FCC Form 481 54.313 and 54.422 Data Collection Form

---

Overview

Form
(0100)_Service Quality
(0200) Voice Outages
(0700) VoicePricing
(0710) BB Pricing
(0800)_Operating Co
(0900)_Tribal Lands
(1110) No Terres Backhaul
(1200) Lifeline Term and Cond.
(2005) Price Cap Data
(3005) ROR Data
CERTIFICATION-REPORTING CARRIER
CERTIFICATION-AGENT
3005a BalanceSheet
3005b IncomeStatement
3005c Cashflow

---

Sheet 1: Form

											Approved by TBD
FCC Form 481 - Carrier Annual Reporting											OMB 3060-0986
Data Collection Form											Avg. Burden Estimate per Respondent: 20 Hours
<010>	Study Area Code
<015>	Study Area Name
<020>	Program Year
<030>	Contact Name: Person USAC should contact
	with questions about this data
<035>	Contact Telephone Number:
	Number of the person identified in data line <030>
<039>	Contact Email:
	Email of the person identified in data line <030>
ANNUAL REPORTING FOR ALL CARRIERS										54.313 Completion Required	54.422 Completion Required
										(check box when complete)
<100>	Service Quality Improvement Reporting					(complete attached worksheet)
<200>	Outage Reporting (voice)					(complete attached worksheet)
<210>				<-- check box if no outages to report
<300>	Unfulfilled Service Requests (voice)
<310>		Detail on Attempts (voice)				(attach descriptive document)
<320>	Unfulfilled Service Requests (broadband)
<330>		Detail on Attempts (broadband)				(attach descriptive document)
<400>	Number of Complaints per 1,000 customers (voice)
<410>			Fixed
<420>			Mobile
<430>	Number of Complaints per 1,000 customers (broadband)
<440>			Fixed
<450>			Mobile
<500>	Service Quality Standards & Consumer Protection Rules Compliance					(check to indicate certification)
<510>						(attached descriptive document)
<600>	Functionality in Emergency Situations					(check to indicate certification)
<610>						(attached descriptive document)
<700>	Company Price Offerings (voice)					(complete attached worksheet)
<710>	Company Price Offerings (broadband)					(complete attached worksheet)
<800>	Operating Companies and Affiliates					(complete attached worksheet)
<900>	Tribal Land Offerings (Y/N)?				(if yes, complete attached worksheet)
<1000>	Voice Services Rate Comparability				(check to indicate certification)
<1010>					(attach descriptive document)
<1100>	Terrestrial Backhaul (Y/N)?				(if not, check to indicate certification)
<1110>					(complete attached worksheet)
<1200>	Terms and Condition for Lifeline Customers				(complete attached worksheet)
	Price Cap Carriers, Proceed to Price Cap Additional Documentation Worksheet
	Including Rate-of-Return Carriers affiliated with Price Cap Local Exchange Carriers
<2000>						(check to indicate certification)
<2005>						(complete attached worksheet)
	Rate of Return Carriers, Proceed to ROR Additional Documentation Worksheet
<3000>						(check to indicate certification)
<3005>						(complete attached worksheet)

---

Sheet 2: (0100)_Service Quality

(100) Service Quality Improvement Reporting									FCC Form 481
Data Collection Form									OMB Control No. 3060-0986
									April 2013
<010>	Study Area Code
<015>	Study Area Name
<020>	Program Year
<030>	Contact Name - Person USAC should contact regarding this data
<035>	Contact Telephone Number - Number of person identified in data line <030>
<039>	Contact Email Address - Email Address of person identified in data line <030>
<110>	Has your company received its ETC certification from the FCC?		(yes / no )
<111>	If your answer to Line <110> is yes, do you have an existing §54.202(a) "5 year plan" filed with the FCC?		(yes / no )
	If your answer to Line <111> is yes, then you are required to file a progress report, on line <112> delineating the status of your company's existing § 54.202(a) "5 year plan" on file with the FCC, as it relates to your provision of voice telephony service.
<112>	Attach Five-Year Service Quality Improvement Plan or, in subsequent years, your annual progress report filed pursuant to 47 C.F.R. § 54.313(a)(1). If your company is a CETC which receives only frozen support, your progress report is only required to address voice telephony service
				Name of Attached Document (.pdf)
	Please check these boxes below to confirm that the attached PDF, on line 112, contains a progress report on its five-year service quality improvement plan pursuant to § 54.202(a). The information shall be submitted at the wire center level or census block as appropriate.
<113>	Maps detailing progress towards meeting plan targets
<114>	Report how much universal service (USF) support was received
<115>	How (USF) was used to improve service quality
<116>	How (USF)was used to improve service coverage
<117>	How (USF) was used to improve service capacity
<118>	Provide an explanation of network improvement targets not met
	in the prior calendar year.

