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Home My WebLink About20150203Potlatch Telephone Company 555.pdf525 Junction Rd Modison, Wl537l7 www.ldstelecom.com January 30,2015 Via Overnisht Mail Ms. Jean D Jewell Commission Secretary ldaho Public Utilities Commission 472W. Washington St. Boise, !D 83720-5983 RE: Case # GNR-T-15-01 FCC Form 555 Annual Lifeline Eligible Telecommunications Carrier Certification Form for TDS Telecom Dear Secretary Jewell: Attached please find a copy of TDS Telecommunications Corporation's ("TDS Telecom") Annual Lifeline Eligible Telecommunications Carrier Certification Form (FCC Form 555) which was filed with the Universal Service Administrative Company via email on January 30,2015. 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 iennifer.heise@tdstelecom.com. Regulatory Compliance Manager Attachments cc: Gail Long 535 JT,IN(:TION ROAD MADISON, WI 53717 P.O. BOX 5158 MADISON. Wt 53705-0158 Sincerely, Jdfinifer R.tleise Approvcdby OMB 3060-08 l9 Annud Ufdlac R.fglhlc Tclcconuudcrtlons Crrrlcr Certlflcaton Form All canicrs rmst colqletc all orportions of all sections Forno must be submitted to USAC and filed with thc Fedcml Communicationc Commission IMPORTAI{T: PLEASE READ INSTRUCTIONS FIRST Deadthe: lanuary 3Id (Annually) Does thc reporting company have afflllatcd ETCs?Yes EI No E Provide o list ol'oll Ercs ilnr are aflillated with tha reporting EN, wlng pge 1 and addttiotol sheets if necawry. l{Jiliation $all be determined ln accorulane with Sectiotr 3(2) o[the Communicationr Act. lhut Sachoa d{lttct "qfllliue" w "u percon lhat (directlv or itlirectll') ovnt or controls, is owned or controlled by, or is undet'comnon ownanhlp or ailttml vlth, a,rothe.r parson." 17 U,S.C, 5 153(2), See also 47 c.f"x..s 76.r200. For purposes of this f,rling, au oflicer is an occulnnt of a position listed in thc rrticlc of incorporailoq articles of fonnation, or other similar legal documeot. An olEcor is a person who oc-crpics a position specificd in tho corporate by- Iaws (or partnership agreement), and would tlpically be prcsidcng vico presidcnt for operations, vico presidont for financc, conrptroller, trcasurer, or a comparable positioo. lf the liler is o sole proprictonhip, the owncr must sign thc ccrtifrcetion. Sectlon l: Initial CcrtlficafronAll EICr t il6tconqletethk rection I certify that the coryany listed above has cetificatiou proccdures in place to: A) Review income and prograrn$ased eligibility docunBntatiou prlor to enrolling a consurler in the Lifeline prograug and tha! ro the best of ray knowlcdge, thc corryany was presented with documemation of each consumer's household incorne and/or progratntused eligihility prior to his or her enrollment in Lifeline; anrVor B) Conlirm consumer etigibility by relying upor access to a state database and/or notice of eligibility from the state Lifeline administaior prior to enrolling a coflsumer in the Lifeline program. I am an officer of the oompany nampd above. I am authorized to rrake this certification for the Study Area Code listed FCC Fornr 555 Novembcr 20 l4 above. ,o,oil_ 472230 Study Area Code (SAC) (An Eligible Teluotnmunicalions Carrio (ET() nust lttovida a caltticotionJbrntfor each SAC thtongh which it prwider Llblfue .renice\ Tdaho Potlatch Telephone Company ETC NarneState TDS Telecom. TDS TDS TelecommuniQations Corpor.ation DBA. Morketins or Other Brandins Narne(f wmb as ETC naite,lttt "NLc" Do m11!eaie blaft)Holdins Comoanv Name 1tfsane o'i ETC nine,'list "MA" Do not lenveh!u*) AffiIiAtCd ETC'S SAC FCC Form 555 November20l4 Section 2: Annual Recertilicetion Do not leave empty bloclcs. If an ETC has nothing to report in a block, enlet a zero. Recertification Resulb: K L Numbcr of subscribcrs whoce eligibllity was rcvlewed by state administrrtor, ETC access to eligibillty datebrse, or by USAC Numbcr of gubgcribers de.enrolled or scheduled to be de-enrollcd as a rcsult of findlng of lncliglbility by ctate administratoB ETC access to cligibility database, or USAC ?n 0 Nolcz lf any nbsolber *a rcviand by an EIC access@ a stale dalabase or by o state admlnlstmtor and subsequenlly @ntaded direaly by the ETC in an attsrnp, ,o rc@rrify cligibiltty, tlpse subrctibers should be listed in Blocks F througft J as appropdote otd not in Blocks K and L. As a result, all subscribers sabjea to recerti/icalion who vere not de-enrolled pior to the recertilication attempt must be accounledfor in Block F or Block K. The total of Bloc* F aail Block K should qual the number rqorted in Block E. support for any Lifeline subscribers for the February I am an officer ofthe company named above. I am Approved byOMB 30604819 Certilication: Based on the dala entered above, inilial the certiJication(s) below that ryply. Both Certilication A and B may apply depending on the reert$ication procedures in place for the SAC reprting on thls form. If Certifcation C applles, neither Cerlification A nor B may apply. A.) t certify that the company listed above has procedures in place to recerti$ the continued eligibility of all of its Lifeline subscribcrs, and that, to the best of my knowlodge, the company obtain€d signed certifications ftom all subscribers attcsting to thcir continuing eligibility for Lifeline. Results are provided in the chart above in Blocks F through J. I arp.aqofficer of the company narned above. I am authorid to mako this certificdion for the SAC listed ainve. 1r )trttfuit>JJZ AND/()R. B.) I certiS thd the company listed aborrc has procedures in placc to recortify cossumer eligibility by relying on: CAPAT Results are provided in the chart above in Blocks K thrcugh L. t am an officcr of ttre company named above, I am authorized to make this certification for the SAC listedabovn tnitiat :f / ' C.) I certifr that my company did not claim federal low income Form 497 data month for the cunent Form 555 calendar year. authorizd to make this certification for the SAC listed above. A B C D E=(A-B-C-D) Numbcr ofsubacrlberc clainred on February FCC Form497 of currcnt Form 555 celcndar yeer (February dalamonrh, Numbcr of lincs cleilred on Februara FCC Form497 of current Form 555 celendrr ycrr provided to wirdinc rcsdlers Numbcr of subscribers claimcd on the February FCC Form 497 tftrt werc iniairllv enrollcd in the currcnt Form 555 crlcndrr yerr (Thcse subsolben dtd rot hae. L$dine wrlce pdor lo tanuaty I oflhe cunent 555 calandat yar.) Number ofsubecribers deenrolled glq to neccrtlfi crtion ettcmpt by cither the ETC, e statc administrator, rcc€$ lo an eligibility drteblsc, or by USAC Numberof eubscribers ETC is rcsponsiblc for recertifying for currtnt Form 555 colendlryetr 46 0 3 2 41. F G H= Ga)T 1= gr+I) Number of rubscribcrs ETC contected dircctly to recertiS cligibility through rtt$trtion Numbcr of subscribcrr respondlng to ETC contrct Number ofnon- rtsponding subscribers Number ofsubocribcrs rcsponding thet thcy rre no longcr eliglble (This should be a subset ofBlock G.) Number of subscribers de. enrolled or schedulcd to be decnrollcd as e rcsult of nolr-nesponsc or rcspOnse of inellgibility from ETC recertilicatlon rttempt 10 4 6 0 6 Initial FCC Form 555 Novombcr 20[4 Section 3: De-enroll Percenttge Using the dato crileretl h Section 2, conpbu the chan below rofudtheprcarldge of suhtcrlben da-enmtletltbr thLe ElX, Iyl=([+K)N-(J+Ll O=((N+i/n r 100) NurnUcr o[rulrscrlbcrs thrt ahe ETC rtternptcd lo recertl$ direclly gg through r stnts ednrlnlstrrtor, ETC rc$sr to a rttte drtdrrsq or by USAC (Thls should qnol thc nanbcr rcpoaad in Bloch E) NunDor of snbrcriberr de- enrollcd or rchoduled to be de- crrolled ar c rcault of non-respomc or lnellgtHllty Pucenlrge of rubcrlbers dc-enrolled or schcduled l0 bc dc-enrolled rr a rccult of lnellglDillty or non-r€rpurse 