Form Be 10A Bank – Fill Out and Use This PDF

MAIL REPORTS TO:

U.S. Department of Commerce

Bureau of Economic Analysis

BE-69(A)

Washington, DC 20230

OR

DELIVER REPORTS TO:

U.S. Department of Commerce

Bureau of Economic Analysis

BE-69(A)

Shipping and Receiving,

Section M-100

1441 L Street, NW

Washington, DC 20005

BEA USE ONLY Reporter ID Number

1.Name and address of U.S. Reporter

IMPORTANT

D

May we use e-mail to correspond with you to discuss questions

	relating to this survey, including questions that may contain		1
		1000
			1
	information about your company that you may consider
	confidential? (Note that electronic mail is not inherently confidential;		1 2
	we will treat information we receive as confidential, but e-mail is

not necessarily secure against interception by a third party.)

Yes — If yes, please provide your e-mail address.

No

E-mail address

1

1001

1002 1 1

1 3

Corporation

Other — Specify

1003 1 1

1 2

Yes — Complete the "BE-10, CLAIM FOR NOT FILING." On the claim, mark (X) box number B.2. and enter the name and address of U.S. business enterprise with whose data your data will be consolidated in accordance with the definition of fully consolidated U.S. domestic business enterprise. (See Instruction Booklet, Part I.B.1.b.) Submit the claim to BEA and forward the remainder of the BE-10 survey packet to the U.S. business enterprise with whose data your data will be consolidated. If this cannot be done, please contact us for further instructions.

No — Complete the remainder of this form.

1004 1

2

1005

Number

1

If you also have exempt foreign affiliates, list them on the BE-10A BANK SUPPLEMENT A and give the requested information for each. (Do not include foreign affiliates listed on the supplement in the number given here.)

1007 1 1

1 2

Yes No

1009 1 1

1 2

Yes

No — PERMISSION MUST HAVE BEEN REQUESTED OF, AND GRANTED BY, BEA TO FILE ON AN UNCONSOLIDATED BASIS. You must file a separate Form BE-10A or BE-10A (BANK) for each unconsolidated U.S. domestic entity. Enter the name under which each separate Form BE-10A or BE-10A (BANK) is being filed.

BE-10A BANK		Reporter ID Number
	Part II – SELECTED FINANCIAL AND OPERATING DATA OF U.S. REPORTER
	See ADDITIONAL INSTRUCTIONS for Part II on page 7 at the back of this form.

D

3047		1	1			Yes – Answer items b and c
		1	2			No – Skip to item 21

NOTE: Complete items b and c ONLY if item a is answered "Yes."

b.Premiums earned – Report premiums, gross of commissions, included in revenue during the reporting year. Calculate as direct premiums written (including renewals) net of cancellations, plus reinsurance premiums assumed, minus reinsurance premiums ceded, plus unearned premiums at the beginning of the year, minus unearned premiums at the end of the year.

Exclude all annuity premiums. Also exclude premiums and policy fees related to universal and
adjustable life, variable and interest-sensitive life, and variable-universal life policies.	3048

c.Losses incurred — Report losses incurred for the insurance products covered by b. above. Exclude loss adjustment expenses and losses that relate to annuities. Also exclude losses related to universal and adjustable life, variable and interest-sensitive life, and variable-universal life polices.

For property and casualty insurance, calculate as net losses paid during the reporting year, minus net unpaid losses at the beginning of the year, plus net unpaid losses at the end of the year. In the calculation of net losses, include losses on reinsurance assumed from other companies and exclude losses on reinsurance ceded to other companies. Unpaid losses include both case reserves and losses incurred but not reported.

For life insurance, losses reflect policy claims on reinsurance assumed or on primary insurance sold, minus losses recovered from reinsurance ceded, adjusted for changes in claims due, unpaid, and in the course of settlement.

3049

Amount

Bil. Mil. Thous. Dols.

1

$

1

$

306

BE-10A BANK

Remarks

Reporter ID Number

D

Part I — IDENTIFICATION OF U.S. REPORTER

9.—15.

Sales or gross operating revenues of fully consolidated domestic U.S. Reporter by industry of sales or gross operating revenues.

If fewer than five ISI codes are used, account for total sales or gross operating revenues in items 9 through 13. Do not include realized gains or losses due to profit or loss on the sale or maturity of investments here. Instead, report them as part of item 17 (Total income).

Part II — SELECTED FINANCIAL AND OPERATING DATA

OF U.S. REPORTER

17.Total income — include:

a.Sales or gross operating revenues.

b.Income from equity investments in affiliates (domestic and foreign). For affiliates owned 20 percent or more (including majority-owned foreign affiliates), report equity in earnings during the reporting period; for those owned less than 20 percent, report dividends.

c.Certain realized and unrealized gains (losses). Report gross before income tax effect. Include:

1.Sales or disposition of investment securities, and FAS 115 impairment losses. Dealers in financial instruments (including securities, currencies, derivatives, and other financial instruments) and finance and insurance companies;

2.Sales or disposition of land, other property, plant and equipment, or other assets, and FAS 144 impairment losses. Exclude gains or losses from the sale of inventory assets in the ordinary course of trade or business;

3.Goodwill impairment as defined by FAS 142;

4.Restructuring. Include restructuring costs that reflect

write-downs or write-offs of assets or liabilities. Exclude actual payments and charges to establish reserves for future expected payments, such as for severance pay, and fees to accountants, lawyers, consultants, or other contractors;

5.Disposals of discontinued operations. Exclude income from the operations of a discontinued segment. Report such income as part of your income from operations in items 9 through 14;

6.Re-measurement of foreign affiliate’s foreign-currency- denominated assets and liabilities due to changes in foreign exchange rates during the reporting period;

7.Extraordinary, unusual, or infrequently occurring items that are material. Include losses from accidental damage or disasters, after estimated insurance reimbursement. Include other material items, including write-ups, write-downs, write-offs, of tangible and intangible assets; gains (losses) from the sale or other disposition of capital assets; and gains (losses) from the sale or other disposition of financial assets, including securities, to the extent not included above. Exclude legal judgments;

8.The cumulative effect of a change in accounting principle.

Do not include unrealized holding gains and losses due to changes in the value of available-for-sale securities as defined by FAS 115.

d. Other income

23.Total employee compensation

Wages and salaries — Report gross earnings of all employees before deduction of employees’ payroll withholding taxes, social insurance contributions, group insurance premiums, union dues, etc. Include time and piece rate payments, cost of living adjustments, overtime pay and shift differentials, bonuses, profit sharing amounts, and commissions. Exclude commissions paid to independent personnel who are not employees.

Include direct payments by employers for vacations, sick leave, severance (redundancy) pay, etc. Exclude payments made by, or on behalf of, benefit funds rather than by the employer.

Include in-kind payments, valued at their cost, that are clearly and primarily of benefit to the employees as consumers. Do not include expenditures that benefit employers as well as employees, such as expenditures for plant facilities, employee training programs, and reimbursement of business expenses.

Employee benefit plans — Report employer expenditures for all employee benefit plans including those mandated by government statute, those resulting from collective bargaining contracts, and those that are voluntary. Include Social Security and other retirement plans, life and disability insurance, guaranteed sick pay programs, workers’ compensation insurance, medical insurance, family allowances, unemployment insurance, severance pay funds, etc. Also, include deferred postemployment and post retirement expenses per FAS 106. If plans are financed jointly by the employer and the employee, include only the contributions of the employer.