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Simpson,Anne_2023-Amended-Org-reportAmendment Disclosure Report Cover ® vea ❑ No Use this form for general report and committee information, must be signed and submitted along with other detailed forms. Do not use this form to update information 1. Committee Information a. Full Name c. ID Number Anne M. Simpson for Commisioner LJMJOX b. Mailing Address (include City, State and Zip Code) it. Date Filed 2517 Trading Ford Dr Waxhaw NC 28173 08/22/2023 L Phone Number 704-2564976 2. Report Year 3. Period Start Date (mm/dd/yy) 4. Period End Date 5. Treasurer Full Name mm/dd/ Anne Marie Simpson 2023 07/07/2023 07/07/2023 6. Type of Committee Check One 9. Type of Report (check only one type of report om one category) ® Candidate Campaign ❑ Party Municipal statelcounty Referendum ❑ PAC ❑ Referendum ® Organizational ❑ Organizational ❑ Organizational Independent Joint Fundraiserfive ❑ Expenditure ❑ ❑ Thi ny- day Quarterly E] Pre -referendum Legal Expense Fund ❑ Pre-primary ❑ Pre-election ❑ First ❑ Second ❑ Final ❑ Supplemental Final 7. Type of Fund (!fapplicable, check ane) ❑ "Booster Fund" ❑ Building Fund ❑ Pre -runoff ❑ Third ❑ Annual Semi-annual ❑ Fourth ❑ Special ❑ Mid Year Semi-mmual ❑ Other. ❑ Year End ❑ Mid Yew 10. Special Report Name ❑ Final ❑ Special ❑ Year End ❑ Final ❑ Special S. Number of Fundraisers this Report 11. Account Information 11. Account Information a. Financial Institution Full Name a. Financial Institution Full Name Wells Fargo b. Purpose c. Account Code b. Purpose c. Account Code Campaign HLUEIVED 4 WX W Finance Activities it. Period Begin Balance AUG 2 2 2023 d. Period Begin Balance $ $ 0 Union Co. Lara of Elac,.. CERTIFICATION I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A, 22B, & 2213-22M of Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or other non -disclosed funds. 1 farther certify that this report is complete, true and correct and that I have been trained by the NC Mate oard of Elections. Anne Marie Simpson L41 08/22/2023 Printed Name of Signer Signature of Appointed Treasurer Date FOR OFFICE USE ONLY r Delivery Method Date Received: Employee: El Normal Mail Registered Mail Date Postmarked: Employee: Hand Delivered 3 Electronically Filed Date Scanned: Employee: 0 E] Signer has not received mandatory training Date Data Entered: Employee: Please Note: This form cannot be used to amend committee information such as the committee address, treasurer, assistant treasurer, custodian of books information, or account information. You must amend the Statement of Organization (CRO -2 100A -E) to make committee changes. CRO -/000 NC State Board of Elections August 2008 Amendment Detailed Summary ® Yes ❑ No Use this form to summarize all disclosure reporting forms and to total monetary information. 1. Committee Full Name and Fund if applicable) 2. T of Report 3. m Num her Anne M. Simpson for Commissioner Organizational LJMJOX Start of Election Cycle: January 1, 2023 Total this Reporting Period Total this Election Cycle 4) Cash on Hand at Start RF�ITiII'TS 5) Aggregated Contributions from Individuals (CRO -1205) 6) Contributions from Individuals (CRO -1210) 7) Contributions from Political Party Committees (CRO -1220) 8) Contributions from Other Political Committees (CRO -1250) 9) Loan Proceeds (CRO -100) 10) Refunds/Reimbursements To the Committee (CRO -1240) 11) Other Receipt Sources Its) Interest on Bank Accounts (CRO -1250) l lb) Contributions from Not -for -Profit Organizations (CRO -1250) Ile) Outside Sources of Income (CRO -1250) l ld) Legal Expense Fund — Other Sources (CRO -1270) 11 e) Exempt Purchase Price Sales (CRO -1265) $ 0 S 0 $ $ $ 5.00 $ 5.00 S $ $ $ $ 2000.00 $ 2000.00 $ $ S $ $ $ $ $ S $ $ $ 12) 13) 14) 15) 16) 17) TOTAL RECEIPTS (Add lines 5.6. 7.8. 9, 10. Ila. 11A 11c.11dand Ile) ENDITURES Disbursements 139) Operating Expenditures (CRO -1310) 13b) Contributions to Candidates/Political Committees / �(CRRO-1310) 13c) Coordinated Party Expenditures R1=(`_vE`l5fQ1310) G Aggregated Non -Media Expenditures R&1315) AUG 2 "t 2is2'� Loan Repayments (CR0.1420) Refunds/Reimbursements From the Con)lp�0. 802nd Oi E�CRta1320) In -Kind Contributions (CR&ISIO) $ 2005.00 $ 2005.00 $ $ $ $ $ $ $ $ $ S S $ $ 5.00 $ 5.00 18) TOTAL EXPENDITURES (Add lutes 130, 13b, Be, 14, 15, 16ard17) S 5.00 S 5.00 19) Cash on Hand at End (Addhne, 1 and12loged¢r, diexsubtracl6ne 18) DITIONAL INFORMATIO $ 2000.00 $ 2000.00 20) 21) 22) 23) 24) 25) 26) 27) 28) Non-Monetan Gifts Given to Other Committees (CRO -1330) Outstanding Loans (incl ones from other campaigns) (CRO -1430) Debts and Obligations owed By the Committee (CRO -1610) Debts and Obligations owed To the Committee (CRO -1620) Account Transfers Within the Committee (CRO -1720) Administrative Support (CRO -1710) Forgiven Loans (CRO -1440) 48 -Hour Notice Reports Sum (CRO -2220) Contributions to be Refunded (CRO -1215) $ $ $ $ $ $ $ $ $ $ $ $ $ CRO -1100 NC State Board of Elections August 2008 Amendment Contributions from Individuals Pg I of I ❑ ves ® No Use this form to report individual contributions over $50 or contributions under $50 if form CRO 1205 is not used 1. Committee Full Name and Fund if applicable) 2. ID Number Anne M. Simpson for Commissioner LJM10X 3. Contributor Information ® Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip) b. Job Tine/Profession d. Comments RN Filing Fee Anne M. Simpson 2517 Trading Ford Dr Waxhaw NC 28173 c. Employer's Name/Specific Field Novant Health C. Election Sum to Date $ 5.00 L Prior g. Account Code h. Form of Payment i. In -Kind Description j. Date (mm/dd/yyyy) h. Amount ❑ Cash Filing Fee 07/07/2023 $ 5.00 ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name. Mailing Address & Phone (include city, state, & zip) b. Job Title/Profession d. Comments c. Employer's Name/Specific Field e Election Sam to Date f. Prior g. Account Code h. Form of Payment 1. In -Kind Description j. Date (mm/ddlyyyy) K Amount ❑ $ ❑ $ 3. Contributor Information ❑ Add ❑ Remove a. Full Name, Mailing Address & Phone (include city, state, & zip)fr— b. Job Title/Profession d. Comments EIVEU R EC AUG 2 2 2023 Union Co. Board of Elections e. Employer's Name/Specific Field e. Election Sum to Date $ L Prior g. Account Code It. Form of Payment L to -Kind Description j. Date (mm/dd/yyyy) b. Amount ❑ $ ❑ $ ❑ $ 4. Total only this Page $ 5.00 5. Total of ALL CRO -1210 Pages $ 5.00 (This line mast be on fine 6 ojDerafied Summmry Page CR0.1100) CRO -1110 NC Slate Board of Elections April 2007 Amendment In -Kind Contributions Pg ? of 1 ❑_Yeas ® No Use this form to report non-monelary contributions, donations, goods or services provided to the committee or fund. Use CRO -1215 if In -Kind Contributions were or will be refunded within 7 days. 1. Committee Fu0 Name (and Fund if applicable) 2. ED Number Anne M. Simpson for Commissioner 3. Contributor Information El Add ORemove . Full Name, Mailing Address & Phone b. Type of Contributor C. Comments W Individual (include city, stale, & zip) ❑ Candidate Campaign filing fee Anne Marie Simpson ❑ Patty 2517 Trading Ford Dr. ❑PAC Waxhaw, NC 28173 ❑ Referendum d. Flection Sum to Date ❑ Other Receipt Source $5 . Description L Date (moIddlyyyy) g. Fair Market Amount 0710712023 $5 Campaign filing fee $ 3. Contributor Information OAdd 0 Remove . Full Name, Mailing Address & Phone b. Type of Contributor c. Comments state, (include city,& � Individual — — ❑ Candidate q 11,L 0 N23 ❑ Patty ❑ PAC E�ec6ons ❑ Referendum d. Election Sum to Date d( d of ❑ Other Receipt Source $ . Description L Date (mm/ddlyyyy) g. Fair Market Amount $ $ . Contributor Information ❑ Add E3Rennove . Full Name, Mailing Address & Phone b. Type or Contributor c. Comments linclude city, state, & zip) ❑ Individual ❑ Candidate ❑ Party ❑ PAC ❑ Referendum d. Election Sum to Date ❑ Other Receipt Source $ . Description L [Ate (mm/ddfyyyy) g. Fair Market Amoss( $ $ 4. Total only this Page s 61 5. Total of ALL CRO -1510 Pages ti s (This Bne must be online 17 of Detailed Summary Page CRO -1100) CRO -1510 NC State Board of Elections December 2007 Amendment Loan Proceeds Pg 1 or 1 ❑ Yes ® No Use this form to report proceeds from a loan and loan endorser's information A loan omceeds statement must acconmanv each loan that is from an individual 1. Committee Fall Name (and Fund fiaPplicable) Anne M. Simpson for Commissioner 2. ED Number 3. Lender Information ® Add Remove . Full Name, Mailing; Address & Phone (include city. state. & zip) _ Anne Marie Simpson 2517 Trading Ford Dr. Waxhaw, NC 28173 b. Job Tide/Profession d. Comments Registered Nurse e. Stan (mmtddtyyyy) cEmployer's Nane/SpeciacField -Date 07/0512023 Novant Health L End Date(aunlddlyyyy) . Rateb. S! ty Pledged t. Account Code Form of Payment L Amount $ 2000 0� 4 wxw Debit . Fall Name of Lending lttetltotlun m. Loun Number 1 d. Endorsers/Makers (Thr people who guarantee the loan.) a. Full Name, Mailing Address & Phone (include city, state, &zip) b. Job Title(Profession c. Employer's Name/Specific Field - -- RECEIVED (UL 0 7 27c3 d. Percentage - — — e. Amount — a. Full Name, Maaitg_,AddrL,s (inrlude city, state, & zip( b. Job Intle/Profession c. Employer's Name/SpeciRc Field d. Percentage e. Amount 5'0 $ . Full Name, Mailing Address & Phone (include city, stale, & zip) b. Job TladProtessioo c, Employer's Name/Specific Field d. Percentage z%n e. Amount $ . Full Name, Mailing Address & Phone (include city. state, & zipg b. Job Tlde/Profession c. Employer's NamelSpecific Field d. Percentage % e. Amount 5. Total of ALL CRO -1410 Pages (This line must he on titre 9 of Detailed Summary Page CRO -1100) S 2000 CRO -1410 � ( ,Gate Board of fikctions April 2007 3n NORTH CAROLINA STATE BOARD OF ELECTIONS Loan Proceeds Statement This Statement is used to report detailed information about a new loan and is required to accompany the Loan Proceeds Form in the report for which the loan is initially disclosed. If the loan is from an individual, the lender's signature is required on this form. This Statement is to be filed with the Election Board where the committee's reports are filed. • Name of committee to receive loan: Anne M. Simpson for Commissioner • Person or committee to make loan: Anne Marie Simpson • Date of loan to committee: July 5, 2023 • Name of lending institution (source): • Amount of loan: $2000 • Description (if in-kind loan): • Names of all parties responsible for payment of loan (guarantors): • Period of loan: • Rate of interest of loan: • Security pledged for loan: I, Anne Marie Simpson acknowledge that all of the information (Person lending money to committee) provided is complete, true, and accurate. I further understand I may not forgive a loan that hnano tt{ standing balance to any source. Is h Sign,Ature, of Lender Signatufe of Treasurer of Committee CRO -6 100 Loan Prur Crib' Slalonent Date Signed July 5, 2023 Date Signed