PSD-3002 Annual Report of Live Poultry Dealers

OMB Control No. 0581-0308

Business Entity ID Number

For PSD Stamp Only

PSD Bar Code Only

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

U.S. Department of Agriculture

Agricultural Marketing Service
Fair Trade Practices Program
Packers and Stockyards Division

ANNUAL REPORT OF LIVE POULTRY
DEALERS

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.
GENERAL INFORMATION - SECTION 1

101

Reporting Period
(mm/dd/yyyy)

b. TO:

a. FROM:

102 Entity Name
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.
b. Title

a. Name

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?

Yes

No

208 Is this business owned or controlled by another business entity, if yes complete line 209

Yes

No

Yes

No

Association

209 If line 208 is yes, identify the owner/controlling business name and address
Does the reporting Business, including any Owners, Officers, Directors, Members or
210 Employees, own an interest in any other Market Agency, Dealer Organization, or Packing
Company?

If line 210 is yes,give the name of related firms, name of person or firms with relationship, and percentage of ownership under lines 211-215
b. Name of Person/Firm with Relationship

a. Name of Related Firm

c. %

211
212
213
214
215

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OMB Control No. 0581-0308

FINANCIAL INFORMATION - SECTION 3

Enter the name and location of the financial institution you use for grower or poultry payments.
301 Name of Financial Institution
302 Physical Address
303 City, State, Zip+4
304 Contact Name

305 Contact Telephone

At the end of the reporting period, were Accounts Receivable and/or Inventories, or any part thereof, pledged or
306
assigned as collateral under a financing or loan agreement?

Yes

No

At any time during the year, Have you been notified by your financial institution that you were in
307
violation of any of the terms, conditions, and/or covenants of your financial agreement?

Yes

No

308 If so notified, have you been provided a waiver from your financial institution?

Yes

No

309

If the financial institution named in line 301 is the same as that used for your financial or loan agreement, check
this box. Otherwise, complete lines 310 through 314, as necessary.

If line 309 is not checked complete lines 310 through 314 for each financial lending institution. Attach additional sheets if more than one.
310 Name of Lending Institution
311 Mailing Address
312 City, State, Zip +4
313 Contact Name

314 Contact Telephone

Poultry Trust Ratio Calculation
Reference the instruction sheet in calculating your Poultry Trust ratio

315 Calculated Trust Ratio

OPERATING INFORMATION - SECTION 4

ACTIVITIES ENGAGED IN (check all that apply)
401

Producing poultry under growout contracts for slaughter

402

Producing poutry under marketing agreements for slaughter

403

Producing poultry under either of the above growing arrangements for sale to another for slaughter

404

Producing poultry under either of the above growing arrangements for slaughter by a custom slaughterer

405

Custom poultry slaughterer

406

Buying live poultry for slaughter (e.g. spent fowl plant)

407

Buying live poultry for slaughter by a custom slaughterer

408

Buying live poultry for resale to a slaughterer

409

Buying live poultry for resale to a live bird market

INPUT AND PRODUCT MARKETS
410 Enter the number of active growout contracts and marketing agreements on the last day of this reporting period ______________
411

Yes

No

412

Yes

No

Live poultry sold outside the state in which it was bought or obtained under a growing arrangment?

413

Yes

No

Poultry meat sold outside the state in which the poultry was slaughtered?

Poultry purchased or obtained under growing arrangements performed outside the state in which it was slaughtered or sold?

LOCATION OF FACILITIES (attach additional page if needed).
Slaughter Facility Name

FSIS #

Street, City, State, Zip+4

Phone

414
415
416
417
418
419
420

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OMB Control No. 0581-0308

Street, City, State, Zip+4

Feed Mill Name

Phone

421
422
423
424
425
426
427
428
429
430
TOTAL SLAUGHTER - SECTION 5

a. Chickens

Total slaughter

Head

b. Turkeys
Lbs.

c. Other
Head

Lbs.

Head

Lbs.

501 Poultry Grown under growout contracts
502 Poultry grown under marketing agreement
503

Poultry grown by the company (e.g.
company owned farms)

504 Live Poultry purchased
505

Total Poultry Procured (sum lines 501 to
504)

506 Live Poultry sold
Total Poultry custom slaughtered by you
for others
Total slaughter (line 505 minus 506 plus
508
507)
507

STATEMENT OF ASSETS, LIABILITIES, AND EQUITY - SECTION 6

ASSETS
Current Assets:
Cash (Enter overdrafts on line 618)

601

$

Current Cash Equivalents (CD's, Savings, etc.)

602

$

Total Trade Accounts Receivables-Net (Due in 1 year or less) (Total lines 603 and 604)

605

$

Inventory

606

$

Total Notes and Loans Receivable (Due in 1 Year or Less) (Total lines 607 and 608)

609

$

Other Current Assets

610

$

Trade Accounts Receivables-Net (Due in 1 year or less):
Owners, Officers, and Affiliated Companies

603

$

All Others (Sources Not Related to Company)

604

$

Notes and Loans Receivable (Due in 1 Year or Less):
Owners, Officers, and Related Entities

607

$

Others (Sources Not Related to Company)

608

$

Total Current Assets (Total of lines 601, 602, 605, 606, 609, and 610)

611

$

Property, Plant, & Equipment Net of Depreciation and Amortization

612

$

Other Assets:
Investments in Subsidiaries and Affiliated Companies

613

$

Due from Owners, Officers, and Related Entities (Due in 1 year or more)

614

$

Other Assets

615

$

Total Other Assets (Total of lines 613 through 615)
TOTAL ASSETS (Total of lines 611, 612, and 616)

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616

$

617

$

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OMB Control No. 0581-0308

LIABILITIES
Current Liabilities:
Overdraft
Payables to Owners, Officers, and Related Entities

619

$

Other Payables (Sources Not Related to Company)

620

$

Total Payables (Total lines 619 and 620)

618

$

621

$

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

622

$

Others

623

$

Total Current Maturities of Long-Term Debt (Total lines 622 and 623)
Other Current Liabilities

624

$

625

$

Total Current Liabilities (Total of Lines 618, 621, 624, and 625)

626

$

Other Liabilities:
Long -Term Debt, Less Current Maturities: (Due after 1 year)
Owners, Officers, and Related Entities

627

$

Others (Sources Not Related to Company)

628

$

Total Long-Term Debt, Less Current Maturities (Total lines 627 and 628)

629

$

630

$

TOTAL EQUITY (total of lines 631 through 634) (Should equal line 617 minus 630)

635

$

TOTAL LIABILITIES AND EQUITY (should equal line 617)

636

$

Total Cost of Sales (line 706 less 707)

708

$

Gross Profit (line 701 less 708)

709

$

714

$

718
719

$

TOTAL LIABILITIES (Total of lines 626, and 629)
EQUITY
Owner's Equity (Unincorporated)

631

$

Stock Issued (Incorporated)

632

$

Additional Paid-in Capital

633

$

Retained Earnings

634

$

OR

STATEMENT OF REVENUES AND EXPENSES - SECTION 7

INCLUDE VALUES ONLY FOR REPORTING ENTITY.
Net Sales (Gross sales less sales returns & allowances)

701

$

706

$

707

$

Cost of Sales
Opening Inventory

702

$

Poultry Grow-Outs

703

$

Poultry Marketing Agreements

704

$

Live Poultry Purchases

705

$

Subtotal (sum lines 702 through 705)
Closing Inventory

Operating Expenses
Manufacturing

710

$

General, Sales, and Administrative

711

$

Depreciation & Amortization

712

$

Total Operating Expenses (sum lines 710 through 712)

713

$

Operating Income or Loss (line 709 less 713)
Adjustments to Operating Income
Other Additions to Income

715

$

Interest Expense (Enter as a negative number)

716

$

Other Deductions from Income (Enter as a negative number)

717 $
Adjustments to Operating Income + or - (Enter the sum total of lines 715 through 717; enter as + or -)
Net Profit or Loss (Add line 718 plus line 714)

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$

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OMB Control No. 0581-0308

CERTIFICATION - SECTION 8
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. Section 10 of the
FTC Act, made applicable by Section 402 of the Act (7 U.S.C. 222).

