Form MI-21101 Crude Petroleum and Natural Gas Extraction

Attachment B

2012 ECONOMIC CENSUS

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Crude Petroleum and Natural Gas Extraction

FORM

MI-21101

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-21101

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:

The reporting unit for this form is an oil and gas field mineral establishment. An oil and gas field mineral
establishment represents oil and gas field activities in one state or offshore area operated by the reporting company.
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 one used for this
establishment on its latest 2012 Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return?
Yes - Go to

2

0022

No - Enter current EIN (9 digits)

0025

-

21101019

0021

PENALTY FOR FAILURE TO REPORT

CONTINUE ON PAGE 2

Form MI-21101
2

Page 2

(DRAFT)

PHYSICAL LOCATION
Answer line A if operations of this establishment are physically located onshore. Answer line B if
operations are located offshore.

State

A. Onshore (Enter name of state. Use 2-letter postal abbreviation.) . . . . . . . . . . . . . . . . . . .

0050

B. Offshore (Mark "X" only ONE box.)
(Refer to map on the last page of the information sheet(s) to determine appropriate offshore area.)

3

0052

Alaska offshore

0055

Texas offshore

0056

Atlantic offshore

0053

California offshore

0057

Northern Gulf of Mexico
offshore

0058

Pacific offshore

0054

Louisiana offshore

OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2012?
(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

Month

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

Day

Year

0018

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

4

Mark "X"
if None

MONTHS IN OPERATION

30 .)

. . . . . . . . . .

0002

21101027

Number of months in operation during 2012 (If none, mark "X" and go to

2012
Number

CONTINUE ON PAGE 3

Form MI-21101

Page 3

(DRAFT)

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

HOW TO
REPORT
DOLLAR
FIGURES

5

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.

21101035

6

0130

CONTINUE ON PAGE 4

Form MI-21101
7

Page 4

(DRAFT)

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 .
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

21101043

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

CONTINUE WITH

7

2012
Mil.

Thou.

2012
Hours
Thou.

0200

ON PAGE 5

CONTINUE ON PAGE 5

Form MI-21101

Page 5

(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.
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

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

Not Applicable.

21101050

8

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. . .

CONTINUE ON PAGE 6

Form MI-21101
9

Page 6

(DRAFT)

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 for mined products and supplies owned by this establishment as of December 31 before Last-in,
First-out (LIFO) adjustment (if any).
1. Crude petroleum,
including lease
condensate . . . . .

Mark "X"
if None

End of 2012
Mil.

$ Bil.

Thou.

Mark "X"
if None

0461

0471

0462

0472

0460

0470

0466

0476

0468

0469

$ Bil.

End of 2011
Mil.

Thou.

2. Supplies, parts, fuels,
etc. . . . . . . . . .
3. Total inventories
before LIFO
adjustment (if any)
(Add lines B1 and
B2.) . . . . . . . . .
4. LIFO reserve (if any) .
5. Total inventories
after LIFO
adjustment value
(Line B3 minus line
B4.) . . . . . . . . .
10 INVENTORIES BY VALUATION METHOD
Report how much of the inventory reported in
A. LIFO valuation
method before
adjustment . . . . .

Mark "X"
if None

$ Bil.

9

, line B3 is subject to the following valuation methods.
End of 2012
Mil.

Thou.

Mark "X"
if None

0465

0475

0487

0485

0510

0508

$ Bil.

End of 2011
Mil.

Thou.

B. Any non-LIFO
valuation method Specify method

21101068

0895

C. TOTAL (Add lines A
and B. Total should
equal 9 , line B3.) . .
11 and 12 Not Applicable.

CONTINUE ON PAGE 7

Form MI-21101

Page 7

(DRAFT)

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

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

0520

B. Capital expenditures for mineral exploration and development . . .

0536

C. TOTAL (Add lines A and B.) . . . . . . . . . . . . . . . . . . .

0535

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

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 MINERAL PROPERTY EXPENSES

A. Current operating expenses for exploration, development, and
mineral land and rights . . . . . . . . . . . . . . . . . . . . .

9855

B. Current operating expenses for royalty payments

. . . . . . . .

9856

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

0141

21101076

C. TOTAL (Add lines A and B.)

CONTINUE ON PAGE 8

Form MI-21101

Page 8

(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

21101084

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 9

CONTINUE ON PAGE 9

Form MI-21101

Page 9

(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.

21101092

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 10