Fillable SENIOR RESIDENTIAL ENTRANCE FEE CONTRACT PROVIDER ANNUAL AUDITED (Arizona)

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SENIOR RESIDENTIAL ENTRANCE FEE CONTRACT PROVIDER ANNUAL AUDITED (Arizona)

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E-SR.AFR (v 20201031)
SENIOR RESIDENTIAL ENTRANCE FEE CONTRACT PROVIDER
ANNUAL AUDITED FINANCIAL REPORT TRANSMITTAL FORM
GENERAL INSTRUCTIONS:
You are required to file an Audited Financial Report prepared by an Independent Certified Public Accountant
within 180 days after your fiscal year end each year.
Send the filing to financialfilings@difi.az.gov
. DO NOT mail a hard copy.
YOU MUST COMPLETE AND INCLUDE THIS FORM WITH THE AUDITED FINANCIAL REPORT for filing
identification and recording purposes.
REQUIRED INFORMATION:
Enter the information below for the Provider whose Audited Financial Report is attached.
REGISTRATION NUMBER:
PROVIDER’S NAME:
FISCAL YEAR END OF REPORT:
Enter the Provider’s Net Worth according to the
attached Report:
$
DO NOT ROUND TO THOUSANDS
Answer each question below.
1. Has this report been prepared in accordance with generally accepted accounting principles?
YES or NO . IF No, explain
2. Is the Auditor’s opinion qualified OR does the Report contain a statement that the Auditors have
substantial doubt about the Provider’s ability to continue as a going concern?
YES or NO . If YES, explain
3. Are subsequent events reported in the Notes to Financial Statements?
YES or NO
If YES, reference the Page Number of the Report:
Page
ENTER THE COMPLETE NAME, TITLE, TELEPHONE NUMBER, AND EMAIL ADDRESS OF THE PERSON
TO BE CONTACTED FOR QUESTIONS CONCERNING THIS FILING:
Type or print name Title Telephone
Email address: Date completed:
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SENIOR RESIDENTIAL ENTRANCE FEE CONTRACT PROVIDER ANNUAL AUDITED (Arizona)

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Completed 1 July 2022

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