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pdfU.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
FORM
2011 ANNUAL ACCOMMODATION REPORT
HOTELS & CASINO HOTELS
SA-721A
OMB No. 0607-0013: Approval Expires 10/31/2011
DUE DATE
Need help or have questions?
Call 1-800-327-4389, option "2"
(8:30 a.m. - 5:00 p.m. EST, M-F)
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.
(Please correct any errors in name, address, and ZIP Code.)
Return via Internet:
Return via Fax:
Return via Mail:
www.census.gov/econhelp/arts
1-800-447-4613
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
Username:
Password:
Use your firm's unique username and
original password. If you change your
password, please keep a record for
future reference.
GENERAL INSTRUCTIONS
72111016
• Always provide book figures. If they are not available, carefully prepared estimates, labeled "Est." are
acceptable.
• Any significant change in your firm's operations should be noted in the "REMARKS" section of this report.
• To view the results of this survey, visit www.census.gov/retail.
INCLUDE
• All domestic/U.S. accommodations establishments operated by your firm and its subsidiaries
• Data for auxiliary facilities of your firm engaged in furnishing supporting services to your covered
establishment(s) (such as warehouses, garages, central administrative offices, and repair services)
• Data for establishment(s) sold or acquired during 2011 for the period they were operated by your firm
EXCLUDE
• Data for establishments operated by other firms, such as franchises
• Departments and concessions operated by other firms in your covered establishment(s)
PENALTY FOR FAILURE TO REPORT
USCENSUSBUREAU
CONTINUE ON PAGE 2
Form SA-721A
Page 2
(DRAFT)
1 A OWNERSHIP OR CONTROL
1. Does another firm own more than 50 percent of the working stock or have the power to control
management and policies of this firm?
Yes - Enter the following information of the owning or
controlling company
Name of owning or controlling company
No - Go to line 2
Employer Identification Number (EIN) for
owning or controlling company (9 digits)
Address (Number and street)
City
State
ZIP Code
2. Did your firm experience any organizational change during 2011?
Yes
No - Go to
1
B
3. Which one of the following best describes your firm's organizational change?
Sold to
Month
Merged with
Date of sale/merger or acquisition
Acquired
AND enter name and address of
company sold to/merged with/acquired
Name of company sold to/merged with/acquired
2011
Year
EIN (9 digits)
Address (Number and street, P.O. Box, etc.)
City
State
ZIP Code
1 B NUMBER OF ESTABLISHMENTS
1. How many establishments, including those your firm manages for another firm,
were covered by this report as of December 31, 2011? . . . . . . . . . . . . . . .
Mark "X"
if None
Number as of
December 31, 2011
2. How many of the above establishments were:
72111024
a. Both owned AND managed by your firm?
b. Owned by YOUR firm, but managed by ANOTHER firm?
c. Owned by ANOTHER firm, but managed by YOUR firm?
CONTINUE ON PAGE 3
Form SA-721A
Page 3
(DRAFT)
2 A REVENUE
INCLUDE
• Receipts from guest rooms or unit rentals for all
establishments owned and/or managed by your
firm
• Receipts from rentals of public rooms such as
ballrooms, conference rooms, etc.
• Sales of meals, alcoholic beverages, and other
merchandise
• Sales of gaming operations
• Site rental and equipment usage fees
• Receipts from valet, laundry, parking, and other
guest services provided by this firm
• For casino hotels, report sales net of promotional
allowances
• Credit and cash sales of merchandise
• E-commerce sales if not submitted on a separate
Annual Retail Trade Report
• Excise taxes (such as those on gasoline, liquor, and
tobacco) which are included in the cost of goods
purchased by this firm
EXCLUDE
• Sales from auxiliary establishments
• Carrying or other finance charges
• Commissions (such as vending machine operators,
government lottery tickets, or other stores)
• Non-operating receipts (such as interest income,
income from investments, and receipts from the
rental or sale of real estate)
• Sales made by departments and concessions
operated by other firms in your firm's
accommodation establishment(s)
• Franchise fees and royalties
• Management fees and reimbursable revenues
• Revenue from casinos without accommodations
• Revenue from timeshares or vacation ownership
DEDUCT
• Refunds and allowances for returned goods
• Actual value of rebates and discounts granted to
the purchaser, even if granted as an increase in
trade-in allowances
Mark "X"
1. What was your firm's revenue for 2011?
if None
(INCLUDE e-commerce sales and excise taxes on gasoline, liquor,
and tobacco. EXCLUDE all sales taxes.) . . . . . . . . . . . . . . .
$ Bil.
Mil.
2011
Thou.
Dol.
2. Did your firm collect any sales taxes during 2011?
Yes - What were the total sales taxes collected?
(Exclude excise taxes reported in line 1.) . . . . . . . . . . . .
No - Go to
2
B
3. What was the total revenue including sales taxes for 2011?
(Sum of lines 1 and 2.) . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 B REVENUE REPORT PERIOD
Do the reported data in 2 A represent the calendar year
(January 1 through December 31) for 2011?
Yes - Go to
2
C
2011
Beginning Date
Month Day
Year
No - What were your beginning and ending dates for 2011? . . . . . . . . . .
72111032
2011
Ending Date
Month Day
Year
CONTINUE ON PAGE 4
Form SA-721A
Page 4
(DRAFT)
2 C E-COMMERCE REVENUE, INCLUDING ROOMS BOOKED ONLINE
1. Did your firm have any e-commerce revenue during 2011?
E-commerce revenue and other operating receipts are sales of goods and services where an order is
placed by the buyer; or price and terms of the sale are negotiated over an Internet, extranet, EDI network,
electronic mail, or other online system. Payment may or may not be made online.
Yes
No - Go to
9
$ Bil.
2. What was the total e-commerce revenue? (Exclude sales taxes.)
3 – 8
9
Mil.
2011
Thou.
Dol.
. . . . . . .
Not Applicable.
TOTAL OPERATING EXPENSES, INCLUDING PAYROLL
INCLUDE
• Expenses arising from the normal course of
business
• Payroll
EXCLUDE
• Bad debt
• Purchases of goods for resale or cost of goods sold
• Income taxes
• Sales and other taxes collected directly from
customers and paid directly to a local, State, or
Federal government agency
• Interest expenses
• Impairment (reduction in value of long-lived assets
due to reappraisal)
• Capitalized expenses (except payroll and fringe
benefits)
Mil.
2011
Thou.
Dol.
