Form MA-10000 2012 Annual Survey of Manufactures

Attachment B

2012 ANNUAL SURVEY OF MANUFACTURES

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

MA-10000

OMB No. 0607-0938: Approval Expires

(DRAFT)

(Please correct any errors in this mailing address.)

DUE DATE
FEBRUARY 12, 2013
Need help or have questions?
• Read the accompanying information sheet(s) before
answering the questions.

MA-10000

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• Call 1-800-233-6136, between 8:00 a.m. and 6:00 p.m.,
Eastern time, Monday through Friday.

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U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47134-0001

Mail your
completed
form to:

- OR -

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.
• Use blue or black ballpoint pen.
• Do not use pencil or felt-tip pen.
• Do not put slashes through 0 or 7.

• Please center numbers in
their respective boxes.
• Place an "X" inside the box.

Examples:

The reporting unit for this form is an establishment. An establishment is generally a single physical location
where business is conducted or where services or industrial operations are performed. For further clarification, see
information sheet(s).
1

EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) shown to the left of the mailing address the same as the one used for this
establishment on its latest 2012 Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return?

10000016

0021

2

Yes - Go to

2

No - Enter current EIN (9 digits)

0022

-

0025

PHYSICAL LOCATION
A. Is this establishment's physical location the same as shown in the mailing address?
(P.O. Box and rural route addresses are not physical locations.)
0031

0032

Yes - Go to line B
0035

Number and street

0036

City, town, village, etc.

No - Enter
physical
location

0037

State

0038

ZIP Code

CONTINUE WITH
PENALTY FOR FAILURE TO REPORT

2

ON PAGE 2
CONTINUE ON PAGE 2

Form MA-10000
2

Page 2

(DRAFT)

PHYSICAL LOCATION - Continued
B. Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
(Mark "X" only ONE box.)
0041

Yes

0042

No

0043

No legal boundaries

0040

Do not know

0024

Do not know

C. In what type of municipality is this establishment physically located?
(Mark "X" only ONE box.)
0046

3

City, village, or
borough

0047

Town or township

0048

Other

OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2012?
(Mark "X" only ONE box.)
0011

In operation

0016

Under construction, development, or exploration

0013

Temporarily or seasonally inactive

0014

Ceased operation - Give date at right

0015

Month

Sold or leased to another operator - Give date at right
AND enter name and address of new owner or operator
and Employer Identification Number (EIN) below
0060

Day

Year

0018

Name of new owner or operator

0061

EIN (9 digits)

0062

Mailing address (Number and street, P.O. Box, etc.)

0063

City, town, village, etc.

0064

State

0065

ZIP Code

4

Mark "X"
if None

MONTHS IN OPERATION

30 .)

. . . . . . . . . .

0002

10000024

Number of months in operation during 2012 (If none, mark "X" and go to

2012
Number

CONTINUE ON PAGE 3

Form MA-10000

Page 3

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.

HOW TO
REPORT
DOLLAR
FIGURES

5

Mark "X"
if None

Dollar figures should be rounded to
thousands of dollars.
If a figure is $2,035,628.79:

Report

If a value is "0" (or less than $500.00):

Report

2012
Mil.

$ Bil.

2

Thou.

0 3 6

EXAMPLE

SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Mark "X"
if None

A. Total value of products shipped and other
receipts (Report detail in 22 .) . . . . . . . .

$ Bil.

2012
Mil.

2011
$ Thou.

Thou.

0100

B. Value of products exported (This is a breakout
of the value reported on line A.)
Report the value of products shipped for
export. Include shipments to customers in
the Commonwealth of Puerto Rico and U.S.
possessions, as well as the value of products
shipped to exporters or other wholesalers for
export. Also, include the value of products
sold to the U.S. Government to be shipped
to foreign governments. Exclude products
shipped for further manufacture, assembly, or
fabrication in the United States. . . . . . . .

0130

C. Shipments to other domestic plants of your
company for further assembly, fabrication, or
manufacture
1. Is this the only establishment of this firm?
0907

Yes - Go to

0908

No - Go to line C2

6

2. Market value of products shipped to
other domestic plants of your company
for further assembly, fabrication, or
manufacture (This is a breakout of the
value reported on line A.) . . . . . . . .

