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U.S. CENSUS BUREAU 1201 East 10th Street Jeffersonville, IN 47132-0001 1 (800) 447–4613

OMB No. 0607-0432: Approval Expires 10/31/2021

FORM QFR-200(MT)

(09-25-2019)

U.S. DEPARTMENT OF COMMERCE

U.S. CENSUS BUREAU

QUARTERLY FINANCIAL

REPORT

MANUFACTURING,

MINING, RETAIL, AND WHOLESALE TRADE

PLEASE READ the accompanying instructions before answering the questions.

NEED HELP?

USE Secure Messaging Center at Internet Website: econhelp.census.gov/qfr/contactus

Call 1 (800) 272–4250 between 8 a.m. and 5 p.m. Eastern time Monday through Friday

NOTE – Audited figures are not required. Estimates are acceptable for line items where actual data are not available.

Submit VIA Internet Reporting at: econhelp.census.gov/qfr

OR MAIL TO:

OR FAX TO:

NOTICE – YOUR RESPONSE IS REQUIRED BY LAW. Title 13 United States Code (U.S.C.), Section 91, authorizes this collection and requires your response. The U.S. Census Bureau is required by Section 9 of the same law to keep your information CONFIDENTIAL and can use your responses only to produce statistics. The Census Bureau is not permitted to publicly release your responses in a way that could identify your business, organization, or institution. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data. This collection has been approved by the Office of Management and Budget (OMB). The eight digit OMB approval number is 0607-0432 and appears at the upper right of this page. Without this approval, we could not conduct this survey. We estimate this survey will take 3 hours to complete. More information about this estimate and an address where you may write with comments is in the instructions that accompany this form.

INTERNET REPORTING — You may complete this survey online at: econhelp.census.gov/qfr

Username:

Password:

Use your firm’s unique username and original password.

●1 Person to contact regarding this report – Print or type

011						012
						012
Name and title						e-mail address
013	Area code		Number		Extension	014 Fax	Area code		Number
Telephone	(	)		–			(	)		–
Telephone	(	)		–			(	)		–

ITEMS 2 THROUGH 7 REFER TO THE CORPORATION NAMED IN THE ADDRESS BOX

●2 a. Annual closing date of this corporation	021

b. Federal Employer Identification Number (FEIN) 022

Month Day

–

●3 Corporation status – Mark "X" only ONE box. Insert discontinued or merged date if corporation is no longer operating.

a.Active

b.Discontinued

034

Month Day

Year

c.Merged

035

Month

Day

Year

●4 Is this corporation owned more than 50 percent by another corporation? (Mark "X" only ONE box.)

	a. No	b. Yes		– Provide the name, FEIN, and address assigned to this corporation below.



043	Name		044		FEIN	045	Address
	Name				FEIN		Address

–

●5 Does this corporation own more than 50 percent of any other corporation – Mark "X" only ONE box.

a. Yes STOP! Read Consolidation Rules below.

b.No

–Proceed to page 2.

●6 What is the total number of domestic and foreign corporations directly or indirectly (all tiers) owned		Number

more than 50 percent by this corporation?	061
●7 a. After reviewing the Consolidation Rules below, how many corporations are consolidated in this report?	071
b. How many corporations are not consolidated in this report?	072

CONSOLIDATION RULES: This is a domestic-only consolidation. Nonconsolidated subsidiaries must be reported using either the equity or cost method of accounting. Fully consolidate the operations of every majority-owned domestic subsidiary (including majority- owned subsidiaries of these subsidiaries) that are taxable under the U.S. Internal Revenue Code. Consolidated subsidiaries should include 1120S corporations.

EXCEPTION: Do not fully consolidate domestic subsidiaries that are primarily engaged in foreign operations, banking, finance, or insurance (as defined in the North American Industry Classification System (NAICS) Sector 52, United States, 2007).

Do not fully consolidate foreign subsidiaries or foreign operations. Nonconsolidated subsidiaries must be reported using the equity method or cost method of accounting.

Equity method of accounting – Report net equity earnings (losses) of all nonconsolidated domestic and foreign operations on 8 line I of the Income Statement. Report the investment on 9 line I on the Balance Sheet. For purposes of this report, domestic operations refer to operations that are within the 50 United States and the District of Columbia. Commonwealths such as Puerto Rico and territories such as the Virgin Islands are not considered domestic.

CONTINUE ON PAGE 2

PLEASE KEEP A COPY OF THIS FORM FOR YOUR RECORDS

BEFORE COMPLETING THIS REPORT, READ THE CONSOLIDATION RULES ON THE PREVIOUS PAGE

AND THE ACCOMPANYING INSTRUCTIONS.

