KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE January 10,2010
FILE WITH SECRETARY OF STATE ,~_, SEE REVERSE SIDE FOR INSTRUCTIONS
A. Name of Comnlittee: Kansas Hospital Association Political Action Committee
Address: 215 SE 8th Street
City and Zip Code: T_o_pe_k_a,_66_6_01 US _
This is a (check one): __ Party Committee x Political Committee
B. Check only if appropriate: __ Amended Filing __ Termination Report
C. Summary (covering the period from January 1,2009 through December 31,2009) $48,987.89 1. Cash on hand at beginning of period .. 2. Total Contributions and Other Receipts (Use Schedule A) .. $60,138.10 3. Cash available this period (Add Lines 1 and 2) .. $109,125.99 4. Total Expenditures and Other Disbursements (Use Schedule C) .. $42,090.25 5. Cash on hand at close of period (Subtract Line 4 from 3) .. $67.035.74
6. In-Kind Contributions (Use Schedule B) $10,779.68
7. Other Transactions (Use Schedule D) .. $0.00
/ -1/- ;)0/0 Date
GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Casb Cbeck LoaD Otber Other Receipt
Steven Wilkinson President and Chief Executive $500.00 5721 West 119th Street Officer 01/08/2009 Overland Park, KS 66209-3722 Menorah Medical Center ~
Associ~ted Purchasing Services APS $1,142.40 215 South East Eighth Associated Purchasing Services 01/08/2009 Topeka, KS 66603 Corporation ~
Todd Burch Administrator and Chief Executive $200.00 PO Box415 Officer 01/29/2009 Tribune, KS 67879-0415 Greeley County Health Services ~
Kenneth Lindsey Chief Medical Officer $355.00 1100 Fairway Drive Hays Medical Center 02/16/2009 Hays, KS 67601-4710 ~
Kevin Conlin President and Chief Executive $500.00 3720 East Bayley Officer 02/24/2009 Wichita, KS 67218-3002 Via Christi Health System ~
William Mahoney Chief Executive Officer $500.00 511 Cedar Cove Labette Health 03/30/2009 Parsons, KS 67357-2256 ~
Chad Austin Vice President, Government $80.62 04/02/2009 6518 SW 26th Court Relations Topeka, KS 66614-4305 Kansas Hospital Association ~
Thomas Bell President $134.61 Kansas Hospital Association 04/02/2009 4301 NW Valley Road Topeka, KS 66618-3445 ~
Melissa Hungerford Sr. Vice President $134.61 04/02/2009 6448 SW Bayshore Dr Kansas Hospital Association Auburn, KS 66402-9324 ~
Fred Lucky Senior Vice President $329.80 04/02/2009 14607 W 89 Kansas Hospital Association Lenexa, KS 66215-2967 ~
Robert Meling Senior Vice President $134.61 04/02/2009 13005 Catalina Street Leawood, KS 66209-2392 .;
$4,011.65 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (N arne 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
Cindy Samuelson Vice President $67.34 1107 NE 54th St Kansas Hospital Association 04/02/2009 Topeka, KS 66617-4505 .f
Deborah Stern Clinical Services/Legal Counsel $250.00 3010 Clark Court Kansas Hospital Association 05/14/2009 Topeka, KS 66604-2660 .f
Chad Austin Vice President, Government $69.24 6518 SW 26th Court Relations 06/26/2009 Topeka, KS 66614-4305 Kansas Hospital Association .f
Thomas Bell President $115.38 4301 NW Valley Road Kansas Hospital Association 06/26/2009 Topeka, KS 66618-3445 .f
Melissa Hungerford Sr. Vice President $115.38 6448 SW Bayshore Dr Kansas Hospital Association 06/26/2009 Auburn, KS 66402-9324 .f
Fred Lucky Senior Vice President $282.72 14607 W 89 Kansas Hospital Association 06/26/2009 Lenexa, KS 66215-2967 .f
Sally Perkins $23.10 06/26/2009 1725 NW Grove Kansas Hospital Association Topeka, KS 66606-1237 .f
Robert MeJing Senior Vice President $115.38 06/26/2009 13005 Catalina Street Leawood, KS 66209-2392 .f
Cindy Samuelson Vice President $57.72 06/26/2009 1107 NE 54th St Kansas Hospital Association Topeka, KS 66617-4505 .f
County Hospital Stafford Community Hospital $200.00 07/29/2009 PO Box 190 Community Hospital Stafford, KS 67578-0190 .f
Kristine Ochs Administrator $160.00 07/29/2009 210 South Vermont Avenue Grisell Memorial Hospital District Ransom, KS 67572-9525 One .f
$1,456.26 Subtotal This Page
Page _2__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Narne 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 Cub Cbeck Loan Otber Other Receipt
Genette Nicholas Hospital Employee $100.00 435 W 59th Street Children's Mercy South 07/29/2009 Kansas City, MO 64113-1232 ~
Stevens County Hospital $300.00 1006 South Jackson Stevens County Hospital 07/29/2009 Hugoton, KS 67951-2842 ~
Scott County Hospital $200.00 310 E 3rd St Scott County Hospital 07/29/2009 Scott City, KS 67871-1203 ~
Jeffrey Colburn $100.00 PO Box 864 Hamilton County Hospital 07/29/2009 Syracuse, KS 67878-0864 ~
Lora Key CEO $100.00 14th and Oregon Streets Sabetha Community Hospital 07/29/2009 Sabetha, KS 66534-0229 ~
Ron Baker CEO $100.00 12409 W. 120th Ct., #1821 Cushing Memorial Hospital 07/31/2009 Overland Park, KS 66213-4875 ~
Sally Border $100.00 07/31/2009 331 Oakhill St. Cushing Memorial Hospital Lansing, KS 66043-1442 ~
Robert Brazil Chief Operating Officer $100.00 Memorial Health System 08/11/2009 1700 Faith Ave Abilene, KS 67410-1728 ~
Janet Hedden Lab Manager $100.00 08/11/2009 10242700 Avenue Memorial Health System Abilene, KS 67410-6008 ~
Jewell County Hospital $160.00 08/11/2009 PO Box 327 Jewell County Hospital Mankato, KS 66956-0327 ~
Lifepoint Hospitals, Inc Good Government State PAC to PAC transfer $500.00 08/11/2009 Fund Western Plains Medical Complex 103 Powell Court Ste. 200 .f Brentwood, TN 37027-5079
$1,860.00 Subtotal This Page
Page _~_ of24_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (N arne 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
Elgin Glanzer Chief Financial Officer $100.00 1108 N. Kuney Memorial Health System 08/11/2009 Abilene, KS 67410-1932 ,
Patricia Berns Hospital Employee $75.00 2570 Hwy. 15 Memorial Health System 08/11/2009 Abilene, KS 67410-6035 ,
Amy Altwegg Executive Director $75.00 2469 Gulf Rd. Memorial Health System 08/11/2009 Abilene, KS 67410-6092 ,
Mark Miller Chief Executive Officer $100.00 1691 Jeep Rd Memorial Health System 08/11/2009 Abilene, KS 67410-6367 ,
James Reagan Chief Executive Officer $350.00 265 Fairway Drive Morris County Hospital 08/12/2009 Council Grove, KS 66846-1404 ,
David Bradley Chief Executive Officer $100.00 6010 N. Red Road Geary Community Hospital 08/12/2009 Junction City, KS 66441-7598 ,
Diane Burton $100.00 08/12/2009 5602 SW Timberlake Ct. Stormont-Vail HealthCare Topeka, KS 66614-4537 ,
Vernon Long Vice President $500.00 Stormont-Vail HeaIthCare 08/12/2009 3440 N.E. Kincaid Topeka, KS 66617-3620 ,
Mary Martell Director $100.00 08/12/2009 2922 SW 20th St. Stormont-Vail HealthCare Topeka, KS 66604-3209 ,
Kent Palmberg Senior Vice President and Chief $600.00 08/12/2009 1216 SW Westside Drive Medical Officer Topeka, KS 66615-1236 Stormont-Vail HealthCare ,
Carol Perry VP and CNO $500.00 08/12/2009 PO Box 3822 Stormont-Vail HealthCare Topeka, KS 66604-6822 ,
$2,600.00 Subtotal This Page
Page _4__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Casb Check Loan Otber Other Receipt
James Kilmartin Director $100.00 4140 SE 53rd Street Stormont-Vail HealthCare 08/12/2009 Berryton, KS 66409-9221 .f
Lisa Carlton Director $150.00 5534 NE Indian Creek Rd Stormont-Vail HealthCare 08/12/2009 Topeka, KS 66617-1604 .f
Bernard Becker VP/Chief Human Resources $350.00 4527 SW Crenshaw Dr. Officer 08/12/2009 Topeka, KS 66610-1615 Stormont-Vail HealthCare .f
Robert O'Neil Medical Advisor $350.00 1401 SW Pembroke Lane Stormont-Vail HealthCare 08/12/2009 Topeka, KS 66604-2535 .f
Angela Gamber $100.00 1801 SW Pembroke Lane Stormont-Vail HealthCare 08/12/2009 Topeka, KS 66604-3260 .f
Carol Wheeler Vice President $350.00 1248 SW Westside Drive Stormont-Vail HealthCare 08/12/2009 Topeka, KS 66615-1236 .f
Kathleen Harr Dean & Professor $100.00 08/12/2009 3732 SW Herefordshire Road Stormont-Vail HealthCare Topeka, KS 66610-1541 .f
Debra Yocum Hospital Administration $350.00 Stormont-Vail HealthCare 08/12/2009 5045 SE 10th Tecumseh, KS 66542-9426 .f
Patricia McGivern Director $100.00 08/12/2009 3031 SW Quail Creek Drive Stormont-Vail HealthCare Topeka, KS 66614-4131 .f
Larry Lane Director $100.00 08/12/2009 2821 NW Halfday PI. Stormont-Vail HealthCare Topeka, KS 66618-1649 .f
Judy Corzine Director, IT $350.00 08/12/2009 3621 SW Woodvalley Place Stormont-Vail HealthCare Topeka, KS 66614-3536 .f
$2,400.00 Subtotal This Page
Page _5__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)
Occupation & Industry of Cbeck Amount of Narne and Address Individual Giving More Appropriate Box Casb, Cbeck, Date of Contributor Tban $150 Loan or Loan Otber Casb Cbeck Otber Receipt
Karlene Lockard Director $100.00 1114 SW Garfield Stormont-Vail HealthCare 08/12/2009 Topeka, KS 66604-1312 .f
Randall Peterson Senior Vice President $1,000.00 2022 N. Red Oaks Via Christi Health System 08/12/2009 Wichita, KS 67206-8909 .f
David Robinson Insurance Agent $300.00 925 S. Highland McCune Robinson Insurance 08/13/2009 Chanute, KS 66720-3018 .f
Julia Woods CNO $150.00 8000 West 146th St Saint Luke's South Hospital 08/13/2009 Overland Park, KS 66223-2421 .f
Holly Koch CFO $100.00 1371 67th Terrace Girard Medical Center 08/13/2009 Uniontown, KS 66779-8010 .f
Jill Straub Health Information Management $100.00 7907 SW 28th Street Director 08/18/2009 Topeka, KS 66614-4891 Stormont-Vail HealthCare .f
Anthony Medical Center $320.00 08/18/2009 1101 E. Spring St. Anthony Medical Center Anthony, KS 67003-2122 .f
Oswego Medical Center $320.00 08/18/2009 800 Barker Drive Oswego, KS 67356-9033 .f
Curt Colson Administrator $100.00 08/18/2009 POBox 326 Satanta District Hospital 400 Watkins .f Satanta, KS 67870-0159
Raymond Lumb Medical Advisor $100.00 08/21/2009 2210 SW Desousa Stormont-Vail HealthCare Topeka, KS 66611-1621 .f
Kevin Han Director, Financial Management $150.00 08/21/2009 6200 SW 34th Terr. Stormont-Vail HealthCare Topeka, KS 66614-4667 .f
$2,740.00 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(N arne of P~rty Committee or Political Committee)
Occupation & Industry of Check Amount of Narne and Address Individual Giving More Appropriate Box C ash, Check, Date of Contributor Than 5150 Loan or Cash Check Loan Other Other Receipt
Beth Browder Director of Professional $100.00 3060 NW 35th Development 08/21/2009 Topeka, KS 66618-2645 Stormont-Vail HealthCare .f
Lenora A. Kinzie Hospital Employee $100.00 1267 Medford Stormont-Vail HealthCare 08/21/2009 Topeka, KS 66604-1517 .f
Ness County Hospital $160.00 312 Custer Ness County Hospital 08/21/2009 Ness City, KS 67560-1654 .f
Mike Wegner Chief Financial Officer $200.00 929 North St Francis Street Via Christi Regional Medical 09/01/2009 Wichita, KS 67214-3821 Center .f
Laurie Labarca Chief Operating Officer $250.00 8242 E. Greenbriar Ct. Via Christi Rehabilitation Center 09/01/2009 Wichita, KS 67226-1807 .f
Gina Ochsner Hospital Employee $100.00 5970 SW 31 st Terrace Stormont-Vail HealthCare 09/01/2009 Topeka, KS 66614-4122 .f
Edwards County Hospital and Healthcare $200.00 Edwards County Hospital and 09/01/2009 Center P.O. Box 99 Healthcare Center Kinsley, KS 67547-0099 .f
Ronald Campbell Director $100.00 Stormont-Vail HealthCare 09/01/2009 4735 SE 25th Tecumseh, KS 66542-9301 .f
Hiawatha Community Hospital hospital contribution $160.00 09/01/2009 300 Utah Hiawatha Community Hospital Hiawatha, KS 66434-2314 .f
Bradley Hoffman Hospital Employee $100.00 09/01/2009 7811 Alden Rd. Shawnee Mission Medical Center Lenexa, KS 66216-4277 .f
County Hospital Logan $160.00 09/01/2009 211 Cherry Logan County Hospital Oakley, KS 67748-1201 .f
$1,630.00 Subtotal This Page
Page _7__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Otber Other Receipt
Joel Phelps $100.00 1220 Columbine Circle Salina Regional Health Center 09/01/2009 Salina, KS 67401-9085 .f
Victoria Hahn Administrator and Chief Executive $200.00 Rural Route 2, Box 38 Officer 09/01/2009 Leoti, KS 67861-9504 Wichita County Health Center .f
Charles Grimwood Vice President $100.00 115 Mt. Barbara Rd. Salina Regional Health Center 09/01/2009 Salina, KS 67401-3414 .f
Blaine Miller Administrator $100.00 2420 'G' Street Republic County Hospital 09/01/2009 Belleville, KS 66935-2400 .f
Joel Phelps $50.00 1220 Columbine Circle Salina Regional Health Center 09/02/2009 Salina, KS 67401-9085 .f
Kathy Howell $350.00 12867 Barton Saint Luke's South Hospital 09/04/2009 Overland Park, KS 66213-4424 .f
Kevin Strecker VP, Imaging and Laboratory $250.00 09/04/2009 Services Via Christi Regional Medical Center .f
Mark Davis Interim CEO $100.00 Stormont-Vail HealthCare 09/04/2009 3700 SW 41st Street Topeka, KS 66610-1184 .f
Kathy Morrison Executive Director of Human $100.00 09/04/2009 1014 Lamplighter Resources Garden City, KS 67846-3240 St. Catherine Hospital .f
Jean Dean CEO $100.00 09/04/2009 1000 W 39th St Trego County-Lemke Memorial Hays, KS 67601-1517 Hospital .f
Kenneth Boyd Administrator $500.00 09/04/2009 PO Box 12 Girard Medical Center Girard, KS 66743-0012 .f
$1.950.00 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (N arne 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
