Blank Arizona Annual Report PDF Form

Blank Arizona Annual Report PDF Form

The Arizona Annual Report form is a crucial document that businesses must file to provide essential information about their operations to the Arizona Corporation Commission. This form includes details such as company ownership, management contacts, and services offered. Ensuring that this report is completed accurately and submitted on time is vital for maintaining compliance and good standing with state regulations.

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The Arizona Annual Report form is an essential document for businesses operating within the state, particularly for those in the utilities sector. This form serves multiple purposes, including providing updated company information, ensuring compliance with regulatory standards, and offering insights into the company's operational status. Key sections of the form require details such as the company's current name, mailing address, and contact information for management and regulatory representatives. Additionally, it prompts businesses to disclose any significant changes in ownership or compliance status during the reporting year. Companies must also indicate their service areas and the specific services they are authorized to provide, which helps the Arizona Corporation Commission monitor and regulate utility services effectively. Furthermore, the form collects statistical data relevant to telecommunications utilities, including customer numbers and revenue information, which can be crucial for assessing market dynamics and ensuring fair practices. Completing this form accurately and timely is vital for maintaining good standing with the state and ensuring that businesses can continue to operate without interruptions.

Document Sample

ARIZONA CORPORATION COMMISSION

UTILITIES DIVISION

ANNUAL REPORT MAILING LABEL – MAKE CHANGES AS NECESSARY

Please click here if pre-printed Company name on this form is not your current Company name or dba name is not included.

Please list current Company name including dba here:

__________________________________________________________________________

ANNUAL REPORT

FOR YEAR ENDING

12

31

2020

FOR COMMISSION USE

ANN 03

20

COMPANY INFORMATION

Company Name (Business Name) _________________________________________________________

Mailing Address ____________________________________________________________________________

(Street)

_________________________________________________________________________________________

(City)(State)(Zip)

__________________________________________________________________________________________

Telephone No. (Include Area Code)Fax No. (Include Area Code)Cell No. (Include Area Code)

Email Address______________________________________________________________________________

Local Office Mailing Address _______________________________________________________________

(Street)

__________________________________________________________________________________________

(City)(State)(Zip)

__________________________________________________________1-800-___________________________

Customer Service Phone No. (Include Area Code)

Website address ___________________________________________________________________________

MANAGEMENT INFORMATION

Management Contact:_________________________________________________________________________________

(Name)(Title)

_______________________________________________________________________________________________________________________

(Street)

(City)

(State)

(Zip)

 

 

 

Telephone No. (Include Area Code)

Fax No. (Include Area Code)

Cell No. (Include Area Code)

Email Address______________________________________________________________________________

Regulatory Contact:___________________________________________________________________

(Name)

(Street)

(City)

(State)

(Zip)

 

 

 

Telephone No. (Include Area Code)

Fax No. (Include Area Code)

Cell No. (Include Area Code)

Email Address______________________________________________________________________________

2

Statutory Agent:__________________________________________________________________________

(Name)

________________________________________________________________________________________________________________________

(Street)(City)(State)(Zip)

____________________________________________________________________________________________________________

Telephone No. (Include Area Code)Fax No. (Include Area CodeCell No. (Include Area Code)

Attorney:________________________________________________________________________________

 

 

(Name)

 

 

 

 

 

(Street)

(City)

(State)

(Zip)

_______________________________________________________________________________________________________________________

Telephone No. (Include Area Code)Fax No. (Include Area Code)Cell No. (Include Area Code)

Email Address:_____________________________________________________________________________

Important Changes During the Year

Yes __ No __

For those companies not subject to the affiliated interest rules, has there been a change in ownership or direct control during the year?

If yes, please provide specific details in the box below.

Yes __ No __

Has the company been notified by any other regulatory authorities during the year that they are out of compliance?

If yes, please provide specific details in the box below.

