SE~~~T~R~~~Asct~TE SEE REVERSE SIDE for INSTRUCTIO}.J~

KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIPTS AND EXPENDITURES REPORT FILED OF A POLITICAL OR PARTY COMMITTI E October 29,2012 OCT 30 2012 FILE WITH SECRETARY OF STATE SE~~~T~R~~~AscT~TE SEE REVERSE SIDE FOR INSTRUCTIO}.j~ A. Name ofCommittee: Heartland Community Bankers Association· PAC Address: 700 S Kansas Ave, Suite 607 City and Zip Code: Topeka, KS 66603 This is a (check one): __ Party Committee .f Political Committee B. Check only ifappropriate: __Amended Filing __ Termination Report C. Summary (covering the period from July 27, 2012 through October 25,2012) 1. Cash on hand at beginning ofperiod . 8211.35 2. Total Contributions and Other Receipts (Use Schedule A) .. 850.00 3. Cash available this period (Add Lines 1 and 2) . 9061.35 4. Total Expenditures and Other Disbursements (Use Schedule C) .. 8000.00 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . 1061.35 6. In-Kind Contributions (Use Schedule B) .. 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 ofmy 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." ~- ~~ 10/29/2012 ........ .& ~ Date GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Heartland Community Bankers Association - PAC (Name of Party Committee or Political Committee) Occupation & Industry of Check Name and Address Individual Giving More Appropriate Box Date of Contributor Than $150 Cash Cheek Loan E funds Other Rich Merker 08/07/12 11302 W 132 Ct $100.00 Overland Park, KS 66213 $100.00 Complete if last page of Schedule A Total Itemized Receipts for Period $100.00 Total Unitemized Contributions ($50 or less) $750.00 Sale ofPolitical Materials (Unitemized) Total Contributions When Contributor Not Known $850.00 page_J_of~ Schedule C EXPENDITURES AND OTHER DISBURSEMENTS Heartland Community Bankers Association - PAC (Name of Party Committee or Political Committee) Name and Address Purpose of Expenditure Amount Date To Whom Expenditure is Made If independent or in-kind expenditure in excess of $300 is is made for a candidate, list candidate name & adress Susan Wagle 10/4/2012 4 N. Sagebrush St. Campaign contribution $250.00 Wichita, KS 67230 Terry Bruce 10/4/2012 5301 N, Centennial Rd Campaign contribution $250.00 Nickerson, KS 67561 Jeff King 10/4/2012 1212 N. Second St. Campaign contribution $250.00 Independence, KS 67301 Rob Olson s1 10/4/2012 19050 W. 161 St. Campaign contribution $250.00 Olathe, KS 66062 Les Donovan, Sr. 10/4/2012 314 N. Rainbow Lake Campaign contribution $250.00 Wichita, KS 67235 Elaine Bowers lh 10/4/2012 1326 N. 150 Rd Campaign contribution $250.00 Concordia, KS 66901 Jeff Longbine 10/4/2012 2801 Lakeridge Road Campaign contribution $250.00 Emporia, KS 66801 Steve Abrams M 10/4/2012 4579 242 Road Campaign contribution $250.00 Arkansas City, KS 67005 Ty Masterson 10/4/2012 1539 Phyllis Lane Campaign contribution $250.00 Andover, KS 67002 Laura Kelly 10/4/2012 234 SW Greenwood Ave. Campaign contribution $250.00 Topeka, KS 66606 Vicki Schmidt rd 10/4/2012 5906 SW 43 Ct Campaign contribution $250.00 Topeka, KS 66610 $2,750.00 Page " of2t: Schedule C EXPENDITURES AND OTHER DISBURSEMENTS Heartland Community Bankers Association - PAC (Name of Party Committee or Political Committee) Amount of Name and Address Purpose of Expenditure Cash, Check, Date To Whom Expenditure is Made If independent or in-kind expenditure In excess of $300 is Loan, or is made for a candidate, list candidate name & adress Other Receipt Arlen Siegfreid 10/4/2012 1403 W. Prairie Terrace Campaign contribution $250.00 Olathe, KS 66061 Jene Vickrey 10/4/2012 502 S. Countryside Drive Campaign contribution $250.00 Louisburg, KS 66053 Marc Rhoades 10/4/2012 1006 Lazy Creek Drive Campaign contribution $250.00 Newton, KS 67114 Steve Brunk 10/4/2012 8119 Champions Court Campaign contribution $250.00 Wichita, KS 67226 Ray Merrick th 10/4/2012 6874 W. 164 Terrace Campaign contribution $250.00 Stilwell, KS 66085 Richard Proehl 10/4/2012 510 Pine Ridge Road Campaign contribution $250.00 Parsons, KS 67357 Bob Grant 10/4/2012 202 S. Appleton Campaign contribution $250.00 Frontenac, KS 66763 Tom Burroughs rd 10/4/2012 3131 S. 73 Terrace Campaign contribution $250.00 Kansas City, KS 66106 Richard Carlson 10/4/2012 26810 Jeffrey Road Campaign contribution $250.00 S1. Marys, KS 66536 Clark Shultz 10/4/2012 515 N. Ash #9 Campaign contribution $200.00 McPherson, KS 67460 Phil Hermanson 10/4/2012 5338 S. Mosley Campaign contribution $200.00 Wichita, KS 67216 $2,650.00 page20f Y Schedule C EXPENDITURES AND OTHER DISBURSEMENTS Heartland Community Bankers Association - PAC (Name of Party Committee or Political Committee) Amount of Name and Address Purpose of Expenditure Cash, Check, Date To Whom Expenditure is Made If independent or in-kind expenditure in excess of $300 is Loan, or is made for a candidate, list candidate name & adress Other Receipt Steven Johnson 10/4/2012 10197 S. Hopkins Rd Campaign contribution $200.00 Assaria, KS 67416 Bob Montgomery 10/4/2012 107 W. Cedar Campaign contribution $200.00 Olathe, KS 66061 Paul Davis 10/4/2012 1731 Indiana Campaign contribution $200.00 Lawrence, KS 66044 Annie Kuether 10/4/2012 1346 SW Wayne Ave. Campaign contribution $200.00 Topeka, KS 66604 Bill Feuerborn 10/4/2012 1600 Park Rd Campaign contribution $200.00 Garnett, KS 66032 Mark Kahrs 10/4/2012 PO Box 781547 Campaign contribution $200.00 Wichita, KS 67278 Virgil Peck 10/4/2012 Box 277 Campaign contribution $200.00 Tyro, KS 67364 Lance Kinzer 10/4/2012 12549 S. Brougham Campaign contribution $200.00 Olathe, KS 66062 Senate Majority Fund 10/4/2012 PO Box 181771 Campaign contribution $500.00 Denver, CO 80218 Colorado Leadership Fund 10/4/2012 PO Box 238 Campaign contribution $500.00 Denver, CO 80201 $2,600.00 Complete if last page of Schedule C Total Itemized Expenditures This Period $8,000.00 Total Unitemized Expenditures of $50 or less $8,000.00 Page !Lof=::L .

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