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Zeneca Inc. Political Action Committee
Name Office (if applicable) District (if applicable)
1800 Concord Pike, PO Box 15437, Wilmington, DE, 19850 3022864997
Mailing Address Telephone No.
kelly.rolison@astrazeneca.com
E-Mail Address

 Select Appropriate Box(es)
CANDIDATE PAC POLITICAL PARTY INDEPENDENT EXPENDITURE
NONPROFIT CORP LEGAL DEFENSE FUND AMENDED
Annual Filing - Due January 15, 2012
Period: Jan 01, 2011 - Dec 31, 2011
Report #1 - Due May 22, 2012
Period: Jan 01, 2012 - May 18, 2012
Report #2 - Due June 08, 2012
Period: May 19, 2012 - Jun 07, 2012
Report #3 - Due October 16, 2012
Period: Jun 08, 2012 - Oct 12, 2012
Report #4 - Due November 02, 2012
Period: Oct 13, 2012 - Nov 01, 2012
Report #5 - Due January 15, 2013*
Period: Nov 02, 2012 - Dec 31, 2012
Annual Filing - Due January 15, 2013
Period: Jan 01, 2012 - Dec 31, 2012
FILED
Jan 11 2012
 
ROSS MILLER
SECRETARY OF STATE
FOR OFFICE USE ONLY
      * Report #5 suffices for the 2013 Annual Filing only if Report #'s 1, 2, 3 and 4 are previously filed
1. Total Monetary Contributions Received in Excess of $100
    (See page 1 of instruction sheet)
$ 1,273.64   $ 1,273.64
2. Total Monetary Contributions in the Form of Loans Guaranteed by a 3rd-Party in Excess of $100
    (See page 1 of instruction sheet)
$ 0.00   $0.00
3. Total Monetary Contributions in the Form of Loans that were Forgiven in Excess of $100
    (See page 2 of instruction sheet)
$ 0.00   $0.00
4. Total Amount of Written Commitments for Contributions in Excess of $100
    (See page 2 of instruction sheet)
$ 0.00   $0.00
5. Total Value of In Kind Contributions in Excess of $100
    (See page 2 of instruction sheet)
$ 0.00   $0.00
6. Total Value of Written Commitments for In Kind Contributions in Excess of $100
    (See page 2 of instruction sheet)
$ 0.00   $0.00
7. Total Amount of all Contributions of $100 or less
    (See page 2 of instruction sheet)
$ 0.00   $0.00
8. Total Amount of All Contributions (Add Lines 1 through 7)
    (See page 2 of instruction sheet)
$ 1,273.64   $1,273.64
 
9. Total Monetary Expenses Paid in Excess of $100
    (See page 2 of instruction sheet)
$ 14,500.00   $14,500.00
10. Total Value In Kind Expenses in Excess of $100
    (See page 3 of instruction sheet)
$ 0.00   $0.00
11. Total Amount of all Expenses of $100 or less
    (See page 3 of instruction sheet)
$ 0.00   $0.00
12. Total Amount of All Expenses (Add Lines 9 through 11)
    (See page 3 of instruction sheet)
$ 14,500.00   $14,500.00
 
MUST SELECT AT LEAST ONE:
 I Declare Under Penalty of Perjury That the Foregoing is True and Correct.
 I Declare Under an Oath to God that the Forgoing is True and Correct*
         * A declaration under an oath to God is subject to the same penalties as declaration under penalty of perjury



Kelly Rolison, Treasurer 01/11/2012
Signature Date
 

 MONETARY
 CONTRIBUTIONS
Report Period   # An.
Zeneca Inc. Political Action Committee
Name (print) Office (if applicable) District (if applicable)

MONETARY CONTRIBUTIONS

NAME AND ADDRESS OF PERSON, GROUP OR ORGANIZATION WHO MADE CONTRIBUTIONDATE OF
CONTRIBUTION
AMOUNT OF
CONTRIBUTION
CHECK HERE IF LOANNAME AND ADDRESS OF 3rd PARTY IF LOAN GUARANTEED BY 3rd PARTYNAME AND ADDRESS OF PERSON, GROUP OR ORGANIZATION WHO FORGAVE THE LOAN, IF DIFFERENT THAN CONTRIBUTOR
Donald J. Cleveland Jr.
3330 Mustang St
LAS VEGAS, NV 89108-4941
01/14/2011
01/31/2011
02/15/2011
02/28/2011
03/15/2011
03/31/2011
04/15/2011
04/29/2011
05/13/2011
05/31/2011
06/15/2011
06/30/2011
07/15/2011
07/29/2011
08/15/2011
08/31/2011
09/15/2011
09/30/2011
10/14/2011
10/31/2011
11/15/2011
11/30/2011
12/15/2011
12/30/2011
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
   
Truman Hester III
844 Fulford Ct
HENDERSON, NV 89052-3816
01/14/2011
01/31/2011
02/15/2011
02/28/2011
03/15/2011
03/31/2011
04/15/2011
04/29/2011
05/13/2011
05/31/2011
06/15/2011
06/30/2011
07/15/2011
07/29/2011
08/15/2011
08/31/2011
09/15/2011
09/30/2011
10/14/2011
10/31/2011
11/15/2011
11/30/2011
12/15/2011
12/30/2011
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
   
