SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee)
Check Amount of Date Name and Address Occupation of Individual Appropriate Box Cash, Check, of Contributor Giving more Than $150 Loan or Check -1 -1 Other Receipt Kansans for a Democratic House KS 10/3112006 Void - Kansans for a C Demouatic - House-Dennis 1 John Peterson 2841 SW Plass Avenue 110312006 Topeka, KS 66611-1629 Consultant IJ
I I Sunflower Cha~terHFMA I PO Box 2196 1/03/2006 Wichita, KS 67201-2196 ( I~etitia Hollingsworth 901 N High Drive I 1103'2006 IMcPherson, KS 67460-2908 I 1 ~ichardMiller P 0 Box 250 1/03/2006 Norton, KS 67654-0250 Administrator and Chief Executive Officer
Ottawa County Health Center I 1I10612006 I~~~d~,"90 I IMinneapolis. KS 67467-1907 Paul Lavender 11/06/2006 12938 SW 57th Street VFO Andover, KS 67002-8454
Steven Kelly 11/06/2006 316 Morningside Lane President and Chief Executive Newton, KS 671 14-1347 Officer
Vallerie Gleason 11/06/2006 3123 N. Lakeridge Ct. Wichita, KS 67205-1928
Jeff Barton 11/06/2006 620 Autumn Glen Parkway Vice President Newton, KS 671 14-9011
Subtotal This Page
Page -1 of 7 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee)
Check Amount of Date Name and Address Occupation of Individual Appropriate Box Cash, Check, of Contributor Giving More Than $150 - Loan or Cash Check Other Receipt
------Holbrook & Osborn. PA 7400 West 110th Street, Suite 600 Overland Park. KS 66210-2360 0
Kevin Conlin 1015 N. Linden Circle Wichita. KS 67206-4075 President and Chief Executive Officer
Ieborah Stern 3010 Clark Court Vice President ropeka, KS 66604-2660
Jennifer Findley 341 5 SW Glendale Drive Director of Education ropeka, KS 66614-4590
rene Cumming 3901 Rainbow Boulevard - -- )avid Haneke 1003 North Main Street ioisington, KS 67544-1745 Administrator lohn Moore 300 Utah Street Administrator iiawatha. KS 66434-2314 Steven Wilkinson i721 West 119th Street President and Chief Executive herland Park. KS 66209-3722 Officer Ihae Veach 105 N Cooper CEO '0 BOX 665 ohnson, KS 67855 ;erald Marquette 110 W. Fifth Chief Executive Officer :offeyville, KS 67337-3916 btotal This Paee Page -2 of 7 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) Check Amount of Date Name and Address Occupation of Individual Appropriate Box Cash, Check, 1 of Contributor Giving More Than $150 Loan or Cnsh Check Other Receipi J. Michael Frost $100.OC 1129 Easter Ave 1111712006 Wa Keeney, KS 67672-1935 VP for Regional Operations I7 Joy Bretz Rt. 1 1 111 712006 BOX 57E Chief Financial Officer Studley, KS 67740-9801 806 Hillside Drive Chief Executive Officer 712006 Quinter, KS 67752-9433 11 i3 N. I111712006 Jordan private practice physician ( Liberal. KS 67901-2409 l~ebraHvrnan 404 ~radle~ 1111712006 I Ellsworth, KS 67439-2304 1 ~eresaPearson I I I Marcia Bubak lgo3 Daisy 11/17/2006 VP, Patient Care Services Manhattan, KS 66502-4948 Steven Poage 11/17/2006 3401 SW Alameda Vice PresidenffCFO Topeka, KS 66614-5109 Cash Miscellaneous 11/17/2006 215 SE 8th Street Topeka, KS 66603-3906 Scott County Hospital 11/17/2006 310 E 3rd St Scott City, KS 67871-1203 Page Page -3 of 7 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) - p~~p Check Amount of Date Name and Address Occupation of Individual Appropriate Box Cash, Check, of Contributor Giving More Than %I50 Loan or Cash - Other Receipt 1 ~ecaturHealth Systems PO BOX 268 11/17/2006 Oberlin, KS 67749-0268 0 - James Murguia 3001 Arnherst Avenue 1/17/2006 Manhattan, KS 66503-3038 Chief Operating and