Quarterly Survey of Financial Statements (IC3)
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For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
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Information
Purpose
Information collected as part of the Quarterly Financial Statistics for Enterprises program provides data used to measure the financial position and performance of incorporated businesses by industry aggregations. It also provides information on financial holdings and transactions in the Canadian System of Macroeconomic Accounts sector accounts.
Additional information
Instructions for completing and returning the questionnaire and the Corporate Structure can be found on the last page.
Authority
Confidential when completed - This survey is conducted under the authority of the Statistics Act, Revised Statutes of Canada, 1985,c. S-19.
Completion of this questionnaire is a legal requirement under the Statistics Act.
Confidentiality
Statistics Canada is prohibited by law from releasing information obtained from this survey which would identify a business without the previous written consent of that business. The data reported on this questionnaire will be treated in confidence, used for statistical purposes and published in aggregate form only. The confidentiality provisions of the Statistics Act are not affected by the Access to Information Act or any other legislation.
Reporting instructions
Please return completed copy within 30 days of quarter end. Si vous préférez ce questionnaire en français, veuillez cocher
FORMAT CHANGES
- Many cell names have been altered or shortened. For example, "Investments in and claims on parent, subsidiaries and affiliates" has been replaced with "Investments in affiliates." In such cases, as long as the SICA box number has not changed, the same definitions and reporting methods apply as before.
- All Supplementary questions have now been placed in the last section of the questionnaire, rather than at the end of each individual section.
Certification
I certify that the information herein is complete and correct to the best of my knowledge.
- 1: Name of company official (please print)
- 2: Name and position of person to contact if different from above (please print)
- 3: Telephone number and Extension
- 4: Position of company official
- 5: E-mail address
- 6: Facsimile number
SECTION A - ASSETS
Balance sheet date: Day, month, year
SECTION A - ASSETS - Question identifier:1.
Cash and deposits
- (a): Canadian currency
- (b): foreign currency
SECTION A - ASSETS - Question identifier:2.
Accounts receivable
- (a): Trade
- (b): consumer credit
- (c): other
- (d): allowance for doubtful accounts
SECTION A - ASSETS - Question identifier:3.
Lease Contracts
- (a): financial leases
- (b): residual value
SECTION A - ASSETS - Question identifier:4.
Inventory
SECTION A - ASSETS - Question identifier:5.
Investments in affiliates
SECTION A - ASSETS - Question identifier:6.
Canadian investments - non affiliates
SECTION A - ASSETS - Question identifier:7.
Foreign investments - non-affiliates
SECTION A - ASSETS - Question identifier:8.
Derivatives
SECTION A - ASSETS - Question identifier:9.
Mortgage loans to non-affiliates
SECTION A - ASSETS - Question identifier:10.
Non-mortgage loans to non-affiliates
SECTION A - ASSETS - Question identifier:11.
Fixed assets
- (a): depreciable assets and land
- (b): capitalized leases of lessee
- (c): accumulated depreciation
- (d): depletable assets
SECTION A - ASSETS - Question identifier:12.
Intangible assets
SECTION A - ASSETS - Question identifier:13.
Other assets
SECTION A - ASSETS - Question identifier:14.
TOTAL ASSETS
SECTION B - LIABILITIES AND EQUITY
Balance sheet date: Day, month, year
LIABILITIES
LIABILITIES - Question identifier:15.
Accounts payable
- (a): trade
- (b): other
LIABILITIES - Question identifier:16.
Income taxes payable
LIABILITIES - Question identifier:17.
Amounts owing to affiliates
- (a): in Canada
- (b): outside Canada
LIABILITIES - Question identifier:18.
Borrowing from non-affiliates
- (a): loans and overdrafts
- (1): from lenders in Canada
- (2): from lenders outside Canada
- (b): commercial paper
- (c): bonds and debentures
- (d): mortgage loans
- (e): capital lease obligations
LIABILITIES - Question identifier:19.
Equity securities classified as liabilities
LIABILITIES - Question identifier:20
Derivatives
LIABILITIES - Question identifier:21.
Future income taxes
LIABILITIES - Question identifier:22.
Minority interest
LIABILITIES - Question identifier:23.
Other liabilities
EQUITY
EQUITY - Question identifier:24.
Share capital
- (a): preferred
- (b): common
EQUITY - Question identifier:25.
Unitholders' capital
EQUITY - Question identifier:26.
Contributed surplus
EQUITY - Question identifier:27.
Accumulated other comprehensive income
EQUITY - Question identifier:28.
Retained earnings
- (a): opening balance
- (b): net income (loss) for the current period
- (c): transfers from (to) share capital
- (d): other additions (deductions)
- (e): dividends declared
- (1): preferred shares
- (2): common shares
- (f): income trust distributions
- (g): closing balance
EQUITY - Question identifier:29.
TOTAL LIABILITIES AND EQUITY
SECTION C - INCOME STATEMENT
From: Day, month, year To: Day, month, year
SECTION C - INCOME STATEMENT - Question identifier:30.
OPERATING REVENUE
OPERATING EXPENSES
OPERATING EXPENSES - Question identifier:31.
Wages and salaries
OPERATING EXPENSES - Question identifier:32.
Employer portion of employee benefits
OPERATING EXPENSES - Question identifier:33.
Pension expense
OPERATING EXPENSES - Question identifier:34.
Stock options expense
OPERATING EXPENSES - Question identifier:35.
Indirect taxes
OPERATING EXPENSES - Question identifier:36.
Depreciation
OPERATING EXPENSES - Question identifier:37.
Depletion
OPERATING EXPENSES - Question identifier:38.
Amortization
OPERATING EXPENSES - Question identifier:39.
