PSD- 3004 Annual Report of Packers

OMB Control No. 0581-0308
Business Entity ID Number

For PSD Stamp Only

PSD Bar Code Only

U.S. Department of Agriculture
Agricultural Marketing Service
Fair Trade Practices Program
Packers and Stockyards Division

Select this box if you want to receive
electronic notification to file your
annual report. This will begin in the
next reporting cycle.

ANNUAL REPORT
OF PACKERS

Electronic Filing
Instructions: If a line's value is zero, enter "0". If a line does not apply, enter "N/A". Return completed form to the
PSD Central Reporting Unit. If all lines are not completed when the form is received, the form will be returned. See
separate instructions for complete information about this report.
You must complete form PSD3005 for each plant that you use for your firm's operation. The total values reported in Section 2 of
Form PSD3005 will be combined and reported as the totals in Section 3 of this form.

GENERAL INFORMATION - SECTION 1
Reporting Period
(mm/dd/yyyy)
102 Entity Name
101

a. FROM:

b. TO:

103 Trade Name/d.b.a.
104 Mailing Address
105 City, State, Zip+4
106 Operating Address
107 City, State, Zip+4
108 Contact Name
109 Contact Telephone

111 E-Mail Address

110 Fax

112 Web Address
ORGANIZATIONAL STRUCTURE - SECTION 2

List owners, officers, partners, and members in control of this business with their ownership percentage.
a. Name
b. Title

c. %

201
202
203
204
205
206 Type organization:

Individual

Partnership

Corporation

L.L.C.

L.L.P.

Co-op

207 Is this the same organization type reported last year?
208 Does the entity own or operate scales on which payment to sellers is determined?
209 What is the basis of payment made to the entity for most livestock you purchase?

Per Head

Live Wt.

Association
Yes

No

Yes

No

Dressed Wt./Carcass Basis

210 Do you use an electronic instrument to measure carcass characteristics to determine payment to sellers?

Yes

No

211 If line 211 is Yes, list the manufacturer and the type of instrument.
212 Is this business owned or controlled by another business entity

Yes

No

If Yes, list the name and address on line 213

213 Owned/controlling business name and address
Does this Business, including any Owners, Officers, Directors, Members or Employees,
214 own an interest in any other Market Agency, Dealer Organization, or Packing
Company?

Yes

No

If line 214 is yes, give the name of related firms, name of person or firms with relationship, and percentage of ownership under lines 215-218
a. Name of Related Firm
215
216
217
218

b. Name of Person/Firm with Relationship

c. %

OMB Control No. 0581-0308

LIVESTOCK FEEDING OPERATIONS, PROCUREMENT, SLAUGHTER,
AND MEAT PROCESSING - SECTION 3
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.
301 Plant Name
302 Mailing Address
303 City, State, Zip + 4
304

Plant Physical Address (if
different from 106)

305 Is this plant federally or state inspected?

Federal

State

Neither

Own

Lease

Neither

306 FSIS or state plant inspection number:
307 Do you own or lease this plant?

Custom Slaughter: If you custom slaughter for other businesses in the plant listed in line 301, complete lines 308-318,
otherwise continue to line 319.
List the names and addresses of the entities for which you provided custom slaughter services at this plant in lines 308-311. List only entities for which
you custom slaughtered at least 100 head or more. Add additional pages as necessary.
Entity Name

Entity Address

Telephone

308 1st Entity
309 2nd Entity
310 3rd Entity
311 4th Entity
Enter the number of head slaughtered on lines 312 to 315, for each entity listed in lines 303 to 311. Combine number of head slaughtered for additional
entities reported on separate pages, and enter on line 316. For those entities you slaughter less than 100 head, enter number of head on line 317. Total
all values on line 318.
Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

312 1st Entity
313 2nd Entity
314 3rd Entity
315 4th Entity
316 Total additional pgs.
317 Total < 100 hd.
318 Total
Committed Procurement: Livestock procured more than 14 days before slaughter:
Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

319 Packer owned
320 From other packers
321 All other sources
322 Total
Non-Committed Procurement: Livestock procured 14 days or fewer before slaughter:
Steer/Heifer (hd)
323 From other packers
324 Direct
Through public
325
markets
326 Total

Cow/Bull (hd)

Calf (hd)

OMB Control No. 0581-0308

Slaughter Adjustments: Livestock procured but not slaughtered:
Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

327 Livestock sold
328 Dead or condemned
329 Total
Total Slaughter:

Line 330 equals line 318 plus 322, plus 326, minus line 329
Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

330 Total Slaughter
Number of Livestock Paid for Based on Carcass Grade; Carcass Weight or Carcass Grade and Weight (i.e., not liveweight):
Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

Carcass Basis/
331
Dressed Wt.
Meat Processing Activities:
Beef (1000 lbs)
332

Pork (1000 lbs)

Veal (1000 lbs)

Lamb (1000 lbs)

Other (1000 lbs)

Purchased externally
or transferred in

Total Products
333 shipped (exclude
offal)
FINANCIAL INFORMATION - SECTION 4
401 Number of days livestock was purchased during the reporting year
402 Total value of livestock purchased for feeding

$

403 Total value of livestock purchased for slaughter

$
$

404 Total value of all livestock purchased (line 402 plus 403)
Enter name and location of bank used for livestock payments. Add additional banks if necessary
405 Name of Financial Institution
406 Physical Address
407 City, State, Zip +4
408 Contact Name

409 Contact Telephone

410

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?

411

At any time during the year, Have you been notified by your financial institution that you were
in violation of any terms, conditions, and/or covenants of your financial agreement?

412 If so notified, have you been provided a waiver from your financial institution?
If the financial institution named in line 405 is the same as that used for your financial or loan agreement,
413
check this box. Otherwise, complete lines 414 through 417, as necessary.
If the checkbox for 413 is not selected, complete lines 414 through 418 for each financial lending institution. Attach
additional sheets if more than one.
414 Name of Lending Institution
415 Mailing Address
416 City, State, Zip +4
417 Contact Name
Livestock Trust Ratio Calculation
Reference the instruction sheet in calculating your Livestock Trust ratio
419 Calculated Trust Ratio

418 Contact Telephone

Yes

No

Yes

No

Yes

No

Same as 405

OMB Control No. 0581-0308

STATEMENT OF ASSETS, LIABILITIES, AND EQUITY - SECTION 5
Include values only for the reporting entity. NOTE: If you provide custom slaughter, and/or your livestock purchase volume is under $500k,
you do not need to complete sections 5 and 6.
ASSETS
Current Assets:
Cash (Enter overdrafts on line 522)
Current Cash Equivalents (CD's, Savings, etc.)
Trade Accounts Receivables-Net (Due in 1 year or less):
Owners, Officers, and Affiliated Companies

501

$

502

$

505

$

509

$

512
513
514

$
$
$

503 $

All Others (Sources Not Related to Company)
504 $
Total Trade Accounts Receivable-Net (Due in 1 year or less) (Total lines 503 and 504)
Inventory:
Livestock Inventory

506 $

Meat and Meat Products Inventory

507 $

Other Inventory
508 $
Total Inventories (Total lines 506, 507, and 508)
Notes and Loans Receivable (Due in One Year or Less):
Owners, Officers, and Related Entities
510 $
Others (Sources Not Related to Company)
511 $
Total Notes and Loans Receivable (Due in 1 Year or Less) (Total lines 510 and 511)
Advances Made on Livestock
Other Current Assets
Total Current Assets (Enter the sum total of lines 501, 502, 505, 509, 512, 513, and 514)
Property, Plant, & Equipment (Net of Depreciation and Amortization)
Other Assets:
Investments in Subsidiaries and Affiliated Companies
Due from Owners, Officers, and Related Entities (Due in 1
year or more)
Other Assets
Total Assets (Total of lines 517 through 519)

