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Home My WebLink AboutFriends of Greg Rothman - 2016 30-Day Post Election Commonwealth of Pennsylvania Page 1 of CAMPAIGN FINANCE REPORT (COVER PAGE) (NOTE: This report must be clear and legible. It may be typed or printed in blue or black ink.) Filer Identification1. 2. 3. Number: p• Report 20150209 Filed By: ` CANDIDATE COMMITTEE LOBBYIST Name of Filing Committee,Candidate or Lobbyist:Friends of Greg Rothman Street Address: P.O. Box 1471 City: Camp Hill State: PA Zip Code: 17001- TYPE OF 6TH TUESDAY 1. 2ND FRIDAY 2. 30 DAY 3. AMENDMENT REPORT PRE-PRIMARY PRE-PRIMARY POST PRIMARY REPORT? YES NO X 6TH TUESDAY 4. 2ND FRIDAY 5. 30 DAY 6. TERMINATION (place X to PRE-ELECTION • PRE-ELECTION POST ELECTION x REPORT? YES NO x the right of - report type) ANNUAL REPORT 7 2016 YEAR / A ( V )CHECK FILING METHOD ONE PAPER X DISKETTE Name of Office Sought by Candidate: DATE OF ELECTION District Office Party County MO. DAY YEAR Number Code Code Code Representative in the General Assembly 11 08 2016 87 STH REP 21 (SEE INSTRUCTIONS FOR CODES) MO. DAY YEAR . MO. DAY YEAR , FOR OFFICE USE ONLY Summary of Receipts1101" 10 25 2016 11 28 2016 and Expenditures from: To • c_a ,..:, A. Amount Brought Forward From Last Report $ 36,740.15 cz c. B. Total Monetary Contributions and Receipts(From Schedule I) $ 8,295.00 - -S Pi C. Total Funds Available(Sum of Lines A and B) $ 45 035.15 r' c--) D. Total Expenditures(From Schedule III) $ 20,384.42 - • Lo E. Ending Cash Balance(Subtract Line D from Line C) $ 24,650.73r'N `0 F. Value of In-Kind Contributions Received(From Schedule II) $ 10,893.64 C: r\,) G. Unpaid Debts and Obligations(From Schedule IV) $ 0.00 `-( CD / I AFFIDAVIT SECTION PART I 7-If this is a'Committee;report,treasurer sign here. If this is a Candidate report,candidate sign here. I swear(or affirm)that this report,including the attached schedules,on paper or computer diskette,are to the best of my owledge and belief true,correct and complete. 1 „ Sworn to and subscribed before me this / f II 2- day of ,4.7.e-Lero *' 20 /4 i. :(!. f iPe . -•m in Report Mal "-fag riS Signaturem Tu Cr:Frni_tSY Amp` Printed Name My commission expires 08 c ,ll,:NWE. < . . —.. k ' ,putrtic 1 Vi qq Li-� D MO. DAY YR. t"<�f,,7:t:� " '' •rea Code Daytime Telephone Number DOUG►-A.gp;tfci D:,uP1ii'„Qt 06 2 19 0:v/” ...-, . 0 PART II -If this is a report of.a Candida :Abe:°:,t.1:. - • m ttee, candidate shall sign here. I swear(or affirm)that to the best of my knowledge and belief this political committee has not violated any provisions of the Act of June 3,1937(P.L.1333,No.320)as amended. Sworn to and subscribed before me this (.A--) / day of 37. .rri.W•*" 20 /4 Sig a re of Candidate / , _ - 1 GR E.G- 8011-1 M/ Sign-ur OF PE SYI.d�4~1A Printed Name 1 My commission expires a& OG -�,�i ON'NEptTH1ALSE' . .1:; I7 5'71- 33 Y5- MO. DAY " 1• KARp-. ata n rea ode Daytime Telephone Number •0UGt-p`ST.RIC r. DaUP111n G 16 p19 Ct.mmission ExPt DSEB-502(7-99) Departme i ureau of Commissions,Elections and