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KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE October 29, 2012 FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS A. Name of Committee: Kansas Health Care Association Address: 117 SW 6th Ave., Suite 200 City and Zip Code: _T_o_p_e_k_a_6_6_6_0_3 _ This is a (check one): __ Party Committee .; Political Committee B. Check only if appropriate: L Amended Filing __ Tennination Report C. Summary (covering the period from July 27, 2012 through October 25, 2012) 1. Cash on hand at beginning of period . 64777.39 2. Total Contributions and Other Receipts (Use Schedule A) .. 1400.00 3. Cash available this period (Add Lines 1 and 2) .. 66177.39 4. Total Expenditures and Other Disbursements (Use Schedule C) .. 42400.00 5. Cash on hand at close of period (Subtract Line 4 from 3) .. 23777.39 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 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." '/f 11/19/12 ~~--'---':....:....---=;:';---~,.L----=--'---=-----;;.;--.~I _ Date Signature of Tr asurer (.-// GEe Form Rev, 2001 SCHEDVLEA I CONTRIBUTIONS AND OTHER RECEIPTS _)~rV\A<r1 s ll:ecd ±h G-x R A-sSOC( cAl (~ (Name ofParty Committee or Politic'al Committee) ­ Occupation & Industry of Check Amount of Narne and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Other Cash Check Loan E funds Other Receipt Carolyn McGinn legislator 10/11/12 .( $500.00 Pat Apple Legislator 10/11/12 .( $200.00 Don Hill legislator 09/25/12 $200.00 ~ Jay Emler legislator 10/05/12 .( $250.00 Ruth Teichman Legislator 10/08/12 .( $250.00 $1,400.00 Subtotal This Page Page __of__ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Kansas Health Care Association (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 Ron Ryckman Campaign contribution 08/14/12 P.O. Box 192 $200.00 Meade, KS 67864 John Alcala for House Campaign contribution 08/16/12 520 NE Lake $100.00 Topeka, KS 66616 J. Stephen Alford for House Campaign contribution 08/31/12 4179 E. Road 19 $200.00 Ulysses, KS 67880 Larry Campbell for House Campaign contribution 08/31/12 15803 S Avalon $200.00 Olathe, KS 66062 Jo~n Barker for House Campaign contribution 08/31/12 108 Wassinger Ave. $200.00 Abilene, KS 67410 Steven Becker for House Campaign contribution 08/31/12 P.O. Box 384 $200.00 Buhler, KS 67522 Edwin Bideau III for House Campaign contribution 08/31/12 14 S. Rutter $200.00 Chanute, KS 66720 Sue Boldra for House Campaign contribution 08/31/12 2405 General Custer $200.00 Hays, KS 67601 Sydney Carlin for House Campaign contribution 08/31/12 1650 Sunny Slope Lane $200.00 Manhattan, KS 66502 Ward Cassidy for House Campaign contribution 08/31/12 P.O. Box 303 $200.00 St. Francis, KS 67756 Marshall Christmann for House Campaign contribution 08/31/12 816 South Grand $200.00 Lyons, KS 67554 $2,100.00 Subtotal This Page Page~_of__ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Kansas Health Care Association (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 J.R. Claeys for House Campaign contribution 08/31/12 P.O. Box 501 $200.00 Salina, KS 67402 Stephanie Clayton for House Campaign contribution 08/31/12 9825 Woddson Drive $200.00 Overland Park, KS 66207 Susan Concannon for House Campaign contribution 08/31/12 921 N. Mill $200.00 Beloit, KS 67420 Travis Couture for House Campaign contribution 08/31/12 2680 Three Road $200.00 Palco, KS 67657 Pete DeGraaf for House Campaign contribution 08/31/12 1545 E. 119th $200.00 Mulvane, KS 67110 Diana Dierks for House Campaign contribution 08/31/12 1221 Sunrise $150.00 Salina, KS 67401 John Doll for House Campaign contribution 08/31/12 2927 Cliff Place $200.00 Garden City, KS 67846 John Edmonds for House Campaign contribution 08/31/12 P.O. Box 1805 $200.00 Great Bend, KS 67530 George Edwards III Campaign contribution 08/31/12 256 Van Arsdale $200.00 Haysville, KS 67060 Keith Esau for House Campaign contribution 08/31/12 11702 S Winchester St. $150.00 Olathe, KS 66061 John Ewy for House Campaign contribution 08/31/12 727 Roughton St. $150.00 Jetmore, KS 67854 $2,050.00 Subtotal This Page Page __of__ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Kansas