,

KANSAS GOVERNMENTAL ETHICS COMMISSION

RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE October 29, 2012 FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Committee: Kansas Insurance Agents Political Action Committee

Address: 815 SW Topeka Blvd

City and Zip Code: _T_o_p_e_k_a_6_6_6_1_2 _

This is a (check one): __Party Committee .f Political Committee

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

C. Summary (covering the period from July 27, 2012 through October 25, 2012) 1. Cash on hand at beginning of period . $39,876.05 2. Total Contributions and Other Receipts (Use Schedule A) . $17,662.75 3. Cash available this period (Add Lines 1 and 2) .. $57,538.80 4. Total Expenditures and Other Disbursements (Use Schedule C) . $49,750.00 5. Cash on hand at close of period (Subtract Line 4 from 3) . $7,788.80 6. In-Kind Contributions (Use Schedule B) $0.00 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 ofmy 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." - /i ~- :'/ v) i) 10/26/12 . i //77/1 \ /1.)/2.~<1'1· ~A-L Date Sighature of Treasur.er I GEe Form Rev, 2001 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Steve Abrams for Senate 10/8/12 4579 242nd Road Donation 500.00 Arkansas City, KS 67005

J. Stephen Alford for HOR 7/30/12 4179 E. Road 19 Donation 100.00 Ulysses, KS 67880

Miranda Allen for Senate 8/2/12 612 Holmes St. Donation 500.00 Kiowa, KS 67070

Tom Arpke for Senate 10/8/12 512 W. Iron Ave. Donation 500.00 Salina, KS 67401

Clay Aurand for HOR 7/30/12 810 Shady Lane Donation 200.00 Belleville, KS 66935

Richard Billinger for HOR 7/30/12 310 Acacia Donation 200.00 Goodland, KS 67735

Barbara Bollier for HOR 7/30/12 6910 Overhill Rd. Donation 250.00 Mission Hills, KS 66208

" " 10/8/12 250.00

Benny Boman for HOR 7/30/12 1914 Euclid Donation 250.00 Wichita, KS 67213

Elaine Bowers for Senate 7/30/12 1326 N. 150th Rd. Donation 500.00 Concordia, KS 66901

" " 10/8/12 500.00

3,750.00 Subtotal This Page

Page _1_ of 16 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

John Bradford for HOR 10/8/12 125 Rock Creed Loop Donation 250.00 Lansing, KS 66043

Marla Brems for HOR 7/30/12 8610 Mackey St. Donation 250.00 Overland Park, KS 66212

" " 10/8/12 250.00

Anthony Brown for Senate 7/30/12 799 E. 2200 Rd. Donation 500.00 Eudora, KS 66025 " " 10/8/12 500.00

Rob Bruchman for HOR 7/30/12 5016 W. 108th Terr. #522 Donation 250.00 Overland Park, KS 66211

Steve Brunk for HOR 7/30/12 8119 Champions Ct. Donation 250.00 Wichita, KS 67226

" " 10/8/12 250.00

Mike Burgess for HOR 7/30/12 6009 SW 23rd St. Donation 250.00 Topeka, KS 66614

" " 10/8/12 250.00

Larry Campbell for HOR Donation 7/30/12 15803 S. Avalon 250.00 Olathe, KS 66062

j: ;1 r,....., OC :» -'-'7[,'. ' , Subtotal This Page

Page ~ ofJ.fi SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Richard Carlson for HOR 7/30/12 26810 Jeffrey Rd Donation 250.00 St Marys, KS 66536

" " 10/8/12 250.00

Will Carpenter for HOR 8/2/12 6965 SW 18th St Donation 250.00 EI Dorado, KS 67042

" " 10/8/12 250.00

J R Claeys for HOR 10/8/12 2356 Montclair Dr Donation 250.00 Salina, KS 67401

Stephanie Clayton for HOR 10/8/12 ' 9825 Woodson Dr Donation 250.00 Overland Park, KS 66207

Susan Concannon for HOR 7/30/12 921 N Mill Donation 100.00 Beloit, KS 67420

Ken Corbet for HOR 10/8/12 10351 SW 61 st St Donation 250.00 Topeka,KS 66610

J David Crum for HOR 7/30/12 2903 Lake Shore Dr Donation 100.00 Augusta, KS 67010

Paul Davis for HOR 10/8/12 1731 Indiana Donation 250.00 Lawrence, KS 66044

Pete DeGraaf for HOR 7/30/12 1545 E 119th Donation 100.00 Mulvane, KS 67110

2,300.00 Subtotal This Page

Page~of 16 "'

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Jim Denning for Senate 10/8/12 8416 W 11 5th St Donation 500.00 Overland Park KS 66210

Leslie Donovan for Senate 7/30/12 314 N Rainbow Lake Donation 500.00 Wichita, KS 67235

" " 10/8/12 500.00

Douthett & Co CPA PA 7/27/12 1100 SW Wanamaker Rd Ste 102 Accounting services 850.00 Topeka, KS 66604

Willie Dove for HOR 10/8/12 14715 Timber Lane Donation 250.00 Bonner Springs, KS 66012

John Edmonds for HOR 7/30/12 209 NE Ten Rd Donation 250.00 Great Bend KS 67530

" " 10/8/12 250.00

Jay Emler for Senate 10/8/12 1457 Shawnee Rd Donation 500.00 Lindsborg, KS 67456

Keith Esau for HOR 10/8/12 11702 S Winchester St Donation 250.00 Olathe, KS 66061

Oletha Faust-Goudeau for Senate 10/8/12 4158 Regents Lane Donation 500.00 Wichita, KS 67208

