Sample SAS Questionnaire

SERVICE ANNUAL SURVEY
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

2016 ANNUAL SERVICES REPORT

Worksheet
FORM

SA-72000E
Due Date

Call 1-877-787-9860, option "1"
(8:00 a.m. - 5:00 p.m. ET, M-F)
or Visit
https://econhelp.census.gov/sas

WORKSHEET
DO NOT use this worksheet to respond to the survey, it is intended to assist you
with gathering and preparing your data prior to reporting online.
Please view the online report for specific instructions that may apply to your EIN
or firm.
Return to https://econhelp.census.gov/sas
_________________________________ when you are ready to report online.

YOUR RESPONSE IS REQUIRED
BY LAW. Title 13, United States
Code, Sections 131 and 182
authorizes this collection. Sections
224 and 225 requires businesses
and other organizations that
receive this questionnaire to
answer the questions and return
the report to the U.S. Census
Bureau. By Section 9 of 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. Under the same law,
information that you report cannot
be used for taxation, regulation,
or investigation and are exempt
from release under the Freedom
of Information Act. Further, copies
of your response retained in
your files are immune from legal
process.

Return via Internet:
https://econhelp.census.gov/sas
Username:

Return via Mail:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

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Need help or have questions?

(08-04-2016)

To view Survey Results:
census.gov/services

Password:

72102015
1

A. MAILING ADDRESS
Is this firm's name and mailing address the same as shown in the mailing address above?
Yes
No - Enter corrections in the mailing address above

PENALTY FOR FAILURE TO REPORT

CONTINUE ON PAGE 2

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GENERAL INSTRUCTIONS
Throughout this survey, any reference to "this firm" is referring to the EIN that is printed in the mailing address
area or the new EIN that was provided as a response in 2 . Any responses related to "this firm" should only
include data for the EIN referenced.
• Any significant change in this firm's operations should be noted in 17 .
• For establishments sold or acquired in 2016 or 2015, report data only for the period the establishments were
operated by this firm.
• Estimates are acceptable if book figures are not available.
• Enter "0" where applicable.
• Do not combine data for two or more detailed lines.
• Report data on an accrual basis, except for payroll.
$ Bil.
Mil.
Thou.
Dol.
• Figures should be rounded to the nearest dollar.
1 030280456
• If a figure is $1,030,280,456 it should be reported as
Include:
• Data for all Services establishments (excluding data for Retail, Wholesale, Manufacturing, Mining, and
Construction operations) operating under the EIN printed in the mailing address area.
• Data for auxiliary facilities primarily engaged in supporting services to those establishment(s) such as warehouses,
garages, central administrative offices, and repair services.

Form SA-72000E
1

Page 2

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B. SURVEY COVERAGE
Did this firm provide the business activities described below?

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Yes
No - Specify this firm's business activity

2

FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
Does this firm report payroll under EIN
Yes
No - Enter current 9-digit EIN AND date payroll was first
reported for this EIN . . . . . . . . . . . . . . . . . . . . . . . . .

EIN (9 digits)

Month

3

Day

Year

ORGANIZATIONAL CHANGE
A. Did this firm experience any acquisitions, sales, mergers, and/or divestitures in 2016 or 2015?

No - Go to

4

B. Which of the following organizational changes occurred in 2016 or 2015?
Check all that apply. If more than one organizational change occurred during the reporting period, explain in
Month

Acquisition
Sale

72102023

Merger

Day

17 .

Year

Date of organizational change . . . . . . . . . . . . . . . .
AND
Enter detailed information below

Divestiture
Name of company

EIN (9 digits)

Address (Number and street, P.O. Box, etc.)

City, town, village, etc.

State

ZIP Code

-

CONTINUE ON PAGE 3

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Yes

Form SA-72000E
4

Page 3

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REPORTING PERIOD
NOTE: Calendar year data are preferred. If it is not available, please report for the fiscal year that includes at least six
months of data for the 2016 and 2015 calendar years.
What time period is covered by the data provided in this report?
2015
Beginning Date
Month Day
Year

Fiscal or partial year - Report beginning and ending
dates . . . . . . . . . . . . . . . . . . . . . . . .
Month

5

Not Applicable.

6

SALES, RECEIPTS, OR REVENUE

Ending Date
Day
Year

Month

Ending Date
Day
Year

What were the revenues for this firm in 2016 and 2015?
Include:
• Report gross billings, except where noted on the form.
• Dues and assessments from members and affiliates.
• Amounts received for work subcontracted to others.
• For locations that were sold or acquired during a year, only report for the periods that this firm operated the
locations.
• Revenue from services performed by domestic locations of foreign parent firms, subsidiaries, branches, etc.
• Revenue from room and board.
• Revenue from camp tuition and campers fees.
• Receipts from guest rooms or unit rentals for all establishments owned by this firm.
• Receipts from rentals of public rooms such as ballrooms, conference rooms, etc.
• Sales of meals, alcoholic beverages, and other merchandise.
• Gaming operations.
• Site rental and equipment usage fees.
• Receipts from valet, laundry, parking, and other guest services provided by this firm.
• E-commerce revenue.