Financial Officer 0 - (~osephPhilipp 2945 Nevada Chief Medical Officer 111712006 Manhattan, KS 66502-2355 0 - Janet Criqui 1-20 Lake Road 'I17/2006 VP - Fiscal Services Council Grove, KS 66846-9801 0 I - Richard Allen 151 Bethany Drive 1/17/2006 Manhattan, KS 66503-3085 President and Chief Executive Officer Il - Judy Wagner Manhattan, KS 66502-8005 Vice President 7 - Margaret Rassette 11/17/2006 683 2150 Lane Director Abilene, KS 67410-6622 7 James Precht 11/17/2006 810 Harrison Street Goodland, KS 67735-3434 Brenda McCants 11/17/2006 1019 E. 10th Street Xr., Development and Goodland, KS 67735-3503 Jolunteers Jay Jolly 1111 604 Arcade Street 2hief Executive Officer Goodland, KS 67735-2130 Subtotal This Page Page -4 of 7 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) - Check Amount of Date Name and Address Occupation of Individual Appropriate Box Cash, Check, of Contributor Giving LMore Than $150 Loan or Cash Other - Other Receipt I - Eugene Meyer 26342 W. 110th Terr. 11/17/2006 Olathe, KS 66061-8413 President and Chief Executive I Officer I Chevenne Counk Hospital 1 I 210 W. First St. ' 7/2006 1 PO Box 547 ISt. Francis, ks 67756 Karen Cole 2404 S. Stilwell Senior VP, Administration 1'17/2006 Pittsburg, KS 66762-6534 Linda Guerue 1012 Twin Lakes Drive 'I17/2006 Vice President Patient Care Pittsburg, KS 66762-6144 - Kiley Floyd P 0 Box 70 '/' 7/2006 Osborne, KS 67473-0070 Administrator Kansas Hospital Attorneys KAHA 112712006 7~p~~x~~76601-2308 KAHA Bond Faulwell for Kansas House 12/04/2006 2344 Overland Park, KS 66213 toid -Bond Faulwell Jr Kansas House Cynthia Smith Lawrence, KS 66047 Martin Ekrem 12/05/2006 991 1 E. 21st Street N., #2103 Wichita, KS 67206-3533 Shelley Boden CEO Hays, KS 67601-1421 Subtotal This Page Page -5 of 7 SCHEDULE A CONTRIBUTIONS kiDOTHER RECEIPTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) Check Amount of Name and Address Occupation of Individual Appropriate Box Cash, Check, of Contributor Giving More Than $150 Loan or Other Receipt John Loyd 8041 West 47th Street 12/05/2006 Suite 100 Principal Overland Park, KS 66203-1 301 I I Leslie Lacy P 0 Box 547 12/0512006 Saint Francis, KS 67756-0547 Administrator I l~nthonyMedical Center I 101 E; Spring St. I IAnthony, KS 67003-2122 Chad Austin $250.00 6518 SW 26th Court 12/11/2006 Vice President, Government Topeka, KS 66614-4305 Relations I I (~erryMcLachlan for Kansas House 1008 W 30th Street South 12/18'2006 Wichita, KS 67217 Thomas Bell Topeka, KS 66618-3445 'resident I I Thomas Bell I 12/28/2006 4301 NW Valley Road 'resident Topeka, KS 66618-3445 Melissa Hungerford 12/28/2006 6448 SW Bayshore Drive Sr. Vice President Auburn, KS 66402-9324 Fred Lucky $1 15.38 12/28/2006 14607 West 89th Street ;enior Vice President Lenexa, KS 66215-2967 Robert Meling 12/28/2006 13005 Catalina Street ienior Vice President (APS) Leawood, KS 66209-2392 ~~~~ Subtotal This Page SCHEDULE A CONTRIBUTIONS AiiD OTHER RECEIPTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) Check Amount of Date Name and Address Occupation of Individual -Appropriate - Box Cash, Check, of Contributor Giving More Than $150 Loan or Cash Check Other Receipt Deborah Stem $57.72 3010 Clark Court Topeka, KS 66604-2660 Vice President 0El Sydney Carlin for Kansas House 1650 sunnyslope Manhattan, KS 66502 loid -Sydney Carlin 00 or Kansas House 0 Complete if last page of Schedule A 1 Total Itemized Receipts for Period ( $16.016.92 1 I Total Unitemized Contributions ($50 or less) I $723.10 