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Campaign Contribution Disclosure Report 1

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Campaign Contribution Disclosure Report 1 CFC FORM CCDR REV 4/12 FILER ID: NC2012000071 State of Georgia Campaign Contribution Disclosure Report 1. Report Type 2. Filing is being made on behalf of: Filing Office Use Report of Organization or Person Other than Candidate's Campaign Committee Only E-Filed on Original Report NC2012000071 - 10/3/12 3:41 pm Koch Industries, Inc. Use Earlier of Post Mark or Hand Delivered Date 3. Identifying and Contact Information (1) Koch Industries, Inc. (2) 10/03/2012 Full Name of Candidate or Non-Candidate Campaign Committee Today's Date (3) 600 14th St, NW Suite 800 Washington, DC 20005 Mailing Address (4) (202) 737-1977 Contact Phone Number (We will understand the release of this information as permission to call your office if necessary.) (5) If a Candidate or Public Official, is there a campaign committee (one or more persons) to make campaign transactions, keep the financial records of the campaign, or file the reports? N/A (6) If so, is the Committee registered with the State Ethics Commission? N/A (7) Chairperson: Heather Love, Controller, Foundations Treasurer: Richard Dinkel, Corporate Controller Name of Chairperson and / or Treasurer of Committee 4. Period for which you are Reporting My Non Election Year My Election Year Run-Offs Special Elections (Report Require Only if you are in a Run Off (Report Require Only if you are in a Special Election) Election) June 30, 2012 March 31, 2012 6 days before Primary 15 days before Run-Off, 2012 Special Primary, Dec. 31, 2012 June 30, 2012 2012 Persons elected to office in each year 6 days before General following the year in which the election occurs Run-Off, 2012 15 days before X September 30, 2012 Special, 2012 Persons leaving office with excess funds 6 days before Special until such funds are expended as provided in the Act Primary Run-Off, October 25, 2012 Unsuccessful candidates with excess funds, 2012 or who receive contributions to retire debt Dec. 31, 2012 incurred, until such funds are expended, or 6 days before Special such unpaid debts are satisfied (December December 31, 2012 31 filing only) Run-Off, 2012 The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. As per modifications of the Ethics in Government Act, filing a separate notarized affidavit is no longer required. See O.C.G.A. §§ 21-5-34.1(e) and 21-5-50(e). Campaign Contribution Disclosure Report for 2012 September 30th - Election Year - Original Electronically Filed with the Georgia Government Transparency and Campaign Finance Commission on: 10/3/2012 3:41:32PM -- Confirmation #NC201200007168423 CFC FORM CCDR REV 4/12 FILER ID: NC2012000071 State of Georgia Campaign Contribution Disclosure Report Summary Report CONTRIBUTIONS RECEIVED 1 I Have: In-Kind Cash Amount No contributions to report. Estimated Value 2 Total contributions previously reported. $0.00 $0.00 3 Total amount of all itemized contributions received in this reporting period which are listed on the "Itemized Contributions" page. $0.00 $0.00 3a All loans received this reporting period. $0.00 3b Interest earned on campaign account this reporting period. $0.00 3c Total amount of investments sold this reporting period. $0.00 3d Total amount of cash dividends and interest paid out this reporting period. $0.00 Total amount of all separate contributions of $100.00 or less received in this reporting 4 period and not listed on the "Itemized Contributions" page. "Common Source" contributions must be aggregated on the "Itemized Contributions" page. $0.00 $0.00 Total contributions reported this reporting period. 5 (Line 3 + 3a + 3b +3c + 3d + 4) $0.00 $0.00 Total contributions to date. 6 $0.00 $0.00 (Line 2 + 5) EXPENDITURES MADE In-Kind Cash Amount 7 I Have: The following expenditures to report: Estimated 8 Total expenditures made and reported prior to this reporting period. $0.00 $0.00 9 Total amount of all itemized expenditures made in this reporting period which are listed on the "Itemized Expenditures" page. $0.00 $100,250.00 10 Total amount of all separate expenditures of $100.00 or less each that were made in this reporting period and not listed on the "Itemized Expenditures" page. $0.00 $0.00 11 Total expenditures reported this reporting period. (Line 9 + 10) $0.00 $100,250.00 Total expenditures to date. 12 $0.00 $100,250.00 (Line 8 + 11) INVESTMENTS 13 Amount of investments at the beginning of this reporting period. $0.00 14 Total amount of investments at the close of this reporting period. $0.00 15 Net Balance On Hand. (Line 6 - 12 + 14) ($100,250.00) Campaign Contribution Disclosure Report for 2012 September 30th - Election Year - Original Electronically Filed with the Georgia Government Transparency and Campaign Finance Commission on: 10/3/2012 3:41:32PM -- Confirmation #NC201200007168423 CFC FORM CCDR REV 4/12 State of Georgia Campaign Contribution Disclosure Report Outstanding Indebtedness General 2012 Indebtedness Amount 1 Outstanding indebtedness at the beginning of this reporting period. $0.00 2 Loans received this reporting period. $0.00 3 Deferred payments of expenses this reporting period. $0.00 4 Payments made on loans this reporting period. $0.00 5 Credits received on loans/deferred payments this reporting period. $0.00 6 Payments this period on previously deferred expenses. $0.00 Total indebtedness at the close of this reporting period. 