20160624Gold Star Communications Form 481 .pdf

Page 1
Page 1
FCC Form 481FCC Form 481 - Carrier Annual Reporting OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code <015>Study Area Name <020>Program Year <030>Contact Name: Person USAC should contact with questions about this data
<035>Contact Telephone Number: Number of the person identified in data line <030> <039>Contact Email Address: Email of the person identified in data line <030>

Data Collection Form

Form Type

54.313 and 54.422
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
Page 2
Page 2
<110>Has your company received its ETC certification from the FCC?(yes / no )
<111>(yes / no )
If your answer to Line <111> is yes, please file a progress report, on line
<112> delineating the status of your company's existing § 54.202(a) "5 year
plan" on file with the FCC, as it relates to your provision of voice telephony
service.
<112>Attach Five-Year Service Quality Improvement Plan or, in subsequent years,
your annual progress report filed pursuant to 47 C.F.R. § 54.313(a)(1). If your company is a
CETC which only receives frozen support, your progress report is only
<113>Maps detailing progress towards meeting plan targets
<114>Report how much universal service (USF) support was received
<115>
<116>
<117>
<118>
(100) Service Quality Improvement Reporting FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
Page 3
Page 3
(200) Service Outage Reporting (Voice)FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
<220><a><b1><b2><b3><b4><c1><c2><d><e><f><g><h>
NORS
Reference
Number
Outage Start
Date
Outage Start
Time
Outage End
Date
Outage End
Time
Number of
Customers Affected Total Number of
Customers
911 Facilities
Affected
(Yes / No)
Service Outage
Description (Check
all that apply)
Did This Outage
Affect Multiple
Study Areas
(Yes / No)
Service Outage
Resolution
Preventative
Procedures

<210> For the prior calendar year, were there any reportable voice service outages?
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
No
(300) Unfulfilled Service Request FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>

<300> Unfulfilled service request (voice)
<310> Detail on attempts (voice)
<320> Unfulfilled service request (broadband)
<330> Detail on attempts (broadband)

Name of Attached Document

Name of Attached Document
Page 4
Page 4
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
0
479011

<010> Study Area Code

<015> Study Area Name
<020> Program Year
<030> Contact Name - Person USAC should contact regarding this data
<035> Contact Telephone Number - Number of person identified in data line
<030>

<039> Contact Email Address - Email Address of person identified in data line
<030>

<400>
Select from the drop-down list to indicate how you would like to report
voice complaints (zero or greater) for voice telephony service in the prior
calendar year for each service area in which you are designated an ETC for
any facilities you own, operate, lease, or otherwise utilize.
<410> Complaints per 1000 customers for fixed voice
<420> Complaints per 1000 customers for mobile voice
<430>
Select from the drop-down list to indicate how you would like to report
end-user customer complaints (zero or greater) for broadband service in
the prior calendar year for each service area in which you are designated
an ETC for any facilities you own, operate, lease, or otherwise utilize.

<440>
<450>
Complaints per 1000 customers for fixed broadband
Complaints per 1000 customers for mobile broadband

Page 5
Page 5
(400) Number of Complaints per 1,000 customers FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
Michelle Motzkus
2017
0.0
[e-mail]
Gold Star Communications LLC
3078836690 ext.
Offered only mobile voice
479011
(500) Compliance With Service Quality Standards and Consumer Protection Rules FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>

Page 6
Page 6
<500> Certify compliance with applicable service quality standards and consumer protection rules

<510> Descriptive document for Service Quality Standards & Consumer Protection Rules Compliance
Michelle Motzkus
479011id510.pdf
Yes
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
<010>
<015>
<020>
<030>
<035>
<039>
Study Area Code
Study Area Name
Program Year
Contact Name - Person USAC should contact regarding this data
Contact Telephone Number - Number of person identified in data line <030>
Contact Email Address - Email Address of person identified in data line <030>
(600) Functionality in Emergency Situations FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013

