02/15/2017 11 : 38 Image# 201702159049696122 PAGE 1 / 10 REPORT OF RECEIPTS AND DISBURSEMENTS FEC FORM 3X For Other Than An Authorized Committee Office Use Only 1. NAME OF COMMITTEE (in full) Example: If typing, type over the lines. TYPE OR PRINT ▼ 12FE4M5 Americas Health Insurance Plans PAC (America's Health Insurance Plans PAC) 601 Pennsylvania Avenue, NW ADDRESS (number and street) ▼ CITY 4. TYPE OF REPORT (Choose One) (b) Monthly Report Due On: (a) Quarterly Reports: April 15 Quarterly Report (Q1) July 15 Quarterly Report (Q2) October 15 Quarterly Report (Q3) Termination Report (TER) AMENDED (A) Feb 20 (M2) May 20 (M5) Aug 20 (M8) Mar 20 (M3) Jun 20 (M6) Sep 20 (M9) Dec 20 (M12) Apr 20 (M4) Jul 20 (M7) Oct 20 (M10) Jan 31 (YE) Election on (d) 30-Day POST-Election Report for the: Election on ✘ Primary (12P) General (12G) Convention (12C) Special (12S) General (30G) Covering Period 01 01 2017 Nov 20 (M11) (Non-Election Year Only) (Non-Election Year Only) Runoff (12R) in the State of M M / D D / Y Y Y Y Runoff (30R) Special (30S) in the State of M M / D D / Y Y Y Y M M / D D / Y Y Y Y M M / D D / Y Y Y Y 5. ZIP CODE NEW (N) OR 12-Day PRE-Election Report for the: January 31 Year-End Report (YE) July 31 Mid-Year Report (Non-election Year Only) (MY) ✘ (c) STATE ▼ 3. IS THIS REPORT C00106740 20004 ▼ ▼ FEC IDENTIFICATION NUMBER C DC Washington ▼ 2. South Building, Suite 500 Check if different than previously reported. (ACC) through 01 31 2017 I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete. Type or Print Name of Treasurer Signature of Treasurer Tavenner, Marilyn, B., , Tavenner, Marilyn, B., , M M / D D / Y Y Y Y [Electronically Filed] Date 02 15 2017 NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 52 U.S.C. § 30109. Office Use Only FEC FORM 3X Rev. 05/2016 Image# 201702159049696123 SUMMARY PAGE OF RECEIPTS AND DISBURSEMENTS FEC Form 3X (Rev. 05/2016 ) Page 2 Write or Type Committee Name Americas Health Insurance Plans PAC (America's Health Insurance Plans PAC) M M / D D / Y Y Y Y Report Covering the Period: From: 01 01 M M / D D / Y Y Y Y To: 2017 COLUMN A This Period 6. (a) Cash on Hand January 1, (d) Subtotal (add Lines 6(b) and 6(c) for Column A and Lines 6(a) and 6(c) for Column B)................ 7. Total Disbursements (from Line 31)............ 8. Cash on Hand at Close of Reporting Period (subtract Line 7 from Line 6(d)).................. 9. Debts and Obligations Owed TO the Committee (Itemize all on Schedule C and/or Schedule D)................. 10. Debts and Obligations Owed BY the Committee (Itemize all on Schedule C and/or Schedule D)................. ✘ 2017 , , . ▲ ▲ ▲ 51355.78 2017 (c) Total Receipts (from Line 19).............. 31 COLUMN B Calendar Year-to-Date Y Y Y Y (b) Cash on Hand at Beginning of Reporting Period............. 01 , , . ▲ ▲ 51355.78 ▲ , , . ▲ ▲ ▲ 4428.56 4428.56 , , . ▲ ▲ ▲ , , . ▲ ▲ 55784.34 ▲ , , . ▲ ▲ 55784.34 ▲ , , . ▲ ▲ 10500.00 ▲ , , . ▲ ▲ 10500.00 ▲ , , . ▲ ▲ ▲ , , . ▲ ▲ 45284.34 ▲ 45284.34 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 This committee has qualified as a multicandidate committee. (see FEC FORM 1M) For further information contact: Federal Election Commission 999 E Street, NW Washington, DC 20463 Toll Free 800-424-9530 Local 202-694-1100 Image# 201702159049696124 DETAILED SUMMARY PAGE of Receipts FEC Form 3X (Rev. 05/2016 ) Page 3 Write or Type Committee Name Americas Health Insurance Plans PAC (America's Health Insurance Plans PAC) M M / D D / Y Y Y Y M M / D D / Y Y Y