KANSAS GOVERNMENTAL ETHICS COMMISSION

RECEIPTS AND EXPENDITURES REPO~Rl'T...Io....- ---, OF A POLITICAL OR PARTY COMMITT E FILED October 27,2014 OCT 23 2014 FILE WITH SECRETARY OF STATE ~ KRIS W KOBACH SEE REVERSE SIDE FOR INSTRUCTIOl' S SECRETARY OF STATE

A. Name ofCommittee: Physician Hospitals of Kansas PAC

Address: 1200 SW 10th Ave.

City and Zip Code: _T_o_p_e_k_a,_6_6_6_0_4 _

This is a (check one): __ Party Committee If' Political Committee

B. Check only ifappropriate: __ Amended Filing __Termination Report

C. Summary (covering the period from July 25,2014 through October 23, 2014)

1. Cash on hand at beginning ofperiod . 40727.24

2. Total Contributions and Other Receipts (Use Schedule A) . 1000.00

3. Cash available this period (Add Lines I and 2) . 41727.24

4. Total Expenditures and Other Disbursements (Use Schedule C) . 7401.00 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . 34326.24

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 ~ document is a class A misdemeanor." ~~_ ¥+ --->.L--'

GEC Form Rev, 2014 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Physician Hospitals of Kansas PAC (Name of Party Committee or Political 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

Kansas Republican Senatorial Party Committee 10/06/14 Committee Returned Contribution $1,000.00 P.O. Box 2663 Topeka, KS 66612

$1,000.00

Complete if last page of Schedule A

Total Itemized Receipts for Period $1,000.00

Total Unitemized Contributions ($50 or less)

Sale of Political Materials (Unitemized)

Total Contributions When Contributor Not Known $1,000.00

Page 2.. of-S--­ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Physician Hospitals of Kansas PAC (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 Brian Caswell for Representative Contribution 10/08/14 2900 Rivers Edge $500.00 Baxter Springs, KS 66713

Kevin Jones for Representative Contribution 10/08/14 416 E. 7th St., $250.00 Wellsville, KS 66092

Gene Vickrey for Representative Contribution 10/08/14 502 Countryside Drive $500.00 Louisburg, KS 66053

Richard Proehl for Representative Contribution 10/08/14 510 Pine Ridge Road $250.00 Parsons, KS 67357

Jim Kelly for Representative Contribution 10/08/14 309 S. 5th $250.00 Independence, KS 67301

Barbara Bollier for Representative Contribution 10/08/14 6910 Overhill Dr. $250.00 Mission Hills, KS 66208

Ray Merrick for Representative Contribution 10/08/14 6874 W. 164th Terr. $500.00 Stillwell, KS 66085

Randy Powell for Representative Contribution 10/08/14 14481 W. 122nd St. $250.00 Olathe, KS 66062

Fred Patton for Representative Contribution 10/08/14 339 NE 46th St $250.00 Topeka, KS 66617

Anne Tietze for Representative Contribution 10/08/14 329 Southwest Yorkshire Road $250.00 Topeka, KS 66606

Blaine Finch for Representative Contribution 10/08/14 5 SW Fairview Dr. $250.00 Ottawa, KS 66067

$3,500.00

pageLof S-­ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Physician Hospitals of Kansas PAC (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 Don Hill for Representative Contribution 10/08/14 1720 Luther $500.00 Emporia, KS 66801

Peggy Mast for Representative Contribution 10/08/14 765 Road 110 $500.00 Emporia, KS 66801

Kristey Williams for State Contribution 10/08/14 Representative $250.00 506 Stone Lake Court, Augusta,

Jim Ward for Representative Contribution 10/08/14 3100 East Clark $250.00 Wichita, KS 67211

Mark Hutton for Representative Contribution 10/08/14 718 Clearmeadow Ct. $500.00 Wichita, KS 67205

Susan Concannon for Contribution 10/08/14 Representative $250.00 P.O. Box 65, Beloit, KS 67420

$2,250.00

Page --.!1.- of ~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Physician Hospitals of Kansas PAC (Name of Party Committee or Political Committee)

Name and Address Purpose of Expenditure Date To Whom Expenditure is Made Amount If independent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address Steve Alford for Representative Contibution 10/08/14 4179 East Road 19 $250.00 Ulysses, KS 67880

Shannon Francis for Contribution 10/08/14 Representative $250.00 1501 Tucker Ct., Liberal, KS 67901

Kansas Republican Senatorial Contribution 10/08/14 Campaign $1,000.00 PO Box 2663, Topeka, KS 66612

Kearney Law Office Preparation of corporate annual report and 07/28/14 1200 SW 10th Ave reimbursement for filing fee. $151.00 Topeka, KS 66604

$1,651.00

Complete if last page of Schedule c

Total Itemized Expenditures This Period $7,401.00

Total Unitemized Expenditures of $50 or less

$7,401.00

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