERAL INSTRUCTIONS
• Any significant change in this EIN's operations should be noted in 14 .
• For establishments sold or acquired in 2011 or 2010, report data only for the period the establishments were
operated by this EIN.
• Estimates are acceptable if book figures are not available.
• Enter "0" where applicable.

72116015

INCLUDE
• All food services establishments located in the U.S. (including the District of Columbia) reporting payroll on
its latest Employer's Federal Tax Return (Treasury Form 941 or 944), under the Employer Identification
Number (EIN) shown in 1 .
• Data for auxiliary facilities primarily engaged in supporting services to this EIN's establishment(s) such as
warehouses, garages, central administrative offices, and repair services.
EXCLUDE
• Data for establishments operated by other firms, such as franchises.
• Departments and concessions operated by other firms in this EIN's establishment(s).
• Data for establishments located in U.S. Territories (such as Puerto Rico, American Samoa, Guam, U.S. Virgin
Islands and Northern Mariana Islands).
SPECIAL INSTRUCTIONS

CONTINUE ON PAGE 2

Form SA-722E
1

Attachment 2 Page 90 of 92
Page 2

(DRAFT)

FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
Does this firm report payroll under EIN
Yes
EIN (9 digits)

No - Enter current 9-digit EIN AND date payroll was first
reported for this EIN . . . . . . . . . . . . . . . . . . . . . . . . .

Month

2

Day

Year

ORGANIZATIONAL CHANGE
A. Did this EIN experience any acquisitions, sales, mergers, and/or divestitures in 2011 or 2010?
Yes
No - Go to

3

B. Which of the following organizational changes occurred in 2011 or 2010?
Check all that apply. If more than one organizational change occurred during the reporting period, explain in
Month

Acquisition

Day

14 .

Year

Date of organizational change . . . . . . . . . . . . . . . .
Sale
AND
Merger
Enter detailed information below
Divestiture
Name of company

EIN (9 digits)

Address (Number and street, P.O. Box, etc.)

City

State

ZIP Code

3

REPORTING PERIOD
What time period is covered by the data provided in this report?
Calendar year

2011
Beginning Date
Month Day
Year

2010
Beginning Date
Month Day
Year

72116023

Fiscal or partial year - Report beginning and ending
dates. . . . . . . . . . . . . . . . . . . . . . . . .
Month

4

Ending Date
Day
Year

NUMBER OF ESTABLISHMENTS

Month

Ending Date
Day
Year

2011

2010

How many food services establishments, including departments and concessions,
did this EIN operate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The remainder of this report refers to the establishments reported here.

CONTINUE ON PAGE 3

Form SA-722E
5

Attachment 2 Page 91 of 92
Page 3

(DRAFT)

SALES, RECEIPTS, OR REVENUE
INCLUDE
• Credit and cash sales of merchandise
• Excise taxes (such as those on gasoline, liquor, and
tobacco) which are included in the cost of goods
purchased by this EIN
• Receipts from the rentals of public rooms such as
ballrooms, conference rooms, etc.
• Sales of meals, alcoholic beverages, and other
merchandise
• Receipts from valet, laundry, parking, and other
guest services provided by this EIN
• Leased departments and concessions operated in
other establishments

EXCLUDE
• Sales from auxiliary establishments
• Carrying or other finance charges
• Commissions (such as vending machine operators,
government lottery tickets, or other stores)
• Non-operating receipts (such as interest income,
income from investments, and receipts from the
rental or sale of real estate)
• Sales made by departments and concessions
operated by other firms in this EIN's food services
establishment(s)
• Franchise revenues and royalties
• Refunds and allowances for returned goods
• Actual value of rebates and discounts granted to the
purchaser, even if granted as an increase in trade-in
allowances

SPECIAL INSTRUCTIONS
Contract feeding
If terms of contract are Management fee basis

Include as sales Management fees plus reimbursement for the cost of food, labor,
and other operating expenses
Sales to customers plus fees or supplements from clients
All sales to customers

Cost-plus basis
Profit-loss basis

$ Bil.

Mil.

2011
Thou.

Dol.

$ Bil.

Mil.

2010
Thou.

Dol.

2011
Thou.

Dol.

$ Bil.

Mil.

2010
Thou.

Dol.

A. What was this firm's total revenue in
2011 and 2010? . . . . . . . . . . . .
B. Did this EIN collect any sales taxes in 2011 or 2010?
Yes
No - Go to

6

C. What were the total sales
taxes collected for this firm in
2011 and 2010?
Exclude excise taxes. . . . . . . . . . .
6

$ Bil.

Mil.

E-COMMERCE
E-commerce is the sale of goods and services where the buyer places an order, or the price and terms of the
sale are negotiated, over an Internet, mobile device (M-Commerce), extranet, EDI network, electronic mail, or
other comparable online system. Payment may or may not be made online.
A. Did this EIN have any e-commerce sales in 2011 or 2010?

72116031

Yes
No - Go to

13

$ Bil.

Mil.

2011
Thou.

Dol.

$ Bil.

Mil.

2010
Thou.

Dol.

B. What were the total e-commerce sales
in 2011 and 2010? . . . . . . . . . . .
7 – 12 Not Applicable.

CONTINUE ON PAGE 4

Form SA-722E

Attachment 2 Page 92 of 92
Page 4

(DRAFT)

13 OPERATING EXPENSES
INCLUDE
• Expenses arising from the normal course of
business
• Payroll

EXCLUDE
• Bad debt
• Purchases of goods for resale or cost of goods sold
• Income taxes
• Sales and other taxes collected directly from
customers and paid directly to a local, State, or
Federal government agency
• Interest expenses
• Impairment (reduction in value of long-lived assets
due to reappraisal)
• Capitalized expenses (except payroll and fringe
benefits)

$ Bil.

Mil.

2011
Thou.

Dol.

$ Bil.

Mil.

2010
Thou.

Dol.

What were the total operating expenses
for this EIN in 2011 and 2010? . . . . . .
14 REMARKS - Please use this space to explain any significant year-to-year changes, to clarify responses, or indicate where
data were estimated.

15 CONTACT INFORMATION
Name of person to contact regarding this report (Please print)

Address - Number and street

Title

City

State

ZIP Code

72116049

Area code
Telephone

Number

-

Extension

Area code
Fax

Number

-

Website address

THANK YOU
for completing your 2011 ANNUAL FOOD SERVICES REPORT.
We suggest you keep a copy for your records.
Public reporting burden for this collection of information is estimated to average 23 minutes per response, including the time for assembling
data from existing records and completing the form. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden to: Paperwork Project 0607-0013, U.S. Census Bureau, 4600 Silver Hill Road,
AMSD-3K138, Washington, DC 20233. You may e-mail comments to [email protected]; use "Paperwork Project 0607-0013" as the
subject. Respondents are not required to respond to any information collection unless it displays a valid approval number from the Office of
Management and Budget (OMB). This 8-digit number appears in the top right corner of the form.