Legislation 210 North •, ice Building • Harrisburg,PA 17120-0029 • (717)787-5280 SCHEDULE I Page 2 of CONTRIBUTIONS AND RECEIPTS Detailed Summary Page Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 1. UNITEMIZED GONTRIBTITI S AND RECEIPTS $5OT00 O-R LIESS •ER GlATRIBI.TiTtiR TOTAL for the Reporting Period p. (1) $ 195.00 r2WON1 RT13-511:ONSMIT01 TOI$250?0'O1(FROM�"A`RT ANDIPA i Contributions Received from Political Committees (Part A) $ 100.00 All Other Contributions (Part B) $ 3,500.00 TOTAL for the Reporting Period O. (2) $ 3,600.00 MC-ONiCt 603iIONSIOVERj$250T001(Eall IPARirLejabIPA'12TID) Contributions Received from Political Committees(Part C) $ 3,000.00 All Other Contributions(Part D) $ 1,500.00 TOTAL for the Reporting Period pp. (3) $ 4,500.00 F3OiTiergiRrCEITAS$RMWDS31N-illy E ill RNEDIRETielaNEDIGI EC S, ETG. EROMIt?ARAE) TOTAL for the Reporting Period Or. (4) $ 0.00 TOTAL MONETARY CONTRIBUTIONS AND RECEIPTS DURING THIS REPORTING PERIOD (Add and enter amount totals from Boxes $ 8,295.00 1, 2, 3 and 4;also enter this amount on Page 1, Report Cover Page, Item B.) DSEB-502(7.99) PART A Page of • CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEES $50.01 TO $250.00 Use this Part to itemize only contributions received from political committees with an aggregate value from $50.01 to $250.00 in the reporting period. Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of Contributing Committee .7.1v1677 WAVE EAR $ 100.00 Eckert Seamans PA Government PAC 10 26 2016 Mailing Address 1Vt0: IDAX `GEAR 600 Grant St 44th Floor $ City State Zip Code(Plus 4) MO:.<QDAY :FEAR` $ Pittsburgh PA _ 15219- PAGE TOTAL Enter Grand Total of Part A on Schedule I, Detailed Summary Page, Section 2. $ 100.00 DSEB-502(7-99) PART B Page of J ALL OTHER CONTRIBUTIONS $50.01 TO$250.00 Use this Part to itemize all other contributions with an aggregate value from $50.01 to$250.00 in the reporting period. (Exclude contributions from political committees reported in Part A.) Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of Contributor MO. DAY YEAR $ 150.00 Edward L Balsavage 10 26 2016 Mailing Address MO. ' DAY YEAR 492 Capitol Hill Rd $ City State Zip Code(Plus 4) MO DAY YEAR Dillsburg PA 17019- Full Name of Contributor MO, DAY YEAR $ 100.00 Susan V Brunoff 11 05 2016 Mailing Address MO. DAY YEAR 334 W Cedar St $ City State Zip Code(Plus 4) MO;. : DAY' YEAR. New Holland PA 17557- Full Name of Contributor MO,. DAY YEAR $ 100. 00 Dennis Burkett 10 26 2016 Mailing Address MO, DAY YEAR 13 Brookwood Ave Suite One City State Zip Code(Plus 4) MO. DAY YEAR Carlisle PA 17015- Full Name of Contributor MO, DAY YEAR $ 125.00 Sherri B Chippo 11 01 2016 Mailing Address MO:, DAY YEAR 1005 Baythorne Dr $ City State Zip Code(Plus 4) MO DAY YEAR Mechanicsburg PA 17050- Full Name of Contributor MOT DAY YEAR $ 250.00 Daniel Deitchman 11 01 2016 Mailing Address MO' DAY' 'YEAR 5060 Ritter Rd Suite B1 City State Zip Code(Plus 4) MO;' DAY YEAR Mechanicsburg PA _ 17055- ._....._,..._. .