Blaine Finch for HOR 10/8/12 5 SW Fairview Dr Donation 250.00 Ottawa, KS 66067

4,600.00 Subtotal This Page

Page~of 16 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Steve Fitzgerald for Senate 10/8/12 3100 Tonganoxie Rd Donation 500.00 Leavenworth,KS 66048

Shanti Gandhi for HOR 10/8/12 5802 Clarion Lakes Way Donation 250.00 Topeka, KS 66610

Randy Garber for HOR 7/30/12 2424 Timberland Terr Donation 250.00 Sabetha, KS 66534

" " 10/8/12 250.00

Ramon Gonzalez for HOR Donation 7/30/12 312 Elm St 250.00 Perry, KS 66073

" to 10/8/12 250.00

John Grange for Senate 7/30/12 2515 Kacy Ct Donation 500.00 EI Dorado, KS 67042

Robert Grant for HOR 7/30/12 202 S Appleton Dr Donation 250.00 Frontenac, KS 66763

" " 10/8/12 250.00

Amanda Grosserode for HOR 10/8/12 12601 W 99th St Donation 100.00 Lenexa, KS 66215

Dennis Hedke for HOR 7/30/12 1669 N Sagebrush St Donation 100.00 Wichita, KS 67230

2,950.00 Subtotal This Page

Page~of ,6 ,

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Jerry Henry for HOR 10/8/12 3515 Neosho Rd Donation 250.00 Cummings, KS 66016

Larry Hibbard for HOR 7/30/12 858 EE75 Rd Donation 250.00 Toronto, KS 66777

Brett Hildabrand for HOR 7/30/12 16820 W 67th St Apt 407 Donation 250.00 Shawnee, KS 66217

" " 10/8/12 250.00

Don Hill for HOR 7/30/12 1720 Luther St Donation 250.00 Emporia, KS 66801

" " 10/8/12 250.00

Don Hineman for HOR 7/30/12 116 S Longhorn Rd Donation 100.00 Dighton, KS 67839

Mitch Holmes for Senate 10/8/12 211 SE 20th Ave Donation 250.00 Stjohn, KS 67576 Jim Howell for HOR 7/30/12 125 Buckthorn Rd Donation 250.00 Derby, KS 67037

" " 10/8/12 250.00

2,350.00 Subtotal This Page

Page~of 18 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Michelle Hucke for HOR 7/30/12 1914 S Locust Donation 250.00 Pittsburg, KS 66762

" " 10/8/12 250.00

Steve Huebert for HOR 7/30/12 619 N Birch Donation 250.00 Valley Center, KS 67147

" " 10/8/12 250.00

Steven Johnson for HOR 7/30/12 10197 S Hopkins Rd Donation 100.00 Assaria, KS 67416

Mark Kahrs for HOR 7/30/12 201 N Post Oak Rd Donation 250.00 Wichita, KS 67206

" " 10/8/12 250.00

Kansans for a Democratic House Donation 10/8/12 500.00

Kasha Kelley for HOR 7/30/12 PO Box 1111 Donation 100.00 Arkansas City, KS 67005

Jim Kelly for HOR 7/30/12 309 S 5th Donation 250.00 Independence, KS 67301

" " 10/8/12 250.00

2,700.00 Subtotal This Page

Page~of 16 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Dan Kerschen for Senate 10/8/12 645 S 263 W Donation 100.00 Garden Plain, KS 67050

Jeff King for Senate 10/8/12 1212 N Second St Donation 500.00 Independence, KS 67301

Lance Kinzer for HOR 7/30/12 12549 S Brougham Donation 200.00 Olathe, KS 66062

" " 10/8/12 250.00

Joe Knopp for Senate 7/30/12 104 Oakwood Cir Donation 500.00 Manhattan, KS 66503

Forrest Knox for Senate 10/8/12 17120 Udall Rd Donation 500.00 Altoona, KS 66710

Brenda Landwehr for HOR 7/30/12 2837 N Edwards St Donation 250.00 Wichita, KS 67204

" " 10/8/12 500.00

Jacob LaTurner for Senate 10/8/12 204 E Euclid St Donation 500.00 Pittsburg, KS 66762

Jeff Longbine for Senate 10/8/12 2801 Lakeridge Rd Donation 500.00 Emporia, KS 66801

3,800.00 Subtotal This Page

Page~of If> SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Garrett Love for Senate 7/30/12 101 Escalanta Donation 500.00 Montezuma, KS 67867

" " 10/8/12 500.00

Steve Lukert for Senate 10/8/12 2420 Acord Rd Donation 250.00 Sabetha, KS 66534

Jerry Lunn for HOR 10/8/12 14512 Horton St Donation 250.00 Overland Park, KS 66223

Julia Lynn for Senate 7/30/12 18837 W 115th Terr Donation 500.00 Olathe, K~ 66061

" " 10/8/12 500.00

Charles Macheers for HOR 10/8/12 21704 W 57th Terr Donation 250.00 Shawnee,KS 66218

Peggy Mast for HOR 7/30/12 765 Road 110 Donation 200.00 Emporia, KS 66801

" " 10/8/12 250.00

Ty Masterson for Senate 10/8/12 1539 Phyllis Lane Donation 250.00 Andover, KS 67002

Carolyn McGinn for Senate 10/8/12 11047 N 87th W Donation 100.00 Sedgwick, KS 67135

3,550.00 Subtotal This Page

Page~of J6 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Dennis McKinney for HOR 7/30/12 1220 S Main Donation 250.00 Greensburg, KS 67054

" " 10/8/12 250.00

Kelly Meigs for HOR 7/30/12 7842 Rosehill Rd Donation 250.00 Lenexa, KS 66216

" " 10/8/12 250.00

Jeff Melcher for Senate 10/8/12 11424 Canterbury Cir Donation 500.00 Leawood, KS 66211