---

Sheet 3: (0200) Voice Outages

(200) Service Outage Reporting (Voice)

FCC Form 481

Data Collection Form

OMB Control No. 3060-0986

April 2013

<010>

Study Area Code

<015>

Study Area Name

<020>

Program Year

<030>

Contact Name - Person USAC should contact regarding this data

<035>

Contact Telephone Number - Number of person identified in data line <030>

<039>

Contact Email Address - Email Address of person identified in data line <030>

<220>

<a>

<b1>

<b2>

<b3>

<b4>

<c1>

<c2>

<d>

<e>

<f>

<g>

<h>

NORS Reference Number

Outage Start Date

Outage Start Time

Outage End Date

Outage End Time

Number of Customers Affected

Total Number of Customers

911 Facilities Affected (Yes / No)

Service Outage Description (Check all that apply)

Did This Outage Affect Multiple Study Areas (Yes / No)

Service Outage Resolution

Preventative Procedures

---

Sheet 4: (0700) VoicePricing

(700) Price Offerings including Voice Rate Data

FCC Form 481

Data Collection Form

OMB Control No. 3060-0986

April 2013

<010>

Study Area Code

<015>

Study Area Name

<020>

Program Year

<030>

Contact Name - Person USAC should contact regarding this data

<035>

Contact Telephone Number - Number of person identified in data line <030>

<039>

Contact Email Address - Email Address of person identified in data line <030>

<701>

Residential Local Service Charge Effective Date

01/01/yyyy

<702>

Single State-wide Residential Local Service Charge

<703>

<a1>

<a2>

<a3>

<b1>

<b2>

<b3>

<b4>

<b5>

<c>

State

Exchange (ILEC)

SAC (CETC)

Rate Type

Residential Local Service Rate

State Subscriber Line Charge

State Universal Service Fee

Mandatory Extended Area Service Charge

Total per line Rates and Fees

---

Sheet 5: (0710) BB Pricing

(710) Broadband Price Offerings

FCC Form 481

Data Collection Form

OMB Control No. 3060-0986

April 2013

<010>

Study Area Code

<015>

Study Area Name

<020>

Program Year

<030>

Contact Name - Person USAC should contact regarding this data

<035>

Contact Telephone Number - Number of person identified in data line <030>

<039>

Contact Email Address - Email Address of person identified in data line <030>

<711>

<a1>

<a2>

<b1>

<b2>

<c>

<d1>

<d2>

<d3>

<d4>

State

Exchange (ILEC)

Residential Rate

State Regulated Fees

Total Rate and Fees

Broadband Service - Download Speed (Mbps)

Broadband Service - Upload Speed (Mbps)

Usage Allowance (GB)