10000032

6

0905

E-SHIPMENTS
A. Did this plant use any electronic network to control or coordinate the flow of any of the shipments of goods reported
in 5 , line A? Or, were the orders for any of the shipments reported in 5 , line A received over an electronic network?
Electronic networks include:
• Electronic Data Interchange (EDI)
• E-mail
• Internet
• Extranet
• Other online systems
0181

Yes - Go to line B

0182

No - Go to

7

B. Percent of total reported in 5 , line A that were ordered, or whose movement
was controlled or coordinated over electronic networks (Report whole
percents. Estimates are acceptable.) . . . . . . . . . . . . . . . . . . . . .

2012
Percent
0109

2011
Percent

%

%

CONTINUE ON PAGE 4

Form MA-10000
7

Page 4

(DRAFT)

EMPLOYMENT AND PAYROLL
Include:
• 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, and filed under the Employer Identification
Number (EIN) shown to the left of the mailing address or corrected in 1 .
• Spread on stock options that are taxable to employees as wages.
Exclude:
• Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN.
• Temporary staffing obtained from a staffing service.
For further clarification, see information sheet(s).
A. Number of employees
1. Number of production workers for pay periods
including:
a. March 12

. . . . . . . . . . . . . . . . . . . .

0325

b. June 12 . . . . . . . . . . . . . . . . . . . . .

0324

c. September 12 . . . . . . . . . . . . . . . . . .

0344

d. December 12 . . . . . . . . . . . . . . . . . . .

0347

2. Add lines A1a through A1d . . . . . . . . . . . .

0329

3. Average annual production workers (Divide line A2 by
4 - omit fractions.) . . . . . . . . . . . . . . . . . .

0335

4. All other employees for pay period including March 12

0336

5. TOTAL (Add lines A3 and A4.) . . . . . . . . . . . .

0337

B. Payroll before deductions (Exclude
employer's cost for fringe benefits.)

Mark "X"
if None

10000040

1. Annual payroll
a. Production workers . . . . . . . . . .

0304

b. All other employees

. . . . . . . . .

0305

c. TOTAL (Add lines B1a and B1b.) . . .

0300

2. First quarter payroll (January-March 2012)

2012
Number

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

2011
Number

2011
$ Thou.

0310

Mark "X"
if None

C. Number of hours worked by production workers (Annual
hours worked by production workers reported on lines
A1a through A1d.) . . . . . . . . . . . . . . . . . . .

CONTINUE WITH

7

2012
Hours
Thou.

2011
Hours
Thou.

0200

ON PAGE 5

CONTINUE ON PAGE 5

Form MA-10000

Page 5

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
7

EMPLOYMENT AND PAYROLL - Continued
D. Employer's cost for fringe benefits - Employer's cost for legally required programs and programs not required
by law.
1. Health insurance - Insurance premiums
on hospitals, medical plans, and single
2012
2011
service plans such as dental, vision, and
Mark "X"
if None
prescription drug plans. Include premium
$ Bil.
Mil.
Thou.
$ Thou.
equivalents for self-insured plans and fees
paid to third party administrators (TPAs).
Do not include employee contributions. . . 0333

0335

b. Defined contribution plans - Costs
under defined contribution plans.
Pension plans that define the employer
contributions to a separate account
provided for each employee. The
employee "benefit" at retirement
depends on the amount contributed
and the results of the account's
activity. Examples include profit
sharing plans, money purchase (e.g.,
401k, 403b) and stock bonus plans
(e.g., ESOPs). . . . . . . . . . . . .

0337

3. Payroll taxes, employer paid
insurance premiums (excluding
health), and other employer paid
benefits - Other fringe benefits (e.g.,
Social Security, workers' compensation
insurance, unemployment tax, state
disability insurance programs, life
insurance benefits, Medicare). . . . . . .

0339

4. TOTAL (Add lines D1 through D3.) . . . .

0220

Not Applicable.

10000057

8

2. Pension plans
a. Defined benefit pension plans Costs for both qualified and
unqualified defined pension plans.
Pension plans that specify the
benefit to be paid to employees
upon retirement, generally either a
specific amount or a percentage of
compensation. Employer contributions
are based on actuarial computations
that include the employee's
compensation and years of service and
are not allocated to specific accounts
maintained for employees. . . . . . .

