iowa physical therapy pac6078scanned

8/7/2019 Iowa Physical Therapy PAC__6078__scanned

1/7

DR- 2 : Di s c l o s u r e Summar y PageI D : 6 07 8

:

I o wa PACsMi c h a el Mande l ( 5 1 5 ) 2 2 3- 6 1 8 0

me : I o wa P h y s i c a l T h er a p y PAC

R e p o r t Du e Da t e 1 0 / 1 9 / 2 00 4Co mmi t t ee C h a i r Dav i d S c o t t ( 31 9 ) 3 32 - 5 4 9 3

S t a t u s : O r i g

N o t i c e o f D i s s o l u t i o n N/ A

S t a t e me nt o f Ca s h On Hand

A d d i t i o n a l As s e t s an d L i a b i l i t i e s

Or i gT h i s Re p o r t Was Pr i n t e d Wi t h T h e I C FRS So f t wa r e o n 1 0 1 1 4 1 2 0 0 4 0 8 : 2 4 : 0 7 AM

FORMDR-2 DI SCLOSUREI CF RS 4 / 9 8 1 REPORT

F o r O f f i c e Us e On l yComm #I n d e x e dA u d i t e dCo mp u t e r

6 0 7 8

L oan s i n P l a c e a t S t a r t o f P e r i o d $ 0 . 0 0Sc h e du l e D UnPa i d B i l l s $ 0 . 0 0

Sc h e d u l e E I n - K i n d C o n t r i b u t i o n s $ 0 . 0 0Sc h e du l e F Ou t s t a n d i n g L oan s $ 0 . 0 0

Sc h d u l e G C o n s u l t a n t B r e ak d o w n ? NoSc h e d u l e H : Camp a i g n P r o p e r t y Va l u e $ 0 . 0 0

F o r g i v e n Lo an s ( Fr o m Sc h e d u l e E ) $ 0 . 0 0

Cas h On Hand a t S t a r t o f P e r i o d $ 3 , 3 82 . 2 7Sc h e du l e A Cas h C o n t r i b u t i o n s T o t a l $ 2 , 4 5 0 . 0 0

Sc h e d u l e F L oan s Re c e i v e d T o t a l $ 0 . 0 0Sc h e d u l e H C ampa i g n P r o p e r t y S a l e s $ 0 . 0 0

SUB - TOTAL $ 5 , 8 32 . 2 7Sc h e du l e B : E x p e n d i t u r e s T o t a l $ 9 2 5 . 0 0

Sc h e du l e F Loan Repa ymen t s T o t a l $ 0 . 0 0Ca s h o n Hand A t En d o f P e r i o d $ 4 , 9 07 . 2 7


2/7

ORI GI NAL

T h i s Re p o r t Wa s P r i n t e d Wi t h Th e I CFRS So f t wa r e o n 1 0 / 1 4 / 2 0 0 4 0 8 : 2 4 : 3 0 AM

P a g e T o t a l $ 7 7 5 . 0 0

P a g e 1 o f 4( f o r s c h e d u l e A )

ULE A C o n t r i b u t i o n s - Mo n e y T a k e n I n SCHEDULE MONET ARYD : 6 0 7 8 A RECE I PTSI CFRS 1 2 / 9 9e I o wa Ph ys i c a l Th e r a p y PAC ORI GI NAL

: I o wa PACsCo mmi t t e e I D

a t e R e l a t i o n s h i p Amoun tv e d Ch e c k # Na me a n d Ad d r e s s o f C o n t r i b u t o r To Ca n d i d a t e R e c e i v e dB e l l , S u s a n No R e l a t i o n $ 2 5 . 0 0

Chk# 3 5 5 8 2 0 9 5 S t r a t f o r d Dr ( F r o m F u n d R a i s e r )M a r i o n I A 5 2 3 0 2

2 0 0 4 B l a n k e r s , Su s a n No R e l a t i o n $ 5 0 . 0 0Chk# 2 3 0 5 5 1 5 Ce n t r a l Av e NE ( F r o m F u n d R a i s e r )Or a n g e C i t y I A 5 1 0 4 1

