Fill - Free fillable Sa3 Statement of Account for Secondary Transmissions by Cable Systems (SA3 Long Form) PDF form

Library of Congress

Copyright Oce-LD

101 Independence Avenue SE

Washington, DC 20557-6400

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OFFICIAL BUSINESS

UNITED STATES COPYRIGHT OFFICE

STATEMENT OF ACCOUNT

SA3

(

LONG FORM

)

IMPORTANT NOTICE ABOUT THIS STATEMENT OF ACCOUNT

Statutory Changes: Congress passed the STELA Reauthorization Act of 2014 (“STELARA”), which the President signed into

law on December 4, 2014, as Public Law 113-200. Read the law at http://copyright.gov/legislation/pl113-200.pdf. For more

information on this law (H.R. 5728), visit the FAQ page on the Copyright Office website at http://copyright.gov/licensing/

stelara.html.

Filing Fees: Effective January 1, 2014, pursuant to the Satellite Television Extension and Localism Act of 2010 (STELA),

which granted authority to the Copyright Office to establish fees for the filing of statements of account (SOAs) under

the section 111, 119, and 122 statutory licenses, the Office now assesses filing fees for all SOAs for current, past, and future

accounting periods. For details, see the Federal Register, November 29, 2013 (78 fr 71498 http://www.copyright.gov/

fedreg/2013/78fr71498.pdf). Please be advised that the filing fee is deducted before the royalty payment is credited; thus the

omission of the appropriate filing fee will result in an underpayment of royalty fees. Please remit the royalty fee and filing

fee in one EFT payment. (SOA3 filing fee: $725).

Low Power Television Stations: STELARA expanded the definition of a “local market” for low power television stations

beginning with the January 1–June 30, 2015, accounting period. See page iv of the General Instructions.

Multicast versus Simulcast: Multicast is a digital stream of programming that is transmitted by a television broadcast

station and is not the station’s primary stream. Simulcast is a multicast stream of a television broadcast station that

duplicates the programming transmitted by the primary stream or another multicast stream of such station.

Photocopy Required (Paper Filings Only): A legible copy of the semiannual statement of account must be submitted

together with the original statement of account to the Copyright Office. Note: If replying to Licensing Division

correspondence or if submitting revisions or amendments to your original SOA, please do not include extra photocopies

of the SOA pages affected. Only one original version of revised SOA pages is required with your reply letter, together with a

single copy of any Licensing Division correspondence.

Fillable SOAs Available Online: Access the fill-in statement of account form at www.copyright.gov/forms/sa3.pdf. Complete

it on a personal computer and print it out. Or print out the form and complete it by hand in dark ink. Give all the required

information.

Electronic Payment of Royalty and Filing Fees Required: Detailed instructions for making royalty payments via electronic

funds transfer (EFT) are contained in circulars 74a, 74b, and 74c, which are available at www.copyright.gov/circs/or by

contacting the Licensing Division (8:30 am and 5:00 pm eastern time) by phone at (202) 707-8150, fax at (202) 707-0905,

or email at licfiscal@copyright.gov. The remittance, which must include the appropriate filing fee, must be made payable

to Register of Copyrights. If you are using www.Pay.gov, contact your bank to determine if your account will accept an

Automated Clearing House (ACH) debit.

Remittance Advice Required: Federal regulations [37 C.F.R. sec. 201.17 (k)] require that a remittance advice be attached to

statement(s) of account. A copy of the remittance advice must be sent by email or fax to the Licensing Division. The Office

uses this remittance information to ensure the funds received by EFT are correctly allocated to each statement of account.

Access a remittance advice form at www.copyright.gov/licensing/remittance-advice.pdf.

Ceased Operations Procedures: If your cable system completely shut down operations during the accounting period,

report the facts as they existed on the last day of operations and submit the SOA with the associated royalty and filing fee

payments and a cover letter informing the Licensing Division of ceased operations. If your cable system had no subscribers

or gross receipts during the entire accounting period, do not submit the SOA or any fees. You do not need to notify us in

this case.

Important: Review Filings: Please review all elements of your filing(s) before submitting them. Filing properly, including

an accurate advice, facilitates processing of your statement(s) of account and payments, minimizes the need for us to

contact you with questions, and reduces administrative and other costs.

Library of Congress

Copyright Office-LD

101 Independence Avenue SE

Washington, DC 20557-6400

Tel: (202) 707-8150 (8:30 am–5:00 pm, eastern time) Fax: (202) 707-0905

Email: licensing@copyright.gov or Web: www.copyright.gov/licensing

THIS FORM IS EFFECTIVE FOR ACCOUNTING PERIODS BEGINNING JANUARY 1, 2015

If you are ling for a prior accounting period, contact the Licensing Division for the correct form.

STATEMENT OF ACCOUNT

for Secondary Transmissions by

Cable Systems (Long Form)

General instructions are at the

end of this form [pages i–viii].

FOR COPYRIGHT OFFICE USE ONLY

DATE RECEIVED

A

Accounting

Period

INSTRUCTIONS: In line 1, give any business or trade names used to identify the business and operation of the system unless these

names already appear in space B. In line 2, give the mailing address of the system, if dierent from the address given in space B.

IDENTIFICATION OF CABLE SYSTEM:

MAILING ADDRESS OF CABLE SYSTEM:

(Number, street, rural route, apartment, or suite number)

(City, town, state, zip code)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

2

C

System

B

Owner

AMOUNT

ALLOCATION NUMBER

$

Form SA3c Rev: 05 ⁄ 2020

SA3

Long Form

Return to:

Library of Congress

Copyright Oce-LD

101 Independence Avenue SE

Washington, DC 20557-6400

(202) 707-8150

For courier deliveries,

see page ii of the general

instructions.

INSTRUCTIONS:

Give the full legal name of the owner of the cable system in line 1. If the owner is a subsidiary of another corporation, give the full

corporate title of the subsidiary, not that of the parent corporation.

In line 2, list any other names under which the owner conducts the business of the cable system.

If there were dierent owners during the accounting period, only the owner on the last day of the accounting period should submit

a single statement of account and royalty fee payment covering the entire accounting period.

Check here if this is the system’s rst ling. If not, enter the system’s ID number assigned by the Licensing Division. __________

LEGAL NAME OF OWNER OF CABLE SYSTEM:

BUSINESS NAME(S) OF OWNER OF CABLE SYSTEM (IF DIFFERENT):

MAILING ADDRESS OF OWNER OF CABLE SYSTEM:

1

2

3

(Number, street, rural route, apartment, or suite number)

(City, town, state, zip)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ACCOUNTING PERIOD COVERED BY THIS STATEMENT: (Check one of the boxes and ﬁll in the year date.)

January 1–June 30 . . . . . . . . . . . . . . .

July 1–December 31 . . . . . . . . . . . . . . .

(Year) (Year)

D

Area

Served

CITY OR TOWN

Instructions: For complete space D instructions, see page 1b. Identify only the rst community served below and relist on page 1b with

all communities.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Below is a sample for reporting communities if you report multiple channel line-ups in Space G.

STATE

SUB GRP#

A l d a M D A 1

A l l i a n c e M D B 2

G e r i n g M D B 3

CITY OR TOWN (SAMPLE)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

STATE CH LINE UP

Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Oce to collect the personally identifying information (PII) requested on this

form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address, and telephone

numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Oce's public indexes and in

search reports prepared for the public. The eect of not providing the PII requested is that it may delay processing of your statement of account and its placement in the

completed record of statements of account, and it may aect the legal suciency of the ling, a determination that would be made by a court of law.

First

Community

Sample

Name

LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 1b.

SUB GRP#

D

Area

Served

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Instructions

: List each separate community served by the cable system. A “community” is the same as a “community unit” as dened

in FCC rules: “a separate and distinct community or municipal entity (including unincorporated communities within unincorporated

areas and including single, discrete unincorporated areas.” 47 C.F.R. §76.5(dd). The rst community that you list will serve as a form

of system identication hereafter known as the “rst community.” Please use it as the first community on all future lings.

Note: Entities and properties such as hotels, apartments, condominiums, or mobile home parks should be reported in parentheses below

the identied city or town.

If all communities receive the same complement of television broadcast stations (i.e., one channel line-up for all), then either associate

all communities with the channel line-up “A” in the appropriate column below or leave the column blank. If you report any stations

on a partially distant or partially permitted basis in the DSE Schedule, associate each relevant community with a subscriber group,

designated by a number (based on your reporting from Part 9).

When reporting the carriage of television broadcast stations on a community-by-community basis, associate each community with a

channel line-up designated by an alpha-letter(s) (based on your Space G reporting) and a subscriber group designated by a number

(based on your reporting from Part 9 of the DSE Schedule) in the appropriate columns below.

CITY OR TOWN STATE CH LINE UP

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

First

Community

Add Page

Name

LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 2.

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Residential:

• Service to rst set

• Service to additional set(s)

• FM radio (if separate rate)

Motel, hotel

Commercial

Converter

• Residential

• Non-residential

SECONDARY TRANSMISSION SERVICE: SUBSCRIBERS AND RATES

In General: The information in space E should cover all categories of secondary transmission service of the cable

system, that is, the retransmission of television and radio broadcasts by your system to subscribers. Give information

about other services (including pay cable) in space F, not here. All the facts you state must be those existing on the

last day of the accounting period (June 30 or December 31, as the case may be).

Number of Subscribers: Both blocks in space E call for the number of subscribers to the cable system, broken

down by categories of secondary transmission service. In general, you can compute the number of subscribers in

each category by counting the number of billings in that category (the number of persons or organizations charged

separately for the particular service at the rate indicated—not the number of sets receiving service).

Rate: Give the standard rate charged for each category of service. Include both the amount of the charge and the

unit in which it is generally billed. (Example: “$20/mth”). Summarize any standard rate variations within a particular rate

category, but do not include discounts allowed for advance payment.

Block 1: In the left-hand block in space E, the form lists the categories of secondary transmission service that cable

systems most commonly provide to their subscribers. Give the number of subscribers and rate for each listed category

that applies to your system. Note: Where an individual or organization is receiving service that falls under dierent

categories, that person or entity should be counted as a subscriber in each applicable category. Example: a residential

subscriber who pays extra for cable service to additional sets would be included in the count under “Service to the

rst set” and would be counted once again under “Service to additional set(s).”

Block 2: If your cable system has rate categories for secondary transmission service that are dierent from those

printed in block 1 (for example, tiers of services that include one or more secondary transmissions), list them, together

with the number of subscribers and rates, in the right-hand block. A two- or three-word description of the service is

sucient.

BLOCK 2

CATEGORY OF SERVICE

NO. OF

SUBSCRIBERS

BLOCK 1

BLOCK 2

CATEGORY OF SERVICE

Continuing Services:

• Pay cable

• Pay cable—add’l channel

• Fire protection

•Burglar protection

Installation: Residential

• First set

• Additional set(s)

• FM radio (if separate rate)

• Converter

RATE

BLOCK 1

Installation: Non-residential

• Motel, hotel

• Commercial

• Pay cable

• Pay cable—add’l channel

• Fire protection

• Burglar protection

Other services:

• Reconnect

• Disconnect

• Outlet relocation

• Move to new address

RATECATEGORY OF SERVICERATE

RATE RATECATEGORY OF SERVICE

NO. OF

SUBSCRIBERS

E

Secondary

Transmission

Service: Sub-

scribers and

Rates

F

Services

Other Than

Secondary

Transmissions:

Rates

SERVICES OTHER THAN SECONDARY TRANSMISSIONS: RATES

In General: Space F calls for rate (not subscriber) information with respect to all your cable system’s services that were

not covered in space E, that is, those services that are not oered in combination with any secondary transmission

service for a single fee. There are two exceptions: you do not need to give rate information concerning (1) services

furnished at cost or (2) services or facilities furnished to nonsubscribers. Rate information should include both the

amount of the charge and the unit in which it is usually billed. If any rates are charged on a variable per-program basis,

enter only the letters “PP” in the rate column.

Block 1: Give the standard rate charged by the cable system for each of the applicable services listed.

Block 2: List any services that your cable system furnished or oered during the accounting period that were not

listed in block 1 and for which a separate charge was made or established. List these other services in the form of a

brief (two- or three-word) description and include the rate for each.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 3.

Name

G

Primary

Transmitters:

Television

PRIMARY TRANSMITTERS: TELEVISION

In General: In space G, identify every television station (including translator stations and low power television stations)

carried by your cable system during the accounting period, except (1) stations carried only on a part-time basis under

FCC rules and regulations in eect on June 24, 1981, permitting the carriage of certain network programs [sections

76.59(d)(2) and (4), 76.61(e)(2) and (4), or 76.63 (referring to 76.61(e)(2) and (4))]; and (2) certain stations carried on a

substitute program basis, as explained in the next paragraph.