515

$

516

$

517 $
518 $
519 $

TOTAL ASSETS (Total of lines 515, 516, and 520)

520

$

521

$

531

$

LIABILITIES
Current Liabilities:
Overdraft

522

$

526

$

Trade AccountsPayables:
Livestock Payables

523

Other Payables to Owners, Officers, and Related Entities

524

$
$

Other Payables (Sources Not Related to Company)

525

$

Total Trade Accounts Payables (Total lines 523, 524, and 525)

Current Maturities of Long-Term Debt: (Demand notes and portion of long-term notes due in 1 year or less)
Owners, Officers, and Related Entities

527

$

Others (Sources Not Related to Company)

528

$

Total Current Maturities of Long-Term Debt (Total lines 527 and 528
Other Current Liabilities

529

$

530

$

Total Current Liabilities (Total lines 522, 526, 529, and 530)
Other Liabilities:
Long -Term Debt, Less Current Maturities: (Due in 1 year or more)
Owners, Officers, and Related Entities

532

$

Others (Sources Not Related to Company)

533

$

Total Long-Term Debt, Less Current Maturities (Total of lines 532 and 533)
All Other Liabilities
TOTAL LIABILITIES (Total of lines 531, 534 and 535)

534

$

535

$

536

$

OMB Control No. 0581-0308

EQUITY
Owner's Equity (Unincorporated)
OR
Stock Issued (Incorporated)

537

$

538

$

Additional Paid-in Capital

539

$

Retained Earnings

540

$

TOTAL EQUITY (Total lines 537 through 540)

541

$

TOTAL LIABILITIES AND EQUITY (should equal line 521)

542

$

STATEMENT OF REVENUE AND EXPENSES - SECTION 6

Include values only for reporting entity.
Income Statement
Net Sales (Gross sales less sales returns & allowances)

601

$

Cost of Sales
Opening Inventory

602

$

Livestock Purchases

603

$

Meat and Meat Product Purchases

604

$

Other Purchases

605

$

Subtotal (sum lines 602 to 605)

606 $

Closing Inventory

607 $

Total Cost of Sales (line 606 less 607)

608 $

Gross Profit (line 601 less 608)

609 $

Operating Expenses
Manufacturing

610 $

General, Sales, and Administrative

611 $

Depreciation & Amortization

612 $

Total Operating Expenses

613

$

Operating Income or Loss (line 609 less line 613)

614

$

618

$

619

$

Adjustments to Operating Income
Other Additions to Income

615 $

Interest Expense (enter as a negative number)

616 $

Other Deductions from Income (enter as a negative number)

617 $

Adjustments to Operating Income + or - (Enter the sum total of lines 615 through 617; enter as + or -)
Net Profit or Loss Before Taxes (Add line 618 plus line 614)
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.
With my signature, I certify the information provided on this form is true and correct to the best of my knowledge and belief, I am an owner,
officer, or have been authorized by responsible management to certify this report.
701 Print Name
703 Telephone Number

702 Signature
704 Date

705 Title

OMB Control No. 0581-0308
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 PSD3005's, Supplement Packer Annual Reports, for multiplant operations.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0581-0308. The time required to
complete this information collection is estimated to average 7 hours per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
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.

OMB Control No. 0581-0308

Instructions to Complete
Annual Report of Packers
Form PSD 3004
As a packer, you must file an annual report with the U.S. Department of Agriculture,
Agricultural Marketing Service, Fair Trade Practices Program, Packers and Stockyards Division
(hereinafter known as “PSD”) on Form PSD 3004, Annual Report of Packers. If your purchases
are less than $500,000, you only need to complete sections 1, 2, 3, and section 7. If you
slaughter at more than one plant, you must complete a separate Form PSD 3005, Supplement to
the Annual Report of Packers, for each plant.
If you report on a calendar year basis, your form must be postmarked/e-filed by April 15 each
year. If you file on a fiscal year basis, you must submit your Annual Report form 90 days after
the close of your fiscal year. Requests for additional time to file this report must be received no
later than the applicable filing dates above. Failure to file this form may result in a fine of $110
for each day the report is delinquent. All items must be completed on this form, in its entirety,
before submitting the form. Failure to do so will result in the form being returned as
incomplete. If available, you may provide financial statements as an attachment to the
fully completed annual report form.
For questions about Form PSD 3004, or additional copies of the form, please contact the PSD
Central Reporting Unit at 303-375-4264 or [email protected]. Forms and instructions
are also on PSD’s website at www.ams.usda.gov. Please fax the completed form to the Central
Reporting Unit at either 314-457-4421/844-303-0332, email to [email protected] or
mail to:
USDA PSD
P.O. Box 110639
Aurora, CO 80042
SECTION-BY-SECTION INSTRUCTIONS
FORM HEADER – BUSINESS ENTITY ID
Business Entity ID should be completed using information on the annual report letter or email.
FORM HEADER – ELECTRONIC FILING
By selecting the Electronic filing check box, the next time you file your annual report you will
receive an email message from our system to the address listed on line 111 of the form, each year
that you file an annual report, reminding you that your annual report is due, with instructions to
go to the E-Forms website located at https://forms.sc.egov.usda.gov/ to file your report. The
forms are also located on our website at http://www.ams.usda.gov.

OMB Control No. 0581-0308

Line No.
101
a and b

102
103
104
and
105
106
and
107
108
109
110
111
112
201a
through
205c

206
207
208
209
210

Subject

Instruction
GENERAL INFORMATION - SECTION
Reporting Period
The reporting year covers the period of time operated the
previous year, either calendar year or fiscal year. (FROM:
should be the beginning of your reporting year; TO: should
be the end of your reporting year, ie., 01/01/20YY to
12/31/20YY)
If you recently registered, please enter the date you started
operating (FROM) and the end of your reporting year (TO).
If you cease operations and go inactive, the end of your
reporting year (TO) will be the last date of operation.
Entity Name
Enter the name under which you are registered with PSD.
Trade Name/d.b.a.
Enter the trade name under which you operate. This is the
name the business uses, if applicable.
Mailing Address
Enter your mailing address. Enter street, city, state, and
zip+4. This is the address where all correspondence from
the Packers and Stockyards Division should be sent.
Operating Address
Enter the physical location of your operating address. Enter
street, city, state, and zip+4. This is the address where you
conduct your business services.
Contact Name
Enter the name of the person to be contacted regarding
questions on the annual report.
Contact Telephone
Enter the telephone where the contact may be reached.
Fax
Enter the fax used by the entity.
E-Mail Address
Enter the entity’s e-mail address.
Web Site Address (if
Enter the complete Web site address the business operates.
applicable)
For example: [email protected]
ORGANIZATIONAL STRUCTURE – SECTION 2
Owners, Members,
For each owner, officer, member, and every partner, enter
Partners, Or Officers,
their name, title, and respective percentage of ownership.
(Name and Title),
Provide this information for every individual with any
Percent
ownership interest, 10% or greater, in the applicant’s
operation. The person signing this report on line 702, must
be listed.
Type of Organization
Check the appropriate box to indicate the type of
organization as it applies to the business’ operation.
Same Organization
Check the appropriate box to indicate if your organization is
Reported
the same as operated the previous year.
Own or Operate a Scale Check the appropriate box to indicate if this entity owns or
operates a livestock scale which payment to sellers is
determined.
Payment for livestock
Check the appropriate box to indicate the basis of payment
for the majority of livestock sold.
Electronic Evaluation
Check the appropriate box to indicate whether or not you use
Device
any type of electronic evaluation device (other than scale)
Yes/No
for payment determination. If yes, enter the type of
equipment and the manufacturer on line 212.

