20260129Blackfoot Telephone Cooperative-Fremont Telcom Co FCC Form 555.pdf

Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers m ust com plete all or portions of
all sections Form m ust be subm tted to USAC and filed with the Federal Com m unications Com m$sion RECEIVED
IM PO RTANT: PLEASE READ INSTRUCTIO NS FIRST January 29, 2026
IDAHO PUBLIC
Deadline: January 31st(Annually) UTILITIES COMMISSION
482235 143002531
Study Area Code(SAC) Service Provider Identification Num ber(SPIN)
(An Eligible Telecom m wications Carrier(ETC)m ust provide a certification form for each SAC that provides Lifeline service).
2025 M T Blackfoot Telephone Cooperative, Inc.
Recertification Year State ETC Name
BTC HO IDING SINC
DBA, M arketing,or O her Branding Nam e Holding Com pony Nam e
(If sam e as ETC nam a list WIA"Do not leave blank) (If sam e as ETC nam a list WIA"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 determ hed in accordance with Section
3(2)of the Com m inications Act. That Section defines"affiliate"as"a person that(directly or indirectly)owns or controls,is owned or controlled by,or is under com Iran
ownership or control 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
472222 Frem cnt Telcom,Co.
489018 Blackfoot Communications, Inc.
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Initial Certification All ETCs m Lst complete this section.
I certify that the com pany listed above:
• I-bs policies and procedures in place to ensure that its Lifeline subscribers are eligible to receive Lifeline
services; and
• Is in com pliance with all federal Lifeline certification procedures; and
• is in com pliance with the m him unn service levels set forth in 47 C.F.R. § 54.408.
1 am an officer of the com pany nam ed above. I am authorized to m eke this certification for the SAC listed
above.
Initial SM
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
Adm nistrator 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 attem pts
C. Total num ber 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 com pany listed above has procedures in place to recertify consumer eligibility by relying upon
notice of eligibility from :—state Lifeline adm histrator X National Verifier
I am an officer of the com pany nam ed above. I am authorized to m*e this certification for the SAC listed
above.
Initial SM
No Subscribers Certification Complete this section if ETC claimed no Lifeline subscribers.
I certify that my com Zany did not claim federal low incom esupport for the current Form 555 data year. I am an officer of the com pany nam ed above. I
am authorized to m eke this certification for the SAC(s)listed on this form
Initial
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ETCs Subject to the Non-Usage Requirements
All ETCs m ust com p'ete the appropriate check-box.ETCs that do not assess and collect a m anthly fee from their Lifeline subscribers are subject to the
non-usage requirem efts.ETCs subject to the non-usage requirem ants m ust indicate the num ter of subscribers de-enrolled by m rnth. ETCs that only
assess a fee but do not collect such fees are subject to the non-usage requirem ents and m ust also indicate the num ter of subscribers de-enrolled by
m anth.
Is the ETC subject to the non-usage requirements?Yes_ No X
If yes,record the num ter of subscribers de-enrolled for non-usage by m anth in Block H below.
G H
M cnth Subscribers De-Enrolled for Non-Usage
January
February
M arch
April
M ay
June
July
August
Septem ber
O dober
Novem ber
Decem ber
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 Sim iar legal docum ant. An officer is a person who occupies a position specified in the corporate by-laws (or
partnership agreem Ent), and would typically be president, vice president for operations, vice president for finance,
com ptroller, treasurer, or a com parable position. If the filer is a sole proprietorship, the owner m Est sign the certification.
Signature Block
By signing below, I certify that the information provided is true and accurate. I am an officer of the com pany nam ed
above. I am authorized to m eke this certification for this SAC.
Signed,
Stacey M seller Stacey M seller-CFO
Signature of O ficer Printed Name and Title of O ficer
[e-mail] 01-20-2026
Email Address of O ficer Date
Beverly Freem an 4065415130
Person Competing This Certification Form Contact Phone Num ber
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