GOVERNMENTAL ETHICS COMMISSION

____---.,--.~---n-f,ECEIPTS AND EXPENDITURES REPORT \ CF 'A POLITICAL OR PARTY COMMITTEE \ \ JAN 0 7 2010 January 10,2010 \ \ RONT~ORN8URGH FILE WITH SECRETARY OF STATE l§.s~F~.ET~qy.Q_r:. STATREE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Committee: HCA Kansas Good Government Fund

Address: _5_50_N_._H_i1_ls_id_e ~-- ____:.... ~ _

City and Zip Code: _W_i_C_h_it_a_6_7_2_1_4 _

This is a (check one): _._ Party Committee ,( Political Committee

B. Check only ifappropriate: __Amended Filing __ Termination Report

C. Summary (covering the period from January 1, 2009 through December 31, 2009) 1. Cash on hand at beginning ofperiod ; . 1,752.13 2. Total Contributions and Other Receipts (Use Schedule A) .. 35,000.00

~. Cash available this period (Add Lines 1 and 2) ;.. 36,752.13

4. Total Expenditures and Other Disbursements (Use Schedule C) .. 32,690.00

5. Cash on hand at close ofperiod (Subtract Line 4 from 3) ~ . 4,062.13

6. In-Kind Contributions (UseSchedule B) ...:..... o

7. Other Transactions (Use Schedule D) . o

D. "I declare that this report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is true, correct and complete. I understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."

Date Signature of; reasurer

. GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

HCA Kansas Good Government Fund (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 Ca.h Check LoaD Other Other Receipt

Menorah Medical Center 9/4/09 5721 West 119th Street .; $8,750.00 Overland Park, KS 66209

Overland Park Regional Med Ctr 10/2/09 10500 Quivira .; $8,750.00 Overland Park, KS 66215

Wesley Medical Center 11/24/09 550 N. Hillside .; $17,500.00 Wichita, KS

$35,000.00

Complete iflast page of Schedule A

Total Itemized Receipts for Period $35,000.00

Total Unitemized Contributions ($50 or less)

Sale of Political Materials (Unitemized)

Total Contributions When Contributor Not Known ",',,"",;,:: ,,'< ",.':' 'l,~l ,L~~~t() ~ c'>:;:",,;";:'." $35,000.00 TOTAL tt,li:) ';c.::":··',"' ..... "

Page __ of__' _ SCHEDULEB IN-KIND CONTRIBUTIONS

HCA Kansas Good Government Fund (Name of Party Committee or Political Committee)

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

$0.00

.-c' $0.00 .~ 11

Complete if last page of Schedule B

Total Itemized (over $100) In-Kind Contributions

Total Un itemized ($100 or less) In-Kind Contributions

$0.00

Page of__ .SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

HCA Kansas Good Government Fund ( Name of Party Committee or Political Committee)

Name and Address Pu rpose of Expend iture Amount To Whom Expenditure is Made Date

See attachment $32,690.00

$32,690.00

Complete if last page of Schedule c

Total Itemized Expenditures This Period $32,690.00

Total Unitemized Expenditures of$50 or less

$32,690.00

Page __ of__ HCA Kansas Good Government Fund SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Date Name Name Address Amount Jan - Dec 09 6/19/2009 Governmental Ethic . Governmental Ethics Comm. 109 SW 9th, Suite 504 Topeka, KS 66612 240.00­ 10/20/2009 Kansas Hospital As . Kansas Hospital Association 215 SE 8th Topeka, KS 66601 2,000.00­ 12/412009 Brown, Tony for Sta . Rep. Tony Brown 702 First St. Box 364 Baldwin City, KS 66006 200.00­ 12/4/2009 Gatewood for State . Rep. Box 306 Columbus, KS 66725 200.00­ 12/4/2009 Jerry Williams for S . Rep. Jerry Williams 21225 Kiowa Road Chanute, KS 66720 200.00­ 12/4/2009 King for State Repr. .. Rep. Jeff King 1212 N 2nd Street Independence, KS 67301 200.00­ 12/4/2009 Kinzer for State Re . Rep. 12549 S Brougham Olathe, KS 66062 250.00­ 12/4/2009 Meng hini for State . Rep. 1207 E Quincy Pittsburg, KS 66762 200.00­ 12/4/2009 Otto for State Repr. .. Rep. Bill Otto 102 9th Street LeRoy, KS 66857 300.00­ 12/4/2009 Peck for State Repr. .. Rep. Virgil Peck, Jr. Box 277 Tyro, KS 67364 200.00­ 12/4/2009 Proehl for State Re . Rep. 510 Pine Ridge Road Parson, KS 67357 200.00­ 12/4/2009 Vickrey for State Re . Rep. Jene Vickrey 502 S. Countryside Drive Louisburg, KS 66053 200.00­ 12/4/2009 Benlon for State Re . Rep. Lisa Benlon 8725 W. 79th St. Overland Park, KS 66204 200.00­ 12/4/2009 Furtado for State R . Rep. 10104 Hemlock Dr Overland Park KS 66212 200.00­ 12/4/2009 Neighbor for State . Rep. 10405 W. 52nd Terrace Shawnee, KS 66203 200.00­ 12/4/2009 Quigley for State R. .. Rep. 13112 SW 84th St. Lenexa KS 66215 250.00­ 12/4/2009 Rardin for State Re ... Rep. Gene Rardin 10900 W. 104th Street Overland Park KS 66214 300.00­ 12/4/2009 Siegfreid for State .. , Rep. 1403 W. Prairie Terrace Olathe, KS 66061 250.00­ 12/4/2009 Slattery for State R. .. Rep. Mike Slattery 5015 Reeds Road Box 1171 Mission, KS 66222 200.00­ 12/4/2009 Talia for State Repr... Rep. Milack Talia 6829 Bluejacket St. Shawnee, KS 66203 200.00­ 12/4/2009 Wolf for State Repr. .. Rep. Kay Wolf 8339 Roe Avenue Prairie Village, KS 66207 200.00­ 12/4/2009 Yoder for State Rep . Rep. Kevin Yoder 5817 W. 1OOth Terrace Overland Park, KS 66207 350.00­ 12/4/2009 Ballard for State Re . Rep. 1532 Alvamar Drive Lawrence, KS 66047 200.00­ 12/4/2009 Burroughs for State . Rep. 3131 S. 73rd Terrace Kansas City, KS 66106 200.00­ 12/4/2009 Colloton for State R. .. Rep. 2513 W 118th Street Leawood, KS 66211 200.00­ 12/4/2009 Crow for State Repr. .. Rep. 302 Shawnee Leavenworth, KS 66048 200.00­ 12/4/2009 Donohoe for State . Rep. 6265 Arapahoe Shawnee, KS 66226 200.00­ 12/4/2009 Merrick for State Re . Rep. Ray Merrick 6874 W. 164th Terrace Stilwell, KS 66085 300.00­ 12/4/2009 Navinsky for State . Rep. Don Navinsky 32421 255 Street Easton KS 66020 200.00­ 12/4/2009 Ruiz for State Repr. .. Rep. 2914 W 46th Avenue Kansas city, KS 66103 200.00­ 12/4/2009 Spalding for State . Rep. 12119 Bluejacket Overland Park, KS 66213 200.00­ 12/4/2009 Worley for State Re . Rep. 8957 Woodstone Street Lenexa, KS 66219 200.00­ 12/4/2009 Davis for State Rep . Rep. Paul Davis 1731 Indiana Lawrence, KS 66044 250.00­ 12/4/2009 Hill for State Repre . Rep. Don Hill 1720 Luther Emporia, KS 66801 200.00-. 12/4/2009 Kleeb for State Rep . Rep. 14206 Eby Overland Park KS 66221 200.00­ 121412009 Lane for State Repr . Rep. Harold Lane 1308 S Kansas Topeka, KS 66612 200.00­ 1214/2009 Mah for State Repr . Rep. 3351 SE Meadowview Drive Topeka KS 66605 200.00­ 12/4/2009 Prescott for State R . Rep. William Prescott 5928 SW 216th Terrace Osage City KS 66523 200.00­ 12/4/2009 Schwab for State R . Rep. Scott Schwab 14953 W. 140th Terrace Olathe, KS 66062 200.00­ 12/4/2009 Sloan for State Rep .. Rep. Tom Sloan 772 Hwy 40 Lawrence, KS 66049 200.00­ 12/4/2009 Tafanelli for State R . Rep. Lee Tafanelli 7075 122nd Street Ozawkie, KS 66070 200.00­ 12/4/2009 Tietze for State Rep . Rep. 329 SW Yorkshire Road Topeka, KS 66606 200.00­ 12/4/2009 Brookens for State .. Rep.Robert Brookens 201 Meadow Lane Marion, KS 66861 200.00­ 12/4/2009 Carlin for State Rep . Rep. 1650 Sunnyslope Lane Manhattan, KS 66505 200.00­ 12/4/2009 Craft for State Repr . Rep. Barbara Craft 110 S. Garfield Box 1767 Junction City, KS 66441 200.00­ 12/4/2009 Hawk for State Rep . Rep. 3115 Harahey Ridge Manhattan, KS 66502 200.00­ 12/4/2009 Henry for State Rep . Rep. Gerald T. Henry 3515 Neosho Road Cummings, KS 66016 . 200.00­ 12/4/2009 Moxley for State Re . Rep. Tom Moxley 1852 S. 200 Road Council Grove, KS 66846 200.00­ ·12/4/2009 Rhoades for State . Rep. 1006 Lazy Creek Drive Newton KS 67114 250.00­ 12/4/2009 Roth for State Repr . Rep. 3 Crestview Drive Salina, KS 67401 200.00­ 12/4/2009 Schroeder for State .. Rep. 131 14th Avenue Inman, KS 67546 200.00­ 12/4/2009 Shultz for State Re .. Rep. Clark Shultz 707Washington Circle Lindsborg, KS 67456 . 250.00­ 12/4/2009 Brunk for State Rep . Rep. Steve Brunk 4430 Janesville Bel Aire, KS 67220 250.00­ 12/4/2009 Crum for State Rep . Rep. David Crum 2903 Lakeshore Drive Augusta, KS 67010 250.00­ 12/4/2009 DeGraaf for State R . Rep. Peter DeGraaf 1545 E. 119th Mulvane KS 67220 250.00­ 12/4/2009 Finney for State Re .. Rep. 1754 N. Madison Avenue Wichita, KS 67214 300.00­ 12/4/2009 Kelley for State Rep . Rep. Kasha Kelley Box 1111 Valley View Arkansas City, KS 67005 200.00­ 12/4/2009 Loganbill for State . Rep. Judy Loganbill 215 S. Erie Wichita, KS 67211 . 200.00­ 12/4/2009 Mast for State Repr . Rep. Peggy Mast 765 Road 110 Emporia, KS 66801 250.00­ 12/4/2009 Pottorff for State Re .. Rep. 6321 E 8th Street Wichita, KS 67208 250.00­ 12/4/2009 Trimmer for State R . Rep. (Kenneth) 1402 E. 9th Street Winfield, KS 67156 200.00­ 12/4/2009 Ward for State Repr . Rep. Jim Ward 3100 E. Clark Wichita, KS 67211 250.00­ . 12/4/2009 Barnes, Melany for . Rep. 1816 Burton Wichita, KS 67213 200.00­ 12/4/2009 Dillmore for State R.oo Rep. Nile Dillmore 1102 Jefferson Wichita, KS 67203 200.00­ 12/4/2009 Flaharty for State R... Rep. Geraldine Flaharty 1816 Fernwood Wichita, KS 67216 250.00­ 12/4/2009 Hermanson for Stat... Rep. Phil Hermanson 5338 S. Mosley Wichita, KS 67216 200.00­ 12/4/2009 Jack, Aaron for Stat... Rep. Aaron Jack 1330 N. Robin Court Andover KS 67002 250.00­ 12/4/2009 Kerschen for State . Rep. 645 S. 263 W. Garden Plain, KS 67050 200.00­ 12/4/2009 Landwehr for State . Rep. 2837 N. Edwards Street Wichita, KS 67204 400.00­ HCA Kansas Good Government Fund SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Date Name Name Address Amount

12/4/2009 McLeland for State ... Rep. Joe McLeland 431 S. Westfield Wichita, KS 67209 250.00­ 12/4/2009 Melody McCray-Mill. .. Rep. Melody McCray-Miller Box 44542121 E. 53rd N. Park City, KS 67219 200.00­ 12/4/2009 Swenson for State . Rep. Dale Swenson 3351 S. McComas Wichita, KS 67217 200.00­ 12/4/2009 Aurand for State Re . Rep. Clay Aurand 2136 30 Road Courtland, KS 66939 200.00­ 12/4/2009 Bowers for State Re . Rep. 1326 N. 150th Road Concordia, KS 66901 200.00­ 12/4/2009 Dan Johnson for St . Rep. Dan .Iohnson 1461 Homestead Rd. Box 247 Hays, KS 67601 200.00­ 12/4/2009 Garcia for State Re . Rep. Delia Garcia Box 48283 Wichita, KS 67201 250.00­ 12/4/2009 Goico for State Rep . Rep. 1254 N. Pine Grove CI. Wichita, KS 67212 200.00­ 12/4/2009 O'Neal for State Re . Rep. Mike O'Neal 8 Windemere Court Hutchinson, KS 67502 300.00­ 12/4/2009 Phelps for State Re . Rep. Eber E Phelps 3103 Olympic Lane Hays, KS 67601 200.00­ 12/4/2009 Schwartz for State . Rep. 2051 20th Road Washington, KS 66968 300.00­ 12/4/2009 Seiwert for State Re . Rep. 1111 E. Boundary Road Pretty Prairie KS 67570 250.00­ 12/4/2009 Svaty, Don for Stat... Rep. Don Svaty 1355 US Highway 156 Ellsworth, KS 67439 200.00­ 12/4/2009 Bethell for State Re . Rep. Box 186 - 104 E. 3rd Alden, KS 67512 250.00­ 12/4/2009 Faber for State Rep . Rep. John Faber HC 2 Box 130 Brewster, KS 67732 200.00­ 12/4/2009 George for State Re . Rep. Pat George 3007 Westview Dodge City, KS 67801 250.00­ 12/4/2009 Hineman for State . Rep. 116 S. Longhorn Road Dighton, KS 67839 200.00­ 12/4/2009 Holmes for State R .. Rep. 211 SE 20th Avenue SI. John, KS 67576 200.00­ 12/4/2009 Larry Powell for Sta . Rep. Larry Powell 2209 Grandview Drive East Garden City, KS 67846 200.00­ 12/4/2009 Maloney for State R .. Rep. Pat Maloney 1740 N. Spruce Kingman, KS 67068 200.00­ 12/4/2009 Morrison for State R . Rep. Jim Morrison #3 Cottonwood Dr. Colby, KS 67701 250.00­ 12/4/2009 Neufeld for State R .. Rep. Melvin Neufeld 7405 15 Road Ingalls, KS 67853 250;00­ 12/4/2009 William Wolf for Sta . Rep. Bill Wolf 1512 Broadway Court Box 445 Great Bend, KS 67530 200.00­ 12/4/2009 Brownback for Gov .. Han. Sam Brownback Box 3739 Topeka, KS 66604 2,000.00­ 12/4/2009 Hayzlett for State R . Rep. 308 E Russell Road Lakin, KS 67860 200.00­ 12/4/2009 Kultala for State Se . Sen. Kelly Kultala 12232 Hubbard Road Kansas City, KS 66109 250.00­ 12/4/2009 Light for State Repr . Rep. Bill Light 504 Washington Box 287 Rolla, KS 67954 200.00­ 12/412009 Lynn for State Senate Sen. Julia Lynn 18837 W. 115th Terrace Olathe KS 66061-9379 250.00­ 12/4/2009 Owens for State Se . Sen. Thomas (Tim) C. Owens 7804 W. 100th Street Overland Park, KS 400.00­ 12/4/2009 Praeger for Insuran .. Han. Sandy Praeger 3601 Quail Creek Court Lawrence, KS 66047 250.00­ 12/4/2009 Pyle for State Senate Sen. 2979 Kingfisher Road Hiawatha, KS 66434 250.00­ 12/4/2009 Schmidt for Attorne . Derek Schmidt Box 804 Independence, KS 67301 500.00­ 12/4/2009 Vratil for State Sen . Sen. John Vratli 9534 Lee Boulevard Leawood,KS 66206 400.00­ 12/4/2009 Brownlee for State . Sen. Karin Brownlee 14725 S. Chalet Drive Olathe, KS 66062 250.00­ 12/4/2009 Brungardt for State .. Sen. Pete Brungardt 522 Fairdale Road Salina, KS 67401 250.00­ 12/4/2009 Donovan for State .. Sen. Les Donovan, Sr. 314 N Rainbow Lake Wichita, KS 67235 250.00­ 12/4/2009 Hensley for State S . Sen. Anthony Hensley 2226 S.E. Virginia Topeka, KS 66605 250.00­ 12/4/2009 Marshall for State S . Sen. Bob Marshall 999 215th Street, Box 1131 Ft. Scott, KS 66701 250.00­ 12i4/2009 Masterson for State . Sen. 1539 Phyllis Lane, Box 424 Andover, KS 67002 250.00­ 12/4/2009 Reitz for State Senate Sen. Roger Reitz 1332 Sharingbrook Manhattan, KS 66503 250.00­ 12/4/2009 Taddiken for State . Sen. Mark Taddiken 2614 Hackberry Road Clifton, KS 66937' 250.00­ 12/4/2009 Umbarger for State .. Sen. Dwayne Umbarger 1585 70th Street Thayer, KS 66776 250.00­ 12/4/2009 Vicki Schmidt for St... Sen. Vicki Schmidt 5906 SW 43rd Court Topeka, KS 66610-1632 250.00­ 12/4/2009 Abrams for State S .. Sen. Steve Abrams 4579 242nd Road Arkansas City, KS 67005 250.00­ 12/4/2009 Colyer for State Se .. . Sen: Jeff Colyer 13825 Horton Overland Park, KS 66223 250.00­ 12/4/2009 Emler for State Sen . Sen. Jay Emler 1457 Shawnee Road Lindsborg, KS 67456 400.00­ 12/4/2009 Faust-Goudeau for .. Sen. Oletha Faust-Goudeau Box 20335 Wichita, KS 67208 400.00­ 12/4/2009 Lee for State Senate Sen. Janis Lee RI. 2, Box 145, 2032 90th Rd. Kensington, KS 66951 250.00­ 12/4/2009 McGinn for State S .. Sen. Carolyn McGinn 11047 N. 87th West Sedgwick KS 67135 250.00­ 12/4/2009 Morris for State Sen . Sen. Steve Morris 600 Trindle Street Hugoton, KS 67951 250.00­ 12/4/2009 Petersen for State . Sen. Mike Petersen 2608 Southeast Drive Wichita, KS 67216 250.00­ 12/4/2009 Teichman for State .. , Sen. Ruth TeichlT]an 434 E Old Hywy 50 Stafford, KS 67589 250.00­ 12/4/2009 Wagle for State Se . Sen. 4 Sagebrush Wichita, KS 67230 250.00­ 12/4/2009 Ostmeyer for State .. Sen. Ralph Ostmeyer 602 S Jefferson Grinnell, KS 67738 250.00­ 12/4/2009 Winn for State Repr . Rep. 1044 Washington Blvd Kansas City, KS 66102' 200.00­ Jan -Dec 09 32,690.00­ SCHEDULE D OTHER TRANSACTIONS

HCA Kansas Good Government Fund (Name of Party Committee or'Political Committee)

Balance at Date Name and Address Nature of Account or Loan Payable Close of or Loan Receivable Period

. ..:....:. .':".;,,' ): ,'." .... ~ ~~i!f~!;~~i'!i ... <;; ...... ;>,. "';,~_ <'C: ';,[: $0.00 ~u i1"l II

Complete if last page of Schedule D

Page of__