State of West Virginia Campaign Financial Statement
(Long Form) in Relation to the 2010 Election Year

Candidate or Committee Name
North Central West Virginia Democracy for America
Candidate or Committee's Treasurer
Wayne Worth
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
163 W. Pike Street, Apt. K 
Office Sought (for Candidates)
City, State, Zip Code
Clarksburg, WV 26301
Daytime Phone #

Election Cycle Reporting Period (check one):

Primary - First Report
Due Mar 27-Apr 02, 2010
Pre-primary Report
Due Apr 26-Apr 30, 2010
Post-primary Report
Due May 24-Jun 23, 2010
General - First Report
Due Sep 20-Sep 24, 2010
Pre-general Report
Due Oct 18-Oct 22, 2010
Post-general Report
Due Nov 15-Dec 15, 2010

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 2010 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  $585.00
Monetary Contributions from all Fund-Raising Events +$1,518.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$2,103.00
In-Kind Contributions +$0.00
Total Contributions: =$2,103.00
Other Income  $165.00
Loans Received +$0.00
Total Other Income: =$165.00
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 +$2,103.00
Total Other Income +$165.00
Subtotal: a. =$3,158.99
Total Expenditures Paid  $2,116.71
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$2,116.71
Ending Balance:
(Subtotal a. - Subtotal b.)

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

$250.00 or LESS

2/3/2010James Tate$5.00
2/3/2010Jean Grapos$5.00
2/3/2010Sally Starkey$5.00
2/14/2010Brad Lueiro$10.00
2/20/2010Debi Matz$5.00
2/20/2010John Matz$5.00
2/24/2010Bernard Raber$5.00
2/24/2010Dale McCray$5.00
2/24/2010Dan Doyle$5.00
2/24/2010Ed Delaney$5.00
2/24/2010John Boyd$5.00
2/24/2010Karen Giminiy$10.00
2/24/2010Mike McKechnie$5.00
2/24/2010Nancy Jamison$5.00
2/24/2010Ruth Raber$5.00
2/24/2010Steve Cork$5.00
3/3/2010Cathy Starkey$10.00
3/3/2010Dave Gobel$10.00
3/3/2010Tim Miley$20.00
3/3/2010Freda Gillespie$5.00
3/3/2010John Mings$10.00
3/3/2010Kari McCrobie$10.00
3/3/2010Mike Withcas$5.00
3/3/2010Rita McCrobie$10.00
3/3/2010Sherri Dezzutti$5.00
3/3/2010Sue Thorn$5.00
3/3/2010Tim Hairston$5.00
3/11/2010Brenda Tacy$5.00
4/13/2009Mike Romano$50.00
9/22/2009Mark Matz$20.00
9/22/2009Diane Parker$50.00
12/2/2009Betty Cottrill$50.00
12/2/2009Gordon Gaynes$20.00
11/18/2009Joe Minard$25.00
11/18/2009Ron Fragale$50.00
11/18/2009Mary E Sullivan$30.00
11/18/2009Dale Payne$10.00
11/18/2009Anita Payne$10.00
11/18/2009Dorothy Underwood$10.00
9/22/2009Martin Shaffer$40.00
9/22/2009Steve Gibson$30.00
 Subtotal of contributions of $250.00 or less$585.00

More than $250.00

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

Fund-Raising Events

All monetary contributions received at a fundraiser must be reported in the Event Summary below.
If contributor's name and amount are not listed, the contribution must be turned over to the West Virginia General Revenue Fund. The only exception to this rule may apply to political party executive committees. (WV Code 3-8-5a).

Ramp Dinner Event Summary

Date of Event: 4/19/2009 Total Monetary Contributions:  $1,518.00
Type of Event: Ramp Dinner Total Expenditures: -$658.11
Name of Place Held: East View Community Center NET RECEIPTS: =$859.89
Address of Place Held: Phillipi Pike
Clarksburg, WV 26301
Total In-Kind Contributions Related to the Fundraiser  $0.00

