Amended Annual Mid Year Supplemental (2015) for TENNESSEE CAPTIVE INSURANCE ASSOCIATION INC. PAC submitted on 04/04/2016
Beginning Balance
$12,710.57
Receipts
Monetary Contributions, Unitemized
$0.00
Monetary Contributions, Itemized
| Contributor | C/P | Date | Amount |
|---|---|---|---|
|
MORSE
, CLAUDE
430 DEERFIELD CIRCLE MANCHESTER , TN 37355 RETIRED |
10/09/2014 | $200.00 | |
|
REFUND -- BUSH INSURANCE AGENCY
P.O. BOX 387 MANCHESTER , TN 37355 |
10/07/2014 | $615.30 | |
|
ROBERTS
, JOHN
2747 HILLSBORO BLVD. MANCHESTER , TN 37355 AUTO DEALER SELF-EMPLOYED |
10/07/2014 | $500.00 |
TOTAL CONTRIBUTIONS
(other than adjustments, loans, and interest)
(other than adjustments, loans, and interest)
$3,300.00
Contribution Adjustments
$0.00
Loans Received
$0.00
Interest Received This Reporting Period
$0.00
TOTAL RECEIPTS
$3,300.00
Disbursements
Expenditures, Unitemized
| Purpose | Amount |
|---|---|
| RENT | $98.31 |
| ROOM RENTAL | $30.00 |
Expenditures, Itemized
| Vendor | C/P | Purpose | In-Kind | Independent | S/O | Date | Amount |
|---|---|---|---|---|---|---|---|
|
CLIFTON MILLER
300 N. JACKSON ST. TULLAHOMA , TN 37388 |
UTILITIES | 10/13/2014 | $198.90 | ||||
|
DUSTY'S OUTDOOR MEDIA, LLC
1207 NETWORK CENTRE BLVD., SUITE 3C EFFINGHAM , IL 62401 |
ADVERTISING | 10/13/2014 | $1,200.00 |
Loan Payments
$0.00
Obligation Payments
$0.00
TOTAL EXPENDITURES
(other than adjustments)
(other than adjustments)
$10,264.75
Expenditures, Adjustments
$0.00
TOTAL DISBURSEMENTS
$10,264.75
Ending Balance
ENDING BALANCE
$5,745.82
Outstanding Loans
TOTAL OUTSTANDING LOAN BALANCE
$0.00
| Loans | Beg Balance | Paid | End Balance* |
|---|---|---|---|
|
MCINTOSH
, TERRY
611 CAT CREEK RD MANCHESTER , TN 37355 |
$300.00 | $0.00 | $300.00 |
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