20131015Mud Lake FCC Form 481 redacted.pdf

Depend on our pec$li._ Count.ori our aduice.\3'
October 15,2013
Jean Jewell
Commission Secretary
ldaho Public Utililties Commission
472W. Washington
Boise, ldaho 83720-007 4
ln the Matter of ETC Certification for Mud Lake Telephone Cooperative Association
PUC Docket Number: GNR-T1301
Dear Dr. Haar:
Enclosed via email filing to [e-mail], please find the Trade Secret and Public
FCC Form 481 - High Cost and Low-lncome Annual Report for Mud Lake Telephone
Cooperative Association (Company). This filing is made pursuant to Sections 54.313 and
54.422 of the FederalCommunications Commission (FCC) Rules.
Portions of the FCC Form 481 - High Cost and Low-lncome Annual Report contain TRADE
SECRET financial information with independent economic value which is not generally know to,
and not readily ascertainable by competitors of the Company which could obtain economic
value from its disclosure. This information includes detailed financial information in the "line
3026 attachment." The Company maintains this information as trade secret.
The Public filing contains a copy of the "Redacted- For Public lnspection" copy of the
Company's 481 Form that will be filed with the FCC. This copy does not include the TRADE
SECRET information described below.
The Trade Secret filing contains the "Confidential Copy" of the Company's 481 Form that has
been filed with USAC and will be filed with the FCC. The Confidential Copy contains the
TRADE SECRET INFORMATION.
We request the ldaho Public Utilities Commission to file the annual certification regarding high-
cost and low income support with USAC and the FCC, pursuant to 47 CFR54.314 (a). Please
contact the undersigned if you need further information.
Sincerely,
S^"trd1"4
Tom Campbell
Telecommu nications Consultant
[e-mail]
651-621-8511
Enclosures
CC: All Parties of Record
5t"9.slOiia I lrjlSlo.rt,rl.trxa [ 5t !n!r.MN!5lt].il17 | 6i,t rIt.4ttl I 1tr4J 246/t / |lllnnr.poirOili(. I lilPrn,reCenrrrDr.Sre )n0 i Min@Fn![1[is]&.;r0d I91j r{t 9rr2 iL:l qr u:rrrlr I or'tr\cLB
State of ldaho
County of Jefferson
HOIIYMA,RIEPRHSIERmn8YnnE.hlGSorAw
CERTIFICATION BY ELIGIBLE TELECOMMUNICATIONS CARRIER
OF COMPLIANCE WTH SERVICE OUALIry AND CUSTOMER
SS PROTECTION, ABILIry TO REMAIN FUNCTIONAL IN EMERGENCIES,
AND USE OF FEDEML HIGH.COST SUPPORT.
AFFIDAVIT OF BUSINESS OR CORPORATE OFFICER
The ldaho Public Utilities Commission Order No. 29841requires that Eligible Telecommunications Carriers
certifo that it is compliant with appticable service quality standards and consumer protection rules; and ETCs
must demonstrate the ability to remain functional in emergencies. ln addition, the Commission must file an
annual certification with the USAC and the FCC that all federal high-cost support provided to ETCs within the
State of ldaho will be used6[E7ihEET6ffifrlfraintenance, and upgrading of facilities and seMces forwhich
the support is intended. Accordingly, the \
1. I am an olficer of Greq Shenton , an eligible telecommunications carrier for receiving federal
universal service support under section 214(e) of the Telecommunications Act of 1 996 in the state of
ldaho.
2. I am familiar with the Company's day{o-day operations in the state of ldaho and with the State's
service quality standards and consumer protection rules as set forth in Commission Order No. 2984'1.
3. Mud Lake Telephone Coooerative Association is complying with applicable service quality
standards and consumer protection rules of the Federal Communications Commission and the ldaho
Public tltilities Commission.
4. I certify to the Commission that the Company is able to remain functional in emergencies as set forth in
Commission Order No. 29841 and in 47 C.F,R. $ 54.201(a)(2).
5. I also certifu that all federal universal service support funds received by Mud Lake Telephone
Cooperative Association during the current calendar year will be used in a manner consistent with
section 254(e); that is, for the provision, maintenance, and upgrading of facilities and services for which
thesupportisintended. Thecompanywill continuetocomplyfortheperiodofJanuaryl,2014,through
December 31 ,2014, to be eligible for federal universal service fund support.
