HomeMy WebLinkAboutBloom for the 199th - 2016 Annual Report ' PAGE 1
Commonwealth of Pennsylvania 1®111111,1®®1111111111
Campaign Finance Report 260135
(NOTE:This report must be clear and legible. It may be typed or printed in blue or black ink.)
Filer Identification 2010108 Report CANDIDATE COMMITTEE 1 LOBBYIST
Number: Filed By :
Name of Filing Committee,Candidate or Lobbyist: BLOOM, STEPHEN FOR THE 199TH COM
Street Address: 2100 LONG GAP ROAD
City: CARLISLE State: PA Zip Code: 17013-8651
TYPE OF 6TH TUESDAY 1. 2ND FRIDAY PRE- 2. 30 DAY POST- 3. AMENDMENT Yes No 4
REPORT PRE-PRIMARY PRIMARY PRIMARY REPORT? //
6TH TUESDAY 4. 2ND FRIDAY PRE- 5. 30 DAY POST- 6. TERMINATION Yes No .1/
(place X to PRE-ELECTION ELECTION ELECTION REPORT? T
the right of �+
report type) ANNUAL REPORT 7.X Year 2016 FILING METHOD PAPER y,DISKETTE
( )CHECK ONE
Name of Office Sought byCandidate: DATE OF ELECTION District Office Party Code County
9 Number Code Code
MO DAY YEAR 199 STM REP 21
REPRESENTATIVE IN THE GENERAL ASSEMBLY
11 8 2016 (SEE INSTRUCTIONS FOR CODES)
Summary of Receipts and MO DAY YEAR MO DAY YEAR FOR OFFICE USE ONLY
Expenditures from: 11 29 2016 TO 12 31 2016
•
A.Amount Brought Forward From Last Report $ 23,665.68 C7 ry
C
t=1'•-...I Total Monetary Contributions And Receipts(From Schedule I) $ 250.00 y
Ca L
C.Total Funds Available(Sum Of Lines A and B) 23,915.68 7:.7
Expenditures(From Schedule III T' coD.Total
) $ 1,482.70 O
E.Ending Cash Balance(Subtract Line D From Line C) $ 22,432.98 C)
CD
F.Value Of In-Kind Contributions Received (From Schedule II) $ 0.00 c W
.
G.Unpaid Debts And Obligations(From Schedule IV) $ 0.00 -G CD
AFFIDAVIT SECTION
PART I-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here.
I swear(or affirm)that this report,including the attached schedules filed on paper or by electronic um re b t of my knowledge and belief,true
correct and complete.
Sworn to and subscribed before me this •
2j ` n, gnatu e of Person Submitting Report
11l TI'1 day of/ WAV�l��tf 20 7
Logarr 'Ti. n6vN
ANA
1 7 - („_ it c^— I. Printed Name
/ Signature TE ORRIS 1.2MQe it a cehC,
E ORRIS f- UVw `Fst•Pa-
MEGAN
My Commission Expires Notary PublicEmail
L
ARLISLE a CUMBERLAND COUNTY " ,l ���- 7� 3
MO Duy etrnwaetne GrPinn.tsn11ant
�9 \Area Code Daytime Telephone Number
Part II-If this is a report of a candidate'sorized Committee,Can idatd .a shall sign here.
I swear(or affirm)that to the best of my knowledge and belief this political committee has not violated any provi 'o ti a ac of 3,1937(P.L.1333,
No 320)as amended.
Sworn to and subscribed before me this
` 1 dayof Signature(of Candidate
"..41401111r, 20 ‘� S-�. &. -._k �l�O, .
✓ '�i c /i role-ir210 L L•OOf"��1 /� Printed Name
% r��u Si:. ature e_i �; '-C,M
My Commis 'nn FYn&Pf1 '' TH OF PENNSYLVANIA Email
NOTARIAL SEAL '�('7 7 o 1 _14-'3 C
BETHANY SALZARULO
Nofdf�l Public DAY YR Area Code Daytime Telephone Number
CARLISLE SORO,CUMBERLAND cur/ •
My Commission Expires Oct'I.2017
1/29/2017 8:30:14 AM
PAGE 2
SCHEDULE I
CONTRIBUTIONS AND RECEIPTS
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
BLOOM, STEPHEN FOR THE 199TH COM From: 11/29/2016 To: 12/31/2016
1.Unitemized Contributions Received-$50.00 or Less Per Contributor
TOTAL for the Reporting Period (1) $ 0.00
2.Contributions Received- $50.01 To$250.00(From Part A and Part B)
Contributions Received From Political Committees(Part A) $ 250.00
All Other Contributions (Part B) $ 0.00
TOTAL for the Reporting Period (2) $ 250.00
3.Contributions Received Over$250.00(From Part C and Part 0)
Contributions Received From Political Committees(Part C) $ 0.00
All Other Contributions (Part D) $ 0.00
TOTAL for the Reporting Period (3) $ 0.00
4.Other Receipts,Refunds,Interest Earned,Returned Checks, Etc.(From Part E)
TOTAL for the Reporting Period (4) $ 0.00
Total Monetary Contributions and Receipts During this Reporting Period(Add and enter amount $ 250.00
totals from Boxes 1,2,3 and 4;also enter this amount on Pagel,Report Cover Page,Item B.)
