KANSAS GOVERNMENTAL ETHICS COMMISSION

RECEIPTS AND EXPENDITURES REPORT RECEIVED OF A POLITICAL OR PARTY COMMITTEE July 30, 2012 JUl 2'7 20\2 mi FILE WITH SECRETARY OF STATE KS Governmental EthiCS Com sian SEE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Committee: Kansas Hospital Association Political Action Committee

Address: 215 SE 8th Street

City and Zip Code: T_o_pe_ka_,_66_6_01 u_s _ This is a (check one): __Party Committee x Political Committee

B. Check only if appropriate: __Amended Filing __ Termination Report

C. Summary (covering the period from January 1, 2012 through July 26, 2012) l. Cash on hand at beginning ofperiod .. $84,199.65 2. Total Contributions and Other Receipts (Use Schedule A) : . $16,906.06 3. Cash available this period (Add Lines 1 and 2) . $101,105.71 4. Total Expenditures and Other Disbursements (Use Schedule C) .. $32,612.06 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) .. $68,493.65

6. In-Kind Contributions (Use Schedule B) ...... $2,438.90

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 of my knowledge and belief is true, correct and complete. I understand that the intentional ;1:;;~: ,~s document or m~;::?::z:t:n: is~t~:::Sdemeanor" .' . ~d ~JLY w~o fYl.ec~ic,.JI Date SigoatureU,fTreasurer;;:." " oJ"M L8::. >-U GEe Form Rev, 2001 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 E funds Other Receipt

Organization of Nurse Leaders Kansas Nursing Professional Association $276.00 KS 01/06/2012

Risk & Quality Mgt KS Assoc of Risk & Quality Management $100.00 CoO Kansas Hospital Association Association 01/06/2012 PO BOX 2308 Topeka, KS 66601-2305

Teresa Deuel Chief Executive Officer 5120.00 POBox310 01/06/2012 Jetmore, KS 67854-0310

Kansas Healthcare Engineers Association Professional Association $500.00 PO Box 308 01/06/2012 Newton, KS 67114-0308

Samuel Turner Chief Executive Officer $500.00 Box 2923 01/31/2012 Shawnee Mission, KS 66201-1323

Patricia Stevenson Manager, Quality Management $100.00 21308 W. 51 sl. Street 01/31/2012 Shawnee Mission, KS 66218·9089

Robin Harrold Senior Vice President $150.00 0113112012 13402 W. 72nd SI. Shawne.e, KS 66216-4158

Bradley Hoffman Hospital Employee $100.00 01/31/2012 7811 Alden Rd. Lenexa, KS 66216-4277

Sheri Hawkins Vice President $100.00 01/31/2012 14013 West 72nd Street Shawnee, KS 66216-3781

David Gregory Adm Director $75.00 01/31/2012 27085 West 226th Street Spring Hill, KS 66083-9190

arry Botts Chief Medical Officer $100.00 02/02/2012 P200 W 68th St Mission Hills, KS 66208-2135

. c _ .

.::. $2,121.00

Page 1 of 6 -- -- 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 Check Loan E funds Other Receipt

Doug Spear Director of Marketing $100.00 12815 S Rene St 02/02/2012 Olathe, KS 66062-6223 .f

Albert Dudley Adm. Director $100.00 16108 Linden SI. 02/02/2012 Stilwell, KS 66085-9399 .f

Steven Poage Vice PresidenUCFO $500.00 3401 SW Alameda 03/07/2012 Topeka, KS 66614-5109 .f

Randall Peterson President and Chief Executive $1,000.00 1500 SW Tenth Avenue Officer 03/22/2012 Topeka, KS 66604-1301 .f

Jodi Schmidt President $100.00 1902 S. U.S. Hwy. 59P.O. Box 956 03/22/2012 Parsons, KS 67357-0956 .f

Mark Miller Chief Executive Officer $350.00 511 NE Tenth Street 03/22/2012 Abilene, KS 67410-2153 .f

Chad Austin Vice President, Government $115.38 03/22/2012 6518.SW 26th Court Relations Topeka, KS66614-4305 .f

