BE-15 Claim for Ex BE-15 Claim for Exemption

FORM BE-15

Claim for Exemption (REV 12/2016)

OMB No. 0608-0034: Approval Expires 11/30/2018
BE-15 Identification Number

2016 ANNUAL SURVEY OF FOREIGN DIRECT INVESTMENT
IN THE UNITED STATES
CLAIM FOR EXEMPTION FROM FILING FORM BE-15A, BE-15B, OR BE-15C

Name and address of U.S. business enterprise

Due date: May 31, 2017
1002

Electronic filing: www.bea.gov/efile
Mail reports to:

Name of U.S. affiliate
0

U.S. Department of Commerce
Bureau of Economic Analysis
Direct Investment Division, BE–49(A)
4600 Silver Hill Rd
Washington, DC 20233

1010

c/o (care of )
0

1003

Street or P.O. Box
0

Deliver reports to: U.S. Department of Commerce

Bureau of Economic Analysis

Direct Investment Division, BE–49(A)

4600 Silver Hill Rd

Suitland, MD 20746

1004

City

0998

0

1005

Fax reports to:

(301) 278–9500

Assistance:

E-mail: be12/[email protected]
Telephone: (301) 278-9247
Copies of blank forms: www.bea.gov/fdi

ZIP Code

OR

0

Or

State

Foreign Postal Code

Include your BE–15 Identification Number with all requests.

Response Required
All persons who are contacted by BEA about reporting in this survey, either by sending them forms or by written inquiry, must respond pursuant to
Section 801.3 of 15 CFR pt. 801 and the survey instructions. They may respond by:
• filing the properly completed Form BE-15A, BE-15B, or BE-15C by May 31, 2017;
• completing and returning the Form BE-15 Claim for Exemption from Filing Form BE-15A, BE-15B, or BE-15C, by May 31, 2017;
Mandatory, Confidentiality, Penalties
This survey is being conducted under the International Investment and Trade in Services Survey Act (P.L. 94–472, 90 Stat. 2059, 22 U.S.C.
3101–3108, as amended). The filing of reports is mandatory and the Act provides that your report to this Bureau is confidential. Whoever fails to
report may be subject to penalties. See page 4 for more details.

CONTACT INFORMATION
Provide information of person to consult about this report:
Name
0
1000

Street 1

Telephone Number

0

— —) — — — - — — — —
Fax Number
0

1001

1029

Street 2
0

0

1030

0999

City
0

State

(—
(—

Extension
0

— —) — — — - — — — —

E-mail Address

Zip

0
1028

1031

NOTE: BEA uses a Secure Messaging System to correspond with you via encrypted message to discuss questions relating to this form. We may use
your e-mail address for survey-related announcements and to inform you about secure messages. When communicating with BEA by e-mail, please do
not include any confidential business or personal information.

CERTIFICATION
The undersigned official certifies that this report has been prepared in accordance with the applicable instructions, is complete, and is substantially
accurate including estimates that may have been provided.
Signature of Authorized Official

Date

Telephone Number
0
0992

Name

Title

0
0990

0991

—

(—

— —) — — — - — — — —

Fax Number

0

0
0993

—)

— — — - — — — —

(—

Extension
0

WHICH SECTIONS TO COMPLETE?

Provide the name and address of U.S. business enterprise, the person to consult concerning questions about this report, and the certification on
page 1. Also, review the questions below to determine the additional information required.
I Were at least 10 percent of the voting rights in your business enterprise directly or indirectly owned by a foreign person or entity at the end of
your fiscal year that ended in calendar year 2016?
Yes – Continue with question II.
No – Complete item 2(a) or (b) or (c) or (f) on page 3. If your business has been liquidated or dissolved, complete (a) or (b).

Do not complete questions II, III, IV, or V.
II Were more than 50 percent of the voting rights in this U.S. business enterprise owned by another U.S. affiliate, or was this U.S. business
enterprise merged into another U.S. affiliate before the end of this U.S. business enterprise’s fiscal year that ended in calendar year 2016?
Note: U.S. affiliate is defined on page 4.

Yes – Continue with question III.

No – Skip to question IV.

III Will the data for this U.S. business enterprise be consolidated into the 2016 BE-15 report filed for the U.S. affiliate that owns it more than
50 percent, or be included on the 2016 BE-15 report filed for the U.S. affiliate into which it was merged?

Yes – Complete item 2d(1) or 2d(2) on page 3.

No – Contact BEA for guidance.

IV Is the U.S. entity a private fund? Note: Private fund is defined on page 4.

Yes – Complete item 2(e) on page 3 if the private fund meets the additional criteria described in item 2(e).
No – Skip to question V.
V Did any one of the items – Total assets, Sales or gross operating revenues, or Net income (loss) – for the U.S. affiliate (not just the foreign

parent’s share) exceed $40 million at the end of, or for, its fiscal year that ended in calendar year 2016?
Yes – You are not eligible to file Form BE-15 Claim for Exemption and
No – Complete items 1(a) through 1(h). Do NOT complete
page 3.
must file either a Form BE-15A, BE-15B, or BE-15C.
Copies of blank forms can be found at: www.bea.gov/fdi
BASIS OF CLAIM FOR EXEMPTION
Select ONE type of exemption -- either based on Value (#1 below) or based on one of the reasons listed under Other Exemptions
(#2 on page 3). Please check box corresponding to the type of exemption you are claiming.
0100

(1)

1

Exemption based on Value. Complete if item V was "NO".