Substitute Basis Stations: With respect to any distant stations carried by your cable system on a substitute program

basis under specic FCC rules, regulations, or authorizations:

• Do not list the station here in space G—but do list it in space I (the Special Statement and Program Log)—if the

station was carried only on a substitute basis.

• List the station here, and also in space I, if the station was carried both on a substitute basis and also on some other

basis. For further information concerning substitute basis stations, see page (v) of the general instructions.

Column 1: List each station’s call sign. Do not report origination program services such as HBO, ESPN, etc. Identify

each multicast stream associated with a station according to its over-the-air designation. For example, report multi-

cast stream as “WETA-2”. Simulcast streams must be reported in column 1 (list each stream separately; for example

WETA-simulcast).

Column 2: Give the channel number the FCC has assigned to the television station for broadcasting over-the-air in

its community of license. For example, WRC is Channel 4 in Washington, D.C. This may be dierent from the channel

on which your cable system carried the station.

Column 3: Indicate in each case whether the station is a network station, an independent station, or a noncommercial

educational station, by entering the letter “N” (for network), “N-M” (for network multicast), “I” (for independent), “I-M”

(for independent multicast), “E” (for noncommercial educational), or “E-M” (for noncommercial educational multicast).

For the meaning of these terms, see page (v) of the general instructions.

Column 4: If the station is outside the local service area, (i.e. “distant”), enter “Yes”. If not, enter “No”. For an ex-

planation of local service area, see page (v) of the general instructions.

Column 5: If you have entered “Yes” in column 4, you must complete column 5, stating the basis on which your

cable system carried the distant station during the accounting period. Indicate by entering “LAC” if your cable system

carried the distant station on a part-time basis because of lack of activated channel capacity.

For the retransmission of a distant multicast stream that is not subject to a royalty payment because it is the subject

of a written agreement entered into on or before June 30, 2009, between a cable system or an association representing

the cable system and a primary transmitter or an association representing the primary transmitter, enter the designa-

tion “E” (exempt). For simulcasts, also enter “E”. If you carried the channel on any other basis, enter “O.” For a further

explanation of these three categories, see page (v) of the general instructions.

Column 6: Give the location of each station. For U.S. stations, list the community to which the station is licensed by the

FCC. For Mexican or Canadian stations, if any, give the name of the community with which the station is identied.

Note:

If you are utilizing multiple channel line-ups, identify the line-up in the far right column here in Space G based on

your channel line-up reported in Space D. Use a separate space G for each channel line-up.

1. CALL

SIGN

2. B’CAST

CHANNEL

NUMBER

3. TYPE

OF

STATION

4. DISTANT?

(Yes or No)

5. BASIS OF

CARRIAGE

(If Distant)

6. LOCATION OF STATION

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Channel

Line-Up

_______________

Add Page

Name

LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 4.

H

Primary

Transmitters:

Radio

PRIMARY TRANSMITTERS: RADIO

In General: List every radio station carried on a separate and discrete basis and list those FM stations carried on an

all-band basis whose signals were “generally receivable” by your cable system during the accounting period.

Special Instructions Concerning All-Band FM Carriage: Under Copyright Oce regulations, an FM signal is generally

receivable if (1) it is carried by the system whenever it is received at the system’s headend, and (2) it can be expected,

on the basis of monitoring, to be received at the headend, with the system’s FM antenna, during certain stated intervals.

For detailed information about the the Copyright Oce regulations on this point, see page (vi) of the general instructions.

Column 1: Identify the call sign of each station carried.

Column 2: State whether the station is AM or FM.

Column 3: If the radio station’s signal was electronically processed by the cable system as a separate and discrete

signal, indicate this by placing a check mark in the “S/D” column.

Column 4: Give the station’s location (the community to which the station is licensed by the FCC or, in the case of

Mexican or Canadian stations, if any, the community with which the station is identied).

CALL SIGN AM or FM S/D LOCATION OF STATION CALL SIGN AM or FM S/D LOCATION OF STATION

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

FORM SA3. PAGE 5.

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I

Substitute

Carriage:

Special

Statement and

Program Log

WHEN SUBSTITUTE

CARRIAGE OCCURRED

7. REASON

FOR

DELETION

1. TITLE OF PROGRAM

2. LIVE?

Yes or No

3. STATION’S

CALL SIGN 4. STATION’S LOCATION

5. MONTH

AND DAY

6. TIMES

FROM — TO

SUBSTITUTE PROGRAM

—

SUBSTITUTE CARRIAGE: SPECIAL STATEMENT AND PROGRAM LOG

In General: In space I, identify every nonnetwork television program broadcast by a distant station that your cable system

carried on a substitute basis during the accounting period, under specic present and former FCC rules, regulations, or

authorizations. For a further explanation of the programming that must be included in this log, see page (vi) of the general

instructions.

1. SPECIAL STATEMENT CONCERNING SUBSTITUTE CARRIAGE

• During the accounting period, did your cable system carry, on a substitute basis, any nonnetwork television program

broadcast by a distant station?

Yes No

Note: If your answer is “No”, leave the rest of this page blank. If your answer is “Yes,” you must complete the program

log in block 2.

2. LOG OF SUBSTITUTE PROGRAMS

In General: List each substitute program on a separate line. Use abbreviations wherever possible, if their meaning is

clear. If you need more space, please attach additional pages.

Column 1: Give the title of every nonnetwork television program (substitute program) that, during the accounting

period, was broadcast by a distant station and that your cable system substituted for the programming of another

station under certain FCC rules, regulations, or authorizations. See page (vi) of the general instructions for further

information. Do not use general categories like “movies” or “basketball.” List specic program titles, for example, “I

Love Lucy” or “NBA Basketball: 76ers vs. Bulls.”

Column 2: If the program was broadcast live, enter “Yes.” Otherwise enter “No.”

Column 3: Give the call sign of the station broadcasting the substitute program.

Column 4: Give the broadcast station’s location (the community to which the station is licensed by the FCC or, in

the case of Mexican or Canadian stations, if any, the community with which the station is identied).

Column 5: Give the month and day when your system carried the substitute program. Use numerals, with the month

rst. Example: for May 7 give “5/7.”

Column 6: State the times when the substitute program was carried by your cable system. List the times accurately

to the nearest ve minutes. Example: a program carried by a system from 6:01:15 p.m. to 6:28:30 p.m. should be

stated as “6:00–6:30 p.m.”

Column 7: Enter the letter “R” if the listed program was substituted for programming that your system was required

to delete under FCC rules and regulations in eect during the accounting period; enter the letter “P” if the listed pro-

gram was substituted for programming that your system was permitted to delete under FCC rules and regulations in

eect on October 19, 1976.

—

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name

LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 6.

J

Part-Time

Carriage

Log

PART-TIME CARRIAGE LOG

In General: This space ties in with column 5 of space G. If you listed a station’s basis of carriage as “LAC” for part-

time carriage due to lack of activated channel capacity, you are required to complete this log giving the total dates and

hours your system carried that station. If you need more space, please attach additional pages.

Column 1 (Call sign): Give the call sign of every distant station whose basis of carriage you identied by “LAC” in

column 5 of space G.

Column 2 (Dates and hours of carriage): For each station, list the dates and hours when part-time carriage oc-

curred during the accounting period.

• Give the month and day when the carriage occurred. Use numerals, with the month rst. Example: for April 10 give

“4/10.”

• State the starting and ending times of carriage to the nearest quarter hour. In any case where carriage ran to the end

of the television station’s broadcast day, you may give an approximate ending hour, followed by the abbreviation

“app.” Example: “12:30 a.m.–3:15 a.m. app.”

• You may group together any dates when the hours of carriage were the same. Example: “5/10-5/14, 6:00 p.m.–

12:00 p.m.”

DATES AND HOURS OF PART-TIME CARRIAGE

WHEN CARRIAGE OCCURRED

DATE

CALL SIGN

HOURS

FROM TO

CALL SIGN

DATE

HOURS

FROM TO

—

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

FORM SA3. PAGE 7.

MINIMUM FEE: All cable systems with semiannual gross receipts of $527,600 or more are required to pay at

least the minimum fee, regardless of whether they carried any distant stations. This fee is 1.064 percent of the

system’s gross receipts for the accounting period.

Line 1. Enter the amount of gross receipts from space K

Line 2. Multiply the amount in line 1 by 0.01064

Enter the result here.

This is your minimum fee.

COPYRIGHT ROYALTY AND FILING FEES

Instructions: Use the blocks in this space L to determine the royalty fee you owe:

• Complete block 1, showing your minimum fee.

• Complete block 2, showing whether your system carried any distant television stations.

• If your system did not carry any distant television stations, leave block 3 blank. Enter the amount of the minimum

fee from block 1 on line 1 of block 4, and calculate the total royalty fee.

• If your system did carry any distant television stations, you must complete the applicable parts of the DSE Schedule

accompanying this form and attach the schedule to your statement of account.

If part 8 or part 9, block A, of the DSE schedule was completed, the base rate fee should be entered on line 1 of

block 3 below.

If part 6 of the DSE schedule was completed, the amount from line 7 of block C should be entered on line 2 in block

3 below.

If part 7 or part 9, block B, of the DSE schedule was completed, the surcharge amount should be entered on line

2 in block 4 below.

Line 1. BASE RATE FEE/3.75 FEE or MINIMUM FEE: Enter either the minimum fee

from block 1 or the sum of the base rate fee/ 3.75 fee from block 3, line 3,

whichever is larger

Line 2. SYNDICATED EXCLUSIVITY SURCHARGE: Enter the fee from either part 7

(block D, section 3 or 4) or part 9 (block B) of the DSE schedule. If none, enter

zero.

Line 3. INTEREST CHARGE: Enter the amount from line 4, space Q, page 9 (Interest

Worksheet)

Line 4. FILING FEE:

TOTAL ROYALTY AND FILING FEES PAYABLE FOR ACCOUNTING PERIOD.

Add Lines 1, 2, 3 and 4 of block 4 and enter total here

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Line 1. BASE RATE FEE: Enter the base rate fee from either part 8, section 3 or

4, or part 9, block A of the DSE schedule. If none, enter zero

Line 2. 3.75 Fee: Enter the total fee from line 7, block C, part 6 of the DSE

schedule. If none, enter zero

Line 3. Add lines 1 and 2 and enter

here

Block

DISTANT TELEVISION STATIONS CARRIED: Your answer here must agree with the information you gave in

space G. If, in space G, you identied any stations as “distant” by stating “Yes” in column 4, you must check

“Yes” in this block.

• Did your cable system carry any distant television stations during the accounting period?

Yes—Complete the DSE schedule. No—Leave block 3 below blank and complete line 1, block 4.

GROSS RECEIPTS

Instructions: The gure you give in this space determines the form you le and the amount you pay. Enter the total of

all amounts (gross receipts) paid to your cable system by subscribers for the system’s secondary transmission service

(as identied in space E) during the accounting period. For a further explanation of how to compute this amount, see

page (vii) of the general instructions.

Gross receipts from subscribers for secondary transmission service(s)

during the accounting period.

IMPORTANT: You must complete a statement in space P concerning gross receipts.

(Amount of gross receipts)

K

Gross Receipts

L

Copyright

Royalty Fee

Block

1

2

Block

3

Block

4

. . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Remit this amount via electronic payment payable to Register of Copyrights. (See page (i) of the general

instructions for more information.)

$

$ 725.00

$

Cable systems

submitting

additional

deposits under

Section 111(d)(7)

should contact

the Licensing

Division for the

appropriate

form for

submitting the

additional fees.

$

Name

LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 8.

Name

CHANNELS

Instructions: You must give (1) the number of channels on which the cable system carried television broadcast stations

to its subscribers and (2) the cable system’s total number of activated channels, during the accounting period.

1. Enter the total number of channels on which the cable

system carried television broadcast stations

2. Enter the total number of activated channels

on which the cable system carried television broadcast stations

and nonbroadcast services

M

Channels

INDIVIDUAL TO BE CONTACTED IF FURTHER INFORMATION IS NEEDED:

(Identify an individual we can contact about this statement of account.)

Name

Address

Telephone

(Area code)

(Number, street, rural route, apartment, or suite number)

(City, town, state, zip)

CERTIFICATION (This statement of account must be certied and signed in accordance with Copyright Oce regu-

lations, as explained in the general instructions.)

• I, the undersigned, hereby certify that (Check one, but only one, of the boxes.)

(Owner other than corporation or partnership) I am the owner of the cable system as identied in line 1

of space B; or

(Agent of owner other than corporation or partnership) I am the duly authorized agent of the owner of

the cable system as identied in line 1 of space B and that the owner is not a corporation or partnership; or

(Ocer or partner) I am an ocer (if a corporation) or a partner (if a partnership) of the legal entity identied as

owner of the cable system in line 1 of space B.

