OCT 202014 October 27, 2014 KS Governmentai Etrllcs Conl,.."",( " FILE with SECRETARY of STATE'.,'"::,,." SEE REVERSE SIDE for INSTRUCTIONS

KANSAS GOVERNMENTAL ETHICS COMMISSION

RECEWTSANDEXPENDITURESREPORT REC;EIVEO OF A POLITICAL OR PARTY COMMITTEE OCT 202014 October 27, 2014 KS Governmentai Etrllcs Conl,.."",( " FILE WITH SECRETARY OF STATE'.,'"::,,." SEE REVERSE SIDE FOR INSTRUCTIONS

A. Name ofCommittee: KANSAS INSURANCE POLITICAL ACTION COMMITTEE (INSPAC)

Address: 3601 VINCENNES ROAD

City and Zip Code: INDIANAPOLIS, IN 46268 This is a (check one): __ Party Committee .f Political Committee

B. Check only if appropriate: __Amended Filing __ Tennination Report

C. Summary (covering the period from July 25, 2014 through October 23,2014) 1. Cash on hand at beginning ofperiod . 11,166.89

2. Total Contributions and Other Receipts (Use Schedule A) .. 10,000.00 3. Cash available this period (Add Lines 1 and 2) .. 21,166.89 4. Total Expenditures and Other Disbursements (Use Schedule C) .. 8,000.00 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . 13,166.89 6. In-Kind Contributions (Use Schedule B) ...... 0 7. Other Transactions (Use Schedule D) .. o

D. "I declare that this report, including any accompanying schedules and statements, has been examined by me and to the best ofmy knowledge and beliefis true, correct and complete. I understand that the intentional failure to file this document or i entionally fi' a false document is a class A misdemeanor."

10/6/14 Date

GEe Form Rev, 2014 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

KANSAS INSURANCE POLITICAL ACTION COMMITTEE (INSPAC) (Name ofParty 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

KANSAS ASSN OF PROPERTY & TRADE ASSOCIATION 07/25/14 CASUALTY INSURANCE .; $10,000.00 COMPANIES

':," :'"... '. ti1fl"~~r'<' ,:; '''':'''''',' " ,., .."", ./sugiot~..... ~i~~:~e, ...... -. $10,000.00 I.,: ' :. ,,:,;,j,,:'};::;i·"::t;'" ".' , i'" . . ...

Complete iflast page of Schedule A

Total Itemized Receipts for Period $10,000.00

Total Unitemized Contributions ($50 or less)

Sale of Political Materials (Unitemized)

Total Contributions When Contributor Not Known

--,;' - ,,'i', .. , ' '" . . .. ~.': .: ' , '. TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary) , . '0 $10,000.00

Page do of 5 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

KANSAS INSURANCE POLITICAL ACTION COMMITTEE (INSPAC) (Name ofParty Committee or Political Committee)

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

Ken Selzer 09/16/14 12504 Buena Vista $2,000.00 Leawood, KS 66209

Dennis Anderson 09/16/14 13100 Woodward Street $500.00 Overland Park, KS 66213

Rick Wilborn 09/16/14 1504 Heritage Place $1,000.00 McPherson, KS 67460

Ray Merrick 09/16/14 6874 W. 164th Terr $250.00 Stilwell, KS 66085

Jene Vickrey 09/16/14 502 S Countryside Drive $250.00 Louisburg, KS 66053

Peggy Mast 09/16/14 765 Road 110 $250.00 Emporia, KS 66801

Scott Schwab 09/16/14 14953 W 140th Terr $500.00 Olathe, KS 66062

Mark Hutton 09/16/14 7118 Cedarmeadow Court $250.00 Witchita, KS 67205 Roderick Houston 09/16/14 4902 Looman Street $100.00 Wichita, KS 67220

Steve Anthimides 09/16/14 2725 Mason Terrace $350.00 Wichita, KS 67216

Barbara Bollier 09/16/14 6910 Overhill Road $100.00 Mission Hills, KS 66208

$5,550.00 Subtotal This Page ..

page.3 of -- --5 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS KANSAS INSURANCE POLITICAL ACTION COMMITTEE (INSPAC) (Name of Party Committee or Political Committee)

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

Pete DeGraaf 09/16/14 1545 E 119th Street $350.00 Mulvane, KS 67110

John Dol/ 09/16/14 2927 Cliff Place $100.00 Garden City, KS 67846 G Stan Frownfelter 09/16/14 4527 Gibbs Road $100.00 Kansas City, KS 66106

Don Hill 09/16/14 $100.00 I 1720 Luther Street Emporia, KS 66801

Richard Proehl 09/16/14 510 Pine Ridge Road $200.00 Parsons, KS 67357

Gene Sullentrop 09/16/14 6813 W Northwind Circle $500.00 Wichita, KS 67205

John Wilson 09/16/14 1923 Ohio Street $100.00 Lawrence, KS 66046

Amanda Grosserodes 09/16/14 12601 W 99th Street $250.00 Lenexa, KS 66215 Ken Corbet 09/16/14 10351 SW 61 $250.00 Topeka, KS 66610

Mark Rhoades 09/16/14 1006 Lazy Creek $250.00 Newton, KS 67114

Marvin Kleeb 09/16/14 14206 Eby $250.00 Overland Park, KS 66221 ,

,. ~ $2,450.00 Subtotal This Page ..

Page L{- of 5 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

KANSAS INSURANCE POLITICAL ACTION COMMITTEE (INSPAC) (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

.. $0.00 Subtotal This Page

Complete iflast page of Schedule c

Total Itemized Expenditures This Period $8,000.00

Total Unitem ized Expenditures of $50 or less $0.00

...... TOTAL EXPENDITURES & oTilER DISBIJRSEMENTS $8,000.00 THIS PERIOD (to line 4 of S~oiniary) . .

Page 5 of 5