Page 1
KANSAS GOVERNMENTAL ETHICS COMMISSION
RECEIPTS AND EXPENDITURES REPORT '. . . OF A POLITICAL OR PARTY COMNIITTEE1~litn/t;u
October 25,2010 OCT 252010 FILE WITH SECRETARY OF S'F-¥'\ijfcmmm~n~IEt'1i~r:~
SEE REVERSE SIDE FOR INSTRUCTIONS -":J..,;.
A. Name of Committee: Kansas Hospital Association Political Action Committee
Address: 215 SE 8th Street
. City and Zip Code: T_o_pe_ka_,_66_6_01 u_s _
Th~s is a (check one): .__ Party Committee .; Political Committee
B. Check only if appropriate: _.__ Amended Filing __ Termination Report .
C. Summary (covering the period from July 23,2010 through October 21, 2010)
1. Cash on hand at beginning ofP1,iOd ,
2. Total Contributions and Other Receipts (Use Schedule A) I '.
3. Cash available this period (Add Lines 1 and 2)
:.
.
.
$59,724.89
$31,701.79
$91,426.68
4. Total Expenditures and Other Disbursements (Use Schedule C) .. $32,420.90
5. Cash on hand at close of period (Subtract Line 4 from 3) . $59,005.78
6. In-Kind Contributions (Use Schedule B) . $1,166.21
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."
~ffk,.~ GEe Form Rev, 2001
Page 2
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Date
08/17/2010
Name and Address
of Contributor
Mark Miller 1691 Jeep Rd Abilene, KS 67410-6367
Occupation & Industry of
Individual Giving More
Than $150
Chief Executive Officer Memorial Health System
Cash
Check
Appropriate Box
Check Loan Olher
Amount of
Cash, Check,
Loan or
Other Receipt
$100.00
08/17/2010
Lora Key POBox 229 Sabetha, KS 66534-0229
Chief Executive Officer Sabetha Community Hospital
$160.00
08/17/2010
08/17/2010
Cheyenne County Hospital 210 W. First SI. PO Box 547 Saint Francis, KS 67756-3540
Ness County Hospital 312 Custer Ness City, KS 67560-1654
Community Hospital Cheyenne County Hospital
Ness County Hospital
$160.00
$160.00
08/17/2010
08/24/2010
Lane County Hospital 235 West Vine PO Box 969 Dighton, KS 67839-0969
John Hinnenkamp 3155 W. Crawford SI. Salina, KS 67401-9706
hospital contribution Lane County Hospital
Department Manager Salina Regional Health Center
$170.00
$100.00
08/24/2010
David Moody 510 Winn.Road Salina, KS 67401-3668
Vice President, Human Resources Salina Regional Health Center .f
$100.00
08/24/2010 Charles Grimwood 115 MI. Barbara Rd. Salina, KS 67401-3414
Vice President Salina Regional Health Center
$100.00
08/24/2010 Jewell County Hospital PO Box 327 Mankato, KS 66956-0327
Jewell County Hospital $160.00
08/24/2010 James Reagan 600 North Washington Street Council Grove, KS 66846-1422
Chief Executive Officer Morris County Hospital
$350.00
08/24/2010 Gayle Arnett 1819 Ridge Road EI Dorado, KS 67042-4033
CEO Susan B. Allen Memorial Hospital
$300.00
$1.860.00
Page _1__ of~
Page 3
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Check Amount of
Name and Address
Occupation & Industry of
Individual Giving More Appropriate Box Cash, Check,
Date Than $150 Chtck
.f
.f
Loan orof Contributor Loon OtherCash
Other Receipt
Fort Scott Mercy Health Center Community Hospital $500.00
401 Woodland Hills Blvd Mercy Health Center-Fort Scott 08/31/2010 Fort Scott, KS 6670,
Patricia Edwards VP of Patient Care $100.00
957 Lost Hills Court Promise Regional Medical 09/07/2010 Derby, KS 67037-9393 Center-Hutchinson
Janet Hamous VP Human Resources $100.00
2615 Wilderness Ct Promise Regional Medical 09/07/2010 Center-HutchinsonWichita, KS 67226-2137
CEO $100.00 I
4801 Pin Oak Rd Linda Harrison
Promise Regional Medical 09/07/2010 Center-HutchinsonHutchinson, KS 67502
$100.00
1104 Barberry Dr. Promise Regional Medical Center Shawnda Heimerman Controller
09/07/2010 Hutchinson, KS 67502-3365
Vicki Caywood Director $200.00
815 Avenue R Promise Regional Medical 09/07/2010 Raymond, KS 67573-9603 Center-Hutchinson
Patricia Goad VP of Nursing $100.00
1085 Heritage Drive Memorial Hospital 09/07/2010 McPherson, KS 67460-2128
President and Chief Executive $150.00James Chromik Officer1000 Hospital Drive 09/07/2010 Memorial Hospital McPherson, KS 67460-2326
Robert Brazil Chief Operating Officer $100.00
1700 Faith Ave Memorial Health System Abilene, KS 67410-1728
Elgin Glanzer
09/07/2010
Chief Financial Officer $100.00
09/07/2010 1108 N. Kuney Memorial Health System Abilene, KS 67410-1932
Patricia Berns Hospital Employee $100.00
09/07/2010 2570 Hwy. 15 Memorial Health System
Abilene, KS 67410-6035
$1,650.00
Page _2__ of~
Page 4
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(N arne 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
Other Receipt
Robert Mullen Chief Executive Officer $350.00
POBox 828 Rice County District Hospital 09/07/2010 Lyons, KS 67554-0828
Thyra Strate Interim CEO $80.00
1521 M Road Edwards County Hospital and 09/07/2010 Lewis, KS 67552-5226 Healthcare Center
Karen Shumate VP $100.00
09/07/2010 1753 E 980 Rd Lawrence, KS 66049-9073
Lawrence Memorial Hospital
Jeffrey Novorr Vice President $100.00
09/07/2010 3105 Tomahawk Drive Lawrence, KS 66049-1924
Lawrence Memorial Hospital
Dana Hale Vice President Nursing $100.00