• I have examined the statement of account and hereby declare under penalty of law that all statements of fact

contained herein are true, complete, and correct to the best of my knowledge, information, and belief, and are

made in good faith. [18 U.S.C. sec. 1001]

Handwritten signature:

Typed or printed name:

Title:

Date:

(Title of ocial position held in corporation or partnership)

O

Certiﬁcation

N

Individual to

Be Contacted

for Further

Information

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

☛☛

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Email (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fax (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Oce to collect the personally identifying information (PII) requested on this

form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address, and telephone

numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Oce's public indexes and

in search reports prepared for the public. The eect of not providing the PII requested is that it may delay processing of your statement of account and its placement in the

completed record of statements of account, and it may aect the legal suciency of the ling, a determination that would be made by a court of law.

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

FORM SA3. PAGE 9.

SPECIAL STATEMENT CONCERNING GROSS RECEIPTS EXCLUSIONS

The Satellite Home Viewer Act of 1988 amended Title 17, section 111(d)(1)(A), of the Copyright Act by adding the fol-

lowing sentence:

“In determining the total number of subscribers and the gross amounts paid to the cable system for the basic

service of providing secondary transmissions of primary broadcast transmitters, the system shall not include sub-

scribers and amounts collected from subscribers receiving secondary transmissions pursuant to section 119.”

For more information on when to exclude these amounts, see the note on page (vii) of the general instructions.

During the accounting period did the cable system exclude any amounts of gross receipts for secondary transmissions

made by satellite carriers to satellite dish owners?

NO

YES. Enter the total here and list the satellite carrier(s) below.

INTEREST ASSESSMENT

You must complete this worksheet for those royalty payments submitted as a result of a late payment or underpayment.

For an explanation of interest assessment, see page (viii) of the general instructions.

Line 3 Multiply line 2 by the number of days late and enter the sum here

Line 4 Multiply line 3 by 0.00274** enter here and on line 3, block 4,

space L, (page 7)

x %

x days

x 0.00274

(interest charge)

Line 1 Enter the amount of late payment or underpayment

Line 2 Multiply line 1 by the interest rate* and enter the sum here

Name

Mailing address

Q

Interest

Assessment

P

Special

Statement

Concerning

Gross Receipts

Exclusions

. . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name

Mailing address

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

*

To view the interest rate chart click on www.copyright.gov/licensing/interest-rate.pdf. For further assistance please

contact the Licensing Division at (202) 707-8150 or licensing@copyright.gov.

** This is the decimal equivalent of 1/365, which is the interest assessment for one day late.

NOTE: If you are ling this worksheet covering a statement of account already submitted to the Copyright Oce,

please list below the owner, address, rst community served, accounting period, and ID number as given in the original

ling.

Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address .......................................................................................

.......................................................................................

First community served ..........................................................................

Accounting period ...............................................................................

ID number .....................................................................................

$

Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Oce to collect the personally identifying information (PII) requested on this

form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address, and telephone

numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Oce's public indexes and

in search reports prepared for the public. The eect of not providing the PII requested is that it may delay processing of your statement of account and its placement in the

completed record of statements of account, and it may aect the legal suciency of the ling, a determination that would be made by a court of law.

DSE SCHEDULE. PAGE 10.

The Minimum Fee ⁄ Base Rate Fee ⁄ 3.75 Percent Fee. All cable sys-

tems ling SA3 (Long Form) must pay at least the minimum fee, which is

1.064 percent of gross receipts. The cable system pays either the minimum

fee or the sum of the base rate fee and the 3.75 percent fee, whichever is

larger, and a Syndicated Exclusivity Surcharge, as applicable.

What is a “Permitted” Station? A permitted station refers to a distant

station whose carriage is not subject to the 3.75 percent rate but is sub-

ject to the base rate and, where applicable, the Syndicated Exclusivity

Surcharge. A permitted station would include the following:

1) A station actually carried within any portion of a cable system prior

to June 25, 1981, pursuant to the former FCC rules.

2) A station rst carried after June 24, 1981, which could have been

carried under FCC rules in eect on June 24, 1981, if such carriage

would not have exceeded the market quota imposed for the importa-

tion of distant stations under those rules.

3) A station of the same type substituted for a carried network, non-

commercial educational, or regular independent station for which a

quota was or would have been imposed under FCC rules (47 CFR

76.59 (b),(c), 76.61 (b),(c),(d), and 767.63 (a) [referring to 76.61 (b),(d)])

in eect on June 24, 1981.

4) A station carried pursuant to an individual waiver granted between

April 16, 1976, and June 25, 1981, under the FCC rules and regulations

in eect on April 15, 1976.

5) In the case of a station carried prior to June 25, 1981, on a part-time

and/or substitute basis only, that fraction of the current DSE repre-

sented by prior carriage.

NOTE: If your cable system carried a station that you believe qualies

as a permitted station but does not fall into one of the above catego-

ries, please attach written documentation to the statement of account

detailing the basis for its classication.

Substitution of Grandfathered Stations. Under section 76.65 of the

former FCC rules, a cable system was not required to delete any sta-

tion that it was authorized to carry or was lawfully carrying prior to

March 31, 1972, even if the total number of distant stations carried

exceeded the market quota imposed for the importation of distant

stations. Carriage of these grandfathered stations is not subject to the

3.75 percent rate, but is subject to the Base Rate, and where applicable,

the Syndicated Exclusivity Surcharge. The former Copyright Royalty

Tribunal (now known as the Copyright Royalty Board) has stated its

view that, since section 76.65 of the former FCC rules would not have

permitted substitution of a grandfathered station, the 3.75 percent Rate

applies to a station substituted for a grandfathered station if carriage

of the station exceeds the market quota imposed for the importation

of distant stations.

COMPUTING THE 3.75 PERCENT RATE—PART 6 OF THE DSE

SCHEDULE

• Determine which distant stations were carried by the system pursuant

to former FCC rules in eect on June 24, 1981.

• Identify any station carried prior to June 25, 198l, on a substitute and/or

part-time basis only and complete the log to determine the portion of

the DSE exempt from the 3.75 percent rate.

• Subtract the number of DSEs resulting from this carriage from the num-

ber of DSEs reported in part 5 of the DSE Schedule. This is the total

number of DSEs subject to the 3.75 percent rate. Multiply these DSEs

by gross receipts by .0375. This is the 3.75 fee.

COMPUTING THE SYNDICATED EXCLUSIVITY SURCHARGE—

PART 7 OF THE DSE SCHEDULE

• Determine if any portion of the cable system is located within a top 100

major television market as dened by the FCC rules and regulations in

eect on June 24, 1981. If no portion of the cable system is located in

a major television market, part 7 does not have to be completed.

• Determine which station(s) reported in block B, part 6 are commercial

VHF stations and place a grade B contour, in whole, or in part, over the

cable system. If none of these stations are carried, part 7 does not have

to be completed.

• Determine which of those stations reported in block b, part 7 of the

DSE Schedule were carried before March 31,1972. These stations are

exempt from the FCC’s syndicated exclusivity rules in eect on June 24,

1981. If you qualify to calculate the royalty fee based upon the carriage

of partially-distant stations, and you elect to do so, you must compute

the surcharge in part 9 of this schedule.

• Subtract the exempt DSEs from the number of DSEs determined in block

B of part 7. This is the total number of DSEs subject to the Syndicated

Exclusivity Surcharge.

• Compute the Syndicated Exclusivity Surcharge based upon these DSEs

and the appropriate formula for the system’s market position.

INSTRUCTIONS FOR DSE SCHEDULE

WHAT IS A “DSE”

The term “distant signal equivalent” (DSE) generally refers to the numerical

value given by the Copyright Act to each distant television station carried

by a cable system during an accounting period. Your system’s total number

of DSEs determines the royalty you owe. For the full denition, see page

(vi) of the General Instructions.

FORMULAS FOR COMPUTING A STATION’S DSE

There are two dierent formulas for computing DSEs: (1) a basic formula

for all distant stations listed in space G (page 3), and (2) a special for-

mula for those stations carried on a substitute basis and listed in space

I (page 5). (Note that if a particular station is listed in both space G and

space I, a DSE must be computed twice for that station: once under the

basic formula and again under the special formula. However, a station’s

total DSE is not to exceed its full type-value. If this happens, contact the

Licensing Division.)

BASIC FORMULA: FOR ALL DISTANT STATIONS LISTED

IN SPACE G OF SA3 (LONG FORM)

Step 1: Determine the station’s type-value. For purposes of computing

DSEs, the Copyright Act gives dierent values to distant stations depend-

ing upon their type. If, as shown in space G of your statement of account

(page 3), a distant station is:

• Independent: its type-value is ........................................................1.00

• Network: its type-value is ...............................................................0.25

• Noncommercial educational: its type-value is .............................0.25

Note that local stations are not counted at all in computing DSEs.

Step 2: Calculate the station’s basis of carriage value: The DSE of

a station also depends on its basis of carriage. If, as shown in space G

of your Form SA3, the station was carried part time because of lack of

activated channel capacity, its basis of carriage value is determined by (1)

calculating the number of hours the cable system carried the station during

the accounting period, and (2) dividing that number by the total number of

hours the station broadcast over the air during the accounting period. The

basis of carriage value for all other stations listed in space G is 1.0.

Step 3: Multiply the result of step 1 by the result of step 2. This gives

you the particular station’s DSE for the accounting period. (Note that for

stations other than those carried on a part-time basis due to lack of ac-

tivated channel capacity, actual multiplication is not necessary since the

DSE will always be the same as the type value.)

SPECIAL FORMULA FOR STATIONS LISTED IN

SPACE I OF SA3 (LONG FORM)

Step 1: For each station, calculate the number of programs that, during the

accounting period, were broadcast live by the station and were substituted

for programs deleted at the option of the cable system.

(These are programs for which you have entered “Yes” in column 2 and

“P” in column 7 of space I.)

Step 2: Divide the result of step 1 by the total number of days in the

calendar year (365—or 366 in a leap year). This gives you the particular

station’s DSE for the accounting period.

TOTAL OF DSEs

In part 5 of this schedule you are asked to add up the DSEs for all of the

distant television stations your cable system carried during the accounting

period. This is the total sum of all DSEs computed by the basic formula

and by the special formula.

THE ROYALTY FEE

The total royalty fee is determined by calculating the minimum fee and

the base rate fee. In addition, cable systems located within certain televi-

sion market areas may be required to calculate the 3.75 fee and/or the

Syndicated Exclusivity Surcharge. Note: Distant multicast streams are not

subject to the 3.75 fee or the Syndicated Exclusivity Surcharge. Distant

simulcast streams are not subject to any royalty payment.

The 3.75 Fee. If a cable system located in whole or in part within a

television market added stations after June 24, 1981, that would not have

been permitted under FCC rules, regulations, and authorizations (hereaf-

ter referred to as “the former FCC rules”) in eect on June 24, 1981, the

system must compute the 3.75 fee using a formula based on the number

of DSEs added. These DSEs used in computing the 3.75 fee will not be

used in computing the base rate fee and Syndicated Exclusivity Surcharge.

The Syndicated Exclusivity Surcharge. Cable systems located in

whole or in part within a major television market, as dened by FCC rules

and regulations, must calculate a Syndicated Exclusivity Surcharge for the

carriage of any commercial VHF station that places a grade B contour, in

whole or in part, over the cable system that would have been subject to

the FCC’s syndicated exclusivity rules in eect on June 24, 1981.

COMPUTING THE BASE RATE FEE—PART 8 OF THE DSE

SCHEDULE

Determine whether any of the stations you carried were partially distant—

that is, whether you retransmitted the signal of one or more stations to

subscribers located within the station’s local service area and, at the same

time, to other subscribers located outside that area.

• If none of the stations were partially distant, calculate your base rate

fee according to the following rates—for the system’s permitted DSEs

as reported in block B, part 6 or from part 5, whichever is applicable.

First DSE 1.064% of gross receipts

Each of the second, third, and fourth DSEs 0.701% of gross receipts

The fth and each additional DSE 0.330% of gross receipts

PARTIALLY DISTANT STATIONS—PART 9 OF THE DSE SCHEDULE

• If any of the stations were partially distant:

1. Divide all of your subscribers into subscriber groups depending on

their location. A particular subscriber group consists of all subscribers who

are distant with respect to exactly the same complement of stations.

2. Identify the communities/areas represented by each subscriber group.

3. For each subscriber group, calculate the total number of DSEs of

that group’s complement of stations.

If your system is located wholly outside all major and smaller television

markets, give each station’s DSEs as you gave them in parts 2, 3, and 4

of the schedule; or

If any portion of your system is located in a major or smaller television

market, give each station’s DSE as you gave it in block B, part 6 of this

schedule.

