20160202TDS Telecom ETC Form 555.pdf

S25Junction Rd
Modison. Wl53717
www,tdstelecom.com
RECEIVED
?0i6 f$ -2 Plt Zr 3h
ti-lr,iiO PUtsLlC.il i: t I li:$ COMMISSION
January 29,2016
Via Overniqht Mai!
Ms. Jean D Jewell
Commission Secretary
ldaho Public Utilities Commission
472W. Washington St.
Boise, lD 83720-5983
RE: Case # GNR-T-16-01
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
29,2016.
lf you have any questions concerning this matter or regarding the attached information,
please contact me at 608-664-2415 or via e-mail at [e-mail].
Sincerely,
.,'l - ...i..i
7 f ".i,i / liro,ctr
Nicole Mauritz '/
Regulatory Compliance Manager
Attachments
cc: Gail Long
Nez Perce Tribe
Approved by OMB
30604819
Annual Lifeline Eligible Telecommunications Carrier Certiflcation Form
All caniers must complete all or portiorrs of all sections
Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: lanuary 31rt (Annuatly)
Does the reporting company have afliliated ETCs?Yes El No E
Provide a list of aU Ercs that are afiliated wirt the reporting 0rc, tsing page 4 and additional sheets if necessary. Afrliation shall be
detcrmined in accordance with Section jQ) of the Communicotions Ad. That Section detines "afiiliate" as "a peison that (directly or indirectly)
ovns or confiols, is owned or con rclled by, or is ander common ownership or conlrol vith, another person." 47 U.S.C. { 153(2), See also 17
c.F.R. $ 76.t200.
Affiliated ETC's SAC Alliliated ETC's Name
Sse Aftached
For purposes of this hling, an officer is an occupant of a position listed in the article of incorporation, articles of
formatioq 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 sigr the certification,
Section 1: Initiel CertilicationAll EICs must complete olis section
I certifr that the company listed above has cstification procedures in place to:
A) Review income and program-based eligibility docurnentation prior to emolling 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 enrolknent in Lifeline; and/or
B) Confirm consumer eligibility by relyrng upon access to a state database and/or notice of eligibility from the state
Lifeline adminisraor prior to enrolling a consurrcr in the Lifeline program.
I am an offrcer of the company named above. I am authoriad to make this certification for the Study Area Code listed
above.
rnrtrartaf
472230
Study Area Code (SAC)
(An Eligible Telecommunications Carrier @TC) nust provide a certiticationlomfor each SAC through which it provides Lifeline semice).
Idaho potlatch Telephone Company
State
TDS Telecom: TDS
ETCName
Tl.)S Talaanmmr rniaafiane Camaraiian
DBA. Marketinc or Other BrandinsName
0Isani.c as Erc rurfe, hst "N/A" Do not le;,* blank)
Holdins Comoanv Name(Ifsane d EIC nine,'tist "N/A" Do not bave blank)
FCC Form 555
November 2014
Section 2: Annual Recertification
Do not leave empty blocks. If an ETC has nolhing lo reporl in a block, enter a zero.
Recertifrcation Results :
K L
Numbcr of
rubccribcrs whose
cligibility wrs
revlewcd by strtc
administrator,
ETC accesc to cligibility
drlrbssc, or by USAC
Numbcr of
subrcribers deenrolled or
scheduled to be deenrolled as
r rcsult oflinding of
ineligibility by state
edminirtrator, ETC rccess to
cligibility databasc' or USAC
24 0
No&,r If any rubscriber was reviewed by an ETC accessing a state database or
by a state administmtor otd subsequently contacted directly by the ETC in an
atlenp, to recerlify eligibility, those subscribers should be lbted in Blocks F
throug! J as appropriate and not in Blocks K and L. As a result, all stbsuibers
stbject to recertificalion who were nol de-enrolled prior lo lhe recerliftcation
attempt must be accountedfil in Block F or Bhck K.
The tolal of Blo* F and Block K should equal lhe number reporled in Block
E.
support for my Lifeline subscriber for the February
I am an officer ofthe company narned above. I am
Approved byOMB
30604819
Certilication:
Based on the data entered above, initial the cerrifrcation(s) belov tlat appty. Both Certi/ication A and B nay apply depending on rte recertification
procedures in placefor the SAC reporting on thisform. If CertiJication C applies, wither Certitication A nor B may apply.
