KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIPTS AND EXPENDITURES REPORT RECEIVED OF A POLITICAL OR PARTY COMMITTEE JUL 2 1 2016 July 25, 2016 FILE WITH SECRETARY OF STATEKS Governmental Ethics commis ion SEE REVERSE SIDE FOR INSTRUCTIONS
A. Name of Committee: HCA Kansas Good Government Fund PAC
Address: c/O 5845 SW 29th Street City and Zip dode: Topeka KS 66614-2462
This is a (check one): __ Party Committee ~Political Committee
B. Check only ifappropriate: __ Amended Filing __ Termination Report
C. Stimmary (cov~rlng the period from January I, 2016 through July 21, 2016) 1. Cash on hai;.d at beginning of period ...... $24,282.02 2. Total Contributions and Other Receipts (Use Schedule A) ...... 45,500.00 3. Cash available this period (Add Lines l and 2) ...... $69,782.02 4. Total Expenditures and Other Disbt1rsements {Use $cheduie C) ...... , ...... $20,800.00 5. Cash on hand at close of peiiod (Subtract Line 4 from 3) ...... $48,982.02 6. In-Kind Co1itrit?utions (Use Schedule B) ...... $0.00 7. Other Transactions (Use Schedule D) ...... $0.00
D. "I declare that tliis report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is true, cottect and complete. I understand that the intentional failure to file !ibis document or intentionally filing a false document is a class A misdemeanor."
j Date Signature of Treasurer
GEC Form Rev, 2016
7 ""Pih "\'1'1 <\~TT T'lnf;;!~TO'.'l .T.An!'I l'JT'iHf r.t:rnr. L7.!Hn YV.>f Ofl: n 910Z ITZ! LO SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
HCA Kansas Good Government Fund PAC (Name of Party Committee or Polihcal Committee)
Occupation of Check Amount of Name an,d Address Individual Giving ).\tore Appropriate Box Cash, Check, Loan or Other Con~ibutor Than$150 Date of Cash Check Lo•11 ~ Other Receipt
Menghini for State Rep Voided check #2751 Issued 11/27/2015 lh error $250.00 11/27/15 and reported on PAC "" rt nn 1/1n/?n1R Barbara Bollier fqr House Refunded $250 for check 06/13/16 #2683lssued $250.00 11/27/2016. Bollier not
Overland Park Reg Med Center Hospital 06/19/16 10500 Quivira $11,250.00 Overland Park K$ 66215
Wesley Healthcare Hospital 06/30/16 550 N. Hillside . $22,500.00 Wichita KS 67214
Menorah Medlca~ Center Hospital 07/06/16 5721 W.119th St. $11,250.00 Overland Park K~ 66221
$45,500.00
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~11 ~NI~1fiSN03 ~AO~ NIHH r.v?.6r.L7.!;;Rl YV.>l TV: f.T !lT07./T7./ LO SCHEDULED IN"KIND (Non-Monetary) CONTRIBUTIONS
HCA Kansas Good Gover~ent Fund PAC (Name of Party Committee or 'Pol~tical Committee)
List Occupation Value of In-Kind Name an'1 Address for Those Glvini an Description of In-Kind Date Contribution of Contributor In-Kind of More Than Contribution $150
$0.00
Complete if last page ofSchedule B
Total Itemized (o~er $100} In-Kind Contributions
Total Unitemize~ (SI 00 or less) In-Kind Contributions $0.00
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J'OO!lJ £v7.6£L7.9RL YV~ 1t:r.1 9107./17./LO SCHEDULEd EXPENDITURES AND OTHER DISBURSEMENTS
HCA Kansas Good Governmeht Fund PAC (Name of Party Committee or Poijtical Committee)
Name an~ Address Purpose of Expenditure Date To Whom Exp~ndlture is Made Amount If independent or bJ-kind expenditure in exces.s of $300 ls made for a candi~ate, list candidate name & address See attachment tp Schedule C $20,800.00
$20,800.00
Complete if last page oflSchedule c
Total Itemized E~penclitures This Period $20,800.00 Total Unitemized.. Expenditures ofSSO or less $20,800.00
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con rm ~.,., !"\lllT.T.'lm::1110:"1 .T.Am'l l'JTITTI CtZ6CLZS8L xv~ 1t:c1 910Z/1Z/LO HCA Kansas Good Government Fund SCHEDULE C EXPENDITURES AND OTHER [)ISBURSEMENTS