$250 or Less

4/19/2009John Payne$10.00
4/19/2009Homer B Kelly$10.00
4/19/2009Sam Moscar$20.00
4/19/2009Joe Minard$10.00
4/19/2009Mary Minard$10.00
4/19/2009D. Glenn Moore$10.00
4/19/2009Bill Thompson$10.00
4/19/2009Steve Gibson$10.00
4/19/2009Carol Thompson$10.00
4/19/2009Kelly Layton$10.00
4/19/2009Jim George$10.00
4/19/2009Nina Rhodes$10.00
4/19/2009Tom Rhodes$10.00
4/19/2009Anne McAtee$10.00
4/19/2009Bill McAtee$10.00
4/19/2009Betty Grogan$10.00
4/19/2009Jean Hyman$10.00
4/19/2009Danny Swiger$10.00
4/19/2009Sue Ann Swiger$10.00
4/19/2009Bill Prine$10.00
4/19/2009Connie Prine$10.00
4/19/2009Charlene Leon$10.00
4/19/2009Vick Leon$10.00
4/19/2009Okey Richards,Sr.$10.00
4/19/2009Mark Matz$10.00
4/19/2009John Matz$10.00
4/19/2009John Allevato$10.00
4/19/2009Jim Trent$20.00
4/19/2009Thomas Limer$10.00
4/19/2009Robert A. Nelson$10.00
4/19/2009Melinda Surrency$10.00
4/19/2009Matt Surrency$10.00
4/19/2009Sam Cann$20.00
4/19/2009Gerry Newlon$20.00
4/19/2009Troy Bombardiere$10.00
4/19/2009Jo Ellen Lopez     $10.00
4/19/2009John Lopez$10.00
4/19/2009Ray Blake$10.00
4/19/2009Tim Gentilozzi$10.00
4/19/2009Lou Ortenzio$10.00
4/19/2009John Ash$10.00
4/19/2009Daine Riffee$10.00
4/19/2009Dave R. Riffee$10.00
4/19/2009Emilia Ash$10.00
4/19/2009Paul Kelley$10.00
4/19/2009Ruby Vincent$10.00
4/19/2009Josh Henthorne$10.00
4/19/2009Emma Flannigan$10.00
4/19/2009Ruth Scott$10.00
4/19/2009David W. Kelley$10.00
4/19/2009Roberta Gross$10.00
4/19/2009Rodney Greynolds$10.00
4/19/2009Robert A Morgan$10.00
4/19/2009Karen Payne$10.00
4/19/2009Christie Harper$10.00
4/19/2009Nellie Layton$10.00
4/19/2009J. Layton$10.00
4/19/2009John Caroli$10.00
4/19/2009Connie Caroli$10.00
4/19/2009Nancy Oliverio$18.00
4/19/2009Asa Bollinger$10.00
4/19/2009Sandra Bollinger$10.00
4/19/2009Bill Wyckoff$10.00
4/19/2009Doug Bailey$10.00
4/19/2009Tim Miley$10.00
4/19/2009Susan Wilcher$10.00
4/19/2009Shirley Dodd$10.00
4/19/2009Bill Dodd$10.00
4/19/2009James Ashcraft$10.00
4/19/2009Kevin Ashcraft$10.00
4/19/2009Helen Mihaliak$10.00
4/19/2009Tom Mihaliak$10.00
4/19/2009Gail Mihaliak$10.00
4/19/2009Freda Skeen$10.00
4/19/2009Lee Martino$20.00
4/19/2009Alan Barr$10.00
4/19/2009Tom Bedell$60.00
4/19/2009Tod Lewark$10.00
4/19/2009Joe Mancina$10.00
4/19/2009Mike Romano$10.00
4/19/2009Ernie Norris$10.00
4/19/2009John Mings$10.00
4/19/2009Richard Duckworth$10.00
4/19/2009Alberta Loar$10.00
4/19/2009Betsy Kocsis$10.00
4/19/2009Mark Ware$10.00
4/19/2009Frank Spadafore$10.00
4/19/2009Libby Stout$10.00
4/19/2009Denise Binion$10.00
4/19/2009Kim Smucker$10.00
4/19/2009Stephanie Kennedy$10.00
4/19/2009Julie Rea$10.00
4/19/2009Bobby Closson$10.00
4/19/2009Angie Closson$10.00
4/19/2009Gary Oldaker$10.00
4/19/2009Phyliss Oldaker$10.00
4/19/2009Gary Oldaker$10.00
4/19/2009John Simon$10.00
4/19/2009Christine Simon$10.00
4/19/2009Lee Kelley$10.00
4/19/2009John F. Mazzie$20.00
4/19/2009Rick Kooken$10.00
4/19/2009Donald Seffick$10.00
4/19/2009Wilson Ashley$10.00
4/19/2009Joanne Ashley$10.00
4/19/2009Sam Lopez$10.00
4/19/2009Sam Perris$10.00
4/19/2009Donald Taylor$10.00
4/19/2009Libby Stout$10.00
4/19/2009Mary Taylor$10.00
4/19/2009Violet Stackpole$10.00
4/19/2009Gordon Gaynes$10.00
4/19/2009Brenda Thomas$10.00
4/19/2009David Thomas$10.00
4/19/2009Joe Hayes$20.00
4/19/2009Mark Linville$10.00
4/19/2009Jack Linville$10.00
4/19/2009Gloria Robey$10.00
4/19/2009Ron Watson$10.00
4/19/2009Chunki Angotti$20.00
4/19/2009M. J. Marsh$10.00
4/19/2009Marie Marsh$10.00
4/19/2009Darlena Doak$10.00
4/19/2009Marylou Brock$10.00
4/19/2009Allison Blake$10.00
4/19/2009George Marsh$10.00
4/19/2009Jerry Ann Gaines$10.00
4/19/2009Gordon Gaynes$10.00
4/19/2009Lisa D. deGruyter$10.00
4/19/2009Robert Helfer$10.00
4/19/2009James Griffin$20.00
4/19/2009Greg Pulice$10.00
4/19/2009Terri DeWitt$10.00
4/19/2009Stanley DeWitt$10.00
4/19/2009Donetta Ortenzio$10.00
4/19/2009Pete Renquist$10.00
4/19/2009Dr. Bornoff$10.00
 Subtotal of event contributions of less than $250.00 $1,518.00