48 6 1,2 .5 Section 4i Pre-Pald ETCs Ai ETC;I uust conrpleu the apputpriate check-btx; pr*poid ETCt musl atmplele oll ol&,r:tion 4. Pr*paid ETCI geterully do not as:wts ot'collect a ,norrlhl)1lbelorntheit'Litbline.tubttcribas. ETCsthutonlyaste:tatitebtrldonotcollectsuc$lietarepre2aidEK)tandnustcompluethe chort bclou,. ts the ETC Pre-Prid?Yes EI No El Il'Yes, reutrl the nunrber of subscribet.t de-em<tllwlfur non-usage bynonth in BlockQ below. Signature Block Approvetlby OMB 3060-0819 By signing procedures, below, Iam Code I cenify that the company listed above is io corryliance with all fedcral Lifeline certificatiou an officer of the coupany named above. I am authorjzed to make this certification for the above. Joel P. Dohmeier, Vice President Printed Namo and Title of OflicprJan.30.2015 _ Date (608) 664-4148 .- - . ContaotPhone Numbor Ernri I Addre"ss of Olficcr .lennifer Heise P o Month Subscribers De-Enrolled for Non-Usaec Janqary Februarv March Anril May June Julv August Scptembcr October Novernber' December Total Subscribcrs Person Complcting Thir Ccrtification Fotm FCC Form 555 November 2014 Approved by OMB 3060-081 I Affiliated ETCs SAC Name 190217 Amelia Telephone Corporation 300s85 Arcadia Telephone Companv 452171 Arizona Telephone Companv 361 350 Arviq Teleohone Comoanv 532404 Asotin Teleohone Comoanv (OR) 522404 Asotin Telephone Company (WA) 330844 Badqer Telecom, LLC 230469 Barnardsville Telephone Companv 330849 Black Earth Teleohone Companv, LLC. 220346 Blue Ridoe Teleohone Comoanv 330851 Bonduel Teleohone Comoanv. LLC. 361362 Bridqe Water Telephone Co. 330856 Burlinqton, Briqhton & Wheatland Telephone Company, LLC 250284 Butler Telephone Gompanv. lnc. 280448 Calhoun Citv Teleohone Companv. lnc. 220351 Camden Teleohone and Teleqraoh Comoanv. lnc. 320744 Camden Telephone Company, lnc. 330859 uentral state leEphone company, LLC 31 0685 Chatham Telephone Companv 401698 Cleveland Countv Teleohone Comoanv. lnc. 100005 Cobbosseecontee Teleohone Comoanv 320776 Communications Corporation of lndiana 310672 Communications Corooration of Michioan 320809 Communications Corooration of Southern lndiana 290559 uoncord l eEphone Exchanqe, lnc 300607 Continental Telephone Companv 401699 Decatur Telephone Companv, lnc. 462184 Delta Countv Tele-Comm. lnc. 1 50089 Deposit Telephone Company, lnc. 330875 Dickewille Telephone. LLC 330914 EastCoast Telecom of Wisconsin, LLC 1 50092 Edwards Telephone Companv, lnc. 330880 The Farmers Telephone Companv. LLC 330930 Grantland Telecom. LLC 1 0001 0 Hamoden Teleohone Comoanv 542321 Happy Valley Telephone Company 1 0001 1 Hartland & St. Albans Telephone Company 12332',1 Hollis Telephone Companv, lnc. 320777 The Home Telephone Company of Pittsboro, lnc. 320778 Home Teleohone Companv, lnc. 542322 Hornitos Telephone Companv 290566 Humohrevs Countv Teleohone Comoanv 310677 lsland Teleohone ComDanv 120045 Kearsaoe Teleohone Comoanv 361413 KMP dibla Mid-State Teleohone Comoanv 26041',!Leslie Countv Teleohone Comoanv 522427 Lewis River Telephone Company, lnc. 260412 Lewsoon leleDhone co. FCC Form 555 November 2014 Approved by OMB 3060-0819 Affiliated ETCs sAc Name 30061 3 Little Miami Communications Corporation 140058 Ludlow Teleohone Comoanv 170183 Mahanov & Mahantanoo Teleohone Comoanv 240533 Mculellanvlle I elepnone uompany, lnc. 522430 [IcDaniel Telephone Company 320788 The Merchants and Farmers Telephone Companv 120047 Merrimack Countv Telephone Companv 432010 Mid-America Teleohone. lnc. 330881 Nllid-Plains Telephone, LLC 361433 Mid-State Teleohone Comoanv 330909 Mlidwav Teleohone Companv. LLC 330917 Mt. Vernon Telephone Comoanv. LLC 330915 Mosinee Telehphone Companv 287449 Myrtle Telephone Company, lnc. 220375 Nelson-Ball Ground Telephone Company 1 93029 New Castle Telephone Co. 140061 Northfi eld Telephone Companv 240535 Norwav Teleohone Co. lnc 25031 1 Oakman Teleohone Companv. lnc. 300645 Oakwood Teleohone Comoanv 431984 Oklahoma Communication Svstems. lnc. 150114 Oriskany Falls Telephone Corporation 2503',t4 Peoples Telephone Companv, lnc. 