Kevin Waite Director of Pharmacy $100.00 881 E 1289 Rd Stormont-Vail HealthCare 09/04/2009 Lawrence, KS 66047-9463 ~
Michael Rowe Vice President & CFO $100.00 4305 West 125th Terrace Sisters of Charity of Leavenworth 09/04/2009 Leawood, KS 66209-2203 Health System ~
John Vox Senior VP $350.00 2220 Center St. Catherine Hospital 09/04/2009 Garden City, KS 67846-3517 ~
Steven Watkins Physician $350.00 8001 SW Huntoon Street Stormont-Vail HealthCare 09/04/2009 Topeka, KS 66615-1417 ~
Donald Schepker Foundation President $100.00 1132 SW Belmont Lane Stormont-Vail HealthCare 09/04/2009 Topeka, KS 66604-1981 ~
Kathleen Davis Assistant to the President $100.00 529 SW 28th Terrace Stormont-Vail HealthCare 09/04/2009 Topeka, KS 66614 ~
David Cunningham Director of Facilities $350.00 09/04/2009 3725 Clarion Park Drive Stormont-Vail HealthCare Topeka, KS 66610-1277 ~
Robert Heath Sr. Vice President - General $100.00 Counsel 09/04/2009 1531 Spring Drive Wichita, KS 67208-2420 Via Christi Regional Medical ~ Center
Loretta Massey Director $100.00 09/04/2009 5940 SW 47th Stormont-Vail HealthCare Topeka, KS 66610-1203 ~
Eric Voth Physician $350.00 09/04/2009 411 Woodbury Court Stormont-Vail HealthCare Topeka, KS 66606-2192 ~
Kenneth Stone $125.00 09/04/2009 2543 SE Faxon Ct. Stormont-Vail HealthCare Topeka, KS 66605-2086 ~
$2.125.00 Subtotal This' Page
Page~__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Otber Cuh Check Other Receipt
Robert Mullen Chief Executive Officer $160.00 816 South St. John Hospital District Number One of 09/11/2009 Lyons, KS 67554-3411 Rice County .f
Robert Boysen Vice President & CIO $100.00 1.0271 South Northlake Avenue Sisters of Charity of Leavenworth 09/11/2009 Olathe, KS 66061-7306 Health System .f
Ninnescah Valley Health Systems Commynity Hospital $250.00 750 West D. Avenue Ninnescah Valley Health System 09/28/2009 Kingman, KS 67068-1266 .f
Lincoln County Hospital $100.00 624 N Second 09/28/2009 PO BOX 406 Lincoln, KS 67455-1738 .f
Cheyenne County Hospital Community Hospital $160.00 210 W. First St. Cheyenne County Hospital 09/28/2009 PO Box 547 Saint Francis, KS 67756-3540 .f
Jackie John Vice President, Resource $500.00 Post Office Box 506 Development 09/28/2009 Phillipsburg, KS 67661-0506 Great Plains Health Alliance, Inc. .f
Simon Scholtz Vice President and Chief Financial $100.00 09/28/2009 1705 St. Andrews Drive Officer Lawrence, KS 66047-1703 Lawrence Memorial Hospital .f
Bruce Whittington VP $100.00 Hays Medical Center 09/28/2009 2912 Walnut Hays, KS 67601-1721 .f
Terry Siek Chief Nursing Officer $100.00 09/28/2009 300 W. 21st Hays Medical Center Hays, KS 67601-3004 .f
Jeffrey Novorr Vice President $100.00 09/28/2009 3105 Tomahawk Drive Lawrence Memorial Hospital Lawrence, KS 66049-1924 .f
Jane Maskus Chief Information Officer $100.00 09/28/2009 24215 W. 68th St. Lawrence Memorial Hospital Shawnee, KS 66226-3539 .f
$1,770.00 Subtotal This Page
Page~~_of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (N arne 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 Cbeck L08n Other Cub Other Receipt
Dana Hale Vice President Nursing $100.00 670 N. 1505 Rd. Lawrence Memorial Hospital 09/28/2009 Lawrence, KS 66049-9121 .f
Karen Shumate VP $100.00 1753 E 980 Rd Lawrence Memorial Hospital 09/28/2009 Lawrence, KS 66049-9073 .f
Janice Early-Weas Hospital Employee $100.00 902 Riverside Ct Lawrence Memorial Hospital 09/28/2009 Lawrence, KS 66044-4092 .f
Joy Bretz Chief Financial Officer $80.00 Rt 1 Box 57E Gove County Medical Center 09/28/2009 Studley, KS 67740-9308 .f
Kathie J. Butcher Assistant Administrator/Quality $100.00 1456 Road 175 Risk Mgm 09/28/2009 Emporia, KS 66801-2597 Newman Regional Health .f
Holly French Chief Financial Officer $100.00 1201 West 12th Avenue Newman Regional Health 09/28/2009 Emporia, KS 66801-2504 .f
Deborah Thompson Vice President, Human Resources $105.50 Lawrence Memorial Hospital 09/28/2009 4423 Gretchen Court Lawrence, KS 66047-9680 .f
Phyllis Macy-Mills Administrator and Chief Executive $100.00 Officer 09/28/2009 709 S. Centennial Rd. Arkansas City, KS 67005-1107 South Central Kansas Regional Medical Center .f
James Chromik CEO $220.00 09/28/2009 320 1/2 S. Walnut St. Memorial Hospital McPherson, KS 67460-4731 .f
Kelene Youngs Director of Infection Control $75.00 09/28/2009 614 East 41st Ave Promise Regional Medical Hutchinson, KS 67502-4922 Center-Hutchinson .f
Beth Worden Hospital Employee $100.00 09/28/2009 2149 U.S. 56 Promise Regional Medical Galva, KS 67443 Center-Hutchinson .f
$1,180.50 Subtotal This Page
Page _1_1_ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Casb Cbeck Loan Other Other Receipt
Shawnda Heimerman Controller $125.00 1104 Barberry Dr. Promise Regional Medical Center 09/28/2009 Hutchinson, KS 67502-3365 .;
Janet S. Hamous Administrative Director of HR $100.00 2615 Wilderness Ct. Promise Regional Medical 09/28/2009 Wichita, KS 67226-2137 Center-Hutchinson .;
Vicki Caywood Director $200.00 815 Avenue R Promise Regional Medical 09/28/2009 Raymond, KS 67573-9603 Center-Hutchinson .;
Gary Montford Physician Information $100.00 1909 N Madison Promise Regional Medical 09/28/2009 Hutchinson, KS 67502-4005 Center-Hutchinson .;
Lynnette RauvolaBouta Vice President Mission Integration $500.00 25 Huntington St. Via Christi Health System 09/28/2009 Eastborough. KS 67206-2047 .;
Sheryle D'Amico VP $200.00 737 N. 1550 Rd. Lawrence Memorial Hospital 09/28/2009 Lawrence, KS 66049-9198 .;
Lane County Hospital hospital contribution $150.00 09/29/2009 235 West Vine Lane County Hospital PO Box 969 .; Dighton, KS 67839-0969
Richard Bergling Administrator and Chief Executive $80.00 Officer 09/30/2009 312 Custer Street Ness City, KS 67560-1654 Ness County Hospital .;
Eugene Meyer President and Chief Executive $500.00 09/30/2009 26342 W 11 Oth Terrace Officer Olathe, KS 66061-8413 Lawrence Memorial Hospital .;
John Jeter President and Chief Executive $500.00 09/30/2009 3103 Tam O'Shanter Officer Hays, KS 67601-8100 Hays Medical Center .;
Bryce Young Chief Operating Officer $100.00 09/30/2009 1001 W. 38th Hays Medical Center Hays, KS 67601-1516 .;
$2,555.00 Subtotal This Page
Page~2_of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Other Cash Chetk Other Receipt
Kenneth Lindsey Chief Medical Officer $100.00 1100 Fairway Drive Hays Medical Center 09/30/2009 Hays, KS 67601-4710 .f
Dale Montgomery Vice President, Support Service $100.00 1300 Schwaller Ave. Hays Medical Center 09/30/2009 Hays, KS 67601-2242 .f
William Overbey CFO $100.00 4107 Smoky Hill Drive Hays Medical Center 09/30/2009 Hays, KS 67601-4713 .f
James McComas VP, Operations $100.00 602 E 41st Promise Regional Medical 09/30/2009 Hutchinson, KS 67502-4922 Center-Hutchinson .f
Chad Austin Vice President, Government $80.78
6518 SW 26th Court Relations 1 09/30/2009 Topeka, KS 66614-4305 Kansas Hospital Association .f
Thomas Bell President $134.61 4301 NW Valley Road Kansas Hospital Association 09/30/2009 Topeka, KS 66618-3445 .f
Melissa Hungerford Sr. Vice President $134.61 Kansas Hospital Association 09/30/2009 6448 SW Bayshore Dr Auburn, KS 66402-9324 .f
Fred Lucky Senior Vice President $329.84 Kansas Hospital Association 09/30/2009 14607 W 89 Lenexa, KS 66215-2967 .f
Sally Perkins $26.95 09/30/2009 1725 NW Grove Kansas Hospital Association Topeka, KS 66606-1237 .f
Cindy Samuelson Vice President $67.34 09/30/2009 1107 NE 54th St Kansas Hospital Association Topeka, KS 66617-4505 .f
Scott Glasrud Senior Vice President and Chief $350.00 09/30/2009 5006 W. 143rd Terrace Financial Officer Overland Park, KS 66224-3745 University of Kansas Hospital .f
$1,524.13 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Cub Cbeck LoaD Otber Other Receipt
Gregory Lundstrom Administrator and Chief Executive $250.00 605 West Lincoln Street Officer 09/30/2009 Lindsborg, KS 67456-2328 Lindsborg Community Hospital .f
Julie Stowe CNO $100.00 622 Oak St Newman Regional Health 09/30/2009 Emporia, KS 66801-2553 .f
Sunflower Chapter HFMA Professional Association $500.00 PO Box 2196 Sunflower Chapter HFMA 09/30/2009 Wichita, KS 67201-2196 .f
Robert Meling Senior Vice President $134.61 13005 Catalina Street 09/30/2009 Leawood, KS 66209-2392 .f
Steven Kelly President and Chief Executive $350.00 POBox 325 Officer 10/15/2009 601 quail Creek Ave Newton Medical Center Newton, KS 67114-0308 .f
Robert Driewer Ch ief Executive Officer $500.00 1201 W. 12th Avenue Newman Regional Health 10/15/2009 Emporia, KS 66801-2504 .f
Paul Lavender Vice President Finance $100.00 10/15/2009 12938 SW 57th St. Newton Medical Center Andover, KS 67002-8454 .f
Larry Van Der Wege $200.00 Lindsborg Community Hospital 10/16/2009 725 Emerald Drive Lindsborg, KS 67456-1834 .f
Floyd Chasse VP $100.00 10/16/2009 1823 College Ave Mercy Regional Health Center Manhattan, KS 66502-3381 .f
John Broberg Chief Executive Officer $500.00 10/16/2009 1020 Parkshire Cir Mercy Regional Health Center Manhattan, KS 66503 .f
Joseph Philipp Chief Medical Officer $100.00 10/16/2009 2945 Nevada St. Mercy Regional Health Center Manhattan, KS 66505-1289 .f
$2,834.61 Subtotal This Page
Page _1_4_ of~4_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (N arne 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 LOIn Other Cuh Check Other Receipt
Judy Wagner Vice President $100.00 912 Davis Drive Mercy Regional Health Center 10/16/2009 Manhattan, KS 66502-8005 .f
Janet Criqui VP - Fiscal Services $250.00 1-20 Lake Road Mercy Regional Health Center 10/16/2009 Council Grove, KS 66846-9801 .f
Roger Masse Chief Executive Officer $80.00 POBox 10 Clifton-Fine Hospital 10/16/2009 Star Lake, NY 13690-0010 .f
Paula Lubbers Director, Respiratory Therapy $75.00 PO Box 78 Meade District Hospital 10/20/2009 Meade, KS 67864-0078 .f
Michael Thomas Administrator $100.00 POBox 939 Meade District Hospital 10/20/2009 Meade, KS 67864-0939 .f
Leonard Hernandez Chief Executive Officer $375.00 POBox 937 Morton County Health System 10/20/2009 Elkhart, KS 67950-0937 .f
W. Charles Waters CEO $100.00 10/20/2009 PO Box 59 Clara Barton Hospital Hoisington, KS 67544-0059 .f
Janice McCart CEO $150.00 Citizens Medical Center 10/26/2009 1818 Harvey Ct Colby, KS 67701-1518 .f
KS Healthcare Environmental Services Professional Association $250.00 10/26/2009 Association PO BOX 3208 Topeka, KS 66601 .f
Association of Health Care Kansas $500.00 10/26/2009 215 SE 8th St. Topeka, KS 66603-3906 .f
Tammy Peterman COO $350.00 10/26/2009 9714 W. 145th Terr. University of Kansas Hospital Overland Park, KS 66221-2543 .f
$2.330.00 Subtotal This Page
Page~_of~_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Narne 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
Robert Page Chief Executive Officer $700.00 13413 W 75th Ct University of Kansas Hospital 10/26/2009 Shawnee, KS 66216-3078 .f
Linda Harrison CEO $200.00 4801 Pin Oak Rd Promise Regional Medical 10/26/2009 Hutchinson, KS 67502 Center-Hutchinson .f
Patricia Edwards VP of Patient Care $100.00 957 Lost Hills Court Promise Regional Medical 10/26/2009 Derby, KS 67037-9393 Center-Hutchinson .f
Kathleen Clausing-Willis Vice PresidenUCDO $100.00 1071 E 1400 Rd Lawrence Memorial Hospital 10/30/2009 Lawrence, KS 66046-9633 .f
Dennis George Chief Executive Officer $500.00 801 N Fourth Coffey County Hospital 10/30/2009 Burlington, KS 66839-0189 .f
Kari Bruffett Government Relations Liaison $100.00 7348 Meadowlark Dr. University of Kansas Hospital 10/30/2009 Shawnee, KS 66227-5516 .f I
Susan Page President and Chief Executive $200.00 Officer 10/30/2009 10315 S Hiway 281 Pratt, KS 67124-8161 Pratt Regional Medical Center .f
Martin Ekrem Vice President, Outreach Services $250.00 Via Christi Health System 10/30/2009 9911 E 21st St. N #2103 Wichita, KS 67206-3533 .f
David Busatti Chief Financial Officer $350.00 10/30/2009 550 North Hillside Avenue Wesley Medical Center Wichita, KS 67214-4910 .f
Michael Ryan Chief Executive Officer $100.00 10/30/2009 910 S. Ash Hillsboro Community Hospital Hillsboro, KS 67063-1541 .f
Lincoln County Hospital $100.00 10/30/2009 624 N. Second Street Lincoln County Hospital Lincoln, KS 67455-1738 .f
$2,700.00 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Check LoaD Other Cash Other Receipt
Washington County Hospital Community Hospital $250.00 304 E. 3rd Washington County Hospital 10/30/2009 Washington, KS 66968-2033 .f
John Peterson Administrator $500.00 2841 SW Plass Avenue Kansas Hospital Association 10/30/2009 Topeka, KS 66611-1629 .f
Richard Miller Administrator and Chief Executive $160.00 810 Valley Vista Dr. Officer 10/30/2009 Norton, KS 67654 Norton County Hospital .f
Terry Deschaine Chief Executive Officer $140.00 POBox 579 Fredonia Regional Hospital 10/30/2009 Fredonia, KS 66736-0579 .f
Richard Vaught Administrator $130.00 2805 Yaeger Dr. William Newton Hospital 10/30/2009 Winfield, KS 67156-8511 .f
Danny Huckvale Assistant Administrator $100.00 120 N. Massachusetts William Newton Hospital 10/30/2009 Winfield, KS 67156-1818 .f
Christian Hansen $350.00 University of Kansas Hospital 10/30/2009 5710 W 128th Street
