201601289004684252

01/28/2016 16 : 11
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PAGE 1 / 37
REPORT OF RECEIPTS
AND DISBURSEMENTS
FEC
FORM 3
1.
For An Authorized Committee
NAME OF
COMMITTEE (in full)
Office Use Only
Example: If typing, type

over the lines.
TYPE OR PRINT
12FE4M5
Jason Lewis for Congress
P.O. Box 515
ADDRESS (number and street)

Check if different
than previously
reported. (ACC)
2.
Cottage Grove
MN
FEC IDENTIFICATION NUMBER
STATE
3. IS THIS
REPORT
C00589234
4. TYPE OF REPORT
(a)
CITY
(Choose One)
(b)
55016
NEW
(N)
ZIP CODE
STATE
DISTRICT
AMENDED
(A)
OR
02
MN
12-Day PRE-Election Report for the:
Quarterly Reports:
Primary (12P)
General (12G)
Convention (12C)
Special (12S)
Runoff (12R)
April 15 Quarterly Report (Q1)

July 15 Quarterly Report (Q2)
M
October 15 Quarterly Report (Q3)
in the
State of
Election on
January 31 Year-End Report (YE)
(c)
30-Day POST-Election Report for the:

General (30G)
Termination Report (TER)
Runoff (30R)
D
Special (30S)
in the
State of
Election on
5.
Covering Period
10
01
2015
through
12
2015
31
I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete.
Type or Print Name of Treasurer
Rita Hillmann Olson

M
Signature of Treasurer
Rita Hillmann Olson
[Electronically Filed]
Date
01
28
2016
NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C. 437g.
Office
Use
Only
FE5AN018
FEC FORM 3
(Revised 02/2003)
Image# 201601289004684253
SUMMARY PAGE
of Receipts and Disbursements
FEC Form 3 (Revised 02/2003)
PAGE
Page
2 2 / 37
Write or Type Committee Name

M
Report Covering the Period:
From:
10
2015
01
To:
COLUMN A
This Period
6.
102574.00
Total Contribution Refunds

(from Line 20(d)) ..................................
0.00
Net Contributions (other than loans)

(subtract Line 6(b) from Line 6(a)) ......
102574.00
Total Operating Expenditures

(from Line 17) ......................................
12291.08
Total Offsets to Operating

Expenditures (from Line 14) ................
0.00
Net Operating Expenditures

(subtract Line 7(b) from Line 7(a)) ......
12291.08
Cash on Hand at Close of

Reporting Period (from Line 27) .................
90282.92
Debts and Obligations Owed TO

the Committee (Itemize all on
Schedule C and/or Schedule D) ................
0.00
10. Debts and Obligations Owed BY

the Committee (Itemize all on
Schedule C and/or Schedule D) ................
5561.89
(b)
(c)
31
2015
102574.00
0.00
102574.00
12291.08
0.00
12291.08
.
.
Net Operating Expenditures

(a)
(b)
(c)
9.
COLUMN B
Election Cycle-to-Date
Total Contributions
(other than loans) (from Line 11(e)) ....
8.
Net Contributions (other than loans)

(a)
7.
12
.
.
.
For further information contact:

Federal Election Commission
999 E Street, NW
Washington, DC 20463
Toll Free 800-424-9530
Local 202-694-1100
FE5AN018
.
.
.
Image# 201601289004684254
DETAILED SUMMARY PAGE

of Receipts
PAGE
Page
3 3 / 37
Write or Type Committee Name

M
Report Covering the Period:
From:
10
2015
01
To:
31
2015
COLUMN B
COLUMN A
Total This Period
I. RECEIPTS
12
11. CONTRIBUTIONS (other than loans) FROM:

(a)
Individuals/Persons Other Than

Political Committees
(i) Itemized (use Schedule A) ...........
65333.00
37016.00
,
,
,
,
102349.00
,
,
,
,
102574.00
0.00
.0.00
.
0.00
.
,
,
,
,
.0.00
.0.00
.0.00
.0.00
102574.00
65333.00
(ii) Unitemized ....................................

(iii) TOTAL of contributions
from individuals .......................
Political Party Committees .................

Other Political Committees
(such as PACs) ...................................
The Candidate ....................................

TOTAL CONTRIBUTIONS
(other than loans)
(add Lines 11(a)(iii), (b), (c), and (d)) ..
,
,
,
,
,
,
,
,
,
,
.
102349.00
.
0.00
.
0.00
.
225.00
.
102574.00
12. TRANSFERS FROM OTHER

AUTHORIZED COMMITTEES ....................
0.00
13. LOANS:
(a) Made or Guaranteed by the
Candidate ............................................
0.00
,
,
0.00
,
,
14. OFFSETS TO OPERATING

EXPENDITURES
(Refunds, Rebates, etc.) ............................
0.00
15. OTHER RECEIPTS

(Dividends, Interest, etc.) ...........................
0.00
16. TOTAL RECEIPTS (add Lines

11(e), 12, 13(c), 14, and 15)
(Carry Total to Line 24, page 4) ............
102574.00
(b)
(c)
(d)
(e)
(b)
(c)
FE5AN018
All Other Loans...................................

