HomeMy WebLinkAboutPA Association of Ambulatory Surgical Centers - 2016 Annual Report COMMONWEALTH OF PENNSYLVANIA
CAMPAIGN FINANCE STATEMENT
File this in lieu of a full report only if aggregate receipts, expenditures, or
liabilities incurred each did not exceed $250.00 during the reporting period.
. _
FILER IDENTWICATIQN 2007017 REPaRT FLED II. timpiDATi I COMMITTEE 1 X
NUMBER ON BEHALF OF r
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
Pennsylvania Association of Ambulatory Surgical Centers
STREET ADDRESS
423 North 21st Street, Suite 104, American Office Center
CITY STATE ZIP CODE
Camp Hill PA 17011 —...
TYPE OF REPORT NAME OF OFFICE SOUGHT SY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) MO.--.. . DAY , :., sieAliff'
8tRii.ieseki*;',
PREPRIMARY ' : 1 FOR OFFICE Uow."
-.%.,:-:-::.:..;', '.• ' . eo. DAY YEAR MEL DAY YEAR
2. DATES OF .r.7
2,NOITIODAY.,.',, -
, PRE:-P:RIMAY1' REPORTING
PERIOD 01 01 201E TO 12 31 2016 c..-
:::'•:lo-isAi,
POBTPRIMARM:-.; .
CASH BALANCE AT END4
' $ 500.00
OF REPORTING PERIOD: .- .
'•.- 6TI-C,rdesiiA,1 -).- — .
. ..
PRETELECTIDN:-.' ......
TOTAL AMOUNT OF FILER'S .--
i‘2iiriAbkit ' OUTSTANDING DEBTS OR LIABILITIES 0.00
pae7E.LecTiohi ..r.,-
, AT THE END OF REPORTING PERIOD: $
, ;.:.. s...)
1..gi-Dai'
PPST4Ecii6t4. AMENDMENT YES
„IiEPoRT? " NO X
— ,
'
ANNUAl... :.-, ,': L,TERMINATION,-
REPDRT ,;=:-. REPORT?- ED NO X
AFFIDAVIT SECTION
PART I-
If statement is filed on behalf of a Political Committee or Candidates's Committee,the Treasurer must sign here.
If statement is filed on behalf of a Candidate,the Candidate must sign here.
If statement is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
15 DAY OF D-e c ern beA_ 20 i Co SIGNATU ON SUBMITTING REPORT
F. Wilson Wilson Jackson, M. D.
4,42,NO /- -/e5A4,_
AT. PRINTED NAME
?=
MY COMMISSION EXPIRES (1,9[ a 5 ?coo 717 761-0930
' .- .\°_,„,•>c` 15:,1'
MO. DAY YR. AREA CODE DAYTIME TELEPHONE
.0t
d".
PART II-
If
statement is filed on behalf of a Candidate's Authorized Committee, Candidate must sign here.
O'ce
I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS POLITICAL COMMITTEE HAS NOT VIOLATED ANY PROVISIONS IN HE ACT OF
JUNE 3, 1937(P.L. 1333,No.320)AS AMENDED,
SWORN TO AND SUBSCRIBED BEFORE ME THIS
SIGNATURE OF CANDIDATE
DAY OF 20_
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280