09/07/2010 670 N. 1505 Rd. Lawrence, KS 66049-9121
Lawrence Memorial Hospital
Janice Early-Weas Hospital Employee $100.00
09/07/2010 902 Riverside Ct Lawrence, KS 66044-4092
Lawrence Memorial Hospital
Sheryle D'Amico VP $200.00
09/07/2010 737 N. 1550 Rd. Lawrence Memorial Hospital Lawrence, KS 66049-9198
Jane Maskus Chief Information Officer $100.00
09/07/2010 24215 W. 68th Sl. Lawrence Memorial Hospital
Shawnee, KS 66226-3539
Deborah Thompson Vice President, Human Resources $100.00
. 09/07/2010 4423 Gretchen Court Lawrence Memorial Hospital Lawrence, KS 66047-9680
Simon Scholtz Vice President and Chief Financial $200.00
09/07/2010 1705 St. Andrews Drive Officer Lawrence, KS 66047-1703 Lawrence Memorial Hospital
Joy Bretz Chief Financial Officer $80.00
09/07/2010 Rt 1 Box 57E Gove County Medical Center
Studley, KS 67740-9308
Cash Check Loan Other
~
.;
.;
~
-
$1,510.00
Page _3__ of~
Page 5
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(N arne of Party Committee or Political Committee)
Date
09/07/2010
Name and Address
of Contributor
Blaine Miller 2420 'G' Street Belleville, KS 66935-2400
Occupation'& Industry of
Individual Giving More
Than $150
Administrator Republic County Hospital
Cosh
Check
Appropriate Box
Check Loan Other
Amount of
Cash, Check,
Loan or
Other Receipt
$100.00
09/14/2010
09/14/2010
09/14/2010
Terry Deschaine POBox 579 Fredonia, KS 66736-0579
Kathy Morrison 1014 Lamplighter Garden City, KS 67846-3240
Oswego Medical Center 800 Barker Drive Oswego, KS 67356-9033
Chief Executive Officer Fredonia Regional Hospital
Executive Director of Human Resources SI. Catherine Hospital
Community Hospital
..; $140.00
$100.00
$160.00
09/14/2010
09/14/2010
09/14/2010
09/14/2010
09/14/2010
09/14/2010
09/14/2010
James McComas 602 E41st Hutchinson, KS 67502-4922
Jennifer Jones 411 Atwood Kinsley, KS 67547-1035
Steven Perkins 20 Crestwood Dr. Arkansas City, KS 67005-9005
Richard Bergling POBox 129 Quinter, KS 67752-0129
Kathleen Willis 1071 E 1400 Rd Lawrence, KS 66046-9633
John Vox 2220 Center Garden City, KS 67846.-3517
AmyAltwegg 2469 Gulf Rd. Abilene, KS 67410-6092
VP, Operations Promise Regional Medical Center-Hutchinson
CFO Edwards County Hospital and Healthcare Center
CEO South Central Kansas Regional Medical Center
Chief Executive Officer Gove County Medical Center
VP/CDO Lawrence Memorial Hospital
SeniorVP SI. Catherine Hospital
Executive Director Memorial Health System
.;
$100.00
$100.00
$175.00
$80.00
$100.00
$500.00
$75.00
$1,630.00
Page _4__ of~
Page 6
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Date
09/14/2010
Name and Address of Contributor
Shelley Boden 4612 188th Rd Russell, KS 67665-8893
Occupation & Industry of Individual Giving More
Than $150
CEO Russell Regional Hospital
ClI5h
Check Appropriate Box
Check Loan Other
Amount of Cash, Check,
Loan or Other Receipt
$100.00
09/14/2010
Kathy Howell 12867 Barton Overland Park, KS 66213-4424
Saint Luke's South Hospital $350.00
09/14/2010
09/14/2010
Ronald Baker 2491 Panther Creek Rd Concordia, MO 64020-6300
Dennis George POBox189 Burlington, KS 66839-0189
CFO Satanta District Hospital
Chief Executive Officer Coffey County Hospital
$100.00
$500.00
09/17/2010
Judy Wagner 912 Davis Drive Manhattan, KS 66502-8005
Vice President Mercy Regional Health Center
$100.00
09/17/2010
09/1712010
09/17/2010
09/17/2010
Joseph Philipp 2945 Nevada Sl. Manhattan, KS 66505-1289
Claudio Ferraro 6414 E. 15th Street Wichita, KS 67206-1112
Joseph Jeans 11802 Delavan Ave Kansas City, KS 66109-4820
Genette Nicholas 435 W 59th Street Kansas City, MO 64113-1232
Chief Medical Officer Mercy Regional Health Center
VP Planning Via Christi Hospitals Wichita
CFO Providence Medical Center
Hospitai Employee Children's Mercy South
.f
.f
$100.00
$100.00
$350.00
$250.00
09/17/2010
09/1712010
Kansas Good Government Fund HCA 215SE8th Topeka, KS 66603-3906
Kristine Ochs 210 South Vermont Avenue Ransom, KS 67572-9525
State PAC to PAC transfer HCA Kansas Good Government Fund
Administrator Grisell Memorial Hospital District One
$3,000.00
$160,00
$5,110.00
Page _5__ of~
Page 7
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
'Date
0911712010
Name and Address
of Contributor
Gregory Lundstrom 605 West Lincoln Street Lindsborg, KS 67456-2328
Occupation & Industryof
Individual Giving More
Than $150
Administrator and Chief Executive Officer Kansas Hospital Association
C"ash
Check
Appropriate Box
Cheek Lonn Other
Amount of
Cash, Check,
Loan or
Other Receipt
$500.00
09/24/2010
09/24/2010
09/24/2010
Norm Lambert 230 Canna Lane Liberal, KS 67901-4900
Robert Driewer 1201 West 12th Avenue Emporia, KS 66801-2504
Holly French 1201 West 12th Avenue Emporia, KS 66801-2504
CEO Southwest Medical Center
.Chief Executive Officer Newman Regional Health
Chief Financial Officer Newman Regional Health
.f $100.00
$500.00
$100.00
09/24/2010
Kathie J. Butcher 1456 Road 175 Emporia, KS 66801-2597
Assistant AdministratorlQuality Risk Mgm Newman Regional Health
$100.00
