I KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIVED I RECEIPTS AND EXPENDITURES REPORT , I OF A POLITICAL OR PARTY COMMITTEE JAN 06 2014 ! Jan uary 10, 20 14 KS Governmental Ethics C mmission FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Committee: HCA Kansas Good Government Fund

Address: 550 N. Hillside

City and lip Code: _.~'c_~~~2.~2~ __ _.. __._.. _.______. This is u (check one): __ Pllrly Commitlee ,( Polilical C01l1mittee

8. Check ouly jf appropriate: __ Amended Filing Termination Report

C. Summary (covcring thc period from January 1,2013 through December 31,2013) J. Cash on hond at beginning of period " .. 5252.02 2. Total Contributions find Other Receipts (Use Schedule A) " . 45000.00 50252.02 3. Cash available this period (Add Lines 1 and 2) " " ""." .. --­ 4. Total Expenditures and Other Disblll'semcnts (Use Schedule C) .. " " .. " " . 34990.00 5. Cash on hand at close of period (Subtract Line 4 from J) """ .. "." " " . 15262.02 6. In-Kine! Contributions (Use Schedule B) " .. 7. Other Transactions (Use Schedule D) .

D. "I declare that this report, including any accompanying schedules !lnd statements, has been examined by me and to the best of my knowledge and belie.Lis true, correct and complete. I understand that the intentiomll ~'H '''' to file th;, d"mne"L" ;"ten U''':'}\' H"""-pe~me~L ;S." oJ '" A m;"I""eon"-_" -_.1/;W- ~ - 'ktkZ{"~=-,=-,Hv1.,-=-.--­ Date 7-/.. Signature of-Tl'ellruror- Chainnan

GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

HCA Kansas Good Government Fund PAC (Name of Pal"ly Committee or Political Committee)

Occupntion & Industry of Checr\ Amount of Name and Addl'ess Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Other ClIsh Checl' LOll 11 [. funds Other Receipt

Overland Pk. Reg. Med. Ctr Hospital 07/22/13 10500 Quivira ..; $11,250.00 Overland Park, KS 66215

Menorah Medical Center Hospital 08/22/13 5721 West 119th Street .f $11,250.00 Overland Park, KS 66209

Wesley Medical Center Hospital 08/27/13 550 N. Hillside .f $22,500,00 Wichita, KS 67214

$45,000.00 Subtotal This Page

Com plete if last page of Schedule A

Total Itemized Receipts for Period $45,000,00

Total Unitem ized Contributions ($50 or less) $0.00

Sale of Political Materials (Unitemized) $0.00

Total Contributions When Conlrihutor Not Known $0,00

TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary) $45,000.00

Page _ of SCHEDULEB IN-KIND (Non-Monetary) CONTRIBUTIONS

HCA Kansas Good Government Fund PAC (Name of Party Committee or Political Committee)

List Occupation & Yalueof Date Name and Address Industry for Those Giving Description of In-Kind In-Kind of Contributor an In-Kind of More Than Contribution Contrlbutlon $150

$0.00 SUbtotal TlilsPage

Complete if last page of Schedule B

Total [lemized (over $100) In-Kind Contributions

Total Unitemized ($100 or less) In-K ind Contributions

TOTAL IN-KIND CONTHIIHJTIONS THIS PERIOD (lo line Ii oJ'SulIllllury) $0,00

Page of _ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS HCA Kansas Good Government Fund PAC (Name ofParly Committee or Political Committee)

Name and Address Purpose of Expenditure Date To Whom Expenditure is Made Amount If independent or in-Idnd expenditure in excess of $300 is made for a candidate,list candidate name & address

Kansas Gov!. Ethics Commission 07/01/13 $240.00

Campaign contributions 10/07/13 See Attachment 1 to Schedule C $33,750.00

$33,990.00 Subtotal This Page

Complete if last page of Schedule c

Total Itemized Expenditures This Period

Total Unitel1l ized Expenditures of $50 or less

TOTA L EXPENDlTURES & OTHER DlSBURSEMENTS $33,990.00 THIS PERIOD (to line 4 ofSummary)

