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Home My WebLink About20150130CenturyLink CenturyTel of the Gem State .pdfFCC Form 555 November 2014 fuproved byOMB 30604819 Annual Lifeline Eligibte Telecommunications Carrier Certillcatlon tr'otm All carriers must corplete all or portions of all sections c: Forrr must be submitted to USAC and filed with the Federal Communications Commissirfrr IMPORTAI\T: PLEASE READ INSTRUCTIONS FIRSE= Deadline: January 31* (Annually) -li*j Does the reporting company have afliliated ETCs?Yes @l No [61 Provide a list of all ETCs that are affiliatedwith the reporting ETC, using page 4 and additional sheets if necessary. Affliation shall be determind in accotdance with Section 3(2) of the Commtmications Aci That Section de/ines "afliliate" as "a person that (directly or indirectly) owns or controls, is owned or controlld by, or is under common ownership or control with, another person." 47 U.S.C, S 1 53(2). See also 47 c.F.R..f 76.r200. Affiliated ETC's SAC Affrliated ETC's Name - See attached worksheet -- For purposes of this filing, an offrcer is an occupant of a 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 agreernent), and would typically be president, vice president for operations, vice president for finance, comptroller, treasurer, or a cornparable position. If the filer is a sole proprietorship, the owner must sigr the certification. lCSdqLff Initial Certification All ETCs must complete this section I certiS that the conpany listed above has certification procedures in place to: A) Review income and program.based eligibility doctmrentation prior to emolling a consumer in the Lifeline progranr, and that, to the best of my knowledge, the conpany was presented with documentation of each consumer's household incorne and/or program-based eligibility prior to his or her enrollment in Lifeline; and/or B) Confirm conswner eligibility by relying upon access to a state database and/or notice of eligibility from the state Lifeline administrator prior to orolling a consumer in the Lifeline program. h,{::) ::F :_::a: ir: 'o) -) I am an offrcer of the company named abone. above. tnitlat JMA ID CenturyLink CenturyTelof the Gem State State CenturyLink ETCName CenturyLink, lnc. DBA. Marketins or Other Branding Name(f sanb as ETC ,affe, list 'N/A" Do not le;'e blork) Holdins ComoanvName (If sane d ETC nirne, Tist " N/A " Do not leme blank) I am authorizpd to make this certification for the Study Area Code listed FCC Form 555 November 2014 Section 2: Annual Recertification Do not leave empty blocks. If an ETC has nothing to rqort in a bloch enter a zero. Recertilication Results: K L Nuderof subccrlbers whose eltgtbillty wrs revierved by stste adnlnlstrator, ETC eccess to eltgtUllty drtaberg or by USAC Nuder of subacrlberr deemolled or scheduled to be deemolled ag e result of flndng of tndlgit iltty by strtc eddnlstrator, ETC eccecs to eliSlH[ty detebase, or USAC 39 13 Note: Ifany subscriber was reviewed by an ETC accessing a state database or by a stofie administrator and subsequently contactd directly by the ETC in an attempt to recertifu eligibility, those subscribers should be listd in Blocks F through J as appropriate and not in Blocks K and L. As a result, all subscibers subject to recertification who were not de-enrolled pior to the recertification attempt