Report of Receipts and Expenditures for Political Committee or Political Fund
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1 Campaign Finance & Public Disclosure Board First Floor South. Centennial Office Building. 658 Cedar Street. St. Paul MN / TTY 800/ Committee Information: Report of Receipts and Expenditures for or Political Fund Period Covered: 1/1/2012 through 12/31/2012 Registration number: Committee name: Candidate address Treasurer name: Treasurer address: Rohde, Wayne 8284 Emerald Ln Woodbury MN Treasurer telephone: Treasurer address Received by the Board January 17, 2013 Special Report Indicators No change since last report The committee received no contributions and made no expenditures during the reporting period. Previous Report Cash Balance: Current Cash Balance: Amendment This report amends a previously filed report for the same period. Termination The committee has settled all its debts, disposed of all its assets in excess of $100 and dissolved. Report of Receipts and Expenditures Printed January 17, 2013 Page 1 of 1
2 Committee Transaction Summary Reg Num Beginning cash balance on 1/1/2012: 9, Cash Unpaid In Kind Total 2 Total Contributions Received: 48, , Receipts from loans payable: 4 Repayment by others of money borrowed from committee: 5 Other miscellaneous income: TOTAL RECEIPTS: 48, , General Expenditures: 42, , Contributions to Candidate Committees: 9 Contributions to Party units: 10 Contributions to political committees or funds: 11 Independent expenditures: 12 Ballot Question Expenditures: 13 TOTAL EXPENDITURES/DISBURSEMENTS: 42, , Ending cash balance on 12/31/2012: 15, Total Loans Payable: Total Loans Receivable: Committee Transaction Summary Printed January 17, 2013 Page 1 of 1
3 Reg Num Certification I,, Wayne Rohde certify that this report is complete, true and correct. (print or type name) Signature of Treasurer 1/17/2013 Date Certified By Valid Person Yes Any person who signs and certifies to be true a report or statement which the person knows contains false information, or who knowingly omits required information, is guilty of a gross misdemeanor. Report Certification Printed January 17, 2013 Page 1 of 1
4 Schedule A1 - Contributions Received Reg Num Blaxill, Mark 22 Fayerweather St. Cambridge MA Booth, Danielle th Avenue Minneapolis MN Carroll, Patti 4236 Sylvia Ln Shoreview MN Fogel, Sylvia 211 Central Park W, #8k New York NY Heckenlively, Kent 7501 May Way San Ramon CA Macinnis, Alexander 809B Cuesta Dr Mountain View CA Moor, Michelle 161 Bowery Road New Canaan CT Segal, Barry 56 Sneider Rd Warren NJ Steinberg, Karen 44 Spruce Street West Windsor NJ Thomas, Andrea 301 George St Excelsior MN Receipt Date Cash In Kind Total Self-employed 3LP Advisors Inc. 1/3/ , , Self-employed Caterer 8/30/ Employer: Vibrant 8/30/ Self-employed Psychiatrist 7/12/ Self-employed Producer 3/20/ /20/ Self-employed Production 3/28/ Self-employed Stay at home Mom 7/18/ Self-employed Retired 7/23/ , , /1/ , , , , Self-employed Unemployed 3/15/ Employer: Thrivent 3/20/ Schedule A1- Contributions Received Page 1 of 2
5 Receipt Date Cash In Kind Total Total Itemized contributions: Total Unitemized contributions: Cash In Kind Total 42, , , , , , Schedule A1- Contributions Received Page 2 of 2 Printed January 17, 2013
6 Schedule A2-MISC Miscellaneous Income Reg Num Cash Total Unitemized Miscellaneous Income: Schedule A2-MISC Miscellaneous Income Printed January 17, 2013 Page 1 of 1