<600> Certify compliance regarding ability to function in emergency situations
Page 7

<610> Descriptive document for Functionality in Emergency Situations
Page 7
Michelle Motzkus
2017
Yes
[e-mail]
479011id610.pdf
Gold Star Communications LLC
3078836690 ext.
479011
Page 8
Page 8
<701>Residential Local Service Charge Effective Date
<702>Single State-wide Residential Local Service Charge

<703><a1><a2><a3><b1><b2>
State Exchange (ILEC)SAC (CETC)Rate Type
Residential Local
Service Rate

<c>
Total per line Rates and Fees
<b5>
Mandatory Extended Area
Service Charge
<b4>
State Universal Service Fee
<b3>
State Subscriber Line Charge
(700) Price Offerings including Voice Rate Data FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>
<015>
<020>
<030>
<035>
<039>
Study Area Code
Study Area Name
Program Year
Contact Name - Person USAC should contact regarding this data
Contact Telephone Number - Number of person identified in data line <030>
Contact Email Address - Email Address of person identified in data line <030>

Michelle Motzkus
1/1/2016
2017
-- See attached worksheet
--
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
Page 9
Page 9
<711><a2><b1><b2><c><d1><d2><d3><d4>
Exchange (ILEC)Residential Rate
State Regulated
Fees Total Rate and Fees
Broadband Service -
Download Speed
(Mbps)
Broadband Service -
Upload Speed (Mbps)
Usage Allowance
Action Taken When
Limit Reached {select}

<a1>
Usage Allowance
(GB)

State
(710) Broadbrand Price Offerings FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>

Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
Page 10
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(800) Operating Companies FCC Form 481
Data Collection Form OMB Control No. 3060-0986
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
<810>Reporting Carrier
<811>Holding Company
<812>Operating Company

<813>

<a3>
Doing Business As Company or Brand Designation
<a1>
Affiliates
<a2>
SAC
<813>

<a3>
Doing Business As Company or Brand Designation
<a1>
Affiliates
<a2>
SAC
<813>

<a3>
Doing Business As Company or Brand Designation
<a1>
Affiliates
<a2>
SAC
<813>

<a3>
Doing Business As Company or Brand Designation
<a1>
Affiliates
<a2>
SAC
/OMB Control No. 3060-0819

Horizon Communications, Inc.
Michelle Motzkus
Gold Star Communications, LLC
2017
[e-mail]
Gold Star Communications. LLC
Gold Star Communications LLC
3078836690 ext.
-- See attached worksheet --
479011
Page 11
<910>Tribal Land(s) on which ETC Serves

<920>Tribal Government Engagement Obligation
<921>
<922>Feasibility and sustainability planning;
<923> Marketing services in a culturally sensitive manner;
<924>Compliance with Rights of way processes
<925>Compliance with Land Use permitting requirements
<926>Compliance with Facilities Siting rules
<927>Compliance with Environmental Review processes
<928>Compliance with Cultural Preservation review processes
<929>Compliance with Tribal Business and Licensing requirements.

(900) Tribal Lands Reporting FCC Form 481
Data Collection Form OMB Control No. 3060-0986
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>

/OMB Control No. 3060-0819

Page 11
<900>Does the filing entity offer tribal land services? (Y/N)
Michelle Motzkus
2017
[e-mail]
No
Gold Star Communications LLC
3078836690 ext.
479011

Page 12
(1000) Voice and Broadband Service Rate Comparability FCC Form 481
Data Collection Form OMB Control No. 3060-0986
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>

/OMB Control No. 3060-0819

<1000> Voice services rate comparability certification
<1010> Attach detailed description for voice services rate
comparability compliance

Name of Attached Document

<1020> Broadband comparability certification

<1030> Attach detailed description for broadband
comparability compliance

Name of Attached Document
Page 12
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
Not Applicable
479011
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Page 13
(1100) No Terrestrial Backhaul Reporting FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013

<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>

<1130>
Certify whether terrestrial backhaul options exist (Y/N)

