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Home My Public Portal AboutForm 460 (Feb 15 - June 30, 2009) Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) COVER ~GE Ty.. 0< print In '~ CO) [P)W r:-'.,"'i:' >:"o~,.: Date Stamp .;,-,;;;.e""""''''/P -~;.~ ~.,"~~ !\ ' !: . CALIFORNIA 460 I 2001/02 FORM Statement covers period from 2/15/2009 SEE INSTRUCTIONS ON REVERSE 6130/2009 through 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ~ Officeholder, Candidate Controlled Committee 0 Primarily Formed Ballot Measure o State Candidate Election Committee Committee o Recall 0 Controlled (AIsoCompleleParl5) 0 Sponsored (Also Complete Part 6) o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee o Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 1.0. NUMBER 1313981 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Bridget Healy for Council 3. Committee Information STREET ADDRESS (NO P.O. BOX) 124 Miramar Ave CITY STATE ZIP CODE AREA CODE/PHONE 909 445 9628 Claremont CA 91711 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E.MAIL ADDRESS L Date of election If applicable: (Month, Day, Year) 03/03/09 J:":~ 0 3 2009 CITY CLERK ITY OF CLAREMONT Page of For Official Use Only 2. Type of Statement: o Preelection Statement o Semi-annual Statement ~ Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) o Quarterly Statement o Special Odd-Year Report o Supplemental Preelection Statement - Attach Form 495 e Treasurer(s) NAME OF TREASURER John Moylan MAILING ADDRESS 124 Miramar Ave CITY STATE ZIP CODE Claremont CA 91711 NAME OF ASSISTANT TREASURER, IF ANY AREA CODE/PHONE 909 445 9628 MAILING ADDRESS CITY JJMoylan@aol.com OPTIONAL: FAX / E.MAIL ADDRESS STATE ZIP CODE AREA CODE/PHON. 4. Verification I have used all reasonable diligence in preparing and reviewing th is statement and to the best of knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of pe~ury under the aws of the State of California that the foregoing is true and ITe. 7 Dille 7/'IL2e?di Executed on By Executed on By Executed on By Dale Executed on By Dille Sig1atu-e ofControlling Officeholder. CandidBte, Stele Measure proponent SiglatLJ'e of Controlling 0ffi0eh0Ider, Candidate. Slate Measure Proponent FPPC Form 460 (January/OS) FPPC Toll-Free Helpline: 8661ASK-FPPC (866/275-3172) State of California Type or print In Ink. Recipient Committee Campaign Statement Cover Page - Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Bridget Healy OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Claremont City Council RESIDENTIAUBUSINESS ADDRESS (NO. AND STREEl) CITY STAlE ZIP 640 Marshall Ct Claremont CA 91711 Related Committees Not Included in this Statement: Ust any committeea not included in t#l/s statement that are controlled by "u or are primarily fonned tQ nu:eive contributions or make expenditures on beha" of "ur candidacy. COMMITTEE NAME 1.0. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES ONO STREET ADDRESS (NO P.O. BOX) COMMITTEE ADDRESS CITY AREA CODE/PHONE STAlE ZIP CODE COMMITTEE NAME 1.0. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES 0 NO STREET ADDRESS (NO P.O. BOX) COMMITTEE ADDRESS CITY ST.6.lE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 CALIFORNIA 460 FORIVI - of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION o SUPPORT o OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any NAME OF OFFICEHOLDER. CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Fonned Candidate/Officeholder Committee Ust names of off1ceholder(s) or cINJdldafe(s) for which this committee Is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OfFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEtlOLDER OR CANDIDATE OfFICE SOUGHT OR HELD o SUPPORT o OPPOSE Attach continuation sheets " necf1ssary FPPC Form 460 (Janua'Y/05) FpPC Tolf-Free Helpline: 86~ASK-FPPC (8l161275-3772) State of Califc!mla Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Bridget Healy for Council Contributions Received 1. Monetary Contributions ........................................... Schedule A, Line 3 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 4. Nonmonetary Contributions .................................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 Type or print in ink. Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) $ 1455.00 -1300.00 150.00 0.00 150.00 SUMMARY PAGE from through ColumnS CALENDAR YEAR TOTALTODATE $ 15070.00 0.00 15070.00 0.00 15070.00 Statement covers period CALIFORNIA 460 FORM 2/15/2009 6/30/2009 Page Qf 1.0. NUMBER $ $ $ $ 1313981 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections . 1/1 through 6/30 7/1 to Date 20. Contributions Received $ 21. Expenditures Made $ $ e $ Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+ 7 $ 9. Accrued Expenses (Unpaid Bills) ...............................ScheduleF; Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 10301.14 $ 0.00 10301.14 $ -904.03 0.00 9397.11 $ 15070.00 0.00 15070.00 0.00 0.00 15070.00 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Volunlllry IixJJe!ldihlre Umll) Date of Election (mmlddlyy) Total to Date I I $ Current Cash Statement 12. Beginning Cash Balance ....................... PrevIous SUmmary Page, Line 16 $ 13. Cash Receipts ................................................... ColumnA, Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedule I. Line 4 15. Cash Payments .................................................. ColumnA, Line 8 above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 10151.14 150.00 0.00 10301.14 0.00 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ o To calculate Column e, add amounts in Column A to the corresponding amounts from Column e of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... AddLine2+Line9inColumnBabove $ o o I $ e . Amounts in this section may be different from amounts reported in Column e. FPPC Form 460 (January/OS) FPPC Toll-Free Helpllne~ 8861ASK-FPPC (866/275-3772) Schedule A Monetary Contributions Received Type or print in Ink. Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Bridget Healy for Council DAlE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE * 2/19/09 California League of Conservation Voters 9112C East Fairview San Gabriel CA 91775 olNO o COM I?)OTH oPTY oscc i2I INO o COM oOTH oPTY oscc Iii!JINO o COM oOTH oPTY OSCC olND o COM oOTH oPTY OSCC olNO o COM oOTH oPTY OSCC 1/18/09 Dennis & Laura Wheeler 470 West 7th Street Claremont CA 91711 1/21/09 Ezikiel Chavez 4022 La Junta Dr Claremont CA 91711 IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Attorney Self Teacher, Rowland Unified School District SUBTOTAL $ Schedule A Summary 1. Amount received this period - itemized monetary contributions. (Include all Schedule A subtotals.) ..... ..... ........ ...... ............. ...... ......................... ............... ........... .......... $ 2. Amount received this period - unitemized monetary contributions of less than $100 ............................. $ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ SCHEDULE A from Statement covers period 2/15/2009 CALIFORNIA 460 FORM through AMOUNT RECEIVED THIS PERIOD 250.00 100.00 100.00 450.00 450.00 1005.00 1455.00 6/30/2009 Page of 1.0. NUMBER 1313981 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 250.00 250.00 e 100.00 100.00 100.00 100.00 e *Contributor Codes INO-Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party sec - Small Contributor Committee FPPC Form 460 (January/OS) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule B - Part 1 Loans Received Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE B - PART 1 from Statement covers period 2/1512009 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER through Bridget Healy for Council FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPlOYED, ENTER NAME OF BUSINESS) a (b) (e) ( OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING BALANCE RECEI ED S BALANCE AT BEGINNING THIS V THI OR FORGIVEN CLOSE OF THIS PERIOD THIS PERIOD * ~PAID $ 1300.00 Bridget Healy Retired Marshall Ct Claremont, CA 91711 $ o FORGIVEN 1300 0 $ 0 3/31/09 DATE DUE o PAID $ $ o FORGIVEN $ DATE DUE o PAID $ $ o FORGIVEN tlii'J INO 0 COM 0 OTH 0 PTY 0 SCC $ to IND 0 COM 0 OTH 0 PTY 0 SCC $ to IND 0 COM 0 OTH 0 PTY 0 SCC $ DATE DUE SUBTOTALS $ $ $ 1300.00 $ Schedule B Summary 1. Loans received this period .... ............................... .......................................................................... ....... $ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period ................ ......... ..................... ..... .... ...... .......... ........... ......... ......... ..... $ (Total Column (e) plus loans under $1 00 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ....................................................... ........ NET $ Enter the net here and on the Summary Page, Column A, Line 2. 1300.00 -1300.00 (May be a negative number) *Amounts forgiven or paid by another party also must be reported on Schedule A. *. If required. 