FCC FORM 114!)1240 liP!),\UrDA TINGliM,; MAXIMUMMAX!Ml.'l CABLECABJ.f: SERVICES Cable Operator: MM
Name of Cable Operator TIme W ...... r Cable - Uberty DivWoa Mailing Address of Cable Operator 11adlUtriaJ Dri.. , City Stale IIZIPCode Mid_...... INY ,1_1 YES NO X
If yes, complete !he franchise aU1hority informallOn below and enlel' !he associaIed CUlD number bore: NY0513 YES NO~0 1. Dea dais IiIiq iDvolw a JiD&Ie fraadlite autborily but multiple _If _1 X
If yes. enlel' !he associaIed CUIo. below and complete !he franchise aulherity infonnalion at !he bonom of 1his pJl8e:
3. Dea dais IiIiq _ multiple fraadlite _rilies?
If yes. anach a separate sheet for each franchise aulherity and inclode the fonowing franchise aulherity information with its _lied CUlD(s): FnUldlise Autborily Iaformalioa:
Name of Local Franchising Authority ViIIHe of Walden Mailing Address of Local Franchisins AU1hority a Seofield Street City Stale IIZIPCode Walden NY 12586 Telepbonenwnber FaxNwnber
4. ForFtn' .....wh.att po..,...,"pu:(JHJ1H' htlhi;; dais formForm 1240tMJl _.IiIed?bdug ·UJ-t>d? PleaseJ-tk•;ji(M~ put auan "X""'X'' iDm lhethe appropriate:i.I})JHPp,·j~tt: boLb-i·I'IL a.'"' OriginalO:<)!,in& Formh.·;rrn 1240. kJG for{,n Basici<.?.~it~ TierTit~
b, AmendedAn~~'XlJt.\d FormF:h'1n 1240l2-~:_. fort~.:·r BasiclJ.c.t7.it:. TierT;r.;:
c,c OriginalOr;.~=;~in.al Formji!~tm 1240~ ;,::,3 forkJ CPS Tier'fi..:.r
.,:id, Amendedi\n'}~:rtd',~l Formf.\;._n;l 1240l2.4·'.i forL'rCP'S CPS Tier
TO 5. ladKate lhe .... year lime period for _ you are settiq nta (lhe Projected Period). 0111101/ll I 12111 (mmlyy) TO 6. ladKate lhe lime periocl for wbicb you ..... performiDc a true-up. 01110 I 12110 (mmlyy) 7. SlallU ofPre.ious FiIin& of FCC Form 1240 (enter an "x" iD lhe appropriate box) YES NO a. Is 1his !he first FCC Form 1240 filed in any jurisdiction? X b, Has an FCC Form 1240 been filed previously with !he FCC? X
If yes. enlel' !he date of !he most recent filing: L.._===_-'09/1S109 (mmlddlyy) YES NO c, Has an FCC Form 1240 been filed previously with !he Franchising Authority? X
If yes. enter !he date of!he most recent filing: '-_=="'--_--'09/1S109 (mmlddIyy)
a. SIa.... of Previous FiliD& of FCC Form lltO (eater ID "s" iD lhe appropriate box) YES NO a. Has an FCC Form 1210 been previously filed with the FCC?
If yes. enIer!he date of!he most recent filing: '----_____-' (mmlddlyy) YES NO b, Has an FCC Form 1210 been previously filed with !he Franchising Authority?
If yes, enlel' !he date of !he most recent filing: '-_____-' (mmlddi)'Y) 9. SlallU of FCC Form 1200 Filial (euter .. "x" iD lhe appropriate bos) YES NO .. Has an FCC Form 1200 been prmously filed WIth !he FCC? If yes, enlel'!he date filed: L ___-' (mmlddi)'Y) YES NO b, Has an FCC Form 1200 been previously filed ",th!he Franchising Authority? If yes, enIer!he date filed: '-_____-' (mmlddIyy)
10. Cable ~ Seni«s Complaiat SlaIlU (eater so "s" iD lhe appropriate bos)
a. Is 1his form being filed in response to an FCC Form 329 complaint?
If ).... enIer !he date of !he complaint: '-_____--'
II.l \_ Isl..r. FCC~··(_(~ Fermt·m:tn 1205t.Z.V~ BeiD&fik>in1;: IDcIuded~m.lnrta:l Wid!Wi!h TIaisThi~ roliaaHlit'l'_:;·
ll.U, Sdoctioa.r"GoiDc:,f:,\t,.:tYXi ~·I '·'f;win~ Forward"fr,,~'JO!J ., ~Cl11-_!lfvtd Ad_Ad4rUt>:u MflIMNIoIocyMe1h~1fh•I(r·~y (eeterff"J.1ti!T ao.u-.~ "s",,. l."' iDw lheftb:.· .ppropriateapprvJ.•tiaW 4-c<':tboo) i'
I ! Check bore if you are using !he onginal rules (MARKUP MElHODj.
: X 1Check bore if you are using !he ne"" alternalive rules ICAPS METIiODl
If using !he CAPS MElHOD, have you elected to "",so recovery for cbameIs added dunng!he penod May 15, 1994 to Dec, 31. 1994?
Page 1i 13. IIeadead U ...... _odol.1f -NOTE: Op.n:uon Must ceTlify 10 IN COMmlniOft !Mir t!bgilnlifY to 1Ut! lhis upgrade /MthoJoIbgy and attach an t!qlllpmenlli$1 anJ ikpITCiation JChtduk,
CJ Check here if you are a qu.a1ii}ing small system USIII8 the streamlined headend lIP8'ade methodology.