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.
801. Print Name:
802. Signature:
803. Telephone:

804. Date:

805. Title:

Submitted information is confidential (9 CFR 201.96). Failure to report will result in forfeiture to the United States $559 per day until
report receipt. Section 10 of the FTC Act, made applicable by Section 402 of the Act (7 U.S.C. 222).
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.
In accordance with Federal law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national
origin, sex, age, disability, and reprisal or retaliation for prior civil rights activity. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means of
communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible State or local Agency that administers the program or
USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information is also available in
languages other than English.
To file a complaint alleging discrimination, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any
USDA office or write a letter addressed to USDA and provided in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your
completed form or letter to USDA by: (a) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410;
(b) fax: (202) 690-7442; or (c) email: [email protected].

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Intentionally Left Blank

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Instructions to Complete
Annual Report of Live Poultry Dealers
Form PSD 3002
Each individual, corporation, and association engaged in business as a live poultry dealer is
required to 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 3002, Annual Report of Live Poultry Dealers.
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 by 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 $559 for each day the report is delinquent. Section 10 of the FTC Act, made applicable
by Section 402 of the Act (7 U.S.C. 222). All items must be completed on this form in
its entirety. 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 3002, 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 314-457-4421/844-303-0332, email to [email protected] or mail to:
USDA PSD
P.O. Box 110639
Aurora, CO 80042
Definition of a marketing agreement: Packers and Stockyards Division defines a marketing agreement
(also known as a marketing contract) as an agreement in which a seller agrees to sell all or part of its
poultry to a processor when price is determined by an agreed-upon formula that may reflect live animal
or carcass quality, prices paid by the processor to other sellers at the time of delivery, publicly reported
prices, or some other method where price is not negotiated for each lot of poultry. The terms of the
agreement may include other conditions affecting the seller’s and processor’s rights and responsibilities.
Terms of sale are not negotiated for individual lots of poultry when animals are purchased through a
marketing agreement. A marketing agreement may include a commitment for the seller to deliver a
specified number of birds each week, month, etc. or may allow the seller considerable discretion in the
number of birds delivered under the agreement.

SECTION-BY-SECTION INSTRUCTIONS
FORM HEADER – BUSINESS ENTITY ID
Business Entity ID should be completed using information on the report letter or email.
FORM HEADER – ELECTRONIC FILING
By selecting the Electronic filing check box, 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.

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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

Form PSD 3002

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, i.e., 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
Packers and Stockyards Program 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 person 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
ownership interest, 10% or greater, in the applicant’s
operation. The person signing this report on line 802, must
be listed in this section.
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.
Business
Check the appropriate box to indicate if this entity is owned
Control/Ownership
or controlled by another business entity.
Business Name and
If line 208 is yes, list the name and address of the
Address
owner/controlling business.
Interest in other Market Check the appropriate box to indicate if this entity, or any of
Agency, Dealer
its owners, officers, directors, members or employees own
Organization or Packing an interest in any other market agency, dealer business, or
Company
packing company. (If no skip lines 211 through 215)

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Line No.
211a.
through
215a.
211b.
through
215b.
211c.
through
215c.
301
through
305
306

307
308
309

310
through
314
315

401
402

403
through
409

Form PSD 3002

Subject
Related firms’ names

Instruction
List the names of the related firms owned by the reporting
business.

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.

FINANCIAL INFORMATION – SECTION 3
Name, Address, City,
Enter the name, mailing address, contact name, and contact
State, Zip+4, Contact
telephone number of the financial institution used for grower
Name, Contact Number or poultry payments.
Accounts
Check the appropriate box indicating whether or not any
Receivables/Inventories Accounts Receivable and/or Inventories, or any part thereof,
committed as collateral
have been pledged or assigned as collateral under a financing
or loan agreement.
Violation of Financial
Check appropriate box indicating whether you received
Agreement
notification you were in violation of any terms, conditions,
and/or covenants of your financial agreement.
Waiver provided
If line 307 is “Yes”, check appropriate box indicating if
financial institution provided a waiver.
Financial Institution
Check the box if using the same financial institution for
same for grower
growing/poultry payments and financial or loan
payments and loan
agreements. If not checked, complete lines 310 through
agreements
314 with appropriate information.
Name, Address, City,
Enter the name, mailing address, contact name, and contact
State, Zip+4, Contact
telephone number of the financial institution used for
Name, Contact Number financial or loan agreements.
Livestock Trust Ratio
To calculate your Poultry Trust ratio, add Cash, Short-Term
Securities (Certificate of Deposits, Money Market accounts,
etc.) Account Receivables, and Inventory together, as of the
analysis date. Divide this number by the amount of Total
Account Payables as of the analysis date. Enter this amount.
(Add lines 601, 602, 605, 606, and 609, then divide by line
621)
OPERATING INFORMATION – SECTION 4
Producing poultry under Check box if you slaughter poultry produced under growout
growout contracts for
contract with independent growers for which the poultry and
slaughter
feed were provided by you to the grower.
Producing poultry under
Check box if you slaughter poultry produced under
marketing agreements
marketing agreement with independent growers.
for slaughter
(For a definition of a marketing agreement, see the first
page of the instructions.)
Type of activity

Check all appropriate boxes.

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Line No.
410
411
through
413
414
through
420
421
through
430
501
a-c
502
a–c

Subject
Number or growout
and/or marketing
agreements
Poultry purchased,
obtained, sold outside
state of slaughter or
sale. Poultry meat sold
outside of state.
Location of Slaughter
Facilities

Instruction
Enter the number of broiler farms with which you have a
contract(s) as of the last day of the reporting period.

Growout Contracts

For each category of poultry, enter the number of head and
number of pounds (lbs.) grown under growout contracts.
For each category of poultry, enter the number of head and
number of pounds (lbs.) raised under marketing agreement
with independent grower.

Enter Slaughter Facility name, FSIS number, address (street,
city, state and zip+ 4) and telephone for each slaughtering
facility in the spaces provided. If more space is needed, you
may attach additional pages.
Location of Feed Mills
Enter Feed Mill name, address (street, city, state and zip+ 4)
and telephone phone or each facility in the spaces provided.
If more space is needed, you may attach additional pages.
TOTAL SLAUGHTER – SECTION 5

Marketing Agreement

503
a–c

Company or Company
owned

504
a–c

Live Poultry Purchased

505
a–c
506
a–c

Total Poultry Procured

507
a–c

Total Poultry custom
slaughtered by you for
others
Total Slaughter

508
a–c

Form PSD 3002

Check either Yes or No.

Live Poultry Sold

(For a definition of a marketing agreement, see the first page
of the instructions.)
For each category of poultry, enter the number of head and
number of pounds (lbs.) grown by your company or
company-owned farm.
For each category of poultry, enter the number of head and
number of pounds (lbs.) livestock poultry as purchased
during the reporting period. Include in this number fully
grown birds purchased, DO NOT include chicks or poults
purchased for raising in this number.
For each column, enter the sum of lines 501 through 504.
For each category of poultry, enter the number of head and
number of pounds (lbs.) sold live during the reporting
period.
For each category of poultry, enter the number of head and
number of pounds (lbs.) slaughtered by you for others during
the reporting period.
For each column, subtract line 506 from 505, add line 507;
enter as Total Slaughtered.

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Line No.

Subject
Instruction
STATEMENT OF ASSETS, LIABILITIES AND EQUITY – SECTION 6

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.
601

Cash

Enter the total book balances of all bank accounts. An
overdraft should be reported on line 618.

602

Cash Equivalents

603

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

Enter the dollar value of any current cash investments
(savings, 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.

604

605
606
607
608
609
610
611
612

Total Current Assets
Plant, Property and
Equipment

613

Investments in
subsidiaries and
affiliated companies
Due from owners ,
officers and related
entities

614

Form PSD 3002

Enter the sum total of lines 603 and 604.
Enter the dollar amounts of inventory
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 607 and 608.
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 601, 602, 605, 606, 609 and 610.
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.

