The URL can be used to link to this page

Home My WebLink About20250123Potlatch Telephone Company Inc Form 555.pdf 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 RECEIVED IMPORTANT: PLEASE READ INSTRUCTIONS FIRST 2025 January 23, 3:43PM Deadline: January 31st(Annually) IDAHO PUBLIC UTILITIES COMMISSION 472230 143002520 Study Area Code(SAC) Service Provider Identification Number(SPIN) (An Eligible Telecommunications Carrier(ETC)must provide a certification form for each SAC that provides Lifeline service). 2024 ID Potlatch Telephone Company, Inc Recertification Year State ETC Name Telephone and Data Systems, Inc. DBA, Marketing,or Other Branding Name Holding Company Name (If same as ETC name,list"N/A"Do not leave blank) (If same as ETC name,list"N/A"Do not leave blank) Does the reporting company have affiliated ETCs? Yes X No 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 orcontrol with,another person."47 U.S.C.§153(2).See also 47 C.F.R.§76.1200. Affiliated ETC's SAC Affiliated ETC's Name 250284 Butler Telephone Company, Inc. 250314 Peoples Telephone Company, Inc. 250311 Oakman Telephone Company, Inc. 452174 Southwestern Telephone Company 220375 Nelson-Ball Ground Telephone Company 320830 Tri-County Telephone Company, Inc 320744 Camden Telephone Company, Inc. 320837 West Point Telephone Company 320829 Tipton Telephone Company, Inc 320816 S &W Telephone Company, Inc. 320809 Communications Corporation of Southern Indiana 320788 The Merchants & Farmers Telephone Company 320778 Home Telephone Company, Inc. (Waldron) 320777 The Home Telephone Company of Pittsboro, Inc. 320776 Communications Corporation of Indiana 452171 Arizona Telephone Company 542323 Winterhaven Telephone Company 542322 Hornitos Telephone Company 542321 Happy Valley Telephone Company 462184 Delta County Tele-Comm, Inc. 462207 Strasburg Telephone Company 1 210338 Quincy Telephone Company (Florida) 220351 Camden Telephone &Telegraph Company, Inc. 220346 Blue Ridge Telephone Company 220338 Quincy Telephone Company (Georgia) 310726 Shiawassee Telephone Company 310685 Chatham Telephone Company 310677 Island Telephone Company 310672 Communication Corporation of Michigan 361413 Mid State Telephone Company KMP 361362 Bridge Water Telephone Company 361350 Arvig Telephone Company 361507 Winsted Telephone Company 361433 Mid-State Telephone Company 287449 Myrtle Telephone Company, Inc 280448 Calhoun City Telephone Company, Inc. 283301 Southeast Mississippi Telephone Company, Inc 120049 Union Telephone Company 120047 Merrimack County Telephone Company 123321 Hollis Telephone Company, Inc. 120050 Wilton Telephone Company 120045 Kearsarge Telephone Company 150133 Vernon Telephone Company, Inc 150129 Township Telephone Company, Inc. 150089 Deposit Telephone Company, Inc. 150092 Edwards Telephone Company, Inc 150118 Port Byron Telephone Company 150114 Oriskany Falls Telephone Corporation 300645 Oakwood Telephone Company 300613 Little Miami Communications Corporation 300607 Continental Telephone Company 300585 Arcadia Telephone Company 300662 The Vanlue Telephone Company 431984 Oklahoma Communication Systems, Inc. DBA TDS Telec om 432010 Mid-America Telephone, Inc. 532404 Asotin Telephone Company-Oregon 170206 Sugar Valley Telephone Company 170183 Mahanoy& Mahantango Telephone Company 240544 St. Stephen Telephone Company 240535 Norway Telephone Company, Inc. 2 240533 McClellanville Telephone Company, Inc. 240551 Williston Telephone Company 290578 Tellico Telephone Company, Inc. 290566 Humphreys County Telephone Company 290559 Concord Telephone Exchange, Inc. 290575 Tennessee Telephone Company 260417 Salem Telephone Company 260412 Lewisport Telephone Company 260411 Lesile County Telephone Company 100005 Cobbosseecontee Telephone Company 100010 Hampden Telephone Company 100007 The Island Telephone Company 100024 Somerset Telephone Company 100034 The West Penobscot Telephone and Telegraph Company 100031 Warren