1/29/2017 8:30:14 AM
• PAGE 3
PART A
CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEES
$50.01 TO $250.00
Use this Part to itemize only contributions received from political committees
with an aggregate value from $50.01 to $250.00 in the reporting period.
Name of Filing Committee or Candidate Reporting Period
BLOOM, STEPHEN FOR THE 199TH COM From: 11/29/2016 To: 12/31/2016
DATE AMOUNT
Full Name of Contributing Committee
an
K&L GATES LLP C7V 1
Mailing Address 210 6TH AVE
$ 250.00
Ci State Zip Code(Plus 4) 12 8 2016
tY PITTSBURGH
PA 15222-2602
PAGE TOTAL
Enter Grand Total of Part A on Schedule I,Detailed Summary Page,Section 2. # 250.00
1/29/2017 8:30:14 AM
PAGE 4
PART B
ALL OTHER CONTRIBUTIONS
$50.01 TO $250.00
Use this Part to itemize all other contributions with an aggregate value from
$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part A)
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing Address
0.00
City State Zip Code(Plus 4)
PAGE TOTAL
Enter Grand Total of Part A on Schedule I,Detailed Summary Page,Section 2. $ 0.00
1/29/2017 8:30:14 AM
PAGE 5
PART C
Contributions Received From Political Committees
OVER$250.00
Use this Part to itemize only contributions received from Political committees
with an aggregate value from Over $250.00 in the reporting period.
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributing Committee
MO DAY YEAR
Mailing Address
$ 0.00
City State Zip Code(Plus 4)
PAGE TOTAL
Enter Grand Total of Part C on Schedule I,Detailed Summary Page,Section 3.
$ 0.00
1/29/2017 8:30:14 AM
PAGE 6
PART D
ALL OTHER CONTRIBUTIONS
OVER $250.00
Use this Part to itemize all other contributions with an aggregate value of
over $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
1
Mailing
Address ;l 0.00
City State Zip Code(Plus 4)
Employer Name Occupation
Employer Mailing Address/Principal Place of City State Zip Code(Plus 4)
Business
PAGE TOTAL
Enter Grand Total of Part C on Schedule I,Detailed Summary Page,Section 3.
$ 0.00
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PAGE 7
PART E
OTHER RECEIPTS
REFUNDS, INTEREST INCOME, RETURNED CHECKS, ETC.
Use this Part to report refunds received, interest earned, returned checks and
prior expenditures that were returned to the filer.
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name
Mailing Address $ 0.00
City State Zip Code(Plus 4)
Receipt Description
PAGE TOTAL
Enter Grand Total of Part E on Schedule I, Detailed Summary Page,Section 4.
$ 0.00
1/29/2017 8:30:14 AM
PAGE 8
SCHEDULE II
IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECEIVED
USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS
DURING THE REPORTING PERIOD.
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
BLOOM, STEPHEN FOR THE 199TH COM From: 11/29/2016 To: 12/31/2016
1.UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR
TOTAL for the Reporting Period (1) $ 0.00
2.IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.0110$250.00(FROM PART F)
TOTAL for the Reporting Period (2) $ 0.00
3.IN-KIND CONTRIBUTION RECIEVED-VALUE OVER$250.00(FROM PART G)
TOTAL for the Reporting Period (3) $ 0.00
TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING PERIOD(Add and enter 0.00
amount totals from Boxes 1,2,and 3;also enter on Page 1,Reports Cover Page,Item F.)
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PAGE 9
SCHEDULE II
PART F
IN-KIND CONTRIBUTIONS RECEIVED
VALUE OF $50.01 TO $250.00
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing Address $ 0.00
City State Zip Code(Plus 4)
Description of Contribution:
Enter Grand Total of Part F on Schedule II,In-Kind Contributions Detailed Summary Page, PAGE TOTAL
Section 2.
0.00
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• • PAGE 10
SCHEDULE II
PART G
IN-KIND CONTRIBUTIONS RECEIVED
VALUE OVER $250.00
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO" "DAY YEAR
Mailing Address
0.00
City State Zip Code(Plus 4)
Employer of Contributor Occupation
Employer Mailing Address/Principal Place of City State Zip Code(Plus Description of Contribution
Business 4)
Enter Grand Total of Part G on Schedule II,In-Kind Contributions Detailed PAGE TOTAL
Summary Page,Section 3. 0.00
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PAGE 11
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
BLOOM, STEPHEN FOR THE 199TH COM From 11/29/2016 To: 12/31/2016
DATE AMOUNT
To Whom Paid
Grp DAY 2HARPHOENIX FUNDRAISING PARTNERS, LLC
Mailing Address 2601 N. FRONT ST, SUITE 101 11 30
$ 1,482.70
City HARRISBURG State Zip Code(Plus 4) Description of Expenditure
PA 17110 DECEMBER INVOICE
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page,Item D.
1,482.70
1/29/2017 8:30:14 AM