Oct. 10 Pre-General Financial Disclosure - Koellisch, Robert - 10/10/2017CAMPAIGN FINANCIAL DISCLOSURE REPORT
SUMMARY PAGE
(Please Print or Type)
Section I
Name of Candidate or Political Committee and Chairperson
Robert J. Koellisch
RECEIVED & FILED
CITY OF EAGLE
Rev. 12/1i
OCT 1 0 2017
File"
Route to•
Office Sought (if candidate) Jistdct (if any)
City Council 1J
/Owing AddreSS i try and up home I r one
wo71[ rnphe
1434 W Franciscan Dr. i Eagle 83616 208-939-2002 N/A
Name 01 pdithcal treasurer
Tracey L. Koellisch
Maif,ng Address I City and Lip Home Phone work Phone
1434 W Franciscan Dr. I Eagle 83616 '208-939-2002 I N/A
Change of address for: Candidate or Political Committee 0 Political Treasurer 0
Section II TYPE OF REPORT
This filing is an: ® Originaa 0 Amendment
This report is for the penod from 08/28/2017 through 09/30//2017 /
0 7 Day Pre -General Report 0 30 Day Post -General Report
October 10 Pre -General Report
0 Annual Report
Is this a Termination Report: 0 Yes I No
Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES
Directions: If you had no contributions or expenditures during this reporting period, check the box next to the statement below and sign this report.
Be sure to carry forward the appropriate "Calendar Year to Date" figures in Column II, Section IV.
❑ I hereby certify that I have received no contributions and have made no expenditures dunng this reporting period.
Section IV SUMMARY
To reach your Calendar Year to Date figure: Add this report's Column 1 COLUMN I COLUMN II
figures to the Column 11 figures of your previous report (except on line 6). This Penod Calendar Year
to Date
Line 1: Cash on Hand January 1, This Calendar Year* $ XXXXXX $ 0.00
Line 2: Enter Beginning Cash Balance** $ 0.00 $ XXXXXX
Line 3: Total Contributions (Enter amount from line 5, page 2) $ 0.00 $ 0.00
Line 4: Subtotal (Add lines 1, 2 and 3i $ 0.00 $ 0.00
Line 5: Total Expenditures (Enter amount from line 11, page 2) $ 254.70 $ 254.70
Line 6: Enter Ending Cash Balance (Subtract line 5 from line 4) $ -254.70 $ -254.70
Line 7: Outstanding Debt to Date (Enter amount from line 18, page 2) $ 638.71
*This same figure should be entered on line 1 of all reports filed this calendar year.
**This is the figure on line 6 of the last Campaign Financial Disclosure Report filed. If this is your first report, this amount is 0.
Note: The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand.
Section V
ELECTRONIC SUBMITAL
REQUIRED Submit to:
cfr@cltyofeagle.org
208939-8827 FAX
Eagle City Clerk
680 E. Civic Ln.
Eagle, ID 83816
208.839.8813
I Tracey L. Koellisch hereby certify that the information in this
Name of Political Treasurer
report is a true, complete correct C4mpaigninanciat Disclosure Report as required by law.