tust be accountedfor in Block F or Block K The tobl olBloc* F and Block K should eqtul lhe nwfier reported h Block E Approved byOMB 30604819 Certification: Basd on the data entered aboye, initial the certification(s) below that apply. Both Certifcation A and B moy apply depending on the recertification prccedures in place for the SAC reporting on rtis form. If Certification C applies, neirter Certification A nor B may apply. A.) I certiff that the company listed above has procedures in place to recertifu the continued eligibility of all of its Lifeline subscribers, and that, to the best of my knowledge, the company obtained sigred certifications from all subscribers attesting to their continuing eligibility for Lifeline. Results are provided in the chart above in Blocks F through J. I am an officer of the conpany named above. I am authorized to make this certification for the SAC listed above. Initial JMA AI\D/ORB.) I certiff that the conpany listed above has procedures in place to recertiS consumer eligibility by relying on: CommrrnitvActionPartnershinAssociafionofldehn(CAPAl\ Results are provided in the chart above in Blocks K through L. I am an officer of the company named above. I am authorized to make this certification for the SAC listed above. 1ai1i11 JMA OR C.) I certiff that my company did not claim federal low income support for any Lifeline subscribers for the February Form 497 data month for the current Form 555 calendar )€ar. I am an omc€r of the conpany nailEd above. I am authorized to rnake this certification for the SAC listed above. Initiat A B c D E= (A_B_C_D) Number ofsubscrlberi clalmd on February FCC Form497 of current Form 555 calendar year (February dau moathl Number of lines clalmd on February f,'CC f,'orm497 of current Form 555 cdendar yeer provlded to wirdlne reseller! Number of subccrlberc claimed on the February FCC Form 497 thrt were inldallv enrolled ln the current Form 555 calendar year (Thcse sabscrlbcn dld tot hovc Lilclinc scmlcc prior to laaury I of the cunvnt SSS calcadar yean) Nuder of subscrlbers de-emolledglqto recertificadon xtteryt by elther the ETC, a state admlnlstrator, rc{ess to rn ellglbtltty datebase, or by USAC Number of subscrlbers ETC is responslble for recerdfylng for current Form 555 crlendar yeer 45 0 3 0 42 r'G H=(F_c)I y = (H+I) Nuder of subscrlben ETC contrcted dlrecdy to recerdfy ellglHllty throrgh attestedon Number of subscrlbers respondrg to ETC contrct Number of non- respondry subscrlberc Number of subscrlberg respondng thrt they are no longer ellglHe (Thls shoukl bc a stbsa of Bloc* G.) Number of subscrdb€rs de. emolled or schduled to be decnrollcd as e rcault of nortsrelponse or reponse of lnetigiHltty from ETC recerdftcrdon sttempt 3 2 1 0 1 FCC Form 555 November 2014 Secfon& De.enroll Percentage Using the dan enkred in Section 2, complete the chart below to ftnd the percentage of sabscriben de-enrclledfor this ETC. 64 =(p+K)N = (J+L)O=((N=M)* 100) Nuder of subocrlbers thet the ETC rttempt€d to recerdfy drecdy gg throqh e state admlnlltrrtor, ETC accesr to e strte drtrbilg or by USAC (This shouW qual the aanber repotd bt Bloch E) Nuderof subscrlben de emolled or scheduled to be de enrolled es a result of non-rerponse or lrellglHllty Peroentege of subscdberi deenrolled or schcduled to be dc.enrolled as e recult of lncllglblllty