Usage Allowance Action Taken When Limit Reached {select}

---

Sheet 6: (0800)_Operating Co

(800) Operating Companies and Affiliates

FCC Form 481

Data Collection Form

OMB Control No. 3060-0986

April 2013

<010>

Study Area Code

<015>

Study Area Name

<020>

Program Year

<030>

Contact Name - Person USAC should contact regarding this data

<035>

Contact Telephone Number - Number of person identified in data line <030>

<039>

Contact Email Address - Email Address of person identified in data line <030>

<810>

Reporting Carrier

<811>

Holding Company

<812>

Operating Company

<813>

<a1>

<a2>

<a3>

Affiliates

SAC

Doing Business As Company or Brand Designation

---

Sheet 7: (0900)_Tribal Lands

(900) Tribal Lands Reporting								FCC Form 481
Data Collection Form								OMB Control No. 3060-0986
								April 2013
<010>	Study Area Code
<015>	Study Area Name
<020>	Program Year
<030>	Contact Name - Person USAC should contact regarding this data
<035>	Contact Telephone Number - Number of person identified in data line <030>
<039>	Contact Email Address - Email Address of person identified in data line <030>
<910>	Tribal Land(s) on which ETC Serves
<920>	Tribal Government Engagement Obligation
				Name of Attached Document (.pdf)
	If your company serves Tribal lands, please select (Yes,No, NA) for each these boxes to confirm the status described on the attached PDF, on line 920, demonstrates coordination with the Tribal government pursuant to § 54.313(a)(9) includes:
			Select (Yes,No, NA)
<921>	Needs assessment and deployment planning with a focus on Tribal community anchor institutions;
<922>	Feasibility and sustainability planning;
<923>	Marketing services in a culturally sensitive manner;
<924>	Compliance with Rights of way processes
<925>	Compliance with Land Use permitting requirements
<926>	Compliance with Facilities Siting rules
<927>	Compliance with Environmental Review processes
<928>	Compliance with Cultural Preservation review processes
<929>	Compliance with Tribal Business and Licensing requirements.

---

Sheet 8: (1110) No Terres Backhaul

(1110) No Terrestrial Backhaul Reporting								FCC Form 481
Data Collection Form								OMB Control No. 3060-0986
								April 2013
<010>	Study Area Code
<015>	Study Area Name
<020>	Program Year
<030>	Contact Name - Person USAC should contact regarding this data
<035>	Contact Telephone Number - Number of person identified in data line <030>
<039>	Contact Email Address - Email Address of person identified in data line <030>
<1120>	Please check this box to confirm no terrestrial backhaul
	options exist within the supported area pursuant to § 54.313(G)
<1130>	Please check this box to confirm the reporting carrier offers
	broadband service of at least 1 Mbps downstream and 256 kbps upstream within the supported area pursuant to § 54.313(G)

---

Sheet 9: (1200) Lifeline Term and Cond.

(1200) Terms and Condition for Lifeline Customers								FCC Form 481
Lifeline								OMB Control No. 3060-0986
Data Collection Form								April 2013
<010>	Study Area Code
<015>	Study Area Name
<020>	Program Year
<030>	Contact Name - Person USAC should contact regarding this data
<035>	Contact Telephone Number - Number of person identified in data line <030>
<039>	Contact Email Address - Email Address of person identified in data line <030>
<1210>	Terms & Conditions of Voice Telephony Lifeline Plans
			Name of attached document (.pdf)
<1220>	Link to Public Website	HTTP
	Please check these boxes below to confirm that the attached PDF, on line 1210, or the website listed, on line 1220, contains the required information pursuant to § 54.422(a)(2) annual reporting for ETCs receiving low-income support, carriers must annually report:
<1221>	Information describing the terms and conditions of any voice telephony service plans offered to Lifeline subscribers,
<1222>	Details on the number of minutes provided as part of the plan,
<1223>	Additional charges for toll calls, and rates for each such plan.

---

Sheet 10: (2005) Price Cap Data

(2005) Price Cap Carrier Additional Documentation

FCC Form 481

Data Collection Form

OMB Control No. 3060-0986

Including Rate-of-Return Carriers affiliated with Price Cap Local Exchange Carriers

April 2013

<010>

Study Area Code

<015>

Study Area Name

<020>

Program Year

<030>

Contact Name - Person USAC should contact regarding this data

<035>

Contact Telephone Number - Number of person identified in data line <030>

<039>

Contact Email Address - Email Address of person identified in data line <030>

CHECK the boxes below to note compliance as a recipient of Incremental Connect America Phase I support, frozen High Cost support, High Cost support to offset access charge reductions, and Connect America Phase II support as set forth in 47 CFR § 54.313(b),(c),(d),(e) the information reported on this form and in the documents attached below is accurate.

