Licensing and Management System

FRN	Entity Name
0028684199	Teen Challenge of American Samoa

Street Address	City (and Country if non U.S. address)	State ("NA" if non-U.S. address)	Zip Code	Phone	Email
PO BOX 277	PAGO PAGO	AS	96799	+1 (684) 258-8298	vickiehaleck@hotmail.com

Name	Organization
VICKIE HALECK	TEEN CHALLENGE OF AMERICAN SAMOA

Street Address	City (and Country if non U.S. address)	State	Zip Code	Phone	Email
PO BOX 277	PAGO PAGO	AS	96799	+1 (684) 258-8298	vickiehaleck@hotmail.com

Not Applicable

(a) Provide the following information about the Respondent:
Relationship to stations/permits	Licensee
Is the Respondent's governing board (or other governing entity) directly or indirectly under the control of another entity?		No

(b) Provide the following information about this report:
Purpose	Report filed by Permittee in conjunction with Permittee’s application for a station license
"As of" date	09/12/2021 When filing a biennial ownership report or validating and resubmitting a prior biennial ownership report, this date must be Oct. 1 of the year in which this report is filed.

Respondent is filing this report to cover the following Licensee(s)/Permittee(s) and station(s)/permit(s):

Licensee/Permittee Name	FRN
Teen Challenge of American Samoa	0028684199

Fac. ID No.	Call Sign	City	State	Service
173422	KMOA	NU'UULI	AS	FM

Licensee/Permittee Respondents should list all contracts and other instruments set forth in 47 C.F.R. Section 73.3613(a) through (c) for the facility or facilities listed on this report. If the agreement is 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.

(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, members of the governing board (or other governing entity), stockholders, 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.

Ownership Information
FRN	0028684199
Entity Name	Teen Challenge of American Samoa
Address	PO Box
	Street 1	PO BOX 277
	Street 2
	City	PAGO PAGO
	State ("NA" if non-U.S. address)	AS
	Zip/Postal Code	96799
	Country (if non-U.S. address)	United States
Listing Type	Respondent
Positional Interests (check all that apply)	Respondent
Interest Percentages (enter percentage values from 0.0 to 100.0)	Voting	0.0%
	Total assets (Equity Debt Plus)	0.0%
Does interest holder have an attributable interest in one or more broadcast stations that do not appear on this report?			No

Ownership Information
FRN	9990143765
Name	VICKIE HALECK
Address	PO Box
	Street 1	PO BOX 277
	Street 2
	City	PAGO PAGO
	State ("NA" if non-U.S. address)	AS
	Zip/Postal Code	96799
	Country (if non-U.S. address)	United States
Listing Type	Other Interest Holder
Positional Interests (check all that apply)	Officer, Member of Governing Board (or other governing entity)
Principal Profession or Occupation	MINISTRY
By Whom Appointed or Elected	BOARD
Interest Percentages (enter percentage values from 0.0 to 100.0)	Voting	25.0%
	Total assets (Equity Debt Plus)	0.0%
Does interest holder have an attributable interest in one or more broadcast stations that do not appear on this report?			No

Ownership Information
FRN	9990143766
Name	KRYSTINE SAVALI
Address	PO Box
	Street 1	PO BOX 1135
	Street 2
	City	PAGO PAGO
	State ("NA" if non-U.S. address)	AS
	Zip/Postal Code	96799
	Country (if non-U.S. address)	United States
Listing Type	Other Interest Holder
Positional Interests (check all that apply)	Officer, Member of Governing Board (or other governing entity)
Principal Profession or Occupation	BOOKKEEPER
By Whom Appointed or Elected	BOARD
Interest Percentages (enter percentage values from 0.0 to 100.0)	Voting	25.0%
	Total assets (Equity Debt Plus)	0.0%
Does interest holder have an attributable interest in one or more broadcast stations that do not appear on this report?			No

Ownership Information
FRN	9990143767
Name	APINERU PASE
Address	PO Box
	Street 1	PO BOX 4144
	Street 2
	City	PAGO PAGO
	State ("NA" if non-U.S. address)	AS
	Zip/Postal Code	96799
	Country (if non-U.S. address)	United States
Listing Type	Other Interest Holder
Positional Interests (check all that apply)	Member of Governing Board (or other governing entity)
Principal Profession or Occupation	VOLUNTEER
By Whom Appointed or Elected	BOARD
Interest Percentages (enter percentage values from 0.0 to 100.0)	Voting	25.0%
	Total assets (Equity Debt Plus)	0.0%
Does interest holder have an attributable interest in one or more broadcast stations that do not appear on this report?			No

Ownership Information
FRN	9990143768
Name	MAUGAOAO ALAILEFALEULA
Address	PO Box
	Street 1	PO BOX 7063
	Street 2
	City	PAGO PAGO
	State ("NA" if non-U.S. address)	AS
	Zip/Postal Code	96799
	Country (if non-U.S. address)	United States
Listing Type	Other Interest Holder
Positional Interests (check all that apply)	Member of Governing Board (or other governing entity)
Principal Profession or Occupation	BROADCASTING
By Whom Appointed or Elected	BOARD
Interest Percentages (enter percentage values from 0.0 to 100.0)	Voting	25.0%
	Total assets (Equity Debt Plus)	0.0%
Does interest holder have an attributable interest in one or more broadcast stations that do not appear on this report?			No

(b) Respondent certifies that any interests, including equity, financial, or voting interests, not reported in this filing are non-attributable. If "No," submit as an exhibit an explanation.

Yes

(c) 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.

No

Section	Question	Response
Authorized Party to Sign	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).
Certification	I certify 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.	Official Title: PRESIDENT Exact Legal Title or Name of Respondent: TEEN CHALLENGE AMERICAN SAMOA Name: VICKIE HALECK Phone: 6842588298 09/17/2021