3

OWNERSHIP INFORMATION

Check the following box that applies to your company:

Sole Proprietor (S)

Partnership (P)

Bankruptcy (B)

Receivership (R)

CCorporation (C) (Other than Association/Co-op) Subchapter S Corporation (Z)

Association/Co-op (A) Limited Liability Company

Other (Describe)______________________________________________________________________

COUNTIES SERVED

Check the box below for the counties in which you are certificated to provide service:

STATEWIDE

APACHE

GILA

LA PAZ

NAVAJO

SANTA CRUZ

COCHISE

GRAHAM

MARICOPA

PIMA

YAVAPAI

COCONINO

GREENLEE

MOHAVE

PINAL

YUMA

4

SERVICES AUTHORIZED TO PROVIDE

Check the following box(es) for the services that you are authorized to provide:

Resold Long Distance/Interexchange Telecommunications Services (RLD) Resold Local Exchange Telecommunications Services (RLEC)

Facilities-Based Long Distance/Interexchange Telecommunications Services (IXC) Facilities Based Local Exchange Telecommunications Services (CLEC)

Facilities Based Private Line Telecommunications Services Alternative Operator Service Provider

Other (Specify)______________________________________________________________________

STATISTICAL INFORMATION

TELECOMMUNICATION UTILITIES ONLY

Total number of residential local exchange access lines

Total number of residential local exchange customers

Total number of business local exchange access lines

Total number of business local exchange customers

Total quantity of phone numbers assigned to Company

Total phone numbers assigned to Customers by Company

Total number of long distance residential customers

Total number of long distance business customers

Total intrastate local exchange revenue from Arizona operations

Total intrastate long distance/interexchange revenue from Arizona operations Total intrastate revenue from Arizona operations

Total intrastate income from Arizona operations

Value of Company’s total assets in Arizona Value of Company’s total assets

(Value of Company’s total assets in Arizona)/(Value of company’s total assets)

Current amount of deposits, prepayments, and advances from customers

(not including monthly service bills)

Current amount of performance bond

Current amount of Irrevocable Sight Draft Letter of Credit

Check box if Company is current on payments for:

Regulatory Assessment

AZ Universal Service Fund

AZ 911/E911

Circuit

Voice over Internet

Switched

Protocol (“VoIP”)

_______________

________________

_______________

________________

_______________

________________

_______________

________________

__________________________________

RetailOther

_______________ ________________

__________________________________

__________________________________

$_________________________________

$_________________________________

$_________________________________

$_________________________________

$_________________________________

$_________________________________

%_________________________________

$_________________________________

$_________________________________

$_________________________________

AZ Telephone Relay Service

5

UTILITY SHUTOFFS/DISCONNECTS

MONTH

Termination without Notice

R14-2-509.B

Termination with Notice

R14-2-509.C

OTHER

TOTALS →

OTHER (description):

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

6

VERIFICATION

AND

SWORN STATEMENT

VERIFICATION

STATE OF ________________

I, THE UNDERSIGNED OF THE

Intrastate Revenues Only

COUNTY OF (COUNTY NAME)

NAME (OWNER OR OFFICIAL) TITLE

COMPANY NAME

DO SAY THAT THIS ANNUAL UTILITY REPORT TO THE ARIZONA CORPORATION COMMISSION

FOR THE YEAR ENDING

MONTH

DAY

YEAR

12

31

2020

HAS BEEN PREPARED UNDER MY DIRECTION, FROM THE ORIGINAL BOOKS, PAPERS AND RECORDS OF SAID UTILITY; THAT I HAVE CAREFULLY EXAMINED THE SAME, AND DECLARE THE SAME TO BE A COMPLETE AND CORRECT STATEMENT OF BUSINESS AND AFFAIRS OF SAID UTILITY FOR THE PERIOD COVERED BY THIS REPORT IN RESPECT TO EACH AND EVERY MATTER AND THING SET FORTH, TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF.