I Overland Park, KS 66209-3681 I .f
Jon Jackson Sr. Vice President, Systems $350.00 Intergration 10/30/2009 8000 Tomahawk Road Prairie Village, KS 66208-4845 University of Kansas Hospital .f
Vallerie Gleason VP $100.00 10/30/2009 3123 N. Lakeridge Ct. Newton Medical Center Wichita, KS 67205-1928 .f
Scott Taylor President and Chief Executive $750.00 11/05/2009 1617 Crestway Officer Garden City, KS 67846-6916 St. Catherine Hospital .f
Kansas Good Government Fund HCA State PAC to PAC transfer $2,000.00 11/05/2009 215 SE 8th HCA Kansas Good Government Topeka, KS 66603-3906 Fund .f
$4,830.00 Subtotal This Page
Page _~__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 LoaD Other Other Receipt
Marcia Walsh Chief Operating Officer $100.00 716 High Street Community Health Care System 11/05/2009 Onaga, KS 66521 .f
Brenda McCants Dir., Development and Volunteers $100.00 1019 E. 10th Street Goodland Regional Medical 11/09/2009 Goodland, KS 67735-3503 Center .f
Kevin Sanderson Director of Information Systems $100.00 PO Box 374 Goodland Regional Medical 11/09/2009 Goodland, KS 67735-0374 Center .f
James Precht Chief Financial Officer $100.00 1410 Arcade St Goodland Regional Medical 11/09/2009 Goodland, KS 67735-3430 Center .f
Jay Jolly Chief Executive Officer $100.00 604 Arcade St Goodland Regional Medical 11/09/2009 Goodland, KS 67735-2130 Center .f
Stanton Hospital Community Hospital $85.00 PO Box 779 Stanton County Health Care 11/10/2009 404 N. Chestnut Facility Johnson, KS 67855-0779 .f
Thomas Macaronas CFO $100.00 Labette Health 11/10/2009 701 West 6th Coffeyville, KS 67337-4021 .f
Gail Billman Assistant Director of Rehabilitation $100.00 Labette Health 11/10/2009 16057 Kiowa Rd. Altamont, KS 67330-9370 .f
Steven Wilkinson President and Chief Executive $500.00 11/10/2009 5721 West 119th Street Officer Overland Park, KS 66209-3722 Menorah Medical Center .f
County Health Center Rawlins $100.00 11/10/2009 Rawlins County Health Center .f
Estella Clark CNO $100.00 11/10/2009 612 Custer Rd Labette Health Parsons, KS 67357-2230 .f
$1,485.00 Subtotal This Page
Page ~8_ of~_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (N arne 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 Casb Check LoaD Other Other Receipt
Greg Unruh Chief Executive Officer $350.00 700 Leonard Community Health Care System 11/10/2009 Onaga, KS 66521-9403 .f
Gayle Arnett CEO $200.00 1819 Ridge Road Susan B. Allen Memorial Hospital 11/10/2009 EI Dorado, KS 67042-4033 .f
Nancy Zimmerman Administrator $160.00 HC 65, Box 8A Comanche County Hospital 11/10/2009 Coldwater, KS 67029-9500 .f
Shae Veach Administrator $100.00 POBox 779 Stanton County Health Care 11/10/2009 Johnson, KS 67855-0779 Facility .f
Christopher Ekrem COO $150.00 506 Third St., PO Box 338 Greeley County Health Services 11/10/2009 Tribune, KS 67879-0338 .f
Michalene Maringer Executive V.P.lChief Hospital $200.00 6117 Woodcreek Drive Officer 11/20/2009 Burr Ridge, IL 60527-5100 Via Christi Regional Medical Center .f
Eldon Schumacher Vice President $250.00 Great Plains Health Alliance, Inc. 11/30/2009 12433 Edgewood Circle Wichita, KS 67206-3601 I .f
Nancy Carpenter CNO $875.00 Wilson Medical Center 11/30/2009 602 Iowa Neodesha, KS 66757-1570 .f
Beth Hedberg Nursing Administration $625.00 11/30/2009 2570 First Avenue Lindsborg Community Hospital Marquette, KS 67464-9801 .f
Patricia Howell CNO $190.00 11/30/2009 445 E Plum St. Citizens Medical Center Colby, KS 67701-3464 .f
Everett Lutjemeier Administrator $650.00 11/30/2009 510 E Street Washington County Hospital Washington, KS 66968-2033 .f
$3,750.00 Subtotal This Page
Page~9_of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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 Loan Other Casb Cbeck Other Receipt
Jackie Leary Director, Managed Care $100.00 8417 W 111 th Ter Shawnee Mission Medical Center 11/30/2009 Overland Park, KS 66210-2471 .f
Joni Brown COO $100.00 6133 N. Cypress Ct Shawnee Mission Medical Center 11/30/2009 Kansas City, MO 64119-4600 .f
Samuel Turner Chief Executive Officer $500.00 11408 Fontana Court Shawnee Mission Medical Center 11/30/2009 Leawood, KS 66211-1344 .f
Robin Harrold Senior Vice President $200.00 13402 W. 72nd St. Shawnee Mission Medical Center 11/30/2009 Shawnee, KS 66216-4158 .f
Sheri Hawkins Vice President $100.00 14013 West 72nd Street Shawnee Mission Medical Center 11/30/2009 Shawnee, KS 66216-3781 .f
Debra Ohnoutka Administrator $100.00 8008 N. Flora Shawnee Mission Medical Center 11/30/2009 Kansas City, MO 64118-8215 .f
Peter Bath VP $150.00 Shawnee Mission Medical Center 11/30/2009 13604 W. 54th Terrace Shawnee, KS 66216-5112 .f
Frederick Zang Administrative Director $100.00 Shawnee Mission Medical Center 11/30/2009 11009 SE Country Lane Lees Summit, MO 64081-3152 .f
Patricia Stevenson Manager, Quality Management $100.00 11/30/2009 21308 W. 51st. Street Shawnee Mission Medical Center Shawnee Mission, KS 66218-9089 .f
Minneola District Hospital Community Hospital $160.00 11/30/2009 212 Main Minneola District Hospital PO Box 127 .f Bloom, KS 67865-8511
Decatur Health Systems $160.00 11/30/2009 PO BOX 268 Decatur County Hospital and Oberlin, KS 67749-0268 Cedar Living Center .f
$1,770.00 Subtotal This Page
Page~of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (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
Norm Lambert CEO $100.00 230 Canna Lane Southwest Medical Center 11/30/2009 Liberal, KS 67901-4900 .f
James Turnbull CEO $150.00 914 N. Main Kiowa District Hospital and Manor 11/30/2009 Hoisington, KS 67544-1744 .f
Lane County Hospital hospital contribution $10.00 235 West Vine Lane County Hospital 11/30/2009 PO Box 969 Dighton, KS 67839-0969 .f
Horton Community Hospital $160.00 Horton Community Hospital Horton Community Hospital 11/30/2009 240 West 18th Street Horton, KS 66439-1245 .f
Janet Kemmerer Director of Nursing . $100.00 419 N. Lincoln, Box 182 Mitchell County Hospital Health 11/30/2009 Jewell, KS 66949 Systems .f
KHHRA Professional Association $250.00 PO BOX 2308 11/30/2009 Topeka, KS 66601-2308 .f
Ronald Bender Chief Executive Officer $525.00
I Clay County Medical Center 11/30/2009 624 Liberty St. Clay Center, KS 67432-1527 .f
Curtis Hawkinson Chief Executive Officer $200.00 Community Memorial Healthcare 11/30/2009 1109 Keystone Rd. Marysville, KS 66508-8771 .f
Deanna Pittman Administrator $125.00 11/30/2009 3557 Queen Rd Wilson Medical Center PO Box 52 .f Neodesha, KS 66757-1646