Cate Name Nam& Address Amount Jan 1 • Jul 21, 18 06/1012016 Governmental Ethics Commission Governmental EthlC3 Comm~ 109 SW 9th, Suite 504 Topeka, KS 6 ... 300.00- 07/1912016 Alford for Slate R~preeentative Rep. J. Stephen Alford 4179. E. Road 19 Ulysses, KS 67860 0.00 Rep. Steven Anthlmldes 2730 S. Southeast Drive Wichita KS 6721 .•. 250.00- g~~~~i~g~~ ~~~~~~re~t~~~ ~~ea:epresentat... Sen. Tom Arpke Box 3003 Salfna, KS 67402-3003 500.00- 07'19/2016 Aurand for State ~epresentatlve Rep. Clay Aurand 810 Shady Lane Belleville, KS 66935 250.00- 07/1912016 Ballard for State tiepresentatlve Rep. Barbara Ballard 153Z Alvamar Drive Lawrence, KS 66047 260.00- 07/19/2016 Barl<.er for State RepresentatiVe Rep. John Barker 103 WassJnger Drive Abilene, KS 67410 250.00- 07/1912016 Baumgardner for\State Senale Sen. Molly Baumgardner 29467 Masters Court Louisburg, KS 66053 600.00- 07119/2016 Bolller for State Senate Ms. Barbara Bollier 691 OOverhlll Road Mission Hills KS 66208 1,000.00- 07/19/2016 Campbell for State Representative Rep. Larry Campbell 15803 S. Avalon Street Olathe, KS 66072-7701 250.00- 07/19/2016 Carlin for State Representative Rep. Sydney Carlin Box 32 Manhattan, KS 66505 250.00- 07/19/2016 Carmichael for Slate Representat... Rep. John Carmlcheel 1475 N. Lleunett Wichita KS 67203 250.00- 07119/2016 Carpenter, Blake;tor State Repre ... Rep. Blake Carpenter 2425 N. Newberry Apt. 3202 Derby KS 67037 250.00- 07/19/2016 Cerpenler, Will fqr State Represe ... Rep. Will Carpenter 6965 SW 18th Street El Dorado KS 67042 250.00- 07/19/2016 Claeys for State ~epresentatlve Rep. J. R. Claeys 2157 Redhawk Lane Salina KS 67041 250.00- 07119/2016 Clayton for StateiRepresentatlve Rep. Stephanie Clayton 9825 Woodson Drive Overland Park, KS 6 ... 250.00- 0711912016 Davis, Erin for Stj:l18 Representatl ... Rep. Elin Davis 12016 S. Clinton Olathe, KS 66061 250.00- 07/19/2016 DeGraaffor State Representative Rep. Peter DeGraaf 1545 E; 1191h Mulvane KS 67220 250.00- 07/19/2016 Dove for State Representative Rep. Willie Dove Box 349-9349 Bonner Springs, KS 66012 250.00- 07/19/2016 Eplee for Stale ~epresentallve Dr. John Eplee 163 Deer Run Atchison KS 66002 250.00- 07119/2016 Esau for State R\!presentative Rep. Keith i::sau 11702 S. Winchester Slreet Olathe, KS 6061 250.00- 0711912016 Estes for State S"enate Mr. Maynard (Bud) Este~ 1401.i Elbow Bend Dodge City KS 67801 600.00- 0711912016 Finell for State Rijpresentatlve Rep. Blaine Finch 101 W. 2nd Street Ottawa, KS 66007 250.00- 07/19/2016 Fitzgerald for St~le Senate Sen. Steve Fil%gerald 3100 Tonganoxie Road Leavenworth, KS 66 ... 250.00- 07119/2016 Gallagher for Sla)e Representative Rep. Linda Gallagher 7804 Monrovia Street Lenexa KS 66216 250.00- 07119/2016 Garoer for State f{epresentatlve Rep. Randy Gerber 2424 Timb1:1rlane Terrace Sabetha KS 66534 250.00· 07/19/2016 Hawk for Slate S,enate Sen. Tom Hawk 2600 Woodhaven Court Manhattan KS 66502 500.00- 07/19/2016 Helgerson for State Representative Rep. Henry Helgerson 12 Ei Peach Tree Lane Wlchitll KS 67207 250.00- 07119/2016 Henderson for Slate Representatl ... Rep. Brodertck Henderson 2710 N. 8th Street Kansas City KS 66101 250.00- 07/19/2016 Highland for Stat~ Repre$entative Rep. Ron Highland 27487 yYefls Creek Road Wamego KS 66547 250.00- 07119/2016 Hildabrand for Stlite Representatl ... Rep. Brett Hlldabrand 16820 W. 67\h Apt. 407 Shawnee KS 66217 250.00- 07/19/2016 Hoffman for State Representative Rep. Kyte Hoffman 1319 Avenue T Coldwater, KS 67029 250.00- 07119/2016 Holland for State.' Senate Sen. Tom Holland Box 165 6aklwln City KS 66006 250.00- 07/19/2016 Huebert for Stat~ Representative Rep. Steve Huebert 619 N. Birch Valley Center, KS 67147 250.00- 07/19/2016 Jennings for State Representative Rep. Russ Jennings P. o. £fox 295 Lakin KS 67860 250.00- 0711912016 Kelly for State R~resentative Rep. Jim Kelly 309 S. 5th Independence, KS 67301 250.00- 07/19/2016 Klegerl for State Representative Rep. Mlke Klegerl 2350 Golf Course Road Olathe, KS 66061 260.00- 07119/2016 Kleeb lor State