Form FCC Form 481 FCC Form 481 54.313/54.422 Data Collection Form

Lifeline and Link Up Reform and Modernization, Advancing Broadband Availability Through Digital Literacy Training and FCC Forms 481, 497, 550, 555 and 560

0986_FCCForm481_ExcelSpreadsheet_052213_final.xlsx

FCC Form 481, 54.313/54.422 Data Collection Form

OMB: 3060-0819

Document [xlsx]
Download: xlsx | pdf

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
















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