KANSAS GOVERNMENTAL ETHICS COMMISSION
RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMNIITTEE October 29,2012 FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS
A. Name of Committee: Kansas Hospital Association Political Action Committee
Address: 215 SE 8th Street
City and Zip Code: T_o_p_ek_a,_6_66_0_1 us _ This is a (check one): __Party Committee x Political Committee
B. Check only if appropriate: __ Amended Filing __ Termination Report
C. Summary (covering the period from July 27,2012 through October 25, 2012) $70,193.65 1. Cash on hand at beginning of period . 2. Total Contributions and Other Receipts (Use Schedule A) .. $33,315.68 3. Cash available this period (Add Lines I and 2) . $103,509.33 4. Total Expenditures and Other Disbursements (Use Schedule C) .. $43,089.62 5. Cash on hand at close of period (Subtract Line 4 from 3) .. $60,419.71 6. In-Kind Contributions (Use Schedule B) . $6,459.40 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."
'. Date Signature of Treasurer
GEe Form Rev, 2001 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
Kathleen Harr Dean & Professor $100.00 3732 SW Herefordshire Road 08/15/2012 Topeka, KS 66610-1541 .f
Curt Colson President and Chief Executive $100.00 508 N Maple St Officer 08/15/2012 Hoisington, KS 67544-2150 .f
Jane Schepmann CNO $100.00 300 W Santa Fe 08/15/2012 Holyrood, KS 67450-9657 .f
Dana Hale Vice President Nursing $100.00 670 N. 1505 Rd. 08/15/2012 Lawrence, KS 66049-9121 .f
Sheryle D'Amico VP $350.00 737 N. 1550 Rd. 08/15/2012 Lawrence, KS 66049-9198 .f
Karen Shumate Chief Operating Officer $100.00 1753 E 980 Rd 08/15/2012 Lawrence, KS 66049-9073 .f
Washington County Hospital Community Hospital $200.00 08/15/2012 304 E. 3rd Washington, KS 66968-2033 .f
Kenneth Stone Director of Corporate Compliance $150.00 08/21/2012 2543 SE Faxon Ct. and Finance Topeka, KS 66605-2086 .f
Karlene Lockard Director $100.00 08/21/2012 1114 SW Garfield Topeka, KS 66604-1312 .f
Kathleen Willis VP/CDO $150.00 08/21/2012 1071 E 1400 Rd Lawrence, KS 66046-9633 .f
Carolyn Bowmer Vice President, Human Resources $100.00 08/21/2012 17301 West 84th Terrace Lenexa, KS 66219-8046 .f
$1,550.00 Subtotal This Page
Page _1__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name ofParty 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
Kathy Howell Vice President & Chief Nursing $350.00 12867 Barton Officer 08/21/2012 Overland Park, KS 66213-4424 .f
Carla Yost Chief Operating Officer $200.00 1823 College Ave. 08/21/2012 POBox 1289 Manhattan, KS 66502-3381 .f
Eric Voth Physician $350.00 411 Woodbury Court 08/21/2012 Topeka, KS 66606-2192 .f
Gayle Arnett CEO $350.00 1819 Ridge Road 08/21/2012 EI Dorado, KS 67042-4033 .f
Eugene' Meyer President and Chief Executive $500.00 325 Maine Street Officer 08/21/2012 Lawrence, KS 66044-1360 .f
Edward Smink Director $100.00 526 Carnpusview St 08/21/2012 Garden City, KS 67846-8559 .f
Joseph Pedley VP/CFO $100.00 08/21/2012 5624 Villa Drive Lawrence, KS 66047-8300 .f
Ness County Hospital Community Hospital $200.00 08/21/2012 312 Custer Ness City, KS 67560-1654 .f
Lane County Hospital Community Hospital $200.00 08/21/2012 235 West Vine PO Box 969 .f Dighton, KS 67839-0969
Charles Grimwood Vice President $100.00 08/21/2012 115 Mt. Barbara Rd. Salina, KS 67401-3414 .f
David Moody Vice President, Human Resources $100.00 08/21/2012 ~10 Winn Road Isalina, KS 67401·3668 .f
$2,550.00 Subtotal This Page
Page _2__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name of Party Committee or Political ConU11ittee)
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
Melissa Atkins Chief Executive Officer $100.00 304 West Prout Street 08/21/2012 Hill City, KS 67642-1435 .;
LoJean Oleen Trustee $200.00 317 S KS. Hwy. 4 08/21/2012 .;
Janet Stanek Sr. Vice President $1,000.00 6755 SW Dancaster Road 08/21/2012 Topeka, KS 66610-1412 .;