7 $0.00 (line 1 + 2 + 3 - 4 - 5 - 6) Primary 2012 Indebtedness Amount 1 Outstanding indebtedness at the beginning of this reporting period. $0.00 2 Loans received this reporting period. $0.00 3 Deferred payments of expenses this reporting period. $0.00 4 Payments made on loans this reporting period. $0.00 5 Credits received on loans/deferred payments this reporting period. $0.00 6 Payments this period on previously deferred expenses. $0.00 Total indebtedness at the close of this reporting period. 7 $0.00 (line 1 + 2 + 3 - 4 - 5 - 6) Campaign Contribution Disclosure Report for 2012 September 30th - Election Year - Original Electronically Filed with the Georgia Government Transparency and Campaign Finance Commission on: 10/3/2012 3:41:32PM -- Confirmation #NC201200007168423 CFC FORM CCDR REV 4/12 FILER ID: NC2012000071 State of Georgia Campaign Contribution Disclosure Report Loan Reporting Date of Loan Person(s) responsible for Occupation & Name of Lender Amount of Loan repayment of loan Place of Employment Mailing Address Election Cycle Mailing Address Fiduciary Relationship I have no loans to report this reporting period. Campaign Contribution Disclosure Report for 2012 September 30th - Election Year - Original Electronically Filed with the Georgia Government Transparency and Campaign Finance Commission on: 10/3/2012 3:41:32PM -- Confirmation #NC201200007168423 CFC FORM CCDR FILER ID: NC2012000071 REV 4/12 State of Georgia Campaign Contribution Disclosure Report Itemized Expenditures Must list expenditures made to a single recipient for which the aggregate total is more than $100.00 List Name and Mailing Address of Expenditure Date Occupation & Expenditure Purpose Amount Recipient Expenditure Type Employer Paid Alan Powell Campaign 09/18/2012 Support $500.00 3059 Ridge Rd. Expenditure Hartwell, GA 30643 Albers for Senate 09/18/2012 Support $500.00 530 Junction Point Expenditure Roswell, GA 30075 Barbara Sims for State Rep. 09/18/2012 Support $250.00 10 Retreat Road Expenditure Augusta, GA 30909 Bethel for Georgia Senate 09/18/2012 Support $1,000.00 1701 Briarcliff Circle Expenditure Dalton, GA 30720 BILL HITCHENS CAMPAIGN 07/23/2012 Support $500.00 COMMITTEE Expenditure 2440 Rincon-Stillwell Rd. Rincon, GA 31326 Billy Mitchell for State Representative 09/18/2012 Support $250.00 PO Box 88 Expenditure Stone Mountain, GA 30086 Carl Rogers Campaign Committee 09/18/2012 Support $250.00 PO Box 639 Expenditure Gainesville, GA 30503 CECIL STATON FOR STATE 07/23/2012 Support $1,000.00 SENATE Expenditure PO Box 26427 Macon, GA 31221 Chance for Senate 09/18/2012 Support $1,000.00 PO Box 267 Expenditure Tyrone, GA 30290 CHARLICE BYRD FOR STATE 07/23/2012 Support $500.00 HOUSE Expenditure PO Box 906 Woodstock, GA 30188 CHUCK SIMS CAMPAIGN 07/23/2012 Support $500.00 PO Box 517 Expenditure Douglas, GA 31534 Citizens for Calvin Hill 09/18/2012 Support $250.00 817 Clubhouse Pointe Expenditure Woodstock, GA 30188 Campaign Contribution Disclosure Report for 2012 September 30th - Election Year - Original Electronically Filed with the Georgia Government Transparency and Campaign Finance Commission on: 10/3/2012 3:41:32PM -- Confirmation #NC201200007168423 Clark for State House 09/18/2012 Support $250.00 6044 Lanier Heights Circle Expenditure Buford, GA 30518 Committee to Elect Alex Atwood 09/18/2012 Support $1,000.00 1515 Newcastle St. Expenditure Brunswick, GA 31520 Committee to Elect Allen Peake 09/18/2012 Support $1,000.00 103 Colony Court Expenditure Macon, GA 31210 Committee to Elect Amy Carter 09/18/2012 Support $500.00 PO Box 4930 Expenditure Valdosta, GA 31604 Committee to Elect Ben Harbin 09/18/2012 Support $500.00 4571-A Cox Road Expenditure Evans, GA 30809 COMMITTEE TO ELECT BROOKS 07/23/2012 Support $500.00 COLEMAN Expenditure PO Box 273 Duluth, GA 30096 Committee to Elect Bubber Epps 09/18/2012 Support $250.00 PO Box 236 Expenditure Dry Branch, GA 31020 Committee to Elect Buddy Harden 09/18/2012 Support $250.00 458 Lakeshore Way Expenditure Cordele, GA 31015 Committee to Elect Butch Miller 09/18/2012 Support $500.00 4734 Arapahoe Trail Expenditure Gainesville, GA 30506 Committee to Elect Butch Parrish 09/18/2012 Support $500.00 224 West Main St. Expenditure
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