2 0 0 4 B o s s e n , Dr e w No R e l a t i o n $ 2 5 0 . 0 0Chk# 5 2 9 5 4 1 9 1 We s t c o t t Dr NE ( F r o m F u n d R a i s e r )I o w a C i t y I A 5 2 2 4 0

C l a r k , S t e v e n R No R e l a t i o n $ 2 5 0 . 0 02 3 8 6 Sc e n i c V i e w D r ( F r o m F u n d R a i s e r )A d e l I A 5 0 0 0 3

Cushman , Ra l p h No R e l a t i o n $ 5 0 . 0 0Chk# 7 3 9 1 1 1 0 1 s o u t h S t a r r Av e ( F r o m F u n d R a i s e r )B u r l i n g t o n I A 5 2 6 0 1

D a v i d , K a t h r y n No R e l a t i o n $ 5 0 . 0 0Chk# 7 6 2 5 3 9 0 4 Wi n d s o r C t ( Fr o m Fu nd R a i s e r )Ames I A 5 0 0 1 4

D i c k k u t , R o b e r t No R e l a t i o n $ 5 0 . 0 0Chk# 2 6 7 7 3 0 5 WJ e f f e r s o n S t ( F r o m F u n d R a i s e r )L a k e C i t y I A 5 1 4 4 9

F i t z p a t r i c k , J u l i e No R e l a t i o n $ 5 0 . 0 0Chk# 3 1 9 2 5 6 5 L i n c o l n s h i r e P I ( F r o m F u n d R a i s e r )Co r a l v i l l e I A 5 2 2 4 1


3/7

ORI GI NAL

T h i s Re p o r t Was P r i n t e d Wi t h Th e I CFRS So f t wa r e o n 1 0 1 1 4 / 2 0 0 4 0 8 : 2 4 : 3 0 AM

P a g e T o t a l $ 7 7 5 . 0

Page 2 o f 4( f o r s c h e d u l e A )

ULE A: Co n t r i b u t i o n s - Mon e y T a k e n I n SCHEDULE MONETARYI D 6 0 7 8 A RECE I PTSe I o wa PAC I CFRS 1 2 / 9 9P h y s i c a l Th e r a p y ORI GI NAL

I o wa PACsCo mmi t t e e I Da t e R e l a t i o n s h i p Amoun t

v e d Ch e c k # Name a n d Ad d r e s s o f C o n t r i b u t o r To Ca n d i d a t e R e c e i v e dH a r t u n g , Sus a n No R e l a t i o n $ 1 0 0 . 0 0Chk# 4 0 4 8 4 1 0 1 T r e e l i n e Dr ( F r o m F u n d R a i s e r )B e t t e n d o r f I A 5 2 7 2 2

H a z e l l , Pa m No R e l a t i o n $ 2 5 0 . 0 0Chk# 2 2 9 0 2 2 0 E a s t 1 7 t h ( F r o m F u n d R a i s e r )Wa s h i n g t o n I A 5 2 3 5 3

J a c o b u s s e , Do n No R e l a t i o n $ 1 0 0 . 0 0Chk# 3 4 2 7 2 0 2 Ro b i n s o n Dr ( F r o m F u n d R a i s e r )A l g o n a I A 5 0 5 1 1

J i c i n s k y , J u d i t h No R e l a t i o n $ 1 0 0 . 0 0Chk# 1 2 7 1 1 0 0 1 Mu l b e r r y P I ( F r o m F u n d R a i s e r )C o r a l v i l l e I A 5 2 2 4 1

K e i m , L a n d o n No R e l a t i o n $ 5 0 . 0 0Chk# 2 1 7 8 6 0 7 E 1 8 t h S t ( F r o m F u n d R a i s e r )A t l a n t i c I A 5 0 0 2 2

L a r a b e e , B r i d g e t No R e l a t i o n $ 5 0 . 0 0Chk# 1 6 9 2 8 2 0 N o r t h w e s t e r n D r ( F r o m F u n d R a i s e r )St o r m L a k e I A 5 0 5 8 8

L a s s e n , Di a n a No R e l a t i o n $ 1 0 0 . 0 0Chk# 1 0 1 3 7 1 9 2 1 H i g h l a n d C t ( F r o m F u n d R a i s e r )C l i n t o n I A 5 2 7 3 2