Page 2 Part 1:I: Preliminary Information Module A: Maximum Permitted Rate From Previous Filing
AI Currcm~ MwmumMaxuman PcnruttedPcm:nttcd RaicRate
Mod u leIe B : S u bse"bebscn 'be rs h'h" iiPIP u.. __ _ui<. b < d . u.. U..Daeri- Buk TlerlTlu2 TlerJTluJ TIor'Tlu4 TierSTIorS BI81 AvcrastA""'"" SubsC5cs CCum::ot...... FCCfCC_f_ 1atlallm Fac:10r 10108 Module D: Calculating the Base Rate u .. __ . b .< d . u.. U..DeaCofTrue-UpTjpCofT... -Up {.BeinglslleingPerl'onncd?(Answ..-"1", Pctfonncd1 (Answer 'I', "2',0<"2', or "3'."3' s..See -...lnslrudions forfur. a descnption o(oflhese these type<)types.) I I 2 lf"l",ptoModllle11"1",10 10 Modale L 1f"2",lf"l",auwerll auwer El alldl.l..... E3. It")",lf"l",auwer auwer £2,El, El,EJ,~aad E4,aad as.£5. E2 NumberofMoathsmNumber ofMooths m the Tt'Ue-UpTrue-Up Period JI 12 E3EJ Nwnbc.-ofMonlhsNumbcrofMomhs betw...,betwcc::u the endofTnoe-Upend of True-Up PenodPcnod 1 and !hethe eudofthemostend of the most....,. m:enl PrOJ...... tProjected pfJ'IOdPaiod 0 E4 NumberNumb<.- ofMonlhsofMoo!h. min True-Up PenodPaiod 2 EligibleEiisible for_fur 1nlerest E5 NwnbccNumber of Months True-Up Period 221nelisibk Inebpble for Interest Module F: Maximum Permitted Rate For True-Up Period 1 _ui<. b < d . u.. Uu .. ~~ner1p~~ooo...riplioll TIorlTlerl n..JTluJ Taer4Tier' n..STluS FIF1 CapsMcthodSepJontFarTrue-UpPcnodCap. Method Sell"""" For True-Up Penod 1I [Wb[Wial] 2)
F2f2 MarlwpM..tup Method SegmentSell"""' For True-Up Period 1I [Wks[Wia 3)3] -
F3FJ Chan M_Mvmnt DeldnDeieIn SepJontSegmcnI For True-Up !'F4fo True·UpTrue-Up PcnodPeriod 1I Rate EligtbleEligsbJe For IntlatiooIntlauon {D8+F1+F2+F3}[D8+Fl +F2+Fl) $11.9894
F5FS _lnftaboo SepJontSegmcnI foefur True-Up PenodPaiod 1I [(F"C3)-F41[(F4*C3)-F4J $0.1646 1
F6 HeadeadHeodend UpgnodeUp(!lllCie SepJontSegment F«for True-UpT_Up PenodPeriod I [Wia[Wb 616]
F1 ExtenulExternal CcstsCoots SepJontSegmcnI ForF..- TNC-UpTrue-Up PenodPeriod I [Wia[Wb 7)7] $1292.$7.2928
F8FS Tt'Ue-Up~ForT~UpP~lTrue-Up SegmcnI For True-Up Penod I $5.9882
F9 MaxMaxPennRoll s._.SegmcnI foefor True-Up PenodPeriod 2 {(G4·C4)-(l41[(G4•C4)-G4] , iI ' I G6 HeadendHe.deod UP@1'IdcSegmcnlforTrue-UpPenod2[Wks61Upgrades._. For True-Up Period 2 (Wia 6j I iI Ii I 07G7 E'IIPagePage3 3 .Module"lndule H: True-Uprr:ll''.:''!!'_'\lljustnH:lt_~~~':'kUialion Adjustment Calculation . b . d . u.. u .. o...ri.- Tied Tier 3 Tier' TierS AoIj_,'orrr-Uphriodl HI ~ucFromPenod 1 5388.032- 0000 I I HZ Revenue from Max Penruttcd Rate for Pmod 1 5616.841.7562 H3 T_UpPmod I Adj_ [HZ-HI] $228.8157562
H4 _",Period I AdjwilJneul SI2.810.8863 AdjutMu, For T,...Vp Pmod 2
H5 _ F.... Period 2 Eh ..bl. fur_ I H6 Revenue From Max Pem Rate for Penod 2 Eligible For mwesa H7 Pcnad 2 Adj_ Fli ..ble Fcc Int=st {H6-H5J , H8 lmercst 00 Penod 2 Adjustment {See lIlStJ'UcUOnS f« formula} I I H9 Re\.'CftUC Frun Pcnod 2 1nebgible for lnt«est I I 1110 _ From Max Pmn a... fur Pcnod 210cbJiblc fur_