TOTAL LOANS
(add Lines 13(a) and (b)) ....................
37016.00
.
.
.
.0.00
.0.00
225.00
.
.
.
Image# 201601289004684255
DETAILED SUMMARY PAGE

of Disbursements
PAGE
Page
4 4 / 37
COLUMN A
Total This Period
II. DISBURSEMENTS
COLUMN B
17. OPERATING EXPENDITURES .....................
12291.08
12291.08
18. TRANSFERS TO OTHER

AUTHORIZED COMMITTEES .....................
0.00
19. LOAN REPAYMENTS:

(a) Of Loans Made or Guaranteed
by the Candidate .................................
,
,
,
,
,
,
0.00
.0.00
.
0.00
.
0.00
.
,
,
,
,
,
,
.0.00
.0.00
.0.00
,
,
,
0.00
,
,
,
.
0.00
.
0.00
.
,
,
,
,
,
,
.0.00
.0.00
.0.00
TOTAL CONTRIBUTION REFUNDS

(add Lines 20(a), (b), and (c))..............
0.00
.0.00
21. OTHER DISBURSEMENTS .........................
0.00
.0.00
22. TOTAL DISBURSEMENTS

(add Lines 17, 18, 19(c), 20(d), and 21)
12291.08
12291.08
23. CASH ON HAND AT BEGINNING OF REPORTING PERIOD ...............................................
.0.00
24
TOTAL RECEIPTS THIS PERIOD (from Line 16, page 3) .....................................................
102574.00
25. SUBTOTAL (add Line 23 and Line 24) ..................................................................................
102574.00
26. TOTAL DISBURSEMENTS THIS PERIOD (from Line 22) ......................................................
12291.08
27. CASH ON HAND AT CLOSE OF REPORTING PERIOD

(subtract Line 26 from Line 25)..............................................................................................
90282.92
(b)
(c)
Of All Other Loans ..............................

TOTAL LOAN REPAYMENTS
(add Lines 19(a) and (b)) .....................
20. REFUNDS OF CONTRIBUTIONS TO:

(a) Individuals/Persons Other
Than Political Committees ..................
(b)
(c)
(d)
Political Party Committees ..................

Other Political Committees
(such as PACs) ....................................
III. CASH SUMMARY
FE5AN018
.
.
.
.
Image# 201601289004684256
SCHEDULE A (FEC Form 3)

ITEMIZED RECEIPTS
Use separate schedule(s)

for each category of the
Detailed Summary Page
PAGE
FOR LINE NUMBER:

(check only one)
OF
11a
11b
11c
11d
12
13a
13b
14
37
15
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)

Full Name (Last, First, Middle Initial)
A.
John Adams
Date of Receipt
Mailing Address 14224 Aalea path
11
City
State
MN
Rosemount
FEC ID number of contributing

federal political committee.
Name of Employer
Hose/Conveyors Inc.
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
30
Transaction ID : SA11AI.4374
55068
Amount of Each Receipt this Period
Occupation
President
199.00
General
299.00
B.
John Adams
Date of Receipt
Mailing Address 14224 Aalea path
12
City
Rosemount
State
MN

Occupation
Hose/Conveyors Inc.
President
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55068
30
100.00
General
399.00
C.
John Allison
Date of Receipt
Mailing Address 205 Shamrock Trail Road
11
City
Lewisville
State
NC

Name of Employer
Other (specify)
2015
27023
Occupation
Retired
None
Receipt For: 2016

Primary
Zip Code
18
2000.00
,
,
,
,
2299.00
General
2000.00
SUBTOTAL of Receipts This Page (optional) ............................................................................

TOTAL This Period (last page this line number only) ...............................................................
.
.
FEC Schedule A (Form 3) (Revised 02/2009)
Image# 201601289004684257

ITEMIZED RECEIPTS

PAGE
FOR LINE NUMBER:

(check only one)
OF
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Richard Ames
Date of Receipt
Mailing Address 2000 Ames Drive
12
City
State
MN
Burnsville

Name of Employer
Ames Constructions
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
31
55306
Occupation
President
2700.00
General
2700.00
B.
Kristen Anderson
Date of Receipt
Mailing Address 3850 Watertown Rd
12
City
Watertown
State
MN

Zip Code
55359
2015
Name of Employer
Occupation
None
Home Maker
Receipt For: 2016

Primary
Other (specify)
29
1300.00
General
1300.00
C.
Mark Anderson
Date of Receipt
11
City
Maple Plain
State
MN

Name of Employer
Other (specify)
2015
55359
Occupation
Retired
None
Receipt For: 2016

Primary
Zip Code
16
1000.00
,
,
,
,
5000.00
General
1000.00

.
.
Image# 201601289004684258

ITEMIZED RECEIPTS

PAGE
FOR LINE NUMBER:

(check only one)
OF
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Mark Anderson
Date of Receipt
12
City
State
MN
Maple Plain

Name of Employer
None
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
29
55359
Occupation
Retired
1700.00
General
2700.00
B.
Chris Andryski
Date of Receipt
Mailing Address 15037 Hillsdale Trail
12
City
Savage
State
MN

Zip Code
55378
14
2015
Name of Employer
Occupation
Minnesota Financial Solutions
Managing Partner
Receipt For: 2016