SWORN STATEMENT

IN ACCORDANCE WITH THE REQUIREMENT OF TITLE 40, ARTICLE 8, SECTION 40- 401, ARIZONA REVISED STATUTES, IT IS HEREIN REPORTED THAT THE GROSS OPERATING REVENUE OF SAID UTILITY DERIVED FROM ARIZONA INTRASTATE UTILITY OPERATIONS DURING CALENDAR YEAR 2020 WAS:

Arizona Intrastate Gross Operating Revenues Only ($)

$___________________________

(THE AMOUNT IN BOX ABOVE

INCLUDES $_________________

IN SALES TAXES BILLED, OR COLLECTED)

**REVENUE REPORTED ON THIS PAGE MUST INCLUDE SALES TAXES BILLED OR COLLECTED. IF FOR ANY OTHER REASON, THE REVENUE REPORTED ABOVE DOES NOT AGREE WITH TOTAL OPERATING REVENUES ELSEWHERE REPORTED, ATTACH THOSE STATEMENTS THAT RECONCILE THE DIFFERENCE. (EXPLAIN IN DETAIL)

SIGNATURE OF OWNER OR OFFICIAL

TELEPHONE NUMBER

SUBSCRIBED AND SWORN TO BEFORE ME

A NOTARY PUBLIC IN AND FOR THE COUNTY OF

THIS

 

DAY OF

(SEAL)

MY COMMISSION EXPIRES____________________________

COUNTY NAME

MONTH

20__

 

 

SIGNATURE OF NOTARY PUBLIC

7

VERIFICATION

AND

SWORN STATEMENT

RESIDENTIAL REVENUE

STATE OF ARIZONA

I, THE UNDERSIGNED

OF THE

INTRASTATE REVENUES ONLY

COUNTY OF (COUNTY NAME)

NAME (OWNER OR OFFICIAL)

TITLE

 

 

COMPANY NAME

DO SAY THAT THIS ANNUAL UTILITY REPORT TO THE ARIZONA CORPORATION COMMISSION

FOR THE YEAR ENDING

MONTH DAY YEAR

12 31 2020

HAS BEEN PREPARED UNDER MY DIRECTION, FROM THE ORIGINAL BOOKS, PAPERS AND RECORDS OF SAID UTILITY; THAT I HAVE CAREFULLY EXAMINED THE SAME, AND DECLARE THE SAME TO BE A COMPLETE AND CORRECT STATEMENT OF BUSINESS AND AFFAIRS OF SAID UTILITY FOR THE PERIOD COVERED BY THIS REPORT IN RESPECT TO EACH AND EVERY MATTER AND THING SET FORTH, TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF.

SWORN STATEMENT

IN ACCORDANCE WITH THE REQUIREMENTS OF TITLE 40, ARTICLE 8, SECTION 40- 401.01, ARIZONA REVISED STATUTES, IT IS HEREIN REPORTED THAT THE GROSS OPERATING REVENUE OF SAID UTILITY DERIVED FROM ARIZONA INTRASTATE UTILITY OPERATIONS RECEIVED FROM RESIDENTIAL CUSTOMERS DURING CALENDAR YEAR 2020 WAS:

ARIZONA INTRASTATE GROSS OPERATING REVENUES

$_________________________

(THE AMOUNT IN BOX AT LEFT INCLUDES $_____________________________

IN SALES TAXES BILLED, OR COLLECTED)

*RESIDENTIAL REVENUE REPORTED ON THIS PAGE MUST INCLUDE SALES TAXES BILLED.

SUBSCRIBED AND SWORN TO BEFORE ME

A NOTARY PUBLIC IN AND FOR THE COUNTY OF

THIS

 

DAY OF

 

 

 

(SEAL)

MY COMMISSION EXPIRES

SIGNATURE OF OWNER OR OFFICIAL

TELEPHONE NUMBER

NOTARY PUBLIC NAME

COUNTY NAME

MONTH

20__

 

 

SIGNATURE OF NOTARY PUBLIC

8

FINANCIAL INFORMATION

Income Statements:

Attach to this annual report a copy of the company’s year-end (Calendar Year 2020) financial statements.

Alternative templates are provided for this information. Please select one from Figure 1A, Figure 1B or Figure 1C.

(All Facilities-Based CLECs, Facilities-Based IXCs, Facilities-Based Access Line Providers & Facilities-Based Private Line Providers must submit FIGURE 1C)

Arizona Administrative Code, R14.2.1115.F, states that one of the items required in this Annual Report is a statement of income for the reporting year

Balance Sheets:

Alternative templates are provided for this information. Please select one from Figure 2A or Figure 2B.