or nonirespomc 42 14 33.34Yo SectiqUi Pre-Paid ETCs All ETCs must complete the apprupriote check-box; pre-paid ETCs must complete all of Section 4. Pre-paid ETCs gaemllydo not ossess orcollect a monthlyfee from their Lifeline sbscibers. ETCs rtat only assess a fee but do not collect such fees are pre-paid ETCs and must complete the chart below. Is the ETC Pre-Paid?Yes S[ No [G[ If Yes, recod the number of wbrcibers de-enrolled for non-usage by month in Block Q below. Signature Block Approved by OMB 30604819 P o Month Subscribers De-Enrolled for Non-Usaee January 0 February 0 March 0 April 0 May 0 June 0 July 0 Aueust 0 Septerrber 0 October 0 November 0 Decernber 0 Total Subscribers 0 By sigrring below, I certi$ that the company listed above is in conpliance with all federal Lifeline certification procedures. I am an ofEcer of the conpany named above. I am authorized to make this certification for the Study Area Code (SAC) listed above. Jerry M. Allen - Vice Presidentsigned, of Revenues Certified Online Sigrature of Offioer ierr.v.allen@centuryIink.com Email Address of Officer Thomas Nehls Petson C,ompleting This Certification Form Printed Name and Title of Officer 0112812015 Date 720-578-5324 Contact Phone Number 3 FCC Form 555 November 2014 Approved byOMB 3060{819 Affiliated ETCs SAC Name I 601 38 Ccnhrrvl.inlr IInifcd Telnhnne Cn nf New lercew (E'KA Fn 170209 Cenfrrrvl .inlr I Inife.l Telenhnne Cn of Pennsvlvanin FKA I 190254 Cenhrrvl.ink Central Telenhone Co. of Viroinia (FKA Em] r90567 Cenhrrvf.ink I Inited Telenhone-Southea,st Tnc. (FK A F.mhl 210741 Cenhrrvlink-Emharo Florida Tnc- fi'KA Emharo) 220356 Cenhrrvl.ink Constel I Itilifies Inc 230470 Cenhrrvl.ink Carolina Telenhone and Telemanh Co FKA F 230471 frentrrruI inlr Ocnfral Tclenhnne Cn -Nnrfh Cornlinqt/E'I(A f 230485 Centrlrvlink MehTel Inc, 240506 Cenhrrvl.inlc I lnifil.l Telcnhnnp nf the Cnrnlines-S0 (EKA 250298 Oenhrnrl.inlr Grrlf Telenhnnc (-nrnnanw ).\918R Centrrru[.ink CenhrnrTel nf Alehama fNorfhern and Sorthe 259789 (lanfrrnrT inlr franfrrnrTal nf Alohamo fNnrfham anzl Snrrfhp 270423 Cenfrrrvl-ink CenfirnrTel nf Cenfral I-orrisiana [.[.C 270424 Centurvlink CenturvTel of Southeast Louisiana LLC 270427 Centurvlink CenturvTel of Chatham LLC 270411 Cenfrrrvlink Ce.nfirnrTel of Norfhwesf Lorrisiena Inc 270434 Ccntrrrul.inlr CentrrruTel nf Fwqnoaline I.T.O 270436 CenturvLink CenturvTel of North Louisana LLC 270439 Centurvl.ink CentrmrTel of Rinooold [ t.C 270440 Cenhrrvl.ink CenhrruTel of F.esf Lorrisiana [.LC 270442 CenhrruI.ink CentrrrvTel of Sorrfhwesf Lorrisiane I.[.C 2804s8 Cenhrrvl-ink CentunrTel nf Nnrth Miscicsinni Inc 290552 CenhrruLink CenfirrvTel nf Adamcville Ine 290557 Centurvlink CenturvTel of Claibome Inc. 290567 Cenhrrvl -ink I Inife.l Telenhnne-Snrrfheqst Ine l'F K A F.mh: 290s74 Cenhrrvl .ink CentrrrvTet of Onlteurnh-Cnlleorlale Tnc 300630 Cenfirnrl.ink CenfirruTel of Ohio Ine 300661 Cenhrrvl.ink Ilnifed Telenhnne Cn of Ohin E'KA F.mhero 31067t Centurvlink CenturvTel of Midwest-Michi san Inc. 3 10689 Centurvlink CenturvTel of Uooer Michisan Inc. 310702 3 10705 Centurvlink CenturvTel of Northem Michisan Inc. 320747 CenturvTel of Central Indiana lnc. 32080r Cenhrrvl-ink Ce.nhrrvTel nf Odnn Inn 320832 Cenhrrvl.ink Ilniterl Telenhnne Cn nf Inrliana /E'KA F.mha 330841 Centurvlink CenturvTel of the Midwest-Wisconsin