P&SP 3004 Annaul Report of Packers

					For P&SP Use Only									P&SP Bar Code Only
U.S. Department of Agriculture					ANNUAL REPORT OF PACKERS
Grain Inspection,
Packers and Stockyards
Administration
Packers and					Instructions: If an item's value is zero, enter "0". If an item does not apply, enter "NA". Upon completion please verify that all items have been answered. Return completed form to the P&SP Central Reporting Unit. See separate instructions for complete information about this report.
Stockyards
Program
										GENERAL INFORMATION - SECTION 1
101			Reporting Period (mm/dd/yy)			a. from									b. to
102			Legal Business Name
103			Business Name (dba)
104			Mailing Address
105			City, State, Zip
106			Physical Address
107			City, State, Zip
108			Contact Name
109			Telephone Number
110			Fax Number
										ORGANIZATIONAL STRUCTURE - SECTION 2
			List owners, officers, partners, and managing members in control of this business
			a. Name									b. Title							c. Percentage Ownership
201
202
203
204
205
206			Type of organization				Individual			Partnership			Corporation			L.L.C.		L.L.P.		Co-op		Other
207			Is this the same organization type reported last year?									Yes		No
208			Is this business owned or controlled by another business entity?									Yes		No
209			If line 208 is yes, identify the owner/controlling business name and address.
210			Does this business own or control other businesses within the livestock-meat sector?												Yes		No
			If line 210 is yes, then provide the names of businesses that you own or control and percentage of control it items 211-214
			a. Name of Business																	b. Percentage of Control
211
212
213
214
Your response to this form is required under the Packers and Stockyards Act of 1921 (9 CFR 201.97 and 7 U.S.C. 181-229). According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information is 0580-0015. The time required to complete this information collection is estimated to average 7 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.
										FINANCIAL INFORMATION - SECTION 3
301			Total value of livestock purchased for feeding												$
302			Total value of livestock purchased for slaughter												$
303			Total value of all livestock purchased (line 301 plus 302)																	$
304			As of the end of the reporting period, were Accounts Receivable and/or Inventories, or any part thereof, pledged or assigned as collateral under a financing or loan agreement?																		Yes		No
			Enter name and location of bank used for livestock payments
305			Bank Name
306			Physical Address
307			City, State, Zip
										BALANCE SHEET - SECTION 4
			Include values only for the reporting entity.
Assets
	Current Assets
		Cash (Enter overdrafts under Current Liabilities - line 418)																	401	$
		Temporary Cash Investments (Marketable Securities, Certificates
			of Deposit, Commercial Paper, etc.)																402	$
		Accounts Receivable (Due in One Year or Less)
			From sources not related to company											403	$
			From sources related to company											404	$
		Total Accounts Receivable																	405	$
		Notes and Loans Receivable (Portion due in One Year or Less)																	406	$
		Inventory
			Livestock											407	$
			Meat and Meat Food Products											408	$
			Other Inventory											409	$
		Total Inventory																	410	$
		Other Current Assets																	411	$
	Total Current Assets																		412	$
	Long-Term Assets
		Investments												413	$
		Property, Plant, & Equipment (Net of Depreciation and Amortization)												414	$
		Other Long-Term Assets												415	$
	Total Long-Term Assets																		416	$
Total Assets																			417	$
Liabilities and Net Worth
Liabilities
	Current Liabilities
		Bank Overdraft																	418	$
		Accounts Payable
			Livestock Purchases											419	$
			Other payables to sources not related to company											420	$
			Other payables to sources related to company											421	$
		Total Accounts Payable																	422	$
		Notes and Loans Payable (Demand Notes and Portion of
			Long-Term Notes due in One Year or Less)																423	$
		Other Current Liabilities																	424	$
	Total Current Liabilities																		425	$
	Long-Term Liabilities (Due after One Year)																		426	$
Total Liabilities																			427	$
Total Net Worth																			428	$
Total Liabilities and Net Worth (Equals Total Assets)																			429	$
									INCOME STATEMENT - SECTION 5
			Include values only for reporting entity.
