Get Arizona Annual Report Form

Get Arizona Annual Report Form

The Arizona Annual Report form is a crucial document that businesses must submit to the Arizona Corporation Commission. This form provides essential information about the company, including ownership details, services offered, and contact information. Completing this report accurately is vital for maintaining compliance, so be sure to fill it out by clicking the button below.

Structure

The Arizona Annual Report form is a critical document for businesses operating within the state, particularly those in the utilities sector. This form requires companies to provide essential information about their operations, including the current business name, mailing address, and contact details for management and regulatory representatives. Companies must also disclose their statutory agent and attorney information. The report includes sections to indicate any significant changes in ownership or compliance issues during the previous year. Additionally, businesses must categorize their ownership structure, whether as a sole proprietor, partnership, corporation, or limited liability company. The form also requests details about the counties served and the specific services authorized for provision, such as telecommunications services. Statistical data specific to telecommunications utilities, including the number of residential and business customers, revenue figures, and asset valuations, must also be reported. This comprehensive overview ensures that the Arizona Corporation Commission can effectively monitor and regulate utility companies operating in the state.

Arizona Annual Report Preview

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

Document Data

Fact Name Description
Purpose of the Form The Arizona Annual Report form is required for utility companies to provide updated information to the Arizona Corporation Commission.
Filing Deadline Companies must submit their annual report by December 31st of each year, covering the previous calendar year.
Governing Law This form is governed by Arizona Revised Statutes Title 40, which pertains to public utilities and their regulation.
Required Information Companies must provide detailed information including ownership, management contacts, and services offered.

How to Use Arizona Annual Report

Filling out the Arizona Annual Report form is an important task for companies operating in the state. This report collects essential information about your business, including ownership, management, and services provided. Once completed, it should be submitted to the Arizona Corporation Commission. Below are the steps to help you accurately fill out the form.

  1. Verify Company Name: Check the pre-printed company name on the form. If it is incorrect or if your doing business as (dba) name is missing, click the appropriate link to update it.
  2. Company Information: Fill in your company name, mailing address, and contact details, including telephone, fax, and email. Make sure all information is accurate and up to date.
  3. Local Office Address: If applicable, provide the mailing address for your local office and customer service phone number. Include the website address if you have one.
  4. Management Information: Enter the contact details for your management and regulatory contacts, including names, titles, addresses, and phone numbers.
  5. Statutory Agent Information: Provide the name and contact details of your statutory agent, which is the person or entity designated to receive legal documents on behalf of your company.
  6. Attorney Information: If you have legal representation, include your attorney's name and contact information.
  7. Important Changes: Indicate if there have been any significant changes during the year, such as changes in ownership or compliance issues. Provide details if applicable.
  8. Ownership Information: Check the box that best describes your company's ownership structure, such as sole proprietor, partnership, or corporation.
  9. Counties Served: Select the counties in Arizona where your company is authorized to provide services. You can choose multiple options if applicable.
  10. Services Authorized: Mark all the services your company is authorized to provide, such as telecommunications services or other specified services.
  11. Statistical Information: If your company is a telecommunications utility, fill in the required statistical data, including customer counts and revenue figures.
  12. Payment Status: Indicate if your company is current on payments for regulatory assessments and other fees, checking the appropriate boxes.

Key Facts about Arizona Annual Report

What is the Arizona Annual Report form?

The Arizona Annual Report form is a document that companies operating in Arizona must submit to the Arizona Corporation Commission. This report provides essential information about the company, including its name, address, management contacts, and services offered. It helps the Commission keep track of businesses and ensures they comply with state regulations.

Who needs to file the Annual Report?

Any business entity registered in Arizona, such as corporations, partnerships, and limited liability companies, must file an Annual Report. This includes both for-profit and non-profit organizations. If your company is providing regulated services, like telecommunications, you must complete this report annually to maintain your operating status.

When is the Annual Report due?