4. Determine the portion of the total gross receipts you reported in space

K (page 7) that is attributable to each subscriber group.

5. Calculate a separate base rate fee for each subscriber group, using

(1) the rates given above; (2) the total number of DSEs for that group’s

complement of stations; and (3) the amount of gross receipts attributable

to that group.

6. Add together the base rate fees for each subscriber group to deter-

mine the system’s total base rate fee.

7. If any portion of the cable system is located in whole or in part within

a major television market, you may also need to complete part 9, block B

of the Schedule to determine the Syndicated Exclusivity Surcharge.

What to Do If You Need More Space on the DSE Schedule. There

are no printed continuation sheets for the schedule. In most cases, the

blanks provided should be large enough for the necessary information. If

you need more space in a particular part, make a photocopy of the page

in question (identifying it as a continuation sheet), enter the additional

information on that copy, and attach it to the DSE schedule.

Rounding O DSEs. In computing DSEs on the DSE schedule, you may

round o to no less than the third decimal point. If you round o a DSE in

any case, you must round o DSEs throughout the schedule as follows:

• When the fourth decimal point is 1, 2, 3, or 4, the third decimal remains

unchanged (example: .34647 is rounded to .346).

• When the fourth decimal point is 5, 6, 7, 8, or 9, the third decimal is

rounded up (example: .34651 is rounded to .347).

The example below is intended to supplement the instructions for calculat-

ing only the base rate fee for partially distant stations. The cable system

would also be subject to the Syndicated Exclusivity Surcharge for partially

distant stations, if any portion is located within a major television market.

DSE SCHEDULE. PAGE 11.

First Subscriber Group

(Santa Rosa)

Gross receipts $310,000.00

DSEs 2.472

Base rate fee $6,497.20

$310,000 x .01064 x 1.0 = 3,298.40

$310,000 x .00701 x 1.472 =

3,198.80

Base rate fee $6,497.20

Third Subscriber Group

(Fairvale)

Gross receipts $120,000.00

DSEs 1.389

Base rate fee $1,604.03

$120,000 x .01064 x 1.0 = 1,276.80

$120,000 x .00701 x .389 = 327.23

Base rate fee $1,604.03

Second Subscriber Group

(Rapid City and Bodega Bay)

Gross receipts $170,000.00

DSEs 1.083

Base rate fee $1,907.71

$170,000 x .01064 x 1.0 = 1,808.80

$170,000 x .00701 x .083 = 98.91

Base rate fee $1,907.71

EXAMPLE:

COMPUTATION OF COPYRIGHT ROYALTY FEE FOR CABLE SYSTEM CARRYING PARTIALLY DISTANT STATIONS

In most cases under current FCC

rules, all of Fairvale would be within

the local service area of both stations

A and C and all of Rapid City and Bo-

dega Bay would be within the local

service ares of stations B, D, and E.

Santa Rosa Stations A and C

35 mile zone

Fairvale

Rapid City

Bodega

Bay

Stations B, D,

and E

35 mile zone

Distant Stations Carried

STATION DSE

A (independent) 1.0

B (independent) 1.0

C (part-time) 0.083

D (part-time) 0.139

E (network) 0.25

TOTAL DSEs 2.472

Identiﬁcation of Subscriber Groups

CITY

Santa Rosa

Rapid City

Bodega Bay

Fairvale

OUTSIDE LOCAL

SERVICE AREA OF

Stations A, B, C, D ,E

Stations A and C

Stations B, D, and E

TOTAL GROSS RECEIPTS

Minimum Fee Total Gross Receipts $600,000.00

x .01064

$6,384.00

Total Base Rate Fee: $6,497.20 + $1,907.71 + $1,604.03 = $10,008.94

In this example, the cable system would enter $10,008.94 in space L, block 3, line 1 (page 7)

LEGAL NAME OF OWNER OF CABLE SYSTEM:

1

2

Computation

of DSEs for

Category “O”

Stations

Instructions:

In the column headed “Call Sign”: list the call signs of all distant stations identied by the letter “O” in column 5

of space G (page 3).

In the column headed “DSE”: for each independent station, give the DSE as “1.0”; for each network or noncom-

mercial educational station, give the DSE as “.25.”

CATEGORY “O” STATIONS: DSEs

CALL SIGN DSE CALL SIGN CALL SIGNDSE DSE

SUM OF DSEs OF CATEGORY “O” STATIONS:

• Add the DSEs of each station.

Enter the sum here and in line 1 of part 5 of this schedule.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GROSS RECEIPTS

FROM SUBSCRIBERS

$310,000.00

100,000.00

70,000.00

120,000.00

$600,000.00

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

TOTAL NUMBER OF DSEs: Give the amounts from the boxes in parts 2, 3, and 4 of this schedule and add them to provide the total

number of DSEs applicable to your system.

1. Number of DSEs from part 2

2. Number of DSEs from part 3

3. Number of DSEs from part 4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CATEGORY LAC STATIONS: COMPUTATION OF DSEs

Instructions: CAPACITY

Column 1: List the call sign of all distant stations identied by “LAC” in column 5 of space G (page 3).

Column 2: For each station, give the number of hours your cable system carried the station during the accounting period. This

gure should correspond with the information given in space J. Calculate only one DSE for each station.

Column 3: For each station, give the total number of hours that the station broadcast over the air during the accounting period.

Column 4: Divide the gure in column 2 by the gure in column 3, and give the result in decimals in column 4. This gure must

be carried out at least to the third decimal point. This is the “basis of carriage value” for the station.

Column 5: For each independent station, give the “type-value” as “1.0.” For each network or noncommercial educational station,

give the type-value as “.25.”

Column 6: Multiply the gure in column 4 by the gure in column 5, and give the result in column 6. Round to no less than the

third decimal point. This is the station’s DSE. (For more information on rounding, see page (viii) of the general instructions.)

1. CALL

SIGN

2. NUMBER

OF HOURS

CARRIED BY

SYSTEM

3. NUMBER

OF HOURS

STATION

ON AIR

4. BASIS OF

CARRIAGE

VALUE

5. TYPE

VALUE

6. DSE

TOTAL NUMBER OF DSEs

SUM OF DSEs OF SUBSTITUTE-BASIS STATIONS:

Add the DSEs of each station.

Enter the sum here and in line 3 of part 5 of this schedule,

SUM OF DSEs OF CATEGORY LAC STATIONS:

Add the DSEs of each station.

Enter the sum here and in line 2 of part 5 of this schedule,

2. NUMBER

OF

PROGRAMS

3. NUMBER

OF DAYS

IN YEAR

4. DSE1. CALL

SIGN

2. NUMBER

OF

PROGRAMS

4. DSE

3. NUMBER

OF DAYS

IN YEAR

1. CALL

SIGN

SUBSTITUTE-BASIS STATIONS: COMPUTATION OF DSEs

Instructions:

Column 1: Give the call sign of each station listed in space I (page 5, the Log of Substitute Programs) if that station:

• Was carried by your system in substitution for a program that your system was permitted to delete under FCC rules and regula-

tions in eect on October 19, 1976 (as shown by the letter “P” in column 7 of space I); and

• Broadcast one or more live, nonnetwork programs during that optional carriage (as shown by the word “Yes” in column 2 of

space I).

Column 2: For each station give the number of live, nonnetwork programs carried in substitution for programs that were deleted

at your option. This gure should correspond with the information in space I.

Column 3: Enter the number of days in the calendar year: 365, except in a leap year.

Column 4: Divide the gure in column 2 by the gure in column 3, and give the result in column 4. Round to no less than the third

decimal point. This is the station’s DSE (For more information on rounding, see page (viii) of the general instructions.)

DSE SCHEDULE. PAGE 12.

3

Computation

of DSEs for

Stations

Carried Part

Time Due to

Lack of

Activated

Channel

Capacity

4

Computation

of DSEs for

Substitute-

Basis Stations

5

Total Number

of DSEs

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

÷ = x =

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

÷ = x =

÷ =

÷ = x =

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

Line 1: Enter the total number of DSEs from part 5 of this schedule

Line 2: Enter the sum of permitted DSEs from block B above

Line 3: Subtract line 2 from line 1. This is the total number of DSEs subject to the 3.75 rate.

(If zero, leave lines 4–7 blank and proceed to part 7 of this schedule)

Line 4: Enter gross receipts from space K (page 7)

Line 5: Multiply line 4 by 0.0375 and enter sum here

Line 6: Enter total number of DSEs from line 3

Line 7: Multiply line 6 by line 5 and enter here and on line 2, block 3, space L (page 7)

BLOCK A: TELEVISION MARKETS

Instructions: Block A must be completed.

In block A:

• If your answer if “Yes,” leave the remainder of part 6 and part 7 of the DSE schedule blank and complete part 8, (page 16) of the

schedule.

• If your answer if “No,” complete blocks B and C below.

Is the cable system located wholly outside of all major and smaller markets as dened under section 76.5 of FCC rules and regula-

tions in eect on June 24, 1981?

Yes — Complete part 8 of the schedule—DO NOT COMPLETE THE REMAINDER OF PART 6 AND 7.

No—Complete blocks B and C below.

BLOCK B: CARRIAGE OF PERMITTED DSEs

Column 1:

CALL SIGN

Column 2:

BASIS OF

PERMITTED

CARRIAGE

Column 3:

$

BLOCK C: COMPUTATION OF 3.75 FEE

List the call signs of distant stations listed in part 2, 3, and 4 of this schedule that your system was permitted to

carry under FCC rules and regulations prior to June 25, 1981. For further explanation of permitted stations, see the

instructions for the DSE Schedule. (Note: The letter M below refers to an exempt multicast stream as set forth in the

Satellite Television Extension and Localism Act of 2010.)

Enter the appropriate letter indicating the basis on which you carried a permitted station.

(Note the FCC rules and regulations cited below pertain to those in eect on June 24, 1981.)

A Stations carried pursuant to the FCC market quota rules [76.57, 76.59(b), 76.61(b)(c), 76.63(a) referring to

76.61(b)(c)]

B Specialty station as dened in 76.5(kk) (76.59(d)(1), 76.61(e)(1), 76.63(a) referring to 76.61(e)(1)

C Noncommerical educational station [76.59(c), 76.61(d), 76.63(a) referring to 76.61(d)]

D Grandfathered station (76.65) (see paragraph regarding substitution of grandfathered stations in the

instructions for DSE schedule).

E Carried pursuant to individual waiver of FCC rules (76.7)

*F A station previously carried on a part-time or substitute basis prior to June 25, 1981

G Commercial UHF station within grade-B contour, [76.59(d)(5), 76.61(e)(5), 76.63(a) referring to 76.61(e)(5)]

M Retransmission of a distant multicast stream.

O Other

List the DSE for each distant station listed in parts 2, 3, and 4 of the schedule.

*(Note: For those stations identied by the letter “F” in column 2, you must complete the worksheet on page 14 of

this schedule to determine the DSE.)

2. PERMITTED

BASIS

3. DSE

1. CALL

SIGN

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1. CALL

SIGN

1. CALL

SIGN

2. PERMITTED

BASIS

2. PERMITTED

BASIS

3. DSE 3. DSE

6

Computation of

3.75 Fee

x 0.0375

x

DSE SCHEDULE. PAGE 13.

$

Do any of the

DSEs represent

partially

permited/

partially non-

permitted

carriage?

If yes, see part

9 instructions.

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

Was any station listed in block B of part 7 carried in any commu-

nity served by the cable system prior to March 31, 1972? (refer

to former FCC rule 76.159)

Instructions: You must complete this worksheet for those stations identied by the letter “F” in column 2 of block B, part 6 (i.e., those

stations carried prior to June 25, 1981, under former FCC rules governing part-time and substitute carriage.)

Column 1: List the call sign for each distant station identied by the letter “F” in column 2 of part 6 of the DSE schedule.

Column 2: Indicate the DSE for this station for a single accounting period, occurring between January 1, 1978 and June 30, 1981.

Column 3: Indicate the accounting period and year in which the carriage and DSE occurred (e.g., 1981/1).

Column 4: Indicate the basis of carriage on which the station was carried by listing one of the following letters:

(Note that the FCC rules and regulations cited below pertain to those in eect on June 24, 1981.)

A—Part-time specialty programming: Carriage, on a part-time basis, of specialty programming under FCC rules, sections

76.59(d)(1),76.61(e)(1), or 76.63 (referring to 76.61(e)(1)).

B—Late-night programming: Carriage under FCC rules, sections 76.59(d)(3), 76.61(e)(3), or 76.63 (referring to

76.61(e)(3)).

S—Substitute carriage under certain FCC rules, regulations, or authorizations. For further explanation, see page (vi) of the

general instructions.

Column 5: Indicate the station’s DSE for the current accounting period as computed in parts 2, 3, and 4 of this schedule.