Page 01'__ HCA Kansas Good Government Fund SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Date Name Name Address Amount Jan - Dec 13 7/1/2013 Governmental Ethics Commission Governmental Ethics Comm. 109 SW 9th. Suite 504 Topeka. KS 66612 240.00­ 101712013 Abrams for State Senate Sen. Steve Abrams 4579 242nd Road Ar'rBarbara Ballard 1532 Alvamar Drive Lawrence. KS 66047 500.00­ 101712013 Bollier, for State Representative Rep. Barbara Bollier 6910 Overhill Road Mission Hills, KS 66208 0.00 101712013 Bowers for State Senate Sen. Elaine Bowers 1326 N, 150th Road Concordia KS 66901 250.00­ 101712013 Bridges for State Representative Rep. Carolyn Bridges 5219 E. First Street Wichita, KS 67208 250.00­ 101712013 Bruce for State Senate Sen. Terry Bruce Box 726 Hutchinson, KS 67504-0726 500.00­ 101712013 Bruchman for State Representative Rep. Rob Bruchman Box 7141 - 5016 W. 108th Terr #522 Overland P... 50000­ 101712013 Brunk for State Representative Rep. Steve Brunk 8119 E. Champions Court Wichita, KS 67226 250.00­ 101712013 Burroughs for State Representative Rep. Tom Burroughs 3131 S. 73rd Terrace Kansas City, KS 66106 250.00­ 101712013 Campbell for State Representative Rep. Larry Campbell 15803 S. Avalon Street Olathe, KS 66072-7701 250.00­ 101712013 Carlin for State Representative Rep. Sydney Carlin Box 32 - 1650 Sunnyslope Lane Manhattan, KS 6... 250.00­ 101712013 Carlson for State Representative Rep. Richard Carlson 26810 Jeffrey Road St. Marys. KS 66536 250.00­ 101712013 Cassidy for State Representative Rep. Ward Cassidy 420 E. 2nd Box 303 St. Francis. KS 67756 250.00­ 101712013 Christmann for State Representative Rep. Marshall Christmann 816 S. Grand Lyons, KS 67554 250.00­ 101712013 Clayton for State Representative Rep. Stephanie Clayton 9825 Woodson Drive Overland Park, KS 66207 250.00­ 101712013 Concannon for State Representative Rep. Susan Concannon 921 N. Mill Beloit. KS 67420 250.00­ 101712013 Crum for State Representative Rep. David Crum 2903 Lakeshore Drive Augusta, KS 67010 500.00­ 101712013 DeGraaf for State Representative Rep. Peter DeGraaf 1545 E. 119th Mulvane KS 67220 250.00­ 101712013 Denning for State Senate Sen. Jim Denning 11184 Antioch, Suite 290 Overland Park KS 66210-... 500.00­ 101712013 Donovan for State Senate Sen. Les Donovan, Sr. 314 N. Rainbow Lake Wichita, KS 67235 250.00­ 101712013 Dove for State Representative Rep. Willie Dove Box 349-0349 Bonner Springs, KS 66012 250.00­ 101712013 Edmonds for State Representative Rep. John Edmonds 209 NE Ten Road Great Bend, KS 67530 250.00­ 1017/2013 EdWards for State Representative Rep. Joe Edwards 256 Van Arsdale Haysville KS 67060 250.00­ 101712013 Esau for State Representative Rep. Keith Esau 11702 S. Winchester Street Olathe, KS 6061 250.00­ 101712013 Faust-Goudeau for State Senate Sen. Oletha Faust-Goudeau Box 203354158 Regents Lane Wichita, ... 500.00­ 101712013 Finch for State Representative Rep. Blaine Finch 101 West Second Street Ottawa, KS 66067 250.00­ 101712013 Finney for State Representative Rep. Gail Finney 1754 N. Madison Avenue Wichita, KS 67214 500.00­ 101712013 Fitzgerald for State Senate Sen. Steve Fitzgerald 3100 Tonganoxie Road Leavenworth, KS 66048 250.00­ 101712013 Francisco for State Senate Sen. Marci Francisco 1101 Ohio Lawrence. KS 66044 250.00­ 101712013 Gandhi for State Representative Rep. Shanti Gandhi 5802 Clarion Lakes Way Topeka, KS 66610 250.00­ 101712013 Goico for State Representative Rep. Mario Goico 1254 N. Pine Grove Ct. Wichita, KS 67212 250.00­ 101712013 Grosserode for