The Annual Report is typically due by December 31st each year. However, companies should check for specific deadlines, as they may vary based on the type of business entity. It’s important to file on time to avoid penalties or potential issues with your business registration.

What information do I need to provide in the report?

The report requires various details, including your company name, mailing address, management contacts, and ownership information. You will also need to disclose the services you are authorized to provide and any changes in ownership or regulatory compliance. Make sure to have accurate and up-to-date information ready when filling out the form.

How do I submit the Annual Report?

What happens if I do not file the Annual Report?

If you fail to file the Annual Report on time, your company may face penalties, including fines. In some cases, the Arizona Corporation Commission may suspend your business license or registration. This could hinder your ability to operate legally in the state, so it’s crucial to stay compliant with this requirement.

Common mistakes

Filling out the Arizona Annual Report form requires careful attention to detail. One common mistake is failing to update the company name. If the pre-printed name is incorrect or the business operates under a different name, it is crucial to make that correction. Not doing so can lead to confusion and potential compliance issues.

Another frequent error involves incomplete contact information. Each section, including the mailing address and management contacts, must be fully filled out. Missing details such as area codes or email addresses can delay communication and hinder the processing of the report.

Many people overlook the importance of selecting the correct ownership type. The form provides various options such as Sole Proprietor, Partnership, or Corporation. Choosing the wrong category can affect regulatory compliance and the company’s legal standing.

Additionally, some individuals fail to provide accurate statistical information. This includes data on residential and business customers, as well as financial figures. Inaccuracies can lead to penalties or additional scrutiny from regulatory authorities.

Another mistake is neglecting to address any important changes during the year. If there have been changes in ownership or compliance issues, these must be reported. Failing to disclose this information can result in significant legal repercussions.

Lastly, many individuals do not review the entire form before submission. A final check can catch errors or omissions that could otherwise lead to delays or complications. Taking the time to thoroughly review the document is essential for ensuring a smooth filing process.

Documents used along the form

The Arizona Annual Report form is a crucial document for businesses operating in the state, particularly those in the utilities sector. Alongside this form, several other documents are often required to ensure compliance with state regulations. Below is a list of these documents, each serving a specific purpose in the reporting process.

  • Certificate of Good Standing: This document confirms that a business entity is authorized to operate in Arizona and is in compliance with state regulations. It is often required when filing the annual report to demonstrate that the company is in good standing with the Arizona Corporation Commission.
  • Financial Statements: These statements provide an overview of the company's financial health. They typically include the balance sheet, income statement, and cash flow statement. Accurate financial reporting is essential for transparency and regulatory compliance.
  • List of Officers and Directors: This document details the individuals serving in key leadership roles within the company. It is important for regulatory authorities to have updated information on who is responsible for the company's operations and governance.
  • Business License: A valid business license is required for most companies to operate legally in Arizona. This document shows that the company has met local licensing requirements and is authorized to conduct business activities.
  • Tax Returns: Companies may need to provide copies of their state and federal tax returns. These documents help verify the company's income and tax obligations, ensuring compliance with tax laws.
  • Service Area Maps: For utility companies, maps showing the areas served are often necessary. These maps help regulatory bodies understand the geographical scope of the company's operations and service commitments.
  • Compliance Reports: Depending on the type of business, compliance reports may be required to show adherence to specific regulations or standards. These reports can include environmental compliance, safety standards, and other regulatory obligations.
  • Customer Service Reports: These reports provide insights into customer service performance, including response times and customer satisfaction metrics. They are important for demonstrating the company's commitment to quality service.

Completing the Arizona Annual Report and accompanying documents accurately is vital for maintaining good standing and avoiding potential penalties. Each document plays a role in providing a comprehensive picture of the company's operations and compliance status. Being thorough and timely in these submissions will help ensure that your business continues to operate smoothly within Arizona's regulatory framework.