Health Care Association (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 Blaine Finch for House Campaign contribution 08/31/12 101 West 2nd $150.00 Ottawa, KS 66067 Gail Finney for House Campaign contribution 08/31/12 1754 N Madison $200.00 Wichita, KS 67214 Stan Frownfelter for House Campaign contribution 08/31/12 5225 Crest Drive $200.00 Kansas City, KS 66106 Kathy Wolfe Moore for House Campaign contribution 08/31/12 3209 N. 131st St. $250.00 Kansas City, KS 66109 Larry Alley for House Campaign contribution 09/06/12 517 Quail Nest Rd. $100.00 Winfield, KS 67156 Barbara Ballard for House Campaign contribution 09/06/12 1532 Alvamar Dr. $250.00 Lawrence, KS 66047 Barbara Bollier for House Campaign contribution 09/06/12 6910 Overhill Rd. $250.00 Mission Hills, KS 66208 Rob Bruchman for House Campaign contribution 09/06/12 5016 W. 108th Terr. #522 $250.00 Overland Park, KS 66211 Steve Brunk for House Campaign contribution 09/06/12 8119 Champions Court $250.00 Wichita, KS 67226 Mike Burgess for House Campaign contribution 09/06/12 6009 SW 23rd St. $200.00 Topeka, KS 66614 Will Carpenter for House Campaign contribution 09/06/12 6965 SW 18th St. $200.00 EI Dorado, KS 67042 $2,300.00 Subtotal This Page Page __of__ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas Health Care Association (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 J. David Crum for House Campaign contribution 09/06/12 2903 Lake Shore Dr. $250.00 Augusta, KS 67010 Paul Davis for House Campaign contribution 09/06/12 1731 Indiana $500.00 Lawrence, KS 66044 Bill Feuerborn for House Campaign contribution 09/06/12 1600 Park Road $500.00 Garnett, KS 66032 Mario Goico for House Campaign contribution 09/06/12 1254 North Pine Grove Court $250.00 Wichita, KS 67212 Ramon Gonzalez Jr. for House Campaign contribution 09/06/12 P.O. Box 12 $250.00 Perry, KS 66073 Bob Grant for House Campaign contribution 09/06/12 202 S. Appleton $250.00 Frontenac, KS 66763 Jerry Henry for House Campaign contribution 09/06/12 3515 Neosho Rd. $250.00 Cummings, KS 66016 Don Hineman for House Campaign contribution 09/06/12 116 S Longhorn Rd. $250.00 Dighton, KS 67839 Kyle Hoffman for House Campaign contribution 09/06/12 1318 Avenue T $200.00 Coldwater, KS 67029 Roderick Houston for House Campaign contribution 09/06/12 4902 Looman St. $100.00 Wichita, KS 67220 Michelle Hucke for House Campaign contribution 09/06/12 1914 S. Locust $200.00 Pittsburg, KS 66762 $3,000.00 Subtotal This Page Page __of__ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Kansas Health Care Association (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 Mark Hutton for House Campaign contribution 09/06/12 7118 W. Clearmeadow Ct. $200.00 Wichita, KS 67205 Mark Kahrs for House Campaign contribution 09/06/12 P.O. Box 781547 $250.00 Wichita, KS 67278 Kasha Kelley for House Campaign contribution 09/06/12 P.O.Box1111 $250.00 Arkansas, KS 67005 Jim Kelly for House Campaign contribution 09/06/12 309 S 5th $250.00 Independence, KS 67301 Lance Kinzer for House Campaign contribution 09/06/12 12549 S. Brougham $250.00 Olathe, KS 66062 Marvin Kleeb for House Campaign contribution 09/06/12 14206 Eby $250.00 Overland Park, KS 66221 Annie Kuether for House Campaign contribution 09/06/12 1346 SW Wayne $250.00 Topeka, KS 66604 Brenda Landwehr for House Campaign contribution 09/06/12 2837 N. Edwards St. $250.00 Wichita, KS 67204 Ann Mah for House Campaign contribution 09/06/12 3351 SE Meadowview Dr. $250.00 Topeka, KS 66605 Peggy Mast for House Campaign contribution 09/06/12 765 Road 110 $250.00 Emporia, KS 66801 Dennis McKinney for House Campaign contribution 09/06/12 1220 S. Main $200.00 Greensburg, KS 67054 $2,650.00 Subtotal This Page Page~_of__ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Kansas Health Care Association (Name of Party Committee or Political Committee) Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made If independent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address Amanda Grosserode for House Campaign contribution 08/31/12 12601 W.

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