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.
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 _______________________________________________________________
__________________________________________________________1-800-___________________________
Customer Service Phone No. (Include Area Code)
Website address ___________________________________________________________________________
MANAGEMENT INFORMATION
Management Contact:_________________________________________________________________________________
(Name)(Title)
_______________________________________________________________________________________________________________________
(City)
(State)
(Zip)
Telephone No. (Include Area Code)
Fax No. (Include Area Code)
Cell No. (Include Area Code)
Regulatory Contact:___________________________________________________________________
(Name)
2
Statutory Agent:__________________________________________________________________________
________________________________________________________________________________________________________________________
(Street)(City)(State)(Zip)
____________________________________________________________________________________________________________
Telephone No. (Include Area Code)Fax No. (Include Area CodeCell No. (Include Area Code)
Attorney:________________________________________________________________________________
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.
Has the company been notified by any other regulatory authorities during the year that they are out of compliance?
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
_______________ ________________
$_________________________________
%_________________________________
AZ Telephone Relay Service
5
UTILITY SHUTOFFS/DISCONNECTS
MONTH
Termination without Notice
R14-2-509.B
Termination with Notice
R14-2-509.C
OTHER
TOTALS →
OTHER (description):
6
VERIFICATION
AND
SWORN STATEMENT
STATE OF ________________
I, THE UNDERSIGNED OF THE
Intrastate Revenues Only
COUNTY OF (COUNTY NAME)
NAME (OWNER OR OFFICIAL) TITLE
COMPANY NAME
DO SAY THAT THIS ANNUAL UTILITY REPORT TO THE ARIZONA CORPORATION COMMISSION
FOR THE YEAR ENDING
DAY
YEAR
HAS BEEN PREPARED UNDER MY DIRECTION, FROM THE ORIGINAL BOOKS, PAPERS AND RECORDS OF SAID UTILITY; THAT I HAVE CAREFULLY EXAMINED THE SAME, AND DECLARE THE SAME TO BE A COMPLETE AND CORRECT STATEMENT OF BUSINESS AND AFFAIRS OF SAID UTILITY FOR THE PERIOD COVERED BY THIS REPORT IN RESPECT TO EACH AND EVERY MATTER AND THING SET FORTH, TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF.
IN ACCORDANCE WITH THE REQUIREMENT OF TITLE 40, ARTICLE 8, SECTION 40- 401, ARIZONA REVISED STATUTES, IT IS HEREIN REPORTED THAT THE GROSS OPERATING REVENUE OF SAID UTILITY DERIVED FROM ARIZONA INTRASTATE UTILITY OPERATIONS DURING CALENDAR YEAR 2020 WAS:
Arizona Intrastate Gross Operating Revenues Only ($)
$___________________________
(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
20__
SIGNATURE OF NOTARY PUBLIC
7
RESIDENTIAL REVENUE
STATE OF ARIZONA
I, THE UNDERSIGNED
OF THE
INTRASTATE REVENUES ONLY
NAME (OWNER OR OFFICIAL)
TITLE
MONTH DAY YEAR
12 31 2020
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 $_____________________________
*RESIDENTIAL REVENUE REPORTED ON THIS PAGE MUST INCLUDE SALES TAXES BILLED.
MY COMMISSION EXPIRES
NOTARY PUBLIC NAME
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
Completing the Arizona Annual Report form is essential for maintaining compliance. Follow these steps to ensure all required information is accurately provided.
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.
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.
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.
The form requires various details, including:
Make sure to provide accurate and up-to-date information to avoid any compliance issues.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Understanding the Arizona Annual Report form can be challenging. Here are ten common misconceptions that often arise:
By addressing these misconceptions, businesses can better navigate the requirements of the Arizona Annual Report form and ensure compliance.
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:
Completing the form accurately and thoroughly is vital for maintaining good standing with the Arizona Corporation Commission.