Blaine Miller Administrator $100.00 2420 'G' Street 08/21/2012 Belleville, KS 66935-2400 .;
Kent Palmberg Senior Vice President and Chief $500,00 1500 SW Tenth Avenue Medical Officer 08/21/2012 Topeka, KS 66604-1301 .;
Tom Jernigan Veterinarian $200.00 925 T Avenue 08/21/2012 Council Grove, KS 66846-8777 .;
William Dickson Hospital Trustee $200,00 08/21/2012 610 Pondway Council Grove, KS 66846-1560 .;
Bonnie Thomas Trustee $200.00 08/21/2012 331 ABAve Council Grove, KS 66846-8334 .;
Robert Brazil Chief Operating Officer $100.00 08/21/2012 511 NE Tenth Street Abilene, KS 67410-2153 .;
Patricia Berns Hospital Employee $100.00 08/21/2012 2570 Hwy. 15 Abilene, KS 67410-6035 .;
Elgin Glanzer Chief Financial Officer $100.00 08/21/2012 ~11 NE Tenth Street Abilene, KS 67410-2153 .;
$2,800.00 Subtotal This Page
Page _3__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name ofParty 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
judy Wagner Vice President $100.00 912 Davis Drive 08/21/2012 Manhattan, KS 66502-8005 .f
Don Harmison Trustee $200.00 1081 Hwy 149 08/21/2012 White City, KS 66872-9413 .f
Lora Key Chief Executive Officer $200.00 POBox 229 08/21/2012 Sabetha, KS 66534-0229 .f
Tom Bell Executive Director of Public $100.00 1215 Columbine Lane Relations 08/21/2012 Salina. KS 67401-9108 .f
Vicky McGrath Director $100.00 211 W 11th 08/21/2012 Auburn, KS 66402-9477 .f
Richard Vaught Administrator $100.00 1300 East Fifth Street 08/21/2012 Winfield. KS 67156-2407 .f
Michael Kongs Director Financial Management $100.00 08/21/2012 7261 SW Fountaindale Topeka, KS 66614-4629 .f
Judy Corzine Administrative Director and Chief $400.00 08/21/2012 3621 SW Woodvalley Place Information Offi Topeka, KS 66614-3536 .f
John Hinnenkamp Department Manager $100.00 08/21/2012 3155 W. Crawford SI. Salina, KS 67401-9706 .f
Anthony Medical Center Community Hospital $200.00 08/21/2012 1101 E. Spring SI. Anthony. KS 67003-2122 .f
Sunflower Chapter HFMA Professional Association $500.00 08/30/2012 PO Box 2196 f/vichita. KS 67201-2196 .f
$2,100.00 Subtotal This Page
Page _4__ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name ofParty 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
Adele Ducharme CNO $250.00 2218 NW 81st Ct 08/30/2012 Kansas City, MO 64151-3700 .f
Derwood Whittington VP of HR $100.00 2220 Canterburry 08/30/2012 Hays, KS 67601-2370 .f
Bryce Young Chief Operating Officer $100.00 POBox 8100 08/30/2012 Hays, KS 67601-8100 .f
Terry Siek Chief Nursing Officer $100.00 300 W. 21st 08/30/2012 Hays, KS 67601·3004 .f
Ashland District Hospital KS Community Hospital $200.00 PO Box 188 08/30/2012 709 Oak Street Ashland, KS 67831-0188 .f
Dean Miller Trustee $200.00 08/30/2012 1925 S 2500 Rd Herington, KS 67449 .f
Ninnescah Valley Health Systems Community Hospital $200.00 08/30/2012 750 West D. Avenue Kingman, KS 67068-1266 .f
Victoria Hahn Administrator and Chief Executive $200.00 08/30/2012 211 East Earl Street Officer Leoti, KS 67861-9620 .f
Roger John President and Chief Executive $500.00 08/30/2012 POBox 366 Officer Phillipsburg, KS 67661-0366 .f
Logan County Hospital Community Hospital $100.00 08/30/2012 211 Cherry Oakley, KS 67748-1201 .f
~ohn Harris Partner $500.00 08/30/2012 1551 N. Waterfront Parkway, Suite 300 Wichita, KS 67206-4467 {
$2,450.00 Subtotal This Page
Page _5__ 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
Jon Jackson Sr. Vice President, Systems $350.00 8000 Tomahawk Road Intergration 08/30/2012 Prairie Village, KS 66208-4845 .f
Bob Page Chief Executive Officer $1,000.00 3901 Rainbow Boulevard 08/30/2012 Kansas City, KS 66160-0001 .f
Roger Masse Chief Executive Officer $120.00 410 Court Ave 08/30/2012 Ellsworth, KS 67439-0087 .f
Vallerie Gleason VP $100.00 3123 N. Lakeridge Ct. 08/30/2012 Wichita, KS 67205-1928 .f
Steven Kelly President and Chief Executive $350.00 POBox 325 Officer 08/30/2012 Newlon, KS 67114-0325 .f
KHHRA Hospital HR Professional $1,000.00 Association 08/30/2012 PO BOX 2308 Topeka, KS 66601-2308 .f
Kevan Trenkle Chief Executive Officer and Chief $150.00 09/21/2012 100 East College Drive Financial Office Colby, KS 67701-3799 .f
Marion Regier Chief Executive Officer $200.00 09/21/2012 701 South Main Street Hillsboro, KS 67063-1500 .f
KAHCE Kansas Assn of Health Care Professional organization $250.00 09/21/2012 Executives 215 SE 8th St Topeka, KS 66603-3906 .f
Scott Taylor President and Chief Executive $500.00 09/21/2012 401 East Spuce Street Officer Garden City, KS 67846-5679 .f
Karen Endicott-Coyan Regional Director Reimbursement $100.00 09/21/2012 401 Woodland Hills Boulevard Fort Scott, KS 66701-8797 .f
$4,120.00 Subtotal This Page
Page _6__ 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
Reta Baker President $280.00 401 Woodland Hills Boulevard 09/21/2012 Fort Scott, KS 66701-8797 .;
Patricia Edwards VP of Patient Care $100.00 957 Lost Hills Court 09/21/2012 Derby, KS 67037-9393 .;
Earl Schulte Medical Director $350.00 3901 Jupiter Hills Drive 09/21/2012 Hutchinson, KS 67502-8096 .;
Beth Worden Hospital Employee $100.00 2149 U.S. 56 09/21/2012 Galva, KS 67443 .;
Tammy Peterman COO $350.00 9714 W. 145th Terr. 09/21/2012 Overland Park, KS 66221-2543 .;
William Marting VP Finance $350.00 437 SE Youngston Lane 09/21/2012 Lees Summit, MO 64063-3449 .;
Lee Norman Chief Medical Officer $350.00 09/21/2012 210 W 5th St #205 .; Kansas City, MO 64105-1166
Shae Veach VP Regional Operations $100.00 09/21/2012 4107 Smoky Hill Drive Hays, KS 67601-4713 .;
Chris Hansen Senior Vice President Ambulatory $350.00 09/21/2012 5710 W 128th Street Services Overland Park, KS 66209-3681 .;
Dale Montgomery Vice President, Support Service $100.00 09/21/2012 1300 Schwaller Ave. Hays, KS 67601-2242 .;
Bill Overbey Chief Financial Officer and Chief $100.00 09/21/2012 ~ 107 Smoky Hill Drive Information Offi Hays, KS 67601-4713 .;
$2,530.00 Subtotal This Page
Page _7__ 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
John Jeter President and Chief Executive $350.00 POBox 8100 Officer 09/21/2012 Hays, KS 67601-8100 .f
Todd Tangeman HR Director $100.00 15798 NW 150th Street 09/21/2012 Newton, KS 67114-8077 .f
Jeff Barton Vice President $350.00 620 Autumn Glen Parkway 09/21/2012 Newton, KS 67114-9011 .f
Mary Sweet Administrator $200.00 721 West Kansas Avenue 09/21/2012 Greensburg, KS 67054-1633 .f
Robert Mullen Chief Executive Officer $100.00 POBox 828 09/21/2012 Lyons, KS 67554-0828 .f
Christine Niblock Chief Financial Officer $100.00 09/21/2012 POBox 167 Hoxie, KS 67740-0167 .f
Steven Granzow Chief Executive Officer $100.00 09/21/2012 POBox 167 Hoxie, KS 67740-0167 .f
KS Healthcare Environmental Services Professional Association $250.00 09/21/2012 Association PO BOX 3208 Topeka, KS 66601 .f
Ronald Baker CFO $100.00 09/21/2012 2491 Panther Creek Rd Concordia, MO 64020-6300 .f
Laura Stufferson Director of Nursing $100.00 09/21/2012 10205 Riviera Circle Hutchinson, KS 67502-8351 .f
erri Floyd Vice President of Finance $100.00 09/21/2012 1705 Hickory Ln Fort Scott, KS 66701-9017 I
$1,850.00 Subtotal This Page
Page _8__ 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
Nancy Killion Exec. Director $100.00 2928 Nancy PI 09/21/2012 Garden City, KS 67846-7399 .f
Lori Penner Hospital Trustee $100.00 2121 9th St 09/21/2012 Clay Center, KS 67432-1547 .f
Chad Austin Vice President, Government $115.38 6518 SW 26th Cou Ii Relations 09/21/2012 Topeka, KS 66614-4305 .f
Thomas Bell President and Chief Executive $115.38 215 Southeast 8th Avenue Officer 09/21/2012 Topeka, KS 66603-3906 .f
Melissa Hungerford Sr. Vice President $115.38 6448 SW Bayshore Dr 09/21/2012 Auburn, KS 66402-9324 .f
Fred Lucky Senior Vice President $1S3.84 14607 W 89 09/21/2012 Lenexa, KS 66215-2967 t/
Cindy Samuelson Vice President $57.72 09/21/2012 1107 NE 54th St Topeka, KS 66617-4505 .f