72111040
What were the total operating expenses, including payroll, during 2011
for establishments reported in 1 B? . . . . . . . . . . . . . . . . . .
Mark "X"
if None $ Bil.
CONTINUE ON PAGE 5
Form SA-721A
Page 5
(DRAFT)
REMARKS - Please use this space to explain any significant year-to-year changes, to clarify your responses, or to indicate
where data were estimated.
Public reporting burden for this collection of information is estimated to average 34 minutes, including the time for
assembling data from existing records and completing this form. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden to: Paperwork Project 06070013, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to
Paperwork@census.gov; use "Paperwork Project 0607-0013" as the subject. Respondents are not required to respond to any
information collection unless it displays a valid approval number from the Office of Management and Budget (OMB). The
OMB eight-digit number appears in the upper right corner of the form.
10
CERTIFICATION - This report is substantially accurate and has been prepared in accordance with the instructions.
Name of person to contact regarding this report (Please print)
72111057
Address - Number and street
City
State ZIP Code
Area code
Telephone
Number
Extension
Area code
Number
Fax
-
-
Internet address (firm's homepage)
http://
Signature of authorized person
Title
Date completed
Thank you for completing your 2011 ANNUAL ACCOMMODATION REPORT form.
WE SUGGEST YOU RETAIN A PHOTOCOPY OF THIS REPORT FOR YOUR RECORDS.
OMB No. 0607-0195: Approval Expires 09/30/2011
2011 ANNUAL WHOLESALE TRADE REPORT
WHOLESALE DISTRIBUTORS
DUE DATE
Need help or have questions?
Call 1-800-327-4389, option "3"
(8:30 a.m. - 4:30 p.m. EST, M-F)
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.
Return via Internet:
www.census.gov/econhelp/awts
Username:
Password:
(Please cross out and update any label information abov
Return via Fax:
Return via Mail:
1-800-447-4613
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
GENERAL INSTRUCTIONS
* This report should cover ALL wholesale distributor establishments in the United States reporting payroll under the
Employer Identification Number (EIN) as referenced in Ø.
* For establishments sold or acquired during 2010, report data only for the period the establishments were operated by your
firm.
* Any significant change in your firm's operations should be noted in section õ REMARKS.
* Include data for auxiliary facilities operated under this EIN primarily engaged in supporting services to your
establishment(s) such as warehouses, garages, and central administrative offices.
* Enter "0" where applicable.
* Estimates are acceptable if book figures are not available.
SPECIAL INSTRUCTIONS
Ø
FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
A. Does your firm currently report payroll under EIN 12-3456789?
“ Yes - Go to Ù
“ No
EIN
B. If not, what is the current EIN under which your firm is reporting payroll?
Month
Year
C. When did your firm start reporting payroll under this EIN?
CONTINUE ON PAGE 2
Page 2
Ù ORGANIZATIONAL CHANGE
A. Did your firm experience any organizational change during 2011?
“ Yes
“ No - Go to Ú
B. What was the organizational change?
Please provide detailed information below.
“
“
“
“
“
Ú
COMPANY AFFILIATION
A. Is your firm owned or controlled by a manufacturer?
“ Yes
“ No - Go to Û
B.
“
“
“
Û
Ü
Acquired
Merged with
Sold to
Divested
Other
If yes, what type of manufacturer?
Domestic
Foreign
Both
NUMBER OF ESTABLISHMENTS
How many establishments are covered by this report?
SALES
Include
* Sales of products that are shipped on this firm's
orders directly to customers
* Retail sales made by wholesale establishments
covered by this report
* Gross value of sales made on a commission basis
(not your actual commissions)
* Receipts from freight, installations, rentals,
maintenance, repairs, alterations, storage, and
other such services
* E-commerce sales
* Excise taxes (such as those on gasoline, liquor, and
tobacco) that are levied on the manufacturer and
included in the cost of products purchased by this
firm
* Sales of nonconsumer durable goods (such as
Industrial machinery, construction machinery, heavy
trucks, and tractors)
* Sales to farmers for farm use (such as farm
equipment, seeds, fertilizer, and feed)
Exclude
* Sales from establishments that are primarily selling
products manufactured or mined in the United
States by your firm
* Foreign sales of products that never enter the
United States
* Taxes (sales, excise, and other) collected directly
from customers and paid directly to a local, State,
or Federal tax agency
* Nonoperating receipts (such as interest income,
income from investments, and receipts from the
rental or sale of real estate)
* Commissions earned for the sale of products
* Receipts from customers for carrying or other credit
charges
Deduct
* Refunds and allowances for returned products
* The actual value of rebates and discounts granted
to the purchaser, even if granted as an increase in
trade-in allowance
A. Did you report sales in item ÜC for the year beginning January 1, 2011 and ending December 31, 2011?
“ Yes - Go to ÜC
“ No
B. If not, what are your beginning and ending dates?
Beginning Date
Month Date
Year
Ending Date
Month Date
Year
CONTINUE ON PAGE 3
Page 3
C. What are the amounts of sales and other operating receipts for the wholesale establishments
reported in Û?
Mil.
Thou.
Dol.
E. What were the total sales taxex collected?
EXCLUDE excise taxes reported in X.
Mil.
Thou.
Dol.
F. What were the total sales including sales taxes for 2011?
Sum of ÜC and ÜE .
Mil.
Thou.
Dol.
D. Did your firm collect any sales taxes during 2011?
“ Yes
“ No - Go to Ý
Ý
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 Electronic Data Interchange (EDI), the Internet, mobile device (M-commerce) or any other
system. Payment may or may not be made online.
*EDI is the exchange of documents in standardized electronic form between organizations in an automated
manner directly from a computer application in one organziation to an application in another.
*Other online systems include the Internet, mobile device (M-commerce), extranets, e-mail, and instant
messaging.
A. Did this firm have any e-commerce sales (as described above) during 2011?
“ Yes
“ No - Go to Þ
B. What was the total e-commerce sales for 2011?
*This amount should equal the sum of B1 and B2 shown below.
*Also include this amount in C
1. What were the EDI network sales during 2011, if any?
*This includes EDI over the Internet.
*EDI is the exchange of documents in standardized electronic form between organizations in an
automated manner directly from a computer application in one organziation to an application in
another.
2. What were the online system sales during 2011?
*This excludes EDI over the Internet.
*Other online systems include the Internet, mobile device (M-commerce), extranets, e-mail, and
instant messaging.
