20180206Potlatch Telephone (TDS) Form 555.pdf

S2SJunction Rd
lVodison, Wl 537.l7
www,tdstelecom,com
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RE
January 31,2018
Via UPS
Ms. Dian Holt
Commission Secretary
Idaho Public Utilities Commission
472W. Washington St.
Boise, lD 83720-5983
Case # GNR-T-18-01
FCC Form 555 Annual Lifeline Eligible Telecommunications Carrier Certification Form
for TDS Telecom
Dear Secretary Holt:
Attached please find a copy of TDS Telecommunications LLC's ('TDS Telecom") Annual
Lifeline Eligible Telecommunications Carrier Certification Form (FCC Form 555) which was
filed with the Universal Service Administrative Company ("USAC") on January 31,2018.
Due to a filing system issue, we were not able to include the affiliate information with our
initial USAC filing. This information will be filed as a revision with USAC when the system
issue is resolved. We are attaching our affiliate information with a copy of our certified Form
555 for this state notification and we will not file revision with the state.
lf you have any questions concerning this matter or regarding the attached information,
please contact me at 608-664-24'15 or via e-mail at [e-mail].
Sincerely,
Nicole Mauritz
Regulatory Compliance Manager
Attachments
cc:Gail Long
Nez Perce Tribe
Annual Lifeline Eligible Telecommunications Carrier Certification Form All caniers must complete all or portions
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: Janaary 3t't (Annually)
Does the reporting company have affiliated ETCs? Yes Eil No E[
Provide a list of all ETCs that are ffiliated 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 contolwith, onother person." 47 U.S.C. S 153(2). See also 47
c.r.R. $ 76.1200.
Affiliated ETC's SAC Affiliated ETC's Name
472230 143002520
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline senice).
2017 ID Potlatch Telephone Company lnc
Recertification Year
N/A
State ETC Name
TDS Telecommunications Corporation
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do 4p11 leave blank)
Holding Company Name
(lf same as ETC name, list "N/A" Do not leaw blank)
7
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthlyfeefrom 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 afee but do not collect suchfees are subject to the non-usage requirements ond must also indicate the number of
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? Yes E[ No E[
Ifyes, record the number of subscribers de-enrolledfor non-usage by month in Block Q below.
P o
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
Mav 0
June 0
July 0
August 0
September 0
0
November 0
December 0
Total Subscribers 0
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.
Initial Ceftificatioll Att ETCs rnust complete this section
I certify that the company listed above has certification procedures in place to:
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.
AKMInitial
2
October
Minimum Service Level
I certifu that the company listed above is in compliance with the minimum service levels set forth in the 47 CFR Section
s4.408:
I am an officer of the company named above. I am authorized to make this certification for the SACs listed above.
Initial AKM
Annual Recertification
Do not leave empty bloclcs. If an ETC has nothing to report in a block, enter a zero.
Report the number of Lifeline subscribers due for recertification by month (January-December)A. Subscribers eligible for recertification by anniversary monthB. Subscribers de-enrolled prior to recertification attemptsC. Total number of subscribers ETC is responsible for recertifuing (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
E. Name of the data source(s) used to verifu consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifu (You may also use this section to report subscriber initiated recertifications).
the number the ETC contacted to obtain
G. Subscribers who failed to recertifu through ETC direct outreach attempt
of Lifeline or to the ETC's outreach
3
Jan Feb Mar Apr May Jun Jul Aug Sep 0ct Nov Dec Year
Total
A.0 0 0 0 0 0 1 0 3 1 4 1 10
B.0 0 0 0 0 0 0 0 0 0 0 0 0
C.0 0 0 0 0 0 1 0 3 1 4 1 10
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
F 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug Sep 0ct Nov Dec Year
Total
G.0 0 0 0 0 0 0 0 0 0 0 0 0
0
H. Subscribers who recertified through ETC direct outeach attempt
the number of Lifeline subscribers that recertified ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administratoq third party administrator, or USAC
the number ofLifeline subscribers contacted a state third administrator or USAC for the of recertification.
J. Name of third party administrator used to verifr subscriber eligibility:
USAC
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of or to outreach from a state third administrator.or USAC.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number oflsubscnbers that recertified from a state third administrator.or USACa
Recertification Method: Database
I certifu that the company listed above has procedures in place to recertify consumer eligibility by relying on a database. I
am an officer of the company named above. I am authorized to make this certification for the SAC(s) listed above.
Initial
4
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
H.0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
I.0 0 0 0 0 0 1 0 3 1 4 1 10
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.0 0 0 0 0 0 1 0 2 1 2 1 7
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
L.0 0 0 0 0 0 0 0 1 0 2 0 3
0
Certification:
Recertification Method: ETC
I certi! that the company listed above has procedures in place to recertiff 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. I am an officer of the company named above. I am authorized to make this
certification for the SAC(s) listed above.
Recertification Method: Third Party
I certifu that the company listed above has procedures in place to recertifu consumer eligibility by relying on an
administrator. I am an officer of the company named above. I am authorized to make this certification for the SAC(s)
listed above.