A.) I certiff 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 company obtained signed 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 offlicer of the company named above. I am authorized to make this certification for the SAC listed
alnve. -r-)tnit;at -J //
AND/ORB.) I ceti$ that the company listed above has_procedures in place to recerti$ consumer eligibility by relying on:' (LisdoLb^"or*^"olodioiri"rrorcrherrr cADAa . Rezults ar" proiid"d in the chirt above in
Blocks K ttuough L. I am an officer of the company named above. I am authorized to make this certification for theiffJry
C.) I certiff that my corpany did not claim federal low income
Form 497 data month for the current Form 555 calendar year.
authorized to rnake this certification for the SAC listed above.
A B C D E=(A-B-C-D)
Numbcr ofsubscribct!
cloimd on Februery
FCC Form 497 of
current Form 555
crlendrr ycrr
(Fcbruary futamonlh)
Numbcr of lines
clrirrd oo Fcbrmry
FCC Form49? of
currcnt Form 555
ctlendrr ycer
provldcd to wirctinc
rcrcllcrs
Number ofsubccribers cbimed on the
Fcbroary FCC Form 497 Shat wcrc
igitiglly carollcd in thc currcnt Form
535 calendtr ycrr
(7h6c f,ilarrlbr,ttr ddaol hate L{cllae
scnlcc pdor to ,lanuary I of the aunnl SSS
colendar !qr.)
Number ofsubccribers
do.cnrcllcd glgto
rccertif cation attcmpt
by eithcr thc ETC, e
strtc administretor,
rccca! to an cligibillty
detabrse, or by USAC
Numbcr of
suhcribctl ETC is
rcsponsiblc for
rercrti$ing for
curnent form 555
crlandrr ycar
32 0 0 I 24
F G H=(ra)I J= (H+r)
Numbcr of
subccribcrs ETC
contrcted dircctly to
rccertify cligibility
through ettestrtion
Numbcr of
subccribcI.lr
rcsponding to ETC
cotltrct
Numbcr ofnon
rccpondirq
sub6cribetr
Numbcr ofsublcribcrs
r:sponding lhat they erc
no longer eligible
(Thls should bc a subsel of Block
c,)
Number of subscribcn dc-
enrolled or scheduled to bc
dcenrclled rs a rtsult of
non-responsc or responsc of
inellglblllty from ETC
rtccrtifi cation ettempa
t_8 L2 5 0 6
Initisl
FCC Form 555
November 2014
Section 3: De-enroll Percentage
Using the data entered in Section 2, complete the clurt belo'w tofmd the percentage of subsuibers de-enrolledfor this ETC.
M=(F+K)N= (J+L)O=(O[+M)*100)
Numbcr ofsubscribcB thet the
ETC attempted to reccrti! direcdyq through r ctete edminlstrator,
ETC rcccss to r strt drt&btse, or
by USAC
(This should qaal lhe ntmber
rcpotdinBloc* E)
Number of
subscribers de-
enrolled or schcdulcd
to bc de enrolled rs r
rtcult of non-respoase
or tneligibility
Perccntr gc of su bscribers
de-enrollcd 6r schcduled to
be de-onrolled as a result of
incligibility or notr-rcsponsg
42 6 L4.29
Seclion 4: Pre-Paid ETCs
All ETCs nust complete the aryropriate che*-box; pre-pid ETC-s must conplete all of Seclion 4. Pre-paid ETCs generully do not assess or collect a
nonthlyfeelrontheirLifelinesubscribers. ETCsthatonlyassessafeebutdotnlcollectsuchfeesarepre-paidETCsandmustcompletethe
chart bebw,
Is the ETC PrePaid? Yes I No E
{ Yes, record the number ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usape
January
February
March
April
May
Jme
July
Auzust
Sefiember
October
November
December
Total Subscribers
Signature Block
Approved by OMB
3060{819
By sigring below, I certi! that the company listed above is in compliance with all federal Lifeline certification
procedures. I am an officer ofthe company named above. I am authorized to make this certification for the
Study Area Code (SAC) listed above.
-loal l)ahmaiar Mcc Praqir{ant
Prinbd Name and Title of Officcr
Januarv 27.2016
Date
6rlA6,An ?L15
Email Addnss of OfEcer
Penon Completing This Certification Form Contact Phone Numbor
3
FCC Form 555
November 2014
Approved by OMB
3060-081 I
Affiliated ETCs
sAc Name
190217 Amelia Telephone Corporation
300585 Arcadia Telephone Comoanv
152171 Arizona Telephone Companv
361350 Arvio Teleohone Comoanv
532404 Asotin Telephone Company (OR)
522404 Asotin Telephone Company (WA)
330844 tsaoqer lelecom, LLL:
330849 Black Earth Telephone Companv, LLC.
220346 Blue Ridoe Telephone Comoanv
330851 Bonduel Teleohone Companv. LLC.
361362 Bridoe Water Teleohone Co.
330856 Burlington, Brighton & Wheatland Telephone Company, LLC
2s0284 Butler Telephone Company, lnc.
280448 Calhoun Citv Telephone Companv. lnc.
220351 Camden Telephone and Teleqraph Companv, lnc.
120744 Camden Telephone Companv. lnc.
330859 Central State Teleohone Comoanv. LLC
31 0685 Chatham Teleohone Comoanv
401698 Cleveland County Telephone Companv, lnc.
1 00005 Cobbosseecontee Teleohone Comoanv
320776 Communications Corporation of lndiana
310672 Communications Corooration of Michioan
320809 Communications Corooration of Southern lndiana
290559 Concord Telephone Exchange, lnc
300607 Continental Telephone Company
401699 Decatur Telephone Companv, lnc.
462184 Delta Countv Tele-Comm, lnc.
1 50089 Deoosit Telephone Comoanv. lnc.
330875 Dickewille Teleohone. LLC
330914 EastCoast Telecom of Wisconsin. LLC
1 50092 Edwards Teleohone Comoanv. lnc.
330880 The Farmers Telephone Company, LLC
330930 Grantland Telecom, LLC
1 0001 0 Hamoden Teleohone Comoanv
542321 Haoov Vallev Teleohone Comoanv
1 0001 1 Hartland & St. Albans Teleohone Comoanv
12332',1 Hollis Telephone Company, lnc.
320777 Ihe Home Telephone Company of Pittsboro, lnc.
320778 Home Telephone Company, lnc.
542322 'lornitos Telephone Company
290566 Humphrevs County Telephone Comoanv
310677 lsland Telephone Companv
120045 Kearsarqe Telephone Comoanv
361413 KMP d/b/a Mid-State Telephone Comoanv
260411 Leslie Countv Telephone Comoanv
522427 Lewis River Telephone Company, lnc.
260412 [ewisoort Teleohone Co.
30061 3 Little Miami Communications Corooration
FCC Form 555
November 2014
Approved by OMB
3060-0819
Affiliated ETGs
sAc Name
140058 Ludlow Teleohone Companv
1 701 83 Mahanov & Mahantanqo Teleohone Comoanv
240533 McClellanville Telephone Companv, lnc
522430 McDaniel Teleohone Companv
320788 The Merchants and Farmers Teleohone Comoanv
120047 Merrimack Countv Teleohone Comoanv
432010 Mid-America Telephone. lnc.
330881 Mid-Plains Telephone, LLC
361433 Mid-State Teleohone Companv
330909 Midway Telephone Company, LLC
330917 l\It. Vernon Telephone Company, LLC
330915 Mosinee Telehphone Companv
287449 Mvrtle Telephone Comoanv. lnc.
220375 Nelson-Ball Ground Teleohone Comoanv
1 93029 New Castle Telephone Co.
140061 Northfield Teleohone Comoanv
240535 Norwav Teleohone Co. lnc
25031 1 Oakman Telephone Company, lnc.
300645 Oakwood Teleohone Comoanv
431984 Oklahoma Communication Svstems. lnc.
150114 Oriskanv Falls Telephone Corporation
250314 Peoples Teleohone Comoanv. lnc.
140062 Perkinsville Telephone Company, lnc.
150118 Port Bvron Teleohone Comoanv
472230 Potlatch Telephone Company, lnc.
21 0338 Quincv Telephone Companv (FL)
