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Home My WebLink AboutColleen for PA - 2021 Annual Report Igt}7 Pennsylvania Department of State Bureau of Campaign Finance&Lobbying Disclosure 500 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov Unsworn Declaration in Lieu of Sworn Statement for Campaign Finance Reports Note: Per Act 2020-15, which was signed into law on April 20, 2020 and allows for unsworn declarations, Campaign Finance Reports (form DSEB-502), Campaign Finance Statements in lieu of full reports (form DSEB-503), Non-Bid Contract Reporting Form (DSEB-504) and Independent Expenditure Reports (form DSEB-505)need not be notarized. Instead, the filer may file with each report or statement the corresponding version of this form signed by the required individual(s). This particular form is to be used only for Campaign Finance Reports. This form must be signed by hand where a signature is required. P GjaaG 051ffliii Committee, Candidate,®yLobbyist Colleen for PA Reporting ❑ Cycle 1 El Cycle 2 ❑ Cycle 3 ❑ Cycle 4 0 Cycle 5 6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election ❑ Cycle 6 NI Cycle 7 ❑ Cycle 8 0 Cycle 9 30 Day Post-Election Annual Report 2nd Friday Pre-Special Election 30 Day Post-Special Election Part I- If this form is submitted with a Committee report, the treasurer must sign here. If this form is submitted with a Candidate report, the candidate must sign here. If this report is submitted with a report by a contributing lobbyist, the lobbyist must sign here. I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the accompanying Campaign Finance Report is true and correct. / q/ZO Signature of Treasurer, Candidate, or Lobbyist Date MM/DD/YYYY) Carol E. Thornton / 2 ('iL (2 I ( PA, (L Printed Name Location (City/State/Couun r ) DSEB-502R Updated 1/5/2022 Pennsylvania Department of State Bureau of Campaign Finance&Civic Engagement be 500 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov Part II-If this form is submitted with a report by a Candidate's Authorized Committee, the candidate must sign here. I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the accompanying Campaign Finance Report is true and correct. Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY) Colleen Gray Nguyen En01. 1 PA t US A Printed Name Location (City/State/Country) DSEB-502R Updated 1/5/2022 " Commonwealth of Pennsylvania PAGE 1 OF 6 Campaign Finance Report (NOTE: This report must be clear and legible. It may be typed or printed in blue or black ink.) Filer Identification Report 1. Number: 20210153 Filed By: Candidate ❑ Committee 2. 0 Lobbyist a. ❑ Name of Filing Committee,Candidate or Lobbyist: Colleen for PA Street Address: 1750 Yorkshire Place City: State: Zip Code: Enola PA 17025 6th Tuesday 1. 2nd Friday2. 30 Day3. Amendment TYPE OF Pre-Primary ❑ Pre-Primary ❑ Post Primary ❑ Report? Yes No ❑✓ REPORT 6th Tuesday 4.❑ 2nd Friday 5. 30 Day 6. ❑ Termination Yes ❑ No ❑✓ Pre-Election Pre-Election ❑ Post Election Report? Other 7. Annual Report ❑✓ YEAR 2021 Name of Office Sought by Candidate: a DATE OF ELECTION District Number: Office Code: Party Code:: County Code: Representative in the General 087 STH DEM 21 Assembly Summary of Receipts and From Date To Date FOR OFFICE USE ONLY Expenditures 11/23/2021 12/31/2021 $8,991.69 C) A. Amount Brought Forward From Last Report C raa w B. Total Monetary Contributions and Receipts(From Schedule I) $297.75 W t.,_ C. Total Funds Available(Sum of Lines A and B)` $9,2 8 9.4 4 Xt 2 D. Total Expenditures(From Schedule III r'— E. Ending Cash Balance(Subtract Line D from Line C) $9,183.78 >`7 ^C C') 3 $1.03 CoF. Value of In-Kind Contributions Received(From Schedule II) C IV Z C G. Unpaid Debts and Obligations(From Schedule IV) $0.00 c4 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,on paper or by electronic medium,are to the best of my knowledge and belief true,correct,and complete. Sworn to and subscribed before me this � -' /�� day of 20 f/ ig ture arson S bmitting Report�l Signature rO 1)rint d Name �" My commission expires 71✓___ —C ( L;7 MO. DAY YR. Area Code ' lephone