Ztm .~... I Date Signature of Treasurer

, ,

KANSAS GOVERNMENTAL ETHICS COMMISSION

RECEIPTS AND EXPENDITURES REPORTRECEIVEt,-.', ,OF A POLITICAL OR PARTY COMMITTEE '

January 10, 201~ FILE WITH SECRETARY OF STATE SEE REVERSESIDE'FOR INSTRUCTIONS

~ospitality A. Name o'fComrnittee: KS Restaurant & Association Political Action Committee

"Address: 3500 N Rock Rd, Bldg 1300 r

City and Zip'Code: Wichi!a, KS 67226

This is a (check one): - ,__ Party Committee ,f Political Committee

B. Check only if appropriate: __' '_, Amended Filing - __' Termination Report(

C. SUmInary (covering the period from January 1,2011 through December 31,2011) 1. Cash on hand at beginning ofperiod , . '5,027.89 2: Total Contributions and Other Receipts (Use Schedule AJ ~ . ,, 44,780:86 ' 3. Cash available t~s period (Add Lines 1 and 2) ~ : : : . 49,808.75 4. Total Expenditures and Other Disbursements (Use Schedule C) : . 45,060.29 "

5. Cash on hand at close ofperiod (Subtract Line 4 from 3) .. 4,748.46 6. In-Kind Contributions (Use Schedule B) .. 15,~24.00

,7. Other Transactions (Use Schedule D) ,

,D. "I declare that this report, including any accompanying schedules and statements, has been examined by me , andtq the best of my knowledge and belief is true, correct and complete~ 1 understand that the intentional failure to file this qocument or i,ntionally filing false document is a class A misdemeanor." V'VIJ . /Ztm .~... I Date Signature of Treasurer

GEe Form Rev, 2001 SCHEDULEA' CONTRIBUTIONS AND OTHER RECEIPTS

KS Restaurant & Hospitality Association PAC (Name of Party Committee or Political Committee)

" Occupation & Industry of Cbeck Amount of Name and Address Individual Giving More Appropri.!lte Box ,Casb, Cbeck, Date of Contributor Tban $150 Loan or C.,b ' Cbeck Loan' Olber Otber Receipt.

See Attached Schedule - $44,780.86

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.~.'< , ," ,~' ,.., ;[~;~)~f~~ '?Y.ir~1~~~~ ~i~~~:~ ':'''~; ...>i· :.> ':~I;,~ $44,780.86 1<:::' <;c,';. ;:, ' .."; ;.s:Z'." ',' l1'li ~faiie. ';;'.::;';\l. ;:i'\ ":/~j; .j" .. .. '

Page .__ of__ KRHA Political Action COl1l1hittee Schedule A Contributions & Other Receipts .

Date Name & Address Amount

Various Kansas Restaurant & Hospitality Association 31,340.86 check 3500 N Rock Rd, Bldg 1300 Wichita, KS 67226

. 7/14/2011 Best Western Butterfield Inn 250.00 check PO Box ~22 Hays, KS 67601

7/14/2011 Healy Biodiesel 350.00 check 205 WIst Sedgwick, KS 67135

7/14/2011 Retail Data Systems 350.00 check 106 Greyston Ave Wyandotte, KS 66103

10/10/2011 Best Western International 250.00 check 701 Fairway Lamed, KS 67550'

, 7/25/2011 Mid-America Orthopedics 500.00 check 1923 N Webb Rd Wichita, KS 67206

Various Best Western Airport 1,000.00 check 6815 W Kellogg Wichita, KS 67209

Various Hyatt Regency 750.00 check 400 W Waterman Wichita, KS 67202

7/26/2011 . Redrock Canyon Grill 250.00 check 3101 W Tecumseh Rd; Ste 200 Norman, OK 73g72

8/1 0/2011 Sasnak 500.00 check 1834 N Topeka . Topeka, KS 66608

8/15/20 II Super Eight Forbes'Landing 250.00 check 5922 SWvTopeka Blvd Topeka, KS 66619 8/15/20 II Missouri Restaurant Association 250.00 check 4049 Pennsylvania Ave, Ste 204 Kansas City, MO 64j II

Various ACT 850.00 check 1620 S Broadmoor Wichita, KS 67207

8/19/2011 Farmers Brothers Family of Coffee 500.00 check . 427 S Washington Wichita, KS 67202

8/19/20 II Savor - Wichita Intrust Bank Arena 340.00 check 500 E Waterman Wichita, KS 67202