Thomas Bell President and Chief Executive $115.38 03/22/2012 215 Southeast 8th Avenue Officer Topeka, KS 66603-3906 .f

Melissa Hungerford Sr. Vice President $115.38 03/22/2012 6448 SW Bayshore Dr Aubum, KS 66402-9324 .f

Fred Lucky Senior Vice President $230.76 03/22/2012 14607 W 89 Lenexa, KS 66215-2967 .f

~indy Samuelson Vice President $57.72 03/22/2012 1107 NE 54th SI tropeka, KS 66617-4505

$2,784.62

Page _2__ of_6__ 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 E funds Other Receipt

Mark Praeger Surgeon 5100.00 330 Arkansas St Ste 202 03/22/2012 Lawrence, KS 66044-1394 .f

Leonard Hernandez Chief Executive Officer $500.00 445 Hilltop Street 03/26/2012 Elkhart, KS 67950-0937 .f

Associated Purchasing Services APS GPO 52.000.00 215 South East Eighth 06/04/2012 Topeka, KS 66603 .f

Associated Purchasing Services APS GPO $2,000.00 215 South East Eighth 06/04/2012 Topeka, KS 66603 .f

Ron Bender Chief Executive Officer $350.00 POBox512 06/11/2012 Clay Center, KS 67432-0512 .f

John Jacobson Chief Executive Officer 5250.00 06/11/2012 800 Raven Hill Drive Atchison, KS 66002-9204 .f

John Broberg President and Chief Executive 5500.00 06/18/2012 1020 Parkshire Cir Officer Manhattan, KS 66503-2475 .f

Greg Lundstrom Director of Hospital Relations 5500.00 06/18/2012 605 West Lincoln Street Lindsborg, KS 67456-2328 - .f

Dennis Franks Chief Executive Officer 5200.00 06/18/2012 PO Box 426 Chanute, KS 66720-0426 .f

Susan Page President and Chief Executive $350.00 06/18/2012 200 Commodore Street Officer Pratt, KS 67124-2903 .f

Chad Austin Vice President, Government 5134.61 06/26/2012 ~518 SW 26th Court Relations Iropeka, KS 66614-4305 ./

.. ,,.., ·,i,'·';'" ',"," i,. ',.' 'i "'..'...... ",;>'," ...•..• $6,884.61 ,"'..,"";;

Paoe0 3 of 6 _ 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 Check Loan E funds Other Receipt

Thomas Bell President and Chief Executive $134.61 215 Southeast 8th Avenue Officer 06/26/2012 Topeka, KS 66603-3906

Melissa Hungerford Sr. Vice President $134.61 6448 SW Bayshore Dr 06/26/2012 AUburn, KS 66402-9324

Fred Lucky Senior Vice President $269.22 14607 W 89 06/26/2012 Lenexa, KS 66215-2967

Sally Perkins Director of Data Services $26.95 1725 NW Grove 06/26/2012 Topeka, KS 66606-1237

Cindy Samuelson Vice President $67.34 1107 NE 54th St 06/26/2012 Topeka, KS 66617-4505 .f

Terrie W. Huntington for State Senate $250.00 07109/2012 PO Box 8378 Praire Village, KS 66208

St Johns Maude Norton Memorial Hospital community hospital $200.00 07/24/2012 220 North Pennsylvania Columbus, KS 66725-1110 .f

Kevin Han Director, Financial Management $500.00 07/24/2012 6200 SW 34th Terr. Topeka, KS 66614-4667

William Miller Board member $200.00 07/24/2012 1193 Four Mile Rd. Council Grove, KS 66846-8719 .f

Diane Burton Director $100.00 07/24/2012 5602 SW Timberlake Ct. Topeka, KS 66614-4537 .f

Jill Straub Health Information Management $100.00 07/24/2012 17907 SW 28th Street Director opeka. KS 66614-4891

$1,982.73

Page _4__ of_6__ 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· Cbeck Loan E funds Other Receipt

Robert O'Neil Medical Advisor $350.00 1401 SW Pembroke Lane 07/24/2012 Topeka, KS 66604-2535 - Lenora Kinzie Director, Library Services $100.00 1267 Medford 07/24/2012 Topeka, KS 66604-1517

Hiawatha Community Hospital Hospital Contribution $200.00 300 Utah 07/24/2012 Hiawatha, KS 66434-2314

$650.00 ...;:..

Page ~5__ of_6__ 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 E funds Olher Receipt

James Reagan Chief Executive Officer $350.00 600 North Washington Street 07/24/2012 Council Grove, KS 66846-1422 t/

Cheyenne County Hospital Community Hospital $200.00 210 W. First Sl. 07/24/2012 PO Box 547 ~ Saint Francis, KS 6~756-3540

Carrie Saia CNO 5100.00 1110 Columbine Dr 07/24/2012 Holton, KS 66436-8824 t/

Grisell Memorial Hospital community hospital $200.00 210 S Vermont 07/24/2012 Ransom, KS 67572-9525 ~

Bernard Becker VPIChief Human Resources $500.00 4527 SW Crenshaw Dr. Officer 07/24/2012 Topeka, KS 66610-1615 t/ -

Carol Wheeler Vice President $350.00 1248 SW Westside Drive 07/24/2012 Topeka, KS 66615-1236 t/

Lisa Carlton Director $100.00 07/24/2012 5534 NE Indian Creek Rd Topeka, KS 66617-1604 ~

Jane Mackey President & Executive Director $100.00 07/24/2012 3817 SW Clarion Park Topeka, KS 66610-1278 .f ~:']\;,::) "" ,"""", ,t,::;;:",{",.:;" ,,,.,, ':,,~;i:f,i:!:;i!' 1~i. ;,,:(:: ~k ii,'·' 'l!i,'~:l)"'':i ," ,(:; $1.900.00 i' ,F2' """""'. ,iW:

Complete if last page of Schedule A

.Total Itemized Receipts for Period $16,322.96

Total Unitemized Contributions ($50 or less) $583.10

Sale ofPolitical Materials (Unitemized) $0.00

Total Contributions When Contributor Not Known $0.00

$16,906.06

Page _6__ of_6__ SCHEDULEB IN-KIND CONTRIBUTIONS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)

List Occupation & Value of Date Name and Address Industry for Those Giving Description of In-Kind In-Kind of Contribu tor an In-Kind of More Than Contribution Contribution $150

Kansas Hospital Association KHA Hospital Association Postage 02/29/2012 215 S.E. 8th Kansas Hospital Association $303.92 Topeka, KS 66603-3906

Kansas Hospital Association KHA Postage 03/31/2012 215 S.E. 8th $31.11 Topeka, KS 66603-3906

Kansas Hospital Association KHA Hospital Association KHA PAC Audit & Income Tax 215 S.E. 8th Kansas Hospital Association Returns 04/09/2012 $1,775.00 Topeka, KS 66603-3906

Kansas Hospital Association KHA Hospital Association KS Gov!. Ethics Registration Fee 215 S.E. 8th Kansas Hospital Association $240.00 06/13/2012 Topeka, KS 66603-3906

Kansas Hospital Association KHA Postage 215 S.E. 8th 06/30/2012 Topeka, KS 66603-3906 $31.52

$2,381.55

Complete if last page of Schedule B

Total Itemized (over $100) In-Kind Contributions $2,381.55

Total Unitemized ($100 or less) In-Kind Contributions $57.35

$2,438.90

Page _1__ of_1__ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)

Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made If independent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address

AHAPAC-American Hospital Association December 2011 KHA PAC Transfer FEDERAL $759.67 01/03/2012 325 Seventh Street, NW Suite 700

AHAPAC-American Hospital Association Jan 2012 KHA to AHA PAC Transfer FEDERAL 02/21/2012 325 Seventh Street, NW $551.25 Suite 700 Kansas Democratic House Campaign Committee 03/07/2012 PO Box 2083 $250.00 Topeka, KS 66601

AHAPAC-American Hospital Association March 2012 KHA to AHA PAC Transfer FEDERAL $1,603.86 03/27/2012 325 Seventh Street, NW Suite 700

Jeff Longbine for , STATE SENATE 17th KS PO Box 1903 $250.00 06/19/2012 Emporia, KS 66801

Senator Steve Morris for Kansas Senate . Stephen Morris, STATE SENATE 39th KS 600 S. Trindle SI. 06/19/2012 $250.00 Hugoton, KS 67951-2734

AHAPAC-American Hospital Association June 2012 KHA to AHA PAC Transfer FEDERAL 06/26/2012 $1,81'8.28 325 Seventh Street, NW Suite 700

Marci Francisco for Kansas Senate , STATE SENATE 2nd KS 1101 Ohio 06/26/2012 $250.00 Lawrence, KS 66044

Kelly Kultala for State Senate Kelly Kultala, STATE SENATE 5th KS 06/26/2012 12232 Hubbard Rd. $250.00 Kansas City, KS 66109

Kay Wolf for Kansas Senate Kay Wolf, STATE HOUSE 21st KS 06/26/2012 8339 Roe Prairie Village, KS 66207 $500.00

$6,483.06

Page _1_ of_1_1 _ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name ofParty Committee or Political Committee)

Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made Ifindependent or in-kil1;d expenditure in excess of $300 is made for a candidate, list candidate name & address

Jim Denning for Kansas Senate Jim Denning, STATE HOUSE 19th KS 8416 West 115thStreet $250.00 06/26/2012 Overland Park, KS 66210

Julia Lynn for Kansas Senate Julia Lynn, STATE SENATE 9th KS 18837 W. 115th Terrace $250.00 06/26/2012 Olathe, KS 66061

Mary Pilcher-Cook for Kansas Senate Mary Pilcher-Cook, STATE SENATE 18th KS 13910 West 58thPIace $250.00 06/26/2012 Shawnee, KS 66216

John Coen for Kansas Senate John Coen, STATE HOUSE 10th KS 4418 Nebraska Terrace $250.00 06/26/2012 Wellsville, KS 66092

Bob Marshall for Kansas Senate Bob Marshall, STATE SENATE-13th KS 999 215th Street $500.00 06/26/2012 Fort Scott, KS 66701

John C Grange for Kansas Senate John Grange, STATE HOUSE 75th KS 2515 Kacy Cl. EI Dorado 06/26/2012 $250.00 EI Dorado, KS 67042

Jeff King for Kansas Senate Jeff King, STATE SENATE 12th KS 1212 North 2nd Street 06/26/2012 $250.00 Independence, KS 67301

Dwayne Umbarger for Kansas Senate Dwayne Umbarger, STATE SENATE 1.4th KS 1585 70th Road 06/26/2012 $250.00 Box 181 B Thayer, KS 66776 Laura Kelly for Kansas Senate Laura Kelly, STATE SENATE 18th KS 06/26/2012 234 SW Greenwood $500.00 Topeka, KS 66606

Anthony Hensley for Kansas Senate Anthony Hensley, STATE SENATE 19th KS 06/26/2012 2226 SE Virginia Topeka, KS 66605 $250.00

,'.'" .,", ' ",i;" ,;: ci):i::;;'~j :i' i/:."T," 'C: ,', ' >F ;"< ,;• ;:';0, i? }"kaithi~ ". : ,'", "i'!,';'<:);> j' $3,000.00 ::,<,';; , " ,". •• . ",:.'; "" ",."" •,(,i,,': j< ,'"

Page _2_ of_1_1_ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Committee)

Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made Ifindependent or in-Idnd expenditure in excess of $300 is made for a candidate, list candidate name & address

Juanita Roy for Kansas Senate Juanita Roy, STATE SENATE 21st KS 20617 West 96th Street $500.00 06/26/2012 Lenexa, KS 66220

Roger P. Reitz for Kansas Senate Roger P. Reitz, STATE HOUSE 67th KS 1332 Sharingbrook $250.00 06/26/2012 Manhattan, KS 66503

Robert Olson for Kansas Senate Robert Olson, STATE SENATE 23rd KS 19050 West 161 st Street· $250.00 06/26/2012 Olathe, KS 66062

Pete Brungardt for Kansas Senate Pete Brungardt, STATE SENATE 24th KS 522 Fairdale Road $500.00 06/26/2012 Salina, KS 67401

Jean Schodorf for Kansas Senate Jean Schodorf, STATE SENATE 25th KS 3039 Benjamin Court $250.00 06/26/2012 Wichita, ks 67204

Leslie D. Donovan for Kansas Senate Leslie Donovan, STATE SENATE 27th KS 314 N. Rainbow Lake 06/26/2012 $500.00 Wichita, KS 67235

Mike Petersen for Kansas Senate Mike Petersen, STATE SENATE 28th KS 06/26/2012 2608 Southeast Drive $500.00 Wichita, KS 67216-2140

Susan Wagle for Kansas Senate Susan Wagle, STATE SENATE 33rd KS 06/26/2012 4N. Sagebursh $250.00 Wichita, KS 67230

Carolyn McGinn for Kansas Senate Carolyn McGinn, STATE SENATE 31st KS 06/26/2012 11047 N 87W $250.00 . SEDGWICK, KS 67135

Ruth Teichman for Kansas Senate Ruth Teichman, STATE SENATE 33rd KS 06/26i2012 402 N. Union $250.00 Stafford, KS 67578

".,,, '":;r~·~;; ';'., > },:,':":: ,)(: >{""'; ::,,,:, .;(:,'.:;:',<'.... 'j':" ;\F'.';(;",: :~')' ,'/.;:.:,;::~,; ii~!l;~l.~:!jl;i;llf;~: ~:;"?"!Y, $3,500.00 ".,~.: :,:; ':::~;;'.:':':;":,,; "~of. .<;;;:;:T:;~ .":. ''':6'··, ": > i': " \A' '. ',:

Page _3_ of_1_1_ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Naine of Party Conunittee or Political Conunittee)

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

Terry Bruce for Kansas Senate Terry Bruce, STATE SENATE 34th KS 401 East Sherman $500.00 06/26/2012 Hutchinson, KS 67501

Jay Emler for State Senate Jay Emler, STATE SENATE 35th KS 1457 Shawnee Rd $250.00 06/26/2012 Lindsborg, KS 67456

Pat Apple for Kansas Senate Pat Apple, STATE SENATE 12th KS PO Box 626 $500.00 06/26/2012 LOUISBURG, KS 66053

Garrett Love for Kansas Senate Garrett Love, STATE SENATE 38th KS P.O. Box 1 $500.00 06/26/2012 Montezuma, KS 67867

Ralph Ostmeyer for Kansas Senate Ralph Ostmeyer, STATE SENATE 118th KS 602 S Jefferson $500.00 06/26/2012 PO Box 97 Grinell, KS 67738

Chris Steineger for State Senate Chris Steineger, STATE SENATE 6th KS 51 South 64th Street 06/26/2012 $250.00 Kansas City, KS 66111-2002

Elaine S. Bowers for Kansas Senate , STATE SENATE 36th KS 1326 N 150th Rd 06/27/2012 $500.00 Concordia, KS 66901

Pat Colloton for Kansas Senate Pat Colloton, STATE SENATE 11th KS 06/27/2012 2513 W 118th Street $500.00 Leawood, KS 66211

Tim Owens for Kansas Senate Tim Owens, STATE SENATE 8th KS 07/03/2012 7804 W. 100th Street $250.00 Overland Park, KS 66212

Steve Abrams for Kansas Senate Steve Abrams, STATE SENATE 32nd KS 07/03/2012 6964 252nd Road Arkansas City, KS 67005 $250.00

hIS 'al!e $4,000.00

Page _4_ of_1_1_ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (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

Robert Grant for Kansas State House Robert Grant, STATE HOUSE 2nd KS 202 S Appleton Dr $250.00 07/03/2012 Frontenac, KS 66763