�.......x_.,.._....._.. ,...,. Full Name of Contributor MO. DAY YEAR $ 100.00 David L Desfor 10 26 2016 Mailing Address MO. DAY YEAR 1943 Monterey Dr $ City State Zip Code(Plus 4) MO. DAY YEAR Mechanicsburg PA 17050- Full Name of Contributor MO., DAY YEAR $ 100.00 Craig Dunkle 10 26 2016 Mailing Address MO:....DAY; . YEAR ; $ 225 Fox Dr City State Zip Code(Plus 4) . MO:` DAY; YEAR' Mechanicsburg PA 17050- _ YEAR Full Name of Contributor MO. DAY YEAR $ 100.00 Shaun R Foote 10 26 2016 Mailing Address MO: DAY YEAR 3 Makenzee Ct City State Zip Code(Plus 4) MO, DAY YEAR. $ Carlisle PA 17015- DSEB-50217-99) PART B Page of ALL OTHER CONTRIBUTIONS $50.01 TO$250.00 Use this Part to itemize all other contributions with an aggregate value from $50.01 to $250.00 in the reporting period. (Exclude contributions from political committees reported in Part A.) Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of ContributorMO, DAY YEAR $ 250. 00 Porsha M Gaughen 10 26 2016 Mailing Address MO.. DAY YEAR 450 Barbara Dr City State Zip Code(Plus 4) MO. DAY YEAR Mechanicsburg PA _ 17050- Full Name of Contributor MO. DAY ,YEAR 4 $ 100.00 Kristin M Gillingham 10 26 2016 Mailing Address MO.' DAY` YEAR 6 Woodmere Dr City State Zip Code(Plus 4) MO. DAY YEAR $ Camp Hill PA 17011- Full Name of Contributor MO. DAY YEAR $ 250.00 Robert Goodling 10 26 2016 Mailing Address MO. DAY YEAR 575 Dogwood Dr $ City State Zip Code(Plus 4) MO, DAY' YEAR Mechanicsburg PA 17055- $ Full Name of Contributor MO. DAY YEAR $ 100.00 Bradley W Gratfius 10 26 2016 Mailing Address MO. DAY YEAR . $ 2790 Sky Top Trl City State Zip Code(Plus 4) "MO, 'DAY'',YEAR`. $ Dover PA 17315- Full Name of Contributor MO. DAY YEAR $ 125.00 William T Habacivch 10 26 2016 Mailing Address MO, DAY YEAR 6346 Pennsboro Dr City State ' Zip Code(Plus 4) MO. 'DAY YEAR $ Mechanicsburg PA 17050- _.._.._ .,,....._ .... ....._.._...._. Full Name of Contributor MO. ;DAY YEAR $ 100.00 Max Hempt 10 26 2016 Mailing Address .-MO, 'DAY . YEAR 205 Creek Rd City State Zip Code(Plus 4) MO. DAY YEAR $ Camp Hill PA 17011- Full Name of ContributorMO. ;DAY. YEARf $ 250.00 Horace Howells 10 26 2016 Mailing Address MO DAY'' YEAR." $ 3045 Ordway St, NW City State Zip Code(Plus 4) MO., DAY YEAR' $ Washington DC 20008- Full Name of Contributor Mtn ,DAY YEAR $ 100.00 Michael J Kushner 10 26 2016 Mailing Address MO. DAY YEAR 2167 Carey Way City State Zip Code(Plus 4) SMO. DAY YEAR $ Humrnelstown PA 17036- DSEB-502(7-99) PART B Page of• ALL OTHER CONTRIBUTIONS $50.01 TO$250.00 Use this Part to itemize all other contributions with an aggregate value from $50.01 to $250.00 in the reporting period. (Exclude contributions from political committees reported in Part A.) Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of Contributor TINOS DA'fI VE $ 100 . 