11;6s1 AKM
No Subscribers
I certify that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
data year. I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial
Signature Block
By signing below, I certifu 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,
Amanda Moore, Assistant Treasurer Amanda Moore, Assistant Treasr
Signature of Officer
a manda. moore@tdstelecom. com
Email Address of Oflicer
Nicole Mauritz
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 31 ,2018
Date
608.664.2415
Contact Phone Number
5
M=(c+K)N: (D|F+I)O = M/N*lfi)
Total number ofsubscribers de-enrolled as
a result of receftification
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertifi cation who were de-enrollcd
7 10 70.0%
Initial
Affiliated ETCs
SAC Name
6
TDS Telecommunications LLC AffiliatestSAC Name SAC Name
100005 Cobbosseecontee Telephone Company
1 00007 The lsland Telephone Company
100010 Hampden Telephone Company
10001 1 Hartland & St. Albans Telephone Company
100024 Somerset Telephone Gompany
1 00031 Warren Telephone Company
1 00034
The West Penobscot Telephone and Telegraph
Company
1 09002 U.S. Cellular
120045 Kearsarqe Telephone Company
120047 Merrimack County Telephone Company
120049 Union Telephone Company
120050 Wilton Telephone Company, lnc.
123321 Hollis Telephone Company, lnc.
129002 NH #1 Rural Cellular, lnc. (U.S. Cellular)
140058 Ludlow Telephone Company
140061 Northfield Telephone Company
140062 Perkinsville Telephone Company, lnc.
1 50089 Deposit Telephone Company, lnc.
1 50092 Edwards Telephone Company, lnc.
150114 Oriskany Falls Telephone Corporation
1501 18 Port Byron Telephone Company
150129 Township Telephone Company, lnc.
1 501 33 Vernon Telephone Company, lnc.
170183 Mahanoy & Mahantango Telephone Company
170206 Suqar Valley Telephone Company
190217 Amelia Telephone Corporation
1 90253 Virginia Telephone Company
193029 New Castle Telephone Co.
209005 Hardy Cellular Telephone Company (U.S. Cellular)
21 0338 Quincy Telephone Company (FL)
220338 Quincy Telephone Company (GA)
220346 Blue Ridge Telephone Company
220351 Camden Telephone and Telegraph Company, lnc.
220375 Nelson-Ball Ground Telephone Company
239006 Wilminqton Cellular Telephone Company
240533 McClellanville Telephone Company, lnc.
240535 Norwav Teleohone Co. lnc
240544 St. Stephen Telephone Company
240551 Williston Telephone Company
250284 Butler Telephone Company, lnc.
250311 Oakman Telephone Company, lnc.
250314 Peoples Telephone Company, lnc.
3LO677 lsland Telephone Company
Chatham Telephone Company
3to726 Shiawassee Telephone Company
310738 Wolverine Telephone Company
320744 Camden Telephone Company, lnc.
320776 Communications Corporation of lndiana
320777
The Home Telephone Company of Pittsboro,
lnc.
320778 Home Telephone Company, lnc.
320788
The Merchants and Farmers Telephone
Company
320809
Communications Corporation of Southern
lndiana
320815 S & W Telephone Company, lnc.
320829 Tipton Telephone Company, lnc.
320830 Tri-County Communications Corporation
320837 West Point Telephone Company
330844 Badqer Telecom, LLC
330849 Black Earth Telephone Company, LLC.
3308s1 Bonduel Telephone Company, LLC
330856
Burlington, Brighton & Wheatland Telephone
Company, LLG
330859 Central State Telephone Company, LLC
330875 Dickeyville Telephone, LLC
330880 The Farmers Telephone Company, LLC
330881 Mid-Plains Telephone, LLC
330909 Midway Telephone Company, LLC
330914 EastCoast Telecom of Wisconsin, LLC
33091s Mosinee Telehphone Company
330917 Mt. Vernon Telephone Company, LLC
Grantland Telecom, LLC
330943 Riverside Telecom, LLC
330945 Scandinavia Telephone Company, LLC
3309s2 Southeast Telephone Co. of Wisconsin, LLC
330954
Stockbridge & Sherwood Telephone Company,
LLC
330955 State Long Distance Telephone Company
330958 Tenney Telephone Company, LLC
330953 Utelco, LLC.
330968 Waunakee Telephone Companv, LLC
339007 United States Cellular Operating Company, LLC
359016
Farmers Cellular Telephone Company, lnc. (U.S
Cellular)
361350 Arvig Telephone Company
36L362 Bridqe Water Telephone Co.
361413 KMP d/b/a Mid-State Telephone Company
351433 Mid-State Telephone Company
361507 Winsted Telephone Company
310685
330930
260411 Leslie County Telephone Company
260412 Lewisport Telephone Co.
260417 Salem Telephone Co
280448 Calhoun Citv Telephone Company, lnc
283301 Southeast Mississippi Telephone Company, lnc.
287449 Myrtle Telephone Company, lnc.
290559 Concord Telephone Exchange, lnc
290566 Humphrevs Countv Telephone Companv
290575 Tennessee Telephone Company
290578 Tellico Telephone Company, lnc.
29901 0
United States Cellular Operating Company of
Knoxville
300585 Arcadia Telephone Company
300607 Continental Telephone Company
30061 3 Little Miami Communications Corporation
300645 Oakwood Telephone Company
300662 The Vanlue Telephone Company
310672 Communications Corporation of Michiqan
43L984 Oklahoma Communication Systems, lnc.
432010 Mid-America Telephone, lnc.
452171,Arizona Telephone Company
452t74 Southwestern Telephone Company
462L84 Delta County Tele-Comm, lnc.
462207 Strasbu rq Telephone Company
472230 Potlatch Telephone Company, lnc.
522404 Asotin Telephone Company (WA)
522427 Lewis River Telephone Company, lnc.
522430 McDaniel Telephone Company
529001
McDaniel Cellular Telephone Company (U.S.
Cellular)
532404 Asotin Telephone Company (OR)
s39002 USCOC of Oregon RSA #5, lnc. (U.S. Cellular)
542321 Happy Valley Telephone Company
542322 Hornitos Telephone Company
542323 Winterhaven Telephone Com pany