Similar forms

  • Annual Report for Corporations: Similar to the Arizona Annual Report form, this document is required for corporations to provide an overview of their financial performance and operational status over the past year. It includes essential company information, management details, and financial data, ensuring compliance with state regulations.

  • LLC Annual Report: Like the Arizona Annual Report, the LLC Annual Report serves to inform the state about the current status of a Limited Liability Company. It typically requires information about the company's address, management, and any changes that may have occurred within the year.

  • Nonprofit Annual Report: This document shares similarities with the Arizona Annual Report in that it provides a summary of activities, financial information, and governance details for nonprofit organizations. It helps maintain transparency and accountability to the public and regulatory bodies.

  • Franchise Tax Report: The Franchise Tax Report is akin to the Arizona Annual Report as it requires businesses to disclose information about their financial status and operations. This report is often necessary for maintaining good standing with the state and may include details on revenue, assets, and compliance with state laws.

Dos and Don'ts

When filling out the Arizona Annual Report form, it's essential to follow certain guidelines to ensure accuracy and compliance. Here’s a helpful list of dos and don'ts.

  • Do verify that the company name on the form matches your current business name.
  • Do include all necessary contact information, such as telephone numbers and email addresses.
  • Do check the appropriate boxes for ownership type and services provided.
  • Do ensure that all addresses are complete and accurate, including street, city, state, and zip code.
  • Do provide details about any changes in ownership or compliance issues if applicable.
  • Don't leave any sections blank unless instructed to do so.
  • Don't use abbreviations or shorthand that may confuse the reader.
  • Don't forget to double-check for any typos or errors before submission.
  • Don't ignore the deadline for filing the report; late submissions can incur penalties.
  • Don't forget to keep a copy of the completed form for your records.

Misconceptions

Understanding the Arizona Annual Report form is crucial for businesses operating in the state. However, several misconceptions can lead to confusion. Here are five common misunderstandings:

  • It is optional to file the Annual Report. Many believe that filing the Annual Report is not mandatory. In reality, it is a requirement for all businesses registered in Arizona. Failing to submit the report can lead to penalties or even administrative dissolution.
  • Only corporations need to file. Some think that only corporations are required to file an Annual Report. However, all business entities, including partnerships and limited liability companies (LLCs), must complete this form to remain compliant with state regulations.
  • The form is the same every year. There is a misconception that the Annual Report form does not change. In fact, the form may be updated annually to reflect changes in regulations or reporting requirements. It is essential to use the most current version of the form when filing.
  • Filing deadlines are flexible. Some business owners believe they can file their reports whenever they choose. In truth, there are strict deadlines for submission, typically set for the end of the fiscal year. Missing the deadline can result in late fees and complications.
  • Only financial information is required. A common misunderstanding is that the Annual Report focuses solely on financial data. While financial information is important, the form also requires details about ownership, management, and services provided. All sections must be completed accurately for a successful filing.

By addressing these misconceptions, businesses can better navigate the filing process and ensure compliance with Arizona's regulations.

Key takeaways

Filling out the Arizona Annual Report form can seem daunting, but understanding its key components can simplify the process. Here are some essential takeaways:

  • Accurate Company Information is Crucial: Ensure that the company name, mailing address, and contact details are current. Any discrepancies could lead to complications in communication with regulatory bodies.
  • Ownership Changes Must Be Reported: If there have been any changes in ownership or direct control during the year, it’s important to disclose these changes. Transparency helps maintain trust with regulatory authorities.
  • Service Areas and Offerings: Clearly indicate the counties served and the types of services your company is authorized to provide. This information is vital for compliance and customer clarity.
  • Statistical Data is Required: For telecommunications utilities, be prepared to provide detailed statistical information. This includes data on access lines, customers, and revenue, which are essential for regulatory assessment.

By keeping these points in mind, you can navigate the Arizona Annual Report form with confidence and ensure compliance with state regulations.