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Amended Annual Mid Year Supplemental (2013) for EYE M.D.S PAC submitted on 08/27/2013

Beginning Balance

$21,300.46

Receipts

Monetary Contributions, Unitemized
$550.00
Monetary Contributions, Itemized
Contributor C/P Date Amount
GODWIN , JAN
2567 CLAY ST
PADUCAH , KY 42001
RETIRED
SELF
04/08/2010 $500.00
TOTAL CONTRIBUTIONS
(other than adjustments, loans, and interest)
$32,050.00

Contribution Adjustments
$0.00
Loans Received
Loan Source Election Rec'd For Date Amount
Self-Endorsed Primary 06/30/2010 $601.62
Interest Received This Reporting Period
$0.00
TOTAL RECEIPTS
$32,050.00

Disbursements

Expenditures, Unitemized
Purpose Amount
OFFICE SUPPLIES $197.11
Expenditures, Itemized
Vendor C/P Purpose In-Kind Independent S/O Date Amount
THE SHIRT SHACK
5434 NEWBERN-ROELLEN RD
NEWBERN , TN 38059
SIGNS 05/11/2010 $1,204.51
Loan Payments
$0.00
Obligation Payments
$0.00
TOTAL EXPENDITURES
(other than adjustments)
$130.72

Expenditures, Adjustments
$0.00
TOTAL DISBURSEMENTS
$130.72

Ending Balance

ENDING BALANCE
$53,219.74


Outstanding Loans


TOTAL OUTSTANDING LOAN BALANCE
$0.00
Loans Beg Balance Paid End Balance*
Self-Endorsed $0.00 $0.00 $601.62
Self-Endorsed $26.00 $0.00 $26.00
Self-Endorsed $1,783.68 $0.00 $1,783.68

In-Kind Contributions

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

Unitemized
$0.00
Itemized
$0.00
TOTAL IN-KIND CONTRIBUTIONS
$0.00

Obligations

Obligations are not included in the report ending balance.

Unitemized
$0.00
Itemized
$0.00
Obligations, Outstanding from Previous Reports
$0.00
TOTAL OBLIGATIONS OUTSTANDING
$0.00

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