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FORM 2100, Schedule 323
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Ownership Report For Commercial Broadcast Stations |
FRN:0123456789 |
Section I – General Information
1. Respondent |
FRN |
Name |
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[FRN] |
[respondent name] |
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Street Address |
City (and Country |
State (“NA” |
Zip |
Phone |
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[street address 1] |
[city] |
[state] |
[zip] |
[phone] |
[email] |
2. Contact Representative |
Name |
Organization |
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[name] |
[organization] |
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Street Address |
City (and Country |
State (“NA” |
Zip |
Phone |
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[street address 1] |
[city] |
[state] |
[zip] |
[phone] |
[email] |
3. Application Filing Fee |
Question |
Response |
Is this application being submitted without a filing fee? |
Yes No |
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If this application is being submitted without a filing fee, Indicate reason for fee exemption. |
[explanation] |
4. Respondent and Report Information |
(a) Provide the following information about the Respondent: |
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Relationship to
stations/ |
Licensee Permittee (non-biennial reports only) Entity required to file a Form 2100, Schedule 323 because it holds an attributable interest in one or more Licensees or, in the case of a non-biennial report, Permittees |
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Nature of Respondent |
Sole proprietorship For-profit corporation Not-for-profit corporation General partnership Limited partnership Limited liability company Other Submit an Exhibit describing the nature of the Respondent. |
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(b) Provide the following information about this report: |
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Purpose |
(1) Biennial
[file number] (3) Transfer of control or assignment of license/permit (4) Report by Permittee filing within 30 days after the grant of a construction permit for a new commercial AM, FM, or full power television broadcast station (5) Report filed by Permittee conjunction with Permittee’s application for a station license
[file number] (7) Amendment to a previously filed ownership report Submit an Exhibit listing, by Section and Question Number, the portions of the previous report that are being revised.
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“As of” date |
[date] |
5. Licensee(s)/ |
Respondent is filing this report to cover the following Licensee(s)/Permittee(s) and license(s)/permit(s): |
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Licensee/Permittee Name |
FRN |
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[licensee name] |
[FRN] |
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Fac. ID No. |
Call Sign |
City |
State |
Service |
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[Fac. ID No.] |
[call sign] |
[city] |
[state] |
[service] |
Section II-A – Non-Biennial Ownership Information
1. 47 C.F.R. Section |
Licensee/Permittee Respondents should list all contracts and other instruments required to be filed pursuant to 47 C.F.R. Section 73.3613 for the facility or facilities listed on this report. If the agreement is an attributable Local Marketing Agreement (LMA), an attributable Joint Sales Agreement (JSA), or a network affiliation agreement, check the appropriate box. Otherwise, select “Other.” Non-Licensee/Permittee Respondents should select “Not Applicable” in response to this question. |
Not Applicable |
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Document Information |
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Description of contract or instrument |
[description of contract or instrument] |
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Parties to contract or instrument |
[parties to contract or instrument] |
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Date of execution (mm/yyyy) |
[date of execution] |
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Date of expiration (mm/yyyy) |
[date of expiration] No expiration date |
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Agreement type (check all that apply) |
Attributable
LMA
Attributable
JSA
[agreement
type] |
2. Ownership Interests |
(a) Ownership Interests. This Question requires Respondents to enter detailed information about ownership interests by generating a series of subforms. Answer each question on each subform. The first subform listing should be for the Respondent itself. If the Respondent is not a natural person, also list each of the officers, directors, stockholders, non-insulated partners, non-insulated members, and any other persons or entities with a direct attributable interest in the Respondent pursuant to the standards set forth in 47 C.F.R. Section 73.3555. (A “direct” interest is one that is not held through any intervening companies or entities.) List each interest holder with a direct attributable interest in the Respondent separately. Leave the percentage of total assets (Equity Debt Plus) field blank for an interest holder unless that interest holder has an attributable interest in the Respondent solely on the basis of the Commission’s Equity Debt Plus attribution standard, 47 C.F.R. Section 73.3555, Note 2(i). In the case of vertical or indirect ownership structures, list only those interests in the Respondent that also represent an attributable interest in the Licensee(s) or Permittee(s) for which the report is being submitted. Entities that are part of an organizational structure that includes holding companies or other forms of indirect ownership must file separate ownership reports. In such a structure do not report, or file a separate report for, any interest holder that does not have an attributable interest in the Licensee(s) or Permittee(s) for which the report is being submitted. Please see the Instructions for further detail concerning interests that must be reported in response to this question. The Respondent must provide an FCC Registration Number for each interest holder reported in response to this question. Please see the Instructions for detailed information and guidance concerning this requirement. |
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Ownership Information |
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FRN |
[FRN] |
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Name |
[name] |
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Address |
Street 1 |
[street 1] |
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Street 2 |
[street 2] |
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City |
[city] |
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State (“NA” if non-U.S. address) |
[state] |
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Zip/Postal Code |
[zip] |
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Country (if non-U.S. address) |
[country] |
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Listing Type |
Respondent Other interest holder |
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Positional Interests (check all that apply) |