Incremental Connect America Phase I reporting

<2010>

2nd Year Certification {47 CFR § 54.313(b)(1)}

<2011>

3rd Year Certification {47 CFR § 54.313(b)(2)}

Price Cap Carrier Receiving Frozen Support Certification {47 CFR § 54.312(a)}

<2012>

2013 Frozen Support Certification

<2013>

2014 Frozen Support Certification

<2014>

2015 Frozen Support Certification

<2015>

2016 and future Frozen Support Certification

Price Cap Carrier Connect America ICC Support {47 CFR § 54.313(d)}

<2016>

Certification Support Used to Build Broadband

Connect America Phase II Reporting {47 CFR § 54.313(e)}

<2017>

3rd year Broadband Service Certification

<2018>

5th year Broadband Service Certification

<2019>

Interim Progress Certification

<2020>

Please check the box to confirm that the attached PDF , on line 2021,

contains the required information pursuant to § 54.313 (e)(3)(ii), as a recipient of CAF Phase II support shall provide the number, names, and addresses of community anchor institutions to which began providing access to broadband service in the preceding calendar year.

<2021>

Interim Progress Community Anchor Institutions

Name of Attached Document Listing Required Information

---

Sheet 11: (3005) ROR Data

(3005) Rate Of Return Carrier Additional Documentation

FCC Form 481

Data Collection Form

OMB Control No. 3060-0986

April 2013

<010>

Study Area Code

<015>

Study Area Name

<020>

Program Year

<030>

Contact Name - Person USAC should contact regarding this data

<035>

Contact Telephone Number - Number of person identified in data line <030>

<039>

Contact Email Address - Email Address of person identified in data line <030>

CHECK the boxes below to note compliance on its five year service quality plan (pursuant to 47 CFR § 54.202(a)) and, for privately held carriers, ensuring compliance with the financial reporting requirements set forth in 47 CFR § 54.313(f)(2). I further certify that the information reported on this form and in the documents attached below is accurate.

Progress Report on 5 Year Plan

(3010)

Milestone Certification {47 CFR § 54.313(f)(1)(i)}

Name of Attached Document Listing Required Information

(3011)

Please check this box to confirm that the attached PDF , on line 3012,

contains the required information pursuant to § 54.313 (f)(1)(ii), as a recipient of CAF Phase II support shall provide the number, names, and addresses of community anchor institutions to which began providing access to broadband service in the preceding calendar year.

(3012)

Community Anchor Institutions {47 CFR § 54.313(f)(1)(ii)}

Name of Attached Document Listing Required Information

(3013)

Is your company a Privately Held ROR Carrier {47 CFR § 54.313(f)(2)}

(Yes/No)

(3014)

If yes, does your company file the RUS annual report

(Yes/No)

Please check these boxes to confirm that the attached PDF, on line 3017, contains the required information pursuant to § 54.313(f)(2) compliance requires:

(3015)

Electronic copy of their annual RUS reports (Operating Report for Telecommunications Borrowers)

(3016)

PDF of Balance Sheet, Income Statement and Statement of Cash Flows

(3017)

If the response is yes on line 3014, attach your company's RUS annual report and all required documentation

Name of Attached Document Listing Required Information

(3018)

If the response is no on line 3014, Is your company audited?

(Yes/No)

If the response is yes on line 3018, please check the boxes below to

confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains :

(3019)

Either a copy of their audited financial statement; or (2) a financial report in a format comparable to RUS Operating Report for Telecommunications Borrowers

(3020)

PDF of Balance Sheet, Income Statement and Statement of Cash Flows

(3021)

Management letter issued by the independent certified public accountant that performed the company’s financial audit.

If the response is no on line 3018, please check the boxes below

to confirm your submission, on line 3026 pursuant to § 54.313(f)(2), contains:

(3022)

Copy of their financial statement which has been subject to review by an independent certified public accountant; or 2) a financial report in a format comparable to RUS Operating Report for Telecommunications Borrowers,

(3023)

Underlying information subjected to a review by an independent certified public accountant

(3024)

Underlying information subjected to an officer certification.