Primary
Other (specify)
1000.00
General
1000.00
C.
Michael Bertelson
Date of Receipt
Mailing Address 5301 W 145th St
11
City
Savage
State
MN

Name of Employer
Other (specify)
2015
55378
Occupation
Lead Systems Engineer
Thomson Reuters
Receipt For: 2016

Primary
Zip Code
07
250.00
,
,
,
,
2950.00
General
250.00

.
.
Image# 201601289004684259

ITEMIZED RECEIPTS

PAGE
FOR LINE NUMBER:

(check only one)
OF
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Jay Blanchard
Date of Receipt
Mailing Address 3495 230th St E
12
City
State
MN
Prior Lake

Name of Employer
Safety Signs
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
17
55372
Occupation
Owner
2500.00
General
2500.00
B.
Susan Blanchard
Date of Receipt
Mailing Address 3495 230th St E
12
City
Prior Lake
State
MN

Occupation
Safety Signs
Owner
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55372
17
2500.00
General
2500.00
C.
Nicholas Conant
Date of Receipt
Mailing Address 2412 Garfield Ave
10
City
Minneapolis
State
MN

Name of Employer
Other (specify)
2015
55405
Occupation
Financial consultant
Wells Fargo Advisors
Receipt For: 2016

Primary
Zip Code
27
2700.00
,
,
,
,
7700.00
General
2700.00

.
.
Image# 201601289004684260

ITEMIZED RECEIPTS

PAGE
FOR LINE NUMBER:

(check only one)
OF
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Roger Conant
Date of Receipt
Mailing Address 2 Sunfish Lake
10
City
State
MN
Sunfish Lake

Name of Employer
None
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
15
55118
Occupation
Retired
1000.00
General
1000.00
B.
Terry Considine
Date of Receipt
Mailing Address 4582 S Ulster Street Ste 310
10
City
Denver
State
CO

Occupation
Considine Accounting
Accountant
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
80237
26
1000.00
General
1000.00
C.
Jonathan Cooper
Date of Receipt
Mailing Address 18870 Meadow View Blvd
12
City
Prior Lake
State
MN

Name of Employer
Other (specify)
2015
55372
Occupation
Physician
Health Partners
Receipt For: 2016

Primary
Zip Code
30
500.00
,
,
,
,
2500.00
General
500.00

.
.
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ITEMIZED RECEIPTS

10 OF
PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
William Cooper
Date of Receipt
Mailing Address 200 Lake St E
11
City
State
MN
Wayzata

Name of Employer
TCF
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
18
55391
Occupation
Banker
2700.00
General
2700.00
B.
Chad Crow
Date of Receipt
Mailing Address 8061 Galway Road
10
City
Woodbury
State
MN

Zip Code
55125
2015
Name of Employer
Occupation
State Farm Ins
Insurance Agent
Receipt For: 2016

Primary
Other (specify)
14
1000.00
General
1000.00
C.
Joan Cummins
Date of Receipt
Mailing Address 18850 Northome Blvd
12
City
Deephaven
State
MN

Name of Employer
Other (specify)
2015
55391
Occupation
Home Maker
None
Receipt For: 2016

Primary
Zip Code
22
1350.00
,
,
,
,
5050.00
General
1350.00

.
.
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ITEMIZED RECEIPTS

11 OF
PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Robert Cummins
Date of Receipt
Mailing Address 18850 Northome Blvd
12
City
State
MN
Deephaven

Name of Employer
Primera Tech
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
22
55391
Occupation
CEO
1350.00
General
1350.00
B.
John Czech
Date of Receipt
Mailing Address 5437 Pine Street
12
City
Circle Pines
State
MN

Occupation
TPI, Inc.
Laborer
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55014
16
1000.00
General
1000.00
C.
Thomas Dolphin
Date of Receipt
Mailing Address 110 Bank St SE Apt 2801
12
City
Minneapolis
State
MN

Name of Employer
Other (specify)
2015
55414
Occupation
Banker
21st Century Bank
Receipt For: 2016

Primary
Zip Code
16
500.00
,
,
,
,
2850.00
General
500.00

.
.
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ITEMIZED RECEIPTS

12 OF
PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Dennis Doyle
Date of Receipt
Mailing Address 9924 Dell Road
12
City
State
MN
Eden Prairie

Name of Employer
Wildamere
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
28
55347
Occupation
CEO
1000.00
General
1000.00
B.
Trent Follmer
Date of Receipt
Mailing Address 30781 98th Street NW
10
City
Princeton
State
MN

Zip Code
55371
30
2015
Name of Employer
Occupation
Trent Printing Sign & Printing
Printer
Receipt For: 2016

Primary
Other (specify)
860.00
In-kind - Signage
General
860.00
C.
Rex Foster
Date of Receipt
Mailing Address 2357 Treehaven Dr
11
City
Snellville
State
GA

Name of Employer
Other (specify)
2015
30078
Occupation
Retired
None
Receipt For: 2016

Primary
Zip Code
08
1000.00
,
,
,
,
2860.00
General
1000.00

.
.
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ITEMIZED RECEIPTS

13 OF
PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Jared Gruett
Date of Receipt
Mailing Address 8932 Highview Lane
10
City
State
MN
Woodbury

