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United Heritage InsuranceCAMPAIGN FINANCIAL DISCLOSURE REPORT SUMMARY PAGE (Please Print or Type) Section I Name of Candidate or Political Committee and Chairperson UHFG Insurance Political Action Committee Mailing Address PO Box 7777 Name of Polificallreasurer -- Jeffrey D. Neumeyer Mailing Address PO Box 7777 Office Sought (if candidate) Meridian 83680 City and Zip Home Phone Meridian 83680 Change of address for: Candidate or Political Committee ❑ Political Treasurer ❑ Section II TYPE OF REPORT This filing is an: A Original ❑ Amendment This report is for the period from through _11. ❑ 7 Day Pre -General Report Is this a Termination Report: ❑ Yes ❑ 30 Day Post -General Report K No C-2 Rev. 12114 District (if any) 208-475-0913 208-475-0913 ❑ October 10 Pre -General Report 9 Annual Report Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES Directions: If you had no contributions or expenditures during this reporting period, check the box next to the statement below and sign this report. Be sure to cavy forward the appropriate "Calendar Year to Date" figures in Column II, Section IV. ❑ I hereby certify that I have received no contributions and have made no expenditures during this reporting period. Section IV SUMMARY To reach your Calendar Year to Date figure: Add this report's Column I figures to the Column II figures of your previous report (except on line 6). Line 1: Cash on Hand January 1, This Calendar Year* Line 2: Enter Beginning Cash Balance** Line 3: Total Contributions (Enter amount from line 5, page 2) Line 4: Subtotal (Add lines 1, 2 and 3) Line 5: Total Expenditures (Enter amount from line 11, page 2) Line 6: Enter Ending Cash Balance (Subtract line 5 from line 4) Line 7: Outstanding Debt to Date (Enter amount from line 18, page 2) COLUMN I This Period 5 XXXXXX $ au 0' •l`,�' $ 00� J q COLUMN II Calendar Year to Date YY II $ �1" $ XXXXXX ()00 . QD $ 5�t. $ $ •; *This same figure should be entered on line 1 of all reports filed this calendar year. **This is the figure on line 6 of the last Campaign Financial Disclosure Report filed. If this is your first report, this amount is 0. Note: The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand. Section V Please remit to: City Clerk's Office City of Meridian 33 E. Broadway Ave. Suite 104 Meridian, ID 83642 (208) 888-4433 cityclerk@merldiancity.org Jeffrey D. Neumeyer Name of Political Treasurer _, hereby certify that the information in this report is a true, complete and correct Campaign Financial Disclosure Report as required by law. Signature of Political Treasu a e1 Name of Candidate or Committee: (.t� DETAILED SUMMARY !mum vie t CMM___ Total This Period Contributions C) Unitemized Contributions ($50 and less) # of Contributors b + $ .,.� 2O Itemized Contributions (Total of all Schedule A sheets) + $ In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets) + $ Loans (Total of all New Loan amounts from Schedule D sheets) + $ Total Contributions (Transfer this figure to page 1, Section IV, Line 3) = $ �. Expenditures © Unitemized Expenditures (Less than $25) # of Expenditures 0 + ..._ 7O Itemized Expenditures (Total of all Schedule B sheets) + $ op ® In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets) + $ gO Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets) + $ 10 Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets) + $ 11 Total Expenditures (Transfer this figure to page 1, Section IV, Line 5) = $ 35'1 SO. Page 2 Loans, Credit Cards and Debt 12 Outstanding Balance from previous reporting period + $ ..._. 13 New Loans received during this reporting period (Total of all New Loan amounts plus Accrued Interest from Schedule D sheets) + $ 14 New Credit Card and Debt incurred this reporting period (Total of all New Incurred Debt amounts from Schedule E sheets) + $ 15 Subtotal $ 16 Repayments of Loans made during this reporting period (Total of all Loan Repayment amounts from Schedule D sheets) - $ 17 Repayments of Credit Card and Debt this reporting period (Total of all Debt Repayment amounts from Schedule E sheets) $ 1 g Total Outstanding Balance at close of this period (Transfer this figure to page 1, Section IV, Line 7) - $ Pledged Contributions 19 Unitemized Pledged Contributions ($50 and less) # of Pledges + �0 Itemized Pledged Contributions this Period (Total of all Schedule F sheets) + $ 0 Total Pledged Contributions this period = $ Page 2 SCHEDULE A ITEMIZED CONTRIBUTIONS of more than Fifty Dollars ($50.00) this period Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2. Received Full Name, Mailing Address and Zip Code of Contributor Cash or Check re / $ Calendar Year -To -Date 2. $ Calendar Year -To -Date 3. Calendar Year -To -Date 4. Calendar Year -To -Date 5. Calendar Year -To -Date 6. Calendar Year -To -Date 7. $ Calendar Year -To -Date $ 8. $ Calendar Year -To -Date $ 9. 