The Arizona Annual Report form, required by the Arizona Corporation Commission Utilities Division, serves as a comprehensive yearly summary for businesses, detailing operational, management, and financial information. This document is crucial for maintaining up-to-date records with the state and ensuring compliance with local regulations. Businesses are urged to meticulously complete and submit their form to avoid potential compliance issues. For assistance in filling out the form, click the button below.
In the vibrant landscape of Arizona's business regulatory environment, the Arizona Corporation Commission Utilities Division's Annual Report form stands as a crucial document for entities operating within the state. This comprehensive form serves multiple purposes, including updating company information, reporting significant changes during the fiscal year, and providing detailed operational statistics. Companies are required to list their current names, including any doing business as (dba) names, along with their official mailing address, contact numbers, and email addresses. Management and regulatory contacts must be specified, ensuring clear channels of communication. Furthermore, the form queries about any ownership or control changes and compliance issues with other regulatory bodies, emphasizing the importance of transparency and accountability. Ownership types—ranging from sole proprietorships to limited liability companies—must be indicated, alongside the geographical areas served. The form extends to authorize the services provided by the company, underpinning the regulatory framework within which these entities operate. Statistical sections demand granular details about customer numbers, service lines, revenue, and the company's asset value in Arizona, painting a detailed picture of its operational footprint within the state. This meticulously structured form not only facilitates regulatory oversight but also underscores the interconnectedness of business operations, regulatory compliance, and the provision of utilities to Arizona's residents.
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
When it's time to complete the Arizona Annual Report form, being thorough and accurate is key. This document is vital for maintaining the status of your business with the Arizona Corporation Commission Utilities Division. The form covers company information, management details, any significant changes that occurred during the year, and specifics about the services your company provides. It's important to ensure all information is current and correct to avoid any complications. Below is a step-by-step guide to help you fill it out.
Once all the sections of the form are accurately filled, double-check your entries for correctness. Submitting accurate and comprehensive information is crucial for compliance and ensuring that your business's records are up to date with the Arizona Corporation Commission Utilities Division.
The Arizona Annual Report form is designed to gather comprehensive information from telecommunications companies operating within the state. This form enables the Arizona Corporation Commission Utilities Division to monitor and regulate the activities of these companies, ensuring they comply with state regulations and standards. It includes details about company management, ownership, services provided, statistical information, and any significant changes during the reporting year.
Any telecommunications company that offers services in Arizona, regardless of its size and the nature of its services, must complete the Arizona Annual Report form. This includes companies offering long distance, local exchange, private line services, and any other telecommunications-related services authorized by the state.
Telecommunications companies are required to submit the Arizona Annual Report annually. The report covers activities and information from the previous year, ending on December 31st.
The company information section requires several details, including:
For the management contact, companies should list a senior executive or manager responsible for overseeing the company's operations. The regulatory contact should be an individual who handles regulatory compliance and interacts with the Arizona Corporation Commission and other regulatory entities.
Companies must disclose any significant changes in ownership, control, or regulatory compliance status. Specific details of these changes, including the nature and impact on the company, should be provided in the designated section of the form.
Companies must indicate their type of ownership structure, choosing from options such as Sole Proprietor, Partnership, Corporation (including C Corporation or Subchapter S Corporation), Limited Liability Company, Association/Co-op, or other forms requiring a detailed description.
Companies need to check the appropriate boxes to indicate:
Telecommunications utilities must provide detailed statistical information, including:
This statistical data helps the Commission analyze the telecommunications landscape in Arizona and ensure companies are serving their customers effectively.
When filling out the Arizona Annual Report form, individuals commonly make several mistakes that can lead to the submission of inaccurate or incomplete information. These mistakes may hinder the processing of the report or potentially lead to penalties for the submitting entity. Below are seven common mistakes made during this process:
Not updating the pre-printed company name and dba (doing business as) name: If there have been changes to the company's name or if the business operates under a dba not included in the pre-printed information, failing to update this can lead to the report being associated with incorrect business identities.
Omitting updated contact information: Changes to the mailing address, telephone numbers, fax numbers, cell numbers, or email addresses that are not reported can disrupt communication between the Commission and the company.
Ignoring changes in management or regulatory contacts: It's vital to update the contact information for new management personnel or regulatory contacts to ensure the Commission communicates with the appropriate individuals.
Overlooking important updates during the year: Not indicating significant changes such as shifts in ownership, changes in direct control, or notifications of non-compliance from other regulatory authorities can lead to inaccuracies in the company's recorded status.
Inaccurately reporting the type of business entity: Mistakes in checking the correct box for the company type (e.g., Sole Proprietor, C Corporation, S Corporation) could lead to an incorrect understanding of the business's structure and legal obligations.
Failing to accurately identify the counties served: By not correctly indicating all counties in which the company is certified to provide service, the report might not fully reflect the company's operational scope within Arizona.
Misreporting services authorized to provide: Incorrectly selecting the services the company is authorized to provide can lead to a misunderstanding of the company's offerings and possibly affect regulatory compliance.
Ensuring accuracy and completeness when filling out the Arizona Annual Report form is crucial for maintaining good standing with the Arizona Corporation Commission and fulfilling regulatory requirements.
When managing a business in Arizona, staying compliant involves several key documents beyond the Arizona Annual Report form. These documents play an integral role in your business's compliance, financial clarity, and operational efficiency. Understanding what these forms are and their importance can help keep your business in good standing.
Each of these documents plays a critical role in the lifecycle of a business, from formation to daily operations, and even as the business grows or changes structure. Being proactive in managing these forms can help avoid legal pitfalls and ensure your business thrives in Arizona's regulatory environment.
The Arizona Annual Report form shares similarities with various other documents required by businesses and organizations. Each document serves its unique purpose, yet they all play integral roles in maintaining the legal and operational statuses of entities within their respective frameworks. Below is a list of 9 documents that exhibit similarities to the Arizona Annual Report form:
Each of these documents, while serving specific regulatory or operational needs, collects and updates vital information about a business or organization. This ensures transparency, legal compliance, and up-to-date records that reflect the entity's current operational status and structure.
When filling out the Arizona Annual Report form, certain practices should be followed to ensure accuracy and compliance. Below are lists of things you should and shouldn't do during this process.
Things You Should Do:
Things You Shouldn't Do:
When dealing with the Arizona Annual Report form, many people hold onto misconceptions that can cause confusion or errors in submission. Addressing these misconceptions directly can help ensure accurate and successful report completion.
Clearing up these misconceptions is vital for companies to comply with regulatory requirements and maintain good standing with the Arizona Corporation Commission. Accurate and timely submission supports not just regulatory compliance but also effective management and operational oversight.
Completing and utilizing the Arizona Annual Report form is an important annual task for businesses operating within the state. This form allows the Arizona Corporation Commission Utilities Division to keep track of crucial company information. Here are six key takeaways to help navigate the process more effectively:
Overall, the Arizona Annual Report form is a vital tool for both the state and the companies operating within it. It ensures transparency, regulatory compliance, and the efficient provision of services across Arizona. Companies should approach this report with attention to detail to ensure their information is accurately represented.
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