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~ ?J ~ Date Sign~Urer KANSAS GOVERNMENTAL ETHICS COMMISSION This is a (check one): __ Party Committee v' Political Committee B. Check only if appropriate: __ Amended Filing __ Termination Report C. Summary (covering the period from July 25, 2008 through October 23,2008) 1. Cash on hand at beginning of period , 36,577.45 2. Total Contributions and Other Receipts (Use Schedule A) . 8,840.96 3. Cash available this period (Add Lines 1 and 2) .. 45,418.41 4. Total Expenditures and Other Disbursements (Use Schedule C) .. 39,800.00 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) .. 5,618.41 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." Oct. 27. 200B ./~ ~ ?J Date Sign~urer GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS KANSAS OPTOMETRIC POLITICAL ACTIO1\' COMMITTEE DATE NAME AND OCCUPATION CHECK AMOUNT ADDRESS OR CASH OF CONTRIBUTOR 07-25-08 Dr. RandalJ Holloway Optometrist Check $25.00 4 S. National Fort Scott, KS 6670 I 07-25-08 Dr. RandalJ Pohlenz Optometrist Check $25.00 2144 SW 36th St. Topeka, KS 66611 07-25-08 Dr. Larry Washburn Optometrist Check $62.50 PO Box 747 Colby, KS 6770 I 07-25-08 Dr. David Nelson Optometrist Check $252.88 4123 SW Gage Center Dr. Topeka, KS 66604 07-29-08 Dr. Ronald Fiegel Optometrist Check $62.50 2230 N. Ridge Rd., Ste. E Wichita, KS 67205 08-06-08 Dr. Lewis LaPierre Optometrist Check $125.00 2069 S. Ohio Salina, KS 67401 08-06-08 Dr. Russell McCaulley Optometrist Check $250.00 181 NE 20 Road Great Bend, KS 67530 08-06-08 Dr. Jan Turnbull Hageman Optometrist Check $250.00 PO Box 1314 McPherson, KS 67460 08-06-08 Dr. Tammy OdJe Goering Optometrist Check $250.00 PO Box 1314 McPherson, KS 67460 08-08-08 Dr. Gloria Hopkins Optometrist Check $100.00 1505 Grandview Drive E. Garden City, KS 67846 08- J4-08 U.S. Bank Interest $0.31 Topeka, KS 08-18-08 Dr. Mike Hattan Optometrist Check $500.00 3501 Fairway Drive Hays, KS 6760 I Subtotal This Page $1,903.19 Page 1 of 5 KANSAS OPTOMETRIC POLITICAL ACTION COMMITTEE DATE NAME AND OCCUPATION CHECK AMOUNT ADDRESS OR CASH OF CONTRIBUTOR 08-20-08 Dr. Brandon Fisher Optometrist Check $100.00 746 N. Maize Road Wichita, KS 67212 08-21-08 Dr. Rebecca Dobbins Optometrist Check $150.00 301 West 11th St. Coffeyville, KS 67337 08-26-08 Dr. Robert Nelson Optometrist Check $62.50 437 N. Tyler Wichita, KS 67212 08-26-08 Dr. Ted Rosentreter Optometrist Check $250.00 975 N. Mur-Len Road Olathe, KS 66062 08-26-08 Dr. Jeff Luthi Optometrist Check $250.00 975 N. Mur-Len Road Olathe, KS 66062 08-29-08 Dr. Wm. S. Benkelman Optometrist Check $100.00 308 6th Street WaKeeney, KS 67672 08-29-08 Dr. Tad Baker Optometrist Check $62.50 1233 N. Rock Rd., Bldg. C Wichita, KS 67206 09-02-08 Dr. R. Kay Driver Optometrist Check $125.00 306 E. 6th St. Goodland, KS 67735 09-03-08 Dr. Eric