10. Total This Page: Calendar Year -To -Date Calendar Year -To -Date $ 0.00 Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2. SCHEDULES B' ITEMIZED EXPENDITURES Twenty -Five Dollars ($25.00) or more this period Name of Candidate or Committee: [ � � � �[ �O�n�rli t rurpose kooes sinter up to 3 purpose cozies per upenalture.) Full Name, Mailing Address and Zip_Code or Recipient Purpose o e s) A All Travel Expenses (Airfare, Fuel, Lodging & Mileage) N Newspaper & Other Periodical Advertising B Broadcast Advertising (Radio, TV, Internet & Telephone) 0 Other Advertising (Yard Signs, Buttons, etc.) C Contributions to Candidates & PAC's P Postage D Donations & Gifts S Surveys & Polls E Event Expenses T Tickets (Events) F Food & Refreshments U Utilities G General Operational Expenses W Wages, Salaries, Benefits & Bonuses H Independent Expenditures Y Petition Circulators L Literature, Brochures, Printing Z Preparation & Production of Advertising M Management Services Date Spent Full Name, Mailing Address and Zip_Code or Recipient Purpose o e s) Cash or CbecR 1. 1 0 P-UE;;L1 C Y PO b0K 4OR 0 0615e [ t> 23*701 $ ('000 2.5e Orr 0CVK6 8015fn U2 3. (. 6 (ASC gEFQE>UCAN CAMDW r 1, PO eaI IG 0OIS l i� 301C $ /,coo 4. 5QVA ` "5Pu CAlYI0_ OF MAH F0 130Y n3 Oise I b V001 C $ I,;00 5. 6. 7. 8. 9. $ 10. $ $-@"M-3 0WD Total This Page: Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7. SCHEDULE C IN-KIND CONTRIBUTIONS and EXPENDITURES Name of Candidate or Committee: 1A1Wr2,4N M V C� Purpose Codes (Enter up to 3 purpose codes per Expenditure.) A All Travel Expenses (Airfare, Fuel, Lodging & Mileage) N B Broadcast Advertising (Radio, TV, Internet & Telephone) 0 C Contributions to Candidates & PAC's P D Donations & Gifts S E Event Expenses T F Food & Refreshments U G General Operational Expenses W H Independent Expenditure Y L Literature, Brochures, Printing Z M Management Services Newspaper & Other Periodical Advertising Other Advertising (Yard Signs, Buttons, etc.) Postage Surveys & Polls Tickets (Events) Utilities Wages, Salaries, Benefits & Bonuses Petition Circulators Preparation & Production of Advertising 1. Contributor Name, Mailing Address and Zip Code ! I Expenditure Name, Mailing Address and Zip Code 2. 'Contributor Name, Mailing Address and Zip Code 3. 4. Expenditure Name, Mailing Address and Zip Code $ Contributor Name, Mailing Address and Zip Code Expenditure Name, Mailing Address and Zip Code Contributor Name, Mailing Address and Zip Code Expenditure Name, Mailing Address and Zip Code Expenditure Total: (Transfer the combined total of all Expenditures on Schedule C pages p,pp to the Detailed Summary, page 2 line 8) Page of $ $ Calendar Year -To -Date Purpose Code(s) Calendar Year -To -Date Purpose Code(s) $ Calendar Year -To -Date Purpose Code(s) $ $ Calendar Year -To -Date Purpose Code(s) Contributor Total: (Transfer the combined total of all Contributors on Schedule C pages D.00 to the Detailed Summary, page 2 line 3) SCHEDULE D - LOANS Name of Candidate or Committee: (A A J(S (AMIV deL;; 1( fr Each Lender to your campaign should be listed separately. Each time a loan is received or you loan money to the campaign, it must be listed as a separate item. Each new loan from any Lender must be listed as a new item from that Lender. You may have the same Lender listed more than once. Except for a candidate making a loan to his or her own campaign, loans from any Lender cannot exceed contribution limits laid out in Section 67-6610A, Idaho Code, even if it is repaid in full. Any loan(s) with a balance(s) appearing on the last report must be listed below with the amount in the Previous Balance column. Any new loan amounts should be listed in the New Loan column. Any interest accrued should be listed in the Interest Accrued column. If a payment was made on the loan, list it in the Repayments column. Note: Any loan that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance plus new loans and accrued interest less any repayments. Name, Mailing Address and Zip Previous Balance New Loan amount Interest accrued Repayments of Loan Balance Code of Lender (Candidate, Individual or Business) of loan at the end of the last received during this reporting period during this reporting period during this reporting period outstanding at the end of this reporting period reporting period 1 Date: Date: Amount: Amount: $ 2 Date: Date: Amount: Amount: S $ 3 Date: Date: l l I 1 Amount: Amount: 4 Date: Date: Amount: Amount: `5 $ 5 Date: Date: Amount: Amount: $ 6 Date: Date: Amount: Amount: 7, Date: Date: Amount: Amount: Previous Received Interest Repayments Ending Balance Previous Total $ 0.00 Received Total: (Transfer the combined total of all received loans to the $ 0.00 Detailed Summary, page 2 line 4),— -- - InterestTotal: $ 0.00 Repayments Total: (Transfer the combined total of all loan repayments to the $ 0.00 n _l_:1_J n...v�__. .