REPORT ALL DOLLAR FIGURES IN THOUSANDS. AUDITED FIGURES ARE NOT REQUIRED.

ESTIMATES ARE ACCEPTABLE FOR LINE ITEMS WHERE ACTUAL DATA ARE NOT AVAILABLE.

●8	Schedule A – Statement of Income and Retained	401	FROM: Month	Day	Year	402	TO: Month	Day	Year		AMOUNT
●8	Schedule A – Statement of Income and Retained										AMOUNT
	Earnings for your 3-MONTH PERIOD (inclusive)										(in thousands)
	Earnings for your 3-MONTH PERIOD (inclusive)										(in thousands)
A Sales, receipts, and operating revenues (net of returns and allowances, and excise and sales taxes)1										101
							. . . . . . . . . .	. . . . . .	. . .
B Depreciation, depletion, and amortization of property, plant, and equipment										102
				. . . .	. . . . .	. . . .	. . . . . . . . . .	. . . . . .	. . .
C All other operating costs and expenses – Include cost of goods sold (net of purchase discounts), selling, general and administrative										103

	expenses, and amortization of intangible assets

DIncome (loss) from operations — 8 line A less the sum of lines B and C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

EInterest expense — Do not net interest income with interest expense. Report interest income in 8 line G. . . . . . . . . . . . . . . . . 105

F Dividend income — Domestic and foreign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

106

G Other recurring nonoperating income (expense) — Include interest income, minority interest, etc. 2 . . . . . . . . . . . . . . . . . . . . . 107

HNonrecurring items — Include gain (loss) on sale of assets, restructuring costs, asset writedowns, disposal of business segments, etc. 2. 108

			109
I	Income (loss) of foreign branches and equity in earnings (losses) of domestic and foreign nonconsolidated subsidiaries and other
	investments accounted for by the equity method, net of foreign taxes	. . . . . . . . . . . . . . . . . . .
J	Income (loss) before income taxes — Sum of 8 lines D, F, G, H, and I less line E	. . . . . . . . . . . . . . . . . . .	111
K Provision for current and deferred domestic income taxes (accrue payable in 10 lines D and H)
			112
	1. Federal 3	. . . . . . . . . . . . . . . . . . .
			113
	2. State and local 3	. . . . . . . . . . . . . . . . . . .
			115
L	Income (loss) before extraordinary items and cumulative effect of accounting changes — 8	line J less lines K-1 and K-2 .
			116
M	Extraordinary gains (losses), net of taxes 2	. . . . . . . . . . . . . . . . . . .
N	Cumulative effect of accounting changes, net of taxes 2	. . . . . . . . . . . . . . . . . . .	117

ONet income (loss) for quarter — Sum of 8 lines L, M, and N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

PRetained earnings at beginning of quarter — If not the same as 10 lines I-2 of preceding quarter, explain below. . . . . . . . . . . . . . 119

Q Cash dividends charged to retained earnings this quarter — Include 1120S cash distributions. . . . . . . . . . . . . . . . . . . . . . . . .

120

R Other direct credits (charges) to retained earnings — Include stock and other non-cash dividends, etc.2 . . . . . . . . . . . . . . . . . . 121 S Retained earnings at end of quarter — Sum of 108 lines O, P, and R less line Q (same as 10 lines I-2). . . . . . . . . . . . . . . 123

●9	Schedule B1 – Balance Sheet – Assets		403			Month			Day	Year		AMOUNT
			Balance Sheet date as of									(in thousands)
			Balance Sheet date as of


A	1. Cash and demand deposits in the U.S										201
A	1. Cash and demand deposits in the U.S
	2. Time deposits (certificates of deposit) in the U.S										202
	2. Time deposits (certificates of deposit) in the U.S										203
	3.	Cash and deposits outside the U.S									203
	3.	Cash and deposits outside the U.S	. . . . . . . . . . . . . . . . . . .	. . .	. . .	. . . . .	. .	. . .	. . . . . .	. . .	204
											204
B	1. U.S. Treasury and Federal agency securities — Subject to agreements to sell										205
	2. U.S. Treasury and Federal agency securities — Other, due in one year or less										205
											206
C 1. Commercial and finance company paper of U.S. issuers											206
C 1. Commercial and finance company paper of U.S. issuers							. .	. . .	. . . . . .	. . .	207
	2.	State and local government securities, due in one year or less									207
	2.										208
	3.	Foreign securities, due in one year or less									208
	3.	Foreign securities, due in one year or less
	4.	Other short-term financial investments — Include financial derivatives and hedging activity									209
	4.						. .	. . .	. . . . . .	. . .
D	1. Trade receivables from the U.S. Government 4 . . . .		. . . . . . . . . . . . . . . . . . .	. . .	. . .	. . . . .	. .	. . .	. . . . . .	. . .	211
	2.	Other trade accounts and trade notes receivable (less allowance for doubtful accounts) 4									212
	2.						. .	. . .	. . . . . .	. . .
E	Inventories4		. . . . . . . . . . . . . . . . . . .	. . .	. . .	. . . . .	. .	. . .	. . . . . .	. . .	214
F All other current assets — Include prepaid expenses and income taxes receivable 4											215
							216. .	. . .	. . . . . .	. . .
G	. . . . . . . . . . . . . . . . . . . . . . .1. Property, plant, and equipment — Include construction in progress						217
	2.	Land and mineral rights					217
	2.	Land and mineral rights	. . . . . . . . . . . . . . . . . . .	. . .	. . .	. . . . .
	3.	Accumulated depreciation, depletion, and amortization					218
	3.	Accumulated depreciation, depletion, and amortization
	4.	Net property, plant, and equipment — Sum of 109	lines G-1 and G-2 less line G-3								219
	4.	Net property, plant, and equipment — Sum of 109	lines G-1 and G-2 less line G-3				. .	. . .	. . . . . .	. . .
H U.S. Treasury and Federal agency securities, due in more than one year											220
							. .	. . .	. . . . . .	. . .