Name of Employer
4 VG Inc
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
27
55125
Occupation
President/CEO
500.00
General
500.00
B.
Harold Hamilton
Date of Receipt
Mailing Address 1142 97th Lane NW
11
City
Coon Rapids
State
MN

Zip Code
55433
2015
Name of Employer
Occupation
Micro Control Company
Electrical Engineer
Receipt For: 2016

Primary
Other (specify)
18
2000.00
General
2000.00
C.
Daniel Harvey
Date of Receipt
Mailing Address 246 Broadview Drive
10
City
Ridgeland
State
SC

Name of Employer
Hargray Communications
Receipt For: 2016

Primary
Other (specify)
Zip Code
16
2015
29936
Occupation
Network Engineer
500.00
,
,
,
,
3000.00
General
500.00

.
.
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ITEMIZED RECEIPTS

14 OF
PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
James Hasselman
Date of Receipt
Mailing Address 3608 Rae Lane
10
City
State
MN
Woodbury

Name of Employer
None
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
27
55125
Occupation
Retired
250.00
General
250.00
B.
Richard Helgeson
Date of Receipt
Mailing Address 1800 Lakeview Ter
12
City
Long Lake
State
MN

Zip Code
55356
2015
Name of Employer
Occupation
Self-Employed
Small Business Consultant
Receipt For: 2016

Primary
Other (specify)
18
250.00
General
250.00
C.
Steven Henseler
Date of Receipt
Mailing Address 9586 Bailey Road
12
City
Woodbury
State
MN

Name of Employer
Other (specify)
2015
55129
Occupation
Dentist
Self-employed
Receipt For: 2016

Primary
Zip Code
16
250.00
,
,
,
,
750.00
General
250.00

.
.
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ITEMIZED RECEIPTS

15 OF
PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Louis Fors Hill
Date of Receipt
Mailing Address 5793 Royal Oaks Drive
12
City
State
MN
Shoreview

Zip Code
2015
04
55126
Name of Employer
Rockwood Capital Management
Occupation
Administrator
Receipt For: 2016

Primary
Other (specify)
500.00
General
500.00
B.
John Johannson
Date of Receipt
Mailing Address 3408 Zenith Avenue South
12
City
Minneapolis
State
MN

Zip Code
55416
2015
Name of Employer
Occupation
Welsh Companies
Commercial Realtor
Receipt For: 2016

Primary
Other (specify)
31
1000.00
General
1000.00
C.
Nancy Jones
Date of Receipt
Mailing Address 6600 Parkwood Lane
12
City
Edina
State
MN

Name of Employer
Other (specify)
2015
55436
Occupation
Co-owner/CFO
Les Jones Roofing, Inc
Receipt For: 2016

Primary
Zip Code
18
500.00
,
,
,
,
2000.00
General
500.00

.
.
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ITEMIZED RECEIPTS

16 OF
PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Christopher Kauffman
Date of Receipt
Mailing Address 10660 Prairie Lane
11
City
State
MN
Hanover

Name of Employer
K Mfg Inc
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
25
55341
Occupation
Owner
500.00
General
500.00
B.
Ralph King
Date of Receipt
Mailing Address 294 Southern Farm Rd
10
City
Gastonia
State
NC

Zip Code
28056
23
2015
Name of Employer
Occupation
SMSC Gaming Enterprise
Finance
Receipt For: 2016

Primary
Other (specify)
500.00
General
500.00
C.
Jeffrey Kohagen
Date of Receipt
Mailing Address 3799 Cardinal St W
10
City
Rosemount
State
MN

Name of Employer
Other (specify)
2015
55068
Occupation
Consultant
QAD, Inc
Receipt For: 2016

Primary
Zip Code
25
250.00
,
,
,
,
1250.00
General
350.00

.
.
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ITEMIZED RECEIPTS

17 OF
PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Jeffrey Kohagen
Date of Receipt
Mailing Address 3799 Cardinal St W
12
City
State
MN
Rosemount

Name of Employer
QAD, Inc
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
31
55068
Occupation
Consultant
50.00
General
400.00
B.
Keith Kostuch
Date of Receipt
Mailing Address 4511 Lakeview Drive
11
City
Edina
State
MN

Zip Code
55424
28
2015
Name of Employer
Occupation
Keith Kostuch, Sole Prop.
Consultant
Receipt For: 2016

Primary
Other (specify)
500.00
General
500.00
C.
Kevin Larkin
Date of Receipt
Mailing Address 28655 Old Towne Road
12
City
Chisago City
State
MN

Name of Employer
Other (specify)
2015
55013
Occupation
President
Power Dynamics, Inc.
Receipt For: 2016

Primary
Zip Code
11
500.00
,
,
,
,
1050.00
General
500.00

.
.
Image# 201601289004684269

ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Jeffrey Lisko
Date of Receipt
Mailing Address 9116 Stephens Point
12
City
State
MN
Eden Prairie

Name of Employer
MNGI
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
16
55347
Occupation
Gastroenterolist
250.00
General
250.00
B.
James Long
Date of Receipt
Mailing Address 15004 Bluebird St NW
12
City
Andover
State
MN

Occupation
Allina
Physician
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55304
18
250.00
General
250.00
C.
Thomas Lowe
Date of Receipt
Mailing Address 2630 W Lafayette Road
12
City
Excelsior
State
MN