More than $250

 Event contributions of $250 or more: 
Event contributions of less than $250: 
Total Contributions: 

Other Income: Interest, Refunds, Miscellaneous Receipts

DateSource of IncomeType of ReceiptAmount
4/21/2009MembersMembership Dues$10.00
6/30/2009MembersMembership Dues$10.00
9/22/2009MembersMembership Dues$10.00
12/2/2009MembersMembership Dues$30.00
2/25/2010MembersMembership Dues$70.00
3/11/2010MembersMembership Dues$10.00
8/5/2009MembersMembership Dues$10.00
4/13/2009MembersMembership Dues$15.00
  Total Other Income: $165.00

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
4/7/2009 Wal-Mart
550 Emily Drive
Clarksburg, WV 26302
Supplies for Ramp dinner$14.42
4/8/2009 USPS
East Point Station
Clarksburg, WV 26301
Postage for Invitations$25.20
4/9/2009 East View Community Center
Phillippi Pike
Clarksburg, WV 26301
Building Rental for Ramp Dinner$250.00
4/15/2009 Denise Binion
Rt 1. Box 225A
Flemington, WV 26347
reimburse for supplies for Ramp Dinner (US Food Service and Ramps)$237.60
4/17/2009 Jerry McKeen
Rt. 2, Box 54
Bristol, WV 26426
reimburse for supplies for Ramp Dinner (WalMart - bowls napkins cups plates creamer)$120.89
5/28/2009 Clarksburg Publishing Company
324 Hewes Ave
Clarksburg, WV 26301
Newspaper Ad for City Council meeting$90.36
5/28/2009 Harrison County Executive Committee
P.O. Box 1188
Clarksburg, WV 26302
1/2 pg newspaper ad$150.00
7/1/2009 Smitty’s Pizza
1639 Hamill Ave
Clarksburg, WV 26301
pizza for regular meeting$102.08
7/15/2009 MCM Business Systems
1315 Buckhannon Pike
Clarksburg, WV 26301
Copies for Glen Elk Festival$28.89
7/18/2009 Wal-Mart
550 Emily Drive
Clarksburg, WV 26301
first aid kit/band aids - to hand out at Glen Elk Festival$33.64
7/25/2009 J&J Graphics
Rt 4, Box 30
Grafton, WV 26354
2x4 Banner for festival; Brochures for NCWVDFA; post cards; decals$177.55
8/17/2009 Wal-Mart
550 Emily Drive
Clarksburg, WV 26301
ink cartridge and clip$60.36
8/21/2009 MCM Business Systems
1315 Buckhannon Pike
Clarksburg, WV 26301
printing for Town Hall & Health Care events$50.35
9/2/2009 Wal-Mart
550 Emily Drive
Clarksburg, WV 26301
Water for Italian Festival; neckaces for wheel of fortune$54.18
9/4/2009 Kroger
788 West Pike St
Clarksburg, WV 26301
Ice & Candy for Dem HQ for Italian Festival$23.66
9/4/2009 John Lozier
345 Virginia Ave
Morgantown, WV 26505
made "Wheel of Fortune" for DFA Healthcare event$50.00
9/17/2009 MCM Business Systems
1315 Buckhannon Pike
Clarksburg, WV 26301
Copies for Health Care Forum$42.40
10/27/2009 MCM Business Systems
1315 Buckhannon Pike
Clarksburg, WV 26301
Letters for funding; copies$21.20
10/27/2009 Rite Aid
Rt 19 South; Rosebud Plaza
Clarksburg, WV 26301
10/28/2009 USPS
East Point Station
Clarksburg, WV 26301
Postage $70.40
11/4/2009 YWCA
305 Washington Ave
Clarksburg, WV 26301
rent room for Sierra Club presentation on Nat Gas Drilling / Frac Water$100.00
11/5/2009 USPS
Clarksburg, WV 26301
PO Box 964 annual rent$44.00
2/3/2010 Jaime Ingram
Fairmont, WV 26330
sponsor trip to 2010 Young Democrats of America - winter Conference in New Orleans$75.00
2/4/2010 Harrison County Executive Committee
PO Box 1188
Clarksburg, WV 26302
donation to help defer rental cost of Dem HQ on Main Street$150.00
3/4/2010 J&J Graphics
Rt 4, Box 30
Grafton, WV 26354
NCWVDFA brochures$29.68
4/1/2009 Diane Parker
Rt 4, Box 30
Grafton, WV 26354
signs for Ramp Dinner$10.00
6/3/2009 Jaime Ingram
Fairmont, WV 26330
sponsor trip to Nat’l Young Democrats conference$100.00
  Total Expenditures: $2,116.71

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
Friday, April 2, 2010 4:45:20 PM