7 Schedule B1 Expenditures Reg Num Brunberg Blatt & Co Wayzata Blvd St Louis Park, MN /30/2012 Accounting Accounting/Tax 1, , Services Svc-Reports 7/31/2012 Accounting Services Chase Credit P.O. Box Palatine, IL Accounting , , /4/2012 Printing and Mantis Graphics Photocopying Printing 1/4/2012 Supplies Fretags/Supplies for conference 1/26/2012 Lodging Travel- 3, , Hyatt/Four Seas/Hyatt 1/26/2012 Airfare / Public Transportation 1/26/2012 Automobile Expense 1/26/2012 Internet Access and Web Hosting 2/2/2012 Advertising - general 2/2/2012 Conference and meeting fees 2/2/2012 Conference and meeting fees United Air/Taxis Car Rental-Avis Connectivity charges Media Charge Health Freedom Expo Health Freedom Expo/Team Meeting Fee 1, , /2/2012 Interest Interest Expense /2/2012 Internet Access and Web Hosting 2/2/2012 Food and Beverages Internet/Connecti vity Meals /2/2012 Supplies Staples - Office Supplies 2/2/2012 Postage/ Delivery Postage Schedule B1 Expenditures Printed January 17, 2013 Page 1 of 5
8 Reg Num /2/2012 Printing and Photocopying GotPrint and Fastsignsconference /2/2012 Lodging Travel-Hyatt/Ritz 1, , /5/2012 Airfare / Public Transportation United /3/2012 Lodging Travel-R Carlton 1, , Fidelity Bank 7600 Parklawn Edina, MN , , /17/2012 Bank Service /31/2012 Bank Service 2/29/2012 Bank Service 3/31/2012 Bank Service 4/30/2012 Bank Service 5/31/2012 Bank Service 6/30/2012 Bank Service 7/31/2012 Bank Service 10/5/2012 Bank Service 10/31/2012 Bank Service Schedule B1 Expenditures Printed January 17, 2013 Page 2 of 5
9 Reg Num /30/2012 Bank Service 12/31/2012 Bank Service 12/31/2012 Bank Service Ink Trax Promotions 6157 Terra LN McCordville, IN /24/2012 Supplies Lapel Pins Larson, David 847 Tonkawa Road Orono, MN /22/2012 Advertising - Radio Clear Channel Brdcst. Radio Advertising Spot 10/22/2012 Conference and meeting fees Larson, Jennifer 847 Tonkawa Rd Orono, MN Reimb. for a Clear Channel Radio Advertising Spot. Food/Beverage/ Hotel Fees for Nat'l Conference 11, , Reimb. for hotel/food/bev/mtg charges put on credit card for Nat'l Conference. 12, , /15/2012 Conference and Health Freedom meeting fees Expo Reimb. for Expo fees paid personally. Schedule B1 Expenditures Printed January 17, 2013 Page 3 of 5
10 Reg Num /15/2012 Advertising - general Vocus PR/The Times 2, , Reimb. for advertising/pr expenses that were paid personally. 6/15/2012 Lodging Hilton-Health 1, , Freedom Expo Paypal 2211 North First Street San Jose, CA Reimb. for travel expenses paid for personally for Health Freedom Expo. 5, , /31/2012 Bank Service Paypal fees from donations Phillips, Leslie Caroline Cove Lane Katy, TX /25/2012 Other Services Scholarships Taylor, Ginger 11 High Street Brunswick, ME Reimb. for hotel room at conference. Scholarship to attend conference /17/2012 Public Relations/ Fundraising Service Prof. Fee for PR/Fundraising/ Committee Work 4, , /11/2012 Public Relations/ Fundraising Service Williams, Beverly 5200 Lincoln Dr #306 Edina, MN Website Development and PR services 4, , , , Schedule B1 Expenditures Printed January 17, 2013 Page 4 of 5
11 Reg Num /5/2012 Accounting Services Williams, Erin 24 Pinecrest Lane Ashland, MA , , , , /18/2012 Conference and meeting fees Scholarship provided to Erin to attend conference 1, , , , Total Itemized Expenditures: Total Unitemized Expenditures: Paid Unpaid In Kind Total 42, , Total Expenditures: 42, , Schedule B1 Expenditures Printed January 17, 2013 Page 5 of 5
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