Various Economic Area Pretesting Activities

E

U.S.
D

E NT O F C

2012 REPORT OF ORGANIZATION

U.S. DEPARTMENT OF COMMERCE

OM

Economics and Statistics Administration

CE
ER
M

M
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PA

U.S. CENSUS BUREAU
FORM

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NC-99001 (DRAFT)

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EA

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BU

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EN
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F THE C

OMB No. : Approval Expires

DUE DATE
FEBRUARY 12, 2013
Mail your completed form to:

NC-9901B

U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47134-0001
Need help or have questions
about filling out this form?

Visit www.census.gov/econhelp
Call 1-800-233-6136, between
8:00 a.m. and 6:00 p.m., Eastern
time, Monday through Friday.
- OR Write to the address above.
Include your 11-digit Census File
Number (CFN) printed in the
mailing address.

(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.

1

COMPANY OWNERSHIP OR CONTROL
A. DOMESTIC OWNERSHIP OR CONTROL
1. Does another domestic company hold more than 50 percent of the voting stock of your company or have the
power to control the management and policies of your company?
0008

09901018

0080

Yes - Enter the following information of the owning or
controlling company
Name of owning or controlling company

0081

0082

Home office address (Number and street)

0083

City, town, village, etc.

No - Go to line B

0009

Enter Employer Identification
Number (EIN) of owning or
controlling company (9 digits)

0084

State

-

0085

ZIP Code

2. What percent of voting stock was held by the owning or controlling company? (Mark "X" only ONE box.)
0027

Less than 50%

0028

50%

0029

CONTINUE WITH

PENALTY FOR FAILURE TO REPORT

USCENSUSBUREAU

1

More than 50%

ON PAGE 2

Form NC-99001
1

1

(DRAFT)

COMPANY OWNERSHIP OR CONTROL - Continued
COMPANY OWNERSHIP OR CONTROL - Continued
B. 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 - Enter the following information of the owning entity and go to line C

6101
6103

Name of foreign beneficial owner

6104

Home office address (Number and street)

6105

City

6106

What was the percent
ownership (direct and
indirect)? (Mark "X" only
ONE box.)
6102

6111

10-24%

6113

50%

6112

25-49%

6114

51-99%

6115

Country

100%

No - Go to line C

C. 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?

2

6126

Yes

6127

No

RESEARCH AND DEVELOPMENT
A. Does your company conduct or sponsor research and development?
6129

Yes - Go to line B

6130

No - Go to

3

B. What was the value of research and development expenditures during 2012?

09901026

3

6132

Less than $3 million

6133

$3 million or more

EMPLOYEES FROM A PROFESSIONAL EMPLOYER ORGANIZATION
Did your company lease 50 percent or more of your permanent full- and part-time workforce from a Professional
Employer Organization during 2012? (Permanent workforce excludes temporary staffing from a staffing service
and contractors.)
0244

Yes

0245

No

Form NC-99001
4

(DRAFT)

SALES, SHIPMENTS, RECEIPTS, OR REVENUE FOR YOUR COMPANY
Include
• Sales, shipments, receipts, or revenue of U.S. companies (i.e., located
in the 50 States or the District of Columbia) for goods produced or
distributed or services provided in 2012 whether or not payment was
received in 2012.
• Sales, shipments, receipts, or revenue (exports) to foreign firms.
• Sales to and receipts from foreign parent firms and subsidiaries.
• Licensing of rights to intellectual property protected by copyright (e.g.,
literary works, software, audio visual works, musical compositions and
recordings) or as industrial property (e.g., patents and trademarks).
• Franchise sales and fees.
• For tax-exempt firms, include contributions, gifts, grants, investments,
and interest.
• For financial institutions, insurance carriers, agents and brokers, include
interest, dividends, net realized capital gains (losses), commissions, and
fees.
• For real estate, rental and leasing, include the following: Interest,
dividends, net realized capital gains (losses), commissions and fees.
Net gains (losses) from the sale of real property owned by your
company for investment, rent or lease (NOT gross sales). Gross sales
(NOT net gains (losses)) of real property developed or buildings built by
your company for sale. Interest earned from financing leases.