220338 Ouincv Teleohone Comoanv (GA)
330943 Riverside Telecom, LLC
320816 S & W Teleohone Comoanv. lnc.
260417 Salem Teleohone Co.
330945 Scandinavia Telephone Companv, LLC
310726 Shiawassee Telephone Companv
't00024 Somerset Teleohone Companv
283301 Southeast Mississiooi Teleohone Comoanv. lnc.
330952 Southeast Teleohone Co. of Wisconsin. LLC
452174 Southwestern Telephone Company
240544 St. Stephen Telephone Companv
330955 State Lonq Distance Telephone Companv
330954 Stockbridge & Sherwood Telephone Company, LLC
462207 Strasburq Telephone Companv
170206 Suoar Vallev Teleohone Comoanv
290578 Iellico Telephone Comoanv. lnc.
290575 lennessee Teleohone Companv
330958 Iennev Teleohone Comoanv. LLC
1 00007 Ihe lsland Teleohone Comoanv
300662 The Vanlue Teleohone Comoanv
320829 Iioton TeleDhone Comoanv. lnc.
150129 Township Telephone Companv, lnc.
FCC Form 555
November 2014
Approved by OMB
3060-081 I
Affiliated ETCs
sAc Name
320830 Tri-Countv Communications Corooration
120049 Union Telephone Company
330963 Utelco, LLC.
150133 Vernon Telephone Companv. lnc.
190253 Viroinia Teleohone Comoanv
1 00031 Warren Teleohone Comoanv
330968 Waunakee Teleohone Comoanv. LLC.
1 00034 The West Penobscot Telephone and Teleqraph Companv
t20837 West Point Telephone Companv
240551 Williston Telephone Comoanv
120050 Wilton Teleohone Comoanv. lnc.
161507 Winsted Teleohone Comoanv
142323 Winterhaven Teleohone Comoanv
31 0738 Wolverine Telephone Company
432034 Wvandotte Teleohone Comoanv
1 09002 U.S. Cellular
239006 Wilminqton Cellular Telephone Comoanv
239006 Jacksonville Cellular Teleohone Comoanv
209005 Hardv Cellular Teleohone Comoanv
359016 Farmers Cellular Telephone Company, lnc.
359016 lowa RSA No. 12 Limited Partnershio
529001 McDaniel Cellular Telephone Companv
539002 USCOC of Oreqon RSA #5, lnc.
529001 USCOC of Washinqton-4, lnc.
359016 lowa RSA No.9 Limited Partnership
339007 United States Cellular Operatinq Company, LLC
339007 Kenosha Cellular Teleohone. L.P.
339007 lVladison Cellular Telephone Company
1 09002 Mlaine RSA #1, lnc.
1 09002 Maine RSA #4, lnc.
129002 NH #1 Rural Cellular, lnc.
539002 Oreoon RSA #2. lnc.
529001 Oregon RSA #2, lnc. (WA)
339007 PCS Wisconsin, LLC
339007 Racine Cellular Teleohone Comoanv
1 09002 Banqor Cellular Telephone, L.P.
359016 3edar Rapids Cellular Telephone, L.P.
349007 United States Cellular Ooeratino Comoanv of Chicaoo. LLC
359016 lubuque Cellular Telephone, L.P.
29901 0 United States Cellular Operatinq Company of Knoxville
29901 0 Iennessee RSA No. 3 Limited Partnershio
29901 0 United States Cellular Telephone Companv (Greater Knoxville). LP.
539002 United States Cellular Ooeratino Companv of Medford
529001 Yakima MSA Limited Partnership
349007 JSCOC of Central lllinois. LLC
35901 6 USCOC of Greater lowa. LLC (lA)
349007 USCOC of Greater lowa. LLC (lL)
FCC Form 555
November 2014
Approved by OMB
3060-081 I
Affiliated ETGs
sAc Name
379019 USCOC of Greater lowa. LLC (NE)
349007 USCOC of Greater Missouri, LLC (lL)
429007 USCOC of Greater Missouri, LLC (MO)
239006 USGOC of Greater North Carolina, LLC
439004 USCOC of Greater Oklahoma, LLC
339007 USCOC of LaCrosse, LLC
419012 USCOC Nebraska/Kansas, LLC (KS)
379019 USCOC Nebraska/Kansas. LLC (NE)
529001 USCOC of Richland, lnc.
439004 lexahoma Cellular LP
1 99004 JSUUU Ot Vrrqrnra RUA #3, lnc.
529001 A/estern Sub-RSA Limited Partnership
1 59014 St. Lawrence Seawav RSA Cellular Partnershio
1590'15 New York RSA 2 Cellular
542343 y'olcano Communications Company