6130/2009 Page of 1.0. NUMBER 1313981 (e) INTEREST PAID THIS PERIOD ORIGINAL AMOUNT OF LOAN 91 CUMULATIVE CONTRIBUTIONS TO DATE CAlENDAR YEAR 0 ~% $ 1300.00 RATE $ 0 11/28/09 DATE INCURRED _% $ RATE $ $ PER ELECTION_ $ CALENDAR YEAR $ PER ELECTION ** DATE INCURRED CALENDAR YEAR _% RATE $ PER ELECTION ** DATE INCURRED (Enter (e) on Schedule E, Line 3) o tContributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e,g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. SCHEDUlEE from 2/15/2009 CALIFORNIA 460 FORM Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER through 6/30/2009 Page of 1.0. NUMBER Bridget Healy for Council 1313981 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. OVP campaign paraphernalia/misc. M3R member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries cve civic donations FEr petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research lRS staff/spouse travel, lodging, and meals N) independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/spons'- LEG legal defense PRO professional services (legal, accounting) VOT voter registration ., LIT campaign literature and mailings PRr print ads V'v'EB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Claremont Courier 1420 North Claremont Blvd Claremont CA 91711 PRT $3,541.01 A & M Direct Mail Service 2115 Aviation Dr Upland CA 91786 LIT $3,294.41 laremont Print and opy 108 Olive St Claremont CA 91711 LIT $487., .. Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTALS 7,322.55 Schedule E Summary 1, Itemized payments made this period. (Include all Schedule E subtotals.) .........................,..............................................,..................................... $ 2. Unitemized payments made this period of under $100 ......................................................................... ................................................................. $ 3. Total interest paid this period on loans. (Enter amountfrom Schedule S, Part 1, Column (e).)............................................................................... $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, ColumnA, Line 6.) ............................. TOTAL $ $10,017.33 283.81 o 10,301.14 FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule "e (Continuation Sheet) Payments Made Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE E (CONT.) from 2/15/2009 6130/2009 CALIFORNIA 460 FORM Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER through Page_ of_ 1.0. NUMBER Bridget Healy for Council 1313981 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. (}.f) campaign paraphernalia/misc. PJIlR member communications RAD radio airtime and production costs CNS campaign consultants MrG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TB. t.v. or cable airtime and production costs AL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FfII) fundraising events POL polling and survey research 1RS staff/spouse travel, lodging, and meals N) independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration _ LIT campaign literature and mailings PFU print ads V\EB information technology costs (internet, e-mail) . NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) VMA Communications 243 Oberlin Ave Claremont CA 91711 LIT $2,382.69 Claremont Family Emergency Fund 207 Harvard Ave Claremont CA 91711 CVC 312.09 e * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2,694.78 FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule F Accrued Expenses (Unpaid Bills) SCHEDULE F Type or print In Ink. Amounts may be rounded to whole dollars. from 2/15/2009 6/30/2009 CALIFORNIA 460 FORM Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER through Page_ of_ 1.0. NUMBER Bridget Healy for Council 1313981 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. O"P campaign paraphernalia/misc. MR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary). OFC office expenses SAL campaign workers' salaries cve civic donations PET petition circulating TB. t.v. or cable airtime and production costs FIL candidate filinglballot fees PHO phone banks lRC candidate travel, lodging, and meals FND fund raising events POL polling and survey research TRS stafflspouse travel, lodging, and meals NJ independent expenditure supporting/opposing others (explain). POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsoa LEG legal defense PRO professional services (legal, accounting) VOT voter registration ,., LIT campaign literature and mailings PfU print ads WEB information technology costs (internet, e-mail) CODE OR (a) (b) (c) (d) NAME AND ADDRESS OF CREDITOR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD 'Claremont Courier PRT 1420 N Claremont Blvd Claremont CA 91711 804 2737.01 3641.04 0 e · Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 804 $ 2737.01 $ 3641.01 $ o Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.)............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total un itemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ................................................................................................................................................ NET $ -904.03 May be a negative number FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK-FPPC (866/275-3772) 2737.00 3641.04