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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