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
|
WAVE |
13989 |
LOUISVILLE KY |
TV |
All of the information furnished in this Report is accurate as of 10/01/2013 (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 INCORPORATION OF ELLIS ACQUISITIONS, INC. |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
CERTIFICATE OF AMENDMENT OF CERTIFICATE OF INCORPORATION (CHANGING NAME TO RAYCOM MEDIA, INC.) |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
CERTIFICATE OF AMENDMENT OF RAYCOM CERTIFICATE OF INCORPORATION (AS AMENDED 09-11-96; 05-27-98; 09-15-98; 10-20-99; 02-15-01; 02-19-02 02/20/02; 12/19/03; 10/04/04; 01/27/06; 09/24/09)) |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
BYLAWS OF RAYCOM MEDIA, INC. (AS AMENDED AND RESTATED) |
RAYCOM |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
RAYCOM MEDIA, INC. 1997 RESTRICTED STOCK PLAN (AS AMENDED DECEMBER 2012) |
RAYCOM |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
AMENDED AND RESTATED RAYCOM MEDIA, INC. 1997 STOCK OPTION PLAN |
RAYCOM |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
CERTIFICATE OF DESIGNATIONS, PREFERENCES AND RIGHTS OF SERIES A PREFERRED STOCK, SERIES B PREFERRED STOCK AND SERIES C PREFERRED STOCK OF RAYCOM MEDIA, INC. |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
FIRST AMENDMENT TO CERTIFICATE OF DESIGNATIONS, PREFERENCES AND RIGHTS OF PREFERRED STOCK OF RAYCOM MEDIA, INC. (AS CORRECTED 03-26-2001) |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
SECOND AMENDMENT TO CERTIFICATE OF DESIGNATIONS, PREFERENCES AND RIGHTS OF PREFERRED STOCK OF RAYCOM MEDIA, INC. |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
THIRD AMENDMENT TO CERTIFICATE OF DESIGNATIONS, PREFERENCES AND RIGHTS OF PREFERRED STOCK OF RAYCOM MEDIA, INC. |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
FOURTH AMENDMENT TO CERTIFICATE OF DESIGNATIONS, PREFERENCES AND RIGHTS OF PREFERRED STOCK OF RAYCOM MEDIA, INC. |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
FIFTH AMENDMENT TO CERTIFICATE OF DESIGNATIONS, PREFERENCES AND RIGHTS OF PREFERRED STOCK OF RAYCOM MEDIA, INC. |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
SIXTH AMENDMENT TO CERTIFICATE OF DESIGNATIONS, PREFERENCES AND RIGHTS OF PREFERRED STOCK OF RAYCOM MEDIA, INC. |
DELAWARE |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
AMENDED AND RESTATED CREDIT AGREEMENT |
WELLS FARGO BANK, N.A., ET AL |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
SEVENTH AMENDED AND RESTATED LOAN AND CREDIT AGREEMENT |
EMPLOYEES' RETIREMENT SYSTEM OF ALABAMA AND TEACHERS RETIREMENT SYSTEMS OF ALABAMA |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
SECOND AMENDED AND RESTATED WARRANT TO PURCHASE COMMON STOCK OF RAYCOM MEDIA, INC. (NO. 1) |
EMPLOYEES' RETIREMENT SYSTEM OF ALABAMA |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
SECOND AMENDED AND RESTATED WARRANT TO PURCHASE COMMON STOCK OF RAYCOM MEDIA, INC. (NO. 2) |
EMPLOYEES' RETIREMENT SYSTEM OF ALABAMA |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
SECOND AMENDED AND RESTATED WARRANT TO PURCHASE COMMON STOCK OF RAYCOM MEDIA, INC. (NO. 3) |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
PLEDGE AGREEMENT AS TO STOCK OF RAYCOM MEDIA, INC. |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
PLEDGE AMENDMENTS (2) |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
FIRST AMENDMENT TO STOCK PLEDGE AGREEMENT |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
AGREEMENT (LLC COLLATERAL) |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
PLEDGE AGREEMENT |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
PLEDGE AGREEMENT |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
PLEDGE AGREEMENT |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
BORROWER SECURITY AGREEMENT |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
FIRST AMENDMENT TO BORROWER SECURITY AGREEMENT |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
SUBSCRIPTION AGREEMENT (SERIES F PREFERRED STOCK) |
TEACHER'S RETIREMENT SYSTEM OF ALABAMA, AS AGENT |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
SUBSCRIPTION AGREEMENT (SERIES F PREFERRED STOCK) |
EMPLOYEES' RETIREMENT SYSTEM OF ALABAMA |
|
|
Description of contract or instrument |
Name of person or organization with whom contract is made |
Date of Execution |
Date of Expiration |
FIRST AMENDMENT TO SEVENTH AMENDED AND RESTATED LOAN AND CREDIT AGREEMENT |
EMPLOYEES' RETIREMENT SYSTEM OF ALABAMA AND TEACHERS' RETIREMENT SYSTEM OF ALABAMA |
|
|
|
|
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
|
|
|
20000000
|
1821910
|
0
|
18178090
|
Class of stock (preferred, common or other)
|
Voting or Non-voting
|
Number of Shares
|
Authorized
|
Issued and Outstanding
|
Treasury
|
Unissued
|
|
|
1000000
|
194586
|
0
|
805414
|
|
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 |
|
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 |
|
6. Positional Interest |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
9.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
4.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
3.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
1.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
2.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
0.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
7. Percentage of votes |
1.00 |
8. Percentage of total assets (equity debt plus) |
0.00 |
1. Name and Address |
|
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 |
|
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?
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Yes No
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|
If "Yes", submit an Exhibit setting forth full information as to the family relationship
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[Exhibit 4]
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(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.
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Yes No
[Exhibit 5]
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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).