. . . . KANSAS GOVERNMENTAL ETHICS COM - I I RECEIPTS AND EXPENDITURE·s REPO JAN 1 1· f."'S I OF A POLITICAL OR PARTY COMMITT E u, I . KR!S VV KOBACH January 10, ~0~6 SECRETAR Y OF STATE FILE WITH SECRETARY OF STATE . SEE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Committee: Kansas Hospital Association Polltlcal Action Committee

Address: 215 SE 8th Street

City and Zip Code: T_op_eka_,6_66_01 ______~------This is a (check one): __ Party Committee x Political Committee

B. Check only if appropriate: __ Amended Filing ·__ Terinination Report

C. Surmmuy (covering the period from January 1, 2015 through December 31, 2015) $73,429.20 1. Cash on hand at beginning of period ...... 2. Total Contributions and Other Receipts (Use Schedule A) ...... · $67,238.85 3. Cash available this period (Add Lines 1 and 2) ... :...... :...... $140,668.05 $58,642.95 4. Total Expenditures and Other Disbursements (Use Schedule C) ...... ~ ...... 5. Cash on hand at close of period (Subtract Line 4 from 3) ...... ' ...... $82,025.10 6. In-Kind Contributions (Use Schedule B) ...... $5,497.17 7. Other Transactions (Use Schedule D) ...... $0.00

D. "I declare that this report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is true, correct and complete. I understand that tlie intentional failure to :file this document o · entionall · g a fals cument is a class A misdemeanor."

GEC Form Rev,"2015 I

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 Other Casl1 Check Loan Efunds Other Receipt

John Hart Chief Executive Officer $100.00 P 0 Box579 Fredonia Regional Hospital 01/20/2015 Fredorila, KS 66736-0579 ./

Dennis George Chief Executive Officer $500.00 3959 Hwy 59 Associated Purchasing Services 01/20/2015 Ottawa, KS 66067-8345 Corporation ./

John Hart Chief Executive Officer 5130.00 PO B.ox579 Fredonia Regional Hospital 02/04/2015 Fredonia, KS 66736-0579

Gregory Burger $100.00 1847 E. 800th Rd. Lawrence Memorial Hospital 02/04/2015 Lecompton, KS 66050-4060

Doyle McKlmmy Chief Executive Officer $200.00 5491 Woodfield Pkwy Jewell County Hospital 02/0412015 Grand Blanc, Ml 48439-9401 ./

J Anderson Administrator and Chief Executive $250.00 1101 East Spring Street Officer 02/04/2015 Anthony, KS 67003-2122 Anthony Medical Center ./

Chad Austin Sr. Vice President, Government $153.84 02/04/2015 · 6518SW26th Court Relations Topeka, KS 66614-4305 Kansas Hospital Association ./

Michael E. Payne CEO $100.00 02/04/2015 9823 Juniper Lane Girard Medical Center Overland Park, KS 66207-3351 ./ _, !

Mark Miller Chief Executive Officer $350.00 02/04/2015 511 NETenthStreet Memorial Health System I Abilene, KS 67410-2153 ./ I Bethany Simpson Program Director $70.00 I 02/04/2015 PO Box 206 Girard Medical Center Pittsburg, KS 66762-0206 ./

rlstlneOchs Administrator $250.00 '02/17/2015 10 South Vermont Avenue Grisel! Memorial Hospital District ansorn, KS 67572-9525 One ./

$2,203.84

29 Page --1 of-- SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

K~~llas Hospital Assoclatlon Polillcal Action Committee (Naine of Party Committee or Political Committee)

···:.. Occupation & Industry of Check Aniountof Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Other Cuh Check Loan E funds Other Receipt

Rick Kellerman Professor and Chair $100.00 521 N. Armour St. University of Kansas Hospital, The 02/17/2015 Wichita, KS 67206-1513 ./ Melissa Atkins Chief Executive Officer $250.00 304 West Prout Street Graham County Hospital . 02/17/2015 Hill City, KS 67642-1435 ./

Mark Davis Interim CEO $100.00 3700 SW 41 st Street Stormont-VaD HealthCare 02/20/2015 Topeka, KS 66610-1184 ./

Carol Wheeler Vice President $100.00 8631 SW Huntoon Stormont-Vail HealthCare 02/23/2015 Topeka, KS 66615-1493 ./

David Tanski Of rector $100.00 KS Stormont-Vall HealthCare 02/23/2015

John Broberg President and Chief Executive $1,000.00 1823 College Avenue Officer 02/27/2015 Manhattan, KS 66502-3381 Via Christi Hospital Manhattan, Inc.

Eric Voth Physician $350.00 03/02/2015 411 Woodbury Court Stormont-Vall HealthCare Topeka, KS 66606-2192

Brenda Legleiter Chief Executive Officer $250.00 03/03/2015 POBox520 Rush County Memorial Hospital La Crosse, Ks 67548-0520 ./

Jody Parks Administrator $200.00 03/03/2015 P 0 Box290 Ottawa County Health Center Minneapolis, KS 67467-0290 ./

Chad Austin Sr. Vice President, Government $76.92 03/03/2015 6518 SW 26th Court Relations Topeka, KS 66614-4305 Kansas Hospital Association ./

Melissa Hungerford Sr. Vice President - $19.24 03/03/2015 448 SW Bayshore Dr Kansas Hospital Association ubum, KS 66402-9324 ,/

$2.546.16

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 Other Cash Loan Check ou;;,:-Efunds Receipt

Cindy Samuelson Vice President $19.24 1107 NE 54th St Kansas Hospital AssoclaUon 03i03/2015 Topeka, KS 66617-4505 '1

Associated Purchasing Services APS GPO $2,000.00 215 South East Eighth Associated Purchasing Services 03/03/2015 Topeka, KS 66603 Corporation {

Donna McGowan Administrator $250.00 P OBox969 Lane County Hospltal 03/03/2015 Dighton, KS 67839-0969 ~

David Cunningham Director of Facilities $500.00 3725 Clarion Park Drive Stormont-Vall HealthCare 03/03/2015 Topeka, KS 66610-1277

Bernard Becker Vice President and Chief Human $500.00 12303 De Paul Dr Resources Officer 03/04/2015 Bridgeton, MO 63044-2512 Stormont-Vall HealthCare '1

Christena Crawford Dir., Birthplace, Breastfeeding $100.00 2600 Staffordshire Rd Cllnlc 03/04/2015 Topeka, KS 66614-4366 Stormont-Vail HealthCare

Karen Reed-Coffman Director, Medical Staff Services $100.00 03/0412015 931 NE Rosewood Terr. Stormont-Vall HealthCare Topeka, KS 66617-2647

Jane Mackey President & Executive Director $100.00 03/04/2015 3817 SW Clarion Park Dr. Stormont.Vail HealthCare Topeka, KS 66610-1278 {

Todd Lutz Director, Managed Care Services $100.00 03/04/2015 1248 SW Westside Dr. Stormont-Vall HealthCare Topeka, KS 66615-1236 '1·

Deborah Bruner Chief Executive Officer and $160.00 03/10/2015 POBox127 Administrator Minneola, KS 67865-0127 Minneola District Hospital

my Kincade Adm. Director, Contlnlum of Care $100.00 516 SW Chauncey Dr. Stormont-Vall HealthCare opeka, KS 66614-4952 {

$3,919.24

Page _3__ 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 Other Cash Check Loan E funds Other Receipt

Joy Bretz Trustee $100.00 790 S Road 14BE Sheridan County Health Complex 03/24/2015 Hoxie, KS 67740-4130 ./ Tom Moxley Board Member $300.00 1B52S 200 Rd Morris County Hospital 03/24/2015 Council Grove, KS 66846-8310 ./

Chad Austin Sr. Vice President, Government $76.92 6518 SW 26th Court Relations 0312412015 Topeka; KS 66614-4305 Kansas Hospital Association ./

Audrey Dunkel Dlrector of Financial Advocacy $43.48 215 SE Bth Street Kansas Hospital Association 03124/2015 Topeka, KS 66603-3906

Jennifer Findley VP Education/Special ProJects $16.00 3517 SW Ashworth CL Kansas Hospital Association 03/24/2015 Topeka, KS 66614-4590

Melissa Hungerford "Sr. Vice President $19.Z4 6448 SW Bayshore Dr Kansas Hospital Association 03124/2015 Auburn, KS 66402-9324

Cindy Samuelson Vice President $19.24 03/24/2015 1107 NE 54th St Kansas Hospital Association Topeka, KS 66617-4505

Margaret Grismer $100.00 03/24/2015 1700 Hardtner St. Kiowa District Hospital and Manor Kiowa, KS 67070-8523 ../

Angela Gamber Director of Post-Surglcal/Ortho $100.00 03125/2015 210 NW Valencia Rd. Services Topeka, KS 66615-9267 Stormont-Vail HealthCare ./

Blaine Miller Administrator $100.00 03/26/2015 2420 'G' Street Republic County Hospital Belleville, KS 66935-2400 ./

$100.00 03/26/2015 Stormont-Vail HealthCare ./

$974.86

Page _4_ _ of-3:.__ 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 Other Cash Check Loan E funds Other Receipt

Jill Straub Health Information Management $100.00 7907 SW 28th Street Director 03/26/2015 Topeka, KS 66614-4891 Stormont-Vail HealthCare

Janet Stanek Executive Vice President $325.00 6755 SW Dancaster Road Stormont-Vail HealthCare 03/26/2015 Topeka, KS 66610-1412 ./

Wllllam Dickson Hospital Trustee $300.00 610 Pondway Morris County Hospital 03/26/2015 Council Grove, KS 66846-1560 ./

Larry Lane Director $100.00 2821 NW Halfday Pl. Stormont-Vall HealthCare 03/26/2015 Topeka, KS 66618-1649

Curt Thomas Administrator $200.00 312 Custer Street Ness County Hospital 03/26/2015 Ness City, KS 67560-1654 ./

Diane Miller $300.00 Morris County Hospital 03/26/2015 436 S. 1200 Rd. Dwight, KS 66849-9531

Leonard Hernandez President and Chief Executive $350.00 03/26/2015 1323 North 'A' Street Officer Wellington, KS 67152-4350 Sumner Regional Medical Center

Kent Palmberg Senior Vice President and Chief $1,000.00 03/26/2015 1216 SW Westside Drive Medical Officer Topeka,_KS 66615-1236 Stormont-Vail HealthCare ./