Rounding – Report currency amounts in U.S. dollars rounded to thousands
(omitting 000). Do not enter amounts in the shaded portions of each line.
Example – If amount is $1,334,891.00 report as: .................................................................

$ Bil.

$ Bil.

(a) Total assets at the close of the fiscal year that ended in calendar
year 2016 – Do not net out liabilities......................................................................

Mil.

Thous.

Dols.

1

335

000

Mil.

Thous.

Dols.

1
2109

000

000

000

1

(b) Sales or gross operating revenues for the fiscal year that ended in calendar
year 2016, excluding sales taxes – Do not give gross margin...............................
(c) Net income (loss) for the fiscal year that ended in calendar year 2016, after
provision for U.S. Federal, state, and local income taxes. .....................................

2149
1

2159

1 3

1

(d) Total liabilities at the close of the fiscal year that ended in
calendar year 2016................................................................................................

2114

Please check box
if total liabilities
are zero.

000

(e) Major product(s) or service(s) of the fully consolidated domestic U.S. affiliate – Briefly describe the major
product(s) and/or service(s) of the U.S. affiliate. If a product, also state what is done to it, i.e., whether it is
mined, manufactured, sold at wholesale, transported, packaged, etc. (For example, “manufacture widgets.”)
0
1163

(f)

Industry code of the fully consolidated domestic U.S. affiliate – Enter the 4-digit International Surveys
Industry(ISI) code of the industry with the largest sales or gross operating revenues. For a full explanation
of each code, see the Guide to Industry Classifications for International Surveys, 2012. A copy of this guide 1164
can be found on our web site at: www.bea.gov/naics2012

ISI Code
1

--Select ISI CODE--

(g) Enter the country in which the foreign parent is incorporated or organized, if a business enterprise, or is resident, if an

individual or government. The foreign parent is the FIRST person or entity outside the U.S. in a chain of ownership that

has a 10 percent or more voting interest in this U.S. affiliate. See diagram on page 4 for an illustration of foreign parent. BEA USE ONLY
Country of foreign parent

1

--Select Country-(h)

3016

Enter the country in which the ultimate beneficial owner (UBO) is incorporated or organized, if a business enterprise,
or is resident, if an individual or government. The UBO is that person or entity, proceeding up the ownership chain
beginning with and including the foreign parent, that is not more than 50 percent owned or controlled by another person
or entity. See diagram on page 4 for an illustration of UBO.
BEA USE ONLY
1

Country of UBO

--Select Country-FORM BE-15 Claim For Exemption (REV 12/2016)

3022

Page 2

Check ONE box corresponding to the type of exemption you are claiming.
This U.S. business enterprise is exempt from filing a Form BE-15A, BE-15B, or BE-15C because:
(2) Other exemptions (check box below)
0170 1 1
(a)

This U.S. business enterprise was a U.S. affiliate of a foreign person or entity at some time during calendar year 2016, but ceased to
be a U.S. affiliate before the end of the fiscal year that ended in calendar year 2016.

Give date foreign ownership ceased or went below 10 percent, or when the business was liquidated or dissolved.

Month

Day
mm/dd/yyyy

Year

7012 1

0110 1 1
(b)

This U.S. business enterprise was not a U.S. affiliate of a foreign person or entity at any time during calendar year 2016, but had
been a U.S. affiliate of a foreign person at some time before January 1, 2016.

Give date foreign ownership ceased or went below 10 percent, or when the business was liquidated or dissolved.
Month
7010 1

Day
mm/dd/yyyy

Year

0180 1 1
(c)

This U.S. business enterprise is a U.S. affiliate of a foreign person or entity, but became a U.S. affiliate after the end of its fiscal year
that ended in calendar year 2016, or if a newly formed company, its first fiscal year did not or will not end until after the end of
calendar year 2016.

Complete items (1) and (2).

(1) Give date when the U.S. business enterprise became a U.S. affiliate of a foreign person.

Month

Day
mm/dd/yyyy

Year

7013 1

(2) Give the ending date of the U.S. business enterprise’s fiscal year that ended in calendar year 2016. If a newly formed company,
give the ending date of the U.S. business enterprise’s first fiscal year. NOTE: For a newly formed company this must be a date
in calendar year 2017.
Month

mm/dd/yyyy
Day

Year

7014 1

(d) This U.S. business enterprise was controlled by a U.S. affiliate of a foreign person or entity during the fiscal year that ended in

calendar year 2016 and is (check appropriate box (1) or (2)):

0112 1 1
(1)
Fully consolidated into the 2016 BE-15 report filed for that U.S. affiliate;

OR

0112 2 1

(2)

0120

Merged into, and included on the 2016 BE-15 report filed for, that U.S. affiliate.

