Arizona Annual Report Template

Arizona Annual Report Template

The Arizona Annual Report form is a crucial document that businesses in Arizona must file annually to provide updated information to the Arizona Corporation Commission. This form collects essential details about your company, including ownership, management, and services offered. Make sure to complete the form accurately and submit it on time to stay compliant with state regulations.

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Table of Contents

The Arizona Annual Report form is an essential document for businesses operating within the state, particularly those in the utilities sector. This form collects vital information about the company, including its name, address, and contact details. It also requires companies to provide management and regulatory contact information, ensuring that the Arizona Corporation Commission can easily reach the appropriate representatives. Companies must indicate any important changes that occurred during the year, such as changes in ownership or compliance issues with other regulatory authorities. Additionally, the form includes sections for ownership classification and the counties served, allowing for a clear understanding of the company's operational scope. Authorized services, statistical data, and financial metrics specific to telecommunications utilities are also part of the report, providing a comprehensive overview of the company's activities and performance in Arizona. Completing this form accurately is crucial for maintaining compliance and ensuring smooth operations within the state's regulatory framework.

Arizona Annual Report 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
2
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______________________________________________________________________________
3
Statutory Agent:__________________________________________________________________________
(Name)
________________________________________________________________________________________________________________________
(Street) (City) (State) (Zip)
____________________________________________________________________________________________________________
Telephone No. (Include Area Code) Fax No. (Include Area Code Cell 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:_____________________________________________________________________________
Yes __
No __
If yes, please provide specific details in the box below.
Yes __
No __
If yes, please provide specific details in the box below.
Important Changes During the Year
For those companies not subject to the affiliated interest rules, has there been a change in ownership or direct control during
the year?
Has the company been notified by any other regulatory authorities during the year that they are out of compliance?
4
OWNERSHIP INFORMATION
Check the following box that applies to your company:
Sole Proprietor (S) C Corporation (C) (Other than Association/Co-op)
Partnership (P) Subchapter S Corporation (Z)
Bankruptcy (B) Association/Co-op (A)
Receivership (R) Limited Liability Company
Other (Describe)______________________________________________________________________
COUNTIES SERVED
Check the box below for the counties in which you are certificated to provide service:
STATEWIDE
APACHE COCHISE COCONINO
GILA GRAHAM GREENLEE
LA PAZ MARICOPA MOHAVE
NAVAJO PIMA PINAL
SANTA CRUZ YAVAPAI YUMA
5
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
Circuit
Switched
Voice over Internet
Protocol (“VoIP”)
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
__________________________________
Retail
Other
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
$_________________________________
$_________________________________
$_________________________________
Check box if Company is current on payments for:
Regulatory Assessment AZ Universal Service Fund AZ 911/E911 AZ Telephone Relay Service
6
UTILITY SHUTOFFS/DISCONNECTS
MONTH
Termination without Notice
R14-2-509.B
Termination with Notice
R14-2-509.C
OTHER
TOTALS
OTHER (description):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
7
VERIFICATION
AND
SWORN STATEMENT
Intrastate Revenues Only
VERIFICATION
COUNTY OF (COUNTY NAME)
STATE OF ________________
NAME (OWNER OR OFFICIAL) TITLE
I, THE UNDERSIGNED
COMPANY NAME
OF THE
DO SAY THAT THIS ANNUAL UTILITY REPORT TO THE ARIZONA CORPORATION COMMISSION
MONTH DAY YEAR
FOR THE YEAR ENDING 12 31 2020
HAS BEEN PREPARED UNDER MY DIRECTION, FROM THE ORIGINAL BOOKS,
PAPERS AND RECORDS OF SAID UTILITY; THAT I HAVE CAREFULLY EXAMINED
THE SAME, AND DECLARE THE SAME TO BE A COMPLETE AND CORRECT
STATEMENT OF BUSINESS AND AFFAIRS OF SAID UTILITY FOR THE PERIOD
COVERED BY THIS REPORT IN RESPECT TO EACH AND EVERY MATTER AND
THING SET FORTH, TO THE BEST OF MY KNOWLEDGE, INFORMATION AND
BELIEF.
SWORN STATEMENT
IN ACCORDANCE WITH THE REQUIREMENT OF TITLE 40, ARTICLE 8, SECTION 40-
401, ARIZONA REVISED STATUTES, IT IS HEREIN REPORTED THAT THE GROSS
OPERATING REVENUE OF SAID UTILITY DERIVED FROM ARIZONA INTRASTATE
UTILITY OPERATIONS DURING CALENDAR YEAR 2020 WAS:
Arizona Intrastate Gross Operating Revenues Only ($)
$___________________________
(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 SIGNATURE OF OWNER OR OFFICIAL
DIFFERENCE. (EXPLAIN IN DETAIL)
TELEPHONE NUMBER
SUBSCRIBED AND SWORN TO BEFORE ME
A NOTARY PUBLIC IN AND FOR THE COUNTY OF
THIS DAY OF
(SEAL)
SIGNATURE OF NOTARY PUBLIC
MY COMMISSION EXPIRES____________________________
COUNTY NAME
MONTH 20__
8
VERIFICATION
AND
SWORN STATEMENT
RESIDENTIAL REVENUE
INTRASTATE REVENUES ONLY
STATE OF ARIZONA
I, THE UNDERSIGNED
OF THE
DO SAY THAT THIS ANNUAL UTILITY REPORT TO THE ARIZONA CORPORATION COMMISSION
FOR THE YEAR ENDING
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:
(THE AMOUNT IN BOX AT LEFT
INCLUDES $_____________________________
IN SALES TAXES BILLED, OR COLLECTED)
*RESIDENTIAL REVENUE REPORTED ON THIS PAGE
MUST INCLUDE SALES TAXES BILLED.
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 SIGNATURE OF NOTARY PUBLIC
COUNTY OF (COUNTY NAME)
NAME (OWNER OR OFFICIAL) TITLE
COMPANY NAME
MONTH DAY YEAR
12 31 2020
NOTARY PUBLIC NAME
COUNTY NAME
MONTH 20__
ARIZONA INTRASTATE GROSS OPERATING REVENUES
$_________________________
9
FINANCIAL INFORMATION
Income Statements:
Attach to this annual report a copy of the companys 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.
Docket No. _____________________ Year Ending: 12-31-20
Company Name: ___________________________________________________
10
FIGURE 1A
Account Description $ Amount
Revenues:
Expenses:
Operating Income:
Net Income:
Attachment 1

