State of West Virginia Campaign Financial Statement
(Long Form) in Relation to the 2011 Election Year

Candidate or Committee Name
Jefferson Co. Democratic Executive Committee
Candidate or Committee's Treasurer
Mike Chapman
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
PO Box 7 mike@rosemont-holdings.com 
Office Sought (for Candidates)
District/Division
City, State, Zip Code
Rippon, WV 25441
Daytime Phone #
304-279-6297

Election Cycle Reporting Period (check one):

    
Primary - First Report
Due Mar 26-Apr 01, 2011
    
Pre-primary Report
Due Apr 29-May 03, 2011
 X 
Post-primary Report
Due May 27-Jun 28, 2011
    
General - First Report
Due Aug 22-Aug 26, 2011
    
Pre-general Report
Due Sep 19-Sep 23, 2011
    
Post-general Report
Due Oct 17-Nov 15, 2011

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 2011 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  $0.00
Monetary Contributions from all Fund-Raising Events +$10,135.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$10,135.00
In-Kind Contributions +$0.00
Total Contributions: =$10,135.00
 
Other Income  $0.36
Loans Received +$0.00
Total Other Income: =$0.36
 
OUTSTANDING LOANS & DEBTS:  
Unpaid Bills  $0.00
Outstanding Loans +$0.00
Total Debts: =$0.00
 
TOTAL CONTRIBUTIONS ELECTION YEAR-TO-DATE
(Add total contributions from all reports)
$10,135.00
 
CASH BALANCE SUMMARY
Beginning Balance
(ending balance from previous report)
 $5,197.36
Total Monetary Contributions +$10,135.00
Total Other Income +$0.36
Subtotal: a. =$15,332.72
 
Total Expenditures Paid  $3,474.98
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$3,474.98
 
Ending Balance:
(Subtotal a. - Subtotal b.)

*Cannot be negative balance
=$11,857.74
 
TOTAL EXPENDITURES ELECTION YEAR-TO-DATE
(Add total expenditures from all reports)
$3,779.38

Contributions
$250.00 or LESS

DATECONTRIBUTOR'S FULL NAME OR COMMITTEE'S NAMEAMOUNT
 Subtotal of contributions of $250.00 or less 
 

Contributions
More than $250.00

DATECONTRIBUTOR'S FULL NAME OR COMMITTEE'S NAMEAMOUNT
 Subtotal of all contributions of more than $250.00
Subtotal of all contributions of $250 or less
Total Contributions:
$0.00
$0.00
$0.00

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).

Gubernatorial Straw Poll Event Summary

Date of Event: 4/30/2011 Total Monetary Contributions:  $10,135.00
Type of Event: Straw Poll and Dinner Total Expenditures: -$3,388.94
Name of Place Held: Hollywood Casino at Charles Town Races NET RECEIPTS: =$6,746.06
Address of Place Held: Rt 51
Charles Town, WV 25414
Total In-Kind Contributions Related to the Fundraiser  $0.00

$250 or Less

DATEFULL NAMEAMOUNT
4/30/2011Garry Geffert$40.00
4/30/2011Robert Sclater$80.00
4/30/2011Susan Kennison$80.00
4/30/2011Rodney Snyder$40.00
4/30/2011Pearl Reardon$40.00
4/30/2011Henry Fowler$40.00
4/30/2011Marylois Gannon-Miller$80.00
4/30/2011Daniel Lutz$40.00
4/30/2011Thomas Youngblood$80.00
4/30/2011Renny Smith$80.00
4/30/2011Rod Snyder$220.00
4/30/201150/50 Raffle$225.00
4/30/2011Jeff Kessler$10.00
4/30/2011Mary Reagan$80.00
4/30/2011Carol Colloton$80.00
4/30/2011Thomas Keyrouze$80.00
4/30/2011Terry Walker$160.00
4/30/2011Ronda Lehman$80.00
4/30/2011Niles Bernick$80.00
4/30/2011Ann Paonessa$80.00
4/30/2011Perdue for Governon$160.00
4/30/2011Paul G. Taylor$80.00
4/30/2011Philip McCarley$80.00
4/30/2011Dale Manuel$40.00
4/30/2011Kay Bresee$80.00
4/30/2011Terry Thorson$80.00
4/30/2011sarah Orrick$80.00
4/30/2011Reva Mickey$80.00
4/30/2011Rod Snyder$80.00
4/30/2011Carol Nelson$40.00
4/30/2011Frances Morgan$40.00
4/30/2011John Michael Cassell$80.00
4/30/2011Patricia Noland$80.00
4/30/2011Herb Snyder$40.00
4/30/2011Scott Sudduth$80.00
4/30/2011Helen Becker$80.00
4/30/2011Roger Perry$80.00
4/30/2011Ruth McQuade$40.00
4/30/2011Alan Sturm$80.00
4/30/2011Carolyn Widmyer$80.00
4/30/2011Richard Bringewatt$40.00
4/30/2011Edwin Wheeless Jr$80.00
4/30/2011John Maxey$80.00
4/30/2011Ed Boober$160.00
4/30/2011Allison Alsdorf$160.00
4/30/2011Jeremy Hutton$80.00
4/30/2011William Hoak$80.00
4/30/2011Ralph Lorenzetti$40.00
4/30/2011Kimberly Crockett$80.00
4/30/2011Mary Paul Rissler$40.00
4/30/2011William Senseney$80.00
4/30/2011E.F. Blake$40.00
4/30/2011Mary Haynes$40.00
4/30/2011Carmela Cesare$40.00
4/30/2011John R Sine$80.00
4/30/2011Jim Eddy$80.00
4/30/2011Ritchie Barron$40.00
4/30/2011Boetner$80.00
4/30/2011Jim Miller$160.00
4/30/2011John Fink$80.00
4/30/2011Jay Winchester$40.00
4/30/2011Eric Lewis$40.00
4/30/2011Tera Palmer$40.00
4/30/2011Peter Dougherty$40.00
4/30/2011Bill Hoak$40.00
4/30/2011Charles Streisel$80.00
4/30/2011Pat Humphreys$40.00
4/30/2011Ouffot$40.00
4/30/2011Cash Ticket Sales$240.00
4/30/2011Cash Sponsorship$120.00
4/30/2011Laura Rattenni$250.00
4/30/2011Tal Sims$250.00
4/30/2011Cheryl Lawrence$250.00
4/30/2011Tiffany Lawrence$250.00
 Subtotal of event contributions of less than $250.00 $6,455.00

