MA-10000(L) 2011 Anual Survey of Manufactures (Long Form)

Attachment C
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

2011 ANNUAL SURVEY OF MANUFACTURES

FORM

MA-10000(L)

OMB No. 0607-0449: Approval Expires 10/31/2011

(DRAFT)

MA-10000

Need help or have questions about
filling out this form?
Visit www.census.gov/econhelp
Call:
- OR Write to the address below. Include
your 11-digit Census File Number (CFN)
printed in the mailing address.
Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001

(Please correct any errors in name and address, including ZIP Code.)
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.

• Use blue or black ballpoint pen.
• Do not use pencil or felt-tip pen.
• Do not put slashes through 0 or 7.

• Please center numbers in
their respective boxes.
• Place an "X" inside the box.

Examples:

Please read the accompanying instructions before answering the questions. The reporting unit for this form is
an establishment which is generally a single physical location where business is conducted or where services or
industrial operations are performed. For further clarification, see information sheet(s).
1

EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) shown to the left of the mailing address the same as the EIN used for this
establishment on its latest 2011 Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return?

Yes - Go to

2

0022

No - Enter current EIN (9 digits)

0025

-

10000016

0021

PENALTY FOR FAILURE TO REPORT

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
2

PHYSICAL LOCATION
A. Is this establishment's physical location the same as shown to the left of the mailing address?
(P.O. Box and rural route addresses are not physical locations.)
0031

0032

Yes - Go to line B
No Enter
physical
location

0035

Number and street

0036

City, town, village, etc.

0037

State

0038

ZIP Code

B. Is this establishment physically located inside the legal boundaries of the city, town, village,
etc.? (Mark "X" only ONE box.)
0041

Yes

0042

No

0043

No legal boundaries

Do not know

0044

C. In what type of municipality is this establishment physically located? (Mark "X" only ONE box.)
City, village, or
Town or
0046
0047
0048
0024
borough
township
Other
Do not know
3

OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of
2011? (Mark "X" only ONE box.)
0011

In operation

0016

Under construction, development, or exploration

0013

Temporarily or seasonally inactive

0014

Ceased operation - Give date at right

0015

0018

Month

Day

Year

Sold or leased to another operator - Give date at
right AND enter name and address of new owner
or operator and Employer Identification Number
(EIN) below
0060

Name of new owner or operator

0061

EIN (9 digits)

0062

Mailing address (Number and street, P.O. Box, etc.)

0063

City, town, village, etc.

0064

State

0065

ZIP Code

10000024

-

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
4

Mark "X" 2011
if None Number

MONTHS IN OPERATION

Number of months in operation during 2011 (If none, mark "X" and go to

Dollar figures should be rounded
to thousands of dollars.

HOW TO
REPORT
DOLLAR
FIGURES

5

30 .)

. . . . . . . . . .

Mark "X"
if None

If a figure is $2,035,628.79:

Report

If a value is "0" (or less than
$500.00):

Report

0002

2011
Mil.

$ Bil.

2

Thou.

0 3 6

SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Mark "X"
if None

A. Total value of products shipped and other
receipts (Report detail in 22 .) . . . . . . . . .

$ Bil.

2011
Mil.

Thou.

2010
$ Thou.

0100

B. Value of products exported (This is a breakout
of the value reported on line A.)
Report the value of products shipped for
export. Include shipments to customers in
the Commonwealth of Puerto Rico and U.S.
possessions, as well as the value of products
shipped to exporters or other wholesalers for
export. Also, include the value of products
sold to the U.S. Government to be shipped
to foreign governments. Exclude products
shipped for further manufacture, assembly, or
fabrication in the United States. . . . . . . .
C. Shipments to other domestic plants of your
company for further assembly, fabrication, or
manufacture

0130

10000032

1. Is this the only establishment of this firm?
0907

Yes - Go to

0908

No - Go to line C2

6

2. Market value of products shipped to
other domestic plants of your company
for further assembly, fabrication, or
manufacture (This is a breakout of the
value reported on line A.) . . . . . . . . .

0905

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
6

E-SHIPMENTS
A. Did this plant use any electronic network to control or coordinate the flow of any of the shipments of goods reported
in 5 , line A? Or, were the orders for any of the shipments reported in 5 , line A received over an electronic network?
Electronic networks include:
• Electronic Data Interchange (EDI)
• E-mail
• Internet
0181

Yes - Go to line B

• Extranet
• Other online systems

0182

No - Go to

7

0109

2010
Percent

%

%

10000040

B. Percent of total reported in 5 , line A that were ordered, or whose movement
was controlled or coordinated over electronic networks (Report whole
percents. Estimates are acceptable.) . . . . . . . . . . . . . . . . . . . .