Mike Hambley Program Development Director $100.00 09/21/2012 926 17th Ave McPherson, KS 67460-7081 t/
Dave Robinson Trustee $300.00 09/21/2012 725 WCherry Chanute, KS 66720-1576 .f
Hugh Tappan CEO $1.000.00 09/21/2012 550 N. Hillside Wichita, KS 67214-4910 t/
Kansas Good Government Fund HCA State PAC to PAC transfer $2,400.00 09/21/2012 ~15SE8th opeka, KS 66603-3906 t/
$4.557.70 Subtotal This Page
Page _9__ of2 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
Michael Thomas Administrator $161.00 POBox 820 09/21/2012 Meade, KS 67864-0820 .f
Meade District Hospital Community Hospital $56.00 510 E Carthage 09/21/2012 Box 820 Meade, KS 67864-6401 .f
Douglas Hinkin Physician $100.00 1426 Sharingbrook Dr. 09/21/2012 Manhattan, KS 66503-7529 .f
Carol Gitto Director, Physician Clinical $100.00 3749 SW Stonybrook Drive Operations 09/28/2012 Topeka, KS 66610-1306 .f
Robert Erickson President, CEO $350.00 900 SW Robinson Ave 09/28/2012 Apt 1302 Topeka, KS 66606-2608 .f
Scott Wells CNO $200.00 Sherwood Hills Apts #165 09/28/2012 Topeka, KS 66606-1690 .f
Eric Barnaby Vice President Strategic & $200.00 09/28/2012 338 SW Woodlawn Ave Business Dev. Topeka, KS 66606-1245 .f
Paul Leavens Director ER Occ Health $100.00 09/28/2012 3402 SW Amarosa Cir Topeka, KS 66614-6502 .f
Paula Ellis Director $100.00 09/28/2012 300 Utah Hiawatha, KS 66434-2314 .f
Helen Williams Director $100.00 09/28/2012 2234 NW 78th Topeka, KS 66618, .f
~homas Macaronas CFO $100.00 10/08/2012 1701 West 6th Coffeyville, KS 67337-4021 .f
$1,567.00 Subtotal This Page
Page _1_0_ of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name ofParty 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 E funds Other Receipt
Jodi Schmidt President $250.00 1902 S. U.S. Hwy. 59P.O. Box 956 10108/2012 Parsons, KS 67357-0956 .f
Labette Health Community Hospital $253.00 P.O. Box 956 10108/2012 Parsons, KS 67357-0956 .f
Karen Endicott-Coyan Regional Director Reimbursement $100.00 401 Woodland Hills Boulevard 10108/2012 Fort Scott, KS 66701-8797 .f
Eric Ammons President and Chief Executive $250.00 POBox 388 Officer 10108/2012 Independence, KS 67301-0388 .f
Terry L. Pound CEO $100.00 420 S Pioneer 10108/2012 Lyons, KS 67554-2613 .f
Kansas Council of Health-System Allied $500.00 Pharmacists 10108/2012 800 SW Jackson Street Suite 1500 .f J~~B~~\z"'''' 000 I L- I LUU Chief Financial Officer $100.00 10108/2012 POBox 129 Quinter, KS 67752-0129 .f
Sharon Collins Asst Admin-H R Director $100.00 10108/2012 Box 275 Gorham, KS 67640-0275 .f
Ryan Stover Trustee $100.00 10108/2012 102 East Holme Norton, KS 67654-1406 .f
Richard Miller Administrator and Chief Executive $200.00 10108/2012 POBox 250 Officer Norton, KS 67654-0250 .f
Bruce Witt Director, Government Relations $100.00 10108/2012 3720 East Bayley Wichita, KS 67218-3002 .f
$2,053.00 Subtotal This Page
Page _1_1_ 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
Jeffrey Korsmo President and Chief Executive $350.00 201 West Center Street Officer 10108/2012 Rochester, MN 55902-3084 .;
Sherry Hausmann President $100.00 2734 N Wilderness St 10108/2012 Wichita, KS 67226-2124 .;
Michael Wegner CFO $150.00 1709 N. Rocky Creek Ct. 10108/2012 Wichita, KS 67230-1753 .;
Letitia Hollingsworth Director of Reimbursement $125.00 2635 SW Santa Fe Dr. 10108/2012 Topeka, KS 66614-4956 .;
Laurie Labarca Executive Vice President and $100.00 929 North St Francis Street Chief Operating Offic 10108/2012 Wichita, KS 67214-3821 .;
KS Health Info Mgmt Sys.Soc. KSHIMSS Allied Organization $350.00 10108/2012 .;
$1,175.00 Subtotal This Page
Page 12 of 13 -- -- SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name ofParty 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
Janeen McWilliams Vice President, Claims S2DD.DD 215 SE 8th Ave., P.O. Box 2308 10/16/2012 Topeka, KS 66601-2308 .f
