State of West Virginia Campaign Financial Statement
(Long Form) in Relation to the 2012 Election Year

Candidate or Committee Name
EPIC West Virginia PharmPAC
Candidate or Committee's Treasurer
Mark Williams
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
Route 50, HC 61 Box 301 
Office Sought (for Candidates)
City, State, Zip Code
Capon Bridge, WV 26711
Daytime Phone #

Election Cycle Reporting Period (check one):

Primary - First Report
Due Mar 31-Apr 06, 2012Mar 31-Apr 06, 2012
Pre-primary Report
Due Apr 23-Apr 27, 2012Apr 23-Apr 27, 2012
Post-primary Report
Due May 21-Jun 19, 2012May 21-Jun 19, 2012
General - First Report
Due Sep 24-Sep 28, 2012Sep 24-Sep 28, 2012
Pre-general Report
Due Oct 22-Oct 26, 2012Oct 22-Oct 26, 2012
Post-general Report
Due Nov 19-Dec 19, 2012Nov 19-Dec 19, 2012

Check if Applicable:

Amended Report
You must also check box of appropriate reporting period
Final Report
Zero balance required.
PAC must also file Form F-6 Dissolution

Non-Election Cycle Reporting Period:

Annual Report 2012 Calendar Year
Due last Saturday in March or within 6 days thereafter

Report Totals

Fill in totals at the completion of the report.

RECEIPTS OF FUNDS: Totals for this Period
Contributions  $580.00
Monetary Contributions from all Fund-Raising Events +$0.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$580.00
In-Kind Contributions +$0.00
Total Contributions: =$580.00
Other Income  $0.00
Loans Received +$0.00
Total Other Income: =$0.00
Unpaid Bills  $0.00
Outstanding Loans +$0.00
Total Debts: =$0.00
(Add total contributions from all reports)
Beginning Balance
(ending balance from previous report)
Total Monetary Contributions +$580.00
Total Other Income +$0.00
Subtotal: a. =$25,886.10
Total Expenditures Paid  $19,200.00
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$19,200.00
Ending Balance:
(Subtotal a. - Subtotal b.)

*Cannot be negative balance
(Add total expenditures from all reports)

$250.00 or LESS

4/25/2012Judy’s Drug Store$20.00
4/25/2012Reed’s Drug Store$20.00
4/25/2012Reed’s Pharmacy$20.00
4/25/2012Sav-A-Lot Pharmacy of Fort Ashby$20.00
4/25/2012Reed’s Pharmacy #2$20.00
4/25/2012Crab Orchard Pharmacy$20.00
4/25/2012American Pharmacy USA$20.00
4/25/2012Goodykoontz Drug Store$20.00
4/25/2012Flat Iron Drug Store$20.00
4/25/2012Fritz’s Pharmacy$20.00
4/25/2012Bluewell’s Family Pharmacy$20.00
4/25/2012Black Diamond PHarmacy$20.00
4/25/2012Clinic Pharmacy$20.00
4/25/2012Poca Valu-Rite$20.00
4/25/2012Health Aid Pharmacy$20.00
4/25/2012Cross Lanes Family Pharmacy$20.00
4/25/2012Med-A-Save Pharmacy$20.00
4/25/2012Nicholas Pharmacy$20.00
4/25/2012McDowell Pharmacy$20.00
4/25/2012Reed’s Drug Store LLC$20.00
4/25/2012Reed’s Pharmacy #4$20.00
4/25/2012Citizens Drug Store$20.00
4/25/2012Charlie’s Pharmacy of Mullens$20.00
4/25/2012Gregg’s Pharmacy$20.00
4/25/2012Judy’s Drug Store #2$20.00
4/25/2012Pill Box Pharmacy$20.00
4/25/2012Craigsville Hometown Pharmacy$20.00
4/25/2012Fritz’s Pharmacy II$20.00
4/25/2012Shepherdstown Pharmacy$20.00
 Subtotal of contributions of $250.00 or less$580.00

More than $250.00

 Subtotal of all contributions of more than $250.00
Subtotal of all contributions of $250 or less
Total Contributions:

Other Income: Interest, Refunds, Miscellaneous Receipts

DateSource of IncomeType of ReceiptAmount
  Total Other Income: $0.00

In-Kind Contributions

DateName and Contributor InformationDescription of ContributionValue
  Total In-Kind Contributions: $0


West Virginia Code: §3-8-5f. Loans to candidates, organizations or persons for election purposes.

"Every candidate, financial agent, person or association of persons or organization advocating or opposing the nomination or election of any candidate or the passage or defeat of any issue or item to be voted upon may not receive any money or any other thing of value toward election expenses except from the candidate, his or her spouse or a lending institution. All loans shall be evidenced by a written agreement executed by the lender, whether the candidate, his or her spouse, or the lending institution. Such agreement shall state the date and amount of the loan, the terms, including interest and repayment schedule, and a description of the collateral, if any, and the full names and addresses of all parties to the agreement. A copy of the agreement shall be filed with the financial statement next required after the loan is executed."