OMB Control No. 0581-0308

Line No.
211
212
213
214

215a.
through
218a.
215b.
through
218b.
215c.
through
218c.

Subject
Manufacturer of
Electronic Device
Business
Control/Ownership
Business Name and
Address
Interest in other Market
Agency, Dealer
Organization or Packing
Company
Related firms’ names

Instruction
List the manufacturer and type of instrument used to
measure carcass characteristics to determine payment to
sellers.
Check the appropriate box to indicate if this entity is owned
or controlled by another business entity.
If line 212 is yes, list the name and address of the
owner/controlling business.
Check the appropriate box to indicate if this entity, or any of
its owners, officers, directors, members or employees own
an interest in any other market agency, dealer business, or
packing company. If line 214 is yes, complete 215a-218c.
List the names of the related firms owned by the person or
firm’s described in line 214.

Person or firm with
Relationship

List the name of the person or firm with ownership or
control of the entity listed in column a.

Percentage

List the percentage of ownership/control held by the
person/firm listed in column b.

LIVESTOCK FEEDING OPERATIONS, PROCUREMENT, SLAUGHTER,
AND MEAT PROCESSING – SECTION 3
NOTE: If you provide custom slaughter, and/or your livestock purchase volume is under
$500k, you do not need to complete sections 5 and 6.
301
Plant Name
Enter the name of plant used for your slaughter operation.
302
and
303

Mailing Address

304

Plant Physical Address

305

Federal or State
Inspection
FSIS or State Inspection
Number
Own or Lease

306
307
308
through
311

Custom Slaughter
Entities

Enter the mailing address of the plant. Enter street, city,
state, and
Zip+4. This is the address where all correspondence to the
plant from Packers and Stockyards Division should be sent.
.
Enter the physical address of the plant if it is different from
the mailing address. Enter street, city, state, and zip+ 4.
Select the level of inspection provided at the plant.
Enter the inspection number assigned to the plant.
Check the ownership status. “Neither” indicates the plant
performs custom slaughter.
Enter name and address (street, city, state, and zip+4), for
each entity for which you slaughter at least 100 head or more
on a custom basis at this plant during the reporting period.
Add additional pages, as necessary.

OMB Control No. 0581-0308

Line No.
312
through
318

Subject
Number of head of
livestock custom
slaughtered

Instruction
For each of the entities listed on lines 308-311, enter total
number of head of each category of livestock slaughtered by
you on a custom basis during the reporting period. Add
additional pages, as necessary. Enter custom slaughter
numbers of head for all others that were listed on separate
pages on line 316. Enter the total number of head for those
entities for whom you slaughter less than 100 head on line
317. Enter sum totals of lines 312 through 317 on line 318,
for each category livestock reported.
For lines 319 through 322 committed supply arrangements include marketing agreements, forward
contracts, and formula contracts agreed on more than 14 days before slaughter. The term
“formula contract” means the commitment of livestock for slaughter by any means other than
through a negotiated purchase or a forward contract, using a method for calculating price in which
the price is determined at a future date. Committed supply arrangements also include written and
verbal agreements on delivery volume and pricing terms in some combination agreed on more than
14 days before slaughter, or to those commitments that only specify number of livestock delivered
or commitments that only specify how price will be settled if livestock are delivered.
319