[interest
type] |
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Interest Percentages (enter percentage values from 0.0 to 100.0) |
Voting |
[voting] |
Jointly Held? Yes No |
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Total assets |
[total assets] |
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Does interest holder have an attributable interest in one or more broadcast stations that do not appear on this report? |
Yes No |
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(b) Respondent certifies that any interests, including equity, financial, or voting interests, not reported in response to Question 2(a) are non-attributable. If “No,” submit as an exhibit an explanation. |
Yes
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(c) Does the Respondent or any interest holder reported in response to Question 2(a) hold an attributable interest in any newspaper entities in the same market as any station for which this report is filed, as defined in 47 C.F.R. Section 73.3555? If “Yes,” provide information describing the interest(s), using EITHER the subform OR the spreadsheet option below. Respondents with a large number (50 or more) of entries to submit should use the spreadsheet option. NOTE: Spreadsheets must be submitted in a special XML Spreadsheet format with the appropriate structure that is specified in the documentation. For instructions on how to use the spreadsheet option to complete this question (including templates to start with), please Click Here. If using the subform, leave the percentage of total assets (Equity Debt Plus) field blank for an interest holder unless that interest holder has an attributable interest in the newspaper entity solely on the basis of the Commission’s Equity Debt Plus attribution standard, 47 C.F.R. Section 73.3555, Note 2(i). If using an XML Spreadsheet, enter “NA” into the percentage of total assets (Equity Debt Plus) field for an interest holder unless that interest holder has an attributable interest in the newspaper entity solely on the basis of the Commission’s Equity Debt Plus attribution standard. The Respondent must provide an FCC Registration Number for each interest holder reported in response to this question. Please see the Instructions for detailed information and guidance concerning this requirement. |
Yes
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Other Newspaper Interests |
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FRN |
[FRN] |
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Name |
[name] |
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Name of Newspaper |
[newspaper] |
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Location of Newspaper |
City |
[city] |
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State |
[state] |
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Positional Interests (check all that apply) |
[interest
type] |
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Interest Percentages (enter percentage values from 0.0 to 100.0) |
Voting |
[voting] |
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Total assets |
[total assets] |
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(d) Are any of the individuals listed in response to Question 2(a) married to each other or related to each other as parent-child or as siblings? If “Yes,” provide the following information for each such the relationship. |
Yes
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Family Relationships |
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FRN |
[FRN] |
Name |
[name] |
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FRN |
[FRN] |
Name |
[name] |
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Relationship |
Spouses Parent/Child Siblings |
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(e) Is Respondent seeking an attribution exemption for any officer or director with duties wholly unrelated to the Licensee(s) or Permittee(s)? If “Yes,” complete the information in the required fields and submit an Exhibit fully describing that individual’s duties and responsibilities, and explaining why that individual should not be attributed an interest. |
Yes
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Attribution Exemptions |
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Name |
[name] |
Title |
[title] |
Section II-B – Biennial Ownership Information
1. 47 C.F.R. Section |
Licensee Respondents that hold authorizations for one or more full power television, AM, and/or FM stations should list all contracts and other instruments required to be filed pursuant to 47 C.F.R. Section 73.3613 for the facility or facilities listed on this report. If the agreement is an attributable Local Marketing Agreement (LMA), an attributable Joint Sales Agreement (JSA), or a network affiliation agreement, check the appropriate box. Otherwise, select “Other.” Non-Licensee Respondents, as well as Licensee Respondents that only hold authorizations for Class A television and/or low power television stations, should select “Not Applicable” in response to this question. |
Not Applicable |
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Document Information |
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Description of contract or instrument |
[description of contract or instrument] |
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Parties to contract or instrument |
[parties to contract or instrument] |
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Date of execution (mm/yyyy) |
[date of execution] |
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Date of expiration (mm/yyyy) |
[date of expiration] No expiration date |
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Agreement type (check all that apply) |
Attributable
LMA
Attributable
JSA
[agreement
type] |
2. Ownership Interests |
(a) This Question requires Respondents to enter detailed information about ownership interests by generating a series of subforms. Answer each question on each subform. The first subform listing should be for the Respondent itself. If the Respondent is not a natural person, also list each of the officers, directors, stockholders, non-insulated partners, non-insulated members, and any other persons or entities with a direct attributable interest in the Respondent pursuant to the standards set forth in 47 C.F.R. Section 73.3555. (A “direct” interest is one that is not held through any intervening companies or entities.) List each interest holder with a direct attributable interest in the Respondent separately. Leave the percentage of total assets (Equity Debt Plus) field blank for an interest holder unless that interest holder has an attributable interest in the Respondent solely on the basis of the Commission’s Equity Debt Plus attribution standard, 47 C.F.R. Section 73.3555, Note 2(i). In the case of vertical or indirect ownership structures, list only those interests in the Respondent that also represent an attributable interest in the Licensee(s) for which the report is being submitted. Entities that are part of an organizational structure that includes holding companies or other forms of indirect ownership must file separate ownership reports. In such a structure do not report, or file a separate report for, any interest holder that does not have an attributable interest in the Licensee(s) for which the report is being submitted. Please see the Instructions for further detail concerning interests that must be reported in response to this question. The Respondent must provide an FCC Registration Number for each interest holder reported in response to this question. Please see the Instructions for detailed information and guidance concerning this requirement. |
