MI-21351 Oil and Gas Field Services - Consolidated

Attachment B

2012 ECONOMIC CENSUS

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Oil and Gas Field Services - Consolidated

FORM

MI-21351

OMB No. 0607-0939: Approval Expires

(DRAFT)

(Please correct any errors in this mailing address.)

DUE DATE
FEBRUARY 12, 2013
Need help or have questions?
• Read the accompanying information sheet(s) before
answering the questions.
• Visit

MI-21351

econhelp.census.gov

• Call 1-800-233-6136, between 8:00 a.m. and 6:00 p.m.,
Eastern time, Monday through Friday.

Report Online - It's fast and secure!
Go to:
econhelp.census.gov

- OR -

Mail your
completed
form to:

U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47134-0001

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:

21351010

The reporting unit for this form is an oil and gas field service establishment. An oil and gas field
service establishment represents all nationwide oil and gas field support activities performed for
operators of oil and gas field properties under your current Employer Identification Number (EIN) on
a fee or contract basis.
Oil and gas field service activities include drilling, exploration, and other support services performed
in the United States and adjoining offshore areas.
For more examples and further clarification, see information sheet(s).

1 – 4

Not Applicable.

PENALTY FOR FAILURE TO REPORT

CONTINUE ON PAGE 2

Form MI-21351

HOW TO
REPORT
DOLLAR
FIGURES

5

Page 2

(DRAFT)

Mark "X"
if None

Dollar figures should be rounded to
thousands of dollars.
If a figure is $2,035,628.79:

Report

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

Report

$ Bil.

2012
Mil.

2

Thou.

0 3 6

EXAMPLE

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

Exclude nonoperating income such as royalties, interest, dividends,
or the sale of fixed assets.
A. Total value of products shipped and other receipts (Report detail
in 22 .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$ Bil.

2012
Mil.

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 Panama Canal Zone, 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. . . . . . . .
Not Applicable.

21351028

6

0130

CONTINUE ON PAGE 3

Form MI-21351

Page 3

(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 for this reporting unit whose payroll was reported on Internal Revenue Service
Form 941, Employer's Quarterly Federal Tax Return.
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.
• Subcontractors and their employees.
For further clarification, see information sheet(s).

2012
Number

Mark "X"
if None

A. Number of employees
1. Number of mining, production, development, and exploration workers for
pay period including March 12 . . . . . . . . . . . . . . . . . . . . . .

0325

2. Number of other employees for pay period including March 12

. . . . . .

0336

3. TOTAL (Add lines A1 and A2.) . . . . . . . . . . . . . . . . . . . . . .

0320

B. Payroll before deductions (Exclude employer's cost for fringe benefits.)
Mark "X"
if None

1. Annual payroll
a. Mining, production, development, and exploration workers .

0304

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

0305

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

0300

2. First quarter payroll (January-March, 2012) . . . . . . . . . .

0310

$ Bil.

Mark "X"
if None

Thou.

2012
Hours
Thou.

0200

21351036

C. Number of hours worked by mining, production, development, and exploration
workers (Annual hours worked by mining, production, development, and
exploration workers reported on line A1.) . . . . . . . . . . . . . . . . . .

2012
Mil.

CONTINUE WITH

7

ON PAGE 4

CONTINUE ON PAGE 4

Form MI-21351
7

Page 4

(DRAFT)

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

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

0333

2. Pension plans
a. Defined benefit pension plans - Costs for both qualified
and unqualified 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. Other - Other fringe benefits (e.g., Social Security, workers'
compensation insurance, unemployment tax, state disability
insurance programs, life insurance benefits, Medicare) . . . .

0339

4. TOTAL (Add lines D1 through D3.) . . . . . . . . . . . . . .

0220

8

Not Applicable.

9

INVENTORIES
Report inventories at cost or market using generally accepted accounting practices.
A. Did this establishment own inventories, regardless of where held, at the end of 2012 and/or 2011?
0486

Yes - Go to line B

0487

No - Go to

13

B. Report inventories and Last-in, First-out (LIFO) adjustment, if any, for products owned by this establishment as of
December 31.

21351044

1. Total inventories
before LIFO
adjustment (if any)

Mark "X"
if None

$ Bil.

End of 2012
Mil.

Thou.

Mark "X"
if None

0460

0470

0466

0476

0468

0469

$ Bil.

End of 2011
Mil.

Thou.

2. LIFO reserve (if any)
3. Total inventories
after LIFO
adjustment value
(Line B1 minus line
B2.) . . . . . . . . .

CONTINUE ON PAGE 5

Form MI-21351

Page 5

(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
A. LIFO valuation
method before
adjustment . . . . .

