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                       kansas secretary of state     
                       Annual Report
            AR         For-Profit Corporation

                                                                                   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 for-profit corporation:                    7b.  Provide both the business entity name and the Kansas Secretary 
                                                                                   of State ID number for each entity that the corporation owns a 
Each of the numbered instructions below corresponds to a section on                majority ownership in. Both fields must be completed.
the form.
                                                                                   8.  Provide an indication if the entity owns land suitable for agricultural 
1.  List the entity’s ID number issued by the Kansas Secretary of                  use. Complete the form AG if answered yes or disregard the form 
            State (this is not a tax ID number). ID numbers may be found by        AG if answered no.
            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.)                                      AG - Annual Report Agricultural Attachment Instructions
                                                                                   1.  Each tract or lot must be detailed in this section. This includes 
3.  Provide the principal office of the entity.
                                                                                   a numerical response for the location, indicate if the land was 
                                                                                   acquired after July 1st, 1981, a brief description of how the land is 
            Principal office: Must be a physical address that must include the 
                                                                                   used, and an indication if the land is owned or leased.
            building number, street, city, state, and zip code. This can’t be a PO 
            box.
                                                                                   2.  Respond to each of the categories if applicable. At least one of the 
                                                                                   categories must have a numerical response.
4.  Provide the tax closing date for the annual report. Annual reports 
            are filed after a tax year end has passed and represent the 
                                                                                   3.  A numerical response must be provided, even if zero.
            information that is true for that year end only (example:  when an 
            entity’s tax year ends on the last day of December, the annual 
                                                                                   4.  Respond to each of the categories if applicable. At least one 
            report due date period would be between January 1st and April 
                                                                                   category with the value and location must have a response.
            15th after each December. The report should reflect December for 
            the month).

5a.  Each name of the officer of the corporation must be listed along 
            with a title for the officer and the address where they may be 
            regularly located.

5b.  Provide each name of the directors of the corporation along with 
            the address where they may be regularly reached. The directors 
            may be omitted if the officers are the same individuals.

6.  Provide the nature of business the entity is engaged in.

7a.  Provide an indication if the entity holds a majority ownership in any 
            other business that is currently filed with the Kansas Secretary of 
            State’s Office. Continue with section 7b if answered yes or continue 
            with section 8 if answered no.

                 K.S.A. 17-7503, 17-7505                                                             Please continue to next page.
Inst.            Rev. 6/16/23 tc



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Please
Do NotStaple
               kansas secretary of state   
               Annual Report
            AR For-Profit Corporation

                                                                                    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.

Fee Schedule                                                         Mail to:

Annual Report                                                        Kansas Secretary of State
                                                                     Memorial Hall, 1st Floor
The filing fee for the annual report is as follows:                  120 SW 10th Avenue
                                                                     Topeka KS 66612
Online Annual Report: ................................... $53
Paper Annual Report: .................................... $55
                                                                     Only checks are accepted for payment. Make checks payable to the 
                                                                     Kansas Secretary of State.
Filing Online
                                                                     Or
The annual report may be filed directly online at https://www.kansas.
gov/annual-reports/index.do.                                         Fax to:

                                                                     This form can’t be faxed unless it is being filed as part of another filing 
                                                                     (i.e., reinstatement, corrected document, foreign application, etc.) See 
                                                                     the fax instructions with the other document for details.

            K.S.A. 17-7503, 17-7505                                                            Please proceed to form.
Inst.       Rev. 6/16/23 tc



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                        kansas secretary of state                                          Print                                Reset
            AR          Annual Report                                                                                                           
            50          For-Profit Corporation                                             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
                                                                                                 THIS SPACE FOR OFFICE USE ONLY.

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

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

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

                                           Month          Year
      4.   Tax closing date:

                                           Name                                            Title
      5a.   Name, title, and 
            address of each 
            officer of corporation:        Address
             
            Title and address 
            required for each              City                                      State Zip   Country
            officer name.
                                           Name                                            Title

                                           Address

                                           City                                      State Zip   Country
            Do not leave blank.

                                           Name                                            Title

                                           Address

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

             K.S.A. 17-7503, 17-7505                                                             Please continue to next page.
1 / 2        Rev. 6/16/23 tc



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                                  Name                                                 Address
5b.   Name and address 
   of each director of 
   corporation:                   City                                           State Zip                  Country

                                  Name                                                 Address
   Leave this question 
   blank if the directors         City                                           State Zip                  Country
   and officers are the 
   same.
                                  Name                                                 Address

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

6. What is the nature and kind of business in which corporation is engaged?

7a.   Does this corporation hold more than 50% equity ownership in any other business entity that is filed with the 
   Kansas Secretary of State? 
o   Yes (Complete Question 7b.) o No (Skip to Question 8.)

                                  Business Entity Name                                 Kansas Secretary of State ID Number
7b.  Name and Kansas 
   Secretary of State 
   ID number of each              Business Entity Name                                 Kansas Secretary of State ID Number
   business:
   Name and ID # should be 
   provided exactly as filed with Business Entity Name                                 Kansas Secretary of State ID Number
   Kansas Secretary of State. 

8. Does this corporation own or lease land in Kansas that is suitable for use in agriculture?
   This question does not apply to 1) tracts of land of fewer than 10 acres, 2) contiguous tracts of land that are fewer than 10 acres in aggregate, or 3)
   state-assessed railroad operating property.
o   Yes (Complete Attachment AG.) o No (Skip to Question 9.)

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. 17-7503, 17-7505                                                              Please review to ensure completion.
2 / 2 Rev. 6/16/23 tc



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                  kansas secretary of state                                                                         Complete this form                                                     only if the business entity 
                  Annual Report Agricultural Attachment                                                             owns or leases land suitable for agricultural 
   AG             for Forms AR or NP                                                                                use. All information must be complete or 
                                                                                                                    this document will not                                                              be accepted for filing.

Note: This form must be completed if Question 8 on annual report form is answered “yes.”

1.   Provide information on each lot, tract or parcel of agricultural land in Kansas owned or leased by corporation. 
Location of tract or lot                                                              Was this tract   Purpose for which land is owned or leased. Indicate for each tract or parcel if the tract is …
                                                                                      acquired 
                                                                                      after July 1, 
                                                                                      1981?

   County Section Township   Range                    Number of acres in tract or lot  Yes          No                                            Owned by corporation           Leased to corporation             Leased from corporation                If leased from              corporation,                  indicate to whom        leased.

                                                                         A. Total acres owned or operated           B. Total acres owned or operated,                                                  and                      irrigated
2.   Total agricultural 
          acres
          Must be numeric values. 
                                                                         C. Total acres leased   theto corporation  D. Total acres leased   theto                      corporation                                                         and irrigated
          “NA” or “—” is unacceptable.

                                                                         E. Total acres leased from the corporation F. Total acres leased from the corporation                                                                             and irrigated

3.   Total number of 
          stockholders

                                                                         Within Kansas - Agricultural
4.        Value and location 
          of agricultural and 
                                                                         Value                                      Location
          nonagricultural assets 
          owned and controlled                                           Within Kansas - Nonagricultural
          by corporation
          Include all assets within and                                  Value                                      Location
          outside of Kansas. 
                                                                         Outside of Kansas - Agricultural
          All lines must be complete.
                                                                         Value                                      Location
                                                                         Outside of Kansas - Nonagricultural

                                                                         Value                                      Location

          K.S.A. 17-7503, 17-7505                                                                                                                 Please review to ensure completion.
Att.      Rev. 6/16/23 tc






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