Column 6: Compare the DSE gures listed in columns 2 and 5 and list the smaller of the two gures here. This gure should be entered

in block B, column 3 of part 6 for this station.

IMPORTANT: The information you give in columns 2, 3, and 4 must be accurate and is subject to verication from the designated

statement of account on le in the Licensing Division.

PERMITTED DSE FOR STATIONS CARRIED ON A PART-TIME AND SUBSTITUTE BASIS

3. ACCOUNTING

PERIOD

4. BASIS OF

CARRIAGE

5. PRESENT

DSE

6. PERMITTED

DSE

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Instructions: Block A must be completed.

In block A:

If your answer is “Yes,” complete blocks B and C, below.

If your answer is “No,” leave blocks B and C blank and complete part 8 of the DSE schedule.

Is any station listed in block B of part 6 the primary stream of a

commercial VHF station that places a grade B contour, in whole

or in part, over the cable system?

7

Computation

of the

Syndicated

Exclusivity

Surcharge

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BLOCK B: Carriage of VHF/Grade B Contour Stations

DSE SCHEDULE. PAGE 14.

1. CALL

SIGN

2. PRIOR

DSE

Worksheet for

Computating

the DSE

Schedule for

Permitted

Part-Time and

Substitute

Carriage

No—Enter zero and proceed to part 8.

Yes—List each station below with its appropriate permitted DSE

BLOCK C: Computation of Exempt DSEs

TOTAL DSEs

CALL SIGN DSE CALL SIGN DSE

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No—Enter zero and complete block D.

TOTAL DSEs

CALL SIGN DSE CALL SIGN DSE

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes—List each station below with its appropriate permitted DSE

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BLOCK A: MAJOR TELEVISION MARKET

• Is any portion of the cable system within a top 100 major television market as dened by section 76.5 of FCC rules

in eect June 24, 1981? Yes—Complete blocks B and C . No—Proceed to part 8

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

• Did your cable system retransmit the signals of any partially distant television stations during the accounting period?

Yes—Complete part 9 of this schedule. No—Complete the applicable section below.

If the gure in section 2, line C is 4.000 or less, compute your surcharge here and leave section 3b blank. NOTE: If the DSE

is 1.0 or less, multiply the gross receipts by .00599 by the DSE. Enter the result on line A below.

A. Enter 0.00599 of gross receipts (the amount in section1)

B. Enter 0.00377 of gross receipts (the amount in section 1)

C. Subtract 1.000 from total permitted DSEs (the gure on

line C in section 2) and enter here

D. Multiply line B by line C and enter here

E. Add lines A and D. This is your surcharge.

Enter here and on line 2 of block 4 in space L (page 7)

Syndicated Exclusivity Surcharge

If the gure in section 2, line C is more than 4.000, compute your surcharge here and leave section 3a blank.

A. Enter 0.00599 of gross receipts (the amount in section 1)

B. Enter 0.00377 of gross receipts (the amount in section 1)

C. Multiply line B by 3.000 and enter here

D. Enter 0.00178 of gross receipts (the amount in section 1)

E. Subtract 4.000 from total DSEs (the gure on line C in section 2) and enter here

F. Multiply line D by line E and enter here

G. Add lines A, C, and F. This is your surcharge.

Enter here and on line 2, block 4, space L (page 7)

Syndicated Exclusivity Surcharge

A. Enter the total DSEs from block B of part 7

B. Enter the total number of exempt DSEs from block C of part 7

C. Subtract line B from line A and enter here. This is the total number of DSEs

subject to the surcharge computation. If zero, proceed to part 8.

. . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the amount of gross receipts from space K (page 7)

SECTION 3: TOP 50 TELEVISION MARKET

BLOCK D: COMPUTATION OF THE SYNDICATED EXCLUSIVITY SURCHARGE

Section

1

Section

2

• Is any portion of the cable system within a top 50 television market as dened by the FCC?

Yes—Complete section 3 below. No—Complete section 4 below.

Section

3a

Did your cable system retransmit the signals of any partially distant television stations during the accounting period?

Yes—Complete part 9, of the Schedule. No—Complete the following sections.

If the gure in section 2, line C is 4.000 or less, compute your surcharge here and leave section 4b blank. NOTE: If the DSE

is 1.0 or less, multiply the gross receipts by 0.003 by the DSE. Enter the result on line A below.

A. Enter 0.00300 of gross receipts (the amount in section 1)

B. Enter 0.00189 of gross receipts (the amount in section 1)

C.Subtract 1.000 from total permitted DSEs (the gure on line C in section 2)

and enter here

D. Multiply line B by line C and enter here

E. Add lines A and D. This is your surcharge.

Enter here and in line 2, block 4, space L (page 7)

Syndicated Exclusivity Surcharge

SECTION 4: SECOND 50 TELEVISION MARKET

Section

4a

Section

3b

7

Computation

of the

Syndicated

Exclusivity

Surcharge

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DSE SCHEDULE. PAGE 15.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

Name

LEGAL NAME OF OWNER OF CABLE SYSTEM:

If the gure in section 2, line C is more than 4.000, compute your surcharge here and leave section 4a blank.

A. Enter 0.00300 of gross receipts (the amount in section 1)

B. Enter 0.00189 of gross receipts (the amount in section 1)

C. Multiply line B by 3.000 and enter here

D. Enter 0.00089 of gross receipts (the amount in section 1)

E. Subtract 4.000 from the total DSEs (the gure on line C in

section 2) and enter here

F. Multiply line D by line E and enter here

G. Add lines A, C, and F. This is your surcharge.

Enter here and on line 2, block 4, space L (page 7)

Syndicated Exclusivity Surcharge

DSE SCHEDULE. PAGE 16.

Instructions:

You must complete this part of the DSE schedule for the SUM OF PERMITTED DSEs in part 6, block B; however, if block A of part

6 was checked “Yes,” use the total number of DSEs from part 5.

• In block A, indicate, by checking “Yes” or “No,” whether your system carried any partially distant stations.

• If your answer is “No,” compute your system’s base rate fee in block B. Leave part 9 blank.

• If your answer is “Yes” (that is, if you carried one or more partially distant stations), you must complete part 9. Leave block B below

blank.

What is a partially distant station? A station is “partially distant” if, at the time your system carried it, some of your subscribers

were located within that station’s local service area and others were located outside that area. For the denition of a station’s “local

service area,” see page (v) of the general instructions.

• Did your cable system retransmit the signals of any partially distant television stations during the accounting period?

Yes—Complete part 9 of this schedule. No—Complete the following sections.

BLOCK A: CARRIAGE OF PARTIALLY DISTANT STATIONS

Section

4b

. . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Computation

of the

Syndicated

Exclusivity

Surcharge

8

Computation

of

Base Rate Fee

. . . . . . . . . . . . . . . . . . . . . . . . .

Enter the amount of gross receipts from space K (page 7)

Enter the total number of permitted DSEs from block B, part 6 of this schedule.

(If block A of part 6 was checked “Yes,”

use the total number of DSEs from part 5.)

If the gure in section 2 is 4.000 or less, compute your base rate fee here and leave section 4 blank.

NOTE: If the DSE is 1.0 or less, multiply the gross receipts by 0.01064 by the DSE. Enter the result on line A below.

A. Enter 0.01064 of gross receipts

(the amount in section 1)

B. Enter 0.00701 of gross receipts

(the amount in section 1)

C. Subtract 1.000 from total DSEs

(the gure in section 2) and enter here

D. Multiply line B by line C and enter here

E. Add lines A, and D. This is your base rate fee. Enter here

and in block 3, line 1, space L (page 7)

Base Rate Fee

BLOCK B: NO PARTIALLY DISTANT STATIONS—COMPUTATION OF BASE RATE FEE

Section

1

Section

2

Section

3

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$

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

IMPORTANT: It is no longer necessary to report television signals on a system-wide basis. Carriage of television broadcast signals

shall instead be reported on a community-by-community basis (subscriber groups) if the cable system reported multiple channel

line-ups in Space G.

In General: If any of the stations you carried were partially distant, the statute allows you, in computing your base rate fee, to exclude

receipts from subscribers located within the station’s local service area, from your system’s total gross receipts. To take advantage

of this exclusion, you must:

First: Divide all of your subscribers into subscriber groups, each group consisting entirely of subscribers that are distant to the same

station or the same group of stations. Next: Treat each subscriber group as if it were a separate cable system. Determine the number

of DSEs and the portion of your system’s gross receipts attributable to that group, and calculate a separate base rate fee for each

group.

Finally: Add up the separate base rate fees for each subscriber group. That total is the base rate fee for your system.

NOTE: If any portion of your cable system is located within the top 100 television market and the station is not exempt in part 7, you

must also compute a Syndicated Exclusivity Surcharge for each subscriber group. In this case, complete both block A and B below.

However, if your cable system is wholly located outside all major television markets, complete block A only.

How to Identify a Subscriber Group for Partially Distant Stations

Step 1: For each community served, determine the local service area of each wholly distant and each partially distant station you

carried to that community.

Step 2: For each wholly distant and each partially distant station you carried, determine which of your subscribers were located

outside the station’s local service area. A subscriber located outside the local service area of a station is distant to that station (and,

by the same token, the station is distant to the subscriber.)

Step 3: Divide your subscribers into subscriber groups according to the complement of stations to which they are distant. Each

subscriber group must consist entirely of subscribers who are distant to exactly the same complement of stations. Note that a cable

system will have only one subscriber group when the distant stations it carried have local service areas that coincide.

Computing the base rate fee for each subscriber group: Block A contains separate sections, one for each of your system’s sub-

scriber groups.

In each section:

• Identify the communities/areas represented by each subscriber group.

• Give the call sign for each of the stations in the subscriber group’s complement—that is, each station that is distant to all of the

subscribers in the group.

• If:

1) your system is located wholly outside all major and smaller television markets, give each station’s DSE as you gave it in parts 2,

3, and 4 of this schedule; or,

2) any portion of your system is located in a major or smaller televison market, give each station’s DSE as you gave it in block B,

part 6 of this schedule.

• Add the DSEs for each station. This gives you the total DSEs for the particular subscriber group.

• Calculate gross receipts for the subscriber group. For further explanation of gross receipts see page (vii) of the general instructions.

• Compute a base rate fee for each subscriber group using the formula outline in block B of part 8 of this schedule on the preceding

page. In making this computation, use the DSE and gross recipts gure applicable to the particular subscriber group (that is, the

total DSEs for that group’s complement of stations and total gross receipts from the subscribers in that group). You do not need

to show your actual calculations on the form.

If the gure in section 2 is more than 4.000, compute your base rate fee here and leave section 3 blank.

A. Enter 0.01064 of gross receipts

(the amount in section 1)

B. Enter 0.00701 of gross receipts

(the amount in section 1)

C. Multiply line B by 3.000 and enter here

D. Enter 0.00330 of gross receipts

(the amount in section 1)

E. Subtract 4.000 from total DSEs

(the gure in section 2) and enter here

F. Multiply line D by line E and enter here

G. Add lines A, C, and F. This is your base rate fee.

Enter here and in block 3, line 1, space L (page 7)

Base Rate Fee

8

Computation

of

Base Rate Fee

Section

4

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. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

Computation

of

Base Rate Fee

and

Syndicated

Exclusivity

Surcharge

for

Partially

Distant

Stations, and

for Partially

Permitted

Stations

DSE SCHEDULE. PAGE 17.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

Name

LEGAL NAME OF OWNER OF CABLE SYSTEM:

DSE SCHEDULE. PAGE 18.

Guidance for Computing the Royalty Fee for Partially Permitted/Partially Nonpermitted Signals

Step 1: Use part 9, block A, of the DSE Schedule to establish subscriber groups to compute the base rate fee for wholly and

partially permitted distant signals. Write “Permitted Signals” at the top of the page. Note: One or more permitted signals in these

subscriber groups may be partially distant.

Step 2: Use a separate part 9, block A, to compute the 3.75 percent fee for wholly nonpermitted and partially nonpermitted distant

signals. Write “Nonpermitted 3.75 stations” at the top of this page. Multiply the subscriber group gross receipts by total DSEs by

.0375 and enter the grand total 3.75 percent fees on line 2, block 3, of space L. Important: The sum of the gross receipts reported

for each part 9 used in steps 1 and 2 must equal the amount reported in space K.

Step 3: Use part 9, block B, to compute a syndicated exclusivity surcharge for any wholly or partially permitted distant

signals from step 1 that is subject to this surcharge.

Guidance for Computing the Royalty Fee for Carriage of Distant and Partially Distant Multicast Streams

Step 1: Use part 9, Block A, of the DSE Schedule to report each distant multicast stream of programming that is transmitted from

a primary television broadcast signal. Only the base rate fee should be computed for each multicast stream. The 3.75 Percent Rate

and Syndicated Exclusivity Surcharge are not applicable to the secondary transmission of a multicast stream.