Bill Feuerborn for Kansas House Bill Feuerborn, STATE HOUSE 5th KS 1600 Park Road 07/03/2012 Garnett, KS 66032 $250.00

Jene Vickrey for State House Jene Vickrey, STATE HOUSE 6th KS 502 S. Countryside / $150.00 07/03/2012 Louisburg, KS 66053 -

Sheryl Spalding for Kansas House Sheryl Spalding, STATE HOUSE 29th KS 12119 Bluejacket $250.00 07/03/2012 Overland Park, KS 66213

Jim Kelly for Kansas House Jim Kelly, STATE HOUSE 12th KS , 309 S. 5th $250.00 07/03/2012 Independence, KS 67301

Virgil Peck for Kansas House Virgil Peck, STATE HOUSE 11th KS Box 277 07/03/2012 $250.00 Tyro, KS 67364

Robert Montgomery for Kansas House Robert Montgomery, STATE HOUSE 26th KS 1300 E. Sleepy Hollow Drive 07/03/2012 $250.00 Olathe, KS 66062 -

Amanda Grosserode for Kansas House Amanda Grosserode, STATE HOUSE 16th KS 12601 West 99thStreet 07/03/2012 $250.00 Lenexa, KS 66215

Brett Hildabrand for Kansas House Brett Hildabrand, STATE HOUSE 23rd KS 07/03/2012 7352 Royalty Way #108 $250.00 Merriam, KS 66203

Rob Bruchman for Kansas House Rob Bruchman, STATE HOUSE 20th KS 07/03/2012 5016 West 108thTerrace #522 $250.00 Overland Park; KS 66211

$2,400.00

Page _5_ of_1_1_ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name ofParty 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

Barbara Bollier for Kansas House Barbara Bollier, STATE HOUSE 25th KS 6910 Overhill Road $250.00 07/03/2012 Mission Hills, KS 66208

Kelly Meigs for Kansas House Kelly Meigs, STATE HOUSE 17th KS 7842 Rosehill Road $250.00 07/03/2012 Lenexa, ks 66216

Ray Merrick for Kansas House Ray Merrick, STATE HOUSE 37th KS 6874 West 164th Terr $250.00 07/03/2012 Stilwell, KS 66085

Lance Kinzer for Kansas House Lance Kinzer, STATE HOUS~ 14th KS 12549 S Brougham $250.00 07/03/2012 Olathe, KS 66062

Ron Worley for Kansas House Ron Worley, STATE HOUSE 30th KS 8957 Woodstone $250.00 07/03/2012 Lenexa, KS 66219

Tom Burroughs for Kansas House Tom Burroughs, STATE HOUSE 33rd KS 3131 So. 73rd Terr 07/03/2012 $250.00 Kansas City, KS 66106

Kathy Wolfe Moore for Kansas House Kathy Moore, STATE HOUSE 36th KS 3209 N 131 st Street 07/03/2012 $250.00 Kansas City, KS 66109

Connie O'Brien for Kansas House Connie O'Brien, STATE HOUSE 42nd KS 22123 211th SI. 07/03/2012 $250.00 Tonganoxie, KS 66086

. Barbara W. Ballard for Kansas House Barbara W. Ballard, STATE HOUSE 44th KS 07/03/2012 1532 Alvamar Drive $250.00 Lawrence, KS 66047

Tom Sloan for Kansas House Tom Sloan, STATE HOUSE 45th KS 07/03/2012 772 Highway 40 $250.00 Lawrence, KS 66049

$2,500.00

Page _6_ of_1_1_ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name ofParty 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

Paul Davis for Kansas House Paul Davis, STATE HOUSE 46th KS 1731 Indiana $150.00 07/03/2012 Lawrence, ks 66044

Ramon Gonzalez for Kansas House Ramo"n Gonzalez, STATE HOUSE 47th KS PO Box 12 $250.00 07/03/2012 Perry, KS 66073

Marvin Kleeb for Kansas House Marvin Kleeb, STATE HOUSE 48th KS 14206 Eby $250.00 07/03/2012 Overland Park, KS 66221

Sean Gatewood for Kansas House Sean Gatewood, STATE HOUSE 57th KS 1628 NW 33rd Place 07/03/2012 $250.00 Topeka, KS 66618 .

