Form Nc 99001 – Fill Out and Use This PDF

99001018

U.S. DEPARTMENT OF COMMERCE	2012 REPORT OF ORGANIZATION
Economics and Statistics Administration
U.S. CENSUS BUREAU
FORM
NC-99001 (06-01-2012)	OMB No. 0607-0444: Approval Expires 10/31/2013

(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		NC-99001
	answering the questions.

• Visit econhelp.census.gov

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

			COPY
INFORMATIONREPORT
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	Report Online - It's fast and secure!			Mail your	U.S. CENSUS BUREAU
			- OR -
				completed	1201 East 10th Street
	Go to:	econhelp.census.gov
				form to:	Jeffersonville, IN 47134-0001

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.

•

Please center numbers in

Examples:

•

Do not use pencil or felt-tip pen.

their respective boxes.

•

Do not put slashes through 0 or 7.

•

Place an "X" inside the box.

1COMPANY OWNERSHIP OR CONTROL

A. DOMESTIC OWNERSHIP OR CONTROL

1.Does another domestic company hold more than 50 percent of the voting stock of your company or have the power to control the management and policies of your company?

0008		Yes - Enter the following information of the owning or	0009		No - Go to line B
		controlling company

0080	Name of owning or controlling company	0081 Employer Identification
		Number (EIN) of	-
		owning or controlling
		company (9 digits)

0082 Home office address (Number and street)

0083	City, town, village, etc.	0084 State	0085 ZIP Code

-

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

	0027			Less than 50%	0028		50%	0029			More than 50%
							CONTINUE WITH 1				ON PAGE 2

PENALTY FOR FAILURE TO REPORT

6126

Yes

6127

No

6139

None

6132

Some, but less than $3 million

Form NC-99001

HOW TO

REPORT

DOLLAR

FIGURES

(06-01-2012)

	Dollar figures should be rounded to		Mark "X"					2012
				if None			$ Bil.	Mil.	Thou.
	thousands of dollars.							2	0 3 6
	If a figure is $2,035,628.79:	Report
	If a value is "0" (or less than $500.00):	Report						EXAMPLE

99001034

3COMPANY ACTIVITIES

A.EMPLOYEES FROM A PROFESSIONAL EMPLOYER ORGANIZATION

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

0244 Yes

	0245				No		INFORMATION			COPY
	B. OPERATING REVENUES AND NET SALES
	1.	Your company's operating revenues and net sales generated fromREPORTU.S. operations (i.e., located in the 50 states
		and the District of Columbia) in 2012.						USE	TO
		Include:					NOT
						of goodsDOand services to foreign firms.
			• Sales

• Revenues of discontinued operations.

• Sales to foreign parent firm and its affiliates not owned by your company.

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"		2012
	if None	$ Bil.	Mil.	Thou.

Operating revenues and net sales . . . . . . . . . . . . . 0100

2.Did your company have foreign subsidiaries in 2012?

9760 Yes - Go to line 3

9761 No - Go to 3 C, ROYALTIES AND LICENSE FEES FOR THE USE OF INTELLECTUAL PROPERTY

3.Does the amount reported on line 1 include inter-company sales by your company's domestic operations to foreign subsidiaries?

9755 Yes - Go to 3 C, ROYALTIES AND LICENSE FEES FOR THE USE OF INTELLECTUAL PROPERTY

9756 No - Go to line 4

	Mark "X"		2012
	if None	$ Bil.	Mil.	Thou.

4.Report inter-company sales by your company's domestic operations to foreign subsidiaries . . . . . . . . . . . . . 9758

CONTINUE WITH 3 ON PAGE 4

9701 Yes - Go to line 2

9702 No - Go to 3 D, MANUFACTURING ACTIVITIES

	INFORMATION
2.			TO
	Revenues from royalties and license fees for rights to use
		USE
	intellectual property in 2012
	NOT
3.	Revenues from yourDOcompany's U.S. operations, as

reported in line 2, for the following types of royalties and license fees in 2012:

a. Technological or industrial processes (Include patents, trade secrets, and proprietary technology. Exclude computer software.) . . . . . . . . . . . . . . . . . .

b. 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.) . . . . . . . . . . . . . . . . . . . . . . .

c. 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.) . . . . . . . . . . . . . . . .

d. Other - Specify

	COPY
	Mark "X"
	if None				$ Bil.
9703	REP				ORT
	Mark "X"
	if None				$ Bil.
9704

9705

9706

2012

Mil.Thou.

2012

Mil.Thou.

99001059

Form NC-99001 (06-01-2012)

3COMPANY ACTIVITIES - Continued

D.MANUFACTURING ACTIVITIES - Please respond even if you are not a manufacturer.

In 2012, did your company do any of the following activities related to manufacturing?

1.Operate manufacturing facilities (such as a factory, plant, or mill) where products are completed or partially produced?

9709 Yes - Go to line 2

9710 No - Go to line 3

2.Provide contract manufacturing services to other companies incorporating their patents, trade secrets, or proprietary technology?

	9711				Yes
					No - Go to line 3
	9712
		Estimate the percent of operating revenues and net sales, as reported in 3								B, OPERATING REVENUES
		AND NET SALES, from contract manufacturing services. COPY
						INFORMATIONREPORT
	9713					Less than 25%
		9714				25% - 49%	NOT	USE	TO
		9715				50%DO- 74%

9716 75% - 99%

9717 100%

3.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 , CERTIFICATION

a.Use 3rd party contract manufacturing services inside the United States (i.e., located in the 50 states and the District of Columbia)?

9720 Yes

9721 No

b.Use 3rd party contract manufacturing services outside the United States (i.e., located outside the 50 states and the District of Columbia)?

9722 Yes

9723 No

c.Use your company's foreign subsidiaries' or affiliates' contract manufacturing services at locations outside the United States (i.e., located outside the 50 states and the District of Columbia)?

9724 Yes

9725 No

d.Estimate the percent of the cost of sales from expenses for contract manufacturing services.

9726 Less than 25%

9727	25% - 49%
9728	50% - 74%
9729	75% - 99%
9730	100%

99001067

Form NC-99001 (06-01-2012)

REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

$$CENSUS_REMARKS$$

			COPY
INFORMATIONREPORT
		USE	TO
DO	NOT

4CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.

Is the time period covered by this report a		Month	Year	Month	Year
calendar year?
Yes	No - Enter time period covered	FROM		TO
Name of person to contact regarding this report			Title

	Area code		Number		Extension
Tele-		-	-	-
							Fax
phone
E-mail address
						Date
						completed

Area code	Number

- -

Month	Day	Year