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PAC111 202001.Pdf KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE RECEIVED January 10,2020 JAN 13 2020 FILE WITH SECRETARY OF STATE KS Governmental Ethics Comm ssion SEE REVERSE SIDE FOR INSTRUCTIONS 'tt Kansas Hospital Association Political Action Committee A. N arne 0 f C OIIlDll ee: _ Address: 215 SE 8th Street C1'ty an d Z'Ip C 0 de: Topeka, 66601 _ This is a (check one): __Party Committee " Political Committee B. Check only ifappropriate: __ Amended Filing __Termination Report C. Summary (covering the period from January 1, 2019 through December 31, 2019) 1. Cash on hand at beginning ofperiod .. 49,766.89 2. Total Contributions and Other Receipts (Use Schedule A) .. 72,222.58 3. Cash available this period (Add Lines 1 and 2) . 121,989.47 4. Total Expenditures and Other Disbursements (Use Schedule C) .. 51,043.16 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) .. 70,946.31 6. In-Kind Contributions (Use Schedule B) .. 4,714.04 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 ofmy knowledge and belief is true, correct and complete. I understand that the intentional failure to file this document or intentionall filing a false document is a class A misdemeanor." Date GEe Form Rev, 2017 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 Cbctk Loao E funds Oth.r Receipt Ms. Tara Ramlochan Chief Executive Officer 175.00 Meade District Hospital 112/2019 Mr. Dennis L George Chief Executive Officer, APS 501.00 3959 Hwy 59 Kansas Hospital Association 11912019 Ottawa, KS 66067-8345 .; Mary Jo Taylor for Kansas Senate 250.00 114 N. Union 1/9/2019 Void - Mary Jo royfor Stafford, KS 67578 .; for Kansas Senate Steve Alford for Kansas House 250.00 4179 East Road 19 2/6/2019 Ulysses, KS 67880 .; Mr. Chad R. Austin Sr. Vice President, Government 76.92 6518 SW 26th Court Relations 2/6f2019 Topeka, KS 66614-4305 Kansas Hospital Association Mr. Chad R. Austin Sr. Vice President, Government 76.92 6518 SW 26th Court Relations 216/2019 Topeka, KS 66614-4305 Kansas Hospital Association Ms. Audrey Dunkel Director of Financial Advocacy 36.46 2/6/2019 215 SE 8th Street Kansas Hospital Association Topeka, KS 66603-3906 Ms. Vallerle L Gleason President and Chief Executive 75.40 2/6/2019 609 Autumn Glen Cl. Officer Newton, KS 67114-9007 Newton Medical Center Mr. Leonard Hernandez Chief Executive Officer 350.00 2/6/2019 220 Apache SI. Coffey County Hospital New Strawn, KS 66839-8801 Shane Hudson 263.49 2/612019 2547 Aberdeen Ln. Central Kansas Foundation Salina, KS 67401-7126 Mr. Randall Peterson President and Chief Executive 100.00 21612019 1500 SW Tenth Avenue Officer Topeka, KS 66604-1301 Stormont Vail Health 2, 157.19 Page --1 of-- 27 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Hospl1al Association Political Action Committee (Name ofParly 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 LoaD or Other Cash Checl< Loan E fund. Other Receipt Ms. Melissa Atkins CPA Chief Executive Officer 260.00 304 West Prout Street Graham County Hospital 2112/2019 Hill City, KS 67642-1435 Mr. Chad R. Austin Sr. Vice President, Govemment 76.92 6518 SW 26th Court Relations 2/15/2019 Topeka, KS 66614-4305 Kansas Hospital Association .f Ms. Audrey Dunkel Director of Financial Advocacy 38.46 215 SE 8th Stree! Kansas Hospital Association 211512019 Topeka, KS 66603-3906 .f Mrs. Jennifer A. Findley VP Education/Special Projects 20.00 3517 SW Ashworth Cl. Kansas Hospital Association 2115/2019 Topeka, KS 66614-4590 t/ Mrs. Cindy Leah Samuelson Vice Preslden! 