Document Attributes

Fact Name Description
Governing Law The Arizona Annual Report form is governed by Arizona Revised Statutes, Title 40, Chapter 2.
Filing Frequency Companies must submit the annual report each year, typically by December 31.
Company Information The report requires current company name, mailing address, and contact details.
Management Contact A designated management contact must be provided, including their name and title.
Regulatory Contact Companies must list a regulatory contact, with complete contact information.
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 The report requires companies to list the telecommunications services they are authorized to provide.
Statistical Information Telecommunication utilities must provide various statistics, including customer counts and revenue.
Compliance Notifications Companies must disclose any notifications from regulatory authorities regarding compliance issues.

Arizona Annual Report: Usage Instruction

Completing the Arizona Annual Report form is an essential step for businesses operating in the state. After filling out the form, you will submit it to the Arizona Corporation Commission, which will review the information provided. Ensuring accuracy and completeness will help avoid any delays or issues with your filing.

  1. Obtain the Arizona Annual Report form from the Arizona Corporation Commission's website or your local office.
  2. Review the pre-printed company name on the form. If it is incorrect, click the designated area to indicate that changes are necessary.
  3. Fill in the current company name, including any "doing business as" (dba) names.
  4. Provide your mailing address, including street, city, state, and zip code.
  5. Enter your telephone number, fax number, cell number, and email address.
  6. If applicable, include the local office mailing address in the designated section.
  7. List the customer service phone number and website address.
  8. Complete the management information section, including the contact person’s name and title, along with their address, phone numbers, and email address.
  9. Fill out the regulatory contact information, providing similar details as in the management section.
  10. Identify the statutory agent by providing their name, address, and contact information.
  11. Include the attorney’s information, if applicable, with their name, address, and contact details.
  12. Answer the questions regarding important changes during the year, indicating “Yes” or “No” as appropriate and providing details if necessary.
  13. Check the box that applies to your company’s ownership structure, such as Sole Proprietor, Corporation, or Limited Liability Company.
  14. Select the counties in which your company is authorized to provide service by checking the appropriate boxes.
  15. Indicate the services your company is authorized to provide by checking the relevant boxes.
  16. For telecommunications utilities, fill in the statistical information requested, including total numbers of customers and revenue figures.
  17. Check the box if your company is current on payments for regulatory assessments and other funds.
  18. Review the entire form for accuracy before submitting it.
  19. Submit the completed form to the Arizona Corporation Commission by the deadline.

Frequently Asked Questions

  1. What is the purpose of the Arizona Annual Report form?

    The Arizona Annual Report form is designed to provide the Arizona Corporation Commission with essential information about a utility company's operations over the past year. This includes details about ownership, services provided, and financial statistics. Submitting this report is crucial for compliance and helps ensure transparency within the industry.