Mark "X"
if None

9

, line B1 is subject to the following valuation methods.

$ Bil.

End of 2012
Mil.

Mark "X"
if None

Thou.

0465

0475

0487

0485

0510

0508

$ Bil.

End of 2011
Mil.

Thou.

B. Any non-LIFO
valuation method Specify method

0895

C. TOTAL (Add lines A
and B. Total should
equal 9 , line B1.) . .
11 and 12 Not Applicable.
13 ASSETS, CAPITAL EXPENDITURES, RETIREMENTS, AND DEPRECIATION
See information sheet(s) on how to report leasing arrangements.
A. Gross value of depreciable assets (acquistion cost) at the
beginning of the year . . . . . . . . . . . . . . . . . . . . . .

0500

B. Capital expenditures for new and used buildings, structures,
machinery, and equipment depreciable assets (Exclude land.) . . .

0520

C. Total retirements and disposition of depreciable assets for the year
(Gross value of assets sold, retired, scrapped, destroyed, etc.) . . .

0510

D. Gross value of depreciable assets at the end of the year (Add lines
A and B minus C.) . . . . . . . . . . . . . . . . . . . . . . . .

0505

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

0540

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

21351051

14 RENTAL PAYMENTS

A. Rental payments for buildings and other structures (Include land.)

0551

B. Rental payments for machinery and equipment

. . . . . . . . .

0552

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

0550

C. TOTAL (Add lines A and B.)
15 Not Applicable.

CONTINUE ON PAGE 6

Form MI-21351

Page 6

(DRAFT)

16 SELECTED EXPENSES
Include costs incurred in mining process such as supplies, resales, contract work, fuels, and electricity.
Mark "X"
if None

A. Selected production related costs
1. Cost of supplies used, natural gas and liquids processed and
purchased machinery installed (Report detail in 17 .) . . . . . .

0421

2. Cost of products bought and sold as such without further
processing (Report sales in 22 .) . . . . . . . . . . . . . . . .

0426

3. Cost of purchased fuels consumed for heat, power, or the
generation of electricity (Report detail in 18 .) . . . . . . . . .

0430

4. Cost of purchased electricity (Report quantity on line B1.)

. . .

0425

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

0424

6. TOTAL (Add lines A1 through A5.) . . . . . . . . . . . . . .

0420

Mark "X"
if None

21351069

B. Quantity of Electricity
1. Purchased electricity (Quantity comparable 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 B1 or B2.) . . . . . . . . . . . . . . . . . . . . . .

0438

CONTINUE WITH

16

$ Bil.

Bil.

2012
Mil.

2012
Kilowatt-hours
Mil.

Thou.

Thou.

ON PAGE 7

CONTINUE ON PAGE 7

Form MI-21351

Page 7

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
16 SELECTED EXPENSES - Continued
C. Other operating expenses paid by this establishment
1.

0176

Expensed equipment - Expensed computer hardware and other
equipment (e.g., copiers, fax machines, telephones, shop and
lab equipment, CPUs, monitors) (Report packaged software on
line C3.) . . . . . . . . . . . . . . . . . . . . . . . . . .

0444

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.) . . . . . . . . . . . . . . . . . . . . . . .

0188

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).] . . . . . . . . . . . . . . . . . .

0198

Purchased communication services - Telephone, cellular,
and fax services; computer-related communications (e.g.,
Internet, connectivity, online) and other wired and wireless
communication services . . . . . . . . . . . . . . . . . . .

0402

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.) . . . . . . . . . . . . . . . . . . . . . .

0394

Water, sewer, refuse removal, and other utility payments
(Include the costs of hazardous waste removal.) . . . . . . . .

0407

Purchased advertising and promotional services (Include
marketing and public relations services.) . . . . . . . . . . .

0405

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.) . . . . . . . . . . . . .

0216

10. Governmental taxes and license fees - Payments to
government agencies for taxes and licenses (Include business
and property taxes. Exclude income taxes.) . . . . . . . . . .

0396

2.

3.

4.

5.

6.

7.
8.

9.

21351077

Mark "X"
if None

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.) . . . . . . . . . . . . . . . . . . . .

$ Bil.

2012
Mil.

Thou.

11. All other operating expenses not reported elsewhere (Exclude
purchases of merchandise for resale and nonoperating
expenses.) - Specify
0897

12. TOTAL (Add lines C1 through C11.) . . . . . . . . . . . . .

0397

0449

CONTINUE ON PAGE 8