Y Report Covering the Period: From: 01 01 To: 2017 COLUMN A Total This Period I. Receipts ▼ 11. Contributions (other than loans) From: (a) Individuals/Persons Other Than Political Committees (i) Itemized (use Schedule A)............. (ii) Unitemized...................................... (iii) TOTAL (add Lines 11(a)(i) and (ii).................. ▼ (b) Political Party Committees................... (c) Other Political Committees (such as PACs)..................................... (d) Total Contributions (add Lines 11(a)(iii), (b), and (c)) (Carry Totals to Line 33, page 5)............... 12. Transfers From Affiliated/Other Party Committees......................................... 13. All Loans Received...................................... 31 2017 COLUMN B Calendar Year-to-Date 0.00 , , . ▲ ▲ ▲ 1115.35 , , . , , . ▲ ▲ 3313.21 ▲ , , . ▲ ▲ 4428.56 ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 4428.56 , , . ▲ ▲ ▲ , , . ▲ ▲ 4428.56 ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ 0.00 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ , , . ▲ ▲ 3313.21 ▲ 4428.56 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 (b) Levin Funds (from Schedule H5).......... 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ (c) Total Transfers (add 18(a) and 18(b))... 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ ▼ 0.00 0.00 4428.56 , , . ▲ ▲ ▲ , , . ▲ ▲ 4428.56 ▲ ▼ 14. Loan Repayments Received........................ 15. Offsets To Operating Expenditures (Refunds, Rebates, etc.) (Carry Totals to Line 37, page 5)................ 16. Refunds of Contributions Made to Federal Candidates and Other Political Committees..................................... 17. Other Federal Receipts (Dividends, Interest, etc.)............................. 18. Transfers from Non-Federal and Levin Funds (a) Non-Federal Account (from Schedule H3).............................. , , . ▲ ▲ 1115.35 ▲ 01 , , . ▲ ▲ ▲ , , . ▲ ▲ 4428.56 ▲ 19. Total Receipts (add Lines 11(d), 12, 13, 14, 15, 16, 17, and 18(c)).......... 20. Total Federal Receipts (subtract Line 18(c) from Line 19).......... 4428.56 Image# 201702159049696125 DETAILED SUMMARY PAGE of Disbursements FEC Form 3X (Rev. 05/2016 ) II. Disbursements ▼ 21. Operating Expenditures: (a) Allocated Federal/Non-Federal Activity (from Schedule H4) (i) Federal Share.............................. (ii) Non-Federal Share....................... (b) Other Federal Operating Expenditures........................................ (c) Total Operating Expenditures (add 21(a)(i), (a)(ii), and (b)).............. 22. Transfers to Affiliated/Other Party Committees.................................................. 23. Contributions to Federal Candidates/Committees and Other Political Committees.................. 24. Independent Expenditures (use Schedule E)........................................ 25. Coordinated Party Expenditures (52 U.S.C. § 30116(d)) (use Schedule F)........................................ Page 4 COLUMN A Total This Period COLUMN B Calendar Year-to-Date 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ , , . ▲ ▲ 10500.00 ▲ , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ 0.00 0.00 , , . ▲ ▲ ▲ 26. Loan Repayments Made............................. 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 27. Loans Made................................................. 28. Refunds of Contributions To: (a) Individuals/Persons Other Than Political Committees.................. 