KANSAS GOVERNMENTAL ETHICS COMMISSIO~ RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE January 10, 2010 FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS A. Name of Committee: KS Restaurant & Hospitality Association Political Action Committee Address: 3500 N Rock Rd, Bldg 1300 City and Zip Code: _W_i_c_h_ita_,_K_S_6_7_22_6 _ This is a (check one): __ Party Committee ~ Political Committee B. Check only if appropriate: __ Amended Filing __Termination Report C. Summary (covering the period from January 1,2009 through December 31, 2009) 1. Cash on hand at beginning of period . 4,441.93 2. Total Contributions and Other Receipts (Use Schedule A) . 52,465.85 3. Cash available this period (Add Lines 1 and 2) .. 56,907.78 4. Total Expenditures and Other Disbursements (Use Schedule C) . 53,965.05 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . 2,942.73 6. In-Kind Contributions (Use Schedule B) 7,150.00 7. Other Transactions (Use Schedule D) . 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 fa,/ document is a class A misdemeanor." 7 ,,//0' .~.,! :/ ,/ . ',.C( Date S'ignature of treasurer GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS KS Restaurant & Hospitality Association PAC (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 Cash Check Loan Other Other Receipt See Attached Schedule $52,465.85 $52,465.85 Subtotal This Page Page __ of__ KRHA Political Action Committee Schedule A Contributions & Other Receipts Date Name & Address Amount Various Kansas Restaurant & Hospitality Association 36,220.85 check 3500 N RockRd, Bldg 1300 Wichita, KS 67226 Various Bill Goodlatte 100.00 check 2959 N Rock Rd, Ste 5100 Wichita, KS 67226 8/21/2009 Gary Poulton 50.00 check PO Box 1652 Hutchinson, KS 67504 7/2i/2009 Retail Data Systems 350.00 check 106 Greyston Ave Wyandotte, KS 66103 7/21/2009 Best Western International 250.00 check 701 Fairway Larned, KS 67550 7/21/2009 LDF Food Group· 1,000.00 check 2959 N Rock Rd Ste 5100 Wichita, KS 67226 7/29/2009 Best Western Airport 250.00 check 6815 W Kellogg Wichita, KS 67209 7/10/2009 Hyatt Regency 500.00 check 400 W Waterman Wichita, KS 67202 7/29/2009 Monitor Liability 1,000.00 check 2850 West Golf Road, Ste 800, Rolling Meadows Chicago, IL 60008 7/31/2009 Earp Distribution 945.00 check 6550 Kansas Ave Kansas City, KS 66111 8/3/2009 Salvus TG 500.00 check 9664 Marion Ridge Kansas City, KS 64137 8/5/2009 House of Schwan 300.00 check 3636 N Comotara Wichita, KS 67226 8/7/2009 Side Pockets 500.00 check 600 S Tyler Rd Wichita, KS 67209 8/10/2009 ServPro 350.00 check 3255 S Oliver St Wichita, KS 67210 8/10/2009 Vagabond Motel 250.00 check 2524 Vine Street Hays, KS 67601 8/10/2009 In the Sauce Brands 500.00 check 101 N Ridge Rd Wichita, KS 67212 8/17/2009 Best Western Angus Inn 250.00 check 2920 10th Great Bend, KS 67530 8/17/2009 Go Wichita CVB 500.00 check 515 S Main Ste 115 Wichita, KS 67202 8/17/2009 Best Western Townsman Inn 250.00 check 123 E 14st St Lamed, KS 67550 8/17/2009 LDF Sales & Distributing 100.00 check 2959 N Rock Rd Ste 5100 Wichita, KS 67226 8/4/2009 Sysco Foods ofKC 500.00 check 1001 S Young Wichita, KS 67209 8/11/2009 Petra 350.00 check 447 N Walnut Wichita, KS 67203 8/14/2009 Darling International 2,150.00 check 685 Adams Kansas City, KS 66105 8/21/2009 Hospitality Insurance Services 350.00 check 3500 N Rock Rd, Bldg 1300 Wichita, KS 67226 8/25/2009 Distilled Spirits Council 750.00 check 1250 Eye NW Ste 400 Washington, DC 20005 3/20/2009 Heartland Payment Systems 800.00 check 9925 Blue Ridge Blvd Kansas City, MO 64134 3/11/2009 Secura 250.00 check PO Box 819 Appelton, WI 54912 3/13/2009 Payless Shoe Source 400.00 check 3231 SE 6th St Topeka, KS 66614 3/20/2009 TopekaCVB 250.00 check 1275 Southwest Topeka Boulevard Topeka, KS 66604 3/20/2009 US Foodservice 800.00 check 4725 NW US Hwy 24 Topeka, KS 66618 3/25/2009 Ben E. Keith 800.00 check 316 S Blackwelder Oklahoma City, OK 73148 3/30/2009 Logicomp 400.00 check PO Box 1480 Blue Springs, MO 64013 4/13/2009 Wheatfields 250.00 check 904 Vermont Lawrence, KS 66044 3/31/2009 Continental Western 250.00 check 11201 Douglas Avenue Urbandale, IA 50322 Total 52,465.85 SCHEDULE B IN-KIND CONTRIBUTIONS KS Restaurant & Hospitality Association PAC (Name of Party Committee or Political Committee) List Occupation & Value of Date Name and Address Industry for Those Giving Description of In-Kind In-Kind of Contributor an In-Kind of M ore Than Contribution Contribution $150 See Attached Schedule $7,150.00 $7,150.00 Subtotal This Page Complete if last page of Schedule B Total Itemized (over $100) In-Kind Contributions Total Unitemized ($100 or less) In-Kind Contributions TOTAL IN-KIND CONTRIBUTIONS THIS PERIOD (to line 6 of Summary) $0.00 Page __ of__ KRHA Political Action Committee Schedule B In-Kind Contributions Date Name & Address Contribution Amount 4/27/2009 McAlisters Deli Food & Beverage 2,000.00 2130 Silicon Ave Apt J-4 Lawrence, KS 66046 4/27/2009 O'Malley Beverage ofKS Food & Beverage 450.00 2050 Packer Court Lawrence, KS 66044 4/27/2009 Free State Brewing Company Food & Beverage 500.00 636 Massachusetts Lawrence, KS 66044 8/24/2009 Dr. Pepper Snapple Group Food & Beverage 100.00 244 Bent Tree Ct. Andover, KS 67002 8/24/2009 Ben E Keith Food & Beverage 100.00 2333 S West St Wichita, KS 67213 8/24/2009 Pepsi Food & Beverage 200.00 101 W 48th St South Wichita, KS 67217 8/24/2009 Hospitality Insurance Services, lJ Food & Beverage 800.00 3500 N Rock Rd, Bldg 1300 Wichita, KS 67226 8/24/2009 Sysco Foodservice ofK.C. Food & Beverage 200.00 1001 S Young Wichita, KS 67205 8/24/2009 Outback Steakhouse Food & Beverage 2,800.00 2020 N Rock Rd Wichita, KS 67206 Total 7,150.00 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS KS Restaurant & Hospitality Association PAC (Name ofParty Committee or Political Committee) Name and Address Purpose of Expenditure Amount Date To Whom Expenditure is Made See Attached Schedule $53,965.05 $53,965.05 Subtotal This Page Page __of__ KRHA Political Action Committee Schedule C Expenditures & Other Disbursements 12/31/2009 Name & Address Pumose of Expenditure Amount 12/9/2009 Dan Johnson for State Representative 2009 General Election Contribution 150.00 1461 Homestead Rd, Box 247 Hays, KS 67601 12/9/2009 Aaron Jack for State Representative 2009 General Election Contribution 150.00 1330 N Robin Court Andover, KS 67002 12/9/2009 Clay Aurand for State Representative 2009 General Election Contribution 200.00 213630 Road Courtland, KS 66939 12/9/2009 Pat Apple for State Senate 2009 General Election Contribution 250.00 Box 626 Louisburg, KS 66053 12/9/2009 Steve Abrams for State Senate 2009 General Election Contribution 250.00 4579 242nd Rd. Arkansas City, KS 67005 12/9/2009 Kasha Kelly for State Representative 2009 General Election Contribution 200.00 Box 1111 Valley View Arkansas City, KS 67005 12/9/2009 Mike Kiegerl for State Representative 2009 General Election Contribution 150.00 2350 Golf Course Road Olathe, KS 66061 12/9/2009 Lance Kinzer for State Representative 2009 General Election Contribution 200.00 12549 S Brougham Olathe, KS 66062 12/9/2009 Forrest Knox for State Representative 2009 General Election Contribution 150.00 17120 Udall Road Altoona, KS 66710-8560 12/9/2009 Kelly Kultala for State Senate 2009 General Election Contribution 200.00 12232 Hubbard Road Kansas City, KS 66109 12/9/2009 Jeff King for State Representative 2009 General Election Contribution 150.00 1212 N 2nd Street Independence, KS 67301 12/9/2009 Dan Kerschen for State Representative 2009 General Election Contribution 200.00 645 S. 263 W Garden Plain, KS 67050 12/9/2009 Marvin Kleeb for State Representative 2009 General Election Contribution 200.00 14206 Eby Overland Park, KS 66221 12/9/2009 Harold Lane for State Representative 2009 General Election Contribution 200.00 1308 S Kansas Ave Topeka, KS 66612 12/9/2009 Bill Light for State Representative 2009 General Election Contribution 200.00 504 Washington Box 287 Rolla, KS 67954 12/9/2009 Brenda Landwehr for State Representative 2009 General Election Contribution 250.00 2837 N Edwards Street Wichita, KS 67204 12/9/2009 Steve Lukert for State Representative 2009 General Election Contribution 200.00 2420 AcomRd Sabetha, KS 66534 12/9/2009 Julia Lynn for State Senate 2009 General Election Contribution 200.00 18837 W 115th Terrace Olathe, KS 66061-9379 12/9/2009 Joe McLeland for State Representative 2009 General Election Contribution 200.00 431 S Westfield Wichita, KS 67209 12/9/2009 Ray Merrick for State Representative 2009 General Election Contribution 250.00 6874 W 164th Terrace Stilwell, KS 66085 12/9/2009 Ann Mah for State Representative 2009 General Election Contribution 200.00 3351 SE Meadowview Drive Topeka, KS 66605 12/9/2009 Ty Masterson for State Senate 2009 General Election Contribution 250.00 1539 Phyllis Lane Box 424 Andover, KS 67002 12/9/2009 Melody McCray-Miller for State Representative 2009 General Election Contribution 200.00 P.