Michael Kongs Director Financial Management $100.00 03/26/2015 7261 SW Fountaindale Stormont-Vail HealthCare Topeka, KS 66614-4629 ./

Christina Sykes Director Human Resources $100.00 03/26/2015 1902 South US Highway 59 Labette Health Parsons, KS 67357-4948 ./

CNO/Risk $100.00 03/26/2015 Labette Health ./

$2,975.00

5 29 Page --· of-- SCHEDULE A · CONTRIBUTIONS AND OTHER RECEIPTS I Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee) ·I

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 Efunds Other Receipt

Doug Stacy Chief lnforma!fon Officer $100.00 3325 Crown Drive Labette Health 03/26/2015 Independence, KS 67301-1517 . ./

Thomas Macaronas Interim Chief Executive Officer $100.00 1902 South US Highway 59 Labette Health 03/26/2015 Parsons, KS 67357-4948 ./

Judy Corzine Administrative Director and Chief $700.00 3621 SWWoodvaJ!ey Place Information Offi 03/26/2015 Topeka, KS 66614-3536 Stormont-Vail HealthCare ./

William Miller Board member $350.00 1193 Four Mile Rd . Morris County Hospital 03/30/2015 Council Grove, KS 66846-8719

Todd Tangeman HR Director $100.00 15798 NW 150th Street Newton Medical Center 04/0212015 Newton, KS 67114-8077

Dean Miller Trustee $300.00 1925 S 2500 Rd Morris County Hospital 04/03/2015 Herington, KS 67449

Don Harmison Trustee $300.00 04/03/2015 1081 Hwy 149 Morris County Hospital White City, KS 66872-9413

Tom Jernigan Veterinarian $300.00 04/03/2015 925T Avenue Jernigan Veterinary Clinic Council Grove, KS 66846-8777

Sharon Cox ·· Chief Executive Officer $100.00 04/08/2015 Po Box47 Rawlins County Health Center twood, KS 67730-0047 ./

Terry Jett Dir. of Physlcan Services $250.00 04110/2015 6917 Red Oak Drive Providence Medlcal Center Shawnee, KS 66217-9538 ./

Administrator $200.00 Osborne County Memorial Hospital ./

$2,800.00

Page_6__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Polllical 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 Other Cash Check Loan Efunds Other Receipt

Robert Mullen Interim Chief Executive Officer $100.00 1704 Sheffield Circle Clay County Medical Center 04/10/2015 Manhattan, KS 66503-2220 .(

Bob Brazil Chief Operating Officer $100.00 1700 FaithAve Memorial Health System 04/24/2015 Abilene, KS67410-1728 .(

Elgin Glanzer Chief Financial Officer $100.00 1602 Parle Place Ct. Memorial Health System 04/24/2015 Abilene, KS 67410-2153 .(

Karen Orr Chief Nursing Officer $100.00 18053 Linwood Rd. Providence Medical Center 04/24/2015 Linwood, KS 66052-4521 .(

David Dulny Chief Financial Officer $100.00 13502 W 75th Ct. Saint John Hospital 04/24/2015 Shawnee, KS 66216-4264

Jodi Fincher Chief Nursing Officer . $100.00 2347 Cambridge Saint John_Hospital 04/2412015 Leavenworth, KS 66048-4066 .(

Randall Nyp President and Chief Executive $400.00 04/24/2015 3500 South Fourth Street Officer Leavenworth, KS 66048-5043 Saint John Hospital .(

Randall Nyp President and Chief Executive $150.00 04/24(2015 3500 South Fourth Street Officer Leavenworth, KS 66048-5043 Saint John Hospital .(

Chad Austin Sr. Vice President, Government $76.92 04/24(2015 6518 SW 26th Court Relalions Topeka, KS 66614-4305 Kansas Hospital Association .(

Audrey Dunkel Director of Financial Advocacy $43.48 04/24(2015 215 SE 8th Street Kansas Hospital AssociaUon Topeka, KS 66603-3906 .(

VP Education/Special Projects $16.00 04/24(2015 Kansas Hospital Association .(

$1,286.40

Page_7_ _ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Politlcal 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 Other C•sh Check Loan Efunds ~ Receipt

Melissa Hungerford Sr. Vice President $19.24 6448 SW Bayshore Dr Kansas Hospital Association 04/24/2015 Auburn, KS 66402-9324 ./

Cindy Samuelson Vica President $19.24 1107 NE 54th St Kansas Hospital Association 04/24/2015 Topeka, KS 66617-4505 ./.

Randall Peterson President and Chief Executive $1,000.00 1500 SW Tenth Avenue Officer 04/24/2015 Topeka, KS 66604-1301 Stormont-Vall HealthCare ./

Reta Baker President $900.00 401 Woodland Hills Boulevard Mercy Hospital Fort Scott 05/13/2015 Fort Scott, KS 66701-8797 ./

Dave Engel CEO $93.00 256 West H Street Phllllps County Hospital 05/13/2015 Phillipsburg, KS 67661 -1743 ./

Dave Engel CEO $102.00 256 West H Street Phillips County Hospital 05/13/2015 Phillipsburg, KS 67661-1743

Sabato Sis!llo Chief Medical Officer $100.00 05/13/2015 PO Box40008 Saint John Hospital Overland Park, KS 66204-0908 ./

KS Healthcare Environmental Services Professional Association $250.00 05/13/2015 Association POBOX3208 Topeka, KS 66601 ./

Bruce Witt Director, Government Relations $100.00 05/13/2015 820 Carriage Rd. Vla Christi Health Maize, KS 67101-9697 ./

Carrie Sala Chief Executive Officer $150.00 05/13/2015 1110 Columbine Drive Holton Community Hospital Holton, KS 66436-8624 ./

homas Bell President and Chief Executive $1,000.00 05/15/2015 15 Southeast Bth Avenue Officer opeka, KS 66603-3906 Kansas Hospltal Association

$3,733.48

Page_8__ o~ J

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Conunittee)

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 Efunds Otii:Cr Receipt

Frank Jordan Doctor S100.00 1905 Faith Ave. Memorial Health System 05{1 5/2015 Abilene, KS 67410-1733 ~

Steven Kelly President and Chlef Executive $600.00 P 0 Box308 Officer 06/0212015 Newton, KS 67114-0308 Newton Medical-Center ~

Vallerle Gleason VP $100.00 3123 N. Lakerldge Ct Newton Medical Center 06/0212015 Wichita, KS 67205-1928 ~

Craig Concannon Board Member $500.00 921 N. Mill Kansas Hospital Association 06/02/2015 Beloit, KS 67420-1751 ~

Craig Concannon Board Member $250.00 921 N. MIU Kansas Hospital Association 06/02/2015 Beloit, KS 67420-1751 ~

Kansas Healthcare Englneer5 Association Professional Association $500.00 PO Box308 0610212015 Newton, KS 67114-0308

Edward Hett President, PMA $100.00 06/0212015 1401 W. River Blvd, Apt 5E Via Christi Health Wichita, KS 67203-3300 ~

Chad Austin Sr. Vice President, Government $11 5,38 06/0212015 6518 SW 26th Court Relations Topeka, KS 66614-4305 Kansas Hospital Association· ~

Audrey Dunkel Director of Financial Advocacy $65.22 06/02/2015 215 SE 8th Street Kansas Hospital Association Topeka, KS 66603-3906 ~

Jennifer Findley VP Education/Special Projects $24.00 06{02/2015 3517 SW Ashworth Ct. Kansas Hospital Association Topeka, KS 66614-4590 ~ , Sr. Vice President $28.86 06/02/2015 Kansas Hospital Association ~

$2,383.46

Page _9_ _ of~ · SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Associatlon Political Actlon 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 Other Co>h Check Loan Efun«h Other Receipt

Sally Perkins Director of Data Services $11 .55 1725 NW Grove Kansas Hospital Association 06/02/2015 Topeka, KS 66606-1237

Cindy Samuelson Vice President $28.86 1107 NE 54th St Kansas Hospital Association 06/02/2015 Topeka, KS 66617-4505 ./

Kathy Morrison Executive Director Human $100.00 1014 E. Lamplighter lane Resources 06/0212015 Garden City, KS 67846-5679 St. Catherine Hospital ./

John Moore Administrator $200.00 300 Utah Street Hiawatha Community Hospital 06/02/2015 Hiawatha, KS 66434-2314 ./

Jody Gragg $100.00 11414 West Central Park St. Via Chrlstl Health 06/02/2015 Wichita, KS 67205-2028

Kelly Speckman CFO 3100.00 PO Box31 Kearny County Hospital 06/05/2015 Lakin, KS 67860-0031

Rob llnderer $100.00 06/09/2015 7927 Rosehill Rd. Midwest Transplant Network Lenexa, KS 66215-2628

Amelia Boyd $150.00 06/09/2015 528 E. Sherman Hutchinson Regional Medical Hutchinson, KS 67501-7352 Center ./

Peggy R. Tuxhorn $100.00 06/09/2015 2503 Rambler Rd. Hutchinson Regional Medical Hutchinson, KS 67502-5133 Center ./

Kendall E. Johnson $100.00 06/09/2015 4403 Spyglass Hutchlnson Regional Medical Hutchinson, KS 67502-5643 Center ./

evin Miller President and Chief Executive $100.00 06/09/2015 701 East 23rd Avenue Officer utchlnson, KS 67502-1105 Hutchinson Regional Medical ./ Center

$1,090.41 I I

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 Other C•sh Check Loan Efunds Othel' Receipt Jenice Schulte OR Manager $100.00 l 3811 Mission Dr. Hutchinson Reglonal Medlcal 06/09/2015 Hutchinson, KS 67502-8096 Center

Peter Mungal $100.00 206 A .East 2nd Ave. Hutchinson Regional Medical 06/09/2015 South Hutchinson, KS 67505-1400 Center t/ Kevin Chiles VP Human Resources $100.00 1200 N. Autumn Drive Hutchinson Reglonal Medical 06/09/2015 Goddard, KS 67052-8444 Center ./

Roger Masse Chief Executive Officer $1 40.00 Po Box87 Ellsworth County Medical Center 06/10/2015 Ellsworth, KS 67439--0087

Donald Kozisek Board Vice-Chair $100.00 1576 4th Road Ellsworth County Medical Center 06/10/2015 Holyrood, KS 67450-9003

Sharon McCaleb Director .Muscularskeletal Service $100.00 16836 NE 94th Rd. St. Francis Health 06/10/2015 Topeka, KS 66617-3216 ./

