NC-99001(S) Reportof Organization

2020 - 2022 Report of Organization

Attachment J - Form NC-99001(S)

2020 - 2022 Report of Organization

OMB: 0607-0444

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Attachment J
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2020-2022 Report of Organization
OMB Control Number 0607-0444
Form NC-99001(S)

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Mailing	Address		Additional	Information

MAILING	ADDRESS
ATTN

Name	1

Name	2

Street

State

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City

ZIP	Code
99999-9999

For	Census	Bureau	Use	Only
CFN

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1

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1A:	Ownership	or	Control

,	
CFN:	

ITEM	1A:	OWNERSHIP	OR	CONTROL
Is	your	company	owned	or	controlled	by	another	domestic	company?
Yes
No

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2

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1B:	Ownership	or	Control	-	Voting	Stock	Validation

,	
CFN:	

ITEM	1B:	OWNERSHIP	OR	CONTROL	-	VOTING	STOCK	VALIDATION
Does	another	domestic	company	own	more	than	50	percent	of	the	voting	stock	of	your	company?
Yes
No

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3

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1C:	Ownership	or	Control	-	Management	and	Policy

,	
CFN:	

ITEM	1C:	OWNERSHIP	OR	CONTROL	-	MANAGEMENT	AND	POLICY
Does	another	domestic	company	have	the	power	to	control	the	management	and	policies	of	your	company?
Yes
No

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4

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1D:	Ownership	or	Control	-	Percent	of	Voting	Stock	Held

,	
CFN:	

ITEM	1D:	OWNERSHIP	OR	CONTROL	-	PERCENT	OF	VOTING	STOCK	HELD
What	percent	of	voting	stock	was	held	by	the	owning	or	controlling	company?
Less	than	50%
50%

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5

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1E:	Ownership	or	Control	-	Company	Information		Additional	Information

,	
CFN:	

ITEM	1E:	OWNERSHIP	OR	CONTROL	-	COMPANY	INFORMATION
What	is	the	name,	address,	and	9-digit	Employer	Identification	Number	(EIN)	of	the	owning	or	controlling	company?
Name	of	owning	or	controlling	company

City,	town,	village,	etc.

State
Select	State	or	Territory

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Home	office	address	(Number	and
street)

ZIP	Code
99999-9999

EIN
99-9999999

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6

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1F:	Foreign	Ownership	or	Control

,	
CFN:	

ITEM	1F:	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
No

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1G:	Foreign	Ownership	or	Control	-	Company	Information

,	
CFN:	

ITEM	1G:	FOREIGN	OWNERSHIP	OR	CONTROL	-	COMPANY	INFORMATION
What	is	the	name,	address,	and	country	of	the	foreign	entity	(company,	individual,	government)?
Name	of	foreign	beneficial	owner

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Home	office	address	(Number	and
street)

City

Country

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8

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1H:	Foreign	Ownership	or	Control	-	Percent	of	Voting	Stock	Owned		Additional	Information

,	
CFN:	

ITEM	1H:	FOREIGN	OWNERSHIP	OR	CONTROL	-	PERCENT	OF	VOTING	STOCK	OWNED
What	percent	of	voting	stock	was	owned	directly	or	indirectly	by	a	foreign	entity	(company,	individual,	government)?
10%	to	24%
25%	to	49%
50%

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51%	to	99%
100%

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9

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	1I:	Foreign	Affiliates

,	
CFN:	

ITEM	1I:	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?
Yes
No

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10

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NC-99001(S)	-	Report	of	Organization
Item	2A:	Research	and	Development		Additional	Information

,	
CFN:	

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OMB No.: 0607-0444

ITEM	2A:	RESEARCH	AND	DEVELOPMENT
Did	your	company	perform	or	fund	research	and	development	(R&D)	in	2020?
Yes
No

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NC-99001(S)	-	Report	of	Organization
Item	2B:	Research	and	Development	Expenses

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CFN:	