Melody Wilke
760 Ponderosa Pl
FALLON, NV 89406-4150
01/14/2011
01/31/2011
02/15/2011
02/28/2011
03/15/2011
03/31/2011
04/15/2011
04/29/2011
05/13/2011
05/31/2011
06/15/2011
06/30/2011
07/15/2011
07/29/2011
08/15/2011
08/31/2011
09/15/2011
09/30/2011
10/14/2011
10/31/2011
11/15/2011
11/30/2011
12/15/2011
12/30/2011
$15.00
$15.00
$15.00
$15.00
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
$15.42
   
Mary Smith
1104 Avellino Ln
LAS VEGAS, NV 89144-1200
01/14/2011
01/31/2011
02/15/2011
02/28/2011
03/15/2011
03/31/2011
04/15/2011
04/29/2011
05/13/2011
05/31/2011
06/15/2011
06/30/2011
07/15/2011
07/29/2011
08/15/2011
08/31/2011
09/15/2011
09/30/2011
10/14/2011
10/31/2011
11/15/2011
11/30/2011
12/15/2011
12/30/2011
$14.21
$14.21
$14.21
$14.21
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
$14.67
   

 

 WRITTEN COMMITMENTS Report Period   # An.
Zeneca Inc. Political Action Committee
Name (print) Office (if applicable) District (if applicable)

WRITTEN COMMITMENTS

NAME AND ADDRESS OF PERSON, GROUP OR ORGANIZATION WHO MADE THE COMMITMENTDATE OF
COMMITMENT
AMOUNT OF
COMMITMENT
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

 

 IN KIND CONTRIBUTIONS Report Period   # An.
Zeneca Inc. Political Action Committee
Name (print) Office (if applicable) District (if applicable)

IN KIND CONTRIBUTIONS






 

 WRITTEN COMMITMENTS FOR IN KIND
 CONTRIBUTIONS
Report Period   # An.
Zeneca Inc. Political Action Committee
Name (print) Office (if applicable) District (if applicable)

WRITTEN COMMITMENTS FOR IN KIND CONTRIBUTIONS

NAME AND ADDRESS OF PERSON, GROUP OR ORGANIZATION WHO MADE THE IN KIND WRITTEN COMMITMENTDATE OF IN KIND
WRITTEN COMMITMENT
VALUE OF IN KIND
WRITTEN COMMITMENT
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

 

 EXPENSE CATEGORIES Report Period   # An.
Zeneca Inc. Political Action Committee
Name (print) Office (if applicable) District (if applicable)


Expense Categories (NRS 294A.365)


 CATEGORIES  CODE
 Office expenses A
 Expenses related to volunteers B
 Expenses related to travel C
 Expenses related to advertising D
 Expenses related to paid staff E
 Expenses related to consultants F
 Expenses related to polling G
 Expenses related to special events H
 Expenses related to legal defense fund I
Goods and services provided in kind for which money would  otherwise have been paid
J
Contributions made to: (i) another candidate; (ii) a nonprofit corporation that is registered or required to be registered pursuant to NRS 294A.225; (iii) a PAC that is registered or required to be registered pursuant to NRS 294A.230; or (iv) a Recall Committee that is registered or required to be registered pursuant to NRS 294A.250
K
 Other miscellaneous expenses L










NRS 294A.362 requires “In Kind” contributions and expenses to be reported separately.
 

 MONETARY EXPENSES Report Period   # An.
Zeneca Inc. Political Action Committee
Name (print) Office (if applicable) District (if applicable)

MONETARY EXPENSES

NAME AND ADDRESS OF PERSON, GROUP OR ORGANIZATION WHO RECEIVED THE PAYMENT FOR THE EXPENSECATEGORY
(NRS 294A.365)
DATE OF
EXPENSE
AMOUNT OF
EXPENSE
ELIZABETH HALSETH FOR SENATE
8022 S RAINBOW SUITE 140
LAS VEGAS, NV 89139
K10/28/2011$500.00
Joe Hardy for State Assembly
882 Fairway Dr
Boulder City, NV 89005
K10/28/2011$1,000.00
Friends of Michael Roberson
P.O. Box 97251
Las Vegas, NV 89193
K10/28/2011$1,000.00
Senate Republican Leadership Conference
PO Box 281
Reno, NV 89504-0281
K10/28/2011$1,500.00
Barbara Cegavske for State Senate
6465 Laredo Street
Las Vegas, NV 89117
K10/28/2011$1,000.00
Friends of Joe Heck
12
Las Vegas, NV 89123
K10/28/2011$2,500.00
BRIAN SANDOVAL FOR GOVERNOR
P.O. BOX 370297
LAS VEGAS, NV 89137
K10/28/2011$5,000.00
Committee to Elect Marcus Conklin
2251 N. Rampart Box 305
LAS VEGAS, NV 89128
K10/28/2011$1,000.00
Debbie Smith Campaign
3270 Wilma Dr.
Sparks, NV 89431
K10/28/2011$1,000.00
 
 


 IN KIND EXPENSES Report Period   # An.
Zeneca Inc. Political Action Committee
Name (print) Office (if applicable) District (if applicable)

IN KIND EXPENSES


Prescribed by Secretary of State
NRS 294A.120, 294A.125,
294A.140, 294A.150, 294A.160
294A.200, 294A.210, 294A.220, 294A.362