2011
Percent

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
7

EMPLOYMENT AND PAYROLL
Include:
• Full- and part-time employees working at this establishment whose payroll was reported on Internal
Revenue Service Form 941, Employer's Quarterly Federal Tax Return, and filed under the Employer
Identification Number (EIN) shown to the left of the mailing address or corrected in 1 .
• Spread on stock options that are taxable to employees as wages.
Exclude:
• Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN.
• Temporary staffing obtained from a staffing service.
For further clarification, see information sheet(s).
A. Number of employees

Mark "X"
if None

1. Number of production workers for pay periods including:
a. March 12 . . . . . . . . . . . . . . . . . . . . . .

0325

b. June 12

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

0324

c. September 12 . . . . . . . . . . . . . . . . . . . .

0344

d. December 12 . . . . . . . . . . . . . . . . . . . .

0347

2. Add lines A1a through A1d

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

0329

3. Average annual production workers (Divide line A2 by A4
- omit fractions.) . . . . . . . . . . . . . . . . . . . .

0335

4. All other employees for pay period including March 12 . .

0336

5. TOTAL (Add lines A3 and A4)

0337

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

B. Payroll before deductions (Exclude employer's cost for
fringe benefits.)

Mark "X"
if None

10000057

1. Annual payroll
a. Production workers . . . . . . . . . . . . . .

0304

b. All other employees . . . . . . . . . . . . . .

0305

c. TOTAL (Add lines B1a and B1b) . . . . . . . .

0300

2. First quarter payroll (January-March 2011) . . . . .

0310

$ Bil.

Mark "X"
if None

C. Number of hours worked by production workers (Annual
hours worked by production workers reported on lines A1a
through A1d.) . . . . . . . . . . . . . . . . . . . . . . .
CONTINUE WITH

7

2011
Number

2011
Mil.

2011
Hours
Thou.

2010
Number

Thou.

2010
$ Thou.

2010
Hours
Thou.

0200

ON PAGE 6
CONTINUE ON NEXT PAGE

Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
7

EMPLOYMENT AND PAYROLL - Continued
D. Employer's cost for fringe benefits - Employer's cost
for legally required programs and programs not
required by law.

Mark "X"
if None

$ Bil.

2011
Mil.

Thou.

2010
$ Thou.

1. Health insurance - Insurance premiums on
hospitals, medical plans, and single service plans
such as dental, vision, and prescription drug plans.
Include premium equivalents for self-insured plans
and fees paid to third party administrators (TPAs).
Exclude disbursement from trusts or funds to
satisfy health insurance claims. Do not include
employee contributions. . . . . . . . . . . . . .

10000065

0333

8

2. Pension plans
a. Defined benefit pension plans - Costs for
both qualified and non-qualified defined
pension plans. Pension plans that specify
the benefit to be paid to employees upon
retirement, generally either a specific
amount or a percentage of compensation.
Employer contributions are based on actuarial
computations that include the employee's
compensation and years of service and are not
allocated to specific accounts maintained for
employees. . . . . . . . . . . . . . . . . . .

0335

b. Defined contribution plans - Costs under
defined contribution plans. Pension plans
that define the employer contributions to a
separate account provided for each employee.
The employee "benefit" at retirement depends
on the amount contributed and the results of
the account's activity. Examples include profit
sharing plans, money purchase (e.g., 401k,
403b) and stock bonus plans (e.g., ESOPs) . . .

0337

3. Payroll taxes, employer paid insurance
premiums (excluding health), and other
employer paid benefits - Include legally-required
fringe benefits (e.g., Social Security, workers'
compensation insurance, unemployment tax, state
disability insurance programs, Medicare). Include
benefits for life insurance, "quality of life" benefits
(e.g., childcare assistance, subsidized commuting,
etc.), employer contributions to pre-tax benefit
accounts (e.g., health savings accounts), education
assistance, and other benefits not specified above.
Exclude disbursements from trusts or funds to
satisfy health insurance claims. . . . . . . . . . .

0339

4. TOTAL (Add lines D1 through D3)

0220

. . . . . . . .

Not Applicable.

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
9

VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2011 and/or 2010?
0488

Yes - Go to line B

0489

No - Go to

13

B. Report inventories

owned by this
establishment as
of December 31
before Last-in,
First-out (LIFO)
adjustment (if any)

1. Finished goods

Mark "X"
if None

End of 2011
Mil.