You must report but not assign a DSE value for

the retransmission of a multicast stream that is the subject of a written agreement

entered into on or before June 30, 2009 between a cable system or an association representing the cable system and a primary

transmitter or an association representing the primary transmitter.

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Name

FORM SA3. PAGE 19.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

COMMUNITY/ AREA

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total DSEs

Gross Receipts Third Group

Base Rate Fee Third Group

COMMUNITY/ AREA

9

Computation

of

Base Rate Fee

and

Syndicated

Exclusivity

Surcharge

for

Partially

Distant

Stations

Base Rate Fee: Add the base rate fees for each subscriber group as shown

in the boxes above. Enter here and in block 3, line 1, space L (page 7)

CALL SIGN DSE CALL SIGN DSE

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BLOCK A: COMPUTATION OF BASE RATE FEES FOR EACH SUBSCRIBER GROUP

. . . . . . . . . . . . . . . . . . . . .

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DSE CALL SIGN DSECALL SIGN

FOURTH SUBSCRIBER GROUP

Total DSEs

Gross Receipts Fourth Group

Base Rate Fee Fourth Group

. . . . . . . . . . . . . . . . . . . . . .

. . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total DSEs

Gross Receipts Second Group

Base Rate Fee Second Group

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total DSEs

Gross Receipts First Group

Base Rate Fee First Group

. . . . . . . . . . . . . . . . . . . . .

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FIRST SUBSCRIBER GROUP SECOND SUBSCRIBER GROUP

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

COMMUNITY/ AREA

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

COMMUNITY/ AREA

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CALL SIGN CALL SIGN DSEDSE CALL SIGN DSE CALL SIGN DSE

THIRD SUBSCRIBER GROUP

. . . . . . . . . . . . . . . . . . . . . .

. . . . .

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

Name

LEGAL NAME OF OWNER OF CABLE SYSTEM:

FORM SA3. PAGE 20.

Line 1: Enter the VHF DSEs

Line 2: Enter the Exempt DSEs

Line 3: Subract line 2 from line 1

and enter here. This is the

total number of DSEs for

this subscriber group

subject to the surcharge

computation

Line 1: Enter the VHF DSEs

Line 2: Enter the Exempt DSEs

Line 3: Subract line 2 from line 1

and enter here. This is the

total number of DSEs for

this subscriber group

subject to the surcharge

computation

9

Computation

of

Base Rate Fee

and

Syndicated

Exclusivity

Surcharge

for

Partially

Distant

Stations

BLOCK B: COMPUTATION OF SYNDICATED EXCLUSIVITY SURCHARGE FOR EACH SUBSCRIBER GROUP

If your cable system is located within a top 100 television market and the station is not exempt in Part 7, you must also compute a

Syndicated Exclusivity Surcharge. Indicate which major television market any portion of your cable system is located in as dened

by section 76.5 of FCC rules in eect on June 24, 1981:

First 50 major television market Second 50 major television market

INSTRUCTIONS:

Step 1: In line 1, give the total DSEs by subscriber group for commercial VHF Grade B contour stations listed in block A, part 9 of

this schedule.

Step 2: In line 2, give the total number of DSEs by subscriber group for the VHF Grade B contour stations that were classied as

Exempt DSEs in block C, part 7 of this schedule. If none enter zero.

Step 3: In line 3, subtract line 2 from line 1. This is the total number of DSEs used to compute the surcharge.

Step 4: Compute the surcharge for each subscriber group using the formula outlined in block D, section 3 or 4 of part 7 of this

schedule. In making this computation, use gross receipts gures applicable to the particular group. You do not need to show

your actual calculations on this form.

FIRST SUBSCRIBER GROUP

SYNDICATED EXCLUSIVITY

SURCHARGE

First Group

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SECOND SUBSCRIBER GROUP

SYNDICATED EXCLUSIVITY

SURCHARGE

Second Group

Line 1: Enter the VHF DSEs

Line 2: Enter the Exempt DSEs

Line 3: Subract line 2 from line 1

and enter here. This is the

total number of DSEs for

this subscriber group

subject to the surcharge

computation

THIRD SUBSCRIBER GROUP

SYNDICATED EXCLUSIVITY

SURCHARGE

Third Group

Line 1: Enter the VHF DSEs

Line 2: Enter the Exempt DSEs

Line 3: Subract line 2 from line 1

and enter here. This is the

total number of DSEs for

this subscriber group

subject to the surcharge

computation

FOURTH SUBSCRIBER GROUP

SYNDICATED EXCLUSIVITY

SURCHARGE

Fourth Group

. . . .

. . . . . .. . . . . .

. . .

. . . . . .

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. . . . . . . . . . . .. . . . . . . . . . . .

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SYNDICATED EXCLUSIVITY SURCHARGE: Add the surcharge for each subscriber group as shown

in the boxes above. Enter here and in block 4, line 2 of space L (page 7)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . .

. . .

. . . . . . . . . . . .

$

IF YOU ARE FILING FOR A PRIOR ACCOUNTING PERIOD,

CONTACT THE LICENSING DIVISION FOR THE CORRECT FORM.

USE THIS FORM WHEN:

• You are the owner (or represent the owner) of a cable system; and

• You are ling the semiannual statement of account required by the copyright law; and

• Your system’s semiannual gross receipts for secondary transmissions (the gure you give in space K of the form) is

$527,600 or more; and

• You are also depositing the required semiannual royalty fee with the Licensing Division of the Copyright Oce.

IF YOUR FIGURE FOR SEMIANNUAL GROSS RECEIPTS IN SPACE K IS LESS THAN $527,600,

USE SA1-2 (SHORT FORM)

GENERAL INSTRUCTIONS FOR SA3 (LONG FORM)

CABLE SYSTEMS

AND THE COPYRIGHT LAW (P.L. 94-553)

Cable systems are subject to copyright liability for their use

of copyrighted material in “secondary transmissions” (the

retransmission of television and radio broadcasts to subscrib-

ers). Cable retransmissions of copyrighted programming are

subject to a system of “statutory licensing.” Among other

things, this means that twice a year the owner of a cable sys-

tem must send a statement of account, together with a royalty

fee, to the Licensing Division of the Copyright Oce.

TERMS

Primary stream. A primary stream is the single digital stream

of programming that, before June 12, 2009, was substantially

duplicating the programming transmitted by the television

broadcast station as an analog signal. If there is no stream,

then the primary stream is the single digital stream of pro-

gramming transmitted by the television broadcast station for

the longest period of time.

Primary transmitter. A primary transmitter is a television

or radio broadcast station licensed by the Federal Commu-

nications Commission, or by an appropriate governmental

authority of Canada or Mexico, that makes primary transmis-

sions to the public.

Subscriber. The term subscriber means a person or entity

that receives a secondary transmission service from a cable

system and pays a fee for the service, directly or indirectly,

to the cable system.

Subscribe. The term subscribe means to elect to become a

subscriber.

In providing copyright liability for cable systems, the law

draws a distinction between “primary transmissions” and

“secondary transmissions”:

• Primary transmissions. A primary transmission is a trans-

mission made to the public by a transmitting facility whose

signals are being received and further transmitted by a

secondary transmission service, regardless of where or

when the performance or display was rst transmitted.

In the case of a television broadcast station, the primary

stream and any multicast streams transmitted by the sta-

tion constitute primary transmissions.

• Secondary transmissions. A secondary transmission

is the basic service of retransmitting television and radio

broadcasts to subscribers. The statute requires all U.S.

cable systems, regardless of how many subscribers they

have or whether they are carrying any distant signals, to

pay some copyright royalties. However, instead of oblig-

ing cable systems to bargain individually for each copy-

righted program they retransmit, the law oers them the

opportunity to obtain a “statutory license” for secondary

transmissions.

Note: Secondary transmissions do not include trans

-

missions originated by a cable system (including local

origination cablecasting, pay cable, program services,

background music services, and originations on leased

or access channels). Cable systems must negotiate for

the use of any copyrighted material in the programming

they originate, and their originations are not subject to

statutory licensing.

HOW TO FILE THE STATEMENT OF ACCOUNT,

ROYALTY AND FILING FEES

1 Study the general information on these pages and read

through the detailed instructions in the statement of ac-

count form itself. Before you start completing the form,

make sure that you have collected all of the necessary

information and that you are using the right form.

2 Fill out the statement of account form, giving all of the

required information about your cable system and about

the television and radio stations carried by it. Print the

information in black ink. If you need more space, use one

or more continuation sheets.

3 Certify the statement of account by signing at space O.

The statement of account is not acceptable unless it bears

the original handwritten signature of one of the persons

indicated in space O as authorized to certify it under

Copyright Oce regulations.

4 Make an electronic payment (see note on page ii) in the

amount you have calculated in space L, to cover the

copyright royalty and ling fees. See the Federal Register,

gov/fedreg/2006/71fr45739.html. The remittance should

be payable to Register of Copyrights.

If you are using Pay.

gov, contact your bank to determine if your account will

accept an Automated Clearing House (ACH) debit.

5 Send the completed statement of account, one legible

copy of the statement of account, all continuation sheets,

and the DSE schedule, if required, to

Library of Congress

Copyright Oce-LD

101 Independence Avenue SE

Washington, DC 20557-6400

Courier deliveries are accepted in the James Madison

Memorial Building, room LM-401, at the address above.

Note: Please DO NOT send pages consisting solely of

instructions. Also note that if replying to Licensing Divi-

sion correspondence or if submitting revisions or amend-

ments to your original SOA, please do not include extra

photocopies of the SOA pages aected. Only one origi-

nal version of revised SOA pages is required with your

reply letter, together with a single copy of any Licensing

Division correspondence.

6 The Copyright Oce will retain your statement of account

and make it a part of our public records. You should

therefore keep a copy of the entire statement, as led, in

case you need it for future reference.

Note: For detailed instructions concerning electronic pay-

ments, see https://www.copyright.gov/licensing/ under elec-

tronic funds transfer (EFT) information.

HOW THE STATUTORY LICENSE WORKS

In general, having a statutory license means that a cable sys-

tem can retransmit broadcast programming without violating

the copyright law, as long as it complies with certain paper-

work requirements and, twice a year, deposits a royalty fee

with the Copyright Oce.

• The cable system can, without negotiated licenses or

advance permission from copyright owners, retransmit

signals of any U.S. television or radio stations that it is

authorized to carry under FCC rules, regulations, or au-

thorizations (plus Mexican or Canadian stations in certain

cases); and

• The cable system must le statements of account with the

Copyright Oce and must also deposit a semiannual roy-

alty. The amount of the royalty, which is established under

a statutory formula, depends on the total of the system’s

gross receipts for secondary transmission service.

• Every six months, the cable system must send the Copy-

right Oce a statement of account on this form, SA3 (Long

Form), or on SA1-2 (Short Form) (if the system’s gross

receipts for the accounting period are less than $527,600).

• Each semiannual statement of account must be accom-

panied by the deposit of a royalty fee covering retransmis-

sions during the preceding six months in the form of an

electronic payment payable to Register of Copyrights.

Why Having a Statutory License Is Important

Most television and radio broadcasts contain copyrighted ma-

terial. Without a statutory license, a cable system would either

have to negotiate licenses for all copyrighted programming it

retransmits or run the risk of substantial civil (or, in some cases,

criminal) liability for multiple acts of copyright infringement.

Who Can Utilize the Statutory License

Under the statute and Copyright Oce regulations, retrans-

missions are subject to statutory licensing only if they are

made by cable systems.

• Cable system. A “cable system” is dened as “a facility,

located in any State, territory, trust territory, or possession

of the United States, that in whole or in part receives signals

transmitted or programs broadcast by one or more televi-

sion broadcast stations licensed by the Federal Communi-

cations Commission, and makes secondary transmissions

of such signals or programs by wires, cables, microwave,

or other communications channels to subscribing members

of the public who pay for such service.” A system that meets

this denition is considered a cable system for copyright

purposes, even if the FCC excludes it from being consid-

ered a cable system because of the number or nature of its

subscribers or the nature of its secondary transmissions.

• Individual cable system. An “individual” cable system is

dened generally as “each cable system recognized as a

distinct entity under the rules, regulations, and practices

of the Federal Communications Commission.” In addition,

two or more cable facilities are considered as one individual

cable system if either (a) the facilities are in contiguous

communities and are under common ownership or control,

or (b) the facilities operate from one headend. Thus, even

if they are owned by dierent entities, two cable facilities

will be considered as one individual cable system if they

share a common headend.

WHAT A STATUTORY LICENSE

DOES NOT PERMIT YOU TO DO

The statutory authority given to cable systems to retransmit

television and radio broadcasts under a statutory license is

limited in several ways:

• Originations. To repeat: a cable system’s statutory license

extends only to secondary transmissions (retransmissions).