CONTINUE ON PAGE 6

Form MA-10000
9

Page 6

(DRAFT)

VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2012 and/or 2011?
0488

Yes - Go to line B

0489

No - Go to

13

B. Report inventories owned by this establishment as of December 31 before Last-in, First-out (LIFO) adjustment (if any).
Mark "X"
if None

End of 2012
Mil.

$ Bil.

Thou.

Mark "X"
if None

$ Bil.

End of 2011
Mil.

Thou.

1. Finished goods . . .
0461

0471

0463

0473

0462

0472

0460

0470

0466

0476

0490

0492

2. Work-in-process . . .
3. Materials, supplies,
fuels, etc. . . . . . .
4. Total inventories
(Add lines B1 through
B3.) . . . . . . . . .
5. LIFO reserve (Report
LIFO gross in 10 ,
line A.) . . . . . . .
6. Total inventories
after LIFO
adjustment (Line B4
minus line B5.) . . .
10 INVENTORIES BY VALUATION METHOD
Report how much of the inventory reported in
Mark "X"

A. LIFO valuation method
if None
before adjustment
(Report LIFO reserve in
9 , line B5.) . . . . . . .

$ Bil.

9

, line B4, is subject to the following valuation methods.
End of 2012
Mil.

Thou.

Mark "X"
if None

0465

0475

0498

0496

0502

0500

0506

0504

0487

0485

0510

0508

$ Bil.

End of 2011
Mil.

Thou.

B. First-in, First-out (FIFO) .
C. Average cost . . . . . .

10000065

D. Standard cost

. . . . .

E. Other valuation method Specify method

0895

F. TOTAL (Add lines A
through E. Total should
equal 9 , line B4.) . . . .

CONTINUE ON PAGE 7

Form MA-10000

Page 7

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
11 INVENTORIES OUTSIDE OF THE UNITED STATES
A. Of the total inventories reported in 9 , line B4, were any stored or en route OUTSIDE the 50 U.S. states and the
District of Columbia?
0256

Yes - Go to line B

0257

B. Report the total value
of these inventories (Do Mark "X"
not report inventory
if None
held in Foreign Trade
Zones or in bond
warehouses in the U.S.)

$ Bil.

No - Go to

End of 2012
Mil.

13

Thou.

0261

Mark "X"
if None

$ Bil.

End of 2011
Mil.

Thou.

0260

12 Not Applicable.
13 ASSETS, CAPITAL EXPENDITURES, RETIREMENTS, AND DEPRECIATION
Refer to the instructions on how to report leasing arrangements.
Report the dollar value of assets, capital
expenditures, and depreciation.
A. Gross value of depreciable assets (acquisition
costs) at the beginning of the year . . . . . .

Mark "X"
if None

0500

$ Bil.

2012
Mil.

Thou.

2011
$ Thou.
Not collected in
2011

B. Capital expenditures for new and used
depreciable assets in 2012
1. Capital expenditures for new and used
buildings and other structures (Exclude
land.) . . . . . . . . . . . . . . . . . .

0525

2. Capital expenditures for new and used
machinery and equipment . . . . . . . .

0530

3. TOTAL (Add lines B1 and B2.) . . . . . .

0520

C. Gross value of depreciable assets sold,
retired, scrapped, destroyed, etc. . . . . . .

0510

Not collected in
2011

D. Gross value of depreciable assets at the end
of 2012 (Add lines A and B3 minus C.) . . . .

0505

Not collected in
2011

E. Normal depreciation charges for all tangible
assets including buildings, machinery, and
equipment . . . . . . . . . . . . . . . . .

0540

Not collected in
2011

10000073

F. Breakdown of expenditures for new and used
machinery and equipment by type (Reported
on line B2.)
1. Automobiles, trucks, etc., for highway use

0522

2. Computers and peripheral data processing
equipment . . . . . . . . . . . . . . .

0523

3. All other expenditures for machinery and
equipment . . . . . . . . . . . . . . .

0524

4. TOTAL (Add lines F1 through F3.) . . . .

0529

CONTINUE ON PAGE 8

Form MA-10000

Page 8

(DRAFT)

14 RENTAL PAYMENTS
(Exclude capital leases (leases with a contract to
own at the end of the lease).)

Mark "X"
if None

A. Rental or lease of buildings, job-site trailers,
and other structures (Include land.) . . . . .

0551

B. Rental or lease of construction equipment and
tools, machinery, office equipment, furniture,
and vehicles . . . . . . . . . . . . . . . .

