20140130Gold Star Communications Form 555.pdf

Jean Jewell
From: Michelle Motzkus [[e-mail]]Sent: Thursday, January 30,2014 2:35 PMTo: Jean JewellSubject: 2013 Form 555-Annual Lifeline ETC Certification Filings (Silver Star Communications); Docket
GNR-T-14-01Attachments: GSC-1D479011 2014F555.pdf; CTCI&SSTCI-\D2295 2014F555.pdf
Ms. Jewell,
Attached are copies of Forms 555 - Annual Lifeline Eligible Telecommunications Carrier Certification as filed with the FCC
and USAC, pursuant to 47 CFR 54.476, for the following companies and Study Areas:
Gold Star Communications, SAC 479071
Columbine Telephone and Silver Star Telephone Company, lnc. SAC 472295 (dba Silver Star Communications)
Note that this year USAC required one filing for both companies within SAC 472295; therefore, we are also filing the
same combined report with the ldaho Public Utilities Commission.
Contact me directly at the number shown below with any questions or concerns.
Michelle Motzkus
Legal & Regulatory Administrator
o: 307.8U3.6690 | f: 307.8t13.2575
P.O. Box 226 - Freedom, WY 8.1 120 | SilverStar.com
Connrcting Communities - Connecting l,ives
IJroadband I Communications I Wirctess
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FCC Form 555
December 2013
Approved by OMB
3060-08 I 9
An n ual Lifeline Etigible Telecommunications Carrier Certifica tion Form
AII carriers must complete all or portions of all sections
Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST :JI
Deadline: January 3ln (Annually)
State
(An Eligible Teleconmuuicotions Carrier @'TC) nust provicle a cefiificolion lonn for each stole in which it provides Ldcline senice\
4790 I I Gold Star Communications LLC
Srudy Area Code(s) (SAC)
Horizon Communications, Inc.
Hol ding Company Name(s)DBA, Marketing or Other Branding Name(s)
i[ated ETCs (include names and SACs, attach -See Attached Sheet-tional sheets d necessary)
ProvideolistolallETCsthotorcolfiliatedviththereporlingETC. Alfiliationshall bedetenninetl inaccordcucewithsectiottS(2)oflhe
Cornlatoticotions Act. That Scction defines "afiliate" as "a persoil that (clirectly or intlirectly) owns or controls, is owned or controlled by, or is
underconnronownershiporcontrol wilh,anotherperson."4TU.S.C..r{/53(2). Seealso4TC.F.R-,i76.1200.
For purposes of this filing, an officer is an occupant of a position listed in the article of incorporation, articles of
formation, or other similar legal document. An officer is a person who occupies a position specified in the corporate by-
Iaws (or partnership agreernent), and would typically be president, vice president for operations, vice president for
finance, comptroller, treasurer, or a comparable position. lf the filer is a sole proprietorship, the owner rnust sign the
certification
Section l: All ETCs MUST COMPLETE SECTION I- Initiol CertiJication
I certifu that the company listed above has certification proccdures in place either to:
A) Review income and program-based eligibility documentation prior to enrolling a consumer in the Lifeline
Program, and that, to the best of my knowledge, the company was presented with documentation of each
consumer's household incorne and/or program-based eligibility prior to his or her enrollment in Lifeline or
B) Confirm consumer eligibility by relying upon access to a state database and./or notice of eligibility from the
state Lifeline administrator prior to enrolling a consumer in the Lifeline program,
ETC Name(s)
Si lver Star Communications
I am an officer of the coSrypny named above. I am authorized ro make this certitication for the Study Area(s)listed above. t"tii^wz,/
FCC Form 555
Decernber 201 3
Section 2: All ETCs MUST COMPLETE SECTION 2- Annual RecertiJication
Donolleaveenptycolumus. lfanETChasnothingtoreportinacoluntn,enterazero.
Approved by OMB
3060-08 r 9
A B C
Number of
Subaeriberr Clainred on
Feb ruary FCC Forn(s),197
of currenl Form 555
calendlr year
Number of Lincs Claimed on
Februrry FCC Form(s) 497
ofcurrent Form 555
cakndlr year provided (o
!Vir€line Resellers
Number of Subscribers clriued
on the Febnrary FCC FormG)
49? thal wcrc inltially enroued ir
currenl. Form 555 calcnder year
I 0 0
lnitial the certificotions below that opply to your ETC and contplete the tables conesponding to the certification below. Depending on
IhE SIAIC, BOTH CERTIFICATION A AND B MAY APPLY.
A) I certify that the company listed above has procedures in place to recertify the continued eligibility of all of its Lifeline
subscribers, and that, to the best of my knowledge, the compaDy obtained signed certifications from all subscribers
attesting to their continuing eligibility for Lifeline. Results are provided in the chart below. I am an officer of the
company named above. I am authorized to make this cetification for the Study Area(s) listed above. Initial _
D E F =D-E G H=(Frc)I
Number of
Subscribers ETC
Coniacted Directly
to Reccrtlfy
Eligibility Through
Atte8tation
Number of
Subscribers
Rcsponding to
ETC Contact
Number ofNon-
Responding
Subscribers
Number of
Subscribers
Rcsponding That
They Are No
Louger Eligiblc
Number of Subscribcrs
Deenrolled or
Schcdulcd (o be De-
Enrollcd as e Result of
Non-Rcsponse or
lnelioibilitv
Number of
Subscribers r'Yho
De.Enrolled Prior
to Recertification
Attempt
0 0 0 0 0
A,IID/OR
ln the space belotv, pleose list the prog'am eligibility data sources, such as ETC access to a state database and/or notice ol eligibility
front lhe sMre Lifeline administralor or the Universol Service. Adntinistrative Company (USAC) and indicate.for which quolifiing
progroms (e.9., SNAP, SSI) th*e sources ore. used to verify subscriber eligibility. If any of sub.rctibers are subsequently contacled
direclly by the ETC in an onempt to recertifi eligibility, those subscribers should be listed in columns D though I ns oppropriale and
nol in coluntns J through L.
B) I certify that the company listed above has procedures in place to re-certiry consumer eligibility by relying on
Nuieof.li8ii;liryfmrrtdCdmuniryAcionPart#hip,Asiniotrofldrlo.dprE6!.,cq{ElbLhldrtpforLjJctif,.'.ddinimri4rsdslolyin@qqsdifsrim. ReSUltS afe
provided in the chart below. I am an officer of the compan& named above. I am authorized to make this
certification for the Study fuea(s) listed above. lnitiatffi/
J L
Number of Subscribers
Whose Eliglbility was
Reviewed By State
Admlnistrator
ETC Access to Eligibility
Datr or bv USAC
Number of
Subscribcrs De-Enrolled or
Sehedulcd to be De-Enrolled ns n
Rcsult of Finding of lneligibitity by
State Administrator, ETC Acccss to
Eliqibility Data or USAC
Number of Subserlbers ryYtro
De-Enrolled Prior to
Recertifi catioo Att€mpt
I 0 0
OR
C) I certify that my company did not claim federal low income support for any Lifeline subscribers for the February Form49'l data month for the current Form 555 calendar year. Lrn on bfti.". of t-he company narned above. I arn authorizedto make this cerrification for the Srudy Area(s) listed above. Initial
FCC Form 555
December 2013
Section 3: ALL ETCS MUST COMPLETE SECfiON 3 -De-enroll percentage
|lhat is the percentoge of subscribers de-enrulledfor lhis ETC?
Approved by OMB
3060-08 I 9
l\l N o P=N +O Q=(P+M)r100)
Number of
Subccriherf, Clnioed
on February FCC
Form(s) 497
(From Colunn A)
Number of Subscribcrs
Dc- Enrolled or
Schedulcd lo bc D6-
Euolled as a Reult of
Noa-Respouse or
lnellgibility
(Fron Column H)
Number of Subscribers
De Enmlled or
Sehedulcd to be De-
Enrolled ar a Resull of
r Finding of loeligibility
(Fron Colmn K)
Total Nunrber of
Subscriberr DeEnrotled
or Scheduled lo bc Dc-E
nmlled
Perccatage of Subscribers
D+.Enrollcd or Schedulcd l(
be D+Enrollcd thot rverc
Clalmed on lhc
Febmrry FCC Form(s) 497
0 0 0 0%
Section 4: ALL ETCS MUST COMPLETE APPROPzuATE CHECK BO& PRE-PAID ETCS MUST COMPLETE
ALL OF SECTION 4
Is the ETC Pre-Paid?
Yes E /V, E Q pre-poid ETC does no! dssess or collect o ntonrhlyfeefront its Lifeline subscibers)
If yes, record the number of subscribers de-enrolledfor non-usage by month in column S below.
Non-Usoge Res ults Applicable to Pre-Paid ETCs :
R s
Mnnfh Srrhcorilrerc Dp-['-nrnlled fnr Nnn-f lcooe
January
February
March
April
Mav
June
July
August
September
October
November
December
Simanrre Block: ALL ETCS MUST COMPLETE SIGNATUfuE FIELDS
By signing below, I certifu that tbe company listed above is in compliance rvith all federal Lifeline certification
procedures. I am an officer of the company named above. I am authorized to make this certification for the Srudy Area(s)
listed above.
Approved by OMB
3060-08 l 9FCC Form 555
December 2013
Title of Officer
Michelle Motzkus
Person Completing this Certification Form Contact Phone Nurnber
Approved by OMB
3060-08 1 9FCC Form 555
December 2013
ETC Identification
Gold Star Conrmunications LLC
Holdin
Marketi or Other Brandin
Approved by OMB
3060-08 I 9
Affiliated ETCs
SAC Name
sr900l S ilver Star Telephone Co. Inc.
472295 Columbine Telephoae Co. Inc.Silver Star Telephone Co, Inc.
5 1 9005 Gold Star Communications LLC
5t2295 Silver Star Telephone Co. Inc.