Telephone Company 100011 Hartland and St. Albans Telephone Company 310738 Wolverine Telephone Company 190217 Amelia Telephone Corporation 190253 Virginia Telephone Company 193029 New Castle Telephone Company 140058 Ludlow Telephone Company 140062 Perkinsville Telephone Company, Inc. 140061 Northfield Telephone Company 522404 Asotin Telephone Company-Washington 522427 Lewis River Telephone Company, Inc. 522430 McDaniel Telephone Company 330945 The Scandinavia Telephone Company, LLC 330943 Riverside Telecom, LLC 330881 Mid-Plains Telephone, LLC 330880 The Farmers Telephone Company, LLC 330875 Dickeyville Telephone, LLC 330859 Central State Telephone Company, LLC 330856 Burlington, Brighton, &Wheatland Telephone Company 330851 Bonduel Telephone Company 330849 Black Earth Telephone Company, LLC 330844 Badger Telecom, LLC 330930 Grantland Telecom, Inc. 330968 Waunakee Telephone Company 330963 UTELCO, LLC 3 330958 Tenney Telephone Company, LLC 330955 State Long Distance Telephone Company, LLC 330954 Stockbridge & Sherwood Telephone Company 330917 Mt. Vernon Telephone Company, LLC 330915 Mosinee Telephone Company, LLC 330914 EastCoast Telecom, Inc 330909 Midway Telephone Company, LLC 330952 Southeast Telephone Company of Wisconsin Inc 4 Initial Certification All ETCs must complete this section. I certify that the company listed above: • Has policies and procedures in place to ensure that its Lifeline subscribers are eligible to receive Lifeline services; and • Is in compliance with all federal Lifeline certification procedures; and • Is in compliance with the minimum service levels set forth in 47 C.F.R. § 54.408. 1 am an officer of the company named above. I am authorized to make this certification for the SAC listed above. Initial TMB Annual Recertification Results Report the results of recertification efforts for the current calendar year. Do not leave blocks empty. If the National Verifier is responsible for conducting recertification, enter zero for blocks A-F. If the state Lifeline Administrator is responsible for conducting recertification,report the results for each block. A. Subscribers eligible for recertification within current calendar year B. Subscribers de-enrolled prior to recertification attempts C. Total number of subscribers required to be recertified (A-B) D. Subscribers successfully recertified E. Subscribers de-enrolled for failed recertification F. Percentage de-enrolled for failed recertification (E/C) I certify that the company listed above has procedures in place to recertify consumer eligibility by relying upon notice of eligibility from: state Lifeline administrator X National Verifier I am an officer of the company named above. I am authorized to make this certification for the SAC listed above. Initial TMB No Subscribers Certification Complete this section if ETC claimed no Lifeline subscribers. I certify that my company did not claim federal low income support 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(s)listed on this form Initial 5 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. ETCs that only assess a fee but do not collect such fees 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 X If yes,record the number of subscribers de-enrolled for non-usage by month in Block H below. G H Month Subscribers De-Enrolled for Non-Usage January February March April May June July August September October November December 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. Signature Block By signing below, I certify that the information provided is true and accurate. I am an officer of the company named above. I am authorized to make this certification for this SAC. Signed, Thomas Bader Thomas Bader-Assistant Treasurer Signature of Officer Printed Name and Title of Officer thomas.bader@tdsinc.com 01-17-2025 Email Address of Officer Date Nicole Mauritz 608-664-2415 Person Completing This Certification Form Contact Phone Number 6