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

Candidate or Committee Name
National Association of Social Workers Action Committee
Candidate or Committee's Treasurer
R. Larry Beckett
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
31 Brittany Woods 
Office Sought (for Candidates)
City, State, Zip Code
Charleston, WV 25314
Daytime Phone #
(304) 553-5144

Election Cycle Reporting Period (check one):

Primary - First Report
Due Mar 26-Apr 01, 2011
Pre-primary Report
Due Apr 29-May 03, 2011
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 +$1,249.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$1,249.00
In-Kind Contributions +$370.98
Total Contributions: =$1,619.98
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 +$1,249.00
Total Other Income +$0.00
Subtotal: a. =$2,763.51
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

 Subtotal of contributions of $250.00 or less 

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).

NASWAC Fundraising reception Event Summary

Date of Event: 4/14/2011 Total Monetary Contributions:  $1,249.00
Type of Event: reception for NASW members to contribute to NASWAC Total Expenditures: -$0.00
Name of Place Held: Charleston Mariott Hotel NET RECEIPTS: =$1,249.00
Address of Place Held: 200 Lee Street East
Charleston, WV 25301
Total In-Kind Contributions Related to the Fundraiser  $370.98

$250 or Less

4/14/2011Deborah Layman$15.00
4/14/2011Joe Deegan$15.00
4/14/2011Ruth Simmons$15.00
4/14/2011Irene M. Adkins$15.00
4/14/2011Laura Rogers$15.00
4/14/2011Ashley Wolf$15.00
4/14/2011Heather Phillips$15.00
4/14/2011Tina Keffer$15.00
4/14/2011Jennifer Hall$15.00
4/14/2011Brandly Milam$15.00
4/14/2011Gavin Parsons$19.00
4/14/2011Dolly Ford$15.00
4/14/2011James Keresztury$15.00
4/14/2011Steve Burton$15.00
4/14/2011Scott Boileau$15.00
4/14/2011Larry Beckett$30.00
4/14/2011Mike Williams$30.00
4/14/2011Sam Hickman$30.00
4/14/2011Timothy Ward$15.00
4/14/2011Mike Toothman$15.00
4/14/2011Lawrence Taylor$15.00
4/14/2011Holly Thomas$15.00
4/14/2011Barbara Staley$15.00
4/14/2011Julie Pratt$15.00
4/14/2011Bob Musick$15.00
4/14/2011Clarence Mizell$15.00
4/14/2011Martha Minter$15.00
4/14/2011Rosa McKinney$15.00
4/14/2011Diane Market$15.00
4/14/2011Jack Husted$15.00
4/14/2011Betsy Hill$15.00
4/14/2011Michael Goldman$15.00
4/14/2011Linda Ferrise$15.00
4/14/2011Lisa Daugherty$15.00
4/14/2011Julie Cerra$15.00
4/14/2011Nancy Burkhammer$15.00
4/14/2011Kim Barber Tieman$15.00
4/14/2011Ira Hartman$100.00
4/14/2011Lewis Wolfe$15.00
4/14/2011Vicki James$30.00
 Subtotal of event contributions of less than $250.00 $749.00

More than $250

4/14/2011 Full Name:  Dianne Market Gaston
Address:  Resident
356 Nicholson Loop
Morgantown, WV 26508

Contributor's Job: (individual contributor only)  social worker
Where Contributor Works: (individual contributor only) 
Affiliation: (political committee only)  NASW member
 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
  Total Other Income: $0.00

In-Kind Contributions

DateName and Contributor InformationDescription of ContributionValue
4/14/2011WV - NASWfood and supplies$140.98
4/14/2011Kim Tiemanbeverages$230.00
  Total In-Kind Contributions: $370.98


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
Thursday, May 3, 2012 5:05:24 PM