(3025)

PDF of Balance Sheet, Income Statement and Statement of Cash Flows

(3026)

Attach the worksheet listing required information

Name of Attached Document Listing Required Information

---

Sheet 12: CERTIFICATION-REPORTING CARRIER

Certification - Reporting Carrier

FCC Form 481

Data Collection Form

OMB Control No. 3060-0986

April 2013

<010>

Study Area Code

<015>

Study Area Name

<020>

Program Year

<030>

Contact Name - Person USAC should contact regarding this data

<035>

Contact Telephone Number - Number of person identified in data line <030>

<039>

Contact Email Address - Email Address of person identified in data line <030>

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING ANNUAL REPORTING ON ITS OWN BEHALF:

Certification of Officer as to the Accuracy of the Data Reported for the Annual Reporting for CAF or LI Recipients

I certify that I am an officer of the reporting carrier; my responsibilities include ensuring the accuracy of the annual reporting requirements for universal service support recipients; and, to the best of my knowledge, the information reported on this form and in any attachments is accurate.

Name of Reporting Carrier:

Signature of Authorized Officer:

Date

Printed name of Authorized Officer:

Title or position of Authorized Officer:

Telephone number of Authorized Officer:

Study Area Code of Reporting Carrier:

Filing Due Date for this form:

7/1/2013

---

Sheet 13: CERTIFICATION-AGENT

Certification - Agent / Carrier

FCC Form 481

Data Collection Form

OMB Control No. 3060-0986

April 2013

<010>

Study Area Code

<015>

Study Area Name

<020>

Program Year

<030>

Contact Name - Person USAC should contact regarding this data

<035>

Contact Telephone Number - Number of person identified in data line <030>

<039>

Contact Email Address - Email Address of person identified in data line <030>

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING ANNUAL REPORTS ON THE CARRIER'S BEHALF:

Certification of Officer to Authorize an Agent to File Annual Reports for CAF or LI Recipients on Behalf of Reporting Carrier

I certify that (Name of Agent)_______________________________________________________ is authorized to submit the information reported on behalf of the reporting carrier. I also certify that I am an officer of the reporting carrier; my responsibilities include ensuring the accuracy of the annual data reporting requirements provided to the authorized agent; and, to the best of my knowledge, the reports and data provided to the authorized agent is accurate.

Name of Authorized Agent:

Name of Reporting Carrier:

Signature of Authorized Officer:

Date:

Printed name of Authorized Officer:

Title or position of Authorized Officer:

Telephone number of Authorized Officer:

Study Area Code of Reporting Carrier:

Filing Due Date for this form:

7/1/2013

TO BE COMPLETED BY THE AUTHORIZED AGENT:

Certification of Agent Authorized to File Annual Reports for CAF or LI Recipients on Behalf of Reporting Carrier

I, as agent for the reporting carrier, certify that I am authorized to submit the annual reports for universal service support recipients on behalf of the reporting carrier; I have provided the data reported herein based on data provided by the reporting carrier; and, to the best of my knowledge, the information reported herein is accurate.

Name of Reporting Carrier:

Name of Authorized Agent or Employee of Agent:

Signature of Authorized Agent or Employee of Agent:

Date:

Printed name of Authorized Agent or Employee of Agent:

Title or position of Authorized Agent or Employee of Agent

Telephone number of Authorized Agent or Employee of Agent:

Study Area Code of Reporting Carrier:

Filing Due Date for this form:

