Transcript
FOR INSTRUCTIONS, SEE BACK OF FORM
COMMITTEE NAME (Must be same as on Statement of Organization)
DISCLOSURE SUMMARY PAGE
Reset Form
(Rev . 12/2005)
DR-2
FORM
I
DISCLOSURE REPORT
Cedar Rapids Physician-Hospital Political Action Committee
IMPORTANT : Indicate by # type of committee you are reporting for: 1 2 J ( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party ( 4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate ( 7 )School Board or Other Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 1.0-)Selpool Board or Other Political Subdivision PAC ( 11 ) Local Ballot Issue CANDIDATE COMMITTEES ONLY : Political Party (if applicable) _y Candidate Name District (if Senate or House)
For Office Use Only Comm . # Logged Scanned Computer Audited File with : Iowa Ethics and Campaign Disclosure Board th 510 E. 12 , Ste. 1A Des Moines, Iowa 50319 Fax: 515-281-3701
Office Sought
Late reports are subject to possible civil and criminal penalties . Pursuant to Iowa Code section 68B.32A(7) the candidate, for a candidate's committee, and the chairperson, for any other type of committee, is the individual responsible for filing timely and accurate reports .
(515)
283-1801
RSON FILING REPORT
TELEPHONE
0 -+DATE SIGNED
Is
I AM FILING A
January 19, 2007
(report date)
REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR . Indicate by # Local Committees, enter Date of Election County & Local Committees, enter County in which Election is held
OCHECK IF AMENDMENT TO REPORT DATED
0
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . (You must continue to file reports until a DR-3 is filed.)
STATEMENT OF CASH ON HAND
CASH ON HAND at the beginning of the reporting period . (Total of all funds held by the committee. This amount MUST be the same as the cash on hand at the end of the last reporting period or must be zero if this is first report filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ ADD TOTAL MONEY TAKEN IN THIS PERIOD Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below) . . . . . . . . . . . . . . . . . . . . . . . . . Schedule F: Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ._ . . . . . . . Schedule H: Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Schedule H applies to Candidates' Committees Only) SUB-TOTAL . . . . . . . . . . . . . .. . . . . . ...$ SUBTRACT TOTAL MONEY SPENT THIS PERIOD Schedule B: Expenditures total (Attach Schedule B) (**also see debts and loans below) . . . . . . . . . . . . . . . . . . Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CASH ON HAND at the end of this reporting period (if final report balance must be zero) (Attach DR-3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ "*UNPAID BILLS From Schedule D - Attach Schedule D $
15,821 .75
0.00 0.00 0. 00
15,821 .75 7, 000.00
0 .00
8,821 .75
0 .00 0.00 0.00
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ **OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ CONSULTANT BREAKDOWN (Schedule G Attached?) CANDIDATE COMMITTEES ONLY: VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) STATE CO MMITTEES : Submit a reconciled campaign account bank statement in January of each year . $
-YES
V
N/A
NO
FOR INSTRUCTIONS, SEE BACK OF FORM
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SCHEDULE (Rev . 07/03)
EXPENDITURES
--
MONEY SPENT FROM COMMITTEE ACCOUNT
B
MONETARY EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS & CAMPAIGN DISCLOSURE BOARD. COMMITTEE NAME (Must be same as on Statement of Organization)
D
CHECK THIS BOX IF AMENDING FORM
Cedar Rapids Physician-Hospital Politial Action Committee
DATE EXPENDED (MM/DD/YR) CANDIDATE ID NUMBER (if applicable) AND PAC CHECK NUMBER NAME AND ADDRESS TO WHOM EXPENDITURE (Disbursement) WAS MADE PURPOSE (DESCRIBE TRANSACTION) AMOUNT EXPENDED
ID# 1324
10-11-06 ,. ,
`' K#
Swati Dandekar 273128thAvenue Marion, IA 52302 Lundby for Iowa Senate P .O . Box 563 Marion, IA 52302 Gipp for Representative Committee 212 High Decorah, IA 52101 Hogg Campaign Committee 2750 Otis Road SE Cedar Rapids, IA 52403 Murphy Campaign Committee 1770 Hale St . Dubuque, IA 52001 Gronstal Campaign Committee 220 Bennett Avenue Council Bluffs, IA 51503 Foege Ro-Election Campaign Comm . 412 4th Ave . S Mt . Vernon, IA 52314 Paulsen Re-Election Cam . Comm . 1305 Kress Parkway Hiawatha, IA 52233
Fundraiser $ Fundraiser
1,000 .00
ID# 952
10-11-06 CK#
1,500 .00
ID# 586
10-11-06
Fundraiser
CK# ID# 1347 CK# ID# 564
500 .00
10-11-06
Fundraiser
1,000 .00
10-11-06
Fundraiser 500 .00 Fundraiser
CK#
ID#
10-11-06
1612
CK#
ID#
500 .00
10-11-06
887
Fundraiser 500 .00
CK#
ID#
10-11-06
1318
Fundraiser
CK#
500 .00
SUB-TOTAL
$ 6,000 .00 $
TOTAL (if last page of this schedule) THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .) Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee. (Refer to Schedule G instructions and Iowa Code 68A.402(3)(i).) Page 1 of 2
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM
Reset Form
'
SCHEDULE (Rev . 07/03)
EXPENDITURES
--
MONEY SPENT FROM COMMITTEE ACCOUNT
B
MONETARY EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS & CAMPAIGN DISCLOSURE BOARD. COMMITTEE NAME (Must be same as on Statement of Organization) Cedar Rapids Physician-Hospital Political Action Committee DATE EXPENDED (MM/DD/YR) CANDIDATE ID NUMBER (if applicable) AND PAC CHECK NUMBER ID# 1586 11-11-06 Ck I D# 11-11-06 CK# 1D# CK# 1D# CK# I D4 C K# 1D# CK# 1D# CK# 1D# CK# 1602 NAME AND ADDRESS TO WHOM EXPENDITURE (Disbursement) WAS MADE PURPOSE (DESCRIBE TRANSACTION)
CHECK THIS BOX IF AMENDING FORM
AMOUNT EXPENDED
Art Staed
2905 Alleghany DR NE Cedar Rapids, IA 52402 Tyler Olson
Fundraiser $ Fundaiser 500.00 500 .00
395 Memorial Drive SE Cedar Rapids, IA 52403
SUB-TOTAL TOTAL (if last page of this schedule) THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:
$ 1,000 .00 $ 7,000.00
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .) Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee . (Refer to Schedule G instructions and Iowa Code 68A.402(3)(i) .)
(for Schedule B)