David Setchel President $150.00 06/10/2015 1700 SW 7th Street St. Francis Health Topeka, KS 66606-2489 t/

Helen Wiiiiams Director $100,00 06/10/2015 2234 NW7Bth St. FrancisHealth Topeka, KS 66618-2111 ,/

Paula Ellis Director $100.00 06/10/2015 9199 K4 Hwy St. Francis Health Meriden, KS 66512-8851 ./

Deborah Bodine $100.00 06/10/2015 1648 W . 269th St. St. Francis Health · Lyndori, KS 66451-9650 ./

CNO $100.00 06/10/2015 St. Francis Health ./

$1,190,00

Page _1_1_ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Assoclatlon Political ActJon 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 Other Cash Check Loart E funds Other Receipt

Thomas Hamllton Chief Medical Officer $100.00 1025 SW Ottawa Trail St. Francis Health 06/10/2015 Topeka, KS 66615-1427 ./

Greg Lundstrom Director of Hospital Relations $500.00 605 West Lincoln Street Kansas Hospital Association 06/10/2015 Lindsborg, KS 67456-2328 ./

Marion Regler Chief Executive Officer $250.00 701 South Main Street Hillsboro Community Hospital 06/15/2015 Hillsboro, KS 67063-1553 ./

Holly Koch Chief Financial Officer $100,00 1371 67th Terrace Girard Medical Center 06/17/2015 Uniontown, KS 66779-8010 ./

Julie Ward Vice President of Patient Care $100.00 3215 Northwestern Avenue Services 06/17/2015 Hutchinson, KS 67502-1105 Hutchinson Regional Medical Center ./

Mary Sweet Administrator $200.00 721 West Kansas Avenue Kiowa County Memorial Hospital 06/25/2015 Greensburg, KS 67054-1633 ./

Laurie Labarca $100.00 06/25/2015 1149 N. Glenmoor Dr_ Via Christi Hospital on SL Francis Wichita, KS 67206-4131 ./

Leslie Lacy $150.00 06/25/2015 1510 Road 5 Great Plains Health Alliance, Inc. Saint Francis, KS 67756-0547 ./

Harold Courtois Chief Executive Officer $200.00 06/25/2015 200 South Main Street Russell Regional Hospital · Russell, KS 67665-2920 ./

Todd Willert Chief Executive Officer $350.00 06/25/2015 6712 Henry#4 Community HealthCare System Wamego, KS 66547 ./

Professional organization $250.00 06/25/2015 Kansas Assn. of Health Care Executives ./

$2,300.00

·. Page~of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Political Action Commltlee (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 ~ Other Receipt

Kansas Hospital Auxiliaries of Volunteers Professlonal $100.00 1449 North High Drive Association 06/2512015 McPherson, KS 67460-2107

Kansas Association of Health Care Professional Association $100.00 Communicators 06/25/2015 215 SE Bth Avenue Topeka, KS 66603-3906 ./

Chad Austln Sr. Vice President, Government $76.92 6518 SW 26th Court Relations 06/25/2015 Topeka, KS 66614-4305 Kansas Hospital Association ./

Audrey Dunkel Director of Financial Advocacy $43.48 215 SE 8th Street Kansas Hospital Association 06(25/2015 Topeka, KS 66603-3906

Jennifer Flndley VP Education/Special Projects $16.00 3517 SW Ashworth Ct. Kansas Hospital Assoclatlon 06/25(2015 Topeka, KS 66614-4590

Melissa Hungerford Sr. Vice President $19.24 6448 SW Bayshore Dr Kansas Hospital Association 06/25/2015 uburn, KS 66402-9324

Sally Perkins Director of Data Services $7.70 06f25f2015 1725 NW Grove Kansas Hospital Association Topeka, KS 66606-1237

Cindy Samuelson Vice President $19.24 06/25(2015 1107 NE 54th St Kansas Hospital Assoclatlon Topeka, KS 66617-4505

Tom Bell Executive Dir.of Govt Public $100.00 07/0212015 1215 Columbine Lane Relations Salina, KS 67401-9108 salina Regional Health Center ../

Curt Colson $200.00 07/0212015 605 N. Main st. Great Plains Health Alliance, Inc. Hoisington, KS 67544-2150 ./

ora Key Chief Executive Officer $250.00 07(09/2015 3BOV Rd Sabetha Community Hospital abetha, KS 66534-2595

$932.58

Page~of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Politlcal 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 Other Casll Check Loan Efunds . ~ Receipt

Ryan Stover Trustee $250.00 102 East Holme Norton County Hospital 07/10/2015 Norton, KS 67654-1406 ./

Roger Harnisch $100.00 7070 W. 107th St. Ste. 200 Double Eagle Insurance Servloes, 07/16/2015 Inc. v Vincent Wilczak $100.00 PO Box8603 Pratt Regional Medical Center 07/16/2015 Pratt, KS 67124-8603 ./

Kelly McDenrneit Director Outreach and Support $75.00 10390 SW Lakeview Drive Services 07/16/2015 Pratt, KS 67124-8209 Pratt Regional Medical Center

Jack Kennedy Vice President & Chief Nursing $100.00 255 SW 60th Ave. Officer 07/16/2015 Pratt, KS 67124-7708 Pratt Regional Medical Center

Doug Meyer Anclllary Service Director $100.00 1405 Riverview Rd Pratt Regional Medical Center 07/16/2015 Pratt, KS 67124-2100 ./

Susan Page President and Chief Executive $350.00 07/16/2015 200 Commodore Street Officer Pratt, KS 67124-2903 Pratt Regional Medical Center ./

Kenneth Brown Vice President & Chief Human $100.00 07/16/2015 307Champa Resource Officer Pratt, KS 67124-1816 Pratt Regional Medical Center ./

Kristie Kaiser $100.00 07/16/2015 1008 N. Main Clara Barton Hospital Hoisington, KS 67544-1746 ./

Ruth Duling Director of PFS $100.00 07/16/2015 2604Carline Girard Medical Center Girard, KS 66743-2213 ./

rent Hanson Chief Executive Officer and HIPM $250.00 14 Cleveland Street Security and Com real Bend, KS 67530-3562 Great Bend Regional Hospital ./

$1.625.00

Page~of~ -

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Hospital Association Political Action Committee I (Name of Party Committee or Political Committee) I I

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 Chock Loan Efunds .. Other Receipt

Dennis Shelby Chief Executive Officer $100.00 P 0 Box360 Wilson Medical Center 07/20/2015 Neodesha, KS 66757-0360. ,f

Meldon Snow Chief Executive Officer $200.00 211 Cherry St. Logan County Hospital 07/23/2015 Oakley, KS 67748-1218_ ,/

David Robinson Trustee $300.00 810 S. Denman Neosho Memorial Regional o712912o1 5 Chanute, KS 66720-25;!6 Medical Center

Chad Austin Sr. Vice President, Government $76.92 6518 SW 26th Court Relations 07/29/2015 Topeka, KS 66614-4305 Kansas Hospital Association

Audrey Dunkel Director of Financial Advocacy $43.48 215 SE 8th Street Kansas Hospital Association 07/29/2015 Topeka, KS 66603-3906

Jennifer Flndley VP Education/Special Projects $16.00 3517 SW Ashworth Ct. Kansas Hospital Association 07/29/2015 Topeka, KS 66614-4590

MeUssa Hungerford Sr. Vice President $19.24 07/29/2015 6448 SW Bayshore Dr Kansas Hospital Associatlon Auburn, KS 66402-9324

Sally Perkins Director of Data Services $7.70 07/29/2015 1725 NW Grove Kansas Hospital Association Topeka, KS 66606-1237

Cindy Samuelson Vice President $19.24 07/29/2015 1107 NE 54th St Kansas Hospital Association Topeka, KS 66617-4505

Jane Schepmann CNO $100.00 07/29/2015 300 W Santa Fe Clara Barton Hospital Holyrood, KS 67450-9657 ,/

$760.00 08/03/2015 Eagle Med LLC ,/

$1,632.58

Page~ of_::_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Political Action Committee (Na.me 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 oo.crEfunds Receipt

. Austin Giiiard Chief Executive Officer $100.00 1604 1 st Street Clay County Medical Center 08/03/2015 Clay Center, KS 67432-0512 ./

Nancy Zimmerman Administrator $250.00 HC65, Box8A Comanche County Hospital 08/10/2015 Coldwater, KS 67029-9500 ./

Teto Henderson Director Human Resources $75.00 P 0Box490 Geary Community Hospital 08/13/2015 Junction City, KS 66441-0490 ./

Dawn Engel $100.00 2909 J Ave Geary Community Hospital 08/14/2015 Herington, KS 67449-4024

Victor Hawkins Executive Director Marketing and $100.00 401 East Spuce Street Development 08/14/2015 Garden City, KS 67846-5679 St Catherine Hospital

Kathleen Clauslng-Wilils Vice President/COO $100.00 1071 E 1400 Rd Lawrence Memorial Hospital 08/18/2015 Lawrence, KS 66046-9633 ./

Sherry Hausmann Senior Administrator $500.00 08/20/2015 929 North St Francis Street Via Christi Hospital on St Francis Wichita, KS 67214-3821 ./

Scott Taylor President and Chief Executive $600.00 08/24/2015 401 East Spruce Street Officer Garden City, KS 67846-5679 St. Catherine Hospital ./

Greg Unruh Chief Executive Officer $350.00 08/24/2015 865 N. Thompson Citizens Medical Center Colby, KS 67701-3702 ./

Brent Wall $100.00 08/24/2015 404 Crestview Ct. Retired McPherson, KS 67460-1631 ./

eorge Halama CFO $100.00 08/24/2015 22N. Eby St. McPherson Hospital -.;, cPherson, KS 67460-3815

$2,375.00

Page~ of-=:_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Polltlcal Actlon 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 Other Cssh Check Loan Efunds Oth•r Receipt

Robert Monlcal President and Chief Executive $100.00 1522 Sunflower Dr. Officer 08/24/2015 McPherson, KS 67460-2326 McPherson Hospital ,/

Organization of Nurse Leaders Kansas Nursing Professional Association $500.00 KS KONL 08/24/2015 ,/

Ron Marshall $100.00 5909 SW Cherokee Ct. Kansas Hospital Association 08/24/2015 Topeka, KS 66614-4563 ,f