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Ownership Information |
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FRN |
[FRN] |
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Name |
[name] |
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Address |
Street 1 |
[street 1] |
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Street 2 |
[street 2] |
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City |
[city] |
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State (“NA” if non-U.S. address) |
[state] |
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Zip/Postal Code |
[zip] |
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Country (if non-U.S. address) |
[country] |
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Listing Type |
Respondent Other interest holder |
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Positional Interests (check all that apply) |
[interest
type] |
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Citizenship, Gender, Ethnicity, and Race Information (Natural Persons Only) |
N/A (entity) |
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Citizenship |
[citizenship] |
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Gender |
Male Female |
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Ethnicity |
Hispanic
or Latino |
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Race (Check all categories that apply to the individual being reported) |
American
Indian or Alaska Native |
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Tribal Nation or Tribal Entity |
Yes |
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Interest Percentages (enter percentage values from 0.0 to 100.0) |
Voting |
[voting] |
Jointly Held? Yes No |
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Equity |
[equity] |
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Total assets |
[total assets] |
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Does interest holder have an attributable interest in one or more broadcast stations that do not appear on this report? |
Yes No |
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(b) Respondent certifies that any interests, including equity, financial, or voting interests, not reported in response to Question 2(a) are non-attributable. If “No,” submit as an exhibit an explanation. |
Yes
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(c) Does the Respondent or any interest holder reported in response to Question 2(a) hold an attributable interest in any newspaper entities in the same market as any station for which this report is filed, as defined in 47 C.F.R. Section 73.3555? If “Yes,” provide information describing the interest(s), using EITHER the subform OR the spreadsheet option below. Respondents with a large number (50 or more) of entries to submit should use the spreadsheet option.
NOTE: Spreadsheets must be submitted in a special XML Spreadsheet format with the appropriate structure that is specified in the documentation. For instructions on how to use the spreadsheet option to complete this question (including templates to start with), please Click Here.
If using the subform, leave the percentage of total assets (Equity Debt Plus) field blank for an interest holder unless that interest holder has an attributable interest in the newspaper entity solely on the basis of the Commission’s Equity Debt Plus attribution standard, 47 C.F.R. Section 73.3555, Note 2(i). If using an XML Spreadsheet, enter “NA” into the percentage of total assets (Equity Debt Plus) field for an interest holder unless that interest holder has an attributable interest in the newspaper entity solely on the basis of the Commission’s Equity Debt Plus attribution standard.
The Respondent must provide an FCC Registration Number for each interest holder reported in response to this question. Please see the Instructions for detailed information and guidance concerning this requirement. |
Yes
|
Other Newspaper Interests |
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FRN |
[FRN] |
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Name |
[name] |
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Name of Newspaper |
[newspaper] |
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Location of Newspaper |
City |
[city] |
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State |
[state] |
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Positional Interests (check all that apply) |
[interest
type] |
||||||
Interest Percentages (enter percentage values from 0.0 to 100.0) |
Voting |
[voting] |
|||||
Equity |
[equity] |
||||||
Total assets |
[total assets] |
||||||
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|
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(d) Are any of the individuals listed in response to Question 2(a) married to each other or related to each other as parent-child or as siblings? If “Yes,” provide the following information for each such the relationship. |
Yes
|
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Family Relationships |
|||||||
FRN |
[FRN] |
Name |
[name] |
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FRN |
[FRN] |
Name |
[name] |
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Relationship |
Spouses Parent/Child Siblings |
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|
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(e) Is Respondent seeking an attribution exemption for any officer or director with duties wholly unrelated to the Licensee(s)? If “Yes,” complete the information in the required fields and submit an Exhibit fully describing that individual’s duties and responsibilities, and explaining why that individual should not be attributed an interest. |
Yes
|
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Attribution Exemptions |
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Name |
[name] |
Title |
[title] |
3. Organizational Chart (Licensees Only) |
Attach a flowchart or similar document showing the Licensee’s vertical ownership structure including the Licensee and all entities that have attributable interests in the Licensee. Licensees with a single parent entity may provide a brief explanatory textual Exhibit in lieu of a flowchart or similar document. Licensees without parent entities should so indicate in a textual Exhibit. Non-Licensee Respondents should select “N/A” in response to this question. |
Not Applicable |
Section III – Certification
[title]
(official title)
[respondent]
(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. |
|
Signature |
[signature] |
Date (mm/dd/yyyy) (When filing a biennial ownership report, date of signature below must be no earlier than Oct. 1 of the filing year.) |
[date] |
Telephone Number (Include area code) |
[telephone number] |
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).
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Jake Riehm |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |