KANSAS GOVERNMENTAL ETHICS COMMISSION
RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE January 10,2013 FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS
A. Name of Committee: Kansas State Farm Insurance Agents and Employees PAC
Address: 825 S. Kansas Avenue, Suite 500
City and Zip Code: _T_o_p_e_k_a_6_6_6_12 _
This is a (check one): __ Party Connnittee .f Political Committee
B. Check only ifappropriate: __ Amended Filing __ Tennination RepOli
C. SUlmnary (covering the period from October 26, 2012 through December 31,2012)
1. Cash on hand at beginning ofperiod . 61,847.41
2. Total Contributions and Other Receipts (Use Schedule A) .. 11,826.02
3. Cash available this period (Add Lines 1 and 2) . 73,673.43
4. Total Expenditures and Other Disbursements (Use Schedule C) .. 11,089.07
5. Cash on hand at close ofperiod (Subtract Line 4 from 3) .. 62,584.36
6. In-Kind Contributions (Use Schedule B) . 0.00
7. Other Transactions (Use Schedule D) .. 0.00
D. "I declare that this repOli, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is true, COlTect and complete. 1 understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."
"j /j ~/:J !;?J.J..fl/1/./ iDate () Signature of Treasurer
GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Check Loan Other Other Receipt
John Langcuster Insurance 12/31/12 7311 W 132nd St Ste 180 AgenUlnsurance .; $250.00 Overland Park, KS 66213
Brian Neuhaus Insurance 12/31/12 7700 E Polo AgenUlnsurance .; $60.00 Wichita, KS 67206
Marcia Charton Insurance 12/31/12 address unknown AgenUlnsurance .; $150.00
Matthew Greer Insurance 12/31/12 4700 S Providence Rd AgenUlnsurance .; $60.00 Columbia, MO 65217
Fred Fulks Insurance 12/31/12 13220 Metcalf, Ste 300 AgenUlnsurance .; $250.02 Overland Park, KS 66213
Judie Laws Insurance 12/31/12 3620 SW Fairlawn Ste 100 AgenUlnsurance .; $180.00 Topeka, KS 66614
Lynn Grover Insurance 12/31/12 7700 E Polo AgenUlnsurance .; $150.00 Wichita, KS 67206
Peggy Schmidt Insurance 12/31/12 7700 E Polo AgenUlnsurance $60.00 Wichita, KS 67206 I
Karl Kunz Insurance 12/31/12 655 S Sage Hill Trl Agent/lnsurance .; $25.00 Garden City, KS 67846
Erin Barrett Insurance 12/31/12 13220 Metcalf Avenue Suite 300 AgenUlnsurance .; $150.00 Overland Park, KS 66213
Sandy Walker Insurance 12/31/12 9666 Quivira AgenUlnsurance $150.00 Lenex, KS 66215-1669 I
$1,485.02 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Check Loan Other Other Receipt
Steve Fischer Insurance 12/31/12 POBox 23205 AgenUlnsurance .; $150.00 Overland Park, KS 66283
Kurt Goeser Insurance 12/31/12 1201 Wakarusa E-1 AgenUlnsurance .; $75.00 Lawrence, KS 66049
Roger Crossman Insurance 12/31/12 1010 S. Kansas, Ste B-6 AgenUlnsurance .; $90.00 Liberal, KS 66901
Brad Lock Insurance 12/31/12 2520 N 14th AgenUlnsurance .; $90.00 Dodge City, KS 67801
David Chavez Insurance 12/31/12 6605 Parallel Pkwy AgenUlnsurance .; $126.00 Kansas City, KS 66102
Karen Jameson Insurance 12/31/12 304 E Chestnut Agent/Insurance .; $60.00 Junction City, KS 66441
Lee Barrett Insurance 12/31/12 2606 N Fleming St Ste 7 AgenUlnsurance .; $60.00 Garden City, KS 67846
Shanda Swinehart Insurance 12/31/12 114 N Main St AgenUlnsurance .; $120.00 Greensburg, KS 67054
Todd Barnes Insurance 12/31/12 1025 N Main AgenUlnsurance .; $60.00 Newton, KS 67114
G. Sam Davis Insurance 12/31/12 6240 W. 135th, Suite 100 AgenUlnsurance .; $75.00 Overland Park, KS 66223
Lowell Hardesty Insurance 12/31/12 10540 Marty #130 AgenUlnsurance .; $75.00 Overland Park, KS 66212
$981.00 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Loan Cash Check Other Other Receipt
Bob Jones Insurance 12/31/12 8118 E Douglas, Ste 103 Agent/Insurance ,f $150.00 Wichita, KS 67206
Galen Shields Insurance 12/31/12 POBox618 Agent/Insurance ,f $150.00 McPherson, KS 67460
Bill Kadyk Insurance 12/31/12 POBox 19416 Agent/Insurance ,f $150.00 Lenexa, KS 66215
Gary Thompson Insurance 12/31/12 3700 N. Woodlawn Agent/Insurance ,f $150.00 Wichita, KS 67220
Terry Johnson Insurance 12/31/12 303 S. Hillside St. Agent/Insurance ,f $300.00 Wichita, KS 67211
Ron Lemon Insurance 12/31/12 1115 Westport Rd Ste A Agent/Insurance ,f $75.00 Manhattan, KS 66502
David Tebbe Insurance 12/31/12 7723 Quivira Rd. Agent/Insurance ,f $105.00 Lenexa, KS 66216
John Schultz Insurance 12/31/12 9431 E. Central, Ste. 2043 Agent/Insurance ,f $150.00 Wichita, KS 67206
Dennis Bivens Insurance 12/31/12 9367 W. 87th St Agent/Insurance ,f $150.00 Overland Park, KS 66212
Ron Culp Insurance 12/31/12 9407 W 87th St Agent/Insurance ,f $75.00 Overland Park, KS 66212
Mark Berquist Insurance 12/31/12 12014 W 87th Agent/Insurance ,f $150.00 Lenexa, KS 66216
$1,605.00 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Check Loan Other Other Receipt
Steve Clark Insurance 12/31/12 1930 N. Maize Rd. Agent/Insurance .( $150.00 Wichita, KS 66212
Everett Euler Insurance 12/31/12 2057 Huntington Rd Agent/Insurance .( $75.00 Emporia, KS 66801
Moe Linden Insurance 12/31/12 P. O. Box 757 Agent/lnsurance .( $150.00 Dighton, KS 67839
Terry Sparks Insurance 12/31/12 POBox 753 Agent/Insurance .( $150.00 lola, KS 66749
Jim LaDuke Insurance 12/31/12 P. O. Box 1334 Agent/Insurance .( $300.00 McPherson, KS 67640
J. Frederick Thurlow Insurance 12/31/12 551 S. Woodlawn Agent/Insurance .( $105.00 Wichita, KS 67218
Rea Laflin Insurance 12/31/12 101 S 5th Agent/Insurance .( $60.00 Atchison, KS 66002
Todd Shepard Insurance 12/31/12 1906 E. 29th St Agent/Insurance .( $75.00 Topeka, KS 66605
Mike Grosdider Insurance 12/31/12 2400 Iowa St Agent/Insurance .( $75.00 Lawrence, KS 66046
Nyle Salmans Insurance 12/31/12 8832 W. 95th St. Agent/Insurance .( $75.00 Overland Park, KS 66212
Dennis Richter Insurance 12/31/12 2704 N Topeka Blvd Agent/Insurance .( $75.00 Topeka, KS 66617
$1,290.00 Subtotal This Page
Page _~_ oc.3_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Check Loan Other Other Receipt
Penny Hardesty Insurance 12/31/12 10540 Marty, Suite 120 AgenUlnsurance .f $150.00 Overland Park, KS 66212
Dan Gillig Insurance 12/31/12 P.O. Box 333 AgenUlnsurance .f $75.00 Pratt, KS 67124
Paul Davault Insurance 12/31/12 3625 SW 29th St AgenUlnsurance .f $60.00 Topeka, KS 66611
Jonathan Wollen Insurance 12/31/12 309 N. Main AgenUlnsurance .f $90.00 Kingman, KS 67068
Sue Zientara Insurance 12/31/12 300 SW 33rd S1. AgenUlnsurance .f $210.00 Topeka, KS 66611
Harold Mann Insurance 12/31/12 P.O. Box 838 AgenUlnsurance .f $150.00 Coffeyville, KS 67337
Paul Brucks Insurance 12/31/12 2121 N Tyler Ste 203 AgenUlnsurance .f $75.00 Wichita, KS 67212
Mike Ayres Insurance 12/31/12 619 W Douglas AgenUlnsurance .f $60.00 Wichita, KS 67213
Gary Urbanek Insurance 12/31/12 P. O. Box 399 AgenUlnsurance .f $150.00 Ellsworth, KS 67439
Josh Salmans Insurance 12/31/12 511 Leavenworth St AgenUlnsurance .f $90.00 Manhattan, KS 66502
Connie Shiverdecker Insurance 12/31/12 810 Main AgenUlnsurance .f $150.00 Neodesha, KS 66057
$1,260.00 Subtotal This Page
Page_6_of~_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Narne and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Check Loan Other Other Receipt
Ernie Ruelas Insurance 12/31/12 11330 E Central Ste 400 Agent/Insurance .f $90.00 Wichita, KS 67206
G.E. Moore Insurance 12/31/12 P. O. Box 688 Agent/Insurance .f $150.00 Leavenworth, KS 66048
John Burns Insurance 12/31/12 P. O. Box 25275 Agent/Insurance .f $75.00 Overland Park, KS 66225
Bruce Detwiler Insurance 12/31/12 1115 E River St Agent/Insurance .f $60.00 Eureka, KS 67045
Kale Erway Insurance 12/31/12 621 Broadway Agent/Insurance .f $75.00 Larned, KS 67550
Kathy Burt Insurance 12/31/12 P. O. Box 180 Agent/Insurance .f $75.00 Hoisington, KS 67544
Betty Blubaugh Insurance 12/31/12 215 SPark Agent/Insurance .f $60.00 Parsons, KS 67357
Antonio Durano Insurance 12/31/12 825 W. Central Agent/Insurance $75.00 Andover, KS 67002 .f
Debbie Nordling Insurance 12/31/12 617 S. Main Agent/Insurance $150.00 Hugoton, KS 67951 .f
Matt Ciani Insurance 12/31/12 11828 Quivira Rd Agent/Insurance $75.00 Overland Park, KS 66210 .f
Marsha Adams Insurance 12/31/12 P.O. Box 505 Agent/Insurance .f $150.00 Osawatomie, KS 66064
$1,035.00 Subtotal This Page
Page _7_ of_~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Check Loan Other Other Receipt
Starlyn Venus Insurance 12/31/12 200 N Summit Agent/Insurance ..( $60.00 Arkansas City, KS 67005
David Lawrence Insurance 12/31/12 3610 W. Central Ave. Agent/Insurance ..( $150.00 Wichita, KS 67203
Ladonna Junghans Insurance 12/31/12 2714 Liberty Hall Rd Agent/Insurance ..( $210.00 Junction City, KS 66441
Debbie Swinney Insurance 12/31/12 2099 E 151st St Ste 100 Agent/Insurance .; $150.00 Olathe, KS 66062
Patty Ann Sanborn Insurance 12/31/12 415N4th Agent/Insurance ..( $90.00 Burlington, KS 66839
Mark Elling Insurance 12/31/12 6011 Nieman Rd., Suite 3 Agent/Insurance ..( $150.00 Shawnee, KS 66203
Dean Jones Insurance 12/31/12 10254 W 13th Agent/Insurance ..( $150.00 Wichita, KS 67212
Julie Stoll Insurance 12/31/12 8600 Shawnee Msn Pkwy, Ste Agent/Insurance ..( $180.00 303 Merriam, KS 66202
Raul Hodgson Insurance 12/31/12 1710 E. Madison, Ste. 100 Agent/I nsurance ..( $105.00 Derby, KS 67037
Kevin Hale Insurance 12/31/12 15295 W 119th St Agent/Insurance ..( $180.00 Olathe, KS 66062
Charlie Hughes Insurance 12/31/12 10394 Mastin Agent/Insurance ..( $150.00 Overland Park, KS 66212
$1,575.00 Subtotal This Page
Page _8__ of_L3z. SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Na me and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Check Loan o tiler Other Receipt
Wayne Voss Insurance 12/31/12 2707 Vine Ste 13 Agent/Insurance ,f $60.00 Hays, KS 67701
Jane Johnson Insurance 12/31/12 P.O. Box 423 Agent/Insurance ,f $150.00 Colby, KS 67661
Karl Kunz Insurance 12/31/12 655 S Sage Hill Trl Agent/Insurance ,f $50.00 Garden City, KS 67846
Edward Sandate Insurance 12/31/12 2400 W Pawnee Ste 114 Agent/Insurance ,f $60.00 Wichita, KS 67213-2886
Kevin Shields Insurance 12/31/12 6160 E. 21St, Ste 160 Agent/Insurance ,f $60.00 Wichita, KS 67208
Rich Huffman Insurance 12/31/12 522 N. Main Agent/Insurance ,f $75.00 Newton, KS 67114-8265
Keith King Insurance 12/31/12 101 N Main St Agent/Insurance ,f $90.00 Ottawa, KS 66067
Rochelle Tramp Insurance 12/31/12 4311 W. 6th St, Ste A Agent/Insurance ,f $90.00 Lawrence, KS 66049
Robert Pinkerton Insurance 12/31/12 P.O. Box 321 Agent/Insurance ,f $150.00 Phillipsburg, KS 67661
Steven Crichton Insurance 12/31/12 126 W. Main Agent/Insurance ,f $150.00 Council Grove, KS 66846
Mindy Dougherty Insurance 12/31/12 P.O. Box 510 Agent/Insurance ,f $90.00 Elkhart, KS 67950
$1,025.00 Subtotal This Page
Page _L of----'3_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Other Cash Check Loan E funds Other Receipt
Brandon Hazel Insurance 12/31/12 124 W Main St Agent/Insurance ,f $60.00 Anthony, KS 67003-2745
Ryan Disbrow Insurance 12/31/12 115 N Maple St Agent/Insurance ,f $120.00 Garnett, KS 66032-9405
Andy Fry Insurance 12/31/12 13822 E. Camden Chase Ct. Agent/Insurance $60.00 Wichita, KS 67228 I
John Wills Insurance 12/31/12 6339 Long Ste A Agent/Insurance ,f $150.00 Shawnee, KS 66216-2564
Steve Bennett Insurance 12/21/12 1700 E. Iron Agent/Insurance $250.00 Salina, KS 67401 I
VOID - Check #2166 VOID - Political 10/26/12 Ken Willard for State Contribution $100.00 Representative I
$740.00 Subtotal This Page
Complete iflast page of Schedule A
Total Itemized Receipts for Period $10,996.02
Total Unitemized Contributions ($50 or less) $830.00
Sale of Political Materials (Unitemized) $0.00
Total Contributions When Contributor Not Known $0.00
TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary) $11,826.02
Page \ c;: of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made If independent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Gaches Braden and Associates Management fee; reimbursement for postage and 11/07/12 825 S. Kansas Avenue, Suite 500 printing $432.78 Topeka, KS 66612
Brownback for Governor Inc. Political Contribution 11/20/12 P.O. Box 3739 $1,000.00 Topeka, KS 66604-0739
Schmidt for Attorney General Inc. Political Contribution 11/20/12 P.O. Box 804 $1,000.00 Independence, KS 67301-0804
Gaches Braden and Associates Event Planning services fee 11/28/12 825 S. Kansas Avenue, Suite 500 $1,000.00 Topeka, KS 66612
Sweet Dreams Catering Board meeting lunch 11/28/12 11249 Rock Creed Rd. $190.66 Meriden, KS 66512
Gaches Braden and Associates Management fee; reimbursement for postage, printing 12/05/12 825 S. Kansas Avenue, Suite 500 and telephone long distance $499.63 Topeka, KS 66612
