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pdf2011 REPORT OF ORGANIZATION
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
FORM
NC-99001
OMB No. 0607-0444: Approval Expires 10/31/2012
(DRAFT)
NC-99001
Need help or have questions about
filling out this form?
Visit www.census.gov/econhelp
- OR Write to the address below. Include
your 11-digit Census File Number (CFN)
printed in the mailing address.
Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
(Please correct any errors in name and address, including ZIP Code.)
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.
The purpose of this form is to obtain an accurate and up-to-date list of your establishments, i.e., separate business locations
that were in operation or new plant(s) under construction during part or all of 2011. This list should include establishments of
your company and each of its subsidiaries. To make it easier for you to complete this report, we have prelisted information
in 5 A that you have previously provided to the U.S. Census Bureau. Please list all other establishments of your organization
on 5 B. Do not duplicate establishments already prelisted in 5 A. Be sure to include items 1 through 4 when returning your
completed report form. Before completing this form, please read the enclosed definitions and instructions.
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?
99001018
0008
0080
Yes - Enter the following information of the owning or
controlling company
Name of owning or controlling company
0082
Home office address (Number and street)
0083
City, town, village, etc.
0081
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%
PENALTY FOR FAILURE TO REPORT
0028
50%
0029
More than 50%
Form NC-99001
1
(DRAFT)
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 perform or fund research and development (R&D)?
6129
Yes - Go to line B
6130
No - Go to line C
B. What were your company's worldwide expenses for research and development (R&D) in 2011?
6132
Less than $3 million
6133
$3 million or more
C. Did your company introduce any new or significantly improved methods of manufacturing, producing,
delivering or distributing goods or services during the years 2009 through 2011?
6135
99001026
3A
Yes
6136
No
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 2011? (Permanent workforce excludes temporary staffing from a staffing service
and contractors.)
0244
Yes
0245
No
HOW TO
REPORT
DOLLAR
FIGURES
Mark "X"
if None $ Bil.
Dollar figures should be rounded to
thousands of dollars.
If a figure is $3,025,628.79:
Report
If a value is "0" (or less than $500.00):
Report
2011
Mil.
Thou.
3 0 2 6
Dol.
Form NC-99001
(DRAFT)
3B OPERATING REVENUES AND NET SALES
A. Your company's operating revenues and net sales generated from U.S. operations (i.e., located in the 50 States
and the District of Columbia) in 2011.
Include:
• Sales of goods and services to foreign firms
• Revenues of discontinued operations
Exclude:
• Sales generated by your company's foreign operations
• Domestic inter-company sales
Special instructions for tax-exempt firms: Report revenues, realized gains and losses and contributions for
all classes of net assets regardless of restrictions.
Mark "X"
if None
Operating revenues and net sales . . . . . . . . . . . . . . . . . . .
2011
$ Bil.
Mil.
Thou.
Dol.
0100
B. Does the amount reported on line A include inter-company sales by your company's domestic operations to
foreign subsidiaries or foreign affiliates?
0000
Yes - Go to
0000
No - Go to line C
3C
99001034
C. If not already included on line A, report inter-company sales by your
company's domestic operations to foreign subsidiaries and foreign
affiliates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mark "X"
if None
0000
2011
$ Bil.
Mil.
Thou.
Dol.
Form NC-99001
(DRAFT)
3C ROYALTIES AND LICENSE FEES FOR THE USE OF INTELLECTUAL PROPERTY
A. Did your company's U.S. operations earn revenues in 2011 from royalties and license fees for rights to use
intellectual property?
Include:
• Revenues from royalties and license fees for intellectual property owned by your company's
domestic operations (i.e., located in the 50 states and the District of Columbia).
• Royalties and license fees paid to your company's domestic operations by foreign subsidiaries.
Exclude:
• Sales involving the transfer of ownership rights.
• Sales of and products sold as end-use licenses.
9701
Yes - Go to line B
9702
No - Go to
3D
Mark "X"
if None
B. Revenues from royalties and license fees for rights to use intellectual
property in 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2011
$ Bil.
Mil.
$ Bil.
Mil.
Thou.
Dol.
Thou.
Dol.
9703
C. Revenues from your company's U.S. operations, as reported in line B, for
the following types of royalties and license fees in 2011
Mark "X"
if None
1. Technological or industrial processes (Include patents, trade secrets,
and proprietary technology. Exclude computer software.) . . . . . . .
9704
2. Entertainment, artistic, educational, and literary original works (Include
royalties and license fees for rights to perform, broadcast, reproduce,
and sell copyrighted materials and other intellectual property such as
films, television and radio programs, written works, and musical and
other artistic works. Exclude computer software.) . . . . . . . . . .
9705
3. Software — Rights to reproduce, distribute, or use software protected
by copyright and owned or controlled by the licensor. (Exclude sales
of software sold with end-use licenses, as well as custom software
and programming services.) . . . . . . . . . . . . . . . . . . . .
9706
4. Business format franchise sales and fees included in line B, if any
. .
9707
. . . .
9708
99001042
5. TOTAL (Add lines C1 through C4. Total should equal line B.)
2011
Form NC-99001
3D
(DRAFT)
MANUFACTURING ACTIVITIES
In 2011, did your company do any of the following activities related to manufacturing?
A. Operate manufacturing facilities (such as a factory, plant, or mill) where products are completed or partially
produced?
9709
Yes
9710
No - Go to line C
B. Provide contract manufacturing services to other companies incorporating their patents, trade secrets, or
proprietary technology?
9711
Yes
9712
No - Go to line C
Estimate the percent of operating revenues and net sales, as reported in
services.
9713
Less than 25%
9714
25 to 49%
9715
50 to 74%
9716
75 to 99%
9717
100%
3B ,
from contract manufacturing
C. Purchase contract manufacturing services from other companies or foreign subsidiaries of your company
incorporating your company's patents, trade secrets, or proprietary technology?
9718
Yes
9719
No - Go to
4
1. Use 3rd party contract manufacturing services inside the U.S.?
9720
Yes
9721
No
2. Use 3rd party contract manufacturing services outside the U.S.?
9722
Yes
99001059
No
9723
3. Use your company's foreign subsidiaries' or affiliates' contract manufacturing services at locations outside
the U.S.?
9724
Yes
9725
No
4. Estimate the percent of the cost of sales from expenses for contract manufacturing services.
9726
Less than 25%
9727
25 to 49%
9728
50 to 74%
9729
75 to 99%
9730
100%
Form NC-99001
(DRAFT)
REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)
4 CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
Name of person to contact regarding this report
Area code
99001067
Telephone
Number
Title
Extension
Area code
Number
Fax
Month
Internet e-mail address
Date completed
Day
Year
File Type | application/pdf |
File Title | NC-99001 $$00 REPORT OF ORGANIZATION - |
Author | stral001 |
File Modified | 2011-06-30 |
File Created | 2011-06-30 |