6. This verification and affidavit is provided to be the ldaho Public Utilities Commission to enable the
IPUC to certify to the FCC that federal universal service support received by the eligible caniers in the
state will be used in a manner consistent with Section 254(e) of the TgJecommunications Act, ., ,,/7. /..t'
SUBSCRIBED AND SWORN to before me this 'n duy of October 20L3
r:r'it ,1,-t O tHol1y Marie ,r"r"r", i-la.( t,H I
My Commission expires 2 018
REDAGTED.FOR PUBLIC INSPEGTION
tCC Form '181Form 481 - Carrier Annual Reporting oi4s c6tor No. 3o6Gorr86/oMB conrd No,3osos19
Collection Form rlba,rt
41 2221
Page l
<010> Study Area Code
MUD I.AG TEL COOP<015> Studv Area Name
<020> Program Year
<030> Contact Name: Person USAC should contact
with ouestions about this data
Tom Campbell
<035> Contact Telephone Number:
Number ot the person identitied in data line <030>
551 621 8511
<039> Contact Email Address: Ecanpbetliorcpas.com
Email ot the person identitied in data line <030>
54.31t I 9.422
Completiofl | Completlon
REPORTING FOR ALt CARRIERS
<100> Service Quality lmprovement Reporting
<200> Outage Reporting (voice)
<zru>
-.
cneLK oox, no oulages ro reporr
<300> Unfulfilled Service Requests (voice)
Detail on Attempts (voice)
l-]l-,I
l- buoch dPrrtiotivP dotumenr)
lcompl e te otto ched wotksh eet)
(compl ete otto ched worksh eet)
<310>
<320> Unfulfilled Service Requests (broadband)
<330>Detail on Attempts (broadband) | kftoch descriptive document)
<400> Number of Complaints per 1,000 customers (voice)
@-
JJ / [ /-ll
ll-Tffi<430> Number of Complaints per 1,000 customers (broadband)
<410>
<420>
<440>
<450>
Fixed
Mobile
Fixed
Mobile
<500> Service Quality Standards & Consumer Protection Rules Compliance
.510rm
<600> Functionality in Emergency Situations
16161 ffi
<700> Company Price Offerings (voice)
<710> Company Price Offerings (broadband)
<800> Operating Companies and Affiliates^
<900> Tribal Land Offerings (Y/N)? U ()
<1000> Voice Services Rate Comparability
.fOfOrF
.iioo, r"r*rt".r er.kh.rl (Y O O<1110>
<1200> Terms and Condition for Lifeline Customers
(check to ndicote cettiJicotion)
(oft ach ed desctip tive docun en t)
(check to indicate certilicotion)
(oft o ched desc ilptjve docu n ent)
(compl ete otta ched worksh eet)
(compl ete otta ched worksh eet)
lcompl ete ottoched w otksh eet)
(il yes, conplete ottoched worksheet)
(check to indicote certification)
( o ttoch des cri pU ve do cum ent)
(il not, theck to indicote certificotion)
( con plete o tt och ed worksheet)
( com plete otto ch ed worksheet)
<2000>
<2005>
<3000>
<3005>
Price Cap Carriers, Proceed to Price Cap Additional Documentation Worksheet
lncluding Rote-of-Return Cdrriers dffilioted with Price Cop Locol Exchonge Corriers
(check to indicote cetttftcotionl
(comple te otto ched wotksh eet)
(check to indicote certilicotion)
( compl? te otto ched worksh eet)
Rate of Return Carriers, Proceed to
10t15t2013 Page 1
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REDAGTED.FOR PUBLIG INSPEGTION
<o1o> study Arca code 412227
<O1S> StudvAreaName MUD LAKE TEL CooP
<020> Prosram Year 20L4
<o3o> contactName-PersonUsAcshouldcontactre(ardinsthisdata Ton campbelL
<035> contactTelephoneNumbcr-Numberofpersonidentifiedindataline<o3o> 651-621-8511
<o3g> contactEmailAddress-EmailAddressofoersonidentifiedindataline<o3o> tcampbell@otcpag com
Certification of Officer as to the Accuracy of the Data Reported for the Annual Reporting for CAF or Ll Recipients
certlfy th.t I am an officer ofth€ reporting carrier; my responsibiliti€s lnclude ensurlng the accumcy of the annual reportlng.equlrements lor univ€rsal service support
€ciplents; and, to the best of my knowledge, th€ lnformatlon reported on this fo.m and in any attachments ls accurate.
,lame of REDortins Ca.rier:
iirnature of Authorized Officer:Date
of Authorized officer:
of Authorized Offi
;tudv Ar.a Code of Reooftine Carrier:Filinq oue Oate for this form:
Persns willfully makint false statements on this form can be puhished by fine or forfeiture under the Communications Act of 193d 47 U.S.C. 99 502 503(b), or fine or imprisonment
under'l-rtle 18 ofthe United Stater Code. 18 U.S.c. 5 1001.
TO BE COMPTETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING ANNUAT REPORTING ON ITS OWN BEHATF:
'tol15t20'13 Page 12
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Page 13
-Agent/Crrrier FccFom481
Colkction Fo]m OMB Control No. 3O5O-O986/oMB Contrcl No. 306so819
July 2013
<o1o> studv Area code 412221
<015> StudvAreaName Mm LAre TEL cooP
<020> prosram year 2014
<030> ContactName-PersonUSACshouldcontactrepardinsthisdata Tom campbell
<035> Conta.t T - Numberof oerson identified indata line<O3O> 551 521-8511
<039> Contact Emai I Add ress - Email Address of person ide ntified in d ata I i ne <O3O> t campbe f l' 30 E cpas - com
TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING ANNUAL REPORTS ON THE CARRIER'S BEHATF:
TO 8E COMPLETED BY THE AUTHORIZED AGENT:
Certification of Officer to Authorize an Agent to File Annual Reports for CAF or Ll Recipients on Behalf ol Reporting Carriel
certify that (Name of Agenthao_lcolbel]is authorized to submit the information reported on behalf of the reporting carrier.I
rlso certify that I am an ofricer of the reporting carier; my responsibilities include ensuring the accuracy of the annual data reporting rquirernts provided to the authorized
rgent; and, to the best of my knowledge, the reports and data provided to the authorized agent is accuate.
{ameofAuthori2edAspnt Tom CampbeLl
{ameofReoortinsCarrier: MtD LAru TEL COOP
ignatureofAuthorized Officer CERTIFIED ONLINE Datei l0/15/2a13
)rinted name of Authorized Officer: Randy Mead
itle or oosition of Authorized Office| General Manager
elephone numberof Authorized officeri 2083?45401
itudv Area Code of RegottinlCariet: 41222f Frllnq Due Date for this form: l0 I5 201 l
underTitle 18oftheUnited StatesCode, 18 U 5.C 5 1001.
Certification of Agent Authorized to File Annual Reports for CAF or Ll Recipients on Behalf of Reporting Carrier
he data reported herein bas€d on data provided by the reportint carrier; and, to the best of my knowledge, th€ information reported herein is accurate.
Jame of Reoortins Carripr M LA(E TEL COOP
Jame ofAuthorized Asent or Fmolovee ofAsent: Tom Campobell
ignatureofAuthori2edAsentorEmoloveeofAsent: CERTTFTED omrNE Dater lO/1\/2013
'flnted name of Authoilzed Agent or Emplovee of Agent Tom Campbell
'itle or r of Authorized Apent or E e ofAgent Consultant
number of Authorized AEent or ofAgent: 651-621-8511
tudv Area Code of ReDortins Carrier: 41222 FilingDueDateforthisformi to/15/2a13
18 oI the United States Code, 18 U.S.C. E 1001
10t15t2013
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Attachments
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REDAGTED.FOR PUBLIG INSPEGTION
Page 1 of 2
SAC:472227
State: lD
Mud Lake Tel Coop
Form 481 Line No. 510 Compliance with Service Quality Standards and Consumer Protection
1. Mud Lake Telephone (Company) will provide service on a timely basis to requesting
customers within the Company's designated service area where the Company's network
already passes the potential customers premises, and
2. The Company will provide service, within a reasonable period of time, if the potential
customer is within the Company's designated service area but outside the Company's
existing network coverage, if the service can be provided at reasonable cost by:
a.
b.