72102031

$ Bil.

1.

TOTAL OPERATING REVENUE

Mil.

2016
Thou.

Dol.

$ Bil.

Mil.

2015
Thou.

Dol.

. . . . . . .

CONTINUE ON PAGE 4

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Exclude:
• Transfers made within the company.
• Taxes collected directly from customers or clients and paid directly to a local, state, or federal tax agency.
• Occupancy Taxes.
• Rents from and revenue of separately operated departments, concessions, etc., which are leased to others.
• Commissions from vending machine operators.
• Revenue of foreign subsidiaries (those located outside the U.S., i.e., outside the 50 states, District of Columbia, U.S.
Commonwealth Territories, or U.S. Possessions).
• Grants and donations.
• Franchise revenues and royalties.

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2016
Beginning Date
Month Day
Year

Calendar year

Form SA-72000E
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SALES TAX
A. Did this firm collect any sales taxes in 2016 or 2015?
Yes
8

B. What were the total sales taxes
collected in 2016 and 2015?
Exclude excise taxes . . . . . . . . . . .
8

$ Bil.

Mil.

2016
Thou.

Dol.

$ Bil.

Mil.

2015
Thou.

Dol.

E-COMMERCE
E-commerce is the sale of goods and services where the buyer places an order, or the price and terms of the sale are
negotiated, over an Internet, mobile device (M-Commerce), extranet, EDI network, electronic mail, or other comparable
online system. Payment may or may not be made online.
A. Did this firm have any e-commerce revenue in 2016 or 2015?
Yes
No - Go to

14

$ Bil.

Mil.

2016
Thou.

Dol.

$ Bil.

Mil.

2015
Thou.

Dol.

B. What was the total e-commerce
revenue in 2016 and 2015? . . . . . .
9 – 13 Not Applicable.

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No - Go to

14 OPERATING EXPENSES

Gross annual payroll
Include salaries and wages, commissions, dismissal pay, bonuses, employee contributions to Social Security, income
tax withholding, union dues, group insurance premiums, savings bonds, cash equivalent in-kind, allowances, holiday
pay, vacation pay, sick leave, stock purchase plans, and employee contributions to pension plans. Exclude the cost of
leased employees, employer's cost for fringe benefits, and temporary staff obtained from temporary help services. For
unincorporated businesses, exclude profit or other compensation of proprietors or partners.
All other operating expenses

72102049

Include travel and entertainment; postage, shipping or delivery services; warehousing and storage services; royalties;
security services; janitorial and grounds maintenance services; purchased transportation with operators; and other
expenses not reported elsewhere.

$ Bil.

1.

Mil.

2016
Thou.

Dol.

$ Bil.

Mil.

2015
Thou.

Dol.

Personnel Costs
a. Gross annual payroll - Total annual
Medicare salaries and wages for all
employees as reported on this firm's IRS
Form 941, Employer's Quarterly Federal
Tax Return, line 5(c) for the four quarters
that correspond to the survey period or
IRS Form 944 Employer's Annual Federal
Tax Return, line 4(c). Include the spread
on stock options that are taxable to
employees as wages . . . . . . . . . . . . .
CONTINUE WITH

14

ON PAGE 5
CONTINUE ON PAGE 5

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What were the operating expenses for this firm in 2016 and 2015?
Exclude:
• Transfers made within the company.
• Capitalized expenses.
• Interest.
• Bad debt.
• Impairment.
• Income tax.

Form SA-72000E

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14 OPERATING EXPENSES - Continued
$ Bil.

2016
Thou.

Dol.

$ Bil.

Mil.

2015
Thou.

Dol.

Personnel Costs - Continued
b. Employer's cost for fringe benefits
- Employer's cost for legally required
programs and programs not required by
law:
1. Health insurance - Insurance
premiums for hospital plans, medical
plans, and single service plans (e.g.,
dental, vision, prescription drugs).
Include premium equivalents for
self-insured plans and fees paid to
third-party administrators (TPAs).
Exclude employee contributions . . .
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 . . . . .
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) . .
3. Payroll taxes, employer paid
insurance premiums (except
health), and other employer
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),
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 . . . . . . . . . . . . . . . . . . . .
c. 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 . . . . . . . . . . . . . . . . . . . . .

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CONTINUE WITH

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72102056

1.

Mil.

14

ON PAGE 6

CONTINUE ON PAGE 6

Form SA-72000E

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(08-04-2016)

14 OPERATING EXPENSES - Continued
$ Bil.

2.

Dol.

$ Bil.