7/1/2013

---

Sheet 14: 3005a BalanceSheet

(3005a) Operating Report for Privately-Held Rate of Return Carriers								FCC Form 481
Balance Sheet - Data Collection Form								OMB Control No. 3060-0986
Page 1 of 3								March 2013
<010>	Study Area Code
<015>	Study Area Name
<020>	Program Year
<030>	Contact Name - Person USAC should contact regarding this data
<035>	Contact Telephone Number - Number of person identified in data line <030>
<039>	Contact Email Address - Email Address of person identified in data line <030>
	Filed as reviewed single company					Filed as audited single company
	Filed as reviewed consolidated company					Filed as audited consolidated company
	Filed as subsidiary of reviewed consolidated company					Filed as subsidairy of audited consolidated company
CERTIFICATION
We hereby certify that the entries in this report are in accordance with the accounts and other records of the system and reflect the status of the system to the best of our knowledge and belief.
	Signature			Date
PART A. BALANCE SHEET
ASSETS		BALANCE PRIOR YEAR		BALANCE END OF PERIOD	LIABILTIES AND STOCKHOLDERS' EQUITY		BALANCE PRIOR YEAR		BALANCE END OF PERIOD
CURRENT ASSETS					CURRENT LIABILITIES
1.	Cash and Equivalents				25.	Accounts Payable
2.	Cash-RUS Construction Fund				26.	Notes Payable
3.	Affiliates:				27.	Advance Billings and Payments
	a. Telecom, Accounts Receivable				28.	Customer Deposits
	b. Other Accounts Receivable				29.	Current Mat. L/T Debt
	c. Notes Receivable				30.	Current Mat. L/T Debt-Rur. Dev.
4.	Non-Affiliates:				31.	Current Mat.-Capital Leases
	a. Telecom, Accounts Receivable				32.	Income Taxes Accrued
	b. Other Accounts Receivable				33.	Other Taxes Accrued
	c. Notes Receivable				34.	Other Current Liabilities
5.	Interest and Dividends Receivable				35.	Total Current Liabilities (25 thru 34)
6.	Material-Regulated				LONG-TERM DEBT
7.	Material-Nonregulated				36.	Funded Debt-RUS Notes
8.	Prepayments				37.	Funded Debt-RTB Notes
9.	Other Current Assets				38.	Funded Debt-FFB Notes
10.	Total Current Assets (1 Thru 9)				39.	Funded Debt-Other
					40.	Funded Debt-Rural Develop. Loan
NONCURRENT ASSETS					41.	Premium (Discount) on L/T Debt
11.	Investment in Affiliated Companies				42.	Reacquired Debt
	a. Rural Development				43.	Obligations Under Capital Lease
	b. Nonrural Development				44.	Adv. From Affiliated Companies
12.	Other Investments				45.	Other Long-Term Debt
	a. Rural Development				46.	Total Long-Term Debt (36 thru 45)
	b. Nonrural Development				OTHER LIAB. & DEF. CREDITS
13.	Nonregulated Investments				47.	Other Long-Term Liabilities
14.	Other Noncurrent Assets				48.	Other Deferred Credits
15.	Deferred Charges				49.	Other Jurisdictional Differences
16.	Jurisdictional Differences				50.	Total Other Liabilities and Deferred Credits (47 thru 49)
17.	Total Noncurrent Assets (11 thru 16)				EQUITY
					51.	Cap. Stock Outstanding & Subscribed
PLANT, PROPERTY, AND EQUIPMENT					52.	Additional Paid-in-Capital
18.	Telecom, Plant-in-Service				53.	Treasury Stock
19.	Property Held for Future Use				54.	Membership and Cap. Certificates
20.	Plant Under Construction				55.	Other Capital
21.	Plant Adj., Nonop. Plant & Goodwill				56.	Patronage Capital Credits
22.	Less Accumulated Depreciation				57.	Retained Earnings or Margins
23.	Net Plant (18 thru 21 less 22)				58.	Total Equity (51 thru 57)
24.	TOTAL ASSETS (10+17+23)				59.	TOTAL LIABILITIES AND EQUITY (35+46+50+58)