Number PART II-If this is a report of a Candidate's Authorized Committee,candidate shall sign here. I swear(or affirm)that to the best of my knowledge and belief this political committee has not violated any provisions of the Act of June 3,1937 (P.L. 1333,No. 320) as amended. Sworn to and subscribed before me this (1) day of 20 SignaturTZUing Report Signature Prin5d Irt My commission expires 1(`--( q-71 - 3 711 MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I PAGE 2 OF 6 Contributions and Receipts Detailed Summary Page Filer Identification Number: 20210153 1. UNITEMIZED CONTRIBUTIONS AND RECEIPTS -$50.00 OR LESS PER CONTRIBUTOR TOTAL for the Reporting Period (1) $297.00 2. CONTRIBUTIONS$50.01 TO$250.00 (FROM PART A AND B) Contributions Received from Political Committees (Part A) $o.00 All Other Contributions (Part B) S o.o 0 TOTAL for the Reporting Period (2) $o.00 3. CONTRIBUTIONS OVER$250.00 (FROM PART C AND D) Contributions Received from Political Committees (Part C) So.00 All Other Contributions (Part D) So.00 TOTAL for the Reporting Period (3) So.00 4. OTHER RECEIPTS-REFUNDS, INTEREST EARNED, RETURNED CHECKS, ETC. (FROM PART E) TOTAL for the Reporting Period (4) $0.7 5 TOTAL MONETARY CONTRIBUTIONS AND RECEIPTS DURING THIS REPORTING PERIOD (Add and enter amount totals from $297.75 Boxes 1,2,3 and 4;also enter this amount on Page 1,Report Cover Page,Item B.) PAGE 3 OF 6 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. Filer Identification Number: 20210153 Full Name MO. , DAY YEAR Members 1st Federal Credit Union 11 30 2021 $0.36 Mailing Address 5000 Louise Dr City State Zip Code(Plus 4) Mechanicsburg PA 17055-4899 Receipt Description Dividend Full Name MO. DAY YEAR Members 1st Federal Credit Union 12 31 2021 $0.39 Mailing Address 5000 Louise Dr City State Zip Code(Plus 4) Mechanicsburg PA 17055-4899 Receipt Description Dividend Enter Grand Total of Part E on Schedule I,Detailed Summary Page,Section 4. PAGE TOTAL $0.75 SCHEDULEPAGE 4 OF 6 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 Filer Identification Number: 2 0210153 1.UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the Reporting Period (1) $1.03 2.IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the Reporting Period (2) $0.00 3.IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the Reporting Period (3) $o.00 TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING PERIOD (Add and enter amount totals from Boxes 1, 2, $1.03 and 3;also enter on Page 1. Report Cover Page,Item F.) Schedule Ill PAGE 5 OF 6 Statement of Expenditures Filer Identification Number: 20210153 0 om m MO nAY YPAR ActBlue 12 ] 3 12021 $12.87 Mailing Address 366 Summer St City State Zip Code(Plus 4) Somerville MA 02144-3132 Description of Expenditure Service Fee To Whom Paid MO. nAY YEAR Leigh Chow 121 28 I 2021 $10.00 Mailing Address 1175 Fleming Dr City State Zip Code(Plus 4) Mechanicsburg PA 17055-5798 Description of Expenditure Refund To Whom Paid Matthew Ozimok 1tSfiAYYFAR 12 1 28 12021 $10.00 Mailing Address 1266 Peggy Dr City State Zip Code(Plus 4) Hummelstown PA 17036-9014 Description of Expenditure Refund To Whom Paid MO, Y 'Elizabeth Rothwell1fiAFAR 12 128 12021 $5.00 Mailing Address 4836 Hazel Ave City State Zip Code(Plus 4) Philadelphia PA 19143-2294 Description of Expenditure Refund To Whom Paid MO nAY WAR Vantiv, LLC 12 I 9 12021 $27.51 Mailing Address 8500 Governors Hill Dr City State Zip Code(Plus 4) Symmes Twp OH 45249-1384 Description of Expenditure Merchant processing fees To Whom Paid MO.. nAY . YEAR Wix.com LTD 11 123 2021 $20.14 Mailing Address 40 Namal City State Zip Code(Plus 4) Tel Aviv Is 6350671 Description of Expenditure Web site fee Enter Grand Total of Expenditures on Page 1,Report Cover Page,Item D. PAGE TOTAL $85.52 Schedule Ill PAGE 6 OF 6 Statement of Expenditures Filer Identification Number: 20210153 0Whom al MO my' YEAR Wix.com LTD 12 1 23 1 2021 $20.14 Mailing Address 40 Namal City State Zip Code(Plus 4) Tel Aviv Is 6350671 Description of Expenditure Web site fee Enter Grand Total of Expenditures on Page 1,Report Cover Page,Item D. PAGE TOTAL $20.14