Eugene Meyer President and Chief Executive $500.00 26342 W. 11oth Terr. Officer 08/24/2015 Olathe, KS 66061-8413 Lawrence Memorial Hospltal

Janice Early $100.00 902 Riverside Ct Lawrence Memorial Hospital 08/24/2015 Lawrence, KS 66044-4092

· Michael Will!ams $250.00 700 Fox Chase Court Lawrence Memorial Hospital 08/24/2015 Lawrence, KS 66049-4748 ,/

Sheryle D'Amlco VP $200.00 08/24/2015 737 N. 1550 Rd. Lawrence Memorial Hospital Lawrence, KS 66049-9198 ./

Joe Pedley Vice President and Chief Flnanclal $100.00 08/24/2015 5624 Villa Drive Officer Lawrence, KS 66047-8300 Lawrence Memorial Hospital ,/

Karen Shumate Chief Operating Officer $100.00 08/24/2015 1753 E 980 Rd Lawrence Memorial Hospital Lawrence, KS 66049-9073 ,/

Carolyn Bowmer Vice President, Human Resources $100.00 08/24/2015 17301West84th Terrace Lawrence Memorial Hospital Lenexa, KS 66219-8046 ,/

arnes Blackwell $100.00 08/24/2015 1105 Park St. Clara Barton Hospital oislngton, KS 67544-1706 ,/

$2, 150.00 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS ·

Kansas Hosprtal Association Politlcal 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 Other Cash Che<:k Loan Efunds Other Receipt

Jeremy Armstrong Chief Executive Officer $154.00 P0Box399 Mitchell County Hospital Health 08/24/2015 Beloit, KS 67420-0399 Systems ./

Claudio Ferraro VP Planning $100.00 541 N. Tallyrand Sl Vla Christi Regional Medical 08/2412015 Wichita, KS 67206-1112 Center-SL Joseph Cam ./

Chad AusUn Sr. Vice Pres.Iden!, Government $76.92 6518 SW 26th Court Relations 08/25/2015 Topeka, KS 66614-4305 Kansas Hospital Association ./

Audrey Dunkel Director of Financial Advocacy $43.48 215 SE 8th Street Kansas Hospital Association 08/25/2015 Topeka, KS 66603-3906

Je.nnlfer Findley VP Education/Special Projects $16.00 3517 SW Ashworth Cl Kansas Hosplt;;il Association 08/25/2015 Topeka, KS 66614-4590

Melissa Hungerford Sr. Vice President $19.24 6448 SW Bayshore Dr Kansas Hospital Association OB/25/2015 Auburn, KS 66402-9324

Sally Perkins Director of Data Services $7.70 08/25/2015 1725 NW Grove Kansas Hospital Association Topeka, KS 66606-1237

Cindy Samuelson Vice President $1924 08/25/2015 1107 NE 54th st Kansas Hospital Association Topeka, KS 66617-4505 ./

Clint McClurg $750.00 08/25/2015 1746 Cole Blvd. Diversified Radiology of Colorado Lakewood, CO 80401-3208 ./

Michael Burroughs Chief Executive Officer $350.00 08/2512015 PO Box 1478 Western Plains Medical Complex Dodge City, KS 67801 -1478 ./

eborah Goodwin $150.00 OB/25/2015 0Box1478 Western Plains Medical Complex odge City, KS 67801-1478 ./

$1,686.58

Page~of~ SCHEDULE A CONTRIBUfJONS 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 Other Cash Check Loan Efund• Other Receipt

Corry Israel Director Human Resources $150.00 PO Box 1478 Western Plains M_edlcal Complex 08/25/2015 Dodge City, KS 67801 -1478

Michael Gordian Chief Financial Officer $140.00 PO Box 1478 Western Plains Medical Complex 08/25/2015 Dodge City, KS 67801 -1478

CurtlsWinter $150.00 1201da Knipp Equipment 08/28/2015 Wichita, KS 67211-1504

Craig Singer $150.00 120 Ida Knipp Equipment 08/28/2015 Wichita, KS 67211-1504

Greg Lundstrom Director of Hospital Relations $100.00 605 West Lincoln Street Kansas Hospital Association 08/28/2015- Lindsborg, KS 67456-2328

Luanne George Sr. Account Executive $750.00 7701 France Ave. South MMIC Group Inc. 08/28/2015 Lenexa, KS 66285 ./

Greg Unruh Chief Executive Officer $150.00 08/28/2015 865 N. Thompson Citizens Medical Center Colby, KS 67701-3702 ./

John Peterson Administrator $250.00 08/28/2015 2841 SW Plass Avenue Kansas Hospital Association Topeka, KS 66611-1629 ./

Laurie Labarca $100.00 08/28/2015 1149 N. Glenmoor Dr. Vla Christi Hospital on St. Francis Wichita, KS 67206-4131 ./

Greg Lundstrom Director of Hospital Relations $40.00 08/28/2015 605 West Lincoln Street Kansas Hospital Association Lindsborg, KS 67456-2328 ./

Administrator $20.00 08/28/2015 Pawnee Valley Community Hospital ~

$2,000.00

Page~o~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political 9ommittee)

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 Ch

Curt Thomas Administrator $20.00 312 Custer Street Ness County Hospital 08/28/2015 Ness City, KS 67560-1654

Michael Machen $60.00 Gove County Medical Center 08/28/2015 ./

Kevin White Administrator $100.00 71 O North Walnut street Medicine Lodge Memorial Hosplta 08(28/2015 Medicine Lodge, KS 67104-1019

Victor Hawkins Executive Director Marketing and $20.00 401 East Spuce Street Development 09/08/2015 Garden City, KS 67846-5679 St. Catherine Hospital ./

Craig Singer $10.00 1201da Knipp Equipment 09/08/2015 Wichita, KS 67211-1504

Curtis Winter $10.00 120lda Knipp Equipment 09/08/2015 Wichita, KS 67211-1504 ./

Curtis Hawkinson Chief Executive Officer $250.00 09(08/2015 708 North 18th Street Community Memorial Healthcare Marysville, KS 66508-1338

Sherri Vaughn MD $140.00 09/09/2015 1216 Waverly Dr. Lawrence Memorial Hospital Lawrence, KS 66049-5016 ./

Lori Penner Hospital Trustee $110.00 09/09/2015 2121 9th St Clay County Medical Center Clay Center, KS 67432-1547 ~

Melissa Atkins Chief Executive Officer $20.00 09/10/2015 304 West Prout Street Graham County Hospital Hill City, KS 67642-1435 ~

aryAdam Executive Director $60.00 09/10/2015 10 E. Walnut, Ste. 210 Pioneer Health Network arden City, KS 67846-5565 ./

$800.00

Page 20 of 29 . -- -- 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 Other Casl1 Check Loan Efunds Other Receipt

Leanne Irsik Senior Vlce President and $100.00 3515 Broadway Street Administrator 09/10/2015 Great Bend, KS 67530-3633 St Rose Ambulatory & Surgery Center Larry Morris Director $400.00 6508SW 28th Stormont-Vall HealthCare 09/11/2015 Topeka, KS 66614 ~

Pam Harmon Chief Nursing Officer $100.00 Rooks County Health Center 09/11/2015 ~

Joy Bretz Trustee $500.00 790 S Road 14BE Sheridan County Health Complex 09/11/2015 Hoxie, KS 67740-4130

Kevin Strecker $100.00 881 O E. Clubslde Circle Via Chris!l Hearth 09/15/2015 Wichita, KS 67206-4039 ~

Genette Nicholas Vice President Government $100.00 1001 West 58th Street Rela!lons 09/15/2015 Kansas City, MO 64113-1232 Children's Mercy Kansas City

Dennis Hachenberg Chief Executive Officer $500.00 09/15/2015 105 N. Oak SL Anderson County Hospital Garnett, KS 66032-0309

Larry VanDerWege Administrator $160.00 09/15/2015 743 Diamond Dr. Lindsborg Community Hospital Lindsborg, KS 67456-2328 ~

Beth Hedberg Nursing Administration $100.00 09/15/2015 2570 First Avenue Lindsborg Community Hospital Marquette, KS 67464-9801 ./

Laraine Gengler Chief Financial Officer $100.00 09/15/2015 605 West Llncoll'l'Street Lindsborg Community Hospital Lindsborg, KS 67456-2328 ~

$200.00 09/15/2015 Ashland Health Center ~

$2,350.00

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 Other Cash Ch•c:k Loan Efunds Other Receipt

John Hughes Administrator $60.00 1115W. 16th Street Pawnee Valley Community p9/16/2015 Lamed, KS 67550-2429 Hospi1al ~

William Widener Administrator and Chief Executive $250.00 700 West 13th Street Officer 09/16/2015 Harper, KS 67058-1401 Harper Hospital District Five ./ John Jacobson Chief Executive Officer $300.00 3955 Highway 73 Atchison Hospital 09/16/2015 Atchison, KS 66002-9204 ./

John Jacobson Chief Execu!Jve Officer $50.00 3955 Highway 73 Atchison Hospital 09/16/2015 Atchison, KS 66002-9204 ./

Deborah Stem Cllnlcal Servlcesllegal Counsel $100.00 3338 SW Alameda Dr. Kansas Hospital Association 09/16/2015 Topeka, KS 66604-2660

Judith Hodgson Chief Nursing Officer $100.00 124028Th Rd Hospl!al District One of Rice 09/16/2015 Hospital District #1 of Rice County County Little River, KS 67457-9004

Terry Pound Chief Financial Officer $150.00 09/16/2015 420 S Pioneer Hospital District One of Rice Lyons, KS 67554-2613 County

George Stover Chief Executive Officer $150.00 09/16/2015 P OBox 828 Hospital District One of Rice Lyons, KS 67554-0826 County ./

Steven Poage Vice President/CFO $500.00 09/16/2015 3401 SW Alameda Kansas Hospital Assocfatlon Topeka, KS 66614-5109 ./

Joseph Stratton Chief Executive Officer $200.00 09/16/2015 4174 Otter Creek Rd. Geary Community Hospital Junction City, KS 66441-0490 ./

President and Chief Executive $1,400.00 09/16/2015 Officer , _ Southwest Medical Center

$3,260.00

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 Other Cush Check Lom E funds other Receipt

Jeremy Clingenpeel Administrator $100.00 PO Sox 159 Satanta District Hospital and Long 09/16/2015 Satanta, KS 67870-0159 Term Care ./

Rosalind Lewis Chief Nursing Officer $100.00 13477 Curtis Circle Community HealthCare System 09/16/2015 Wamego, KS 66547-8994 ./

. Robin Harrold Senior Vice President $150.00 13402 W. 72nd St. Shawnee Mission Medlcal Center 09/16/2015 Shawnee, KS 66216-4158 ./

Mark MiUer Chief Executive Officer $60.00 511 NE Tenth Street Memorlal Health System 09/16/2015 Abflene, KS 67410-2153

Craig Concannon Board Member $100.00 921 N. Mill Kansas Hospital Association 09/16/2015 Beloit, KS 67420-1751 ./

Kansas Hospital Attorneys KAHA Professional Organization $1,000.00 PO BOX2308 Kansas Hospital Attorneys KAHA 09/16/2015 Topeka, KS 66601-2308 ./

Coleen Tummons Chief Executive Officer $200,00 09/16/2015 200 Castle Rock Stree_t Gove County Medical Center Quinter, KS 67752-0129

Coleen Tummons Chief Executive Officer $20.00 09/16/2015 200 Castle Rock Street Gove County Medical Center Quinter, KS 67752-0129 ./

KHHRA Hospital HR Professlonal $1,000.00 09/16/2015 215 SE Eighth Assoclatlon Topeka, KS 66603-3906 KHHRA ./

Melanie Urban $425.00 09/16/2015 3244CR300 Hays Medical Center Hays, KS 67601 ./

Sr. Vice President, Government $'76.92 09/16/2015 Relations Kansas Hospital Association ./

$3,231.92

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 Other Cash Check Loan Efunds Other Receipt

Audrey Dunkel Director of Financial Advocacy $43.48 215 SE 8th Street Kansas Hospital Association 09/16/2015 Topeka, KS 66603-3906

Jennifer Findley VP Education/Special Projects $16.00 3517 SW Ashworth Cl Kansas Hospital Association 09/16/2015 Topeka, KS 66614-4590 {

MeUssa Hungerford Sr. Vice President $19.24 6448 SW Bayshore Dr Kansas Hospital Association 09/16/2015 Auburn, KS 66402-9324 {

Sally Perkins Director of Data Services $7.70 1725 NW Grove Kansas Hospital Association 09/16/2015 Topeka, KS 66606-1237 {

Cindy Samuelson Vice President $19.24 1107 NE 54th St Kansas Hospital Assoc!atlon 09/16/2015 Topeka, KS 66617-4505

Letltia Holl!ngsworlh Director of Reimbursement $150.00 09/16/2015 2635 SW Santa Fe Dr. Kansas Hospital Association Topeka, KS 66614-4956 {

Jan Fenwick Sr. Program Manager $100.00 09/16/2015 1020 SW Red Oaks Place Communications Topeka, KS 66615-1241 Kansas Hospital Association

Leanne Irsik Senior Vice President and $40.00 09/16/2015 3515 Broadway Street Administrator Great Bend, KS 67530-3633 St. Rose Ambulatory & Surgery { Center , Kansas Hospital donations $490.00 09/16/2015 215 SE 8th Kansas Hospital Association Topeka, KS 66603-3906 {

Cindy Knoeppel $100.00 10/1212015 200 N. Walnut Newton Medical Center Whitewater, KS 67154-9080 {

Consultant $250.00 Boden Healthcare

$1,235.66

Page~of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Politlcal 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 Other Cash Check Loan Efunds Other Receipt

Dallas Polen Director of Government Relations $250.00 5401West101th Terrace Chlldren's Mercy Hospitals and 10{23{2015 Overland Park, KS 66207-3127 Clinics

Robin Crawford Vice President and Chief Flnanclal $350.00 405 Counby Hills Drive Officer 10{26/2015 Augusta, KS 67010-2518 Susan B. Allen Memor!al Hospital .(

Br!anWllllams $100.00 1307 Partridge Ave. Labette Health 10{26/2015 Parsons, KS 67357-5000 .(

Marion Thompson Chief Executive Officer $100.00 223 S. Colborn Allen County Regional Hospital 10/26(2015 Iola, KS 66749-3405 .(

Carrie Sala Chief Executive Officer $100.00 1110 Columbine Drive Holton Community Hospital 11/16(2015 Holton, KS 66436-a824 .(

Jon Jackson Sr. VP, Chief Administrative $500.00 8000 Tomahawk Road Officer 11/17/2015 Prairie Village, KS 66208-4845 Unlversity of Kansas Hospital, The

Lee Norman Chief Medical Officer $500.00 11/18(2015 210W5th St University of Kansas Hospital, The #205 .( Kansas City, MO 64105-1166

Chad Austin Sr. Vice President, Government $115.38 11/191201{) 651 S SW 26th Court Relations Topeka, KS 66614-4305 Kansas Hospital Association .(

Audrey Dunkel Director of Financial Advocacy $65.22 11/19/2015 215 SE 8th Street Kansas Hospital Association Topeka, KS 66603-3906 .(

Jennifer Findley VP Education/Special Projects $24.00 11/19/2015 3517 SW Ashworth Cl Kansas Hospital Association Topeka, KS 66614-4590 .(

Sr. Vice President $26.66 11/19/2015 Kansas Hospital Association ./

$2, 133.46

Page~of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Hospital Association Polltlcal 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 Other Cash Check Loan E funds OtlITT Receipt

Saffy Perkins Director of Data Services $11.55 1725 NW Grove Kansas Hospital Association 11/19/2015 Topeka, KS 66606-1237

Cindy Samuelson Vice President $28.86 1107 NE 54th St Kansas Hospital Association 11/19/2015 Topeka, KS 66617-4505 ./

Jan Fenwick Sr. Program Manager $200.00 1020 SW Red Oaks Place Communications 11/19/2015 Topeka, KS 66615-1241 Kansas Hospital Association ./

Bob Page Chief Executive Officer $1,000.00 13413 W 75th Court University of Kansas Hospital, The 11120/2015 Shawnee, KS 66216-3078

Dick Roberts $250.00 1602 N. Elm Greenwood County Hospital 11127/2015 Eureka, KS 67045-1090

Steven Stites $500.00 5901 Ballevlew Ave. University of Kansas Hospital, The 11/30/2015 Kansas City, MO 64113-1372 ./

Steven Granzow Chief Executive Officer $200.00 11/30/2015 422 S. Fourth St Lincoln County Hospital Lincoln, KS 67455-0406

Tammy Peterman Executive Vice President, Chief $500.0Q 11/30/2015 3901 Rainbow Boulevard Operatlng Officer Kansas City, KS 66160-8500 University of Kansas Hospital, The ./

Steven Edgar $350.00 12/01/2015 8430 N. Northridge Ct. Wesley Medical Center Wichita, KS 67205 ./

Jana Burdolskl $100.00 12/01/2015 7035 Santa Fa Drive Shawnee Mission Medical Center overland Park, KS 66204-1358 ./

oug Spear Director of Marketing $100.00 12815 S Rene St Shawnee Mission Medical Center lathe, .KS 66062-6223 ./

$3,240.41

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 Other Cash Check Loan ~ Other Receipt

Larry Botts Chief Medical Officer $500.00 3200 W 68th St Shawnee Mission Medical Center 12/02/2015 Mission Hills, KS 66208-2135 ./

Thomas Henton Chief Executive Officer $200.00 PO Box 157 Sumner County Hospital District 12103/2015 Lamont, OK 74643-0157 One

Chad Austin Sr. Vice President, Government $76.92 6518 SW 26th Court Relations 12104/2015 Topeka, KS 66614-4305 Kansas Hospital Association ~

Audrey Dunkel Director of Financial Advocacy $43.48 215 SE 8th Street Kansas Hospital Association 12/04/2015 Topeka, KS 66603-3906

Jennifer Findley VP Educatlon/Speclal Projects $16.00 3517 SW Ashworth Cl Kansas Hospital Association 12/04/2015 Topeka, KS 66614-4590

Melissa Hungerford Sr. Vice President $19.24 6448 SW Bayshore Dr Kansas Hospital Association 12104/2015 Auburn, KS 66402-9324

Sally Perkins Director of Data Services $7.70 12/0412015 1725 NW Grove Kansas Hospital Association Topeka, KS 66606-1237

Cindy Samuelson Vice President $19.24 12/04/2015 1107 NE 54th St Kansas Hospital Association Topeka, KS 66617-4505

Mark Brady $100.00 12/05/2015 9403 W. 146!h Place Shawnee Mission Medical Center Overland Park, KS 66221 -2260 ./

Bill Marting Senior Vice President and Chief $100.00 12/07/2015 2808 NW Thoreau Dr. Financial Officer Lees Summit, MO 64081-2265 University of Kansas Hospital, The ./

Chief Exec.utive Officer and $100.00 Administrator Kearny County Hospital ~

$1,182.58

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 Other Cash Checlt Loan ~ Other Receipt

Roxanne Schottel RH IT - Patient Accounts Manager $200.00 304 E. Third SL Washington County Hospital 12/08/2015 Washington, KS 66968-2098 I

Bobby Olm-Shipman $600.00 10920 Elm Avenue Saint Luke's Health System 12/08/2015 Kansas City, MO 64134-4108 I

Adele Ducharme Chief Executive Officer $300.00 711 Marshall Street Saint Luke's Cushing Hospital 12/08/2015 Leavenworth, KS 66048-3235 I

Bill Marting Senior Vice President and Chief $400.00 2808 NW Thoreau Dr. Financial Officer 12/10/2015 Lees Summit, MO 64081-2265 University of Kansas Hospital, The

Kimberly King $100.00 17711 W. 83rd Terr. Shawnee Mission Medical Center 12/11/2015 Lenexa, KS 66219-8139

Richard Bergllng Interim Chief Executive Officer $100.00 POBox937 Morton County Health System 12/16/2015 Elkhart, KS 67950-0937 I

$1 ,700.00 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 Other Cash Ch..,k Loan Efuuds Othe1· Receipt

Risk & Quality Mgt KS Assoc of Risk & Quality Management $100.00 C-0 Kansas Hospital ,/\ssoclation Association 12117/2015 PO BOX2308 Topeka, KS 66601-2305 ./

Richard Bergllng Interim Chief Executive Officer $100.00 POBox937 Morton County Health System 12/17/2015 Elkhart, KS 67950-0937 ./

Greg Maddux $100.00 13910 W. 75th Ct Shawnee Mission Medical Center 12/18/2015 Shawnee, KS 66216-4271

Charles Laird Chief Executive Officer $1,000.00 5721 West 119th Street Menorah Medical Center 12/18/2015 Overland Park, KS 66209-3722

Kevin Hicks President and CEO $1,500.00 PO Box 15959 Overland Pall< Regional Medical 12118/2015 Overland Park, KS 66215-5959 Center

BlllVo!och President and Chief Executive $2.000.00 550 North Hillside Officer 12/18/2015 Wichita, KS 67214-4910 Wesley Medical Center ./

Marion Thompson Chief Executive Officer $200.00 12/1812015 223 S. Colborn Allen County Reglona_I Hospital Iola, KS 66749-3405 ./

Steven Edgar $300.00 12/18/2015 8430 N. Northridge Cl Wesley Medical Center Wichita, KS 67205

$5,300.00

Complete if last page of Schedule A

Total Itemized Receipts for Period $64,238.64 Total Unitemized Contributions ($50 or less)

. Sale of Political Materials (Unitemized) $0.00

Total Contnoutions When Contributor. Not Known $0.00

$67,238.85

Page~of~ SCHEDULEB IN-KIND CONTRIBUTIONS

Kansas Hospital Association Political Actlon Committee (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

Kansas Hospital Association KHA Hospital Association The Vernon Company - Murtl-tool 12131/2015 215 S.E. 8th Kansas Hospital Association $825.47 Topeka, KS 66603-3906

Kansas Hospital Association KHA Hospital Association Fed Ex to AHA PAC 12131/2015 215 S.E. 8th Kansas Hospital Assoeiatlon $523.53 Topeka, KS 66603-3906

Kansas Hospital Association KHA Hospital Association KS Government Ethics - PAC Kansas Hospital Association Registration 12131/2015 . 215 S.E. 8th $240.00 Topeka, KS 66603-3906

Kansas Hospital Association KHA Hospital Association Cindy Samuelson - Golf Event 215 S.E. 6th Kansas Hospital Association $1,260.00 12131/2015 Topeka, KS 66603-3906

Kansas Hospital Association KHA Premier Global - Conference Call 215 S.E. 8th 12131/2015 Topeka, KS 66603-3906 $126.31

Kansas Hospital Association KHA Hospital Association WNNJ, Audit/Tax Return 215 S.E. 8th Kansas Hospital Association 12131/2015 Topeka, KS 66603-3906 $1,500.00

Kansas Hospital Association KHA Hospital Association WNNJ, Audit/Income Tax Prep 215 S.E. 8th Kansas Hospital Association 12/31(2015 Topeka, KS 66603-3906 $375.00

Kansas Hospital Association KHA Hospital Association Wichita State - Massage Therapist 215 S.E. 8th Kansas Hospital Association 12/31/2015 Topeka, KS 66603-3906 $270.00

Kansas Hospital Association KHA Balloon Studio - Convention 215 S.E. 8th 12131/2015 Topeka, KS 66603-3906 $64.00

$5,204.31

Complete if last page of Schedule B

Total Itemized (over $100) In-Kind Contributions

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

Page _1__ of_2_ _ SCHEDULEB IN"KIND CONTRIBUTIONS

Kansas Hospital Association PolltJcal Action Committee (Name of Party Committee or Political Committee)

List Occupation & Vaine of Date Name and Address Industry for Those Giving Description of In-Kind In-Kind of Contributor an In-Kind of More Than Contribnti6n Contribution $150

Kansas Hospital Association KHA Hospital Association Integrative Therapies - Massage 12/31/2015 215 S.E. 8th Kansas Hospital Association Therapist $260.00 Topeka, KS 66603-3906

$260.00

Complete if last page of Schedule B

Total Itemized (over $100) In-Kind Contributions $5,464.31

Total Unitemized ($100 or less) In-Kind Contributions $32.86

$5,497.17

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 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

Square Up John Broberg 2127/15 . $27.50 02127/2015

Square Up Eric Voth 3/2/15

03/02/2015 $9.63

Square Up David Cunningham 3/3115

03/03/2015 $13.75

The Senate Demm:rats PAC. PO Box 1911 $500.00 03/04/2015 Topeka, KS 66601

AHAPAC-Amerfcan Hospital Association Federal PAC $2,263.27 03/05/2015 800 10th Street, N.W. Two CltyCenter, Suite 400

Square Up Debbie Bruner 3/10/15 03/10/2015 $4.13

Steve Elmore 1107 McArtar Rd. 03/11/2015 $100.00 Dodge City, KS 67801-6031

Square Up Marion Zirger 3/30/15 03/30/2015 $0.69

Square Up William Miller 3/30/15 03/30/2015 $9.63

AHAPAC-American Hospital Association 03/30/2015 Federal PAC 800 10th Street, N.W. $2,102.54 Two CityCenter, Suite 400

$5,031 .14

Page_1_of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name of Pa1ty_ Committee or Political Committee)

PurJ!OSe ofE~enditure Name and Address Amount Date To Whom Expenditure is Made H independent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address

Square Up Todd Tangeman 4/2115 $2.75 04{02/2015

Square Up Greg Sullivan 4/2/15

$0.69 04{02/2015

Square Up Sharon Cox 04!08!15

04{08{2015 $2.75

Square Up Terry Jett 04/10/15

04/10/2015 $6.88

Square Up Kiley Floyd 04/10/15

04/10/2015 $5.50

AHAPAC-Amerlcan Hospital Assoclatlon FEDERAL 04/27/2015 $1,610.04 800 10th Street, NW Two City Center, Suite 400

Square Up Bruce Witt 05/13/15 05{15/2015 $2.75

Square Up Carrie Sala 5/13{15 05{15/2015 $4.13

AHAPAC-Amerlcan Hospital Association 05/19(2015 FEDERAL $702.50 800 10th Street, NW Two City Center, Suite 400

Square Up Dee Dea Dewell 6{2/15 06/02/2015 $1.38

$2,339.37

Page_2_of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (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 ili excess of $300 is made for a candidate, list candidate name & address

Square Up Kathy Morrison 6/2115 $2.75 06/02/2015

Square Up Jody Gragg 6/2115

$2.75 06/02/2015

Square Up John Moore 6/2115

06/0212015 $5.50

Square Up Kelly Speckman 6/5/15

06/05/2015 $2.75

Square Up Cassie Dolen 6-9-15

06/P9/2015 $1.38

Square Up Jarrod Urban 6/9/15 06109/2015 $1.38

Square Up Peter Mungal 6/9/15 06/09/2015 $2.75

Square Up Kevin Chiles 6/9/15 06/10/2015 $2.75

AHAPAC-Arnerlcan Hospita[ Association 06/11/2015 FEDERAL $2,476.94 800 10th Street, NW Two City Center, Suite 400

Square Up Marlon Regier 6/15/15 06/15/2015 $6.88

$2,505.83

Page _._3_ o~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS I Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee) r I 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

Square Up Holly Koch 6/17/15 $2.75 06/17/2015

Square Up Julie Ward 6/17/15

06/17/2015 $2.75

Square Up Wllllam Rea 6/26/15 06/26/2015 $0.69

Square Up Tom Bell 712/15 07102/2015 $2.75

Square Up Curt Colson 7/2/15 07/0212015 $5.50

Square Up Ryan Stover 7/10/15 07/1012015 $6.88

AHAPAC-Arnerican Hospital Association 07/10/2015 FEDERAL $1,166.29 800 10th Street, NW Two City Center, Suite 400 Square Up Kristle Kaiser 7/16/15 07/1612015 $2.75

Square Up Ruth Duling 7/16/15 07/16/2015 $2.75

Square Up Brent Hanson 7/17/15 07/17/2015 $6.88

$1, 199.99

· Page_4_o~ I SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Politi.cal Committee)

PurJ!OSe ofE!J!enditure 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

Square Up Laura Dean 7/20/15 $0.69 07/20/2015

CoreFirst Bank & Trust Bank Fee for Credit Card Services 3035 SW Topeka Blvd 07/20/2015 Topeka, KS 66611 $45.00

Square Up Julie Nichol 7/20/15

07/20/2015 $0.69

Square Up Michelle Bohannon 7/21/15 07/21/2015 $0.69

Square Up Jane Schepmann 7/29/15 07/22/2015 $2.75

Square Up Mel Snow 7/23/15 07123/2015 $5.50

Square Up Dennis Shelby 7/20/15 07/29/2015 $2.75

Square Up Cindy Landgraf 8/3/15 08/03/2015 $20.63

Square Up Heather Odell 8/3/15 08/03/2015 $0.69

Square Up ustln Gillard 8/3/15 OB/03/2015 $2.75

$82.1 4

Page_S_of~ . SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital AssodaUon Political Action Committee (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

Square Up Julie Quanstrom 8/3115 $0.69 08103/2015

AHAPAC-American Hospital Association FEDERAL $1 ,078.79 08/04/2015 800 10th street, NW Two City Center, Suite 400 Square Up Nancy Zimmerman 08/10/15 08110/2015 $6.88

Square Up Teto Henderson 08/13115 08113/2015 $2.06

Square Up Dawn Engel 8114115 08114/2015 $2.75

Square Up Victor Hawkins 08/14/15 08114/2015 $2.75

Square Up Sherry Hausmann 08120/15 08/20/2015 $13.75

Square Up Kathy Clausing-Willis 08118/15 08125/2015 $2.75

Square Up Cllnt McClurg 08125/15 08125/2015 $20.63

Square Up Mike Burroughs 08/25/15 08/25/2015 .$9.62

$1, 140.67

Page_6_ of_32__ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)

PurEose 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

Square Up Deborah Goodwin 08/25/15 $4.13 08/25/2015

Square Up Corry Isreal 08/25/15 $4.13 08/25/2015

Square Up Michael Gordian 08/25/15

08/25/2015 $3.85

CoreFirst Bank & Trust Bank Fee for Credit Card Services 3035 SW Topeka Blvd 08/25/2015 $45.04 Topeka, KS- 66611

Square Up Kevin White 08/28/15 08/28/2015 $2.75

AHAPAC-American Hospital Association FEDERAL 08/31/2015 $1,691.29 BOO 10th Street, NW Two City Center, Suite 400

CoreFlrst Bank & Trust · Bank Fee for Credit Card Services 08/31/2015 3035 SW Topeka Blvd $179.35 Topeka, KS 66611

Square Up Sherri Vaughn 9/9/15 09/09/2015 $3.85

Square Up Lori Penner 9/9/15 09/09/2015 $3.03

Square Up Melissa Atkins 09/10/15 09/10/2015 $0.55

$1,937.97

Page_7._o~ SCHEDULEC EXPENDITURES AND OTHER DISBURSE:MENTS

Kansas Hospital Association Polttical Action Committee (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

Square Up Nancy Zimmerman 09/10/15 $1.10 09/10/2015

Square Up Mary Adam 09/10/15

09/10/2015 $1 .65

Square Up Leanne Irsik 9/10/15 09/10/2015 $2.75

Square Up Joy Bretz 9/11/15 09/11/2015 $13.75

Square Up Donations 9/11115 09111/2015 $1.38

Square Up Beth Worden 09/11115 09/11/2015 $1 .10

Square Up Larry Morris 09/11/15 09/16/2015 $11 .00

Square Up Pam Harmon 9/11/15 09/16/2015 $2.75

Square Up Curtis Hawkinson 09/08/15 09/16/2015 $6.88

AHAPAC-Amerlcan Hospital Association 09/18/2015 FEDERAL 800 10th Street, NW $4,132.58 Two City Center, Suite 400

$4,174.94

Page_a_. o~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEIVlENTS ·

Kansas Hospital Association Political Action Committee (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

Adam Luskerfor Kansas House Adam Lusker, STATE HOUSE 2nd KS 452 S. 210th St. $250.00 10/01/2015 Frontenac, KS 66763

Chuck Smith for Kansas House Charles Smith, STATE HOUSE 3rd KS 2112 w. 4th $250.00 10/01/2015 Pittsburg, KS 66762

Marty Read for Kansas House , STATE HOUSE 4th KS 18244 KS Hwy 52 . $250.00 10/01/2015 Mound City, KS 66056

Jene Vickrey for State House Jene Vickrey, STATE HOUSE 6th KS 502 S. Countryside $500.00 10/01/2015 Louisburg, KS 66053

Richard Proehl for Kansas House , STATE HOUSE 7th KS 510 Pine Ridge Rd $500.00 10/01/2015 Parsons, KS 67357

Kent Thompson for Kansas House Kent Thompson, STATE HOUSE 9th KS PO Box 626 10/01/2015 $500.00 Iola, KS 667 49

John Wilson for Kansas House John Wilson, STATE HOUSE 10th KS 1923 Ohio St. 10/01/2015 $250.00 Lawrence, KS 66046

Jim Kelly for Kansas House Jim Kelly, STATE HOUSE 12th KS 309 5th 10/01/2015 s. $500.00 Independence, KS 67301

Larry Hibbard for Kansas House , STATE HOUSE 13th KS 10/01/2015 858 EE 75 Rd. $500.00 Toronto, KS 66m

Erin Davis for State House , STATE HOUSE 15th KS 10/01/2015 12018 S. Clinton Olathe, KS 66061 $250.00

$3,750.00

Page_9_of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee) .

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

Stephanie Clayton for Kansas House , STATE HOUSE 19th KS 9825 Woodson Dr. $250.00 10/01/2015 Overland Park, KS 66207

Barbara Bollier for Kansas House Barbara Bollier, STATE HOUSE 21st KS 691 OOverhill Road $250.00 10/01/2015 Mission Hills, KS 66208

Nancy Lusk for Kansas House , STATE HOUSE 22nd KS PO Box 35 $250.00 10/01/2015 Overtand Park,

Linda Gallagher for Kansas House Linda Gallagher, STATE HOUSE 23rd KS 7604 Monrovia St. $250.00 10/01/2015 Lenexa, KS 66215

Melissa Rooker for State Representative , STATE HOUSE 25th KS 4124 Brookrtdge Drive $250.00 10/01/2015 Fairway, KS 66205

Larry Campbell for Kansas House Larry Campbell, STATE HOUSE 26th KS 15803 S. Avalon 10/01/2015 $500.00 Olathe, KS 66062

Louis Ruiz for Kansas House , STATE HOUSE 32nd KS 2914 W. 46th Ave 10/01/2015 $250.00 Kansas City, KS 66103

Pam Curtls for Kansas House , STATE HOUSE 32nd KS 322 N. 16th Sl 10/01/2015 $250.00 Kansas City, KS 66102

Tom Burroughs for Kansas House , STATE HOUSE 33rd KS. 10/01/2015 3131 So. 73rd Terr $500.00 Kansas City, KS 66106

Kathy Wolfe Moore for Kansas House Kathy Moore, STATE HOUSE 36th KS 10/01/2015 3209 N 131st Street Kansas City, KS 66109 $500.00

$3,250.00

Page~o~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Assoclatlon Political Action Committee (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

Stan Frownfefter for Kansas House , STATE HOUSE 37th KS PO Box 6145 $250.00 10/01/2015 Kansas City, KS 66106

Connie O'Brien for Kansas House Connie O'Brien, STATE HOUSE 42nd KS 22_123211thSt $250.00 10/01/2015 Tonganoxie, KS 66086

Barbara W. Ballard for Kansas House Barbara W. Balfar.d, STATE HOUSE 44th KS 1532 Alvamar Drive $250.00 10/01/2015 Lawrence, KS 66047

Tom Sloan for Kansas House Tom Sloan, STATE HOUSE 45th KS 772 Highway 40 $250.00 10/01/2015 Lawrence, KS 66049

Ramon Gonzalez for Kansas House Ramon Gonzalez, STATE HOUSE 47th KS PO Box 12 $250.00 10/01/2015 Perry, KS 66073

Marvin Kleeb for Kansas House , STATE HOUSE 48th KS 14206 Eby 10/01/2015 $500.00 Overland Park, KS 66221

Fred Patton for Kansas House , STATE HOUSE 50th KS 10/01/2015 339 NE46th $250.00 Topeka, KS 66048

Ron Highland for Kansas House , STATE HOUSE 51st KS 10/01/2015 27487 Wells Creek Rd . $250.00 Wamego, KS 66547

Annie Tietze for Kansas House , STATE HOUSE 53rd KS 10/01/2015 329 SW Yorkshire Road $250.00 To~ka, KS 66606

Lane Hemsley for Kansas House Lane Hemsley, STATE HOUSE 56th KS 10/01/2015 2909 SW 33rd Circle Topeka, KS 66614 $250.00

$2,750.00

Page_11_ of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Polltlcal Action Committee (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

Blaine Finch for Kansas House , STATE HOUSE 59th KS 5 SW Fairview Dr. $500.00 10/01/2015 Ottawa, KS 66067

Don Hill for Kansas House Don Hill, STATE HOUSE 60th KS 1720 Luther $500.00 10/01/2015 Emporia, KS 6680.1

Jerry Henry for Kansas House Gerald Henry, STATE HOUSE_63rd KS 3515 Neosho Road $250.00 10/01/2015 Cummings, KS 66016

Susie Swanson for Kansas House Susie Swanson, STATE HOUSE 64th KS 1422 5th $500.00 10/01/2015 Clay Center, KS 67432

Lonnie Clark for State Representative , STATE HOUSE 65lh KS 824 B S. Madison $500.00 10/01/2015 Junctlon City, KS 66441

Tom Phillips for Kansas House Tom Phillips, STATE HOUSE 67th KS PO Box 1731 10/01/2015 $500.00 Manhattan, KS 66505-1732

Tom Moxley for Kansas House Tom Moxley, STATE HOUSE 68th KS 1852 S 200 Road 10/01/2015 $500.00 Council Grove, KS 66846

JR Claeys for Kansas House J.R. Claeys, STATE HOUSE 69th KS P_O Box501 10/01/2015 $250.00 Salina, KS 67402

John Barker for Kansas House John Barker, STATE HOUSE 70th KS 10/01/2015 103 Wassinger Ave $500.00 Abilene, KS 67410

Diana Dierks for Kansas House , STATE HOUSE 71st KS 10/01/2015 1221 Sunrise Dr. Salina, KS 67401 $500.00

$4,500.00

Page~of~ . SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospita! Association Political Action Committee (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

Les Mason for Kansas House , STATE HOUSE 73rd KS 108 Arcadian Ct. $500.00 10/01/2015 McPherson, KS 67460

Don Schroeder for Kansas House , STATE HOUSE 74th KS 13114th .Ave. $500.00 10/01/2015 Inman, KS 67546

Wlll Carpenter for Kansas House Wlll Carpenter, STATE HOUSE 75th KS 6965 SW 18th St. $500.00 10/01/2015 El Dorado, KS 67042

Kristey Wiiiiams for State Representative Kr!stey Williams, STATE HOUSE 77th KS 21 Taylor Ave. $500.00 10/01/2015 Augusta, KS 67010

Ron Ryckman for Kansas House Ron Ryckman, STATE HOUSE 78th KS 14234W158th St. $500.00 10/01/2015 Olathe, KS 66062

Ed Trimmer for Kansas House , STATE HOUSE 78th KS 1402 East 9th 10/01/2015 $250.00 Winfield, KS 67156

Bridges for Kansas House Carolyn Bridges, STATE HOUSE 83rd KS 10(01/2015 5219 E. First St $250.00 Wichita, KS 67208

Jim Ward for Kansas State House Jim Ward, STATE HOUSE 86th KS 3100 E Clark 10/01/2015 $250.00 Wichita, KS 67211

Carmichael for Kansas John Carmichael, STATE HOUSE 92nd KS 10/01/2015 1475 North Lleunett $250.00 Wichita, KS 67203

Tom Sawyer for Kansas House Tom Sawyer, STATE HOUSE 95th KS 10/01/2015 1041 S. Elizabeth St $250.00 Wichita, 67213

$3,750.00

Page_13_ of~ . SCHEDULEC . EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Polttlcal Action Committee (Name of Party Committee or Political Committee)

Purpose ofExPenditure 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

Brandon Whipple for Kansas House Brandon Whipple, STATE HOUSE 96th KS 2925 S. Walnut $250.00 10/01/2015 . Wichita, KS 67217

Leslle Osterman for Kansas House , STATE HOUSE 97th KS 1401 West Dallas $250.00 10/01/2015 Wichita, KS 67217

Steven Becker for Kansas House , STATE HOUSE 104th KS PO Box384 $500.00 10/01/2015 Buhler, KS 67522

Mark E. Hutton for Kansas House , STATE HOUSE 105th KS 7118 W. Clearmeadow ct $500.00 10/01/2015 Wichita, KS 67205