1 I Sale of Political Materials (Unitemized) I $0.00 I I Total Contributions When Contributor Not Known I $0.00 1 - I TOTAL RECEIPTS THIS PERIOD (to line 2 of summary) ------I $16,740.02 Page -7 of - 7 SCHEDULE B m-KmD COiVTRLBUTIONS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) Name, Address and Occupation of Contributor Description of Value of List occupation for those giving In-Kind In-Kind an in-kind more than $150 Kansas Hospital KHA AHA - PAC annual fee for Aug 2005-Aug 2006 215 S.E.8th Topeka, KS 66603-3906 Kansas Hospital KHA Postage - Thank you letters 21 5 S.E. 8th Topeka, KS 66603-3906 Kansas Hospital KHA Postage 21 5 S.E. 8th $48.35 Topeka, KS 66603-3906 -- - (ansas Hospital KHA Federal Express - Nov PAC Fed Ex Charges 21 5 S.E. 8th Topeka. KS 66603-3906 I I (ansas Hospital KHA 2006 convention decorations - KHA PAC booth 215 S.E.8th ropeka, KS 66603-3906 (ansas Hospital KHA 2006 Conv-PAC auction items !I5 S.E.8th ropeka, KS 66603-3906 (ansas Hospital KHA Vocus, Inc. - Travel expenses for Firm Rein 21 5 S.E.8th ropeka, KS 66603-3906 Complete if last page of Schedule B Total Itemized (over $50) In-Kind Contributions $7,028.10 Total Unitemized ($50 or less) In-Kind Contributions $0.00 I TOTAL IN-KZND CONTRIBUTIONS THIS PERIOD (to line 6 of Summary) I Page 1of 1 SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) Date I Name and Address Purpose of Expenditure Amount or Disbursement Kansans for a Democratic House To replace original check 1375 - lost by recipient KS 10131I2006 Connie Burns for Kansas House Connie Burns, STATE HOUSE 56th KS 5719 SW Woodbridge Dr 10/31/2006 Topeka, KS 66606 I I Bond Faulwell for Kansas House Bond Faulwell, STATE HOUSE 49th KS 12344 Long I 10/31/2006 Overland Park, KS 66213 I I AHAPAC-American Hospital Association FEDERAL October 31 2006 AHA-PAC Check 325 Seventh Street, NW I 10131R006 ISuite 700 I I Washington. DC 20004 I ISenate Republican Leadership Committee PO Box 1772 110712006 Topeka, KS 66601 Republican Senatorial Campaign Committee Plaza Lights Holiday Celebration 2348 SW Topeka Blvd 1/07/2006 Topeka, KS 6661 1 Roger C. Pine for Kansas Senate Roger Pine, STATE SENATE 3rd KS 1111 012006 1783 E 1500 Rd Lawrence, KS 66044 Dwayne Urnbarger for Kansas Senate Dwayne Umbarger. STATE SENATE 14th KS 11/10/2006 1585 70th Road $100.00 Box 1818 Thayer, KS 66776 Suite 700 Washington, DC 20004 Doug Gatewood for Kansas House Doug Gatewood, STATE HOUSE Olst KS 2104/2006 41 1 S. Florida PO Box 306 Columbus, KS 66725 Subtotal This Page Page 1of -5 SCHEDULE C EXPENDITURES AID OTHER DISBURSEMENTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) Name and Address Purpose of Expenditure Amount or Disbursement Jene Vickrey for State House Jene Vickrey, STATE HOUSE 06th KS 502 S. Countryside Louisburg, KS 66053 William Otto for Kansas House William Otto, STATE HOUSE 09th KS 102 9th LeRoy, KS 66857 Tom Holland for Kansas House Tom Holland. STATE HOUSE 10th KS 961 E 1600 Rd Baldwin City, KS 66006 Arlen Siegfreid Campaign Arlen Siegfreid, STATE HOUSE 15th KS 1403 W. Prairie Terrace Olathe, ks 66061-6807 Stephanie Sharp for Kansas House Stephanie Sharp, STATE HOUSE 17th KS 8012 Westgate Drive P.O. Box 19556 Lenexa, KS 66215 Cindy Neighbor Sindy Neighbor, STATE HOUSE 18th KS 10405 West 52nd Terrace Shawnee. KS 66203 Louis Ruiz for Kansas House -ouis Ruiz, STATE HOUSE 32nd KS 2914 W. 46th Ave Kansas City, KS 66103 Tom Sloan for Kansas House Tom Sloan, STATE HOUSE 45th KS 772 Highway 