Don Hill for Kansas House Don Hill, STATE HOUSE 60th KS 1720 Luther $250.00 07/03/2012 Emporia, KS 66801

Richard Carlson for Kansas House Richard Carlson, STATE HOUSE 61st KS 26810 Jeffrey Rd 07/03/2012 $250.00 St. Marys, KS 66536

Jerry Henry for Kansas House Gerald Henry, STATE HOUSE 63rd KS 3515 Neosho Road 07/03/2012 $250.00 Cummings, KS 66016

Vern Swanson for Kansas House Vern Swanson, STATE HOUSE 64th KS 07/03/2012 14225th St. $250.00 Clay Center, KS 67432

Fred Rinne for Kansas House Fred Rinne, STATE HOUSE 13th KS 07/03/2012 610 Madison St $250.00 Fredonia, KS 66736

Tom Phillips for Kansas House Tom Phillips, STATE HOUSE 103rd KS 07/03/2012 1530 Barrington Drive Manhattan, KS 66503 $250.00 -

;'i: ....• ...,. ",::,..,'"" .•..• , .f'.';, "":),,,,,:,,::,, '·i, "(".,. "0", ·""""".i',,;~tJ;l;:;,:·,:;:"i .. ,.. ",."",,, ; .. ,:: .• , , .. "" \Y,., , i::'1!]i~!~'f:j;! ."'.,;, ·;';i,~!~·.!.:'!:,,!1; !":;;,, ,'no ',,, $2,400.00 'his pap ";;,::,,. 'r·'· .... ,.,,""'. ".,,,.,,,, .,.' , t:"" ",."", """.'

Page _7_ of_1_1_ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (Name of Party Committee or Political Conunittee)

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

Tom Moxley for Kansas House Tom Moxley, STATE HOUSE 68th KS 1852 S 200 Road $250.00 07/03/2012 Council Grove, KS 66846

Marc Rhoades for Kansas House Marc Rhoades, STATE HOUSE 72nd KS 100 Duncan Terrace $150.00 07/03/2012 Newton, KS 67114

Clark Shultz for Kansas House . Clark Shultz, STATE HOUSE 73rd KS 707 Wasington Circle $250.00 07/03/2012 Lindsborg, KS 67456

Don Schroeder for Kansas House Don Schroeder, STATE HOUSE 74th KS 131 14th Ave. $250.00 07/03/2012 Inman, KS 67546

J. David Crum for Kansas House J. Crum, STATE HOUSE 77th KS 2903 Lakeshore Dr. $250.00 07/03/2012 Augusta, KS 67010

Ed Trimmer for Kansas House Ed Trimmer, STATE HOUSE 78th KS 1402 East 9th 07/03/2012 $250.00 Winfield, KS 67156

Kasha Kelley for State House Kasha Kelley, STATE HOUSE 79th KS Box 1111 07/03/2012 $250.00 Arkansas City, KS 67005

Pete DeGraaf for Kansas House Peter DeGraaf, STATE HOUSE 81st KS 1545 E 119th Street 07/03/2012 $250.00 Mulvane, KS 67110

Steven Brunk for Kansas State House Steven Brunk, STATE HOUSE 85th KS 07/03/2012 8119 E Champions Ct $250.00 Wichita, KS 67226 \

Mario Goico for Kansas House Mario Goico, STATE HOUSE 100th KS 07/03/2012 1254 North Pine Grove Ct. Wichita, KS 67212 $250.00

... ; $2,400.00

Page _8_ of_1_1_ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association P91itical Action Committee (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

Joe Seiwert for Kansas House Joe Seiwert, STATE HOUSE 101st KS 1111 East Boundary Road $250.00 07/03/2012 Pretty Prairie, KS 67570