Income Statement
	Net Sales (Gross sales less sales returns & allowances)																		501	$
		Cost of Sales
			Opening Inventory						502	$
			Livestock Purchases						503	$
			Meat and Meat Food Product Purchases						504	$
			Other Purchases						505	$
			Subtotal (sum lines 502 to 505)											506	$
			Closing Inventory											507	$
		Total Cost of Sales (line 506 less 507)																	508	$
	Gross Profit																		509	$
	Operating Expenses
			Manufacturing											510	$
			General, Sales, and Administrative											511	$
			Depreciation & Amortization											512	$
	Total Operating Expenses																		513	$
	Operating Income or Loss																		514	$
	Adjustments to Operating Income
			Other Additions to Income											515	$
			Interest Expense											516	$
			Other Deductions from Income											517	$
	Total Adjustments to Operating Income																		518	$
Net Profit or Loss before Income Tax																			519	$
					LIVESTOCK FEEDING OPERATIONS, PROCUREMENT, SLAUGHTER, AND MEAT PROCESSING - SECTION 6
Plant Information.
			If you use only one plant for slaughter operations, report values here. If you use more than one plant, then use Supplement Form 3005 for each plant and report totals here.
601			Plant Name
602			Mailing Address
603			City, State, Zip
604			Plant Physical Address (if different from 106)
605			Is this plant federally or state inspected?						Federal		State		Neither		606. FSIS or state plant inspection number:
607			Do you own or lease this plant?						Own		Lease		Neither
Custom Slaughter: If you custom slaughter for other businesses in the plant listed in line 601, complete lines 608-617, otherwise continue to line 618.
			List the names and addresses of the four largest entities you slaughter for in lines 608-611. List only entities for which you slaughter at least 100 head. Add total slaughter for entities not in your largest four and less than 100 head together and list on line 616. Total all values on line 617.
				Entity Name									Entity Address
608			1st Entity
609			2nd Entity
610			3rd Entity
611			4th Entity
			Enter the number of head slaughtered for each entity listed in lines 608-611
				Steer/Heifer (hd)				Cow/Bull (hd)			Calf (hd)			Hog (hd)				Sheep/Lamb (hd)			Other (hd)
612			1st Entity
613			2nd Entity
614			3rd Entity
615			4th Entity
616			All others
617			Total
Committed Procurement: Livestock procured more than 14 days before slaughter.
				Steer/Heifer (hd)				Cow/Bull (hd)			Calf (hd)			Hog (hd)				Sheep/Lamb (hd)			Other (hd)
618			Packer owned
619			From other packers
620			All other committed sources
621			Total
Non-Committed Procurement: Livestock procured 14 days or fewer before slaughter.
				Steer/Heifer (hd)				Cow/Bull (hd)			Calf (hd)			Hog (hd)				Sheep/Lamb (hd)			Other (hd)
622			From other packers
623			Direct
624			Through public markets
625			Total
Slaughter Adjustments: Livestock procured but not slaughtered.
				Steer/Heifer (hd)				Cow/Bull (hd)			Calf (hd)			Hog (hd)				Sheep/Lamb (hd)			Other (hd)
626			Livestock sold
627			Dead or condemned
628			Total
Total Slaughter.
			Line 629 equals line 617 plus line 621 plus line 625 minus line 628
				Steer/Heifer (hd)				Cow/Bull (hd)			Calf (hd)			Hog (hd)				Sheep/Lamb (hd)			Other (hd)
629			Total slaughter
Number of Livestock Paid for Based on Carcass Basis and Dressed Weight (i.e., not liveweight).
				Steer/Heifer (hd)				Cow/Bull (hd)			Calf (hd)			Hog (hd)				Sheep/Lamb (hd)			Other (hd)
630			Carcass and Dressed
631			Do you use an electronic instrument to determine payment for carcasses or livestock?														Yes		No
632			If you answered yes in item 631, list the manufacturer and the type of instrument.
Meat Processing Activities
				Steer/Heifer (lbs)				Cow/Bull (lbs)			Calf (lbs)			Hog (lbs)				Sheep/Lamb (lbs)			Other (lbs)
633			Purchased externally or transferred in
634			Total products shipped (exclude offal)
										CERTIFICATION - SECTION 7
Under the Packers and Stockyards Act any person who willfully makes, or causes any false entry or statement of fact in this report shall be deemed guilty of offense against the United States, and be subject to a fine of $1,000 to $5,000, or to imprisonment for a term of not more than 3 years, or to both fine and imprisonment.
I certify that this report has been prepared by me or under my direction, and to the best of my knowledge and belief correctly reflects reporting entity operations.
701 Print Name												702 Signature (Must be signed by a person listed on 201-205)
703 Phone Number								704 Date				705 Title
Submitted information is confidential (9 CFR 201.96). Failure to report will result in forfeiture to the United States $110 per day until report receipt 7 (U.S.C. 222). Enclose with this form all completed Form 3005's, Supplement Packer Annual Reports, for multiplant operations.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.