Various In the Sauce Brands 500.00 check 101 N Ridge Rd Wichita, KS 67212

8/19/2011 Alternative Risk Company 250.00 . check PO BoxA Indepenclence,MO 64051

7/19/2011 Go Wichita CVB 350.00 check 515 S Main Ste lIS Wichita, KS 67202

8/23/2011 SecureNet Alarm Systems 350.00 check

10501 Hampton Lakes Rd ! Maize, KS 67101

4/6/2011 Sunset Equities 1,000.00 check PO Box-1303 McPherson, KS 67460

Various Sysco Foods ofKC 1,000.00 check 1001 S Young Wichita, KS 67209

4/1812011 Specialty Foods 250.00 check PO Box271 Webb City, MO 64870

5/4/2011 Darling International 500.00 check 685 Adams Kansas City, KS 66105

5/4/2011 Avivo Brick Oven Pizzeria 250.00· check 101 N ~dge Rd Wichita, KS 67212 5/4/201] . Treat America Food Services 500.00 check 8500 Shawnee Mis~ion Pkwy Ste ] 00 Merriam, KS 66202

5IJ 0/20] ] KC Hopps 600.00 check 10551 Barkley #615 Overland Park, KS 66212

5IJ2/201] Springfield Grocer . 250.00 check PO Box 215 Kingsville, MO 64061

8IJ 9/20 11 Ben E. Keith 1,000.00 check 3]6 S Blad.'Welder Oklahoma City, OK 73 ]48

5IJ 2/20 11 Continental Western 250.00 check 11201 Douglas Avenue Urbandale, IA 50322

Total 44.780.86

, r -SCHEDULEB IN-KIND CONTRIBUTIONS

KS Restaurant & Hospitality Association PAC _ (Name 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

See Attached Schedule $15,524.00

$15,524.00

-Complete if last page of Schedule B

Total Itemized (over $100) In-Kind Contributions

Total Unitemized ($100 or less) In-Kind Contributions

$0.00

Page __ of__ KRHA Political Action Committeer Schedule B· . In-Kind Contributions

Date Name & Address· Contribution Amount

8/22/2011 Fanner Brothers Family of Coffe Food & Beverage 100.00 427 S Washington Wichita, KS 67202

8/22/20 II Trezo Vino Food & Beverage 100.00 11570.Ash Leawood, KS 66211

8/22/2011 Terradyne Food & Beverage 100.00 1400 Terradyne Rd Andover, KS 67002

8/22/20 II Sheraton Food & Beverage 125.00 '6100 College Blvd Overland Park,KS 66213

8/22/20 II Sand Creek Golf Course .Food & Beverage 250.00 920 Meadowbrook Dr Newton, KS 67114

8/22/2011 Heroes Food & Beverage 100.00 8100 E 22nd N, Ste 2100-3 Wichita, KS 67226

8/22/2011 130nefish Food & Beverage 800.00 10250 E 13th St N .Wichita, KS 67206

8122/2011 LDF Companies Food & Beverage 1,800.00 10610 E 26th Circle North' Wichita, KS 67226

8/22/2011 Freddy's Frozen Custard Food & Beverage 100.00 1445N RockRd, Ste210 Wichita, KS 67206

8/22/2011 Hilton Wichita Airport . Food & Beverage 75.00 2098 Airport Rd Wichita, KS 67209

5/9/2011 Spring Hill Suites by ¥arriott Food & Beverage 100.00 12000 Blueyalley Pkwy Overland Park, KS 66213

5/9/2011 Residence Inn by Marriot Food & Beverage 100.00 1620 SW Westport Dr Topeka, KS 66604

5/9/2011 Secura Food & Beverage 300.00 2050 Packer Court Lawrence, KS 66044

5/9/2011 Free State Brewing Company Food & Beverage 900.00 636 Massachusetts Lawrence, KS 66044 \

5/9/2011 Boulevard Brewing Company Food & Beverage 500.00 2501 Southwest Blvd Kansas City, MO 64108

Various - Tallgrass Brewing Company Food & Beverage 650.00 8845 Quail Lane Manhattan, KS 66502

Various Dr. Pepper Snapple Group Food & Beverage 200.00 244 Bent Tree Ct. Andover, KS 67002

5/9/2011 Jimmy Johns Food & Beverage" 936.00' 922 Mass-achusetts St Lclwrence, KS 66044

5/2/2011 23rd St Brewery Food & Beverage 75.00 3512 Clinton Pk.'W)' Lawrence, KS 66047