Þ
INVENTORIES
Include
* All inventories of products covered by this report,
including auxiliary locations (such as warehouses,
garages, and central administrative offices) servicing
these establishments, regardless of where held
* Inventory held in Foreign Trade Zones or in bond
warehouses in the United States
* Report at cost or market value as of the end of your
reporting period
* If any part of inventory is valued using the LIFO
method, report the amount of inventories before any
adjustment for LIFO reserve
Mil.
Thou.
Dol.
Mil.
Thou.
Dol.
Mil.
Thou.
Dol.
Exclude
* Items such as fixtures, equipment, and supplies
not held for resale
* Products owned by others that are being held on
consignment
CONTINUE ON PAGE 4
Page 4
A. Do establishments covered by this report own inventories, regardless of where held, at the end
of the month (or the end of the period for which you are reporting)?
“ Yes
“ No - Go to ó on the next page
B. Are you reporting inventories as of December 31, 2011?
“ Yes - Go to 4D
“ No
Month
Year
C. For what date are you reporting inventories?
D. What are the value of your inventories?
1. Total inventories (if applicable, before Last-in, First-out (LIFO) adjustment)
Mil.
Thou.
Dol.
Mil.
Thou.
Dol.
Mil.
Thou.
Dol.
Mil.
Thou.
Dol.
2. LIFO reserve, if applicable (enter zero if not applicable)
3. Book value of inventories (ÞD1 minus ÞD2)
E. Were any of the inventories reported in ÞD1 stored outside or en route to the 50 states and the
District of Columbia?
“ Yes
“ No
F. What was the value of the inventories stored outside or en route to the 50 states and the District
of Columbia? Exclude inventory held in Foreign Trade Zones or in bond warehouses in the U.S.
ó
INVENTORY VALUATION METHOD
A. Were any of the inventories reported in ÞD1 subject to the LIFO valuation method?
“ Yes
“ No
B. How much of the inventory was subject to:
1. LIFO valuation method before adjustment
2. Any other valuation method
3. Verify Total (Add óB1 and óB2. Total must equal ÞD1 above.)
à
PURCHASES OF PRODUCTS
Include
* Amounts allowed for trade-ins
* Both raw and finished goods
* Products in transit to you for which you have taken
title
* Freight, delivery, and other transportation costs
included in product cost
* Import duties (if paid separately)
* Value of goods shipped from your manufacturing
plants to be sold
* The cost of services resold without processing
* Parts and supplies used in repair work or other
service type activities
Exclude
* Returns, allowances, and trade and cash discounts
* Purchases of containers, wrapping, packaging,
and selling supplies
* Expenditures for supplies, equipment, and parts
purchased for your company's use
* Taxes (sales, excise, and other) collected directly
from customers and paid directly to a local, State,
or Federal tax agency
* Intra-company purchases between establishments
of this reporting unit
What was the total cost of all products purchased for resale for which you took title whether or not
payment was made during 2011?
NOTE: If purchases are greater than sales, please explain in 11.
Mil.
Thou.
Dol.
CONTINUE ON PAGE 5
Page 5
õ
OPERATING EXPENSES
Include
* Expenses arising from the normal course of
business, including payroll
Exclude
* Bad debt/customer related loss
* Purchases of goods for resale or cost of goods
sold
* Income taxes
* Taxes (sales, excise, and other) collected directly
from customers and paid directly to a local, State,
or Federal tax agency
* Interest expense
* Impairment (reduction in value of long-lived assets
due to reappraisal
* Capitalized expenses (except payroll and fringe
benefits
* Transfers made within the company
What were the total operating expenses for the wholesale establishments reported in Û?
Mil.
Thou.
Dol.
11 REMARKS - Please use this space to explain any significant month-to-month changes, clarify your responses, or
indicate where data are estimated.
12 CONTACT INFORMATION
Name of person to contact regarding this report (Please print)
Title
Telephone
Fax
Company Website
THANK YOU
for completing your Annual Wholesale Trade Report
We suggest you keep a copy for your records.
Public reporting burden for this collection of voluntary information is estimated to average 7 minutes per response, including the
time for assembling data from existing records and completing the form. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0190,
U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington , DC 20233. You may e-mail comments to
Paperwork@census.gov; use "Paperwork Project 0607-0190" as the subject. Respondents are not required to respond to any
information collection unless it displays a valid approval number from the Office of Management and Budget. This 8-digit number
appears in the top right corner of this form.
OMB No. 0607-0190: Approval Expires 03/31/2011
MONTHLY WHOLESALE TRADE REPORT
OCTOBER 2010
DUE DATE
Need help or have questions?
Call 1-800-772-7852
(8:30 a.m. - 4:30 p.m. EST, M-F)
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.
Return via Internet:
www.census.gov/econhelp/mwts
Username:
Password:
(Please cross out and update any label information abov
Return via Fax:
Return via Mail:
1-800-447-4613
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
GENERAL INSTRUCTIONS
* This report should cover ALL wholesale distributor establishments in the United States reporting payroll under the
Employer Identification Number (EIN) as referenced in Ø.
* For establishments sold or acquired during 2010, report data only for the period the establishments were operated by your
firm.
* Any significant change in your firm's operations should be noted in section Ü REMARKS.
* Include data for auxiliary facilities operated under this EIN primarily engaged in supporting services to your
establishment(s) such as warehouses, garages, and central administrative offices.
* Enter "0" where applicable.
* Estimates are acceptable if book figures are not available.
SPECIAL INSTRUCTIONS
Ø
FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
A. Does your firm currently report payroll under EIN 12-3456789?
“ Yes - Go to Ù
“ No
EIN
B. If not, what is the current EIN under which your firm is reporting payroll?
Month
Year
C. When did your firm start reporting payroll under this EIN?
Ù
NUMBER OF ESTABLISHMENTS
How many establishments are covered by this report?
CONTINUE ON PAGE 2
Page 2
Ú
SALES
Include
* Sales of products that are shipped on this firm's
orders directly to customers
* Retail sales made by wholesale establishments
covered by this report
* Gross value of sales made on a commission basis
(not your actual commissions)
* Receipts from freight, installations, rentals,
maintenance, repairs, alterations, storage, and
other such services
* E-commerce sales
* Excise taxes (such as those on gasoline, liquor, and
tobacco) that are levied on the manufacturer and
included in the cost of products purchased by this
firm
* Sales of nonconsumer durable goods (such as
Industrial machinery, construction machinery, heavy
trucks, and tractors)
* Sales to farmers for farm use (such as farm
equipment, seeds, fertilizer, and feed)
A.
