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 |
ARCTIC SLOPE REGIONAL CORPORATION, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JACOB ADAMS, P.O. BOX 129, BARROW, ALASKA 99723 |
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, CEO AND DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
OLIVER LEAVITT, P.O. BOX 129, BARROW, ALASKA 99723 |
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 CHAIRMAN, DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
CONRAD BAGNE, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
CHIEF OPERATING OFFICER |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
FRANK ZIRNKILTON, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
CHIEF FINANCIAL OFFICER |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
ALMA UPICKSOUN, P.O. BOX 129, BARROW, ALASKA 99723 |
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 PRESIDENT - GENERAL COUNSEL |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
PATSY AAMODT, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
TREASURER, DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MARY AHMAOGAK, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
CORPORATE SECRETARY, DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
REX ROCK, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
VICE CHAIRMAN, DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
ROBERTA QUINTAVELL, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
FIRST VICE PRESIDENT, DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
CRAWFORD PATKOTAK, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
SECOND VICE PRESIDENT, DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
RAYMOND PANEAK, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
THIRD VICE PRESIDENT, DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
CANDACE ITTA, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
GEORGE SIELAK, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MOLLY PEDERSON, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DON NUNGASAK, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
AMOS AGNASAGGA, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
BRENDA ITAA-LEE, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
DIRECTOR |
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
GEORGE KALEAK, P.O. BOX 129, BARROW, ALASKA 99723 |
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 |
|
8. Percentage of total assets (equity debt plus) |
|
|
(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]
|
|