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ITEM	2B:	RESEARCH	AND	DEVELOPMENT	EXPENSES
What	were	your	company's	worldwide	expenses	for	research	and	development	(R&D)	in	2020?
Less	than	$3	million
$3	million	or	more

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12

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NC-99001(S)	-	Report	of	Organization
Item	3A:	Professional	Employer	Organization

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CFN:	

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ITEM	3A:	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	2020?
(Permanent	workforce	excludes	temporary	staffing	from	a	staffing	service	and	contractors)
Yes
No

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13

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NC-99001(S)	-	Report	of	Organization
Item	3B:	Business	Cooperative

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CFN:	

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ITEM	3B:	BUSINESS	COOPERATIVE
A	cooperative	is	a	business	or	organization	owned	by,	controlled	by,	and	operated	for	the	benefit	of	members	using	its	services.	Members	(also
known	as	user-owners)	can	be	individuals	or	organizations,	and	benefit	from	the	use	of	services,	products,	and/or	earnings	generated	by	the	co-op.
This	includes	purchasing	co-ops,	member/patron	organizations,	member-controlled	non-profits,	consumer	co-ops,	marketing	co-ops,	worker	co-ops,
etc.

Yes
No

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Is	this	company	a	cooperative?

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14

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NC-99001(S)	-	Report	of	Organization
Item	4A:	Certification

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CFN:	

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2020	Report	of	Organization

OMB No.: 0607-0444

ITEM	4A:	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?
Yes
No	-	Enter	time	period	covered	below
	Enter	To	Date:

MM

YYYY

MM

YYYY

Select	Month

Select	Year

Select	Month

Select	Year

Name	of	person	to	contact	regarding
this report

Title

Phone	Number

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Enter	From	Date:	

Fax	Number

E-mail	address

MMDDYYYY

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Date	Completed:
MMDDYYYY

15

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	4B:	Remarks

,	
CFN:	

ITEM	4B:	REMARKS	(Optional	-	Enter	remarks	only	if	necessary)
Please	use	this	space	only	for	any	explanations	that	may	be	essential	in	understanding	your	reported	data.	(Maximum	length	is	1,000	characters.)

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You	have	 1000 	characters	remaining

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2020	Report	of	Organization
NC-99001(S)	-	Report	of	Organization
Item	5B:	Additional	Locations	of	Operation		Additional	Information

ITEM	5B:	ADDITIONAL	LOCATIONS	OF	OPERATION
A. LOCATION	INFORMATION
What	is	this	establishment's	physical	location?
(P.O.	Box	and	rural	route	addresses	are	not	physical	locations)
CFN

EIN
99-9999999
Name

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Secondary	Name

Store	or	plant
No.

Physical	Location	(Number	and	Street)

City,	town,	village,	etc.

State
Select	State	or	Territory

ZIP	Code
99999-9999

Date	establishment
opened or is expected	to
open
MMDDYYYY

B. EMPLOYMENT	AND	PAYROLL

2020
What	was	the	number	of	employees	for	pay	period	including	March	12?
2020
What	was	the	annual	payroll?

$

,000.00

2020
What	was	the	first	quarter	payroll	(January-March	2020)?

$

,000.00

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Include	the	number	of	employees	and	payroll	for	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
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.

17

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NC-99001(S)	-	Report	of	Organization
C. MAJOR	ACTIVITY	CODE
Select	the	ACTIVITY	CODE	that	best	describes	the	activity	of	this	establishment	and	what	were	the	principal	products	or	services?
Activity	Code

Principal	products	or	services

D. FORMER	OWNER	OR	OPERATOR	INFORMATION
If	this	establishment	was	acquired,	who	was	the	former	owner	or	operator,	and	when	was	this	establishment	acquired?

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Name	of	former	owner	or	operator

Mailing	Address	(Number	and	Street,
P.O. Box, etc.)

State
Select	State	or	Territory

Month
Acquired

Year
Acquired

ZIP	Code
99999-9999

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City,	town,	village,	etc.

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18


File Typeapplication/pdf
AuthorBlynda K Metcalf (CENSUS/EWD FED)
File Modified2020-06-25
File Created2020-06-25

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