Ifrrt; ��
QartiiTsurer
Page 1
DETAILED SUMMARY
Name of Candidate or Committee: Robert J. Koellisch
Total This Period
Contributions
T Unitemized Contributions ($50 and less) # of Contributors 0 + $0.00
ZO Itemized Contributions (Total of all Schedule A sheets) + $0.00
30 In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets) + $0.00
® Loans (Total of all New Loan amounts from Schedule 0 sheets) + $0.00
50 Total Contributions (Transfer this figure to page 1, Section IV, Line 3) = $0.00
Expenditures
0 Unitemized Expenditures (Less than $25) # of Expenditures 5 + $89.02
70 Itemized Expenditures (Total of all Schedule B sheets) + $81.68
0 In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets) + $0.00
g0 Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets) + $0.00
1 p Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets) + $84.00
11 Total Expenditures (Transfer this figure to page 1, Section IV, Line 5) = $254.70
Loans, Credit Cards and Debt
12 Outstanding Balance from previous reporting period
13 New Loans received dunng this reporting period
(Total of all New Loan amounts plus Accrued Interest from Schedule D sheets)
14 New Credit Card and Debt incurred this reporting period
(Total of all New Incurred Debt amounts from Schedule E sheets)
Subtotal
16 Repayments of Loans made during this reporting period
(Total of all Loan Repayment amounts from Schedule D sheets)
Q Repayments of Credit Card and Debt this reporting period
(Total of all Debt Repayment amounts from Schedule E sheets)
1 g Total Outstanding Balance at close of this period (Transfer this figure to page 1, Section IV, Line 7)
+ $0.00
+ $0.00
+ $722.71
= $ 722.71
$0.00
$84.00
_ $638.71
Pledged Contributions
1 g Unitemized Pledged Contributions ($50 and Tess) # of Pledges 0 + $0.00
®0 Itemized Pledged Contnbutions this Period (Total of all Schedule F sheets) + $0.00
®1 Total Pledged Contributions this period = $0.00
Page 2
SCHEDULE E - CREDIT CARDS and DEBT
Name of Candidate or Committee: Robert J. Koellisch
Each incurred expense not yet paid (i.e. credit card purchases and debt) should be listed on a separate line. Each time you make purchases with a
credit card or incur debt, it is considered to be a separate item. However, you will maintain a single item for each credit card and add purchases to that
item. Each Creditor listed below with a New Debt amount must have a Schedule E-1 accompanying it. The Schedule E-1 lists where and when the
debt was incurred.
Credit Cards are considered debt to the campaign. Regardless of whether the credit card is repaid when the statement is received, all credit card
transactions will appear on Schedule E and E-1. However, only Repayments of Debt dunng this reporting penod appear in the Expenditure Section of
the Detailed Summary Page.
Any creditor(s) with a balance(s) appearing on the last report must be listed below with the amount in the Previous Balance column. Any new debt
should be listed In the New Debt column, including any accrued interest. If a payment was made on the debt, list it In the Repayments column. Note:
Any debt that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column Is the Previous
Balance plus New Debt Tess any Repayments of Debt.
Name, Mailing Address and Zip Code of Previous Balance of
Creditor debt at the end of the
(Candidate, Individual or Business) last reporting period
1. Cabela's Club Visa
PO Box 82575
Lincoln, NE 68501
2. US Bank
PO Box 790408
St. Louis, MO 63179
3.
4.
5.
6.
0.00
0.00
New Debt amount
incurred during this
reporting period
Date:
9 /2 /17
Amount
$ 638.71
Date:
9 J5 /17
Amount
$ 84.00
Date:
Amount
Date:
/ /
Amount
Date:
—J—J
Amount
Date:
Amount
Previous Incurred
Previous Total: $ 0.00
Repayments of Debt
during this reporting
period
Date:
9 /30 J17
Amount
$ 0.00
Date:
9 J22 /17
Amount
$ 84.00
Date:
_/ /
Amount
Date:
Amount
Date:
Amount:
Date:
—_//
Amount
Balance outstanding
at the end of this
reporting period
638.71
0.00
Repayments Ending Balance
Incurred Total:
(Transfer the combined total of all incurred debt to the $722.71
Detailed Summary, page 2 line 14)
Repayments Total:
(Transfer the combined total of all debt repayments to the $84.00
Detailed Summary, page 2 line 10 & 17)
Ending Balance Total: $638.71
SCHEDULE B
ITEMIZED EXPENDITURES
Twenty -Five Dollars ($25.00) or more this period
Name of Candidate or Committee: Robert J. Koellisch
Purpose Codes (Enter up to 3 purpose codes per expenditure.)
A All Travel Expenses (Airfare, Fuel, Lodging & Mileage)
B Broadcast Advertising (Radio, TV, Internet & Telephone)
C Contributions to Candidates & PAC's
D Donations & Gifts
E Event Expenses
F Food & Refreshments
G General Operational Expenses
H Independent Expenditures
L Literature, Brochures, Pnnting
M Management Services
vale spent rail ruame, mailing Annress and up
1. Facebook.com
1 Hacker Way
Menlo Park, CA 94205
N Newspaper & Other Penodical Advertising
O Other Advertising (Yard Signs. Buttons, etc.)