State Representative Rep. Amanda Grosserode 12601 W. 99th Street Lenexa KS 66215 50000­ 101712013 Haley for State Senate Sen. David Haley Box 171110 Kansas City, KS 66117 250.00­ 101712013 Hawkins for State Representative Rep. Daniel Hawkins 9406 Harvest Lane Wichita, KS 67212 250.00­ 101712013 Henry for State Representative Rep. Gerald T. Henry 3515 Neosho Road Cummings. KS 66016 500.00­ 101712013 Hensley for State Senate Sen. Anthony Hensley 2226 S.E. Virginia Topeka, KS 66605 500.00­ 101712013 Hermanson for State Representative Rep. Phil Hermanson 5338 S. Mosley Wichita, KS 67216 0.00 101712013 Hill for State Representative Rep. Don Hill 1720 Luther Emporia, KS 66801 50000­ 101712013 Hoffman for State Representative Rep. Kyle Hoffman 1319 Avenue T Coldwater, KS 67029 250.00­ 101712013 Holland for State Senate Sen. Tom Holland 961 E. 1600 Road Box 165 Baldwin City KS 66006 250.00­ 101712013 Holmes for State Senate Sen. Mitch Holmes 211 SE 20th Avenue St. John. KS 67576 0.00 101712013 Houston for State Representative Rep. Roderick Houston 4902 Looman Street Wichita, KS 67220 250.00­ 101712013 Hutton for State Representative Rep. Mark Hutton 7118 W. Clearrneadow Court Wichita. KS 67205 500.00­ 101712013 Jones for State Representative Rep. Kevin Jones 416 E. 7th Street Wellsville, KS 66092 25000­ 101712013 Kahrs for State Representative Rep. Mark Kahrs P. O. Box 597 Wichita KS 67201 250.00­ 101712013 Kansas Hospital Association PAC Kansas Hospital Association 215 SE 8th Topeka. KS 66601 3.500.00­ 101712013 Kelley for State Representative Rep. Kasha Kelley Box 1111 Valley View Arkansas City, KS 67005 250.00­ HCA Kansas Good Government Fund SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Date Name Name Address Amount 10f712013 Kelly for State Representative Rep. Jim Kelly 309 S. 5th Independence, KS 67301 10f712013 250.00­ Kelly for State Senate Sen. Laura Kelly 234 SW Greenwood Ave. Topeka, KS 66606-1228 10f712013 250.00­ Kerschen for State Senate Sen. Dan Kerschen 645 S. 263rd West Garden Plain KS 67050 10f712013 250.00­ King for State Se nate Sen. Jeff King 1212 N. 2nd Street Independence, KS 67301 10f712013 500.00­ Kleeb for State Representative Rep. Marvin Kleeb 14206 Eby Overland Park, KS 66221 10f712013 250.00­ Lane for State Representative Rep. Harold Lane 2202 SE Monroe Street Topeka, KS 66605 10f712013 LaTurner for State Senate 250.00­ Sen. Jacob LaTurner 204 E. Euclid Street Pittsburg, KS 66762 250.00­ 10f712013 Love for State Senate Sen. Garrett Love Box 1 Montezuma, KS 67867 10f712013 250.00­ Lunn for State Representative Rep. Jerry Lunn 14512 Horton Street Overland Park KS 66223 10f712013 Lusk for State Representative 250.00­ Rep. Nancy Lusk Box 4678 Overland Park, KS 66204--4678 250.00­ 10f712013 Lynn for State Senate Sen. Julia Lynn 18837 W. 115th Terrace Olathe KS 66061-9379 250.00­ 10f712013 Macheers for State Representative Rep. Charles Macheers 21704 W. 57th Terrace Shawnee, KS 66218 250.00­ 10f712013 Mast for State Representative Rep. Peggy Mast 765 Road 110 Emporia, KS 66801 10f712013 500.00­ Masterson for State Senate Sen Ty Masterson 1539 Phyllis Lane, Box 424 Andover, KS 67002 10f712013 McGinn for State Senate 0.00 Sen. Carolyn McGinn 11047 N. 87th West Sedgwick KS 67135 250.00­ 10f712013 McPherson for State Representative Rep. Craig McPherson 11091 W. 133rd Terr. #7 Overland Park, KS 6 . 250.00­ 10f712013 Melcher for State Senate Sen. Jeff Melcher 10300 W. 103rd SI. Suite 300 Overland Park KS 66 . 