(All Facilities-Based CLECs, Facilities-Based IXCs, Facilities-Based Access Line Providers & Facilities-Based Private Line Providers must submit FIGURE 2B)

Arizona Administrative Code, R14.2.1115.F, states that one of the items required in this Annual Report is a balance sheet as of the end of the reporting year

ALL INFORMATION MUST BE ARIZONA-SPECIFIC AND REFLECT OPERATING

RESULTS IN ARIZONA.

9

Docket No. _____________________Year Ending: 12-31-20

Company Name: ___________________________________________________

FIGURE 1A

Account Description

$ Amount

Revenues:

Expenses:

Operating Income:

Net Income:

Attachment 1

10

File Specifics

Fact Name Details
Governing Law The Arizona Annual Report form is governed by Arizona Revised Statutes, Title 40.
Filing Deadline The report must be filed annually by March 31st for the previous calendar year.
Company Information Companies must provide their current name, mailing address, and contact details.
Management Contact A designated management contact must be included with their details.
Regulatory Contact Companies must list a regulatory contact for compliance issues.
Ownership Structure Companies must indicate their ownership structure, such as corporation or partnership.
Counties Served Companies must specify the counties in Arizona where they provide services.
Services Authorized Companies must list the telecommunications services they are authorized to provide.
Statistical Information Telecommunication utilities must provide detailed statistics on their operations.
Important Changes Companies must disclose any significant changes in ownership or regulatory compliance.

How to Use Arizona Annual Report

Completing the Arizona Annual Report form is essential for maintaining compliance. Follow these steps to ensure all required information is accurately provided.

  1. Obtain the Arizona Annual Report form from the Arizona Corporation Commission website.
  2. Check the pre-printed company name. If it is incorrect, click the designated link and enter the current company name, including any "doing business as" (DBA) names.
  3. Fill in the company information section with the following details:
    • Company Name
    • Mailing Address (Street, City, State, Zip)
    • Telephone, Fax, and Cell Numbers (including area codes)
    • Email Address
    • Local Office Mailing Address (if applicable)
    • Customer Service Phone Number
    • Website Address
  4. Provide management information, including:
    • Management Contact (Name, Title, Address, Phone, Email)
    • Regulatory Contact (Name, Address, Phone, Email)
    • Statutory Agent (Name, Address, Phone)
    • Attorney (Name, Address, Phone, Email)
  5. Indicate if there were any important changes during the year by checking "Yes" or "No" and providing details if applicable.
  6. Specify the ownership information by checking the appropriate box (e.g., Sole Proprietor, Corporation, LLC).
  7. Select the counties where you are certificated to provide service by checking the relevant boxes.
  8. Check the boxes for the services you are authorized to provide.
  9. Fill in the statistical information section with the required data for telecommunications utilities only.
  10. Review all entries for accuracy and completeness.
  11. Sign and date the form as required.
  12. Submit the completed form to the Arizona Corporation Commission by the specified deadline.

Your Questions, Answered

What is the Arizona Annual Report form?

The Arizona Annual Report form is a document that businesses operating in Arizona must file annually. It provides essential information about the company, including its ownership structure, services offered, and contact details. This report helps the Arizona Corporation Commission maintain accurate records and ensures compliance with state regulations.

Who needs to file the Annual Report?

All corporations, limited liability companies (LLCs), and certain other business entities registered in Arizona are required to file an Annual Report. This includes both for-profit and non-profit organizations. If your business is operating under a different name (DBA), it’s crucial to include that information on the form.

When is the Annual Report due?

The Annual Report is typically due on or before the anniversary of the entity's formation or registration in Arizona. It’s essential to check the specific due date for your business type, as late filings may incur penalties or affect your business standing with the state.

What information is required on the form?

The form requires various details, including:

  • Company name and mailing address
  • Management and regulatory contact information
  • Ownership structure
  • Counties served
  • Services authorized to provide
  • Statistical information specific to telecommunications utilities

Make sure to provide accurate and up-to-date information to avoid any compliance issues.

How can I submit the Annual Report?