---

Sheet 15: 3005b IncomeStatement

(3005b) Operating Report for Privately-Held Rate of Return Carriers							FCC Form 481
Income Statement - Data Collection Form							OMB Control No. 3060-0986
Page 2 of 3							March 2013
<010>	Study Area Code
<015>	Study Area Name
<020>	Program Year
<030>	Contact Name - Person USAC should contact regarding this data
<035>	Contact Telephone Number - Number of person identified in data line <030>
<039>	Contact Email Address - Email Address of person identified in data line <030>
PART B. STATEMENTS OF INCOME AND RETAINED EARINGS OR MARGINS
ITEM						PRIOR YEAR	THIS YEAR
1.	Local Network Services Revenues
2.	Network Access Services Revenues
3.	Long Distance Network Services Revenues
4.	Carrier Billing and Collection Revenues
5.	Miscellaneous Revenues
6.	Uncollectible Revenues
7.	Net Operating Revenues (1 thru 5 less 6)
8.	Plant Specific Operations Expense
9.	Plant Nonspecific Operations Expense (Excluding Depreciation & Amortization)
10.	Depreciation Expense
11.	Amortization Expense
12.	Customer Operations Expense
13.	Corporate Operations Expense
14.	Total Operating Expenses (8 thru 13)
15.	Operating Income or Margins (7 less 14)
16.	Other Operating Income and Expenses
17.	State and Local Taxes
18.	Federal Income Taxes
19.	Other Taxes
20.	Total Operating Taxes (17+18+19)
21.	Net Operating Income or Margins (15+16-20)
22.	Interest on Funded Debt
23.	Interest Expense - Capital Leases
24.	Other Interest Expense
25.	Allowance for Funds Used During Construction
26.	Total Fixed Charges (22+23+24-25)
27.	Nonoperating Net Income
28.	Extraordinary Items
29.	Jurisdictional Differences
30.	Nonregulated Net Income
31.	Total Net Income or margins (21+27+28+29+30-26)
32.	Total Taxes Based on Income
33.	Retained Earnings or Margins Beginning-of-Year
34.	Miscellaneous Credits Year-to-Date
35.	Dividends Declared (Common)
36.	Dividends Declared (Preferred)
37.	Other Debits Year-to-Date
38.	Transfers to Patronage Capital
39.	Retained Earnings or Margins end-of-Period [(31+33+34)-(35+36+37+38)]
40.	Patronage Capital Beginning-of-Year
41.	Transfers to Patronage Capital
42.	Patronage Capital Credits Retired
43.	Patronage Capital End-of-Year (40+41-42)
44.	Annual Debt Service Payments
45.	Cash Ratio [(14+20-10-11)/7]
46.	Operating Accrual Ratio [(14+20+26)/7]
47.	TIER [(31+26)/26]
48.	DSCR [(31+26+10+11)/44]

---

Sheet 16: 3005c Cashflow

(3005c) Operating Report for Privately-Held Rate of Return Carriers							FCC Form 481
Cash Flow - Data Collection Form							OMB Control No. 3060-0986
Page 3 of 3							March 2013
<010>	Study Area Code
<015>	Study Area Name
<020>	Program Year
<030>	Contact Name - Person USAC should contact regarding this data
<035>	Contact Telephone Number - Number of person identified in data line <030>
<039>	Contact Email Address - Email Address of person identified in data line <030>
PART C. STATEMENTS OF CASH FLOWS
1.	Beginning Cash (Cash and Equivalents plus RUS Construction Fund)
CASH FLOWS FROM OPERATING ACTIVITIES
2.	Net Income
Adjustments to Reconcile Net Income to Net Cash Provided by Operating Activities
3.	Add: Depreciation
4.	Add: Amortization
5.	Other (Explain)
Changes in Operating Assets and Liabilities
6.	Decrease/(Increase) in Accounts Receivable
7.	Decrease/(Increase) in Materials and Inventory
8.	Decrease/(Increase) in Prepayments and Deferred Charges
9.	Decrease/(Increase) in Other Current Assets
10.	Increase/(Decrease) in Accounts Payable
11.	Increase/(Decrease) in Advance Billings & Payments
12.	Increase/(Decrease) in Other Current Liabilities
13.	Net Cash Provided/(Used) by Operations
CASH FLOWS FROM FINANCING ACTIVITIES
14.	Decrease/(Increase) in Notes Receivable
15.	Increase/(Decrease) in Notes Payable
16.	Increase/(Decrease) in Customer Deposits
17.	Net Increase/(Decrease) in Long Term Debt (Including Current Maturities)
18.	Increase/(Decrease) in Other Liabilities & Deferred Credits
19.	Increase/(Decrease) in Capital Stock, Paid-in Capital, Membership and Capital Certificates & Other Capital
20.	Less: Payment of Dividends
21.	Less: Patronage Capital Credits Retired
22.	Other (Explain)
23.	Net Cash Provided/(Used) by Financing Activities
CASH FLOWS FROM INVESTING ACTIVITIES
24.	Net Capital Expenditures (Property, Plant & Equipment)
25.	Other Long-Term Investments
26.	Other Noncurrent Assets & Jurisdictional Differences
27.	Other (Explain)
28.	Net Cash Provided/(Used) by Investing Activities
29.	Net Increase/(Decrease) in Cash
30.	Ending Cash