Kiley Floyd Administrator $135.00 11/30/2009 224 N 4th Osborne County Memorial Osborne, KS 67473-1912 Hospital .f
Douglas Newman CEO $100.00 11/30/2009 104 E Mulberry St Graham County Hospital Hill City, KS 67642-1962 .f
$1.855.00 Subtotal This Page
Page _2_1_ of~_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box C ash, Check, Date of Contributor Than $150 Loan or Loan Other Cash Check Other Receipt
Juanita Roy Regional Vice President, Finance $300.00 20617 West 96th Street Providence Medical Center 11/30/2009 Lenexa, KS 66220-2659 .f
Michael Dorsey President and Chief Executive $500.00 26303 W 111th Terrace Officer 11/30/2009 Olathe, KS 66061-8434 Providence Medical Center .f
Jean Dean CEO $60.00 1000 W 39th St Trego County-Lemke Memorial 11/30/2009 Hays, KS 67601-1517 Hospital .f
Robert Bean President and Chief Executive $110.00 18 Sunset Officer 11/30/2009 Wellington, KS 67152-4707 Sumner Regional Medical Center .f
Teresa Dewel $160.00 402 Clay St Hodgeman County Health Center 11/30/2009 Jetmore, KS 67854-0072 .f
Deanna Freeman Administrator $60.00 708 Blaine Rawlins County Health Center 11/30/2009 Atwood, KS 67730-2033 .f
Gerald Marquette Chief Executive Officer $500.00 Coffeyville Regional Medical 11/30/2009 1400 West Fourth PO Box 1446 Center Coffeyville, KS 67337-3306 .f
Kevin Conlin President & CEO $500.00 Via Christi Health System 11/30/2009 422 Pine Meadow Ct. Andover, KS 67002-8842 .f
James Wahlmeier President and Chief Executive $160.00 11/30/2009 1100 Highland Drive Officer Concordia, KS 66901-3923 Cloud County Health Center .f
Ken Alexander KHA Board of Director $150.00 11/30/2009 155 SW Lakeside Dr. Stormont-Vail HealthCare Topeka, KS 66603 .f
Mary Sweet Administrator $160.00 11/30/2009 603 South Spruce Kiowa County Memorial Hospital Greensburg, KS 67054-0616 .f
$2,660.00 Subtotal This Page
Page _~_ of~~_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Narne 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 LoaD Other Other Receipt
Letitia Hollingsworth Director of Reimbursement $200.00 2635 SW Santa Fe Dr. Kansas Hospital Association 11/30/2009 Topeka, KS 66614-4956 ~
Kansas Association of Health Care Professional Association $100.00 Communicators 11/30/2009 215 SE 8th Avenue ~ Topeka, KS 66603-3906
David Dick Chief Executive Officer $350.00 621 N Highland Ave Mitchell County Hospital Health 11/30/2009 Beloit, KS 67420-0399 Systems ~
Don Paxson Trustee $80.00 2046 US Hwy 24 Graham County Hospital 11/30/2009 Penokee, KS 67659-2056 ~
Marvin Fairbank $100.00 8640 SW 45th Stormont-Vail HealthCare 11/30/2009 Topeka, KS 66610-9198 ~
Leonard Hernandez Chief Executive Officer $150.00 POBox 937 Morton County Health System 11/30/2009 Elkhart, KS 67950-0937 ~
Larry Van Der Wege $85.00 Lindsborg Community Hospital 11/30/2009 725 Emerald Drive Lindsborg, KS 67456-1834 ~
Rita Buurman $100.00 Formerly Sabetha Community 11/30/2009 450 Parkview Drive Sabetha, KS 66534-2200 Hospital ~
Chad Austin Vice President, Government $250.00 12/01/2009 6518 SW 26th Court Relations Topeka, KS 66614-4305 Kansas Hospital Association ~
Education Council Kansas Healthcare $250.00 12/01/2009 ~
Stella Clark VP of Patient Services/CNO $470.00 12/02/2009 PO Box 1032 Labette Health Parsons, KS 67357-1032 ~
$2.135.00 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(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 Loan Other Cash Check Other Receipt
Brad Eustace Trustee $700.00 Edwards County Hospital and 12/02/2009 Healthcare Center .f
Benjamin Anderson Administrator $190.00 709 Oak Ashland Health Center 12/02/2009 PO Box 188 Ashland, KS 67831-0188 .f Kevin White Administrator $240.00 915 Goodview Medicine Lodge Memorial Hospital 12/02/2009 Medicine Lodge, KS 67104-1036 .f
Jack Wagner Executive Vice President and $350.00 13900 Howe Drive CFO 12/02/2009 Leawood, KS 66224-4500 Shawnee Mission Medical Center .f
Kansas Hospital Attorneys KAHA KAHA $500.00 PO BOX 2308 KAHA 12/08/2009 Topeka, KS 66601-2308 .f
KS Assoc of Hosp Pt Acct Mgrs KAHPAM Professional Association $350.00 215 S. E. 8th Avenue 12/08/2009 Topeka, KS 66603-3906 .f
$2,330.00 Subtotal This Page
Complete if last page of Schedule A
Total Itemized Receipts for Period $56,482.15
Total Unitemized Contributions ($50 or less) $3,655.95
Sale of Political Materials (Unitemized) $0.00
Total Contributions When Contributor Not Known $0.00
TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary) $60,138.10 SCHEDULEB IN-KIND CONTRIBUTIONS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)
List Occupation & Value of Date N arne and Address Industry for Those Giving Description of In-Kind In-Kind of Contributor an In-Kind of More Than Contribution Contribution $150
Kansas Hospital KHA Hospital Association 2008 Audit Expenses 04/08/2009 215 S.E. 8th Kansas Hospital Association $1,550.00 Topeka, KS 66603-3906
Kansas Hospital KHA KHA Inkind - Federal Express 04/30/2009 215 S.E. 8th $18.94 Topeka, KS 66603-3906
Kansas Hospital KHA Hospital Association KS Govt Ethics Annual 215 S.E. 8th Kansas Hospital Association Registration Fee 06/08/2009 $240.00 Topeka, KS 66603-3906
Kansas Hospital KHA Hospital Association InKind Postage 215 S.E. 8th Kansas Hospital Association $187.90 07/09/2009 Topeka, KS 66603-3906
Kansas Hospital KHA KHA Inkind - Federal Express 215 S.E. 8th 07/31/2009 Topeka, KS 66603-3906 $19.13
Kansas Hospital KHA Hospital Association KHA Inkind - Printing 215 S.E. 8th Kansas Hospital Association 07/31/2009 Topeka, KS 66603-3906 $2,828.84
Kansas Hospital KHA Conference Calls 215 S.E. 8th 07/31/2009 Topeka, KS 66603-3906 $32.35
Kansas Hospital KHA KHA InKind - Stamp 215 S.E. 8th 09/08/2009 Topeka, KS 66603-3906 $20.00
Kansas Hospital KHA KHA Inkind - Federal Express 215 S.E. 8th 09/08/2009 Topeka, KS 66603-3906 $20.17
$4,917.33 Subtotal This Page
Complete if last page of Schedule B
Total Itemized (over $100) In-Kind Contributions
Total Unitemized ($100 or less) In-Kind Contributions
TOTAL IN-KIND CONTRIBUTIONS THIS PERIOD (to line 6 of Summary)
Page _1__ of_2__ SCHEDULEB IN-KIND CONTRIBUTIONS
Kansas Hospital Association Political Action Committee
(N arne of Party Committee or Political Committee)
List Occupation & Value of Date Name and Address Industry for Those Giving Description of In-Kind In-Kind of Contributor an In-Kind of More Than Contribution Contribution $150
Kansas Hospital KHA KHA Inkind - Federal Express 09/30/2009 215 S.E. 8th $20.17 Topeka, KS 66603-3906
Kansas Hospital KHA Hospital Association Annual Vocus Fee 10/30/2009 215 S.E. 8th Kansas Hospital Association $5,000.00 Topeka, KS 66603-3906
