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ITEM A. COMPANY IDENTIFICATION 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 competed fiscal year, give the previous name and mailing address:

Name

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.

Name
Address

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 Distruct 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 in 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):

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):

First:

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

11. State the names and addresses of all persons owning or 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 distribution 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 company and the "other company.'

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(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:

ITEM C. FINANCIAL DATA FOR THE COMPANY DEFINITIONS An Establishment is a retail store from which goods are sold to the consuming public.

Sales or Receipts is the value (measured at invoice prices) of merchandise sold or services rendered during the fiscal year, not of returns and allowances.

Media Advertising Expense is all expenditures related to advertising the company's name, products, or services by television, radio, newspapers, newspaper supplements, magazines, business periodicals, billboards (outdoor advertising), transit, direct mail, handbills, and other media. Expenditures for the use of media and for advertising agency services are included. Expenditures for the support of advertising such as the cost of an advertising department, a market research group which specializes in evaluation of advertising and promotional efforts, a media buying department, or a graphic arts department that specializes in the preparation of advertising copy, are also included.

65-141 O - 76 - 18

Selling Expense Other Than Media Advertising Expense is all expenditures for sales promotion activities except those included in media advertising expense.

Research and Development Expense is all expenditures for basic or applied research in the sciences and engineering, including design and development of prototypes and processes. Expenditures for quality control, routine product testing, market research, sales promotion, sales service, research in the social sciences or psychology, other nontechnological activities, and technical service are not included.

Cost of Sales and Operations is labor, including fringe benefits and employer contributions for payroll taxes; cost of materials used in manufacturing; cost of goods purchased for resale; changes in inventories; depreciation, depletion, and amortization; property taxes; and other factory costs. Selling costs, research and development expense, and general and administrative costs are not included in cost of sales and operations.

1. Identify the location of each establishment owned or controlled by the addressee company.

2. For each establishment, state for the most recent fiscal year the following:

(a) the total sales volume (b) the costs of sales allocated to each store, including but without limitation, materials costs, labor costs, media advertising expense, other costs of sales and operations, selling expense other than media advertising expense, research and development expense, other general and administrative expense;

(c) each non-operating expense, including interest expense, depreciation, depreciation and amortization on plant, property, and equipment;

(d) the average gross margin
(e) the average gross margin as percentage of total sales
(f) the average gross margins as percent of gross profit; and

(g) gross profit 3. For each establishment, describe the geographical boundaries which your company believes circumscribe its area of effective competition, i.e., the area from which it draws the substantial number of its customers.

4. For each establishment, identify the names and addresses of each supermarket with which it competes for the custom of the consuming public.

5. For each establishment, identify the newspaper in which the company advertises.

6. For each establishment, identify the radio and/or television station on which the company advertises.

7. For each of the answers to questions 5 and 6, provide the most recent price list or rate card of said media company.

8. State whether your company conducts surveys, prepares studies or the like, of existing competition prior to entering a lease or purchasing a location for a new establishment.

9. If the answer to question 8 is in the affirmative, please attach a copy of those surveys presently in your possession.

10. If the answer to question 8 is anything other than an unqualified negative, state the criteria utilized by your company in deciding whether to open a new establishment, with particular, although not limited, reference to the number and location of other potential competitors and/or the particular identity of those potential competitors.

11. State whether, during the last five years, your company has refused to open another establishment because of the presence in the market area of too many competitors. Please detail each instance where this occurred, including a complete statement of the reasons for your non-entry.

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