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
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