Kansas Hospital KHA KHA Inkind - Federal Express 215 S.E. 8th 11/30/2009 $20.08 Topeka, KS 66603-3906
Kansas Hospital KHA KHA In Kind - Office Supplies 215 S.E. 8th $140.32 12/10/2009 Topeka, KS 66603-3906
Kansas Hospital KHA Hospital Association KHA Inkind - Office Supplies 215 S.E. 8th Kansas Hospital Association 12/11/2009 Topeka, KS 66603-3906 $636.11
:.00. $5,816.68 S~'btJt';i This Page
Complete if last page of Schedule B
Total Itemized (over $100) In-Kind Contributions $10,734.01
Total Unitemized ($100 or less) In-Kind Contributions $45.67
TOTAL IN-KIND CONTRIBUTIONS THIS PERIOD (to line 6 of Summary) $10,779.68
Page _2__ of_2__ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)
Purpose of Expenditure
Date Narne and Address List candidate name & address if independent or in-kind Amount expenditure in excess of $300
AHAPAC-American Hospital Association January 2009 KHA-AHA PAC Transfer FEDERAL $350.00 01/29/2009 325 Seventh Street, NW Suite 700
AHAPAC-American Hospital Association Feb 2009 KHA - AHA transfer FEDERAL $427.50 02/27/2009 325 Seventh Street, NW Suite 700
Kansas Democratic House Campaign Committee $500.00 02/27/2009 PO Box 2083 Topeka, KS 66601
AHAPAC-American Hospital Association 1st quarter KHA payroll contributions FEDERAL $697.53 04/02/2009 325 Seventh Street, NW Suite 700
AHAPAC-American Hospital Association May-June 2009 AHA PAC Distribution FEDERAL $508.69 06/30/2009 325 Seventh Street, NW Suite 700
Dennis McKinney for Kansas Dennis McKinney, TREASURER 116th KS 1220 S. Main 08/03/2009 $250.00 Greensburg, KS 67054
AHAPAC-Artlerican Hospital Association July Kansas PAC exchange FEDERAL 08/05/2009 $171.25 325 Seventh Street, NW Suite 700
AHAPAC-American Hospital Association September 2009 KHA PAC Transfer 09/01/2009 FEDERAL $3,623.75 325 Seventh Street, NW Suite 700
Sandy Praeger for Insurance Commissioner Sandy Praeger, COMMISS OF INSURANCE 2nd KS 09/10/2009 3601 Quail Creek Ct. $1,000.00 Lawrence, KS 66047
Republican Senatorial Campaign Committee 09/24/2009 2348 SW Topeka Blvd $250.00 Topeka, KS 66611
$7,778.72 Subtotal This Page
Page _1_ of__9_ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)
Purpose of Expenditure
Date Name and Address List candidate name & address if independent or in-kind Amount expenditure in excess of $300
Michael R. O'Neal for Kansas House Michael O'Neal, STATE HOUSE 104th KS 8 Windemere Ct. $250.00 09/30/2009 Hutchinson, KS 67504
Lee Tafanelli for Kansas House Lee Tafanelli, STATE HOUSE 47th KS 7075 122nd St. $250.00 09/30/2009 Ozawkie, KS 66070
CoreFirst Bank &Trust Bank Service Charge 3035 SW Topeka Blvd $14.83 09/30/2009 Topeka, KS 66611
Virgil Peck for Kansas House Virgil Peck, STATE HOUSE 11th KS Box 277 $250.00 10/01/2009 Tyro, KS 67364
Lance Kinzer for Kansas House Lance Kinzer. STATE HOUSE 14th KS 12549 S Brougham $250.00 10/01/2009 Olathe, KS 66062
Cindy Neighbor for Kansas House Cindy Neighbor, STATE HOUSE 18th KS 10405 West 52nd Terrace 10/01/2009 $250.00 Shawnee, KS 66203
Dolores Furtado for State House Dolores Furtado, STATE HOUSE 19th KS 10104 Hemlock Drive 10/01/2009 $250.00 Overland Park, KS 66212
Mike Slattery for State House Mike Slattery, STATE HOUSE 24th KS 5015 Reeds Rd 10/01/2009 $250.00 Mission, KS 66049
Ray Merrick for Kansas House Ray Merrick, STATE HOUSE 27th KS 10/01/2009 6874 West 164th Terr $250.00 Stilwell, KS 66085
Anthony Brown for Kansas House Anthony Brown, STATE HOUSE 38th KS 10/01/2009 799 E. 2200 Rd. $250.00 Eudora, KS 66025
$2,264.83 Subtotal This Page
Page _2__ of__9_ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)
Purpose of Expenditure
Date Name and Address List candidate name & address if independent or in-kind Amount expenditure in excess of $300
Paul Davis for Kansas House Paul Davis, STATE HOUSE 46th KS 1527 Massachusetts $250.00 10101/2009 Lawrence, ks 66044
Annie Tietze for Kansas House Annie Tietze, STATE HOUSE 56th KS 329 SW Yorkshire Road 10101/2009 Topeka, KS 66606 $250.00
Sean Gatewood for Kansas House Sean Gatewood, STATE HOUSE 57th KS 1408 NW Central Ave. $250.00 10101/2009 Topeka, KS 66608
Steve Lukert for Kansas House Steve Lukert, STATE HOUSE 62nd KS 2420 Acorn Road $250.00 10101/2009 Sabetha, KS 66534
Vern Swanson for Kansas House Vern Swanson, STATE HOUSE 64th KS 1422 5th St. $250.00 10101/2009 Clay Center, KS 67432
Brownback for Governor Sam Brownback, GOVERNOR KS P.O. Box 3739 10101/2009 $1,000.00 Topeka, KS 66604-0739
Marc Rhoades for Kansas House Marc Rhoades, STATE HOUSE 72nd KS 10101/2009 11006 Lazy Creek Drive $250.00
I Newton, KS 67114
I Clark Shultz for Kansas House Clark Shultz, STATE HOUSE 73rd KS 707 Wasington Circle 10101/2009 $250.00 Lindsborg, KS 67456
Peggy Mast for Kansas House Peggy L. Mast, STATE HOUSE 76th KS 10101/2009 765 Road 110 $250.00 Emporia, KS 66801
J. David Crum for Kansas House J. Crum, STATE HOUSE 77th KS 10101/2009 2903 Lakeshore Dr. $250.00 Augusta, KS 67010
$3,250.00 Subtotal This Page
Page ~__ of__9 _ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)
Purpose of Expenditure
Date Narne and Address List candidate name & address if independent or in-kind Amount expenditure in excess of $300
Ed Trimmer for Kansas House Ed Trimmer, STATE HOUSE 78th KS 1402 East 9th $250.00 10101/2009 Winfield, KS 67156
Vincent Wetta for Kansas House Vincent Wetta, STATE HOUSE 80th KS 1204 N Poplar 10101/2009 Wellington, KS 67152 $250.00
Jim Ward for Kansas State House Jim Ward, STATE HOUSE 88th KS 3100 E Clark $250.00 10101/2009 Wichita, KS 67211
Brenda Landwehr for Kansas House Brenda Landwehr, STATE HOUSE 91st KS 1927 N. Gow $250.00 10101/2009 Wichita, KS 67203
Nile Dillmore for Kansas House Nile Dillmore, STATE HOUSE 92nd KS 11 02 Jefferson $250.00 10101/2009 Wichita, KS 67203 I
Geraldine Flaharty for Kansas House Geraldine Flaharty, STATE HOUSE 98th KS 1816 E Fernwood 10101/2009 $250.00 Wichita, KS 67216
Janice L. Pauls for Kansas House Janice L. Pauls, STATE HOUSE 102nd KS 10101/2009 1634 North Baker $250.00 Hutchinson, KS 67501
Jason Watkins for Kansas House Jason Watkins, STATE HOUSE 105th KS 6525 West Northwind 10101/2009 $250.00 Wichita, KS 67205
Eber Phelps for Kansas House Eber E. Phelps, STATE HOUSE 111th KS 10101/2009 3103 Olympic Lane $250.00 Hays, KS 67601
Bob Bethell for Kansas House Bob Bethell, STATE HOUSE 113th KS 10101/2009 104 E 3rd $250.00 P.O. Box 186 Alden, KS 67512
$2,500.00 Subtotal This Page
Page _4_ of__~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)
Purpose of Expenditure