0.00 , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ (b) Political Party Committees.................. (c) Other Political Committees (such as PACs).................................... 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ , , .0.00 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ , , . ▲ ▲ 10500.00 ▲ , , . ▲ ▲ 10500.00 ▲ , , . ▲ ▲ 10500.00 ▲ , , . ▲ ▲ 10500.00 ▲ ▼ (d) Total Contribution Refunds (add Lines 28(a), (b), and (c))............ 0.00 29. Other Disbursements (Including Non-Federal Donations).................................... (b) (c) (ii) "Levin" Share................................. Federal Election Activity Paid Entirely With Federal Funds............... Total Federal Election Activity (add Lines 30(a)(i), 30(a)(ii) and 30(b))...... ▼ 30. Federal Election Activity (52 U.S.C. § 30101(20)) (a) Allocated Federal Election Activity (from Schedule H6) (i) Federal Share................................. 32. Total Federal Disbursements (subtract Line 21(a)(ii) and Line 30(a)(ii) from Line 31)............................................... ▼ 31. Total Disbursements (add Lines 21(c), 22, 23, 24, 25, 26, 27, 28(d), 29 and 30(c))... 0.00 10500.00 0.00 0.00 0.00 Image# 201702159049696126 DETAILED SUMMARY PAGE of Disbursements FEC Form 3X (Rev. 05/2016 ) III. Net Contributions/ Operating Expenditures ▼ Total Contributions (other than loans) (from Line 11(d), page 3)........................... Total Contribution Refunds (from Line 28(d))......................................... Net Contributions (other than loans) (subtract Line 34 from Line 33)................. Total Federal Operating Expenditures (add Line 21(a)(i) and Line 21(b)).......... Offsets to Operating Expenditures (from Line 15, page 3)............................... Net Operating Expenditures (subtract Line 37 from Line 36)................. ▼ 33. 34. 35. 36. 37. 38. Page 5 COLUMN A Total This Period COLUMN B Calendar Year-to-Date , , . ▲ ▲ 4428.56 ▲ , , . ▲ ▲ 4428.56 ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 4428.56 , , . ▲ ▲ ▲ , , . ▲ ▲ 4428.56 ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ 0.00 , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ , , . ▲ ▲ ▲ 0.00 0.00 Image# 201702159049696127 SCHEDULE A (FEC Form 3X) ITEMIZED RECEIPTS FOR LINE NUMBER: (check only one) Use separate schedule(s) for each category of the Detailed Summary Page ✘ 11a 13 PAGE 6 11b 11c 12 14 15 16 OF 10 17 Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee. NAME OF COMMITTEE (In Full) Americas Health Insurance Plans PAC (America's Health Insurance Plans PAC) Full Name of Individual (Last, First, Middle Initial) or Full Organization Name A. Allen, Jeremy, , , Date of Receipt M M / D D / Y Y Y Y Mailing Address 601 Pennsylvania Avenue N.W. 01 Suite 500, South Building City Washington FEC ID number of contributing federal political committee. State DC Zip Code 20004 27 2017 Transaction ID : 2017012417134-2 Amount of Each Receipt this Period C ▲ ▲ ▲ , , . 115.38 Name of Employer (for Individual) Occupation (for Individual) Americas Health Insurance Plans Receipt For: Primary General Other (specify) ▼ Vice President Memo Item Aggregate Year-to-Date ▼ 230.76 ▲ ▲ ▲ , , . Full Name of Individual (Last, First, Middle Initial) or Full Organization Name B. Amontree, Tom, , , Date of Receipt M M / D D / Y Y Y Y Mailing Address 601 Pennsylvania Avenue N.W. Suite 500, South Building City Washington FEC ID number of contributing federal political committee. 01 State DC 27 2017 Transaction ID : 2017012417134-3 Amount of Each Receipt this Period 20004 C Name of Employer (for Individual) Americas Health Insurance Plans Receipt For: Primary General Other (specify) ▼ Zip Code 192.30 ▲ ▲ ▲ , , . Occupation (for Individual) Executive Vice President, Business Aff Memo Item Aggregate Year-to-Date ▼ 384.60 ▲ ▲ ▲ , , . Full Name of Individual (Last, First, Middle Initial) or Full Organization Name C. Berry, Catherine, , , Date of Receipt M M / D D / Y Y Y Y FEC ID number of contributing federal political committee. Zip Code 20004 27 2017 Transaction ID : 2017012417134-4 Amount of Each Receipt this Period C 192.30 , , . Occupation (for Individual) Senior Vice President Clinical Affairs Memo Item Aggregate Year-to-Date ▼ 384.60 ▲ ▲ ▲ , , . SUBTOTAL of Receipts This Page (optional)............................................................................. ▼ Name of Employer (for Individual) Americas Health Insurance Plans Receipt For: Primary General Other (specify) 01 State DC TOTAL This Period (last page this line number only)................................................................ ▼ Mailing Address 601 Pennsylvania Avenue N.W. Suite 500, South Building City Washington 499.98 , , . ▲ ▲ ▲ , , . FEC Schedule A (Form 3X) Rev. 06/2016 Image# 201702159049696128 SCHEDULE A (FEC Form 3X) ITEMIZED RECEIPTS FOR LINE NUMBER: (check only one) Use separate schedule(s) for each category of the Detailed Summary Page ✘ 11a 13 PAGE 7 11b 11c 12 14 15 16 OF 10 17 Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee. NAME OF COMMITTEE (In Full) Americas Health Insurance Plans PAC (America's Health Insurance Plans PAC) Full Name of Individual (Last, First, Middle Initial) or Full Organization Name A. Hamelburg, Mark, , , Date of Receipt M M / D D / Y Y Y Y Mailing Address 601 Pennsylvania Avenue N.W. 01 Suite 500, South Building City Washington FEC ID number of contributing federal political committee. State DC Zip Code 20004 27 2017 Transaction ID : 2017012417134-16 Amount of Each Receipt this Period C ▲ ▲ ▲ , , . 115.38 Name of Employer (for Individual) Occupation (for Individual) Americas Health Insurance Plans Receipt For: Primary General Other (specify) ▼ Senior Vice President Memo Item Aggregate Year-to-Date ▼ 230.76 ▲ ▲ ▲ , , . Full Name of Individual (Last, First, Middle Initial) or Full Organization Name B. Horoschak, Donna, , , Date of Receipt M M / D D / Y Y Y Y Mailing Address 601 Pennsylvania Avenue N.W. Suite 500, South Building City Washington FEC ID number of contributing federal political committee. 01 State DC 27 2017 Transaction ID : 2017012417134-18 Amount of Each Receipt this Period 20004 C Name of Employer (for Individual) Americas Health Insurance Plans Receipt For: Primary General Other (specify) ▼ Zip Code 115.39 ▲ ▲ ▲ , , . Occupation (for Individual) Senior Vice President, Product Policy Memo Item Aggregate Year-to-Date ▼ 230.78 ▲ ▲ ▲ , , . Full Name of Individual (Last, First, Middle Initial) or Full Organization Name C. Khalid, Aryana, , , Date of Receipt M M / D D / Y Y Y Y FEC ID number of contributing federal political committee. Zip Code 20004 27 2017 Transaction ID : 2017012417134-20 Amount of Each Receipt this Period C 192.30 , , . Memo Item Occupation (for Individual) Executive Vice President Aggregate Year-to-Date ▼ 384.60 ▲ ▲ ▲ , , . SUBTOTAL of Receipts This Page (optional)............................................................................. ▼ Name of Employer (for Individual) Americas Health Insurance Plans Receipt For: Primary General Other (specify) 01 State DC TOTAL This Period (last page this line number only)................................................................ ▼ Mailing Address 601 Pennsylvania Avenue N.W. Suite 500, South Building City Washington 423.07 , , . ▲ ▲ ▲ , , . FEC Schedule A (Form 3X) Rev. 06/2016 Image# 201702159049696129 SCHEDULE A (FEC Form 3X) ITEMIZED RECEIPTS FOR LINE NUMBER: (check only one) Use separate schedule(s) for each category of the Detailed Summary Page ✘ 11a 13 PAGE 8 11b 11c 12 14 15 16 OF 10 17 Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee. NAME OF COMMITTEE (In Full) Americas Health Insurance Plans PAC (America's Health Insurance Plans PAC) Full Name of Individual (Last, First, Middle Initial) or Full Organization Name A. Tavenner, Marilyn, , , Date of Receipt M M / D D / Y Y Y Y Mailing Address 601 Pennsylvania Avenue N.W. 01 Suite 500, South Building City Washington State DC FEC ID number of contributing federal political committee. Zip Code 20004 Transaction ID : 2017012417134-36 ▲ ▲ ▲ , , . 192.30 Occupation (for Individual) Americas Health Insurance Plans Receipt For: Primary General Other (specify) ▼ President & CEO Memo Item Aggregate Year-to-Date ▼ 384.60 ▲ ▲ ▲ , , . Full Name of Individual (Last, First, Middle Initial) or Full Organization Name Date of Receipt B. Mailing Address City 2017 Amount of Each Receipt this Period C Name of Employer (for Individual) 27 M M / D D / Y Y Y Y State Zip Code Amount of Each Receipt this Period FEC ID number of contributing federal political committee. C Name of Employer (for Individual) Receipt For: Primary General Other (specify) ▼ ▲ ▲ ▲ , , . Memo Item Occupation (for Individual) Aggregate Year-to-Date ▼ ▲ ▲ ▲ , , . Full Name of Individual (Last, First, Middle Initial) or Full Organization Name Date of Receipt C. Mailing Address City M M / D D / Y Y Y Y State Zip Code Amount of Each Receipt this Period FEC ID number of contributing federal political committee. Name of Employer (for Individual) Memo Item Occupation (for Individual) Aggregate Year-to-Date ▼ ▲ ▲ ▲ , , . SUBTOTAL of Receipts This Page (optional)............................................................................. ▼ General , , . TOTAL This Period (last page this line number only)................................................................ ▼ Receipt For: Primary Other (specify) C 192.30 , , . ▲ ▲ 1115.35 ▲ , , . FEC Schedule A (Form 3X) Rev. 06/2016 Image# 201702159049696130 SCHEDULE B (FEC Form 3X) ITEMIZED DISBURSEMENTS Use separate schedule(s) for each category of the Detailed Summary Page FOR LINE NUMBER: (check only one) 21b 22 28a 28b PAGE 9 ✘ 23 28c 26 27 29 30b OF 10 Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee. NAME OF COMMITTEE (In Full) Americas Health Insurance Plans PAC (America's Health Insurance Plans PAC) Full Name (Last, First, Middle Initial) A. Brady For Congress Mailing Address PO Box 8277 City The Woodlands Purpose of Disbursement 2018 Primary Date of Disbursement M M / D D / Y Y Y Y 01 State TX Zip Code 77387-8277 Brady, Kevin, Patrick, , Office Sought: State: TX House Senate President District: 08 ✘ Disbursement For: 2018 General ✘ Primary Other (specify) ▼ C Category/ Type Carlos Curbelo Congress Mailing Address 8724 SW 72Nd St City Miami Purpose of Disbursement 2018 Primary C00311043 Transaction ID : B6D49BEDBC3896279EF Amount of Each Disbursement this Period ▲ ▲ 2500.00 ▲ , , . Memo Item Full Name (Last, First, Middle Initial) B. 2017 FEC Identification