0552

C. TOTAL (Add lines A and B.) . . . . . . . . .

0550

$ Bil.

2012
Mil.

Thou.

10000081

15 Not Applicable.

CONTINUE ON PAGE 9

Form MA-10000

Page 9

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
16 SELECTED EXPENSES
Mark "X"
if None

A. Selected production related costs
1. Cost of materials, parts, containers,
packaging, etc. used (Report detail in

17 .)

0426

3. Cost of purchased fuels consumed for heat,
power, or the generation of electricity . . .

0430

4. Cost of purchased electricity (Report
quantity on line B1.) . . . . . . . . . . .

0425

5. Cost of work done for you by others on
your materials . . . . . . . . . . . . . .

0424

6. TOTAL (Add lines A1 through A5.)

0420

Mark "X"
if None

B. Quantity of Electricity
1. Purchased electricity (Quantity comparable
to cost reported on line A4.) . . . . . . . .

0436

2. Generated electricity (Gross less generating
station use.) . . . . . . . . . . . . . . .

0437

3. Electricity sold or transferred to other
establishments (Include on lines B1 or B2.)

0438

C. Other operating expenses paid by this
establishment
1. Temporary staff and leased employee
expense - Total costs paid to Professional
Employer Organizations (PEOs) and
staffing agencies for personnel. (Include all
charges for payroll, benefits and services.)

10000099

2.

3.

2012
Mil.

Thou.

2011
$ Thou.

Thou.

2011
Kilowatt-hours
Thou.

0421

2. Cost of products bought and sold as such
without further processing (Report sales
in 22 .) . . . . . . . . . . . . . . . . . .

. . . .

$ Bil.

Mark "X"
if None

Bil.

$ Bil.

2012
Kilowatt-hours
Mil.

2012
Mil.

Thou.

0176

Expensed equipment - Expensed computer
hardware and other equipment (e.g.,
copiers, fax machines, telephones, shop
and lab equipment, CPUs, monitors).
(Report packaged software on line C3.) . .

0403

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.) . .

0188

CONTINUE WITH

16

ON PAGE 10

CONTINUE ON PAGE 10

Form MA-10000

Page 10

(DRAFT)

16 SELECTED EXPENSES - Continued
4.

Data processing and other purchased
computer services (Include computer
facilities management services, computer
input preparation, data storage, computer
time rental, optical scanning services,
and other computer-related advice and
services, including training. Exclude
expensed integrated systems, repair and
maintenance of computer equipment,
payroll processing and credit card
transaction fees, and expenses for
telecommunication services (e.g., Internet,
connectivity, telephone).) . . . . . . . . .

0198

Purchased communication services Telephone, cellular, and fax services;
computer-related communications (e.g.,
Internet, connectivity, online) and other
wired and wireless communication
services. . . . . . . . . . . . . . . . . .

0427

Purchased repairs and maintenance
to buildings and/or machinery and
equipment (Exclude materials, parts, and
supplies used for repairs and maintenance
performed by this firm's employees.) . . .

0401

Water, sewer, refuse removal, and other
utility payments (Include the costs of
hazardous waste removal.) . . . . . . . .

0407

Purchased advertising and promotional
services (Include marketing and public
relations services.) . . . . . . . . . . . .

0409

Purchased professional and technical
services (Include management consulting,
accounting, auditing, bookkeeping, legal,
actuarial, payroll processing, architectural,
engineering, and other professional
services. Exclude salaries paid to your own
employees for these services.) . . . . . .

0216

10. Governmental taxes and license fees Payments to government agencies for
taxes and licenses. (Include business and
property taxes. Exclude income taxes.) . .

0405

5.

6.

7.

8.

9.

Mark "X"
if None

11. All other operating expenses not reported
elsewhere. (Exclude purchases of
merchandise for resale and nonoperating
expenses.) - Specify

10000107

0417

12. TOTAL (Add lines C1 through C11.)

0415

. . .

0422

$ Bil.

2012
Mil.

Thou.