Слике страница




Data collected under these questionnaires are gathered for the purpose of preparing statistical compilations, consistent with the confidentiality strictures contained herein. While the Commission intends to utilize tabulations of 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.

[ocr errors]


QUESTIONNAIRE The purpose of this report is to enable the Legislative Commission on Food to aggregate business data for persons engaged in the distribution of food products to non-consumers (wholesalers and brokers). 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: 20 days after receipt of this questionnaire.

Precise corporate 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 dollars, 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.

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 (i)"; and put at the end of the completed report. The number of attachment sheets should be indicated in the blank which is provided below.

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)


[ocr errors]

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 10 days of its receipt.


Employer ldentification 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:


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


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 referers 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 of Columbia 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 addressee company.

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


1. Please describe in complete detail the company's principal activities.

2. Please state the names and addresses of your company's 15 largest customers by dollar volume and state the exact amount of that dollar volume.

3. Please state the names and addresses of your company's 20 largest suppliers by dollar volume and state the exact amount of that dollar volume.

4. Please state the names and addresses of the persons with whom you have competed in the past and presently compete against for the custom of the 20 customers listed in paragraph 2 above.

5. Please state whether there is any equity or long-term (more than 120 days) debt interest of your company in any company engaged in the retail distribution of food products.

6. Please describe the manner in which food brokers compete with food wholesalers.


7. State whether your company provides services or facilities to its customers, in addition to the sale of products to them, in any of the following areas: (a) retail pricing

No (b) advertising


No (c) delivery/pick-up


No (d) credit

Yes No (e) in store set-up

Yes No (f) computerized order taking

Yes No (g) other:


No b.

Yes No 8. If the answer to question number 7 is answered either fully or in part in the affirmative, please describe in precise detail the service provided; whether there is a charge therefor; if it is available to all customers; whether there is a minimum dollar on unit order before these services are made available; whether any or all of these services are provided by your competitors to their customers.


9. With regard to the extension of credit by your company, please state:

(1) The terms which are generally available to your customers:

(2) Whether certain customers are provided with better terms than others, and if so, what criteria are utilized by your company in determining which company receives the best credit terms.


1. 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.

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

3. 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

« ПретходнаНастави »