P Postage
S Surveys & Polls
T Tickets (Events)
U Utilities
W Wages, Salaries, Benefits & Bonuses
Y Petition Circulators
Z Preparation & Production of Advertising
9 1 17
/ /
9 30 17
/ /
2. Fred Meyer Fuel #685
Meridian, ID 83646
3.
6.
7.
8.
9.
10.
crone or Keapient
NOTHING FOLLOWS*
Nage
1
rurpose Loaets) Gash or check
B
A
25.10
56.58
$
$
$
$
Total This Page: $ 81.68
Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7
SCHEDULE E-1 - CREDIT CARD and DEBT ITEMIZATION
Name of Candidate or Committee: Robert J. Koellisch
Name of Creditor from Schedule E: Cabela's Club Visa
Each Creditor listed on Schedule E with a New Debt amount must have a Schedule E-1 accompanying it. The Schedule E-1 lists where and when
the debt was incurred.
Purpose Codes (Enter up to 3 purpose codes per Expenditure.)
Page of
1 I2
A
B
C
D
E
F
G
H
L
All Travel Expenses (Airfare, Fuel, Lodging & Mileage)
Broadcast Advertising (Radio TV. Internet & Telephone)
Contributions to Candidates & PAC's
Donations & Gifts
Event Expenses
Food & Refreshments
General Operational Expenses
Independent Expenditure
Interest Accrued & Finance Charges
Literature, Brochures, Pnnting
M Management Services
N Newspaper & Other Penodical Advertising
0 Other Advertising (Yard Signs, Buttons, etc.)
P Postage
S Surveys & Polls
T Tickets (Events)
U Utilities
W Wages, Salaries, Benefits & Bonuses
Y Petition Circulators
Z Preparation & Production of Advertising
uate cn: urreo run game, Maiimg iwaress ano up L. Oil
1. BuildASign.com
11525A Stonehollow Dr., Suite 100
.9 2 17 Austin, TX 78758
9 7 17
/ /
2. IDGOP
PO Box 2267
Boise, ID 83701
3. Vistaprint.com
275 Wyman Ave
9 8 17 Waltham, MA 02451
4.
5.
6.
7.
9.
e or rxpenoiture
NOTHING FOLLOWS
*****************
rurpose L.00eLs)
0
C, E
L
Total This Page:
Hmounc
368.99
115.00
154.72
$ 638.71
The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor.
SCHEDULE E-1 - CREDIT CARD and DEBT ITEMIZATION
! Name of Candidate or Committee: Robert J. Koellisch
f Name of Creditor from Schedule E: US Bank
Each Creditor listed on Schedule E with a New Debt amount must have a Schedule E-1 accompanying it. The Schedule E-1 lists where and when
he debt was incurred.
Purpose Codes (Enter up to 3 purpose codes per Expenditure.)
'Page of
2 2
A
B
C
D
E
F
G
H
L
All Travel Expenses (Airfare, Fuel, Lodging & Mileage)
Broadcast Advertising (Radio, TV, Internet & Telephone)
Contributions to Candidates & PAC's
Donations & Gifts
Event Expenses
Food & Refreshments
General Operational Expenses
Independent Expenditure
Interest Accrued & Finance Charges
Literature, Brochures, Printing
Are mcurreo
1 Wix.com
9 5 17
2.
3.
4.
1
7.
9.
M Management Services
N Newspaper & Other Periodical Advertising
0 Other Advertising (Yard Signs, Buttons, etc.)
P Postage
S Surveys & Polls
T Tickets (Events)
U Utilities
W Wages, Salaries, Benefits & Bonuses
Y Petition Circulators
Z Preparation & Production of Advertising
run name, mamng Raoress ono up L.oae or txpenanure Irurpose t.oee(s)
NOTHING FOLLOWS
B
Amount
84.00
Total This Page: $ 84.00
The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor.