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 ofCOlmnittee: Kansas State Farm Insurance Agents and Employees PAC Address: 825 S. Kansas Avenue, Suite 500 City and Zip Code: _T_o_p_e_k_a_6_6_6_1_2 _ This is a (check one): __ Party COlmnittee '" Political Committee B. Check only if appropriate: __Amended Filing __ Tennination Report C. Sunnnary (covering the period from July 27,2012 through October 25, 2012) 1. Cash on hand at beginning of period .. 96,673.43 2. Total Contributions and Other Receipts (Use Schedule A) . 12,276.02 3. Cash available this period (Add Lines I and 2) . 108,949.45 4. Total Expenditures and Other Disbursements (Use Schedule C) .. 47,102.04 5. Cash on hand at close of period (Subtract Line 4 from 3) .. 61,847.41 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 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." 7 (l., J- -1-. ;)f" 'J!.:) ,I,){ .~/ .,,1'1 I...; Date l Signature of Treasurer GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas State Farm Insurance Agents and Employees PAC (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 Cash Check Loan Other Other Receipt John Langcuster Insurance 10/10/12 7311 W 132nd St Ste 180 AgenUlnsurance .; $300.00 Overland Park, KS 66213 Brian Neuhaus Insurance 10/10/12 7700 E Polo AgenUlnsurance .; $60.00 Wichita, KS 67206 Marcia Charton Insurance 10/10/12 address unknown AgenUlnsurance .; $150.00 Matthew Greer Insurance 10/10/12 4700 S Providence Rd AgenUlnsurance .; $60.00 Columbia, MO 65217 Fred Fulks Insurance 10/10/12 13220 Metcalf, Ste 300 AgenUlnsurance .; $250.02 Overland Park, KS 66213 Judie Laws Insurance 10/10/12 3620 SW Fairlawn Ste 100 AgenUlnsurance .; $180.00 Topeka, KS 66614 Jody Parker Insurance 10/10/12 101 S Ridge Rd Ste B AgenUlnsurance .; $30.00 Wichita, KS 67209-2110 Lynn Grover Insurance 10/10/12 7700 E Polo Agent/Insurance .; $150.00 Wichita, KS 67206 Peggy Schmidt Insurance 10/10/12 7700 E Polo AgenUlnsurance .; $60.00 Wichita, KS 67206 Karl Kunz Insurance 10/10/12 655 S Sage Hill Trl AgenUlnsurance .; $75.00 Garden City, KS 67846 Erin Barrett Insurance 10/10/12 13220 Metcalf Avenue Suite 300 AgenUlnsurance .; $150.00 Overland Park, KS 66213 $1,465.02 Subtotal This Page Page _2-._ of_2-q SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas State Farm Insurance Agents and Employees PAC (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 Loan Other Cash Check Other Receipt Sandy Walker Insurance 10/10/12 9666 Quivira Agent/Insurance ,f $150.00 Lenex, KS 66215-1669 Steve Fischer Insurance 10/10/12 POBox 23205 Agent/Insurance ,f $150.00 Overland Park, KS 66283 Kurt Goeser Insurance 10/10/12 1201 Wakarusa E-1 Agent/Insurance ,f $75.00 Lawrence, KS 66049 Roger Crossman Insurance 10/10/12 1010 S. Kansas, Ste B-6 Agent/Insurance ,f $90.00 Liberal, KS 66901 Brad Lock Insurance 10/10/12 2520 N 14th Agent/Insurance ,f $90.00 Dodge City, KS 67801 David Chavez Insurance 10/10/12 6605 Parallel Pkwy Agent/Insurance ,f $126.00 Kansas City, KS 66102 Karen Jameson Insurance 10/10/12 304 E Chestnut Agent/Insurance ,f $60.00 I Junction City, KS 66441 Lee Barrett Insurance 10/10/12 2606 N Fleming St Ste 7 Agent/Insurance ,f $60.00 Garden City, KS 67846 Shanda Swinehart Insurance 10/10/12 114 N Main St Agent/Insurance ,f $120.00 Greensburg, KS 67054 Todd Barnes Insurance 10/10/12 1025 N Main Agent/Insurance ,f $60.00 Newton, KS 67114 G. Sam Davis Insurance 10/10/12 6240 W. 135th, Suite 100 Agent/Insurance ,f $100.00 Overland Park, KS 66223 . $1,081.00 Subtotal This Page Page 3__ of "Z.-C\ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving 1\1 ore Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Check Loan Other Other Receipt Lowell Hardesty Insurance 10/10/12 10540 Marty #130 AgenUlnsurance .; $50.00 Overland Park, KS 66212 Bob Jones Insurance 10/10/12 8118 E Douglas, Ste 103 Agent/Insurance .; $150.00 Wichita, KS 67206 Galen Shields Insurance 10/10/12 POBox 618 AgenUlnsurance .; $150.00 McPherson, KS 67460 Bill Kadyk Insurance 10/10/12 POBox 19416 AgenUlnsurance .; $150.00 Lenexa, KS 66215 Gary Thompson Insurance 10/10/12 3700 N. Woodlawn AgenUlnsurance .; $150.00 Wichita, KS 67220 Terry Johnson Insurance 10/10/12 303 S. Hillside St. AgenUlnsurance .; $300.00 Wichita, KS 67211 Ron Lemon Insurance 10/10/12 1115 Westport Rd Ste A AgenUlnsurance .; $75.00 Manhattan, KS 66502 David Tebbe Insurance 10/10/12 7723 Quivira Rd. AgenUlnsurance .; $105.00 Lenexa, KS 66216 John Schultz Insurance 10/10/12 9431 E. Central, Ste. 2043 AgenUlnsurance .; $50.00 Wichita, KS 67206 Dennis Bivens Insurance 10/10/12 9367 W. 87th St AgenUlnsurance .; $150.00 Overland Park, KS 66212 Ron Culp Insurance 10/10/12 9407 W 87th St AgenUlnsurance .; $75.00 Ov~rland Park, KS 66212 $1,405.00 Subtotal This Page Page _~_ of~~ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas State Farm Insurance Agents and Employees PAC (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 Cash Check Loan Other Other Receipt Mark Berquist Insurance 10/10/12 12014 W 87th Agent/Insurance .; $100.00 Lenexa, KS 66216 Steve Clark Insurance 10/10/12 1930 N. Maize Rd. Agent/Insurance .; $150.00 Wichita, KS 66212 Everett Euler Insurance 10/10/12 2057 Huntington Rd Agent/Insurance .; $75.00 Emporia, KS 66801 Moe Linden Insurance 10/10/12 P. O. Box 757 Agent/Insurance .; $150.00 Dighton, KS 67839 Mindy Dougherty Insurance 10/10/12 P.O. Box 510 Agent/Insurance .; $90.00 Elkhart, KS 67950 Ryan Disbrow Insurance 10/10/12 115 N Maple St Agent/Insurance .; $120.00 I Garnett, KS 66032-9405 Terry Sparks Insurance 10/10/12 POBox 753 Agent/Insurance .; $150.00 lola, KS 66749 Jim LaDuke Insurance 10/10/12 P. O. Box 1334 Agent/Insurance .; $300.00 McPherson, KS 67640 J. Frederick Thurlow Insurance 10/10/12 551 S. Woodlawn Agent/Insurance .; $85.00 Wichita, KS 67218 Rea Laflin Insurance 10/10/12 101 S 5th Agent/Insurance .; $60.00 Atchison, KS 66002 Todd Shepard Insurance 10/10/12 1906 E. 29th St Agent/Insurance .; $75.00 Topeka,KS \36605 $1,355.00 Subtotal This Page Page _~ of 2.'1. SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas State Farm Insurance Agents and Employees PAC (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 Cash Check Loan Other Other Receipt Mike Grosdider Insurance 10/10/12 2400 Iowa St AgenUlnsurance $75.00 ~ Lawrence, KS 66046 Nyle Salmans Insurance 10/10/12 8832 W. 95th St. AgenUlnsurance $75.00 ~ Overland Park, KS 66212 Dennis Richter Insurance 10/10/12 2704 N Topeka Blvd AgenUlnsurance $75.00 ~ Topeka, KS 66617 Penny Hardesty Insurance 10/10/12 10540 Marty, Suite 120 AgenUlnsurance .; $150.00 Overland Park, KS 66212 Dan Gillig Insurance 10/10/12 P.O. Box 333 AgenUlnsurance $65.00 ~ Pratt, KS 67124 Paul Davault Insurance 10/10/12 3625 SW 29th St AgenUlnsurance $60.00 ~ Topeka, KS 66611 Jonathan Wollen Insurance 10/10/12 309 N. Main Agent/lnsurance $80.00 ~ Kingman, KS 67068 Sue Zientara Insurance 10/10/12 300 SW 33rd St. AgenUlnsurance ~ $210.00 Topeka, KS 66611 Harold Mann Insurance 10/10/12 P.O. Box 838 AgenUlnsurance $150.00 ~ Coffeyville, KS 67337 Paul Brucks Insurance 10/10/12 2121 N Tyler Ste 203 Agent/Insurance ~ $75.00 Wichita, KS 67212 Mike Ayres Insurance 10/10/12 619 W Douglas AgenUlnsurance ~ $60.00 Wichita, KS 67213 . $1,075.00 Subtotal This Page Page _6__ of 2-q SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas State Farm Insurance Agents and Employees PAC (Name of Party Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, I Date of Contributor Than $150 Loan or Check L02n Other Cash Other Receipt Gary Urbanek Insurance 10/10/12 P. O. Box 399 AgenUlnsurance .; $150.00 Ellsworth, KS 67439 Josh Salmans Insurance 10/10/12 511 Leavenworth St AgenUlnsurance .; $90.00 Manhattan, KS 66502 Connie Shiverdecker Insurance 10/10/12 810 Main Agent/Insurance .; $150.00 Neodesha,KS 66057 Ernie Ruelas Insurance 10/10/12 11330 E Central Ste 400 AgenUlnsurance .f $70.00 Wichita, KS 67206 G.E. Moore Insurance 10/10/12 P. O. Box 688 AgenUlnsurance .; $150.00 Leavenworth, KS 66048 John Burns Insurance 10/10/12 P.