You can submit the Arizona Annual Report form online through the Arizona Corporation Commission's website. Alternatively, you may choose to mail a printed version of the form. Be sure to check the submission guidelines to ensure your report is processed correctly.

What happens if I miss the filing deadline?

If you miss the filing deadline, your business may face penalties, including late fees. Additionally, failure to file can result in administrative dissolution or revocation of your business license. It’s crucial to stay on top of these deadlines to maintain good standing.

Can I make changes to the information after filing?

Yes, if there are changes to your company’s information after you have filed the Annual Report, you can submit an amendment. This may include updates to your company name, address, or ownership structure. Keeping your information current is vital for compliance and communication purposes.

Common mistakes

  1. Incorrect Company Name: Failing to update the company name or dba (doing business as) name can lead to significant issues. Ensure the name matches what is registered with the Arizona Corporation Commission.

  2. Missing Contact Information: Omitting essential contact details, such as phone numbers or email addresses, can hinder communication. All sections requiring contact information should be filled out completely.

  3. Inaccurate Ownership Information: Selecting the wrong ownership type (e.g., Sole Proprietor, Corporation) can result in compliance issues. It’s crucial to choose the correct option that accurately reflects the company’s structure.

  4. Neglecting Regulatory Changes: If there have been changes in ownership or regulatory compliance, failing to report these can lead to penalties. Always check the appropriate boxes and provide detailed information if applicable.

  5. Incomplete Statistical Information: Leaving out statistics related to local exchange access lines or customer numbers can affect regulatory assessments. Ensure all relevant data is accurately reported.

  6. Not Checking Service Authorizations: Failing to indicate the services the company is authorized to provide can create confusion. Review and check all applicable service boxes.

  7. Ignoring Deadlines: Submitting the report after the deadline can result in fines or other repercussions. Mark the due date on your calendar and submit the report on time.

Documents used along the form

The Arizona Annual Report form is essential for businesses operating in the state, ensuring compliance with regulatory requirements. Several other forms and documents are commonly submitted alongside this report to provide additional information about the company's structure, operations, and financial status.

  • Articles of Incorporation: This document establishes a corporation's existence in Arizona. It includes details such as the company's name, purpose, and the number of shares authorized for issuance.
  • Operating Agreement: For limited liability companies (LLCs), this internal document outlines the management structure and operational procedures. It details member responsibilities and profit distribution.
  • Bylaws: Bylaws govern the internal management of a corporation. They cover topics such as board meetings, voting procedures, and the roles of officers, ensuring smooth operations.
  • Certificate of Good Standing: This certificate verifies that a business is compliant with state regulations and has met all filing requirements. It may be requested for various business transactions.
  • Financial Statements: These documents provide an overview of a company's financial health. They typically include balance sheets, income statements, and cash flow statements, offering insights into profitability and stability.

Submitting these documents alongside the Arizona Annual Report can help ensure that a business remains in good standing and compliant with state regulations. Each document serves a specific purpose, contributing to a comprehensive understanding of the company's operations and legal status.

Similar forms

The Arizona Annual Report form shares similarities with the IRS Form 990, which is used by tax-exempt organizations to report their financial information. Both documents require detailed disclosures about the organization’s structure, management, and financial activities. Just as the Arizona form gathers information about a company's ownership and services, Form 990 collects data on revenue sources, expenses, and governance. Transparency is a key objective for both forms, ensuring that stakeholders have access to relevant information regarding the organization’s operations.

Another document that resembles the Arizona Annual Report is the California Statement of Information. This form serves a similar purpose for businesses operating in California, requiring them to provide updated information about their company’s address, officers, and registered agent. Both reports aim to keep state regulatory bodies informed about the current status of the business. Additionally, they both include sections for notifying the state of any significant changes that may have occurred during the reporting period, such as ownership changes or compliance issues.

The Florida Annual Report is yet another document akin to the Arizona Annual Report. Like its Arizona counterpart, the Florida report requires businesses to disclose essential information such as the company’s name, address, and management details. Both documents are filed annually and serve to maintain good standing with state authorities. They also emphasize the importance of providing accurate and up-to-date information, as failure to do so may result in penalties or loss of business privileges.