Martin Ekrem Vice President, Outreach Services S25D.DD 9911 E 21st Sl. N #2103 10/16/2012 Wichita, KS 67206-3533 .f
Lincoln County Hospital Community Hospital S2DD.DD 624 N. Second Street 10/16/2012 Lincoln, KS 67455-1738 .f
Charles Johnston CEO S1DD.DD 326 N 12th 10/22/2012 Fredonia, KS 66736-1606 .f
Claudio Ferraro VP Planning S1DD.DD 6414 E. 15th Street 10/25/2012 Wichita, KS 67206-1112 .f
David Engel Chief Executive Officer $200.00 POBox 607 10/25/2012 Phillipsburg, KS 67661-0607 .f
Reta Baker President S5DD.DD 10/25/2012 401 Woodland Hills Boulevard Fort Scott, KS 66701-8797 .f
Shelley Boden Administrator and Chief Executive S100.00 10/25/2012 4612 188th Rd Officer Russell, KS 67665-8893 .f
$1,650.00 Subtotal This Page
Complete if last page of Schedule A
Total Itemized Receipts for Period $30,952.70
Total Unitemized Contributions ($50 or less) $2,362.98
Sale of Political Materials (Unitemized) $0.00
Total Contributions When Contributor Not Known $0.00
TOTAL RECEIPTS TillS PERIOD (to line 2 of Summary) $33,315.68
Page _1_3_ of~ SCHEDULEB IN-KIND CONTRIBUTIONS
Kansas Hospital Association Political Action 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 Travel Expenses - AHA PAC 08/07/2012 215 S.E. 8th Kansas Hospital Association Retreat $693.89 Topeka, KS 66603-3906
Kansas Hospital Association KHA Hospital Association Travel Expenses - AHA PAC 08/07/2012 215 S.E. 8th Kansas Hospital Association Retreat $592.16 Topeka, KS 66603-3906
Kansas Hospital Association KHA Postage 215 S.E. 8th 09/05/2012 $10.02 Topeka, KS 66603-3906
Kansas Hospital Association KHA Postage 215 S.E. 8th 09/10/2012 Topeka, KS 66603-3906 $108.12
Kansas Hospital Association KHA Hospital Association AHA-Vocus Annual SUbscription 215 S.E. 8th Kansas Hospital Association Fee 10/23/2012 Topeka, KS 66603-3906 $5,000.00
$6,404.19 Subtotal This Page
Complete if last page of Schedule B
Total Itemized (over $100) In-Kind Contributions $6,404.19
Total Unitemized ($100 or less) In-Kind Contributions $55.21
TOTAL IN-KIND CONTRIBUTIONS THIS PERIOD (to line 6 of Summary) $6,459.40
Page ~_ of_1__ SCHEDULE C 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 Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
AHAPAC-American Hospital Association KHA PAC to AHA PAC July 2012 Transfer FEDERAL $1,900.00 08/22/2012 325 Seventh Street, NW Suite 700
Marc Rhoades for Kansas House Marc Rhoades, STATE HOUSE 72nd KS 100 Duncan Terrace $150.00 08/28/2012 Newlon, KS 67114
AHAPAC-American Hospital Association August 2012 KHA PAC to AHA PAC Transfer FEDERAL $4,432.50 08/30/2012 325 Seventh Street, NW Suite 700
Bill Feuerborn for Kansas House Bill Feuerborn, STATE HOUSE 5th KS 1600 Park Road $250.00 08/31/2012 Garnett, KS 66032
Jene Vickrey for State House Jene Vickrey, STATE HOUSE 6th KS 502 S. Countryside $250.00 08/31/2012 Louisburg, KS 66053
Richard Proehl for Kansas House Richard Proehl, STATE HOUSE 7th KS 510 Pine Ridge Rd 08/31/2012 $250.00 Parsons, KS 67357
Jim Kelly for Kansas House Jim Kelly, STATE HOUSE 12th KS 309 S. 5th 08/31/2012 $250.00 Independence, KS 67301
Robert Montgomery for Kansas House Robert Montgomery, STATE HOUSE 15th KS 1300 E. Sleepy Hollow Drive 08/31/2012 $250.00 Olathe, KS 66062
Amanda Grosserode for Kansas House Amanda Grosserode, STATE HOUSE 16th KS 08/31/2012 12601 West 99thStreet $250.00 Lenexa, KS 66215
Brett Hildabrand for Kansas House Brett Hildabrand, STATE HOUSE 17th KS 08/3112012 7352 Royalty Way #108 $250.00 Merriam, KS 66203
$8,232.50 Subtotal This Page
Page_1_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 Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Barbara Bollier for Kansas House Barbara Bollier, STATE HOUSE 21st KS 6910 Overhill Road $250.00 08/31/2012 Mission Hills, KS 66208
Kelly Meigs for Kansas House Kelly Meigs, STATE HOUSE 23rd KS 7842 Rosehill Road $250.00 08/31/2012 Lenexa, ks 66216
