HomeMy WebLinkAboutBFMG FORM 461Major Donor and
Independent Expenditure Committee
Campaign Statement
(Gov~nment Code sections 84200q~4216.5)
SEE INSTRUCTIONS ON REVERSE
1. Name and Address of Filer
from
through
Statement covers period
01/01/02
12/31/02
NAME OF FILER
{Include name(s) of all affiliated entities whose contributions are included in this statement.)
BAKERSFIELD FAMILY MEDICAL GROUP, INC.
RESIDENTIAL OR MAILING ADDRESS {NO. AND STREET)
CITY STATE ZIP CODE
RESPONSIBLE OFFICER AREA CODE/DAY-nME PHONE
(if filer is other than an individual)
MARY INGLIS (
2. Nature and Interests of Filer (Complete each applicable sectio~.)
r~A FILER WHO IS AN INDIVIDUAL MUST LIST THE NAME. ADDRESS, AND BUSINESS INTERESTS
OF EMPLOYER OR, IF SELF-EMPLOYED, THE NAME, ADDRESS, AND NATURE OF THE BUSINESS
BUSINESS INTERESTS
NAME OF EMPLOYER/BUSINESS
ADDRESS OF EMPLOYER/BUSINESS
A FILER THAT IS A BUSINESS ENTITY MUST DESCRIBE THE BUSINESS ACTIVITY IN WHICH IT IS
r~ ENGAGED
CONTRACT MEDICAL SERVICES
Type or print in ink.
MAJOR DONOR AND INDEPENDENT EXPENDITURE
COMMn'TEE STATEMENT
Date Stamp
[] A FILER THAT IS AN ASSOCIATION MUST PROVIDE A SPECIFIC DESCRIPTION OF ITS INTERESTS
i-3 PM I:h6
Date of election if applicable:
(Month, Day, Year) BAKEF SF'IEL0 Cll Y CLERI
I 4
Page of .__
For Official Use Only
[~A FILER THAT IS NOT AN INDIVIDUAL, BUSINESS ENTITY, OR ASSOCIATION MUST DESCRIBE THE
COMMON ECONOMIC INTEREST OF THE GROUP OR ENTITY
3. Summary
(Amounts may be rounded to whole dollars.)
1. Expenditures and contributions
(including loans) of $100 or more
made this period. (Part 5.) ........................................... $ 26,000
2. Unitamized expenditures and
contributions (including loans) under
$100 made this period ................................................. $
3. Total expenditures and contributions
made this period. (Add Lines 1 + 2.) ............ SUBTOTAL $ 26,000
4. Total expenditures and contributions
made from prior statement. (Enter
amount from Line 5 of last statement
tiled, If this is the tirst statement for
the calendar year, enter zero.) ..................................... $
5. Total expenditures and contributions
(including loans) made since
January 1 of the current calendar year,
(Add Lines 3 + 4.) ............................................. TOTAL $ 26,000
4. Verification
I have used all reasonable diligence in pmpadng this statement, I have
reviewed the statement and to the best of my knowledge the information
contained herein is true and complete. I certify under penalty of perjury under
the laws of the State of California that the foregoing is true and correct.
Executed on. 1131/03 By '~/~o~v'~ C,~,~-
FPPC Form 461 (Jard03)
[] Amendment (Explain): FPPC Toll-Free Helpline: 866/ASK-FPPC
866/275-3772
Major Donor and
Independent Expenditure Committee
Campaign Statement
SEE INSTRUCTIONS ON REVERSE
Type or print in ink,
Amounts may be rounded
to whole dollars.
INDEPENDENT EXPENDITURE COMM['FrEE AND
MAJOR DONOR COMM~ ~ I EE STA'rEMENT
Statement covers period
from 01/01/02
through 12/31/02 Page 2 of 4
NAME OF FILER
BAKERSFIELD FAMILY MEDICAL GROUP, INC.
5. Contributions (Including Loans, Forgiveness of Loans, and Loan Guarantees) and Expenditures Made
(If more space is needed, use additional copies of this page for continuation sheets.)
