ACT Tulsa Annual Submission

[vc_row][vc_column][vc_custom_heading text=”ACT Tulsa Annual Submission” font_container=”tag:h2|font_size:50|text_align:left|color:%23333333″ google_fonts=”font_family:Open%20Sans%3A300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C800%2C800italic|font_style:600%20bold%20regular%3A600%3Anormal”][rd_line color=”#0ff0ff” alt_color=”#ebacfd” width=”100″ margin_bottom=”19″]

As an ACT Tulsa funding recipient, we ask that you complete the below Annual Report. Data entered should reflect only performance for the periods indicated. This survey can take up to 30 minutes to complete and requires knowledge of your company's financial information.

Are you a current ACT Tulsa funding recipient?*
- Yes
- No
Company Name*
EIN*
Contact Name*
Email of person submitting form.*
Annual Reporting Period End*
Please put 12/31 and the corresponding year.
MM slash DD slash YYYY
Cash on Hand as of 12/31*
Annual Payroll*
What is your current annualized payroll? (current monthly payroll X 12 months)*
Take your current or previous month's payroll and multiply it by 12.
Annual Revenue*
Annual Expenses*
Include all period expenses: Cost of Goods Sold, SG&A, DD&A & Interest.
Annual Net Income
If you had product/service sales during the year, what percentage of sales were made to Oklahoma Customers?
If you had product/service sales during the year, what percentage of sales were made to Customers outside Oklahoma, but in the U.S.?
If you had product/service sales during the year, what percentage of sales were made to Customers outside the U.S.?
This field should add up to 100%
Current Full Time Employees (FTEs) in Oklahoma
For Part-time employees treat them as .5 of an FTE
Current Full Time Employees (FTEs) outside Oklahoma
For Part-time employees treat them as .5 of an FTE
How many FTEs did you add during the previous calendar year?
For Part-time employees treat them as .5 of an FTE
Equity (including convertible notes) raised in the year:*
If no Equity was raised please enter 0.
Equity (including convertible notes) raised since inception:*
If no Equity was raised please enter 0.
Debt (Commercial - Bank, non-equity) raised in the year:*
If no Debt was raised please enter 0. Please do no include ACT Tulsa funding.
How much equity or convertible note capital does your company plan to raise in the coming year?*
State Grants received in the year:*
State Grants received since inception:*
Federal Grants received in the year:*
Federal Grants received since inception:*
If you received any funding during the year, please provide details regarding the investment/grant in the space below.
Information such as: what round and/or series, the date the funds were invested, and the names of investors or type of investor (Oklahoma Angel or Out of State Angel) are helpful for Plains Ventures/i2E's records. Thank you.
How many patents have you been issued since company inception?*
How many patents were issued in the previous year?*
How many new products and/or services have you introduced to the market, either directly or through licensing agreements since inception?*
Please provide a short company update for the reporting period
Information to include: Changes in management, changes in the Board of Directors, Address/Phone number change, notable sales/partnerships, milestones/goals met in the period, and what the company looks to achieve in the coming year. Thank you.
How do you feel about the overall quality of services you have received from Plains Ventures/i2E?
- 5 = Very satisfied
- 4 = Satisfied
- 3 = Somewhat satisfied
- 2 = Dissatisfied
- 1 = Very dissatisfied
Please provide a short company update for the reporting period
Information to include: Changes in management, changes in the Board of Directors, Address/Phone number change, notable sales/partnerships, milestones/goals met in the period, and what the company looks to achieve in the coming year. Thank you.
Please share any questions or comments about Plains Ventures or i2E's services.
Please upload your financials for the reporting period.
Additional fields are available below if submitting multiple files, including individual financial reports and insurance verification. Please include a Profit and Loss Report, Balance Sheet, and Statement of Cash Flows. If you receive any errors after uploading your financial documents and attempting to submit this form please submit this form without your documents. After submitting this form please email your financial documents to Shaun O'Fair at [email protected]
Max. file size: 50 MB.
Upload additional items.
Max. file size: 50 MB.
Upload additional items.
Max. file size: 50 MB.
Upload additional items.
Max. file size: 50 MB.
Upload additional items.
Max. file size: 50 MB.
CAPTCHA

Save and Continue Later

[/vc_column][/vc_row]

Shaun

ACT Tulsa Annual Submission

Author

More News

Titan Intake Automates Patient Referrals to Accelerate Care

Stories of Oklahoma Innovation: Building a Startup

Bayesic Technologies Improves Effectiveness and Efficiency of Data Analysis in Healthcare

Bison Underground Merges Nature, Science, and Technology to Tackle Climate Change

Fokes Connects Families, Caregivers and Care Agencies for Smoother Communications and Care