Resource royalties expense
OPERATING EXPENSES - Question identifier:40.
Bad debts expense, charitable donations and write-down of inventory
OPERATING EXPENSES - Question identifier:41.
Purchased goods and services
OPERATING EXPENSES - Question identifier:42.
TOTAL OPERATING EXPENSES
OPERATING EXPENSES - Question identifier:43.
OPERATING INCOME (LOSS)
OTHER REVENUE AND EXPENSES
OTHER REVENUE AND EXPENSES - Question identifier:44.
Canadian interest revenue
OTHER REVENUE AND EXPENSES - Question identifier:45.
Canadian dividends
OTHER REVENUE AND EXPENSES - Question identifier:46.
Foreign interest and dividend revenue
OTHER REVENUE AND EXPENSES - Question identifier:47.
Interest expense
- (a): short-term debt
- (b): bonds and debentures
- (c): mortgages
- (d): other long-term debt
OTHER REVENUE AND EXPENSES - Question identifier:48.
Dividends paid on equity securities classified as liabilities
OTHER REVENUE AND EXPENSES - Question identifier:49.
Gains (losses) on the sale of assets
OTHER REVENUE AND EXPENSES - Question identifier:50.
Foreign currency gains (losses)
OTHER REVENUE AND EXPENSES - Question identifier:51.
Derivatives gains (losses)
- (a): realized
- (b): unrealized
OTHER REVENUE AND EXPENSES - Question identifier:52.
Revaluations, (write-downs) and (write-offs)
OTHER REVENUE AND EXPENSES - Question identifier:53.
INCOME (LOSS) BEFORE INCOME TAX
OTHER REVENUE AND EXPENSES - Question identifier:54.
Current income tax expense
OTHER REVENUE AND EXPENSES - Question identifier:55.
Future income tax expense
OTHER REVENUE AND EXPENSES - Question identifier:56.
INCOME (LOSS) AFTER INCOME TAX
OTHER REVENUE AND EXPENSES - Question identifier:57.
Equity in unconsolidated affiliates
OTHER REVENUE AND EXPENSES - Question identifier:58.
Minority shareholders' portion of net income of consolidated affiliates
OTHER REVENUE AND EXPENSES - Question identifier:59.
Extraordinary gains (losses)
OTHER REVENUE AND EXPENSES - Question identifier:60.
NET INCOME (LOSS)
OTHER REVENUE AND EXPENSES - Question identifier:61.
Other comprehensive income
- (a): unrealized gains (losses)
- (b): realized (gains) losses
- (c): income taxes
OTHER REVENUE AND EXPENSES - Question identifier:62.
COMPREHENSIVE INCOME
SECTION D - DISCLOSURE OF SELECTED ACCOUNTS
BALANCE SHEET DISCLOSURE
BALANCE SHEET DISCLOSURE - Question identifier:63.
Current assets
BALANCE SHEET DISCLOSURE - Question identifier:64.
Current liabilities
PENSION PLAN FUNDING
PENSION PLAN FUNDING - Question identifier:65.
Funded status
- (a): plan assets
- (b): benefit obligation
- (c): funded status
- (d): accrued benefits (liability) or asset
INCOME STATEMENT DISCLOSURE
INCOME STATEMENT DISCLOSURE - Question identifier:66.
Cost of goods and services sold
INCOME STATEMENT DISCLOSURE - Question identifier:67.
Exploration and development costs expensed
INCOME STATEMENT DISCLOSURE - Question identifier:68.
Software costs expensed
INCOME STATEMENT DISCLOSURE - Question identifier:69.
Equity method dividends
- (a): Canadian
- (b): foreign
INCOME STATEMENT DISCLOSURE - Question identifier:70.
Unusual items
INCOME STATEMENT DISCLOSURE - Question identifier:71.
Consolidation accounting elimination of sales
INCOME STATEMENT DISCLOSURE - Question identifier:72.
CAPITAL EXPENDITURES
OTHER DISCLOSURE
OTHER DISCLOSURE - Question identifier:73.
Hours spent completing questionnaire
Additional comments
Please use this section to report any comments you may have.
Instructions
Report only Canadian operations - please exclude foreign affiliates.
Report all amounts in thousands of Canadian dollars - "$ 000s"
Use parentheses to report negative values.
If actual data are not available, estimates may be used.
The term "affiliate" used in this questionnaire covers unconsolidated:
- parent, subsidiary and related corporations
- related joint ventures and partnerships
- head offices, branches and divisions
- directors, officers and individual shareholders
Affiliates are entities within a common family of corporations controlled or significantly influenced by the reporting company or another company within the corporate family.
Returning your questionnaire and Corporate Structure:
Return the completed questionnaire and Corporate Structure in the enclosed envelope or fax it to Statistics Canada at (800) 552-4428 within 30 days of quarter end.
Fax or other electronic transmission disclosure:
Statistics Canada advises you there could be risk of disclosure during facsimile or other electronic transmission. However, upon receipt of your information, Statistics Canada will provide the guaranteed level of protection afforded all information collected under the authority of the Statistics Act.
For further information, definitions of terms used, or questions concerning this survey, please consult the "Quarterly Survey of Financial Statements Reporting Guide" (available at www.statcan.gc.ca/imdb-bmdi/2501-eng.htm), and/or contact Statistics Canada at:
Telephone: (877) 898-6686 Fax: (800) 552-4428 E-mail: QSFS-RTEF@statcan.gc.ca Statistics Canada Business Survey Section/Central Region 2nd Floor, Jean Talon Building 150 Tunney's Pasture Driveway Ottawa, Canada, K1A 0T6
THANK YOU FOR YOUR CO-OPERATION
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