00 Peter J Ostrowski 10 26 2016 Mailing Address , ilVOlt MA'YEAR $ 1213 Hillside Dr _ City State Zip Code(Plus 4) elm DAY YEAR* $ Carlisle PA 17013- Full Name of Contributor Mg OWUrall, $ 100.00 David Padden 10 26 2016 Mailing Address `IMON%WO k YEAR $ 1215 W Powderhorn Rd City State Zip Code(Plus 4) •:0/104)DAYOLowEsAl $ Mechanicsburg PA 17050- Full Name of Contributor >S ftAN Vali Robert C Pantaieo 10 26 2016 $ 100.00 Mailing Address = M.e. NDAYe +NiYE,ARa $ 109 E York St City State Zip Code(Plus 4) NRION 1•1:AY,*.YEAR* $ Biglerville PA 17307- Full Name of Contributor tV1OSYY $ 100.00 John Pohl 10 26 2016 Mailing Address *MOS NOMM,Mrt $ 207 W 1st St City State Zip Code(Plus 4) *MOS MAYA!JiYEAR,Il, $ Boiling Springs PA 17007- Full Name of Contributorb` ' A744t0 $ 250.00 Garrett H Rothman 10 26 2016 Mailing Address 'IMO*lQ ti:)/NY liYEAR► $ 3517 Foxcroft Dr City State Zip Code(Plus 4) lm04.It3AYil (YEAR* $ Camp Hill PA 17011- Full Name of Contributor ralt Y,PAM $ 150.00 Richard A Russell, Jr. 11 05 2016 Mailing Address 0104 MAYA MAR $ 7 Gunpowder Rd City State Zip Code(Plus 4) VMOSif MAW ilEAR01 $ Mechanicsburg PA 17050- Full Name of Contributor M0' IX* 1%E`A`E§ $ Judith E Thomas 10 26 2016 100.00 Mailing Address 01,0*.:*.PoPqgc VENit. $ 407 Pawnee Dr City State Zip Code(Plus 4) IMQ DAY YEAR $ Mechanicsburg PA 17050- Full Name of Contributor MOflAY YEA, Kenneth L Tuckey 11 01 2016 $ 100.00 Mailing Address WOO pat YEAR* $ 408 Meetinghouse Spring Rd City State Zip Code(Plus 4) $MQ*10:4Ym YEAR* $ Carlisle PA 17013- DSEB-502(7-99) PART B Page of ALL OTHER CONTRIBUTIONS $50.01 TO$250.00 Use this Part to itemize all other contributions with an aggregate value from $50.01 to $250.00 in the reporting period. (Exclude contributions from political committees reported in Part A.) Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of Contributor MO . .:DA $ 100.00 Eric S Williams 11 05 2016 Mailing Address DAMd ;DAY ;YEAR $ 5 Graystone Manor Dr City State Zip Code(Plus 4) FitMO,d4DAY ¢YEAR`:L $ Camp Hill PA 17011- Full Name of Contributor SMO 'CLAY :NEAR $ 100.00 Brian N Zulli 10 26 2016 Mailing Address MO s;' V.YEAW"; 1706 Linewood Dr City State Zip Code(Plus 4) Mp ;DAY" YEAS $ Camp Hill PA 17011- , PAGE TOTAL Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2. $ 3,500.00 DSEB-502(7-99) PART C Page of CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEES OVER$250.00 Use this Part to itemize only contributions received from political committees with an aggregate value over$250.00 in the reporting period. Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of Contributing Committee 500.00 Capozzi and Associates PAC 10 26 2016 Mailing Address AMC)*IDAY9■Y,EARI 2933 N. Front St City State Zip Code(Plus 4) IMO*IDAYJ WEAN Harrisburg PA 17110- Full Name of Contributing Committee FMO Uni reM $ 1, 000.00 Comcast Corp. & NBCUNIVERSAL PAC _ 10 26 2016 Mailing Address iMOIIIDAY1&YEAR. One Comcast Center 1701 JFK Blvd City State Zip Code(Plus 4) IMC *'DAY/*YEARI $ Philadelphia PA 19103- Full Name of Contributing Committee $OI ro £ EA t1 $ 500.00 Pennsylvania Residential Owner PAC 11 01 2016 Mailing Address AMON tDAYa WEAN 2205 Strawberry Sq City State Zip Code(Plus 4) I€M0111#DAYg Harrisburg PA 17101- Full Name of Contributing Committee 'MO itIM $ 1, 000.00 Wells Fargo & Co. PA Employees Good Government Fund 10 26 2016 Mailing Address •MO tiDAYI ISY.EARI 301 S College St $ City State Zip Code(Plus 4) IMci111 IDAY4 WEAR.' $ Charlotte NC 28288- PAGE TOTAL Enter Grand Total of Part C on Schedule I, Detailed Summary Page, Section 3. $ 3,000.00 DSEB•502(7-99) PART D Page of ALL OTHER CONTRIBUTIONS OVER$250.00 Use this Part to itemize all other contributions with an aggregate value of over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part C.) Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of Contributor 111110 AY BAR $ R Scott Hartman 10 26 2016 1, 000.00 Mailing Address 71K7:VW7,1'EJ s $ 63 Spruce Dr City State Zip Code(Plus 4) 7M5.7;TD—Ar.7YEAfr $ Gettysburg PA 17325- Employer Name Occupation PA General Certified Appraiser Vice President Employer Mailing Address/Principal Place of Business 121 Buford Ave, Gettysburg, PA 17325 Full Name of Contributor MO 'DAY�'YEAt.,: $ 500.00 Chad W Mullen 10 26 2016 Mailing Address ; RC*T;:DA' YEA t.. 41 King Dr City State Zip Code(Plus 4) i=MCy •`DAY :YE 47. $ Carlisle PA 17015- Employer Name Occupation FXG Sign & Label President Employer Mailing Address/Principal Place of Business 145 Salem Church Rd, Building 2, Mechanicsburg, PA 17050 PAGE TOTAL Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3. $ 1,500.00 DSEB-502(7.99) PARTE Page of OTHER RECEIPTS REFUNDS, INTEREST INCOME, RETURNED CHECKS, ETC. Use this Part to report refunds received, interest earned, returned checks and prior expenditures that were returned to the filer. Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 PAGE TOTAL Enter Grand Total of Part E on Schedule I, Detailed Summary Page, Section 4. $ 0.00 • DSEB-502(7-99) SCHEDULE II Page of IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECEIVED USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS DURING THE REPORTING PERIOD. Detailed Summary Page Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the Reporting Period pi. (1) $ 0.00 2. IN-KIND CONTRIBUTIONS RECEIVED—VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the Reporting Period NO. (2) $ 61.33 3. IN-KIND CONTRIBUTIONS RECEIVED VALUE OVER$250.00(FROM PART 0) TOTAL for the Reporting Period 11110. (3) $ 10,832.31 TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING PERIOD (Add and enter amount totals from Boxes 1, 2, $ 10,893.64 and 3;also enter on Page 1, Report Cover Page, Item F.) DSEB-502(7-99) SCHEDULE II Page of • PART F IN-KIND CONTRIBUTIONS RECEIVED VALUE OF $50.01 TO $250.00 Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of ContributorM©•' DAY;`'Y�� $ 61.33 Pennsylvania ProLife Federation PAC 10 26 2016 Mailing Address '""N10" 57 4800 Jonestown Rd Suite 102 City State Zip Code(Plus 4) ,c AR $ Harrisburg PA 17109- Description of Contribution: Lists Enter Grand Total of Part F on Schedule II, In-Kind Contributions Detailed PAGE TOTAL Summary Page, Section 2. $ 61.33 DSEB-502(7-99) SCHEDULE II Page of PART G IN-KIND CONTRIBUTIONS RECEIVED VALUE OVER$250.00 Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 DATE AMOUNT Full Name of Contributor .O_ ,SAY_ ,:Y,EAC $ 