Free 40408.FH11 - Indiana

ANNUAL REPORT
State Form 40408 (R15 / 12-08) / U.D. Form 45 Prescribed by Department of Local Government Finance

DLGF FILE NUMBER

FOR DEPARTMENT OF LOCAL GOVERNMENT FINANCE (DLGF) USE ONLY

PRIVACY NOTICE: The records in this series are CONFIDENTIAL according to IC 6-1.1-35-9.

DLGF DISTRIBUTABLE

INSTRUCTIONS: 1. This Annual Report should be prepared in duplicate. 2. Send one (1) copy to: Department of Local Government Finance Utility Specialist 100 North Senate Ave., Room N1058 Indianapolis, IN 46204 Telephone: (317) 232-3756 or (317) 232-3765 Additional forms or information may be found on our website: www.in.gov/dlgf/ 3. One (1) copy is to be kept in the files of the taxpayer as a part of its permanent records. NOTICE: All public utility companies, including all water, sewage, electric and pipeline, telephone, telegraph and bus companies are required to file annual reports under IC 6-1.1-8-19. Failure to file the required reports by the due date will result in penalties.
Name of utility company Tax year

Street address

City, state, and ZIP code

Name of officer to whom notice of assessment and correspondence should be sent

Telephone number

(
Mailing address of officer, (if different from above) (number and street)

)

Email address

City, state, and ZIP code

Fax number

(
Type of utility

) REMC

Electric

Gas

Water

Sewage

Pipeline

Telephone

Bus

QUESTIONS:
Fiscal year end If Federal Return is filed as part of a consolidated group, name filed under Form of business Federal Income Tax year end Location of accounting records

Partnership or Joint Venture

Sole Proprietorship

Corporation

Other (describe) ____________________________________________________________________ FEIN: _____________________________
Did you own, hold, possess or control any leased or rented depreciable property on March 1?

Yes

No

If yes, then report the local fixed personal property on Form 1-N to the township assessor and list on Part I-A or Part II of Schedule A-2 of this report. Report the leased personal property used as distributable on Part I-B or Part II of Schedule A-2 of this report. Under penalties of perjury, I hereby certify that this report (including accompanying schedules and statements), to the best of my knowledge and belief, is true, correct and complete; reports all taxable property owned, held, possessed or controlled by the named taxpayer on the assessment date of this report, as required by law; and is prepared in accordance with IC 6-1.1-8 and regulations promulgated with respect thereto.
Signature of authorized person Printed name of authorized person Title Date signed (month, day, year)

Page 1

SUPPLEMENTAL INFORMATION
Please complete the sections that apply to the taxpayer IN INDIANA OUTSIDE INDIANA INDIANA %

A. All Utility Companies Revenues Investment (Net) B. Telephone Companies Miles of single wire Miles of fiber optic cable Miles of other wire or cable

TOTAL
Number of microwave sites Number of access lines C. Electric Companies & REMC's Miles of transmission lines Miles of distribution lines

TOTAL
D. Gas, Pipeline, Water & Sewage Companies Miles of main or trunk lines Miles of laterals or gathering lines

TOTAL
E. Bus Companies Route miles
NAME AND VALUE OF EACH FRANCHISE OR PRIVILEGE OWNED OR ENJOYED BY THE COMPANY, CORPORATION OR PARTNERSHIP FILING THIS REPORT By Whom Granted Privilege Granted Term From To Value

TOTAL
Additional information and/or remarks

Page 2

SCHEDULE A - COMPUTATION OF ASSESSMENT
Report all values at federal tax basis unless otherwise noted.

Name of taxpayer

1. Utility Plant and Property in Service 2. Non-Utility Property 3. Plant Held For Future Use 4. Subtotal (Sum of Lines 1, 2 and 3) Less: Locally Assessed Real Property Included In: (Do not include R/O/W, easements or towers) Utility Plant and Property in Service Non-Utility Property Plant Held For Future Use Subtotal - Locally Assessed Real Property (Sum of Lines 5, 6 and 7)

1 2 3 4

5. 6. 7. 8.