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Line No.
615
616
617
618
619
620
621
622
623
624
625
626
627
628

629
630
631
632
633
634
635
636

Form PSD 3002

Subject
Other Assets
Total Other Assets
Total Assets
Overdraft
Payables to Owners,
Officers, and Related
Entities
Other Payables (Sources
Not Related to
Company)
Total Payables
Amount due to owners,
officers, or related
entities, 1 year or less
Amount due to others 1
year or less
Total Current Maturities
of Long Term Debt
Accrued and Other
Current Liabilities
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
Total Liabilities
Owner’s Equity
(Unincorporated)
Stock Issued
(Incorporated)
Additional paid-in
capital
Retained Earnings
Total Equity
Total Liabilities and
Equity

Instruction
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 line 613 through 615.
Enter the sum total of lines 611, 612, and 616.
Enter the total overdraft balances of all bank accounts.
Enter the total dollar amount you owe to owners, officers,
and related entities.
Enter the total dollar amount you owe to all other vendors.
Enter the sum total of lines 619 and 620.
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 622 and 623.
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 618, 621, 624, and 625.
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 627 and 628.
Enter the sum total of lines 626 and 629
If unincorporated, enter the dollar value of the owner’s net
worth
If incorporated, enter the dollar value of common stock.
If incorporated, enter the dollar value of any additional paidin capital.
If incorporated, enter the retained earnings.
Enter the sum of lines 631 through 634 (should equal line
617 less line 630).
Enter the sum total of lines 630 and 635 (should equal line
617)

Expires 02/28/2021

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Line No.
701
702
703

704
705

706
707
708
709
710
711
712
713
714
715
716
717
718

Form PSD 3002

Subject
Instruction
STATEMENT OF REVENUES AND EXPENSES – SECTION 7
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.
Poultry Grow-Outs and Enter the dollar amount spent on poultry growouts during the
Company Owned Farms reporting period if poultry was acquired through a growout
contract, or poultry grown by your company or companyowned farm (Line 501 a-c and/or 503 a-c). Include in this
number chick or poultry cost, grower payments, and all of
the following costs: feed, medication, disinfectant, litter
supplement, fuel supplement, veterinary expenses, etc.
Poultry Procured under
Enter the dollar amount of poultry procured through
marketing agreements (line 502 a- c).
Marketing Agreement
Live Poultry Purchases
Enter the dollar amount of live poultry purchased during the
reporting period. If you reported live poultry purchased on
line 504 a – c. Include in this number the cost of poultry
purchased for slaughter, i.e. fully grown birds. DO NOT
include chicks or poults purchased for raising in this number.
Subtotal
Enter the sum of lines 702 through 705.
Closing Inventory
Enter the dollar amount of inventory at the end of the
reporting period.
Total Cost of Sales
Subtract line 707 from 706; enter the difference as the Total
Cost of Sales.
Gross Profit
Subtract line 708 from line 701; enter the difference as Gross
Profit.
Manufacturing
Enter the dollar amount of manufacturing expenses incurred
during the reporting period. This includes all direct costs
related to your slaughtering and process operations.
General, Sales, and
Enter the dollar amount of all General, Sales, and
Administrative
Administrative expenses incurred during the reporting
period.
Depreciation and
Enter the dollar amount of depreciation and amortization
Amortization
during the reporting period.
Total Operating
Enter the sum of lines 710 through 712
Expenses
Operating Income or
Subtract line 713 from line 709; enter the difference as
Loss
Operating Income (+) or Loss (-).
Other Additions to
Enter any other additions to income during the reporting
Income
period.
Interest Expense
Enter the dollar amount of all interest expenses incurred
during the reporting period as a negative number.
Other Deductions from
Enter any other deductions from income during the reporting
Income
period as a negative number.
Adjustments to
Enter the sum of lines 715 through 717.
Operating Income (+) or
Loss (-)

Expires 02/28/2021

Page 13 of 14

Line No.
719

Subject
Net Profit or Loss

801

Print Name

802
803
804
805

Signature
Telephone
Date
Title

Form PSD 3002

Instruction
Add line 718 to line 714; enter the sum as Net Profit (+) or
Loss (-).
CERTIFICATION – SECTION 8
Print the name of the owner, officer, partner, or member
responsible for this report.
The report must be signed by a responsible person.
Enter the telephone of the person signing the report
Enter the date the report is signed.
Enter the title of the person signing the report.

Expires 02/28/2021

Page 14 of 14