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 |
REV. EDWARD BALFOUR, 150 MITCHELL RD., CAPE ELIZABETH, ME 04107 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
REV. VICTOR BELTON, 231 DODD AVENUE, SW, ATLANTA, GA 30315 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DR. BETTY DUDA, 185 SOUTH ATLANTIC AVE., COCOA BEACH, FL 32931 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
REV. JAMES E. FANDREY, 534 N. WESTON AVE., ELGIN, IL 60123 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MISS ELIZABETH FLUEGEL, 1734 KINGSGATE COURT, #302, ALEXANDRIA, VA 22302 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DR. JEAN GARTON, 4808 SHOAL CREEK DR., BENTON, AR 72015 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MR. DAVID HAWK, 2814 BAYWOOD TRAIL, FORT WAYNE, IN 46845 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MR. THEODORE A. KOBER, 785 PAINTBRUSH PLACE, BILLINGS, MT 59106 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
THE REVEREND DR. ROBERT T. KUHN, 1387 HAVEN DR., OVIEDO, FL 32765 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MS. JULIE MARTINEZ, PO BOS 475, PAGOSA SPRINGS, CO 81147 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MR. CHRISTIAN PREUS, 17330 COUNTY ROAD #24, PLYMOUTH, MN 55447 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MR. WALTER TESCH, 1674 NORTH 117TH STREET, WAUWATOSA, WI 53226 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DR. EDWIN A. TRAPP, JR., 7624 GLENN ALBENS CIRCLE, DALLAS, TX 75225 |
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 |
VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
THE REVEREND DR. GERALD B. KIESCHNICK, 1333 SOUTH KIRKWOOD ROAD, ST. LOUIS, MO 63122 |
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, VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
THE REVEREND DR. WILLIAM DIEKELMAN, 1333 SOUTH KIRKWOOD RD., ST. LOUIS, MO 63122 |
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 |
FIRST VICE PRESIDENT, NON-VOTING BOARD MEMBER |
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
THE REVEREND DR. PAUL L. MAIER, 8383 WEST MAIN ST., KALAMAZOO, MI 49009 |
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, NON-VOTING BOARD MEMBER |
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
THE REVEREND DR. DEAN NADASDY, WOODBURY LUTHERAN CHURCH, 7380 AFTON RD., WOODBURY, MN 55125 |
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, NON-VOTING BOARD MEMBER |
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
THE REVEREND DR. ROBERT H. KING, 901 ROLAND COURT, JEFFERSON CITY, MO 65101 |
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 |
FOURTH VICE PRESIDENT, NON-VOTING BOARD MEMBER |
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
THE REVEREND DR. DAVID BUEGLER, FIFTH VICE PRESIDENT, 4321 JAYCOX ROAD, AVON, OHIO 44011 |
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 |
FIFTH VICE PRESIDENT, NON-VOTING BOARD MEMBER |
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
THE REVEREND DR. RAYMOND L. HARTWIG, 1333 SOUTH KIRKWOOD RD., ST. LOUIS, MO 63122 |
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 |
SECRETARY, VOTING BOARD MEMBER |
7. Percentage of votes |
6.66 |
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DR. THOMAS W. KUCHTA, 1333 SOUTH KIRKWOOD ROAD, ST. LOUIS, MO 63122 |
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 PRESIDENT FINANCE/TREASURER, NON-VOTING BOARD MEMBER |
7. Percentage of votes |
0.00 |
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]
|
|