IAll other noncurrent assets — Include investment in nonconsolidated entities, long-term investments, intellectual property, etc. . . . . 221

JTOTAL ASSETS – Sum of 109 lines A-1 through F, G-4, H, and I (must equal 10 line J) 223

●10	Schedule B2 – Balance Sheet – Liabilities and Stockholders’ Equity
				1. Loans from banks			301
			{	1. Loans from banks			302
A	Short-term debt (original maturity of one year or less) — Include overdrafts			2.Commercial paper			302
				2.Commercial paper			303
				3.Other short-term loans			305
B Advances and prepayments by the U.S. Government4							305
B Advances and prepayments by the U.S. Government4		. . . . . . . . . . . . . .	.	. . . .	. . . . . . .	. . . . . . . . . . . .	306
C	Trade accounts and trade notes payable						306
C	Trade accounts and trade notes payable
D	Domestic income taxes accrued, prior and current years, net of payments —		{	1. Federal			307
D				1. Federal
	Include overpayments	. . . . . . . . . . . . .		2. State and local			308
				2. State and local			310
				1. Loans from banks			310
				1. Loans from banks
E	Current portion of long-term debt — Classify noncurrent portion in	10 line G.	{ 2.Bonds and debentures				311
E		10 line G.
							312
				3.Other long-term loans			314
F All other current liabilities — Include excise and sales taxes, accrued expenses, and current portion of operating leases 4							314

				1.Loans from banks			316
				1.Loans from banks
G	Long-term debt, due in more than one year — Classify current portion in 10 line E.. . . . . { 2.Bonds and debentures						317
G							318
				3. Other long-term loans			320
							320
H All other noncurrent liabilities — Incl. deferred taxes, minority stockholders’ interest, and long-term portion of operating leases
I 1. Capital stock and other capital — Include additional paid in capital					321
					321
			.	. . . .	. . . .
	10				322
	2. Retained earnings (same as 8 line S)	. . . . . . . . . . . . . .	.	. . . .	. . . .
	3. Cumulative foreign currency translation adjustment				323
	3. Cumulative foreign currency translation adjustment	. . . . . . . . . . . . . .	.	. . . .	. . . .
	4. Other stockholders’ equity items — Include unearned compensation and ESOP debt guarantees				324
					. . . .
	5. Treasury stock at cost				325
	5. Treasury stock at cost	. . . . . . . . . . . . . .	.	. . . .	. . . .
	6. Stockholders equity — Sum of 10 lines I-1 through I-4 less lines I-5						327
			.	. . . .	. . . . . . .	. . . . . . . . . . . .	328
J	TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY — Sum of 10 lines A-1 through H and I-6						328
J

1Report sales and costs from the normal business activities of discontinued operations in the same manner as sales and costs from continuing operations.

2Attach a list and explain, on a separate sheet, the principal debits and credits reflected during the quarter.

3Attach a brief explanation on a separate sheet if tax provision is not shown (e.g., "net operating loss," "1120S," etc.).

4Progress payments and billings from U.S. Government and others should not be deducted from 109 lines D-1, D-2, E, and F; but included in 10 lines B and F.

IMPORTANT: IN ALL CORRESPONDENCE WITH US, PLEASE REFER TO THE 10-DIGIT USERNAME LOCATED ON THE FRONT OF THIS FORM.

FORM QFR-200(MT) (09-25-2019)

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Form Name	Qfr 200 Fillable Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	census 2020, qfr 200, qfr form pdf, qfr 200 mt form

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