Mil.

2015
Thou.

Dol.

Expensed Materials, Parts, and Supplies
(not for resale)
a. Expensed equipment - Expensed
computer hardware and other equipment
(e.g., copiers, fax machines, telephones,
shop and lab equipment, CPUs, monitors).
Report packaged software in line 3a.
Report leased and rented equipment in
line 3i . . . . . . . . . . . . . . . . . . . . . .
b. Expensed purchases of other
materials, parts, and supplies Materials and supplies used in providing
services to others; materials and parts
used in repairs; office and janitorial
supplies; small tools; containers and other
packaging materials; and motor fuels . . .
Expensed Purchased Services
a. 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 . . . . . . . . . . . . . . . . . . .
b. Data processing and other purchased
computer services - Include web
hosting, computer facilities management
services, computer input preparation, data
storage, computer time rental, optical
scanning services, and other computerrelated 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) . .
c. Purchased communication services Telephone, cellular, and fax services;
computer-related communications (e.g.,
Internet, connectivity, online), and other
wired and wireless communication
services . . . . . . . . . . . . . . . . . . . . .
d. Purchased repairs and maintenance to
machinery and equipment - Expensed
repair and maintenance services to
machinery, vehicles, equipment, and
computer hardware. Exclude materials,
parts, and supplies used for repairs and
maintenance performed by this firm's
employees . . . . . . . . . . . . . . . . . . .
e. Purchased repairs and maintenance
to buildings, structures, and offices Include repair and maintenance to
integral parts of buildings (e.g., elevators,
heating systems). Exclude materials,
parts, and supplies used for repairs and
maintenance performed by this firm's
employees. Report janitorial and grounds
maintenance services in line 4c . . . . . .
f. Purchased electricity - If the cost of
electricity is included in lease or rental
payments, report in line 3j . . . . . . . . .
CONTINUE WITH

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72102064

2016
Thou.

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3.

Mil.

14

ON PAGE 7

CONTINUE ON PAGE 7

Form SA-72000E

Page 7

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14 OPERATING EXPENSES - Continued
$ Bil.

3.

72102072

Dol.

$ Bil.

Mil.

2015
Thou.

Dol.

Expensed Purchased Services - Continued
g. Purchased fuels (except motor fuels) Fuel for heating, power, or generating
electricity (e.g., natural gas, propane, oil,
coal). If the costs are included in lease or
rental payments, report in line 3j . . . . .
h. Water, sewer, refuse removal, and
other utility payments - Include the
cost of hazardous waste removal. If the
costs of these utilities are included in
lease or rental payments, report in line 3j
i. Lease and rental payments for
machinery, equipment, and other
tangible items - Include lease and
rental of transportation equipment without
operators and penalties incurred for
broken leases. Exclude capital and
financing lease agreements and licensing/
leasing of software . . . . . . . . . . . . . .
j. Lease and rental payments for land,
buildings, structures, store spaces,
and offices - Include penalties incurred
for broken leases . . . . . . . . . . . . . . .
k. Purchased advertising and
promotional services - Include
marketing and public relations services
.
l. 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 . . . . . . . . . . . . . . . . .
Other Operating Expenses
a. Depreciation and amortization
charges - Include depreciation charges
taken against tangible assets owned and
used by this firm, tangible assets and
improvements owned by this firm within
leaseholds, tangible assets obtained
through capital lease agreements, and
amortization charges against intangible
assets (e.g., patents, copyrights).
Exclude impairment . . . . . . . . . . . . .
b. Governmental taxes and license fees Payments to government agencies for
taxes and licenses. Include business and
property taxes. Exclude income taxes
and sales and excise taxes collected from
customers . . . . . . . . . . . . . . . . . . .
c. All other operating expenses - All
other operating expenses not reported
above, unless specifically excluded in
the general instructions. Include office
postage paid and package delivery.
Exclude purchases of merchandise for
resale and non-operating expenses. If
this item is greater than 20% of the
total operating expenses, specify
the primary source of the expenses
below

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5.

2016
Thou.

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4.

Mil.

TOTAL OPERATING EXPENSES
Sum of lines 1a through 4c . . . . . . . . . .

CONTINUE ON PAGE 8

Form SA-72000E

(08-04-2016)

Page 8

15 and 16 Not Applicable.

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72102080

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CONTINUE ON PAGE 9

Form SA-72000E

Page 9

(08-04-2016)

17 REMARKS - Please use this space to explain any significant year-to-year changes, to clarify responses, or indicate where
data were estimated.

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Name of person to contact regarding this report (Please print)

Area code

72102098

Telephone
E-mail address

Number

-

Title

Extension

Area code
Fax
Website address

THANK YOU for completing your 2016 ANNUAL SERVICES REPORT.
We suggest you keep a copy for your records.

Number

-

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18 CONTACT INFORMATION