09901034

Exclude
• Refunds and allowances for returned merchandise as well as sales and
other taxes collected directly from customers.
• Receipts of foreign parent firms and subsidiaries.
• Domestic intra-company transfers. . . . . . . . . . . . . . . . . . .

Mark "X"
if None $ Bil.

2012
Mil.

Thou.

Dol.

Form NC-99001
5

(DRAFT)

MANUFACTURING SERVICES
1. In 2012, did your company or its' U.S. affiliates purchase manufacturing services?
Yes - Go to line 2
No - Go to

6

2. What was value of the payments made by your company or your U.S.
subsidiaries to purchase contract manufacturing services from your foreign
affiliates using your materials? . . . . . . . . . . . . . . . . . . . . . . .
Include:
• Payments you made to affiliates located OUTSIDE the 50 States,
District of Columbia, U.S. Commonwealth Territories, or U.S.
possessions to process materials and components you own, including
payments for fabricating, assembling, labeling, and packaging.
• Payments you made to affiliated foreign firms (i.e., foreign parent
firms and foreign subsidiaries and branches)
Exclude:
• Payments you made to the U.S. subsidiaries of foreign firms
• Payments you made for materials and components you owned
3. What was the value of the payments made by your company or its U.S.
subsidiaries to purchase contract manufacturing services from unaffiliated
foreign firms using your materials? . . . . . . . . . . . . . . . . . . . .
Include:
• Payments you made to unaffiliated firms located OUTSIDE the 50
States, District of Columbia, U.S. Commonwealth Territories, or U.S.
possessions to process materials and components you own, including
payments for fabricating, assembling, labeling, and packaging.
• Payments to the foreign firms for processing and for the materials and
components those firms supplied.

09901042

Exclude:
Payments you made to the U.S. subsidiaries of foreign firms.
Payments made by your foreign parent or your foreign subsidiaries or
branches.
Payments you made for materials and components you owned.
4. What was the value of the payments made by your company or its U.S.
subsidiariesto purchase contract manufacturing services using the materials
purchased by foreign (both affiliated and unaffiliated firms? . . . . . . . . .
Include:
• Payments you made to firms located OUTSIDE the 50 States, District
of Columbia, U.S. Commonwealth Territories, or U.S. possessions
to process materials and components owned by others, including
payments for fabricating, assembling, labeling, and packaging.
• Payments to the foreign firms for processing and for the materials and
components those firms supplied.
Exclude:
• Payments you made to the U.S. subsidiaries of foreign firms.
• Payments made by your foreign parent or your foreign subsidiaries or
branches.
• Payments you made for materials and components you owned.
5. What was value of the payments made by your company and its U.S.
subsidiaries to purchase contract manufacturing services from unaffiliated
domestic firms? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Total value of payments made to purchase contract manufacturing services .

Mark "X"
if None $ Bil.

2012
Mil.

Thou.

Dol.

Form NC-99001
6

(DRAFT)

INTELLECTUAL PROPERTY
1. Did your company collect receipts for the licensing of rights to use
intellectual property in 2012?
• Exclude outright sale of rights and products sold with end-use licenses.
Yes - Go to 2
Mark "X"
if None $ Bil.

No - Go to Certification
Receipts for licensing of rights to use intellectual property in 2012.

2012
Mil.

Thou.

. . .

2. Report receipts for the licensing of rights to the following types of
intellectual property:
a. Patents, trade secrets and proprietary technology, excluding computer
software. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Trademarks, excluding computer software. . . . . . . . . . . . . . .
c. Business format franchise sales and fees.
• Include the use of a trademark together with a business format.
• Exclude the sale of goods to the franchisee. . . . . . . . . . . . .
d. Content in entertainment, artistic, and literary works . . . . . . . . .
• Include rights to perform, broadcast, reproduce, and sell copyrighted
material and other intellectual property such as films, television and
radio programs; musical works; and artistic and literary works. . . .
e. Computer software
• Include licensing of rights to reproduce, distribute, or use published
(packaged) computer software.
• Exclude sales of computer software (sold with an end-use license) as
well as custom software and programming services. . . . . . . . .
f. Rights to other intellectual property
Specify - ______________________________________________
7 CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
Name of person to contact regarding this report

Area code
Telephone

Number

-

Title

Extension

Area code

Month

Internet e-mail address
Date completed

09901059

Number

Fax

Day

Year

Dol.