Ray Merrick for Kansas House Ray Merrick, STATE HOUSE 27th KS 6874 West 164th Terr $500.00 08/31/2012 Stilwell, KS 66085
Lance Kinzer for Kansas House Lance Kinzer, STATE HOUSE 30th KS 12549 S Brougham $500.00 08/31/2012 Olathe, KS 66062
Tom Burroughs for Kansas House Tom Burroughs, STATE HOUSE 33rd KS 3131 So. 73rd Terr $250.00 08/31/2012 Kansas City, KS 66106
Kathy Wolfe Moore for Kansas House Kathy Moore, STATE HOUSE 36th KS 3209 N 131 st Street 08/31/2012 $500.00 Kansas City, KS 66109
Connie O'Brien for Kansas House Connie O'Brien, STATE HOUSE 42nd KS . 22123 211th St. 08/3112012 $250.00 Tonganoxie, KS 66086
Barbara W. Ballard for Kansas House Barbara W. Ballard, STATE HOUSE 44th KS 1532 Alvamar Drive 08/31/2012 $250.00 Lawrence, KS 66047
Paul Davis for Kansas House Paul Davis, STATE HOUSE 46th KS 08/3112012 1731 Indiana $250.00 Lawrence, ks 66044
Ramon Gonzalez for Kansas House Ramon Gonzalez, STATE HOUSE 47th KS 08/31/2012 PO Box 12 Perry, KS 66073 $250.00
Subtotal This Page $3,250.00
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 Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Marvin Kleeb for Kansas House Marvin Kleeb, STATE HOUSE 48th KS 14206 Eby $250.00 08/31/2012 Overland Park, KS 66221
Shanti Gandhi for Kansas House Shanti Gandhi, STATE HOUSE 52nd KS 5802 Clarion Lakes Way $250.00 08/31/2012 Topeka, KS 66610
Don Hill for Kansas House Don Hill, STATE HOUSE 60th KS 1720 Luther $250.00 08/31/2012 Emporia, KS 66801
Richard Carlson for Kansas House Richard Carlson, STATE HOUSE 61st KS 2681 0 Jeffrey Rd $250.00 08/31/2012 SI. Marys, KS 66536
Jerry Henry for Kansas House Gerald Henry, STATE HOUSE 63rd KS 3515 Neosho Road $250.00 08/31/2012 Cummings, KS 66016
Tom Phillips for Kansas House Tom Phillips, STATE HOUSE 67th KS 1530 Barrington Drive 08/31/2012 $250.00 Manhattan, KS 66503
Marc Rhoades for Kansas House Marc Rhoades, STATE HOUSE 72nd KS 08/31/2012 100 Duncan Terrace $350.00 Newlon, KS 67114
Clark Shultz for Kansas House Clark Shultz, STATE HOUSE 73rd KS 707 Wasington Circle 08/31/2012 $250.00 Lindsborg, KS 67456
Peggy Mast for Kansas House Peggy L. Mast, STATE HOUSE 76th KS 08/31/2012 765 Road 110 $250.00 Emporia, KS 66801
J. David Crum for Kansas House J. Crum, STATE HOUSE 77th KS 08/31/2012 2903 Lakeshore Dr. Augusta, KS 67010 $500.00
$2,850.00 Subtotal This Page
Page_3_of~ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)
Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Kasha Kelley for State House Kasha Kelley, STATE HOUSE 80th KS Box1111 $250.00 08/31/2012 Arkansas City, KS 67005
Steven Brunk for Kansas State House Steven Brunk, STATE HOUSE 85th KS 8119 E Champions Ct 08/31/2012 Wichita, KS 67226 $250.00
Steve Huebert for Kansas House Steve Huebert, STATE HOUSE 90th KS 619 North Birch $250.00 08/3112012 Valley Center, KS 67147
Gene Suellentrop for Kansas House Gene Suellentrop, STATE HOUSE 91st KS 6813 W. Northwind Circle $250.00 08/31/2012 Wichita, KS 67205
Brenda Landwehr for Kansas House Brenda Landwehr, STATE HOUSE 92nd KS 2837 N Edwards $500.00 08/31/2012 Wichita, KS 67203
Sharon Schwartz for Kansas House Sharon Schwartz, STATE HOUSE 106th KS 2051 20th Road 08/31/2012 $250.00 Washington, KS 66968
Susan L. Concannon for Kansas House Susan Concannon, STATE HOUSE 107th KS 921 North Mill 08/31/2012 $500.00 Beloit, KS 67420
Eber Phelps for Kansas House Eber E. Phelps, STATE HOUSE 111 th KS 3103 Olympic Lane 08/31/2012 $250.00 Hays, KS 67601
Ronald Ryckman for Kansas House Ronald Ryckman, STATE Hau SE 115th KS 08/31/2012 P.O Box 192 $250.00 Meade, KS 67864
Brian Weber for Kansas House Brian Weber, STATE HOUSE 119th KS 08/31/2012 PO Box 804 Dodge City, KS 67801 $250.00
Subtotal This Page $3,000.00
Page_4_of~ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)
Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Arlen Siegfreid for Kansas House Arlen Siegfreid, STATE HOUSE 121st KS 1403 W. Prairie Terrace $500.00 08/3112012 Olathe, ks 66061-6807