Ma n c h e s t e r , S h e r y l No R e l a t i o n $ 2 5 . 0 0Chk# 3 6 9 3 4 1 7 C h e r r y H i l l Rd NW ( F r o m F u n d R a i s e r )Ce d a r Ra p i d s I A 5 2 4 0 5


4/7

ORI GI NAL

T h i s Re p o r t Was P r i n t e d Wi t h Th e I CFRS So f t wa r e o n 1 0 1 1 4 1 2 0 0 4 0 8 : 2 4 : 3 0 AM

P a g e T o t a l $ 5 4 5 . 0 0

Pag e 3 o f 4( f o r s c h e d u l e A )

5DULE A C o n t r i b u t i o n s - Mo n e y T a k e n I n SCHEDULE MONETARYI D 6078 A RECE I PTSe I o wa PAC I CFRS 1 2 / 9 9Ph y s i c a l Th e r a py ORI GI NAL

I o wa PACsCo mmi t t e e I Da t e R e l a t i o n s h i p Amoun t

v e d Ch e c k # Name a n d Ad d r e s s o f C o n t r i b u t o r To C a n d i d a t e Re c e i v e dM a y , Mi c h a e l No R e l a t i o n $ 1 0 0 . 0 0Chk# 3 6 6 2 8 0 2 2 n d S t SE ( F r o m F u n d R a i s e r )Or a n g e C i t y I A 5 1 0 4 1

2 0 0 4 R e i n i g , L i n d a No R e l a t i o n $ 5 0 . 0 0Chk# 7 3 7 1 2 5 5 1 V i e nn a Av e ( F r o m F u n d R a i s e r )Po r t s mo u t h I A 5 1 5 6 5

2 0 0 4 R i s i n g e r , P a t t y No R e l a t i o n $ 5 0 . 0 0Chk# 2 4 9 3 8 2 1 0 Go o d m a n Dr . ( F r o m F u n d R a i s e r )De s Mo i n e s I A 5 0 3 2 2

2 0 0 4 S a w y e r , E r i n No R e l a t i o n $ 1 0 0 . 0 01 8 2 We s t s i d e Dr # 1I o wa C i t y I A 5 2 2 4 6 ( F r o m F u n d R a i s e r )

2 0 0 4 S c h i n z e l , Mi c h a e l No R e l a t i o n $ 1 0 0 . 0 01 2 0 0 S Ri d g e RdOs c e o l a I A 5 0 2 1 3 ( F r o m F u n d R a i s e r )

2 0 0 4 S c o t t , P e g g y No R e l a t i o n $ 2 5 . 0 0Chk# 7 7 3 8 3 0 8 6 K Av e ( F r o m F u n d R a i s e r )A d e l I A 5 0 0 0 3

2 0 0 4 Sk o gman , S u s a n No R e l a t i o n $ 2 0 . 0 0Chk# 2 7 8 0 1 0 1 2 Av e K ( F r o m F u n d R a i s e r )Ha w a r d e n I A 5 1 0 2 3

2 0 0 4 S t r u b , C h a r l o t t e No R e l a t i o n $ 1 0 0 . 0 0Chk# 3 0 3 3 2 2 2 9 Gr e e n w o o d Av e ( F r o m F u n d R a i s e r )Ce d a r F a l l s I A 5 0 6 1 3


5/7

ORI GI NAL P a g e T o t a l $ 3 5 5 . 0 0R e p o r t T o t a l $ 2 , 4 5 0 . 0 0

P a g e 4 o f 4T h i s Re p o r t Was P r i n t e d Wi t h Th e I CFRS So f t wa r e o n 1 0 / 1 4 / 2 0 0 4 0 8 : 2 4 : 3 0 AM ( f o r s c h e d u l e A )

LE A : C o n t r i b u t i o n s - Mo n e y T a k e n I n SCHEDULE MONETARYI D 6 0 7 8 A RECEI PTSe I o wa PAC I CFRS 1 2 / 9 9P h y s i c a l Th e r a p y ORI GI NALI o wa PACs

