Federal Communications Commission
Washington, D.C. 20554
Approved by OMB
3060-0084 (June 2002)
FCC 323-E
FOR FCC USE ONLY
 
Ownership Report For Noncommercial Educational Broadcast Station

Read INSTRUCTIONS Before Filling Out Form

FOR COMMISSION USE ONLY
FILE NO.

BOA - 20041122ADB
Section I - General
1. Legal Name of the Licensee/Permittee
BOARD OF GOVERNORS OF THE COLORADO STATE UNIVERSITY SYSTEM
Mailing Address
410 17TH STREET;
SUITE 1415
City
DENVER
State or Country (if foreign address)
CO
ZIP Code
80202 -
Telephone Number (include area code)
9704916643
E-Mail Address (if available) 
FCC Registration Number:
0007648199
Call Sign 
KCSU-FM
Facility ID Number 
62435
2. Contact Representative (if other than Licensee/Permittee)
CARY S. TEPPER, ESQ.
Firm or Company Name
BOOTH, FRERET, IMLAY & TEPPER, P.C.
Mailing Address

City
State or Country (if foreign address)
ZIP Code
-
Telephone Number (include area code)
3017181818
E-Mail Address (if available)
TEPPERLAW@AOL.COM
3. Name of entity, if other than licensee or permittee, for which report is filed

Mailing Address


City
State or Country (if foreign address)
ZIP Code
-
Telephone Number (include area code)
E-Mail Address (if available)



Section II - Ownership Information

4.
All of the information furnished in this Report is accurate as of 11/19/2004 (Date must comply with 47 C.F.R. Section 73.3615(d), i.e., information must be current within 60 days of filing of this report, when 4(a) below is checked.)

This Report is filed for (check one)
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
KCSU-FM 62435 FORT COLLINS CO FM


5.
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]



6.
Is the governing board directly or indirectly under the control of another entity?
Yes No
If Yes, is a separate FCC Form 323-E submitted for such entity?
Yes No
 7.
List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages, if necessary.
[Enter Owner Information]

Owner Information
List officers, members of governing board, and holders of 1% or more ownership interest, if any. Use one column for each individual or entity. Attach supplemental pages if necessary.
(Read carefully - The numbered items below refer to line numbers in the following table.)
a. Name and address of officer, member of governing board, and holders of 1% or more ownership interest (if other than individual also show name, address and citizenship of natural person authorized to vote the interest). List officers first, then board members, and thereafter, holders of 1% or more ownership interest, if any.
b. Citizenship.
c. Office held.
d. Percent of interest held.
e. Principal profession or occupation.
f. By whom appointed or elected.
g. Existing interests in any other broadcast station, including the nature and size of such interests.
a. Name and Address. DONALD HAMSTRA, 1929 EGBERT, BRIGHTON, CO, 80601
b. Citizenship. US

c. Office held.

CHAIR, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

HEALTHCARE ADMINISTRATOR

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE

a. Name and Address. JEFF SHOEMAKER, 966 S. YORK STREET, DENVER, CO 80209
b. Citizenship. US

c. Office held.

VICE CHAIR, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

EXECUTIVE DIRECTOR, GREENWAY FOUNDATION

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE

a. Name and Address. PATRICK GRANT, 4655 HUMBOLT STREET, DENVER, CO 80216
b. Citizenship. US

c. Office held.

MEMBER, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

HEAD OF NATIONAL WESTERN STOCK SHOW

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE

a. Name and Address. CONNIE CALAWAY, 1023 HERITAGE DRIVE, CARBONDALE, CO 81623
b. Citizenship. US

c. Office held.

MEMBER, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

N/A

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE

a. Name and Address. PHYLLIS 'DIANE' EVANS, 512 WILCOX STREET, CASTLE ROCK, CO 80104
b. Citizenship. US

c. Office held.

MEMEBER, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

LAND TITLE GUARANTEE CO.

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE

a. Name and Address. A. FRED KERST, 202 REMINGTON STREET, FORT COLLINS, CO 80524
b. Citizenship. US

c. Office held.

MEMBER, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

REMINGTON REDSTONE CORP.

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE

a. Name and Address. CHARLES W. SMITH, 400 WEST 16TH STREET, PUEBLO, CO 81003
b. Citizenship. US

c. Office held.

MEMBER, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

PARKVIEW HEALTH SYSTEM

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE

a. Name and Address. REGINALD L. WASHINGTON, 10103 RIDGE GATE PARKWAY, SUITE 107, LONE TREE, CO 80124
b. Citizenship. US

c. Office held.

MEMBER, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

PEDIATRIC CARDIOLOGIST

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE

a. Name and Address. CHAD C. MCWHINNEY, 2725 ROCKY MOUNTAIN AVENUE, SUITE 200, LOVELAND, CO 80538
b. Citizenship. US

c. Office held.

MEMBER, BOARD OF GOVERNORS

d. Percent of interest held.

11.11

e. Principal profession or occupation.

MCWHINNEY REAL ESTATE SERVICES, INC.

f. By whom appointed or elected.

GOVERNOR OF COLORADO

g. Existing interests

NONE




SECTION III - CERTIFICATION


I certify that I am CHAIRMAN, BOARD OF GOVERNORS

(Official Title)


of BOARD OF GOVERNORS OF THE COLORADO STATE UNIVERSITY SYSTEM

(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 4, Section II and in no event prior to that date.)

Signature
DONALD HAMSTRA
Date
11/19/2004
Telephone Number of Respondent (Include area code) 9704916643


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