Steve Alford for Kansas House J. Stephen Alford, STATE HOUSE 124th KS 4179 East Road 19 08/31/2012 Ulysses, KS 67880 $250.00
Jerry D Lunn for Kansas House Jerry Lunn, STATE HOUSE 28th KS 14512 Horton St. $250.00 08/31/2012 Overland Park, KS 66223
Charles Macheers for Kansas House Charles Macheers, STATE HOUSE 39th KS 21704 W. 57th Terrace $250.00 09/04/2012 Shawnee, KS 66218
John Barker for Kansas House John Barker, STATE HOUSE 70th KS 103 Wassinger Ave $250.00 09/04/2012 Abilene, KS 67410
Daniel R. Hawkins for Kansas House Daniel Hawkins, STATE HOUSE 100lh KS 9406 Harvest Ln. 09/04/2012 $250.00 Wichita, KS 67212
Mark E. Hutton for Kansas House Mark Hutton, STATE HOUSE 105th KS 7118 Clearmeadow Ct. 09/04/2012 W. $250.00 Wichita, KS 67205
Troy L. Waymaster for Kansas House Troy Waymaster, STATE HOUSE 109th KS 112 N Fairview Ave 09/04/2012 $250.00 Luray, KS 67649
Jack Thimesch for Kansas House Jack Thimesch, STATE HOUSE 114th KS 09/04/2012 234 N Henderson $250.00 Cunningham, KS 67035
J. Russell Jennings for Kansas House J Jennings, STATE HOUSE 122nd KS 09/04/2012 515 Pleasntview $250.00 Lakin, KS 67830
Subtotal This Page $2,750.00
Page_5_of~ SCHEDULE C 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 Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
John Doll for Kansas House John Doll, STATE HOUSE 123rd KS 2927 Cliff Place $250.00 09/04/2012 Garden City, KS 67846
Reid Petty for Kansas House Reid Petty, STATE HOUSE 125th KS 818 N. Lincoln 09/04/2012 Liberal, KS 67901 $250.00
Stephanie Clayton for Kansas House Stephanie Clayton, STATE HOUSE 19th KS 9825 Woodson Dr. $250.00 09/04/2012 Overland Park, KS 66207
Blaine Finch for Kansas House Blaine Finch, STATE HOUSE 59th KS 5 SW Fairview Dr. $250.00 09/04/2012 Ottawa, KS 66067
Travis Couture-Lovelady for Kansas House Travis Couture-Lovelady, STATE HOUSE 110th KS 2680 Three Rd $250.00 09/04/2012 Palco, KS 67657
Marci Francisco for Kansas Senate Marci Francisco, STATE SENATE 2nd KS 1101 Ohio 09/04/2012 $250.00 Lawrence, KS 66044
Anthony Brown for Kansas Senate Anthony Brown, STATE SENATE 3rd KS 799 E. 2200 Rd. 09/04/2012 $250.00 Eudora, KS 66025
Kelly Kultala for State Senate Kelly Kultala, STATE SENATE 5th KS 12232 Hubbard Rd. 09/04/2012 $250.00 Kansas City, KS 66109
Kay Wolf for Kansas Senate Kay Wolf, STATE SENATE 7th KS 09/04/2012 8339 Roe $500.00 Prairie Village, KS 66207
Jim Denning for Kansas Senate Jim Denning, STATE SENATE 8th KS 09/04/2012 8416 West 115thStreet Overland Park, KS 66210 $500.00
Subtotal This Page $3,000.00
Page_6_of~ SCHEDULE C 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 Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Julia Lynn for Kansas Senate Julia Lynn, STATE SENATE 9th KS 18837W.115thTerrace $500.00 09/04/2012 Olathe, KS 66061
Mary Pilcher-Cook for Kansas Senate Mary Pilcher-Cook, STATE SENATE 10th KS 13910 West 58th Place 09/04/2012 Shawnee, KS 66216 $500.00
Caryn Tyson for Kansas Senate Caryn Tyson, STATE HOUSE 12th KS 19984 County Road 1077 $500.00 09/04/2012 Parker, KS 66072
Jacob LaTurner for Kansas Senate Jacob LaTurner, STATE SENATE 13th KS 204 E. Euclid SI. $500.00 09/04/2012 Pittsburg, KS 66762
Forrest Knox for Kansas Senate Forrest Knox, STATE HOUSE 13th KS 17120 Udall Road $500.00 09/04/2012 Altoona, KS 66710
Jeff King for Kansas Senate Jeff King, STATE SENATE 15th KS 1212 North 2nd Street 09/04/2012 $500.00 Independence, KS 67301
Ty Masterson for Kansas Senate Ty Masterson, STATE SENATE 16th KS 1539 Phyllis Lane 09/04/2012 $500.00 Andover, KS 67002
Jeff Longbine for Kansas Senate Jeff Longbine, STATE SENATE 17th KS PO Box 1903 09/04/2012 $250.00 Emporia, KS 66801
Anthony Hensley for Kansas Senate Anthony Hensley, STATE SENATE 19th KS 09/04/2012 2226 SE Virginia $250.00 Topeka, KS 66605
Vicki Schmidt for Kansas Senate Vicki Schmidt, STATE SENATE 20th KS 09/04/2012 5906 SW 43rd Court $500.00 Topeka, KS 66610-1632
