Form CS-**A Farmer Cooperative Statistics (Regional cooperatives - s

Form Approved

OMB No. 0570-0007

CP-20__A

O No. 0570-0007

United States Department of Agriculture

Rural Development

COOPERATIVE STATISTICS, 20__

Multi-state operations and membership Co-ops

If address is incorrect,

please correct mailing label.

Is this address your headquarters?

YES NO

Your help is needed in developing and maintaining complete and accurate nationwide statistics on cooperatives for use in education, research, and decision-making. The data you provide will remain confidential as provided for by law.

1. Person completing this questionnaire:

a. NAME

b. TITLE

c. PHONE NUMBER ( ) - d. FAX ( ) - e. DATE

f. E-MAIL ADDRESS

g. COOPERATIVE’S INTERNET HOME-PAGE ADDRESS

2. If your cooperative at the above address was sold to or merged into another organization recently, please complete this question and question 1 only.

a. NAME

b. ADDRESS

c. DATE OF SALE OR MERGER

If you have any questions related to this survey of cooperatives, please feel free to contact Eldon Eversull at (202) 690-1415 or send an e-mail message to [email protected]. You are not required to respond, but your participation is very important. If you have any comments, please write them on page two.

Please attach the enclosed return mailing label to your envelope and return this questionnaire to:

USDA/RBS, STOP 3256, 1400 Independence Ave., SW, Washington, D.C. 20250-3256

GROUP I; CENTRALIZED INTER-STATE; FEDERATED, 20__

According to the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information especially if the form fails to display a valid OMB control number. The valid OMB control number for this information collection is 0570-0007. The time required to complete this information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection.

Please use for comments and questions.

(NOTE: If you attach a consolidated annual or audit report, fill in only information requested that is not included in the consolidated annual or audit report.)

3. In what month did your cooperative end its fiscal or business year during 20__? MONTH

4. Please provide the amounts for these balance sheet items for your business year that ended in 20__.

(114) $

a. CURRENT ASSETS?

(108) $

b. INVESTMENTS IN ALL OTHER COOPERATIVES (Include CoBank.)?

(115) $

(107) $

c. PROPERTY, PLANT, AND EQUIPMENT(Net)?

d. TOTAL ASSETS?

(116) $

e. CURRENT LIABILITIES?

(109) $

f. TOTAL LIABILITIES?

Office use only

g. ALLOCATED MEMBER EQUITIES?

(118) $

h. UNALLOCATED MEMBER EQUITIES (Retained Earnings)?

(110) $

Office use only

i. TOTAL NET WORTH (Total Equity)?

j. TOTAL LIABILITIES AND NET WORTH (Equals Total Assets)?

5. From your income statement, please provide the following for your business year that ended in 20__.

(124) $

a. TOTAL SALES (Exclude service receipts, other income,

and patronage refunds.)?

(131) $

b. COST OF GOODS SOLD?

Office use only

c. GROSS MARGIN (Total sales minus cost of goods sold)?

(106) $

d. SERVICE RECEIPTS AND OTHER OPERATING INCOME OR REVENUE

(Include service revenues, storage and handling fees, etc.)?

Office use only

e. GROSS REVENUE (Gross Margin plus Service Receipts and other Income)?

f. TOTAL WAGES AND BENEFITS EXPENSE (Include payroll

(123) $

taxes, group insurance, commissions, profit-sharing, and any

other related benefits.)?

(120) $

g. DEPRECIATION EXPENSE?

(121) $

h. INTEREST EXPENSE?

Office use only

i. OTHER EXPENSES?

(125) $

j. TOTAL EXPENSES (Include Operating and all Other Expenses)?

Office use only

k. NET MARGINS FROM OPERATIONS (Local Savings)?

l. TOTAL PATRONAGE REFUNDS AND DIVIDENDS RECEIVED

(113) $

FROM ALL OTHER COOPERATIVES (Include CoBank and all other

cooperatives, less any equity writeoffs.)?

m. NONOPERATING INCOME (Include sale of assets, discontinued operations,

(136) $

non-cooperative investment income, extraordinary items and all other revenues

or losses not already accounted for)?

(112) $

n. NET INCOME BEFORE TAXES?

(135) $

o. INCOME TAXES?

(122) $

p. TOTAL NET INCOME (OR LOSS)?

6. If your cooperative marketed any of the following products in fiscal 20__, please report sales for each product or product group and the percentage of each that your cooperative received from other cooperatives (so that we do not double count cooperative volume). (If your cooperative had subsidiaries or branches, base responses on consolidated statements. Round reported figures to nearest dollar. Estimate if actual records are not available. If your cooperative performed bargaining functions or operated on a commission basis, please indicate and provide estimated sales value for those commodities. If your cooperative did not market any products, please go to the next question).

Product(s) marketed	Sales (or market value)	Percentage of total dollar sales marketed for or received from other cooperatives
Grains and oilseeds other than cottonseed (Exclude meals and oils, distillers grains sold for feed, etc.)1	201 $	251 %
Rice	203 $	253 %
Cotton, Lint	205 $	255 %
Cottonseed (Exclude meal and oil.)2	206 $	256 %
Tobacco	207 $	257 %
All nuts	208 $	258 %
Sugar beets, sugarcane, honey, and related products	210 $	260 %
Dry beans and peas, lentils	212 $	262 %
Fresh fruits and vegetables (For fresh and processed market.)	214 $	264 %
Processed fruits and vegetables	216 $	266 %
Milk and milk products	219 $	269 %
Poultry, eggs, turkeys, ratite, squab, and related products	221 $	271 %
Livestock and meat products (Include all species)	223 $	273 %
Wool and mohair	225 $	275 %
Fish, shellfish, aquaculture products	526 $	576 %
Biofuels, ethanol, biodiesel	626 $	676 %
Manufactured or processed food or other products (Include CO2, fur, other crops or resale items). (Please specify.)	226 $	276 %
TOTAL	227 $

¹ Include all meal sales with feed (in question 7) and all oil sales with manufactured food products (item 226 in question 6.)