1111 Period 2 Adj ...... ~ Fcc _ (H1O-1I9] T .... T-.tIpAoIj_.
1112 Pre~iowl Remaming True-Up AdJustmeol IIll Tooo1 True-Up Adj_ 013+114+117+I18+1I11+1112J 5241.686.6425 III' _ of True-Up CIIimed Fcc This l'roJee1Col Pmod I 5241.686.6425 HIS l!cmatrung True-Up Adj_ (H1l-H14J SO.OOOO
}'artPart Ill:III: ProjectedProic!~tcd Period Module.\1.,;;.\ule I:l: ."it'WNew .'\cfa\imumMaximum PermittedPcml.ilted HaleRate . b . d . u.. u.._ ... Tier2 Tied Tier • TierS II Cap. Method Scgmeot For Projee1Col Pcnad {WIrs 2J SO.OOOO
12 Markup Method Scgmeot For ~ Pcnod {Wks lJ SO.OOOO
13 Cban Mvnmt Dde1n Segmen. Foc ~ Pcnod (WIrs 415J SO.OOOO 14 Proj. Period RJI1c EbgibleF« Inflation [D8+FS+G5+ll+12+I3+Wks Ll) $12.1540
15 _ Scgmeot fur ~ Period {(I4'C5}-l4J SO.lll3 16 _ Upgrade Segment F", ~ Period {Wks 6] SO.OOOO I 11 _ C_Se_For~Period [Wb 7] 56.9195 18 True-Up Se_ For l'roJee1Col Period $10.1720 19 Max PenniUcd Rate for Projected Period [14+IS+l6+17+18+\\"ks U+Wks M51 529.4l68 110 Operator Selected Rate For Projeeted Period $17.0000
WILLFULWH..Lfl !L FALSEFALSI.' STATEMENTS'fATE\.fL?>'i TInSll-llS FORMfORM ARE.\RJ PUNISHABLEP(;odSH~\HLF BYHY FINEF!'\E AND/OR~NUiOl< IMPRISONMENTiMPR1SOx"FNI (U.S. CODE TITLE 18, SECTION 1001), AND/OR FORFEITURE (u.s.S. CODE.CODl':. TITLETJTLE 41,•17. SECTIONSECl.ION 503). I certify !hat 1h e statements made in this f~:~l to f my knowledage and beli e.f and are mad emg(ood r... 1h Signature IDate: September 30. 2011
Name and Tide of P.... on Completing this Form: Tom Longstreet, RVP Finance Telephone moober IFax Number (845)695-9613 1(1145)692-0'101
Page 4 Basic Tier2Tier 2 Current MPR 23.5336 True-Up Subs 2021 Projected Subs 1980 Unclaimed Inflation 1 Inflation 1 0.0108 2 0.0108 3 0.0108 4 0.0191 5 0.0191 6 0.0191 7 0.0209 8 0.0209 9 0.0209 10 0.0041 11 0.0041 12 0.0041 Projected Inflation 1.0108 Current Externals 4.9036 Current True-Up 6.3097 Current Inflation 0.3309 True-Up Months 12 Months Lag 0 Prior Form True-Up $s 145225.07 L 1 Subscribers 0 L2 BSTSST Rate 0 True-Up Externals 151002.65 Copyright 13522.915 Other 0 Other 0 Projected Externals 149678.5 Copyright 4585.68 Other 0 Other 0 Actual Rate 16 1 17 2 17 3 17 4 17 5 17 6 17 7 17 8 17 9 17 10 17 11 17 12 17 Projected MPR 29.4368 8.5
Page 1 o0
Page2Page 2 Worksheet 1-1 - True-UpTrue-l!Jl Period Inflation
For instructions, see Appendix A of Instructions For FCC Fonn 1240
Line Period FCC blilalioD Factor
101Hli Month,\L:mtb I 1.08%
102 Month 2 1.08% 103 Month 3 ! 1.08% 104 Month 4 I 1.91% 105 Month 5 1.91%
106 Month 6'<) 1.91% 107 Month 7 2.09%
lOS MonthS 2.09"A.
109 Month 9 2.09%
110 Month 10 0.41%
l'l• 111"' Month II 0.41% 112 Month 12 0.41% .1. '·''·
113 AvenIIJ" Inflation Factor for True-Up Period I 1.0137
114t i4 Month\-kmth 13\3
115 Month 14 116 Month 15
117 Month 16
118 Month 17
119 Month 18
120 Month 19
121 Month 20
122 Month 21
123l23 Month~vtonth 222 2
1241211 Month,\1125 Month 24
126 Average Inflation Factor for True-Up Period 2
Page 1 Worksheet 44- - Residual True-Up Period
FMFor 1IlStrUdlonI,"WUUCbacs, see AppeD:IixAJap:adlx A oflrlstrucbcosoflnstruetwnl For FCC FarmFonn 1240
Truo-UpPenodTtuo-UpPcnod
xX
' lu..lu.e Tkr1Tlerl TkrJT"...-J TkrSTierS foo•~I A-PumittodebqeA_PenmttodOwp SI6.8GGO$16. .... fll~2 A....,..,._,..c.....A"ua&C ExtcnuJ eo.u $7.2928$1.2928 AW1'9A\!11'13C TotalTor.J Per CbaMelC'haonel AdJUlt:lacnUaftcrAdJuttmeots&fter S/141945/14194 for CiJanncUCbanno1s Added Ulln8Ulin& C..,.Caps ~, ~· Mo!ws,...,5 AvcnacAw:rqc Cbaand.lCbaMda per R.egula1edRc:guWed TitirTlCr
,...,. AvenracAWft&O CapsCapa MdbodMethod CbanndsClwmclJ pet"per TtetTw I'm10m""" A--A_ Remomona Cbam>cbCboMds 14054061J405-406J f>•~. A-Period!A_PaiodI PorChoMela...doWI4041407JP«ChooocIRcadual1404l4011
I14 AvereseA\111'1141C c.p.c.pa Method CbamelsCbame1s per Tiel"Tier-
15 A_A--CiwmelsJ4ll-414J Remomona CboMds 141''''14)
16I. A-A\lUl@CPeriod2PcrChame1Residual[41214151PeriosidoWj41214!SJ
Page 1 Worksheet 44- - Residual Projected Period
Truo-UpPenodTl\IIC\-UpPenod
xX
. ' !u...... , TlerlTier> TiedTletJ Tier ..
