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Please
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secretarykansas of state
Annual Report
PA Kansas Professional Association

SUBMIT THE DOCUMENTS
WITHOUT THIS PAGE
INSTRUCTIONS FOR FILING

AN ANNUAL REPORT

Note: All documents filed by the Secretary of State’s office is considered public record and may be viewable online. File
this document directly online at https://www.kansas.gov/annual-reports/index.do.

How to complete the annual report for a professional association: 7. Provide the name of each individual who isn’t qualified as defined
by K.S.A. 17-2707.
Each of the numbered instructions below corresponds to a section on
the form. 8. Provide the beginning date that shares or memberships were
held by an individual who isn’t qualified as defined by K.S.A.
1. List the entity’s ID number issued by the Kansas Secretary of 17-2707 and the name of the individual who held the shares or
State (this is not a tax ID number). ID numbers may be found by memberships.
clicking on Business Entity Database at https://www.kansas.gov/
bess/. 9. An authorized person on behalf of the entity must sign.

2. Provide the complete legal entity name, including words of
formation (e.g., LLC, Inc., etc.) Fee Schedule

3. Provide the principal office of the entity. Annual Report

Principal office: Must be a physical address that must include the The filing fee for the annual report is as follows:
building number, street, city, state, and zip code. This can’t be a PO For-profit professional association:
box. Online Annual Report: ................................ $53
Paper Annual Report: ................................. $55
4. Provide the tax closing date for the annual report. Annual reports
are filed after a tax year end has passed and represent the Not-for-profit professional association:
information that is true for that year end only (example: when an Online Annual Report: ................................ $40
entity’s tax year ends on the last day of December, the annual Paper Annual Report: ................................. $40
report due date period would be between January 1st and April
15th after each December. The report should reflect December for
the month). Filing Online

5a. Each name of the officers of the professional association must be The annual report may be filed directly online at https://www.kansas.
named along with a title for the officer and the address where they gov/annual-reports/index.do.
may be regularly located.

5b. Provide each name of the directors for for-profit professional Mail to:
associations or members of the governing body for not-for-profit
professional associations along with the address where they may Kansas Secretary of State
be regularly located. The directors may be omitted if the officers Memorial Hall, 1st Floor
are the same individuals. 120 SW 10th Avenue
Topeka KS 66612
5c. If the professional association issues shares, provide the names of
each shareholder or if the professional association doesn’t issue Only checks are accepted for payment. Make checks payable to the
shares, provide the name of each member along with the address Kansas Secretary of State.
of each.
Or
6. Indicate if each person is a qualified person pursuant to K.S.A. 17-
2707 for the named individuals in section 5a, 5b, or 5c. If any of the Fax to:
individuals named aren’t qualified, a response must be provided in
section 7 and 8. If all individuals are qualified, review section 8 and This form can’t be faxed unless it is being filed as part of another filing
provide a response if applicable. (i.e., reinstatement, corrected document, foreign application, etc.) See
the fax instructions with the other document for details.

K.S.A. 17-2718 Please proceed to form.
Inst. Rev. 6/16/23 tc

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Please
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secretarykansas Print Reset of state
Annual Report
PA Kansas Professional Association Please complete the form, print, sign and mail to the
Kansas Secretary of State with the filing fee. Selecting
'Print' will print the form and 'Reset' will clear the entire
form.
Memorial Hall, 1st Floor (785) 296-4564
120 S.W. 10th Avenue kssos@ks.gov
Topeka, KS 66612-1594 sos.ks.gov 50
THIS SPACE FOR OFFICE USE ONLY.

1. Business entity ID/file
number:
Kansas Secretary of State
issued file number.

2. Name of corporation:
Must match name on record
with Kansas Secretary of State.
(Required)

Street Address (A PO box is unacceptable.)
3. Principal office
address:
Must be a street, rural route City State Zip Country
or highway. A PO box is
unacceptable.

4. Tax closing date: Month Year

5a. Name, title, and address Name Title
of each officer of
corporation:
Address

Title and address
required for each officer City State Zip Country
named.

Name Title

Address

Do not leave blank. City State Zip Country

Name Title

Address

If additional space is needed, City State Zip Country
please provide attachment.

K.S.A. 17-2718 Please continue to next page.
1 / 2 Rev. 6/16/23 tc

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5b. Name and address of Name Address
each of the directors/
members of the
governing body: City State Zip Country

Leave this question
blank if the directors/ Name Address
members of the
governing body and
officers are the same. City State Zip Country
If additional space is needed,
please provide attachment.

5c. Name and address Name Address
of each shareholder/
member:
City State Zip Country
Leave this question
blank if the Name Address
shareholders/members
and officers are the
same. City State Zip Country
If additional space is needed,
please provide attachment.

6. Is each officer, director/member of the governing body, and shareholder/member a qualified person as defined by
K.S.A. 17-2707 by the tax closing date?
Only a qualified person may be a shareholder of a professional corporation (K.S.A. 17-2712). Exception: A certified public accountant (K.S.A. 1-308). No
person may be a director or officer, other than the secretary, of a professional corporation unless that person is a shareholder (K.S.A. 17-2713).

o Yes (Complete 8, if applicable.) o No (Complete 7 and 8, do not leave blank.)

7. List each of the officers, Name Name
directors/members of
the governing body, and
Name Name
shareholders/members
who are not qualified as
defined by statute: Name Name

8. For the tax period this Date Name
annual report covers,
list the dates that any
shares/memberships Date Name
of the corporation
were no longer owned
by a qualified person
Date Name
and the names of the
shareholders/members:

9. I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and correct.

Signature of Authorized Person (Required) Title/Position (Required)

X
Name of Signer (printed or typed) Phone Number (Not required)

K.S.A. 17-2718 Please review to ensure completion.
2 / 2 Rev. 6/16/23 tc

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