Subtotal This Page $4,500.00
Page_7_of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)
Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Juanita Roy for Kansas Senate Juanita Roy, STATE SENATE 21st KS 20617 West 96th Street $500.00 09/04/2012 Lenexa, KS 66220
Greg Smith for Kansas Senate Greg Smith, STATE SENATE 21st KS 8605 Robinson $500.00 09/04/2012 Overland Park, KS 66212
Robert Olson for Kansas Senate Robert Olson, STATE SENATE 23rd KS 19050 West 161 st Street $500.00 09/04/2012 Olathe, KS 66062
Tom Arpke for Kansas Senate Tom Arpke, STATE SENATE 24th KS 512 West Iron Avenue $500.00 09/04/2012 Salina, KS 67401
Michael O'Donnell for Kansas Senate Michael O'Donnell, STATE SENATE 25th KS 1435 W. Haskell $500.00 09/04/2012 Wichita, KS 67213
Dan Kerschen for Kansas Senate Dan Kerschen, STATE HOUSE 26th KS 645 South 263 West 09/04/2012 $500.00 Garden Plain, KS 67050
Leslie D. Donovan for Kansas Senate Leslie Donovan, STATE SENATE 27th KS 314 N. Rainbow Lake 09/04/2012 $500.00 Wichita, KS 67235
Mike Petersen for Kansas Senate Mike Petersen, STATE SENATE 28th KS 2608 Southeast Drive 09/04/2012 $500.00 Wichita, KS 67216-2140
Susan Wagle for Kansas Senate Susan Wagle, STATE SENATE 30th KS 09/04/2012 4 N. Sagebursh $750.00 Wichita, KS 67230
Carolyn McGinn for Kansas Senate Carolyn McGinn, STATE SENATE 31st KS 09/04/2012 11047 N 87W SEDGWICK, KS 67135 $250.00
Subtotal This Page $5,000.00
Page_8_of~ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)
Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Steve Abrams for Kansas Senate Steve Abrams, STATE SENATE 32nd KS 6964 252nd Road $500.00 09/04/2012 Arkansas City, KS 67005
Mitch Holmes for Kansas Senate Mitch Holmes, STATE SENATE 33rd KS 211 SE 20th Ave $500.00 09/04/2012 St. John, KS 67576
Terry Bruce for Kansas Senate Terry Bruce, STATE SENATE 34th KS 401 East Sherman $500.00 09/04/2012 Hutchinson, KS 67501
Jay Emler for State Senate Jay Emler, STATE SENATE 35th KS 1457 Shawnee Rd $250.00 09/04/2012 Lindsborg, KS 67456
Elaine S. Bowers for Kansas Senate Elaine Bowers, STATE SENATE 36th KS 1326 N 150th Rd $500.00 09/04/2012 Concordia, KS 66901
Pat Apple for Kansas Senate Pat Apple, STATE SENATE 37th KS PO Box 626 09/04/2012 $500.00 LOUISBURG, KS 66053
Garrett Love for Kansas Senate Garrett Love, STATE SENATE 38th KS P.O. Box 1 09/04/2012 $500.00 Montezuma, KS 67867
Subtotal This Page $3,250.00
Page_9_of~ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action 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 Larry R. Powell for Kansas Senate Larry R. Powell, STATE SENATE 39th KS 9555 N. Dewey Rd. 09/04/2012 Kalvesta, KS 67835 $500.00
Ralph Ostmeyer for Kansas Senate Ralph Ostmeyer, STATE SENATE 118th KS 602 S Jefferson 09/04/2012 PO Box 97 $500.00 Grinell, KS 67738 AHAPAC-American Hospital Association KHA PAC to AHA PAC Transfer - September 2012 FEDERAL 10103/2012 325 Seventh Street, NW $3,728.12 Suite 700 Bob Reader for Kansas Senate Bob Reader, STATE SENATE 22nd KS 6560 N. 52nd SI. 10/12/2012 Manhattan, KS 66503 $500.00
Janet M. Mitchell for Kansas House Janet Mitchell, STATE HOUSE 56th KS 1921 SW Damon Court 10/24/2012 Topeka, KS 66611 $250.00
John Edmonds for Kansas House John Edmonds, STATE HOUSE 112th KS 1607 Tyler 10/24/2012 P.O. Box 1816 $250.00 Great Bend, KS 67530 Republican House Campaign Committee 2025 SW Gage Blvd 10/24/2012 Topeka, KS 66603 $1,000.00
Jeff Melcher for Kansas Senate Jeff Melcher, STATE SENATE 11th KS 11424 Canterbury Circle 10/24/2012 Leawood, KS 66211 $500.00
$7,228.12 Subtotal This Page
Complete if last page of Schedule c
Total Itemized Expenditures This Period $43,060.62
Total Unitemized Expenditures of $50 or less $29.00
TOTAL EXPENDITURES & OTHER DISBURSEMENTS $43,089.62 THIS PERIOD (to line 4 of Summary)
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