500.00­ 10f712013 Menghini for State Representative Rep. Julie Menghini 1207 E. Quincy Pittsburg, KS 66762 250.00­ 10f712013 Merrick for State Representative Rep. Ray Merrick 6874 W. 164th Terrace Stilwell, KS 66085 500.00­ 10f712013 O'Donnell for State Senate Sen. Michael O'Donnell 1435 W. Haskell Wichita KS 67213 250.00­ 10f712013 Olson, Rob for State Senate Sen. Rob Olson 19050 W. 161st Olathe KS 66062 250.00­ 10f712013 Osterman for State Representative Rep. Leslie Osterman 1401 W. Dallas Wichita, KS 67217 250.00­ 10f712013 Peck for State Representative Rep. Virgil Peck, Jr. Box 277 Tyro, KS 67364 250.00­ 10f712013 Petersen for State Senate Sen. Mike Petersen 2608 Southeast Drive Wichita, KS 67216 250.00­ 10f712013 Pilcher Cook for State Senate Sen. Mary Pilcher Cook 13910 W. 58th Place Shawnee, KS 66216 500.00­ 10f712013 Powell for State Senate Sen. Larry Powell 2209 Grandview Drive East Garden City, KS 67846 250.00­ 10f712013 Rhoades for State Representative Rep. Marc Rhoades 1006 Lazy Creek Drive Newton KS 67114 500.00­ 10f712013 Rooker for State Representative Rep. Melissa Rooker 4124 Brookridge Drive Fairway KS 66205 25000­ 10f712013 Rubin for State Representative Rep. John Rubin 13803 W. 53rd Street Shawnee, KS 66216 25000­ 10f712013 Ryckman, Jr. for State Representa... Rep. Ron Ryckman, Jr. 14234 W. 158th Street Olathe KS 66062 250.00­ 10f712013 Sawyer for State Representative Rep. Tom Sawyer 1041 S. Elizabeth Street Wichita, KS 67213 25000­ 10f712013 Schmidt for Attorney General Hon. Derek Schmidt Box 804 Independence, KS 67301 1.500.00­ 10f712013 Schmidt, Vicki for State Senate Sen. Vicki Schmidt 5906 SW 43rd Court Topeka KS 66610-1632 25000­ 10f712013 Schwartz for State Representative Rep. Sharon Schwartz 2051 20th Road Washington, KS 66968 250.00­ 10f712013 Seiwert for State Representative Rep. Joe Seiwert 1111 E. Boundary Road Pretty Prairie KS 67570 250.00­ 10f712013 Sloop for State Representative Rep. Patricia Sloop 1950 S. Webb Dr., HM #121 Wichita, KS 67207 10f712013 250.00­ Smith, Greg for State Senate Sen. Greg Smith 8605 Robinson Overland Park KS 66212 250.00­ 10f712013 Suellentrop for State Representative Rep. Gene Suellentrop 6318 W. Northwind Circle Wichita, KS 67205 250.00­ 10f712013 Thompson for State Representative Mr. Kent Thompson 18162800 Street LaHarpe, KS 66751 500.00­ 10f712013 Todd for Slate Representative Rep. James Todd 9731 W. 115th Terrace Overland Park, KS 66210 250.00­ 10f712013 Tyson for State Senate Sen. Caryn Tyson P. O. Box 191 Parker KS 66072 500.00­ 10f712013 Vickrey for State Representative Rep. Jene Vickrey 502 S. Countryside Drive Louisburg, KS 66053 500.00­ 10f712013 Victors for State Representative Rep. Ponka-We Victors Box 48081 Wichita, KS 67201 250.00­ 10f712013 Wagle for State Senate Sen. Susan Wagle 4 Sagebrush Wichita, KS 67230 500.00­ 10f712013 Ward for State Representative Rep. Jim Ward 3100 E. Clark Wichita, KS 67211 500.00­ 10f712013 Whipple for State Representative Rep. Brandon Whipple 2925 S. Walnut Wichita, KS 67217 250.00­ 10f712013 Wilson, John for State Representat.. Rep John Wilson 1923 Ohio Street Lawrence. KS 66046 250.00­ 10f712013 WOlf, Kay for State Senate Sen. Kay Wolf 8339 Roe Prairie Village, KS 66207 250.00­ 10f712013 Wolfe Moore for State Representat... Rep. Kathy Wolfe Moore 3209 N. 131s1 Street Kansas City, KS 66109 250.00­ 10f712013 Bollier for State Representative Rep. Barbara Bollier 6910 Overhill Road Mission Hills. KS 66208 500.00­ HCA Kansas Good Government Fund SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Dare Name Name Address Amount

