Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0010 (June 2002)
FCC 323
FOR FCC USE ONLY
 
OWNERSHIP REPORT FOR COMMERCIAL BROADCAST STATIONS

Read INSTRUCTIONS Before Filling Out Form

FOR COMMISSION USE ONLY
FILE NO.

BOS - 20041028AHK
Section I - General Information
1. Legal Name of the Applicant 
DAVIDSON MEDIA CAROLINAS STATIONS, LLC
Mailing Address
670 BROADWAY
2ND FLOOR
City
NEW YORK
State or Country (if foreign address)
NY
ZIP Code
10012 -
Telephone Number (include area code)
2128136775
E-Mail Address (if available) 
PDAVIDSON@DAVIDSONMEDIAGROUP.COM
FCC Registration Number:
0010931798
Call Sign 
Facility ID Number 
74380
2. Contact Representative (if other than Licensee/Permittee)
FRANCISCO R. MONTERO
Firm or Company Name
FLETCHER, HEALD & HILDRETH, PLC
Telephone Number (include area code)
7038120400
E-Mail Address (if available)
MONTERO@FHHLAW.COM
3. Name of entity, if other than licensee or permittee, for which report is filed
DAVIDSON MEDIA GROUP, LLC
Mailing Address
670 BROADWAY
2ND FLOOR

City
NEW YORK
State or Country (if foreign address)
NY
ZIP Code
10012 -
Telephone Number (include area code)
2128136775
E-Mail Address (if available)
PDAVIDSON@DAVIDSONMEDIAGROUP.COM
4. If this application has been submitted without a fee, indicate reason for fee exemption (see 47 C.F.R. Section 1.1114):
Governmental Entity Fee-exempt Report Other
N/A (Fee Required)



Section II - Ownership Information

5.

a. Biennial b. Transfer of Control or Assignment of License/Permit c. Other
d. Amendment to pending application


for the following stations:

[Enter Station Information]


Station List


This Report is filed for the following stations:

Call Letters
Facility ID Number
Location (City/State)
Class of service
WBZK 74380 YORK SC AM


Call Letters
Facility ID Number
Location (City/State)
Class of service
WCXN 71306 CLAREMONT NC AM


Call Letters
Facility ID Number
Location (City/State)
Class of service
WFTK 53104 WAKE FOREST NC AM


Call Letters
Facility ID Number
Location (City/State)
Class of service
WNOW 10646 MINT HILL NC AM


Call Letters
Facility ID Number
Location (City/State)
Class of service
WSGH 72967 LEWISVILLE NC AM


Call Letters
Facility ID Number
Location (City/State)
Class of service
WTIK 53105 DURHAM NC AM



All of the information furnished in this Report is accurate as of 10/20/2004 (Date must comply with 47 C.F.R. Section 73.3615(a), i.e., information must be current within 60 days of filing of this report, when 5(a) below is checked.)

This Report is filed for (check one)
6.
Respondent is:
Sole proprietorship Not-for-profit corporation Limited partnership
For-profit corporation General partnership Other
If "Other", describe nature of the respondent in an Exhibit.
[Exhibit 1]
7.
List all contracts and other instruments required to be filed by 47 C.F.R. Section 73.3613.   (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject licensee or permittee shall respond.)

[Enter Contract/Instrument Information]


Contracts/Instruments Information


List all contracts and other instruments required to be filed by 47 C.F.R. Section 73.3613. (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject shall respond.)

Description of contract or instrument Name of person or organization with whom contract is made Date of Execution Date of Expiration
CERTIFICATE OF FORMATION STATE OF DELAWARE 04/29/2004

Description of contract or instrument Name of person or organization with whom contract is made Date of Execution Date of Expiration
CORPORATE BY-LAWS DAVIDSON MEDIA HOLDING CORPORATION 04/30/2004

Description of contract or instrument Name of person or organization with whom contract is made Date of Execution Date of Expiration
NOTE PURCHASE AGREEMENT CAPSTREET II, L.P., CAPSTREET PARALLEL II, L.P., CITICORP NORTH AMERICA, INC., MERCURY CAPITAL PARTNERS III, L.P., HILLMAN DMG LLC, ASTRON SERVICES, LLC, BLACK ENTERPRISE/GREENWICH STREET CORPORATE GROWTH PARTNERS, LLC 04/30/2004

Description of contract or instrument Name of person or organization with whom contract is made Date of Execution Date of Expiration
SECURITY AGREEMENT DAVIDSON COLLATERAL AGENT 05/14/2004