Ray Merrick for HOR 8/2/12 6874 W 164th Terr Donation 500.00 Stilwell, KS 66085

" " 10/8/12 500.00

Janet Mitchell for HOR 10/8/12 1921 SW Damon Ct Donation 250.00 Topeka, KS 66611

Lee Modesitt for HOR 7/30/12 1200 Fremont #15 Donation 250.00 Manhattan, KS 66502

Robert Montgomery for HOR 7/30/12 107 W Cedar Donation 250.00 Olathe, KS 66061

Stephen Morris for Senate 7/30/12 600 S Trindle St Donation 500.00 Hugoton, KS 67951

3,750.00 Subtotal This Page

Page~of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Connie O'Brien for HOR 7/30/12 22123211th Donation 250.00 Tonganoxie, KS 66086

" " 10/8/12 250.00

Rob Olson for Senate 7/30/12 19050 W 161st St Donation 500.00 Olathe, KS 66062

" " 10/8/12 500.00

Thomas Owens for Senate 7/30/12 7804 W 100th St Donation 500.00 Overland Park, KS 66212

Jan Pauls for HOR 7/30/12 101 E 11th Donation 250.00 Hutchinson, KS 67501

" " 10/8/12 250.00

Virgil Peck for HOR 10/8/12 PO Box 277 Donation 250.00 Tyro, KS 67364 Mike Petersen for Senate 7/30/12 2608 Southeast Dr Donation 400.00 Wichita, KS 67216

" " 10/8/12 500.00

Tom Phillips for HOR 10/8/12 1530 Barrington Dr Donation 250.00 Manhattan,KS 66503

3,900.00 Subtotal This Page

Page _1_'_ of J6 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Mary Pilcher-Cook for Senate 10/8/12 13910 W 58th PI Donation 500.00 Shawnee,KS 66216

Larry Powell for Senate 10/8/12 2209 Grandview Dr E Donation 500.00 Garden City, KS 67846

Willie Prescott for HOR 7/30/12 5928 W 216th Terr Donation 200.00 Osage City, KS 66523

Richard Proehl for HOR 10/8/12 510 Pine Ridge Rd Donation 250.00 Parsons, KS 67357

Dennis Pyle for Senate 7/30/12 2979 Kingfisher Rd Donation 500.00 Hiawatha, KS 66434

" " 10/8/12 500.00

Marty Read for HOR 10/8/12 18244 KS Hwy 52 Donation 250.00 Mound City, KS 66056

Marc Rhoades for HOR 7/30/12 1006 Lazy Creek Dr Donation 250.00 Newton, KS 67114

" " 10/8/12 250.00

-­ Aimee Rosenow for HOR 10/8/12 2536 SE Alexander Dr Donation 250.00 Topeka,KS 66605

3,450.00 Subtotal This Page

Page \2... of~ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

John Rubin for HOR 7/30/12 13803 W 53rd St Donation 250.00 Shawnee,KS 66216

" " 10/8/12 250.00

IOJ~5//Z- Ronald Ryckman for HOR 503 N Cedar St Donation 250.00 Meade, KS 67864

" " 10/8/12 250.00

Allen Schmidt for Senate 7/30/12 1464 B Hopewell Rd Donation 250.00 Hays, KS 67601

Vicki Schmidt for Senate 10/8/12 5906 SW 43rd Ct Donation 500.00 Topeka, KS 66610

Don Schroeder for HOR 7/30/12 708 Charles St Donation 100.00 Hesston, KS 67062

Scott Schwab for HOR 7/30/12 14953 W 140th Terr Donation 100.00 Olathe, KS 66062

" " 10/8/12 250.00

Sharon Schwartz for HOR 7/30/12 2051 20th Rd Donation 200.00 Washington, KS 66968

" " 10/8/12 250.00

2,650.00 Subtotal This Page

Page~of )6 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Leslie Scoby for HOR 8/2/12 2112 Deer Run Trail Donation 250.00 Sabetha, KS 66534

Joe Seiwert for HOR 7/30/12 1111 E Boundary Rd Donation 250.00 Pretty Prairie, KS 67570

Clark Shultz for HOR 7/30/12 515 NAsh #9 Donation 500.00 McPheffion,KS 67460

" " 10/8/12 250.00

Arlen Siegfreid for HOR 10/12/12 1403 W Prairie Terr Donation 500.00 Olathe, KS 66061

Tom Sloan for HOR 7/30/12 772 Hwy 40 Donation 100.00 Lawrence, KS 66049

Greg Smith for Senate 10/8/12 8605 Robinson Donation 500.00 Overland Park, KS 66212

Chris Steineger for Senate 10/8/12 51 S 64th St Donation 250.00 Kansas City, KS 66111

Gene Suellentrop for HOR 7/30/12 6813 W Northwind Cir Donation 250.00 Wichita, KS 67205

" " 10/8/12 250.00

Bill Sutton for HOR 10/8/12 301 W Westhoff PI Donation 250.00 Gardner, KS 66030

3,350.00 Subtotal This Page

Page J:l. of 16 SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents 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

Vern Swanson for HOR 7/30/12 1422 5th St Donation 100.00 Clay Center, KS 67432

Jack Thimesch for HOR 10/8/12 234 N Henderson Donation 250.00 Cunningham, KS 67035

James Todd for HOR 10/8/12 9731 W 115th Terr Donation 250.00 Overland Park, KS 66210

Caryn Tyson for Senate 10/8/12 PO Box 191 Donation 500.00 Parker, KS 66072

Jene Vickrey for HOR 10/12/12 502 S Countryside Dr Donation 100.00 Louisburg, KS 66053