Number 011 Candidate Name 11 Date of Disbursement M M / D D / Y Y Y Y 01 State FL Zip Code 33173-3512 ✘ House Senate President District: 26 C Category/ Type Curbelo, Carlos, Luis, , Office Sought: State: FL Disbursement For: 2018 ✘ Primary Other (specify) 2017 FEC Identification Number 011 Candidate Name 31 C00546846 Transaction ID : 43D07587AA41FEEAF4A Amount of Each Disbursement this Period ▲ ▲ 1000.00 ▲ , , . General Memo Item Full Name (Last, First, Middle Initial) Date of Disbursement C. Friends Of Pat Toomey Mailing Address 228 S. Washington St., Suite 115 City Alexandria Purpose of Disbursement 2022 Primary M M / D D / Y Y Y Y 01 State VA Zip Code 22314 House ✘ Senate President District: C Disbursement For: 2022 General ✘ Primary Other (specify) ▼ Category/ Type SUBTOTAL of Disbursements This Page (optional)................................................................... C00461046 Transaction ID : 7E0B0BF914BF9F829A2 Amount of Each Disbursement this Period ▲ ▲ 1000.00 ▲ , , . Memo Item ▼ Toomey, Patrick, Joseph, , Office Sought: State: PA 2017 FEC Identification Number 011 Candidate Name 30 ▼ TOTAL This Period (last page this line number only)................................................................ ▲ ▲ 4500.00 ▲ , , . , , . FEC Schedule B (Form 3X) Rev. 05/2016 Image# 201702159049696131 SCHEDULE B (FEC Form 3X) ITEMIZED DISBURSEMENTS Use separate schedule(s) for each category of the Detailed Summary Page FOR LINE NUMBER: (check only one) 21b 22 28a 28b PAGE 10 OF ✘ 23 28c 26 27 29 30b 10 Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee. NAME OF COMMITTEE (In Full) Americas Health Insurance Plans PAC (America's Health Insurance Plans PAC) Full Name (Last, First, Middle Initial) A. Ryan Costello For Congress Mailing Address PO Box 3154 City West Chester Purpose of Disbursement 2018 Primary Date of Disbursement M M / D D / Y Y Y Y 01 State PA Zip Code 19381-3154 Costello, Ryan, A., , Office Sought: State: PA House Senate President District: 06 ✘ Disbursement For: 2018 General ✘ Primary Other (specify) ▼ 2017 FEC Identification Number C 011 Candidate Name 30 Category/ Type C00554899 Transaction ID : 58BF4CEF4E2DB6C32F4 Amount of Each Disbursement this Period ▲ ▲ 1000.00 ▲ , , . Memo Item Full Name (Last, First, Middle Initial) Date of Disbursement B. Tiberi For Congress Mailing Address 2931 E Dublin Granville Road Suite 190 City Columbus Purpose of Disbursement 2018 Primary M M / D D / Y Y Y Y 01 State OH Zip Code 43231-2098 ✘ House Senate President District: 12 C Category/ Type Tiberi, Patrick, Joseph, , Office Sought: State: OH Disbursement For: 2018 ✘ Primary Other (specify) 2017 FEC Identification Number 011 Candidate Name 31 C00347492 Transaction ID : 67D956624C55159B946 Amount of Each Disbursement this Period ▲ ▲ 5000.00 ▲ , , . General Memo Item Full Name (Last, First, Middle Initial) Date of Disbursement C. M M / D D / Y Y Y Y Mailing Address City State Zip Code FEC Identification Number C Purpose of Disbursement Office Sought: State: House Senate President District: Disbursement For: Primary General Other (specify) ▼ Category/ Type SUBTOTAL of Disbursements This Page (optional)................................................................... Amount of Each Disbursement this Period ▲ ▲ ▲ , , . Memo Item ▼ Candidate Name ▼ TOTAL This Period (last page this line number only)................................................................ ▲ ▲ 6000.00 ▲ , , . 10500.00 , , . FEC Schedule B (Form 3X) Rev. 05/2016