Name of Employer
Other (specify)
2015
55331
Occupation
Executive
Lyman Lumber
Receipt For: 2016

Primary
Zip Code
16
250.00
,
,
,
,
750.00
General
250.00

.
.
Image# 201601289004684270

ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Russell Mace
Date of Receipt
Mailing Address 1401 West 94th St
10
City
State
MN
Bloomington

Name of Employer
Craw, LLC
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
27
55431
Occupation
Sales
2700.00
General
2700.00
B.
Thomas McKay
Date of Receipt
Mailing Address 3449 Ridgeway W
10
City
Woodbury
State
MN

Occupation
Personnel plus
Owner
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55129
12
1000.00
General
1000.00
C.
Douglas McMillan
Date of Receipt
Mailing Address 272 Salishan Drive
12
City
Hudson
State
WI

Name of Employer
McMillan Electric Company
Receipt For: 2016

Primary
Other (specify)
Zip Code
31
2015
54016
Occupation
Business Owner
500.00
,
,
,
,
4200.00
General
500.00

.
.
Image# 201601289004684271

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
James Midtling
Date of Receipt
Mailing Address 822 Bear Paw Trail
12
City
State
MN
Eagan

Zip Code
2015
09
55123
Name of Employer
Midtling Maxillofacial Surgery
Occupation
Maxillofacial Surgeon
Receipt For: 2016

Primary
Other (specify)
500.00
General
500.00
B.
Cushman Minar
Date of Receipt
Mailing Address 4660 Weston Woods Way
12
City
St Paul
State
MN

Occupation
None
Retired
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55127
10
500.00
General
500.00
C.
Richard Morgan
Date of Receipt
Mailing Address 9106 Breckenridge Lane
12
City
Eden Prairie
State
MN

Name of Employer
Bowmanand Brooke, LLP
Receipt For: 2016

Primary
Other (specify)
Zip Code
23
2015
55347
Occupation
Attorney
250.00
,
,
,
,
1250.00
General
250.00

.
.
Image# 201601289004684272

ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Dan Mueller
Date of Receipt
Mailing Address 31319 Lakeview Avenue
12
City
State
MN
Red Wing

Name of Employer
Mueller Ventures, LLC
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
11
55066
Occupation
Self employed
250.00
General
250.00
B.
Ellis Naegele
Date of Receipt
Mailing Address 7993 Via Vecchia
12
City
Naples
State
FL

Zip Code
34108
2015
Name of Employer
Occupation
None
Home Maker
Receipt For: 2016

Primary
Other (specify)
31
2500.00
General
2500.00
C.
Robert Naegele
Date of Receipt
Mailing Address 7993 Via Vecchia
12
City
Naples
State
FL

Name of Employer
Other (specify)
2015
34108
Occupation
Retired
None
Receipt For: 2016

Primary
Zip Code
31
2500.00
,
,
,
,
5250.00
General
2500.00

.
.
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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Jeffrey Nottum
Date of Receipt
Mailing Address 7238 Main Street
12
City
State
MN
Centerville

Name of Employer
Test ER
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
18
55038
Occupation
Tester
250.00
General
250.00
B.
Ryan Novaczyk
Date of Receipt
Mailing Address 708 N 1st #642
12
City
Minneapolis
State
MN

Occupation
NPSL
CFO
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55401
31
1000.00
General
1000.00
C.
Clifford Olson
Date of Receipt
Mailing Address 18787 Hobby Hills Circle
10
City
Prior Lake
State
MN

Name of Employer
National Flooring Equipment
Receipt For: 2016

Primary
Other (specify)
Zip Code
30
2015
55445
Occupation
Business Owner
1000.00
,
,
,
,
2250.00
General
1000.00

.
.
Image# 201601289004684274

ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Michael Plunkett
Date of Receipt
Mailing Address 607 Ivy Falls Ave
11
City
State
MN
Mendota Heights

Zip Code
2015
19
55118
Name of Employer
Consulting Radiologists, Ltd
Occupation
Physician
Receipt For: 2016

Primary
Other (specify)
500.00
General
500.00
B.
Darwin Reedy
Date of Receipt
Mailing Address 51 Peninsula Road
12
City
Dellwood
State
MN

Occupation
Self-employed
Art Dealer
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55110
30
250.00
General
250.00
C.
Warren Roberts
Date of Receipt
Mailing Address 1114 Beaver Creek Pkwy
12
City
Maplewood
State
MN

Name of Employer
Other (specify)
2015
55119
Occupation
Retired
None
Receipt For: 2016

Primary
Zip Code
18
300.00
,
,
,
,
1050.00
General
300.00

.
.
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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Thomas Ryan
Date of Receipt
Mailing Address 14055 Kings Court
12
City
State
MN
Savage

Name of Employer
Ryan Contracting, Inc.
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
23
55378
Occupation
President
250.00
General
250.00
B.
Bron Scherer
Date of Receipt
Mailing Address 617 Turnberry Ct
11
City
Northfield
State
MN

Zip Code
55057
2015
Name of Employer
Occupation
Self Employed
Business Owner
Receipt For: 2016