It does not permit the system to make any originations of

copyrighted material without a negotiated license covering

that material.

• Nonsimultaneous retransmissions. In general, to be sub-

ject to statutory licensing under the copyright law, a cable

retransmission must be simultaneous with the broadcast

being carried. As a rule, taping or other recording of the

program is not permitted. Taping for delayed retransmis-

GENERAL INSTRUCTIONS, FORM SA3, PAGE (ii).

GENERAL INSTRUCTIONS, FORM SA3, PAGE (iii).

sion is permissible only for some (not all) cable systems

located outside the 48 contiguous states, and, even in

these exceptional cases, there are further limitations and

conditions that the cable system must meet.

• FCC violations. The broadcast signals that a cable sys-

tem can carry under a statutory license are limited to those

that it is permitted to carry under FCC rules, regulations,

and authorizations. If signal carriage is in violation of FCC

requirements, the cable system may be subject under the

Copyright Act to a separate action for copyright infringe-

ment for each unauthorized retransmission.

• Foreign signals. In general, the copyright law does not

permit a cable system to retransmit signals of foreign televi-

sion and radio stations under a statutory license. The only

exceptions have to do with the signals of certain Mexican

and Canadian stations. Unless foreign signals fall within

these exceptions, their carriage would not be authorized

under a statutory license, even if permissible under FCC

rules.

• Program alteration or commercial substitution. Cable

systems are not permitted to alter the content of retransmit-

ted programs, or to change, delete, or substitute commer-

cials or station announcements in or adjacent to programs

being carried. There is only one exception: under

certain

circumstances, substitutions involving commercial adver-

tising market research may be permitted.

Accounting Periods

The statute establishes two six-month accounting periods

for purposes of computing the royalty fee and reporting the

information called for in the statement of account. The rst

semiannual period runs from January through June, and the

second from July through December, of each calender year.

You must use these accounting periods whether or not they

coincide with the beginning or ending of your cable system’s

scal year.

Filing Dates

Cable systems are given 60 days after the close of each ac-

counting period in which to le their statements of account,

ling and royalty fees. The following are the two ling dates

you must observe each year.

• For the January–June accounting period: File between

July 1 and August 29, inclusive;

• For the July–December accounting period: File between

January 1 and March 1, inclusive.

Note: If August 29 or March 1 falls on a weekend or federal

holiday, statements of account, royalty and ling fees may

be led on the next succeeding business day.

Statements of account, royalty and ling fees received

before the end of the accounting period will not be accept-

ed. Statements and fees received after the August 29 or

March 1 deadlines will be accepted for whatever legal eect

they may have, if any. The Copyright Oce takes no position

as to what this eect will be, and a cable system that les

late runs a substantial risk.

Refunds

Refund requests must be received within 60 days of the

close of the ling period (by April 30 or October 28). Also,

refund requests for late and amended payments must be

received before the expiration of 60 days from the date of

receipt at the Copyright Oce of the royalty payment that

is the subject of the request. The Debt Collection Improve-

ment Act of 1996 requires that refunds be made through

electronic funds transfer (EFT). Note: Late payments are

subject to interest assessment. See page (viii) of the gen-

eral instructions. Contact the Licensing Division for addi-

tional information.

How Royalty Fees Are Handled

For purposes of computing the semiannual royalty fee a cable

system must pay, the statute creates three brackets, depend-

ing upon the system’s gross receipts from subscribers for sec-

ondary transmissions during the accounting period:

1 Gross receipts of $137,100 or less: royalty fee of $52;

2 Gross receipts of more than $137,100 and less than

$527,600: royalty fee determined by a formula based on

percentage of gross receipts;

3 Gross receipts of $527,600 or more: royalty fee deter-

mined by a formula based on percentage of gross re-

ceipts and on the number of distant stations carried by

the system.

A cable system is required to deposit its semiannual roy-

alty fee with the Copyright Oce at the time it les each

statement of account. The royalty must be made by elec-

tronic payment, and the related statement of account must

be led by the appropriate deadline accompanied by a cover

letter (see circulars 74a, 74b, and 74c). The Copyright Of-

ce transfers these fees into a special fund, which is later

distributed to copyright owners as payment for the use of

their works by cable systems.

PURPOSES OF THE STATEMENT OF ACCOUNT

The law requires a cable system to le statements of ac-

count for two purposes:

• To show the basis for the semiannual royalty fee the cable

system owes under its statutory license, and

• To give the information needed to allocate royalty fees

among copyright owners.

Thus, some of the information you give on your statement

of account has nothing to do with computing your gross

receipts or deciding the amount of your royalty fee. Never-

theless, you are required to give the additional information in

order to provide the basis for the second phase of the statu-

tory license: the distribution of fees to copyright owners.

GENERAL INSTRUCTIONS, FORM SA3, PAGE (iv).

SOME POINTS TO REMEMBER

ABOUT STATUTORY LICENSES:

• As long as a cable system keeps its statutory license

in force by complying with the requirements of the new

copyright law, it is not obliged to negotiate individual

copyright licenses for retransmission of television and

radio broadcasts.

• The following are among the various ways a cable

system can lose its statutory license: by failing to le

the statements of account or royalty fees; by taping for

delayed retransmission; by carrying signals in violation

of FCC requirements; by carriage of certain foreign

stations; and by altering programs or substituting com-

mercials.

• Without a statutory license, a cable system can be sued

by a copyright owner for the full range of civil rem-

edies for copyright infringement, including injunctions,

actual damages and prots, or statutory damages (of

up to $150,000 in cases of willful infringement). The

statute also provides for criminal penalties in cases of

willful infringements for commercial purposes.

WHAT FACTS THE STATEMENT OF ACCOUNT

SHOULD COVER

All of the information you give in a statement of account

must be an accurate presentation of the facts existing dur-

ing the accounting period covered by that statement (or, in

certain cases, on the last day of that period).

• Spaces D, G, H, I, and J. List all areas served, stations

carried, and certain substitute or part-time programs car-

ried at any time during the accounting period.

• Spaces K and M. You should report the total of gross

receipts attributable to the particular accounting period in

space K. The gures requested in space M should be the

appropriate totals of channels for the entire period.

• Spaces B, C, E, and F. Even if items of information concern-

ing the owner, system, subscribers, or rates have changed

during the accounting period, your statement of account

does not need to reect the change. Give only the facts

existing on the last day of the accounting period. If there

were dierent owners during the accounting period, only

the owner on the last day of the accounting period should

submit a single statement of account and royalty fee pay-

ment covering the entire accounting period.

SPACE G (Primary Transmitters: Television)

Stations Actually Carried. Make sure that space G lists all

the television stations your system actually carried at any

time during the accounting period (except as explained in

space G of the form). Do not list stations that were not in fact

carried during that period, even if the FCC has authorized

their carriage, and even if they were carried during earlier

accounting periods.

Low Power Television Stations

• For lings beginning with the January 1–June 30, 2015,

accounting period, the Copyright Act in section 111(f) de-

lineates the local status of a low power television station as

follows: “In the case of a low power television station, as

dened by the rules and regulations of the Federal Com-

munications Commission, the ‘local service area of a pri-

mary transmitter’ comprises the designated market area,

as dened in section 122(j)(2)(C), that encompasses the

community of license of such station and any community

that is located outside such designated market area that is

either wholly or partially within 35 miles of the transmitter

site or, in the case of such a station located in a standard

metropolitan statistical area which has one of the 50 largest

populations of all standard metropolitan statistical areas

(based on the 1980 decennial census of population taken

by the Secretary of Commerce), wholly or partially within

20 miles of such transmitter site.”

• For lings prior to the January 1–June 30, 2015, accounting

period, in the case of low power television stations, the

“‘local service area of a primary transmitter’ comprises the

area within 35 miles of the transmitter site, except that in the

case of such a station located in a standard metropolitan

statistical area which has one of the 50 largest populations

of all standard metropolitan statistical areas (based on the

1980 decennial census of population taken by the Secre-

tary of Commerce), the number of miles shall be 20 miles.”

• This means that a low power television station carried by

a cable system within an area as dened above will be

considered “local.” A low power television station should

be identied as “distant” in column 4 of space G if it is

carried by your cable system in whole or in part beyond

the low power television station’s local service area.

Translator Stations

Translator stations must be listed. For copyright purposes, a

translator station is a primary transmitter not only of any pro-

grams it originally transmits but also of all the programming

it receives from its parent station and retransmits. Thus, if

your cable system carried signals emanating from a translator

station, you must list the translator station in space G. And, if

your system separately carried signals from both a translator

station and its “parent” station, both the translator and the

parent station should be identied.

• Type of Translator Station. For any translator station listed

in space G, the type of station indicated in column 3 should

be that of the parent station.

GENERAL INSTRUCTIONS, FORM SA3, PAGE (v).

• Translator Stations As Distant Stations. As explained

below in these general instructions for space G, a television

station is considered a distant station if the cable system is

carrying the station wholly or partly beyond that station’s

local service area. The determination of whether a transla-

tor station should be identied as distant in column 4 of

space G depends on the local service area of the translator,

not that of the parent station.

Multicast stream. A multicast stream is a digital stream of

programming that is transmitted by a television broadcast

station and is not the station’s primary stream.

Simulcast. A simulcast is a multicast stream of a television

broadcast station that duplicates the programming trans-

mitted by the primary stream or another multicast stream of

such station.

Denitions of Types of Stations. Under the Copyright Act,

the terms used in connection with column 3 of space G

mean the following:

• Network station: A primary stream of a television broad-

cast station that is owned or operated by, or aliated with,

one or more of the television networks in the United States

providing nationwide transmissions, and that transmits

a substantial part of the programming supplied by such

networks for a substantial part of the primary stream’s

typical broadcast day.

The term network station also applies to a multicast

stream on which a television broadcast station transmits

all or substantially all of the programming of an intercon-

nected program service that is owned or operated by,

or aliated with, one or more of the television networks

described above and oers programming on a regular

basis for 15 or more hours per week to at least 25 of

the aliated television licensees of the interconnected

program service in 10 or more states.

• Independent station: A primary stream or multicast stream

of a television broadcast station that is not a network station

or a noncommercial educational station. For purposes of

determining a station’s type-value this category includes

all specialty, Canadian and Mexican stations.

• Noncommercial educational station: A primary or mul-

ticast stream of a television broadcast station that is a

noncommercial educational broadcast station which is

owned and operated by a public agency or nonprot pri-

vate foundation, corporation, or association; or owned

and operated by a municipality and which transmits only

noncommercial programs for educational purposes.

• Local Service Area of a Primary Transmitter: In general,

the ‘local service area of a primary transmitter’, in the case

of both the primary stream and any multicast streams

transmitted by a primary transmitter that is a television

broadcast station, comprises the area where such pri-

mary transmitter could have insisted upon its signal being

retransmitted by a cable system pursuant to rules, regula-

tions, and authorizations of the FCC in eect on April 15,

1976. Eective July 1, 1994, a station’s local service area

also includes the station’s television market as dened in

section 76.55(e) of title 47, Code of Federal Regulations

(as in eect on September 18, 1993), or any modications

to such television market made on or after September 18,

1993, pursuant to section 76.55(e) or 76.59 of title 47 of

the Code of Federal Regulations or within the noise-limited

contour as dened in 73.622(e)(1) of title 47, Code of Federal

Regulations. For the full denition see Section 111 (f) of the

Copyright Act.

Basis of Carriage of Distant Stations. In column 5 of space

G you are asked to identify the basis on which you carried

the signals of distant television stations during the account-

ing period. The three categories are as follows:

LAC Part-Time Carriage Because of Lack of Activated

Channel Capacity. In referring to this category, the Copy-

right Act speaks of “a station carried on a part-time basis

where full-time carriage is not possible because the cable

system lacks the activated channel capacity to retransmit

on a full-time basis all signals which it is authorized to carry.”

A cable system can only claim lack of activated channel

capacity (LAC) in column 5, space G if (a) all of its activated

television channels are used exclusively for the secondary

transmission of television signals, and (b) the number of

primary television transmitters secondarily transmitted by

the cable system exceeds the number of its activated tele-

vision channels.

“E” Exempt for Multicast Stream. This category covers the

retransmission of a multicast stream that is the subject

of a written agreement entered into on or before June 30,

2009, between a cable system or association representing

the cable system and a primary transmitter or an associa-

tion representing the primary transmitter. This category

also covers simulcast streams.

“O” Any other basis of carriage. This category covers all

distant television stations you carried, including full-time

stations, except:

• those identied in category LAC above;

• those identied in category “E” above;

• those carried only on a substitute basis (see the general

instructions regarding the use of space I); and

• those carried only on a part-time network basis under

former FCC rules cited in space G of the form.

Note: Simulcast streams are not subject to a royalty payment.