Co mmi t t e e I Da t e R e l a t i o n s h i p Amoun tv e d Che ck # Name a n d Ad d r e s s o f C o n t r i b u t o r To C a n d i d a t e Re c e i v e d

2 0 04 T a y l o r , Wi l l i a m No R e l a t i o n $ 2 0 0 . 0 0P h y s i c a l T he r a p y D e p t . Wa v e r l y M u n i c i p a l H o s p ( F r o m F u n d Ra i s e r )Wa v e r l y [ A 5 0 6 7 7

2 0 04 U n i t e mi z e d C o n t r i b u t i o n ( s ) - No c o n t a c t r e q u i r e d $ 3 0 . 0 0( F r o m F u n d Ra i s e r )

2 0 04 We l l s , L i l i m o r e No R e l a t i o n $ 5 0 . 0 0Chk# : 2 5 7 9 3 0 0 S 6 t h S t ( F r o m F u n d Ra i s e r )F a i r f i e l d I A 5 2 5 5 6

2 0 04 Z a l e t e l , My r t l e No R e l a t i o n $ 2 5 . 0 0Chk# : 2 2 6 5 3 9 3 3 6 4 t h S t ( F r o m F u n d Ra i s e r )De s Mo i n e s I A 5 0 3 2 2

4 Y o r k , An n M. No R e l a t i o n $ 5 0 . 0 0Chk# : 1 1 2 4 1 49 8 2 Ha wt h o r n DrDe s Mo i n e s I A 5 0 3 2 5EXPLANATI ON : C o n t r i b u t i o n


6/7

ORI GI NAL Page T o t a l $ 2 7 5 . 0 0Page 1 o f 2T h i s Re p o r t Was P r i n t e d Wi t h Th e I CFRS So f t wa r e o n 1 0 / 1 4 / 2 0 0 4 0 8 : 2 4 : 3 7 AM ( f o r s c h e du l e B )

EDULE B : E x p e n d i t u r e s - - Money S pe n t F r o m Co mmi t t e e A c c o u n t SCHEDULE MONETARYI D : 6 0 7 8 B EXPENDI TURESI CFRS 1 2 / 9 9

: I o wa Ph y s i c a l T h e r a p y PAC ORI GI NAL: I o wa PACs

a t e C o mmi t t e e I D Name a n d A d d r e s s T o Whom E x p e n d i t u r e Amount E x p e n d e dC h e c k # ( D i s b u r s e me n t ) Was Made/ 2 0 0 4 I D : 7 3 4 C i t i z e n s Co mmi t t e e f o r Ed F a l l o n $ - 5 0 . 0 01 3 2 1 8 t h S t

De s Mo i n e s I A 5 0 3 1 4REVERSE TRANSACTI ON : R e v e r s e u n c a s h e d c h e c k # 1 5 4 5 d t d 1 2 - 2 2 - 0 3

/ 2 0 0 4 I D : 7 3 4 C i t i z e n s Co mmi t t e e f o r Ed F a l l o n $ - 5 0 . 0 01 3 2 1 8 t h S tDe s Mo i n e s I A 5 0 3 1 4

REVERSE TRANSACTI ON : R e v e r s e u n c a s h e d c h e c k # 1 5 3 5 d t d 1 2 - 2 2 - 0 3

McCa s k e y , J o d y $ - 5 0 . 0 03 5 1 3 5 4 7 t h S tAmes I A 5 0 0 1 0

REVERSE TRANSACTI ON : R e v e r s e u n c a s h e d c h e c k # 1 5 1 8 d t d 1 0 - 1 - 0 3

I D : 1 1 2 3 Rae c k e r f o r S t a t e R e p r e s e n t a t i v e Co mmi t t e e $ - 5 0 . 0 08 0 1 9 Sh a r o n D r i v eUr b a nd al e I A 5 0 3 2 2

REVERSE TRANSACTI ON : R e v e r s e u n c a s h e d c h e c k # 1 4 8 6 d t d 1 - 6 - 0 3

