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Every year, companies operating in Arizona must submit an Annual Report to the Arizona Corporation Commission's Utilities Division. This essential document serves multiple purposes, providing a comprehensive overview of a company's operations and compliance with state regulations. The report includes vital information such as the company's name, mailing address, and contact details, ensuring that the Commission has accurate and up-to-date records. Additionally, it requires companies to disclose significant changes that may have occurred over the past year, such as alterations in ownership or compliance status. The form also asks for details regarding the services offered, the counties served, and statistical data pertinent to telecommunications utilities. By gathering this information, the Annual Report not only helps maintain transparency but also facilitates regulatory oversight, ultimately benefiting consumers and the industry alike. Completing this form accurately and on time is crucial for companies to remain in good standing and continue serving their communities effectively.

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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

Form Specifications

Fact Name Description
Governing Law The Arizona Annual Report form is governed by Arizona Revised Statutes, Title 10, Chapter 28.
Filing Deadline Annual reports must be filed by April 1st of each year for the previous calendar year.
Required Information Companies must provide updated contact details, ownership information, and services offered.
Submission Method The report can be submitted online or mailed to the Arizona Corporation Commission.

Arizona Annual Report: Usage Guidelines

Filling out the Arizona Annual Report form is an important task for your business. After completing this form, you'll need to submit it to the Arizona Corporation Commission. Make sure all the information is accurate and up-to-date to avoid any issues.

  1. Obtain the Form: Download the Arizona Annual Report form from the Arizona Corporation Commission website.
  2. Company Name: Check if the pre-printed company name is correct. If not, write your current company name and any "doing business as" (DBA) name in the provided space.
  3. Mailing Address: Fill in your business's mailing address, including street, city, state, and zip code.
  4. Contact Information: Provide your telephone number, fax number, cell number, and email address.
  5. Local Office Address: If applicable, fill in the local office mailing address, including street, city, state, and zip code.
  6. Customer Service Phone: Enter your customer service phone number.
  7. Website: Write your company's website address.
  8. Management Information: List the name and title of your management contact, along with their address and contact details.
  9. Regulatory Contact: Fill in the name and address of your regulatory contact, along with their contact information.
  10. Statutory Agent: Provide the name and address of your statutory agent, including their contact details.
  11. Attorney Information: If you have an attorney, fill in their name, address, and contact information.
  12. Ownership Information: Check the box that applies to your business structure (e.g., Sole Proprietor, Corporation, LLC).
  13. Counties Served: Mark the counties where you are authorized to provide services.
  14. Services Authorized: Check the boxes for the services your company is authorized to provide.
  15. Statistical Information: Fill in the required statistics related to your telecommunications services.
  16. Check Compliance: Confirm if your company is current on payments for regulatory assessments and other funds.

Your Questions, Answered

What is the Arizona Annual Report form?

The Arizona Annual Report form is a document that companies operating in Arizona must file with the Arizona Corporation Commission. This report provides essential information about the company, including its name, contact details, ownership structure, and the services it offers. It is a requirement for maintaining good standing and compliance with state regulations.

Who is required to file the Arizona Annual Report?

All businesses registered in Arizona, including corporations, limited liability companies, and partnerships, must file the Arizona Annual Report. This requirement ensures that the state has up-to-date information about each business operating within its jurisdiction.

When is the Arizona Annual Report due?

The Arizona Annual Report is typically due on the last day of the month in which the business was incorporated or registered. For example, if a company was established in March, its report would be due by the end of March each year. It is crucial to file on time to avoid penalties or loss of good standing.

What information is needed to complete the form?

To complete the Arizona Annual Report form, companies need to provide their current business name, mailing address, contact information, management details, and ownership structure. Additionally, companies must indicate the services they are authorized to provide and any significant changes that occurred during the year.

Can I make changes to my company information on the form?

Yes, the Arizona Annual Report form allows for updates to company information. If the pre-printed company name is incorrect or if a "doing business as" (dba) name is not included, there is a section on the form where you can list the current name. Ensure all information is accurate to avoid issues with compliance.

What happens if I do not file the Annual Report?

