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It~~~~Rllt~~FILED -L KANSAS GOVERNMENTAL ETlIICS COMMISSION ~:~EJbl~A~fLE~~~~~~iT~~~~rllT~~FILED -l . JAN 10 2011 January 10,2011 I FILE WITH SECRETARY OF STAitECRETAFfLOFSTATEI SEE REVERSE SIDE FOR INSTRUCTIONS --.J A. Name ofComrnittee: Kansas State Farm Agents and Employees Political Action Committe Address: 825 S. Kansas Avenue, Suite 500 City and Zip Code: _T_o_p_e_k_a_,_6_66_1_2 _ This is a (check one): __ Party Committee '" Political Committee B. Check only if appropriate: __Amended Filing __ Tennination Report C. Summary (covering the period from October 22, 2010 through December 31,2010) 1. Cash on hand at beginning of period . 64,534.27 2. Total Contributions and Other Receipts (Use Schedule A) . 2,150.00 3. Cash available this period (Add Lines 1 and 2) : .. 66,684.27 4. Total Expenditures and Other Disbursements (Use Schedule C) .. 10,934.44 5. Cash on hand at close of period (Subtract Line 4 from 3) . 55,749.83 6. In-Kind Contributions (Use Schedule B) ......... 0.00 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 the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor." ~ 2)4/1 Date Signature of Treasurer GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas State Farm Agents and Employees Political Action C (N arne of Party Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Cbeck Loan Other Other Receipt Jim Garrison Insurance 10/25/10 2115 SW Fairlawn Plaza Dr Agent/Insurance $100.00 Topeka, KS 66602 Rael Hodgson Insurance 10/25/10 1710 E Madison, Ste. 100 Agent/Insurance $500.00 Derby; KS 67037 Harlan Parker Insurance 10/25/10 13095 S Murlen #180 Agent/Insurance $300.00 Olathe, KS 66062 Karl Kunz Insurance 11/12/10 655 S Sage Hill Trl Agent/Insurance $250.00 Garden City, KS 67846-8980 Vicki Burnett Insurance 11/12/10 411W6thAve Agent/Insurance $100.00 Emporia, KS 66801 Joseph Oldham Insurance 11/12/10 224 E Main St Agent/Insurance $100.00 Gardner, KS 66030 Tom Harris Insurance 11/12/10 2112 10th St, Box 1184 Agent/Insurance $100.00 Great Bend, KS 67530 Bonnie Buckman Insurance 11/12/10 208SMain Agent/Insurance $250.00 EI Dorado, KS 67042 Ryan Mohwinkle Insurance 11/19/10 5855 SW 29th St Agent/Insurance $50.00 .Topeka, KS 66614-2463 Michele Jacobs Insurance 11/19/10 420 A Lincoln Agent/Insurance $100.00 Wamego, KS 66547 Robert Carlson Insurance 11/30/10 2400 Iowa St, Ste. 2 Agent/I nsurance $100.00 Lawrence, KS 66046 ,....,....,....,.....",..,..,,....,....,.+-,-,....,....,....,....,....,....,....,....==,....,....,....,....,....,.....,,+,....,....= $1,950.00 Page L... of ~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas State Farm Agents and Employees Political Action C (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 Contrihutor Than $150 Loan or Cash Check Loan Other Other Receipt VOID Check #1843 12/31/10 Karin Brownlee for State Senate $200.00 Original Check Date: 10/6/2010 $200.00 Complete if last page of Schedule A Total Itemized Receipts for Period $2,150.00 Total Unitemized Contributions ($50 or less) $0.00 Sale of Political Materials (Uriitemized) $0.00 Total Contributions When Contributor Not Known $0.00 $2,150.00 Page 3> of '2::> SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas State Farm Agents and Employees Political Action Committee (Name ofParty Committee or Political Committee) Name and Address Purpose of Expenditure Amount Date To Whom Expenditure is Made INTRUST Bank Credit card processing fees 11/05/10 105 N Main $35.20 Wichita, KS 67201 Stan Frownfelter for State Rep political contribution 11/10/10 4527 Gibbs Road $250.00 Kansas City, KS661 06 Greg Smith for State Rep political contribution 11/10/10 8605 Robinson $250.00 Overland Park, KS 66212 Barbara Bollier for State Rep political contribution 11/10/10 6910 Overhill Road $250.00 Mission Hills, KS 66208 John Rubin for State Rep political contribution 11/10/10 13803 W. 53rd St. $250.00 Shawnee,KS 66216 Tom Burroughs for State Rep political contribution 11/10/10 3131 South 73rd Terr. $250.00 Kansas City, KS 66106 Kelly Kultala for State Senate political contribution 11/10/10 12232 Hubbard Rd. $250.00 Kansas City, KS 66109 Jana Goodman for State Rep political contribution 11/10/10 410 S. Broadway $250.00 Leavenworth, KS 66048 Marci Francisco for State Senate political contribution 11/10/10 1101 Ohio $250.00 Lawrence, KS 66044 Terri Lois Gregory for State Rep political contribution 11/10/10 324 Dearborn $250.00 Baldwin City, KS 66006 David Haley for State Rep political contribution 11/10/10 936 Cleveland Ave. $250.00 