The loan agreement must include all items asked for in the statute. (See above.) The loan agreement does not have to follow a certain format; generally, if all the required information is listed, any format is acceptable. Candidates or political committees that take out a loan for the campaign through a bank or other commercial lending institution must include a copy of the loan agreement executed with that bank or institution. Candidates should not take out loans which are partially for personal use and partially for the campaign. It is almost impossible to keep reporting straight in this case. Any money a candidate contributes to his or her campaign committee with the hope of repayment must be treated as a loan and reported in this section. When a candidate determines that no further repayment can be expected, the loan can be reported as repaid in this section by entering the amount left to repay in the repayments column and reporting the same amount as a contribution from the candidate on Page 2. These loans must be executed in writing. Caution: Candidates may not carry outstanding loans from one campaign to the next. Each campaign is separate. Funds from a current campaign cannot be used to repay a loan from a previous campaign.

How To Report Loans

  1. Each loan for your campaign should be listed on a separate line. (Each time you loan money to the campaign or get a loan, it is considered to be a separate loan.) Include the following information ont he form below.
    1. loans(s) from prior reporting periods and the balance of each loan (Col A.) If a payment was made on the loan, list that in Col. C. Any loan that was repaid in previous reporting periods does not need to be listed.
    2. new loans, the amount (Col. B), any repayments (Col. C), and the balance (Col. D.)
  2. Attach a copy of the loan agreement for each loan received during the reporting period.

Loans (Continued)

Bank Loans: List name & address or financial institution
Candidate or Candidate's Spouse Loans: List name, residence and mailing address of person(s) making or cosigning loan
Column A
Balance of previous loan at end of period
Column B
Amount of new loan received during period
Column C
Repayments during period
Column D
Balance outstanding at end of period
Amount Date Amount Date Amount Amount
Loans Received Repayment of Loans Outstanding Loans
Totals: $0.00 $0.00 $0.00

