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Financial Statement of John Henry

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Financial Statement of John Henry Mlnlstty of Municipal Attains • nd Houelng Financial Statement - Auditor's Report fJ;>Ontario Form4 Municipal Becffons Act 1996 (Section 78) Instructions: All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses beyond the nomination fee must complete Boxes C, 0, Schedule 1, and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses in excess of$10,000 must also attach an Auditor's Report. All surplus funds (after any refund to the candidate or his or her spouse) shall be paid immediately over to the cleric who was responsible for the conduct of the election. YYYY MM DD yyyy MM OD For tho campaign period from (day candld1ta flied nomination) 1 2014 I 06 10 to 2014 12 31 [81 Primary filing reflecting finances to December 31 (or 45" day after voting day in a by-election) D Supplementary filing including finances after December 31 (or 45" day after voting day in a by-election) Box A: Name of Candidate and Office Candidate's name as shown on the ballot Last Name Given Name(s) Henry John Name of office for which the candidate sought election Ward name or no. (if any) Oshawa Mayor Name of Municipality Durham Spending limit issued by clert< s101,206.55 D I did not accept any contmutions or incur any expenses other than the nomination fee. (Complete Box A and B only) Box B: Declaration I. John Henry , a candidate in the municipality of _O_sh_a_w_a,_;_O_n_t_an_·o________________•hereby declare that to the best of my knowledge and belief that these financial statements and attached supporting schedules are true and correct. Declared before (clerk or commissioner) in th e City of Oshawa on (yyyy/mm/dd) EGc<: k a':\ a Q , < ~ - ' } Signature or Cieri< or Commissioner M~ a 'i , a ot5 Date Filed in the Clerk's Office (yyyy/mm/dd) 9503P (20 13111) C Qu&en'a Printer torOntJirlo, 2013 Oisponiblo on fnln~s Page 1ol 8 Box C: Statement of Campaign Income and Expenses LOAN Name of bank or recognized lending Institution Amount borrowed • - - • --- - + ....;;;..s _______ INCOME Total amount of all contributions (From line 1A in Schedule 1) + s 43,438.60 Refund of nomination filing fee + s 200.00 Sign deposit refund + s Revenue from fund-raising events not deemed a contribution (From Part Ill of Sdledule 2) + s Interest earned by campaign bank account + s Other (provide full details) 1. + s ----~2. _____ - ------_ ___________________- ------- ----- --_+ s 3. + s -----------------~---~--- _.. --...;;~;.;..;;...;;_. Total Campaign Income (Do not include loan) = s____43,638.60 C1 EXPENSES (Note: include the value of contributions of goods and serviees) Expenses subject to spending llmlt Nomination filing fee + -"-s_________ 200.00""-'-'­ lnventory from prev10us campaign used in this campaign (Ost details in Table 5 of Schedule 1) + -""s_ ___._3,138__.60_ Advertising + _s-'--___.......3.396....._~...._.75 Brochureslftyers + _s__________10,508.19-""­ Signs (including sign deposit) + _s=-------- ­ Meetings hosted + _s______4_____,341.68___ Office expenses incurred until voting day + ---"-s ___..-....~....._.9,453. 15 - Phone and/or Internet expenses incurred until voting day + s ----------....::;.. SaIa rie s, benefits, honoraria, professional fees incurred until voting day + s _______ Bank charges incurred until voting day + ....::;..s ___.......::~;.:.;..:-572.17 lnterest charged on loan until voting day + .....:;..S _______ Other (provide full details) _1 ._vv_e__b s__ite_rr_e_____chno l o~gy..________________+ s 2,690.45 2. Rent/Utilities/Insurance + s 7,138.56 _3---~------""""~...._• _ _________~~-----_________----____----_- + s Total Expenses subject to spending limit = s 41,439.55 C2 ExpenHa not subject to spending llmlt Accounting and audit + _ s-'-----'-'-'--..;.-'--1,779.95 Cost of fund-raising events/activities (list details in Part IV of Schedule 2) + s Voting day party/appreciation notices + -'-------­s ------..:.r.::~.;.:;...:l.l 19.90'- - Office expenses Incurred after voting day + _s=------....:....;;;-=-~408.49 Phone and/or Internet expenses incurred after voting day + ....;;;..s ________ Salaries, benefits, honoraria, professional fees incurred after voling day + ---"'------s -­ Bank charges incurred after voting day + --------s Interest charged on loan after voting day + .....;:;;.s _______ Expenses related to recount + .....;:;;.s _______ Expenses related to controverted election + _s.________ Expenses related to compliance audit + s Expenses related to candidate's disability (provide full details) ---------- 1. + --s ------ 2. + s 3. + --------s 0th er (provide run details) --------- 1. + -'----s - --­ 2. + -s--- ---­ 3 + $ ------------~---- Total Expenses not aubjact to spending llmlt :. s 3,308.34 C3 Total Campaign Expenses (C2 + C3) = s 44,747.89 C4 9503P (2013111) Page2c0 Box 0: Calculation of Surplus or Deficit Excess (deficiency) of income over expenses (Income - Total Expenses) (C1 - C4) + $ (1.109 .29) 01 E.llgible deficit carried forward by the candidate from the last election - $ 02 Total (01 - 02) = s Ifthere Is a surplus, deduct any refund ofcandidate's or spouse's contributions to the campaign - $ Surplus (or deficit) for the campaign • $ (l,109.29) 03 If fine 03 shows a surplus. the amount must be paid in trust, at the tine the financial statements are filed, to the municipal clerk who was responsible for the conduct of the election. Amount of _s______paid to municipal clertc in the municipafity of-------------------­ 9503P (2013111) Pege 3 cl 8 Schedule 1 - Contributions Part 1- Summ.ary of Contributions Contribution from candidate (Include tt1e value of inventory listed In Table 5) + s 13,138.60 Contribution from spouse + s Total value of contributions not exceeding $100 per contributor • Include ticket revenue. contributions in money, goods and services where the total contribution from a contributor is $100 or less (do not include contributions from candidate or spouse). + s 11000.00 Total value of contributions exceeding $100 per oontributor (from line 18; list details in Tables 1 - 4) • Include ticket revenue. contributions In money, goods and services where the total contribution from a contributor exceeds $100 (do not include contributions from candidate or spouse). + s 29,300.00 l.eH: Contributions returned or payable to the contributor - s Contributions paid or payable to the clel1<, including contributions from anonymous sources exceeding $10 - s Tolal Amount of Contributions (Record In Box C) • s 43!438.60 1A Part II - List ofContributions from Each Slngle Contributor Totalllng more than $100 Tabla 1: Monetary contrlbutJona from Individuals other than candidate or spouse Name Full Address Amount$ Mark Sheriff 706 Athol St, Unit I, Whitby, LIN4A2 300.00 Kevin Miyauchi 4 Wood Glen Road 18, Roseneath, KOK2XO 150.00 Annette Henry 7276-6 County Road 18, Roseneath, KOK2XO 100.00 Andrew Wilk 1305 Glenridge Court, Oshawa, LIH8L9 400.00 Oleg Rudnitsky 38 Quail Run Blvd, Maple, L6A IE9 150.00 Andrew Kowlsky 2083 Lake Shore Blvd W, Unit 711, Toronto, M8V4G2 500.00 Shufeng Jiang 481 Rougemount Dr, Pickering. LI W288 200.00 John Kellam 152 King St E, Oshawa. LIHIB6 250.00 John McGovern I 1795 Woodbine Ave, Box 553, Gonnley, LOH IGO 750.00 Sandra Lauzon 156 Sheridan St, Oshawa, L1G8A4 300.00 Gerald A Anderson 104 King St E, Bowmanville, LICIN5 400.00 Michael Rice 15 Gonnley Industrial Ave, Gonnley, LOHIGO 750.00 181 Additional information ls fisted on separate supplementary attachment To1al 5,450.00 ~03P (2013111) Page4' of& Table 2: Monetary contributions from corporations or union• Name (Legal and Carrying on Full Address President or Authorized Amounts Business As) Business Manager Rep111sentatlve None 0 Additional infonnation is listed on separate supplementary attachment Total Table 3: Contribution• In good• or eervlces from Individuals other than candidate or epcuse (Note: must also be recorded H eJtDenees In Box Cl Name Full AddreH Description of Goode Value S or services None 0 Additional infonnation is Usted on separate supplementaty attachment Total 9503P (2013/11) Page 5 of 8 Table 4: Contributions In goods or servlcea from corooratforus or unions (Note: mustalso be recorded as exoenses In Box C) Name of Corporation Full Addre88 President or Authorized Description of Value$ (Legat and Carrying on Business Manager Representative Goods or Services Business Asl None 0 Additional information is listed on separate supplementary attachment Total Total Part II Contributions {Add Totals from Tables 1-4) (Record in Part I - Summary) -----s 1B Part Ill - Inventory Table 5: Inventory of Campaign Goods and Materials from Previous Campaign used In this Campaign (Note: value must be recorded as a contribution from the candidate and as an expense) Description Date Acquired Supplier Current Market Quantlty Total Value $ (yyyy/mm/dd) Value$ Lawn signs- Large 2010/08/20 Callaghan & Assoc. 6.70 363 2,432. 10 Lawn signs· Small 2010/08/20 Callaghan & Assoc. 2.25 314 706.50 0 Additional informauon is listed on separate supplementary attachment Total 3,138.60 95031' (2013111) Page 6 of 8 Schedule 2 - Fundralslng Events and Activities Fundralslng EvenUActivlty Complete a separate schedule for each event or activity held 0 Additional schedule(s) attached Description of fundraising event/activity _N_o_n_e_____________________________ Date ofevent/activity (yyyy/mm/dd) Part l - Ticket Revenue Admission charge (per person) (If lhere are a range ofticket prices, attach complete breakdown ofall ticket sales) + --------S 2A Number of tickets sold x --------2B Total
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