Aaron Jack for Ins Commissioner Political Contribution 12/19/12 4230 SW Clarion Lakes Drive $250.00 Topeka, KS 66610
Annie Tietzke for State Rep Political Contribution 12/19/12 329 SW Yorkshire Rd $200.00 Topeka, KS 66606
Anthony Hensley for State Senate Political Contribution 12/19/12 2226 SE Virginia Avenue $350.00 Topeka, KS 66605
Barbara Ballard for State Rep Political Contribution 12/19/12 1532 Alvamar Drive $200.00 Lawrence, KS 66047
Brian Weber for State Rep Political Contribution 12/19/12 3105 Gary Ave. $200.00 Dodge City, KS 67801
$5,323.07 Subtotal This Page
Page_!_\_ of---l2 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made If independent or in-kind expenditure in excess of$300 is made for a candidate, list candidate name & address
Garrett Love for State Senate Political Contribution 12/19/12 101 Escalanta $250.00 Montezuma, KS 67867
Greg Smith for State Senate Political Contribution 12/19/12 8605 Robinson $850.00 Overland Park, KS 66212
J. David Crum for State Rep Political Contribution 12/19/12 2903 Lake Shore Dr. $200.00 Augusta, KS 67010
Jeff King for State Senate Political Contribution 12/19/12 1212 N. 2nd S1. $650.00 Independence, KS 67301
Jeff Longbine for State Senate Political Contribution 12/19/12 2801 Lakeridge Rd $500.00 Emporia, KS 66801
Jene Vickrey Political Contribution 12/19/12 502 S. Countryside Dr $200.00 Louisburg, KS 66053
Julia Lynn for State Senate Political Contribution 12/19/12 18837 W. 115th Terr $250.00 Olathe, KS 66061
Julie Menghini for State Rep Political Contribution 12/19/12 1207 E. Quincy $200.00 Pittsburg, KS 66762
Kyle Hoffman for State Rep Political Contribution 12/19/12 1318 Avenue T $200.00 Coldwater, KS 67029
Lance Kinzer for State Rep Political Contribution 12/19/12 12549 S. Brougham $200.00 Olathe, KS 66062
Laura Kelly for State Senate Political Contribution 12/19/12 234 SW Greenwood Ave $200.00 Topeka, KS 66606
$3,700.00 Subtotal This Page
Page L of--l.3 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee)
Name and Address Purpose of Expenditure Date To Whom Expenditure is Made Amount Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Marci Francisco for State Senate Political Contribution 12/19/12 1101 Ohio St. $200.00 Lawrence, KS 66044
Phil Hermanson for State Rep Political Contribution 12/19/12 5338 S. Mosley $200.00 Wichita, KS 67216
Ray Merrick for State Rep Political Contribution 12/19/12 6874 W. 164th Terr. $200.00 Stilwell, KS 66085
Rob Bruchman for State Rep Political Contribution 12/19/12 5016 W. 108th Terr., #522 $400.00 I Overland Park, KS 66211
Robert Grant for State Senate Political Contribution 12/19/12 407 W Ma'gnolia $500.00 Cherokee, KS 66724
Tom Hawk for State Senate Political Contribution 12/19/12 3115 Harahey Ridge $350.00 Manhattan, KS 66502
Valdenia Winn for State Rep Political Contribution 12/19/12 1044 Washington Blvd. $200.00 Kansas City, KS 66102
$2,050.00 Subtotal This Page
Complete iflast page of Schedule c
Total Itemized Expenditures This Period $11,073.07
Total Unitemized Expenditures of$50 or less $16.00
TOTAL EXPENDITURES & OTHER DISBURSEMENTS $11,089.07 THIS PERIOD (to line 4 of Summary)
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