1, 186.49 House Republican Campaign Committee 11 28 2016 Mailing Address 3/[O p ;; ; A� ; P.O. Box 11787 City State Zip Code(Plus 4) ' T40711JA ,4,;; : '7: Harrisburg PA 17108- Employer Name of Contributor Occupation Employer Mailing Address/Principal Place of Business Description of Contribution Data and Printing Full Name of Contributor kVlO.mm E DAT!'NEAR $ Republican Party of Pennsylvania 11 05 2016 2, 171.82 Mailing Address Mb MAY •':l''-EATk7 $ 7,474.00 112 State Street 11 05 2016 City State Zip Code(Plus 4) 1 U-!'7A�1 "YEAf ` Harrisburg PA 17101- Employer Name of Contributor Occupation Employer Mailing Address/Principal Place of Business Description of Contribution Printing Enter Grand Total of Part G on Schedule II, In-Kind Contributions Detailed PAGE TOTAL Summary Page, Section 3. $ 10,832.31 0556-502(7-99) ' SCHEDULE III Page of STATEMENT OF EXPENDITURES Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 To Whom Paid EON EDA"Y� y.EARAmount Hallowell & Branstetter 10 26 2016 L$ 5, 152.28 Mailing Address Description of Expenditure 3031 Logan St Printing and Postage City State Zip Code(Plus 4) Camp Hill PA 17011- To Whom Paid 11.10111I .1 IYEXR! Amount Maverick Finance 10 27 2016 $ 1, 505.30 Mailing Address Description of Expenditure 403 N Second St, 2FL Commission City State Zip Code(Plus 4) Harrisburg PA 17101- To � Whom Paid IM01 IIbAY7 IYEAR1 Amount Carriage House Tavern 10 30 2016 $ 2, 120.00 Mailing Address Description of Expenditure 1582 Holly Pk Food and Beverage City State Zip Code(Plus 4) Carlisle PA 17015- To Whom Paid INICM IDA?I IYEAR1 Amount House Republican Campaign Committee 10 30 2016 $ 10, 000.00 Mailing Address Description of Expenditure P. 0. Box 11787 Contribution City State Zip Code(Plus 4) Harrisburg PA 17108- To Whom Paid i<tVl() ,iDA? &YEAR1 Amount DTR Consulting 11 01 2016 $ 500.00 Mailing Address Description of Expenditure 210 Kelker St Professional Services City State Zip Code(Plus 4) Harrisburg PA 17102- To Whom Paid IMOl IDA.Y1 IYE ;R1 Amount Churchill Strategies, LLC 11 05 2016 $ 500.00 Mailing Address Description of Expenditure 23 N Front St Design City State Zip Code(Plus 4) Harrisburg PA 17101- To Whom Paid IM01I JDAY1WEAR)) Amount Maverick Finance 11 09 2016 $ 354.12 Mailing Address Description of Expenditure 403 N Second St, 2FL Printing City State Zip Code(Plus 4) Harrisburg PA 17101- To Whom Paid I111A11t fit MI Amount Maverick Finance 11 19 2016 $ 252.72 Mailing Address Description of Expenditure 403 N Second St, 2FL Printing and Postage City State Zip Code(Plus 4) Harrisburg PA 17101- Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. PAGE TOTAL *REFER TO INSTRUCTIONS FOR EXPENDITURE CODE NUMBERS. $ 20,384.42 DSEB-502(7-99) SCHEDULE IV Page of 1 STATEMENT OF UNPAID DEBTS Use this Section to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Name of Filing Committee or Candidate Reporting Period Friends of Greg Rothman From 10/25/2016 To 11/28/2016 PAGE TOTAL Enter Grand Total of Unpaid Debts on Page 1, Report Cover Page, Item G. $ 0.00 DSEB-502(7-99)