On the lines below give the name, address, and BE-15 Identification Number of the U.S. affiliate into which this U.S. business
enterprise is fully consolidated or merged.
7011 BE-15 Identification Number
0

Name
0

0130 Street
0
0140 City
0

0160 1 1
(e)

0141 State
0

0150 Zip Code
0

This U.S. business enterprise was identified by BEA as required to file a BE-15A, BE-15B, or BE-15C survey form and ALL of the
following 3 statements apply: 1) The U.S. business enterprise is a private fund, 2) the private fund does not own, directly or
indirectly through another business enterprise, an "operating company" - i.e., a business enterprise that is not a private fund or
a holding company - in which the foreign parent owns at least 10 percent of the voting interest, AND 3) if the foreign parent owns
the private fund indirectly (through one or more other U.S. business enterprises); there are no U.S. "operating companies" between
the foreign parent and the indirectly-owned private fund. Note: The foreign investment in the U.S. private fund may be required to
be reported on Treasury International Capital (TIC) Surveys. Review reporting requirements for TIC surveys at
www.treasury.gov/tic. For more information regarding private funds, visit www.bea.gov/privatefunds.

0190 1 1
(f)
Other – Specify and include reference to section of regulations or instructions on which claim is based – attach remarks
on a separate sheet if necessary.
7015

0

FORM BE-15 Claim For Exemption (REV 12/2016)

Page 3

Authority – This survey is being conducted under the International Investment and Trade in Services Survey Act (P.L. 94-472, 90 Stat. 2059,
22 U.S.C. 3101-3108, as amended), and the filing of reports is MANDATORY pursuant to Section 5(b)(2) of the Act (22 U.S.C. 3104). The
implementing regulations are contained in Title 15, CFR, Part 801.
Penalties – Whoever fails to report may be subject to a civil penalty of not less than $4,454, and not more than $44,539, and to injunctive
relief commanding such person to comply, or both. The civil penalties are subject to inflationary adjustments. Those adjustments are found
in 15 CFR 6.4. Whoever willfully fails to report shall be fined not more than $10,000 and, if an individual, may be imprisoned for not more
than one year, or both. Any officer, director, employee, or agent of any corporation who knowingly participates in such violation, upon
conviction, may be punished by a like fine, imprisonment, or both. (22 U.S.C. 3105)
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure
to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information
displays a currently valid OMB Control Number. The control number for this survey is at the top of page 1.
Respondent Burden – Public reporting burden for this form is estimated to vary from 20 to 75 minutes per response, with an average
of 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden, to: Director, Bureau of Economic Analysis (BE-1), U.S. Department of Commerce, 4600 Silver Hill Road, Washington, DC 20233; and to the Office of Management and Budget, Paperwork Reduction
Project 0608-0042, Washington, DC 20503.
Confidentiality – The Act provides that your report to this Bureau is CONFIDENTIAL and may be used only for analytical or statistical
purposes. Without your prior written permission, the information filed in your report CANNOT be presented in a manner that allows it to be
individually identified. Your report CANNOT be used for purposes of taxation, investigation, or regulation. Copies retained in your files are
immune from legal process.

ILLUSTRATION OF FOREIGN PARENT AND ULTIMATE BENEFICIAL OWNER (UBO)
Foreign Company X
(UBO)

Foreign Company Y is the foreign
parent but it is not the UBO
because it is more than 50 percent
owned or controlled by Foreign Company X. Foreign Company
X is the UBO.

>50 Percent
Foreign Company Y
(Foreign Parent)

Foreign
United States

10 to 100 Percent

U.S. affiliate A

Foreign Company Y directly owns 10
percent or more of the voting rights of
U.S. affiliate A.

U.S. affiliate B
U.S. affiliate B is indirectly owned by
Foreign Company Y through
U.S. affiliate A.

NOTE: In the illustration above, if Foreign Company Y does not have at least a 10 percent indirect voting interest in U.S. affiliate B, then U.S. affiliate B is exempt from filing Form BE-15. In addition, if U.S. affiliate A owns
more than 50 percent of U.S. affiliate B, then the data for U.S. affiliate B should be consolidated on the BE-15
report filed for U.S. affiliate A.

DEFINITIONS OF KEY TERMS
Affiliate means a business enterprise located in one country that is directly or indirectly owned or controlled by a person or entity of another
country to the extent of 10 percent or more of its voting stock for an incorporated business or an equivalent interest for an unincorporated
business, including a branch.
Direct investment means the ownership or control, directly or indirectly, by one person or entity of 10 percent or more of the voting securities
of an incorporated business enterprise or an equivalent interest in an unincorporated business enterprise.
Private Fund refers to the same class of financial entities that must report to the Securities and Exchange Commission as private funds on
Form PR: "any issuer that would be an investment company as defined in section 3 of the Investment Company Act of 1940 but for section
3(c)(1) or 3(c)(7) of ...[that] Act."
U.S. affiliate means an affiliate located in the United States in which a foreign person or entity has a direct investment.

FORM BE-15 Claim For Exemption (REV 12/2016)

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