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

Candidate or Committee Name
West Virginia Community Action Program PAC
Candidate or Committee's Treasurer
Mary Chipps
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
2 Hale Street, Suite 100 
Office Sought (for Candidates)
City, State, Zip Code
Charleston, WV 25301
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  $850.00
Monetary Contributions from all Fund-Raising Events +$0.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$850.00
In-Kind Contributions +$0.00
Total Contributions: =$850.00
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 +$850.00
Total Other Income +$0.00
Subtotal: a. =$2,656.89
Total Expenditures Paid  $0.00
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$0.00
Ending Balance:
(Subtotal a. - Subtotal b.)

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

$250.00 or LESS

5/12/2010Debbie Gillispie$5.00
5/12/2010Mary Chipps$5.00
5/12/2010Vicki Geary$5.00
5/12/2010Greg Stephens$10.00
5/12/2010Christy Kinder$2.00
5/12/2010Sara Holt$6.00
5/12/2010Dawn Fredrick$2.00
5/12/2010Rose Kinney$6.00
5/12/2010Judy Raveaux$5.00
5/12/2010Rita Coyne$2.00
5/12/2010Michael Adams$10.00
5/12/2010Eric Yeater$10.00
5/12/2010Cheryl Olexia$6.00
5/12/2010Kim Bourne$2.00
5/12/2010Michelle Griffith$6.00
5/12/2010Dawn Hoke$12.00
5/12/2010Courtney Bailey$6.00
5/12/2010Emily Elkins$6.00
5/12/2010James McCracken$10.00
5/12/2010Connie Chester$6.00
5/12/2010Leland Swafford$10.00
5/12/2010Matthew Milam$6.00
5/12/2010Vanessa Smith$2.00
5/12/2010Tracie Heath$6.00
5/12/2010Andy Austin$2.00
5/12/2010Anastasia Dycus$4.00
5/12/2010Cindy Abram$6.00
5/12/2010Vicky Browning$12.00
5/12/2010Bobbi Bailey$12.00
5/12/2010Melissa Barone$11.00
5/12/2010Jim Boniey$9.00
5/12/2010Gerald Brown$12.00
5/12/2010Zach Brown$12.00
5/12/2010Caron Burgess$1.00
5/12/2010Junior Burgess$5.00
5/12/2010Kim Burns$5.00
5/12/2010Violet Burdette$5.00
5/12/2010Tammy Byers$5.00
5/12/2010Mary Chipps$22.00
5/12/2010Connie Chester$5.00
5/12/2010Crystal Christian$12.00
5/12/2010Karla Cline$6.00
5/12/2010Rita Coyne$22.00
5/12/2010Marcy Crago$12.00
5/12/2010Lori Curry$8.00
5/12/2010Agnes Davis$6.00
5/12/2010Kelly Davis$6.00
5/12/2010Anastaya Dycees$6.00
5/12/2010Emily Elkins$6.00
5/12/2010Melanie Fugett$5.00
5/12/2010Vicki Geary$24.00
5/12/2010Tonia Gibson$6.00
5/12/2010Debbie Gillispie$20.00
5/12/2010Michelle Griffith$5.00
5/12/2010Cindy Hamrick$5.00
5/12/2010Nettie Harper$9.00
5/12/2010Marcella Hood$9.00
5/12/2010Dereck Hover$6.00
5/12/2010Melissa Hunt$4.00
5/12/2010Agnes Johnson$6.00
5/12/2010Bryan Johnson$6.00
5/12/2010Reggie Jones$3.00
5/12/2010Lisa June$4.00
5/12/2010Roni Kazee$6.00
5/12/2010Kim Starkey$17.00
5/12/2010Nancy Keller$18.00
5/12/2010Paul Krull$7.00
5/12/2010Teresa Lilly$10.00
5/12/2010Becky Lowery$6.00
5/12/2010Ed Martin$9.00
5/12/2010Chris Mazar$4.00
5/12/2010Kathy McMurray$12.00
5/12/2010Lori Milam$9.00
5/12/2010Rick Miller$50.00
5/12/2010Ellen Mulligan$6.00
5/12/2010Virginia Newsome$9.00
5/12/2010Angie Nowak$12.00
5/12/2010Heather Oglesby$4.00
5/12/2010Jane Pingley$11.00
5/12/2010Dreama Padgett$20.00
5/12/2010Julie Palas$10.00
5/12/2010Cliff Pannell$5.00
5/12/2010Dan Pauley$12.00
5/12/2010Stephanie Paynter$6.00
5/12/2010Jeff Plymale$6.00
5/12/2010Rick Proctor$5.00
5/12/2010Judy Raveaux$6.00
5/12/2010Maggie Rider$6.00
5/12/2010Tonya Ross$4.00
5/12/2010Colette Sandzimer$5.00
5/12/2010Tim Salmons$6.00
5/12/2010Cammie Saul$8.00
5/12/2010Kurt Schmidt$6.00
5/12/2010Don Shaw$7.00
5/12/2010Alicia Shaffer$1.00
5/12/2010Barbara Simmons$6.00
5/12/2010Jim Simpkins$24.00
5/12/2010Verna Smith$6.00
5/12/2010Susan Stafford$4.00
5/12/2010Greg Stephens$5.00
5/12/2010Glen White$14.00
5/12/2010Kevin Wynn$6.00
5/12/2010Randy Shears$12.00
 Subtotal of contributions of $250.00 or less$850.00

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
  Total Expenditures: $0.00

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
Tuesday, March 15, 2011 1:23:09 PM