Packer Owned

320

From other packers

321

All other sources

322
323

Total Procurement
From Other Packers

324

Direct

325

Through Public Markets

326

Total Procurement

327

Livestock Sold

328

Dead or Condemned

329

Total

330

Total Slaughter

Enter all livestock slaughtered which were owned, in whole
or in part, more than 14 days by your firm or its subsidiaries.
Your firm’s parent or ultimate parent firm, or another firm
owned, in whole or in part, by your firm’s parent or ultimate
parent firm.
Enter all livestock slaughtered that were procured from other
packers through committed supply arrangements more than
14 days before slaughter.
Enter all other livestock slaughtered that were procured
through committed supply arrangements more than 14 days
before slaughter, not entered in lines 317 or 318.
Enter column totals of lines 319 through 321.
Enter all livestock slaughtered that were procured from other
packers through non-committed supply arrangements, which
procure 14 days or less before slaughter.
Enter the number of head procured directly at the packing
plant, buying stations, feedlots, etc., from non-committed
supply arrangements, which procure 14 days or less before
slaughter.
Enter the number of head procured through public markets
from non-committed supply arrangements, which were
procured 14 days or less before slaughter.
Enter column totals of lines 323 through 325.
For each category of livestock procured but not slaughtered,
enter the number of head sold during the reporting period.
For each category of livestock procured but not slaughtered,
enter the number of head that died or were condemned
during the reporting period.
Enter column totals of lines 327 and 328.
For each category of livestock, add lines, 318, 322, 326, then
subtract line 329; enter as Total Slaughter.

OMB Control No. 0581-0308

Line No.
331

332

333

401
402
403
404
405
through
409
410

Subject
Number Paid on
Carcass Basis/Dressed
Weight

Instruction
For each category of livestock, enter total number of
livestock slaughtered that were purchased and paid for on a
dressed weight or a carcass merit basis (i.e., other than liveweight purchases)
Meat Purchased
For each category of livestock, enter total pounds of meat in
Externally
thousands that are purchased externally or transferred in
from another plant for processing at your plant during the
reporting period.
Total Products Shipped For each category of livestock, enter total pounds of
processed meat in thousands, excluding offal, shipped from
your plant during the reporting period.
FINANCIAL INFORMATION – SECTION 4
Number of days
Enter the number of days livestock was purchased during the
livestock purchased
reporting year.
Livestock purchased for Enter the gross dollar value of all livestock purchased for
feeding
feeding.
Livestock purchased for Enter the gross dollar value of all livestock purchased for
slaughter
slaughter.
Total value livestock
purchased
Name, Address, City,
State, Zip+4, Contact
Name, Contact Number
Accounts
Receivables/Inventories
committed as collateral

411

Violation of Financial
Agreement

412

Waiver Provided

413

Financial Institution
same for livestock
payments and loan
agreements
Name, Address, City,
State, Zip+4, Contact
Name, Contact Number
Livestock Trust Ratio

414
through
418
419

Total amount of lines 402 plus 403. This should be equal to
line 603.
Enter the name, mailing address, contact name, and contact
telephone number of the financial institution used for
livestock payments.
Check the appropriate box indicating whether or not any
Accounts Receivable and/or Inventories, or any part thereof,
have been pledged or assigned as collateral under a financing
or loan agreement.
Check appropriate box indicating whether you received
notification you were in violation of any of the terms,
conditions, and/or covenants of your financial agreement.
If line 411 is “Yes”, check appropriate box indicating
financial institution provided a waiver.
Check the box if using the same financial institution for
livestock payments and financial or borrowing agreements.
If not checked, complete lines 414 through 418 with
appropriate information.
Enter the name, mailing address, contact name, and contact
telephone number of the financial institution used for
financial or loan agreements.
To calculate your Livestock Trust ratio, add Cash, ShortTerm Securities (Certificate of Deposits, Money Market
accounts, etc.) Account Receivables, and Livestock and
Meat Inventories together, as of the analysis date. Divide
this number by the amount of livestock Account Payables as
of the analysis date. Enter this amount. (Add lines 501, 502,
505, 506, 507, and 512 and divide by line 523)

OMB Control No. 0581-0308

Line No.

