THE STATE OF WYOMING Public Service Commission Wyoming Universal Service Fund Wyoming Telecommunications Companies (Certificated) Company Name Docket Management System Number Study Area Code This WUSF Annual Report form is available on the Public Service Commission website at the following link: http://psc.state.wy.us/pscdocs/wusf/forms.html
This WUSF Annual Report form is to be completed by all certificated telecommunications companies realizing any retail intrastate revenue from telecommunication services in Wyoming. The information disclosed will be used by the Fund Manager to perform the computations necessary for collection and distribution of the Fund and calculation of the assessment percentage for the fiscal year beginning July 1, 2017. Collection of this data is authorized and required under Chapter 5 of the Rules and Regulations of the Wyoming Public Service Commission and W.S. 37-15-501. Chapter 5, Section 4 Annual Reports and Record Keeping provides: (a) By February 15 th of each year, all Companies shall provide the information required by the Commission to perform the computations necessary for collection and distribution of the Fund. [2]
INSTRUCTIONS 1. Please complete the WUSF Annual Report using company information as of December 31, 2016. 2. Each inquiry contained in this report must be answered. If none or not applicable applies to a certain question, please respond accordingly. 3. The verification page should be completed and signed before a notary public by an officer or employee of the reporting company. 4. If the Company provides a service to customers in more than one state, please limit responses to amounts specific to the Company's Wyoming operations, unless otherwise noted. 5. This WUSF Annual Report is in addition to and separate from, any reports and filings required by the Commission s Rules. 6. Questions regarding the WUSF Annual Report should be directed to 307-777-5704 or by email at rachel.meeker2@wyo.gov or contact the Fund Manager, Melisa Mizel, by phone at 307-777-5706 or by email at melisa.mizel2@wyo.gov. 7. Please return the WUSF Annual Report with all forms and attachments by February 15, 2017, to the Public Service Commission by any of the following methods: Mail: Public Service Commission Wyoming Universal Service Fund 2515 Warren Avenue, Suite 300 Cheyenne, WY 82002 Email: wusf@wyo.gov [3]
CONTACT INFORMATION Please enter the current company information below. Company Name Address City, State Zip Code Company Contact Phone Number Email Fax Number Primary Telecommunications Business in Wyoming (Please check box) CLEC ILEC as defined by 47 U.S.C. 251(h) Other (Please describe) Please enter the current Wyoming Universal Service Fund (WUSF) contact information below. Check here if same information as above WUSF Contact(s) Reporting Service (if applicable) Address City, State Zip Code Phone Number Email Fax Number Additional Report Contacts and Emails [4]
A. Revenues The data requested here is necessary to compute the proposed assessment rate that shall be applied to gross intrastate retail revenues pursuant to Commission Rule Chapter 5, Section 3. Please answer all questions completely. 1. Did the Company realize any intrastate retail revenue from telecommunication services in Wyoming as of December 31, 2016? YES NO 2. Did the Company submit the required reports for Wyoming gross intrastate retail revenue to the Commission? YES NO, please explain: 3. Please provide the Company s annual total gross intrastate retail revenue from telecommunication services in Wyoming as of December 31, 2016. $ 4. Does the Company anticipate having similar Wyoming gross intrastate retail revenue in the coming year? YES NO, please explain: [5]
B. Lines and Prices The data requested here is necessary to compute the eligible Wyoming Universal Service Fund support distributions pursuant to Commission Rule Chapter 5, Section 6. Please use additional attachments as needed to support specific line counts and data figures. Do not include lines from purchasers of intrastate access and interconnection agreements. Please provide information for each distinct geographic area, zone, mileage, or other customer grouping to which different essential local exchange service prices apply. Though not required, the Company may continue to report its lines and prices by residential and business customer groupings. For each grouping, please distinguish between inside and outside the base rate area and separately for each rural zone or mileage band or for other Commission approved aggregated and disaggregated groups as follows: 1. For each distinct group or area, provide the number of access lines for essential telecommunications service and applicable price as of December 31, 2016. 1 2. Please provide a copy of a representative customer bill (residential and business) for each distinct group or area (zone or different rate areas) where your company has different prices. 