<1100>
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
Yes
479011
Page 14
Page 14
(1200) Terms and Condition for Lifeline Customers FCC Form 481LifelineOMB Control No. 3060-0986/OMB Control No. 3060-0819Data Collection Form July 2013

<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
<1210>Terms & Conditions of Voice Telephony Lifeline Plans
<1221>
<1222>
<1223>Additional charges for toll calls, and rates for each such plan.
<1220>Link to Public Website HTTP
Information describing the terms and conditions of any voice telephony service plans offered to Lifeline subscribers,
Details on the number of minutes provided as part of the plan,

Michelle Motzkus
2017
[e-mail]
479011id1210.pdf
Gold Star Communications LLC
3078836690 ext.
4
4
4
479011
Page 15
Page 15
(2000) Price Cap Carrier Additional Documentation FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
Including Rate-of-Return Carriers affiliated with Price Cap Local Exchange Carriers July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>

Incremental Connect America Phase I reporting
<2010> 2nd Year Certification 47 CFR § 54.313(b)(1)(i) - Note that for the July 1
2016 certification, this applies to Round 2 recipients of Incremental
Support

<2011> 3rd Year Certification 47 CFR § 54.313(b)(1)(ii) - Note that for the July 1
2016 certification, this applies to Round 1 recipients of Incremental
Support

<2022> Recipient certifies, representing year two after filing a notice of
acceptance of funding pursuant to 54.312(c), that the locations in
question are not receiving support under the Broadband Initiatives
Program or the Broadband Technology Opportunities Program for
projects that will provide broadband with speeds of at least 4
Mbps/1Mbps - 54.313(b)(2)(i). Round 2 recipients only.

<2023> The attachment on line 2024 includes a statement of the total amount of
capital funding expended in the previous year in meeting Connect
America Phase I deployment obligations, accompanied by a list of census
blocks indicating where funding was spent. This covers year two -
54.313(b)(2)(ii). Round 2 recipients only.

<2024A> Round 2 Recipient of Incremental Support?

<2024B> Attach list of census blocks indicating where funding was spent in year
two - 54.313(b)(2)(ii). Round 2 recipients only.
Name of Attached Document Listing
Required Information
<2025A> Round 1 or Round 2 Recipient of Incremental Support?
<2025B> Attach geocoded Information for Phase I milestone reports (Round 1 for
year three and Round 2 for year two) - Connect America Fund , WC
Docket 10-90, Report and Order, FCC 13-
Name of Attached Document Listing
Required Information

<2015> 2016 and future Frozen Support Certification 47 CFR § 54.313(c)(4)
Select the appropriate responses below (Yes, No, Not Applicable) to note compliance as a recipient of Incremental High Cost support, High Cost support to offset access charge reductions,
and Connect America Phase II support as set forth in 47 CFR § 54.313(b),(c),(d),(e). The information reported on this form and in the documents attached below is accurate.
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
Page 16
(2000) Price Cap Carrier Additional Documentation (Continued)FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
Including Rate-of-Return Carriers affiliated with Price Cap Local Exchange Carriers July 2013
Price Cap Carrier Connect America ICC Support {47 CFR § 54.313(d)}
<2016> Certification support used to build broadband
Page 16
Connect America Phase II Reporting {47 CFR § 54.313(e)}
<2017A> Connect America Fund Phase II recipient?
<2017B> Attach information for Phase II - 54.313(e)(1) - list of geocoded locations
already meeting the 54.309 public interest obligations at the end of
calendar year 2015 and total amount of Phase II support, if any, the price
cap carrier used for capital expenditures in 2015.
Name of Attached Document Listing
Required Information
<2018> Attach the number, names, and addresses of community anchor
institutions to which the carrier newly began providing access to
broadband service in the preceding calendar year - 54.313(e)(2)(ii)
Name of Attached Document Listing
Required Information

<2019> Recipient certifies that it bid on category one telecommunications and
Internet access services in response to all FCC Form 470 postings seeking
broadband service that meets the connectivity targets for the schools and
libraries universal service support program for eligible schools and
libraries located within any area in a census block where the carrier is
receiving Phase II model-based support, and that such bids were at rates
reasonably comparable to rates charged to eligible schools and libraries in
urban areas for comparable offerings - 54.313(e)(2)(v)

<2020> Recipient certifies that it offered broadband meeting the requisite public
interest obligations specified in §54.309 to 40% of its supported locations
in the state on December 31, 2017 - 54.313(e)(3)

<2021> Recipient certifies that it offered broadband meeting the requisite public
interest obligations specified in §54.309 to 60% of its supported locations
in the state on December 31, 2018 - 54.313(e)(4)

<2026>Recipient certifies that it offered broadband meeting the requisite public
interest obligations specified in §54.309 to 80% of its supported locations
in the state on December 31, 2019 - 54.313(e)(5)

<2027>Recipient certifies that it offered broadband meeting the requisite public
interest obligations specified in §54.309 to 100% of its supported locations
in the state on December 31, 2020 - 54.313(e)(6)
<010> Study Area Code

<015> Study Area Name
<020> Program Year
<030> Contact Name - Person USAC should contact regarding this data
<035> Contact Telephone Number - Number of person identified in data line <030>
<039> Contact Email Address - Email Address of person identified in data line <030>

Complete the items below to note compliance with five year service quality plan (pursuant to 47 CFR § 54.202(a)) and, for privately held carriers, ensuring
compliance with the financial reporting requirements set forth in 47 CFR § 54.313(f)(2). I further certify that the information reported on this form and in
the documents attached below is accurate.

Progress Report on 5 Year Plan
(3009) Carrier certifies to 54.313(f)(1)(iii)

(3010A) Milestone Certification {47 CFR § 54.313(f)(1)(i)}

(3010B) Please Provide Attachment Name of Attached Document Listing Required
Information
(3012A) Community Anchor Institutions {47 CFR §
54.313(f)(1)(ii)}

(3012B) Please Provide Attachment Name of Attached Document Listing Required
Information

(3013) Is your company a Privately Held ROR Carrier {47 CFR
§ 54.313(f)(2)}
(Yes/No)

(3014) If yes, does your company file the RUS annual report

Please check these boxes to confirm that the
attached PDF, on line 3017, contains the required
information pursuant to § 54.313(f)(2) compliance
requires:
(Yes/No)

(3015) Electronic copy of their annual RUS reports
(Operating Report for Telecommunications
Borrowers)

(3016) Document(s) with Balance Sheet, Income Statement
and Statement of Cash Flows

(3017) If the response is yes on line 3014, attach your
company's RUS annual report and all required
documentation
Name of Attached Document Listing Required
Information

(3018) If the response is no on line 3014, is your company
audited?
If the response is yes on line 3018, please check the
boxes below to confirm your submission on line
3026 pursuant to § 54.313(f)(2), contains:
(Yes/No)

(3019) Either a copy of their audited financial statement; or
(2) a financial report in a format comparable to RUS
Operating Report for Telecommunications Borrowers

(3020) Document(s) for Balance Sheet, Income Statement
and Statement of Cash Flows

(3021) Management letter and/or audit opinion issued by
the independent certified public accountant that
performed the company’s financial audit.
If the response is no on line 3018, please check the
boxes below to confirm your submission on line
3026 pursuant to § 54.313(f)(2), contains:

(3022) Copy of their financial statement which has been
subject to review by an independent certified public
accountant; or 2) a financial report in a format
comparable to RUS Operating Report for
Telecommunications Borrowers

(3023) Underlying information subjected to a review by an
independent certified public accountant

(3024) Underlying information subjected to an officer
certification.

(3025) Document(s) for Balance Sheet, Income Statement
and Statement of Cash Flows

(3026) Attach the worksheet listing required information Name of Attached Document Listing Required
Information

page 17
(3005) Rate Of Return Carrier Additional Documentation FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
Page 17
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
Page 18
Page 18
(3005) Rate Of Return Carrier Additional Documentation (Continued)FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
Name of Attached Document Listing Required Information

Financial Data Summary
(3027) Revenue
(3028) Operating Expenses
(3029) Net Income
(3030) Telephone Plant In Service(TPIS)
(3031) Total Assets
(3032) Total Debt
(3033) Total Equity
(3034) Dividends
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011

<010> Study Area Code
<015> Study Area Name
<020> Program Year
<030> Contact Name - Person USAC should contact regarding this data
<035> Contact Telephone Number - Number of person identified in data line <030>
<039> Contact Email Address - Email Address of person identified in data line <030>

4005 Rural Broadband Experiment

Authorized Rural Broadband Experiment (RBE) recipients must address the certification for public interest obligations, provide a list of newly served
community anchor institutions, and provide a list of locations where broadband has been deployed.

Public Interest Obligations – FCC 14-98 (paragraphs 26-29, 78)
Please address Line 4001 regarding compliance with the Commission’s public interest obligations. All RBE participants must provide a response to Line 4001.
4001. Recipient certifies that it is offering broadband to the identified locations meeting the requisite public
interest obligations consistent with the category for which they were selected, including broadband speed,
latency, usage capacity, and rates that are reasonably comparable to rates for comparable offerings in urban
areas?

Community Anchor Institutions – FCC 14-98 (paragraph 79)

4003a. RBE participants must provide the number, names, and addresses of community anchor institutions to
which they newly deployed broadband service in the preceding calendar year. On this line, please respond
(yes – attach new community anchors, no – no new anchors) to indicate whether this list will be provided.

If yes to 4003A, please provide a response for 4003B.

4003b. Provide the number, names and addresses
of community anchor institutions to which the
recipient newly began providing access to
broadband service in the preceding calendar year.
Name of Attached Document Listing Required Information

Broadband Deployment Locations – FCC 14-98 (paragraph 80)

4004a. Attach a list of geocoded locations to
which broadband has been deployed as of the
June 1st immediately preceding the July 1st filing
deadline for the FCC Form 481.

Name of Attached Document Listing Required Information

4004b. Attach evidence demonstrating that the
recipient is meeting the relevant public service
obligations for the identified locations. Materials
must at least detail the pricing, offered broadband
speed and data usage allowances available in the
relevant geographic area.

Name of Attached Document Listing Required Information

FCC Form 481 (4005) Rural Broadband Experiment Additional Documentation OMB Control No. 3060-0986/OMB Control No. 3060-0819

Data Collection Form
July 2013

page 19
Page 19
Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
Page 20
Page 20
Certification - Reporting Carrier FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING ANNUAL REPORTING ON ITS OWN BEHALF:
Printed name of Authorized Officer:
Certification of Officer as to the Accuracy of the Data Reported for the Annual Reporting for CAF or LI Recipients
Name of Reporting Carrier:
Signature of Authorized Officer:Date
I certify that I am an officer of the reporting carrier; my responsibilities include ensuring the accuracy of the annual reporting requirements for universal service support
recipients; and, to the best of my knowledge, the information reported on this form and in any attachments is accurate.
Title or position of Authorized Officer:
Telephone number of Authorized Officer:
Study Area Code of Reporting Carrier:Filing Due Date for this form:

Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C. §§ 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001.