1924 1107 NE 54th St Kansas Hospital Association 2115/2019 Topeka, KS 66617-4505 Brooke Bollman 250.00 601 South Osage Street Sumner County Hospital District 1 3/20/2019 Caldwell, KS 67022-1654 Dr. Lynn Fisher MD Chief of Staff 100.00 3/27/2019 POBox 389 Rooks County Health Center Plainville, KS 67663-{)389 Ms. Tracl Hoopingarner RN Chief Nursing Officer 50.00 312712019 20048 Linwood Rd. LMH Health Linwood, KS 66052-4341 .f Ms. Karan Orr Chief Nursing Officer 950.00 4/212019 18053 Linwood Rd. Providence Medical Center Linwood, KS 66052-4521 .f Ms. Judy Corzine Administrative Director and Chief 775.00 4/3/2019 3621 SW Woodvalley Place Information Offi Topeka, KS 66614-3536 Stormont Vail Health .f Interim CEO 100.00 4/4/2019 Stormont Vail Health t/ 2,629.62 Page --2 of-- 27 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 K fund. Other Receipt Thyra Strate 100.00 1521 M Road Edwards County Medical Center 4/412019 Lewis, KS 67552-5226 I Mr. Russell W. Johnson President and Chief Executive 1,000.00 325 Maine Slreet Officer 41512019 Lawrence, KS 66044-1360 LMH Health I Mary J. Martell Director 100.00 2922 SW 20th SI. Stormont Vail Health 4/5/2019 Topeka, KS 66604-3209 I Associated Purchasing Services APS GPO 4,000.00 215 South East Eighth APS 4/8/2019 Topeka, KS 66603 I Mr. Chad R. Austin Sr. Vice President, Govemment 115.38 6518 SW 26th Court Relations 4/8/2019 Topeka, KS 66614-4305 Kansas Hospital Association I Mr. Robert C Copple FACHE, PE Senior Administrator 500.00 Ascension Via Christi Hospital, 4/8/2019 5739 Tuttle Cove Road Manhattan, KS 66503-8444 Manhattan Mrs. Sheryle A. D'Amico VP 200.00 4/8/2019 737 N. 1550 Rd. LMH Health Lawrence, KS 66049-9198 I Ms. Audray Dunkel Director of Financial Advocacy Sl.69 4/8/2019 215 SE 8th Street Kansas Hospital Association Topeka, KS 66603-3906 I Mrs. Jennifer A. Findley VP Education/Special Projects 30.00 41812019 3517 SW Ashworth Ct. Kansas Hospital Association Topeka, KS 66614-4590 I Mr. Doyle L McKimmy FACHE Chief Executive Officer 250.00 4/8/2019 100 Crestvue Jewell County Hospital Mankato, KS 66956-2407 I r. Michael Ramirez Director of PT/OT/SLP 100.00 4/8/2019 25 Sliver Rain Road Stormont Vail Health Lawrence, KS 66049-5034 I 6,453.07 Page --3 of-- 27 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, Checl{, Date of Contributor Than $150 Loan or Other C••h Check Loan E funds Ofher Receipt Ronald Robinson MD 202.60 519 Rugged Rock Rd. Goodland Regional Medical 4/8/2019 Loveland, CO 80537-8357 Center Mr. Ronald Robln6on MD Chief Executive Officer 202.60 519 Rugged Rock Rd. Rawlins County Health Center 4/8/2019 Loveland, CO 80537-8357 ~ Mrs. Cindy Leah Samuelson Vice President 28.86 1107 NE 54th SI Kansas Hospital Association 4/8/2019 Topeka, KS 66617-4505 ~ Ms. Roxanne R. Schottel 260.00 304 E. Third SI. Washington County Hospital 4/812019 Washington, KS 66968-2098 Nlchole Charnley 100.00 214 E. 5th SI. Stormont Vail Health 4/15/2019 Onaga, KS 66521-9792 Ms. Angela Gamber Director of Post-Surgical/Ortho 100.00 Services 4/1512019 210 NW Valencia Rd. Topeka, KS 66615-9267 Stormont Vall Health ~ Michael J Kongs Director Financial Management 100.00 4/15/2019 7261 SW Fountalndale Stormont Vail Health Topeka, KS 66614-4629 ~ Ms. Tracy O'Rourke Chief Strategy Officer 500.00 4/15/2019 1500 SW Tenth Avenue Stormont Vall Health Topeka, KS 66604-1301 { Kevin Steck 100.00 4/15/2019 9523 East 109th Street Stormont Vail Health Tulsa, OK 74133-7187 ~ Thomas Baker 100.00 4/1612019 1605 SW 27th Stonnont Vail Health ~ Topeka, KS66611-1638 s. Carol Perry RN, BSN, MSM Vlce President and Chief Nursing 600.00 4/16/2019 1500 SW Tenth Avenue Officer Stormont Vail Health ~ opeka, KS 66604-1301 2,164.06 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 Checl' LoBn EfJrnda Other Receipt Salena Gillam 100.00 2928 Fenwick Rd. Stormont Vail Health 4/17/2019 Lawrence, KS 66046-5476 Ms. Amy Kincade Adm. Director, Contlnlum of Care 100.00 2516 SW Chauncey Dr. Stormon1 Vail Health 4/17/2019 Topeka, KS 66614-4952 .f Mr. Harold Courtois Chief Executive Officer 550.00 515 Elise Heights SI. Memorial Health System 4119/2019 Abilene, KS 67410 Mr. Jeremy Ensey Chief Executive Officer 58.00 535 South Freebom SI. Luke Hospital and living 4/19/2019 Marian, KS 66861-1256 Center Mr. Elgin Glanzer Chief Rnanclal Officer 300.00 1602 Park Place Cl Memorial Health System 4/1912019 Abilene, KS 67410-2153 Ms. Vallerie L Gleason President and Chief Executive 82.94 Officer 4/19/2019 609 Autumn Glen Cl. Newton, KS 67114-9007 Newton Medical Center .f Betty Greer 726.70 4/19/2019 2802 Road M Kearny County Hospital Deerfield, KS 67838-3833 Mrs.
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