“
“
“
Exclude
* Sales from establishments that are primarily selling
products manufactured or mined in the United
States by your firm
* Foreign sales of products that never enter the
United States
* Taxes (sales, excise, and other) collected directly
from customers and paid directly to a local, State,
or Federal tax agency
* Nonoperating receipts (such as interest income,
income from investments, and receipts from the
rental or sale of real estate)
* Commissions earned for the sale of products
* Receipts from customers for carrying or other credit
charges
Deduct
* Refunds and allowances for returned products
* The actual value of rebates and discounts granted
to the purchaser, even if granted as an increase in
trade-in allowance
What type of reporting period do this month's sales represent?
Calendar month reporting period - Go to 3C
4-week reporting period
5-week reporting period
B. If not a calendar month reporting period, what is the ending date for the period you are
reporting sales?
C. What are the amounts of monthly sales and other operating receipts for the wholesale
establishments reported in Ù?
Û
INVENTORIES
Include
* All inventories of products covered by this report,
including auxiliary locations (such as warehouses,
garages, and central administrative offices) servicing
these establishments, regardless of where held
* Inventory held in Foreign Trade Zones or in bond
warehouses in the United States
* Report at cost or market value as of the end of your
reporting period
* If any part of inventory is valued using the LIFO
method, report the amount of inventories before any
adjustment for LIFO reserve
Month
Date
Year
Mil.
Thou.
Dol.
Exclude
* Items such as fixtures, equipment, and supplies
not held for resale
* Products owned by others that are being held on
consignment
A. Do establishments covered by this report own inventories, regardless of where held, at the end
of the month (or the end of the period for which you are reporting)?
“ Yes
“ No - Go to Ü on the next page
B. Are you reporting inventories as of the last day of the month?
“ Yes - Go to 4D
“ No
CONTINUE ON PAGE 3
Page 3
Mil.
Thou.
Dol.
C. What are the value of your inventories (before Last-in, First-out (LIFO) adjustment)?
Month
Year
D. For what date are you reporting inventories?
Ü
REMARKS - Please use this space to explain any significant month-to-month changes, clarify your responses, or
indicate where data are estimated.
Ý
CONTACT INFORMATION
Name of person to contact regarding this report (Please print)
Title
Telephone
Fax
Company Website
THANK YOU
for completing your Monthly Wholesale Trade Report
We suggest you keep a copy for your records.
Public reporting burden for this collection of voluntary information is estimated to average 7 minutes per response, including the
time for assembling data from existing records and completing the form. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0190,
U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington , DC 20233. You may e-mail comments to
Paperwork@census.gov; use "Paperwork Project 0607-0190" as the subject. Respondents are not required to respond to any
information collection unless it displays a valid approval number from the Office of Management and Budget. This 8-digit number
appears in the top right corner of this form.
2011 Annual Services Report
Service Annual Survey
FORM
SA-62TE
REPORT DUE
Need help or have questions?
Call 1-800-772-7851
M-F, 8:30 a.m. - 5:00 p.m. EST
or
Visit our web site:
www.census.gov/econhelp/sas
or
Write to:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
Internet Reporting
To complete this report online go to: www.census.gov/econhelp/sas
Username:
Click on "Census Taker" and enter your username and password to login
Password:
YOUR RESPONSE IS REQUIRED BY LAW.
Title 13, United States Code, requires businesses and other organizations that receive this questionnaire to answer
questions and return the report to the U.S. Census Bureau.
YOUR RESPONSE IS CONFIDENTIAL BY LAW
Title 13, United States Code, requires that your response may be seen only by persons sworn to uphold the
confidentiality of Census Bureau information and may be used only for statistical purposes. The law also provides
that copies retained in your files are immune from legal process.
YOUR RESPONSE IS IMPORTANT
The services industries account for nearly 70 percent of all economic activity. We conduct this survey to obtain
timely, comprehensive, and consistent measures needed by policy-makers, businesses, and the public to
accurately assess domestic economic performance.
General Instructions
* Any significant change in your firm's operations should be noted in the "REMARKS" section of this report.
* Estimates are acceptable if book figures are not available.
* Enter "0" where applicable.
* For establishments sold or acquired during 2010, report data only for the period the establishments were operated by
your firm.
Include:
* Data for auxiliary facilities operated under this EIN primarily engaged in supporting services to your establishment(s).
Need to add detailed instructions from instruction sheet (TBD)
1. SURVEY COVERAGE
Does this firm provide the business activities described in the statement above?
O Yes - Go to 2.
O No - Specify the firm's business activity and go to 2.
2. FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
Did your firm report payroll under this EIN <123456789>?
O Yes - Go to 3.
O No - Enter current EIN (9 digits) and date you started reporting payroll under this EIN.
EIN
-
Month
Day
Year
3. ORGANIZATIONAL CHANGE
A. Did your firm experience any organizational change during 2011?
O Yes
O No - Go to 4.
B. What was the organizational change?
Please provide detailed information below.
O Aquired
O Merged with
O Sold to
O Divested
O Other
Name of new owner
Employer Identification Number
Enter EIN of new owner (9 digits)
Mailing address (Number and street, P.O. Box., etc.)
City, town, village, etc.
State
4. NUMBER OF ESTABLISHMENTS
How many establishments, including auxilliary establishments, are covered by this report?
ZIP Code
5. TAX STATUS
A. Is this establishment operated on a not-for-profit basis?
O Yes - Go to 4.B.
O No - Go to 5.
B. Was all or part of the income of this esablishment or organization exempt from Federal income taxes under
section 501 of the Internal Revenue Code?
O Yes
O No
6. REPORTING PERIOD
What time period is covered by the data to be provided in this report?
O Calendar year
O Other than calendar year - enter time period covered
Beginning Date
Month
Day
Year
Ending Date
Month
Day
Year
7. SALES, RECEIPTS, OR REVENUE
Report the total revenue for this firm’s locations defined in 1. for the following categories.
Include:
• Revenue from services provided in fulfillment of legal contracts.
Exclude:
• Transfers made within the company.
A. NET REVENUE
Patient Care Revenue
• Using net patient revenues, report your success of funding in each of the following categories.
1. Medicare - Report fee for service revenue under
traditional Medicare parts A and B and part D. Exclude
Medicare part C, revenue from Medicare under
arrangement with a private health insurance plan for
HMOs……………………………………………………………….
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
2. Medicaid - Report fee for service and funding from
the State Children's Health Insurance Program (SCHIP).
Exclude Medicaid managed care plans………………………..
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
3. Other government - Report reveue from government
entities, except Medicare and Medicaid revenue reported
in lines 1 and 2, e.g., state and local medical assistance,
Civilian Health and Medical Programs of the Veteran's
Admin (CHAMPVA), Department of Defense TRICARE,
Substance Abuse and Mental Health Services
Administration (SAMSHA), and Indian Health Services………
Specify
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
4. Worker's compensation………………………………………
Mark "X"
if None
O
5. Private Insurance
a. Private health insurance - Report health benefits
paid for by employers and/or individuals and financed
by insurance premiums, such as group or self-insured
plans, HMO, Federal, State, and Local government
health insurance, Medicare Part C and Supplemental
Insurance, Medicaid managed care plans……………….
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
Mark "X"
if None
b. Property/Casualty and auto insurance…………………….
O
Bil.
Mil.
Thou.
Dol.
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
6. Patient (out-of-pocket) - Include all deductibles and coinsurance from private health insurance, Medicare,
Medicaid, and other public programs……………………………
7. All other revenue for patient care not included in
lines 1-6. ……………………………..………….………..
Specify
Non-Patient Care Revenue
• If you answered Yes in 5.A. and 5.B., please complete lines 8 - 11.
• If you answered No to either 5.A.
and 5.B. or both, please complete lines 10 and 11.
Mark "X"
if None
8. Contributions, gifts, and grants received………………………
O
Bil.
Mil.
Thou.
Dol.
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
10. All other non-operating revenue - Include
Mark "X"
philanthropy, gift shop, cafeteria sales, parking lot receipts,
if None
florist receipts, etc…………………..……….…...……………………
O
Specify
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
11. TOTAL NET REVENUE - Sum of lines 1 - 10……………...
Mark "X"
if None
O
B. GROSS PATIENT REVENUE - Include the full established
rates (charges) for all services rendered to inpatients and
outpatients………………………………………………………….
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
9. Investment and property income - Include interest and
dividends. Exclude gains (losses) from assets sold……………....
C. SALES TAX
1. Did your firm collect any sales taxes during 2011?
O Yes
O No - go to 8.
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
Mark "X"
if None
3. What was the total revenue including sales taxes for 2011.…...… O
Bil.
Mil.
Thou.
Dol.
2. What were the total sales taxes collected……………………..
Exclude excise taxes reported in -
Sum of
A11 ., B. , and C2.
8. E-COMMERCE
E-commerce sales and other operating receipts are sales of goods and services where an order is placed by the buyer;
or price and terms of the sale are negotiated over an Internet, mobile device (M-commerce), extranet, EDI network,
electronic mail, or other online system. Payment may or may not be made online.
1. Did this firm have any e-commerce sales in 2011?
O Yes
O No - go to 14.
Mark "X"
if None
2. What was the total e-commerce sales/receipts/revenue…………
O
Bil.
Mil.
Thou.
Dol.
Thou.
Dol.
9. - 13. NOT APPLICABLE
14. OPERATING EXPENSES
Report operating expenses for this firm's locations as defined in 1. for the following categories.
Exclude:
• Transfers made within the company
• Capitalized expenses
• Interest
• Bad debt
• Impairment
• Income tax
Personnel Costs
1. Gross annual payroll - Total annual Medicare salaries and
wages for all employees as reported on your 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)………………………………………………………………….
Mark "X"
if None
O
Bil.
Mil.
2. Employer's cost for fringe benefits - Employer's cost for
legally required programs and programs not required by
law. Include insurance premiums for hospital plans,
medical plans, and single service plans (e.g., dental,
vision, prescription drugs); premium equivalents for selfinsured plans and fees paid to third-party administrators
(TPAs); defined benefit pension plans; defined contribution
plans (e.g., profit sharing, 401K and stock option plans);
and other fringe benefits (e.g., Social Security, workers'
compensation insurance, unemployment tax, state
Mark "X"
disability insurance programs, life insurance benefits,
if None
Medicare). Exclude employee contributions…………………………… O
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
5. Expensed equipment - Expensed computer hardware and
other equipment (e.g., copiers, fax machines, telephones,
shop and lab equipment, CPUs, monitors). Report packaged
Mark "X"
software in line 7. Report leased and rented equipment in
if None
O
line 9…………………………………………………………………………
Bil.
Mil.
Thou.
Dol.
6. 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
Mark "X"
janitorial supplies, small tools, containers and other
if None
packaging materials, and motor fuels…………………………………..
O
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
3. Temporary staff and leased employee expenses - Total
costs paid to Professional Employer Organizations (PEOs)
and staffing agencies for personnel. Include all charges for
payroll, benefits, and services…………………………………….
Mark "X"
if None
O
Expensed Materials, Parts, and Supplies (not for resale)
4. Medical supplies - Materials and supplies used in providing
Mark "X"
medical services to others. Report medical equipment in
if None
line 5……………………………………………………..…………………
O
Expensed Purchased Services
7. 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…………………………………..
Mark "X"
if None
O
8. Purchased electricity and fuels (except motor fuels) - If
the cost of electricity and heating fuels (e.g., natural gas,
Mark "X"
propane, oil, coal) are included in lease or rental payments,
if None
report in line 9…………………………………………………………….
O
9. Lease and rental payments - For land, building, offices,
structures, machinery, equipment, and other tangible items.
Include lease and rental of transportation equipment without
operators and penalties incurred for broken leases.
Mark "X"
Exclude capital and financing lease agreements and
if None
licensing/leasing of software……………………………………………..
O
10. Purchased repair and maintenance - Include expensed
repair and maintenance to buildings and integral building
components (e.g., elevators, heating and cooling systems),
structures, offices, machinery, vehicles, equipment, and
computer hardware. Exclude materials, parts, and supplies
used for repair and maintenance performed by this firm's
Mark "X"
employees. Report janitorial and grounds maintenance
if None
services in line 15…………………………………………………………
O
Bil.
Mil.
Thou.
Dol.
Mark "X"
if None
O
Bil.
Mil.
Thou.
Dol.
12. Professional liability insurance - The cost of professional
Mark "X"
liability insurance. Include professional liability insurance
if None
premiums and amounts set aside for self-insurance…………………
O
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
Bil.
Mil.
Thou.
Dol.
Thou.
Dol.
11. Purchased advertising and promotional services Include marketing and public relations services………………….
Other Operating Expenses
13. Depreciation and amortization charges - Include
depreciation charges taken against tangible assets owned
and used by your firm, tangible assets and improvements
owned by your firm within leaseholds, tangible assets
obtained through capital lease agreements, and amortization
charges against tangible assets (e.g., patents, copyrights).
Exclude income taxes and sales and excise taxes collected
from customers…………………………………………………………….
Mark "X"
if None
O
14. Governmental taxes and license fees - Payments to
government agencies for taxes and licenses. Include
Mark "X"
business and property taxes. Exclude income taxes and
if None
sales and excise taxes collected from customers…………………………
O
15. All other operating expenses - All other operating
expenses not reported above, unless specifically excluded
in the general instructions at the top of the page. Include
office postage paid and package delivery. Exclude
Mark "X"
purhcases of merchandise for resale and on-operating
if None
expenses………………………...……………...……………………………
O
Mark "X"
if None
16. TOTAL OPERATING EXPENSES - Sum of lines 1 - 15……………
O
15. INTEREST EXPENSES
Report interest expense for this firm's locations as defined in 1. and operated on a not-for-profit basis.
Exclude:
• Transfers made within the company
• Capitalized expenses
• Impairment
• Bad debt
• Income tax
1. Interest Expense - Interest expense incurred in the
Mark "X"
financing of operations and long lived assets used in
if None
continuing operations………………………………………………………
O
Bil.
Mil.
16. REMARKS
Please use this space to explain any significant year-to-year changes, to clarify your responses, or to indicate
where data were estimated.
17. CONTACT INFORMATION
Name of person to contact regarding this report
Address
Title
City
State
Telephone
Fax Number
Internet Email address
Website address
Zip
QUARTERLY SERVICES SURVEY
First Quarter 2011
FORM
QSS-2(E)
NOTICE - Your report to the Census
Bureay is confidential by law (Title
13, U.S. Code). It may be seen only
by persons sworn to upold the
confidentiality of Census Bureau
information and may be used only for
statistical purposes. The law also
provides that copies retained in your
files are immune from legal
process.
RETURN
COMPLETED FORM TO: U.S.
CENSUS BUREAU
1201
East 10th Street
Jeffersonville, IN 47132-0001
Fax: 1-800-447-4613
NEED HELP?
Visit our website:
http://www.census.gov/econhelp/qss
or
Call 1-800-772-7851 between 8:30
a.m. and 5:00 p.p. EST, Monday
through Friday
(Please correct any errors in name, address, or ZIP Code)
INTERNET REPORTING
You may complete this survey online at:
http://www.census.gov/econhelp/qss
Username:
using you firm's unique username and original password. If you change
your password, please keep a record for reference.
Password:
General Instructions
*Any significant change in your firm's operations should be noted in the "REMARKS" section of this report.
*Estimates are acceptable if book figures are not available.
*Enter "0" where applicable.
*For establishments sold or acquired during this quarter, report data only for the period the establishments were operated by your firm.
Include:
* Data for auxiliary facilities operated under this EIN primarily engaged in supporting services to your establishment (s).
Need to add detailed instructions from the instruction sheet (TBD)
1. SURVEY COVERAGE
Does this firm provide the business activities described in the statement above for the time period covered by this
report?
O Yes - Continue with 2.
O No - Specify your business activity and and go to 2 .
2. FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
Did this firm report payroll under this EIN ?
O Yes - Go to Item 3 .
O No - Enter current EIN and date you started reportin g payroll under this EIN.
Federal Employer Identification Number (EIN)
3. ORGANIZATIONAL CHANGE
Month Year
Name of company acquired/merged with/sold to
Did this firm undergo an organizational change Number and street
during January 2011 - March 2011?
City, State, and ZIP Code
1. O Yes
2. O No - Go to 4.
g
g
Please provide detailed information below
Date of
acquisition
merger or sale.
Month
EIN
Year
1. O acquired
2. O merged with
3. O sold to
4. O divested
5. O other
4. NUMBER OF ESTABLISHMENTS
How many establishments, including auxiliary establishments, are covered by this report?
5. REPORTING PERIOD
What time period is covered by the data to be provided in this report?
1. O January 1, 2011 - March 31, 2011
2. O Other - Entire time period covered
Most recent quarter
Month
Day
Year
Beginning date………………………..
Ending date………….………………..
6. SALES, RECEIPTS, OR REVENUE
A. What was the firm's quarterly REVENUE ?...............................................
See page 5 for additional instructions
Jan 1 - Mar 31, 2011
Bil.
Mil.
Thou.
Dol.
7. INPATIENT DAYS AND DISCHARGES - See page 5 for additional instructions
Inpatient Days - The unit of measure in which lodging was provided and
services rendered to inpatients.
Jan 1 - Mar 31, 2011
A. What was the firm's quarterly INPATIENT days?…………………..
Discharges - The termination of the granting of lodging in the hospital and the
formal release of the patient (including patients admitted and discharged on
the same day).
Jan 1 - Mar 31, 2011
B. What was the firm's quarterly DISCHARGES?......................................
8. OPERATING EXPENSES
A. What was the firm's quarterly operating EXPENSES? Include
payroll and employee benefits .…………………….
Jan 1 - Mar 31, 2011
See page 5 for additional instructions
Bil.
Mil.
Thou.
Dol.
7. REMARKS - Please use this space to explain any significant quarter-to-quarter changes, to clarify you
response, or to indicate where data was estimated
response
estimated.
8. CONTACT INFORMATION
Telephone
Name of person to contact regarding this report
Area code Number
Extension
E-mail address
Fax
Company website
Area code Number
THANK YOU
for completing your Quarterly Services Survey.
2010 ANNUAL RETAIL TRADE REPORT
GENERAL INSTRUCTIONS
o Any significant change in your firm’s operations should be noted in the “REMARKS” section of
this report.
o Estimates are acceptable if book figures are not available.
o For establishments sold or acquired during 2010, report data only for the period the
establishment were operated by your firm.
Include
All U.S. retail establishments reporting payroll on its latest Employer’s Federal Tax Return
(Treasury Form 941 or 944), under the Employer Identification Number (EIN) shown in item 1.
o Data for auxiliary facilities operated under this EIN primarily engaged in supporting services to
your establishment(s) such as warehouses, garages, central administrative offices, and repair
services.
o Retail leased departments and concessions operated by this firm in establishments of others
(e.g., shoe departments in department stores or prescription counters in food stores) which
report payroll under this firm’s EIN shown in item 1.
Exclude
o Data for establishments operated by other firms, such as franchises
o Departments and concessions operated by other firms in your retail store(s).
1. FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
o
Did your firm report payroll under this EIN ?
o Yes
o No – Enter current EIN and date you started reporting payroll under this EIN.
2. ORGANIZATIONAL CHANGE
A. Did your firm experience any organizational change during 2010?
o Yes
o No – Go to 2.B
B. What was the organization change?
Please provide detailed information below.
o acquired
o merged with
o sold to
o divested
o other
1
3. NUMBER OF RETAIL ESTABLISHMENTS
How many retail establishments, including departments and concessions were covered by this
report?
4. SALES, RECEIPTS, OR REVENUE
A.. Did you report sales in item 4 for the year beginning January 1, 2010 and ending December
31, 2010?
o
o
Yes – Go to 4
No – Please report the beginning and ending dates
B. What were the total sales of merchandise and other operating receipts for 2010?
C. Did your firm collect any sales taxes during 2010?
o Yes
o No – go to 5
D. What were the total sales taxes collected?
EXCLUDE excise taxes reported in 4.1.
E. What were the total sales of merchandise and other operating receipts including sales taxes
for 2010?
F. LEASED DEPARTMENT SALES
1: Were there leased departments and concessions operated by other firms in your department
store(s) in 2010?
o Yes
o No – Go to 6
2: What were the total sales collected by departments and concessions operated by other firms
in your department store(s) for 2010?
Exclude sales tax. Do not include in 4.1.
5. E‐COMMERCE
A. Did this firm have any e‐commerce sales in 2010?
o Yes
o No, go to 7
B. What were the total e‐commerce sales?
6. CLASS OF CUSTOMER
2
1. What percentage of sales reported in 4.B was received from the following classes of
customers?
Household consumers and individual users
Wholesales and other retailers
Business firms and not‐for‐profit organizations
Government (Federal, state, local)
7. VALUE OF INVENTORIES
Include
A. Did establishments covered by this report own inventories, regardless of where held, at the end of
2010 (or the end of period for which you are reporting)?
o Yes
o No – Go to 9
B. Are you reporting inventories as of December 31, 2010?
o Yes – Go to 7.D
o No
C. For what date are you reporting inventories?
D. What was the value of inventories?
1. Merchandise inventories in retail stores (include leased departments and concessions
operated by your firm in other establishments).
2. Merchandise inventories in warehouses, offices, or in transit for distribution to retail
stores
3. Total inventories (if applicable, before Last‐in, First‐out (LIFO) adjustment)
4. LIFO reserve, if applicable (enter 0 if not applicable)
5. Book value of inventories
E. Were any of the inventories reported in 7.D.3, stored outside or en route to the 50 states and the
District of Columbia?
o Yes
o No – go to 8
F. What was the value of the inventories stored outside or en route to the 50 states and the District of
Columbia?
Exclude inventory held in Foreign Trade Zones or in bond warehouses in the U.S.
8. INVENTORY VALUATION METHOD
A. Were any of the inventories reported in 7.D subject to the LIFO valuation method?
o Yes
o No – Go to 10
3
B. How much of the inventory was subject to
1. LIFO valuation method before adjustment
2. Any other valuation method
3. Verify Total (Add 8.B.1 and 8.B.2. Total must equal 7.D.3 above)
9. TOTAL PURCHASES
What was the total cost of all merchandise purchased for resale for which you took title,
whether or not payment was made during the 2010?
NOTE: If purchases are greater than sales, explain in the “REMARKS” section.
10. OPERATING EXPENSES
What were the total operating expenses for the retail establishments reporting in 2?
11. REMARKS
Please use this space to explain any significant year‐to‐year changes, to clarify your responses, or to
indicate where data were estimated.
4
Due Date: Omb No. xxxx‐xxx: Approval Expires MM/DD/YYYY
Form SM‐44(06) AS ADVANCE MONTHLY RETAIL TRADE REPORT
U.S. Department of Commerce For assistance in completing the form, you may visit www.census.gov/econhelp/marts
Mailing Address
CONTACT PERSON
Name
Title
Telephone (Area Code, number)
Fax (Area Code, number)
(Please correct any error(s) in name, address, and ZIP CODE)
1: FEDERAL EMPLOYER IDENTIFICATION (EIN)
Did your firm report payroll under this EIN (12‐3456789)? ® Yes – Go to Item 4
2: Number of Retail Establishments
® No‐ Enter current EIN and date started reporting payroll under this EIN
‐
How many establishments, including retail establishments, leased departments, and concessions are covered
by this report?
3: Sales, Receipts, or Revenue
A. Reporting Period
Did you report sales in item 3B(1) for the month beginning and ending ?
* Yes – Go to Item 4
* No – Please report the beginning and ending dates and 4 or 5 week period.
B. Sales
(1) What were the total sales in ?
Does the sales reported in item 4a(1) represent a book figure(s) or estimate(s)? ® Book ®Estimate
4: E‐commerce
(1) Did this firm have any e‐commerce sales in ?
* Yes
* No
(3) What was the total e‐commerce sales?
OR
(4) If e‐commerce sales not available‐ What was the percent of total sales in item 4a(1) that represents e‐
commerce?
REMARKS‐ Please use this space to explain any significant month‐to‐month changes, to clarify your
responses, or to indicate where data were estimated.
US CENSUS BUREAU
COVERAGE INSTRUCTIONS AND DEFINITIONS OF DEPARTMENT STORES,
E‐COMMERCE SALES, AUXILLARY ESTABLISHMENTS, LEASED DEPARTMENTS AND CONCESSIONS
I.
II.
Coverage Instructions
III. Auxillary Establishments are
facilities primarily engaged in
furnishing supporting services (such as
warehouses, garages and central
administrative offices) to your retail
establishments.
E‐Commerce Sales and other operating receipts are IV. Leased Departments and
sales of goods and services where an order is placed Concessions are separate businessby the
buyer; or price and terms of the sale are lease space on the premises of another
negotiated over an Internet, mobile device business.
(M‐commerce), extranet, EDI network,
electronic mail, or other online system. Payment
may or may not be made online.
V. General Instructions
Any significant change in your firm’s operations should be noted in the “REMARKS” section of this report.
Estimates are acceptable if book figures are not available.
Enter “0” where applicable.
For establishments sold or acquired during the month, report data only for the period the establishment were
operated by your firm.