3. Please provide the price schedule/tariff or other applicable documentation as of December 31, 2016 that will support the retail rates for each line reported. If a tariff or other documentation is located on a website, please provide the URL. 1 Rule Chapter 5, Section 4 provides: Each Company shall report its number of essential local exchange service lines and calendar year-end essential local exchange service price(s) separately for each distinct geographic area, zone, mileage, or other customer grouping to which different essential local exchange service prices apply. The price reported shall include all standard charges associated with each Company s essential local exchange service or each wireless Company s supported wireless service. Such charges include: the essential local exchange service price, whether flat or measured, zone and mileage charges. The price reported shall exclude: bill credits related to prior period Fund receipts; federally mandated customer service line charges; mandatory extended area service charges; surcharges for 911; franchise taxes; and other similar charges or taxes. [6]
C. Federal Universal Service Fund Support 1. Did the company receive Federal support payments during the year ending December 31, 2016? YES NO 2. If you answered yes to question 1 above, please provide a breakdown of the portions of receipts disbursed and allocated to your Wyoming operations during the year ending December 31, 2016. Please attach the USAC summary for all high cost support mechanisms and please note any discrepancies below. Example: allocations of disbursements for Wyoming differences from USAC website. [7]
D. For Companies Electing (Initial) Distribution Pursuant to W.S. 37-15-501(g) 2 ELECTION AND CERTIFICATION I, (name), the (title) of (company name), after being duly sworn upon my oath, depose and state that the aforementioned company is making its one-time irrevocable election to receive distributions pursuant to W.S. 37-15-501(g). In addition, I certify that the company is qualified to receive funds because it: [i] provides essential local exchange service, or its functional equivalent, upon reasonable request throughout the local exchange area of a rural incumbent local exchange carrier; 3 and [ii] does not provide essential local exchange service at a price exceeding the $30 imputed price benchmark. The company information is true and correct, to the best of my knowledge, information and belief. Signature: Date: STATE OF ) COUNTY OF ) On this day of, before me, a notary public personally appeared, (name of person), the (title) of (Company name), to me known to be the identical person named in and who executed this WUSF Annual Report, and acknowledged that he/she executed it as the voluntary act and deed of the person and of the Company. Witness my hand and official seal. My Commission Expires: Notary Public 2 W.S. 37-15-501(g) provides that a Company who elects to receive distributions pursuant to this subsection shall receive funds only to the extent that its costs, as reflected in the company s most recent annual filing of unseparated loop costs filed with USAC, exceeds the company s most recent annual FUSF receipts and annual local revenues. 3 The Federal Communications Commission (FCC) defines incumbent local exchange company (ILEC) and rural telephone company that together make up the definition for a rural ILEC. 47 C.F.R. 51.5 Terms and definitions provides: Incumbent Local Exchange Carrier (Incumbent LEC). With respect to an area, the local exchange carrier that: (1) On February 8, 1996, provided telephone exchange service in such area; and (2)(i) On February 8, 1996, was deemed to be a member of the exchange carrier association pursuant to 69.601(b) of this chapter; or (ii) Is a person or entity that, on or after February 8, 1996, became a successor or assign of a member described in paragraph (2)(i) of this section. Rural Telephone Company. A rural telephone company is a LEC operating entity to the extent that such entity: (1) Provides common carrier service to any local exchange carrier study area that does not include either: (i) Any incorporated place of 10,000 inhabitants or more, or any part thereof, based on the most recently available population statistics of the Bureau of the Census; or (ii) Any territory, incorporated or unincorporated, included in an urbanized area, as defined by the Bureau of the Census as of August 10, 1993; (2) Provides telephone exchange service, including exchange access, to fewer than 50,000 access lines; (3) Provides telephone exchange service to any local exchange carrier study area with fewer than 100,000 access lines; or (4) Has less than 15 percent of its access lines in communities of more than 50,000 on February 8, 1996. [8]
