Amended Annual Mid Year Supplemental (2021) for TENNESSEE CAPTIVE INSURANCE ASSOCIATION INC. PAC submitted on 01/24/2022

Beginning Balance

Receipts

Contributor	C/P	Date	Amount
BIDWELL , KATE 3579 WATAUGA MEMPHIS , TN 38111 STUDENT UNIVERSITY OF MEMPHIS		09/25/2009	$30.00
GOODWIN , WARREN 112 BOBBY DRIVE FRANKLIN , TN 37069-6440 Architect Retired		09/25/2009	$200.00
HAGAN , JOSEPH 729 N. EVERGREEN ST. MEMPHIS , TN 38107 Architect Architecture, Inc.		9/25/2009	$120.00
PROCTOR , KATHERINE 2429 LAKEMOOR DR. KNOXVILLE , TN 37920 ARCHITECT KSP GALLERY		09/25/2009	$800.00
SHOCKLEY , ROY PO BOX 333 OLD HICKORY , TN 37138 ARCHITECT R. DARWIN SHOCKLEY, ARCHITECT		09/25/2009	$425.00

Disbursements

Vendor	C/P	Purpose	In-Kind	Independent	S/O	Date	Amount
BB&T INSURANCE SERVICES P.O. BOX 890635 CHARLOTTE , NC 28289-0635		Fidelity Bonds				8/07/2009	$100.00
HACKWORTH , JIM THREE ROCKY TOP LANE CLINTON , TN 37716	C	CAMPAIGN CONTRIBUTION				12/15/2009	$250.00
HAYNES , RYAN P.O. BOX 22091 KNOXVILLE , TN 37933	C	CAMPAIGN CONTRIBUTION				12/15/2009	$250.00
LYNN , SUSAN 510 BARTON SHORE CT. LEBANON , TN 37087	C	CAMPAIGN CONTRIBUTION				12/15/2009	$500.00
MCCORMICK , GERALD PO BOX 4741 CHATTANOOGA , TN 37405	C	CAMPAIGN CONTRIBUTION				12/15/2009	$500.00
ODOM , GARY 119 DUNHAM SPRINGS LANE NASHVILLE , TN 37205	C	CAMPAIGN CONTRIBUTION				12/15/2009	$500.00
RICHARDSON , JEANNE 797 N. EVERGREEN MEMPHIS , TN 38107	C	CAMPAIGN CONTRIBUTION				12/15/2009	$250.00
TNPAC 5419 COVE ISLAND KNOXVILLE , TN 37919	P	CAMPAIGN CONTRIBUTION				12/15/2009	$500.00

Ending Balance

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Outstanding Loans

In-Kind Contributions

In-Kind Contributions are not included in the report ending balance.

Obligations

Obligations are not included in the report ending balance.

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