Description of contract or instrument Name of person or organization with whom contract is made Date of Execution Date of Expiration
COLLATERAL AGENCY AGREEMENT DAVIDSON COLLATERAL AGENT, LLC,PETER W. DAVIDSON,CAPSTREET II,L.P.,CAPSTREET PARALLEL II,L.P.,CITICORP NORTH AMERICA,INC.,MERCURY CAPITAL PARTNERS III,L.P.,HILLMAN DMG LLC,ASTRON SERVICES,LLC,BLACK ENTERPRISE/GREENWICH STREET CORPORATE GROWTH PARTNERS,LLC 05/14/2004


8. Capitalization (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise exercises de facto control over the subject licensee or permittee shall respond.)

[Enter Capitalization Information]


Capitalization


Capitalization (Only licensees, permittees, or a reporting entity with a majority interest in or that otherwise excercises de facto control over the subject licensee or permittee shall respond.)

Class of stock (preferred, common or other)
Voting or Non-voting
Number of Shares
Authorized
Issued and Outstanding
Treasury
Unissued
COMMON
V
100
100


9.
(a.) List the respondent, and, if other than a natural person, its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. If a corporation or partnership holds an attributable interest in the respondent, list separately its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. Create a separate row for each individual or entity. Attach supplemental pages, if necessary.
[Enter Owner Information]

Owner Information

List the respondent, and, if other than a natural person, its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. If a corporation or partnership holds an attributable interest in the respondent, list separately its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. Create a separate row for each individual or entity. Attach supplemental pages, if necessary.
(Read carefully - The numbered items below refer to line numbers in the following table.)
1. Name and address of respondent and each party to the respondent holding an attributable interest (if other than individual also show name, address and citizenship of natural person authorized to vote the stock or holding the attributable interest). List the respondent first, officers next, then directors and, thereafter, remaining stockholders and other entities with attributable interests, and partners.
2. Gender (male or female).
3. Ethnicity (check one).
4. Race (select one or more).
5. Citizenship.
6. Positional interest: Officer, director, general partner, limited partner, LLC member, investor/creditor attributable under the Commission's equity/debt plus standard, etc.
7. Percentage of votes.
8. Percentage of total assets (equity debt plus).

1. Name and Address BLACK ENTERPRISE/GREENWICH STREET CORPORATE GROWTH PARTNERS, L.P., 399 PARK AVENUE, 7TH FLOOR, NEW YORK, NY 10043
2. Gender (male or female)
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER
7. Percentage of votes 10.91
8. Percentage of total assets (equity debt plus) 10.94

1. Name and Address HILLMAN DMG LLC, C/O WILMINGTON SECURITIES, INC., 824 MARKET STREET, SUITE 900, WILMINGTON, DE 19801
2. Gender (male or female)
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER
7. Percentage of votes 4.59
8. Percentage of total assets (equity debt plus) 4.61

1. Name and Address MERCURY CAPITAL PARTNERS III, L.P., 220 NORTHPOINTE PKWY., SUITE D, AMHERST, NY 14228
2. Gender (male or female)
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER
7. Percentage of votes 6.89
8. Percentage of total assets (equity debt plus) 6.91

1. Name and Address ASTRON SERVICES, INC., 5080 SPECTRUM DRIVE, SUITE 609, EAST ADDISON, TX 75001
2. Gender (male or female)
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER
7. Percentage of votes 0.00
8. Percentage of total assets (equity debt plus) 0.00

1. Name and Address DAVIDSON MEDIA GROUP, LLC, 670 BROADWAY, 2ND FLOOR, NEW YORK, NY 10012
2. Gender (male or female)
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest RESPONDENT
7. Percentage of votes 0.00
8. Percentage of total assets (equity debt plus) 0.00

1. Name and Address CAPSTREET II, L.P., 600 TRAVIS, SUITE 6110, HOUSTON, TX 77002
2. Gender (male or female)
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER
7. Percentage of votes 38.51
8. Percentage of total assets (equity debt plus) 38.60

1. Name and Address CAPSTREET PARALLEL, L.P., 600 TRAVIS, SUITE 6110, HOUSTON, TX 77002
2. Gender (male or female)
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER
7. Percentage of votes 5.14
8. Percentage of total assets (equity debt plus) 5.15