For more help, access our Business Help Site at www.census.gov/econhelp/marts
To view the resuts of this survey, visit www.census.gov/retail
SPECIFIC INSTRUCTIONS FOR COMPLETING ITEMS 2 AND 3
Item 2 – Number of Retail Establishments
INCLUDE
• Total number of retail establishments, leased departments, and concessions covered by this report
• Leased departments and concessions operated by this firm in other establishments
EXCLUDE
• Auxiliary establishments
• Leased departments and concessions operated by other firms in your retail establishments
Item 3 – Sales, Receipts, or Revenue
INCLUDE
• Cash and credit sales of merchandise whether or not payment was received
• Leased departments and concessions operated in other establishments
• E‐commerce sales if not submitted on a separate monthly retail report
• Wholesale sales made by retail establishments covered by this report
• Receipts from layaway purchases
• Receipts from the rental or leasing of vehicles, equipment, instruments, tools, etc.
• Receipts from deliveries
• Receipts from installations, maintenance, repairs, alterations, storage, and other such services
• Value of trade‐ins taken as part payment for other merchandise
• Excise taxes (such as those on gasoline, liquor, and tobacco) which are levied on the manufacturer or wholesaler
and included in the cost of goods purchased by this firm
EXCLUDE
• Sales taxes collected from customers and paid directly to a local, State, or Federal tax agency
• Leased departments and concessions operated by other firms in your retail establishments
• Carrying or other finance charges
• Commissions from vending machine operators
• Nonoperating receipts (such as interest income, income from investments, and receipts from the rental or sale of
real estate)
• Commissions from sales of government lottery tickets • Sales from auxiliary establishments
DEDUCT
• Refunds and allowances for returned goods
• The actual value of rebates and discounts granted to the purchaser, even if granted as an increase in trade‐in
allowance
Automotive Dealers
INCLUDE
• In e‐commerce the sales of cars where a binding sales price is established online through the dealer’s or a third
party’s web site
• Charges for dealer preparation, warranty charges, and delivery costs.
• Combined sales for all new and used car locations and service facilities within the immediate vicinity of the new
car showroom when such locations are considered integral parts of the "new car" business and separate books are
not maintained for their operations
EXCLUDE receipts from customers for tag and title fees, licenses, etc., forwarded to State or local licensing
agencies.
US CENSUS BUREAU
Due Date: Omb No. xxxx‐xxx: Approval Expires MM/DD/YYYY
Form SM‐44(06) BE MONTHLY RETAIL TRADE REPORT
U.S. Department of Commerce For assistance in completing the form, you may visit www.census.gov/econhelp/mrts
Mailing Address
CONTACT PERSON
Name
Title
Telephone (Area Code, number)
Fax (Area Code, number)
(Please correct any error(s) in name, address, and ZIP CODE)
COVERAGE INSTRUCTIONS AND DEFINITIONS OF DEPARTMENT STORES,
E‐COMMERCE SALES, AUXILLARY ESTABLISHMENTS, LEASED DEPARTMENTS AND CONCESSION
I.
Coverage Instructions
III. Auxillary Establishments are
facilities primarily engaged in
furnishing supporting services (such as
warehouses, garages and central
administrative offices) to your retail
establishments.
II.
E‐Commerce Sales and other operating receipts are IV. Leased Departments and
sales of goods and services where an order is placed Concessions are separate business
by the buyer; or price and terms of the sale are lease space on the premises of another
negotiated over an Internet, mobile device business.
(M‐commerce), extranet, EDI network,
electronic mail, or other online system. Payment
may or may not be made online.
V. General Instructions
Estimates are acceptable if book figures are not available.
Any significant change in your firm’s operations should be noted in the “REMARKS” section of this report.
For establishments sold or acquired during 2010, report data only for the period the establishment were
operated by your firm.
Include data for auxiliary facilities operated under this EIN primarily engaged in supporting services to your
establishment(s) such as warehouses, garages and central administrative offices to your retail establishments.
Enter “0” where applicable.
For more help, access our Business Help Site at www.census.gov/econhelp/mrts
To view the resuts of this survey, visit www.census.gov/retail
US CENSUS BUREAU
1: FEDERAL EMPLOYER IDENTIFICATION (EIN)
Did your firm report payroll under this EIN (12‐3456789)? ® Yes – Go to Item 4
® No‐ Enter current EIN and date started reporting payroll under this EIN
‐
2: Number of Retail Establishments
How many establishments, including retail establishments, leased departments, and concessions are covered by
this report?
3: Sales, Receipts, or Revenue
Report cash and credit sales
Include sales from e‐commerce if not submitted on a separate monthly retail report. E‐commerce sales and other
operating receipts are sales of goods and services where an order is placed by the buyer; or price and terms of the sale are
negotiated over an Internet, mobile device (M‐commerce), extranet, EDI network, electronic mail, or other online system.
Payment may or may not be made online.
Include leased departments and concessions operated in other establishments.
Exclude leased departments and concessions operated by other firms in your retail establishment.
Exclude sales taxes and finance charges.
A. Report Period
Did you report sales in item 3B(1) for the month beginning and ending ?
* Yes – Go to Item 3B(1)
* No – Please report the beginning and ending dates and 4 or 5 week period.
B. Sales
(1) What were the total sales in ?
Does the sales reported in item 3B(1) represent a book figure(s) or estimate(s)? ® Book ®Estimate
4: E‐commerce
(1) Did this firm have any e‐commerce sales in ?
* Yes
* No – go to Item 5.
(3) What was the total e‐commerce sales?
OR
(4) If e‐commerce sales not available‐ Enter percent of total sales in item 3B(1) that represents e‐commerce
5: Value of Inventories
INCLUDE
EXCLUDE
The cost value of all merchandise for the end of the month Fixtures, equipment, and supplies not held for resale
Merchandise under contract for sale
Merchandise owned by this firm but held by others for consignment.
What are the values of inventories of products covered by this report, regardless of where held, owned as of the
end of the month?
a. Merchandise inventories in retail stores. Include leased departments and concessions operated by your firm in
other establishments.
b. Merchandise in warehouses, offices, or in transit for distribution to retail stores.
c. Total inventories (if applicable, before Last‐in, First‐out (LIFO) adjustment).
d. For what date are you reporting inventories?
REMARKS‐ Please use this space to explain any significant month‐to‐month changes, to clarify your
responses, or to indicate where data were estimated.
| File Type | application/pdf |
| File Title | C:\DOCUME~1\cogan300\LOCALS~1\Temp\tmp66.tmp |
| Author | cogan300 |
| File Modified | 2010-12-03 |
| File Created | 2010-11-10 |