MA-10000(S) 2014 Annual Survey Of Manufactures

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Attachment C
2014 ANNUAL SURVEY OF MANUFACTURES

FORM

MA-10000(S) (DRAFT)

OMB No. 0607-0449: Approval Expires 11/30/2014
MA-10001

Need help or have questions?
Read the accompanying information
sheet(s) before answering the
questions.
Visit econhelp.census.gov/cosasm
- OR Call:

Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001

(Please correct any errors in this mailing address.)
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 one used for this
establishment on its latest 2014 Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return?

10001014

0021

2

Yes - Go to

2

0022

No - Enter current EIN (9 digits)

-

0025

PHYSICAL LOCATION
A. Is this establishment's physical location the same as shown in 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

CONTINUE WITH
PENALTY FOR FAILURE TO REPORT

2

ON PAGE 2
CONTINUE ON NEXT PAGE

Form MA-10000(S)
If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
2

PHYSICAL LOCATION - Continued
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

0044

Do not know

0024

Do not know

C. In what type of municipality is this establishment physically located?
(Mark "X" only ONE box.)
0046

3

City, village, or
borough

0047

Town or township

0048

Other

OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2014?
(Mark "X" only ONE box.)
0011

In operation

0016

Under construction, development, or exploration

0013

Temporarily or seasonally inactive

0014

Ceased operation - Enter date at right.

0015

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

Month

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

Number of months in operation during 2014 (If none, mark "X" and go to

10001022

Mark "X"
if None

MONTHS IN OPERATION

30 .)

. . . . . . . . . .

2014
Number

0002

Where available, this form shows your establishment's prior year data in the 2013 column. The figures
may differ from those actually reported because of changes made by the U.S. Census Bureau as a result
of correspondence or a comparison with prior data. Check these figures and make any necessary
corrections. If 2013 Inventories figures are not printed on your form, report these figures in 9 , and if
applicable, 10 , 11 , and 12 .

CONTINUE ON NEXT PAGE

Form MA-10000(S)
If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.

EXAMPLE:
HOW TO
REPORT
DOLLAR
FIGURES

5

Dollar figures should be rounded to
thousands of dollars (Divide dollar
amount by 1,000):
$2,036,000.00 / 1,000 = $2,036:

Report

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

Report

SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Total value of products shipped and other
receipts (Exclude freight charges and excise
taxes. Report detail in 22 .) . . . . . . . . . . .

6

Mark "X"
if None

Mark "X"
if None

$ Bil.

2014
Mil.

$ Bil.

2

Thou.

0 3 6

EXAMPLE
2014
Mil.

2013
$ Thou.

Thou.

0100

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 ? Or, were the orders for any of the shipments reported in 5 received over an electronic network?
Electronic networks include:
• Electronic Data Interchange (EDI)
• E-mail
• Internet
• Extranet
• Other online systems
0181

Yes - Go to line B

0182

No - Go to

7

0109

2013
Percent

%

%

10001030

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

2014
Percent

CONTINUE ON NEXT PAGE

Form MA-10000(S)
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.
• Purchased professional and technical services.
For further clarification, see information sheet(s).

1. Number of production workers for pay period
including March 12 . . . . . . . . . . . . . . . . .

0325

2. All other employees for pay period including March 12

0353

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

0356

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

Mark "X"
if None

1. Annual payroll . . . . . . . . . . . . . .

0300

2. First quarter payroll (January-March 2014)

0310

8

Not Applicable.

9

INVENTORIES

2014
Number

Mark "X"
if None

A. Number of employees

$ Bil.

2014
Mil.

2013
Number

Thou.

2013
$ Thou.

Report total inventories, regardless of where held, before Last-in, First-out adjustments (if any) owned by this
establishment as of December 31.

TOTAL (Include finished
goods, work-in-process,
materials, supplies, fuels,
etc.) . . . . . . . . . . . .

Mark "X"
if None

$ Bil.

End of 2014
Mil.

Thou.

0460

Mark "X"
if None

End of 2013
Mil.

$ Bil.

Thou.

0470

10 – 12 Not Applicable.
13 CAPITAL EXPENDITURES

10001048

(Refer to the instructions on how to report leasing arrangements.)
Total capital expenditures for new and used
depreciable assets spent in 2014 (Include
buildings and other structures, machinery and
equipment. Exclude land.) . . . . . . . . . . .

Mark "X"
if None

$ Bil.

2014
Mil.

Thou.

2013
$ Thou.

Mark "X"
if None

$ Bil.

2014
Mil.

Thou.

2013
$ Thou.

0520

14 RENTAL PAYMENTS
(Exclude capital leases. Include operating leases.)
Total cost for rental or lease of buildings and
other structures, machinery and equipment
(Include land, construction equipment, tools,
office equipment, furniture, and vehicles.) . . . .

0550

CONTINUE ON NEXT PAGE

Form MA-10000(S)
If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
15 Not Applicable.
16 SELECTED EXPENSES
Cost of materials, parts, containers,
packaging, etc., used; cost of products
bought and sold without further processing
(Report sales in 22 under census product
code 9998991.); cost of purchased fuels
consumed for heat, power, or the generation
of electricity; cost of purchased electricity;
and cost of work done for you by others on
your materials . . . . . . . . . . . . . . .

Mark "X"
if None

$ Bil.

2014
Mil.

Thou.

2013
$ Thou.

0420

10001055

17 – 21 Not Applicable.

CONTINUE ON NEXT PAGE

Form MA-10000(S)
If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
General - The manufactured products and services listed below are generally made in your industry. If you make products that are
not listed, please enter a description of your products in column (a) and enter their value in column (c) in the blank lines
provided in Item 22 . If additional lines are needed please use the "REMARKS" section. PLEASE DO NOT COMBINE PRODUCT LINES.
If the information as requested cannot be taken directly from your book records, REASONABLE ESTIMATES ARE ACCEPTABLE.
Valuation of Products - Report the value of the products shipped and services performed at the net selling value, f.o.b. plant to the
customer; i.e., after discounts and allowances, and exclusive of freight charges and excise taxes. Report separately for each major kind of
product. Include the value of products exported and interplant transfers in the appropriate product line(s). Exports and interplant transfers
should also be reported separately in 5 .
Contract Work - REPORT PRODUCTS MADE BY OTHERS FOR YOU FROM YOUR MATERIALS on the specific lines as if they were made
in this establishment. On the other hand, DO NOT REPORT on the specific product lines PRODUCTS THAT YOU MADE FROM MATERIALS
OWNED BY OTHERS. Report only the amount that you received for "commission or contract receipts" under Census code 9998992.
Resales - DO NOT REPORT on the specific product lines those PRODUCTS BOUGHT AND SOLD OR TRANSFERRED FROM OTHER
ESTABLISHMENTS OF YOUR COMPANY AND SOLD WITHOUT FURTHER MANUFACTURE. Report only a value under Census code
9998991, "Resales." Report the corresponding cost in 16 , line A2.

Products and services

Product Class
code

(a)

(b)

Products shipped and other receipts, including interplant
transfers and exports
Value, f.o.b. plant
2014
2013
(c)
(d)
$ Bil.
Mil.
Thou.
$ Thou.

018

026

034

042

059

10001063

067

075

083

091

CONTINUE ON NEXT PAGE

Form MA-10000(S)
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.)

$$CENSUS_REMARKS$$

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?

10001071

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

Internet e-mail address

Number

Month

Day

Year

Date
completed

Thank you for completing your 2014 ANNUAL SURVEY OF MANUFACTURES form.
PLEASE RETAIN A COPY OF THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.