5/9/2011 - RJ Reynolds Food & Beverage 425.00 PO Box 1629 Parker, CO 80134

8/22/2011 Ben E Keith Food & Beverage 150.00 2333 S West St Wichita, KS 67213

Various Best Western Airport Food & Beverage 330.00 6815 W Kellogg . Wichita, KS 67209

8/22/2011 In the Sauce Brands .Food & Beverage 60.00 101 N Ridge Rd Wichita, KS 67212

Various Perkins. . Food & Beverage 220.00 1720 SW Wanamaker Rd Topeka, KS 66604"

! 5/9/2011 Crown Plaza Hotel Food & Beverage 200.00 ,12601 West 95th Street Lenexa, KS 66215

5/9/20n Holiday Inn Food & Beverage 200.00·

200 McDonald Dr <: LmNrence, KS 66044

5/9/2011 KC Hopps Food & Beverage 100.00 .J0551 Barkley #615 Overland Park, KS "

Various Yacht Club Bar & Grill Food & Beverage 200.00 530 Wisconsin St Lawrence, KS 66044

5/9/2011 Ramada Food & Beverage 150.00 700 ~W Jackson St Ste 200 Topeka, KS 66603 5/9/2011 Hospitality Insurance Services, Il Food & Beverage 2,228.00 3500 N Rock Rd, Bldg 1300 Wichita, KS 67226

Various Sysco Foodservice ofK.C. Food & Beverage' 550.00 1001 S Young Wichita, KS 67205

Various Outback Steakhouse Food & Beverage 3,400.00 2020 N Rock Rd Wichita, KS 67206

Total 15.524.00

. \ SCHEDULEC .EXPENDITURES AND OTHER DISBURSEMENTS

KS Restaurant & Hospitality Association PAC (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

See Attached Schedule $45,060.29

" ,

$45,060.29'

. Paae of . '='-- - KRHA Political Action Committee Schedule C Expenditures & Other Disbursements 12/31/2011

Name & Address Purpose of Expenditure Amount

10/18/2011 Terry Calloway for State Representative 2011 General Election Contribution 250.00 3402 Airport Circle' Pittsburg, KS 66762

10118/2011 Caryn Tyson for State Representative 20u General Election Contribution 250.00 19984 Co. Road 1077 Box 191 Parker, KS 66072

10/18/2011 . Terri Lois Gregory for State Representative 2011 General Election Contribution 250.00 324 Dearborn Baldwin City, KS 66006 , 10/18/2011 Pat Apple for StateSenate 2011 General Election Contribution 250.00 Box 626 Louisburg, KS 66053

1011812011 Steve Abrams for State Senate 20 11 Genera~ Election Contribution 250.00 4579 242nd Rd. Arkansas City, ~S 67005

- (' 10118/2011 Jim Kelly for State Representative 2011 General Election Contribution 250.00 . 309 S ~th Independence, KS 67301

10/18/2011 ArlenSiegfreid for State Representative 2011 General Election Contribution 350.00 1403 W Prairie Terrace Olathe, KS 66061-6807

10118/2011 Lance Kinzer for State Representative 20 11 General Election Contribution 250.00 12549 S ~rougha~ Olathe, KS 66062

10118/2011 ForrestKnox for State Representative 2011 General Election Contribution 250:00 17120 Udap Road Altoona, KS 66710-8560

,,"10118/2011 .Amanda Grosserode for State Senate 2011 General Election Contribution 250.00 12601 W. 99th Street Lenexa,KS 66215

10/18/2011 Kelly Meigs for State Representative 2011 General Election Contribution 250.00 . 7842 Rosehill Road Lenexa, KS 66216

10118/2011 . Dan Kerschen for State Representative 20 I 1 General Election Contribution 250.00 645 S. 263 W Garden Plain, KS 67050 .

10/18/2011 Marvin Kleeb for State Representative 201 I General Election Contribution 250.00 14206 Eby Overland Park, KS 66221

10/18/2011 John Rubin for State Representative 2011 General Election Contribution 250.00 13803 W 53rd St Shawnee, KS 66216

10/18/2011 Jim Denning for State Representative 20 I 1 General Election Contribution 250.00 84 I6 W. 115th Street . Overland Park, KS 66210 ]0/1S/2011 Rob B~uchman for State Representative 2011 Genera] E]ection Contribution 250.00 50] 6 W. 1OSth Terrace #522 Overland Park, KS 662] ] - ]0/1 S/20] ] Brett Hildabrand for State Representative 2011 Genera] Election Contribution 250.00 2420 Acorn Rd Sabetha, KS 66534

1O/1S/2011 Julia Lynn for State Senate 2011 General Election Contribution 250.00 lSS37 W 115th Terrace Olathe, KS 6606] -9379

10/1S/201 ] · Barbara Bollier for State Representative 201] General Election Contribution 200.00 43] S Westfield Wichita, KS 67209

]0/1S/2011 Robert Montgomery for State Representative 2011 General Election Contribution 250.00 1300 E. Sleepy liollow Dr. Olathe, KS 66062 .