Date Name and Address List candidate name & address if independent or in-kind Amount expenditure in excess of $300
Mitch Holmes for Kansas House Mitch Holmes, STATE HOUSE 114th KS 211 SE 20th Ave $250.00 10101/2009 St. John, KS 67576
Melvin Neufeld for Kansas House Melvin Neufeld, STATE HOUSE 115th KS 7405 15 Road $250.00 10101/2009 Ingalls, KS 67853
Kelly Kultala for State Senate Kelly Kultala, STATE SENATE 5th KS 12232 Hubbard Rd. $250.00 10101/2009 Kansas City, KS 66109
Tim Owens for Kansas Senate Tim Owens, STATE SENATE 8th KS 7804 W. 100th Street $250.00 10101/2009 Overland Park, KS 66212
Julia Lynn for Kansas Senate Julia Lynn, STATE SENATE 9th KS 18837 W. 115th Terrace $250.00 10101/2009 Olathe, KS 66061
John Vratil for Kansas Senate John Vratil, STATE SENATE 11th KS 9534 Lee Blvd. 10101/2009 $250.00 Leawood, KS 66206
Dwayne Umbarger for Kansas Senate Dwayne Umbarger, STATE SENATE 14th KS 1585 70th Road 10101/2009 $250.00 Box 181 B Thayer, KS 66776
Ty Masterson for Kansas Senate Ty Masterson, STATE SENATE 16th KS 1539 Phyllis Lane 10101/2009 $250.00 Andover, KS 67002
Vicki Schmidt for Kansas Senate Vicki Schmidt, STATE SENATE 20th KS 10101/2009 2619 SW Randolph Ct $250.00 Topeka, KS 66614
Pete Brungardt for Kansas Senate Pete Brungardt, STATE SENATE 24th KS 10101/2009 522 Fairdale Road $250.00 Salina, KS 67401
$2,500.00 Subtotal This Page
Page __5_ of__~_ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)
Purpose of Expenditure
Date Name and Address List candidate name & address if independent or in-kind Amount expenditure in excess of $300
Susan Wagle for Kansas Senate Susan Wagle, STATE SENATE 33rd KS 4 N. Sagebursh $250.00 10101/2009 Wichita, KS 67230
Carolyn McGinn for Kansas Senate Carolyn McGinn, STATE SENATE 31st KS 11047 N 87W $250.00 10101/2009 SEDGWICK, KS 67135
Ruth Teichman for Kansas Senate Ruth Teichman, STATE SENATE 33rd KS 402 N. Union $250.00 10101/2009 Stafford, KS 67578
Jay Emler for State Senate Jay Emler, STATE SENATE 35th KS 1457 Shawnee Rd $250.00 10101/2009 Lindsborg, KS 67456
Janis Lee for Kansas Senate Janis Lee, STATE SENATE 36th KS 2032 90th Road $250.00 10101/2009 Kensington, KS 66951
Senator Steve Morris for Kansas Senate Stephen Morris, STATE SENATE 39th KS 600 S. Trindle St. 10101/2009 $250.00 Hugoton, KS 67951-2734
Republican House Campaign Committee 10101/2009 2025 SW Gage Blvd $500.00
Topeka, KS 66603 I
Aaron Jack for Kansas House Aaron Jack, STATE HOUSE 99th KS 10101/2009 1330 N Robin Ct $250.00 Andover, KS 67002
Jill Quigley for Kansas House Jill Quigley, STATE HOUSE 17 10101/2009 13112 West 84th Street $250.00 Lenexa, KS 66215
Derek Schmidt for Attorney General Derek Schmidt, ATTORNEY GENERAL 15th KS 10/19/2009 416 N. 5th Street $500.00 P.O. Box 747 Independence, KS 67301-3128
$3,000.00 Subtotal This Page
Page ~_ of__9_ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)
Purpose of Expenditure
Date Name and Address List candidate name & address if independent or in-kind Amount expenditure in excess of $300
Steve Six for Attorney General Steve Six, ATIORNEY GENERAL KS POBox 478 $500.00 10/19/2009 Topeka, KS 66601
AHAPAC-American Hospital Association September/October 2009 AHA PAC Exchange FEDERAL $8,199.42 11/03/2009 325 Seventh Street, NW Suite 700
Bill Feuerborn for Kansas House Bill Feuerborn, STATE HOUSE 5th KS 1600 Park Road $250.00 12/02/2009 Garnett, KS 66032
Jerry D. Williams for Kansas House Jerry Williams, STATE HOUSE 8th KS 21225 Kiowa Road $250.00 12/02/2009 Chanute, KS 66720
Kevin Yoder for Kansas House Kevin Yoder, STATE HOUSE 20th KS 6618 W 91 st #242 $250.00 12/02/2009 PO Box 122333 Overland Park, KS 66212
Kay Wolf for Kansas House Kay Wolf, STATE HOUSE 21st KS 8339 Roe 12/02/2009 $250.00 Prairie Village, KS 66207
Milack Talia for Kansas House Milack Talia, STATE HOUSE 23rd KS 12/02/2009 6829 Bluejacket Street $250.00 Shawnee, KS 66203
Barbara W. Ballard for Kansas House Barbara W. Ballard, STATE HOUSE 44th KS 1532 Alvamar Drive 12/02/2009 $250.00 Lawrence, KS 66047
Tom Sloan for Kansas House Tom Sloan, STATE HOUSE 45th KS 12/02/2009 772 Highway 40 $250.00 Lawrence, KS 66049
Joe Patton for Kansas House Joe Patton, STATE HOUSE 54th KS 12/02/2009 3546 SW Summerwood Court $250.00 Topeka, KS 66614
$10,699.42 Subtotal This Page
Page 7 of 9 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)
Purpose of Expenditure
Date Name and Address List candidate Dame & address if independent or in-kind Amount expenditure in excess of $300
Don Hill for Kansas House Don Hill, STATE HOUSE 60th KS 1720 Luther $250.00 12/02/2009 Emporia, KS 66801
Jerry Henry for Kansas House Gerald Henry, STATE HOUSE 63rd KS 3515 Neosho Road $250.00 12/02/2009 Cummings, KS 66016
Tom Moxley for Kansas House Tom Moxley, STATE HOUSE 68th KS 1852 S 200 Road $250.00 12/02/2009 Council Grove, KS 66846
Don Schroeder for Kansas House Don Schroeder, STATE HOUSE 74th KS 13114thAve. $250.00 12/02/2009 Inman, KS 67546
Gail Finney for Kansas House Gail Finney STATE HOUSE KS 084 1754 N. Madison St $250.00 12/02/2009 Wichita, KS 67214
Phil Hermanson for Kansas House Phil Hermanson, STATE HOUSE 96th KS 5338 S. Mosley 12/02/2009 $250.00 Wichita, KS 67216
Bob Marshall for Kansas Senate Bob Marshall, STATE SENATE 13th KS 12/02/2009 999 215th Street $250.00 Fort Scott, KS 66701
Mark Taddiken for Kansas Senate Mark Taddiken, STATE SENATE 21st KS 2614 Hackberry Road 12/02/2009 $250.00 Clifton, KS 66937
Ks. Sen. Karin Brownlee Karin Brownlee, STATE SENATE 23rd KS 12/02/2009 14725 S Chalet Drive $250.00 Olathe, KS 66062
Republican Senatorial Campaign Committee 12/02/2009 2348 SW Topeka Blvd $1,000.00 Topeka, KS 66611
$3.250.00 Subtotal This Page
Page __8_ of__9_ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee
( Name of Party Committee or Political Committee)
Purpose of Expenditure Amount Narne and Address Date List candidate name & address if independent or in-kind expenditure in excess of $300
AHAPAC-American Hospital Association November 2009 KHA PAC Transfer FEDERAL 12/02/2009 325 Seventh Street, NW $6,303.75 Suite 700
Sandy Praeger for Insurance Commissioner Sandy Praeger, COMMISS OF INSURANCE 2nd KS 3601 Quail Creek Ct. 12/29/2009 Lawrence, KS 66047 $500.00
$6.803.75 Subtotal This Page
Complete if last page of Schedule c
Total Itemized Expenditures This Period $42,046.72
Total Unitemized Expenditures of $50 or less $43.53
TOTAL EXPENDITURES & OTHER DISBURSEMENTS $42,090.25 THIS PERIOD (to line 4 of Summary)
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