Mark "X"
if None

Thou.

0461

0471

0463

0473

0462

0472

0460

0470

0466

0476

0490

0492

2. Work-in-

process . . . .

$ Bil.

$ Bil.

End of 2010
Mil.

Thou.

3. Materials,

supplies, fuels,
etc. . . . . . .

4. Total

inventories
(Add lines B1
through B3) . .

5. LIFO reserve

(Report LIFO
gross in 10 ,
line A) . . . .

6. Total

10000073

inventories
after LIFO
adjustment
(Line B4 minus
line B5) . . . .

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
10 INVENTORIES BY VALUATION METHOD
Report how much of the
inventory reported in
9 , line B4 is subject to
the following valuation Mark "X"
if None
methods.
A. LIFO valuation

method before
adjustment (Report
LIFO reserve in 9 ,
line B5) . . . . . .

B. First-in, First-out

$ Bil.

End of 2011
Mil.

Mark "X"
if None

Thou.

$ Bil.

End of 2010
Mil.

Thou.

0465

0475

(FIFO) . . . . . . .

0498

0496

C. Average cost . . .

0502

0500

D. Standard cost . . .

0506

0504

0487

0485

0510

0508

E. Other valuation

method - Specify
method

0895

F. TOTAL (Add lines

A through E. Total
should equal 9 ,
line B4.) . . . . . .

11 INVENTORIES OUTSIDE OF THE UNITED STATES
A. Of the total inventories reported in
and the District of Columbia?
0256

Yes - Go to line B

0257

No - Go to

9

, line B4 were any stored or en route OUTSIDE the 50 U.S. states

13

B. Report the total value

of these inventories (Do
not report inventory
held in Foreign Trade
Zones or in bonded
Mark "X"
warehouses in the
if None
U.S.) (Please see
www.ia.ita.doc.gov/
ftzpage/info/
ftzstart.html for more
detailed definitions.) . . 0261

$ Bil.

End of 2011
Mil.

Thou.

Mark "X"
if None

$ Bil.

End of 2010
Mil.

Thou.

0260

10000081

12 Not Applicable.

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
13 CAPITAL EXPENDITURES
(Refer to the instructions on how to report leasing arrangements.)
A. Capital expenditures for new and used
depreciable assets spent in 2011
1. Capital expenditures for new and used
buildings and other structures (Exclude
land.) . . . . . . . . . . . . . . . . . .

0525

2. Capital expenditures for new and used
machinery and equipment . . . . . . . .

0530

3. TOTAL (Add lines A1 and A2)

0520

. . . . . .

Mark "X"
if None

$ Bil.

2011
Mil.

Thou.

2010
$ Thou.

Mark "X"
if None

$ Bil.

2011
Mil.

Thou.

2010
$ Thou.

B. Breakdown of expenditures for new and used
machinery and equipment by type (Reported on
line A2.)
1. Automobiles, trucks, etc., for highway use .

0522

2. Computers and peripheral data processing
equipment . . . . . . . . . . . . . . . .

0523

3. All other expenditures for machinery and
equipment . . . . . . . . . . . . . . . .

0524

4. TOTAL (Add lines B1 through B3) . . . . .

0529

14 RENTAL PAYMENTS
(Exclude capital leases (leases with a contract to
own at the end of the lease).)
A. Rental or lease of buildings, job-site trailers,
and other structures (Include land.) . . . . . .
0551

B. Rental or lease of construction equipment and
tools, machinery, office equipment, furniture,
and vehicles . . . . . . . . . . . . . . . . .

0552

C. TOTAL (Add lines A and B)

0550

. . . . . . . . .

10000099

15 Not Applicable.

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
16 SELECTED EXPENSES AND DEPRECIATION
A. Selected production related costs
1. Cost of materials, parts, containers,
packaging, etc. used . . . . . . . . . . .
2. Cost of products bought and sold without
further processing (Report sales in 22 .) . . .

Mark "X"
if None

$ Bil.

2011
Mil.

Thou.

2010
$ Thou.

Mark "X"
if None

$ Bil.

2011
Mil.

Thou.

2010
$ Thou.

Bil.

2011
Kilowatt-hours
Mil.

Thou.

2010
Kilowatt-hours
Thou.

0421

0426

3. Cost of purchased fuels consumed for
heat, power, or the generation of electricity
. . . . . . . . . . . . . . . . . . . . .

0430

4. Cost of purchased electricity (Report
quantity on line C1.) . . . . . . . . . . .

0425

5. Cost of work done for you by others on
your materials . . . . . . . . . . . . . .

0424

6. TOTAL (Add lines A1 through A5)

0420

. . . .

