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Home My WebLink About20170207Potlatch Telephone (TDS) Form 555.pdfJanuary 31, 2017 Via UPS Ms. Jean D Jewell Commission Secretary 525 Junction Rd Madison, WI 53717 www.tdstelecom.com Idaho Public Utilities Commission 472 W. Washington St. Boise, ID 83720-5983 RE: Case# GNR-T-17-01 zon FEB -7 A 9: 38 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 on January 30, 2017. If you have any questions concerning this matter or regarding the attached information, please contact me at 608-664-2415 or via e-mail at nicole.mauritz@tdstelecom.com. Sincerely, Nicole Mauritz Regulatory Compliance Manager Attachments cc: Gail Long Nez Perce Tribe FCC Form555 November 2016 0MB Approval 3060-0819 Annual Lifeline Eligible Telecommunications Carrier Certification Form P. [:CE VE D All carriers must complete all or portions of all sections Form must be submitted to USAC and filed with the Federal Communications C01'}1\1f S¥?:f3 -1 g: 3 8 IMPORTANT: PLEASE READ INSTRUCTIONS FIRST ,-I • " Deadline: January 3P' (Annually) i 1 : .. ·, }(:<')\\:~/ss10.1 472230 143002520 Study Area Code (SAC) Service Provider Identification Number (SPIN) (An Eligible Telecommunications Carrier (ETC) must provide a certification form f or each SAC through which it provides Lifeline service). 2016 ID Recertification Year State Potlatch Telephone Company, Inc. DBA, Marketing, or Other Branding Name (If same as ETC name, list "NIA" Do not leave blank) Does the reporting company have affiliated ETCs? Potlatch Telephone Company Inc ETC Name TDS Telecommunications Corporation Holding Company Name (If same as ETC name, list "NIA" Do not leave blank) Yes [ii] No [g] Provide a list of all ETCs that are affiliated with the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall be determined in accordance with Section 3(2) of the Communications Act. That Section defines "affiliate" as "a person that (directly or indirectly) owns or controls, is owned or controlled by, or is under common ownership or control with, another person." 47 USC.§ 153(2). See also 47 C.F.R. § 76.1200. Affiliated ETC's SAC Affiliated ETC's Name --See attached worksheet --I 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 t; Initial Certification All ETCs must complete this section I certify that the company listed above has certification procedures in place to: l 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; and/or B) Confirm consumer eligibility by relying upon access to a state database and/or notice of eligibility from the state Lifeline administrator prior to enrolling a consumer in the Lifeline program I am an officer of the company named above. I am authorized to make this certification for the Study Area Code listed above. I .. I AKM mtia FCC Form 555 Approved by 0MB November 2014 3060-0819 Sectiop 2; Annual Recertification Do not leave empty blocks. If an ETC has nothing to report in a block, enter a zero. A B C D E = (A -B -C -D) Number of subscribers Number of lines Number of subscribers claimed on the Number of subscribers Number of claimed on February claimed on February February FCC Form 497 that were de-enrolled prior to subscribers ETC is FCC Form 497 of FCC Form 497 of initially enrolled in the current Form recertification attempt responsible for current Form SSS current Form SSS SSS calendar year by either the ETC, a recertifying for calendar year calendar year state administrator, current Form SSS provided to wireline (These subscribers did not have Lifeline access to an eligibility calendar year (February data month) resellers service prior to January I of the current 555 database, or by USAC calendar year.) 25 0 0 3 22 Recertification Results: F Number of subscribers ETC contacted directly to recertify eligibility through attestation 11 K Number of subscribers whose eligibility was reviewed by state administrator, ETC access to eligibility database, or by USAC 11 Certification: G H= (F-G) I J = (H+I) Number of Number of non-Number of subscribers Number of subscribers de- subscribers responding responding to ETC subscribers contact 5 6 L Number of subscribers de-enrolled or scheduled to be de-enrolled as a result of finding of ineligibility by state administrator, ETC access to eligibility database, or USAC 0 responding that they are enrolled or scheduled to be no longer eligible de-enrolled as a result of non-response or response of (This should be a subset of Block ineligibility from ETC G.) recertification attempt 0 6 Note: If any subscriber was reviewed by an ETC accessing a state database or by a state administrator and subsequently contacted direct~v by the ETC in an attempt to recertify eligibility, those subscribers should be listed in Blocks F through J as appropriate and not in Blocks Kand L. As a result, all subscribers subject to recertification who were not de-enrolled prior to the recertification attempt must be accounted for in Block For Block K. The total of Block F and Block K should equal the number reported in Block E. Based on the data entered above, initial the certification(s) below that apply. Both Certification A and B may apply depending on the recertification procedures in place for the SAC reporting on this form. If Certification C applies, neither Certification A nor B may apply. A) I certify 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 officer of the company named above. I am authorized to make this certification for the SAC listed above. Initial AKM AND/OR B) I certify that the company listed above has procedures in place to recertify consumer eligibility by relying on: ~~~~--------------------------· (List database or name of administrator here) 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. Initial AKM OR C) I certify 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 year. I am an officer of the company named above. I am authorized to make this certification for the SAC listed above. Initial ___ _ 2 FCC Form 555 Approved by 0MB November 2014 3060-0819 Sectiop 3: De-enroll Percentage Using the data entered in Section 2, complete the chart below to find the percentage of subscribers de-enrolled for this ETC. M=(F+K) N = (J+L) 0 = ((N 7 M) * 100) Number of subscribers that the Number of subscribers Percentage of subscribers ETC attempted to recertify directly de-enrolled or de-enrolled or scheduled to or through a state administrator, scheduled to be de-be de-enrolled as a result of ETC access to a state database, or enrolled as a result of ineligibility or non-response byUSAC non-response or (This should equal the number ineligibility reported in Block E) 22 6 27.27% Section 4: ETCs Subject to the Non-Usage Requirements All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthly fee.from their Lifeline subscribers are subject to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number of subscribers de-enrolled by month in Section 4. ETCs that only assess a f ee but do not collect such f ees are subject to the non-usage requirements and must also indicate the number of subscribers de-enrolled by month. Is the ETC subject to the non-usage requirements? Yes~ No [ml If yes, record the number of subscribers de-enrolled for non-usage by month in Block Q below. p Q Month Subscribers De-Enrolled for Non-Usage January 0 February 0 March 0 April 0 May 0 June 0 July 0 August 0 September 0 October 0 November 0 December 0 Total Subscribers 0 Signature Block By signing below, I certify that the company listed above is in compliance with all federal Lifeline certification procedures. I am an officer of the company named above. I am authorized to make this certification for the Study Area Code (SAC) listed above. Signed, Certified Online Signature of Officer amanda.moore@tdstelecom.com Email Address of Officer Nicole Mauritz Person Completing This Certification Form Amanda Moore, Assistant Treasurer Printed Name and Title of Officer 01/30/2017 Date 608-664-2415 Contact Phone Number 3 FCCForm555 November 2014 SAC 100005 100007 100010 100011 100024 100031 100034 109002 1?004'i 120047 120049 120050 123321 129002 140058 140061 140062 150089 150092 150114 150118 150129 150133 170183 170206 190217 190253 193029 209005 210338 220346 220351 220375 239006 240533 240535 240544 240551 250284 250311 250314 260411 260412 260417 280448 283301 287449 290559 290566 290575 Affiliated ETCs Name Cobbosseecontee Telenhone Comnanv The Island Teleohone Comoanv Hamnden Teleohone Comoanv Approved by 0MB 3060-0819 Hartland and St. Albans Teleohone Comoanv Somerset Teleohone Comoanv Warren Teleohone Comoanv The West Penobscot Teleohone and Tele2raoh Comoanv Yakima MSA Limited Partnershio KP-arsarP"e Telenhone C:omnanv Merrimack Countv T eleohone Comoanv Union Teleohone Comoanv Wilton Telenhone Comnanv Contoocook Teleohone Comoanv. Hollis Teleohone Comm Yakima MSA Limited Partnershio Ludlow Teleohone Comoanv Northfield Teleohone Comoanv Perkinsville Teleohone Comoanv Inc. Deoosit Teleohone Comoanv Inc. Edwards T eleohone Comoanv Inc Oriskanv Falls Telenhone Comoration Port Bvron Teleohone Comoanv Townshio Teleohone Comoanv Inc. Vernon Teleohone Comoanv Inc Mahanov and Mahantan20 Teleohone Comoanv Su2ar Vallev Teleohone Comoanv Amelia Teleohone Comoration Virninia Teleohone Comoanv New Castle Teleohone Comoanv Yakima MSA Limited Partnershio Ouincv Teleohone Comoanv (Florida) Blue Rid2e Teleohone Comoanv Camden Teleohone and Tele2raoh Comoanv Inc. Nelson-Ball Ground Teleohone Comoanv Yakima MSA Limited Partnershio McClellanville Teleohone Comoanv Inc. Norwav Teleohone Comoanv Inc. St. Steohen Teleohone Comoanv Williston Teleohone Comoanv Butler Teleohone Comoanv Inc. Oakman Teleohone Comoanv Inc. Peonies Teleohone Comoanv Inc. Lesile Countv Teleohone Comoanv Lewisoort Teleohone Comoanv Salem Teleohone Comoanv Calhoun Citv Teleohone Comoanv Inc. Southeast Mississiooi Teleohone Comoanv Inc Mvrtle Teleohone Comoanv Inc Concord Teleohone Exchanl!e Inc. Humohrevs Countv Teleohone Comoanv Tennessee Teleohone Comoanv 4 FCC Form555 November 2014 SAC 290578 299010 300585 300607 300613 300645 300662 310672 11or,77 310685 310726 310738 320744 320776 320777 320778 320788 320809 320816 320829 320830 320837 330844 330849 330851 330856 330859 330875 330880 330881 330909 330914 330915 330917 330930 330943 330945 330952 330954 330955 330958 330963 330968 339007 359016 361350 361362 361413 361433 361507 Approved by 0MB 3060-0819 Affiliated ETCs Name Tellico Telenhone Comnanv Inc. Yakima MSA Limited Partnershio Arcadia Telenhone Comnanv Continental Teleohone Comoanv Little Miami Communications Corooration Oakwood Teleohone Comoanv The Vanlue T eleohone Comoanv Communication Comoration ofMichiean Island Telenhone f:omnanv Chatham Teleohone Comoanv Shiawassee Teleohone Comoanv Wolverine Telenhone Comnanv Camden Teleohone Comoanv Inc. Communications Como ration of Indiana The Home Teleohone Comoanv of Pittsboro Inc. Home Teleohone Comoanv Inc. (Waldron) The Merchants and Farmers Teleohone Comoanv Communications Comoration of Southern Indiana Sand W Teleohone Comoanv Inc. Tinton Telenhone Comoanv Inc Tri-Countv Teleohone Comoanv Inc West Point Teleohone Comoanv Badeer Telecom LLC Black Earth Teleohone Comoanv LLC Bonduel Teleohone Comoanv Burline:ton Briehton and Wheatland Teleohone Comoanv Central State Teleohone Comoanv LLC Dickevville Teleohone LLC The Farmers Teleohone Comoanv LLC Mid-Plains Teleohone LLC Midwav T eleohone Comoanv LLC EastCoast Telecom Inc Mosinee Teleohone Comoanv LLC Mt. Vernon T eleohone Comoanv LLC Grantland Telecom Inc. Riverside Telecom LLC The Scandinavia Teleohone Comoanv LLC Southeast Teleohone Comoanv of Wisconsin Inc Stockbridee and Sherwood Teleohone Comoanv State Lone Distance Teleohone Comoanv LLC Tennev Teleohone Comoanv LLC UTELCO LLC Waunakee Teleohone Comnanv Yakima MSA Limited Partnershin Yakima MSA Limited Partnershio Arvie Teleohone Comoanv Bridee Water Teleohone Comoanv Mid State Teleohone Comoanv KMP Mid-State Teleohone Comoanv Winsted Teleohone Comoanv 4 FCC Form555 November 2014 SAC 431984 432010 452171 452174 462184 462207 522404 522427 'i??.:i<fl 529001 532404 539002 542321 542322 542323 Affiliated ETCs Name Approved by 0MB 3060-0819 Oklahoma Communication Svstems Inc. DBA TDS Teleco Mid-America Teleohone Inc. Arizona Telenhone Comnanv Southwestern Teleohone Comoanv Delta Countv Tele-Comm Inc. Strasburn: Teleohone Comoanv Asotin Teleohone Comoanv-Washin!:!:ton Lewis River Teleohone Comoanv Inc. McDaniel Teleohone romoanv Yakima MSA Limited Partnershio Asotin Teleohone Comoanv-Ore!:!:on Yakima MSA Limited Partnershio Haoov Vallev Teleohone Comoanv Homitos Teleohone Comoanv Winterhaven Teleohone Comoanv 4