,
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
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