401101 A-Pcmuttoda.q.A_ Pamitted Chars< S:U.5336W.!W6 402102 AYl!:P3CEldemalC-.Average Extcmal Costs Ii sum$6."'" ! AA~To&alPctC'blnnd.... TottJ. PcrCbmod A4jtllfm«ltSatb::tAdj~ attcr S/141945114194 forCbanndsfor Channels Added Vana:UsmgC.,. Cap8 !OJ 103 Med>od
104 AverageAw:nge TlCI'RCSJduaI{401-401-403)T1« RCildu&i [401.-402-403] Sl6.5SUSl'-.~1 ! ... - ! 005 A~'el'lf>CCbanndsAva'ap CbaMelJ petper~ Replawd TtuTier i'<'> I fo06106 A~A'W:faF Ctplc.p. MethodMelbod. C'hanl'IeIsC"hanads per TlCfT~er I I
A""'3"A_~CbanncbI!05_1 "--Clwmels (IOS-406) i"nfw7 I I Ii ~ A-A_!'madPcnod IP«CIwmeI_I<04I401jI PctChmod Raldual(404/407J
Page2Page 2 Worksheet 77- - External Costs True-Up Period
~~I.F«.._1JIDIIIpcnodweyw6Dqout1bal~ 1. For.adtlillMlf*'1OllwoyuuliDPlrlouttlld~ fPw.ID"'X".wappropnUebox,l(Putu"X~mdlllappropna~~C:bolt.j Xx
()Maoal.Howiouctslhclinlpmad.•IIWII!b.f«'lllilil;:hi'UIIIllnlbaacsaiWllbdld~QuaaoD 1. HolIv kite 1I ae .. pcmd...... lOt wt.dI,... 11ft; baI& Jell Wdb *' MWfabItcI? 12 ~l.Howbtiut..ICIII*ldpnod.m.GIOQIIIs.forMiichrateah.._,lltitdllhta~()JCItIoIl)_Howblcd .. ..-..1pmod..~Iat.__ ....,..'"'bcdraltlt ...... ~ . . I1...... _1• TkrJ' ...... • nor. - Period!_1 -· '''"'"'...... :l1),S21.92 so.oo.10.00 Sl&4,51'-"$164,S25.S7 $}76,164-9156!SIU,86·UIS6
.....so.oo ~~FobFcrPwiod .... PnctC.,~~-~ruF.4-.~.ofTIIIB& w_... SocWea.aa .. ... $176.1'4.9156 ...... sooooo 10.0000 ...... so._ 10 sum
II Cotlol~F«~MdedPri«to5/15/Mt¥'AfterY1S!94USaa Matbp Mielllod For 1\waod
11.1 PricoCap~pc:rhc:lioDW_f .... ottimcW~n~«Soc:WCmlrKI
PagePagel 1 Worksheet 77- - ExternalExtt'mal Costs Projectedl'ro.it·N,,d PeriodPniod
~1.F«-wa"pmod_)'WfiIkI&OUIiIIS~ IPut_"X"'III"~box.l x
~:1 How .... dilt6rltI**l.~ ror .... ,...ttebcuc .. 1IIIithIbitworbbact? QIIomanl.Howblitd_MWDdpcnod...llUllltl,b .....ant....,tdwtlll. .. ~ " a . I"", ..... , TIorJ ""'...... Period I -...&1 C_ EIIai .... for Marbp - ">'1"""""''''''''''''- $149.611.50 .. .. I "'. M.t.D MoItIod F« Panod ..... 2 ~C..... Foaf«Penod ,., ~f«:IForPlwiod S4,,,ut ".00 ... F.xt:nIIl COllI EliP* Ftw "f." Markup SISU6'.I' , MuWUpF..lciorMleo. SJd,I31W1 EmraaI C_ Noc Ell...... for_. po. c.bk Spoci6c; T_ F« Ptmd I L r,....,RoiaWCOIIIIForPcwiod 1'" ~~foeff'of~ ..... I ..... Pnr:c .~.. AIowaacc,. s.:... m.F.4.& oCTiIriIo Wamcr SociN ~ 10.00 ".00 TocalExlr:mlleo.FwJlrl:rial S16!.1l3.te1 ... I "'"•• MaaIbIy, P«~ ExaihllCOItlF« Period I ...... -
Page 2 Worksheet 8-8 - True-Up Rate Charged forForillstrudJODI.ICCAppaMbxAO(~forFCCFOtm m.struc:t~c:m, ace AppeadlxA o(Jnstrucuom For FCC Fonn 1240
QucsboIll,Qucs'a bh , 4 U .. . _. . u.. Uoelloocri.-IleKri_ Tlerl_1 ' • TIerSn..s ""I!I<' I ...-1Moo~~> I $16.0000- Moolhl 116.0000$J6JXlOO- ---· -· 1'0Bol1 "'-2_3 803 ...... , $!6.0000$160000 1'03 _4 ...... SJ6.0000$16.0000 ~S .....MonthSth, $16.0000$16,11000 '""106"" -..Month. SI6.0000SI6Jl000 107"'" ...... -7 , $160000$16.0000 lOS1011 Moalh8Month.. Sl6JXXlO$16.0000 809109 ...... _ $160000$16.0000 1610 MonthMoalhlO 16 SI6.0000$16.0000 II MonthMoalhll II 116_0000$16.0000 _ 12 11ll Moalhll Sl6.0000$16.0000 Il13 PeriodPenocll 1 AvcraceAvaagc RateRile $16.0000
14J4 MonthMoalhll Il _ I. "IS ...... I.16 MonthMoalhiS 15 17 MonthMoalhl6 I. ..II Month 17 19 -·7MonthMootb.J8 18 I' 120 ...... "'-1. ill•ill MonthMoalhlO 20 pW Moatb21Montbll iu' Moalhll_21 iu<~ MonthMoalhll 23 iusrs MonthMoalhl4 24 l626 PeriodPeriodlA~R.are 2. Avenge Race
