KANSAS GOVERNMENTAL ETHICS COMMISSION
RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE October 31,2016 FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS
A. Name of Committee: Kansas Pharmacists Association Political Action Committee
Address: _1~0_20_S_W_F_a_ir_la_w_n_R_d_. ~ ~ _
City and Zip Code: Topeka, KS 66604
This is a (check one): __ Party Committee ~ Political Committee
B. Check only if appropriate: L Amended Filing __Termination Report
C. Summary (covering the period from July 22,2016 through October 27,2016) .1 VI 1. Cash on hand at beginning of period . $18,840.22 2. Total Contributions and Other Receipts (Use Schedule A) .. $12,438.66 3. Cash available this period (Add Lines I and 2) .. $31,278.88
4. Total Expenditures and Other Disbursements (Use Schedule C) . $22,450.44
5. Cash on hand at close of period (Subtract Line 4 from 3) . $8,828.44 6. In-Kind Contributions (Use Schedule B) . 7. Other Transactions (Use Schedule D) ..
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."
July 17, 2017 Date Signature of Treasurer
GEe Form Rev, 2016 Kansas Pharmacists Association PAC Schedule A - Contributions and Other Receipts
,:~;< Oat!!;;, · •• S;;'H!"> .Name···,.:Z'H:"'· "h'''''':';:: ",:Hu": ,::>71,::/.: .. \' . ,'>c .::/i,f·. Ti!>::i>:"i:i., ., I.," flayment Type • Amount ., -;' 07/31/2016 Emily Prohaska 8193 W 123rd Terr, Overland Park, KS 66213 Pharmacist Credit Card 25000 08/01/2016 Brian Caswell 2900 Rivers Edge, Baxter Springs, KS 96713 Pharmacist Credit Card 200.00 08/01/2016 Jody Reel 311 Harrison St, Sabetha, KS 66534 Pharmacist Credit Card 100.00 08/01/2016 Kevin Vohs 1036 sutherland Dr., Louisburg, KS 660S3 Pharmacist Credit Card 200.00 08/01/2016 Nathan Rockers 23937 Eagle Court Paola KS 66071 Pharmacist Credit Card 100.00 08/01/2016 Van Coble .. 1919 E. 14th St., Winfield, KS 67156 Pharmacist Credit Card 100.00 08/11/2016 Zahra Nasrazadani 745 New York Street, Lawrence. KS 67401 Resident Credit Card 5.00
08/16/2016 Harold Godwin " 10112 W, 98th St. Overland Park, KS 66212 Pharmacist Credit Card . 250.00 08/16/2016 Independent Pharmacy Cooperative 1550 Columbus St, Sun Prairie, WI 53590 Corporation Credit Card 1,000.00 08/16/2016 Michael Bellesine 1660 Troon N., EI Dorado, KS 67042 PharmaCist Credit Card . 1,000.00 08/16/2016 Nicole Ellermeier 5823 W 69th Street, Overland Park, KS 66204 Pharmacist Credit Card 250.00 08/16/2016 Robert Rosenbaum 443 W 7th St, Concordia, K566901 Pharmacist Credit Card 250.00 08/16/Z016 Tonya McClain 1518 E. Fallbrook, Valley Center, KS 67147 Pharmacist Credit Card 1.00 08/18/2016 Barbara AnneSmith 516 N Main Street, Erie, KS 66733-1018 Pharmacist Credit Card 10.00 08/19/2016 Terry Kepka 408 Bradley Street, Ellsworth. KS 67439-3216 Pharmacist Credit Card 315.00 08/22/2016 Julie Keeton 12155 Oak. Greenburg, KS 67054 "" Pharmacist Credit Card 250.00 08/24/2016 Lyle Dauner 217 W North Street, Mankato. KS 66956 Pha rmacist Credit Card 100.00 08/25/2016 John Isaacs ..... 4184 County Rd 2000. Coffeyville, KS 67337 Pharmacist Credit Card 150.00 08/30/2016 Jeffrey Denton 2524 Brett Ave., Salina, KS 67401 Pharmacist Credit Card 250.00 08/30/2016 Sharon Denton 2524 Brett Ave .• Salina, KS 67401 Pharmacist Credit Card 250.00 08/31/2016 David Butler 1406 N. St. Atchison, KS 66002 Pharmacist Credit Card 25.00 08/31/2016 Gary Jones: , 616 Rolling Hills Circle, Newton, KS 67114 Pharmacist Credit Card 25.00 " 08/31/2016 Tim Bredehoft 6209 Palisades Dr, Lawrence. KS 66049 Pharmacist Credit Card 250.00 08/31/2016 Van Coble 1919 E. 14th St., Winfield, KS 67156 Pharmacist Credit Card 65.00 08/31/2016 Zahra Nasrazadani 745 New York Street. Lawrence. KS 67401 Resident Credit Card 10.00 09/01/2016 Brian Caswell 2900 Rivers Edge. Baxter Springs, KS 66713 Pharmacist Credit Card 100.00 09/01/2016 Dared Price 610 Quail Nest Road Winfield, KS 67158 Pharmacist Credit Ca rd 250.00 09/01/2016 lody Reel 311 Harrison St, 5abetha. KS 66534 Pharmacist Credit Card 100.00 09/01/2016 Jody Reel 311 Harrison St, Sabetha, KS 66534 Pharmacist Credit Card 100.00 09/01/2016 Kevin Vohs 1036 Sutherland Dr.. Louisburg, KS 66053 Pharmacist Credit Card 100.00 09/01/2016 Lance Freeman 12762 SE Naron. 5haron, KS 67138 Pharmacist Credit Card 250.00 09/01/2016 Nate Rockers 23937 Eagle Court Paola KS 66071 Pharmacist Credit Card 100.00 09/01/2016 Robert NyqUist 1580 EI Dorado, lawrence. K5 66047 Pharmacist Credit Card 65.00 09/01/2016 Sloane Freeman ...... 1.2762 S6 Naron, Sharon. KS 67138 ..> .... Pharmacist Credit Card 250.00 09/07/2016 Sam Boyajian 440 Skylark Circle, Gardner, KS 66030-1794 Pharmacist Credit Card 100.00 09/12/2016 Merlin McFarland .> .. 1945 Jayhawk Dr., Kingman, KS 67068 ...... '" ' ...... Pharmacist .. Credit Card 50.00 09/15/2016 Don Hill 1720 Luther, Emporia, KS 66801 Pharmacist Credit Card 500.00 09/16/2016 Charlie· Blizard" ' Page 1 of 2 Kansas Pharmacists Association PAC Schedule A - Contributions and Other Receipts atlon ·;·1/ 10/01/2016IV Page 2 of 2 Schedule C Expenditures and Other Disbursements Kansas Pharmacists Association PAC 07/22/2016 Barbara Bollier 6910 Overhill Rd. Shawnee Mission 6620B Campaign Contribution $ 500.00 07/22/2016 Jim Denning 8416 W. 115th St Overland Park 66210 Campaign Contribution $ 500.00 07/22/2016 Jeff Longbine 2801 Lakeridge Rd Emporia 66801 Campaign Contribution $ 1,000.00 07/22/2016 Laura Kelly 234.5W Greenwood Av Topeka 66606 Campaign COntribution $ 500.00 07/22/2016 Carolyn McGinn PO BoxA Sedgwick 67135 Campaign Contribution $ 500.00 07/22/2016 Larf)' D. Salmanns 104 5. Highway 51. Hanston 67849 Campaign Contributio'n $ 500.00 07/22/2016 Elaine S. Bowers 1326 N. 150th Rd. Concordia 66901 Campaign Contribution $ 250.00 07/22/2016 Jene Vickrey 502 S. Countf)'side Dr. Lewisburg 66053 Campaign Contribution $ 500.00 07/22/2016 John Wilson 1923 Ohio 51. Lawrence 66046 Campaign Contribution $ 25000 07/22/2016 Tom BUrroughs 3131 S. 73rd Terrace Kansas City 66106 Campaign Contribution $ 500.00 07/22/2016 Willie Dove 14715 Timber Ln. Bonner Springs 66012 Campaign Contribution $ 50000 07/22/2016 Scott Schwab 14953 W. 140th Terr Olathe 66062 Campaign Contril;lUtion $ 500.00 07/22/2016 Brenda S. Dietrich 6110 S.W. 3Bth Terrace Topeka 66610 Campaign Contribution $ 500.00 07/22/2016 Mark Schreiber 1722 Yucca Lane Emporia 66B01 Campaign Contribution $ 500.00 07/22/2016 Daniel Hawkins 9406 Harvest Ln. Wichita 67212 Campaign Contribution $ 500.00 10/12/2016 QuikPrint 6300 SW 9th Terrace A Topeka 66615 PAC Banner $ 300.17 10/12/2016 Halls Commercial Printing 1935 NW Topeka Blvd. Topeka 66608 PAC Easel Signs $ 150.27 10/19/2016 Jene Vickrev 502 S. Countryside Dr. Louisbur~ 66053 CampalRn Contribution: $ 500.00 10/19/2016 Jim Kellv 309 South 5th 51. Independence 67301 Campaign Contribution $ 25000 10/19/20i6 CindY Neighbor 10405 W. 52nd Terr Shawnee 66203 Campal~n Contribution $ 250.00 10/19/2016 Tom Burroughs 3131 S. 73rd Terrace Kansas Citv 66106 Camoaign Contribution $ 500.00 10/19/2016 Kathv Wolfe Moore 3209 N. 131st Street Kansas CItv 66109 Camoaign Contribution $ 250.00 10/19/2016 Tom Sloan 772 Hwy 40 lawrence 66049 Camoaign Contribution $ 250.00 10/19/2016 Marvin Kleeb 14206 Eby Overland Park 66221 Campaign Contribution· $ 250.00 10/19/2016 Scott Schwab 14953 W. 140th Terr Olathe 66062 Campaign Contribution $ 500.00 10/19/2016 Brenda S. Dietrich 6110 S.W.38th Terrace Topeka 66610 Campaign Contribution .. $ 250.00 10/19/2016 Jim Gartner 928 SW Woodbrid~e CI. Topeka 66606 Camoaign Contribution $ 250.00 10/19/2016 Blaine finch 5 SW Fairview Drive Ottawa 66067 Campai~ri Contribution $ 250.00 10/19/2016 Mark Schreiber 1722 Yucca Lane Emooria 66801 Campai n Contribution $ 250.00 10/19/20i6 Randv Garber 2424 Timberlane Ter. Sabetha 66534 Camoai~n Contribution $ 250.00 10/19/2016 Susie Swanson 1422 5th St. Clay Center 67432 Campaign Contribution $ 250.00 10/19/2016 SvdnevCarlin 1650 Sunny Slope Lane Manhattan 66502 Campai~n Contribution $ 250.00 10/19/2016 Tom Phillios 1530 Barrin~ton Drive Manhattan 66503 Campaign Contribution $ 25000 10/19/2016 MarY Martha Good 89 Sf 20th Street EI Dorado 67042 CamOalRn Contribution $ 250.00 10/19/2016 Ron Rvckman 14234 W lS8th St. Olathe 66062 Campa;~n Contribution $ 250.00 10/19/2,016 Johncarrnicnael 1.475 N. Ueunett , Wichita 67203 Camoai~rici'"tributii,"" 'r' $ 250.00 10/19/2016 Daniel Hawkins 9406 Harvest Ln. Wichita 67212 Camoai.n Contribution $ 500.00 ;10/19/20i6 Susan V Concannon ·,de: 921 N. Mill· , TP:,"," 8eloit '.:. 67420 Pc ',' campaigncilritfibUtion .;., ··v, '.'y<,<' $ 250.00 10/19/2,016 Adam Smith 1970 RD 3 Weskan 67762 Campaign Contribution $ 250.00 10/19/2016 h:RQ$sell JenniOlts." 515 Pleasantview.'; " Lakin .. '.. ; ..... 67860 1,;1·"'·i" • '.', Campaign COntribUtion' :. $ :250.00 10/19/2016 John P. Wheeler Jr. 902 Anderson Street Garden Citv 67846 Campaign Contribution $ 250.00 10/19f2016 JerrvHenrv 3515 Neosho Road Cummin~s 66016 :,- CamoaiRnContribution .. >" $ 500.00 10/19/2016 Tom Holland 961 E. 1600 Road Baldwin Citv 66006 Camoai~n Contribution $ 500.00 . " '1019/2,oi6 Barbarii'aollier 6910 Overhill Rd. ",,:,; -"~h' MiSsion Hills 66208 'co .:;> Camoai~nContJibution .: $ 500,00 10/19/2016 Jim Dennin. 8416 W. 115th St Overland Park 66210 Camoaign Contribution $ 500.00 tOli9/i016 Bruce Givens<; :'" 1525 County Club Fid/' ; ElDorado· . ,<> 67042 ';Carnoal~riContribUtiOn" . ·'::·:j.v" 5" 500.00 10/19/2016 Jeff L"ngbine 2801 Lakeridge Rd Emooria 66B01 Campaign Contribution $ 500.00 10/19/2016 Laura Kellv '" >'0; 234.5W Greenwood Av Topeka L ..••• 66606· :.... ;' CampaignContrlbutlori >: i 5' 500.00 10/19/2016 Vicki L. Schmidt 5906 SW 43rd Ct Topeka 66610 Campaign Contribution $ 1,000.00 10/19/20i6 Tom HaWk i 2600 Woodhaven Ct. Manhattan 66502 Ca",oalRn Contribotion $ 500.00 10/19/2016 Susan Wagle 4 N. Sa~ebfUsh Wichita 67230 Campai~n Contribution " $ 1.000.00 10/19/2016 Edward f: 8er.er 2501 Briarwood Ln :';' Hutchinson 67502 Campal~n Contribution, 1$ 500.00 10/19/2016 Elaine S. Bowers 1326 N. 150th Rd. Concordia 66901 Campaign Contribution $ 50000 10/19/2016 Richard Blllin~er 310 Acacia Dr Goodland 67735 Campaign Contribution $ 500.00 TOTAL $ 22,450.44 Page 1 of 1