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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 <ansas City, KS 66160-0001 Chief Executive Officer - -- )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.
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