E. For Companies (Recertifying) Distribution Pursuant to W.S. 37-15-501(g) I, (name), the (title) of (company name), after being duly sworn upon my oath, depose and state that the aforementioned company is recertifying its irrevocable election to receive distributions pursuant to W.S. 37-15-501(g). In addition, I certify that the company is qualified to receive funds because it: [i] provides essential local exchange service, or its functional equivalent, upon reasonable request throughout the local exchange area of a rural incumbent local exchange carrier; 4 and [ii] does not provide essential local exchange service at a price exceeding the $30 imputed price benchmark. The company information is true and correct, to the best of my knowledge, information and belief. Signature: Date: STATE OF ) COUNTY OF ) On this day of, before me, a notary public personally appeared, (name of person), the (title) of (Company name), to me known to be the identical person named in and who executed this WUSF Annual Report, and acknowledged that he/she executed it as the voluntary act and deed of the person and of the Company. Witness my hand and official seal. My Commission Expires: Notary Public 4 The Federal Communications Commission (FCC) defines incumbent local exchange company (ILEC) and rural telephone company that together make up the definition for a rural ILEC. 47 C.F.R. 51.5 Terms and definitions provides: Incumbent Local Exchange Carrier (Incumbent LEC). With respect to an area, the local exchange carrier that: (1) On February 8, 1996, provided telephone exchange service in such area; and (2)(i) On February 8, 1996, was deemed to be a member of the exchange carrier association pursuant to 69.601(b) of this chapter; or (ii) Is a person or entity that, on or after February 8, 1996, became a successor or assign of a member described in paragraph (2)(i) of this section. Rural Telephone Company. A rural telephone company is a LEC operating entity to the extent that such entity: (1) Provides common carrier service to any local exchange carrier study area that does not include either: (i) Any incorporated place of 10,000 inhabitants or more, or any part thereof, based on the most recently available population statistics of the Bureau of the Census; or (ii) Any territory, incorporated or unincorporated, included in an urbanized area, as defined by the Bureau of the Census as of August 10, 1993; (2) Provides telephone exchange service, including exchange access, to fewer than 50,000 access lines; (3) Provides telephone exchange service to any local exchange carrier study area with fewer than 100,000 access lines; or (4) Has less than 15 percent of its access lines in communities of more than 50,000 on February 8, 1996. [9]
F. For Companies (Initially Electing and Recertifying) Distribution Pursuant to W.S. 37-15-501(g) The data requested here is necessary to compute the eligible Wyoming Universal Service Fund support distributions pursuant to W.S. 37-15-501(g). Please use additional attachments as needed to support specific line counts and data figures. Please provide individualized information for each Company seeking distribution from the Fund: 1. Please provide the Company s most recent annual unseparated loop costs filed with USAC. This figure can be found in the Company s annual October 1 submittal made by NECA pursuant to 47 C.F.R. 54.1307, if applicable or equivalent. Description Amount Most Recent Annual unseparated loop costs $ 2. Please attach a copy of the above filing showing such reported costs. Specifically, please provide the USF3013-0 All Study Areas, Study Area Detail for All Exchange Carriers overview found at the Federal Communications Commission s (FCC) website http://transition.fcc.gov/wcb/iatd/neca.html. 3. Please provide the Company s most recent annual FUSF Receipts, including all high cost support mechanisms except intercarrier compensation. This figure can be obtained from the Company s annual USAC Funding Disbursements found at USAC s website http://usac.org/hc/tools/disbursements/results.aspx. Description Amount Most Recent Annual FUSF Receipts $ 4. Please provide a copy of the above USAC Funding Disbursements found at USAC s website http://usac.org/hc/tools/disbursements/results.aspx. 5. In order to calculate the Company s statutory annual local revenues, please provide the Company s total number of service lines as of December 31, 20. If these figures differ from those found in section B1 of this Report, please explain the discrepancy. Description Total Wyoming Service Lines Line Count 6. In order to calculate the Company s additional annual local revenues, please provide the Company s total number of single lines charged subscriber line charges, AND the total number of multi-lines charged subscriber line charges. If these aggregated figures differ from those found in section B1 of this Report, please explain the discrepancy. [10]
Description Total Single Lines Charged SLC Total Multi Lines Charged SLC Line Count G. VERIFICATION I, (name), the (title) of (company name), after being duly sworn upon my oath, depose and state that the information contained on the foregoing 20 WUSF Annual Report, including attachments thereto, is true and correct, to the best of my knowledge, information and belief. Signature: Date: STATE OF ) COUNTY OF ) On this day of, before me, a notary public personally appeared, (name of person), the (title) of (Company name), to me known to be the identical person named in and who executed this WUSF Annual Report, and acknowledged that he/she executed it as the voluntary act and deed of the person and of the Company. Witness my hand and official seal. Notary Public My Commission Expires: [11]