If a company fails to file the Arizona Annual Report by the due date, it may face penalties, including fines. Additionally, the company could lose its good standing status with the state, which can affect its ability to conduct business legally. In severe cases, the state may initiate administrative dissolution of the company.

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

Yes, there is typically a filing fee associated with the Arizona Annual Report. The fee amount can vary based on the type of business entity. It is important to check the current fee schedule on the Arizona Corporation Commission's website to ensure the correct amount is submitted along with the report.

Where can I find the Arizona Annual Report form?

The Arizona Annual Report form can be obtained from the Arizona Corporation Commission's official website. The form is available for download, and it can also be submitted online in many cases. Ensure you are using the most current version of the form to avoid any issues during the filing process.

Common mistakes

  1. Incorrect Company Name: One common mistake is failing to update the company name if it has changed. Always ensure that the name on the form matches your current business name or any "doing business as" (DBA) name.

  2. Missing Contact Information: Some people forget to provide complete contact details. This includes telephone numbers, email addresses, and mailing addresses for both management and regulatory contacts. Incomplete information can lead to delays or issues.

  3. Neglecting Ownership Information: It's essential to accurately check the ownership type of your company. Failing to select the correct box, such as Sole Proprietor, Corporation, or LLC, can create complications in processing your report.

  4. Omitting Services Offered: Another frequent error is not checking all the services your company is authorized to provide. Ensure that every applicable box is checked to avoid any misunderstandings regarding your service offerings.

  5. Ignoring Regulatory Compliance Questions: Some individuals overlook the questions about changes in ownership or compliance notifications from regulatory authorities. Providing this information is crucial for transparency and can affect your standing with the commission.

Documents used along the form

When filing the Arizona Annual Report, several other forms and documents may be required to ensure compliance with state regulations. These documents help provide a complete picture of a company’s operations and status. Below is a list of common forms that often accompany the Arizona Annual Report.

  • Articles of Incorporation: This document establishes the existence of a corporation in Arizona. It includes essential information such as the company name, purpose, and details about its registered agent.
  • Operating Agreement: For limited liability companies (LLCs), this internal document outlines the management structure and operating procedures. It helps clarify the roles of members and managers.
  • Bylaws: Bylaws govern the internal management of a corporation. They detail the rules for holding meetings, electing directors, and other corporate governance matters.
  • Certificate of Good Standing: This certificate verifies that a company is legally registered and compliant with state regulations. It is often required for business transactions and licensing.
  • Annual Financial Statements: These statements provide a summary of a company’s financial performance over the past year. They typically include the balance sheet, income statement, and cash flow statement.
  • Tax Returns: Companies may need to submit their federal and state tax returns to demonstrate compliance with tax obligations. This information is crucial for assessing the financial health of the business.
  • Change of Address Form: If there has been a change in the company’s mailing address, this form ensures that all communications from the Arizona Corporation Commission are sent to the correct location.
  • Application for Authority to Transact Business: If a company is registered in another state but wishes to operate in Arizona, this application is necessary to gain the authority to do so legally.

These documents play a vital role in maintaining transparency and compliance with Arizona's business regulations. Ensuring that all forms are accurately completed and submitted on time can help avoid potential legal issues and foster good standing with state authorities.

Similar forms

  • Annual Report (Form 10-K) - Similar to the Arizona Annual Report, the Form 10-K is a comprehensive report filed annually by publicly traded companies with the SEC. It provides a detailed overview of a company's financial performance, including audited financial statements and management discussions.
  • State Business License Renewal - This document requires businesses to confirm their operational status and compliance with state regulations, much like the Arizona Annual Report, which updates the state on the company's status and activities.
  • Franchise Tax Report - Similar to the Arizona Annual Report, this report is filed by businesses to provide information on their income and operations, often required for tax purposes.
  • Corporate Bylaws - While not a report, corporate bylaws outline the governance structure of a corporation, similar to how the Arizona Annual Report provides essential details about company management and operations.
  • Certificate of Good Standing - This document verifies that a business is compliant with state regulations, akin to the compliance checks included in the Arizona Annual Report.
  • Operating Agreement (for LLCs) - This document outlines the management structure and operational procedures of an LLC, similar to the management information provided in the Arizona Annual Report.
  • Quarterly Financial Statements - These statements provide updates on a company's financial health throughout the year, similar to the statistical information section of the Arizona Annual Report.
  • Tax Returns - Businesses must file tax returns annually, which require detailed financial information akin to what is reported in the Arizona Annual Report.
  • Employment Reports (e.g., EEO-1) - These reports require companies to disclose workforce demographics, paralleling the ownership information in the Arizona Annual Report.
  • Business Plan Updates - Like the Arizona Annual Report, updates to a business plan reflect changes in strategy and operations, ensuring stakeholders are informed of current business direction.