Primary
Other (specify)
06
1000.00
General
1000.00
C.
Steve Schmidt
Date of Receipt
Mailing Address 5280 Salem Lane
12
City
Loretto
State
MN

Name of Employer
Other (specify)
2015
55357
Occupation
Business Owner
AbeTech
Receipt For: 2016

Primary
Zip Code
30
250.00
,
,
,
,
1500.00
General
250.00

.
.
Image# 201601289004684276

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Tamara Schuette
Date of Receipt
Mailing Address 1446 Englert Road
12
City
State
MN
Eagan

Name of Employer
TCF
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
09
55122
Occupation
Executive
100.00
General
300.00
B.
Tamara Schuette
Date of Receipt
12
City
Eagan
State
MN

Occupation
TCF
Executive
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55122
28
50.00
General
350.00
C.
Tamara Schuette
Date of Receipt
12
City
Eagan
State
MN

Name of Employer
Other (specify)
2015
55122
Occupation
Executive
TCF
Receipt For: 2016

Primary
Zip Code
31
25.00
,
,
,
,
175.00
General
375.00

.
.
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ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Keith Schwartzwald
Date of Receipt
Mailing Address 660 Hidden Creek Trail
12
City
State
MN
Mendota Heights

Name of Employer
None
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
07
55118
Occupation
Retired
250.00
General
250.00
B.
Moe Sharifkhani
Date of Receipt
Mailing Address 833 Park Place Dr
12
City
Mendota Heights
State
MN

Zip Code
55118
2015
Name of Employer
Occupation
Downtowner Woodfire
Business Owner
Receipt For: 2016

Primary
Other (specify)
10
500.00
General
500.00
C.
Steve Smith
Date of Receipt
Mailing Address 3919 Canter Glen Dr
10
City
Eagan
State
MN

Name of Employer
Other (specify)
2015
55123
Occupation
Manager
3M
Receipt For: 2016

Primary
Zip Code
13
500.00
,
,
,
,
1250.00
General
500.00

.
.
Image# 201601289004684278

ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Brian Sullivan
Date of Receipt
Mailing Address 16305 36th Avenue
10
City
State
MN
Minneapolis

Name of Employer
Celcuity
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
19
55340
Occupation
CEO
2700.00
General
2700.00
B.
Blair Tremere
Date of Receipt
Mailing Address P.O. Box 27667
12
City
Golden Valley
State
MN

Occupation
None
Retired
2015
Name of Employer
Receipt For: 2016
Primary
Other (specify)
Zip Code
55427
31
250.00
General
250.00
C.
Jennifer VanDerHorst-Larson
Date of Receipt
Mailing Address 847 Tonkawa Road
12
City
Orono
State
MN

Name of Employer
Vibrant Technologies, Inc.
Receipt For: 2016

Primary
Other (specify)
Zip Code
28
2015
55356
Occupation
CEO
999.00
,
,
,
,
3949.00
General
999.00

.
.
Image# 201601289004684279

ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Scott Weber
Date of Receipt
Mailing Address 2601 Sunset Blvd Apt 3G
12
City
State
MN
Minneapolis

Name of Employer
Self-Employed
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
30
55416
Occupation
Real Estate
2700.00
General
2700.00
B.
Joseph Weis
Date of Receipt
Mailing Address 2227 7th St. NW
11
City
Rochester
State
MN

Zip Code
55901
2015
Name of Employer
Occupation
Weis Builders
Building Contractor
Receipt For: 2016

Primary
Other (specify)
18
250.00
General
250.00
C.
Joseph Weis
Date of Receipt
Mailing Address 2227 7th St. NW
12
City
Rochester
State
MN

Name of Employer
Other (specify)
2015
55901
Occupation
Building Contractor
Weis Builders
Receipt For: 2016

Primary
Zip Code
17
500.00
,
,
,
,
3450.00
General
750.00

.
.
Image# 201601289004684280

ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
John Woodford
Date of Receipt
Mailing Address 5132 W 95th Street
10
City
State
MN
Bloomington

Name of Employer
Union Brass Mfg
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
14
55437
Occupation
Manufacturing
1000.00
General
1000.00
B.
Date of Receipt
Mailing Address
City
State

Name of Employer
Receipt For:
Primary
Other (specify)
Zip Code
Occupation
General
C.
Date of Receipt
Mailing Address
City
State

Name of Employer
Receipt For:
Primary
Other (specify)
Zip Code
Occupation
,
,
,
,
General

1000.00
.
65333.00
.
Image# 201601289004684281

ITEMIZED RECEIPTS

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PAGE
FOR LINE NUMBER:

(check only one)
11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Jason Lewis
Date of Receipt
Mailing Address 3057 Arden Drive
10
City
State
MN
Woodbury

Name of Employer
None
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
09
Transaction ID : SA11D.4195
55129
H6MN02149
Occupation
Retired
100.00
General
100.00
B.
Jason Lewis
Date of Receipt
10
City
Woodbury
State
MN

Zip Code
55129
Occupation
None
Retired
Receipt For: 2016

Primary
Other (specify)
2015
H6MN02149
Name of Employer
12
25.00
General
125.00
C.
Jason Lewis
Date of Receipt
10
City
Woodbury
State
MN

Name of Employer
Other (specify)
2015
55129
H6MN02149
Occupation
Retired
None
Receipt For: 2016

