Form NC-99001 2012 Report of Organization

2012 REPORT OF ORGANIZATION

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

NC-99001

OMB No. 0607-0444: 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

NC-99001

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

Mail your
completed
form to:

- OR -

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.
The purpose of this form is to obtain an accurate and up-to-date list of your establishments, i.e., separate business locations that were in
operation or new plant(s) under construction during part or all of 2012. This list should include establishments of your company and each of
its subsidiaries. To make it easier for you to complete this report, we have prelisted information in 5 A that you have previously provided to
the U.S. Census Bureau. Please list all other establishments of your organization on 5 B. Do not duplicate establishments already prelisted in
5 A. Be sure to include items 1 through 4 when returning your completed report form. Before completing this form, please read the enclosed
definitions and instructions.

• Use blue or black ballpoint pen.
• Do not use pencil or felt-tip pen.
• Do not put slashes through 0 or 7.
1

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

Examples:

COMPANY OWNERSHIP OR CONTROL
A. DOMESTIC OWNERSHIP OR CONTROL
1. Does another domestic company hold more than 50 percent of the voting stock of your company or have the
power to control the management and policies of your company?

99001018

0008

0080

Yes - Enter the following information of the owning or
controlling company
Name of owning or controlling company

0081

0082

Home office address (Number and street)

0083

City, town, village, etc.

No - Go to line B

0009

Employer Identification
Number (EIN) of
owning or controlling
company (9 digits)

0084

State

-

0085

ZIP Code

CONTINUE WITH
PENALTY FOR FAILURE TO REPORT

1

ON PAGE 2

Form NC-99001 (DRAFT)
1

COMPANY OWNERSHIP OR CONTROL - Continued
A. DOMESTIC OWNERSHIP OR CONTROL - Continued
2. What percent of voting stock was held by the owning or controlling company? (Mark "X" only ONE box.)
Less than 50%

0027

0028

50%

0029

More than 50%

B. FOREIGN OWNERSHIP OR CONTROL
Does a foreign entity (company, individual, government, etc.) own directly or indirectly 10 percent or more of the
voting stock or other equity rights of your company?
Yes - Enter the following information of the owning entity and go to line C

6101
6103

Name of foreign beneficial owner

6104

Home office address (Number and street)

6105

City

6106

What was the percent
ownership (direct and
indirect)? (Mark "X"
only ONE box.)
6102

6111

10%-24%

6113

50%

6112

25%-49%

6114

51%-99%

6115

Country

100%

No - Go to line C

C. FOREIGN AFFILIATES
Does this company alone, or with its domestic affiliates, own 10 percent or more of the voting stock of an
incorporated foreign business enterprise, or an equivalent interest in an unincorporated business enterprise,
including ownership of real estate?

99001026

2

6126

Yes

6127

No

RESEARCH AND DEVELOPMENT
How much research and development (R&D) did your company perform or fund in the United States in 2012?
6139

None

6132

Some, but less than $3 million

6133

$3 million or more

Form NC-99001 (DRAFT)
Mark "X"
if None

Dollar figures should be rounded to
thousands of dollars.

HOW TO
REPORT
DOLLAR
FIGURES

If a figure is $2,035,628.79:

2012
Mil.

Thou.

2

Report

0 3 6

EXAMPLE

If a value is "0" (or less than $500.00): Report
3

$ Bil.

COMPANY ACTIVITIES
A. EMPLOYEES FROM A PROFESSIONAL EMPLOYER ORGANIZATION
Did your company lease 50 percent or more of its permanent full- and part-time workforce from a
Professional Employer Organization during 2012? (Permanent workforce excludes temporary staffing from a
staffing service and contractors.)
0244

Yes

0245

No

B. OPERATING REVENUES AND NET SALES
1. Your company's operating revenues and net sales generated from U.S. operations (i.e., located in the 50 states
and the District of Columbia) in 2012.
Include:
• Sales of goods and services to foreign firms.
• Revenues of discontinued operations.
• Sales to foreign parent firm and its affiliates not owned by your company.
Exclude:
• Sales generated by your company's foreign operations.
• Domestic inter-company sales.
Special instructions for tax-exempt firms: Report revenues, realized gains and losses and contributions for
all classes of net assets regardless of restrictions.
Mark "X"
if None

Operating revenues and net sales . . . . . . . . . . . . .

$ Bil.

2012
Mil.

Thou.

0100

2. Did your company have foreign subsidiaries in 2012?
9760

Yes - Go to line 3

9761

No - Go to

3

C, ROYALTIES AND LICENSE FEES FOR THE USE OF INTELLECTUAL PROPERTY

99001034

3. Does the amount reported on line 1 include inter-company sales by your company's domestic operations to
foreign subsidiaries?
9755

Yes - Go to

9756

No - Go to line 4

3

C, ROYALTIES AND LICENSE FEES FOR THE USE OF INTELLECTUAL PROPERTY

Mark "X"
if None

4. Report inter-company sales by your company's domestic
operations to foreign subsidiaries . . . . . . . . . . . . .

CONTINUE WITH

3

9758

ON PAGE 4

$ Bil.

