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Amended Annual Year End Supplemental (2011) for INDEPENDENT MEDICINE'S PAC-TN submitted on 05/03/2012

Beginning Balance

$71,247.90

Receipts

Monetary Contributions, Unitemized
$3,961.49
Monetary Contributions, Itemized
Contributor C/P Date Amount
DOANE , JACK
2628 ALCOA HWY
ALCOA , TN 37701
SALES
CLAYTON HOMES
07/28/2010 $55.00
MANSFIELD , MARTY
3926 FOUNTAIN VALLEY ROAD
KNOXVILLE , TN 37918
Manager
Clayton Manufacturing
08/11/2010 $150.00
TOTAL CONTRIBUTIONS
(other than adjustments, loans, and interest)
$131,791.49

Contribution Adjustments
$0.00
Loans Received
$0.00
Interest Received This Reporting Period
$0.00
TOTAL RECEIPTS
$131,791.49

Disbursements

Expenditures, Unitemized
$0.00
Expenditures, Itemized
Vendor C/P Purpose In-Kind Independent S/O Date Amount
DAVIS , LINCOLN
629 N. MAIN STREET
JAMESTOWN , TN 38556
CONTRIBUTION 08/24/2010 $500.00
TRUIST BANK
P. O. BOX 622227
ORLANDO , FL 32862
BANK FEES 09/30/2010 $5.00
TRUIST BANK
P. O. BOX 622227
ORLANDO , FL 32862
BANK FEES 08/31/2010 $5.00
TRUIST BANK
P. O. BOX 622227
ORLANDO , FL 32862
BANK FEES 07/31/2010 $5.00
Loan Payments
$0.00
Obligation Payments
$0.00
TOTAL EXPENDITURES
(other than adjustments)
$123,321.53

Expenditures, Adjustments
$0.00
TOTAL DISBURSEMENTS
$123,321.53

Ending Balance

ENDING BALANCE
$79,717.86


Outstanding Loans


TOTAL OUTSTANDING LOAN BALANCE
$0.00

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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