Primary
Zip Code
12
50.00
,
,
,
,
175.00
General
175.00

.
.
Image# 201601289004684282

ITEMIZED RECEIPTS

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11a
11b
11c
11d
12
13a
13b
14
37
15

A.
Jason Lewis
Date of Receipt
10
City
State
MN
Woodbury

Name of Employer
None
Receipt For: 2016
Primary
Other (specify)
Zip Code
2015
14
55129
H6MN02149
Occupation
Retired
50.00
General
225.00
B.
Date of Receipt
Mailing Address
City
State

Name of Employer
Receipt For:
Primary
Other (specify)
Zip Code
Occupation
General
C.
Date of Receipt
Mailing Address
City
State

Name of Employer
Receipt For:
Primary
Other (specify)
Zip Code
Occupation
,
,
,
,
50.00
General

.
225.00
.
Image# 201601289004684283
SCHEDULE B (FEC Form 3)

ITEMIZED DISBURSEMENTS

32 OF
PAGE
FOR LINE NUMBER:

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37
17
18
19a
19b
20a
20b
20c
21

A. Trent Follmer
Date of Disbursement
M
City
Princeton
Purpose of Disbursement
In-kind - Signage
State
MN
Zip Code
55371
2015
30
860.00
Transaction ID : SB17.4502
Category/
Type

House
Senate
President
02
District:
Amount of Each Disbursement this Period
004
Candidate Name
Office Sought:
10
Mailing Address 30781 98th Street NW
Disbursement For: 2016

Primary
Other (specify)
General
MN
State:
B. Jason Lewis
M

City
Woodbury
No vendor aggregates over $200
State
MN
Zip Code
State:
MN
House
17
2015
001
328.32
Category/
Type

Senate
President
02
District:
55129
Candidate Name
Office Sought:
11

Primary
General
Other (specify)
C. Mail Chimp
M
Mailing Address 675 Ponce De Leon Ave NE, Ste 5000

City
Atlanta
Electronic mailing subscription
State
GA
Zip Code
30308
003
MN
01
2015
150.00
House
Senate
President
District:
02

Primary
Other (specify)
General
SUBTOTAL of Disbursements This Page (optional) ..................................................................

FE5AN018
Category/
Type
State:
Candidate Name
Office Sought:
12
,
,
,
,
1338.32
.
.
FEC Schedule B (Form 3) (Revised 02/2009)
Image# 201601289004684284


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37
17
18
19a
19b
20a
20b
20c
21

A. Pac Engine.com
M
Mailing Address 2035 Sunset Lake Road

Suite B-2
City
Newark
Web services
State
DE
Zip Code
19702
2015
31
1339.72
Category/
Type

House
Senate
President
02
District:
001
Candidate Name
Office Sought:
10

Primary
Other (specify)
General
MN
State:
B. Pac Engine.com
M

Suite B-2
City
Newark
Web services
State
DE
Zip Code
State:
MN
House
30
2015
001
834.30
Category/
Type

Senate
President
02
District:
19702
Candidate Name
Office Sought:
11

Primary
General
Other (specify)
C. Pac Engine.com
M

Suite B-2
City
Newark
Web services
State
DE
Zip Code
19702
001
MN
31
2015
963.60
House
Senate
President
District:
02

Primary
Other (specify)
General

FE5AN018
Category/
Type
State:
Candidate Name
Office Sought:
12
,
,
,
,
3137.62
.
.
Image# 201601289004684285


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37
17
18
19a
19b
20a
20b
20c
21

A. Pinnacle Direct
M
City
Stillwater
Direct mail services
State
MN
Zip Code
55082-9575
2015
27
2996.25
Category/
Type

House
Senate
President
02
District:
003
Candidate Name
Office Sought:
11
Mailing Address 15260 113th St North

Primary
Other (specify)
General
MN
State:
B. Pinnacle Direct
M
Mailing Address 15260 113th St North

City
State
MN
Stillwater
Zip Code
State:
MN
House
27
2015
003
1400.00
Category/
Type

Senate
President
02
District:
55082-9575
Candidate Name
Office Sought:
11

Primary
General
Other (specify)
C. Republican Party of Minnesota
M
Mailing Address 2200 E Franklin Ave #201

City
Minneapolis
Table Rental
State
MN
Zip Code
55405
004
MN
09
2015
250.00
House
Senate
President
District:
02

Primary
Other (specify)
General

FE5AN018
Category/
Type
State:
Candidate Name
Office Sought:
11
,
,
,
,
4646.25
.
.
Image# 201601289004684286


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37
17
18
19a
19b
20a
20b
20c
21

A. Stephano's Restaurant
M
City
Burnsville
Campaign kick-off
State
MN
Zip Code
55337
2015
11
600.00
Category/
Type

House
Senate
President
02
District:
007
Candidate Name
Office Sought:
11
Mailing Address 11849 Millpond Avenue

Primary
Other (specify)
General
MN
State:
B. Stephano's Restaurant
M
Mailing Address 11849 Millpond Avenue

City
Burnsville
Campaign kick-off
State
MN
Zip Code
State:
MN
House
18
2015
007
100.00
Category/
Type

Senate
President
02
District:
55337
Candidate Name
Office Sought:
11

Primary
General
Other (specify)
C. Stripe
M
Mailing Address 3180 18th St

City
San Francisco
Online credit card processing
State
CA
Zip Code
94110
001
MN
31
2015
368.57
House
Senate
President
District:
02

Primary
Other (specify)
General

FE5AN018
Category/
Type
State:
Candidate Name
Office Sought:
10
,
,
,
,
1068.57
.
.
Image# 201601289004684287


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37
17
18
19a
19b
20a
20b
20c
21

A. Stripe
M
City
San Francisco
State
CA
Zip Code
94110
2015
30
521.55
Category/
Type

House
Senate
President
02
District:
001
Candidate Name
Office Sought:
11

Primary
Other (specify)
General
MN
State:
B. Stripe
M

City
San Francisco
State
CA
Zip Code
State:
MN
House
31
2015
001
614.97
Category/
Type

Senate
President
02
District:
94110
Candidate Name
Office Sought:
12

Primary
General
Other (specify)

C.
Mailing Address
City
State
Zip Code
Candidate Name
Office Sought:
State:
,
,
,
,
1136.52
Category/
Type
House
Senate
President
District:
Disbursement For:
Primary
Other (specify)
General

FE5AN018
.
11327.28
.
Image# 201601289004684288
SCHEDULE D (FEC Form 3)

DEBTS AND OBLIGATIONS
PAGE
(Use separate
schedule(s)
for each
numbered line)
Excluding Loans
37 OF
37
FOR LINE NUMBER:

(check only one)
9
10

Nature of Debt (Purpose):
A. Full Name (Last, First, Middle Initial) of Debtor or Creditor
Pinnacle Direct
Mailing Address
City
15260 113th St North
State
Zip Code
Stillwater
MN
55082-9575
Transaction ID : SD10.6016
Outstanding Balance Beginning This Period
.0.00
Amount Incurred This Period
5561.89
Outstanding Balance at Close of This Period
Payment This Period
.0.00
B. Full Name (Last, First, Middle Initial) of Debtor or Creditor
5561.89
Mailing Address
City
State
Zip Code
Payment This Period
C. Full Name (Last, First, Middle Initial) of Debtor or Creditor
Mailing Address
City
State
Zip Code
Payment This Period
1) SUBTOTALS This Period This Page (optional) ...................................................................
,
,
5561.89
2) TOTALS This Period (last page this line number only) ......................................................
,
,
3) TOTAL OUTSTANDING LOANS from Schedule C (last page only) ..................................
4) ADD 2) and 3) and carry forward to appropriate line of Summary Page (last page only)
,
,
,
,
.0.00
5561.89
.
.
5561.89
.
FEC Schedule D (Form 3) (Revised 02/2003)
FE5AN018

201601289004684252

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01/28/2016 16 : 11

For An Authorized Committee

Office Use Only

Example: If typing, type

Jason Lewis for Congress

P.O. Box 515

ADDRESS (number and street)

FEC IDENTIFICATION NUMBER

12-Day PRE-Election Report for the:

April 15 Quarterly Report (Q1)

October 15 Quarterly Report (Q3)

January 31 Year-End Report (YE)

30-Day POST-Election Report for the:

Termination Report (TER)

Rita Hillmann Olson

Rita Hillmann Olson

FEC Form 3 (Revised 02/2003)

Write or Type Committee Name

Jason Lewis for Congress

Report Covering the Period:

Total Contribution Refunds

Net Contributions (other than loans)

Total Operating Expenditures

Total Offsets to Operating

Net Operating Expenditures

Cash on Hand at Close of

Debts and Obligations Owed TO

10. Debts and Obligations Owed BY

Net Operating Expenditures

Net Contributions (other than loans)

For further information contact:

DETAILED SUMMARY PAGE

FEC Form 3 (Revised 12/2003)

Write or Type Committee Name

Jason Lewis for Congress

Report Covering the Period:

11. CONTRIBUTIONS (other than loans) FROM:

Individuals/Persons Other Than

(ii) Unitemized ....................................

Political Party Committees .................

The Candidate ....................................

12. TRANSFERS FROM OTHER

14. OFFSETS TO OPERATING

15. OTHER RECEIPTS

16. TOTAL RECEIPTS (add Lines

All Other Loans...................................

DETAILED SUMMARY PAGE

17. OPERATING EXPENDITURES .....................

18. TRANSFERS TO OTHER

19. LOAN REPAYMENTS:

TOTAL CONTRIBUTION REFUNDS

21. OTHER DISBURSEMENTS .........................

22. TOTAL DISBURSEMENTS

23. CASH ON HAND AT BEGINNING OF REPORTING PERIOD ...............................................

TOTAL RECEIPTS THIS PERIOD (from Line 16, page 3) .....................................................

25. SUBTOTAL (add Line 23 and Line 24) ..................................................................................

26. TOTAL DISBURSEMENTS THIS PERIOD (from Line 22) ......................................................

27. CASH ON HAND AT CLOSE OF REPORTING PERIOD

Of All Other Loans ..............................

20. REFUNDS OF CONTRIBUTIONS TO:

Political Party Committees ..................

III. CASH SUMMARY

SCHEDULE A (FEC Form 3)