09/24/2010
Patricia McGivern 3031 SW Quail Creek Drive Topeka, KS 66614-4131
Director Stormont-Vail HealthCare
$100.00
09/24/2010
09/24/2010
09/24/2010
Kent Palmberg 1216 SW Westside Drive Topeka, KS 66615-1236
Debra Yocum 5045 SE 10th Tecumseh, KS 66542-9426
Kenneth Stone 2543 SE Faxon Ct. Topeka, KS 66605-2086
Senior Vice President and Chief Medical Officer Stormont-Vail HealthCare
Hospital Administration Stormont-Vaii HealthCare
Stormont-Vail HealthCare
.;
.;
$500.00
$350.00
$150.00
09/24/2010
09/24/2010
Lisa Carlton 5534 NE Indian Creek Rd Topeka, KS 66617-1604
Jill Straub 7907 SW 28th Street Topeka, KS 66614-4891
Director Stormont-Vail HealthCare
Heaith Information Management Director Stormont-Vail HealthCare
$100.00 I
$100.00
$2,600.00
Page _6__ of~
Page 8
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(N arne 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
Michael Kongs Director Financial Management $100.00
7261 SW Fountaindale Stormont-Vail HealthCare 09/24/2010 Topeka, KS 66614-4629
Diane Burton $100.00
5602 SW Timberlake Cl. Stormont-Vail HealthCare
.f09/24/2010 Topeka, KS 66614-4537
Robert O'Neil Medical Advisor $350.00
1401 SW Pembroke Lane Stormont-Vail HealthCare .;09/24/2010 Topeka, KS 66604-2535
Ronald Campbell Director $100.00
4735 SE 25th Stormont-Vail HealthCare 09/24/2010 Tecumseh, KS 66542-9301
Kathleen Harr Dean & Professor $100.00
09/24/2010 3732 SW Herefordshire Road Stormont-Vail HealthCare Topeka, KS 66610-1541
Beth Browder Director of Professional $100.00
09/24/2010 3060 NW 35th Development Topeka, KS 66618-2645 Stormont-Vail HealthCare
Janet Stanek Sr. Vice President $1,000.00
09/24/2010 6755 SW Dancaster Road Stormont-Vail HealthCare Topeka, KS 66610-1412
Lenora A. Kinzie Hospital Employee $100.00
09/24/2010 1267 Medford Stormont-Vail HealthCare
.fTopeka, KS 66604-1517
Judy Corzine Director, IT $375.00
09/24/2010 3621 SW Woodvalley Place Stormont-Vail HealthCare .;Topeka, KS 66614-3536
Carol Wheeler Vice President $350.00
09/24/2010 1248 SW Westside Drive Stormont-Vail HealthCare Topeka, KS 66615-1236
Deborah D'Orvilliers $100.00
09/24/2010 22955 S Rd. Stormont-Vail HealthCare .fHolton, KS 66436-8597
$2,775.00
Page _7__ of~
Page 9
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Date
09/24/2010
Name and Address
of Contributor
Kevin Han 6200 SW 34th Terr. Topeka, KS 66614-4667
Occupation & Industry of
Individual Giving More
Than $150
Director, Financial Management Stormont-Vail HealthCare
Ca.5h
Check
Appropriate Box
Check Loan Other
Amount of
Cash, Check,
Loan or
Other Receipt
$350.00
09/24/2010
09/24/2010
09/24/2010
09/24/2010
Bernard Becker 4527 SW Crenshaw Dr. Topeka, KS 66610-1615
Kari Holt 406 Sunset Lane Maple Hill, KS 66507-9405
Carolyn Hess POBox 349 Smith Center, KS 66967-0349
Richard Vaught 1300 East Fifth Street Winfield, KS 67156-2407
VP/Chief Human Resources Officer Stormont-Vail HealthCare
Director Stormont-Vail HealthCare
Administrator Smith County Memorial Hospital
Administrator William Newton Hospital
.;
$350.00
$100.00
$100.00
$100.00
09/24/2010
Danny Huckvale 120 N. Massachusetts Winfield, KS 67156-1818
Assistant Administrator William Newton Hospital
$100.00
09/27/2010
09/27/2010
09/27/2010
09/27/2010
09/27/2010
Nick Rogers 1939 N 11 th Street Arkansas City, KS 67005-1724
Lance Niles 14 Crestwood Dr. Arkansas City, KS 67005-9005
Chad Austin 6518 SW 26th Court Topeka, KS 66614-4305
Thomas Bell 4301 NW Valley Road Topeka, KS 66618-3445
Melissa Hungerford 6448 SW Bayshore Dr Auburn, KS 66402-9324
Trustee South Central Kansas Regional Medical Center
Trustee South Central Kansas Regional Medical Center
Vice President, Government Relations Kansas Hospital Association
President Kansas Hospital Association
Sr. Vice President Kansas Hospital Association
$100,00
$100.00
$80.78
$134.61
$134.61
$1,650.00
Page _8__ of~
Page 10
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Date
09/27/2010
Name and Address
of Contributor
Fred Lucky 14607 W 89 Lenexa, KS 66215-2967
Occupation & Industry of
Individual Giving More
Than $150
Senior Vice President Kansas Hospital Association
Cash
Check
Appropriate Box
Check LOlln Other
.f
Amount of
Cash, Check,
Loan or
Other Receipt
$302.89
09/27/2010
Robert Meling 13005 Catalina Street Leawood, KS 66209-2392
Senior Vice President Ass'ociated Purchasing Services Corporation .f
$134.61
09/27/2010
Cindy Samuelson 1107 NE 54th St Topeka, KS 66617-4505
Vice President Kansa,s Hospital Association
$67.34
10/01/2010
10/01/2010
KS Healthcare Environmental Services Association PO BOX 3208 Topeka, KS 66601
Helen Williams 2234 NW 78th Topeka, KS 66618,
Professional Association
Director Sl. Francis Health Center
$250.00
$100.00
10/01/2010
Jean Dean 1000 W 39th St Hays, KS 67601-1517
CEO Trego County-Lemke Memorial Hospital
$100.00
10/01/2010
10/01/2010
Robert Bean 1323 North 'A' Street Wellington, KS 67152-4350
Douglas Newman 104 E Mulberry St Hill City, KS 67642-1962
President and Chief Executive Officer Sumner Regional Medical Center
CEO Graham County Hospital
.f
-.f
$100.00
$100.00
10/01/2010 Don Paxson 2046 US Hwy 24 Penokee, KS 67659-2056
Trustee Graham County Hospital
$100.00
10/01/2010 Deanna Freeman POBox 47 Atwood, KS 67730-0047
Administrator and Chief Executive Officer Rawlins County Health Center
$250.00
10/01/2010 Mary Sweet 721 West Kansas Avenue Greensburg, KS 67054-1633
Administrator Kiowa County Memorial Hospital
$160.00
$1,664.84
Page _9__ of~
Page 11
SCHEDULE A CONTRIBUTIONS AND OTH.ER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individu~1 Givin~ More Appropriate Box Cash, Check,
Date of Contributor Than $150 Loan or Cuh Check Loan Other
Other Receipt
W. Charles Waters CEO $100.00
PO Box 59 Clara Barton Hospital 10101/2010 Hoisington, KS 67544-0059
Daniel Sheehan Chief Administrative Officer $350.00
14147 Belrive Circle Saint John Hospital 10/01/2010 Basehor, KS 66607-5,
Holly Koch CFO ( $100.00
1371 67th Terrace Girard Medical Center 10101/2010 Uniontown, KS 66779-8010
Kenneth Boyd Administrator $125.00
302 North Hospital Drive Girard Medical Center 10101/2010 Girard, KS 66743-2000
Dale Montgomery Vice President, Support Service $135.00
10101/2010 1300 Schwaller Ave. Hays Medical Center Hays, KS 67601-2242
Terry Siek Chief Nursing Officer $150.00
10101/2010 300 W. 21st Hays Medical Center Hays, KS 67601-3004
Bruce Whittington VP $135.00
10101/2010 2912 Walnut Hays Medical Center Hays, KS 67601-1721
Kenneth Lindsey Chief Medical Officer $135.00
10101/2010 1100 Fairway Drive Hays Medical Center
Hays, KS 67601-4710
William Overbey CFO $135.00
10101/2010 4107 Smoky Hill Drive Hays Medical Center Hays, KS 67601-4713
Karen Endicott-Coyan Regional Director Reimbursement $100.00
10101/2010 401 Woodland Hills Boulevard Mercy Health Center-Fort Scott Fort Scott, KS 66701-8797
Janet Criqui VP - Fiscal Services $100.00
10101/2010 1-20 Lake Road Mercy Regional Health'Center .;Council Grove, KS 66846-9801
$1,565.00 .
Page _1_0_ of~
Page 12
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Date
10101/2010
10105/2010
10105/2010
10105/2010
10105/2010
10105/2010
10105/2010
10105/2010
10105/2010
10105/2010
Name and Address
of Contributor
Richard Miller POBox 250 Norton, KS 67654-0250
John Jeter POBox 8100 Hays, KS 67601-8100
John Broberg 1020 Parkshire Cir Manhattan, KS 66503-2475
Bryce Young 923 Carroll Avenue Larned, KS 67550-2429
Nicki Bradbury 5040 SW Brentwood Topeka, KS 66606-2210
Donald Schepker 1132 SW Belmont Lane Topeka, KS 66604-1981
Karlene Lockard 1114 SW Garfield Topeka, KS 66604-1312
Mark Davis 3700 SW 41 st Street Topeka, KS 66610-1184
Larry Sellers" 7818 W Ezekiel Ct Mapleton, IL 61547-9690
David Tanski KS
Occupation & Industry of Individual Giving More
Than $150
Administrator and Chief Executive Officer Norton County Hospital
President and Chief Executive Officer Hays Medical Center
Chief Executive Officer Mercy Regional Health Center
Interim Administrator Pawnee Valley Community Hospital
Director NICU/Peds Stor.mont-Vail HealthCare
Foundation President Stormont-Vail HealthCare
Director Stormont-Vail HealthCare
Interim CEO Stormont-Vail HealthCare
Director, Technology Infrastructure Stormont-Vail HealthCare
Director Stormont-Vail HealthCare
Cash
Check
Appropriate Box
Check Loan Olher
Amount of
Cash, Check,
Loan or
Other Receipt
$200.00
$500.00
$500.00
"$135.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
10105/2010 Eric Voth 411 Woodbury Court Topeka, KS 66606-2192
Physician Stormont-Vail HealthCare
$350.00
$2,285.00
Page _1_1_ of~
Page 13
SCHEDULE A - CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Date
10105/2010
Name and Address of Contributor
Raymond Lumb 2210 SW Desousa Topeka, KS 66611-1621
Occupation & Industry of Individual Giving More
Than $150
Medical Advisor Stormont-Vail HealthCare
Cuh
Check Appropriate Box
Check Loan Oth~r
Amount of Cash, Check,
Loan or Other Receipt
$100.00
10105/2010
Carol Perry PO Box 3822 Topeka, KS 66604-6822
VP and CNO Stonmont-Vail HealthCare
$350.00
10105/2010
David Cunningham 3725 Cladon Park Drive Topeka, KS 66610-1277
Director of Facilities Stormont-Vail HealthCare
$350.00
10105/2010
Robert Smith 1160 SW Warren Topeka, KS 66604-1646
Director Design & Construction Stormont-Vail HealthCare .f
$100.00
10105/2010
10105/2010
Steven Watkins 8001 SW Huntoon Street Topeka, KS 66615-1417
Scott Taylor 401 East Spuce Street Garden City, KS 67846-5679
Physician Stormont-Vail HealthCare
President and Chief Executive Officer Sl. Catherine Hospital
.f
'.f
$350.00
$500.00
10105/2010
10/11/2010
Lincoln County Hospital 624 N. Second Street Lincoln, KS 67455-1738
Roger Masse POBox 87 Ellsworth, KS 67439-0087
Lincoln County Hospital
Administrator Ellsworth County Medical Center
.f
$200.00
$100.00
10/19/2010 Rita Buurman 450 Parkview Drive Sabetha, KS 66534-2200
Formerly Sabetha Community Hospital .f
$250.00
10/19/2010 John Moore 300 Utah Street Hiawatha, KS 66434-2314
Administrator Hiawatha Community Hospital.
$160.00
10/19/2010 Michael Wegner 1709 N. Rocky Creek Cl. Wichita, KS 67230-1753
\..
CFO ' Via Christi Hospitals Wichita
$100.00
$2,560.00
Page _1_2_ oC~
Page 14
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of
Individual Giving More Than $150
ClUh
Check Appropriate Box
Check Loan Other
Amount of
Cash, Check, Loan or
Other Receipt
10/19/2010
David Bradley POBox 490 Junction City, KS 66441-0490
Chief Executive Officer Geary Community Hospital .;
$100.00
10/19/2010
Michael Thomas POBox 820 Meade, KS 67864-0820
Administrator Meade District Hospital .;
$150.00
10/19/2010
Phillip Knox 319 Hastings Road Brewster, KS 67732-8606
Citizens Medical Center .; $60.00
10/19/2010
10/19/2010
Robert Erickson 900 SW Robinson Ave Apt 1302 Topeka, KS 66606-2608
Kathy Linhart 1015 SW Billard Ave Topeka, KS 66604-1608
President, CEO Sisters of Charity of Leavenworth Health System
Director, Food and Nutrition Dept Sl. Francis Health Center
,f $350.00
$100.00
10/19/2010
Kevin Mapes 2510 SW Windslow Ct Topeka, KS 66614-6105
IS Site Coordinator Sl. Francis Health Center
$100.00
10/19/2010
Mandie Brzon 2506 SW Berkshire Dr. Topeka, KS 66614-6103
Director, Revenue Cycle Sl. Francis Health Center
$100.00
10/19/2010 Kirk Starr 7924 SW 28th Street Topeka, KS 66614-4892
Pharmacy Operations Coordinator Sl. Francis Health Center
$100.00
10/19/2010 Kimberly Brown 2325 Adare Rd. Ann Arbor, M148104-4019
Health Care Administration Henry Ford Health System
$100.00
10/19/2010
10/19/2010
Dan Fieker 900 SW Robinson apt 1711 Topeka, KS 66606-2613
Terry Wendell 1 Cottonwood Drive Colby, KS 67701-3902
Exec VP COOIChief Medical Officer Sl. Francis Health Center
Trustee
$100.00
$100.00
$1,360.00
Page _1_3_ of~
Page 15
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Hospital Association Political Action Committee
(N arne of Party Committee or Political Committee)
Occupation & Industry of Check Amount of
Name and Address Individual Giving More Appropriate Box Cash, Check,
Date Than $150 Loan orof Contributor Cash Check Loan Other
Other Receipt
$350.00County Hospital Stafford Community Hospital PO Box 190 Community Hospital
10/19/2010 Stafford, KS 67578-0190
Shannan Flach CEO $160.00
RR1 Box415 Wamego City Hospital 10/19/2010 Paxico, KS 66526
Bruce Witt Director, Government Relations $100.00
Via Christi Health System 10/19/2010
$100.00
716 High Street Community Health Care System Marcia Walsh Chief Operating Officer
10/19/2010 Onaga, KS 66521 .f $350.00
POBox 512 Clay County Medical Center Ron Bender Chief Executive Officer
10/19/2010 Clay Center, KS 67432-0512
Ninnescah Valley Health Systems Commynity Hospital $200.00
750 West D. Avenue Ninnescah Valley Health System 10/19/2010 Kingman, KS 67068-1266
Kevan Trenkle Chief Financial Officer $75.00
100 East College Drive Citizens Medical Center 10/19/2010 Colby, KS 67701-3799
$1.335.00
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
$29,554.84
$2,146.95
$0.00
$0.00
$31,701.79
Page _1_4_ of~
Page 16
SCHEDULE B IN-KIND CONTRIBUTIONS
Kansas Hospital Association Political Action Committee, (Name of Party Committee or Political Committee)
Value of
Date
List Occupation & In-Kind
. of Contributor
Description of In-KindName and Address Industry for Those Giving Contribution Contributionan In-Kind of More Than
$150
PAC Postage UPS 07/31/2010
Kansas Hospital Association KHA $133.32
Topeka, KS 66603-3906
Kansas Hospital Association KHA PAC FedEx Postage
07/31/2010
215 S.E. 8th
215 S.E. 8th $21.82 Topeka, KS 66603-3906
Kansas Hospital Association KHA Telephone Conference Call 215 S.E. 8th $63.1807/31/2010 Topeka, KS 66603-3906
Kansas Hospital Association KHA Hospital Association PAC Postage Fed Ex 215 S.E. 8th Kansas Hospital Association
09/14/2010 $186.94Topeka, KS 66603-3906
Hospital Association PrintingKansas Hospital Association KHA Kansas Hospital Association 215 S.E. 8th
09/30/2010 $409:60Topeka, KS 66603-3906
Kansas Hospital Association KHA PAC Postage Fed Ex 215 S.E. 8th
10/12/2010 $21.61
Kansas Hospital Association KHA Hospital Association Postage 215 S.E. 8th Kansas Hospital Association
10/19/2010
Topeka, KS 66603-3906
$329.74Topeka, KS 66603-3906
$1,166.21
Complete if last page of Schedule B
$1,166.21Total Itemized (over $100) In-Kind Contributions
Total Unitemized ($100 or less) In-Kind Contributions $0.00
$1,166.21~f§:t~:~~K~~X~:~Cj~Q~!t~;Jf~i~~'§"11j~f$;:~~c~!:&'p~{~.~.l]~~~~t:i;~~;~:M~~~~N~~l~~i~~t\~i~~
Page _1__ of_1__
Page 17
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Date
08/05/2010
Name and Address To Whom Expenditure is Made
Brownback for Governor P.O. Box 3739 Topeka, KS 66604-0739
Purpose of Expenditure
Sam Brownback, GOVERNOR KS
Amount
$1,000.00
08/11/2010
Nancy Bauder for State Representative 721 S21stSt Leavenworth, KS 66048
Nancy Bauder, STATE HOUSE 41st KS
$500.00
08/16/2010
Annie Tietze for Kansas House 329 SW Yorkshire Road Topeka, KS 66606
Annie Tietze, STATE HOUSE 56th KS
$250.00
08/16/2010
Cindy Neighbor for Kansas House 10405 West 52nd Terrace Shawnee, KS 66203
Cindy Neighbor, STATE HOUSE 18th KS
$250.00
08/20/2010
08/20/2010
Derek Schmidt for Attorney General 416 N. 5th Street P.O. Box 804 Independence, KS 67301
Kathy Wolfe Moore for Kansas House 3209 N 131 st Street Kansas City, KS 66109
Derek Schmidt, ATIORNEY GENERAL 15th KS
Kathy Moore, STATE HOUSE 36th KS
$500.00
$250.00
08/20/2010
Melanie Meier for State House 31301 175th Street Leavenworth, KS 66048
Melanie Meier, STATE HOUSE 40th KS
$250.00
08/20/2010 Lana Gordon for Kansas House 5820 SW 27th SI. Topeka, KS 66614
Lana Gordon, STATE HOUSE 52nd KS
$250.00
08/20/2010 Kyle Kessler for Kansas House 2644 SW Santa Fe Drive Topeka, KS 66614
Kyle Kessler, STATE HOUSE 52nd KS
$250.00
08/20/2010 Vern Swanson for Kansas House 1422 5th SI. Clay Center, KS 67432
Vern Swanson, STATE HOUSE 64th KS
$250.00
$3,750.00
Page _1_ of__9 _
Page 18
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Amount Date
Purpose of ExpenditureName and Address To Whom Expenditure is Made
Tom Moxley for Kansas House Tom Moxley, STATE HOUSE 68th KS 1852 S 200 Road
$250.00Council Grove, KS 66846 08/20/2010
Don Schroeder for Kansas House Don Schroeder, STATE HOUSE 74th KS 131 14th Ave.
$250.00Inman, KS 6754608/20/2010
Clark Shultz for Kansas House Clark Shultz, STATE HOUSE 73rd KS 707 Wasington Circle $250.0008/20/2010 Lindsborg, KS 67456
Ed Trimmer for Kansas House Ed Trimmer, STATE HOUSE 78th KS 1402 East 9th $250.0008/20/2010 Winfield, KS 67156
Vincent Wetta for Kansas House Vincent Wetta, STATE HOUSE 80th KS 1204 N Poplar
$250.0008/20/2010 Wellington, KS 67152
Bob Bethell for Kansas House Bob Bethell, STATE HOUSE 113th KS 104 E 3rd 08/20/2010 $250.00P.O. Box 186 Alden, KS 67512
Kansas Democratic House Campaign Committee08/20/2010 $250.00 PO Box 2083 Topeka, KS 66601
AHAPAC-American Hospital Association August KHNAHA PAC Transfer 09/01/2010 FEDERAL $477.50
325 Seventh Street, NW Suite 700
Kansans for Praeger Sandy Praeger, COMMISS OF INSURANCE 2nd KS 09/21/2010 PO Box 1001
$1,000.00Topeka, KS 66601 )
Jeff Longbine for Kansas Senate Jeff Longbine, STATE SENATE 17th KS 09/28/2010 PO Box 1903
$250.00Emporia, KS 66801
$3,477.50
Page _2_ of__9_
Page 19
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
-
Date Name and Address
To Whom Expenditure is Made Purpose of Expenditure Amount
10105/2010
AHAPAC-American Hospital Association FEDERAL 325 Seventh Street, NW Suite 700
September KHA PAC to AHA transfer
$8,343.40
10106/2010
Doug Gatewood for Kansas House PO Box 306 411 S. Florida Columbus, KS 66725
Doug Gatewood, STATE HOUSE 1st KS
. $250.00
10106/2010
Robert Grant for Kansas State House Robert Grant, STATE HOUSE 2nd KS
$250.00
10106/2010
Bill Feuerborn for Kansas House 1600 Park Road Garnett, KS 66032
Bill Feuerborn, STATE HOUSE 5th KS
$250.00
10106/2010
Jerry D. Williams for Kansas House 21225 Kiowa Road Chanute, KS 66720.
Jerry Williams, STATE HOUSE 8th KS
$250.00
10106/2010
William Otto for Kansas House 1029th LeRoy, KS 66857
William Otto, STATE HOUSE 9th KS
$250.00
10106/2010
Virgil Peck for Kansas House Box 277 Tyro, KS 67364
Virgil Peck, STATE HOUSE 11th KS
$250.00
10106/2010 Jeff King for Kansas House 1212 North 2nd Street Independence, KS 67301
Jeff King, STATE HOUSE 12th KS
$250.00
10106/2010 Lance Kinzer for Kansas House 12549 S Brougham Olathe, KS 66062 .
Lance ~inzer, STATE HOUSE 14th KS
$250.00
10106/2010 Arlen Siegfreid for Kansas House 1403 W. Prairie Terrace Olathe, ks 66061-6807
Arlen Siegfreid, STATE HOUSE 15th KS
$250.00
$10,593.40
Page _3_ of__9_
Page 20
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Amount Date
Purpose of ExpenditureName and Address To Whom Expenditure is Made
Gene Rardin for Kansas House Gene Rardin, STATE HOUSE 16th KS 10900 West 104th Street
$250.00Overland Park, KS 6621410106/2010
Cindy Neighbor for Kansas House Cindy Neighbor, STATE HOUSE 18th KS 10405 West 52nd Terrace
$250.0010106/2010 Shawnee, KS 66203
Kay Wolf for Kansas House Kay Wolf, STATE HOUSE 21st KS 8339 Roe $250.0010106/2010 Prairie Village, KS 66207
Mike Slattery for State House Mike Slattery, STATE HOUSE 24th KS 5015 Reeds Rd $250.0010106/2010 Mission, KS 66049
Barbara Bollier for Kansas House Barbara Bollier, STATE HOUSE 25th KS 6910 Overhill Road $250.0010106/2010 Mission Hills, KS 66208
Ray Merrick for Kansas House Ray Merrick, STATE HOUSE 27th KS 6874 West 164th Terr 10106/2010 $250.00Stilwell, KS 66085
Sheryl Spalding for Kansas House Sheryl Spalding, STATE HOUSE 29th KS 12119 Bluejacket 10106/2010 $250.00 Overland Park, KS 66213 /
Ron Worley for Kansas House Ron Worley, STATE HOUSE 30th KS 10106/2010 8957 Woodstone $250.00
Lenexa, KS 66219
Valdenia Winn for Kansas House Valdenia Winn, STATE HOUSE 34th KS 10106/2010 1044. Washington' Blvd
$100.00Kansas City, KS 66102
Anthony Brown for Kansas House Anthony Brown, STATE HOUSE 38th KS 10106/2010 799 E. 2200 Rd.
$250.00Eudora, KS 66025
$2,350.00
Page _4_ of__9_
Page 21
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Amount Date
Purpose of ExpenditureName and Address To Whom Expenditure is Made
Owen Donohoe for Kansas House Owen Donohoe, STATE HOUSE 39th KS 6265 Arapahoe
$250.00Shawnee, KS 6622610/06/2010
Connie O'Brien for Kansas House Connie O'Brien, STATE HOUSE 42nd KS 22123 211th Sl.
$250.00Tonganoxie, KS 6608610/06/2010
Barbara W. Ballard for Kansas House Barbara W. Ballard, STATE HOUSE 44th KS 1532 Alvamar Drive $250.0010/06/2010 Lawrence, KS 66047
Tom Sloan for Kansas House Tom Sloan, STATE HOUSE 45th KS 772 Highway 40 $250.0010/06/2010 Lawrence, KS 66049
Paul Davis for Kansas House Paul Davis, STATE HOUSE 46th KS 1731 Indiana $250.0010/06/2010 Lawrence, ks 66044
Lee Tafanelli for Kansas House Lee Tafanelli, STATE HOUSE 47th KS 7075 122nd Sl.
10/06/2010 $250.00Ozawkie, KS 66070
Marvin Kleeb for Kansas House Marvin Kleeb, STATE HOUSE 48th KS
10/11/2010 14206 Eby $250.00 Overland Park, KS 66221
Scott Schwab for Kansas House Scott Schwab, STATE HOUSE 49th KS 10/11/2010 14953 W 140th Terr $250.00
Olathe, KS 66062
Ann Mah for Kansas House Ann Mah, STATE HOUSE 53rd KS 10/11/2010 3351 SE Meadowview Drive
$250.00Topeka, KS 66605
Joe Patton for Kansas House Joe Patton, STATE HOUSE 54th KS 10/11/2010 3546 SW Summerwood Court
$250.00Topeka, KS 66614
$2,500.00
Page _5_ of__9_
Page 22
I
I
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
K~nsas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
Name and Address Date To Whom Expenditure is Made
Sean Gatewood for Kansas House 1628 NW 33rd Place Topeka, KS 6661810/11/2010
Willie Prescott for Kansas House 5928 W. 216th Terrace
10/11/2010 Osage City, KS 66523
Don Hill for Kansas House 1720 Luther
10/11/2010 Emporia, KS 66801
Steve Luker! for Kansas House 2420 Acorn Road
10/11/2010 Sabetha, KS 66534
Jerry Henry for Kansas House ' 3515 Neosho Road
10/11/2010 Cummings, KS 66016
Sydney Carlin for Kansas House 1650 su~nyslope10/11/2010 Manhattan, KS 66502
Charles Roth for State House 3 Crestview Dr. Salina, KS 67401
10/11/2010
Marc Rhoades for Kansas House 10/11/2010 100 Duncan Terrace
Newton, KS 67114
John CGrange for Kansas House 10/11/2010 1115 Rim Rock Rd
EI Dorado, KS 67042
Peggy Mast for Kansas House 10/11/2010 765 Road 110
Emporia, KS 66801
:er~:,1;~~1t~~'~I, '" i}' 1111'''';ll4 __;;2","!'i;> ii' cW $2,500.00
,}c, ,icc ,c.ee .,
Amount
$250.00
$250.00
$250.00
$250.00
$250.00
$250.00
$250.00
$250.00
$250.00
$250.00
Purpose of Expenditure
Sean Gatewood, STATE HOUSE 57th KS
William Prescott, STATE HOUSE 59th KS
Don Hill, STATE HOUSE 60th KS
Steve Luker!, STATE HOUSE 62nd KS
Gerald Henry, STATE HOUSE 63rd KS
Sydney Carlin, STATE HOUSE 66th KS
Charles Roth, STATE HOUSE 71st KS
Marc Rhoades, STATE HOUSE 72nd KS
John Grange, STATE HOUSE 75th KS
Peggy L. Mast, STATE HOUSE 76th KS
Page _6_ of__9_
Page 23
I
I
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee
(Name ofParty Committee or Political Committee)
Amount Date
Name and Address Purpose of Expenditure To Whom Expenditure is Made
Pete DeGraaf for Kansas House Peter DeGraaf, STATE HOUSE 81st KS 1545 E 119th Street
$250.0010/11/2010 Mulvane, KS 67110
Gail Finney for Kansas House Gail Finney, STATE HOUSE 84th KS 1754 N: Madison St
$250.00Wichita, KS 67214
Steven Brunk for Kansas State House Steven Brunk, STATE HOUSE 85th KS 4430 Janesville
10/11/2010
$250.0010/11/2010 Bel Aire, KS 67220
Judith Loganbill for Kansas House Judith Loganbill, STATE HOUSE 86th KS 215 S Erie $250.0010/11/2010 Wichita, KS 67211
Jim Ward for Kansas State House Jim Ward, STATE HOUSE 88th KS 3100 E Clark
$250.0010/11/2010 Wichita, KS 67211
Brenda Landwehr for Kansas House Brenda Landwehr, STATE HOUSE, 91 st KS 2837 N Edwards 10/11/2010 $500.00Wichita, KS 67203
Nile Dillmore for Kansas House Nile Dillmore, STATE HOUSE 92nd KS 1102 Jefferson 10/11/2010 $250.00Wichita, KS 67203
Phil Hermanson for Kansas House Phil Hermanson, STATE HOUSE 96th KS 10/11/2010 5338 S. Mosley , $250.00
Wichita, KS 67216
Aaron Jack for Kansas House Aaron Jack, STATE HOUSE 99th KS 1330 N Robin Ct 10/11/2010 $250.00Andover, KS 67002
Janice L. Pauls for Kansas House Janice L. Pauls, STATE HOUSE 102nd KS 10/11/2010 1634 North Baker
$250.00Hutchinson, KS 67501
$2,750.00
Page _7_'_ o~__9_
Page 24
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Committee
(Name of Party Committee or Political Committee)
AmountPurpose of Expenditure
Michael O'Neal, STATE HOUSE 104th KS
$500.00
Gene Suellentrop, STATE HOUSE 105th KS
$250.00
Elaine Bowers, STATE HOUSE 107th KS
$250.00
Eber E. Phelps STATE HOUSE KS 111
$250.00
Mitch Holmes, STATE HOUSE 114th KS
$250.00
Don Hineman, STATE HOUSE 118th KS
$250.00
$250.00
$1,000.00
Milack Talia, STATE HOUSE 23rd KS
$250.00
Pat Colloton, STATE HOUSE 28th KS
$250.00
$3,500.00 ,
Name and Address Date To Whom Expenditure is Made
Michael R. O'Neal for Kansas House 8 Windemere Cl.
10/11/2010 Hutchinson, KS 67504
Gene Suellentrop for Kansas House 6813 W. Northwind Circle
10/11/2010 Wichita, KS 67205
Elaine S. Bowers for Kansas House 1326 N 150th Rd
10/11/2010 Concordia, KS 66901
Eber Phelps for Kansas House 3103 Olympic Lane
10/11/2010 Hays, KS 67601
Mitch Holmes for Kansas House 211 SE 20th Ave
10/11/2010 Sl. John, KS 67576
Don Hineman for Kansas House 116 S Longhorn Rd
10/11/2010 Dighton, KS 67839
Republican House Campaign Committee
10/11/2010 2025 SW Gage Blvd Topeka, KS 66603
Republican Senatorial Campaign Committee 10/11/2010 2348 SW Topeka Blvd
Topeka, KS 66611
Milack Talia for Kansas House 10/12/2010 6829 Bluejacket Street
Shawnee, KS 66203
Pat Colloton for Kansas House 10/12/2010 2513 W 118th Street
Leawood, KS 66211
Page _8_ of__9_
Page 25
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Hospital Association Political Action Co'mmittee
(Name of Party Committee or-Political Committee)
Amount To Whom Expenditure is Made
Date
Purpose of ExpenditureName and Address
Derek Schmidt, ATIORNEY GENERAL 15th KS 416 N. 5th Street
10/12/2010 P.O. Box 804
Derek Schmidt for Attorney General
$500.00
Independence, KS 67301
Vicki Schmidt, STATE SENATE 20th KS 2619 SW Randolph Ct
10/14/2010 Topeka, KS 66614
Vicki Schmidt for Kansas Senate
$500.00
: .•...
$1,000.00 ,,"
Complete if last page of Schedule C
Total Itemized Experiditures This Period $32,420.90
Total Unitemized Expenditures of $50 or less $0.00
$32,420.90
Page _9_ of__9 _