Kansas City, KS 66101 $2,535.20 Page~6f b SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas State Farm Agents and Employees Political Action Committee (Name ofParty Committee or Political Committee) Name and Address Purpose of Expenditure Amount Date To Whom Expenditure is Made Gaches Braden and Associates management fee, postage, printing, and long distance 11/10/10 825 S Kansas Avenue, Ste 500 $458.01 Topeka, KS 66612 Clark Shultz for State Rep political contribution 11/17/10 707 Washington Cir. $250.00 Lindsborg, KS 67456 Don Schroeder for State Rep political contribution 11/17/10 708CharlesSt. $250.00 Hesston, KS 67062 Vern Swanson for State Rep political contribution 11/17/10 14225th $250.00 Clay Center, KS 67432 Jim Fawcett for State Rep political contribution 11/17/10 711 Crestview Drive $250.00 Junction City, KS 66441 Roger Reitz for State Senate political contribution 11/23/10 1332 Sharingbrook $250.00 Manhattan, KS 66503 Stephen Morris for State Senate political contribution 11/23/10 600 Trindle Street $250.00 Hugoton, KS 67951 Jerry Henry for State Rep political contribution 11/23/10 3515 Neosho Road $250.00 Cummings, KS 66016 Virgil Peck for State Rep political contribution 11/23/10 Box277 $250.00 Tyro, KS 67364 Randy Garber for State Rep political contribution 11/23/10 1317 Lakeview Dr $250.00 Sabetha, KS 66534 William Prescott for State Rep political contribution 11/23/10 5928 W. 216th $250.00 Osage City, KS 66523 $2,958.01 Page~of-h SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas State Farm Agents and Employees Political Action Committee (Name ofParty Committee or Political Committee) Name and Address Purpose of Expenditure Amount Date To Whom Expenditure is Made Richard Carlson for State Rep political contribution 11/23/10 26810 Jeffrey Rd $250.00 St. Marys, KS 66536 Sharon Schwartz for State Rep political contribution 11/23/10 2051 20thRoad $250.00 Washington, KS 66968 Sydney Carlin for State Rep political contribution 11/23/10 1650 Sunny Slope Lane $250.00 Manhattan,KS 66502 Mike Burgess for State Rep political contribution 11/23/10 6009 SW 23rd St $250.00 Topeka, KS 66614 Annie Tietze for State Rep political contribution 11/23/10 329 SW Yorkshire Rd $250.00 Topeka, KS 66606 Rocky Fund for State Rep political contribution 11/23/10 13161SRoad $250.00 Hoyt, KS 66440 Ann Mah for State Rep political contribu~on 11/23/10 3351 SE Meadowview Dr $250.00 Topeka, KS 66605 Bob Bethell for State Rep political contribution 12/06/10 104 E Third $250.00 Alden, KS 67512 Jan Pauls for State Rep political contribution 12/06/10 1634 N. Baker $250.00 Hutchinson, KS 67501 Leslie Osterman for State Rep political contribution 12/06/10 1401 W Dallas $250.00 Wichita, KS 67217 Joseph Scapa for State Rep political contribution 12/06/10 2209 S White Cliff $250.00 Wichita, KS 67207 ~~~ $2,750.00 Page ----1:L of.-l::L SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas State Farm Agents and Employees Political Action Committee (Name of Party Committee or Political Committee) Name and Address Purpose of Expenditure Amount Date To Whom Expenditure is Made Joe Seiwert for State Rep political contribution 12/06/10 1111 E Boundary Rd $250.00 Pretty Prairie, KS 67570 Steve Johnson for State Rep political contribution 12/06/10 10197S. Hopkins Rd. $250.00 Assaria, KS 67416 Kyle Hoffman for State Rep political contribution 12/06/10 1318 Avenue T $250.00 Coldwater, KS 67029 Geraldine Flaharty for State Rep. political contribution 12/06/10 .1816 E. Fernwood $250.00 Wichita, KS 67216 Jo Ann Pottorff for State Rep political contribution 12/06/10 6321 E. 8th $250.00 Wichita, KS 67208 Steve Brunk for State Rep political contribution 12/06/10 4430 Janesville $250.00 Bel Aire, KS 67220 Jim Ward for State Rep political contribution 12/06/10 3100 E. Clark $250.00 Wichita, KS 67211 Steve Bennett reimbursementfor legislative breakfast 12/09/10 P.O. Box 1125 $370.04 Salina, KS 67402-1125 Gaches Braden and Associates management fee, postage and printing 12/09/10 825 S Kansas Avenue, Ste 500 $560.84 Topeka, KS 66612 $2,680.88 Page ~ of-.fL SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas State Farm Agents and Employees Political Action Committee (Name ofParty Committee or Political Committee) Name and Address Purpose of Expenditure Amount To Whom Expenditure is Made Date $0.00 Complete if last page of Schedule C Total Itemized Expenditures This Period $10,924.09 Total Unitemized Expenditures of$50 or less $10.35 $10,934.44 Page '0 of~ .
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