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Licensing and Management System

Approved by OMB 3060-0010
September 2019
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission)Commercial Broadcast Stations Biennial Ownership Report (FCC Form 323)

File Number:
0000173435
Submit Date:
2021-11-30
FRN:
0003745494
Purpose:
Commercial Broadcast Stations Biennial Ownership Report
Status:
Received
Status Date:
11/30/2021
Filing Status:
Active

Section I - General Information

1. Respondent

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FRN Entity Name

0003745494

Bustos Media Holdings, LLC

Street Address City (and Country if non U.S. address) State ("NA" if non-U.S. address) Zip Code Phone Email

5110 S. E. Stark Street

Portland

OR

97215

+1 (503) 233-5280

abustos@bustosmedia.com

2. Contact Representative

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Name Organization

Dennis J. Kelly

Law Office of Dennis J. Kelly

Street Address City (and Country if non U.S. address) State Zip Code Phone Email

Post Office Box 41177

Washington

DC

20018-0577

+1 (202) 293-2300

dkellyfcclaw1@comcast.net

3. Application Filing Fee

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Question Response

Is this application being submitted without a filing fee?

No

Fees

Application Type Form Number Fee Code Quantity Fee Amount Subtotal
Total $2,210.00

Biennial Form 323 MAR 26 85
$2,210.00

4. Nature of Respondent

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(a) Provide the following information about the Respondent:

Relationship to stations/permits

Licensee

Nature of Respondent

Limited liability company

(b) Provide the following information about this report:
Purpose Biennial
"As of" date 10/01/2021

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.

5. Licensee(s) and Station(s)

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Respondent is filing this report to cover the following Licensee(s) and station(s):
Licensee/Permittee Name FRN
Bustos Media Holdings, LLC 0003745494
Fac. ID No. Call Sign City State Service
953 KZTB MILTON-FREEWATER OR FM
2431 KQRR OREGON CITY OR AM
4042 KZUS EPHRATA WA FM
4758 KMMG BENTON CITY WA FM
6266 KZXR-FM PROSSER WA FM
13969 KVOI CORTARO AZ AM
15137 KZML QUINCY WA FM
19242 KSND MONMOUTH OR FM
21602 KMNA MABTON WA FM
30906 KZSJ SAN MARTIN CA AM
33622 KDDS-FM ELMA WA FM
33683 KMIA AUBURN-FEDERAL WAY WA AM
33829 KZTM MCKENNA WA FM
36006 KZTA NACHES WA FM
49731 KRCW ROYAL CITY WA FM
50709 KHHZ GRIDLEY CA FM
51638 KZSZ COLUSA CA FM
57504 KTGV ORACLE AZ FM
68212 KOOR MILWAUKIE OR AM
71631 KREH PECAN GROVE TX AM
71752 KGDD PORTLAND OR AM
82538 KZZR GOVERNMENT CAMP OR FM
160794 KXET MOUNT ANGEL OR AM
183328 KYXE UNION GAP WA FM
191491 KZNW OAK HARBOR WA FM
191536 KZGI SEDRO-WOOLLEY WA FM

Section II – Biennial Ownership Information

1. 47 C.F.R. Section 73.3613 and Other Documents

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Licensee Respondents that hold authorizations for one or more full power television, AM, and/or FM stations 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. In addition, attributable Local Marketing Agreements (LMAs) and attributable Joint Sales Agreements (JSAs) must be disclosed by the licensee of the brokering station on its ownership report. If the agreement is an attributable LMA, an attributable 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.


Document Information
Description of contract or instrument Articles of Organization
Parties to contract or instrument State of California
Date of execution 12/1998
Date of expiration No expiration date
Agreement type
(check all that apply)
Other

Agreement Type: Corporate

2. Ownership Interests

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(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) 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.


Ownership Information
FRN 0003745494
Entity Name Bustos Media Holdings, LLC
Address PO Box
Street 1 5110 S. E. Stark Street
Street 2
City Portland
State ("NA" if non-U.S. address) OR
Zip/Postal Code 97215
Country (if non-U.S. address) United States
Listing Type

Respondent

Positional Interests
(check all that apply)

Respondent
Tribal Nation or Tribal Entity

Interest holder is not a Tribal nation or Tribal entity

Interest Percentages
(enter percentage values from 0.0 to 100.0)
Voting 0.0% Jointly Held?

No

Equity 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 0020031183
Entity Name Bustos Asset Management, LLC
Address PO Box
Street 1 5110 S. E. Stark Street
Street 2
City Portland
State ("NA" if non-U.S. address) OR
Zip/Postal Code 97215
Country (if non-U.S. address) United States
Listing Type

Other Interest Holder

Positional Interests
(check all that apply)

LC/LLC/PLLC Member
Tribal Nation or Tribal Entity

Interest holder is not a Tribal nation or Tribal entity

Interest Percentages
(enter percentage values from 0.0 to 100.0)
Voting 100.0% Jointly Held?

No

Equity 100.0%
Total assets (Equity Debt Plus) 100.0%
Does interest holder have an attributable interest in one or more broadcast stations that do not appear on this report?

No

Ownership Information
FRN 0004071924
Name Amador S. Bustos
Address PO Box
Street 1 5110 S. E. Stark Street
Street 2
City Portland
State ("NA" if non-U.S. address) OR
Zip/Postal Code 97215
Country (if non-U.S. address) United States
Listing Type

Other Interest Holder

Positional Interests
(check all that apply)

LC/LLC/PLLC Member, Other - LLC Manager
Citizenship, Gender, Ethnicity, and Race Information (Natural Persons Only)
Citizenship US
Gender

Male

Ethnicity

Hispanic or Latino

Race White
Interest Percentages
(enter percentage values from 0.0 to 100.0)
Voting 0.0% Jointly Held?

No

Equity 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 0026723445
Name Rosalie L. Bustos
Address PO Box
Street 1 5110 S. E. Stark Street
Street 2
City Portland
State ("NA" if non-U.S. address) OR
Zip/Postal Code 97215-1751
Country (if non-U.S. address) United States
Listing Type

Other Interest Holder

Positional Interests
(check all that apply)

LC/LLC/PLLC Member
Citizenship, Gender, Ethnicity, and Race Information (Natural Persons Only)
Citizenship US
Gender

Female

Ethnicity

Hispanic or Latino

Race White
Interest Percentages
(enter percentage values from 0.0 to 100.0)
Voting 0.0% Jointly Held?

No

Equity 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

(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

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(c) Does the Respondent or any reported interest holder 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.

No

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(d) Are any of the individuals listed as an attributable interest holder in the Respondent 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

Family Relationships
FRN 0004071924 Name Amador S Bustos
FRN 0026723445 Name Rosalie L Bustos
Relationship Spouses
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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.

No

3. Organizational Chart (Licensees Only)

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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.


File Name Uploaded By Attachment Type Description
Bustos Media Holdings LLC--Organizational Chart 102621.pdf Applicant Ownership Chart Organizational Chart

Section III - Certification

Certification

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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 and Manager

Exact Legal Title or Name of Respondent: Bustos Media Holdings, LLC

Name: Amador S. Bustos

Phone: 5032335280


11/30/2021