I D : 1 2 1 6 E l g i n f o r S t a t e R e p r e s e n t a t i v e ( n e w) $ 1 0 0 . 0 0C h k # : 1 5 8 9 6 9 4 0 Bo wman La ne NECe d a r Ra p i d s I A 5 2 4 0 2POL I T I CAL CONTRI BUTI ON :

/ 2 0 0 4 I D : 9 9 7 F r i e n d s f o r Di x $ 2 0 0 . 0 0C h k # : 1 5 8 2 PO Bo x 2 2 0S h e l l Ro c k I A 5 0 6 7 0POL I T I CAL CONTRI BUTI ON :

I D : 1 5 8 4 F r i e n d s f o r Ru s s Wi e s l e y $ 7 5 . 0 0C h k # : 1 5 9 0 8 0 5 Wa l n u t Ri d g e DrWa u k e e I A 5 0 2 6 3POL I T I CAL CONTRI BUTI ON :

I D : 1 3 5 6 Qu i r mb a c h f o r Se n at e $ 1 0 0 . 0 0C h k # : 1 5 8 6 1 0 0 2 J a r r e t t C i r c l eAmes I A 5 0 0 1 4P OL I T I CA L CONTRI BUTI ON :


7/7

ORI GI NAL Page T o t a lRe p o r t T o t a l

$ 6 5 0 . 0 0$ 9 2 5 . 0 0

Page 2 o f 2T h i s Re p o r t Was Pr i n t e d Wi t h Th e I CFRS So f t wa r e o n 1 0 1 1 4 1 2 0 0 4 0 8 : 2 4 : 3 7 AM ( f o r s c h ed u l e B )

B : E x p e n d i t u r e s - - Mone y S p e n t Fr o m C o mmi t t e e A c c o u n t SCHEDULE MONETARYI D : 6 0 7 8 B EXPENDI TURESI CFRS 1 2 / 9 9e : I o wa P h y s i c a l T he r a p y PAC ORI GI NAL

: I o wa PACsa t e Co mmi t t e e I D Name a n d Ad d r e s s T o Whom Ex p en d i t u r e Am o u n t E x p e n d e d

Ch e c k # ( Di s b u r s e men t ) Was Made/ 2 0 0 4 I D : 1 5 6 1 S a n d e f o r H o u s e o f R e p r e s e n t a t i v e s $ 7 5 . 0 0

Ch k # : 1 5 8 7 2 9 0 5 Gr e e n e S tA d e l I A 5 0 0 0 3P OL I T I CA L CONTRI BUTI ON :

/ 2 0 0 4 I D : 1 5 1 3 S a n d s f o r S t a t e Se n a t e $ 7 5 . 0 0Ch k # : 1 5 8 5 2 9 2 2 3 7 t h S tDe s Mo i n e s I A 5 0 3 1 0P OL I T I CA L CONTRI BUTI ON :

/ 2 0 0 4 I D : 9 1 3 Th e C a r r o l l Co mmi t t e e ( n e w ) $ 2 0 0 . 0 0Ch k # : 1 5 8 3 2 4 4 4 00 t h A v e n u eG r i n n e l l I A 5 0 1 1 2P OL I T I CA L CONTRI BUTI ON

I D : 1 2 1 1 T y m e s o n f o r H o u s e $ 7 5 . 0 0Ch k # : 1 5 8 8 1 5 2 4 Hi g h wa y 1 6 9Wi n t e r s e t I A 5 0 2 7 3POL I T I CAL CONTRI BUTI ON :

I D : 1 5 2 1 Z a u n f o r Se n a t e $ 7 5 . 0 0Ch k # : 1 5 8 4 7 1 2 5 Do u g l a s Av eDe s Mo i n e s I A 5 0 3 2 2P OL I T I CA L CONTRI BUTI ON :

/ 2 0 0 4 I D : 4 4 0 V o l u n t e e r s f o r Mag g i e Ti n s ma n 1 $ 1 5 0 . 0 0Ch k # : 1 5 9 1 2 8 6 5 H i c k o r y H i l l s L nB e t t e n d o r f I A 5 2 7 2 2POL I T I CAL CONTRI BUTI ON :

iowa physical therapy pac__6078__scanned

Documents

iowa physical therapy pac6078scanned