R;epresentatlve Rep. Marvin Kleeb 14206 Eby Overland Palk, KS 66221 250.00- 0711912016 La.Kin for State Reprssentatlve Dr. Greg Lakin 2824 W. Tinibercreek Circle Wichita KS 67204 260.00- 07/19/2016 L1mdwehr for State Representative Ms. Brenda Landwehr 2611 N. Bayside Court Wichita, KS 67205 500.00· 07/19/201.6 Longbine for Stale Senate Sen. Jeff Longbine Box 1903 Emporia, KS 66801 250.00- 07119/2016 Lunn for Slate Representative Rep. J11rry Lunn 14512 Horton Street Overland Part< KS 66223 250.00- 07/19/2016 Lusk for State Representative Rep. Nancy Lusk Box 36 Overland Parl<, KS 66201-0035 250.00- 07/19/2016 Mscheel"$ for St11te Representative Rep. Charles Macheers 21704 W. 571h Terrace Shawnee, KS 66218 250.00- 07/1912016 McGlnn for Sb1\f.i Senate Sen. Carolyn McGinn P. 0. Box A Sedgwick KS 67135 250.00- 07/19/2016 McPherson for SJate Representat ... Rep. Craig McPherson Box ·23442 Overland Park, KS 66062 250.00- 07/1912016 Ohaeboslm for State Reptesentat... Mr. Kelechl Ohaeboslm 2330 N. Oliver #511 Wichita KS 67220 250.00- 07/1912016 Osterman for St11te Representative Rep. he$1le Osterman 1401 W. Dallas Wichita, KS 87217 250.00- 0711912016 Pauls for State F{epresentatlve Rep. Jan Pauls 101 E. 11th Hutchinson, KS 67501 250.00- 07/1912016 Petersen for St11ie Senate Sen. Mike Petersen 2608 Sj)utheast Drive Wichita, KS 67216 250.00· 07/19/2016 Phllllps for Slate:Representatlve Rep. Tom Phllllps 1630 Barrington Drive Menhattan KS 66503 250.00- 0711912016 Powell, Randy for State Represe ... Rep. Randy Powell 14481 W. 122nd Street Olathe KS 66062 250.00- 07/19/2016 Proehl for State Representative Rep. Richard Proehl 510 Pina Ridge Road Parson, KS 67357 250.00- 07119/2016 Rhoades for Sta\e Representative Rep. Marc Rhoades 1006 L~zy Creek Drive Newton KS 67114 250.00- 0711912016 Rooker for State 1Representatlve Rep, Melissa Rooker 4124 Brookrtdge Drive Fairway KS 66205 250.00· 0711912016 Sawyer for Slate: Representative Rep. Tom Sawyer 1041 s. Elizabeth Street Wichita. KS 67213 250.00- 07/1912016 Scapa for Stale Representative Rep. Joseph S~pa 2209 s: White Cliff Wichita KS 67207 250.00- 07/19/;.!016 Schmidt for Attoiney General Hon. Derek Schmidt Box 804 Independence, KS 67301 500.00- 07 /19/2016 S chmldt, VielJoe Seiwert 1111 E. Boundary Road Pretty Prairie KS 67570 250.00- 07/1912016 Smith, Greg for $tate Senate Sen. Greg Smith 8605 Robl11son Overland Park KS 66212 500.00- 07 /19/2016 S uallentrop for s,tate Senate Mr. Gene Suellentrop 6813 W. Northwlnd Clrc!a Wichita KS 67205 600.00- 07119/2016 Sutton for St11te Represantatlve Rep, Biii Sutton 301 W. Westhoff Piece Gardner KS 66030 250.00- 07119/2016 Todd for Slate Representative Rep. James Todd 9812 W. 118lh st. Apt. 3 Overland Pail<, KS 662 ... 250.00- 07/1912016 Victors for State:Representative Rep. Ponka-We Victors Bo~ 46081 Wichtta, KS 67201 250.00- 07/19/2016 Weymaster for *ate Representat. .. Rep. Troy Waymaster 3528.192nd Street Bunker Hiii, KS 67626 250.00· 0711912016 Weber, Chuck for State Represe ... Rep. Chuck Weber 2331 N;Winslead Circle Wichita KS 67226 250.00· 0711912016 Whipple for Stalil Representative Rep. Bri!ndon Whipple 4455 S. Washington Ct Wichita, KS 67216 250.00·
011 DNU10SNO::> .LAOD NIHH HCA Kansas Good Government Fund SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS
Date Nam& Name Address Amount 07/19/2016 Whllmer for Stat~ Representative Rep. John Whitmer 12905 W. Red Rock Wichita KS 67235 250.00- 07119/2016 Wrnlams, Krlstey for Stale Repre ... Rep. Krist f:OO® ::>'11 ~NLT,1f1SNOO .LAO~ NIHH SCHEDULED OTHER TRANSAC".f'IONS HCA Kansas Good Gover~ment Fund PAC (Name of Party Committee or Political Committee) Balance at Date Name an~ Address Nature o:r Account or Loan Payable Close of c>r Loan Receivable Period $0.00 Complete if last page of Schedule n $0.0 Page __ of__ 900 Ii'! :'.>'l'l mJT.T.'lnSMO~ .T.AOfl MTHH t'f77.IBU.7.