Susan L. Concannon for Kansas House Susan Concannon, STATE HOUSE 107th KS 921 North Mill '$500.00 07/03/2012 Beloit, KS 67420

Steven Johnson for Kansas House Steven Johnson, STATE HOUSE 108th KS 10197 South Hopkins Road $250.00 07/03/2012 Assaria, KS 67416

Eber Phelps for Kansas House Eber E. Phelps, STATE HOUSE 111th KS 3103 Olympic Lane $250.00 07/03/2012 Hays, KS 67601

Tom Simpson for Kansas House . Tom Simpson, STATE HOUSE 114th KS 400 S 3rd $500.00 07/03/2012 Sterling, KS 67035

Ronald Ryckman for Kansas House Ronald Ryckman, STATE HOUSE 115th KS P.O Box 192 07/03/2012 $250.00 Meade, KS 67864

Vincent Wetta for Kansas House VincentWetta, STATE HOUSE 80th KS 07/03/2012 1204 N Poplar $250.00 Wellington, KS 67152

Kyle Hoffman for Kansas House Kyle Hoffman, STATE HOUSE 116th KS 07/03/2012 1318 Avenue T $250.00 Coldwater, KS 67029

Don Hineman for Kansas House Don Hineman, STATE HOUSE 118th KS 07/03/2012 116 S Longhorn Rd $250.00 Dighton, KS 67839 -

Brian Weber for Kansas House Brian Weber, STATE HOUSE 119th KS 07/03/2012 PO Box 804 $250.00 Dodge City, KS 67801

." '.' ...... : .. .,; $3,000.00 ;:' ..

Page _9_ of_1_1_ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action Committee (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

Rick Billinger for Kansas House , STATE HOUSE 121st KS 310 Acacia Drive $250.00 07103/2012 Goodland, KS 67735

Ward Cassidy for Kansas House Ward Cassidy, STATE HOUSE 120th KS P.O. Box 303 07103/2012 SI. Francis, KS 67756 $250.00

Arlen Siegfreid for Kansas House Arlen Siegfreid, STATE HOUSE 15th KS 1403 W. Prairie Terrace $150.00 07103/2012 Olathe, ks 66061-6807

$650.00

Page _10_ of_1_1_ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Hospital Association Political Action C'ommittee (Name of Party Committee or Political Committee)

Name and Address Purpose of Expenditure Date To Whom Expenditure is Made Amount Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address

Steve Alford for Kansas House J. Stephen Alford, STATE HOUSE 124th KS 4179 East Road 19 07103/2012 Ulysses, KS 67880 $250.00

Shanti Gandhi for Kansas House Shanti Gandhi, STATE HOUSE 52nd KS 5802 Clarion Lakes Way 07106/2012 Topeka, KS 66610 $250.00

Annie Tietze for Kansas House Annie Tietze, STATE HOUSE 56th KS 329 SW Yorkshire Road 07106/2012 Topeka, KS 66606 $250.00

Gene Suellentrop for Kansas House , STATEHOUSE 105th KS 6813 W. Northwind Circle 07106/2012 Wichita, KS 67205 $250.00

Brenda Landwehr for Kansas House Brenda Landwehr, STATE HOUSE 91 st KS 2837 N Edwards 07106/2012 Wichita, KS 67203 $500.00

Bridget Schneider for Kansas House Bridget Schneider, STATE HOUSE 100th KS 9414 Sterling Ct 07106/2012 Wichita, KS 67205 $250.00

Mark Hagen for Kansas House Mark Hagen, STATE HOUSE 28th KS 10801 Mastin Blvd #110 07/10/2012 Overland Park, KS 66210 $250.00

Oletha Faust-Goudeau for Kansas Senate Oletha Faust-Goudeau, STATE SENATE 29th KS 4158 Regents Lane 07/16/2012 Wichita, KS 67208 $250.00

$2,250.00

Complete if last page of Schedule C

Total Itemized Expenditures This Period $32,583.06

$29.00

$32,612.06

. .lJ:LL~·

Page _11_ of__11_