]0/1S/2011 Ty Masterson for State Senate l 2011 General Election Contribution 250.00 1539 Phylli~ Lane Box 424 Andover, KS 67002

10/1S/201] Owen Donohoe for. State Representative 2011 General Election Contribution, 250.00 6265 Arapahoe Shawnee; KS 66226

]0/1S/2011 Jana Goodman for State Senate 20] 1 General Election Contribution 250.00 410 S. Broadway Leavenworth, KS6604S - 10/1S/2011 Ramon Gonzalez for State Representative 20]] General Election Contribution 250.00 Box 12 Ozawkie, KS 66073_

, \ 1O/1S/20] ] Trent LeDoux for State Representative 2011 General Election Contribution 250.00 32421 255 Street Easton, KS 66020

10/1S/20] ] ~ichael R. O'Neal for State Representative . 20] ] General Election Contribution 350.00 S Windrnere Court Hutchinson, KS 67502

]0/1S/20"] ] Randy Garber for State Representativ~ 2011 General Election Contribution 250;00 2424 Timberl,ane Terrace Sabetha, KS 66534

1O/1S/2011 James Fawcett for State Representative 201) General Election Contribution 250.00 7n Crestview Drive · Junction City, KS 6644]

]0/1S/2011 Susan Mosier for State Representative 2011 General Election Contribution 250.00 35] 7 Amy Lane Manhattan, KS 66503

1O/1S/201 ] C1arl5 Shultz for State Reyresentatiye 2011 General Election Contribution 250.00 \ 707 Washington Cir; Lindsborg, KS 67456

10/1S/2011 · Sandy Praeger for Insurance Commissioner 20] ] General Election Contribution 250 ..00 360 I Quail Creek Court Lawrence, KS 66047

.10/1S/201 ] · Mast for State Representative 2011 General Election Contribution. 250.00 765 Road 1]0 Emporia, KS 66S0] 10118/2011 Virgil Peck, Jr. for State Representative 20 II General Election Contribution 250.00 Box 277 Tyro, KS 67364

10/18/2011 Jim Howell for 5;tate Representative 20 II General Election Contribution 250.00 125 E. Buckthorn Road DerbY,KS 67037

10/18/2011 Joseph Scapa for State Representative 2011 General Election Contribution .250.00 2209 S. White Cliff Wichita, KS 67207

10/18/2011 William Prescott for State Represen,ative 20 II General Election Contribution 250.00 5928 SW 216th Terrace Osage City; KS 66523

10/18/2011 Mike Petersen for State Senate 2011 General Election Contribution 250.00 2608 Southeast Dr Wichita, KS 67216

10/18/20 II Mary Pilcher Cook for State Senate 20 II General Election Contribution 250.00 13910 W.58th Place . Shawnee, KS 6621 q

10/18/2011 Benny Boman for State Representative 2011 General Election Contribution 250.00' 1914 EuClid Wichita, KS 67213

10/18/2011 Leslie Osterman for State Representative 20 II General Election Contribution 250.00 1401 W. Dallas' Wichita, KS 67217

10/18/201l Marc Rhoades for State Representative 2,0 II General Election Contribution 350.00 1006 Lazy Creek Drive Newton, KS,671 i4 - 10/18/2011 Dennis Hedke for State RepresentatiVe . 20 II General.Election Contribution 250.00 1669 N, Sagebrush Wichita, KS 67230

10/18/2011 Stev~,n J.9hn!ions for State Representative 20 II General Election Contribution 250.00 10197 S, Hopkins Road Assaria, KS 67416

10/18/2011 Chris Steineger for State Senate 20 II General Election Contribution 250.00 51 S. 64th S1. Kansas City, KS 66111

10/18/2011 Derek Schmidt for Attorney General . 2011 General Election Contribution 250.00 Box 804 Independence, KS 6730 I

10/18/20 II . Dan Collins for State Representative 2011 General Election Contribution 250.00 -1720 Y Road Plainville, KS 67663

.-' 10/18/2011 Mitch Holmes for State Representative 20 II General Election Contribution 250.00 211 SE 20th Avenue S1. John, KS 67576

