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another company (other company) engaged in the production, transportation or distribution of food products at the wholesale or retail level.

4. In each instance where you have listed an individual in answer to question 3, 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.

5. 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

6. If the answer to question 5 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.

7. Please attach to your answers a copy of your company's four most recent profit and loss statements and balance sheets.

8. Please identify the location of your company's facilities, i.e., office, warehouse, etc., and describe each by size, use and type of building.

9. Please state how many motor vehicles your company utilizes in its business and fully describe each such vehicle by year, make, and load capacity

10. Please state whether your company presently has any written or oral agreements with any of its customers providing that your company will supply those customers with products or services over an extended period of time, i.e., greater than nine months.

11. If the answer to question 10 is in the affirmative, please describe in complete detail the agreement.

12. Please state what, if any, kinds of foods are not supplied by your company to its customers, e.g., fruits and vegetables, meats, and explain why this is so.

13. Please state whether your company provides promotional allowances, gifts, rebates, or other things of value to its customers as incentives to purchase your products and services.

14. If the answer to question 13 is in the affirmative, please describe in complete detail the nature, amount, and length of time you have provided these incentives.

15. Please state whether all of your customers pay the same price for your products and services and if there are any differences in the prices paid, explain in complete detail the basis for those differences.

16. Please identify each trade association or other business group of which your company is a member, which consists in whole or in part of persons engaged in the wholesale distribution of food products.

17. Please state whether your company requires or suggests as a condition to the sale of any of its products or services to its customers that the customers purchase or utilize other products or services sold by your company.

18. Please state whether your company suggests or in any other manner is involved in the process of selecting the retail price which its customer resells the products which you have sold to it.



Data collected under the Line of Business Report Program are gathered for the purpose of preparing statistical compilations, consistent with the confidentiality structures 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.



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: 14 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 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 (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.

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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