7 day Pre General 10-1-17---10-22-17 - Koellisch, Robert - 10/31/2017RECEIVED & FILED
CITY OF EAGLE
CAMPAIGN FINANCIAL DISCLOSURE REPORT
SUMMARY PAGE
(Please Print or Typel File.
Route to:
Section t
Na:re of CardNeta or Parka! Curirmit ar,; c harrw sol
Robert J. Koellisch
mar:.nc x. -cress
1434 W Franciscan Dr.
a,r of i c uti , a ress;urer
Tracey L. Koellisch
Mang Fess
1434 W Franciscan Dr.
cry 3nc Ls�
Eagle 83616
OCT 1 2017
C7:_a Sa,gn' ' Viet ii? amrr
City Council
G r -_ 1 nom r.. (kye
208-939-2002 i N/A
biyam, Zip ih_rr�Ptx iii-.-- orc
Eagle 83616 208-939-2002 ' N/A
Change of address for Candidate or Political Committee D Political Treasure• El
Section H TYPE OF REPORT
This filing is an: ® Original 0 Amendment
This moat is for the period from 10/01/2017 tiro; jgh 1012242017 !
7 Day Pre -General Report
Is tills a Terminatio Report: ❑
0 30 Day Post -General Report
Yes Cd No
❑ Oc tone r 1r Pre-Generai Report
❑ Annual Report
Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES
Directions: If you had no contributions or expenditures daring 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 1 have received no contributions and have made no expenditures during this reporting pesod,
Section IV SUMMARY
To reach your Calendar Year to Date figure: Add this report's Column
figures to the Column II figures of your prevous report (except on line 6).
COLUMN!
This Period
COLUMN II
Calendar Year
to Date
Line 1: Cash on Hand January 1. This Calendar Year' S XXXXXX S 0.00
Line 2: Enter Beginning Cash Balance.'
Line 3: Total Contributions (Enter amount from line 5, page 2)
Line 4: Suototal (Add lines 1, 2 and 3)
Line 5: Total Expenditures (Enter amount from fine 11, page 2)
Line 6: Enter Ending Cash Balance (Subtract line 5 from line 4)
Line 7: Outstanding Debt to Date (Enter amount from line 18, page 2)
a
-254.70
3,001.39
_ 2,746.69
$ 1,399.47
s 1,347.22
S 2,504.61
3,001.39
s 2,746.69
5 1,654.17
s 1,092.52
"Tris same figure should be entered on line i of all reports filed this calendar year_
"This is the '!gure on line 6 of the Fast Campaign Financial Disclosure Report flied_ If this is your first report. this amount is C,
Nets The clo_ng cash balance for the current reporting period appears on the next report as rhe beginning cash on hand.
Section V
ELECTRONIC SUBMITAL
REQUIRED Submit to:
cfrgicityofeagle.org
208-933.6827 FAX
Engin City Clark
660 E. Civic Ln.
Eagle, ID 8361
208-939-6813
I Tracey L. Koellisch
Nam bl Peti;icd Treasurer
report is a true, complete and correct Campaign Figs loofa! Dissclbsure Repo.} as required by law.
. hereby certify that the information ,n this
Page 1
Signature of Political Treasurer
DETAILED SUMMARY
Narne of Candidate or Committee_ Robert J. Koetlisch
Total This Period
Contributions
0 Unitemized Contributions ($50 and less) # of Contributors 7 + $144.00
0 Itemized Contributions (Total of all Schedule A sheets) + $1,700.00
0 In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets) + $
0 Loans (Total of all New Loan amounts from Schedule D sheets) + $1,157.39
O Total Contributions (Transfer this figure to page 1, Section IV, Line 3) _ $3,001.39 v
Expenditures
0 Unitemized Expenditures (Less than $25) # of Expenditures 3 + $34.00
0 Itemized Expenditures (Total of all Schedule B sheets) + $726.76'/
J In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets) + $
g f Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets) + $
CI_(.:) Credit Card and Debt Repayments (Total of ail Repayment amounts from Schedule E sheets) + $638.71 /
• Total Expenditures (Transfer this figure to page 1, Section IV, Line 5) = 51,399.47
Loans, Credit Cards and Debt
2 Outstanding Balance from previous reporting period
New Loans received during 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
Repayments of Loans made during this reporting period
16 (Total of all Loan Repayment amounts from Schedule D sheets)
Repayments of Credit Card and Debt this reporting period
Lr (Total of ail Debt Repayment amounts from Schedule E sheets)
1 g Total Outstanding Balance at dose of this period (Transfer this figure to page 1. Section IV, Line 7)
+ 5638.71
+ $1,157.39 ✓
+ $1 347.22
r. $3.143.32
- 5
$638.71 J
• 52,504.61v
Pledged Contributions
1g, Unitemized Pledged Contributions ($50 and less) # of Pledges + $
c, Itemized Pledged Contributions this Period (Total of all Schedule F sheets) + $
• Total Pledged Contributions this period = $
Page 2
SCHEDULE A
ITEMIZED CONTRIBUTIONS
of more than Fifty Dollars ($50.00) this period
Name of Candidate or Committee: Robert J. Koellisch
Date Received Fut] Nacre, Maiiirxg Address and Zip Code of Contributor
1, Building Contractors Association of Southwestern Idaho, Inc.
10 10 17 6206 N. Discovery Way, Suite A
Boise, ID 83713
2. Boise Regional Realtors
10 20 17 9550 Bethel Ct.
Boise, ID 83709
3. Kellie Ortiz
10 122 117 174 E. Grove Creek Ln.
Eagle, ID 83616
10 122 117
10 122 117
4, Barbara Knuff
1616 S. River Grove Way
Eagle, ID 83616
5. John Ortiz
174 E. Grove Creek Ln.
Eagle, ID 83616
7.
8.
9,
10.
5
[Page o
1 I 1
Cash or Ctieas
1,000.00
$ 1,000.00
Calendar Year -7o -Date
$ 500.00
$ 500.00
Careldar Year -To -Cate
50.00
S
S 50.00
Calendar Year -To -Date
5 100.00
100.00
Ca€eadar Year•T .O+a1e
$ 50.00
50.00
Co idarYear-TT-Crate
$
$
$
$
s
$
Calendar Year•T -C to
Calendar Yea; -To --Data
Calendar Year -To -Date
Calendar Year -To -Date
Calendar Year -To -Date
Total This Page: $1,700.00'
Transfer the combined total of ail Schedule A pages to the Detailed Summary on page 2 line 2.
SCHEDULE B
ITEMIZED EXPENDITURES
Twenty.Fiwe Dollars ($25.0C) or more this period
I Name of Candidate or Committee: Robert J. Koellisch
Purpose Lodes itnter up to 3 Purpose codes per txpersaitUre.)
A All Traver Expenses Chrfare, Fuel, Lodging & Mileage) N Newspaper & Other Periodical Advertising
8 Broadcast Advertising (Radio, DJ, tntemet & Telephone) 0 Other Advertising {Yard Signs. Buttons. etc.)
C Contributions to Candidates & PAC's P Postage
D Donations & Gifts S Surveys & Polis
E Event Expenses T Tickets (Events)
F Food & Refreshments U Utilites
G General Operational Expenses W Wages, Salaries, Benefits & Bonuses
H Independent Expenditures Y Petition Circulators
L Literature, Brochures, Printing Z Preparation & Production of Advertising
M Management Services
a Sart ruu game. Albress ar}n Lip Lone or necipiert irurpose t,00ets; t:asn or uneck
1. USPS P
141 N. Palmetto Ave.
10 2 17 Eagle, ID 83616
10 4 17
2. Stinker #105
434 S. Eagle Rd.
Eagle, ID 83616
10 5 17
10 5 17
3. USPS
141 N. Palmetto Ave.
Eagle, ID 83616
4, Facebook.corn
1 Hacker Way
Menlo Park, CA 94205
5. North Channel Chevron
503 S. Eagle Rd.
10 9 17 Eagle, ID 83616
10 11 17
r
/
10 16 17
t i
10 18 17
! I
1
6, BuildASign.com
11525A Stoneholiow Dr., Suite 100
Austin, TX 75758
7. USPS
141 N. Palmetto Ave.
Eagle, ID 83616
8. Stinker #105
434 S. Eagle Rd.
Eagle, ID 83616
9.
10.
A
P
B
A
P
A
34.00
s
35.15
34.00
S
48,50
�S
Total This Page::
Transfer the combned total of all Schedule B pages to the Detailed Summary on page 2 line 7
41.90
5
s
423.51
68.00
41.70
S 726,76
SCHEDULE D - LOANS
Name of Candidate or Committee: Robert J. Koellisch
Each Lender to your campaign should be listed separately. Each time a loan is received or you loan money to the campaign, it must be listed as a
separate item. Each new loan from any Lender must be listed as a new item from that Lender. You may have the same Lender listed more than once,
Except for a candidate making a loan to his or her own campaign, loans from any Lender cannot exceed contribution limits laid out in
Section 67-6610A. Idaho Code, even it It is repaid in full_
Any loans) with a balance(s) appearing on the last report must be listed below with the amount in the Previous Balance column. Any new loan amounts
should be listed rn the New Loan column. Any interest accrued should be listed in the Interest Accrued column. If a payment was made on the loan. list
it in the Repayments column. Note: Any loan 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 loans and accrued interest less any repayments.
Name, Mailing Address and Zip
Code of Lender
(Candidate. Individual or Business)
1. Robert J. Koellisch
1434 W. Franciscan Dr.
Eagle, ID 83616
2.
3.
5
6.
Previous Total
Previous Balance
of loan at the
end of the last
reporting period
0.00
Previous
$ 0.00
Received Total
(Transfer the combined total of all received loans to the S 1,157, 39
Detailed Summary, page 2 Zine 4'
New Loan amount
received during this
reporting period
Dare:
10 /22 /17
Amount:
5 1,157.39
Dale:
/
Amount
Dale:
Amount:
Date:
Amount
Date:
Interest accrued
during this
reporting period
0.00
Repayments of Loan
during this reporting
period
Date:
Amount
$ 0.00
Date.
Amount:
Date:
/ /
Amount
Date:
/ /
Amount
$
Date:
/
Amount Amount:
$ $
Date: Date:
/ /
/ /
Amount Amount
$ $
Date: Date:
/
Amount Amount
Received
Interest Repayments
Balance
outstanding at
the end of this
reporting period
1,157.39
Ending Balance
Interest Total: $ 0.00
Repayrrents Total:
(Transfer the combined total of all loan repayments to then $ 0.00
Detailed Summary, page 2 line 9 & 16;
Ending Balance Total $1,157.39 ✓
(NOTE: Transfer tate combined total of all Accrued interest and Received Loans to the Detailed Summary. page 2 line 13)
SCHEDULE E - CREDIT CARDS and DEBT
Name of Candidate or Committee: Robert J. Koen inch
Each incurred expense not yet paid (i.e. credit card purchases and debt) should be listed on a separate tine, 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 during this reporting period appear in the Expenditure Section of
the Detailed Summary Page.
Any creditor(s) with a balance(s) appearing an the last report must be listed below with the amount in the Previous Balance column. Any new deist
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 less any Repayments of Debi
Name, Maiing Address and Zip Code of Previous Balance of New Debt amount Repayments of Debt Balance outstanding
Creditor debt at the end of the incurred during this during this reporting at the end of this
(Candidate, Individual or Business) last reporting period reporting period period reporting period
1. Cabela's Club Visa Date: [tate:
PO Box 82575 10 /17 117 10 11 /17
Lincoln, NE 68501 638.71 Amount: Amount 1,347.22
S 1.347.22 $ 638.71
2. Date Date:
/
Amount Amount
5 $
3, Dale' Date:
i 1 l
Amount: Amount
$ $
4, Date: Date:
i / i -____l
Amownt: Amount
S s
5. Date: Date:
/ 1 l !
Amoc:nt: Amount
$ s
6. Date: Date:
1 ! / 1
Amount: Amount
$ $
Previous Incurred Repayments Ending Balance
Previous Total: $ 638.71
Incurred Total:
(Transfer the combined total of ail incurred debt to the S1,347.22
Detailed Summary, page 2 line 14)
Repayments Total: ✓
(Transfer the combined total of all debt repayments to the $ 638.71
Detailed Summary. page 2 line 10 & 17)
Ending Balance Total:
$1,347.22
SCHEDULE E-1 - CREDIT CARD and DEBT ITEMIZATION
;Name of Candidate or Committee: Robert J. Koellisch
(Marne of Creditor from Schedule E: Cabela's Club Visa
Each Creditor listed on Schedule E w to a''1ew Debt amount must have a Schedule E-1 accompanying a. The Schedule E -Hiss where and when
the deli was incurred.
Purpose Codes (Enter up to 3 purpose codes per Expenditure.)
A
B
C
D
G
L
All Travel Expenses (Airfare, Fuel. Lodging & Mileage(
Broadcast Advertising (Radio, TV, Internet & Telephone)
Contributions to Candidates & PAC's
Donations & Gift
Event Experses
Food & Refreshments
General Operational Expenses
Independent Expenditure
Interest Accrued & Finance Charges
Literature, Brochures, Printing
oats incurea
10 17 17
N
0
P
S
T
U
VV
Y
z
Management Services
Newspaper & Other Periodical Advertising
Other Advertising (Yard Signs, Buttons, etc.)
Postage
Surveys & Polls
Tickets (Events)
Uti(ttes
Wages. Salaries. Benefits & Bonuses
Petition Circulators
Preparation & Productcon ofAdvertistrg
P-uu name. MaRang Accress aic ata vice a txpehdre
1, Vistaprint.com
275 Wyman Ave.
Waltham, MA 02451
2.
14.
8.
Furoose k,00etsl Amount
L,P
s
1,347.22
S
Total This Page: $1,347.22
The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor,