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Home My WebLink About20140131TDS Telecom-Potlatch Form 555.pdfS25Junction Rd Modison, W537]7 www.tdstelecom,com ?fli; -ltili 3l Fi'i ?: 50 t; January 30,2014 : i-at! I'iIi--i ; Via Overnisht Mail Ms. Jean D Jewell Commission Secretary ldaho Public Utilities Commission 472W. Washington St. Boise, lD 83720-5983 t4-llRE: Case # GNR-T-B:O.1- FCC Form 555 Annual Lifeline Eligible Telecommunications Carrier Certification Form for TDS Telecom Dear Secretary Jewell: Attached please find a copy of TDS Telecom's Annual Lifeline Eligible Telecommunications Carrier Certification Form (FCC Form 555) which was filed with the Universal Service Administrative Company via email on January 30,2014. lf you have any questions concerning this matter or regarding the attached information, please contact me at 608-664-4148 or via e-mail at ien n ifer. la utenschleqer@tdstelecom. com. Sincerely, Regulatory Compliance Manager Attachments cc: Gail Long 535 JUNCTION ROAI) M/4D|SON, l,YI 537 l7 P.O. ROX5t58 MAD|SON. Wt 53705-0t58 '*];- . \ j- r'l .'- ... .1 . nifer R. Lautenschleger Approved by OMB 3060-08 r 9FCC Form 555 December 2013 Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers must complete all or portions of all sections Form must be submifted to USAC and filed with the Federal Communications Commission IMPORTANT: PLEASE READ INSTRUCTIONS FIRST Deadline: fanuary 3lil (Annualty) ldaho State (An Eligible Telecommunications Carrier (ETC) must provide a certification form for each state in which il provides Lifeline service). 472234 Potlatch Telephone Company Study Area Code(s) (SAC)ETC Name(s) TDS Telecommunications Corp, lnc. TDS Telecom, TDS Holding Company Name(s)DBA, Marketing or C)ther Branding Name(s) Affiliatcd ETCs (include names and SACs, auqch I . ..-_,_, additional sheels ifnecessary) | sce attachcd Provide a list of all ETCs thot are afJilialed with the reporting ETC. Affrliation shall be determined in accordance with section 3(2) r{the Communications Act, That Section deJ1nes "a./frliute" as "a person that (directly or indirectly) owns or controls, is owned or controlled by, or is under common ownership or contol with, another person. " 47 U.S.C. S I 53(2). See also 47 C.F.R. I 76.1 200. 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-laws (or partnership agreement), and would typically be president, vice president for operations, vice president for finance, comptroller, treasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the certification Section l: All ETCs MUST COMPLETE SECTION l- Initial Certitication I certify that the company listed above has certification procedures 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 income 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 andlor notice of eligibility from the state Lifeline administrator prior to enrolling a consumer in the Lifeline program. I am an officer of the coryplny named above. I am authorized to make this certification for the Study Area(s) listed above. tnifia@' Approved by OMB 3060-08 r 9FCC Form 555 December 201 3 Section 2: All ETCs MUST COMPLETE SECTION 2-Annual RecertiJicalion Do no! leave empty columns. lf an ETC has nothing to report in a column, enler a zero. A B C Number of Subscribers Claimed ou Fcbruary ICC l'orm(s) 497 of currenl Form 555 crleodrr vear-<-,.1 Number ofLines Cleimed on Febru.ry FCC Form(s) 497 ofcurrent forrn 555 calendrr year providcd to Wireline Rescllcrs r\ Nrmber of Subscribers chimed on the fehruarT FCC Fo?m(s) 497 that were iniiially enrolled ir current Form 55S calendar yerr )tJ)*-J Initial the certifications bclow that apply to your ET C and complete the tables corresponding to the certi,fication below. Depending on the state, BOTH CERTIFICAT'ION A AND R MAy APPLY. A) I certif that the company listed above has procedures in placc to recerlif, the continued eligibility of all of its Lifbline subscribers, and that, to the best of my knowledge, the company obtained signed certifications fronr 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 certification for the Study Area(s) listed above. Initial _ D E F =D-E G It: (F+G)I Number of Subscrihrrs El'C Contccled Dircctly to Reccrtify Eligibility ThroughAttcststion ..- Numher of Subscrihers Rcsponding to ETC Contact lVr Numbcr ofNon- Responding Subccribers Number of Subscribcrs Rerponding 'I-hat They Arc No Longcr Eligibler\ Numbcr ofSubscribcrs Deenrolled or Schedulcd to bcDe- Enrolled es e Result of Non-Responsc orInclicibilitv 7, Number of Subscribcrs \Yho Dc.f,nrolled Prior to Rcccrtificrtion Attcmnt' r',Ll LJ \-/L-/' AND/OR ln lhe :;1tace below, pleare li.st the program eligibility data soutces, such as ETC access to a slate database and/or notice of eligibilitl'!'on the skilc l.felina administ, otor u' the Uuiver:tal Service Adninistratiye Company (USAC), and indicate Jbr u,hich qaalilying prttgtunt.t (e.g.,.$,Vr'lP, S',S, rhesc towces are a.ted to verifl subscriber eligibilily. I/any of subscribers are subsequently cantacled directly by lhe E7C in an attempt lo recerti/y eligibilily, those subscribers should be listed in columns D lhrough I as appropriate andnot in columns J lhrough L. B) I cediff that the company listed above has procedures in place to re-certi$ consumer eligibiliry by relying on C-A P A:r , Results are provided in the chart below. I am an otficer of the comEggu/rgmed above. I am authorized to make this certification for the Study Area(s) listed above. lnitia(J '// J K L Numbcr ofSubscribcrs Whose E,ligibility wrs Reviewcd By State Adminis(rrtor ETC Access to liligibllity Data or bv USAC ,y -- Number of Subscribers Dc-Enrolled or Schedulcd to be Dc..Errolled as r Result of I inding of Incligibility by State Administrator, ETC Access to Eligibility Data or I}SAC r\ Number of Subscribers Who De-Enrolled Prior to Rccertifi cetion Attcmpt , )J OR C) I certifu that my company did not claim federal low income support tbr any Lifeline subscribers for the February Form 49'7 data month for the current Form 555 calendar year. I am an officer ofthe company named above. I am authorized to make this certification for the Study Area(s) listed above. tnitial - Approved by OMB 3060-08 r 9FCC Form 555 Decernber 2013 Section 3: ALL ETCS MUST COMPLETE SECTION 3 - De-enroll percentage What is the percentage of subsuibers de-enrclledfor this ETC? Section 4: ALL ETCS MUST COMPI,ETE APPROPRIATE CHECK BOX; PRE-PAID ETCS MUST COMPLET'E, ALL OF SE,CTION 4 Is the ETC Pre-Puid? "^ E *o Y ft Pre-Paid ETC does not assess or collect a nonthlyfeeftom its Lifeline subscribers) If yes, record the number of subscribers de-enrolledfor non-usage b1t month in column S below. Non-Usage Results Applicable to Pre-Paid ETCs: R S Month Subscritrers De-Enrolled for Non-[Jsase .Ianuarv February Marclr April May June Julv Ausust September October November December Sisnature Block: ALL ETCS MUST COil,IPLETE SIGNATURE FIELDS By signing below, I certify that the company listed above is in compliance with all federal Lifeline certification procedures. I am an olficer of the company named above. I am authorized to make this certification for the Study Area(s) listed above. M N O P=N+O Q=ttr*M)*loo) Number of Subscribers Chimrd on February FCC form(s) {97 (From Column A) Number ofSubscribers De- Enrollcd or Scheduled to be Dc- Enrolled rs a Result of Non-Responsc or Incligibility (From Colurnn Il) Numbcr of Subscribcrs De- Enrollcd or Schrdulcd to b€ De- Enrolled rs r Rcsult of r linding of lncligibility (From Column K) Total Number of Subscribers De-Enrollcd or Schedulcd to be Dc-E nrolled Perrcntegc of Subscribers Dr.Enrolled or Scheduled t< bc Dr-Enrolled thrt werc Claimcd on the February FCC !'orm(s) 497 53 0 I I 16.98 FCC Form 555 December 2013 Approved by OMB 3060-08 r 9 Joel P. Dohmeier Printed Name of Officer 1t3A12014 Date 608-664-4148Jen nifer Lautenschleger Contact Phone Number ETC Identification SAC HTC Name 472230 Potlatch Telephone Co. FCC Form 555 November 2013 Approved by OMB 3060-08'19 Affiliated ETCs SAC Name 190217 Amelia Telephone Corporation 300585 Arcadia Telephone Company 452171 Arizona Telephone Company 361 3s0 Arvio Teleohone Companv 532404 Asotin Telephone Gompany (OR) 522404 Asotin Telephone Company (WA) 330844 Badqer Telecom, LLC 230469 Barnardsville Teleohone Comoanv 330849 Black Earth Telephone Company, LLC. 220346 Blue Ridoe Teleohone Comoanv 330851 Bonduel Telephone Company, LLC. 361 362 Bridoe Water Telephone Co. 330856 Burlington, Brighton & Wheatland Telephone Company, LLC 250284 Butler Telephone Company, lnc. 280448 Calhoun City Telephone Companv, lnc. 220351 Camden Telephone and Telegraph Company, lnc. 324744 Camden Telephone Company, lnc. 330859 Central State Telephone Company, LLC 31 0685 Chatham Teleohone Comoanv 401698 Cleveland County Telephone Company, lnc 1 00005 Cobbosseecontee Telephone Companv 320776 Communications Corooration of lndiana 