KANSAS GOVERNMENTAL ETHICS COMMISSION
RECEIPTS AND EXPENDITURES REPORT RECEiVED OF A POLITICAL OR PARTY COMMITTEE January 10,2016 FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS
A. ~ame of Committee: Kansas Chiropractic Association PAC
."\.'ddress: 1334 S. Topeka Blvd _ City and Zip Code: Topeka, KS 66612
This is a (check one): __ Party Committee ,f Political Committee
B. Check only if appropriate: L Amended Filing __ Termination Report
C. Summary (covering the period from January 1,2015 through December 31,2015)
1. Cash on hand at beginning ofperiod , . 6881.15 2. Total Contributions and Other Receipts (Use Schedule A) . 17947.29 3. Cash available this period (Add Lines 1 and 2) .. 24828.44 4. Total Expenditures and Other Disbursements (Use Schedule C) . 6090.00 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) .. 18738.44 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 ~lse doc ent is a class A misdemeanor."
06/17/2016 Date Signature of Treasurer
GEe Form Rev, 2015 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
KS Chiropractic PAC (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 Check Loan E funds Other Receipt
KS Chiropractic Association Association of chiropractic 07/17/15 1334 S. Topeka Blvd providers and educators $17,947.29 Topeka, KS 66612 vi
$17,947.29 Subtotal This Page
Complete if last page of Schedule A
Total Itemized Receipts for Period $17,947.29
Total Unitemized Contributions ($50 or less) $0.00
Sale ofPolitical Materials (Unitemized) $0.00
Total Contributions When Contributor Not Known $0.00
TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary) $17,947.29
Page __ of__ 3:25 PM Kansas Chiropractic Association 01/07/16 Check Detail January through December 2015 Name and Address Purpose of Expenditure Date To Whom Expenditure is Made Amount
7/7/2015 KS Gov. Ethics Commission PAC Registration 240.00
11/17/2015 Blake Carpenter for Representative Campaign Contribution 200.00 6965 SW 18th St EI Dorado, KS 67042
11/17/2015 Bowers for Senate Campaign Contribution 250.00 1326 N 150th Rd Concordia, KS 66901
11/17/2015 Broderick Henderson for representative Campaign Contribution 200.00 2710 N 8th St Kansas City, KS 66101
11/17/2015 Bud Estes for Representative Campaign Contribution 200.00 1405 Elbow Bend Dodge City, KS 67801
11/17/2015 Dan Hawkins for Representative Campaign Contribution 200.00 9406 Harvest Lane Wichita, KS 67212
11/17/2015 Denning for Senate Campaign Contribution 250.00 8416 W 115th St Overland Park, KS 66210
11/17/2015 Dick Jones for Representative Campaign Contribution 200.00 4231 Marlboro Rd Topeka, KS 66610
11/17/2015 Don Hill for Representative Campaign Contribution 200.00 1720 Luther Street Emporia, KS 66801
11/17/2015 Haley for Senate Campaign Contribution 250.00 936 Cleveland Ave Kansas City, KS 66101
Page 1 of 3 3:25 PM Kansas Chiropractic Association 01/07/16 Check Detail January through December 2015
11/17/2015 Hensley for Senate Campaign Contribution 250.00 2226 SE Virginia Ave Topeka, KS 66605
11/17/2015 Jene Vickrey for Representative Campaign Contribution 200.00 502 S. Countryside Dr Louisburg, KS 66053
11/17/2015 Jim Kelly for Representative Campaign Contribution 200.00 309 South 5th Independance, KS 67301
11/17/2015 Jim Ward for Representative Campaign Contribution 200.00 3100 E. Clark St Wichita, KS 67211
11/17/2015 John Edmonds for representative Campaign Contribution 200.00 PO Box 1816 Great Bend, KS 67530
11/17/2015 Kelly for Senate Campaign Contribution 250.00 2345 SW Greenwood Ave Topeka, KS 66606
11/17/2015 Kevin Jones for Representative Campaign Contribution 200.00 416 E 7th St Wellsville, KS 66092
11/17/2015 Longbine for Senate Campaign Contribution 250.00 2801 Lakeridge Rd Emporia, KS 66801
11/17/2015 Marvin Kleeb for Representative Campaign Contribution 200.00 14206 Eby Overland Park, KS 66221
11/17/2015 O'Donnell for Senate Campaign Contribution 250.00 1309 N High St. Wichita, KS 67203
11/17/2015 Pilcher-Cook for Senate Campaign Contribution 250.00
Page 2 of 3 3:2~ PM Kansas Chiropractic Association 01/07/16 Check Detail January through December 2015 13910 W 58th PI. Shawnee, KS 66216
11/17/2015 Ray Merrick for Representative Campaign Contribution 200.00 6874 W 164th Terr Stilwell, KS 66085
11/17/2015 Roderick Houston for Representative Campaign Contribution 200.00 4902 Looman Wichita, KS 67220
11/17/2015 Tom Burroughs for Representative Campaign Contribution 200.00 3131 S 73rd Terr Kansas City, KS 66106
11/17/2015 Wagle for Senate Campaign Contribution 250.00 4 N. Sagebrush St Wichita, KS 67230
11/17/2015 Amanda Grosserode for House of Rep. Campaign Contribution 200.00 12601 West 99th St Lenexa, KS 66215
11/17/2015 Rob Bruchman for Representative Campaign Contribution 200.00 5016 W 108th Terr. Overland Park, KS 66211
11/17/2015 Susan Concannon for Representative Campaign Contribution 200.00 921 N. Mill St Beloit, KS 67420 6,090.00
Page 3 of 3 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS KS Chiropractic PAC (Name ofParty 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
$0.00 Subtotal This Page
Complete if last page of Schedule C
Total Itemized Expenditures This Period $6,090.00
Total Unitemized Expenditures of $50 or less $0.00
TOTAL EXPENDITURES & OTHER DISBURSEMENTS $6,090.00 THIS PERIOD (to line 4 of Summary)
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