CERTIFIED ONLINE
07/01/2016
3078836675 ext.
Michelle Motzkus
Jefferson England
2017
06/23/2016
[e-mail]
Gold Star Communications LLC
CFO
Gold Star Communications LLC
3078836690 ext.
479011
479011
Page 21
Page 21
Certification - Agent / Carrier FCC Form 481Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>

Certification of Agent Authorized to File Annual Reports for CAF or LI Recipients on Behalf of Reporting Carrier
TO BE COMPLETED BY THE AUTHORIZED AGENT:
Telephone number of Authorized Agent or Employee of Agent:
Signature of Authorized Agent or Employee of Agent:
Name of Authorized Agent Firm:
I, as agent for the reporting carrier, certify that I am authorized to submit the annual reports for universal service support recipients on behalf of the reporting carrier; I have provided
the data reported herein based on data provided by the reporting carrier; and, to the best of my knowledge, the information reported herein is accurate.
Date:
Name of Authorized Agent Employee:
Title or position of Authorized Agent or Employee of Agent
Name of Reporting Carrier:
Study Area Code of Reporting Carrier:Filing Due Date for this form:
Printed name of Authorized Officer:
Name of Reporting Carrier:
Study Area Code of Reporting Carrier:
Title or position of Authorized Officer:
Telephone number of Authorized Officer:
Filing Due Date for this form:
TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING ANNUAL REPORTS ON THE CARRIER'S BEHALF:
Certification of Officer to Authorize an Agent to File Annual Reports for CAF or LI Recipients on Behalf of Reporting Carrier
I certify that (Name of Agent)_______________________________________________________ is authorized to submit the information reported on behalf of the reporting carrier. I
also certify that I am an officer of the reporting carrier; my responsibilities include ensuring the accuracy of the annual data reporting requirements provided to the authorized
agent; and, to the best of my knowledge, the reports and data provided to the authorized agent is accurate.
Date:
Name of Authorized Agent:
Signature of Authorized Officer:

Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C. §§ 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001.
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C. §§ 502, 503(b), or fine or imprisonment under Title
18 of the United States Code, 18 U.S.C. § 1001.

Michelle Motzkus
2017
[e-mail]
Gold Star Communications LLC
3078836690 ext.
479011
Attachments
(700) Price Offerings including Voice Rate Data FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
<701>Residential Local Service Charge Effective Date
<702>Single State-wide Residential Local Service Charge
<703>

<a1><a2><a3><b1><b2>
State Exchange (ILEC)SAC (CETC)Rate Type
Residential Local
Service Rate

<c>
Total per line Rates and Fees
<b5>
Mandatory Extended Area
Service Charge
<b4>
State Universal Service Fee
<b3>
State Subscriber Line Charge

Michelle Motzkus
1/1/2016
29.99
49.99
69.99
24.99
39.99
89.99
2017
[e-mail]
0.0
0.0
0.0
0.0
0.0
0.0
Gold Star Communications LLC
ID
ID
ID
ID
ID
ID
MS
MS
MS
MS
MS
3078836690 ext.
FR
0.0
0.0
0.0
0.0
0.0
0.0
49.99
69.99
89.99
29.99
39.99
24.99
0.0
0.0
0.0
0.0
479011
0.0
0.0
<813>

<a3>
Doing Business As Company or Brand Designation
<a1>
Affiliates
<a2>
SAC
(800) Operating Companies FCC Form 481
Data Collection Form OMB Control No. 3060-0986
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
<810>Reporting Carrier
<811>Holding Company
<812>Operating Company

/OMB Control No. 3060-0819

Horizon Communications, Inc.
Michelle Motzkus
Gold Star Communications, LLC
Silver Star Communications
Silver Star Communications
2017
Silver Star Communications
Silver Star Communications
Silver Star Communications
[e-mail]
Gold Star Communications. LLC
Gold Star Communications LLC
3078836690 ext.
Columbine Telephone Company, Inc.
Silver Star Telephone Company, Inc.
Gold Star Communications, LLC
Millennium Networks, LLC
Silver Star Telephone Company, Inc.
479011
519001
512295
472295
519005
Attachments
Gold Star Communications, LLC
dba Silver Star Communications (“Silver Star”)
SAC 479011 – Idaho

Service Quality Standards & Consumer Protection Rules
Statement of Compliance
(FCC Form 481 – Line 510)

Silver Star has established operating procedures designed to facilitate compliance with applicable
consumer protection rules; including rules regarding verification of orders for telecommunications
service as required of submitting carriers (i.e., Slamming) {Section 64.1100}, compliance with the FCC’s
Truth-in-Billing Requirements {64.2400}, compliance with the FCC’s customer proprietary network
information (CPNI) Requirements {64.2009}, consumer protection and service quality rules pursuant to
the CTIA Code of Conduct, and all other customer protection rules including employee training and
policy manual development as applicable.

