KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIPTS AND EXPENDITURES REPORr!-'T'--=F=I~L-:;;:E::-:;;D~---' OF A POLITICAL OR PARTY COMMITTEE January 10,2012 JAN 0 9 2012 FILE WITH SECRETARY OF STATE KRISWKOBACH SEE REVERSE SIDE FOR INSTRUCTIONt..S~sE~c~RE~TA.:.:...:.RY~O~F~s1:;.,,;,:AT-=-E----J A. Name of Committee: Teamsters 696 D. R. 1. V. E. For KANSAS Address: 3600 NE Sardou Ave.« Bldg #2 City and Zip Code: -------.IT>-l.0.J-f:p,ue;:.Jk,...a;l.....--,--JK.,..S.;l...-----u-66u-6U-.J...-11.1-6=-.1..1..... 6-1-7J..:-R _ This is a (check one): __ Party Committee -----X..- Political Committee B. Check only if appropriate: . __. _ Amended Filing __ Tennination Report C. Summary (covering the period from January 1,2011 through December 31, 2011) . 1. Cash on hand at beginning ofperiod ..' ~............................................... S 2 1 « 14 2 ; 0 3 2. Total Contributions and Other Receipts (Use Schedule A) $ J 0 99'3 . 8....0..- . 3.. Cash available this period (Add Lines 1 and 2) : ;...................... $ 32 ) 1 35.. 8.i 4. Total Expenditures and OtherDisbursements (Use Schedule C) S 8 r 740. 00 .'. .' 5. Cash on hand at close ofperiod (Subtract Line 4 from 3) ~ ;........... S 2 3 r 395.83 6. In-KindContributions (Use ScheduleB) ;.. 7. Other Transactions (Use Schedule D) .. D. ·"1 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 intentionallyflling a false document is a class A misdemeanor." . Signatur 0 reasurer . GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Teamsters 696 D.R.I.V.E. For KANSAS (Narne ofCandidate) 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 Other Receipt 2/17/1 B.L.E.T. KS P.A.C. X 300.00 PO Box 3752 Sa1ina,KS 67401 2/22/1 MoKanNeb Conf of Team ters x 250.00 1850 E Division St ·Sprlngfie1d MO 65803 Labor Union 3/18/1 IBT-DRIVE Committee Non-Profit Labor x 3321.25 25 Louisiana Ave NW Washin ton DC 20001 6/06/1 IBT-DRIVE Committee Non-Profit Labor x 2455.00 25 Louisiana Ave NW Washington DC 20001 8/22/11 IBT-DRIVE Dept Non-Profit Labor x 2391.00 25 Louisiana Ave NW Washington DC 20001 Jl/07/11 IBT-DRIVE Committee Non-Profit Labor x 2155.00 25 Louisiana Ave NW Washin ton DC 20001 10,872.25 Page_l_ of__2_ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Teamsters 696 D.R.I.V.E. For KANSAS (Narne of Candidate) Occupation & Industry of Check Name and Address . Individual Giving More Appropriate Box . Date of Contributor Than $150 Cash Check Loan E funds Other (2) Complete if last page of Schedule A Total Itemized Receipts for Period Total Unitemized Contributions ($50 or less) Sale of Political Materials (Unitemized) Total Contributions When Contributor Not Known Page --.2- of~ SCHEDULEB IN-KIND CONTRIBUTIONS Teamsters 696 D.R.I.V.E. For KANSAS (Narne of Party Committee or Political Committee) Date Name and Address List Occupation & Description of In-Kind Value of of Contributor Industry for Those Giving Contribution In-Kind an In-Kind of More Than Contribution· $150 . .... .......•... / .. Complete if last page .of Schedule B . - Total Itemized (over $100) In-Kind Contributions ~ Total Unitemized ($100 or less) In-Kind Contributions .~ it; •.......... .. TOTAL ~-KINDCONTRIBlrhoNSTm:SPERIOD(to line 60fSummary) 0 Page --l-of--.L SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS ­ Teamsters 696 D.R.I.V.E. For KANSAS (Name ofParty Committee or Political Committee) Purpose of Expenditure Name and Address Amount Date To Whom Expenditure is Made If independent or in-kind expenditure in excess of$300 is ­ made for a candidate, list candidate name & address 1/06/1 Mike MachellforCity Commission Donation 500.00 PO-BOX 442549 Lawrence, KS 66044-25 9 1/28/1 John Alcala-Dist2 Co ricilperson Donation 500.00 520 NE -Lake st Topeka, KS 66616 2/09/1 Revilla 4 City Counc~ Donation 500.00 PO Box5101 To eka, KS 66605 2/09/1" Manspeaker for Topeka city Council Dist #6 Donation 500.00 1304 SW ~ollege Ave Topeka, KS 66604-275 3/18/1 Manspeaker for Topeka Donation 500.00 1304 SW College Ave Topeka, KS 66604-275 3/21/11 Denise Everhart, City Council -Donation 500.00 1706 SE 44th Ter Topeka, KS66609 6/02/11 Governmental Ethics C mmission Register Fee 240.00 109 W 9ih St., Ste 50 Topeka, KS 66612 8/22/1 Annie Kuether Campaig Donation 500.00 1346 SW Wayne Topeka, KS 66604 8/22/11 Ann Mah Campaign Donation 500.00 3351 SE Meadowview Dr Topeka, KS 66605 8/22/-1 Annie Tietze for Kans sHouse Donation 500.00 329 SW Yorkshire Rd Topeka, KS 66606 8/22/11 Sydney Carlin for Rep esentative Donation 500.00 P.O. Box 32 Manhattan, KS 66505 5240.00 Page _1_ of__2_ SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS Teamsters 696 D.R.LV.E. For KANSAS (Name ofParty Committee or Political Committee) Purpose of Expenditure Date Name and Address , Amount To Whom Expenditure is Made Ifindependent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address 9/09/1 Mike Slattery for Kan as House Donation 500.00 P. O. Box 1171 Mission, KS 6621~ 9/27/11 Hensley for Senate Donation 1000.00 2225 SE Vir~inia Ave Topeka, KS 66605 9/27/11 Tbm Hb11and for Kansa Senate Donation 1000.00 P.,O. Box'165 Baldwin City, KS 660 6 9/27/11 Laura Kelly for State Senate Donation 1000.00 234 SW Greenwood Ave Topeka, KS 66606 3500.00 . Complete if last page of Schedule c Total Itemized Expenditures This Period Total Unitemized Expenditures of $50 or less 8740.00 Page ~ of----2­ SCHEDULED OTHER TRANSACTIONS' Teamsters 696 D.R.I.V.E. For KANSAS (Name of Party Committee or Political Committee) Balance at Date Name and Address Nature of Account or LoanP'~y'able Close of or Loan Receivable Period J l . , , ) .,.~ :,~\ ~. J .. ""'?' : ,,>, .': ' >. .,.: ";':',::.'. ..' .. ;) , ." '.. :::'}'\ ..c,.:.. .. '."';"::" 'd-' .. L"" ". .••.• ',', .' •. ~:,;...$ubt9talThis:eage>;: ....•;.: _ , _:,;~<>;.:v>.. .. >: >.:.:),f}:,.';U·': " Complete iflast page of Schedule D Page _1_ of_1_ .