Subject
Instruction
STATEMENT OF ASSETS, LIABILITIES AND EQUITY – SECTION 5

This section must be completed on this form. Include only the Assets, Liabilities and Net Worth of
the reporting Entity. If available, you may provide financial statements as an attachment to the
fully completed annual report form.
501

Cash

502

Current Cash
Equivalents

503

Trade Accounts
Receivable from
Owners, Officers, and
Affiliated Companies
Accounts Receivable
from All Others
(Sources Not Related to
Company)
Total Accounts
Receivable-Net (Due in
1 year or less)
Livestock Inventory

504

505
506
507
508

509
510

Meat and Meat Food
Products Inventory
Other Inventory

513

Total Inventories
Notes Receivable from
Owners, Officers,
Related Entities
Notes Receivable from
All Others (Sources Not
Related to Company)
Total Notes and Loans
Receivable (Due in 1
year or less)
Advances on Livestock

514

Other Current Assets

515

Total Current Assets

511
512

Enter the total book balances of all bank accounts. An
overdraft should be reported on line 522.
Enter the dollar value of any current cash investments
(money market accounts, securities, CD’s, etc.). Include
only those marketable securities that represent the cash
available for current operations and not otherwise pledged as
security.
Enter the dollar amounts owed by owners, officers, or
affiliated companies as a result of delivering goods or
services, and extending credit in the ordinary course of
business.
Enter the dollar amounts owed by customers as a result of
delivering goods or services, and extending credit in the
ordinary course of business.
Enter the sum total of lines 503 and 504.
Enter the dollar amount of livestock inventory
Enter the dollar amount of meat and meat food products
inventory.
Enter any merchandise, raw materials, work in process,
finished goods, operating supplies and ordinary maintenance
materials and parts other than livestock, or meat and meat
products to be consumed in the business during the next
year.
Enter the sum total of lines 506 through 508.
Enter the total dollar value owed to the company by owners,
officers, or related entities that is due in 1 year or less.
Enter the total dollar value owed to the company by other
than owners, officers or related entities that is due in 1 year
or less.
Enter the sum total of lines 510 and 511.
Enter the dollar value of cash advances given for the
purchase of livestock.
Enter the dollar value of prepaid expenses and other assets
expected to be converted to cash or sold or consumed during
the next year.
Enter the sum total of lines 501, 502, 505, 509, 512, 513 and
514.

OMB Control No. 0581-0308

Line No.
516
517
518
519
520
521
522
523
524
525
526
527
528
529
530
531
532

Subject
Plant, Property and
Equipment
Investments in
subsidiaries and related
companies
Due from owners,
officers and related
entities
Other Assets
Total Other Assets
Total Assets
Overdraft
Livestock Payables
Other Payables to
Owners, Officers, and
Related Entities
Other Payables (Sources
Not Related to
Company)
Total Trade Accounts
Payables
Amount due to owners,
officers, or related
entities, 1 year or less
Amount due to others 1
year or less (Sources not
Related to Company)
Total Current Maturities
of Long Term Debt
Other Current Liabilities

535

Total Current Liabilities
Amount due to owners,
officers, or related
entities, after 1 year
Amount due to others
after 1 year (Sources
Not Related to
Company)
Total Long-Term Debt,
Less Current Maturities
All Other Liabilities