Gold Star Communications, LLC
dba Silver Star Communications (“Silver Star”)
SAC 479011 – Idaho

Functionality in Emergency Situations
Statement of Compliance
(FCC Form 481 – Line 610)

Silver Star has established operating procedures designed to facilitate compliance with
applicable service quality standards, which may include customer remedies and
improvement plans. Specifically Silver Star maintains its entire plant and system in such
condition as to enable it to furnish safe and continuous service and it inspect its system
and facilities in such manner and with such frequency as may be necessary to obtain
knowledge of their current condition and adequacy. Silver Star is capable of functioning
in emergency situations, by maintaining both battery and generator back-up power,
which ensure reasonable functionality of voice services without an external power
source. Additionally, voice traffic can be routed around damaged facilities, and Silver
Star is capable of managing traffic spikes resulting from emergency situations.

(700) Price Offerings including Voice Rate Data FCC Form 481
Data Collection Form OMB Control No. 3060-0986/OMB Control No. 3060-0819
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
<701>Residential Local Service Charge Effective Date
<702>Single State-wide Residential Local Service Charge
<703>

<a1><a2><a3><b1><b2>
State Exchange (ILEC)SAC (CETC)Rate Type
Residential Local
Service Rate

<c>
Total per line Rates and Fees
<b5>
Mandatory Extended Area
Service Charge
<b4>
State Universal Service Fee
<b3>
State Subscriber Line Charge

Michelle Motzkus
1/1/2016
29.99
49.99
69.99
24.99
39.99
89.99
2017
[e-mail]
0.0
0.0
0.0
0.0
0.0
0.0
Gold Star Communications LLC
ID
ID
ID
ID
ID
ID
MS
MS
MS
MS
MS
3078836690 ext.
FR
0.0
0.0
0.0
0.0
0.0
0.0
49.99
69.99
89.99
29.99
39.99
24.99
0.0
0.0
0.0
0.0
479011
0.0
0.0
<813>

<a3>
Doing Business As Company or Brand Designation
<a1>
Affiliates
<a2>
SAC
(800) Operating Companies FCC Form 481
Data Collection Form OMB Control No. 3060-0986
July 2013
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
<810>Reporting Carrier
<811>Holding Company
<812>Operating Company

/OMB Control No. 3060-0819

Horizon Communications, Inc.
Michelle Motzkus
Gold Star Communications, LLC
Silver Star Communications
Silver Star Communications
2017
Silver Star Communications
Silver Star Communications
Silver Star Communications
[e-mail]
Gold Star Communications. LLC
Gold Star Communications LLC
3078836690 ext.
Columbine Telephone Company, Inc.
Silver Star Telephone Company, Inc.
Gold Star Communications, LLC
Millennium Networks, LLC
Silver Star Telephone Company, Inc.
479011
519001
512295
472295
519005
Gold Star Communications, LLC
dba Silver Star Communications (“Silver Star”)

SAC 479011 – Idaho

Low-Income Telephone Assistance Program Terms & Conditions

Statement of Compliance
(FCC Form 481 – Line 1210)

Silver Star provides unlimited local calling for lifeline-eligible residential
customers, discounted by the federally authorized amount of $9.25, and
state telephone assistance discounts, where applicable. Silver Star’s
lifeline-discounted monthly telephone service provides access to
emergency, operator, interexchange, and directory assistance services.
The service does not include enhanced calling features such as voice
mail, caller ID, call forwarding, internet or long distance telephone
service. Toll Limitation service is provided at no charge for lifeline
customers, upon customer request and pursuant to FCC guidelines.