GENERAL INSTRUCTIONS, FORM SA3, PAGE (vi).

THREE POINTS TO REMEMBER IN CONNEC-

TION WITH COLUMN 5 OF SPACE G:

1 Due to changes in FCC rules, it is no longer

possible for cable systems to specify part-time

carriage of specialty and late-night program-

ming. Carriage by your cable system on either of

those bases must now be included in category

“O” cited above.

2 The “basis of carriage” to be identied in column

5 does not include substitute carriage. If a sta-

tion was carried only on a substitute basis, you

need not list it in space G but you must list it in

space I. A station carried on a substitute basis,

and also on some other basis, must be logged

in space G and space I.

3 A part-time carriage log (space J) must be pro-

vided for stations carried on a LAC basis.

Distant Signal Equivalent:

The distant signal equivalent (DSE) is the value assigned to

the secondary transmission of any non-network television

programming carried by a cable system in whole or in part

beyond the local service area of the primary transmitter. The

DSE is computed by assigning a value of one to each primary

stream and to each multicast stream (other than a simulcast)

that is an independent station, and

by assigning a value of

one-quarter to each primary stream and to each multicast

stream (other than a simulcast) that is a network station or

a noncommercial educational station.

GENERAL INSTRUCTIONS REGARDING THE

RETRANSMISSION OF MULTICAST STREAMS

A royalty payment shall be made for the retransmission of

non-network television programming carried on each multi-

cast stream of a distant digital television signal if such stream

was rst retransmitted by a cable system on or after February

27, 2010.

• Please list all of the multicast streams that the cable system

carried during the accounting period.

• Assign a DSE value to each multicast stream that the cable

system began to retransmit on or after February 27, 2010.

• Do not assign a DSE value for the retransmission of a

multicast stream that is the subject of a written agreement

entered into on or before June 30, 2009, between a cable

system or an association representing the cable system

and a primary transmitter or an association representing

the primary transmitter.

Notes:

• No royalties payments shall be made for a distant multicast

stream that “simulcasts” (i.e., duplicates) a primary stream

or another multicast stream of the same station that the

cable system is carrying.

• Distant multicast streams shall not be subject to the 3.75

percent fee or the syndicated exclusivity surcharge.

• Cable operators are not entitled to refunds, or osets, for

the retransmission of any distant multicast stream carried

prior to the 2010/1 accounting period.

SPACE H (Primary Transmitters: Radio)

All-Band Carriage. If your system carried FM radio stations

on an all-band basis, you are not required to list every sta-

tion that subscribers might possibly have received during

the accounting period. Instead, Copyright Oce regulations

require you to monitor your FM transmission service at your

system’s headend from time to time during the accounting

period and to report the generally receivable FM stations

identied as a result of your monitoring.

Stations Generally Receivable. There are two standards for

determining whether an FM station is “generally receivable”:

1 Is the station usually carried whenever it is received at

your system’s headend; and

2 Can the station be expected to be received at the head-

end, with your system’s FM antenna at least three con-

secutive hours each day at the same time each day, ve

or more days a week, for four or more weeks during any

calendar quarter, with a strength of not less than 50 mi-

crovolts per meter measured at the foot of the tower or

pole to which the antenna is attached?

The monitoring arrangements you set up should be aimed

at determining what stations can reasonably be expected

to meet these standards.

Monitoring Activities. It is not necessary to monitor con-

tinuously throughout the accounting period, and you are not

required to make precise measurements to determine which

stations in fact meet the technical standards and which do

not. Your monitoring activities should take place periodi-

cally at your headend during the accounting period and you

should use a good FM receiver.

SPACE I (Substitute Carriage: Special Statement

and Program Log)

Substitute Programs Must Be Logged and Reported. The

Copyright Act requires all cable systems to submit, with their

statement of account, logs showing the times, dates, sta-

tions, and programs involved in any nonnetwork television

programming that was carried in whole or in part beyond

the local service area of the primary transmitter under rules,

regulations, or authorizations of the FCC permitting the sub-

stitution or addition of signals under certain circumstances.

The applicable present and former rules and regulations are

identied in item 3, which follows.

What Programs Must Be Listed. You must list a program

in space I if all three of the following conditions apply:

1 The program is a nonnetwork television program. A

“nonnetwork television program” is a program that was not

GENERAL INSTRUCTIONS, FORM SA3, PAGE (vii).

and the DSE calculations shall be made against the aggre-

gated amount. Gross receipts for secondary transmission

services do not include installation (including connection,

relocation, disconnection or reconnection) fees; separate

charges for security, alarm, or facsimile services; charges

for late payments; or charges for pay cable or other program

origination services provided that the origination services

are not oered in combination with secondary transmission

service for a single fee.

SATELLITE CARRIER GROSS RECEIPTS EXCLUSION

• The Satellite Home Viewer Act of 1988, Public Law 100-

667, as amended by Public Law 103-369, Public Law

106-113, Public Law 108-447, Public Law 111-175, and

Public Law 113-200, establishes a statutory license for

certain secondary transmissions made by satellite carri-

ers to satellite dish owners. Satellite carriers are subject

to copyright liability for their use of copyrighted material

when they make secondary transmissions (retransmis-

sions of television broadcasts) to satellite dish owners

and they make a direct or indirect charge for that service.

Satellite carrier retransmissions of the copyrighted pro-

gramming embodied in the signals of non-network sta-

tions or network stations are eligible under an operational

system of statutory licensing that is established in section

119 of the Copyright Act.

• A satellite carrier is dened in the Satellite Home Viewer

Extension and Reauthorization Act of 2004 as “an entity

that uses the facilities of a satellite or satellite service

licensed by the Federal Communications Commission,

and operates in the Fixed-Satellite Service under part

25 of title 47 of the Code of Federal Regulations or the

Direct Broadcast Satellite Service under part 100 of title

47 of the Code of Federal Regulations, to establish

and operate a channel of communications for point-to-

multipoint distribution of television station signals, and

that owns or leases a capacity or service on a satellite

in order to provide such point-to-multipoint distribution,

except to the extent that such entity provide such distri-

bution pursuant to tari under the Communications Act

of 1934, other than for private home viewing pursuant to

Section 119.”

• As provided in the Satellite Home Viewer Act [amend-

ment of section 111(d)(1)(A)], any amounts collected by

a cable system or distributor from subscribers should

be excluded from the cable system’s determination of

gross receipts received for the basic service of providing

secondary transmissions of primary broadcast transmit-

ters pursuant to the cable compulsory license, section

111 (c) to (f). This provision contemplates the situation

where the same entity may be oering both satellites and

cable distribution of secondary transmissions of primary

broadcast transmitters.

• If a cable system oers both satellite and cable services to

satellite dish owners, then it may exclude those amounts

attributed to the satellite service under section 119 of the

being broadcast by a station as part of a network television

broadcast at the time the cable system carried it.

2 The program is picked up from a distant station. A

“distant station” is a television station carried by a cable

system in whole or in part beyond that station’s local

service area. For the denition of “local service area,” see

the “Distant Station” section on page iv of the general

instructions.

3 The program was carried by the cable system in sub-

stitution for another program under FCC rules, regula-

tions, or authorizations:

• Where FCC rules and regulations in eect on the date

of carriage require the deletion of certain programming

of one station and permit substitution of programming

from another distant station. That is, if a cable system

is required to delete a station because of FCC program

or sports exclusivity rules.

• Where the FCC rules, regulations, and authorizations in

eect on October 19, 1976, permit a cable system at its

option to delete programming and authorize the system

to substitute programming from another distant station.

That is, if the cable system elects to delete a distant

station while that station is broadcasting a program

primarily of local interest to the distant community, for

copyright purposes former FCC rules sections 76.61(b)

(2) and 76.63 [incorporating 76.61(b)(2)] continue to

authorize the station to substitute the programming

of any other distant station.

Notes

1 The provisions of the Copyright Act dealing with volun-

tary deletion and substitution of programs are limited to

programs substituted under FCC rules, regulations, and

authorizations in eect on October 19, 1976.

2 Eective January 1, 1990, the FCC amended Parts 73

and 76 of its rules relating to program exclusivity in the

cable and broadcast industries.

THERE ARE TWO DIFFERENT LOGS IN

SA3 (Long Form):

• The Log of Substitute Programs (block 2 of space I),

and

• The Part-Time Carriage Log (space J).

DO NOT CONFUSE THESE TWO LOGS. THEY DO

NOT OVERLAP, AND THEY SHOULD BE COMPLET-

ED SEPARATELY.

SPACE K (Gross Receipts)

What Are Gross Receipts? The gross receipts you enter in

secondary transmissions of primary broadcast transmitters.

They include the full amount of monthly (or other periodic)

service fees for any and all services or tiers of services that

include one or more secondary transmissions of television

or radio broadcast signals, for additional set fees, and for

converter fees. All such gross receipts shall be aggregated

GENERAL INSTRUCTIONS, FORM SA3, PAGE (viii).

act. Such a system should declare on page 9 the amount

of gross receipts that are excluded for this service and list

the name and address of each satellite carrier in which

the system has contracted as a distributor or agent to

market the carrier’s retransmissions service. The system

should also maintain separate records of the subscriber

fees received for satellite carrier retransmissions.

Accrual Basis. If your revenue accounts are kept on an ac-

crual basis, the gure you give in space K should be the total

of all gross receipts for secondary transmission service ac-

crued for the accounting period. Subtract bad debts actually

written o during the period and add previously written-o

debts that were actually recovered during the period.

Cash Basis. If your revenue accounts are kept on a cash

basis, your gross receipts are all amounts actually received

during the accounting period for secondary transmission

service.

SPACE L (Copyright Royalty and Filing Fees)

The method for calculating your royalty fee depends upon

whether your system carried any distant stations and, if so,

the number you carried. If the system did not carry any dis-

tant stations, you pay a minimum fee, which is calculated

in space L.

If the system carried any distant stations, you must com-

pute distant signal equivalents (DSEs) in parts 1 through 5

of the DSE schedule accompanying this form. Each cable

system regardless of whether or not it is located in a televi-

sion market area must compute a base rate fee if it carried

any distant stations. This gure is computed in part 8 of the

DSE schedule and is entered in block 3 of space L. (NOTE:

Unless the system is located totally outside of all television

markets, part 8 cannot be completed until parts 6 and 7

have been completed.) If any portion of the cable system is

located within a television market area as dened by the FCC

and that system carried any nonpermitted distant television

stations, then you must compute the 3.75 fee in part 6 of the

DSE schedule. This gure is to be entered on line 2, block 3

of space L. The base rate fee and the 3.75 percent fee are

then added together and the sum compared to the minimum

fee. Either the minimum fee or the sum of the base rate fee

and the 3.75 percent fee (whichever is greater) is listed on

line 1, block 4.

Additionally, if any portion of the cable system is located

within a top 100 major market area as dened by the FCC

and that system carried any distant stations, then you may

need to compute the Syndicated Exclusivity Surcharge in

part 7 of the DSE schedule. This gure is to be entered on

line 2, block 4 of space L. The total copyright royalty fee due

is computed in block 4 of space L by adding together (1) the

minimum fee or the sum of the base rate fee/3.75

percent

fee (whichever is greater), (2) the Syndicated Exclusivity Sur-

charge, (3) the interest charge and (4) the ling fee.

Rounding O DSEs. In computing DSEs on the DSE

schedule, you may round o to no less than the third decimal

point. If you round o a DSE in any case, you must round

o DSEs throughout the schedule as follows:

• When the fourth decimal point is 1, 2, 3, or 4, the third

decimal remains unchanged—(example: .34647 is round-

ed to .346)

• When the fourth decimal point is 5, 6, 7, 8, or 9, the third

decimal is rounded up—(example: .34651 is rounded to

.347)

Filing Fee. Include the $725.00 ling fee payment.

Note: Cable systems submitting additional deposits under

Section 111(d)(7) should contact the Licensing Division for

the appropriate form for submitting the additional fees.

Interest Charges For Underpayments

and Late Payments

Underpayments or late payments received after the ling

deadline shall be subject to an interest assessment. Cable

systems must calculate their own interest charge. (A work-

sheet is provided at space Q, page 9.) The interest rate set

for a specic accounting period is the U.S. Treasury Current

Value of Funds Rate in eect on the rst business day after

the close of the ling deadline for that accounting period.

Cable systems may obtain the interest rate for the applicable

accounting period(s) by calling the Licensing Division at (202)

707-8150 or by clicking on to www.copyright.gov/licensing/

interest-rate.pdf.

For underpayments and late payments the interest shall

begin to accrue on the rst day after the close of the ling

date for that accounting period.

The accrual period ends

on the date that the remittance is received in the Copyright

Oce.

Note: The Oce shall not require, nor notify a cable

system of, an interest charge of $5.00 or less.

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