Similar to the Arizona Annual Report, the New York Biennial Statement serves to keep the state informed about the status of businesses. While the New York document is filed every two years, it requires similar information regarding the company’s contact details and management structure. Both reports highlight the need for businesses to communicate changes in their operations, ensuring that state agencies have the most current information available for regulatory purposes.

Lastly, the Texas Franchise Tax Report bears resemblance to the Arizona Annual Report in that it requires companies to disclose their financial information and operational details to the state. Both documents serve to assess compliance with state laws and regulations. The Texas report, like the Arizona form, includes sections for reporting revenue, expenses, and ownership structure, thereby enabling state authorities to evaluate the business's financial health and regulatory adherence.

Dos and Don'ts

When completing the Arizona Annual Report form, it is important to follow certain guidelines to ensure accuracy and compliance. Below is a list of things you should and shouldn't do.

  • Do verify that the company name and any doing business as (dba) names are current before submission.
  • Do provide complete and accurate contact information for management and regulatory contacts.
  • Do check the appropriate boxes for ownership type and services authorized to provide.
  • Do ensure all required statistical information is filled out correctly, especially if your company is a telecommunications utility.
  • Don't leave any sections blank unless specifically instructed; incomplete forms may lead to delays.
  • Don't forget to include area codes for telephone and fax numbers.
  • Don't ignore any notifications from regulatory authorities regarding compliance issues.
  • Don't submit the form without reviewing it for accuracy; errors can result in penalties or additional scrutiny.

Misconceptions

Understanding the Arizona Annual Report form can be challenging. Here are ten common misconceptions that often arise:

  1. Only corporations need to file. Many people believe that only corporations are required to submit an annual report. In fact, various business entities, including partnerships and limited liability companies, must also file.
  2. The report is optional. Some think that filing the annual report is a choice. However, it is mandatory for most businesses operating in Arizona to maintain compliance with state regulations.
  3. Filing deadlines are flexible. There is a misconception that deadlines for submission can be adjusted. In reality, businesses must adhere to specific deadlines to avoid penalties.
  4. Only financial data is required. Many assume that the report only requires financial information. However, it also includes management contacts, ownership details, and service authorizations.
  5. Changes in company name don’t need to be reported. Some believe that if a company changes its name, it does not need to update the report. This is incorrect; businesses must reflect any name changes on their annual report.
  6. One report covers multiple years. It is a common misconception that one annual report can cover several years. Each year requires a separate report to ensure accurate and up-to-date information.
  7. All counties served must be listed. Some think they need to list every county, even if they serve only one. Companies should only indicate the counties where they are certificated to provide service.
  8. There is no need for regulatory contact information. Many assume that providing regulatory contact details is unnecessary. However, this information is crucial for compliance and communication with regulatory authorities.
  9. The report is not public information. Some believe that annual reports are private documents. In fact, they are public records and can be accessed by anyone.
  10. Filing is the same for all businesses. Lastly, there is a misconception that the filing process is identical for all types of businesses. Each business entity type has specific requirements and forms to complete.

By addressing these misconceptions, businesses can better navigate the requirements of the Arizona Annual Report form and ensure compliance.

Key takeaways

Filling out the Arizona Annual Report form is a crucial task for companies operating in the state. Here are key takeaways to ensure compliance and accuracy:

  • Verify Company Name: Ensure the company name on the form matches the current legal name or any "doing business as" (dba) name.
  • Complete Contact Information: Provide accurate mailing addresses, phone numbers, and email addresses for both management and regulatory contacts.
  • Ownership Information: Clearly indicate the type of ownership structure, such as sole proprietor, partnership, or corporation.
  • Counties Served: Check all counties where your company is authorized to provide services. This is essential for regulatory compliance.
  • Services Offered: Mark all the services your company is authorized to provide, including telecommunications services.
  • Statistical Data: Be prepared to report various statistics, such as the number of customers and revenue generated from operations in Arizona.
  • Compliance Check: Indicate if there have been any changes in ownership or regulatory compliance issues during the year.

Completing the form accurately and thoroughly is vital for maintaining good standing with the Arizona Corporation Commission.