5 6 7 8 9 10 11 12

9. TOTAL COST OF PROPERTY IN SERVICE (Excluding Locally Assessed Real Property) (Line 4 less Line 8) 10. Organization Expense 11. Acquisition Adjustment 12. ADJUSTED COST (Sum of Lines 9, 10 and 11) DEDUCTIONS AND EXEMPTIONS (at cost) 13. 14. 15. 16. 17. Intangibles (Attach explanation) Less: Intangibles For Locally Assessed Real Property Net Intangibles (Please provide supporting documentation) Industrial Air Purification Equipment in Service (Schedule A-3) Water Pollution Control Equipment in Service (Schedule A-4)

13 14 15 16 17 18 19

18. TOTAL DEDUCTIONS AND EXEMPTIONS (Sum of Lines 15, 16 and 17) 19. TOTAL ADJUSTED COST OF PROPERTY IN SERVICE (Line 12 less Line 18) LESS: 20. 21. Locally Assessed Personal Property (at cost) (Total of Schedule G, Column A) Less Leased Locally Assessed Personal Property Included in Line 20 but Not Included in Line 1 (at cost)

20 21 22 23

22. TOTAL COST OF LOCALLY ASSESSED PERSONAL PROPERTY - OWNED (Line 20 less Line 21) 23. TOTAL ADJUSTED COST OF PROPERTY IN SERVICE EXCLUDING LOCALLY ASSESSED PERSONAL PROPERTY (Line 19 less Line 22)

SCHEDULE A IS CONTINUED ON FOLLOWING PAGE

Page 3

SCHEDULE A - COMPUTATION OF ASSESSMENT (continued)
Report all values at federal tax basis unless otherwise noted.

23. TOTAL ADJUSTED COST OF PROPERTY IN SERVICE EXCLUDING LOCALLY ASSESSED PERSONAL PROPERTY (carry forward Line 23 of Page 3) DEPRECIATION, AMORTIZATION AND CREDIT FOR GROSS ADDITIONS 24. Accumulated Depreciation (as computed for Federal Tax purposes) 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. Accumulated Amortization Reserve Subtotal - Depreciation and Amortization (Line 24 plus Line 25) Less: Accumulated Depreciation Applicable to Locally Assessed Real Property Accumulated Depreciation Applicable to Locally Assessed Personal Property Accumulated Depreciation and Amortization Applicable to Pollution Control Equipment Amortization Reserve for Locally Assessed Real Property Amortization Reserve for Intangibles Deducted on Line 15 Subtotal - Net Depreciation and Amortization (Line 26 less Lines 27, 28, 29, 30 and 31) Credit for Gross Additions (Schedule A-1) TOTAL DEPRECIATION, AMORTIZATION AND CREDITS (Sum of Lines 32 and 33) TENTATIVE VALUE OF PROPERTY IN SERVICE (Line 23 minus Line 34) MINIMUM VALUE OF PROPERTY IN SERVICE [Thirty Percent (30%) of Line 23] NET VALUE OF PLANT AND PROPERTY IN SERVICE (Greater of Lines 35 or 36) ADDITIONS: (report at True Tax Value from appropriate schedule) 38. 39. 40. Construction in Process (Schedule A-1) Leased Distributable Property (Part 1-B of Schedule A-2) (Not included in Line 1) TOTAL ADDITIONS (Line 38 plus Line 39) OTHER SCHEDULES (if applicable) 41. 42. 43. 44. 45. 46. 47. REMC Schedule (Schedule A-5) Pipelines - Pipe Valuation (Schedule A-6) Pipelines - Other Property (Schedule A-7) Passenger Buses (Schedule A-8) Other __________________________________________________ (attach explanation) TOTAL (Sum of Lines 37, 40, 41, 42, 43, 44 and 45) ASSESSED VALUE (Line 46, rounded to nearest ten dollars)

23

24 25 26 27 28 29 30 31 32 33 34 35 36 37

38 39 40

41 42 43 44 45 46 47

Page 4

SCHEDULE A-1

COMPUTATION OF VALUE FOR CONSTRUCTION IN PROCESS COMPUTATION OF CREDIT FOR GROSS ADDITIONS REPORTING OF CONTRIBUTIONS IN AID OF CONSTRUCTION AND CUSTOMER ADVANCES FOR CONSTRUCTION
A. CONSTRUCTION IN PROCESS AS OF 12/31 FEDERAL TAX COST FEDERAL DEPRECIATION (if any) NET TAX VALUE (Cost Less Depreciation)

CIP %

VALUE OF CIP

Carry value below to Line 38 of Schedule A Distributable Equipment $ $
FEDERAL DEPRECIATION (if any) FEDERAL TAX COST B. GROSS ADDITIONS MADE DURING THE PAST YEAR (carry to UD-ID worksheet, if applicable)

$
NET TAX VALUE (Cost Less Depreciation)

x 10%

$

(50 IAC 5.1-6-8)

CREDIT %

CREDIT FOR GROSS ADDITIONS

Carry value below to Line 33 of Schedule A Distributable Equipment $
COST BASIS OF GROSS ADDITIONS FROM PRIOR TWO TAX YEARS (Required if applying for Investment Deduction) C.