² Include sales of cottonseed meal with feed (in question 7) and sales of cottonseed oil with manufactured food products (item 226 in question 6).

7. If your cooperative sold any supplies (feed, seed, fertilizer, crop protectants, petroleum products, and other supplies) and/or equipment in fiscal 20__, please report retail and wholesale sales and percentage sold to other cooperatives (so that we do not double count cooperative volume). (If your cooperative had subsidiaries or branches, base responses on consolidated statements. Round reported figures to nearest dollar. Estimate if actual records are not available. If your cooperative did not sell any supplies or equipment, please go to the next question.)

Supplies and equipment	Retail sales	Wholesale sales	Percentage of wholesale sales to other cooperatives
Feed (Complete feeds, ingredients, hay, grains, oilseed meal, distillers grains, etc.)1	501 $	551 $	601 %
All seeds (For planting: include seed potatoes)	502 $	552 $	602 %
Fertilizer (Bagged and bulk; include anhydrous ammonia, lime, etc.)	503 $	553 $	603 %
Crop Protectants (Herbicides, insecticides, fungicides, etc.)	504 $	554 $	604 %
Petroleum products (Include gasoline, fuel oil, diesel, propane, LP gas, lube oil, etc.)	505 $	555 $	605 %
All other 2	511 $	561 $	611 %
TOTAL	513 $	563 $

¹ Include value of feed sales under grower contracts. Do not include sales of whole grains and oilseeds reported in question 6.

² Include building materials; tires, batteries, and accessories (TBA); containers and packaging supplies; machinery and equipment; home

equipment; animal health products; pet food; semen; hardware; food; clothing; fencing; paint; etc.

8. Did producers hold membership in your cooperative during fiscal 20__? (Please check one.)

NO (If "NO," please go to the next question.) YES If "YES," how many producer-members were:

(103)

a. ENTITLED TO VOTE? NUMBER

9. Did other cooperatives hold membership in your association?

NO (If "NO," please go to the next question.) YES If "YES,” continue with a.)

(102)

a. How many other cooperatives were entitled to vote for directors

of your organization at the end of fiscal 20__? NUMBER

10. How many employees did your cooperative operate with during fiscal 20__?

(101)

a. FULL-TIME EMPLOYEES? NUMBER

(972)

b. PART-TIME and/or SEASONAL EMPLOYEES? NUMBER

11. Did your cooperative operate facilities at branch locations during fiscal 20__? (Exclude your headquarters location.)

NO (If "NO," please go to the next question.) YES

(950)

IF "YES," AT HOW MANY BRANCH LOCATIONS DID

YOUR COOPERATIVE OPERATE? NUMBER

12. Did your cooperative have any export sales in fiscal 20__? (If "NO," please go to the next question.) Please indicate what products you mainly exported (by circling) fruits or vegetables, grains or oilseeds, dairy, rice, sugar, cotton, cottonseed oil, dry beans, nuts, poultry or turkey, semen, farm supplies, other

(971) $

WHAT WAS THE VALUE OF SUCH EXPORTS?

13. If your cooperative acquired (by purchase or merger) another organization during fiscal 20__, and is the surviving organization, please check a. or b. and complete c. (Otherwise, go to the next question.)

a. PURCHASED b. MERGED

c. Give name and address of the purchased or merged organization and the date it occurred

(If more than one, provide name, address, and date occurred on page 2.).

NAME

ADDRESS

DATE OF PURCHASE OR MERGER

Was the other organization a cooperative? NO YES

14. Please enter the name and title of the manager or CEO of your cooperative (or of the surviving firm).

GENERAL MANAGER OR CEO

PLEASE ENCLOSE A COPY OF YOUR FISCAL 20__ ANNUAL OR AUDIT REPORT.

(If you would like your annual or audit report returned to you, please let us know.)

THANK YOU!

Your contribution to this effort is appreciated. A copy of our report will be sent to you.

U.S. Department of Agriculture

Rural Development

STOP 3256

Washington, D.C. 20250‑3256

Web: http://www.rurdev.usda.gov

Committed to the future of rural communities.

USDA Rural Development provides research, management, and educational assistance to cooperatives to strengthen the economic position of farmers, ranchers, fishermen, and other rural residents. It works directly with cooperative leaders and Federal and State agencies to improve organization, leadership, and operation of cooperatives and to give guidance to further development.

Rural Development’s cooperative program (1) helps farmers, ranchers, fishermen, and other rural residents develop cooperatives to obtain supplies and services at lower cost and get better prices for products they sell; (2) advises rural residents on developing existing resources through cooperative action to enhance rural living; (3) helps cooperatives improve services and operating efficiency; (4) informs members, directors, employees, and the public on how cooperatives work and benefit their members and their communities; and (5) encourages international cooperative programs.

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form (PDF), found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected].

Individuals who are deaf, hard of hearing or have speech disabilities and you wish to file either an EEO or program complaint please contact USDA through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in Spanish).

Persons with disabilities, who wish to file a program complaint, please see information above on how to contact us by mail directly or by email. If you require alternative means of communication for program information (e.g., Braille, large print, audiotape, etc.) please contact USDA's TARGET Center at (202) 720-2600 (voice and TDD).

GROUP I; CENTRALIZED INTER-STATE; FEDERATED, 20__