HomeMy WebLinkAboutHubka, Brenda - Report of Expenditures and Contributions [REDACTED]City of Englewood FCPA Filing Form - 2021
REPORT OF CONTRIBUTIONS AND EXPENDITURES
(1-45-108, C.R.S.)
Full Name of Committee/Person:
As Shown On Registration
Address of Committee/Person:
City, State & Zip Code:
Committee Type:
Name and Address of Financial
Institution
Type of Report
Regularly Scheduled Filing.
Amended Filing. This amends previous report filed on (date)
Submit changes or new information ONLY
Termination Report. (Termination Reports MUST Have a Monetary Balance of Zero in Line 5)
Check this box if this Report Contains Electioneering Communications Information
Reporting Period Covered: Through
Date Date
Declared Total Spending (if applicable)
[Art. XXVIII, Sec. 4(1)]
Totals Detailed Summary Page
1 Funds on Hand at the Beginning of Reporting Period (monetary only)$
2 Total Monetary Contributions (line 11) $
3 Total of Monetary Contributions & Beginning Amount (line 1 + line 2) $
4 Total Monetary Expenditures (line 19) $
5 Funds on Hand at the End of Reporting Period (monetary) (line 3 – line 4) $
Authorization (Must be completed by either the Registered Agent OR the Candidate): I hereby certify and declare, under
penalty of perjury, that to the best of my knowledge or belief all contributions received during this reporting period,
including any contributions received in the form of membership dues transferred by a membership organization, are from
permissible sources.
Print Registered Agent’s Name: _______________________________________________________________________________
Registered Agent’s Signature: ________________________________________________ Date: _____________
Print Candidate Name: ________________________________________________________________________
Candidates Signature: ______________________________________________________ Date: ___________
$
Colorado law requires municipal clerks to impose penalties for failure to file disclosure reports or
if disclosure reports are filed past the due date.
Return to:
City of Englewood
City Clerk's Office
1000 Englewood Parkway
Englewood, CO 80110
cityclerk@englewoodco.gov
303-762-2430
Brenda Hubka, Committee to Elect Brenda Hubka
3639 South Fox Street
Englewood, Colorado 80110
Election Campaign
Community Banks of Colorado, 3501 S Broadway, Englewood, Co 80113
n
10/13/2023 10/27/2023
2145.13
Brenda Hubka
Brenda Hubka
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: ___________________________________________________________
Current Reporting Period: Through
Funds on hand at the beginning of reporting period (Monetary Only) $
6 Itemized Contributions $20 or More [C.R.S. 1-45-108(1)(a)]
(Please list on Schedule “A”)$
7 Total of Non-Itemized Contributions (Contributions of $19.99 and Less) $
8
9
Loans Received
(Please list on Schedule “C”)
Total of Other Receipts
(Interest, Dividends, etc.)
$
$
10 Returned Expenditures (from recipient)
(Please list on Schedule “D”) $
11 Total Monetary Contributions
(Total of lines 6 through 10)
$
12 Total Non-Monetary Contributions
(From Statement of Non-Monetary Contributions) $
13 Total Contributions
(Line 11 + line 12)$
14 Itemized Expenditures $20 or More [C.R.S. 1-45-108(1)(a)]
(Please list on Schedule “B”)
$
15 Total of Non-Itemized Expenditures
(Expenditures of $19.99 or Less) $
16 Loan Repayments Made
(Please list on Schedule “C”) $
17
18
Returned Contributions (To donor)
(Please list on Schedule “D”)
Total Coordinated Non-Monetary Expenditures
(Candidate/Candidate Committee & Political Parties only)
$
$
19 Total Monetary Expenditures
(Total of lines 14 through 17)
$
20 Total Spending
(Line 18 + line 19) $
DETAILED SUMMARY
All fields must be entered. Please put $0.00 if the amount is zero .
Brenda Hubka
10/13/2023 10/27/2023
47.16
682.92
0
1700.00
0
0
2382.92
0
2382.92
2145.13
0
0
0
2145.13
2145.13
0
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person:
PLEASE PRINT/TYPE
1.Date Accepted 4.Name (Last, First): ____________________________________________________________________________________
5.Address: __________________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7. Description: ________________________________________________________________
8. Employer (if applicable, mandatory): _____________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
2.Contribution Amt.
$
3.Aggregate Amt. *
$
Check box if
Electioneering
Communication
1.Date Accepted 4.Name (Last, First): ____________________________________________________________________________________
5.Address: __________________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7. Description: ________________________________________________________________
8. Employer (if applicable, mandatory): _____________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
2.Contribution Amt.
$
3.Aggregate Amt. *
$
Check box if
Electioneering
Communication
1.Date Accepted 4.Name (Last, First): ____________________________________________________________________________________
5.Address: __________________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7. Description: ________________________________________________________________
8.Employer (if applicable, mandatory): _____________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
2.Contribution Amt.
$
3.Aggregate Amt. *
$
Check box if
Electioneering
Communication
1.Date Accepted 4.Name (Last, First): ____________________________________________________________________________________
5.Address: __________________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7. Description: ________________________________________________________________
8. Employer (if applicable, mandatory): _____________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
2.Contribution Amt.
$
3.Aggregate Amt. *
$
Check box if
Electioneering
Communication
* For contribution limits within a committee’s election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate
Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art.
XXVIII, Sec. 2(14).
Schedule A – Itemized Contributions Statement ($20 or more)
[C.R.S. 1-45-108(1)(a)] A spreadsheet attachment may be uploaded if additional lines are needed.
Please see attachment
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: ________________________________________________________________
PLEASE PRINT/TYPE
1.Date Expended 4. Name: ___________________________________________________________________
5. Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
1.Date Expended 4. Name: ___________________________________________________________________
5.Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
1.Date Expended 4. Name: ___________________________________________________________________
5. Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
1.Date Expended 4. Name: ___________________________________________________________________
5. Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
1.Date Expended 4. Name: ___________________________________________________________________
5. Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
Schedule B – Itemized Expenditures Statement ($20 or more)
[1-45-108(1)(a), C.R.S.] A spreadsheet attachment may be uploaded if additional lines are needed.
10/23/2023
GrowMail
425 E Spruce Street
1737.01 Tarpon Springs, FL 34689
campaign literature / mail
10/25/2023
Federal Express Printing
333 W Hampden Avenue, Suite 130
9.23 Englewood, Co 80110
Printing campaign materials
10/26/2023
Signal Graphics
5120 S Broadway, Suite A
391.36 Englewood, Co 80110
Printing Campaign Materials
10/31/2023
GrowMail
425 E Spruce Street
7.53 tarpon Springs, FL 34689
Printing Campaign Materials
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: __________________________________________
LOAN SOURCE
Name (Last, First or Institution): __________________________________________________________
Address: __________________________________________________________________________
City/State/Zip: _____________________________________________________________________
Original Amount of Loan: $______________________ Interest Rate: _____________________
Total of All Loans This Reporting
Loan Amount Received This Reporting Period: $______________ Period: $ _____________
(Place on line 8 of Detailed Summary Report)
Principal Amount Paid This Reporting Period: $______________
Interest Amount Paid This Reporting Period: $______________
Amount Repaid This Reporting Period: $______________ Total Repayments Made: $_________
(Amount Repaid is sum of Principal & Interest entered on Detail Summary) (Sum of Schedule C pages, Place on line 16 of
Detailed Summary)
Outstanding Balance: $ ______________
TERMS OF LOAN: ________________ ___________________
Date Loan Received Due Date for Final Payment
LIST ALL ENDORSERS OR GUARANTORS OF THIS LOAN
Full Name Address, City, State, Zip Amount Guaranteed
LOANS - Loans Owed by the Committee
(Use a separate schedule for each loan. This form is for line item 8 and 16 of the Detailed Summary Report.)