Susan Wagle for Senate 7/30/12 4 N Sagebrush St Donation 500.00 Wichita, KS 67230

" " 10/8/12 500.00

Brian Weber for HOR 10/8/12 3105 Gary Ave Donation 250.00 Dodge City, KS 67801 Ken Willard for HOR 7/30/12 24 Dakota Dr Donation 250.00 Hutchinson, KS 67502

Kay Wolf for Senate 10/8/12 8339 Roe Donation 500.00 Prairie Village, KS 66207

Ron Worley for HOR 7/30/12 8957 Woodstone Donation 200.00 Lenexa, KS 66219

3,400.00 Subtotal This Page

Pagehof J& SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Insurance Agents Political Action Committee (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 V / / / / V / /

l// / / $0.00 Subtotal This Page

Complete if last page of Schedule c

Total Itemized Expenditures This Period $49,750.00

Total Unitemized Expenditures of$50 or less 0.00

TOTAL EXPENDITURES & OTHER DISBURSEMENTS $49,750.00 THIS PERIOD (to line 4 of Summary)

Page lJlL of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Insurance Agents 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

1st Choice Insurance LLC 8/20/12 118 W Greeley Ave 75.00 Tribune, KS 67879 ..f

ABK Insurance Agency Inc 8/14/12 3339 SE Adams St 75.00 Topeka, KS 66605-1276 ..f

Agency One 8/9/12 110 N Main ..f 75.00 Otis, KS 67565

Air Capital Insurance LLC 8/21/12 125 E 2nd St ..f 75.00 Wichita, KS 67202

Albright Investment Company Inc 8/15/12 1603 Main ..f 75.00 Winfield, KS 67156

All Insurance Access LLC 8/2/12 3706 S Topeka Blvd Suite 411 t/ 75.00 Topeka, KS 66609-1239

All Insurance Inc 9/4/12 120 E Third .; 75.00 Pratt. KS 67124-0804

Allen Insurance Associates Inc 8/20/12 2153 SE California Ave ..f 75.00 Topeka, KS 66605-1753

Almena State Bank 8/27/12 500 Main ..f 75.00 . Almena, KS 67622

Ambassador Insurance Midwest 8/7/12 11233 Nail Ave Suite 100 ..f 75.00 Leawood, KS 66211

Atkins Insurance Agency 9/6/12 3 E Wall St .; 75.00 Fort Scott, KS 66701-1476

825.00 Subtotal This Page

,", f', Page_.I _of d( . SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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

Autosure Inc 8/8/12 11 00 S Second 75.00 Dodge City, KS 67801 .f

Ayres Insurance Agency LLC 8/27/12 201 Starr Ave 75.00 Miltonvale, KS 67466 .f

Banco Insurance Agency 8/9/12 201 N Main .f 75.00 Haviland, KS 67059

Bergkamp Insurance Center Inc 8/16/12 300 N Main St .f 75.00 South Hutchinson, KS 67505

Berkley & Berkley Agency 7/30/12 104 S Main .f 75.00 Tescott, KS 67484

Bieker Insurance Agency Inc 8/22/12 107 W 13th St t/ 75.00 Hays, KS 67601

Billups Snyder & Associates LLC 8/23/12 905 Walnut .f 75.00 Blue Springs, MO 64013

Bob Dittmann Agency 7/31/12 121 W 5th St .f 75.00 Pittsburg, KS 66762

Bolz Insurance Inc 9/1/12 622 Topeka .f 75.00 Lyndon, KS 66451

Boxler Insurance Agency Inc 8/16/12 108 N First .f 75.00 Norton, KS 67654-0186

Brethren Mutual Aid Agency Inc 8/22/12 3094 Jeep Rd .f 75.00 Abilene, KS 67410-2617

825.00 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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

Bridges Group Inc 9/24/12 117 N Kansas 75.00 Norton, KS 67654-2050 v'

Brown Business Services Inc 10/22/12 127 E 6th St 75.00 Concordia, KS 66901 v'

C Ray Tyler Agency Inc 8/7/12 1999 N Amidon Suite 121 v' 75.00 Wichita, KS 67203-6618

Campbell Insurance Agency 8/6/12 220 Center v' 75.00 Oakley, KS 67748

Cardinal Insurance 10/15/12 332 W 7th St v' 75.00 Junction City, KS 66441

Carson Insurance Group 9/6/12 122 W Main .f 75.00 Mulvane, KS 67110-1763

CBIZ Insurance Services 9/1/12 11440 Tomahawk Creek Pkwy v' 75.00 Leawood, KS 66211-2672

Central Insurance 9/17/12 222 W 8th v' 75.00 Coffeyville, KS 67337

Central Insurance Agency 8/23/12 Box 68 ,f 75.00 Tipton, KS 67485-0068

Cersovsky Insurance Inc 8/6/12 370 N Franklin v' 75.00 Colby, KS 67701

Charlson-Wilson Insurance Agency 8/30/12 555 Poyntz Ave Suite 205 ,f 75.00 Manhatlan,KS 66505

825.00 Subtotal This Page SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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

Citizens Insurance Agency 8/2/12 124 E Commercial St 75.00 Waterville, KS 66548 .f

Clarence L Gile Agency 10/9/12 3174thSt 75.00 Scandia, KS 66966 .f

Cline Wood Agency Inc 8/17/12 4300 W 133rd St .f 75.00 Leawood, KS 66209

Cockrum Insurance Agency 8/1/12 202 S Main .f 75.00 Johnson, KS 67855

Coffey County Insurance LLC 9/13/12 300 Neosho .f 75.00 Burlington, KS 66839

Cohen Brokerage LLC 8/18/12 4120 W 54 St .f 75.00 Roeland Park, KS 66205

Commercial Insurance Assoc Inc 8/13/12 4100 SE 3rd St Suite 104 .f 75.00 Lees Summit, MO 64063