B. Normal depreciation charges for all tangible
assets including buildings, machinery, and
equipment . . . . . . . . . . . . . . . . .

0540

Mark "X"
if None

10000107

C. Quantity of Electricity
1. Purchased electricity (Quantity
corresponding to cost reported on line A4.)
. . . . . . . . . . . . . . . . . . . . .

0436

2. Generated electricity (Gross less
generating station use.) . . . . . . . . .

0437

3. Electricity sold or transferred to other
establishments (Include on lines C1 or C2.)

0438

CONTINUE WITH

16

ON PAGE 11

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
16 SELECTED EXPENSES AND DEPRECIATION - Continued
D. Other operating expenses paid by this
establishment (Include expenses normally
considered as non-production related costs and
purchased from other companies)
1.

2.

3.

10000115

4.

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.) . . . . . . . . . . . . . . . .
Expensed computer hardware and related
equipment - Include costs for purchased
computer hardware and supplies that is
expensed. Exclude capitalized computer
hardware expenses, which are to be
reported in items 13A2 and 13B2. . . . .
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.) Exclude capitalized computer
software costs. Exclude costs associated
with computer software developed within
your own company. . . . . . . . . . . .
Data processing and other purchased
computer services (Include computer
facilities management services, computer
input preparation, data storage, computer
time rental, optical scanning services,
and other computer-related advice and
services, including training. Exclude
expensed integrated systems, repair and
maintenance of computer equipment,
payroll processing and credit card
transaction fees, and expenses for
telecommunication services (e.g., Internet,
connectivity, telephone)) . . . . . . . . .

Mark "X"
if None

$ Bil.

2011
Mil.

Thou.

2010
$ Thou.

0176

0403

0188

0198

CONTINUE WITH

16

ON PAGE 12

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
16 SELECTED EXPENSES AND DEPRECIATION - Continued
5.

6.

7.
8.
9.

Purchased communication services Telephone, cellular, and fax services;
computer-related communications (e.g.,
Internet, connectivity, online) and other
wired and wireless communication
services. . . . . . . . . . . . . . . . .
Purchased repairs and maintenance
to buildings and/or machinery and
equipment (Exclude materials, parts,
and supplies used for repairs and
maintenance performed by this firm's
employees.) . . . . . . . . . . . . . .
Water, sewer, refuse removal, and other
utility payments (Include the costs of
hazardous waste removal.) . . . . . . .
Purchased advertising and promotional
services (Include marketing and public
relations services.) . . . . . . . . . . .
Purchased professional and technical
services (Include management consulting,
accounting, auditing, bookkeeping, legal,
actuarial, payroll processing, architectural,
engineering, and other professional
services. Exclude salaries paid to your
own employees for these services.) . . .

10. Governmental taxes and license fees Payments to government agencies for
taxes and licenses. (Include business and
property taxes. Exclude income taxes.) . .
11. All other operating expenses not reported
elsewhere. (Exclude purchases of
merchandise for resale and nonoperating
expenses.) - Specify

0417

12. TOTAL (Add lines D1 through D11.) . . .

Mark "X"
if None

$ Bil.

2011
Mil.

Thou.

2010
$ Thou.

0427

0401

0407

0409

0217

0405

0415

0422

10000123

17 – 21 Not Applicable.

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
If you cannot locate the description of any products that you produce, please enter a description of your products
in column (a) and enter their value in column (c). If additional lines are needed please use the "REMARKS" section.
Report separately for each major kind of product. Include the value of products exported and interplant transfers in the
appropriate product line(s). They should also be reported separately in 5 . Report separately under Product Class code
9998900 sales of products bought and sold without further manufacture, processing, or assembly.
Enter TOTAL value of shipments under code 7700000.

Products and services

Product Class
code

(a)

(b)

Products shipped and other receipts, including interplant
transfers and exports
2011
$ Bil.

(c)
Mil.

2010
Thou.

(d)
$ Thou.

018

026

034

042

059

067

10000131

075

083

091

109

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Form MA-10000(L)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
23 – 29 Not Applicable.
REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

30 CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
Is the time period covered by this report a calendar year?

Month

Year

FROM

10000149

Yes

Month

Year

TO

No - Enter time period covered

Name of person to contact regarding this report

Area code
Telephone

Number

Title

Extension

Area code

Number

Fax
Month

Internet e-mail address

Day

Year

Date
completed

Thank you for completing your 2011 ANNUAL SURVEY OF MANUFACTURES form.
PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.