$
FEDERAL TAX COST

$
FEDERAL DEPRECIATION

x 60%

$

NET TAX VALUE (Cost Less Depreciation) Carry to UD-ID worksheet.

$

$

$

2007 pay 2008 Additions
PRIOR TO 1987 1987 TO PRESENT

D. CONTRIBUTIONS IN AID OF CONSTRUCTION (CIAC) AND CUSTOMER ADVANCES FOR CONSTRUCTION (CAFC)

Cost of: CIAC and CAFC included in Line 1 of Schedule A Amount of Depreciation:
Note:

$ $

$ $

Included in Line 24 of Schedule A that is applicable to CIAC and CAFC

CIAC and CAFC are taxable per 50 IAC 5.1-2(b).

E. Adjust additions value by the following formula to determine your Minimum Value Ratio (MVR) if the assessed value of your business is at or below the 30 percent floor (per IC 6-1.1-12.1-4.5). (A) TENTATIVE VALUE OF PROPERTY IN SERVICE Line 35 from page 4 (B) 30 PERCENT MINIMUM VALUE Line 36 from page 4 (C) MVR Divide Column B by Column A

Page 5

SCHEDULE A-2 - LEASED PROPERTY
INSTRUCTIONS: 1. 2. 3. 4. SCHEDULE I - ASSESS TO TAXPAYER PART 1-A - REPORTED ON FORM 1-N AS LOCALLY ASSESSED COUNTY TOWNSHIP, CITY, TOWN OR TAXING DISTRICT NAME AND ADDRESS OF OWNER DESCRIPTION OF PROPERTY COST Report below all tangible personal property within the state which is held, possessed or controlled but not owned. If property is to be assessed to person holding, possessing or controlling the property, the taxpayer shall complete Schedule I. If property is to be assessed to the owner, the taxpayer shall complete Schedule II. Attach additional schedules if necessary.

ACCUMULATED DEPRECIATION

TRUE TAX VALUE

NOTE: The information above should also be reported on Form 1-N, Schedule II.

PART 1-B - LEASED DISTRIBUTABLE PROPERTY COUNTY TOWNSHIP, CITY, TOWN OR TAXING DISTRICT NAME AND ADDRESS OF OWNER DESCRIPTION OF PROPERTY COST

ACCUMULATED DEPRECIATION

TRUE TAX VALUE

TOTALS - CARRY TRUE TAX VALUE TO SCHEDULE A, LINE 39 SCHEDULE A-2 IS CONTINUED ON THE NEXT PAGE
Page 6

SCHEDULE A-2 - LEASED PROPERTY (continued)
INSTRUCTIONS: 1. 2. 3. 4. Report below all tangible personal property within the state which is held, possessed or controlled but not owned. If property is to be assessed to person holding, possessing or controlling the property, the taxpayer shall complete Schedule I. If property is to be assessed to the owner, the taxpayer shall complete Schedule II. Attach additional schedules if necessary.

SCHEDULE II - ASSESS TO OWNER COUNTY TOWNSHIP, CITY, TOWN OR TAXING DISTRICT NAME AND ADDRESS OF OWNER

DESCRIPTION OF PROPERTY

NOTE: The information above should also be reported on Form 1-N, Schedule I.

Page 7

SCHEDULE B - BALANCE SHEET As of December 31st
ASSETS

LIABILITIES & STOCKHOLDERS' EQUITY

Utility Plant: Utility plant in service Less accumulated depreciation Net plant in service Construction-in-progress Property held for future use Total Utility Plant Other Property: Nonutility property and investments - net Other assets - net Total Other Property - Net Current Assets: Cash and cash equivalents Financial investments Accounts receivable (net of doubtful accounts) Material and supplies Fuel Gas in storage Other inventories Prepayments and other current assets Total Current Assets Deferred Debits: Unamortized debt discount and expense Other: Stockholders' Equity: Common stock Preferred stock Paid-in capital Retained earnings Other capital Total Deferred Debits TOTAL ASSETS
Page 8

Current Liabilities: Notes payable Accounts payable Accrued expenses Short-term debt Current maturities of long-term debt Other current liabilities Total Current Liabilities Deferred Credits: Deferred income taxes Unamortized investment tax credit Customer advances for construction Other deferred credits Total Deferred Credits Long-term debt Other liabilities Contributions in aid of construction Total Liabilities

Total Stockholders' Equity

TOTAL LIABILITIES & STOCKHOLDERS' EQUITY

SCHEDULE C - RECONCILIATION
This schedule is to be used to reconcile your book basis numbers to your tax basis numbers and to reconcile schedule B to schedule A. Balance - January 1 Net Additions Balance - December 31

Total Plant - Book Basis Reconciling Items:

Total Plant - Tax Basis (December 31st balance must be reflected in Line 4 of Schedule A)
Balance - January 1 Net Additions Balance - December 31

Accumulated Depreciation - Book Basis Reconciling Items:

Accumulated Depreciation - Tax Basis (Carry December 31st balance to Line 24 of Schedule A)
Check box if tax depreciation was estimated Balance - January 1 Net Additions Balance - December 31

Accumulated Amortization - Book Basis Reconciling Items:

Accumulated Amortization - Tax Basis (Carry December 31st balance to Line 25 of Schedule A)
Explanations:

Page 9

SCHEDULE D - CAPITAL STOCK AND INDEBTEDNESS
INSTRUCTIONS: 1. List the following if applicable to taxpayer. 2. * If pledged, star and show issue for which pledged. 3. Attach additional sheets if necessary. SHARES OF STOCK AND UNITS OF INDEBTEDNESS A B C Total Outstanding Held By Company In Hands Of Public

NAME OF ISSUE (Segregate Stock and Debts and Show Sub-total for Each Class) PAR

D Average of Monthly High and Low Quotations 20__________

E

Total Value in Hands of Public (C x D)

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. TOTALS
Page 10

SCHEDULE E - INCOME STATEMENT FOR LAST FIVE YEARS
ITEM 1. OPERATING INCOME REVENUES Gross Operating Revenues (Years ending Dec. 31st) Expense Operation Maintenance Depreciation State and Local Property Taxes Other State Taxes Federal Taxes Other: ________ ________ ________

________

________

Total Operating Expenses OPERATING INCOME 2. OTHER INCOME Interest Income Dividend Income Miscellaneous Income Other:

Total Other Income INCOME BEFORE INTEREST AND OTHER CHARGES 3. INTEREST AND OTHER CHARGES Interest on Long Term Debt Other Interest Charges Other Charges:

Total Interest and Other Charges NET INCOME OR (LOSS)
Page 11

SCHEDULE F - REAL ESTATE AND IMPROVEMENTS
Assessed by Local Assessor
INSTRUCTIONS: 1. List the real estate and improvements owned within the State, the location and value thereof in each county, township, city, town or taxing district where the property is located for the current year. 2. IMPORTANT: Please include parcel number. 3. Attach additional schedules if necessary. True Tax Value can be found on Form II from the county. TAXING DISTRICT Name DLGF No. DESCRIPTION OF REAL ESTATE AND IMPROVEMENTS / PARCEL NUMBER TRUE TAX VALUE

COUNTY (arrange counties in alphabetical order)

$

$

Page 12

SCHEDULE G - UTILITY TANGIBLE FIXED PERSONAL PROPERTY
Assessed by Local Assessor
INSTRUCTIONS:

1. List all automotive equipment, furniture and fixtures, and appliances owned within the State, the location and value thereof in each county, township, city, town or taxing district where the property is located. 2. Attach additional schedules if necessary. 3. In the taxing districts where the 30% minimum value applies, please report the 30% minimum in Column B for those taxing districts if the depreciated amount is less than 30% of cost.

COUNTY Name

TAXING DISTRICT STBD No.

DEPRECIABLE ASSETS (From Form 1, Schedule A) A Total Cost

B True Tax Value

SUB-TOTAL - CARRY TOTAL IN COLUMN (A) TO SCHEDULE A, LINE 20

TOTAL TRUE TAX VALUE OF LOCALLY ASSESSED PERSONAL PROPERTY
Page 13

$

SCHEDULE H - ASSESSMENT DISTRIBUTION
INSTRUCTIONS:

1. Report Distributable property as a percent of investment or as a mileage figure. 2. See Instructional letter for Annual Report UD-45 for further instruction. 3. Attach additional sheets as necessary, only totaling at the end of all lines. DO NOT SUBTOTAL BY COUNTY. 4. If you are unsure of the DLGF number (taxing district number), please contact the Township Assessor in which the property is located. If you do not know the township, please contact the county assessor for assistance. DO NOT LEAVE DLGF NUMBER BLANK. 5. If you have over 20 different taxing districts, it would be helpful if the Schedule H was reported electronically. You may report it on disk or via e-mail to [email protected] or [email protected]. Please contact us for the proper electronic format. 6. If you use a percentage, please be sure your total is equal to 100 percent. Rounding errors may cause variances.

Please check the box if your distribution has not changed from prior year. You do not need to fill out the section below.
COUNTY TAXING DISTRICT Name Name (Alphabetical order)

DLGF NUMBER

DISTRIBUTABLE PROPERTY

(Numerical order)

Percent or Mileage in Each Taxing District

Page 14