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Data collected under the Line of Business Report Program are gathered for the purpose of preparing statistical compilations, consistent with the confidentiality strictures contained herein. While the Commission intends to utilize tabulations of Line of Business data in the Commission Report, no individual company data contained in the Line of Business Reports will be revealed in these reports prepared by the Commission. However, these reports may be utilized in connection with any Commission investigation.

The names of companies, financial data and all other information which are obtained from respondent companies are confidential, and persons authorized to have access to this information may not release, discuss or in any way provide access to such information to anyone not authorized to have access.

Authorized access and use.—Access to and use of individual company data is restricted to members of the Legislative Commission on Food except that upon recommendation of the Commission, the data may be turned over to appropriate government authorities. Access by members of the Commission is authorized only during and for the purpose of electronic processing of such data.

All persons having use or possession of individual company data will be personally responsible for securing the confidentiality of those data and for following the rules set forth above. Any violation of these rules, either through neglect or otherwise, will result in prosecution to the full extent of the law or any other legal action decided on by the Chairman of the Commission.


LINE OF BUSINESS REPORT QUESTIONNAIRE The purpose of this report is to enable the Legislative Commission on Food to aggregate business data for the retail food and related industries. Each company being surveyed is asked to provide certain items of financial information on each of the lines of business in which it operates. Due date: 35 days after the receipt of this questionnaire.

Company name and mailing address (please correct any errors):

If some item or subitem is not applicable to the addressee company, enter “NA” in the appropriate space. All financial data should be for the addressee company's most recently completed fiscal year. Dollar amounts should be reported to the nearest thousand doilars, e.g., $2,397,629 is to be reported as $2,398. Report all percentages to the nearest tenth of one percent, e.g., $491,126 as a percentage of $2,397,629 is to be reported at 20.5 percent. Foreign monetary values are to be converted to dollar equivalents as of the date customarily used by the addressee company.

Continuation sheets for Items B through E have been included in the packet of materials you received. Additional copies of those sheets may be reproduced by you, or they will be supplied by the Commission.

The Addendum to the report form contains a list of industry categories. It does not need to be returned when the completed report form is filed.

Footnotes should be used to explain fully any answer which appears to be inconsistent with instructions or which needs additional clarification as to its meaning; they may be put on the form itself (where space permits) or on attachment sheets. If attachment sheets are used, they should be: identified with the letter(s) to which they apply; numbered consecutively, beginning with "attachment sheet (1)”; and put at the end of the completed report. The number of attachment sheets should be indicated in the blank which is provided below. The numbers of continuation and attachment sheets are:

Item B --; Item C .-; Item D --; Item E --; Attachment Representative of the addressee company who should be contacted regarding this report:

Telephone number


This report was prepared under my supervision. To the best of my knowledge, the information presented is true, correct, and complete.

(Signature and title of company official)



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The purpose of this item is to determine any changes in the identity of the addressee company and to determine whether the addressee company is owned by another firm.

1. If the name and/or the mailing address of the addressee company has been changed during its most recently completed fiscal year, give the previous name and mailing address:


Address 2. Did another domestic company have more than a 50 percent ownership interest in the addressee company at any time during the fiscal year (yes or no)? If no, skip subitem 3, and complete the rest of the report form.

3. Give the name, mailing address, and Employer Identification Number(s) of the owning company. If the addressee company is to be consolidated for reporting purposes by the owning company, do not complete the rest of the report form. Return the first three pages of the report form within ten days of its receipt.


Employer Identification Number(s) under which the addressee company reported income and payroll taxes: 4. The addressee company's fiscal year (month/day/year) for which this report is being filed:

Began on:

Ended on: 5. Employer Identification Number(s) under which the addressee company reported income and payroll taxes:

ITEM B. COMPANY AFFILIATIONS The purpose of this item is to identify active domestic companies in which the addressee company has a majority ownership interest

: For purposes of this report, Domestic refers to the 50 States and the District of Columbia. Hence, a Domestic Corporation is one incorporated in one of the 50 States or the District of Columbia, and a Domestic Operation is one in which production of a good or rendering of a service occurs in one or more of the 50 States and/or in the District of Columbia. Note that an operation taking place in one or more of the 50 States and/or in the District is domestic even though all of the output is exported. Foreign refers to other than the 50 States and the District of Columbia. Hence, a Foreign Entity is one which is legally organized in other than the 50 States or the District of Columbia and a Foreign Branch is a branch operating in other than the 50 States or the District of Columbia.

Complete one Item B-sheet for each active domestic company in which the addressee company had more than a 50 percent ownership interest at any time during the fiscal year given in Item A above. If


there were no such companies, enter "none" in subitem 1, and go to Item C. An Active company is a company with assets, or with receipts from operations, or both. Any company which is more than 50 percent owned by a subsidiary of the addressee company is considered to be more than 50 percent owned by the addressed company.

1. Exact company title:
2. Mailing address:
3. Place of incorporation (State or country):
4. Date of incorporation (month/day/year):

5. Employer Identification Number(s) assigned to this company for reporting income and payroll taxes :

6. Describe the company's principal activities:

7. Total sales or receipts (including transactions with affiliates) in this company's most recently completed fiscal year:

8. Approximate percentage of total sales or receipts, as given in subitem 7 above, which originated from domestic operations:

9. If company was not more than 50 percent owned throughout entire fiscal year, give the first and last days on which it was more than 50_percent owned (month/day/year):

10. If subitem 9 is applicable, please explain what happened.

11. State the names and addresses of all persons, corporate, institutional or otherwise, controlling 10 percent or more of the outstanding shares of stock of your company.

12. State the names and addresses of the directors and officers of your company.

13. State the names and addresses of each person who is an officer, shareholder, director or employee with management or supervisory responsibilities of your company (hereafter referred to as a “controlling representative”) who is also a "controlling representative" of another company (other company) engaged in the production, transportation or distributor of food products at the wholesale or retail level.

14. In each instance where you have listed an individual in answer to question 13 please state:

(a) The name and address of the "other company”:

(b) How long the person so listed has acted for both your company and the "other company":


(c) Whether your company or the other company" has a financial interest (e.g., loans, stock ownership, customers or supplies) in each other.

15. State whether your company has been a participant, since its incorporation in any merger, consolidation, exchange of stock or other combination of assets or stock with any other company engaged in the production, transportation, or distribution of food products at the wholesale or retail level. Yes. No

16. If the answer to question 15 is in the affirmative, state:
(a) The date of the transaction:
(b) The names and addresses of the entities involved:

(c) The principal activities of the entities involved before and after the transaction, i.e., merger, consolidation, etc.


The purpose of this item is to identify your firm's lines of business and to gather information on the degree to which these lines are specialized to a single industry category.

Complete a separate Item Č for each line of business.

A Line of Business is the combination of all segments. Unless your company presently allocates all expenses and assets of an establishment to subunits of it, the establishment is a segment. If such allocations are currently done for any of your establishments, you must use the subunits of those establishments as segments.

An Establishment is a plant or other economic unit, generally at a single physical location, where manufacturing operations or other services are performed. Central administrative offices, auxiliary units, and sales offices which primarily wholesale or retail goods manufactured by the same firm are separate establishments.

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