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.
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 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
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.
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.
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.
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.
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.
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.
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.
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:
By addressing these misconceptions, businesses can better navigate the filing process and ensure compliance with Arizona's regulations.
Filling out the Arizona Annual Report form can seem daunting, but understanding its key components can simplify the process. Here are some essential takeaways:
By keeping these points in mind, you can navigate the Arizona Annual Report form with confidence and ensure compliance with state regulations.