More than $250

DATE AMOUNT
4/30/2011 Full Name:  Mike Chapman
Address:  Resident
1505 Berryville Pike
Rippon, WV 25441
Mailing
PO Box 184
Rippon, WV 25441

Contributor's Job: (individual contributor only)  Director of Information Technology
Where Contributor Works: (individual contributor only)  Royal Vendors
Affiliation: (political committee only)  Democratic Executive Committee
$400.00
4/30/2011 Full Name:  Stephen G. Skinner
Address:  Resident
PO Box 315
Charles Town, WV 25414

Contributor's Job: (individual contributor only)  Attorney
Where Contributor Works: (individual contributor only)  Skinner Law Firm
Affiliation: (political committee only) 
$500.00
4/30/2011 Full Name:  Angela Banks
Address:  Resident
23 Persimmon Knoll
Shepherdstown, WV 25443

Contributor's Job: (individual contributor only)  County Assessor
Where Contributor Works: (individual contributor only)  Jefferson County Government
Affiliation: (political committee only) 
$600.00
4/30/2011 Full Name:  Rick Thompson
Address:  Resident
PO Box 1746
Charleston, WV 25326

Contributor's Job: (individual contributor only)  Speaker of the House
Where Contributor Works: (individual contributor only)  State of WV
Affiliation: (political committee only) 
$500.00
4/30/2011 Full Name:  Jeff Kessler
Address:  Resident
607 Wheeling Ave
Glen Dale, WV 26038

Contributor's Job: (individual contributor only)  President of Senate
Where Contributor Works: (individual contributor only)  State of WV
Affiliation: (political committee only) 
$500.00
4/30/2011 Full Name:  James Eddy
Address:  Resident
263 Mara Rose Lane
Harpers Ferry, WV 25425

Contributor's Job: (individual contributor only)  Retired
Where Contributor Works: (individual contributor only)  Retired
Affiliation: (political committee only) 
$680.00
4/30/2011 Full Name:  Donn E. Marshall
Address:  Resident
14 Ryan Court
Shepherdstown, WV 25443
Mailing
PO Box 1685
Shepherdstown, WV 25443

Contributor's Job: (individual contributor only)  Director of Charity
Where Contributor Works: (individual contributor only)  Self
Affiliation: (political committee only) 
$500.00
 Event contributions of $250 or more: 
Event contributions of less than $250: 
Total Contributions: 
$3,680.00
$6,455.00
$10,135.00

Other Income: Interest, Refunds, Miscellaneous Receipts

DateSource of IncomeType of ReceiptAmount
5/10/2011BCT Interest Income$0.36
  Total Other Income: $0.36

In-Kind Contributions

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

Loans

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
4/29/2011 Morgan Awards
219 N. Queen St
Martinsburg, WV 25401
Printing and Reproduction$36.04
4/30/2011 Hollywood Casino
P.O. Box 551
Charles Town, WV 25414
Venue Rental/Meals for Fundraiser$2,740.60
4/30/2011 Mike Chapman
PO Box 184
Rippon, WV 25441
Reimbursement of Deposit paid to Hollywood Casino$500.00
4/30/2011 Kay Breese
RR
Kearneysville, WV 25430
Printing and Advertising$94.92
4/30/2011 Independent Fire Company
200 West Second Ave
Ranson, WV 25438
Donation in Memory of Mike Wysong$50.00
5/23/2011 Gail Boober
PO Box 1125
Charles Town, WV 25414
Reimbursement for decoration/items used at fundraiser$53.42
  Total Expenditures: $3,474.98

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, July 1, 2011 5:39:20 PM