1. Name and Address CITICORP NORTH AMERICA, INC., C/O CITIGROUP VENTURE CAPITAL INTERNATIONAL, 399 PARK AVENUE, NEW YORK, NY 10043
2. Gender (male or female)
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER
7. Percentage of votes 32.74
8. Percentage of total assets (equity debt plus) 32.81

1. Name and Address PETER W. DAVIDSON, C/O DAVIDSON MEDIA GROUP, LLC, 670 BROADWAY, 2ND FLOOR, NEW YORK, NY 10012
2. Gender (male or female) Male
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER/BOARD CHAIR
7. Percentage of votes 1.22
8. Percentage of total assets (equity debt plus) 0.99

1. Name and Address KATHERINE D. MCGHEE, C/O DAVIDSON MEDIA GROUP, LLC, 670 BROADWAY, 2ND FLOOR, NEW YORK, NY 10012
2. Gender (male or female) Female
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest MEMBER
7. Percentage of votes 0.00
8. Percentage of total assets (equity debt plus) 0.00

1. Name and Address PETER S. HANDY, 5080 SPECTRUM DRIVE, SUITE 609, EAST ADDISON, TX 75001
2. Gender (male or female) Male
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest DIRECTOR
7. Percentage of votes 0.00
8. Percentage of total assets (equity debt plus) 0.00

1. Name and Address GEORGE B. KELLY, C/O CAPSTREET II, L.P., 600 TRAVIS, SUITE 6110, HOUSTON, TX, 77002
2. Gender (male or female) Male
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest DIRECTOR
7. Percentage of votes 0.00
8. Percentage of total assets (equity debt plus) 0.00

1. Name and Address R. ANDREW DE PASS, C/O CITIGROUP VENTURE CAPITAL INTERNATIONAL, 201 S. BISCAYNE BOULEVARD, SUITE 700, MIAMI, FL 33131
2. Gender (male or female) Male
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship CA
6. Positional Interest DIRECTOR
7. Percentage of votes 0.00
8. Percentage of total assets (equity debt plus) 0.00

1. Name and Address JEFFREY SCOTT, C/O BLACK ENTERPRISE/GREENWICH STREET CORPORATE GROWTH PARTNERS, L.P., 399 PARK AVENUE, 7TH FLOOR, NEW YORK, NY 10043
2. Gender (male or female) Male
3. Ethnicity (check one) Hispanic or Latino
Not Hispanic or Latino
4. Race (select one or more) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. Citizenship US
6. Positional Interest DIRECTOR
7. Percentage of votes 0.00
8. Percentage of total assets (equity debt plus) 0.00


(b) Respondent certifies that equity and financial interests not set forth in response to Question 9(a) are non-attributable. Yes No

N/A

See Explanation in
[Exhibit 2]

(c) Is the respondent or any party holding an attributable interest in the respondent also the holder of an attributable interest in any other broadcast station or in any cable or newspaper entities in the same market or with overlapping signals in the same broadcast service, as described in 47 C.F.R. Sections 73.3555 and 76.501? Yes No
If "Yes", submit an Exhibit identifying the holder of that other attributable interest, listing the call signs, locations and facilities identifiers of such other broadcast stations, and describing the nature and size of the ownership interest and the positions held in the other broadcast, cable or newspaper entities. [Exhibit 3]
(d) Are any of the individuals listed in response to Question 9(a) related as parent-child, husband-wife, brothers and sisters?

Yes No

 

If "Yes", submit an Exhibit setting forth full information as to the family relationship

[Exhibit 4]

(e) Is respondent seeking an attribution exemption for any officer or director with duties unrelated to the licensee or permittee?

If "Yes", submit an Exhibit identifying that individual by name and title, fully describing that individual's duties and responsibilities, and explaining why that individual should not be attributed an interest.

Yes No

[Exhibit 5]



SECTION III - CERTIFICATION


I certify that I am PRESIDENT

(Official Title)


of DAVIDSON MEDIA GROUP, LLC

(Exact legal title or name of respondent)


and that I have examined this Report and that to the best of my knowledge and belief, all statements in this Report are true, correct and complete.

(Date of certification must be within 60 days of the date shown in Question 5, Section II and in no event prior to that date.)

Signature
PETER DAVIDSON
Date
10/27/2004
Telephone Number of Respondent (Include area code) 2128136775

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1)), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503).



Exhibits
Exhibit 1
Description:
NATURE OF RESPONDENT

RESPONDENT IS A DELAWARE LIMITED LIABILITY COMPANY.

Attachment 1