2012
Mil.

Thou.

Form NC-99001 (DRAFT)
3

COMPANY ACTIVITIES - Continued
C. ROYALTIES AND LICENSE FEES FOR THE USE OF INTELLECTUAL PROPERTY
1. Did your company's U.S. operations earn revenue in 2012 from royalties or license fees for rights to use
intellectual property?
Include:
• Revenues from royalties and license fees for intellectual property owned by your domestic
company's domestic operations (i.e., located in the 50 states and the District of Columbia).
• Royalties and license fees paid to your company's domestic operations by foreign subsidiaries.
Exclude:
• Sales involving the transfer of ownership rights.
• Sales of and products sold with end-use licenses.
• Franchise fees.
9701

Yes - Go to line 2

9702

No - Go to

3

D, MANUFACTURING ACTIVITIES

2. Revenues from royalties and license fees for rights to use
intellectual property in 2012 . . . . . . . . . . . . . . . .

a. Technological or industrial processes (Include patents,
trade secrets, and proprietary technology. Exclude
computer software.) . . . . . . . . . . . . . . . . . .

9704

b. Entertainment, artistic, educational, and literary original
works (Include royalties and license fees for rights to
perform, broadcast, reproduce, and sell copyrighted
materials and other intellectual property such as films,
television and radio programs, written works, and
musical and other artistic works. Exclude computer
software.) . . . . . . . . . . . . . . . . . . . . . . .

9705

c. Software — Rights to reproduce, distribute, or use
software protected by copyright and owned or
controlled by the licensor (Exclude sales of software sold
with end-use licenses, as well as custom software and
programming services.) . . . . . . . . . . . . . . . .

9706

d. Other - Specify

9751

9708

99001042

e. TOTAL (Sum of lines 3a through 3d should equal
line 2.) . . . . . . . . . . . . . . . . . . . . . . . .

CONTINUE WITH

3

$ Bil.

2012
Mil.

Thou.

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

9703

3. Revenues from your company's U.S. operations, as
reported in line 2, for the following types of royalties and
license fees in 2012:

9752

Mark "X"
if None

ON PAGE 5

Form NC-99001 (DRAFT)
3

COMPANY ACTIVITIES - Continued
D. MANUFACTURING ACTIVITIES - Please respond even if you are not a manufacturer.
In 2012, did your company do any of the following activities related to manufacturing?
1. Operate manufacturing facilities (such as a factory, plant, or mill) where products are completed or partially
produced?
9709

Yes - Go to line 2

9710

No - Go to line 3

2. Provide contract manufacturing services to other companies incorporating their patents, trade secrets, or
proprietary technology?
9711

Yes

9712

No - Go to line 3
Estimate the percent of operating revenues and net sales, as reported in
AND NET SALES, from contract manufacturing services.
9713

Less than 25%

9714

25%-49%

9715

50%-74%

9716

75%-99%

9717

100%

3

B, OPERATING REVENUES

3. Purchase contract manufacturing services from other companies or foreign subsidiaries of your company
incorporating your company's patents, trade secrets, or proprietary technology?
9718

Yes

9719

No - Go to

4

, CERTIFICATION

a. Use 3rd party contract manufacturing services inside the United States (i.e., located in the 50 states and
the District of Columbia)?
9720

Yes

9721

No

b. Use 3rd party contract manufacturing services outside the United States (i.e., located in the 50 states
and the District of Columbia)?
9722

Yes

9723

No

99001059

c. Use your company's foreign subsidiaries' or affiliates' contract manufacturing services at locations
outside the United States (i.e., located in the 50 states and the District of Columbia)?
9724

Yes

9725

No

d. Estimate the percent of the cost of sales from expenses for contract manufacturing services.
9726

Less than 25%

9727

25%-49%

9728

50%-74%

9729

75%-99%

9730

100%

Form NC-99001 (DRAFT)
REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

$$CENSUS_REMARKS$$

4

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?

99001067

Yes

Month

No - Enter time period covered

Telephone

-

Year

TO
Title

Number

-

Month

FROM

Name of person to contact regarding this report

Area code

Year

Extension

-

Area code

Fax

E-mail address

Number

Month

Day

Date
completed

Thank you for completing your 2012 REPORT OF ORGANIZATION form.
PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.

Year

Form NC-99002

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

(DRAFT)

U.S. CENSUS BUREAU

2012 REPORT OF ORGANIZATION
5

Refer to this
CENSUS FILE NUMBER
in any correspondence
pertaining to this report

A. PRE-IDENTIFIED LOCATIONS OF OPERATION
We have listed establishments of your company based
on Census records. Please update this list as follows:
Column (a) - Correct any errors or omissions in the
information. The establishments are listed in the following
sequence: Employer Identification Number (EIN), major
activity, and geographic location.

Column (b) - Report the number of employees and
payroll for full- and part-time employees working at
each establishment whose payroll was reported on
your Internal Revenue Service Form 941, Employer's
Quarterly Federal Tax Return. Include part-year
operations. Do not combine data for establishments.
If book figures are not available for employment and
payroll for each establishment, please provide your
best estimates.
Column (c) - Report operational status of each
establishment at the end of 2012.

Company Establishments and Subsidiaries
(Add store or plant number, if any, and
correct any errors or omissions.)

Employment and Payroll

Operational Status at the End of 2012
(Mark "X" only ONE box.)

(b)

(c)

(a)
Line No. EIN

NAICS

2012
Number of employees for pay
period including March 12

Major activity

Name

First quarter payroll
(January-March 2012)

Secondary name

Store/Plant No.

$Bil.

Mil.

Thou.

Physical location (Number and street)

In
operation
Ceased
operation
- Give
date

Temporarily or
seasonally inactive
Month

Day

Year

Sold or leased to another operator - Give date
above AND enter name and address of new
owner or operator below
Name of new owner or operator

Mailing address (Number and street, P.O. box, etc.)
2012

City, town, village, etc.

State

Annual payroll

ZIP Code
$Bil.

Mil.

City, town, village, etc.

State

ZIP Code

Thou.

Other Specify
Line No. EIN

NAICS

2012
Number of employees for pay
period including March 12

99002016

Major activity

Name

First quarter payroll
(January-March 2012)

Secondary name

Store/Plant No.

$Bil.

Mil.

Thou.

Physical location (Number and street)

In
operation
Ceased
operation
- Give
date

Temporarily or
seasonally inactive
Month

Day

Year

Sold or leased to another operator - Give date
above AND enter name and address of new
owner or operator below
Name of new owner or operator

Mailing address (Number and street, P.O. box, etc.)
2012

City, town, village, etc.

State

Annual payroll

ZIP Code
$Bil.

Mil.

City, town, village, etc.

Thou.

Other Specify

State

ZIP Code

Form NC-99002 (DRAFT)
A. PRE-IDENTIFIED LOCATIONS OF OPERATION - Continued

5

(a) Company Establishments and Subsidiaries
Line No. EIN

(b) Employment and Payroll

NAICS

2012
Number of employees for pay
period including March 12

Major activity

Name

First quarter payroll
(January-March 2012)

Secondary name

Store/Plant No.

$Bil.

Mil.

Thou.

Physical location (Number and street)

(c) Operational Status at the End of 2012
In
operation
Ceased
operation
- Give
date

Temporarily or
seasonally inactive
Month

Day

Year

Sold or leased to another operator - Give date
above AND enter name and address of new
owner or operator below
Name of new owner or operator

Mailing address (Number and street, P.O. box, etc.)
2012

City, town, village, etc.

State

Annual payroll

ZIP Code
$Bil.

Mil.

City, town, village, etc.

State

ZIP Code

Thou.

Other Specify
Line No. EIN

NAICS

2012
Number of employees for pay
period including March 12

Major activity

Name

First quarter payroll
(January-March 2012)

Secondary name

Store/Plant No.

$Bil.

Mil.

Thou.

Physical location (Number and street)

In
operation
Ceased
operation
- Give
date

Temporarily or
seasonally inactive
Month

Day

Year

Sold or leased to another operator - Give date
above AND enter name and address of new
owner or operator below
Name of new owner or operator

Mailing address (Number and street, P.O. box, etc.)
2012

City, town, village, etc.

State

Annual payroll

ZIP Code
$Bil.

Mil.

City, town, village, etc.

State

ZIP Code

Thou.

Other Specify
Line No. EIN

NAICS

2012
Number of employees for pay
period including March 12

99002024

Major activity

Name

First quarter payroll
(January-March 2012)

Secondary name

Store/Plant No.

$Bil.

Mil.

Thou.

Physical location (Number and street)

In
operation
Ceased
operation
- Give
date

Temporarily or
seasonally inactive
Month

Day

Year

Sold or leased to another operator - Give date
above AND enter name and address of new
owner or operator below
Name of new owner or operator

Mailing address (Number and street, P.O. box, etc.)
2012

City, town, village, etc.

State

Annual payroll

ZIP Code
$Bil.

Mil.

City, town, village, etc.

Thou.

Other Specify

State

ZIP Code

Form NC-99003

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

(DRAFT)

U.S. CENSUS BUREAU

2012 REPORT OF ORGANIZATION
5

Refer to this
CENSUS FILE NUMBER
in any correspondence
pertaining to this report

B. ADDITIONAL LOCATIONS OF OPERATION
Column (a) - List separately any establishments
of your company and its subsidiaries that were not
included on the PRE-IDENTIFIED LOCATIONS OF
OPERATION. If your company operates at locations for
which you have received separate report forms, do not
list them, instead complete those forms. For acquired
establishments that you list, complete column (c2).

MAJOR ACTIVITY CODES FOR COLUMN (c1)

Column (b) - Report the number of employees and
payroll for full- and part-time employees working at
each establishment whose payroll was reported on
your Internal Revenue Service Forms 941, Employer's
Quarterly Federal Tax Return. Include part-year
operations. Do not combine data for establishments.
If book figures are not available for employment and
payroll for each establishment, please provide your
best estimates.

05 - Utilities

Column (c1) - Enter the code from the MAJOR
ACTIVITY CODES list that best describes the activity of
each establishment and specify the principal products
or services.

12 - Transportation/public warehousing

Column (c2) - Complete for acquired establishments.

16 - Professional/scientific/technical service

01 - Agricultural production
02 - Agricultural services
03 - Minerals extraction/ore processing
04 - Mining services/oil and gas field services
06 - Construction
07 - Manufacturing
08 - Merchant wholesaler
09 - Commission merchant/broker/agent/electronic marketer
(business to business)
10 - Manufacturers' sales branch/manufacturers' sales office
11 - Retail
13 - Information services/publishing/telecommunications
14 - Finance/insurance
15 - Real estate/renting/leasing
17 - Waste management/remediation service/administrative/
support service
18 - Educational service
19 - Health care
20 - Social assistance
21 - Arts/entertainment/recreation
22 - Accommodation/food service
23 - Corporate/subsidiary/regional/managing office
24 - Other - Specify major activity along with principal products
or services in column (c1) below.

IMPORTANT - DO NOT DUPLICATE ESTABLISHMENTS PRELISTED IN
Company Establishments and Subsidiaries
(Enter Employer Identification Number (EIN),
establishment name, your store or plant number, if any,
address of physical location, including ZIP Code.)

Employment and Payroll

(a)

(b)

EIN

5

A.

Major Activity in 2012
(Enter code from the MAJOR ACTIVITY CODES list
and specify the principal products or services.)
(c1)

2012

Code

Specify

Number of employees for pay
period including March 12

Name

99003014

(c2) Former Owner or Operator
Secondary name

Store/Plant No.

Physical location (Number and street)

City, town, village, etc.

Date
establishment
opened or is
expected to
open . . . .

Month

State

Day

First quarter payroll
(January-March 2012)
$Bil.

Mil.

Thou.

ZIP Code

Year

Name of former owner or operator

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

City, town, village, etc.

$Bil.

2012
Annual payroll
Mil.
Thou.

State

Month

Date acquired

. . .

ZIP Code

Year

Form NC-99003 (DRAFT)
5

B. ADDITIONAL LOCATIONS OF OPERATION - Continued
(a) Company Establishments and Subsidiaries

(b) Employment and Payroll

EIN

2012

(c1) Major Activity in 2012
Code

Specify

Number of employees for pay
period including March 12

Name

(c2) Former Owner or Operator
Secondary name

Store/Plant No.

Physical location (Number and street)

City, town, village, etc.

Date
establishment
opened or is
expected to
open . . . .

Month

State

Day

First quarter payroll
(January-March 2012)
$Bil.

Mil.

Thou.

ZIP Code

Year

Name of former owner or operator

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

City, town, village, etc.

$Bil.

2012
Annual payroll
Mil.
Thou.

2012

ZIP Code

Month

Date acquired

EIN

State

Code

Year

. . .

Specify

Number of employees for pay
period including March 12

Name

(c2) Former Owner or Operator
Secondary name

Store/Plant No.

Physical location (Number and street)

City, town, village, etc.

Date
establishment
opened or is
expected to
open . . . .

Month

State

Day

First quarter payroll
(January-March 2012)
$Bil.

Mil.

Thou.

ZIP Code

Year

Name of former owner or operator

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

City, town, village, etc.

$Bil.

2012
Annual payroll
Mil.
Thou.

2012

ZIP Code

Month

Date acquired

EIN

State

Code

Year

. . .

Specify

Number of employees for pay
period including March 12

Name

99003022

(c2) Former Owner or Operator
Secondary name

Store/Plant No.

Physical location (Number and street)

City, town, village, etc.

Date
establishment
opened or is
expected to
open . . . .

Month

State

Day

First quarter payroll
(January-March 2012)
$Bil.

Mil.

Thou.

ZIP Code

Year

Name of former owner or operator

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

City, town, village, etc.

$Bil.

2012
Annual payroll
Mil.
Thou.

State

Month

Date acquired

. . .

ZIP Code

Year