� _ n �:.�_ n O 4B uCiauCu ounnnaiy, NayC c nnC y a ivy — —� Ending Balance Total: $ 0.00 (NOTE: Transfer the combined total of all Accrued Interest and Received Loans to the Detailed Summary, page 2 line 13) SCHEDULE E - CREDIT CARDS and DEBT Name of Candidate or Committee: tAlHF(q I AMAN PAC- l Each incurred expense not yet paid (i.e. credit card purchases and debt) should be listed on a separate line. Each time you make purchases with a credit card or incur debt, it is considered to be a separate item. However, you will maintain a single item for each credit card and add purchases to that item. Each Creditor listed below with a New Debt amount must have a Schedule E-1 accompanying it. The Schedule E-1 lists where and when the debt was incurred. Credit Cards are considered debt to the campaign. Regardless of whether the credit card is repaid when the statement is received, all credit card transactions will appear on Schedule E and E-1. However, only Repayments of Debt during this reporting period appear in the Expenditure Section of the Detailed Summary Page. Any creditor(s) with a balance(s) appearing on the last report must be listed below with the amount in the Previous Balance column. Any new debt should be listed in the New Debt column, including any accrued interest. If a payment was made on the debt, list it in the Repayments column. Note: Any debt that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance plus New Debt less any Repayments of Debt. Name, Mailing Address and Zip Code of Previous Balance of New Debt amount Repayments of Debt Balance outstanding Creditor debt at the end of the incurred during this during this reporting at the end of this (Candidate, Individual or Business) last reporting period reporting period period reporting period 1. Date: Date: Amount: Amount: 2. Date: Date: Amount: Amount: & Date: Date: Amount: Amount: 4. Date: Date: Amount: Amount: 5. Date: Date: Amount: Amount: $ $ 6. Date: Date: Amount: Amount: Previous Incurred71 Repayments Ending Balance Previous Total: $ 0.00 Incurred Total (Transfer the combined total of all incurred debt to the $ 0.00 Detailed Summary, page 2 line 14) Repayments Total: (Transfer the combined total of all debt repayments to the Detailed Summary, page 2 line 10 & 17) Ending Balance Total: $ 0.00 SCHEDULE E-1 - CREDIT CARDandDEBT ITEMIZATION rage oV Name of Candidate or Committee: V Name of Creditor from Schedule E: Each Creditor listed on Schedule E with a New Debt amount must have a Schedule E-1 accompanying it. The Schedule E-1 lists where and when the debt was incurred. Purpose Codes (Enter up to 3 purpose codes per Expenditure.) Fullame,aing Address an iZ^p Code of xpen i ureurpose odeCs A All Travel Expenses (Airfare, Fuel, Lodging & Mileage) M Management Services B Broadcast Advertising (Radio, TV, Internet & Telephone) N Newspaper & Other Periodical Advertising C Contributions to Candidates & PAC's 0 Other Advertising (Yard Signs, Buttons, etc.) D Donations & Gifts P Postage E Event Expenses S Surveys & Polls F Food & Refreshments T Tickets (Events) G General Operational Expenses U Utilities H Independent Expenditure W Wages, Salaries, Benefits & Bonuses I Interest Accrued & Finance Charges Y Petition Circulators L Literature, Brochures, Printing Z Preparation & Production of Advertising Dale Incurred Fullame,aing Address an iZ^p Code of xpen i ureurpose odeCs - Amok 1. 1 1 $ 2. 3. 4. 5. I� $ 6. 7. 8. 9. — Total This Page: $ The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor. SCHEDULE F PLEDGED CONTRIBUTIONS BUT NOT YET RECEIVED Name of Candidate or Committee: (A �.� (N,SU/ c AI CT: PAc ageof - � r jl Directions: Complete this schedule if you were promised and agreed to accept a contribution during this reporting period but have not actually received the money, goods or services offered before the end of the reporting period. Do not include these entries on Schedule A until you actually receive the contribution. J Date Full Name, Mailing Address and Zip Code of Contributor 1. Amount Pledged 2. 3. 4. - 5. 6, 7. 8. 9. 10. 11. Total Amount of Pledged Contributions: $ 0.00 Transfer the combined total of all Schedule F pages to the Detailed Summary on page 2 line 20.