CUMULATIVE AMOUNT
DESCRIPTION OF CANDIDATE AND OFFICE, AMOUNT THIS RELATED TO THIS
DATE NAME, STREET ADDRESS, CITY, STATE AND ZIP CODE TYPE OF PAYMENT PAYMENT MEASURE AND JURISDtCTION, PERIOD CANDIDATE, MEASURE,
OF PAYEE IF OTHER THAN MONETARY OR COMMITTEE OR COMMI3-~EE
(tF COMMITTEE. ALSO ENTER ID. NUMBER} CONTRIBUTION OR LOAN)
] Monetary
KEVIN MCCARTHY Contribution KEVIN MCCARTHY 1,000 1,000
5/31/02 COMMITTEE TO ELECT #1234227 [] Loan 32ND STATE ASSEMBLY
RAY KARPE, TREAS [] Non-Monetary
[] Independen~
Expenditur
[] Monetary
DAVID COUCH, RE-ELECT Contribution DAVID COUCH 1,000 1,000
6/6/02 COMMITTEE # 982190 [] Loan CITY COUNCIL
~] Support [] Oppose
IRMA CARSON FOR RE-ELECTION Contribution IRMA CARSON 1,000 1,000
6/6/02 COMMITTEE #942253 [] Loan CITY COUNCIL
ture [] Suppo[~ [] Oppose
HAROLD HANSON FOR RE-ELECTION c~ntdbutio. HAROLD HANSON 1,000 1,000
6/6/02 COMMITTEE # 1225870 [] Loan CITY COUNCIL
Expenditure [] Suppo~ [] Oppose
SUBTOTAL $
4,000
FPPC Form461(Ja~03)
FPPC Toll-Free Helpline: 866/ASK-FPPu
866/275
Major Donor and
Independent Expenditure Committee
Campaign Statement
SEEINSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars,
iNDEPENDENT EXPENDITURE COMMI3~'EE AND
MAJOR DONOR COMMFI'rEE STATEMENT
Statement covers period . ~
from 01/01/02 i ~ ~ I~11j
through 12/31/02 Page 3 of 4
NAME OF FILER
BAKERSFIELD FAMILY MEDICAL GROUP, INC.
5, Contributions (Including Loans, Forgiveness of Loans, and Loan Guarantees) and Expenditures Made
(If more space is needed, use additional copies of this page for continuation sheets.)
CUMULATIVE AMOUNT
DESCRIPTION OF CANDIDATE AND OFFICE, AMOUNT THIS RELATED TO THIS
NAME, STREET ADDRESS, CITY, STATE AND ZIP CODE TYPE OF PAYMENT PAYMENT MEASURE AND JURISDICTION, PERIOD CANDIDATE, MEASURE,
CATE OF PAYEE IFOTHERTHAN MONETARY OR COMMITrEE OR COMMI3-i-EE
] Monetary
JACQUIE SULLIVAN Contribution IACQUIE SULLIVAN 1,000 1,000
6~6/02 COMMITTEE # 950347 [] Loan CITY COUNCIL
[] Independent
ExpencJiture [] Support [] Oppose
MARK SALVAGGIO 1,000
6/6/02 COMMITTEE # 850625 [] Loan CITY COUNCIL
Expenditure [] Support [] Oppose
MIKE MAGGARD FOR RE-ELECTION 1,000
6/6/02 COMMITTEE # 980600 [] Loan CiTY COUNCIL
[] Independent [] Support [] Oppose
SUSAN BENHAM FOR RE-ELECTION 1,000
6/6/02 COMMITTEE # 1225162 [] Lo~n CITY COUNCIL
Expenditure
866J275-3772
Major Donor and
Independent Expenditure Committee
Campaign Statement
SEEINSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
INDEPENDENT EXPENDITURE COMMI3q'EE AND
MAJOR DONOR COMMITTEE STATEMENT
Statement covers period
from 01/01/02
through 12/31/02 Page 4 of. 4__~___
NAME OF FILER
BAKERSFIELD FAMILY MEDICAL GROUP, INC.
5. Contributions (Including Loans, Forgiveness of Loans, and Loan Guarantees) and Expenditures Made
(ff more space is needed, use additiona/ copies of this page for continuation sheets.)
DESCRIPTION OF CANDIDATE AND OFFICE, CUMULATIVE AMOUNT
DATE NAME, STREET ADDRESS, CITY, STATE AND ZIP CODE TYPE OF PAYMENT PAYMENT MEASURE AND JURISDICTION, AMOUNT THIS RELATED TO THIS
OF PAYEE (IF OTHER THAN MONETARY OR COMMITTEE PERIOD CANDIDATE, MEASURE,
(IF COMMITTEE ALSO ENTER I D NUMBER) CONT~JBUTION OR LOAN) OR COMMITTEE
] Monetary
RAY WATSON FOR 4TH DISTRICT Contribution RAY WATSON
12/31/02 COMMITTEE TO ELECT # 1245952 [] Loan COUNTY SUPERVISOR 3,000 3,000
SHAWN P. KELLY, TREAS. [] Non-Monetary 4TH DISTRICT
[] Independent
Expenditure
[] Independent
Expenditure [] Support [] Oppose
MACK WIMBUSH FOR SHERIFF Contribution MACK WIMBUSH
12/31/02 BUD PILGRIM, TREASURER [] Loan
OMMITTEE # 1236810 [] No.-Monetary
[] II-¢:~ependent
Expenditure [] Support [] Oppose
Expenditure [] Support [] Oppose
SUBTOTAL $ 18,000