Campaign Finance Receipts and Expenditures Report Page 1 of 1 Print this form or Go Back Campaign Finance Receipts Governmental Ethics Commission & Expenditures Report 901 S. Kansas Ave. 10/31/2016 Topeka, KS 66612 Office (785) 296-4219 Fax (785) 296-2548 ethics.kansas.gov Check only if appropriate ~ Amended Filing Termination Report Campaign Finance Organization Name: Blue Cross and Blue Shield of Filing Report Kansas City Political Action Committee for Kansas Address: 2301 Main Address2: City: Kansas City Zip: 64108 Chairperson Home Phone: (913) 685-1502 Chairperson Business Phone: (816) 395-2801 Party Committee ~ PAC SUMMARY (covering the period from 7/22/2016 through 10/27/2016) 1 CASH ON HAND AT BEGINNING OF PERIOD 91856.08 2 TOTAL CONTRIBUTIONS AND OTHER RECEIPTS (Schedule A) view/print $0.00 3 CASH AVAILABLE THIS PERIOD (Add Lines 1 and 2) $91,856.08 4 TOTAL EXPENDITURES AND OTHER DISBURSEMENTS (Schedule C) view/print $7,000.00 5 CASH ON HAND AT CLOSE OF PERIOD Subtract Line 4 from 3) $84,856.08 6 IN-KIND (NON-MONETARY) CONTRIBUTIONS (Schedule B) view/print $0.00 7 OTHER TRANSACTIONS (Schedule D) view/print $0.00 "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." Electronically filed on: 6/5/2017 11 :36:55 AM Signature of Treasurer: Coni K. Fries Print this form or Go Back http://www.sos.ks.gov/elections/cfr_viewer/reports/expJeport_main.aspx 6/9/2017 Campaign Finance Schedule C Report Page 1 of2 Print this form or Go Back SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS Committee: Blue Cross and Blue Shield of Kansas City Political Action Committee for Kansas Purpose of Expenditure or Disbursement Date Name and Address Candidate Name & address if Amount independent or in-kind expenditure in excess of $300 DonationiContrib Kansans for Ryckman Ron Ryckman 10/24/16 14234 W. 158th St. $500.00 14234 W. 158th St. Olathe KS 66062 Olathe KS 66062 DonationiContrib Campaign to Elect Schwab Scott Schwab 10/20/16 14953 W. 140th Terr, $500.00 14953 W. 140th Terr, Olathe KS 66062 Olathe KS 66062 DonationiContrib Longbine for Senate Jeff Longbine 10/20/16 PO Box 1903 $1,000.00 PO Box 1903 Emporia KS 66801 Emporia KS 66801 DonationiContrib Kansans for Selzer Ken Selzer 7113 W. 135th. St., Suite #353 10/18/16 7113 W. 135th. St. $500.00 Suite #353 Suite #353 Overland Park MO 66223 Overland Park MO 66223 DonationiContrib Ty Masterson for Kansas Ty Masterson 10/05/16 PO Box 424 $1,000.00 PO Box 424 Andover KS 67002 Andover KS 67002 DonationiContrib Hawkins Campaign Fund Dan Hawkins 10/04/16 9406 Harvest Lane $500.00 9406 Harvest Lane Wichita KS 67212 Wichita KS 67212 DonationiContrib John Skubal for Kansas Senate John Skubal 09/20/16 6503 W. 134th Terr. $250.00 6503 W. 134th Terr. Overland Park KS 66209 Overland Park KS 66209 DonationiContrib Jim Denning for Kansas Senate Jim Denning 08/06/16 11184 Antioch, Suite 290 $1,000.00 11184 Antioch, Suite 290 Overland Park KS 66210 Overland Park KS 66210 07/29/16 Ty Masterson for Kansas DonationiContrib $500.00 PO Box 424 Ty Masterson http://www.sos.ks.gov/elections/cfr_viewer/reports/schedule_c_report.aspx 6/9/2017 Campaign Finance Schedule C Report Page 2 of2 , Andover KS 67002 PO Box 424 Andover KS 67002 Donation/Contrib Longbine for Senate Jeff Longbine 07/29116 PO Box 1903 $500.00 PO Box 1903 Emporia KS 66801 Emporia KS 66801 Donation/Contrib Sykes for Senate Dinah Sykes 08/26115 10227 Theden Circle $250.00 10227 Theden Circle Lenexa KS 66220 Lenexa KS 66220 Donation/Contrib Kessinger 4 Kansas Jan Kessinger 08116115 12605 Walmer St $500.00 12605 Walmer St Overland Park KS 66210 Overland Park KS 66209 Total Itemized Expenditures This Period $7000.00 Total Unitemized Expenditures of $50 or less $0 TOTAL EXPENDITURES & OTHER DISBURSEMENTS THIS PERIOD $7000.00 Print this form or Go Back http://www.sos.ks.gov/elections/cfr_viewer/reports/schedule_cJeport.aspx 6/9/2017.