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 |
SOUTHERN VERMONT COLLEGE, 982 MANSION DRIVE, BENNINGTON, VT 05201 |
2. Gender (male or female) |
N/A
|
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 |
WALLACE ALTES, 65 THIRD STREET, APT 501, TROY, NY 12180 |
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 |
BOARD CHAIR, BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
MARY WICKER, COO, SOUTHWESTERN VERMONT HEALTH CARE, 100 HOSPITAL DRIVE, BENNINGTON, VT 05201 |
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 |
VICE CHAIR, BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
ANDREA WEISBERG, P.O. BOX 197, SHAFTSBURY, VT 05262-0197 |
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 |
SECRETARY, BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
JAMES J. WILLIAMS, PRESIDENT, WILLIAMS FINANCIAL MANAGEMENT LLC, 210 UNION STREET, BENNINGTON, VT |
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 |
TREASURER, BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
KAREN GROSS, PRESIDENT, SOUTHERN VERMONT COLLEGE, BENNINGTON, VT 05201 |
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 |
PRESIDENT, BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
SHAUN ADAMS, 138 SUMMER STREET, APT. 1, NORTH BROOKFIELD, MA 12159 |
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 |
ALUMNI REPRESENTATIVE, BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
STEVEN BRODY, GREENWICH ORAL AND MAXILLOFACIAL SURGERY ASSOC., 23 MAPLE AVENUE, GREENWICH, CT 06830 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
TRACI CHICKERELL, CHAIR, STUDENT ASSOCIATION, SOUTHERN VERMONT COLLEGE, BENNINGTON, VT 05201 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
JON GOODRICH, MACE SECURITIES INTERNATIONAL, 160 BENMONT AVENUE, BENNINGTON, VT 05201 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
JAMES J. GOZZO, PRESIDENT, ALBANY COLLEGE OF PHARMACY OF UNION UNIVERSITY, 106 NEW SCOTLAND AVENUE, ALBANY, NY 12208-3492 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
NORMAN GREENBERG, H. GREENBERG & SON, INC., 321 MAIN STREET, BENNINGTON, VT 05201 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
MERRITT HEWITT JR., P.O. BOX 114, NORTH BENNINGTON, VT 05257 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
ROBERT HOWE, P.O. BOX 785, N. BENNINGTON, VT 05257 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
RANDALL KRUM, FACULTY ASSOCIATION, SOUTHERN VERMONT COLLEGE, BENNINGTON, VT 05201 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
RAYMOND D. LENOUE, PRESIDENT, EDUCATIONAL RESOURCES NETWORK, INC., 25 VAN ZANT STREET, NORWALK, CT 06855 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
SCOTT MCENANEY, EASTERN DIRECTOR OF ELOG, THE ORVIS COMPANY, INC., 178 CONSERVATION WAY, SUNDERLAND, VT 05250 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
KENNETH NORRIS, CHAIR, ADMINISTRATIVE FORUM, SOUTHERN VERMONT COLLEGE, BENNINGTON, VT 05201 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
NANCY SCATTERGOOD, M.D., 2074 SOUTH STREAM ROAD, BENNINGTON, VT 05201 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
IRA WAGNER, EVP, COO, AMERICAN CAPITAL, 2 BETHESDA METRO CENTER, 14TH FLOOR, BETHESDA, MD 20814 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
DEBORAH E. WILEY, SR. VP, CORPORATE COMMUNICATIONS, JOHN WILEY & SONS, INC., 111 RIVER STREET, HOBOKEN, NJ 07030-5774 |
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 |
BOARD MEMBER |
7. Percentage of votes |
5.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
DR. WILLIAM A. GLASSER, P.O. BOX 7066, CAPE PORPOISE, ME 04014 |
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 |
PRESIDENT EMERITUS, SOUTHERN VERMONT COLLEGE |
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
DR. BARBARA P. SIRVIS, 24 ARBOR ROAD, SO. BURLINGTON, VT 05407 |
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 |
PRESIDENT EMERITA, SOUTHERN VERMONT COLLEGE |
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]
|
|