_hOh _ --_.~------1017/2013 Holmes for State Senate Sen. Mitch Holmes 211 SE 20th Avenue St. John. KS 67576 250.00­ 1017/2013 Masterson for State Senate Sen. Ty Masterson 1539 Phyllis Lane, Box 424 Andover. KS 67002 500.00­ Jan - Dec 13 34,990.00­ SCHEDULED OTHER TRANSACTIONS

HCA Kansas Good Government Fund PAC (Name of Party Committee or Political Committee)

Balance at Date Name and Address Nature of Account or Loan Payable Close of or Loan Receivable Period

$0.00 Sublcltul This Pngc

Complete if last page of Schedule D

TOTAL OTHER TRANSACTIONS (to lille 7 OfSUl1IlllllJ')') $0.00

Page _~_ oC _ 10:22 AM HCA Kansas Good Government Fund 01/02/14 Reconciliation Detail Checking Account, Period Ending 12/31/2013

Clr Amount Balance ___Typo___ Dale Num Name _.---_._.~.,,--._- ~.~-~._~._- 32,262.02 Beginning Balance Cleared Transactions Checks and Payments. 36 Items -500.00 -500,00 Bill Pmt -Check 10/7/2013 2494 Hill for Stale Repres". X -500.00 -1,000.00 Bill Pmt -Check 1OnJ2013 2530 Rnoades for State R". X -500,00 -1.500.00 Bill Pmt -Check 10/7/2013 2516 Mast for State Repre." X -500.00 -2,000.00 Bill Pmt ·Check 10/7/2013 2462 Bruce for State Senate X -500.00 -2,500.00 Bill Pmt-Check 10/7/2013 2481 Faust-Goudeau for S... X -500.00 -3.000.00 Bill Pmt -Check 10/7/2013 2545 Vickrey for State Re ... X -500.00 -3,500.00 Bill Pmt ·Check 10/7/2013 2473 Cnum for State Repr". X -500.00 -4,000.00 Bill Pmt .Check 10nJ2013 2528 Pilcher Cook for Stat... X -500.00 -4,500.00 Bill Pmt -Check 10/7/2013 2483 Finney for State Rep." X -500.00 -5,000.00 Bill Pmt -Check 10/7/2013 2547 Wagle for State Sen", X -250.00 -5,250.00 Bill Pmt·Check 10/7/2013 2471 Clayton for State Re ... X -250.00 -5,500.00 Bill Pmt-Check 10nJ2013 2472 Concannon for State." X -250.00 -5.750.00 Bill Pmt -Check 10/7/2013 2486 Gandhi for State Re". X -250.00 -6,000.00 Bill Pmt -Check 10/7/2013 2487 Goico for Slate Repr... X -250.00 -6,250.00 Bill Pmt -Check 10/7/2013 2541 Suellentrop for State ... X -250,00 -6,500.00 Bill Pmt -Check 10/7/2013 2501 Kahrs for Stale Repr... X -250.00 -6,750.00 Bill Pmt -Check 10/7/2013 2461 Bridges for State Re". X ·250.00 -7,000.00 Bill Pmt-Check 10/7/2013 2527 Petersen for State S". X -250.00 -7,250.00 Bill Pmt -Check 10/7/2013 2523 O'Donnell for State S... X -250.00 -7,500.00 Bili Pmt -Check 101712013 2476 Donovan for State S". X -250.00 -7,750.00 Bill Pmt -Check 10/7/2013 2508 