40 awrence, KS 66049 -ee Tafanelli for Kansas House -ee Tafanelli, STATE HOUSE 47th KS 7075 122nd St. 3zawkie. KS 66070 3ond Faulwell for Kansas House 30nd Faulwell, STATE HOUSE 49th KS 12344 Long herland Park, KS 66213 Subtotal This Page Page 2of -5 SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Kansas Hospital Association Political Action Committee -- (Name of candidate, Party Committee or Political Committee) Date Name and Address Purpose of Expenditure Amount or Disbursement Tom Hawk for Kansas House Tom Hawk, STATE HOUSE 67th KS 3115 Harahey Ridge Manhattan, KS 66502 Tom Moxley for Kansas House Tom Moxley, STATE HOUSE 68th KS I852 S 200 Road Council Grove, KS 66846 J. David Crum for Kansas House J. Crum, STATE HOUSE 77th KS 2903 Lakeshore Dr. Augusta, KS 67010 Ed Trimmer for Kansas House Ed Trimmer, STATE HOUSE 78th KS 1402 East 9th Winfield, KS 67156 Tom Sawyer for Kansas House Tom Sawyer, STATE HOUSE 95th KS 1041 S. Elizabeth St Wichita, 67213 - Mario Goico Mario Goico, STATE HOUSE 100th KS 1254 North Pine Grove Ct. Wichita, KS 67212 Jason Watkins for Kansas House lason Watkins. STATE HOUSE 105th KS 6525 West Northwind Wichita, KS 67205 Republican House Campaign Committee cay Wolf, STATE HOUSE 21st KS Topeka, KS 66603 Vicki Schmidt for Kansas Senate licki Schmidt, STATE SENATE 20th KS 2619 SW Randolph Ct Topeka, KS 66614 Thomas Owens for Kansas House 'homas Owens, STATE HOUSE 19th KS 7804 W. 100th Street 3verland Park, KS 66212 Subtotal This Yaee Page 3of -5 SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) Name and Address Purpose of Expenditure Amount or Disbursement -- -- William M. Wolf for Kansas House William Wolf. STATE HOUSE 112nd KS 1512 Broadway Court Great Bend, KS 67530 Benjamin Hodge for Kansas House Benjamin Hodge, STATE HOUSE 49th KS 12401 W 119 PI Overland Park, KS 66213 Raj Goyle for Kansas House Raj Goyle, STATE HOUSE 87th KS 214 S Lochinvar Street Wichita, KS 67207 Vincent Wetta for Kansas House Vincent Wetta, STATE HOUSE 80th KS 1204 N Poplar Wellington. KS 67152 Steve Lukert for Kansas House Steve Lukert, STATE HOUSE 62nd KS 2420 Acorn Road Sabetha. KS 66534 Terry McLachlan for Kansas House Terry McLachlan, STATE HOUSE 96th KS 1008 W 30th Street South Nichita. KS 67217 hieTietze for Kansas House 4nnie Tietze, STATE HOUSE 56th KS 329 SW Yorkshire Road ropeka, KS 66606 wlarc Rhoades for Kansas House darc Rhoades. STATE HOUSE 72nd KS 1006 Lazy Creek Drive rlewton. KS 67114 Sene Rardin for Kansas House 3ene Rardin, STATE HOUSE 16th KS I0900 West 104th Street herland Park. KS 66214 Iemocratic Senatorial Campaign Committee-KS '0 Box 1811 -opeka, KS 66601 Subtotal This P'age Page 4 of -5 SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Kansas Hospital Association Political Action Committee (Name of Candidate, Party Committee or Political Committee) Date Name and Address Purpose of Expenditure Amount or Disbursement Sydney Carlin for Kansas House Sydney Carlin, STATE HOUSE 66th KS 1650 sunnyslope Manhattan. KS 66502 - &dm4;,w? -& L4i-d Terry McLachlan for Kansas House Terry McLachlan, STATE HOUSE 96th KS 1008 W 30th Street South Wichita, KS 67217 4HAPAC-American Hospital Association FEDERAL 325 Seventh Street, NW Suite 700 Nashington, DC 20004 Subtotal This Page Complete if last page of Schedule C Total Itemized Expenditures This Period Total Unitemized Expenditures of $50 or less $6.00 TOTAL EXPENDITURES & OTHER DISBURSEMENTS $23,201.49 THIS PERIOD (to line 4 of Summary) Page 5 of 5