10/18/20 II - Ron Ryckman forState Representative 20 II General Election Contribution 250.00 Box 192 Meade, KS 67864

10118/2011 Kyle Hoffman for State Representative 2011 General Election Contribution 250.00 13'18 Avenue T Coldwater, KS 67029 10118/20 II Brian Weber for State Representative 20 II General Election Contribution ~50.00 Box 804 Dodge City, KS 6780 I

10/18/2011 Ward Cassidy for State Representative 20 II General Election Contribution 250.00 420 E. 2nd Box 303 St. Francis, KS 67756

10118/2011 Rick Billinger for State Representative 2011 General Election Contribution 250.00 310 Acacia Drive Goodland, KS 67735

10118/2011 Reynaldo Mesa for State Representative 2011 General Ele~tion Contribution 250.00 1719Crestway .Garden City, KS 67846

10118/20 II J. Stephen Alford for State Representative 2011 General Election Contribution 250.00 4179 E. Road 19 . Ulysses, KS 67880

10/18/20 II Jay 5icott Emler for State Senate 2011 General Election Contribution 250.00 1457 Shawnee Road Lindsborg, KS 67456

10/18/2011 Mark Taddiken for State Senate 2011 General Election Contribution 250.00 . 2614 Hackberry Road Clifton, KS 66937

10118/20 II Gene Suel/enttop for State Representative 2011 General Election Contribution 400.00 6318 W. Northwirid Circle' Wichita, KS 67212

10118/2011 Ray Merrick for State Senate 20 II General Election Contribution 250.00 6874 W 164th'Terrace Stilwell, KS 66085

10/18/2011 Garrett Love for State Senate . 2011 General Election Contribution 250.00 2450613 Road - Box 1 Montezuma, KS 67867

10/18/2011 Ralph Ostmeyer for State Senate 2011 General Election Contribution 250.00 602 S Jefferson Box 97 Griimell, KS 67738

10/18/20 II Ste~eBrunkfor State Representative 20 II General Election Contribution 250.00 4430 lanesville Bel Aire, KS '67220

10/18/2011 JeffLongbine for.State Senat~ 2011 General Election Contribution 250.00 . 2801 Lake~idge Road Emporia, KS 66801

10/18/2011 Terry Bruce for State Senate 2011 General Election Contribution 250.00 40 I E. Shennan Hutchinson, KS67501

10/18/2011 Sam Brownback for Govenor 20 II General Election Contribution 1,000.00 P:O. BoX. 3739 Topeka, KS 66604

~ 10/18/20 II Jene Vickrey for State Representative 20 II General Election Contribution . 250.00 502 S Countryside Drive . Louisburg, KS 66053

10118/2011 Anthony Brown for State Representative 2011 General Election Contribution 250.00. 1229 Acorn Eudora, KS 66025 10/18/2011 Susan Wagle for State Senate 2011 General Election Contribution 250.00 4 Sagebrush Wichita, KS 67230

10/18/2011 Richard Carlson for State Representative 2011 General Election Contribution 250.00 26810 Jeffrey Road St. Marys,XS 66536

10/18/2011 Laura Kelly for State Senate 2011 General Election Contribution 250.00 234 SW Greenwood Ave Topeka, KS 66606

10/18/2011 David Crum for State Representative 2011 General Election Contribution· 250.00 2903 Lakeshore Drive . Augusta, KS 670 I0

.10/18/2011 Doug Gatewood for State R~presentative 2011 General Election Contribution 150.00 411 S Florida, Box 306 Columbus, KS 66725

10/18/2011 Vicki Schmidt for State Senate 2011 General Election Contribution 250.00 5906 SW 43rd Court Topeka, KS 66610

10/18/2011 Robert Olson for State Senate 2011 General Election Contribution 250.00 19050 W 161st Olathe, KS 66062

r 10/18/20 II Phil Hermanson for State Representative 2011 General El~ction Contribution 250.00 5338 S. Mosley .Wichita, KS 67216

10/18/20 II Robert Grant for State Representative 2011 General Election Contribution 150.00 407 W Magnolia Cherokee, KS 66724

9/16/2011 Sand Creek Station Golf Course Fund Raisillg Expense 4,670.00 920 Meadowbrook Dr

Newton, KS 67114 ./'.

6/10/2011 Alva"mar Country Club Fund Raising Expense 6,966.40 1809 Crossgate Drive Lawrence,KS 66047

Various Kansas Restaurant & Hospitality Association Fund Raising Expense 13,723.89 3500 N'Rock Rd, Bldg 1300 . , Wichita, KS 67226

. Report Total 45,060.29