Community Insurance Service Inc 10/5/12 309 Maple .f 75.00 Overbrook, KS 66524

Conrad Insurance Agency 8/24/12 10701 Barkley .f 75.00 Overland Park, KS 66204

Conrade Insurance Group Inc 8/7/12 129 E Broadway Suite 200 .f 75.00 Newton, KS 67114

Corns & Ballard Agency Inc 7/31/12 240 S Main .f 75.00 Greensburg, KS 67054

825.00 Subtotal This Page

!\ 'Jr. Page~of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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

Corporate Insurance Group Inc 10/11/12 15357 Carter ,f 131.25 Overland Park, KS 66221

Cushing Insurance Agency Inc 8/10/12 800 Morgan Ave ,f 75.00 Downs, KS 67437

The Davidson Agency Inc 8/15/12 124 W 2nd ,f 75.00 Delphos, KS 67436

Design Benefits 8/18/12 7570 W 21 st St N #1 038B ,f 75.00 Wichita, KS 67205

Double Eagle Insurance Services 8/31/12 Inc - 7070 W 107th St .f 75.00 Overland Park, KS 66212

E C Mellick Agency LP 7/31/12 415 State t/ 75.00 Atwood, KS 67730

Eberle Insurance Agency 8/8/12 272 Main .( 75.00 Grainfield, KS 67737

Eck Agency Inc 8/8/12 123 N Main ,f 75.00 Attica, KS 67009

Eklund Insurance LLC 8/6/12 1617 Clark ,f 75.00 Goodland, KS 67735

Elliott Insurance Group 8/20/12 278 Fairlane Dr .f 75.00 Louisburg, KS 66053

Elliott Insurance Group Agency Inc 8/1/12 207 N Main ,f 75.00 McPherson, KS 67460

881.25 Subtotal This Page

r ./) I"~ Page J of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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 Casb Cbeck Loan E funds Otber Receipt

Evans Insurance Agency 7/31/12 22 W Broadway 75.00 Lebo, KS 66856 .f

Evans Real Estate Company Inc 10/10/12 502 4th St 75.00 Tonganoxie, KS 66086 .f

Fairview Insurance Agency 8/22/12 412 W Commercial .f 75.00 Fairview, KS 66425

Farmers Crop Insurance LLC 8/6/12 651 E Industrial Trfwy Suite 2 .f 75.00 Rossville, KS 66533

Fidelity LLC 8/24/12 4800 Lamar Ave Suite 101 .; 75.00 Mission, KS 66202-1775

Financial Strategies Inc 8/7/12 100 S 4th St .f 75.00 Leavenworth, KS 66048-2702

First Choice Insurance Agency 8/29/12 105 W Main .f 75.00 Norton, KS 67654

First Group Insurance 8/8/12 136 S Broadway .f 75.00 Sterling, KS 67579-0067

First Insurance Agency 8/16/12 108 E Main .f 75.00 Mount Hope, KS 67108

First Insurance Inc 8/6/12 133 S Main .; 75.00 Smith Center, KS 66967

Flint Hills Insurance Agency 8/14/12 103 N Main .f 75.00 Eskridge, KS 66423

825.00 Subtotal This Page , /AJ ,'"' Page JD..- of --x'L ' SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents Political Action Committee (Name ofParty Committee or Political Committee)

Occupation & Industry of Check Amount of ,I Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Other I Cash Check Loan E funds Other Receipt

Fouts Insurance & Citizens State 8/9/12 Agency - 121 E Main ~ 75.00 Beloit, KS 67420

Fredrickson Insurance Agency Inc 8/10/12 183 S Penn ~ 75.00 Oberlin, KS 67749

Frewen Insurance Agency Inc 8/3/12 115 W Washington ~ 75.00 St Francis, KS 67756

Fuqua Ruth Typer 9/15/12 100 N Lancaster ~ 75.00 Hesston, KS 67062-8954

Garry & Assoc Insurance Agency 8/17/12 135 E 20th Ave .; 75.00 N Kansas City, MO 64116-3412

George J Siebers & Co Inc 8/6/12 8500 Shawnee Mission Pkwy #111 .f 75.00 Shawnee Mission, KS 66202

Goodman Gravley Insurance 10/9/12 Source - 14812 W 117th St .f 75.00 Olathe,. KS 66062-9304

Grant County Insurance Agency 8/6/12 112 W Central Ave ~ 75.00 Ulysses, KS 67880

Great Plains Agency LLC 9/14/12 375 8th Rd ~ 75.00 Bushton, KS 67427

Grinnell Insurance Agency LLC 8/18/12 PO Box 365 .; 75.00 Grinnell, KS 67738

Hagerty Rose & McPherron Inc 9/12/12 106 W 11th Suite 1250 ~ 75.00 Kansas City, MO 64105

825.00 Subtotal This Page

7 '~):\I Page -----L- of.?:! . SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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

Halpin & Company 8/24/12 10701 Barkley 75.00 Overland Park, KS 66211 .f

Hanston Insurance Agency Inc 8/22/12 102 N Logan 75.00 Hanston, KS 67849 .f

Harkness Insurance Inc 8/17/12 119B S Pennsylvania .f 75.00 Ness City, KS 67560

Harrison Brothers Agency LLC 8/6/12 900 N Morgan .f 75.00 Downs, KS 67437

Hattrup Ag Services Inc 9/19/12 313 Colony Ave .f 75.00 Kinsley, KS 67547

Haven Insurance Agency Inc 7/31/12 101 N Kansas Ave .; 75.00 Haven, KS 67543

Healy Insurance Inc 8/31/12 Jayhawk Plaza - 4004 W Hwy 4 .; 75.00 Healy, KS 67850-0200

Heilman Insurance Agency 8/6/12 507 Court St .f 75.00 Clay Center, KS 67432

Heiman Insurance Agency 8/6/12 611 N 2nd St .f 75.00 Seneca, KS 66538

Heinze & Assoc Insurance Inc 9/10/12 107 N Main St .f 93.75 Luray, KS 67649

Heritage Insurance Group Inc 8/17/12 105 N Douglas .f 75.00 Logan, KS 67646

843.75 Subtotal This Page

r. ~. -" >-' 'j\ Page~of~ '.

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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 Efunds Other Receipt , Herndon Insurance Agency Inc 8/3/12 331 Quincy ~ 75.00 Herndon, KS 67739

Hier Insurance Services 10/10/12 301 Main ~ 75.00 Maple Hill, KS 66507

Highland Insurance Services LLC 8/1/12 310 W Main ~ 75.00 Highland, KS 66035

Holmes Insurance Agency 8/15/12 422 N Juliette Ave ~ 75.00 Manhattan,KS 66502-5917

Houtz Agency Inc 7/31/12 709 Broadway ~ 75.00 Marysville, KS 66508

Hoxie State Insurance Inc 8/27/12 824 Main t/ 75.00 Hoxie, KS 67740

ICI 8/4/12 120 W Central ~ 75.00 EI Dorado, KS 67042

IMA of Kansas Inc 8/17/12 8200 E 32nd N ~ 75.00 Wichita, KS 67226 Insurance Back Office Inc 8/29/12 332 N Eaton Dr ~ 75.00 Lawrence, KS 66049-4834

The Insurance Center 8/13/12 105 S Main .; 75.00 Hillsboro, KS 67063

The Insurance Center of Kansas 8/16/12 22121stAve .f 75.00 Dodge City, KS 67801

825.00 Subtotal This Page

r. ~ '---f '"'. 1 Page _J_ of ,y\~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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

Insurance Planning Center Inc 9/6/12 220 N Main ~ 75.00 Eureka, KS 67045

Insurance Professionals Inc 8/21/12 6606 W Central Bldg 101 ~ 75.00 Wichita, KS 67212

Insurance Resources Group Inc 9/12/12 1310 E Park St ~ 75.00 Olathe, KS 66061

Insurance Services Inc 9/24/12 101 N Main ~ 75.00 Caldwell, KS 67022

Insurance Specialists Group LLC 8/1/12 8415 E 21st St N Suite 210 .f 75.00 Wichita, KS 67206-2952

Insurance Store/Edwards Agency 8/2/12 437 N Marshall ,f 75.00 Chapman, KS 67431

Insurance Works 8/30/12 143 E Lincoln .f 75.00 Lincoln, KS 67455

Insurors Inc 8/6/12 9415 E Harry Suite 701 ~ 75.00 Wichita, KS 67207

Island Insurance Inc 8/22/12 Washington St ~ 75.00 Long Island, KS 67647

J & 0 Insurance dba Karl A Scholz 8/6/12 Insurance Inc - 201 N Broadway .f 75.00 Lancaster, KS 66041-0135

J Goodman Insurance Agency 10/25/12 1990 E Santa Fe Suite 103 ~ 75.00 Olathe, KS 66062

825.00 Subtotal This Page

f,'. ....Y·) Page~of~ '.

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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 Cbeck Loan E funds Otber Receipt

Jean A Joyce Agency 8/17/12 567 Diamond Springs Rd ,f 75.00 Denton, KS 66017

Jelinek Insurance Agency 8/28/12 100 Main St ,f 75.00 Munden, KS 66959-0100

Jensen Associates Inc 8/6/12 16 N Main ,f 75.00 Ellinwood, KS 67526

Jepson &Associates 8/27/12 307 Sycamore ,f 75.00 Valley Falls, KS 66088

Jim Gill Agency Inc 9/5/12 215 W Main .; 75.00 Cherryvale, KS 67335

Joe McGuire Inc 8/13/12 1034 E 30th Ave .f 75.00 Hutchinson, KS 67502

John Jaco Inc 10/4/12 820 Main St .f 75.00 GreatBend,KS 67530

Johnston Fiss Insurance 8/10/12 5225 W 75th St Suite 200 ,f 75.00 Shawnee Mission, KS 66208-4403

Kallman Insurance Services LLC 9/10/12 1212 18th St ,f 75.00 Belleville, KS 66935

Kansas Central Services Inc 8/23/12 PO Box 66 .; 75.00 Lyons, KS 67554

KASB Workers Comp Fund 8/3/12 1420 SW Arrowhead Rd ,f 75.00 Topeka, KS 66604

825.00 Subtotal This Page

I /) ~, Page JL-ofdL "

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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 Casb Cbeck Loan E funds Otber Receipt

Kastl-Powell Agency Inc 8/7/12 117 C St .; 75.00 Washington, KS 66968

Keller-Leopold Insurance Inc 8/13/12 302 N Fleming Suite 1 .; 75.00 Garden City, KS 67846

Kellerman Insurance Inc 8/1/12 101 W 4th St .; 75.00 Holton, KS 66436

Kellner Insurance Services 8/21/12 100 Center Dr .; 75.00 Silver Lake, KS 66539

KFSA 8/20/12 PO Box 1747 .f 75.00 Hutchinson, KS 67504-1747

Kidney Insurance Agency 9/17/12 9939 NW US Hwy 24 Suite 2A ~ 75.00 Silver Lake, KS 66539

Kimball Insurance Agency Inc 9/14/12 402 N Washington .; 75.00 Wellington, KS 67152-4060

Kinban Inc 7/31/12 616 Colony Ave .; 75.00 Kinsley, KS 67547

Kingman Insurance Agency Inc 8/27/12 120 W B Ave .; 75.00 Kingman, KS 67068

Kingrey-Kellum Agency Inc 7/31/12 1100 Military Ave .f 75.00 Baxter Springs, KS 66713

The Koger Agency Inc 7/31/12 7154 SW Wattling Ct .; 75.00 Topeka, KS 66614

825.00 Subtotal This Page

'''Vi Page !2of~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Insurance Agents 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 U!!!!!!l Other Receipt

Kralicek Crop Insurance 8/7/12 406 E 1st St 75.00 Hunter, KS 67452 .f

Kramer Agency Inc 8/10/12 106 Main 75.00 Ozawkie, KS 66070 .f

L & W - Andrist Insurance Agency 8/10/12 LLC - 102 E 8th St .f 75.00 Goodland, KS 67735

Labette Insurance Agency 8/13/12 319 4th St .f 75.00 Altamont, KS 67330

Lambert Insurance Agency Inc 8/8/12 2310 Planet Ave .; 75.00 Salina, KS 67401-7510

L1A - Concordia LLC dba Peoples 8/9/12 Insurance - 1409 Lincoln St t/ 75.00 Concordia, KS 66901-4828

Lind-Merrill Inc 8/16/12 6045 Martway Suite 111 .; 75.00 Mission, KS 66202

Linton Insurance Agency LLC 8/7/12 121 N Mill .f 75.00 Beloit, KS 67420

Lonnie Soukup Agency LLC 8/7/12 104 N Douglas Ave .f 75.00 Ellsworth, KS 67439

M & M Insurance Associates 8/23/12 1700 E Douglas .; 75.00 Wichita, KS 67214

Madrigal & Associates Inc 10/5/12 431 Lulu St .f 75.00 Wichita, KS 67211-1716

825.00 Subtotal This Page '.

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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

Marquette Insurance & Real Estate 9/7/12 Agency - 205 N Washington ,f 75.00 Marquette, KS 67464

Max Insurance Agency Inc 8/6/12 4400 College Blvd Suite 250 ,f 75.00 Overland Park, KS 66211

Maximum Insurance LLC 8/1/12 126 W 8th ,f 75.00 Horton,KS 66439

Midland Insurance Group Inc 8/4/12 2969 W 13th St N ,f 75.00 Wichita, KS 67203-6618

Midwest Ag Professionals Inc 8/20/12 28236 SW KK Rd - S Hwy 283 .f 75.00 Jetmore, KS 67854

Midwest Crop Insurance 8/21/12 611 N 11th .; 75.00 Seneca, KS 66538-1583

Midwest Insurance Agency Inc 8/28/12 123 N Tyler Suite 100 .; 75.00 Wichita, KS 67212-3713

Miller & Midyett Real Estate 8/8/12 1045 E 23rd St ,f 75.00 Lawrence, KS 66046 Miller Agency Inc 9/4/12 711 Main St ,f 75.00 Eudora, KS 66025

Miller Insurance Agency RE 8/17/12 9415 E Harry #407 .f 75.00 Wichita, KS 67207-5083

Miner Brothers Company 9/1/12 101 S Pennsylvania Ave .; 75.00 Ness City, KS 67560

825.00 Subtotal This Page

,:/ j 1)/1 Page~of ·..::xl ' I "

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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 ~ Other Receipt

New Century Insurance Group Inc 8/1/12 14161 S Mur-Len Rd 75.00 Olathe, KS 66062 .f

Newkirk Dennis & Buckles Inc 8/3/12 304 N Penn 75.00 Independence, KS 67301 .f

Northeast Kansas Insurance 8/6/12 Agency - 520 Main St .f 75.00 Nortonville, KS 66060

O'Malley Insurance Services LLC 9/10/12 7610 Canterbury .f 75.00 Prairie Village, KS 66208

O'Malley Martin Group LLC 9/1/12 121A East Park St .f 75.00 Olathe, KS 66061

Offerle National Bank Agency 8/3/12 104 E Santa Fe .f 75.00 Offerle, KS 67563

Oliver Insurance Agency Inc 10/22/12 6201 College Blvd #230 .f 75,00 Overland Park, KS 66211-2338

Palmer Insurance Agency 8/6/12 104 E 2nd .f 75.00 Palmer, KS 66962

Personal Service Insurance Inc 8/6/12 211 South St .f 75.00 lola, KS 66749

Pike Insurance 8/27/12 127 Main .; 75.00 Minneola, KS 67865

Plainville Insurance LLC 8/23/12 218 W Mill .f 75.00 Plainville, KS 67663

825.00 Subtotal This Page "

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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

Porter-Spears & Bundy Insurance 8/8/12 Agency Inc - 310 S Main ~ 75.00 Ottawa, KS 66067

Porter Crop Insurance Inc 8/14/12 90101650 Rd ~ 75.00 Fredonia, KS 66736

Prairie Land Insurance Agency 9/1/12 303 Bellview Ave .f 75.00 Winona, KS 67764

Professional Insurance Mgmt Inc 7/31/12 2120 Airport Rd 2nd Floor ~ 75.00 Wichita, KS 67209

Quivira Insurance Agency 8/13/12 118 S Main .f 75.00 Stafford, KS 67578

Raleigh Insurance Agency Inc 8/1/12 340 Main St .f 75.00 Little River, KS 67457

Raymond Bauer Agency Inc 8/6/12 204 Elm St .f 75.00 Burdett, KS 67523

The Reilly Company 8/3/12 608 Delaware ~ 75.00 Leavenworth,KS 66048 Rich & Cartmill - Midwest LLC 10/22/12 13025 S Mur-Len Rd Suite 200 .f 75.00 Olathe, KS 66062-5440

Riegel Insurance Inc 8/23/12 523 Main St .f 75.00 Ford, KS 67842

Robben Insurance Inc 8/3/12 416 Main St .f 75.00 Victoria, KS 67671

825.00 Subtotal This Page

r j o)i;r-) Page ltD of .yl/ '. "

'0

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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 Otber Receipt

Robert E Miller Insurance Agency 8/22/12 373 W 101st Terr Suite 200 .; 75.00 Kansas City, MO 64114-4408

Romme Agency Inc 8/15/12 1008 E 17th St .; 75.00 Hays, KS 67601

Rush County Insurance Services 8/15/12 Inc - 821 Main .; 75.00 LaCrosse, KS 67548

Russell Insurance Agency 8/27/12 1000-3 N Main .; 75.00 Lansing, KS 66043

Rutter-Cline Associates Inc 8/8/12 312 N 8th .f 75.00 Garden City, KS 67846

Salina Insurance Services 7/31/12 157 N 9th .f 75.00 Salina, KS 67401

Samford Stover Agency 8/6/12 525 N Summit .f 75.00 Arkansas City, KS 67005-0833

Saylor Insurance Service Inc 7/30/12 21 Main .; 75.00 Sabetha, KS 66534

SBAIC dba Howell Insurance 8/30/12 713 Main .; 75.00 Ashland, KS 67831

SBS Insurance Agency 8/1/12 502 Main .f 75.00 Seneca, KS 66538

Schifman Remley & Assoc Inc 8/6/12 5201 Johnson Dr Suite 500 .; 75.00 Mission, KS 66205

825.00 Subtotal This Page

.7 ,,~\ Page _1_ of ;{.' '.

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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 ~ Other Receipt

Scribner Insurance Agency LLC 8/4/12 320 Friend St ~ 75.00 Cottonwood Falls, KS 66845

Sims Insurance Services Inc 8/13/12 4621 N Maize Rd ~ 75.00 Maize, KS 67101

Smart Insurance Services 8/24/12 300 N Cedar ~ 75.00 Abilene, KS 67410

Smith County Insurance Services 9/1/12 109 E Court ~ 75.00 Smith Center, KS 66967-0307

Southern Kansas Agency Inc 8/9/12 131 E Randolph ~ 75.00 Howard, KS 67349

Stephens Insurance Inc 8/20/12 2711 W 6th Suite A t/ 75.00 Lawrence, KS 66049

Strongs Insurance Inc 7/31/12 142 r--I Main ~ 75.00 Kingman, KS 67068

Strutt Insurance/F&M Ins Store 8/9/12 990 S Range Suite 2B ~ 75.00 Colby, KS 67701

Stucky Becker Insurance Group 8/7/12 101 N Christian ~ 75.00 Moundridge,KS 67107

Summit Insurance Group 8/16/12 4041 NE Lakewood Way Suite 140 ~ 75.00 Lees Summit, MO 64063-2027

Surety Support Services Inc 8/1/12 7255 W 98th Terr Suite 170 ~ 75.00 Overland Park, KS 66212-2200

825.00 Subtotal This Page

! ,r)r: . ..-,,)r' Page~of~ '.

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents 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...f:!!!!!!l Other Receipt

Tallman Insurance Agency . 10/3/12 406 W 34th St Suite 806 75.00 Kansas City, MO 64111 .f

The Agency Inc 8/16/12 122 N Main 75.00 Lakin, KS 67860 .f

Thomas McGee LC 8/17/12 920 Main Suite 1700 .f 75.00 Kansas City, MO 64105

Troy Insurance Services Inc 8/10/12 111 S Main .f 75.00 Troy, KS 66087

TrustPoint Services Inc dba 8/3/12 TrustPoint Insurance .f 75.00 800 N 4th St Suite 101 D Tyner Insurance Group Inc 7/30/12 226 W Main .; 75.00 Council Grove, KS 66846

United Agency Inc 8/28/12 726 N Summit .; 75.00 Arkansas City, KS 67005

Van Hercke Insurance Agency Inc 8/8/12 11807 College Blvd .f 75.00 Overland Park, KS 66210-1314 W E Avery Agency 7/30/12 201 N Walnut .f 75.00 Peabody,KS 66866

Wade Patton Insurance 10/18/12 527 N Main St .f 75.00 Hutchinson, KS 67501

Walker Insurance Group LLC 8/13/12 PO Box 66 .; 75.00 Sylvia, KS 67581

825.00 Subtotal This Page

," ".~\ Page J of--.JL; '.

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Insurance Agents 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

Whitehead Insurance LLC 10/9/12 5112 E Central 75.00 Wichita, KS 67208 .f

Whitmer Insurance & Financial 8/20/12 Planning - 308 N Douglas Ave .; 75.00 Ellsworth, KS 67439

Willow Brook Insurance LLC 10/19/12 675 E 253rd St .; 75.00 Lyndon, KS 66451-9449

Wright Insurance Agency 10/15/12 112 W Fourth .; 75.00 Bird City, KS 67731

Z Insurance Group LLC 8/13/12 654 N Woodchuck Suite A 75.00 Wichita, KS 67212 .f

375.00 Subtotal This Page

Complete if last page of Schedule A

Total Itemized Receipts for Period 16,125.00

Total Unitemized Contributions ($50 or less) 1,537.75

Sale of Political Materials (Unitemized) 0.00

Total Contributions When Contributor Not Known 0.00

TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary) 17,662.75

.~/" )'\ Page~of0\ Cr