Dos and Don'ts

When filling out the Arizona Annual Report form, it is essential to be thorough and accurate. Here’s a list of things you should and shouldn’t do to ensure a smooth process.

  • Do verify that the company name is current and matches official records.
  • Do provide complete and accurate contact information for all relevant parties.
  • Do check the appropriate boxes for ownership type and services provided.
  • Do include any significant changes in ownership or compliance notifications.
  • Don't leave any sections blank; incomplete forms may lead to delays.
  • Don't forget to double-check all numbers and figures for accuracy.
  • Don't submit the form late; adhere to the filing deadlines to avoid penalties.
  • Don't ignore the instructions provided on the form; they are there for a reason.

Following these guidelines will help ensure that your Arizona Annual Report is processed efficiently and correctly.

Misconceptions

There are several misconceptions surrounding the Arizona Annual Report form that can lead to confusion for businesses. Understanding these misconceptions can help ensure that you complete the form accurately and on time.

  • Misconception 1: The Annual Report is optional for all businesses.
  • This is not true. Most businesses operating in Arizona are required to file an Annual Report with the Arizona Corporation Commission. This requirement helps maintain transparency and ensures that the state has up-to-date information about the business.

  • Misconception 2: The information on the Annual Report is not important.
  • On the contrary, the information provided in the Annual Report is critical. It includes essential details about the business, such as ownership, contact information, and services offered. Accurate reporting is vital for compliance and can affect the company's standing with regulatory authorities.

  • Misconception 3: Only large corporations need to file an Annual Report.
  • All businesses, regardless of size, must file an Annual Report if they are registered in Arizona. This includes sole proprietorships, partnerships, and limited liability companies. Each entity type has its own requirements, but filing is necessary for all.

  • Misconception 4: The deadline for filing is flexible.
  • The filing deadline for the Annual Report is strict. Companies must submit their reports by a specific date, typically by the end of the year. Late submissions can lead to penalties or even administrative dissolution of the business.

  • Misconception 5: The Annual Report can be filed without any supporting documents.
  • While the Annual Report itself is a primary document, certain supporting information may be required, depending on the type of business. This could include financial statements or details about changes in ownership. Ensuring all necessary documents are included is crucial for a successful filing.

Key takeaways

When completing the Arizona Annual Report form, there are several important points to consider. These takeaways will help ensure that the process goes smoothly and that all necessary information is accurately provided.

  • Verify Company Name: Ensure that the company name on the form is current. If it is not, make the necessary changes at the top of the form.
  • Accurate Contact Information: Fill in all contact details, including mailing addresses, phone numbers, and email addresses for both management and regulatory contacts. This information is crucial for communication.
  • Ownership Changes: If there have been any changes in ownership or direct control during the year, be sure to provide specific details in the designated area.
  • Services Provided: Clearly indicate the services your company is authorized to provide by checking the appropriate boxes. This ensures compliance with regulatory requirements.
  • Statistical Information: For telecommunications utilities, accurately report statistical data, such as the number of customers and revenue figures. This information is vital for regulatory assessment.
  • Timely Submission: Submit the completed report by the deadline to avoid penalties. Ensure all sections are filled out completely to prevent delays in processing.

By keeping these key points in mind, you can navigate the Arizona Annual Report form with confidence and clarity. This will not only help in maintaining compliance but also foster positive relationships with regulatory authorities.