Kleeb for State Repr... X -250.00 -8,000.00 Bill Pmt-Check 10/7/2013 2490 Hawkins for State R... X -250.00 -8,250.00 Bill Pmt -Check 10/7/2013 2538 Seiwen for State Re... X -250.00 -8,500.00 Bill Pmt -Check 101712013 2551 Waf, Kay for State S", X -250.00 -8.750,00 Bili Pmt-Check 10/7/2013 2465 Burroughs for State ... X -250.00 -9,000.00 Bill Pmt ·Check 10/7/2013 2479 Edwards for State R... X ·250.00 -9,250.00 Bill Pmt -Check 10/7/2013 2554 Holmes for State Se." X -250.00 -9,500.00 Bill Pmt -Check 10/7/2013 2474 DeGraaf for State R... X -250.00 -9,750.00 Bill Pmt -Check 10nl2013 2484 Fitzgeraid for State S... X ·250.00 .10,000.00 Bill Pmt -Check 101712013 2533 Ryckman, Jr. for Sta ... X -250.00 .10,250.00 Bill Pmt -Check 10nl2013 2524 Olson, Rob for State ... X -250.00 -10,500.00 Bill Pmt -Check 1OnJ2013 2543 Todd for State Repre ... X -250.00 -10,750.00 Bill Pmt -Check 10/7/2013 2534 Sawyer for State Re ... X -250,00 ·11,000.00 Bill Pmt -Check 10nJ2013 2539 Sloop for State Repr... X -250.00 -11,250.00 Bill Pmt -Check 10/7/2013 2466 Campbell for State R... X X ·250.00 -11,500.00 Smith, Greg for Stat... ~_A"' Bill Pmt -Check 10/7/2013 2540 __' __·_··-_" -11,500,00 -11,500.00 Tolal Checks and Payments •... N." ..•. ~~._·· _____ -11,500.00 -11,500,00 _ •.• «_•..... ~_~."_"_,,.~ .•.•..•_ ••_ ••MM..._._ Total Cleared Transaclions .....~ •••• H ••••••••••···············.···, -11,500,00 20,762.02 Cleared Balance Uncleared Transactions Checks and Payments· 14 Items -1,500.00 -1,500.00 Bili Pmt -Check 10/7/2013 2535 Schmidt for Attorney ... -500,00 -2,000.00 Bill Pmt -Check 101712013 2458 Ballard for State Rep .. , -500.00 -2,500.00 Bill Pmt -Check 10/7/2013 2542 Thompson for State ... -500.00 -3,000.00 Bill Pmt ·Check 10/7/2013 2555 Masterson for State ... ·250.00 -3,250.00 Bili Pmt -Check 10/7/2013 2506 Kerschen for Stale S... -250.00 -3,500.00 Bill Pmt -Check 101712013 2505 Kelly for Siate Senate -250.00 -3,750.00 Bill Pmt -Check 101712013 2478 Edmonds for State R. .. -250,00 -4,000,00 Bill Pmt -Check 10nJ2013 2503 Kelley for Stale Repr... -250.00 -4,250.00 Bill Pm! -Check 10/7/2013 2514 Lynn for State Senate -250.00 -4,500.00 Bill Pmt -Check 10/7/2013 2525 Osterman for State ... -250.00 -4,750.00 Bill Pmt -Check 10nl2013 2552 Wolfe Moore for Stat... -250.00 -5,000.00 Bill Pml -Check 10nJ2013 2457 Alford for Slate Repr...

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