fNorth 330857 Centurvlink CenturvTel of the Midwest-Wisconsin fNorth 330877 Centurvlink CenturvTel of Fairwater-Brandon-Alto LLC 330884 Centurvlink CenturvTel of Forestville LLC 33089s CenturvLink CenturvTel of Wisconsin LLC 330898 CenturvLink CenturvTel of Laresen-Readfield LLC 330913 Cenhrnrl-ink CenfirrvTel of Mnnroe Cnrrnfv LI-C 330922 Centurvlink CenturvTel of the Midwest-Wisconsin fNorth 330924 Centurvlink CenturvTel of the Midwest-Kendall LLC 33093 l Centurvlink CenturvTel of Southern Wisconsin LLC 330934 Cenhrrvlink CenturvTel of the Midwest-Wisconsin fNorth 330950 Cenfrrrvl.ink CentrrnrTel of Northure<i W'iscnncin I.LC 330956 Centurvlink CenturvTel of Northern Wisconsin LLC 330959 Centurvlink CenturvTel of the Midwest-Wisconsin (North FCC Form 555 November 2014 Approved by OMB 3060-08 r 9 Affiliated ETCs SAC Name 330970 (lontrrrrf inlz l-anfrrnrTol af tho I\rfidrvact-\l/isnnnein l'Nnrth 331 155 faanfrrnrf inL Tclonhnna I TSA nf Wicnnnsin f I C 33r 159 /aaafirrrf inlr laanhrnr'Fol nf /aontral Wicnnncin f f 1- 141057 CcnhrrvT.inlr Gnllefin Riwer Cnmmrrnicefinns L[.C 751126 Centrrrwl .ink (-enhrnrTel of Cheqtet Inc 751274 Cpntrrnr[.inlr CpnflrnrTpl nf Fnctwille Inc 355141 Centurvlink Owest Comorati on 35 445 Cenhrrvl .ink (-enhrnrTel nf Minneqotn Tnc 161456 Cenhrrvl-ink - F-mharn Minnesnfe Inc fFKA F.mhern) 365142 Cenfr rrvlink Owesf Cornoration 371595 CenturvLink United Teleohone Co. of the West GKA Emt 175141 flanfirnrf iaL f.lrrracf fanmnrafian 38s I 44 Centrrnrl .inlr f)wact (-nrnnrntinn 39-5145 fl enh rrvl .inlr Orveef (-nrnnrnfinn 40 142 Cenhrrvl -inlr CenhrnrTcl nf Rrrcqellwille 40 143 Cenhrrvl .ink (-enfrrnrTel nf Rrrssellvitte 40 144 (-anfrrarTal nf l\rf ammnfh Sn#no f aaLc^n.ri lla 40 705 Cenhrnrlink CenhrnrTel of Arkansas Inc 40 7tt CenturvTel of Mountain Home Inc. 40 720 Cenhrrvlink CenhrrwTel of Redfield Inc 40 727 Centrrrvlink CentrrrvTel of Sorrth Arkansas Inc- 411317 Centrrrvl.ink I Inited Telenhone Co-F.aqtern Kansas (FKA F 4t 842 (rpnhrruf inlr I Tnitarl Tplcnhnna (h - I(qncqc /FK A Fmhqz 411957 l-anfrrruf inL-Fmhora Miscnrrri Inn l'E'KA Fmhqrn\ 42 r5l Snenlre (-nmrnrrninefinnc Grnnn I .I -a dhle Cenfrrnrl .ink 42 957 Cenhrrvl.ink-F.mhera Missorri Inc fFK A F.mharo\ 429784 Centurvlink CenturvTel of Missouri LLC 429785 Centurvlink CenturvTel of Missowi LLC 429786 Centurvlink CenturvTel of Missouri LLC 429787 Centurvlink CenturvTel of Missouri LLC 442084 CenturvLink United Teleohone Co of Texas Inc. FKA Em 442tOt 442114 Centurvlink Central Telenhone Co. of Texas FKA Embarc 442117 Centurvlink CenturvTel of Port Aransas Inc. 442140 Ccnhrnrl.inlr CentrrruTel nf Sen Mernnc fnc 455 I 0t Cenhrrv[ -inlr Orvccf Cnrnnrqfinn 46218s Cenhrrvl .ink CenfirnrTel nf F-aole Inc 462187 Centurvlink The El Paso Countv Telenhone Comnanv 462208 Centurvlink CenturvTel of Colorado Inc. 465102 Canfrrrvf .inlr Orvesf Cnrnnratinn 472223 Centurvlink CenturvTel of the Gem State fNevada) 472225 Centurvlink CenturvTel of Idaho Inc. 475103 Cenhrrvlink Owesf Comoration 475162 Centrrnrf .inlr f)rvect (-nrnnrcfinn 482249 Cenfirrvl.inlr CentrrnrTel nf Mnnfana Tnc 485 104 Cenhrrvl -inlr Orrrecf Cnrnnrafinn 492274 Centrrrvl.ink CenfirrvTel of the Southwest (New Mexico) 495 1 0s Centurvlink Owest Comoration 505 107 CenturvLink Owest Comoration 5l I 59s Centurvlink tlnited Telenhone Co. of the West (FKA Emt