Itemized Expenditures

DateName of Person or Vendor And AddressPurposeAmount
4/27/2012 Andes for House
15 Deer Valley Drive
Hurricane, WV 25526
Campaign Contribution$300.00
4/27/2012 Friends of Randy Swartzmiller
218 Heartwood Drive
Chester, WV 26034
Campaign Contribution$200.00
4/27/2012 Ryan Ferns for House
27 Jenna Way
Wheeling, WV 26003
Campaign Contribution$200.00
4/27/2012 Mike Ferro for House
2 Ninth Street
McMechen, WV 26040
Campaign Contribution$200.00
4/27/2012 Anna Border for House
39 Highland Meadows Drive
Davisville, WV 26142
Campaign Contribution$300.00
4/27/2012 Craig for House 2012 (Kevin J)
34 Chestnut Drive
Huntington, WV 25705
Campaign Contribution$400.00
4/27/2012 Jim Morgan for House
P.O. Box 117
Huntington, WV 25706
Campaign Contribution$400.00
4/27/2012 Carol Miller for House
1316 12th Street
Huntington, WV 25701
Campaign Contribution$300.00
4/27/2012 Rick Thompson for House
4625 Route 152
Lavalette, WV 25535
Campaign Contribution$500.00
4/27/2012 Committee to Re-Elect Harry Keith White
P.O. Box 1985
Gilbert, WV 25621
Campaign Contribution$500.00
4/27/2012 Ted Tomblin for House
P.O. Box 191
Logan, WV 25601
Campaign Contribution$300.00
4/27/2012 Linda Goode Phillips for House
P.O. Box 505
Pineville, WV 24874
Campaign Contribution$300.00
4/27/2012 Joe Ellington for House
613 Pigeon Roost Trail
Princeton, WV 24740
Campaign Contribution$300.00
4/27/2012 John Shott for House
422 Oakhurst Ave.
Bluefield, WV 24701
Campaign Contribution$300.00
4/27/2012 Linda Summer for House
155 Oak Run Road
Beckley, WV 25801
Campaign Contribution$300.00
4/27/2012 Perry for House (Dave)
330 East Martin Ave.
Oak Hill, WV 25901
Campaign Contribution$300.00
4/27/2012 Committee to Elect Brent Boggs
145 Holly Gray Drive
Sutton, WV 26601
Campaign Contribution$300.00
4/27/2012 Bobbie Hatfield for House
3 Wilbur Drive
South Charleston, WV 25303
Campaign Contribution$500.00
4/27/2012 Committee to Elect Chris Morris
619 Churchill Drive
Charleston, WV 25314
Campaign Contribution$300.00
4/27/2012 Skaff for House (Doug)
3 Joplin Place
South Charleston, WV 25303
Campaign Contribution$300.00
4/27/2012 Committee to Elect Eric Nelson
P.O. Box 186
Charleston, WV 25314
Campaign Contribution$300.00
4/27/2012 Bob Johns for House Committee
216 Brooke St., Suite 200
Charleston, WV 25314
Campaign Contribution$300.00
4/27/2012 Tim Armstead for House
20 Pine Cone Drive
Elkview, WV 26241
Campaign Contribution$300.00
4/27/2012 Hartman for House (Bill)
P.O. Box 243
Elkins, WV 26241
Campaign Contribution$500.00
4/27/2012 Joe Talbott for House
148 Webster Ave.
Webster Springs, WV 26288
Campaign Contribution$300.00
4/27/2012 Sam Cann for House
21 Maple Lake Road
Bridgeport, WV 26288
Campaign Contribution$300.00
4/27/2012 Richard Iaquinta for House
139 Vermont Ave
Clarksburg, WV 26301
Campaign Contribution$300.00
4/27/2012 Committee to Elect Tim Miley
c/o The Miley Legal Group
230 W Pike St, Suite 205
Clarksburg, WV 26301
Campaign Contribution$500.00
4/27/2012 Friends to Re-Elect Mike Caputo
RR 1, Box 155
Riversville, WV 26588
Campaign Contribution$400.00
4/27/2012 Pasdon for House (Amanda)
P.O. Box 106
Morgantown, WV 26507
Campaign Contribution$300.00
4/27/2012 Barill for the House (Tony)
18 W. 5th Street
Westover, WV 26501
Campaign Contribution$200.00
4/27/2012 Gary Howell for House
P.O. Box 39
Keyser, WV 26726
Campaign Contribution$200.00
4/27/2012 Ruth Rowan for House
HC 60, Box 113-A
Points, WV 25437
Campaign Contribution$300.00
4/27/2012 Cowles for House
2612 Martinsburg Road
Berkeley Springs, WV 25411
Campaign Contribution$500.00
4/27/2012 Householder for House (Eric)
212 Snooks Lane
Martinsburg, WV 25405
Campaign Contribution$300.00
4/27/2012 Tiffany Lawrence
652 Sawgrass Drive
Charles Town, WV 25414
Campaign Contribution$300.00
4/27/2012 Committee to Elect Earl Ray Tomblin
P.O. Box 11530
Charleston, WV 25339
Campaign Contribution$500.00
4/27/2012 Re-Elect Jack Yost for Senate
1413 Pleasant Ave.
Wellsburg, WV 26070
Campaign Contribution$300.00
4/27/2012 Kessler for Senate (Jeffrey)
607 Wheeling Ave
Glen Dale, WV 26038
Campaign Contribution$500.00
4/27/2012 Committee to Elect Mitch Carmichael
101 Court St.
Ripley, WV 25271
Campaign Contribution$500.00
4/27/2012 Mark Wills for State Senate
218 Hale Ave.
Princeton, WV 24740
Campaign Contribution$300.00
4/27/2012 Kirkendoll for Senate (Art)
P.O. Box 1227
Chapmanville, WV 25508
Campaign Contribution$300.00
4/27/2012 Friends of Joshua Martin
P.O. Box 513
Poca, WV 25159
Campaign Contribution$300.00
4/27/2012 Browning 2012 (Richard)
P.O. Box 158
Oceana, WV 24870
Campaign Contribution$500.00
4/27/2012 Clark Barnes for Senate
Route 2, Box 12-C
Beverly, WV 26253
Campaign Contribution$300.00
4/27/2012 Committee to Elect Doug Facemire
774 Shannon Road
Bridgeport, WV 26330
Campaign Contribution$400.00
4/27/2012 Committee to Re-Elect Roman Prezioso
1806 Dogwood Drive
Fairmont, WV 26554
Campaign Contribution$500.00
4/27/2012 Bob Williams for State Senate Committee
P.O. Box 562
Grafton, WV 26354
Campaign Contribution$300.00
4/27/2012 Elect Snyder Committee (Herb)
P.O. Box 400
Shenandoah Junction, WV 25442
Campaign Contribution$400.00
4/27/2012 Don Perdue for House
635 White’s Creek Road
Prichard, WV 25555
Campaign Contribution$500.00
4/27/2012 Staggers for House (Margaret Anne)
36 Barrington Hill Road
Fayetteville, WV 25840
Campaign Contribution$300.00
4/27/2012 Mark Hunt for House
406 Capitol Street, Suite 1009
Charleston, WV 25301
Campaign Contribution$500.00
4/27/2012 Sharon Spenser for Delegate
412 Midland Ave.
Belle, WV 25015
Campaign Contribution$300.00
4/27/2012 Walters for House (Ron)
P.O. Box 3665
Charleston, WV 25336
Campaign Contribution$300.00
4/27/2012 Cliff Moore for House
P.O. Box 67
Thorpe, WV 24888
Campaign Contribution$400.00
  Total Expenditures: $19,200.00

Receipt of a Transfer of Excess Funds

DateCandidate Committee Name and YearAmount
 Total Receipts of Transfer of Excess Funds: $0.00

Disbursement of Excess Funds

DateName of candidate committee and election year disbursing excess fundsPurpose of DisbursementAmount
  Total Disbursement of Excess Funds: $0

Unpaid Bills

DateGroup or Firm AffiliationPurposeAmount
  Total Unpaid Bills: $0.00

Office Use Only
Filed With West Virginia Secretary of State
Thursday, May 31, 2012 10:08:43 AM