20190204Potlatch Telephone Form 555.pdf

525 Junction Rd
lVlodison, Wl53717
www,tdstelecom,com
f[fi -l+ F,l'l ll: 3 I
January 31,2019
Via UPS
Ms. Diane Hanian
Commission Secretary
ldaho Public Utilities Commission
472W. Washington St.
Boise, lD 83720-5983
RE: Case # GNR-T-19-01
FCC Form 555 Annual Lifeline Eligible Telecommunications Carrier Certification Form
for TDS Telecom
Dear Secretary Hanian
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 29,2019.
TDS' FCC Form 555 included the Affiliated SACs in our filing with USAC. Due to a USAC
system issue, the affiliate information does not appear in the certified forms. We are attaching
the affiliate information with a copy of our certified Form 555 for this state notification.
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,
Nicole Mauritz
Regulatory Compliance Manager
Attachments
Gail Long
Nez Perce Tribe
cc:
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 semice).
2018 lD Potlatch Telephone Company lnc
Recertification Year
N/A
State ETC Name
TDS Telecom munications Corporation
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do nu leave blank)
Holding Company Name
(lf same as ETC name, list "N/A" Do not leave blank)
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers 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: January 31st (Annually)
Does the reporting company have affiliated ETCs? Yes @ No @
Provide a list of all ETCr that are ffiliated with the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall be
determined in accordonce 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 contol with, another person. " 17 U.S.C. S I 53(2). See also 47
c.F.R. $ 76.t200.
Affiliated ETC's SAC
I
lAffiliated ETC's Name
-- See attache{ worksheet -
1
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not assess and collect a monthlyfee from their Lifeline subscribers are subjectlo lhe non-usage requiremenls. ETCs subject lo lhe non-usage requirements must indicate lhe number ofsubscribers de-enrolled by monlh in
Section 4. ETCs that only assess afee but do not collect suchfees are subject to the non-usage requirements and musl also indicate the number of
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? yes E[ No ED
I/yes, record the number ofsubscribers 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
May 0
June 0
July 0
August 0
September 0
October 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 Certificati oo All ETCs must 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
Minimum Service Level
I certify that the company listed above is in compliance with the minimum service levels set forth in the 47 CFR Section
s4.40{.
I am an officer of the company named above. I am authorized to make this certification for the SACs listed above.
Initiat AKM
Annual Recertification
Do nol leave empty blocl<s. 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 recertifying (A-B)
Recertification Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number verified access to a state or federal database.
E. Name of the data source(s) used to veriff consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertifo (You may also use this section to repon subscriber initiated recertifications).
the number ine subscribers the ETC contacted to obtain recertification ofel
G. Subscribers who failed to recertify through ETC direct outreach attempt
the number of Lifeline subscribers to ot to the
3
Jan Feb Mar Apr May Jun Jul Aug Sep 0ct Nov Dec Year
Total
A.2 1 1 0 3 0 0 0 2 0 2 2 13
B.0 0 0 0 0 0 0 0 0 0 0 0 0
C.2 1 1 0 3 0 0 0 2 0 2 2 13
Jan Feb Mar Apr May Jun Jul Aug sep Oct \ov Dec Year
Total
D 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan F'eb Mar Apr Mav Jun Jul Aug Sep Oct Nov Dec Year
Total
r 0 0 0 0 0 0 0 0 0 0 0 0 0
Apr May Jun Jul Aug Sep Oct )tiov Dec Year
I'otal
Jan ['eb !tar
G.0 0 0 0 0 0 0 0 0 0 0 00
H. Subscribers who recertified through ETC direct outreach attempt
the number of Lifeline subscribers that recertified ETC's outreach
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number of Lifeline subscribers contacted a state third administrator.or USAC for the of recertification.
Name of third party administrator used to verifo 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 outrgach lrom a state third administrator or USAC.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number of subscribers that recertified from a state administrator third administrator. or USAC
Certification:
Recertification Method: Database
I certify 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
Jun Jul Aug sep Oct \ov Dec Year
Total
Jan F'eb Mar Apr )Iav
0 0 0 0 0 0 0 0 0 0H.0 0 0
Year
Total
Jan Feb Mar Ap.May Jun Jul Aug Sep Oct Nov Dec
I 2 1 1 0 3 0 0 0 2 0 2 2 13
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.
1 1 1 0 1 0 0 0 0 0 1 1 6
Oct Nov Dec Year
Total
Jan t-cb Mar Apr May Jun Jul Aug sep
1 7L.
1 0 0 0 2 0 0 0 2 0 1
J.
M: (G+K)N = (D+F+I)O = MAti*100
Total number ofsubscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent of subscribers due for
recertifi cation w ho were de-enrolled
6 13 46.15o/o
Recertification Method: ETC
I certify that the company listed above has procedures in place to recertifu 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.
Initial
Recertification Method: Third Party
I certify that the company listed above has procedures in place to recertify 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.
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 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,
Amanda Moore, Assistant Treasurer Amanda Moore, Assistant Treasr
Signature of Officer
amanda. moore@tdstelecom. com
Email Address of Officer
Nicole Mauritz
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 29,2019
Date
608.664.2415
Contact Phone Number
5
1n;1;s1 AKM
Affiliated ETCs
SAC Name
6
SAC Name
Attachment - TDS Telecommunications LLC Affiliates
SAC Name
10000s Cobbosseecontee Telephone Company
1 00007 The lsland Telephone Company
1 0001 0 Hampden Telephone Company
1 0001 1 Hartland & St. Albans Telephone Company
100024 Somerset Telephone Company
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
1 20050 Wilton Telephone Company, lnc.
123321 Hollis Telephone Company, lnc
129002 NH #1 RuralCellular, lnc. (U.S. Cellular)
140058 Ludlow Telephone Company
140061 Northfield Telephone Company
140062 Perkinsville Telephone Company, lnc.
I 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
1 701 83 Mahanoy & Mahantango Telephone Company
170206 Sugar Valley Telephone Company
190217 Amelia Telephone Corporation
I 90253 Virqinia Teleohone Companv
1 93029 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 Ridqe 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.
240s35 Norwav Telephone Co. lnc
240544 St. Steohen Teleohone Companv
240551 Williston Telephone Company
250284 Butler Telephone Company, lnc.
25031 1 Oakman Telephone Company, lnc.
250314 Peoples Teleohone Companv, lnc.
370677 lsland Telephone Company
31058s Chatham Telephone Company
3L0726 Shiawassee Telephone Company
310738 Wolverine Telephone Companv
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
320831 West Point Telephone Company
330844 Badger Telecom, LLC
330849 Black Earth Telephone Company, LLC.
3308s1 Bonduel Telephone Companv, LLC.
330856
Burlington, Brighton & Wheatland Telephone
Companv, LLC
330859 Central State Telephone Company, LLC
330875 Dickewille 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
330930 Grantland Telecom, LLC
330943 Riverside Telecom, LLC
330945 Scandinavia Telephone Company, LLC
330952 Southeast Telephone Co. of Wisconsin, LLC
3309s4
Stockbridge & Sherwood Telephone Company,
LLC
3309ss State Long Distance Telephone Company
3309s8 Tenney Telephone Company, LLC
330963 Utelco, LLC.
330968 Waunakee Telephone Company, LLC.
339007 United States Cellular Operating Company, LLC
3s9016
Farmers Cellular Telephone Company, lnc
(U.S. Cellular)
361350 Arvig Telephone Company
36t362 Bridqe Water Telephone Co
351413 KMP d/b/a Mid-State Telephone Company
361433 Mid-State Telephone Company
361507 Winsted Telephone Company
Attachment - TDS Telecommunications LLC Affiliates
260411 Leslie Countv Telephone Companv
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.
299010
United States Cellular Operating Company of
Knoxville
300585 Arcadia Telephone Company
300607 Continental Telephone Company
300613 Little Miami Communications Corporation
300645 Oakwood Telephone Company
300662 The Vanlue Telephone Company
310672 Communications Corporation of Michiqan
43L984 Oklahoma Communication Svstems, lnc
4320t0 Mid-America Telephone, lnc.
452171.Arizona Telephone Company
452174 Southwestern Telephone Company
462L84 Delta County Tele-Comm, lnc
462207 Strasburg Telephone Company
472230 Potlatch Telephone Company, lnc.
522404 Asotin Telephone Company (WA)
522427 Lewis River Telephone Comoanv, lnc.
522430 McDaniel Telephone Company
529001
McDaniel Cellular Telephone Company (U.S.
Cellular)
532404 Asotin Telephone Company (OR)
539002 USCOC of Oregon RSA #5, lnc. (U.S. Cellular)
542321.Happy Valley Telephone Company
s42322 Hornitos Telephone Company
542323 Winterhaven Telephone Company