  2. Who needs to file the Arizona Annual Report?

    Any utility company operating in Arizona is required to file this report. This includes various business structures such as corporations, partnerships, and limited liability companies. If your company provides utility services in Arizona, you must complete and submit this form annually.

  3. When is the Arizona Annual Report due?

    The report is typically due by December 31st of each year. However, companies should verify specific deadlines with the Arizona Corporation Commission to ensure timely submission and avoid penalties.

  4. What information is required on the form?

    The form requests a variety of information, including:

    • Company name and mailing address
    • Management and regulatory contacts
    • Ownership structure
    • Counties served and services authorized
    • Statistical data related to utility operations

    Completing all sections accurately is essential for compliance.

  5. What happens if I miss the filing deadline?

    Missing the deadline can result in penalties or fines. Additionally, it may affect your company's standing with the Arizona Corporation Commission. If you realize you will be late, it is advisable to contact the Commission as soon as possible to discuss your options.

  6. Can I amend my Annual Report after submission?

    Yes, if you discover errors or need to update information after submitting the report, you can file an amendment. It's important to clearly indicate what changes have been made and provide the necessary details to ensure accuracy.

  7. Is there a fee associated with filing the Arizona Annual Report?

    While there may not be a direct filing fee for the Annual Report itself, companies should be aware of any associated fees for regulatory assessments or other requirements. It's best to check with the Arizona Corporation Commission for the latest information on any potential costs.

  8. What if my company has undergone changes during the year?

    If there have been significant changes, such as ownership or control, you must disclose these in the report. Providing accurate and complete information about any changes is vital for maintaining compliance with state regulations.

  9. Where can I find assistance if I have questions about the form?

    If you have questions or need assistance, the Arizona Corporation Commission provides resources and support. You can contact their office directly or visit their website for guidance on completing the Annual Report form.

Common mistakes

When filling out the Arizona Annual Report form, many people make common mistakes that can lead to delays or complications. One frequent error is failing to update the company name or doing business as (dba) name. If the pre-printed name on the form is outdated, it is essential to correct it. Ignoring this step can result in official documents being sent to the wrong address or, worse, create confusion regarding the company’s identity.

Another mistake involves incomplete or incorrect contact information. It is crucial to provide accurate mailing addresses, phone numbers, and email addresses. If any of this information is incorrect, it can hinder communication with the Arizona Corporation Commission. Additionally, failing to include the area codes for telephone numbers can lead to missed calls or messages, which can be detrimental to business operations.

Many individuals overlook the section regarding changes in ownership or direct control. If there have been any significant changes during the year, it is vital to indicate this on the form. Failing to disclose such information can lead to compliance issues and may even result in penalties. Transparency is key, and this section should not be taken lightly.

Lastly, people often neglect to check the appropriate boxes for the services they are authorized to provide. The report requires companies to specify their services, and failing to do so can lead to misunderstandings about what the company is permitted to offer. This oversight may affect regulatory compliance and could impact the company's standing with the Commission.

Documents used along the form

The Arizona Annual Report form is an essential document for businesses operating within the state. However, several other forms and documents are often required alongside it to ensure compliance with state regulations. Each of these documents serves a specific purpose and contributes to the overall transparency and accountability of the business.

  • Articles of Incorporation: This document establishes a corporation's existence in Arizona. It includes essential details such as the company's name, purpose, and the number of shares it is authorized to issue. Filing this document is a crucial first step for any corporation.
  • Operating Agreement: For Limited Liability Companies (LLCs), this internal document outlines the management structure and operational procedures. It details the rights and responsibilities of the members and can help prevent disputes in the future.
  • Bylaws: These are the rules that govern the internal management of a corporation. Bylaws typically cover aspects such as the election of directors, meeting protocols, and the roles of officers, ensuring that the corporation operates smoothly.
  • Certificate of Good Standing: This document certifies that a business is compliant with state regulations and has paid all necessary fees. It may be required for various transactions, such as securing loans or entering contracts.
  • Tax Registration Forms: Businesses must register for various state taxes, including sales tax and employer taxes. Completing these forms ensures compliance with Arizona tax laws and helps avoid potential penalties.
  • Business Licenses: Depending on the nature of the business, specific licenses may be required at the local or state level. These licenses confirm that the business meets all legal requirements to operate in its industry.
  • Annual Financial Statements: These statements provide a snapshot of the company’s financial health, including income statements and balance sheets. They are often required for transparency and may be requested by investors or regulatory agencies.