536

Total Liabilities

533

534

Instruction
Enter the dollar value of land, buildings, plant, equipment
and amortizable assets less accumulated depreciation and
amortization.
Enter the total dollar value of any investments in subsidiaries
and related companies.
Enter the dollar value due from owners, officers, and related
entities that is expected to be received in more than 1 year
from the reporting date of this report.
Enter the total dollar value of all others assets expected to be
converted to cash, or sold or consumed in more than 1 year
from the reporting date of this report.
Enter the sum total of lines 517 through 519.
Enter the sum total of lines 515, 516 and 520.
Enter the total overdraft balances of all bank accounts.
Enter the total dollar amount you owe for livestock.
Enter the total dollar amount you owe to owners, officers,
and related entities, for other than livestock.
Enter the total dollar amount you owe to all vendors for
other than livestock, meat, and meat products.
Enter the sum total of lines 523, 524, and 525
Enter dollar amount of notes and loans due by you to
owners, officers, and related entities in 1 year or less.
Enter the dollar amount of notes and loans due by you to
other than owners, officers, and related entities in 1 year or
less.
Enter the sum total of lines 527 and 528.
Enter the total dollar value of any accrued liabilities and
other current liabilities due within 1 year of the reporting
date of this report.
Enter the sum total of lines 522, 526, 529 and 530.
Enter the total dollar value of notes, mortgages, bonds, and
installments that are payable to owners, officers, and related
entities after 1 year.
Enter the total dollar value of notes, mortgages, bonds, and
installments that are payable to other than owners, officers,
and related entities after 1 year.
Enter the sum total of lines 532 and 533.
Enter all other liabilities owed after 1 year.
Enter the sum total of lines 531, 534, and 535.

OMB Control No. 0581-0308

Line No.
537

540

Subject
Owner’s Equity
(Unincorporated)
Stock Issued
(Incorporated)
Additional paid-in
capital
Retained Earnings

541

Total Equity

539
530

Instruction
If unincorporated, enter the dollar value of the owner’s net
worth (should equal line 521 less line 536).
If incorporated, enter the dollar value of stock issued.
If incorporated, enter the dollar value of any additional paidin capital.
If incorporated, enter the retained earnings.

606

Enter the sum of lines 537 through 540 (should equal line
521 less line 536).
Total Liabilities and
Enter the sum total of lines 536 and 541 (should equal line
Equity
521).
STATEMENT OF REVENUE AND EXPENSES – SECTION 6
Net Sales
Enter the value of gross sales less sales returns and
allowances.
Opening Inventory
Enter the dollar amount of inventory at the beginning of the
reporting period.
Livestock Purchases
Enter the dollar amount of livestock purchases during the
reporting period (this should equal line 404).
Meat and Meat Products Enter the dollar amount of meat and meat products
Purchases
purchased during the reporting period.
Other Purchases
Enter the dollar amount of all other purchases during the
reporting period.
Subtotal
Enter the sum of lines 602 through 605.

607

Closing Inventory

608
609
610

Total Cost of Sales
Gross Profit
Manufacturing

611

General, Sales, and
Administrative

612

Depreciation and
Amortization
Total Operating
Expenses
Operating Income or
Loss
Other Additions to
Income
Interest Expense

542
601
602
603
604
605

613
614
615
616
617
618

Other Deductions from
Income
Adjustments to
Operating Income + or -

Enter the dollar amount of inventory at the end of the
reporting period.
Subtract line 607 from 606.
Subtract line 608 from line 601.
Enter the dollar amount of manufacturing expenses incurred
during the reporting period. This includes all direct costs
related to your slaughtering and process operations.
Enter the dollar amount of all General, Sales, and
Administrative expenses incurred during the reporting
period.
Enter the dollar amount of depreciation and amortization
during the reporting period.
Enter the sum of lines 610 through 612.
Subtract line 613 from line 609; enter the difference as
Operating Income (+) or Loss (-).
Enter any other additions to income during the reporting
period.
Enter the dollar amount of all interest expenses incurred
during the reporting period as a negative number.
Enter any other deductions from income during the reporting
period as a negative number.
Enter the sum of lines 615 through 617.

OMB Control No. 0581-0308

Line No.
619

Subject
Net Profit or Loss

Instruction
Add line 618 to line 614; enter the sum as Net Profit (+) or
Loss (-) Before Income Tax.
CERTIFICATION – SECTION 7
Print the name of the owner, officer, partner, or member
responsible for this report.
The report must be signed a responsible person.

701

Print Name

702

Signature

703
704

Telephone
Date

Enter the telephone number of the person signing the report.
Enter the date the report is signed.

705

Title

Enter the title of the person signing the report.