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Name of Cable ()peraIor Time Warner Cable - Liberty _ Mailing Address of Cable Operator llD4uslrial Driw City ; S:r.'l':.' __0_ IStale !IZIPCode ---·'-'"!NY 10941 YES NO x
If yes, comple1e the franclu .. aulbonty informalion below end ...... the associated CUID number bore: NYOS13 YES NO 2. Does IbiJ fiIia& iIn'oIw a smile f ...... authority but multiple .-uaiIy UDits? x
If yes, enter the associated CUIDs below end comple1e the francluse auIbority informalion .. the bottom of this page:
3. Does IbiJ filial ia\'Olve multiple __ authoriliol?
If yes, attach • separate sheet for ..... francluse authority and include the foUowmg _ aulbority informalion with its associated CUlD(s)' Fraudlise Autborily Iaformaliou:
Name of Local Franchising Authority ViUapofWaI..... Mailing Address of Local Franchising Authority 8ScofNldS_ City Stale Z1PCode Walden NY 11lZ586 Telephone number Fax Number
4. For what purpoae illbiJ Form 1240 beiDC filed? Please put au "X" ia !be appropriore boL a Onginal Form 1240 for Basic Tier b. Amended Form 1240 for Basic Tier c. Original Form 1240 for CPS Tier d. Amended Form 1240 for CPS Tier TO~ 5. Iadi..... te !be ODe year lime period for wbith you are setIiD& roles (!be Proje<1ed Period). OllIl I U/U (lnI11i}y) TO 6. Indicatelnd:i:ral£: !betli:'l!' limetime periodtter\(ul forfof which\\ill('h youvo.u anan• perforosinePt~•-fm'mint,a a true-up.r.rut:-tlf), 01/11 I lUll (mmIyy) 7.-"'!.Statu) Status of PreviousPn~lflom> 1'11mt"Fi1iul of FCCf'f.'C FormFonu 124011.40 (euter(t>-.;rrer anau "I""x" ia!bem th«1 .pproprioreappr·(ipt·iat~ boIllxn:' YES NO a. Is this the flfSt FCC Form 1240 filed in any jurisdiction? X b. Has In FCC Form 1240 been filed previously with the FCC? X If yes, enter the dale of the most recent filing: '-_===-=-_-'09130/10 (mmlddlyy) YES NO C. Has an FCC Form 1240 been filed previously with the Franchising Authorit}'? X
If yes, enter the dale of the most recent filing: '-_==:'::"_--'09/30/10 (mmlddl)'Y)
S. Status of P...-.iotu FiIia.of FCC Form 1210 (ooter ... "I" ia !be appropriote boI) YES NO a Has In FCC Form 1210 been previously filed with the FCC?
If yes, enter the dale of the most recent filing: '--_____-'
b. Has an FCC Form 1210 been previously filed with the Franchising Authorit}'? If yes, enter the dale of the most recent filing: '--_____--' 9. Status of FCC Form 1200 Yl!iDi (euter aD "I" ia !be appropriore bol)
a. Has an FCC Form 1200 been previously filed ",th theIIWFCC FCC?1 If yes, enter the dale filed: '---____---'
b. Has an FCC Form 1200 been previously filed W1th the Franclusing Authonty? If).... enter the dale filed: '-____---' 10. Cable ProarommiDC!lervi.- C_pla.iDt Status (euter a.o "I" ia !be appropriate bol)
II Is this form being filed in response Ie an FCC Form 329 compIa.inO
If yes, enter Ihe dale of the complJunt '-_____-'
II. Is FCC Form 12D5 BeiDc IDcID4ed Witll This YI!iDc 12. __ of"Geiac F_ard" CIwIad ... _ MetIIodoLlaY (enter an "I" ia!be appropriow bo.)
L..J Check here ify"" .... uslll8lhe onginal ruk!s [MARKUP METHOD/. I x I Check here .(you "'" using the _. ahemative rules (CAPS METHOD/.
If usmg the CAPS METIiOD. have you elected to revise recover')' for channel.. dded during the pencd MIy IS. 1994 Ie Dec 31. 1994'
Page 1 13. _ Unnde Me_oIo&Y
WOTE: OMl'OIOn ""at certify ftj lite Co.... ission lMir#liglb;lily 10 U3e tJrt~ upgrad¥ IfUthodology muJ attach 0If equipment luI and tkprt'cialion scMduk. o Check here if you are a qualifYmg small system using the streamlined beadend upgrade me!hodology.
Page 2 Part]>art I: Preliminary Information ModuleVloduk A: MaximumMax1mum Permittedl'ermitltil Rate FromFnnn Previousl'reviou; FiJiDgFiling b TIer 2 Tlerl TIer 4 TIerS
Mod ule B: S u bscribershlp u.. __ ---~~--·------·-- . b < . LIoc Tler2 TIer 3 TIer•" 4 TIer! BI A"""l!" SuhsmbcnbJp For I ....Up Period I -- 1,915 01 0 82 A"""l!" Subs<:nbcnbJp Fo< r ..... up Period 2 ! B3 EiIImudcd A,....., Subs<:nbcnbJp For ~ Perwd 1,8&5 01 0 Module C" InflatIOn InformatIOn
LIoc u.._.- Uncl ...... _ ~S~From 1210 To 1240 CI 1.0000 Unclaimed _: Unrcplat£d ~ ~to Rato Cotopt"'t C2 1.0000 C3 _F""",ForTru<-UpPerwdIIWksIJ 1.0206 C4 _F"""",FocTNC-UpPerwd21WksIJ Cum:nt FCC _ F...... CS 1.0206 Module D: Calculating the BaBe Rate . b . d . LIoc LIocn-.tp_ TIer 2 TIer 3 TIer 4 TIerS 01 Cum:ntHcadeod Upgrade ~ D2 Cum:nt External C-5<_ -$6.9195 OJ C...... Cops Mdbod ~
D4 Cum:nt Markup Mdbod ~ D5 Cum:ntChanncl ~aod_~
D6 Cum:nt T_Up Sepncnt $10.1120
D1 Cum:nt_~ $0.1313 08 Sase Rato [AI-Dl-D2-03-D4-OS-D6-01J SJ:!.I5411 Partl)art II:ll: True-UpTrut'-l.ip Period ModuleMmlule E:f:: TimiDgTiming InformationInformation
LIoc LIocDucri._ EI What T)p< ofT_Up Is BetngPerilxmed? (Answer "I", "2", or "3". s.. _ fur ._ptioo ofthesc typea) I I 2 II'"." t 10 to Modale- L 11"1", auwcr II aIId £3. It"l", auwet El, El, E4, ad E!I. E2 Number ofMcaths in the T.... Up Period I 12
E3 NumberofMcaths _ the end ofT_Up Period I and the end oftbe"""'''''''' ~Period 0 E4 Number of Months in True-Up Perwd 2 Elipble for lntcmIt ES Number ofMcaths True-Up Perwd 2lDe1igible for In..... Module F: Maximum Permitted Rate For True-Up Period 1 . b < . u.. u.._.- Bule Tler2 TIer! Trer4• TIerS FI Caps Mdbod ~ For True-Up Period I [Wks 2J
F2 Markup MdItod ~ For True-Up Perwd 1 [Wks 3)
F3 Chao Mwmt Dcletn ~ For True-Up Period 1 [Wks' 4/5J
F4 true-Up Period 1 Rate Eligible For Intlation [D8+Fl+F2+F3] S12.IS4O
FS _~forT"","UpPerwd 1 [(F"C3)-F') $0.2504 F6 HcadeodUpgrade5<_ForT.... UpPeriod I [Wks6J
F1 ExternaIC-Sepncnt For True-Up Period 1 [Wks1J $12928
Fa True~Up Segment For TI"IJC..-Up Period 1 $10.5113
F9 Max p..,. Rato for True-Up Period 1 [F4;fS+F6+F1+F8J $30.2144
u.. ___,1odull' Module G: _'\faximumMaximum__ PermittedI'~I"Init~ed Ratel~al!' !'tlr1'rnc:_t)>_P_erimlFor True-U., Period 1.2 . bI> c . u.. Tfer2 TIer! TIer.• TIerS 01 Caps Mdbod ~ For T_Up Period 2 [Wks 2J -- 02 Markup Mdbod ~ F... True-Up Period 21Wks 3J I 03 Chao M.... Dcletn Se8mG4 TU Perwd 2 Rato Eligible for _ (D8+fS+GI+G2+G3J os _ ~ fOr T_Up Period 2 [(G4'C4)-G4J
G6 Hcadeod Upgrade ~ F", True-Up Perwd 2 IWks6) I 01 ExternaIc-~ ForT.... UpPerwd2[Wks1] I L os True-Up Se8mPage 3 Module H: True-Up Adjustment CaleulationCalculation . b . d . u.. U..O..Cri-u..Dacrl_ ... Tiu2Tier1 Tiu3llerJ Tior4 Tior~TiuS AdjUbDeltIAdj..,_tJ'orT.,...Uphriod 'or T,...,Vp Period 1 HI Revenue From Period I $390,660.0000$390.660.0000-- Revenue From. Period 1 H2 Revenue:Rcvcouc FnmFrom Max PamluedPcnnined R.akRate: farfor- PenodPcnod lI 5694,327.66435694.127.6643 H3 TTrue-Up.... UpPeriodI Period I Adj-{H2-HI]Adj_ (H2-HII 5303.667.6643$303.667 6643 114H4 ln""""ooInterest on. PeriodPenod I Ad)-Adjuscmcct Sl1,0SI.ltl61517.0813061 ~_.Mj-ForT,....Vpl'H9 -From_ From Period 2lnclitliblc2lndi8iblo furfu<- ......
1110HIO RtvcGue- FromFrun Max Penn RAitRAIe for Period 22lnehtllbl• InebIPb1e for-for InIeresI HllHII Period 2 Adj.....,...fnebtllbleAdj ...... lndi8iblo FocFor- _ (Hl0-119)[HIO-H9] TOIaIT_IJ,AdjT-TI'H-VpMJ- _ 1112HI2 _i'm'loo&R1113Hl3 TotaIT.....up~[H3+H4+H7+H8+H11+H121Toul Truo-Up AdJ"""""' (H3+114->t17+H8+Hil +11121 5320.148.9704$320.748.9704 1114HI' AmoontofTruo-UpClaimedFcc'llusProjcdedPeriodAmoont ofT.... Up Claimed For n.. Projoct13 ChonCbae MWllltMwmt DeIe!nDeldn SegmoatSegmem For ProjcdedProjected PeriodPonod IWks[Wits 415] $0.0000 14I. Proj. Period RoleRAit Eligible ForFoc lnlllliooInfialioo (D8[ll8+F5!_ C..UCosts SegmentSegmem For ProjectedProjcded Period IWks[Wks 717) $8.4909 18 TI1IO-UpTtue-Up Se-Segmem FccFor ProjcdedProjeetcd PeriodPmod $14.1799
19 Max PcmuttodPenmttcd RoleRAit ro.-for ProjoctWILLFUL FALSE STATEMENTS MADE ON TinSnus FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S.(U.s. CODE TITLE 18, SECTION 1001).1001), AND/OR FORFEITURE (U.S. CODE, TITLElTILE 47, SECTION 503). I[ cenuycertify !hat 1hethe _lsstatements made in thisIbis fonnform are true and correct to 1hethe best of my knowledge and belief;belief, and are made in goodgoed faith. Signa!UrOSignanue IDate: September 30, 2011
Name and TilleTide ofP""""of Person Completing Ibisthis Fonn:Form: Tom Longstreet,Longstreet. RVP Finance Telephone number IjfaxNumberFaxNwnber I1845)695-96231845l69S-9613 1(845)691-0901I 184Sl0i9l-0901
Page4Page 4 Basic Tier2Tier 2 Current MPR 29.4368 True-Up Subs 1915 Projected Subs 1885 Unclaimed Inflation 1 Inflation 1 0.0206 2 0.0206 3 0.0206 4 0.0206 5 0.0206 6 0.0206 7 0.0206 8 0.0206 9 0.0206 10 0.0206 11 0.0206 12 0.0206 Projected Inflation 1.0206 Current Externals 6.9795 Current True-Up 10.172 Current Inflation . 0.1313 True-Up Months 12 Months Lag 0 Prior Form True-Up $s 241686.64 L 1 Subscribers 0 L2 BSTSST Rate 0 True-Up Externals 143082.67 Copyright 12813.648 Other 0 Other 0 Projected Externals 165312.58 Copyright 13350.744 Other 0 Other 0 Actual Rate 17 1 18 2 18 3 18 4 18 5 18 6 18 7 18 8 18 9 18 10 18 11 18 12 18 Projected MPR 35.3306 8.5
Page 1 Worksheet\Vm·k•o;hcet 1l- - True-UpTrue-l'p Period Inflation
For insttuetions, see Appendix A of Instructions For FCC Form 1240
Line Period FCC Inflationlu!lati<>n Factorfatl<>r 101.ID! Month I 2.06%
102 Month 2 2.06%
103 Month 3 2.06%
104 Month 4 2.06%
lOS MonthS 2.06%
106 Month 6 2.06% 107 Month 7 2.06%
108 MonthS 2.06%
109 Month 9 2.06%
1I0 Month 10 2.06%
IIIl" Month II 2.06%
112 Month 12 I 2.06%
1I3 Average Inflation Factor for Tr....,-Up Period I 1.0206
1I4 Month 13i 115llo Month 14
116 Month IS
117 Month 16
118 Month 17
119ll'l Month)v:!onrh 18lS
12011f• Month\iouth 19J9
121 Month 20
122 Month 21
123 Month0.1onth 221'2
124 Month\·1onth 23 12S Month 24
126 Average Inflation Factor for True-Up Period 2
Page 1 Worksbeet\Yorksheet 44- - Residual True-UpTrt1<~-Up Periodl'cl"iod
x . , ..... Tlnl Tier) TIer 4 TIer! !wI A_PcmuUod<:lwJe --SI7.'" !w2 A~~eo.u ! $1.:1928
Awnae: iotal Pes-ctwmc1 Adj~afttI' Sil4J94 f(;JCbannds Added Uama Caps Fa' McIbod Fo- A~ TICt R.esuJuaJ [401-402401} ".7072
~S Awnge CbanndJpc:r ~ TJ« I I
406 AYC:tII8C Caps Method Cbawocls per TI«
<07 A_1IanaiIWta CbuulcIs I-I
108 A_ Period I PwCbanod _ [40414071 fw9 A_ Pcmu.... <:IwJe
10 A\OCtIiC ExtcmaI Coso
Aw:raae Total Per Chancl A,dJw:tment/iI after 5/14/94 for CJ:wmeJs Added Umng Capt II Mdhod
12 A-.uqe TlCl' Rcadua1l409-4I~11}
13 Aw:nsae Cbaond. JXf' R,.w.ted Tier
14 A_ c.po McIbod CbamIcIs por T_
IS A_ R16 AVCIO&C Period 2 PerChannd Residuai [41214151
Page 1 Worksheet 4-4 - Residual Projected Period
Truo-UpPcnodTn.Up Pcnod .Xx ... , TiulTied Tlcr4 TierS Period .,.. lro•~I A_PmruI1CdC'llu-gPagePage2 2 WoW orks heetllC I 7 - ExteExternalrnal CoCo ts TTru rue-Up PerPeriioodd
TNlt-VpPtnod
~1-Far-..r::b~DCpowtOCI-yo~~filila&Oiltlllll~~1 . f«toadlll1Mpn!d_ywfiUartaOtlS"'~ [P\Jtc-x:•••lpSW'OpnllDbo:lc.J[P\d_"X'·.~~boLJ QualaaDl-lUrwbtau"Que:-.ll . Howlclrcubtlinlpcnod,a....._fbr~tUOJnbcillltttt.,...,~ hp!nOd...... two,.. ""-'td""'iu ~ "11 ~]QMI:raoel.~bWuiii'...Spanod.a...... _b.,...,....,..balll&llll'lldlau~. Howbcu ... lCICtII!Idpenod, • .oaIa.b""'''''''''''""""""""WClfblIo«t . • . ,...,, ,...,. lu.. ... Tlul n.rTlulJ n..' • "." I""" P•<'k>l SI4JSIUOIlA7.Oil.l7 ... PO ' w:;o;oWIlt...... ,....,r.,... .:-~ ...... a....,_Fur .... ~"' ...... c:-..,...FPage 1, Worksheet\\' orJ..•. slu:.-et 7 -.. External{:,xtt•nta! CostsCt,t:d.-. ProjectedPruje-ett:d PeriodPcdtJd
~1.For'lWK.bl'llMpcriocI_}'Wuu.,WI"~ {Puf .. ":\.-.IIhe~box.l
~l HowkqdmefirJtpanod,lIIlIKlft1ht.fo-1IIbIc:h"'lRbclataelWdbdla~ ~l.~""IlIboI«ondJNtlO4,.~ftlfIllflA:bWlDl_b-aJdwilh*J~ • • ...... TIor • TIor • ...... P~riod 1 E...... eo-Elilible ..... Marb. - """c.". , ..,/1,,,,«,,,,,, $16':,31251 ,"00 .. =~..... i .. .. I 702 ~o..:td"f«=I;""orhnocf FoaF«Pvn04 $1J.)S01. SO.OOi ,.. ExIIInvIlCOlU Eh&Jbk For 7.S'Mwbip I SI1t,.Md.Jl po. MIrtod Up £XIIItDIoI Co.III Sltl,OQ._ _ C_NoI Eliliblef.. Marb_ p.. CaW/: Spoa6c TWIS F« Pcnad I i , ~R.wCOlilfarPlWMld ~~HaForPtnod .... P'nce Cap ~ per Soaion W.F.4.a ,,(TUDe W___ Soo.I.I Coatntt 10,00 " .... "" Ttlfal ~ Com fU Pcnod SJtJ.OUe.tO "'-1 "",. ~.hr~Exlc:nWComForPa'JOdI a_
I
Page 2 I I Worksheet 8-8 - True-Up Rate Charged For l.llJtrUCtlCm.1IlStl'UctioGI. see~ AppendixAppeDd.lx A of .lomucttonslastnx:bons For FCC FonnFoan 1240
~Qucsuoc I. HowHowlqlstheTrue-UpPenod lq IS the True-Up Pcnod I,l.inllll'lll1hs1 m maaths? 1112 Quc:sbooQucsboo2. 1 HowHaw Joo&long IIulhe the Trut-UpTrue-Up Period 12. in month51months? , . •b c •d . U.u .. uU .. o..,,,,_o•• ,,.,_ ..... ThrlTIer 2 n.r>TIer 3 TIor' Tlu5TIer' ~I101 Monlh_I I I $11.0000St7J)000- IOl _2Monlh2 517.0000 -· ~2 'i ~)10! MoothMonlh 3, I Si7JlOOOS11.oooo lw<~ ...... ,,Monlh4 SI7.0000$17.0000 ~',"' Mooth S $170000SI7.0000 Monlh6Moolb6-- $170000 ~iIo6 SI10000 I ~107 Monlh 7 $170000117.0000 I -,Moo1h 8 ~"" I $17.0000117.0000 ~109 -·MoothMonth9 • 517.0000SJ7.0000 10 MonthMoo1h 10 SI7Jl000511.0000 11ll Moo1hMonlh 11ll S17.0000517.0000 1211 MonlhMooth12 11 117.00005170000 13Il PmodPenod 1l A-vengeAYeI'aIC Rate Si7.0000Sl7.0000
14 Monlh_13 13 "IS Monlh_14 14 16 Moo1hMeath IS 17 Month_16 16 18 MoothMonth 17 19 MoothMonth 18IS 110 _20Monthl9Month 19 Bll~·21 MonlhlO illIII Mmth21Monthll ~,123 MonthllMoo1h21 ~124 Month23Mouth 23 ~ru Monlhl4Moo1h24 ~126 Period l2 Average RateRite
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