In summary, while the Arizona Annual Report form is a vital document for businesses, it is important to recognize the other forms and documents that accompany it. Each plays a significant role in ensuring that a business operates legally and effectively within the state. By understanding these requirements, businesses can better navigate the regulatory landscape and maintain compliance.

Similar forms

The Arizona Annual Report form shares similarities with several other documents. Here’s a list of ten documents that are comparable, along with how they relate:

  • Annual Report for Corporations: Like the Arizona Annual Report, this document provides a summary of a corporation's financial performance and operational activities over the year.
  • Business License Renewal Application: Both require current business information and may include updates on ownership or management changes.
  • Tax Return Forms: Similar to the annual report, tax returns summarize financial activities and are submitted to government authorities for compliance.
  • Certificate of Good Standing: This document shows that a business is compliant with state regulations, much like the compliance checks in the annual report.
  • State Business Registration Forms: These forms collect essential information about a business, including ownership and contact details, similar to the Arizona Annual Report.
  • Financial Statements: Both documents provide a snapshot of a company's financial health, detailing assets, liabilities, and revenues.
  • Utility Service Provider Application: This application gathers information about services offered and company structure, paralleling the service sections in the annual report.
  • Change of Address Form: This form is used to update contact information, just as the annual report requires current mailing addresses.
  • Corporate Bylaws: Bylaws outline the governance structure of a company, similar to how the annual report provides insight into management and ownership.
  • Regulatory Compliance Reports: These reports track compliance with industry regulations, akin to the compliance questions found in the Arizona Annual Report.

Dos and Don'ts

When filling out the Arizona Annual Report form, it's essential to be thorough and accurate. Here are some important dos and don'ts to keep in mind:

  • Do ensure that the company name is current and matches official records.
  • Do provide complete contact information, including phone numbers and email addresses.
  • Do check all boxes that apply to your company’s ownership structure.
  • Do report any significant changes in ownership or compliance status.
  • Don't leave any sections blank; incomplete forms may delay processing.
  • Don't forget to double-check the accuracy of all numerical data provided.
  • Don't submit the form without reviewing it for spelling and grammatical errors.
  • Don't ignore deadlines; late submissions can result in penalties.

By following these guidelines, you can help ensure that your Arizona Annual Report is completed correctly and submitted on time.

Misconceptions

Misconceptions can often lead to confusion regarding the Arizona Annual Report form. Below are nine common misconceptions along with clarifications.

  • Annual Reports are Optional for All Businesses: Many believe that submitting an annual report is optional. In reality, it is a requirement for most businesses operating in Arizona to maintain good standing with the Arizona Corporation Commission.
  • Only Corporations Need to File: Some think that only corporations must submit an annual report. However, various business entities, including LLCs and partnerships, are also required to file.
  • The Report is Only for Financial Information: A misconception exists that the report focuses solely on financial data. In fact, it includes details about management, ownership, and services provided, among other information.
  • Filing Deadlines are Flexible: Many assume that deadlines for filing can be adjusted. This is incorrect; businesses must adhere to specific deadlines to avoid penalties.
  • Changes in Company Information are Not Required: Some believe they can ignore changes in company details. Any updates, such as a change in ownership or address, must be reported promptly.
  • Filing is the Same for All Business Types: There is a misconception that the filing process is uniform across all business types. Each type of entity has its own requirements and forms that must be completed.
  • Filing Fees are the Same for Everyone: Many think that all businesses pay the same filing fee. In reality, fees can vary based on the type of business entity and other factors.
  • Failure to File is a Minor Issue: Some individuals view failure to file as a minor oversight. However, neglecting to submit the report can lead to significant penalties, including the loss of good standing.
  • Assistance is Not Available: Lastly, there is a belief that businesses must navigate the filing process alone. In fact, resources and assistance are available through the Arizona Corporation Commission and other organizations.

Key takeaways

  • Accurate Information: Ensure that all company details are up to date, including the business name and mailing address.
  • Contact Details: Provide current contact information for management, regulatory, and statutory agents.
  • Ownership Changes: Report any changes in ownership or control, as required by the form.
  • Compliance Notifications: Indicate if the company has received notifications regarding non-compliance from regulatory authorities.
  • Ownership Structure: Clearly check the box that corresponds to your company's ownership structure, such as corporation or LLC.
  • Counties Served: Select all counties where the company is authorized to provide services.
  • Authorized Services: Mark all services that your company is authorized to offer, such as telecommunications services.
  • Statistical Data: Fill in all required statistical information accurately, especially for telecommunications utilities.
  • Timely Submission: Submit the annual report by the deadline to avoid penalties or compliance issues.