KANSAS CITY, Mo. — For the sixth year in a row, Missouri is at the top of the Humane Society of the United States Horrible Hundred list of puppy mills in the country.

The Humane Society of the United States combs through federal and state inspections to compile the report each year.

The organization believes there are up to 10,000 puppy mills in the country and as many as 1,600 licensed and unlicensed puppy mills in Missouri alone.

The Horrible Hundred list is a sampling of the 100 especially problematic puppy mills in the nation.

This year, Missouri is once again in the top spot with the largest number of problematic puppy mills — 23. Next is Ohio with 13, then Iowa with 10.

"When somebody doesn't pass an inspection, they need to be held accountable,” said Kate Fields, President and CEO of the Humane Society of Greater Kansas City.

Fields said in Missouri breeders are not held accountable. According to the Horrible Hundred List, many of breeders are repeat offenders and have been on the list several years in a row.

Nate Meador, President and Chief Development Marketing Officer at Great Plains SPCA, said the high demand for puppies isn’t helping the problem.

"For-profit organizations have taken advantage of that by overproducing the puppies and that's what has created the challenge and it's easy to do in Missouri,” said Meador.

Meador said regulations in Missouri are more lax than other states and they need the public’s help to make a change.

"It takes all of us working together not just the shelters teaming up, but citizens teaming up and talking with their legislators and lawmakers and having those conversations about protecting our animals,” said Meador.

"That's where it starts. It's making sure that the state holds people accountable. That's it,” said Fields.

To read the report, follow this link.