't40062 Perkinsville Telephone Companv, lnc. 1501 18 Port Bvron Teleohone Comoanv 472230 Potlatch Telephone Company, lnc. 21 0338 Quincv Teleohone Comoanv 220338 Quincv Telephone Companv 330943 Riverside Telecom, LLC 320816 S & W Telephone Companv, lnc. 260417 Salem Teleohone Co. 230498 Saluda Mountain Teleohone Co. 330945 Scandinavia Teleohone Comoanv. LLC 230500 Service Teleohone Co. 310726 Shiawassee Telephone Company 100024 Somerset Telephone ComDanv 283301 Southeast Mississiooi Teleohone Comoanv. lnc. 330952 Southeast Telephone Co. of Wisconsin. LLC 452174 Southwestern Telephone Comoanv 240544 St. Steohen Teleohone Comoanv 330955 State Lono Distance Teleohone Comoanv 330954 Stockbridqe & Sherwood Telephone Company, LLC 462207 Strasburq Telephone Companv 170206 Suqar Valley Telephone Company 290578 fellico Telephone Company. lnc. 290575 Iennessee Telephone Company 330958 Iennev Teleohone Comoanv. LLC 1 00007 Ihe lsland Telephone Comoanv FCC Form 555 November 2014 Approved by OMB 3060-081 I Affiliated ETCs SAC Name 300662 The Vanlue Teleohone Comoanv 320829 lrpton Ielephone uompany, lnc. 150129 Iownship Telephone Company. lnc. 320830 Iri-Countv Communications Corporation 120049 Union Telephone ComDanv 330963 Utelco. LLC. 1 501 33 Vernon Teleohone Companv. lnc. 1 90253 Viroinia Teleohone Comoanv 1 00031 Warren Telephone Company 330968 ily'aunakee Telephone Company, LLC. 1 00034 Ihe West Penobscot Teleohone and Teleoraoh Comoanv 320837 West Point Telephone Companv 240551 A/illiston Teleohone Comoanv 120050 uvilton Telephone ComDanv, lnc. 361 507 Winsted Teleohone Comoanv 542323 y'Vinterhaven Telephone Companv 31 0738 y'Volverine Teleohone Comoanv 432034 A/vandofte Teleohone Com oanv 1 09002 U.S. Cellular 239006 A/ilminqton Gellular Telephone company 239006 Jacksonville Cellular Telephone Company 209005 Hardv Cellular Telephone Comoanv 359016 armers Cellular Telephone Company, lnc. 359016 lowa RSA No. 12 Limited Partnership 529001 VIcDaniel Cellular Teleohone Companv 539002 JSCOC of Oreoon RSA #5. lnc. 529001 JSUUU Ot Wasnrnglon-4, lnc. 359016 owa RSA No.9 Limited Partnershio 339007 United States Cellular Operatino Companv. LLC 339007 (enosha Cellular Teleohone. L.P. 339007 Madison Cellular Telephone Companv 1 09002 Maine RSA #1. lnc. 1 09002 uarne KUA *4, tnc. 129002 \H #1 RuralCellular, lnc. 539002 Jreqon RSA #2, lnc. (OR) 529001 Jreqon RSA #2, lnc. (WA) 339007 PCS Wsconsin. LLC 339007 Racine Cellular Telephone Companv 1 09002 3anqor Cellular Teleohone, L.P. 359016 ledar Rapids Cellular Telephone, L.P. 349007 Jnited States Cellular Operatinq Company of Chacaoo, LLC 359016 JuDuoue uellular leleDnone. L.P. 29901 0 Jnited States Cellular Operatinq Companv of Knoxville 29901 0 lennessee t{sA No. 3 Ltmfted Partnershtp 29901 0 Jnited States Cellular Teleohone Comoanv (Greater Knoxville). LP. 539002 Jnited States Cellular Ooeratino Comoanv of Medford 529001 Yakima MSA Limited Partnershio FCC Form 555 November 2014 Approved by OMB 3060-0819 Affiliated ETCs sAc Name 349007 JSCOC of Central lllinois, LLc 359016 JSCOC of Greater lowa, LLG (lA) 349007 JSCOG of Greater lowa, LLC (lL) 37901 I JSCOC of Greater lowa, LLC (NE) 349007 JSCOC of Greater Missouri. LLC (lL) 429007 JSCOC of Greater Missouri, LLC (MO) 239006 JSCOC of Greater North Carolina, LLC 439004 JSCOG of Greater Oklahoma, LLC 339007 JSCOC of LaGrosse. LLC 419012 JSCOC Nebraska/Kansas. LLC (KS) 379019 JSCOC Nebraska/Kansas, LLC (NE) 529001 JUUUU OT KICN|aNO. INC. 439004 Texahoma Cellular LP 199004 JSCOC of Virginia RSA #3, lnc. 529001 A/estem Sub-RSA Limited Partnership 1 59014 St. Lawrence Seaway RSA Cellular Partnership 159015 tlewYork RSA 2 Cellular 542343 y'olcano Communications Comoanv