[No information copied from such reports shall be sold or used by any person for the purpose of soliciting contributions or for any commercial
purpose. [Art. XXVIII, Sec. 9(e)] Notwithstanding any other section of this article to the contrary, a candidate’s candidate c ommittee may receive a
loan from a financial institution organized under state or federal law if the loan bears the usual and custo mary interest rate, is made on a basis that
assures repayment, is evidenced by a written instrument, and is subject to a due date or amortization schedule [Art. XXVIII, Sec. 3(8)]
Schedule C - Loans
Brenda Hubka
Brenda Hubka
3639 S Fox Street
Englewood
1700.00 0
1700.00
0
0
0
2330.00
10/19/2023 12/1/2023
not applicable
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: __________________________________________________________
Returned Contributions
(Previously reported on Schedule A – Contributions accepted and then returned to donors)
PLEASE PRINT/TYPE
1.Date Accepted 4. Name (Last, First): _________________________________________________________
5. Address: ________________________________________________________________
6.City/State/Zip: _________________________________________________________________________
7.Purpose: ________________________________________________________________________________
2.Date Returned
3.Amount
$
1.Date Accepted 4. Name (Last, First): _________________________________________________________
5. Address: ________________________________________________________________
6.City/State/Zip: _________________________________________________________________________
7.Purpose: _______________________________________________________________________________
2.Date Returned
3.Amount
$
Returned Expenditures
(Previously reported on Schedule B – Expenditures returned or refunded to the committee)
PLEASE PRINT/TYPE
1.Date Expended 4. Name (Last, First): _________________________________________________________
5. Address: ________________________________________________________________
6.City/State/Zip: _________________________________________________________________________
7.Comment (Optional): _____________________________________________________________________
2.Date Returned
3.Amount
$
1.Date Expended 4. Name (Last, First): _________________________________________________________
5. Address: ________________________________________________________________
6.City/State/Zip: _________________________________________________________________________
7.Comment (Optional): _____________________________________________________________________
2.Date Returned
3.Amount
$
Schedule D – Returned Contributions & Expenditures
not applicable
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: ________________________________________________________________
PLEASE PRINT/TYPE
1.Date Provided 4. Name (Last, First): _____________________________________________________________
5. Address: ____________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7.Description: ________________________________________________________________________
8.Employer (if applicable, mandatory): ______________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. *
2.Fair Market Value
$
3.Aggregate Amt.
$
Check box if
Electioneering
Communication
1.Date Provided 4. Name (Last, First): _____________________________________________________________
5. Address: ____________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7.Description: ________________________________________________________________________
8.Employer (if applicable, mandatory): ______________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. *
2.Fair Market Value
$
3.Aggregate Amt.
$
Check box if
Electioneering
Communication
1.Date Provided 4. Name (Last, First): _____________________________________________________________
5. Address: ____________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7.Description: ________________________________________________________________________
8.Employer (if applicable, mandatory): ______________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. *
2.Fair Market Value
$
3.Aggregate Amt.
$
Check box if
Electioneering
Communication
* Note: If coordinated, then contribution must also be reported as a non-monetary expenditure on Detailed Summary. Art. XXVIII, Sec. 2(9) states: “…Expenditures
that are controlled by or coordinated with a candidate or candidate’s agent are deemed to be both contributions by the maker of the expenditures, and expenditures by
the candidate committee.”
Statement of Non-Monetary Contributions
Statement of Non-Monetary Contributions
[Art. XXVIII, Sec. 2(5)(a)(II)(III) & Sec. 5(3) & 1-45-108(1), C.R.S.]
Donation Date Donation Amount Gross Amount Net Amount Anedot Fee TOTAL DONATFirst Name Midd Last Name Address Line 1 Address Line 2 City State Zip Countr Source Type Employer Occupation Donor Type Donor Covere Total Donation
2023-10-26 $200.00 $200.00 $200.00 $8.65 $191.35 Phillip Zierke 3395 S Logan St Englewood CO 80113 US credit_card Englewood Grand proprietor individual $8.65 $208.65
2023-10-23 $40.00 $40.00 $40.00 $1.98 $38.02 Dan Keller 3130 S Race St Englewood CO 80113 US credit_card Momentum Group Vice President individual $1.98 $41.98
2023-10-21 $100.00 $100.00 $100.00 $4.48 $95.52 Meg Froelich 5801 E Princeton Ave Englewood CO 80111 US credit_card State of Colorado State Represenindividual $4.48 $104.48
2023-10-20 $15.00 $15.00 $14.10 $0.90 $13.20 Marie Hotta 4811 S Kalamath St Englewood CO 80110 US credit_card Self Homemaker individual $0.00 $15.00
2023-10-18 $300.00 $300.00 $300.00 $12.81 $287.19 Joel Olson 3175 South York Street Englewood CO 80113 US credit_card retired retired individual $12.81 $312.81
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