Sharon Schwartz for Kansas House , STATE HOUSE 106th KS 2051 2oth Road $250.00 10/01/2015 Washington, KS 66968

Susan L. Concannon for Kansas House , STATE HOUSE 107th KS 921 North Mill 10/01/2015 $500.00 Beloit, KS 67420

Steven Johnson for Kansas House Steven Johnson, STATE HOUSE 10Bth KS 10/01/2015 10197 South Hopkins Road $500.00 Assaria, KS 67416

Troy L Waymasterfor Kansas House , STATE HOUSE 109th KS 112 N Fairview Ave 10/01/2015 $500.00 Luray, KS 67649

Sue Boldra for Kansas House Sue Boldra, STATE HOUSE 111th KS 10/01/2015 2405 General Custer $250.00 Hays, KS 67601

John Edmonds for Kansas House John Edmonds, STATE HOUSE 112lh KS 10/01/2015 1607Tyler $500.00 P.O. Box 1816 Great Bend, KS 67530

$4,000.00

Page~of~ SCHEDULEC EXPENDITURES AND OTHER DISBURsEMENTS

Kansas Hospital Association Political Action Committee (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

Jack Thimesch for Kansas House Jack Thlmesch, STATE HOUSE 114th KS 234 N Henderson $250.00 10/01/2015 Cunningham, KS 67035

Ronald Ryckman for Kansas House Ronald Ryckman, STATE HOUSE 115th KS P.O Box 192 $500.00 10/01/2015 Meade, KS 67864

Kyle Hoffman for Kansas House , STATE HOUSE 116th KS 1318 Avenue T $250.00 10/01/2015 Coldwater, KS 67029

John Ewy for Kansas House John Ewy, STATE HOUSE 117th KS 801 Roughton St. $500.00 10/01/2015 Jetmore, KS 67854

Don Hineman for Kansas House , STATE HOUSE 118th KS 116 S Longhorn Rd $500.00 10/01/2015 Dighton, KS 67839

Bud Estes for Kansas House Bud Estes, STATE HOUSE 119th KS 1405 Elbow Bend 10/01/2015 $500.00 Dodge City, KS 67801

Rick Billinger for Kansas House Rick Billinger, STATE HOUSE 121st KS 10/01/2015 310 Acacia Drive $500.00 Goodland, KS 67735

J. Russell Jennings for Kansas House J Jennings, STATE HOUSE 122nd KS 10/01/2015 515 Pleasntview $500.00 Lakin, KS 67830

Steve Alford for Kansas House J. Stephen Alford, STATE HOUSE 124th KS 10/01/2015 4179 East Road 19 $500.00 Ulysses, KS 67880

Shannon Francis for Kansas House , STATE HOUSE 125th KS 10/01/2015 1501 Tucker Court $500.00 Liberal, KS 67901

$4,500.00 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association PoliUcal Ac;tion Committee (Name of Party Committee or Political Committee)

Pur~ose 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

Marci Francisco for Kansas Senate Marci Francisco, STATE SENATE 2nd KS 1101 Ohio $250.00 10/01/2015 Lawrence, KS 66044

Tom Holland for Kansas Senate Tom Holland, STATE SENATE 3rd KS ...~ 961E1600 Rd $250.00 10/01/2015 Baldwin City, KS 66006

Pat Pettey for Kansas Senate Pat Pettey, STATE SENATE 6th KS 5316 lakewood St. $250.00 10/01/2015 Kansas City, KS 66106

Kay Wolf for Kansas Senate Kay Wolf, STATE SENATE 7th KS 7921 Bristol Court $250.00 10/01/2015 Prairie Village, KS 66208

Jim Denning for Kansas Senate Jim Denning, STATE SENATE 8th KS 8416 West 115thStreet $250.00 10/01/2015 Overland Park, KS 66210

Jacob laTurner for Kansas Senate Jacob laTurner , STATE SENATE 13th KS 204 E. Euclid St. 10/01/2015 $250.00 Pittsburg, KS 66762

Jeff King for Kansas Senate Jeff King, STATE SENATE 15th KS 10/01/2015 1212 North 2nd Street $300.00 Independence, KS 67301

Jeff Longbine for Kansas Senate Jeff Longbine, STATE SENATE 17th KS 10/01/2015 PO Box 1903 $500.00 Emporia, KS 66801

laura Kelly for Kansas Senate Laura Kelly, STATE SENATE 18th KS 10/01/2015 234 SW Greenwood $500.00 Topeka, KS 66606

Anthony Hensley for Kansas Senate Anthony Hensley, STATE SENATE 19th KS 10/01/2015 2226 SE Virginia $250.00 Topeka, KS 66605

$3,050.00

Page~ of___E._ SC.HEDULEC EXPENDITURES AND pTBER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)

Purpose of Ex~enditure 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

Vicki Schmidt for Kansas Senate Vicki Schmidt, STATE SENATE 20th KS 5906 SW 43rd Court $250.00 10101/2015 Topeka, KS 66610-1632

Tom Hawk fo-r Kansas Senate Tom Hawk, STATE SENATE 22nd KS 2600 Woodhaven Ct. $250.00 10/01/2015 Manhattan, KS 66502

Robert Olson for Kansas Senate Robert Olson, STATE SENATE 23rd KS 19050 West 161st Street $250,00 10/01/2015 Olathe, KS 66062

Michael O'Donnell for Kansas Senate Michael O'Donnell, STATE SENATE 25th KS 1435 W. Haskell $250.00 10/01/2015 Wichita, KS 67213

Mike Petersen for Kansas Senate Mike Petersen, STATE SENATE 26th KS 2608 Southeast Drive $500.00 10/01/2015 Wichita, KS 67216-2140

Oletha Faust-Goudeau for Kansas Senate Oletha Faust-Goudeau, STATE SENATE 29th KS 4158 Regents Lane 10/01/2015 $250.00 Wichita, KS 67208

Carolyn McGlnn for Kansas Senate Carolyn McGlnn, STATE SENATE 31st KS 10101/2015 11047 N 87W $500.00 SEDGWICK, KS 67135

Wilborn for Senate Richard Wilborn, STATE SENATE 35th KS 10/01/2015 1504 Heritage Place $500.00 McPherson, KS 67460

Dan Kerschen for Kansas Senate Dan Kerschen, STATE HOUSE 26th KS 10/02/2015 645 South 263 West $250.00 Garden Plain, KS 67050

Elaine S. Bowers for Kansas Senate Elaine Bowers, STATE SENATE 36\h KS 10/02/2015 1326 N 1501h Rd $250.00 Concordia, KS 66901

$3,250.00

Page~of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (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

Molly Baumgartner for Kansas Senate Molly Baumgartner, STATE SENATE 37th KS 29467 Masters Cl $500.00 10/0212015 Louisburg, KS 66053

Garrett Love for Kansas Senate Garrett Love, STATE SENATE 38th KS P.O. Box 1 10/02/2015 Montezuma, KS 67867 $250.00

Ralph Ostmeyer for Kansas Senate Ralph Ostmeyer, STATE SENATE 40th KS 602 S Jefferson $250.00 10/02/2015 PO Box97 Grlnell, KS 67738

CoreFirst Bank & Trust Bank Fee for Credit Card Services 3035 SW Topeka Blvd $45.00 10/02/2015 Topeka, KS 66611

Square Up Chet Johnson 10/8/15

10/06/2015 $1.38

Square Up Cindy Knoeppel 10/12/15 10/15/2015 $2.75

Square Up Dallas Polen 10i23/15 10/23/2015 $6.88

Square Up Marlon "Tony" Thompson 10/26/15 10/26/2015 $2.75

AHAPAC-Amerlcan Hospltal Association 10/26/2015 FEDERAL $575.00 800 10th Street, NW Two City Center, Suite 400

CoreFirst Bank & Trust Bank Fee for Credit Card Services 11/02/2015 3035 SW Topeka Blvd Topeka, KS 66611 $45.04

$1 ,678.80

Page~of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (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

Square Up Carrie Sala 11/16/15 $2.75 11/16/2015

Square Up Jon Jackson 11/17/15

$13.75 11/17/2015

Square Up Lee Norman 11/18/15

11/1 B/2015 $13.75

AHAPAC-Amerlcan Hospital Association FEDERAL $1,023.87 11/20/2015 BOO 1oth Street, NW Two City Center, Suite 400

Square Up Bob Page 11/20/15

11/20/2015 $27.50

Kansas Republican Senatorial Committee Plaza Lights Holiday Celebration PO Box2663 11/2412015 $1,000.00 Topeka, KS 66601

Square Up Dick Roberts 11/27/15 11/27/2015 $6.88

Square Up Steven Stites 11/30/15 11/30/2015 $13.75

Square Up Steve Granzow 11/30/15 11/30/2015 $5.50

Square Up Tammy Peterman 11/30/15 11/30/2015 $13.75

$2,121.50

Page~of~

_) SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)

Purpose of Exeenditure 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

Square Up Jane Burdo!skl 1,211/15 $2.75 12101/2015

Square Up Doug Spear 1211/15 $2.75 12101/2015

Square Up David Gregory 12/1/15 12101/2015 $1 .38

Square Up Larry Botts 1212115 12102/2015 $13.75

CoreFlrst Bank & Trust Bank Fee for Credit Card Service5 3035 SW Topeka Blvd $45.00 12/0212015 Topeka, KS 66611

Square Up Thomas Hinton 1213/15 12/03/2015 $5.50

Square Up Steven Edgar 1211 /15 12/04/2015 $9.63

Square Up Bill Marting 12/7/15 12/07/2015 $2.75

$83.51

· Page~of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political AcUon Committee (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 Square Up Benjamin Anderson 1217/15

12/07/2015 $2.75

Square Up Mark Brady 12/5/15

12/08/2015 $2.75

AHAPAC-American Hospital Association FEDERAL 12110/2015 800 1Oth Street, NW $2,932.58 Two City Center, Suite 400 Square Up Bill Marting 12/10/15

12110/2015 $11 .00

Square Up Kimberly King 12111/15

12111/2015 $2.75

Kansans for a Democratic Hous~ PO Box2083 12116/2015 Topeka, KS 66601 $500.00

Square Up Richard Bergling 12116/15

1211712015 $2.75

Square Up Thyra Strate 12121115

12/21/2015 $1 .38

$3,455.96

Complete if last page of Schedule c

Total Itemized Expenditures This Period $58,551.82

Total Unitemized Expenditures of$50 or less $91.13

$58,642.95

Page_21_ of~