310672 Communications Corooration of Michioan 320809 Communications Corporation of Southern lndiana 290559 Concord Teleohone Exchanoe. lnc 300607 Continental Telephone Companv 401699 Decatur Telephone Company, lnc. 462184 Delta County Tele-Comm, lnc. 1 50089 Deposit Telephone Company, lnc. 330875 Dickewille Telephone, LLC 33091 4 EastCoast Telecom of Wisconsin, LLC '150092 Edwards Telephone Company, lnc. 330880 The Farmers Telephone Company, LLC 330930 Grantland Telecom, LLC 1 0001 0 Hamoden Teleohone Comoanv 542321 Happv Valley Telephone Companv 1 0001 1 Hartland & St. Albans Telephone Company 532377 Home Teleohone Companv 320777 The Home Telephone Company of Pittsboro, lnc. 320778 Home Telephone ComDany, lnc. 542322 Hornitos Teleohone Comoanv 290566 Humphrevs CounW Telephone Companv 310677 lsland Telephone Companv 120045 Kearsaoe Telephone Company 361 41 3 KMP d/b/a Mid-State Telephone Company 260411 Leslie Counfu Teleohone Comoanv 522427 Lewis River Telephone Company, lnc. 260412 Lewisoort Telephone Co. FCC Form 555 November 201 3 Approved by OMB 3060-081 I Affiliated ETCs SAC Name 30061 3 Little Miami Communications Corooration 140058 Ludlow Telephone Companv '170183 Mahanov & Mahantanoo Teleohone Comoanv 244533 McClellanville Telephone Companv, lnc, 522430 McDaniel Teleohone Comoanv 320788 The Merchants and Farmers Telephone Company 123321 MCTA 't20047 Merrimack County Telephone Company 432010 Mid-America Telephone, lnc. 330881 Mid-Plains Teleohone. LLC 361433 Mid-State Telephone Company 330909 Midway Telephone Company, LLC 33091 7 Mt. Vernon Telephone Company, LLC 33091 5 Mosinee Telehphone Company 287449 Myrtle Telephone Company, lnc. 220375 Nelson-tsall Ground I elepnone uompany 193029 New Castle Telephone Co. 421928 New London Telephone Company 140061 Northfield Telephone Comoanv 240535 Norwav Telephone Co. lnc 25031 1 Oakman Telephone Company, lnc. 300645 Oakwood Telephone Company 431984 Oklahoma Communication Svstems. lnc, 421934 Orchard Farm Teleohone Comoanv 150114 Oriskany Falls Telephone Corporation 254314 Peoples Telephone Company, lnc. 140462 Perkinsville Telephone CompanV, lnc. 150118 Port Bvron Teleohone Comoanv 472230 Potlatch Telephone Company, lnc. 210338 Quincv Teleohone Comoanv 220338 Quincy Telephone Company 330943 Riverside Telecom, LLC 320816 S & W Telephone Company, lnc. 260417 Salem Teleohone Co 230498 Saluda Mountain Telephone Co. 330945 Scandinavia Telephone Company, LLC 230500 Service Teleohone Co. 31072.4 Shiawassee Telephone Company 100024 Somerset Telephone Companv 283301 Southeast Mississippi Telephone Company, lnc. 330952 Southeast Telephone Co. of Wisconsin, LLC 452174 Southwestern Teleohone Com oanv 240544 St, Stephen Telephone Companv 3309s5 State Lono Distance Teleohone Comoanv 330954 Stockbridqe & Sherwood Telephone Company, LLC 421951 The Stoutland Telephone Company 462207 Strasburo Teleohone Comoanv 174206 Sugar Valley Telephone Company FCC Form 555 November 201 3 Approved by OMB 3060-081 I Affiliated ETCs SAC Name 290578 Tellico Telephone Company, lnc. 290575 Tennessee Telephone Company 330958 fennev Telephone Company, LLC 100007 The lsland Teleohone Companv 300662 The Vanlue Telephone Company 320829 Tipton Telephone Company, lnc. 150129 Township Telephone Company, lnc, 320830 Tri-CounW Communications Corporation 120449 Union Telephone Company 330963 Utelco, LLC. 1 501 33 Vernon Telephone Companv, lnc. 1 90253 Virginia Telephone Company 1 00031 Warren Telephone Company 330968 Waunakee Telephone Company, LLC. 100034 The West Penobscot Telephone and Teleoraph Companv 320837 West Point Telephone Company 240551 Williston Telephone Company 't20050 Wilton Telephone Company, lnc. 361 507 Winsted Teleohone Comoanv 542323 Winterhaven Telephone Company 310738 Wolverine Telephone Company 432034 Wvandotte Telephone Company 539002 UNITED STATES CELLULAR CORPORATION' 529001 YAKIMA MSA LP. dba US CELLULAR 339007 UNITED STATES CELLULAR OPERATING CO 359016 UNITED STATES CELLULAR CORPORATION 429007 USOG OF GREATER MISSOURI 37901 I USCOC- NE 29901 0 US CELLULAR OPERATING COMPANY, LLC-TN 1 5901 5 NY RSA 2 CELLULAR PARTNERSHIP 239006 US CELLULAR OPERATING COMPANY, LLC. NC 129002 US CELLULAR OPERATING COMPANY, LLC- NH 349007 USCC - IL 209005 USCC.WV 1 99004 UNITED STATES CELLULAR OPERATING CO, LLG-VA 1 09002 USCC.BANGOR CELLULAR TEL. CO 439004 USCG-USGOC OF OK RSA #1O,1NC 419A12 USCC - USCOC of Greater lowa, lnc. 1 5901 4 ST. LAWRENCE SEAWAY RSA CELLULAR PARTNERSHIP