McPeak Optometrist Check $400.00 800 Oregon St., Ste. C Hiawatha, KS 66434 09-05-08 Dr. Jessica Mai Optometrist Check $50.00 4318 SW Misty Harbor Dr. Topeka, KS 66610 09-10-08 Dr. David Reynolds Optometrist Check $]25.00 465 Deer Creek Run Deerfield Beach, FL 33442 09-10-08 Dr. Gary Nickel Optometrist Check $250.00 PO Box 474 Independence, KS 67301 09-14-08 U.S. Bank Interest $0.27 Topeka, KS Su btotal This Page $1,925.27 Page 2 of 5 KANSAS OPTOMETRIC POLITICAL ACTION COMMITTEE DATE NAME AND OCCUPATION CHECK AMOUNT ADDRESS OR CASH OF CONTRIBUTOR 09-17-08 Dr. Robert Nelson Optometrist Check £62.50 437 N. Tyler Wichita, KS 67212 09-17-08 Whitney Coleman Student Check $25.00 623 Mediterranean Drive Florissant, MO 63031 10-02-08 Dr. Craig Baier Optometrist Check $50.00 206 N. Main Ne\.\'1:on, KS 67114 10-02-08 Dr. Jeremy Durham Optometrist Check $100.00 1233 Seasons Court Goddard, KS 67052 10-02-08 Dr. William Crawford Optometrist Check $62.50 9616 Glenwood St. Overland Park, KS 66212 10-02-08 Dr. James Morrison Optometrist Check $100.00 PO Box 366 Colby, KS 67701 10-03-08 Dr. Mike Hattan Optometrist Check $500.00 3501 Fairway Drive Hays, KS 67601 10-06-08 Dr. David Cooper Optometrist Check $62.50 1000 E. Cloud Salina, KS 67401 10-06-08 Dr. Chris Banninger Optometrist Check $62.50 1000 E. Cloud Salina, KS 67401 J0-06-08 Dr. Kendall Krug Optometrist Check £ J ,000.00 2203 Canterbury Hays, KS 67601 10-07-08 Dr. Michael Malone Optometrist Check $125.00 2144 SW 36th St., Ste. 1 Topeka, KS 66611 10-07-08 Dr. Roger Joyce Optometrist Check $125.00 PO Box 1216 El Dorado, KS 67042 Subtotal This Page $2,275.00 Page 3 of 5 KANSAS OPTOMETRIC POLITICAL ACTION COMMITTEE DATE NAME AND OCCUPATION CHECK AMOUNT ADDRESS OR CASH OF CONTRIBUTOR 10-07-08 Dr. Greg Joyce Optometrist Check $12500 PO Box 1216 EI Dorado, KS 67042 10-07-08 Dr. Anthony Hartness Optometrist Check $250.00 1851 N. Webb Road Wichita, KS 67206 10-09-08 Dr. Lewis LaPierre Optometrist Check $125.00 2069 S. Ohio Salina, KS 6740 I 10-09-08 Dr. Wayne Gilmore Optometrist Check $125.00 501 Main Parsons, KS 67357 10-09-08 Dr. Craig Newland Optometrist Check $125.00 501 Main Parsons, KS 67357 10-09-08 Dr. Terry Hawks Optometrist Check $250.00 5703 W. 95th Street Overland Park, KS 66207 10-09-08 Dr. Jason Rogers Optometrist Check $250.00 5703 W. 95th Street Overland Park, KS 66207 10-09-08 Dr. Greg Besler Optometrist Check $250.00 5703 W. 95th Street Overland Park, KS 66207 10-09-08 Dr. M.D. Torrence Optometrist Check $125.00 314 W. 1st A venue Hutchinson, KS 67501 10-09-08 Dr. Jason Eubank Optometrist Check $250.00 139 N. Ridgewood Drive Wichita, KS 67217 10-11-08 Dr. Jim Johnson Optometrist Check $62.50 1820 S. Ohio Salina, KS 67401 10-11-08 Dr. Larry Harris Optometrist Check $100.00 403 W. Lymand Road Topeka, KS 66608 Su btotal This Page $2,037.50 Page 4 