Form NC-99001(L) Report of Organization

Mailing Address

MAILING ADDRESS  More
ATTN

Name 1

Name 2

Street

City

ZIP Code

State
Select State or Territory

99999-9999

For Census Bureau Use Only
CFN

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Item 1A: Ownership or Control

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CFN:

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

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Item 1B: Ownership or Control - Voting Stock Validation

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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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Item 1C: Ownership or Control - Management and Policy

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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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Item 1D: Ownership or Control - Percent of Voting Stock Held

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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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Item 1E: Ownership or Control - Company Information

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CFN:

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

Home office address (Number and street)

City, town, village, etc.

ZIP Code

State
Select State or Territory

99999-9999

EIN
99-9999999

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Item 1F: Foreign Ownership or Control

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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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Item 1G: Foreign Ownership or Control - Company Information

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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

Home office address (Number and street)

City

Country

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Item 1H: Foreign Ownership or Control - Percent of Voting Stock Owned

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CFN:

ITEM 1H: FOREIGN OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK OWNED  More
What percent of voting stock was owned directly or indirectly by a foreign entity (company, individual, government)?
10% to 24%
25% to 49%
50%
51% - 99%
100%

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Item 1I: Foreign Affiliates

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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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Item 2A: Research and Development

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CFN:

ITEM 2A: RESEARCH AND DEVELOPMENT  More
Did your company perform or fund research and development (R&D) in 2022?
Yes
No

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Item 2B: Research and Development Expenses

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CFN:

ITEM 2B: RESEARCH AND DEVELOPMENT EXPENSES
What were your company's worldwide expenses for research and development (R&D) in 2022?
Less than $3 million
$3 million or more

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Item 3A: Professional Employer Organization

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CFN:

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 2022?
(Permanent workforce excludes temporary staffing from a staffing service and contractors)
Yes
No

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Item 3B: Business Cooperative

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CFN:

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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.

Is this company a cooperative?
Yes
No

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Item 3C: Exported Services

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CFN:

ITEM 3C: EXPORTED SERVICES
Did this company sell services (not goods) to foreign businesses in 2022 (i.e. exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).

Include:
Services provided to any foreign businesses, whether unaffiliated or affiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No

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Item 3D: Imported Services

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CFN:

ITEM 3D: IMPORTED SERVICES
Did this company purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).

Include:
Services purchased from any foreign businesses, whether unaffiliated or affiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No

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Item 4A: Certification

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CFN:

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 From Date:                                                  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

Fax Number

E-mail address

Date Completed: MMDDYYYY
MMDDYYYY



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Item 4B: Remarks

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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.)

You have

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1000

characters remaining

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Item 5A: Pre-Identified Locations of Operation

ITEM 5A: PRE-IDENTIFIED LOCATIONS OF OPERATION  More
A. LOCATION INFORMATION

We have listed establishments of your company based on Census records. Correct any errors or omissions below.
(P.O. Box and rural route addresses are not physical locations)
EIN

Store or plant No.
99-9999999

NAICS

Major Activity

Name

Secondary Name

Physical Location (Number and Street)

City, town, village, etc.

ZIP Code

State
Select State or Territory

CFN

99999-9999

Line No.

B. EMPLOYMENT AND PAYROLL
Include the number of employees and payroll for full- and part-time employees working at this establishment (including employees working from home) 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.
2022
What was the number of employees for pay period including March 12?
2022
$

What was the annual payroll?

,000.00

2022
$

What was the first quarter payroll (January-March 2022)?

,000.00

C. OPERATIONAL STATUS

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Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other

CEASED OPERATION OR SOLD OR LEASED INFORMATION

If this establishment ceased operation or was sold or leased to another operator, what was the date?
MMDDYYYY
MMDDYYYY



If this establishment was sold or leased to another operator, what is the name, address, and 9-digit Employer Identification Number (EIN) of this establishment's new owner or operator?
Name of new owner/operator

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

City, town, village, etc.

ZIP Code

State
Select State or Territory

99999-9999

EIN
99-9999999

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Item 5B: Additional Locations of Operation

ITEM 5B: ADDITIONAL LOCATIONS OF OPERATION  More
Do not add locations that already exist in one of the other listed surveys.
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

Secondary Name

Store or plant No.

Physical Location (Number and Street)

City, town, village, etc.

ZIP Code

State
Select State or Territory

99999-9999

Date establishment opened or
is expected to open
MMDDYYYY



B. EMPLOYMENT AND PAYROLL
Include the number of employees and payroll for full- and part-time employees working at this establishment (including employees working from home) 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.
2022
What was the number of employees for pay period including March 12?
2022
$

What was the annual payroll?

,000.00

2022
$

What was the first quarter payroll (January-March 2022)?

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,000.00

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C. MAJOR ACTIVITY CODE

Select the ACTIVITY CODE that best describes the activity of this establishment and what were the primary products or services?
Activity
Code

Primary 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?
Name of former owner or operator

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

City, town, village, etc.

ZIP Code

State
Select State or Territory

Month
Acquired

EIN

99999-9999

Year
Acquired

99-9999999

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