Modifying or replacing the requesting customers equipment;
Adjusting network or customer facilities;
Service Qualitv Standards
The Company:. Provides voice grade access to the public switched network.. Provides flat rated local exchange service with no addition charge to end users.. Provides access to the emergency services provided by local government or other
public safety organization, such as 911 and enhanced 911.. Provides toll blocking and toll limitation services.. Advertises the availability of its services and the charges using media of general
distribution and on its website.. Maintains a business office providing customers with access to a customer service
representative either in person or via a local telephone call or toll-free telephone
number during normal business hours.. Directs after hour calls to the Company's help desk.. Directs trouble reports to the on-call technician.. Tracks all service orders to ensure they are completed in a timely manner.. Measures its service connection and service interruption performance on a regular
basis.. Trains employees to:o Answer all incoming calls promptly.o Respond to all inquiries for information promptly and courteously.o lnvestigate thoroughly all customer complaints.o Be knowledgeable about products and service offerings so they can assist
the customer with selecting the best service option.. Has a process for periodic inspection, testing and preventive maintenance of its
equipment to permit the rendering of safe, adequate and continuous service at all
times.
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Page2 of 2
SAC:472227
State: lD
Mud Lake Tel Coop
Form 481 Line No. 510 Compliance with Service Quality Standards and Consumer Protection
4. Consumer Protection Rules
The Company has established operating procedures designed to facilitate compliance with
applicable consumer protection rules which include compliance with the Customer
Proprietary Network lnformation (CPNI) rules. The operating procedures include:
. Appointment of a compliance officer.. A manual detailing the specific procedures for protecting consumer information.. Employee training on an annual basis.. A disciplinary process for improper use of consumer information.
REDAGTED.FOR PUBLIG INSPEGTION
Page 1 of 1
SAC:472227
State: lD
Mud Lake Tel Coop
Form 481 Line No. 610 Description of Functionality in Emergency Situations
Mud Lake Telephone has:
o Established reasonable provisions' to meet emergencies resulting from failures of lighting or power
service, sudden and prolonged increases in traffic, or from fire, storm, or acts of God including
provisions for emergency power that provide:
o A minimum of four hours of battery service in each central office.
o A permanently installed power unit in exchanges, or
o Mobile power units that can be delivered on short notice and which can be readily.
connected in offices without installed emergency power facilities.
lnformed employees as to the procedures to be followed, including reasonable rerouting of traffic
around damaged facilities and the deployment of emergency power, in the event of emergency in
order to prevent or mitigate interruption or impairment of telecommunications service.
REDAGTED-FOR PUBLIG INSPEGTION
Page 1 of 2
SAC:472227
State: lD
Mud Lake Tel Coop
Form 481 Line No. 1210 Lifeline Plans Terms and Conditions
Lifeline Terms and Conditions
1. Mud Lake Telephone (Company) offers lifeline program-supported service to qualified low-
income residential consumers forone telephone line pereligible household. The lifeline prog ram
provides discounts to eligible low-income consumers to help them establish and maintain telephone
service. Lif eline assistance lowers the cost of basic, monthly local telephone service. Eligible
consumers can receive$9.25 per month in discounts. ln addition, the Federal Universal Service
Charge is not assessed to consumers participating in Lifeline. Toll Blocking prevents the placement
of all long distance calls for which a subscriber would be charged. Toll Blocking is available to eligible
consumers at no cost. Also, by choosing the option, consumers are usually not charged a deposit.
Lifeline Prooram Eliqibilitv lnformation
Proqram Based Eliqibilitv
Consumers are eligible for Lifeline if they, one of their dependents ortheir h ousehold participate in
one of the following qualifying assistance programs:
Low-lncome Home Energy Assistance Program (LIHEAP)
Federal Public Housing Assistance (Section 8)
Supplemental Nutrition Assistance Program (SNAP)
Medicaid
NationalSchool Lunch Program's Free Lunch Program
Supplemental Security lncome (SSl)
Temporary Assistance for Needy Families (TANF)
Lifeline applicant must present documentation demonstrating eligibility either through participation in
one of the qualifying federal assistance programs or through income-based means.
Acceptable documentation of program-based eligibility includes: current or prior year's statement of
benefits from a qu alifying program; notice letter of participation in a q ualifying program; p rogram
participation documents; or anothe r official document evidencing the consumer's participation in a
qualifying program.
lncome Based Eliqibilitv
ln addition, consumers are eligiblefor Lifelineif their household income isat or below 135% of the
federal poverty guidelines.
201 3 Federal Poverty Guidelines - 135o/o
Household
Size
1
2
3
4
5
6
7I
For Each Additional Person, Add
48 Gontiguous
States and D.C.
$ 15,512
20,939
26,366
31,793
37,220
42,647
48,074
53,501
5,427
Acceptable documentation of income eligibility includes: prior year's state, federal or Tribal tax return;
current income statement from an employer or paycheck stub; social security statement of benefits;
Veterans Administration statement of ben efits; retirement/pension statement of benefits;
unemployment/workmen's compensation statement of benefits; federal o r Tribal notice of letter
participating in General Assistance; or a divorce decree or child support award or oth er official
document containing income information.
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Page 2 of 2
SAC:472227
State: lD
Mud Lake Tel Coop
Form 481 Line No. 1210 Lifeline Plans Terms and Conditions
Lifeline Terms and Conditions (Continued)
Lifeline Proqram Eliqibilitv lnformation (Continued)
Recertifi cation of Lifeline Eliqibi litv
Lifeline recipients are required to recertify their eligibility annually. Failure to properly recertify a
recipient's continuedeligibilityfo r theLifelineprogram will result in termination oftheLifeline
recipient's monthly Lifeline discount and de-enrollment from the Lifeline Program.
Additional Lifeline Proqram lnformation
The Lifeline program is limited toone benefit per household, consisting of eitherwireline orwireless
service. Ahousehold isdefined, forpurposes of the LifelineProgram, asan individual orgroup of
individuals who live toget her at the same address and sha re income and expenses. Lifeline is
government benefit program, and consumers who willfully make false statements in orderto obtain
the benefit can be punished by fine or imprisonment or can be barred from the program.
2. The Local services for (Company) that serve as its Lifeline Plans are in Compliance with the
Essentialtelecommunications service as specified in North Dakota Chapter 49-21 4.c as follows:
C. Primary flat rate residence basic telephone service including the following service elements:1) Billing and collecting of the telecommunications company's charges for the service2) Primary directory listing3) Access to assistance4) Access to emergency 911 service and emergency operator assistance in the local exchange
areas in which emergency 911 service is not available5) Except as provided in section 49-02-01.1, mandatory, flat-rate extended area service to
designated nearby local exchange areas.6) Transmission service necessary for the connection between the end user's premises and the
local exchange central office switch including a trunk connection that has inward dialing and
necessary signaling service such as touchtone used by end users for service.
3. The Company's flat rate plans include unlimited local exchange calling including usage to designated
nearby local exchange areas. The flat rate plans do not include any toll usage. The rates for any toll
usage are determined by the rate plans of the Toll Provider(s) that are selected by lifeline end users.
4. The Company has met and will meet the requ irements of eligible tele communications carrier
advertising. This includes:
a. A full description of available services in the Company's Official telephone directory, including
the process to be used by customers to quality for lifeline and link-up service.b. Advertising of the available universal service in media of general circulation in the Company's
designated service area. Availability ma y be advertised in newsp apers, company
newsletters, company or civic internet sites, bill stuffer, direct mailings, or other means
intended to convey availability throughout the designated service area.
The specific Company terms and conditions for the Companies Lifeline Plans are set forth in pages
included in Exhibit 1, attached.
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sAC:472227 Exhibit 1
State: lD
Mud Lake Tel Coop
Form 481 Line No. 1210 Lifeline Plans Terms and Conditions
REDAGTED.FOR PUBLIG INSPEGTION
Phone (2OB) 374-5401
Fox (2O8) 374-5688
www.mudlake.net
Mud loke. TT1TPTOTT,208.374.640I
59 W AAoln St
P.O. Box 235
Dubols, XD ffi4e3
BASIC TTLEPHONE SERVICE
CALL WAITING
CALL FORWARDING
THREE.WAY CALLING
SPEED CALLING
$14.00 DrsTlNCnvE R|NG sG.OO
lNsrDE wrRE SERVTCE $0.s0
STNGLE TELEPHONE LEASE s1.50
TWO L|NE TELEPHONE LEASE $e.00
vorcEMArL s6.oo
FCc AND oTHER MANDATED FEES Sg.oe
$3.00
$2.00
Sz.so
Sg.oo
REDAGTED.FOR PUBLIG INSPEGTION
SAC:472227
State: lD
Mud Lake Tel Coop
Form 481 Line No. 3026
ATTACHMENT REDACTED IN ENTIRETY