of 5 KANSAS OPTOJ\1ETRIC POLITICAL ACTIO~ COMMITTEE DATE NAME AND OCCUPATION CHECK AMOUNT ADDRESS OR CASH OF CONTRIBUTOR 10-14-08 Dr. Mark Norris Optometrist Check $250.00 2301 Tenth Avenue Leavenworth, KS 66048 10-14-08 Dr. Kyle Kelly Optometrist Check $250.00 2301 Tenth Avenue Leavenworth, KS 66048 10-14-08 Dr. Larry Washbum Optometrist Check $62.50 PO Box 747 Colby, KS 67701 10-16-08 Dr. Scon Landes Optometrist Check $62.50 1710 S. Hillside Wichita, KS 672 11 10-16-08 Dr. F. Rodney Copeland Optometrist Check $62.50 2405 Central Dodge City, KS 67801 10-17-08 Dr. Jeremy Guenthner Optometrist Check $12.50 8113 E. Kellogg Wichita, KS 67207 Subtotal This Page $700.00 Total Itemized Receipts for Period 5) 8,840.96 Total Unitemized Contributions ($50 or Less) $ ­ TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary) 5) 8,840.96 Page 5 of 5 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS KANSAS OPTOMETRlC POLITICAL ACTION COMMITTEE DATE NAME AND ADDRESS PURPOSE OF EXPENDITURE A1v10UNT OR DrSBlJRSEMENT 8-13-08 Rocky Fund for State Rep. Fund Raiser $500.00 13161 S. Road Hoyt, KS 66440 8-19-08 Brungardt for Senate Campaign Contribution $1,000.00 436 S. Ohio Salina, KS 67401 8-21-08 Stan Frovvnfelter for State Rep. Campaign Contribution $250.00 4527 Gibbs Rd. Kansas City, KS 66106 8-21-08 Lance Kinzer for State Rep. Fund Raiser $250.00 12549 S. Brougham Olathe, KS 66062 8-21-08 Joe Patton for State Rep. Fund Raiser $250.00 800 SW Jackson, Ste. 1414 Topeka, KS 66612 8-21-08 Terry McLachlan for State Rep. Campaign Contribution $250.00 1008 W. 30th St. South Wichita, KS 67217 8-21-08 Rob Olson for State Rep. Campaign Contribution $250.00 19050W.161st St. Olathe, KS 66062 8-21-08 Tom Hawk for State Rep. Fund Raiser $250.00 3115 Harahey Ridge Manhattan, KS 66502 8-21-08 Sean Gatewood for State Rep. Campaign Contribution $250.00 1408 NW Central Ave. Topeka, KS 66608 8-22-08 Kay Wolf for State Rep. Fund Raiser $250.00 8339 Roe Ave. Prairie Village, KS 66207 8-22-08 Jim Barnett for Senate Campaign Contribution $500.00 PO Box 1937 Emporia, KS 66801 8-22-08 Bruce for Senate Campaign Contribution $500.00 401 E. Sherman Hutchinson, KS 67501 Subtotal This Page $4,500.00 Page 1 of 9 KL\NSAS OPTOMETRIC POLITICAL ACTION COMMITTEE DATE NAME AND ADDRESS PURPOSE OF EXPENDITURE AMOUNT OR DISBURSEMENT 8-22-08 Anthony Hensley for Senate Campaign Contribution $500.00 2226 SE Virginia Topeka, KS 66605 8-22-08 Tim Huelskamp for Senate Campaign Contribution $500.00 PO Box 379 Fowler, KS 67844 8-22-08 Mike Peterson for Senate Campaign Contribution $500.00 2608 Southeast Dr. Wichita, KS 67216 8-22-08 Carolyn McGinn for Senate Fund Raiser $1000.00 11047 N. 8ih S1. W. Sedgwick, KS 67135 8-22-08 Laura Kelly for Senate Campaign Contribution $500.00 234 SW Greenwood Ave.
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